Monday Morning Update 10/25/10

From Polemic: “Re: Epic-certified resources. Only Epic knows and they’re not sharing. That leaves everyone else to make sense of what it means when someone claims to be Epic-certified (what module, what release, etc.) Tightly controlled certification keeps qualified people in high demand, but doesn’t seem to take into account the rate at which they are signing new accounts. One has to wonder whether the ‘we’re Epic, you’ll do it our way’ approach won’t perhaps come back to bite them someday.”

From Celling Yourself: “Re: AirStrip’s Sprint announcement. I don’t get this. AirStrip’s target customer carries an iPhone, which doesn’t work on Sprint.” It is interesting since the deal offers hospitals Sprint’s help creating an in-building Sprint infrastructure for running AirStrip’s apps on 4G smart phones, but AirStrip says it’s staying carrier agnostic. I can’t imagine docs giving up their iPhones (and thus AT&T now and possibly Verizon soon) or carrying a second Sprint-capable device only for on-property access. It sounds like little more than a targeted Sprint promo for its infrastructure business.

From Former McKessoner: “Re: long overdue. I’m one of the many departures from the McKesson senior sales ranks since the June 1 beginning of the fiscal year. It took over 10 years, but the Horizon undoing is coming fast. No new business, customers grudgingly upgrading.” Unverified. All I’ve seen is the recent KLAS report, which says Horizon lost more clients than it gained in 2009 (along with the other faders you might expect — QuadraMed, GE, and Eclipsys). The company has announced nothing pertaining to its Horizon strategy as far as I know, so unless a customer verifies they were told something officially (and those I’ve asked haven’t responded), I’d say it’s business as usual.

From Introspect: “Re: Houston hacker. Here’s an update with the hospital’s side of the story. I wish you had withheld judgment until at least hearing both sides of the story.” I agree, although I assumed the newspaper’s account was accurate and complete and I did hedge my bets by referencing the hospital’s “apparent” security incompetence. The original article said the hospital had to hire outside help to fix the problems the kid claimed he told them about. The CIO’s story is different, although he didn’t mention the problems the kid says he discovered. He says the 21-year-old had installed “back door” code on the hospital’s server that would have let him bypass security to log on at any time, which he accomplished by using a doctor’s password instead of actually penetrating the hospital’s security (I’m surprised he was able to do that with a doctor’s security privileges, which I assume means any doctor could do the same, but that’s not my area of expertise). As the CIO says, “He didn’t discover a breach, he was the breach.” The outside help was engaged to make sure the kid didn’t do anything else, the CIO told the newspaper.

At least most readers think their employer’s economic conditions are no worse than they were six months ago, although more say they’re unchanged than better New poll to your right: what’s your experience working for an employer that has won a “best place to work” award?

It’s easy to confuse patients about healthcare benefits. A non-profit clinic in California sends out ID cards to all its recent patients that include the patient’s name, medical record number, and doctor name. They wanted to speed up registration by giving staff information needed to look up patients in their new EMR. Puzzled patients seen at the clinic but not its regular patients are calling their providers and insurance companies demanding to know why they’ve been turfed off to a new clinic and doctor.

RemCare, fresh off $2.7 million in new financing, renames itself (warning: PDF) after its product, Care Team Connect. The Illinois company’s product helps hospital care managers by creating evidence-based discharge care plans and coordinating care, reducing readmissions.

Vanguard Communications, which offers the MedMarketLink marketing service for specialty practices, signs a partnership deal with Intuit Health to market its portal.

HP announces its Slate 500 would-be iPad competitor, which it will market to businesses (note the medical apps featured in the above promo). It’s more expensive (starting at $799) and runs Windows 7, meaning that unlike the iPad, it supports Flash. It comes with 2 GB of memory (which is needs since it’s running Windows), has a shorter battery life (Windows again), and does not support 3G (WiFi only). I’m guessing all of those facts led to the decision to steer a wide berth around the consumer market created and owned by Apple in the hopes that businesses are so pro-Windows they’ll pay more to get less. This will be problematic: all those users with iPhones, iPods, and iPads at home are not likely to be thrilled by their employer’s offering. Apple doesn’t make mistakes too often, but failure to reach detente over Flash is a big one since that’s one of few chinks in its armor and it involves all of its products as its competitors will tell you constantly.

Mobile Health Expo announces its 2010 award winners. HIStalk sponsors winning were PatientKeeper (best patient safety innovation) and Voalte (outstanding contribution to nurse communications).

Greenway acquires Visual MED’s PACS technology, which will power its PrimeIMAGE solution for its PrimeSUITE 2011 EHR.

The radiologist who founded teleradiology services vendor Virtual Radiologic launches an early stage venture fund that will invest in consumer, healthcare, and technology companies. Sean Casey was kicked out of the company, which he started and took public, with $68 million worth of stock. It was the subject of a private equity buyout for $294 million this past May.

HHS CTO Todd Park is added to the speaker lineup of the mHealth Summit next month, run by the NIH, its foundation, and the mHealth Alliance. Also speaking: Bill Gates, Ted Turner, and US CTO Aneesh Chopra. I’ll be filing daily reports from there as will HIStalk Mobile editor Dr. Travis Good.

The Austrian man who was the first person to use a mind-controlled robotic arm for driving dies in a single-car crash that may or may not have been related to the technology.

I can’t decide if HIMSS is clueless or evil with this announcement: attendees at the Orlando annual conference in February will be tracked by RFID for the benefit of exhibitors, who can “… derive a more accurate score of a visitor’s buying potential.” RSNA has been doing this, apparently, triggering specific booth ads to play based on who’s around (Philips is a happy customer cited in the above promo video). An RFID tag will be attached to conference badges that will let vendors track attendees by job and employer (and name if the conference allows it), ending the days of anonymous and obligation-free booth cruising. The technology will log booth visits and duration by product being viewed and will alert vendors in real-time when a “key prospect” is in the area (CIO alert! Ignore everyone else!) The conference keeps getting more similar to a cattle butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours, you’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors, and now you’ll be tracked like livestock throughout the process. Let me just say that, as a paying attendee and member, I resent the hell out of this (I’m sure I can get info on how to cripple the RFID tag and I’ll run it here if so). I can imagine what was going through the minds of the HIMSS dim bulbs who approved this: hey, we can charge vendors even more by selling them the personal information of attendees, vendors can pounce like snakes when attendees identified by job title as a decision-maker enter their air space, companies can monitor whether competitors are encroaching into their proprietary neighborhood, and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members. I say it’s time for provider members to push back and make the conference theirs again. Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

AHRQ spends $26.5 million of its ARRA money to hire a high-powered PR agency. Ogilvy Washington will “market and promote” the findings of Patient-Centered Outcomes Research in a newly created Publicity Center. I didn’t volunteer to have my taxes used for wasteful economic stimulus projects, but if I had, I’m pretty sure dozens of millions for a HHS PR wouldn’t have been on my list even though the general idea of comparative effectiveness research is a good one (but hugely expensive – $1.1 billion in stimulus money).

Four NICU babies in a hospital in Canada are given insulin instead of heparin in their TPNs, killing one of them.

Shares in athenahealth jumped by 23% on Friday after good Q3 numbers that beat estimates.

E-mail me.

From BeKind: “Re: the Senate Committee on Veterans’ Affairs testimony about MUMPS. This dialog occurred at 75:26 in the video.”

Senator Richard Burr: If you maintain MUMPS can the private sector have full access into the VA system, into the MUMPS system, for the exchange of electronic information?

Roger W. Baker, Assistant Secretary for Information and Technology, Department of Veterans Affairs: I would answer it this way, I believe just as much as if we implemented it in any other language because at the bottom it’s the data that’s important.

Senator Burr: Let me turn to Mr. Tullman if I can just simply because he’s out there. Now, let’s see what the limitation is.

Glen Tullman, Allscripts CEO: What I would say is again that you can extract data from any system. What we’re really talking about, and I don’t want to get too technical, is the native exchange of information. So you can pull information out of a mainframe system and put it into a PC if you want two people to talk to each other. The question is why would you do that when you could have two PCs that were talking with each other? So again we think MUMPS was the right decision to make when it was made. We think there’s a reason to carry it forward. We’re just saying as we go forward into the future we need to broaden the understanding of what systems to use, what architectures to use, and what the general reason we need these systems for and that is for communication and I think that’s this idea of this community is important and no one’s using MUMPS to build systems that communicate and exchange data efficiently today in anywhere else but the US government.

Wow, there’s a lot of interesting stuff in this video of the committee meeting, which runs two hours (meaning I didn’t listen to every word yet). The chair, bless his heart, leads off by reminding everybody that the VA and its contractors flopped big-time with CoreFLS and the projects it had to kill because they weren’t being managed well. Ed Meagher talks about the VistA Modernization Committee’s recommendation to put VistA on a stabilization program while developing its replacement. Glen criticizes MUMPS-based systems (meaning not just VistA, but his company’s competitors Epic, MEDITECH, QuadraMed, etc.) and saying the military’s evolution requires new EMR requirements for data sharing. He also says its replacement should be either Microsoft-based or open source (technically, VistA sort of open source, so I assume he means non-MUMPS open source). He says its time for the government to learn from the private sector.

Tom Munnecke, a former VA guy who helped build VistA, testifies at around the 61 minute mark. He credits the original VistA developers, all of whom were clinicians turned developers, for its success, starting it with “good enough” and then refining it from field experience instead of sitting around writing specs. He said MUMPS criticism isn’t new, going back to the beginning, but it works and has been stable. He likes the open source idea for a VistA replacement but cautions against throwing out the lessons learned from VistA. He also advocates additional forms of communication other than the EMR, saying that 25% of VistA’s use was the Mailman app used to simply communicate among professionals (comparing that to today’s social networking). He talks up personalization that can be delivered by cheap, easily implemented tools.

The chairman also asks VA CIO Roger Baker directly what assurances he can give that they won’t screw up again like they did with their replacement scheduling system. He cites the VA’s cancelled or retooled projects as proof that they’ll kill projects with minimal chance for success (the “fail fast” approach of identifying and killing the dog projects fast before they cost too much). Munnecke agrees, but says users need to scale back expectations and allow the software to develop instead of going for the gold-plated Cadillac upfront.  

Munnecke: “Mr. Tullman’s comments have a number of technical issues that I think we need to talk about over coffee some time, but I probably largely agree with his conclusion. I don’t want to be characterized as pro-MUMPS. I do want to be characterized as having a very successful legacy system that has accomplished a lot and just going with the standards of the information technology industry and thinking we’re going to take the shiny new technologies and word on PowerPoint presentations and develop a successful system is not going to work.” When interrupted by Sen. Burr’s comment that he’s never heard anybody comment that DoD actually has working EMR software and wondering why it’s so hard to send DoD medical records to the VA, to which Munnecke replies, “I think you’d have to look at DoD actually throttling back CHCS and crippling the features that were design into it for communication in order to protect their bureaucratic stovepipes.”

Sen. Burr’s summation (in which he repeatedly refers to VistA as “the MUMS system”): “It is absolutely essential, in my estimation, that private sector companies buy in to what technology decisions you make at VA because of exactly what Mr. Tullman references, and that’s that this is no longer our population of people that we’re taking care of. They’re bouncing back and forth … if we want to reach the efficiencies long-term of private healthcare, as most have realized, then we’ve got to have this interoperability solved … if a company like Allscripts, a leader, is questioning whether they’ll be able to exchange through your system, I think we ought to pause for a minute and talk to those companies and find out what is your concern …”

Then came the comments BeKind mentioned above. Sen. Burr mentions that three people in the room have iPads, yet soldiers returning from the military hospital at Landstuhl have paper medical records taped to their chests, saying that the VA should collaborate with the private sector.