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October 26, 2010 News 12 Comments

From Southern Belle: “Re: Epic. I hear they’re thinking about changing their consultant non-compete agreement from one year to two.” Unverified.

From Blame the Dog: “Re: BlackBerry tablet. Here’s some video up of a demo of the eUnity PACS virtual workstation running quite seamlessly on the BlackBerry PlayBook through their fancy new QNX-based Tablet OS. I’m a big fan of the trend Apple has started with (finally) user friendly tablets, and there’s been a lot of interest in healthcare for the iPad so far because of the cost and usability factors, but I have a feeling there are more than a few healthcare CIOs out there collectively holding their breath for the PlayBook. Apple has some management tools for the iPad and I think they’re starting the realize the potential there, but they’re still nowhere near RIM on the enterprise, information security, and compliance management front. The PlayBook is going to be a BES-compliant device, meaning all those hospitals out there with existing BlackBerry infrastructure don’t have to do much to start putting the PlayBook into lab coat pockets early next year. No matter what, RIM, Google, and Apple are finally giving hospitals and practices simple and cost-effective devices that can integrate more comfortably into existing workflows. No more bulky notebooks posing as tablets, no more clumsy laptop carts, no more silly workstations in every exam room. Finally.”

10-26-2010 7-08-21 PM 

From BCS Luv: “Re: Epic. Who’s implementing it in Boise?” I’d have to guess St. Luke’s since Saint Alphonsus just went up last week on an unnamed system (Cerner, I assume, since St. Al’s is a Trinity hospital and their Genesis Project runs Cerner, if I remember correctly).

Inga is posting live from MGMA on HIStalk Practice with our patented blend of news, rumors, booth critiques, and observations (she says she got hit in the head by a lady’s tossed beads, which I hope doesn’t mean that she flashed her, French Quarter-style). Check out her posts from today and yesterday.

Core Health Technologies releases its HL7 survey results (warning: PDF). Demand for HL7 expertise will increase, said 85% of CIOs. Respondents predicted that Cloverleaf will lead the integration engine market.

Cardinal Health signs a marketing agreement with Swisslog that will allow Cardinal to offer that company’s drug packaging and distribution technologies.

New York eHealth Collaborative plans to spend $129 million in state and federal money to create a statewide electronic medical records network.

10-26-2010 7-01-29 PM

UW Health (WI) is using palm scanning to positively identify patients and to reduce identity theft and insurance fraud. They spent $70,000 for 200 of the scanners.

McKesson announces Q2 numbers: revenue up 1%, EPS $1.25 vs. $1.11, missing on both revenue and earnings excluding a one-time asset sale. Revenue for Technology Solutions was down 3% (with some one-time adjustments), with the press release saying the reduced operating margin “was impacted by continued investment in our clinical and enterprise revenue management solutions.” The company also wrote off $72 million because of Horizon Enterprise Revenue Management, which readers have told us is in big trouble with high development costs and rumored missed deliverables. I looked up their term asset impairment charge and it means (in my non-accountant interpretation, anyway) that an asset’s value has declined even faster than it’s being depreciated and amortized, requiring  one-time adjustment in value.

Disappointing perfomance in McKesson’s Technology Solutions business was surely the cause of Monday’s big McKesson reorg, which I mentioned on Facebook (actually the performance would have been great without the HERM charge). Clinical and revenue cycle groups will be combined to form Health Systems Enterprise Solutions (seems odd). The president of Revenue Cycle Solutions was let go. Several other products (workforce management, surgery, performance, analytics, HR, etc.) are being combined under Health Systems Performance Management. Enterprise Imaging will be made part of Medical Imaging. Sales teams will be integrated with their business lines. They seem to be focusing on differentiating Horizon vs. Paragon prospects.

10-26-2010 7-49-35 PM

Healthland promotes sales VP Angie Franks to CEO. Former Interim CEO John Trzeciak of Francisco Partners will keep his board seat.

10-26-2010 10-07-37 PM

Surescripts expands (warning: PDF) its e-prescribing network to become a “national backbone” that will allow exchange of clinical messages, expanding on its work with CVS’s MinuteClinic. The company is marketing itself as a trusted network, using messaging tools made possible by its investment in secure messaging vendor Kryptiq. Surescripts says it will follow standards for NHIN, HL7, CCD, CCR, etc. VA CIO Roger Baker was quoted as saying that the Surescripts network would help his organization connect with community providers. John Halamka was also quoted, although in a non-committal way (he doesn’t generally shill products, just ideas). This is a big announcement, both in length and in impact. Implementation dates: Net2Net connect to allow providers and vendors to connect outside their networks (December), Message Stream secure messaging (December), and Clinical Message Portal for providers who don’t have an EHR (January). I had to refresh my memory about who owns Surescripts: the founders, the National Association of Chain Drug Stores, the National Community Pharmacists Association, CVS Caremark, Express Scripts, and Medco.

Even Weird News Andy is speechless at this article (well, almost – he only said “wow”). In England, a quadriplegic home care patient, convinced that he was not receiving good nursing care, puts a bedside camera in his room. It caught an NHS agency nurse panicking after incorrectly adjusting his ventilator’s controls and setting off its alarm. The nurse, who says she was given no training on the ventilator, couldn’t get it restarted and didn’t know how to resuscitate him. It took paramedics 21 minutes to arrive and give him oxygen, but by then he had suffered major brain damage, reducing his mental capacity to that of a child. NHS says it’s sorry.

Panasonic invests in Houston-based CardioNexus, announcing its intention to become a global leader in personalized preventive medicine. CardioNexus, formed last year, is a product of Baylor College of Medicine’s commercialization organization and works with Texas Medical Center, which was already working with Panasonic. The company focuses on early detection of heart disease, which I assume means imaging.

Sage Intergy Meaningful Use Edition is ONC-ATCB certified by Drummond Group. Also earning certification, but from CCHIT: GE Centricity Practice Solution version 9.5.

AirStrip Technologies provided some clarification about its agreement with Sprint that I mentioned recently. Users can choose any mobile device (including Android-powered ones in the next couple of weeks, but 80% of their users are on iPhones so far). Those users generally use AirStrip on their personal smart phones (makes sense – they wouldn’t want to have to carry two). Sprint helps the hospital pay for AirStrip to encourage them to use more Sprint devices, but they help subsidize the cost for all users, not just those who choose Sprint smart phones. AirStrip gets what it says is better 4G performance from Sprint, which will allow it to eventually expanding its offerings to real-time video collaboration, imaging, and extended historical waveform data. Thanks to AirStrip for the clarification. I usually steer clear of proclaiming a company or technology as “hot” since I’m just a cheap seat observer, but I’m pretty sure they are.

Folks I know at Cedars-Sinai tell me that they’re up on Epic’s nurse documentation and care plans. They’ve also shut down CareVue now that they’re live on device integration and doing some physician documentation in the ICUs.

Our Lady of Lourdes (NY) chooses Allscripts EHR for its 16 employed medical groups. They’ll also implement Allscripts Remote, which allows physicians to access the system via the iPhone, iPod Touch, iPad, BlackBerry, Android, and Windows Mobile smart phones.

10-26-2010 10-10-26 PM

Martin Memorial Medical Center (FL) borrows $25 million for equipment they say is EMR and HITECH related, including smart pumps and patient monitors.

A prospective sponsor e-mailed me a question I’ve not been asked and couldn’t answer without digging through some stats. How many unique people read HIStalk each month? The answer: just over 19,000. I also noticed the countries they’re from: the US, of course (over 93%), then Canada, Australia, UK, India, Israel, Ukraine, UAE, China, and so on. All I see from this end is a blank screen that I have to fill each day while sitting in my inner sanctum and playing music at excessive volume levels, so it’s fun to occasionally be reminded that real people are on the other end.

Healthcare futurist Jeff Goldsmith says HIT adoption is lagging because there’s no return on investment. He says the payment system is largely at fault for piling tedious documentation requirements on doctors, made worse by new quality measures (I assume those prescribed by Meaningful Use are among them). He says he would have done Meaningful Use differently, offering providers an immediate malpractice shelter for following guidelines instead of a payoff down the road. He also thinks that hospitals buying practices will drive more HIT usage than Meaningful Use since the new owners will want them to communicate with each other (and will want to monitor and control their performance, which Jeff didn’t say but I will). His estimate of consumer influence on EHR adoption by doctors: “nearly zero” since people have stayed away from PHRs in droves and the improved communication that patients really want doesn’t require IT. Jeff’s an investor in some startups, which I’d love to do if I had the money (although I probably therefore wouldn’t have it for long since those rarely pay off).

10-26-2010 10-11-03 PM

Francisco Partners takes a majority stake in Quantros, which sells quality and risk applications. The private equity firm is no stranger to HIT, with investments in AdvancedMD, API Healthcare, Healthland, QuadraMed, and T-System. I interviewed Quantros CEO Sanjaya Kumar this past April. Worth a read (or re-read). I have to say that if your vendor is bought by someone, you should hope that it’s Francisco Partners since they appear to be the most patient, most HIT-savvy, least change-demanding acquirer out there. They seem to help the companies they invest in succeed instead of slashing and burning their way to a fast payoff.

A Modern Healthcare article says that the AMA is getting into the EMR business with its Amagine project, which will go live in 2011 after the current pilot in Michigan is finished. It will charge vendors to list their wares on a portal, then take a cut of the action. AMA will actually providing technical support and possibly implementation services. I’m having a rather strong reaction to this, but leave a comment at the bottom of this post and let’s hear what you think first.

Ever wonder how those frequent flier patients get to your ED? By ambulance, of course. One health commissioner said, “The misuse of ambulances speaks to our health system. If we had a place as user-friendly as an emergency room, people would likely use it. The fix is to have more primary care and a better way to get to it.” One New York patient called for a ride to the hospital 313 times in one year. Like the rest of healthcare and the country in general, relying on personal responsibility is a bad idea, especially with a government willing to subsidize stupid decisions by taking money away from those too responsible to make them.

10-26-2010 9-41-37 PM

HealthPartners launches virtuwell (annoying all lower case besides being a pun), an online MinuteClinic-type alternative to office visits that offers online nurse practitioners around the clock. Online users (only in Minnesota for now) get a diagnosis, treatment plan, and prescriptions for $40 or less, depending on insurance.

The Wisconsin State Health Information Network is named as the overseer of the statewide HIE, set to launch next year.The group is a non-profit with members Wisconsin Hospital Association, the Wisconsin Health Information Organization, the Wisconsin Collaborative for Health Care Quality and the Wisconsin Medical Society.

Sponsor Updates

  • All Children’s Hospital (FL) will use GetWell Town from GetWellNetwork as its interactive bedside TV system offering Internet browsing, games, movies, and behind-the-scenes clinical applications.
  • RelayHealth beats the mandatory 2012 date for complying with Version D.0 of the NCPDP pharmacy claim standard. The company’s prescription transaction solutions are compliant now.
  • RelayHealth also announces at MGMA its RelayAnalytics Financial Diagnostics, a visibility dashboard into claims and remittance information.
  • Revenue cycle vendor ZirMed announces that it has processed 750 million healthcare transactions and is doing 20 million per month. The company says its 39% annual growth rate required adding two executives: former Allscripts sales VP Kevin Weinstein as VP of marketing and Kraig Brown as sales VP.
  • MEDSEEK announces its Sprint to Meaningful Use solution, which will help organizations meet the MU goals involving patients and families.

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Currently there are "12 comments" on this Article:

  1. “I told you so.” Unfortunately, I can’t really call the CIO of a Northern NJ hospital and say ‘I told you so’, but I really want to. I told them they were making a bad call trying to be one of the thirty McKesson betas for HERM (next-generation Financials) and now their install is on-hold and McKesson is going through a re-org. They avoided replacing SMS with Soarian and passed on Eclipsys, but now McKesson is a dud. I’m sure the hospital is frozen in time; too small to buy Epic and too proud for Meditech.

    I’d hate to be an exec at McKesson right now; must be getting some pretty irate calls from customers.

  2. I commiserate with Mr. Goldsmith as noted: Healthcare futurist Jeff Goldsmith says HIT adoption is lagging because there’s no return on investment. His understanding of the problem is deficient. The reason why HIT adoption is lagging is because the HIT is just as deficient. It behooves your readers to read the report at this link.

    http://jamia.bmj.com/content/17/6/617.abstract

    Is it not surprising that no one has mentioned this sentinal paper?

    [From Mr. HIStalk] Suzy (since I see you’re posting under a different name) it isn’t surprising that nobody has mentioned this paper because it’s frankly not all that interesting or original IMHO. I’ll be posting my comments about it shortly, but my quick take is that the only people who would find it some kind of rallying cry are those looking for any possible reasons to slam EHRs, those who sell them, and those who are using them successfully. Goldsmith’s argument is as anecdotal as yours, but far more convincing.

  3. Two-year non-competes: I heard the same thing from my friends who are still at Epic that the recent slew of new hires this summer had to sign two-year non-competes. This really sucks for the recent undergrads that don’t understand what this type of agreement means when they are hired. When they get burned out and leave after 3-4 years, they’ll then find that they aren’t really qualified for anything outside of HIT besides entry-level jobs, which certainly don’t support the car payment, mortgage and travel lifestyle they’ve gotten used to while at Epic.

  4. RE: 2 year non-competes at Epic… I don’t get it. Isn’t this cutting off your nose to spite your face?? If you prevent all your former employees from taking jobs implementing Epic for your new contracts, how are you going to get those customers implemented?? You can barely find Epic implementers as it is now, at least here in the Midwest.

  5. Re: 2 year non-competes at Epic: The anecdotes I’ve heard are that Epic’s only employee retention policies make it unpleasant to leave. Non-competes prevent consulting groups from siphoning employees off, and I’ve heard bosses are not allowed to give recommendations without Judy’s approval. Awfully Byzantine policies – I wonder if the 2-year clause is an indication that they’re hemorrhaging employees more so than usual?

  6. EHR Geek, my guess is that the goal is to discourage those people from leaving in the midst of a busy period. Epic consultants are getting hard to find, and leaving the company to go private for more money hurts the company even more. It’s selfish, but it’s business.

  7. Anonymous – No it’s not ‘business.’ Is it an employer dictating what an employee can or can’t do well after his or her term of employment is finished with their employer. It is ridiculous that there is a 2-year non-compete clause. Too bad no one will likely have the personal stones to challenge this nonsense in court although they would to find a judge that isn’t employer-friendly and be willing to bear a personal cross.

  8. I agree that having a non-compete stinks. For purely geographic reasons, I considered taking a job with another company in the HIT space (one that I didn’t feel belonged on the non-compete list & still don’t feel does given what the standards are supposed to be for a company to make the list), but in the end I didn’t want to take the risk.

    On the flip side though, if you look around other health care industries, non-competes are not uncommon, so to suggest that this is just Epic taking advantage of fresh undergrads is a bit overstated.

    By the way, Mr. H. thanks for the transparency in pointing out that Suzy is now writing under a pen name…graduated to MD too. I’m trying to decide what I should put next to my name – maybe JD.

  9. Re: [From Mr. HIStalk] Suzy (since I see you’re posting under a different name) it isn’t surprising that nobody has mentioned this paper because it’s frankly not all that interesting or original IMHO.

    If memory serves, one of that paper’s co-authors at Hopkins, is married to the Chief Scientific Officer / Deputy National Coordinator for Health Information Technology, medical informaticist Charles Friedman, MD.

  10. I should also add that the JAMIA paper referenced above “Health information technology: fallacies and sober realities” includes a path of remediation. SInce the article does not appear publicly available yet, I will summarize:

    At the most fundamental level, HIT must be focused on transforming care and improving patient outcomes and must be designed to support the needs of clinicians and their patients:

    * The needs of users and the complexities of clinical work must be analyzed first, followed by evaluation of the entire scope of potential solutions, rather than examining the current array of available products and characterizing the needs that they might meet.
    * Appropriate metrics for HIT success should not be adoption or usage, but rather impact on health.
    * The ‘comparative effectiveness’ perspective must also be applied to HIT – what is the return-on-investment of each HIT initiative compared with alternative uses of these funds?
    * There must be substantive collaboration with those who can contribute unique and important expertise such as human factors engineers, applied psychologists, medical sociologists, communication scientists, cognitive scientists, and interaction designers.
    * During HIT development, vendors and healthcare organizations must focus on more meaningful measures of design success: clinician and patient ease of learning, time to find information, time to solve relevant clinical problems, use errors, accuracy of found information, changes in task and information flow, workload, situation awareness, communication and coordination effectiveness, and patient and clinician
    satisfaction.
    * We must also consider the likely undesirable consequences of current policies and regulations on HIT advancement, e.g., hold harmless clauses.







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Reader Comments

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