Germany-based medical software vendor CompuGROUP Medical AG announced today that it will buy HealthPort LLC of Columbia, SC, the solutions business of HealthPort, for $24.3 million in cash.

The Alpharetta, GA HealthPort will apparently keep its other business lines, including Release of Information and auditing services, as they were not mentioned in the CompuGROUP announcement. The company was named as the top-selected RAC vendor in a recent KLAS report.

Rumor reporter Iggy told HIStalk readers in August that HealthPort was preparing to sell its non-ROI business, possibly in preparation for an Initial Public Offering like the $100 million one it cancelled last November, citing poor market conditions. Another rumor reporter Staff Infection specifically mentioned on August 11 that CompuGROUP was in talks with HealthPort.

CompuGROUP also announced its Q3 earnings today, reporting revenues of $102 million and operating profit of $24 million. The company has 3,000 employees and a market cap of $720 million.

CompuGROUP acquired Cleveland-based ambulatory systems vendor Noteworthy Medical Systems in February 2009. In September, CompuGROUP acquired the US-based Visionary Healthcare Group for up to $65 million, noting that gaining the PM/EMR vendor’s 10,000-physician customer base was a commitment to CompuGROUP’s plans to make the US a key market. CompuGROUP also announced this week that it had completed the acquisition of Swedish hospital EMR vendor Profdoc Care.

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From HIPAA Police: “Re: spelling. You would think a group sending a mass e-mail pitching its market research services would spell HIPAA correctly.” You would indeed.

From Limber Lob: “Re: getting physicians to standardize processes. Princeton economist Uwe Reinhardt says that trying to get physicians to work together is like trying to get eagles to fly in formation.” I like that analogy a lot.

From Capone’s Vault: “Re: Motion Computing Mobile Clinical Assistant C5V. This is slick. The pressure will be on the iPad to match the healthcare-friendly features of this.” It’s a full tablet with a docking station, optional barcode scanner, camera, Gorilla glass breakage resistance, and hot-swap batteries. It weighs three pounds, can be disinfected, and can withstand drops (big thumbs down to the iPad in that regard). Sounds great, just a little bit expensive at the mid-$2,000 range, but IT-friendly. Motion was bad about not getting enough nurse input on their previous models, so I’ll withhold judgment until I heard from nurses who have used a C5V at the bedside.

From Randy: “Re: Connected for Health review. I am enrolled in a Health Systems Management class at Morehead State University. This book is required reading.” I’m glad to hear that – I bet its great for that. Another reader is using it in an informatics course for public health students they’re teaching. For those who don’t know, Morehead State is in eastern Kentucky. I went to a seminar at St. Claire Regional Medical Center once, which is how I knew. Thanks for the report.

From Duke Nukem: “Re: NEJM article saying doctors should beat hospitals to the punch in forming their own ACOs to protect their own interests. Harrumph – you mean the same way they protect themselves by walling off nurse practitioners and claiming medical expertise is required to deliver acupuncture? A hundred years ago, they were barely better trained than barbers and butchers.”

Microsoft says its genomic sequencing project with Seattle Children’s Hospital consumed $18,000 worth of cloud-based supercomputing resources compared to the $3 million it would have cost using traditional local hardware. It used the Windows Azure cloud computing platform.
 
Wake Forest University Baptist Medical Center is going Epic, I’m told.

Nuesoft’s IT and product groups throw down a pretty good Lady Gaga video spoof. It sounds a lot like her and many other singers today, i.e. heavy on the Auto-Tune, which I really dislike — think Cher’s Believe from 1998, which sounds kind of Peter Framptony like somebody’s singing into a keyboard (meaning you don’t really have to be able to carry a tune to be a “singer” with computer-perfect pitch – it just came a few years too late for Milli Vanilli, but in plenty of time for the cast of Glee). But I digress – it’s a pretty good video. 

A former Fallon Clinic (MA) doctor brags on the clinic’s EMR, but complains that his access to it was terminated when he left to join another clinic. His point: he can’t treat patients as effectively who have chosen to move with him since “their” information is being held captive by Fallon Clinic, who says they’ll mail him a CD in a few weeks. I think it’s a bit presumptuous to assume that his former employer will continue to let him use their systems and I assume the CD they’re sending will have the information about his patients in some standard format he can review. Beyond that, that’s why there are HIEs (other than to get federal money).

The OncoEMR oncology EMR by Altos Solutions becomes the first oncology-specific EMR to receive ONC-ATCB certification as a complete EHR, the company says.

Patient Privacy Rights releases an informed consent white paper and the results of a new patient privacy poll. The rags are picking up the poll result as big news since it finds that 90% of Americans want to be able to decide who can see and use their health information, but I should add a cautionary counterpoint that the questions were loaded with what the ever-witty Inga always calls bias of the “Do you like babies and puppies?” variety. For example: it asked lay people whether providers should be able to “share or sell your sensitive health information without your consent” and “Who should make the decision on whether corporations and researchers can see and use the information in your health records without your permission?” I don’t know how far that skewed the percentages that ended up in the 90s, but I’d say quite a bit. Still, I don’t doubt the conclusions, just the methodology. I’d also guess that quite a lot of Americans would divulge just about anything for cash (like those Brits and their passwords a couple of years ago), so maybe that’s the backup plan for those profiting from their data – just buy it from them and mark it up.

Stanford Hospital runs a pilot project in which cath and angiography patients are given iPads preloaded with movies, books, games, and Internet access to entertain themselves before and after their procedures. The hospital likes the idea because TV installation was going to be a pain.

Inga did her usual bang-up job with the latest installment in her ongoing Vendor Executive Series on HIStalk Practice. She asked 14 top executives to comment on a recent survey that found that about half of physicians in private practice expect their EMR vendor to help them qualify for Meaningful Use money. It’s always fun to compare and contrast their answers.

McKesson CEO John Hammergren comes in at #10 in the list of the highest-paid CEOs of publicly traded companies, bringing home $24.5 million in total compensation for the year ending September 30. The company declined to comment.

Vocera acquires two Tennessee hospital communications companies: Clinical Health Communications and Integrated Voice Solutions. Guille Cruze, founder of White Stone Group that spun off Clinical Health Communications, will run both organizations as a Vocera VP in charge of handoff communications products like the ones offered by those two vendors. I interviewed him back in January 2008. The companies have 30 employees and 150 hospital customers between them.

Bill Gates says robots will be the next big technology. Maybe he’s right: check out the Actroid-F from Japan, which the developing company will market to provide social services such as those delivered by hospitals. I creeped myself out when I realized that I was thinking that she’s pretty cute. I bet I’m not the first.

Healthcare is the #3 enterprise user of iPads, trailing only financial services and the tech sector.

Maybe the iPad will rank higher in healthcare in Australia, where Victorian Premier John Brumby promises that every state hospital doctor will be given an iPad if his party is re-elected. He says $12 million will cover it, but he seems vague about exactly what’s going to be running on those devices that will give doctors “easy access to time-critical clinical information,” not to mention who’s going to support them. 

In the UK, Portsmouth Hospitals NHS Trust wins a patient safety award for co-developing a PDA vital signs capture application.

Odd lawsuit: a prisoner serving 10 years for running over and killing a teenager on a bicycle while going 83 in a 45 mph zone is suing the dead teen’s parents, who he claims were negligent in allowing the dead teen to ride his bike without a helmet. He wants compensation for his “great mental and emotional pain and suffering.”

E-mail me.

HERtalk by Inga

UPMC says it will add 815 new full-time jobs, including up to 80 in IT. This announcement came following the release of UPMC’s first quarter financials, in which operating revenues grew by $77 million to $2.1 billion and profit increased $28 million to $93 million from July through October. The health system is on track to spend about $500 million on capital improvements this year, including about $100 million on its EMR implementation.

Former Sentillion and Microsoft executive Rick Dean moves to Humedica as VP of provider sales.

KLAS introduces an RSNA Resource Center that features several radiology-focused KLAS reports, including the Medical Imaging Buyers Guide. It’s free for providers and thousands of dollars for the rest of us.

Florida Hospital DeLand, which is part of Adventist Health System, goes live on Cerner CPOE.

Memorial Hospital (IL) selects Summit Healthcare as its integration partner as it migrates to Meditech 6.0.

Saint Luke’s Health System (MO) will implement the SeeMyRadiology.com platform to share medical images across the enterprise.

I’m guessing that Mr. H is the new BFF of Louise L. Liang. MD. In case you missed it, Mr. H wrote a terrific review of her book, Connected for Health, recommending that that basically anyone with an even remote interest in IT and healthcare read the book. The masses took the message to heart and from about 8:00 this morning until 3:15 this afternoon, the book has climbed from #2,223 on Amazon’s bestseller list to #218. It also moved from #90 to #8 on the Medicine bestseller list and from #4 to #1 in the Public Health category. Heck, Dr. Liang should buy Mr. H a Christmas ham. Speaking of Christmas, I’m putting the book on my list.

Preliminary data from HIMSS Analytics suggests that 22% of hospitals are capable of achieving 10 or more of the required core measurements for Stage 1 Meaningful Use; 40% have the capability to meet five or more of the menu items. HIMSS Analytics says it will provide quarterly updates on hospitals’ progress beginning January 2011.

Apple’s AppsStore rankings for the Top 10 EMR and Operational apps can be found here. Bedside by IMS MAXIMS tops the EMR and Operational apps list and ranks 150th in the overall medical category.

A spokesperson for Advocate Health Care says patients experienced little or no interruption in care despite an 11-hour computer crash that affected 10 Chicago-area hospitals. The health system’s Cerner system went down about 5:00 a.m. Saturday, requiring employees to take patient orders on papers and access records using backup computer systems.

Sponsor Updates

• Chandler Regional Medical Center (AZ) will implement the GetWellNetwork interactive patient care solution and integrate it with its Meditech 6.0 system.
• API Healthcare names Lisa LaBau COO. She was previously with Cerner and Dynamic Healthcare Technology.
• Precyse Solutions appoints William F. Bria II, MD, CMIO for Shriners Hospital for Children in Tampa, to its advisory council.
• Allscripts wins the 2010 Excellence Award as the fastest growing company by the North Carolina Technology Association.
• Baptist Health Care (FL/AL) executes an agreement with NextGen to deploy its EHR and PM solutions  for its employed physicians. Baptist will also offer system access for community physicians who choose to purchase the solution.
• CareTech Solutions added three new healthcare clients to its Web products and services division last month, including San Juan Regional Medical Center (NM), Southern New Hampshire Medical Center (NH), and  Wheaton Franciscan Healthcare (WI). The company also announces Version 4.0 of its CareWorks content management system for hospitals.
• CapSite will present at the 22nd Annual Piper Jaffray Health Care Conference, to be held November 30 – December 30 in New York.
• ICA earns a spot of The Nashville Post’s Fast 50 Award for being one of Middle Tennessee’s fastest growing companies.
• At its annual user conference last week, Nuance recognized 25 healthcare organizations for saving one million dollars or more on medical transcription costs as a result of implementing Nuance’s eScription platform. Eight other organizations were also recognized for their gains in medical transcriptionist productivity.
• McKesson partners with the Emergency Nurses Association to offer the ED Benchmarks Collaborative, a Web-based subscription service that helps EDs identify trends and compare their performance with that of other facilities.
• Ingenix CTO Art Glasgow will speak Thursday at a congressional luncheon on the state of HIE initiatives at the Institute for eHealth Policy in Washington, DC. It will be broadcast online for those who can’t make it to DC.

E-mail Inga.

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I’m rarely a fan of healthcare IT books. My criticisms generally fall along these lines:

• The author isn’t original, authoritative, or knowledgeable.
• The book tells me nothing that wasn’t obvious or that I don’t already know
• Its content isn’t really “meaty” enough to get excited about.
• It uses too much material already available elsewhere, with lots of citations and excerpts that make it look like an imitative journal article.
• Whatever knowledge the author possesses isn’t generalizable to everybody else.
• The book is a chore to read because it’s written pedantically or without skill.
• It doesn’t deliver an end result that makes me happy to have spent the time and money to earn it.

Connected for Health: Using Electronic Health Records to Transform Care Delivery raises none of these criticisms. I found it to be fascinating and informative. It is easily the best work I’ve read on healthcare IT’s role in changing how healthcare is delivered.

I’ll try to keep my review short, but there’s literally something on every page that’s highly useful even to someone like me who’s been in the industry forever and thought they’d figured it all out by now. I’m pretty sure I’ll read it at least five times over the next few weeks since there’s a lot to absorb.

(By the way, if you teach any kind of healthcare or healthcare IT class, this would be a great course resource).

In the interest of disclosure, here’s all I have to share. A book PR company asked if they could send me a free copy in case I wanted to review it. I said OK, but didn’t commit to anything since I don’t like reviewing books (I almost always have lots of criticisms, but then I feel guilty for laying them out even though someone asked me to review their book honestly). I don’t have any connection to Kaiser, I don’t know any of the authors, and I didn’t even try to sneak one of those commission-paying Amazon links above just in case you click on over to buy a copy.

Now I’m not about to sell out my integrity for the price of a book, so rest assured that it’s the same old cynical, dismissive Mr. H talking. Keep that in mind because I’m about to turn into an uncharacteristic cheerleader for Connected for Health. I’m hoping this doesn’t taint my curmudgeonly image (or encourage other authors to send me books to review that I’ll probably not like).

Every hospital that’s using or planning to use clinical information systems should buy copies for every board member and executive. It’s that good. It sets the vision and perspective needed to embark on big-budget projects involving CPOE, nursing documentation, ancillary systems, and data warehousing. It doesn’t tell you what you should do, but it tells you what KP did. And a lot of what KP did and is doing is what everybody else should aspire to.

I think you’d have a tough time arguing why KP’s methods wouldn’t work in some form for other hospitals. Instead of having one of those dopey CPOE kickoff meetings where the winner of the “name our clinical system” contest is announced and everybody pretends they are committed to something they don’t even understand, pass out copies of Connected for Health (even better, do it well before any important decisions are made, like choosing a vendor or developing the project plan).

The book covers in perfect detail Kaiser Permanente’s HealthConnect project, the largest non-governmental HIT project in the world. You might think, “What does that huge organization and its $4 billion project budget have to do with my hospital?” Plenty, as it turns out. Most everything in the book is relevant to the EMR-type projects of even modest-sized organizations. Only the scale differs. The issues are pretty much the same everywhere.

Maybe the most important takeaway is that you’re wasting your money on software if you can’t back it up with the pieces that go with it. Hospitals where I’ve worked shot their wads buying an arguably overpriced clinical system, then ensured mediocrity by trying to run it as an on-the-cheap IT project. We didn’t have enough dedicated resources, we weren’t willing to pay community-based doctors for their time to help out, and we went cheap on end user devices and support resources. Maybe Kaiser did a lot more than a typical hospital could afford, but their results have been proportionately more impressive. They spent a ton of money, effort, and planning to go live, but then as the book says, “Welcome to the starting line.”

If you ask me, the foreword by Don Berwick (then of the Institute of Healthcare Improvement, now of the Center for Medicare and Medicaid Services) is worth more than the cost of the book. Don’s a quality and outcomes guy, not some IT geek doctor with four smart phones on his belt. He focuses on patients, not vendors and deals and Gantt charts. I could have worn out a highlighter marking the parts that had my head nodding.

Here’s a snip that struck home as I thought of all the failed, expensive implementations that are wasting the budgets and energies of hospitals looking for an electronic magic bullet to will absolve them of the responsibility to change themselves and instead just convince themselves that swapping out their data plumbing is the Holy Grail:

Without clear incorporation into the actual processes of care, and without the re-engineering of those processes, and without the changes in norms, capabilities, and culture to allow those new systems to take root, KP HealthConnect would become what far too many other health care organizations had already discovered in their own modernization journeys: the computerization of a defective status quo. Kaiser Permanente was not after a modern information system; they were after a modern health care system. Halvorson called building KP HealthConnect “laying tracks”, but he and I both knew that, in the end, it would be the trains, not the tracks, that mattered more.

Kaiser’s former SVP of quality, Louise Liang, MD, ran the HealthConnect project and edited the book (quite nicely, I should add, since I’m highly critical of editing in general). Its chapters were written by local Kaiser experts on everything to system selection to redesigning primary care. Every one of them is a gem, coming from slightly different perspectives, but with a lot of useful information from an organization that has actually done what all hospitals wish they could do.

Now a cynic (like me) might assume that some of the accomplishments might have been glorified a bit by the home team authors, and maybe they were (certainly anyone who has attended a “look what we did” presentation at HIMSS knows that reality and PowerPoints sometimes don’t intersect). KP probably struggled more than was detailed here, and most likely made some stupid implementation mistakes not listed and let politics and let executive egos drive expensively bad decisions that are regretted to this day but not brought up in polite company (like everybody else does, in other words).

I didn’t find that possibility at all concerning since the material has high value even if that’s true. If you’re a skeptic, just consider the book a picture of a desirable future state that Kaiser may or may not have achieved.

Besides, there are some KP warts in there. They had a terrible time getting regions to standardize (I loved this saying: No one is either so high in Kaiser Permanente that they can make a decision, or so low that they cannot veto a decision.) They wasted a lot of money on failed EMR projects. They had to fight human nature. They overspent. They first decided to expand the use of a homegrown system that one of its regions had developed, but then reconsidered when it fell short on its ability to turn KP into an enterprise-wide electronic backbone going beyond just automating clinic offices. They had to sell the vision to the board with the frank admission that KP was “betting the farm” that KP’s form of medicine was where the country was going and their existing systems couldn’t support the transition.

I found this tidbit interesting. They could find only two commercial vendors able to handle everything from medical offices to hospitals. Epic was named, but KP thought they were shaky because their hospital experience was limited back in 2003. The other vendor wasn’t named, but I assume it had to be Cerner, and whoever it was got axed because of inadequate ambulatory experience. Everybody always wants to know why the Epic wins big hospital deals – the book makes it clear from the customer’s perspective that it’s partly because of the company’s vision and leadership, but maybe mostly because their competitors aren’t very good, especially when it comes to connecting the multiple venues of care offered by larger health systems.

KP did a lot of upfront thinking about HealthConnect, which hospitals unfortunately rarely do beyond choosing their vendor. They brought in a wide variety of people to set the vision, not just for the Epic system, but for how care should be delivered. The items that group came up with in 2003 are pretty much dead on with what’s happening today. Their themes were: (a) Home as the Hub; (b) Integration and Leveraging; (c) Secure and Seamless Transition; and (d) Customization.

The book has a wealth of information about project structure, implementation, budgeting, and leadership. Maybe you don’t buy the vision thing (which probably means you shouldn’t be in charge of anything involving patient-centered IT) but these project details will make your time spent reading worthwhile.

The idea of a Collaborative Build was key, where HealthConnect would be built at a national level, but with some customizability allowed by each Kaiser region. The key point was: first standardize, then diverge. They knew that it would be much easier to force standardization and then relax it later as needed, rather than trying to tighten up after the fact (that’s a Management 101 principal that I’ve always embraced – start out as a tough guy, then loosen up later, because the opposite never works).

There is much detail on how KP identified and involved physicians of different capabilities (operational leaders, opinion leaders, and technically adept). They helped choose the system, develop the clinical content, and sell the idea to their peers (clinicians won’t necessarily be faster, but they should be better, they said).

I’m happy to see that a whole chapter was devoted to nursing leadership and impact. It talks about standardizing terminology, involving nurses in system decisions, and looking at specific goals for barcode medication administration and medication administration.

There’s a really nice chapter called Making It Matter that looks at value and quality.The best part was the description of how the goals of HealthConnect were aligned with KP’s commitment to members, something I have pretty much never seen by hospitals anxious to whip out their checkbook and get their CPOE implementation underway before everybody loses interest. KP knew exactly what it wanted to do in a big picture way: make clinical information available around the clock, deliver superior outcomes, become national leaders in patient safety, use patient preferences to make decisions, and several other very specific organizational goals. HealthConnect was the technology enabler, not the project itself.

An idea I really liked was called SmartBooks for Value Realization and Optimization, which was an extremely well developed list of 250 opportunities that each Kaiser organization (region, department, etc.) could use to improve performance by using HealthConnect. The book also has a lot of information about quality data, outcomes measures, and a full chapter on population health (nearly always ignored by four-walls-centric hospitals and health systems). When you see the scope of HealthConnect, suddenly it’s clear where the $4 billion went — most of it not into Epic’s pocket.

Kaiser took a creative approach to designing primary care services. They decided to design processes to meet the needs of their populations even if capacity seemed insufficient, expecting that they could increase capacity virtually by offering more services by telephone, group visits, and e-visits. They had to have a lot of confidence to go that route.

Everybody’s heard of Epic’s MyChart, which Kaiser calls My Health Manager. The book makes an interesting argument about personal health records: surveys that show low PHR use by consumers are asking the wrong question. Consumers will use them if their services are useful and of high quality, and KP’s patients are big users of patient-to-doctor e-mails, checking online lab results, ordering prescription refills, reviewing office visit summaries, and self-scheduling their appointments.

The book has a very nice summary called Refocusing on Systems Versus Individuals that lays out a hierarch of controls for reducing risk. It says that the most effective changes are, in order: simplifying and standardizing, removing opportunities for error, making it hard to do the wrong thing, making it easy to do the right thing, providing intrusive alarms and warnings, and using reminders and non-intrusive decision support. What doesn’t work as well: policies, procedures, and training. Surprised?

Just about every group involved with clinical systems that I can think of would get an immense amount of highly useful information from the book: clinical leaders, physicians, informatics people, and executives. Every group, that is, except one: the average CIO. Kaiser intentionally ran HealthConnect without much direct IT strategic involvement, correctly identifying it as a huge change project, not an IT project. IT’s job was to handle the infrastructure and technology components, not to convince the doctors to use order sets or demand that nurses scan meds before administration. That’s nearly always true of successful big-hospital clinical IT projects. People on the IT dark side don’t usually have a lot of credibility with clinicians, no different than a Mac-using surgeon who thinks he can educate the CIO on how to run a networking team.

If you’re a CIO who thinks you need to be in charge of anything that plugs into a network jack, you will probably be licking your wounds that it’s not Kaiser’s CIO or IT people bragging about their key involvement in the book. Those willing to look at the big picture and share project responsibility without feeling threatened will find it refreshing and enlightening. It isn’t that the CIO’s role was marginalized, it’s that KP let the operational and clinical leadership lead the changes, with IT providing the technical support to enable them. The CEO set the vision, paved the way with resources, and set up the means to collaborate across several regions. CIOs will still look darned smart among their executive, medical, and technical peers for having read this book.

I would consider Connected for Health essential reading for leaders of any hospital that has an interest in quality, data, clinical transformation, and yes, technology (and I would hope that every hospital falls into that category, or at least any that I’d want to be admitted to). The $40 cost of the paperback (the hardcover isn’t out yet) is just ridiculous. At five times that price, you would be getting a steal considering the ideas it has for projects costing dozens or hundreds of millions of dollars. If they packaged up a tenth of what the book covers into a two-day seminar, you would happily pay 50 times the price of a copy. If you are an enterprising consultant, you could probably make a handsome living for many years by just traveling around the country like a honeybee spreading pollen to grateful plants, sharing your purloined wisdom about strategic vision and IT’s role in quality and cost that’s all right there for the taking.

Like I said, I don’t generally like HIT books. I hit the HIMSS bookstore with enthusiasm, but I’ve been burned too many times. I recommend Connected for Health without reservation. It did for me what no book, presentation, or article has done recently: it got me excited all over again at the potential of IT to change healthcare in a way that actually benefits patients.

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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.

How Opaque is your Transparency?

All humans desire relationship. Solitary confinement is the greatest torture. A psychologist would tell you that no person can mentally survive being alone for long periods.

Even the entertainment industry knows this. One reason for the long-term success of the television hit Cheers is that the producers and writers tapped into our human need. Their theme dwells in the show’s chorus.

Be glad there’s one place in the world,
Where everybody knows your name,
And they’re always glad you came.
You wanna go where people know,
People are all the same,
You wanna go where everybody knows your name.

Leaders talk of transparency and its many forms — from quality outcomes to business performance to personal. Many opinions on the level of transparency arise, especially when it comes down to personal revelations. How open should you be with your manager, peers, and staff? Does familiarity really breed contempt? How much is too much information? Should there be a wall between professional and personal?

As I began my career, I wondered what it was like to be a manager or director, vice president, CEO, etc. I wondered how they prioritized, how they managed their time, and how they dealt with challenges. This was always a great mystery, and I wanted to know more. I longed to observe, learn, and understand the essentials and what it took to get there. Therefore, as my career journey unfolded, I elected to be as transparent as I hoped my management would be.

I recall the advice Captain Davies gave to us impressionable 2nd Lieutenants on this topic at our army engineer school. “I am all for hanging out with troops after hours. But once the conversation gets into work matters, I take leave.” I believe personal transparency carries more benefits that costs. I acknowledge the risks and am careful not to violate necessary confidences. And, like Captain Davies, I avoid discussing work matters.

One benefit of personal transparency is a friendlier work environment. When people see that you’re a genuine person and that you want to get to know them, you’re breaking down the walls between management and staff. Once people see your heart and understand your motives, they’ll be more compelled to follow.

Your authenticity will expand your level of influence. Over time, your proactive interest in others will increase their level of engagement. The fact that your manager knows you and cares about you can speak louder than an annual raise. People also enjoy the recognition that comes with the investment and gift of your time.

Another benefit is the opportunity to model appropriate behavior. Many emerging leaders have not seen management up close and may not know the protocol for social and business contexts. This can help remove the fear of interfacing with executives and understanding etiquette. 

I employ the following to ensure a level of personal transparency:

• Host annual wine, cheese, and chocolate parties for emerging leaders and significant others (my wife also helps spouses see the genuine human side of an executive).
• Host annual Christmas parties at my home with leaders and their significant others.
• Host in-home parties for teams to celebrate accomplishments.
• Attend almost every event I’m invited to, including parties, weddings, and my favorite — RockBand jam sessions.
• Attend funerals of an employee or his/her spouse.
• Yammer (micro-blog) daily on my agenda and other items of interest, and sometimes offer an impromptu lunch.
• Accept Facebook invites and Twitter followers from co-workers.
• Participate in all work events, such as fundraisers, contests, and celebrations (dancing, sumo wrestling, etc).
• Organize and participate in sport events.
• Volunteer my home and time for work-related fundraisers.
• Send handwritten notes saying “thank you” or “good job”.

This open approach has greatly accelerated the development of relationships with my leaders and staff. Something magical happens when you put aside the pretenses and trappings of the formal work environment, let your guard down, and be who you truly are. Create a place where everyone knows your name and you also know theirs.

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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From Simon Stiles: “Re: Georgia HIT Leadership Summit. It was a huge success in that it united the leaders and vendors to begin talking ‘collaboration’ to benefit the growth of both large and small companies that are part of the health IT cluster that has developed in Georgia. The organizers are focused on attracting and creating more HIT vendors in Atlanta and Georgia that will provide high-quality, high-paying HIT jobs, not to sell products. Success was measured by the number of participating companies (110), the number of speakers and panelists who agreed to future collaboration (100%), and the number of companies that are interested in ongoing events that bring Georgia’s HIT companies together (100%).”

From Jenny from Venice: “Re: you and Inga. Let’s hook up at HIMSS. I love everything you both do, I really do. Lurve you!” Thanks, but I ran your proposal up the Mrs. HIStalk flagpole and she didn’t salute. I can’t speak for Inga. I had to look up “lurve” since I wasn’t exactly sure what it means, so that’s probably a good indication that we wouldn’t have hit it off anyway.

From MarketWatcher: “Re: Merge and Fletcher Flora. That was a very quiet acquisition and and odd one at that. Insight?” Coming soon, quite possibly – I’ll be interviewing a top exec there shortly, provided I can figure out a time after work to connect (darned day job).

From Tony: “Re: HIMSS reception. Has the signup page gone up yet?” Not yet. Look for it in January.

Inga mentioned that Henry Ford Health System is working on rolling out a new version of its CarePlus Next Generation EHR. A reader tells me that the Web-based SOA system was developed by RelWare, which offers its commercial version of it under the EXR nameplate.

AMIA says it doesn’t like “hold harmless” clauses in vendor software contracts. At a reader’s suggestion, I e-mailed CEO Ed Shortliffe to ask if AMIA will put some teeth behind its proclamation by turning down the sponsorship of vendors who won’t go on record as saying they don’t use those. He hasn’t responded, but I’ll let you know if he does.

It’s close to an even split whether recent election results will reduce or delay HITECH payments. New poll to your right: have you personally seen a “hold harmless” clause in a HIT vendor’s software contract? They’re supposed to be everywhere, but nobody every provides an example. I know I’ve seen them in some old copies of contracts that I discarded a few years ago.

San Juan Regional Medical Center (NM) sends four tons of old computer hardware to a Canada-based company that takes electronic waste for free, pays a third party to process it, and donates the profit to Feed the Children.

A Tampa publication mentions the cost of implementing clinical systems at a couple of local hospitals: BayCare ($200 million) and Tampa General ($120 million).

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Four small, closely-located Texas hospitals (the largest has 45 beds) join to create a RHIO around the Prognosis ChartAccess EMR.

Cloud-based population data analytics vendor Explorys, co-founded last year by Cleveland Clinic, hires Anil Jain, MD of the Cleveland Clinic IT department as its part-time chief medical officer.  

The health authority of Norway signs a $120 million deal with IBM to provide a variety of services and to implement a custom logistics solution built around SAP.

Healthrageous, which offers consumer health solutions based on technologies developed by the Center for Connected Health at Partners HealthCare, is chosen as one of the 50 most promising tech startups. It collects health data from patient biometric devices, analyzes it, then sends out recommendations to the patient. I like the name.

Laboratory middleware vendor Data Innovations is sold to Battery Ventures. Old news from last month, but I missed it first time around.

The government of Hong Kong invites proposals to develop a territory-wide platform for sharing electronic health records. More information on the project is available from the eHealth Record Office.

Newborn twins die of a IV-related medication error at a scandal-ridden UK hospital that is already under public inquiry for the unnecessary deaths of 400 to 1,200 patients.

The CEO of National Health Insurance Board of Turks and Caicos Islands has a financial interest in the vendor chosen to process medical claims there, critics claim. The CEO disclosed his “minority interest” in Mitan, but the company’s Web site lists him as founder, director, president, and CEO since 1999.

Odd lawsuit: the transplant center of Georgetown University Hospital calls a cirrhosis patient who’s on the liver transplant list to tell her that a matching donor liver is available for immediate transplantation. They didn’t call any of the emergency numbers she had given, instead leaving a message on her home answering machine. The woman, as it turned out, had a good excuse for not being home – she was an inpatient at the same hospital at that time. When her family found the message and returned the call, they were told that the liver had been given to the next patient in line. The woman died, her family is suing.

Sponsor Updates

• MedPlus announces collaborations with several regional extension centers that involve the company and its Web-based Care360 EHR .

E-mail me.

mHealth Reaction
By Deja Vu All Over Again

For anyone who attended Web or Internet conferences in the mid-90s, your description of the market is a flashback. mHealth as a separate model does not make a lot of sense, which is why they are having a hard time trying to figure it out.

Like in the late 90s for eHealth, all those new mHealth corporate groups will be integrated back into the main lines of business. Mobility is just a different (and exciting) way to deliver much more interactive and innovative value for core health care processes. The dot-com bubble experience will keep the fervor in check this time around.

Having said that, mHealth will have profound changes in US health care over the next five years for the following reasons:

1. Our 5-10 year industry technology lag sets up a great deal of potential disruption for mobile components as the current brittle systems start to move towards loosely coupled modular application platforms like in other industries. Many large HIT vendors are about to enter the SAP enterprise model death spiral.
2. Historically institutions and "back channel" processes have been the focus, not mobile savvy consumer / patients who are rapidly becoming financially forced to be more engaged in their health.
3. Care delivery transformation from payment reform and skill shortages will require fluid care approaches that require mobility, and
4. Most care is now done in the home, but will move from routine to chronic disease management due to aging and the obesity explosion.

Note to bright-eyed entrepreneurs who have not been in the health care industry a long time: the existing HIT vendor mafia has always been much more effective in squashing innovation from disruptive outsiders to maintain the status quo than competitively innovating against each other. If you fashion yourself as David vs. Goliath, make darn sure that God is on your side before you start hurling rocks.

Therefore, there will be a great deal of opportunity for those niche companies that focus on meeting the needs above by complimenting the old guard entrenched HIT vendor systems, but with an eye towards explosive disruption when they are embedded, delivering value, and the market timing is right.

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