From Donde Esta: “Re: hands-free interface. Interesting.” A group in Switzerland uses Microsoft’s Xbox Kinect 3D motion controller to enable voice and gesture commands with PACS.

From Woody the Wabbit: “Re: Allscripts. As positions EMR and PM positions open in Raleigh, they will be moved to India.” Unverified.

From AccidentalCIO: “Re: Meditech. On a conference call last week, they said customers will need to purchase their data repository to meet the requirement for electronic capture of quality measures. Nothing on their site, no press release. No other customers that I know have been made aware.” Unverified. I e-mailed the Meditech press contact, but haven’t heard back.

From Vanilla Ice: “Re: GE Centricity Enterprise. I hear they’ve told customers it’s going into maintenance mode.” Not exactly, according to my GE contact who tracked down “conversations” the company is having with customers (I’m quoting that since I don’t know exactly what it means, so I’ll use their word). GE says that, to demonstrate their commitment to the success of existing customers, priorities have been changed to help them rather than going after new sales. Not many were buying anyway, of course, and I can’t imagine there are more than a few dozen existing customers left, but GE is at least promising to support them in their quest for HITECH money and other benefits.

Testing 1-2-3 … can you hear me? OK, maybe we were silly to post the day before what is a holiday for most folks. But Inga and I are hard-working, salt-of-the-earth types who don’t want to let our equally dedicated readers down just because most people are sleeping late, shopping, and preparing to overeat. We’ll keep it short, but we’ll make sure to include something useful or entertaining that the less industrious will miss.

A CEO sent me this today, wanting to renew their HIStalk sponsorship: “We absolutely want to continue our support and participation with HIStalk. In fact, I personally believe it’s the most valuable marketing dollar we spend.” Nice! I appreciate that very much. And from another CEO, “Thank you again for all you do. I do not know of anyone who does more to keep everyone honest in this less-than-honest business of healthcare.” I know it’s like a tiresome grandparent whipping out endless pictures of a shriveled, newborn grandchild while everybody rolls their eyes, but I promise to brag only infrequently.

The VA finds that employees are using Web-based applications to store patient information, which CIO Roger Baker says is both a security challenge and a call for the VA to offer something similar. They discovered residents and employees using a Yahoo calendar and Google Docs to store patient information, going back to 2007. Apparently it was a primitive interoperability project: the residents covered multiple hospitals and needed to see VA patient information while off campus. The VA blocked access and sent letters to those whose information was stored there, even though it was secured.

Weird News Andy offers this Christmas gift to all. A woman sues her surgeon, who she claims was negligent in performing her hemorrhoidectomy. The gas she passed during the procedure was ignited by the surgeon’s electrosurgery pen, setting her genitals on fire. She lost the case.

Pinnacle Health (PA) reports exposure of patient information when its contracted transcription vendor inadvertently opens up its server to the Internet.

Verizon provides a $100,000 grant to UMDNJ-University Hospital for the STAT-MI system, which allows ambulances to send ECGs directly to a hospital cardiologist’s smart phone so that patients having a heart attack can be transported directly to the cath lab.  

Jobs on the Sponsor Job Board: Senior Software Engineer, VP of Sales, Application Consultant. On Healthcare IT Jobs: RN Clinical Informatics Transformation Leader, Senior Clinical Analyst, Enterprise Integration Architect, Meditech EDM Consultant.

CCHIT certifies Ingenix CareTracker as a Complete EHR.

Just a suggestion: sometimes I use the HIStalk mailing list to offer benefits to those readers on it (first notice of stuff, HISsies voting privileges). If you haven’t signed up, that “Subscribe to Updates” box to your upper right is your ticket to paradise.

The news that Dell is acquiring InSite One caught me by surprise since I had just finished interviewing the company’s CEO. I’ll have it up soon.

Strange: Zsa Zsa Gabor’s husband (her eighth) is admitted to the hospital after he apparently mistakes Zsa Zsa’s nail glue for his eye drops and seals his eye shut. I figured he might be a bit old to be taking care of himself since she’s 93, but he’s only 66 and planned to run for Governor of California this year until Zsa Zsa’s health became an issue.

Vermont’s REC adds Greenway’s PrimeSUITE to its list of preferred EHR partners.

A hospital in Canada loses $1.5 million to a minimally supervised accounts receivable clerk responsible for loading its ATM machine with cash. The $40K per year employee treated nine friends to a trip to Hawaii and had blown $400K on slot machine gambling at a local casino.

I hope your Christmas is just peachy and that Santa brings you whatever you want. All is right with the world when the marathon of A Christmas Story is on, gift wrap is strewn everywhere, and the smell of turkey or beef or tofu or whatever traditional food you cook is wafting over the Cowboys on the big screen. Once the holidays are behind us, HIMSS looms, so you know it’s going to be a whirlwind (for me, anyway). Thank you for being involved with HIStalk in whatever fashion. I’ll be here with the usual Monday Morning Update, which probably means working Christmas Day, so don’t forget to come back.

E-mail me.

HERtalk by Inga

From Zebedee: “Re: St. Joseph’s. Merry Christmas, Inga, thanks for an educational year. I heard this story on NPR this morning.” The Catholic church strips St. Joseph’s Hospital and Medical Center (AZ) of its religious affiliation after providers terminate a pregnancy. Hospital officials insist the surgery was in line with Catholic teachings and was performed to save the mother’s life; the local bishop disagrees and severs the church’s tie with the hospital (facility excommunication?) St. Joseph administrators insist the move will have little effect on its ongoing operations or hurt donor contributions.

From Sam the Snowman: “Merry Christmas, Inga. You never seem to age in your pictures. Keep it up.” Thanks for noticing, Sam. Clean living.

Florida’s Agency for Health Care Administration awards Harris Corporation a four-year, $19 million contract to implement a statewide HIE infrastructure.

Also from Florida: Good Samaritan Medical Center and West Boca Medical Center are using the RF Surgical Detection System to prevent and detect foreign items inadvertently left inside patients during surgery.

Let the registration begin. Beginning January 3rd, eligible providers and hospitals can apply for participation in the Medicare EHR incentive program. Eleven states will open Medicaid registration the same day; other states will begin accepting Medicaid applications in coming months. David Blumenthal says, “It’s time to get connected,” which is kind of a hokey statement at this point in the game. But heck, maybe he is just in the holiday spirit.

Rhode Island MSO Polaris Medical Management selects DiagnosisONE as its exclusive provider of clinical decision support for EHR deployments.

McKesson wins anti-trust approval to complete its $2.16 billion purchase of US Oncology on Tuesday, the same day an interim court order stalls the acquisition. The Supreme Court of the State of NY puts the purchase on hold, based on a case filed against McKesson by the Cancer Clinics of Excellence. The network of oncology practices claims the deal breaches an existing contract it has with McKesson.

In India, seven health department employees are suspended after allegedly organizing a “vulgar dance” program at work. I bet Mr. H’s holiday party outlook would be greatly improved if his hospital hosted a similar program. He might even wear a Santa hat to show his support.

From Luke O’Cyte: “Re: Santa and shoes. We know that’s not you sitting in Santa’s lap because the real Inga would never have posted a photo that didn’t show her fancy shoes!  Obviously this photo was one of a woman wearing inappropriate shoes, which necessitated the cropping of the photo, lest it clue viewers in that this wasn’t the ‘real’ Inga! Here’s hoping that Santa brings you lots of fancy footwear for under the tree, and with that note, I give you The 12 Shoes of Christmas:

On the twelfth shoe of Christmas,
my true love sent to me
Twelve sandals peeking,
Eleven flip-flops flopping,
Ten pumps a-pumping,
Nine loafers dancing,
Eight moccasins a-walking,
Seven slippers slipping,
Six golf shoes putting,
Five golden boots,
Four peep toes,
Three Mary Janes,
Two canvas runners,
And a high heel in a shoe tree!”

Brilliant. Thank you, Luke, my newest BFF. Wishing all readers a lovely holiday!

E-mail Inga.

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Beth Pickard is president and CEO of Clairvia of Durham, NC.

Tell me about yourself and about Clairvia.

I’ve been in the staff management business for health care organizations my entire career, going on 25-plus years, implementing software solutions to improve the staffing and hospital organization. Clairvia is the second company that I’ve managed in staffing. We’re seeing staffing management being transformed into new staffing practices. This company is focused on the patient experience and the value that staffing brings to that patient experience.

Give me the elevator speech definition of Care Value Management.

Care Value Management is a transformational solution that bridges the gap by linking workforce management to the patient experience. It integrates the patient’s condition to the care levels that are required to move each patient through the hospital organization to the best possible outcomes.

In the old days, resource allocation or staff management meant a rigid model based on acuity or historical trends. How is real-time staff resource allocation different?

The biggest difference is that the data is real time now. Historically, it was retrospective or just looking at the next shift.

All of our solution sets are utilized by clinicians at the bedside. That’s a core strength of our technologies as well.

The third piece is that we never linked the value those resources brought to improving the patient’s movement through the organization. In other words, we always predicted or planned for the next shift, but what we hadn’t done is look at, “Are these staffing levels actually making the patient better quicker or moving them through the organization with a better experience?” It was more in terms of looking at what staff we needed versus were those staff members really impacting the patient’s care.

Success used to be measured by simply getting through the shift with the predicted low staffing number, regardless of the clinical result.

What’s really changed is the value-based proposition. We have to start looking at what improves quality and cost, and obviously staff resources. We have to start looking at what care models do improve quality or how they impact cost or the patient experience.

How is your system used in the management of a typical nurse shift? 

A patient comes into an organization. We immediately put them on a plan of care based off of their reimbursable working DRG. At all points in time of rounding and working with that patient, we know in our minds what that patient’s planned movement through the organization is.

It changes as their condition changes. At all times, the collaborative team is working towards whether or not that patient is moving to expected outcomes and moving to their expected discharge date in the system.

Think of it as managing to a flow and ensuring that the resources are available at all points in time so that that flow is complete or as it’s happening or occurring as planned. As charge nurses and caregivers are planning for those patient needs, they do interdisciplinary rounds. They’re managing to that expected progress as well as assigning caregivers who will actually provide the care for those expected events.

Are your prospective customers already doing that process of managing to an expected outcome and discharge date, or is that a concept you have to sell them on?

Absolutely. I would say that the technology enables the process. Typically we find that the planned discharge dates are managed in silos of organizations or departments within the hospital. The technology enables everyone to have more of a collaborative approach. That’s one of the transformational processes that occurs.

Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell. I think we are one of the few systems out there that as we’re tracking to the length of stay, we’ve linked the staffing component to that management. They are fully integrated and affect each other. You have to have the resources available and working to impact the length of stay management. 

We have both of those pieces. It is the key and the value of the system. You’ll find people that have one or the other, but there hasn’t been another technology that has linked the two together.

Hospitals are always transferring patients for many reasons, not all of which are clinical in nature, without really considering the skills and staffing levels on the receiving unit. Can your system help make the transfer process more efficient?

Absolutely. One of the first things it does is to get patients in the correct location. We’re very much linked into capacity management. As you’re looking for available beds, you’re also checking to be sure that — based on their progression of care and their planned care – patients are being placed in the right area.

That’s the number one most expensive error that organizations make: getting them from the ER to the correct care area. Then once they’re in that care area, we obviously have already assigned and have waiting the correct resources to provide that care. 

If you’re moving them from the ER to the ICU, we start looking at well how’s that patient been tracking through the ICU to ensure that they also move in a timely manner from the ICU, which is a high-resource cost, to routine care. But most importantly, that their outcomes are also good and their condition is also what we would consider ready to move to that next level of care.

A lot of hospitals have bought bed-tracking type applications. Do you see this as the level above those systems?

Patient flow is one piece. But with patient flow, you have to see whether the staffing is available to move that patient where they need to go. Is the unit staffed to transfer them from one area to the other? Without the complete staffing area, you’re missing a key piece.

But the second most important piece that I remind people about is that this is an outcomes system. That’s where our success is really driven. We’re tracking which patients are moving to the best outcome, because at the end of the day, it’s not always a good idea to move people faster through an organization. 

We talk more about optimizing. What’s most important is that at each point in time of their stay, they’re achieving the desired level of wellness or the desired outcome. I think that’s a key and critical component in a value-based organization or an accountable care organization.

You just landed a large customer in Sutter. What are their plans for your products?

The key to their implementation was to leverage existing clinical data. When people ask me why didn’t we do this 25 years ago like I wish we did, I say we really didn’t have the clinical data available to track whether or not the patients’ progression or health-wellness was improving. 

The key for Sutter was that it managed and evaluated the outcomes of each of their patients and ensured that the resources were available for safe, effective care. Very key to the implementation is the clinical integration and leveraging the rich clinical data that they’re getting through their Epic implementation.

What kind of success metrics do they have?

At each of point along the way, we’ll look at total resource cost, length of stay or patient cost by DRG, NDNQI outcomes, employee satisfaction, position satisfaction, and patient satisfaction outcomes. With all of our implementations, we benchmark those indicators and then track them post-implementation to assure that our clients really get the results that they technology should provide them.

States like California where Sutter is located is have mandated nurse staffing levels. Do you think those requirements do enough to ensure that patients have access to the care they need?

States like California have mandated staffing levels are because there’s never been a way to measure whether or not staffing levels really affected patient care. In California, what we’ll be able to do is see which staffing levels have the associated better outcome.

We’ll get past strict ratio staffing, which basically says that since we don’t know what staffing levels produce the best outcomes, we’re going to mandate them. We’ll collect data that will show which models of care or which ratios provide the best patient experience or best patient’s stay or quality by patient population.

You can imagine the data that we now have by patient population and staffing ratios is going to provide us the evidence for new models of care and staffing. That’s how we’re going to get better. We’re not going to get better with just looking at whether or not we’re using outside agency use or overtime costs.

Most hospitals have already done what I call the “squeezing” in their staff resources. We must look at are the staffing levels that actually making most patients get better. That’s where our technology solutions are going to help move organizations. California is a very good area for needing the technology.

Other than the technology readiness that enabled the real-time use of data, how do you think the political and the healthcare delivery climate is to come up with a potential way to introduce new models?

I think they’re going to have to. Very little is written about how hospitals are going to save dollars or show efficiencies.

With 60- 70% of their cost being staffing, they’re going to have to look at new ways of doing things to get better. Not only for efficiency of the care, but to retain and attract the best talent. Hospitals that are providing and managing their patients to good quality outcomes will attract the best talent — not only nurses and caregivers, but physicians.

Those are the hospitals that are going to be ready for what we know already to be an acute shortage of talent over the next several years. I see it as a way of retaining and tracking the best talent, as well as providing the good patient experience.

One solution companies came up with was the shift-bidding model to use your own experienced employees who wanted to work extra shifts. How are hospitals using your shift-bidding application?

It’s absolutely popular. It’s used by 100% of our clients. Employee self-service eliminates the paper in the scheduling and staffing process because you close the loop between signing up and posting shifts. It absolutely has enabled our clients to move from a paper-intensive process to paperless. 

A second benefit is that it definitely improved employee satisfaction. Staff love it. Employees, especially new nurses, want to work for organizations that allows that communication and transparency in the scheduling and staffing process. Employee satisfaction and moving to a paperless process have been enabled through those types of technologies.

I’ve not seen a time where so many people at the top are saying that nurses should have a voice on determining how healthcare delivery should change. As a nurse, what do you think of that?

In my entire career, it’s the most exciting work that I’ve been involved with. We’re finally focused on what brings value to the patient’s care or the patient’s experience. We know patient care brings value, including both the medical and nursing or caregiver care. 

To finally be in a place where we have data available to affect and make those decisions to improve patient care is a good time. It has been extremely rewarding to work with the clients we’re implementing.

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Dell announced this morning that it will acquire InSite One. The Wallingford, CT company offers cloud-based, vendor-neutral medical image storage and archiving, with 800 clinical sites as customers. Its InDex enterprise architecture is based on the IHE framework and supports recovery and migration services.

Dell says the company’s technology will extend Dell’s Unified Clinical Archive solution.

Berk Smith, Dell’s vice president over healthcare and life sciences, said, “As the first company to bring cloud technology to the medical archive space, InSite One will help Dell’s healthcare customers take advantage of the economics and scalability of the cloud for medical archiving and retention. And looking beyond archiving, the cloud will also be a valuable tool for information exchange which is foundational to the transformation of healthcare.”

Terms of the acquisition were not announced.

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From Vendor Prez: “Re: RFID tagging of HIMSS conference attendees. I think this is appalling. As an exhibitor, the last thing I want is for the attendees to feel more ‘targeted’ that they already do. Frankly, if exhibitors can’t get attendees in their booth on their own merit, they don’t deserve to capture key information from drive-bys. This is pitiful and my company will not be participating. We will however, proudly display the HIStalk Sponsor poster that you always drop by!” Above is the end result of tracking us attendees like stray cattle via the RFID chip tucked away in our badges. Vendors pay $3,000 for the basic package up to more than $20,000 for a turnkey tracking service. You can opt out on your conference registration like I did. And thanks to Vendor Prez for displaying our amateurishly made “We Power HIStalk” signs in their booth. I know it’s hokey, but we are really proud that many HIStalk sponsors participate because they want to support what we do. As you might imagine, I really appreciate that.

Speaking of which, you would think the stray cattle tracking company could at least spell the name of its excessively vendor-friendly partner correctly.

From Chatty Cathy: “Re: instant messaging. Do nurses typically use it in hospitals to communicate with each other and with doctors? Just curious.” In mine, the PCs are theoretically locked down and IM clients aren’t allowed, although I’m sure someone has figured out a way to bypass that (like using an online chat client like Meebo or the ones built into Yahoo or Google). I like the question, though, and would appreciate comments. It’s a pager-driven world in many hospitals, made kind of IM-ey with Amcom’s Web-based paging app that lets people chat primitively back and forth. Staff could also use SMS messages or specific VoIP apps. They could even use FaceTime video calling if they have iPhones or iPads.

From IT Begins: “Re: Ingenix. Appears to be the first steps of unveiling strategy around the recent acquisitions.” Inga covers it below, but Bethesda Healthcare System (FL) chooses Ingenix to manage the revenue cycle of both the hospital and its outpatient services. Ingenix will provide its Electronic Financial Record, coding solutions, patient financial counseling, an ED information system (since it bought Picis and can offer ED PulseCheck), and full-time employees in scheduling, registration, HIM, PFS, and decision support. It sounds like a great business move, although odd that a hospital would hire a company owned by an insurer to manage its revenue cycle, most of which involves dealing with insurance companies. Who better, right?

From Epic User: “Re: FDA oversight of EHRs. Epic’s ‘fear of stifling innovation’ doesn’t resonate with this long-time user of their applications. They routinely fail to prioritize making simple changes to their system (icons, language on screens, similar functions in different applications) that are consistent and would reduce user confusion / error. They also fail to prioritize making enhancements to their systems requested by customers year after year (apart from the annual voting, which is application-based and not focused on consistency across applications), and instead focus on new features that help sell the systems (e.g. focus on ‘what sells’ vs. ‘what’s useful’. If FDA oversight stifles their innovation and helps make their systems more consistent from application to application in terms of functionality, user experience, etc. then that’s a good thing.” Here’s who I blame for that: customers and prospects, since most vendors work pretty much the same as you describe, i.e. creating what the market demands. If customers don’t like their apps or feel they endanger patients, then it’s their fault for writing that check anyway. I’m growing weary of hearing how big, bad vendors prey on helpless health systems and their excessively paid C-level leadership who can’t be bothered to understand exactly what they are getting in return for their many, many millions of dollars or creating a vision of how it could be better. I’d like to see better applications, but those voting with their dollars are saying otherwise – guess whose vote counts? If there’s a demand for iffy software applications, unhealthy Big Macs, or illegal drugs, economics assures that someone will meet that demand.

This is sobering, but not surprising: Fitch Ratings downgrades the bonds of Lima Linda University Medical Center (CA) BBB with a negative outlook due to poor liquidity and inconsistent financial results (54 days days cash on hand). Once concern is the $1.4 billion it will need in capital over the next 10 years, mostly for seismic compliance requirements (which management has already said they can’t possibly meet) and implementation of electronic medical records.

The chief nursing officer of Capsule, Susan Niemeier, receives a slew of social media awards for her work under the pseudonym Nurse Sue.

KLAS releases a report covering single sign-on, concluding that high customer expectations aren’t always met, but that they are generally glad they implemented it. Imprivata edged out Microsoft (Sentillion) for the top ranking.

This sounds like something I’d come up with: UMass Memorial Health care allegedly hires hot models for $75 per hour to approach mall shoppers and football game attendees and ask them to give cheek swab DNA samples for its bone marrow registry. Those agreeing were told that their insurance would pay the $100 charge, only to find that their EOBs showed charges of $8,400, not to mention that many of them may not have been made aware that they were obligating themselves to donate marrow if they matched. A hospital worker supposedly told the models, for which the hospital paid up to $4 million, to wear short black skirts, heels, a white lab coat, and colorful wigs.

Good news: today is the shortest day of the year, meaning it can only get better when it comes to driving home from work in the dark.

The guy who robbed and shot Wheaton Franciscan Healthcare IT VP Tim Belec in WFH’s parking lot three year ago is finally sentenced to 12 years in prison after pleading guilty to a single charge of attempted intentional homicide. I never heard how Tim did after taking two bullets in the chest, but I Googled his name and articles I ran across indicate that he’s back on the job at WFH.

A Dean Health System (WI) doctor breaks hospital rules by storing patient information on her laptop, which was then stolen. The hospital sends the usual “so sorry, how about some free credit protection?” letters to 3,000 surgery patients. And in Virginia, Centra notifies 14,000 patients that their billing information was exposed when an employee atttending a Georgia conference has her laptop stolen from her rental car.

Cerner opens a Collaboration Center in its London offices. I’m not clear on what its point is, but the Cerner UK GM says it will help clients “identify their respective organisational imperatives, such as financial savings or patient safety initiatives, and align them with the capabilities of Cerner Millennium.” I guess it’s like a Vision Center for existing customers.

David Brailer’s Health Evolution Partners launches Halcyon Home Health, which he says will “redefine how home care is delivered” through clinical excellence and IT. Its Web site (above) isn’t quite ready.

The government of Hong Kong starts the next phase of its EHR project, soliciting proposals for pilot projects and interface work that involve patient-facing health applications and standard terminology. Proposals are due by January 31.

Healthland’s inpatient EHR earns CCHIT certification as a Complete EHR.

I happened to drive by one of those consumer lab store fronts the other day and noticed a somewhat fun sign in their window pitching their lab tests: “Sex, Drugs, and Cholesterol.”

iSoft finds a new source of revenue: offering another company’s technology that will extract information from its EMR and de-identify it for researchers (hopefully not selling it outright). The Cliniworks platform sounds kind of cool, actually.

The GAO says HHS missed the 2007 date set by Congress to develop a plan for an electronic system to support sharing of information in public health emergencies. I guess they aren’t Meaningful Users.

Clinical trials software vendor DrugLogic files suit against Oracle, claiming patent violations related to two life sciences software companies that Oracle acquired, Relsys and Phase Forward. In the mean time, Oracle turned in killer Q2 numbers, with revenues up 47% to $8.6 billion and profit up 28% to $1.9 billion.

The local Massachusetts paper runs an interview with eClinicalWorks CEO Girish Kumar Navani, focusing on the company’s local economic impact and impending move to bigger quarters. Tidbits: eCW will be hiring 100-200 people in 2011, it has more than 1,300 employees, its new building will cost $18 million, 2010 revenues are expected to be $130-$150 million, and its five-year goal is to have 100,000 providers and 100 million patients.

We’re having the usual semi-lame holiday events at work this week (you can’t say Christmas, of course, since somebody’s lawyer would show up before you finished the sentence). There are always a few really disturbing souls wearing Santa hats in an unwelcome public display of carefully orchestrated holiday exuberance (especially since they are usually the really obnoxious people or oddballs who haven’t said a peep since last Christmas). There’s the white elephant gift exchange, which everybody hates because it comes with pages of rules and the person who organizes it always seems to parlay their knowledge into ending up with the only good gift. There’s the door decorating contest, where hastily covering a door with old gift wrap and cut-out occupant pictures is considered extraordinary effort worthy of a noble prize, like a free frozen yogurt in the cafeteria. Leftover celebration food is dumped unceremoniously and anonymously on break room tables, fallen upon instantly and ravenously by beaming IT geeks who should be applying some of their vaunted analytical skills into questioning whether it’s a good idea to eat something that’s been standing at room temperature in a different conference room or office until everyone got tired of looking at it and decided to deposit it in the collective food trough rather than throw it out (hey look, everybody, there’s deviled eggs in the break room!) Guys wear hideous light-up Santa ties and ladies show up in Christmas sweaters smelling of mothballs from their once-yearly exposure to air (the sweaters, not the ladies). But the worst thing is that it will be over in a week, leaving a long stretch of no holidays as the serious work restarts. I’m going to study this holiday phenomenon once I finish my current observational research that questions why a large percentage of men puzzlingly spit in the urinal before or after using it for its intended purpose.

E-mail me.

HERtalk by Inga

A Puget Sound-based public radio station compiles a list of the 86 “top-earners” from area hospitals, including 15 executives who earned over $1 million in 2008. On top: former Swedish CEO Richard Peterson, whose total package exceeded $8 million.

The 600 physician member Morris-Somerset IPA (NJ) contracts with eCast Corporation for its ACO-Care HIE product.

Essent Healthcare (TN) selects ProVation Order Sets  from Wolters Kluwer Health as its electronic order set solution. Essent operates five hospitals across four states.

Billings Clinic (MT) signs a multi-year agreement with Craneware for five charge process applications and implementation services.

Child Health Corporation of American will offer LodgeNet Healthcare’s eSuite interactive television solutions to its owned hospitals.

More than a quarter of doctors in the Czech Republic have declared their intention to resign and emigrate to a better-paying country if their government can’t address pay concerns, long hours, and poor working conditions. The starting base salary for a Czech physician is about $11,000 year. In nearby Germany, pay is about $96,000 a year.  Government officials claim the current financial crisis prevents them from increasing doctor pay.

Vista Health System IPA and Central Jersey Physician Network IPA form a new accountable care organization, Optimus Healthcare Partners LLC. The organization will initially include 650 physician members.

HIT consulting firm PHNS realigns its management team following its acquisition by the ConJoin Group. PHNS founder Richard S. Garnick will remain as CEO.

The Texas Organization of Rural & Community Hospitals Foundation is offering QuadraMed’s ICD-10 Countdown Program and Readiness Assessment Services to its 150 member hospitals. Almost 70 hospitals have already contracted for the program.

mdi Consultants will be the anchor tenant for the Nashville Medical Trade Center, according to the center’s management company. Market Center Management Company also announced the creation of a Global Business Development Center to be located within the center. The 1.5 million square foot development is scheduled to open in 2013 and expected to attract 160,000 visitors a year.

Sponsor Updates

• Wishard Health Services (IN) expands its use of Surgical Information Systems (SIS) products to include SIS Anesthesia, SIS Analytics, and SIS Com.
• Ochsner Health System (LA) goes live on Orion Health HIE.
• CDW and Greenway Medical Technologies announce a partnership to offer a practice EMR package that includes PrimeSUITE 2011, technology, and services.
• BayCare Health System (FL) partners with MEDSEEK to develop and deploy an integrated eHealth solution for consumers, patients, clinicians, and employees.
• Bethesda Healthcare System (FL) picks Ingenix to manage RCM functions for its hospitals and outpatient facilities. Ingenix will deploy its Electronic Financial Record technology as well as provide full-time onsite staff to manage RCM functions.
• Momentum Billing LLC (CA) chooses Advanced MD’s medical management software for its medical practice operations and RCM business.
• McKesson says that Community Hospitals and Wellness Centers (OH) is the 100th hospital to go live on its Paragon HIS.
• Cumberland Consulting Group has been honored as a Patriotic Employer for supporting employees who serve in the National Guard and Reserve. The company was nominated by Major John Gobel, one of its consultants who served 20 years in the Guard, stayed on in the Reserves, and served in Iraq.

I stepped away from my HIStalk duties yesterday and met with The Jolly Guy. I shared with him my special request for fabulous boots. Santa said, “maybe.” True story: he asked me to leave out a glass of vino on Christmas Eve, in lieu of milk and cookies. My kind of Santa.

Send holiday greetings to Inga.

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John Glaser is CEO of the Health Services Business of Siemens Healthcare.

I’m not clear on your exact title and the scope of your job. Maybe you could explain that to me.

The exact title is CEO, Health Services Business of Siemens Healthcare. I’m responsible for, across the globe, the healthcare IT business. This is and Soarian, Invision, MedSeries4. Not only the products, but also the services that go with them … the hosting, managed services, implementation services. That is the pretty typical portfolio that I’m responsible for.

Almost never do provider CIOs become vendor CEOs. What motivated Siemens to pick you for the job and for you to take it?

Their motives were a couple. One is that having lived like I have for two decades on the customer side of it, I would bring an orientation to know what it’s like to go through CPOE implementations to what it’s like to sit in front of the board and request a capital budget. And that perspective would be helpful and useful in the course of the normal discussions one would have with a vendor.

I suspect that the other thing that was attractive to them was the demonstrated ability to lead and manage a complex organization, so there’s a high likelihood that I could actually get something done. Partners HealthCare isn’t the same as Siemens, but nonetheless, Partners HealthCare is a large, complex, highly matrixed organization.

I think the third is that I have a knowledge base of this industry, from CHIME circles or having spent time at ONC or to HIMSS or a variety of Institute of Medicine committees. There’s an understanding of the range of healthcare at the government level, but also because a number of these groups are part of our multi-stakeholders. How to plan things.

That’s probably a series of reasons – the customer orientation, the leadership ability, and the sheer knowledge that comes if you spend a lot of time in this industry.

The reason for me is that I spent 22 years at Partners, both 15 years at Partners itself and seven years at the Brigham and Women’s prior to that. I think we did some pretty good work and we have a lot to be proud of in that. But it can happen to anybody, if you get an itch, to try something different. That itch initially led me to spend some time with ONC and that itch continued.

When Siemens called and said, “Janet Dillione has moved on. Would you be interested in the CEO position?” I thought, well this would be … I’d learn a lot by sitting on this other side of the industry that I know and have been part of for quite some time.

It may sound corny in a way, but I believe deeply in the fact that the technology can improve care. I’m going to give every waking breath I have to that. I thought, I can have an impact – different, but a significant impact – by sitting on the vendor side of this. I have impacted Partners, but you can have a different impact. It was new, it was interesting, it had a wide streak of altruistic ability or potential there. That was the reason I decided to do that.

It’s a bold pick for them, not because you’re not qualified, but companies at that size that are conglomerates with international spans usually have someone they’ve groomed internally or they pick some interchangeable business leader that really doesn’t, in their minds, even need domain-specific knowledge. Is that an indication that Siemens is changing, or has it always been brave enough to say, “We don’t follow the mold and groom people by moving them from manufacturing nuclear weapons and sticking them in healthcare?”

I think it has learned, particularly under Peter Loscher, the new CEO – and I had an interview with him – that they believe you have to be careful in the idea of the interchangeable CEO. There really is deep domain knowledge that comes with it, and a series of relationships that can be very important. They are increasingly picking people that come from an industry who know that industry well and hence are likely to be much more effective at developing strategies and knowing what will work and what will not work.

Obviously you’re complemented by all kinds of people who know how do to the finance stuff that goes in the vendor community and the sales and marketing that goes with that. There’s a lot of corporate talent that can be applied. So I think they’re careful with the interchangeability idea. Sometimes that works, but sometimes it doesn’t.

I also think that they understood that here you’re putting someone who’s the CEO of a large business unit who you haven’t seen demonstrating their stuff for some period of time. They probably thought that on that, while I’m unproven in our situation or context, there is proof elsewhere. One of your earlier questions about having customer perspective and stuff like that, he brings that to the table.

I think it was a bold move on their part, a smart move on their part. It’s certainly not a typical move.

The most important question – is your office nicer than what you had at Partners?

[Laughs] It is truly bigger. I’d be comfortable living in a trailer for the rest of my life. You know, seriously, I don’t need that much. I’m a pretty simple guy in a lot of ways. It’s certainly bigger with a couch and whole bunch of tables and you could put a bowling alley in there if you wanted to. You have to plan on three minutes extra just to go from one end to the other. So it’s nice. It’s a nice place. That’s cool. That’s kind of neat. I don’t need all that space, but I’m certainly not going to start walling it off and living in something the size of a phone booth.

It seems like the hardest thing to get used to would be the incredible span of control that you now have. It was big at Partners, but it was somewhat localized and now it’s international. Has that been a struggle to understand, much less to change to how you want it run?

At Partners, I had 1,500 staff. At that point, you don’t know who most of the folks are. You don’t know all the things that are going on or that are being done. You can know that when your staff is 100, but you cannot know that when it’s 1,500.

One of the challenges of going from a staff of 100 to 1,500 is that your efficiency becomes more abstract and you’re more removed from the daily reality of stuff. So that I’ve gotten used to years ago and just realize that you’re very dependent on the folks who report to you and you trust them and they do good work and every now and then there’s an issue and you have to handle it.

When you come to Siemens, which has a staff of 4,800, it’s the same phenomenon. I don’t really know who all these people are or what they’re all doing or exactly what’s going on here or there. But you’ve got a team that is much closer to you to help you.

The thing that’s been a really steep learning curve is that this is a complex, large organization. It’s matrixed. I’ve been trying to figure out who does what. If you want to float an idea, how exactly does that work? Not only the formal way that it would work, but if you really want to vet an idea and build an alliance, who are you building an alliance with? That has been navigation in a complex organization both politically and formally how you get things done. It’s something you have to learn and I think it will take a while to learn.

Because it is global, you realize that the healthcare system in Japan is different and the healthcare system in Germany is different. These differences are real. It can be cultural differences in addition to the fact that Japan has 9,000 hospitals. Golly, that’s almost twice the number in the US. Average length of stay is almost three weeks. It’s just a different healthcare system, and hence you have to understand that and how systems work and that the role of the physician and the nurse can be different. In the US, things that the nurse does, in other countries, the doctor does that. Documentation is not the same as it is in the US. You have to understand that and appreciate all of those kinds of differences so that you can be effective.

The other is that there’s so much going on. There’s 1,000 customers and we’re in on the order of 20 different countries here. At any given moment, there’s some issue somewhere or something not working like you’d like it to work. You have to triage and knowing what to pay attention to and what not to. That takes a little bit of an experiential gain and refinement of antennae. The analogy that I use sometimes is that when you have your first kid and they cry, you’re all over it, but by the time you have your third, you can distinguish a cry that matters from one that doesn’t.

It’s been a steep learning curve in lots of different ways: complex organization, different countries, really learning about products and what they do and the services and where they’re strong and where they’re not so strong. I’ve been making a boatload of visits out to customer sites, who are they and what are they doing and what are the issues? It’s really neat if you want to be in a mode where you’re learning a lot all the time. Man, this is terrific.

It must be easier for you since you know a lot of the CIOs out there.

I think that’s true. When you’re sitting across from a CIO colleague, you know exactly what their life is like – the issues they face and the things that are hard for them. I get to meet with a lot of CEOs and a couple of times I met with board members. Shoot, I remember sitting across from the CEO of Partners and the CEO of the Brigham and Mass General and what they worry about and how they think.

Certainly a lot of the CIOs I know by name. You can be in these meetings and think, golly, I remember exactly what things were like. And it wasn’t that long ago that I had conversations about capital budgets and strategic direction and what should we do about Meaningful Use and personal health records, all that stuff. It is a very familiar territory.

When you entered discussions with Siemens about the job, was there an agenda on their part about wanting change, or was there an allowance that you’re going to want to make changes?

As you know, they went through some tough years when Soarian first came out. In the last couple of years, it’s been a nice recovery. I don’t think it’s complete, but a nice recovery. You see that KLAS score, you see that in sales, etc. It’s a nice recovery.

The basic directive is to continue the recovery. Let’s see what we can do here, let’s make it as good as it can possibly be.

Within that direction, I got a chance to look at the team, at the budget. Basically the FY11 budget was nailed down, but in a couple of areas we’ve got to add some investment if we really want to do this well. I was able to re-open the budget and insert some things along those lines.

The team had gone through a set of changes over the summer. Tom Miller, who was in the interim role, was orchestrating that. He and I talked all the time about who to put in what chair and what chairs to leave open for when I arrived. There was a real willingness to let me put an imprint on it, both people and roles, but also what is the agenda and what does the budget look like?

Soarian was a punchline for a number of years, but it’s suddenly the overnight success. With the recent KLAS recognition, it’s real. Obviously it was on that trajectory before you got there unless you’re a true miracle worker, but what’s changed and where does it go from here?

I’ve got to give Janet Dillione and Tom Miller a lot of credit for orchestrating that. To your point, coming in with a KLAS score of #3 overall – terrific, golly, that’s not where it was a couple of years ago. It was a lot of focus. There’s no substitute for saying, “We’ve got trouble with quality of software here. We’ve gotta focus.”

That’s not something you turn around in a week. That takes months and can take years. Plus you’ve got to put up with a customer base that’s saying, “Oh my God, I got trouble in River City here” and to help make sure that they don’t wind up in a bad place and stay the course, etc.

In the times I got into trouble with Partners, it was when systems were not behaving like they ought to. There is no substitute for just focusing and putting the best talent you’ve got on it. It’s like a form of guerilla warfare – day in and day out, week in and week out. You get enough small and medium-sized victories and you’ll get through it. In the meantime, you provide air cover for the team, trying to keep the distractions or whatever away. There was a lot of focus getting into that, focus on product, focus on service. It sounds simple, but man, that’s not an easy journey to go through.

So I think that’s a credit to the folks who were there and to Janet and Tom who preceded me. Where to from here? We’re entering a decade of healthcare which will be one of the most profound we’ve seen in 40 years. You’d probably have to go back to the Medicare and Medicaid act to see something as substantive as this. Healthcare is a payment system. When you change that, you change the industry in a very big way.

The Affordable Care Act and the financial changes and the private sector response moving to bundles and episodes and prove your quality and we’re going to pay you in a holistic sense, which is managing a diabetic over the course of a year or managing a total hip surgery through the rehab phase as a single payment, and by the way, prove quality to get your money.

That will be a big change. The level of financial risk will be a lot higher. There will be lots of experiments and Congress will futz with it, but hardly likely to materially change it in the near term. It was not lost on the Republicans that we’ve got a problem here in healthcare cost and quality. So that will be a hell of a time. It will be a hell of a time for providers – doctors, hospitals, health systems – but it will also be for those of us who serve them through products and services.

To be specific about it, if you look at the stuff we have, we’ve gotta have a stronger ambulatory-based story offering. We’ll continue to work with NextGen, but you’ve gotta have that integrated suite. I think Epic and Cerner have shown the value of that in the market.

We have to have much stronger analytics than we currently have, because you’re going to want to know if a diminished quality score’s going to cost you a lot of money or it’s not. We have to have better interoperability offerings that go with this. We’re going to grow the services base that we have because people put out a lot of money on this stuff and they go through this tough exercise of getting it in and now the stakes are higher and they want to make sure that they get yield. I think we’ve got some strong stuff.

I think the Soarian inpatient clinicals are strong, revenue cycle is strong, but you’ve got to round out ambulatory, round out analytics, round out the interoperability and the services base.

I can see partnering or acquiring on the analytics side, but there’s only so many ways to skin the ambulatory cat. What can you do there?

We’re looking at that now. We’ve got a couple of ideas on the table. Obviously we’ve got a relationship with NextGen, so we’re engaging them in the conversation about how they might help with that.

In a way, what an EHR does is pretty well understood. You have to write prescriptions and record a problem list and things like that. That doesn’t diminish the challenge, but in some ways there’s not a lot of mystery here. These things have been around for several decades.

I’m going to fast-forward five years from now, in which there’s a big shift in payment and you’re responsible for cohorts, for population management. You’re going to get paid by bundles and episodes. What exactly does that do to the ambulatory record? How different is it? That’s the analysis that’s underway – how different is that?

In a way, you can bring in consultants and smart people to help you take you through it, but if you look around the country, there are risk arrangements in place now. There are people doing population management now. You can learn a lot from them. So we’re plotting out the specifics of that. I think we need to get a little crisper, frankly, in our own assessment.

You mentioned Epic and Cerner. In all but the smallest hospitals, that’s where all the action is, with maybe Allscripts becoming a player, although two of those three weren’t very strong on the ambulatory side and had to become that. Can you gear up in time as people make their decisions now?

I think that’s fair. I think obviously the faster we get this done, the better, but we’re not going to have it done by the end of this calendar year, that’s for sure.

There’s a normal replacement pattern that goes on in this industry. At any given time, there’s enough people who have said, for whatever reason — my incumbent vendor, I’ve had it. There’s a normal churn you can arrive at. I don’t believe that you get to the year 2015 that nobody buys any more for a period of time. Even through the Meaningful Use ebb and flow, there’s a normal churn that goes on.

An unknown at this point is whether there is a second wave coming. There’s a first wave that was Meaningful Use induced. People scrambled to round out their portfolio to get their payment. There’s a second wave probable. The second wave has two things that will drive it. One is a whole bunch of people got to Meaningful Use by cobbling things together. By hook or by crook, they assembled this piece and that piece and they jury-rigged this and jury-rigged that and by golly, they’re going to get it done in 2011 and 2012 to get their payment. But they know that this is not a long-term answer. They’re here for the couple of years until they get to Meaningful Use payment, then you go into this couple of year window before the penalties start kicking in and they may say let’s do it for real at that point.

That will be one phenomenon, because not everybody did a wholesale replacement. I may not have the capital, I’ve got other commitments, so I’m just going to cross the finish line in whatever fashion, but not a long-term fashion by any stretch.

The second is the read, and it’s hard to know, whether the payment reform stuff will cause hospitals to say, hey listen, we made a commitment a couple of years ago, but boy, given what is coming down the pike here, this just isn’t keeping up with what we’ve gotta do. Is it an EHR or ambulatory? Sure, but it’s different enough that we need a different set of capabilities to complement the normal core set.

I think we’ll see both play on top of the normal churn that goes on. Obviously I’d rather have it sooner than later, but I don’t believe that if you’re not there at a particular point in time there won’t be a shot.

You mentioned Soarian, which is clearly the new star. What happens with Invision and MedSeries4? Will those customers be encouraged to move to Soarian, which doesn’t seem like a good fit?

We’ve got some work to do on Soarian before you could legitimately turn to an Invision or MS4 customer and say, listen, the things that you like about MS4 and Invision, not just the feature function, but the cost of it, that we can get you that in Soarian, too. So we have some work to do to fill out some Soarian gaps. There’s still development engine that has to go on for a couple of years.

We’re increasingly hosting it and using the cloud techniques of virtualization so you can drop the cost of hosting it down to what it would cost you to today to host MS4. In addition, there’s been some really nice progress on getting the time required to do an implementation down and the variability of implementation down such that the conversion process is relatively inexpensive and relatively quick. We still have some work to do there.

We won’t move anybody unless they want to until we’re in a good position to say, you’ll not only be equivalent, you’ll be better off, and they’ll have the same price points and the same brief, straightforward implementation that they’ve seen before. The timetable is slightly fuzzy around the edges, but some people are moving now. I think it will be a couple of years before we’re in a great position to really tell the rest of the base that it’s in your interest to move rather than stay where you are.

You’re making a lot of changes and you had to start there almost immediately by overseeing layoffs. How is employee morale?

I think it’s pretty good. Obviously as you know and you cover, we’re moving 475 jobs offshore. It seems high, but we’re adding about 600-700 positions in other areas. It’s a combination of working with the folks who are affected over a two-year period of time and saying, hey, we’ve got this role over here and happy to fit you in there and retrain you if you’d like to do that and make sure that we do all that we can so that you land well. The other part of it is making sure that we reduce as much as we possibly can the people who wind up out of a job.

We have to make sure people understand what’s going to happen in the provider community. The financial pressures will become significant. I mean scary significant. They will be turning to us and saying, “You’ve got to reduce your costs.” Then it won’t be the normal arm-wrestling with a vendor that goes on – that will be real. What we cannot do is be in a position where they cannot afford us. If that is the case, we will have failed them. And what we cannot do is fail those who, day in and day out, deliver care. That is just not why we’re here.

Whether it is hosting costs will be reduced or implementation costs being reduced or support costs being reduced, we have got to reduce the cost, because they are in a position where they will need that if we are to serve them and serve them well. I remind them, not that they need much reminding, that at the end of the day, there are real physicians and real nurses taking care of real people who are just like us and the people that we love and our job is to serve them. That’s fundamentally why we’re here and we’ll fail to serve them if we become increasingly out of cost reach.

That obviously, to your point, had a morale plunge. I think overall morale is pretty darned good, because what people see, as in earlier this week, Number 3, that’s pretty darned good given where we were. Man, we’re getting’ our mojo back. We have some work to do, but golly, all that hard work over the last couple of years, that’s starting to pay off. And then they hear from customers who are live with CPOE and are pleased with that.

I think the net of it is the feeling that after a struggle, they’re back and they’re where they want to be, mindful of all the work still to be done. By and large, it’s pretty high. The morale is pretty darned good, mindful of all the challenges we face and some of the tough choices we will continue to have to make.

If companies have a personality, and I tend to think they do based on their corporate culture, Siemens always to me seemed really rigid and conservative and quite cold. It just never seemed like it was a very fun, creative, and hip kind of company based on the Web site and the marketing materials. Do you think that’s accurate and do you think that needs to or will change?

I don’t know that it’s accurate. It’s an engineering company at its core. It’s a 76 billion euro company, 420,000 people and all the stuff they do. They do fast trains, they do windmills, they do water purification plants, they do MRIs. They’re an engineering company.

One of the things that comes with an engineering company is a drier appearance. They’re not inherently marketeers. They believe if you engineer a perfect product, people will realize the spec and they’ll buy it. Sometimes I think the coldness is really engineers. They’re not cold, they just don’t understand the need for sizzle and pizazz and that kind of activity.

There’s a need to change that. They understand that it’s not inherent in their DNA that they know how to be more flashy. I don’t know that it’s cold, it’s just engineering-like, for lack of a better word.

I think we have to, and part of the things I got more money for, be more effective and out there in marketing and methods and stuff like that. It matters. People won’t inherently buy from the spec sheet. They’ll need certain messages and understanding and a sense, particularly, of the human-ness that comes with healthcare, and that we’re part of that. That we’re trying to change. It won’t always be easy because at their core, they’re engineers.

Do they get your sense of humor?

[Laughs]. Frankly, the real reason for leaving Partners is that I’d used up all my jokes. I had to find a brand new audience. They were going, “Uh no, not again, not that one, I’ve heard that 26 times.” You can’t help be in certain meetings and not come out with this, that, or another, so I think they appreciate it. At times, I have to use my judgment about which ones to use internally versus which ones I can use in a public setting. So far, they’ve shown me they’ve got a sense of humor and they’re quality individuals.

Your stint with ONC probably changed your perspective. We’ve talked about this before. How do you feel about the time you spent there in advising the government and what’s your feeling about how it all turned out?

I thought that was one of the most extraordinary years that I’ve ever had. There you are, in the middle of them, where you’ve got legislative language that says, we need this definition of Meaningful Use and we need it fundamentally by Labor Day of last year, and you realize that Blumenthal didn’t show up until the last week of April. You’ve got three months to get this thing because then it’s got to go into the rule-making process and all that other stuff.

Listening to all these ideas, and they came from all over kingdom come, from small physician practices, public health people, patient advocates, Web 2.0. There were a lot of ideas, but we can’t crush the clinical community, either. We’ve got to narrow this thing down and that’s your job, to come up with a definition of Meaningful Use that’s a good balance that pushes the envelope, but that’s also in reach.

That’s just a really interesting, cool conversation to be in the middle of that and realize it’s not only complicated and hard to figure out, but whatever you do figure out has a phenomenal impact on the industry. You better be darned careful and thoughtful about it. It was just really neat to be in the middle of a very formative time, Meaningful Use and Regional Extension Center grants, all that kind of stuff.

As I mentioned in one of the things I sent you, I came out of there with an extraordinary respect for the government. Whether it’s Blumenthal or all the people who work at ONC, but also the folks that work for CMS and the Office of Management and Budget – they were smart people who worked their butts off and wanted to get this right and very receptive to feedback from people who were out in the community. This was a terrific set of characters and human beings and professionals.

I think what they did in an amazingly short period of time is extraordinary. There are clearly things you might have done a little bit differently, but jeez, when you look at how well the Meaningful Use definition was done and the various grants they had to get out the door and the standards they did … give a lot of credit to the Policy and Standards Committees and all the time spent there … that was just really remarkable. I think it was remarkable for me. It was an extraordinary piece of work done by all those folks in an amazingly short period of time.

One of the things you come out of that with was an appreciation of the challenge of how diverse this country is. There were conversations about Meaningful Use where it was said that this has to work at Mass General, big old academic medical center, but also it also has to work at Seward Community Hospital in Alaska. Three beds, average occupancy 0.8. I though, 0.8? You’ve gotta be kidding me. If you were at Partners and said 0.8 occupancy, people would say you’re off by two orders of magnitude. But it has to work there to make all that happen.

I also have an appreciation for policy. What we did in these meetings at Siemens is think about how far down in bed size can you move. You say, if we did this, if we did that, we could get to 50. Actually, because of the way healthcare works in this country, you’ve gotta get even further south than that, because from a policy perspective, what you can’t do is strand the 20-bed community hospital. You can’t strand the solo practitioner, because that is so much of the care in this country. It’s interesting to me that the policy angle factors into business decisions because business decisions, if they are done well, also help support a broader national policy.

If we look back in two years and we’re doing your report card of how you’ve done at Siemens, how will we know you did a good job?

I’ve been asked a couple of times by people at Siemens the same question. I say, I’ll know we’ve done a good job if those who are our customers say to us, “Our care is better. It’s safer, higher quality, more efficient. We run a more effective operation and we do all the things we wanted to do as a provider and our strategy and our goals and our plan, because of the work we did with you, because of the products you have and the services.” If they say that, and uniformly or 90-odd percent, then we will have done well.

Obviously there’s numbers that you’ve gotta meet and this that and the other, and I’m not naïve about the need to do that, but that won’t be the success metric. Whether we’re 3, 2, or 1 on a KLAS score here, there, or in between – those would be great, but that will be the real – that you walk into one of these places and the CEO shakes your hand and says, “Working with you guys has been terrific, in fact it’s been essential for doing all the things we’ve done.” Then we’ll know that we’ve done a good job and I’ve done a good job and we can be pretty darned pleased with all the time, effort, money, and anxiety that we’ve put into this.

Any final thoughts?

You’ve got good questions, as you always do. I’m having a great time. I think we’ll do some good. I think we have done some good.

I came out of 22 years at Partners believing deeply in the mission of what they do. That is so part of my fiber that it’s kind of scary … sounds a little nauseating, frankly, at times, almost too much of a Boy Scout. But I believe it.

What I think we’re going to be able to do is we’re going to help those places do that. I honestly feel really good about that, that whenever I punch out of my time on this planet, if I can say that we helped a whole bunch of people do good things and care better … not a bad run. I’ll be OK with that.

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