Jonathan Bush is CEO, president, and chairman of athenahealth of Watertown, MA.

We’re into the nuts and bolts phase of HITECH and the checks are going out. How are your customers responding to it, what are your opinions of it so far, and where do you think it’s going?

Well, you know, they’re doing their thing. I guess there’s a lens of how is Nation doing. Does Nation like it? My sense is that Nation got a little something that Nation didn’t want, which is that Nation didn’t want vertical integration and more pricing power as the cost of healthcare goes up. You know they wanted more buying power, not less.

So Nation might not be psyched about that, but the vendor world, whether they live in the cloud or don’t, are happy at the stir and the flurry of energy and excitement around information technology. When someone’s whipping you from behind, you might not make the coolest, smoothest, most permanent of decisions. There’s going to be a lot do-over. I see grounds for a lot of do-over right now, which is, I think, exciting. Unfortunate, but exciting. 

For example, at the JP Morgan conference, the most interesting data point I heard in the entire conference … they had a not-for-profit hospital track and the JP Morgan guy who runs the desk that floats the bonds that hospitals use to finance their activities — these not-for-profit hospitals, you know, they depend on good bond ratings  — he said that between 30% and 45% of all the bonds he’s floated in 2010 are underwritten by software, but the life of those bonds, the payback period, is between 10 and 15 years. I don’t know. Do you, Mr. HIStalk, have any 10- to 15-year-old applications running on your D: drive there?

What I see is the perfect sub-prime mortgage crisis type in store. It’s just the beginning. It’s just the drop in barometric pressure that’s causing the weather systems to move. You know, the birds are still flapping their wings, the fish are still jumping, Clooney isn’t being turned upside down in his boat yet. But it’s a perfect set-up. 

These physician subsidy deals will certainly not last at current levels. The difference between those physician subsidy deals this time around and the time around before – which ended around ’95 – is that this time, significant system investments are being layered on top to fuel the marriage. I expect those kids to be orphaned. That’s wonderful for athena at some level because all the Athena clients aren’t putting out any capex on these things and none of their bonds have IT inside of them. They will be in a very good place to acquire or pick up off the ground the systems that overextend in this way.

That’s the result of this rush to hit these deadlines. Now, maybe that’s OK. Maybe these mostly weaker, more isolated not-for-profit hospitals are being pushed off a cliff that they were already on the edge of. I don’t know. I don’t have the judgment on that.

Most of our big enterprise clients are for-profit. They were the first ones to find the cloud and value that freedom of the balance sheet that we offer. They had the least problem with the idea of laying off large numbers of billers and medical records clerks, so they represent a large portion of our base. They’re obviously in a position to expand dramatically for the first time in a while as these independent, not-for-profit, more urban systems get strapped.

Hospitals live day-to-day by their capital spending, which is a problem in itself, but they money they’re spending on buildings, electronic medical records, and practices comes as margins are about to get thinner. When you see Loma Linda’s bond ratings slip, you know something has to give. Are hospitals not being prudent or are they overreacting to what they think healthcare reform will be?

Well, you have an interesting confluence. Obama’s policies have been interesting in this way. There’s so much to gain by rallying behind the ACO banner in the form of non-ACO, short-term gain. “This is my chance to lock down my catchment area,” you know. “Inside the ACO, all my Stark rules are relaxed.” It spooked the doctors where they’re ready to reconsider the whole idea of being independent. It works from a pure “driving up referrals” perspective. 

I think all of them have obviously the very best of intentions on building the ability to coordinate care more effectively. I don’t think there are any evil … all of the evil that I’ve seen done in healthcare in my 13 years has been done by really good people. That’s one of the great ironies and excitement of healthcare. 

I don’t think it’s malicious, but I do think it’s attractive and it caused a free agent season. The rush caused the price at which a physician would switch to full employment to go higher than the physician could ever actually pay back in the form of admissions. I don’t know these numbers cold, but looking at our claims and referrals traffic, I would say that the best primary care doc could do in terms of admissions to a hospital, you know, if you imagine a doc who does zero admissions with Hospital X, and then Hospital X acquires the practice and is now subsidizing the doc. The doc goes to 100% admissions to Hospital X, right? So that’s the best-case scenario.

The most that doc can bring in in admissions – not the most, but you know, a good number for that guy to bring in — would be about a million bucks’ worth of admissions per year. The hospital’s got a 3% margin. You’re talking about $30,000 in contribution to the bottom line, assuming 100% of the admissions are new that they weren’t getting already. Well, the average subsidy is over $100,000 for a primary care doc in this current season, these new compensation deals. So that’s a negative $70,000 deal for the hospital annually, and that’s before the IT investment.

And that’s before the doctor’s schedule tends to, as we’ve seen before … I love docs, I represent them, I’d take a bullet for most docs … and the calendar does tend to lighten up with somebody’s who’s got a rock-solid floor on their salary. I don’t know what it is. It’s just quality, quality. “Don’t ask me to see more patients — what about quality?” Quality suddenly becomes capitalized, italicized. 

So, anyway, those are some of the things that I haven’t seen people write about that are going on. Obviously the energy level, the excitement, the interest in ambulatory care by hospitals and by really everyone in healthcare, government … the payers space is an interesting space where payers did not do a very good job in all the healthcare reform debate of putting forward their own solution. We’ve calmed society down and lost a lot of ground now. As they see the hospitals vertically integrate and further erode their own pricing power, their own buying power, we’re seeing a real spike in really serious pay-for-performance where the payer’s saying, “No, no, I’ll be the ACO. I’ll coordinate all that. I’ll pay the bonuses and you can still be independent because I really want you to feel just as good sending the patient to a non-hospital based surgery center as you would to a much more expensive hospital-based surgery center.” 

The payers are late for the game, but certainly the most provider-side oriented payers like Humana are now fully headlong into the ambulatory care space. In fact, I think the most interesting announcement of all – unfortunately it was not during 2010, but they must have been working on it – was when Humana bought Concentra. So Humana now is full-on, back to the future, employing 800 docs. The athena deal was a 2010 deal, where they are talking about paying 25% more to primary care doc that remain independent and stay on Humana-sponsored systems like athenaNet versus the hospital sponsor’s system. Very interesting.

What about the insurance companies buying the HIE platforms like Medicity and…?

Ah, another good example. Not sure what they’re going to do with that bad boy, but I’m not very close to either one of those companies. I really like the leadership. I love Ron Williams and I really like Kipp Lassetter a lot, so – I don’t know the new guy at Aetna at all though – so they must have a good idea there. Clearly it had something to do with making patients able to leave the borg. There’s the cloud and there’s the borg. Most HIT investments have been on the borg side of things. Mostly $100 million, “everything is included as long as you stay inside the biosphere” IT systems are not good for buying power. They’re not good for patient power. They’re good for the traditional, more paternalistic approach that most of society is still very interested in.

Do you think that there’s any chance that ARRA will be repealed or that HITECH will be de-funded?

Oh, no, no, no… No, no, they’re going to do their ritualistic dance and then they’re going to begin … this is the first beating. Then there’ll be other beatings. Then the lights will be on at night and then the dog barking and then the waterboarding. These guys know how to do this.

This is the first of many major congressional movements to chip away at and personalize and just whittle down the more Malthusian forces that have been in government since 2008. Basically, it’s not that there’ll be any … unfortunately I wish there’d been more reasoned argument against the more micro-managerial approach and for a more… but instead they’ll just be random beatings of these well-meaning Malthusians, you know, until they just get tired and go back and take a nice job on the other side of the revolving door for a while, if only to rest.

We’ve seen it before. I mean, the Republicans had it in a mid-term and Clinton had it after his mid-term. You know, it’s just one of those things that people do. It’s funny because it will certainly make the Republicans look ridiculous and probably get Obama his seat back if they’re as aggressive as I imagine they will be, which is ironic of course, but the way things work, you know.

It doesn’t seems that EMR certification was as much as a barrier as people said because it seems like every system I’ve never heard of suddenly keeps becoming certified. Do you think the bar has been set too low or does certification maybe measure the wrong thing since it doesn’t seem to really distinguish between no-name products and ones that are household names?

This again is the problem with the Malthusian approach, where you get all these detailed things that you’re going to make people do, and then no one does them. Now what do you do? My three-dimensional model of the universe that I so carefully and lovingly built actually doesn’t work because no one is doing it.

In this case, the specific problem was this was part of the ARRA. This was supposed to be a set of shovel-ready projects. The mandate is to spend the money. It’s not to incent people who cross a bar, which would be a very cost-effective program because they could set the bar where it really ought to be and no one would pass, and we’d really separate the wheat from the chaff.

But that’s the rubric this program was authorized under. This was, “Get the $30 billion in the economy.” What has been going on since the original ARRA bill passed was the bar has been lowered and lowered and lowered until Oompa Loompa could jump it, so that it could be jumped by everybody, right? And that was their mandate. 

In the very end, you’ve got this bar laying on the ground with this doctor who’s got … you can imagine the guy who qualifies for the ARRA and how much work he’s done and what he looks like. The guy who came in last place that still passed. You know, you can do that cartoon at HIMSS [laughing]. He’s got a copy of Microsoft Word, you know, and the password feature turned on, you know… a couple of little whizbangies and he’s wearing a Sony Walkman with the Dolby button turned on. I can see this guy. He’s like [laughing], and he’s like, “What? What, I’m fine! I’m totally Meaningful-Use certified. Yeah, absolutely!

But what are you going to do? Their job was to get the money out the door. Now they’re saying, “Next time around, the bar is going to be much higher. This 2011 thing was just a shot across the bow. Wait until you see what we’re going to do in 2012. Oops, no, we’re not going to do anything in 2012. Wait until you see what we do, God damn it, it’s going to be amazing in 2013. The bar’s going to be sky-high! No, you’re going to need a pole vault to get over the bar in 2013.” And so the guy’s, “Sure. Maybe.” 

In fact, if other forces are in play and people get much more able to engage in the verb “health information exchange,” I fully believe that they will end up with a more aggressive set of rules. The nice thing about all of it is they … it is a rule-making rather than a Congressional act, literally an act of Congress to the get these things moved around. So if society somehow gets all online, then sure, they’ll try to move the bar up. But remember, society’s buying mostly legacy IT, which does not exchange information outside of the server. It’s unlikely the bar will be terribly much higher in 2013 than it is today unless athena Community works or some of these other more social network type concepts take hold.

Even with what limited work is required to meet the first Meaningful Use stages, there’s already is the first pushback that says, “Hey, it’s too hard, it’s too fast, I’m not ready.”

Can you believe that? I mean, can you believe that? This is the greatest argument against public schools. That’s been going on for decades in our public school system. “Really? You can’t pass that one, Jimmy? That’s one crab and there’s two crabs in the basket. There’s one crab and the … now how many crabs are in the basket?”

The whole premise is to get people hooked with the easy money and then move them up. But what happens if everybody opts out even on the easy money?

I think there’s that, but more importantly, if you latch people into easy money by getting them to blow their wad, financial and operational, on offline technology, you know, non-exchange technology, they are interoper-able, but not interoperating with anyone. There’s one argument that says that no breath is lot better than bad breath, that if you actually put everybody on static systems that are attached with the obvious motive of keeping people stuck inside that system environment – keeping patients inside that system and referral environment – you run the risk that it will be very hard to then wake that system up and get them to make that system talk to others.

This magical talk that you hear Halamka going on about middleware is … you know, this is the guy who manages to be on giant billboards but can’t exchange information with the hospital across the street that teaches with the same medical school and the same doctors for 100 years. I love the guy and I’m sure he’s got perfectly good reasons why literally one side of the street can only exchange information via paper airplane. But you know, it’s pretty amazing. 

Fundamentally, if you’re not in the cloud, if you aren’t in a system, and… the cloud I think is a business model as well, it’s not just if the technology uses browsers or whatever else is… It’s the underlying incentives to everyone who plays ball, mitigate, correlate profit with exchange to give in more exchange. The doctor makes more money in an exchange setting if they do more exchanges. If the hospital makes more money in exchange setting, they’re going to do more exchange, right? The IT vendor or the cloud and service vendor make more money with successful exchanges. Are you going to be more successful with exchange? It’s that simple. Certainly that’s the intention of the government is to create that, but right now, in a way, one very much seems to be oriented in an exchange prevention initiative. Everybody’s got to be inside my biosphere.

Vendors are using this opportunity to rebrand themselves. Allscripts claims it’s an open system. Every vendor who used to be SaaS now says they’re cloud-based because it sounds cooler. Now vendors are saying that private interoperability among their own customers is exactly what the market needs, that you don’t need all this outside stuff, just let Epic hook everybody up …

Yeah, yeah — private interoperability. That was like the guy I watched, the CEO of Kaiser, and the panelist says, “Now that you know about the cloud, are you sure you would have spent that money on Epic?” And he said, “Oh, we have our own cloud.” I mean, you can’t have your own cloud. The whole point of a cloud is that it’s part of the universe, it’s not a thing that you … can you see him there, like with a smoke machine from the disco room? You know, “It’s my cloud!” It’s just so perfect.

I don’t know if he doesn’t get it or just it was so embarrassing in front of a thousand people, but you’re right, I mean, what’s he – and you know, it’s been very hard for athena because we work for our customers, and it’s our customers… as the employer, if our docs are actually not organized as independent groups, our job is to work for that hospital, to make that hospital successful. Now, I believe — and our hospital clients believe — that the slightly passive-aggressive strategy of making it technically impossible for a patient to go where they want is not the long-term winning strategy. Being the lower-cost hospital with better coordination, whether the person is inside your biosphere or not, is a long-term winning strategy and the guys that we serve …

I was talking to someone from one of our big enterprise clients. He is so for the open system it’s unbelievable. He can’t wait. He said, “I need to get every low-rent colonoscopy center off the Interstate connected to my hospital because I want to go after every bankrupt union and state employee health insurance fund and take that stuff over at seventy cents on the dollar. But I can’t do that if everything is adding to my fixed cost base.” This is a really brilliant visionary. He’s been around for a while and he’s talking about eviscerating his costs, turning his hospitals into variable costs. That’s a guy who’s going to win.

The HIMSS boat show is coming up. Are you mellower about it now that athena has exhibited there for a few years?

We are bringing down a ladder where you’ll be able to climb up and if you take off your shoes, we will show you our new thrusters. You’ll climb up the ladder, you’ll take off your shoes, you’ll step in, and you’ll go below decks, and there’s going to be our thrusters there. I recommend your readers come and the new athena bow-thrusters will be on display. They are turbo, and they are cloud-based thrusters.

You met Judy Faulkner last year at the HIStalk reception. How was it?

It was your event. Actually, it’s been hard to talk trash about Epic ever since, because I actually think she’s lovely. I think she’s a really inspired person. It pains me. It’s like Old Yeller. It’s a beautiful, beautiful thing she’s built that now has to walk quietly over the hill.

At least it’s cooler than many.

Well, yeah, I know the rest of it’s like making burgers for McDonald’s – no issue with the other animals in going over the hill, you know, moving through rapidly and quickly; hang them on the racks, move them through the line …

With all these changes to healthcare, do you think consumers are gaining control or losing it?

Losing right now. But you know, they’ll be back. We will bankrupt any all-you-can-eat buffet. The food goes. In healthcare, we’ve been figuring new things to put on the all-you-can-eat buffet for 15 years. More — 20 years, 25. Once we neutered the payer – see, we don’t like all this “mean payer beating people up” thing – then the payers stopped and they figured out … first of all, they did a lot of mergers and acquisitions, so they were getting a lot of return on that.

But then also they figured out that now that there are very few in every market, as long as they just pass the full cost increase right through, they actually make more money in the medium and long term as rates go up. So there is the obvious disincentive. When you see an obvious incentive … if you’re one of many sellers, you can’t control — you know, there’s no oligopoly — you want to be the lowest cost player, right? But if you can actually wink or rub your eyebrow or just let the world know that you’re going to just let costs go up. There’s not that many players left to see your body language, and everybody gets into the habit of letting costs go up? Everybody wins. All the different sellers win. That’s exactly what has been going on since Barbara Walters threw a cranky fit from Humana’s headquarters on 60 Minutes in 1994.

This industry doesn’t even need collusion.

There’s not enough players for  collusion. You just start moving and you’re so big, “I think I’m going to go to the bathroom now!” And you get your big ass up and start heading down the hall. Everybody knows what’s going to happen next. Nobody has to spy on the stall, you know? 

We need more new entrants in healthcare. We need more crazy ones …um, not that I’m crazy, of course, that’s not what I mean, although it’s possible. That consumer power, I imagine, will drive the crazy human ones into the marketplace. Crazy sellers, vending to consumers, as soon as we run over all of the money we’ve newly allocated to healthcare in this last buying spree. Eventually there will be a market, whether it’s a radical reform of the existing market, or whether it’s a market that forms on top of the benefits provided by the health insurance market, like our private school market or the health insurance market in India or UK, where you have a fully functioning, consumer-centric market for a smaller portion of the population that sits on top of the nationalized healthcare system beneath, but acts as a sentinel. It creates the new innovative products, that then pull down through the public school system of healthcare.

That’s what they have in the UK, where they also have the NPfIT implosion, which may be another aspect that we’re headed toward. Do do you think there are enough lessons learned?

We are headed towards a … and it’s a beautiful… What UK healthcare system is is just a really big IDN. What we’re doing is we are blow-by-blow copying the IDN-IT implosion that they did, only they’ve got much more of a European comfort with discomfort that we don’t have. They could stick it patients and put them in queues and stuff like that in ways to make things pencil out in the short term that we can’t do, or won’t do, I don’t think. But you’re absolutely right. That is the playbook for what’s happening right now. The giant RFP …  just like the same vendors, same deal, right? The giant purchase, the giant multi-years long implementation and then the wheels coming off the cart.

Athena was the disruptive cool innovator a few years ago. That’s always a tough label to keep. Do you think it’s still athena and what other companies do you think are doing something interesting in healthcare IT?

Gosh, I should know the answer to that. OK, here’s an interesting thing that I’m seeing in terms of new innovators. It’s not vendors of IT, but actual vendors of healthcare services that are the disruptive innovators now. They pay for or build their own IT as part of the offering. There’s this incredible company, OneHealth I think it’s called, based in San Francisco. Incredible, no-wait, concierge private clinic for the masses.

The entire company is built on proprietary IT that looks a lot like athena, but they don’t view that as a thing that you buy and set up with your CIO and send them to him. They actually built the company around that technology. They’ve been iterating their version of athenaNet. It’s going to be a hell of a sell for me to get in there, because they really view themselves as fundamentally a deliverer of a service and the service is fundamentally leveraged by proprietary technology.

That’s an example where the technology is not the product. Technology enables the product. athena figured out a long time ago that we don’t sell IT. These guys figured out that what they’re selling is patient care. They’ve actually got technology as an ingredient to that. We have luckily gotten a bunch of these new kinds of VC-backed, aggressive, disruptive type companies to go to market on the athenaNet backbone in order to better accomplish this open exchange of patients.

So you look at MinuteClinic. MinuteClinic’s accumulating primary care patients much more quickly than those newly subsidized, newly acquired primary care docs at the hospital. They’re advertising. They’re putting their places where people actually are. They’re aggressively going after patients. What they’re going to do is have athena move them into the hospital only when they actually need to go to the hospital; so they’re going to be a non-hospital ACO. They’re going to be an ACO for whom … I mean, I don’t know what their plans are, but I’m seeing this happen. They’re emerging as a really compelling champion of the patient.

Healthcare is one of few industries where there is not a competitive differentiator because everybody uses the same software. Nobody wants to build it, they just want to buy it. But if everybody’s got Epic, then you’re down to nuances of how you use it. Travelocity didn’t go out and say, “I’m going to find some travel reservation software.”

Oh, but didn’t they build a lot of technology on top? Like Kayak. Isn’t that fundamentally different at the DNA level?

I think, though, that the more interesting stuff is the littler companies whose names are escaping me. The general feeling I had, both times, both of the two last Health 2.0s is, we need an ecosystem. We need a place where any little company with a great idea but who could never raise enough money to go and find doctors and sell to them and get them to buy, especially now that they’re of aggregating; to come and sell their wares. Can sell them at the doc level even if docs are employed by larger systems. Whether it’s an iPhone-based EMR that only works for anesthesiologists or a patient-centered pain monitor rap that can be routed into any EMR, or a lot of this homecare stuff that Alere is looking at where you pee in your cup at home and your EMR gets an update and your doctor reads the abnormals and the patient has never shown up at the doctor’s office.

Those are all kinds … another company like this is … what is his name? Roy Schoenberg. American Well. A huge investment in technology, but what they’re selling is, they’re selling extra billing opportunities in the cracks to docs, and they’re selling instant access to a doc over the cloud to patients. So this idea of convergence where we’re selling the ones and zeroes on a disk; or even renting the ones and zeroes over the Internet, is no longer the product — it’s some larger value-added service which is necessarily enabled. The technology almost becomes the store into which you walk to buy the thing, and the thing is the service.

What are your top goals for the company for the next five years?

Form the first hardcore business-to-business social network. I want any doctor on athenaNet to be able to friend any other doctor in the country and be able to execute referrals and authorization. I want to be able to execute the referral and authorization work so that they can move patients back and forth anywhere they want to move with a click and have all the crap-work go away.

How do you do that? Are you building that now?

Yeah, athena Community. We’re actually starting mostly with hospitals, because hospitals are the people that are most interested in fomenting connection with docs. But it works doc-to-doc just as easily as doc-to-hospital. And as hospitals become large acquirers of docs, they become the first eager occupants of this new, cloud-based supply chain. We piloted it, we did an alpha test in 2010, and we intend to do 15 markets in 2011 if we’re lucky. Probably won’t get there, but that’s my goal.

Everybody sees the great parts about being Jonathan Bush: smart, rich, famous. What sucks about being you?

I disappoint everyone I love. I want everybody … I want things to work so badly that I… and I’ve got the false power and then you know, the electrical energy that comes with the title and the brand that it isn’t really me. So I let them believe all the greatness that could be around the corner, and then when it isn’t, it’s like they say about me, “Shit, I really believed that loser.” 

I hate disappointing. I hate disappointing my kids. I hate disappointing my wife. I hate disappointing my ex-wife. I hate disappointing my team. And I disappoint them all, all the time, because I dream too far ahead of the curve. It’s exhausting.

But companies like Apple have someone at the top who’s a visionary and is somewhat merciless to their direct reports to make things happen, even though it may not be the most fun place to work if you happen to be one of those direct reports.

Well, yeah. I just personally can’t stand letting people down. When you have to tell someone it wasn’t enough, or you have to miss dinner, it’s just torture for me, I just can’t stand it.

Anything else you wanted to talk about?

No, I’m a big fan. I changed my kids’ vacation with my ex-wife so I can be at the HISsies.

I appreciate that. I didn’t really expect that, so that’s definitely a plus. It wouldn’t have been the same without you, I’ll say that.

It is the single thing about HIMSS that I most look forward to. It’s really fun and I can’t believe you’ve pulled off such a happening after all your .. well, I can believe that it, makes total sense, but it took huge balls and I’m glad you did it.

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From Expandable Beltway: “Re: VA. Opens a solicitation for VistA.” I skimmed the document – the VA is looking for help to define an open source structure to support VistA modernization. I don’t know if they’ve ditched their previous plans to buy commercial systems like Cerner’s LIS.

From Epic Employee: “Re: Epic. If you’re a star, you’ll go far. If you’re not a star, you won’t. It’s like a professional sports team – you grab the best college recruits and some work out, some get cut. You are compensated based on your talent, so your subordinates may out-earn you if they’re better at what they do than you are at what you do. You don’t have to be CxO to be financially set. If you need a manager to succeed, you won’t like it here.”

From Merger Pain: “Re: Allscripts. Over 30 sales reps let go this week.” Unverified.

From Philly BlackBerry: “Re: widespread e-mail outage Saturday morning. RIM is not commenting.”

From Lupus: “Re: sponsors. Why do you have so many?” I freely admit that I’m an incompetent, unmotivated, and staggeringly lucky accidental businessperson who just wanted to write work-related stuff for fun back in 2003. I expend zero effort to solicit sponsors. I’ll reply tersely to e-mail inquiries from vendors and the always-nice ad agency and marketing people, but replying to the e-mails is all I’ll do. Every other HIT-related blog you read is written by someone trying to sell something – consulting services, EMRs, conferences, speaking engagements, etc. I’m a money-indifferent guy who’s happy working full time for a non-profit hospital. If I get sponsors, great, I get paid for the endless hours I spend on HIStalk. If not, that’s fine since that was the case for much of HIStalk’s eight-year existence and my hospital job ensures that I won’t starve anyway. I like staying anonymous because it keeps me honest: you can’t get too full of yourself if nobody knows who you are. My About page explains everything.

From The PACS Designer: “Re: cloud basics. FedEx CIO Rob Carter explains cloud basics and how FedEx deploys a private cloud solution to run the giant package distribution system. He explains the cost advantage of private clouds this way: ‘What’s happening, and this is such a big deal in our world, is that for the first time ever, you can make investments in a whole new class of technology for about the same price of just maintaining the base.’ This cost advantage is something to think about in the effort to employ cloud solutions in healthcare settings.”

Thanks to everyone who signed up for the “I want to come” list for HIStalkapalooza. The page has been turned off since it was scheduled to run for a week. I haven’t checked the count to see if we can accommodate everyone, but I’m hoping we can, and anyone we can’t will go on the waitlist in case someone cancels. We’ll be sending out e-mail invitations soon. It’s only three weeks away, as I just now realized in near-panic as I think about all the HIMSS-related stuff Inga and I have to do between now and then. I should take a week off from work just to catch up.

Here’s the HIStalkapalooza agenda for those who need to plan their existence down to the minute. Doors will open at 6:30, starting with red carpet interviews streamed to a big screen on stage (it’s a “big entrance” kind of thing that I thought would be fun, but you can bypass straight to the bar if you’d rather). Eating and drinking commences, with IngaTinis in abundance and beauty queen sashes strutted by a chosen few. The video and photo crews will be plying their trade and I’ll have a roving reporter inside BB King’s covering the event for summarization in HIStalk afterward. The official welcome comes at 8:00, followed by Jonathan Bush and the HISsies awards (special guests are always possible, but I usually get a polite “no thanks” when I ask, so don’t count on it). We’ll have a short HIStalk Queen and King contest with voting by applause (like high school, winners will be chosen based on fashion, poise, and willingness to pander shamelessly to the audience). Inga’s BFFs will choose the “Inga Loves My Shoes” winners while most of the men head off for another beer. Our super sponsor, Medicomp, will offer up some doctor recognition at 9:00. At 9:10, the Insomniacs concert starts, running until 11:30, with food and drink available most of the evening if I remember correctly. Dancing will be encouraged by our HIStalk ambassadors, the band, and the open bar. Inga, Dr. Jayne, and I will probably be in anonymous attendance, overwhelmed and schizophrenic (am I me or Mr. H?) Everybody who works hard all year deserves a little bit of silliness and entertainment and that’s what we’re offering (but I bet that as in past years, important contacts will be made and deals will be struck by high-powered attendees hammered on IngaTinis).

A Weird News Andy graphic moment, in the form of a patient instructions handout.

Listening: Tiamat, because sometimes you need a little depressing Swedish doom metal (Pink Floyd meets Metallica) to brighten up your day. It’s good.

A reader tells me those Extormity EHR parody people will be unveiling themselves at HIMSS, revealing themselves to be sellers of some flavor of PM/EMR. I’d scoop them by announcing it here except I have no idea who they are.

These poll results confirm what people are telling me (not that I didn’t already know since recruiters are burning up my phone and e-mail at the hospital): it’s getting tough to find experienced HIT people. New poll to your right: how many hours per week do you work? I’m curious since the comments from Epic’s employees seemed to raise some curiosity. The poll accepts comments, so add yours if you like. 

Quality Systems, Inc. (the NextGen people) turns in record Q3 numbers: revenue up 23% to $91.9 million, EPS $0.60 vs. $0.46, expectations beaten, dividend raised. Board chair, founder, and former CEO Sheldon Razin holds almost $400 million worth of shares. He started the company in his garage in 1973 with $2,000 in capital and took it public in 1982. Its market cap is now over $2 billion.

I’m happy to announce Symantec as a new Platinum Sponsor of HIStalk. Everybody knows Symantec for their security products (Norton, Ghost, pcAnywhere, Veritas, etc.) but I’ll call your attention to Symantec Health. They offer Symantec Health Safe, a medical image archiving and sharing service designed to complement existing medical imaging infrastructure. Per-TB Storage costs are reduced since you pay for only the capacity you use with no upfront capital expense or data center operating expenses, lowering the total cost of image archiving by 25 to 50%  or even more. Images can be retrieved directly to PACS and shared securely online with any other provider. The trusted leader in online security is offering a free cost savings analysis. Thanks to Symantec for supporting HIStalk.

If you’re interested in more than my brief explanation of Symantec Health Safe, I found the above video on YouTube.

David Darnell, a 39-year-old VP with healthcare data analytics vendor MDI Holdings of Ponte Vedra, FL, died Thursday in car accident. He is survived by his wife and four children ages 1 to 7. Condolences.

UPMC’s insurance division forms a joint venture with UK company Ultrasis to create a US version of that company’s Beating the Blues online CBT (Cognitive Behavioral Therapy) patient tool for treating depression.

University of Iowa Hospitals opens an investigation after determining that the electronic medical records of 13 University of Iowa football players may have been inappropriately accessed. The hospitalized players have been diagnosed with rhabdomyolysis, a kidney-damaging condition caused by damaged muscle and sometimes by nutritional supplements. The university has also launched a separate investigation into the football program’s off-season workouts, which started last week.

The Methodist Hospital (TX) opens a 35,000 square foot simulation-based surgical training center that will teach physicians to use technology such as image-guided procedures and robotic surgery. One tool uses a thermal camera to determine a student’s surgical expertise.

An interventional radiologist who patented the idea behind drug-eluting stents while a medical resident in 1993 is awarded $482 million in his suit claiming that Cordis stole his idea and made $13 billion from it. Bruce Saffran, MD PhD had already settled with Boston Scientific for $50 million after winning a $431 million judgment against that company three years ago.

Mobile drug reference vendor Epocrates plans an IPO next week valued at around $50 million.

I appreciate and acknowledge the support of Perceptive Software of Shawnee, KS, a new HIStalk Platinum Sponsor. The company offers the ImageNow document management, imaging, and workflow solution that ties unstructured documents to the EMR and streamlines paper processes and workflow. The benefit: a comprehensive, hybrid patient record that improves care by offering immediate access to content, provides secure access, reduces the cost and space requirements inherent with paper, and quick implementation. It integrates with any HIT system including those from Meditech, Epic, Cerner, Allscripts / Eclipsys, Lawson, and Oracle. There’s an overview demo series here and they’ll send you a copy of The Top 10 Things You’ll Save with ECM if you mention HIStalk (or if you don’t, for that matter, but maybe I’ll score points with them if you do). Thanks to Perceptive Software for supporting what I do.

Above is video I found on Perceptive Software’s healthcare solutions. It’s just some real-life customers (North Kansas City Hospital, Asante Health System, Citizens Memorial Health) talking in a seemingly unscripted way about how they’re using the ImageNow solution.

Digital Prospectors Corp. of Exeter, NH is supporting HIStalk as a Gold Sponsor and we appreciate that very much. DPC is a fast-growing boutique consulting firm whose healthcare division provides consultants and direct-hire candidates for all areas of HIT, including experts in Cerner, Allscripts / Eclipsys, Epic, McKesson, Lawson, and Quovadx. The company has won several awards (Inc. 5000, top woman-owned business, best places to work) since its founding in 1999. I found a nice profile of the company in a local publication here and also its Facebook page. You can also check out their open positions. Thanks to Digital Prospectors Corp. for supporting HIStalk.

Awarepoint’s 2010 results include 91 hospitals contracted for its RTLS solutions (up 30%) and revenue up over 100% for the third straight year.

Bizarre: a pregnant woman finds out that her husband has impregnated his mistress as well. She decides to kill the mistress’s baby, forging a doctor’s prescription for Cytotec, an ulcer drug that also causes abortions, and calls the woman pretending to be the doctor’s employee and tells her take the medication to protect the unborn baby against Down syndrome. The mistress takes the Cytotec, sending her into immediate labor, but the baby survives in the hospital. The wife then sends a male friend to the hospital with two bottles of poisoned baby milk, which suspicious staff refuse to pass along. Somewhere along the way, the wife pretends to be a hospital executive in an attempt to get the baby’s ventilator turned off. Says her lawyer, “My client was in the last trimester of her pregnancy and was acting irrationally.” The jury didn’t buy it: she’s going to prison for four years. I’m sure she’ll make a stellar mom.

E-mail me.

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From Whillikers: “Re: vendor receiving a percentage of a hospital’s stimulus money. I don’t see this as necessarily wrong. We don’t know how the contract was worded – perhaps the vendor is sharing risk and reduced license and support fees in return for helping the hospital earn the incentive money, or maybe even faced penalties if they didn’t achieve Meaningful Use.”

From Arliss: “Re: managers not knowing what their employees make. I’ve worked in several large companies over many years and rarely knew what my reports made. Does it really make a difference? Middle management is middle management, sometimes just to manage process that happen to include certain assets called people.” I don’t know if it’s necessary to know, but you’d need a much better appraisal / rating system than places I’ve worked to take that out of the hands of managers. Epic supposedly fires the bottom 25% of its staff each year according to some of the comments I’ve seen, so I’m sure they do have such a rigorous rating system.

From Sporting Group: “Re: mobile app that rocks. Very cool development for first responders. I remember when this was an idea … how to locate AEDs and identify those with CPR training when someone drops with an MI.” The iPhone app, called Fire Department, asks when you first launch it if you’re trained in CPR and would be willing to help a stranger in need. When 911 gets an emergency call, the operator can send a push notification to those volunteers who are near the location, also telling them where the nearest automated defibrillator is. That’s brilliant if you ask me. As screwed up as America seems to be at times, its citizens will usually do anything they can to help someone in need.

From 70HourWeek: “Re: Epic work week. The long hours aren’t unique to Epic. I work 50 hours on a slow week. That doesn’t mean I like it, but our systems are constantly changing and our facilities are 24×7. Where we could improve is to recognize what we do and adopt truly alternative schedules and options to work from home. We all work long hours and are lucky if enlightened managers recognize the need for work-life balance. Epic does have a reputation for favoring young employees, which saddens me both that it exploits new hires right out of college as that it will eventually catch up with Epic.” I don’t disagree, except I’m always skeptical when someone claims consensual exploitation.

From InDenial: “Re: Epic. I keep reading that they set their price and don’t negotiate, but that’s not entirely accurate. I was previously with a large health system and Epic was definitely negotiating with us against their competitors. They didn’t get down the level of discount the others were offering, but they did make an aggressive offer that was much different from their initial proposal.” Unverified.

From Nasty Parts: “Re: eCW not paying commissions. Not true. HIStalk has a responsibility to publish facts and retract inaccuracies.” That statement, just like yours, came from a reader. I don’t claim that reader comments that I run, including yours, are 100% accurate, although they often are. In this case, Inga had confirmed with eCW, who told her that they do indeed not pay commissions, so I ran the item without tagging it as unverified. Several readers sent details indicating otherwise (such as precise commission percentages and specific salesperson income). Inga forwarded that to eCW, who then amended their previous statement to say that the company does indeed pay a few salespeople commissions (I didn’t understand or really care from their explanation which ones get commissions and which ones don’t). I believe I met the test of prudence in obtaining verification, even though it turned out to be incorrect.

From Natty Boh: “Re: Epic employee comments about hours, management, obsolete technologies, and lack of credentials to work elsewhere. How funny – this is EXACTLY what Cerner associates say as well, all except the ‘experienced Cerner resources are hard to find due to selling more big sites’ part).” I tried not to conclude from all the complaining that the upcoming generation of US workers are the marginally motivated, Facebook-obsessed, self-absorbed children of excessive privilege, instead choosing to believe that they’re doing exactly what I and everybody else should have done decades ago in refusing to sell one’s soul to an employer who sneers at paying 40 hours’ worth of salary for 40 hours’ worth of work. Sometimes all of that extra effort pays off, but generally you’re going to end up bitter after being stabbed in the back by someone with better connections, passed over in favor of a co-worker with less distaste for shameless up-sucking, or clueless management. Like the old saying goes, nobody’s epitaph brags on how many hours they spent at work.

Want to come to the HIStalk reception (aka HIStalkapalooza) at the HIMSS conference? Sign up now on the “I want to come” page since it will be turned off in a couple of days. People e-mail me every year after the fact claiming they didn’t know about the sign-up, which tells me right away they don’t really read HIStalk very carefully since I make a big deal out of it for precisely that reason. I can only reiterate: if you want to come, sign up right now, please. I’m especially reaching out to providers, who often get lost in the shuffle among all the vendors who attend – if you are a doctor, nurse, CIO, programmer, help desk tech, field support analyst, professor, or whatever you do for a hospital, clinic, practice, university, or agency, I will do everything I can to get you an invitation, which is why I changed the sign-up process. I’m not prone to hyperbole, so believe it when I tell you that it’s going to be the talk of HIMSS.

Listening: new from The Script, Ireland-based alt-pop. You’ve heard them but just don’t know it: play Breakeven on their MySpace page. It’s a little soft for me, but it’s pretty good and the new album is better.

CareTech Solutions opens a new $5 million, 30,000 square foot operations center and technology hub in Troy, MI to handle its growing business. The company has 1,100 employees, hired 200 in 2010, says it will hire more than that in 2011, serves 155 hospital customers, and expects to quadruple its business in the next three years.

EXR, the enterprise EHR from Reliance Software Systems (aka RelWare), is certified as a complete inpatient EHR and a module outpatient EHR by InfoGard. I don’t have a link, but friend of HIStalk Dann Lemerand sent over the press release. Dann started the HIStalk Fan Club on LinkedIn that’s now up to 1,328 members. I’m slightly embarrassed by having a fan club, but I can tell you without hesitation that it provides a psychological boost when I’m having a crappy day (which is thankfully rare since I have perpetually low expectations). I also admit that when someone wants a favor from me while claiming undying devotion, I often make less of an effort if they aren’t members.

Among the listings on the HIStalk Jobs Page: VP of Sales Central Region, Vendor Partner Product Executive, RVP Sales – Southeast Territory, Meditech ADM B/AR Sr. Consultant. On Healthcare ITJobs: Epic Cadence Application Coordinator, Pharmacy Informatics Specialist, Clinical Data Analyst, Epic ADT Consultants / Analysts. Lots of good jobs there from Vitalize, Marshfield Clinic, Joint Commission, Olympus, Ivesia, and other companies.

Ryann Winn, former IT director at Munson Health (MI), is named VP/CIO of MidMichigan Health.

CPSI’s Q4 numbers: revenue up 28%, EPS $0.61 vs $0.33, beating the bejesus out of consensus estimates of $0.43. The company also declared a dividend, although one might argue that in the rapidly growing HIT sector they might have been better off using the money to grow or acquire instead of sending out tiny checks that non-grandmotherly shareholders don’t usually care about.

The Methodist Hospitals (IN) is suing consulting firms FTI Cambio and HealthNET as well as Meditech for convincing the hospital to abandon its in-progress, $26 million Epic implementation and instead spend $16 million to replace it with Meditech to save money. Methodist wasn’t meeting its bond covenants, so it hired Cambio and subcontractor HealthNET to evaluate its Epic project. The two firms said it would cost $25 million more to install Epic, although the hospital says the real number was closer to $11 million. Methodist also claims that the consulting firms advised them to dial back their security protection, which led to a widespread virus infection. The hospital says it gave up on the Meditech implementation in 2009 after finding that data wasn’t being updated properly, which had forced employees to go back to charting on paper. Interestingly, the hospital claims its own CEO, CFO, and COO were also responsible because they were all Cambio employees. Methodist wants out of its Meditech contract and is asking for $16 million in damages. I guess the lawyers have to get involved when a tanking hospital has spent $42 million on two abandoned IT projects and is still stuck on paper, but I’ll also be interested to hear the other side of the story, which is probably just as believable despite being the opposite of this version. As for saving money with Meditech, I don’t doubt it a bit – I bet if you compared annual maintenance between Epic and Meditech it wouldn’t have taken long to cover that extra $5 million to switch.

The new 289-bed, $1.6 billion UCSF Medical Center at Mission Bay (that’s  $5.5 million per bed, $1,800 per square foot) requires an $80 million contract for wiring alone. It will have a wireless Distributed Antenna System to feed EMR access to touch-screen systems at each bed. The announcement says the new hospital will be a showcase for best practices, presumably not among them being building an affordable structure that won’t require the hospital to milk the healthcare system for generations to pay off the debt. I just don’t get why we need Taj Mahospitals when healthcare costs are already making the country non-competitive globally. I’ll bet money that their Edifice Complex doesn’t improve their patient outcomes a bit (and you don’t even need an EMR-type study to easily find that out).

I’m not going to harp on this, but it’s odd: the rags that e-mail out healthcare IT related news blasts don’t seem to have a clue which press releases they use as sources really relate to HIT. Case in point: Cisco is buying Pari Networks, which offers network management tools. So why is one networking company buying another hot healthcare IT news worthy of an e-mail? Those updates always have unrelated junk about some non-healthcare arm of Siemens, a non-HIT related acquisition by a vendor for whom healthcare is a small vertical (like Cisco), or some pharma executive’s promotion. If you get those updates (and actually read them), I bet you’ll find at least one “why should I care” story written up in breathy excitement in every one of them. If I’m wrong, tell me.

A string of medication errors at Seattle Children’s Hospital, two of which occurred in babies who died, cause the hospital to scramble to regain its credibility. Hiring the Institute for Safe Medication Practices to review their processes isn’t going to do it for them, as ISMP finds many problems, including a “culture of intimidation” in which doctors belittle nurses and senior doctors and nurses alike bully their junior peers. The day before the report was announced, the Department of Health found that the hospital may have killed a baby being transferred by regularly allowing transport nurses to give meds without a doctor’s order.

The former ophthalmology chair of Temple University School of Medicine is charged with insurance fraud by the Department of Justice, which claims he submitted more than $3 million in false charges for patients he didn’t actually see. DOJ says the doctor told employees to bring him the charts of patients seen by other doctors, which he would then alter to indicate that he had evaluated the patients.

E-mail me.

HERtalk by Inga

Mississippi Medicaid contracts with ACS for use of its State Level Registry solution to manage EHR incentive payment applications, including verification of qualified applicants and certified EHR use.

Telehealth provider Teladoc Medical Services secures a $4 million investment from Cardinal Partners and HLM Venture Partners.

Dana-Farber Cancer Institute (MA) selects Versus Advantages RTLS for patient tracking, room utilization, workflow optimization, and reporting. The system will be deployed at Dana-Farber’s new Yawkey Center for Cancer Care.

Three hospital companies and two hospital systems invest in the Heritage Healthcare Innovation Fund, a venture fund targeting healthcare services and HIT. The fund says it can place up to $10 million in early- and growth-stage healthcare businesses.

AirStrip Technologies appoints Alan W. Portela to its board of directors and to serve as the company’s senior strategic advisor. He’s the founder and CEO of Hybrid Clinical Transformation and the former president and current board member of CliniComp.

New from KLAS: providers are planning to purchase more diagnostic imaging equipment in 2011. Radiology departments anticipate spending about $200 million on equipment this year, 10% more than last year. Siemens and GE are the most-considered vendors in the space, but competition continues to grow. MRIs are the most discussed purchase, followed by CTs, ultrasounds, digital X-rays, and digital mammography.

Swedish Medical Center (WA) experiences a four-hour shutdown of its Epic EMR, forcing providers to use pen and paper to document. The system automatically turned itself off upon noticing an error that could have potentially corrupted data. During the outage, users across all Swedish’s campuses could see data, but not add or change anything. The health system is now exploring “more sophisticated levels of backup,” which might include a giant server in a different geographic location.

Laurens County Health Care System (SC) chooses Summit Healthcare’s Summit Scripting Toolkit to automate billing and administrative workflow within its CPSI system.

I’ve enjoyed the dialog this week about HIT salespeople and commissions. I think Mr. H had it wrong, as many pointed out. Most companies don’t pay 100% of the commissions when the sale is made, and thus are highly motivated to make sure an implementation is successful. Car salespeople probably get paid 100% up front, but HIT is a different beast. Salespeople who are in it for the long haul will sell clean and earnestly work to make sure their solution fits their clients’ needs. Those that sell a “bad” deal and leave it to others to clean up lose credibility within their organization and find it difficult to get assistance on the next deal. Customers remember the sales rep who did them wrong and happily share their woeful story with potential customers. Other vendors also learn the names of “sleazy” sales reps and have no interest in hiring them after they’re fired from the  original company. Of course there are a few bad eggs in the business, but, I believe there’s honor in being a commission-based salesperson in HIT.  Every successful salesperson I’ve ever met works 50-60-70 hour weeks, which means they miss miss out on soccer games, birthday parties, and bunco (!) Base pay ranges from 40K to 120K (if you are a superstar.) That means that if you aren’t closing business, you’re not exactly making the big bucks. A big deal may pay a big commission check, but you may only close one or two big deals a year. In the ambulatory world deals are smaller, so a salesperson must close multiple sales a month. To be successful, a sales rep must effectively manage time and resources. If you are a sales rep working on commission, I salute you for your hard work and believe you when you say you’re committed to your customers’ success.

Hill-Rom posts 77% growth in its first quarter earnings and a five percent increase in revenue to $374 million. Revenue from the company’s North America Acute Care segment grew 6 percent to $218 million. Capital sales rose 12%, led by a 22% jump in sales for patient support systems.

Communicating via social networking leads to faster hook-ups, according to a new survey. To test the theory or to just make us feel desired, you can friend Mr. H, Dr. Jayne, or Inga on Facebook; additional foreplay opportunities are available by liking HIStalk. Find us on LinkedIn as well.

This week on HIStalk Practice: pay for performance programs don’t improve outcomes. Dow Jones files suit to allow open access of Medicare records containing provider payment details. Louisiana Medicaid issues the nation’s first EHR stimulus for an FQHC. Dr. Alexander says finding an EHR ain’t easy. Dan Nelson, a practice administrator for a family practice group, discusses his testimony before the HIT Standards Committee’s Implementation Workgroup.

Dr. David Blumenthal posts a new note on ONC site, noting plans to increase REC funding to $32 million and to award $16 million in new Challenge Grants to encourage HIE innovation.

I can’t believe WNA didn’t send us this story. The Florida Supreme court refuses to overturn a slander award against a hospital executive in favor of a surgeon. The surgeon had been denied surgery privileges at the hospital’s open heart institute. The hospital executive, in describing the surgeon’s skill level to another surgeon, said, “I would not send my dog to him for surgery.” A jury awarded the surgeon $5 million in punitive damages.

E-mail Inga.

Sponsor Updates

• St. Patrick Hospital and Health Sciences Center (MT) contracts for the Meds Tracker medication reconciliation system from Design Clinicals.
• Kansas Health Information Network chooses the CareAlign solution from Informatics Corporation of America for all of Kansas and parts of Missouri. It provides a provider and patient portal, secure clinical communication, interoperability, EHR Lite, population management tools, and a patient health record.
• McKesson declares a shareholder dividend of 18 cents. Shares are trading near their 52-week high and are almost back to their pre-HBOC meltdown levels of 1998.
• GetWellNetwork is named among Washington DC’s fastest-growing companies.
• F.F. Thompson Hospital (NY) will replace its existing hospital information system with McKesson’s Paragon HIS.
• Voalté releases a white paper called The Smartphone Tsunami – Will Your Hospital Sink or Swim?

EPtalk by Dr. Jayne

I’ve enjoyed reading some of the testimony from last week’s HIT Standards Committee Implementation Workgroup. My new crush is Robert Murry, MD, PhD, medical director of informatics at Hunterdon Medical Center (NJ). His testimony has given me a host of phrases I’ll be stealing when I next speak with hospital executives who continually expect their IT resources to deliver the impossible again and again. Among my favorites: doing an EHR upgrade in a large organization is like “upgrading the engines on an airplane while it is flying.”

Murry also goes on to say that by interfering with the go-live schedule and causing resource strain, “meaningful use has slowed down our implementation schedule, perversely having the opposite of the intended effect of rapidly rolling out robust EHR technology in our enterprise.” He lobbies for more clinical informaticists to “speak the language of physicians, understand their time pressure, perfectionism, and medico-legal stresses, but also able to understand IT, prioritize development and implementation resources, and construct the amalgam of workflow and software changes that is acceptable efficient in practice.”

CIOs and IT purists, take heed — you need someone like this in your organization, whether you call him/her a CMIO or not. You’re not just slapping a system in a doctor’s office, you’re potentially imploding their entire workflow. The last word: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Dr. Murry, if you’re out there, I hope to see you at HIStalkapalooza. I’m still working my way through a lot of the testimony, so if readers have other favorites, e-mail me and I’ll bump them to the top of my reading list.

Several people have written to follow up on my PQRI to PQRS comments, particularly on how the new acronym can be pronounced. Some of the suggestions are downright hilarious, but I’m too much of a lady to quote them, so feel free to comment below with your thoughts.

I’ve had a pretty harsh week at work, which has led to the need for an unusual amount of vegetative Netflix, Facebook and YouTube activities. I’m a big fan of www.xtranormal.com so thanks to Betty for brightening my day with this one (and yes, I think I did see this patient the last time I had office hours.)

Speaking of Facebook, I just passed the 50-friend mark. Not anywhere near Inga-like status, but it’s helping me feel part of the HIStalk universe. The friend suggestions I’m receiving look like fun people, so don’t be surprised if I start randomly friending you.

Have a question about medical informatics, electronic medical records, or how many pre-meds cheat on their chemistry labs? E-mail Dr. Jayne.

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Jeff Surges is CEO of Merge Healthcare of Chicago, IL.

Tell me about yourself and about Merge Healthcare.

Merge Healthcare is a leading provider of imaging information systems. Over time, it has consolidated a number of acquisitions in the imaging space, neutral archives, PACS, and branched that out to any provider looking for solutions that an image would follow in the -ology or -ography space. Publicly traded on the NASDAQ, 730 employees, and aspiring for the future of interoperability and connecting to electronic health records.

I’ve been in healthcare IT on the vendor/provider side since 1995. I’ve been with a number of companies on the management team. Built, taken public, sold to HBOC back in the day, funded my own company called ECIN, which was a start-up that helped case management and discharge planning, ultimately sold that business to Allscripts in 2007, was on the senior leadership team for Allscripts during their acquisitions of Misys and most recently Eclipsys. I joined the board of directors of Merge back in June of 2010 and joined the company as chief executive officer on November 9, 2010.

You ran sales at Allscripts and Michael Ferro said you were chosen for the Merge CEO job with one of your responsibilities being to build a similar sales organization. What’s involved with that and what’s the desired result?

I think that what we find similar in my past and the opportunity here at Merge is solution selling, consultative selling, and relationship-building. Those are the three primary objectives if you want to gain the trust of CIOs, COOs, CEOs, and CFOs. Having experience in this business is important.

A key ingredient in both my Allscripts days and here at Merge is successful products, successful teams, and building great relationships with clients and partners and your employees so that the word trust is what ultimately binds everybody together.

Merge’s portfolio creates that opportunity on the back side. Bringing in and complementing the existing team with industry people throughout that have similar qualities that we look for will help Merge with that message as we educate people about the new Merge in the coming years.

You mentioned in the recent earnings conference call that Merge is a well-kept secret, but a lot of the news about it has involved fluctuating share price, executive turnover, and boardroom drama. As you’re trying to get the word to the two publics that you sell to — the IT departments and the radiology decision-makers — what message do you take to them?

I think what has always worked for me in the past and the companies that I’ve worked with is to prioritize your clients as the top of the food chain and talk about your value proposition — the problems you solve, the return on investment you create, how your systems compliment their existing strategies as they lay out five-year plans and strategies for their own businesses. We have to position ourselves to help them be successful, because inherently their success becomes the company’s success.

A lot of the historical perspective on Merge is good reading for the weekend, but it doesn’t solve client problems and it doesn’t return value to the customer who bought the application. I think if we follow suit, which I’ve been able to do in the past, the DNA of the company is really client-driven on solutions.

One urgency is that PACS has become a price-sensitive market, almost a commodity, and big companies that sell other products can lowball their PACS price and make it up someplace else. Is that part of what needs to change about the business, or do you have a different strategy to compete in that environment?

Merge looks at the opportunity two-fold. One is to re-establish the value of the existing PACS system. Rip and replace sounds exciting, but is heavy lifting and requires a lot of money when dollars are tight.

The second piece then is to show how that investment can be re-traded to other value propositions and interoperability. Moving images across the continuum of care to vendor-neutral archives and moving that image to the electronic health record becomes a great complement with not a lot of investment. We can capitalize on what’s already a sunk cost and show value that way.

Imaging is on the upswing again, with people talking about sharing images beyond just looking at them for diagnosis. Do you see a fundamental change that’s a second wave of digital images?

I think the affect of ARRA and this Meaningful Use driver has asked people to not only implement electronic health records — and those winners are going to be decided in time — but then find the credible assets to add to the electronic health record. While interfacing flat-file data is going to be important to round out the view, nothing is going to be more important than the image. It’s one of the first things everybody asks to see. It’s one of the first things people want to get their hands on.

Yet inherently, prior to PACS, neutral archiving, and images being in an interoperable state, it was heavy lifting. You needed big pipes to move the data. I think what we’re seeing with cloud computing, hosted PACS, as well as Web access, you’ll see that images can move real time to accommodate the schedules of physicians every day.

I was interested that the company has said that more than 90% of the data that providers generate is in the form of images, which really makes them a key component of electronic health records. Do you think that Meaningful Use emphasizes images enough, or do you think that providers already know that and it doesn’t further emphasis?

I think Meaningful Use has provided radiologists and the whole industry with two opportunities. One is they can qualify for Meaningful Use on their own by getting to a certified EHR that has and meets the criteria. 30,000 radiologists in the country have a $44,000 opportunity each, which creates over a billion dollars of market opportunity to qualify.

Secondarily — and maybe more important to community healthcare, to accountable care, and this bundled payment story — is the interoperability of the image. For Stage 2 and Stage 3 funding, we are seeing the importance of the image being attached to that record. Whether it’s from the American College of Radiology, whether it’s from RSNA, or the eCoalition of imaging, we’re finding third-party constituents really rising up right now and talking about not only Meaningful Use for the radiologist’s practice, but for the image being a critical part of Stage 2 and Stage 3.

The early challenge was capturing and storing images, but now it seems it has advanced to the point that metadata is being used in different ways, where the image is more than a picture that you just go look at by clicking a link in the EMR. Where do you see the use of images in the EHR going?

We really have seen two focuses there. One is the general availability, which I would call, “How do I get access to the image?” Second, which is really the more important question, is, “What’s the quality of the view of that image — is it 3-D, is it a zero-client view, can I move it from a mobility or a cloud standpoint so that it’s a value-add to the decision that either a radiologist has to make on that study or that the physician has to make when making a care plan decision?” 

Early on, people want to review the investment on the PACS, but there wasn’t a quick way to do that. Starting to see the cloud, starting to see an iConnect share model allows you to move studies within your continuum of care and within your community. Whether that be called interoperability or intraoperability, you’re starting to see that. That will ultimately reduce exams, duplicative exams are what a lot of our clients call convenience exams — that is, “I don’t have my X-ray with me.” “Oh, that’s OK, let’s take another one.”

We want to help the efficiency model by moving that through the connection, as well as starting to track radiation dosage. If every time it was convenient just to go in for one more scan, you’re actually putting more radiation in somebody. California back in November made a law on tracking radiation dosage, we start to think about that for overall consumerism and patient health.

I wanted to ask you about interoperability and connectivity because I know it’s been prominently mentioned lately, especially with the iConnect suite that was pieced together from some of the acquisitions. How does connectivity fit in with where you want to take the company?

I think the ability to move the image and the ability to share the image — not only within a health system that wants to be efficient for their own owned entities, but then as you collaborate your care model in a community where you’re working with affiliate organizations — you have to be able to show up with a model that says, “Not only can I move the records, but I can also move the image.”

iConnect in the value proposition suggests that you can move it from within the system and outside of the system by connecting it to the interoperability standards, connecting it to our third-party partners, and connecting it to government or federal-type opportunities where for Medicare and Medicaid, the uninsured scans are some of the most expensive ones out there today. It’s an efficiency play, and it’s the ability to really complete the record for 70 to 80% of those records that require the image to be present.

If you look at your competition, what advantages does iConnect give you?

Most importantly is that it’s available today. We have customers that are using it. We’re moving images electronically in the operable state. 

What we continue to see is people wanting to know what it’s going to be like and what they’re planning to build. We have existing customers – 1,500 hospitals, 6,000 imaging centers — that today say, “I need to move those images now. How do I get started with my connectivity story?” We can actually start implementing that.

There are existing community models out there, whether it’s with our partners on the electronic health record side or new name partners that want to collaborate to move the image. You have to be able to show up under this time-sensitive trail of Meaningful Use and say you have it, you have it available, and you can meet the project plan. 

Years ago, without a Meaningful Use carrot and stick, you had a lot of people saying, “Well, we’ll delay. We’ll go live next year. We’ll go live next year.” I think the sense of urgency to capture the reimbursement is really the call to action to get people excited, but I think the end-state of a complete record has the radiology industry excited and the overall connectivity play.

The sense of urgency must include HITECH and the potential for Accountable Care Organizations, where images may need to be shared with folks who haven’t been shared in real time before. Is that what your customers are telling you is most important to them right now?

Yes. Back in November at the RSNA show here in Chicago, one of the recurring themes we heard loud and clear from not only OEM partners, customers, and prospects was that this time is now. We have to move now, because of the sensitivity of not only meeting the standards, but the timeline. The larger hospitals and health systems have longer plans, but they have to start now.

Some of the other radiology centers are just learning about this, so there’s almost a catch-up mentality going on in this industry that wasn’t present in my last industries where Meaningful Use and EHR was front and center. This one here is catching up. I think Merge has an opportunity, as does the whole industry, to quickly educate and facilitate this transition.

How have mobile devices impacted your business and the industry in general?

We continue to think of mobile devices and mobile computing as an ongoing opportunity. I think Merge, like everybody, saw the iPad and the iPhone and the Droid as something that they quickly had to showcase, but then practically had to figure out what the longevity, what the real value was.

On the imaging front, you have to be able to have a quality image that somebody can read real time to make an informed decision. So not only is the end-state of the device important, but the quality of that image, the way to move that image, and to do in seconds and not minutes becomes the priority. Having the end-state solved looks good. It is all the work that the client expects to be able to move that image quickly when time is of the essence, so, we see a lot of focus on the speed and the cloud, more so than the device right now. That seems to be solved.

It appears that Merge has multiple PACS and archiving products that overlap. Are there plans to change the product line?

Most of our focus in on, not only the current client and the retention on their investment, but really focused on the next generation. That kaleidoscope, so to speak, allows us to take existing functionality from only a couple of systems and bring it forward, partner with our advisory groups and our clients, and build a next generation of PACS or next generation of neutral archive. 

iConnect is already bringing that to bear. We’re showing those results. We’ll continue to capitalize on the iConnect investment that sits on top of, in many cases, the current customer’s opportunity, and then can also show an upgrade methodology for some of the systems that are maybe longer in the tooth that need reinvestment because the customer strategy has changed.

But you have no immediate plans to retire or sunset any products?

Most of our announcements that we’ve made around products were made at each of those acquisitions to those clients. We have not come out recently our plan to announce any big sunsets. We have a user group for over 600 client attendees coming in the late spring-early summer and our teams will be hard at work, working with clients on showing them how to upgrade, how to move for Meaningful Use to qualify, and how to get ready for interoperability and iConnect.

It’s been almost a year since the AMICAS acquisition. How would you say that’s gone?

If I were to qualify and judge that by the client attrition, I would say it’s an A-plus. The client base within AMICAS has been impressive in terms of their utilization and impressive in terms of how they extract value from that investment.

I think the uncertainty around “who’s on first, what’s on second, I don’t know’s on third” has presented Merge with a great branding opportunity to showcase where we are today, where we we’re going, and why that client base is so important to Merge, and again, focusing on the client. The back half of FY10 and all of FY11 will be really focused on our customer base, which is large and growing and valuable to the company.

In that regard, are you generally happy with the KLAS ratings and the trend within those for your product line?

Again, I want to reiterate that so much of our acquisition strategy over the last 24 months — it started with the end in mind, which is as we saw interoperability and we saw Meaningful Use coming, we had this asset called the image. Strategically, each one of our acquisitions that we’ve made all have a similar theme. They’re complementary to the overall image and its importance to the record, and it stayed in the interoperable world. I just wanted to make sure that that was clarified. That’s an important base.

Yes, I actually am very pleased with not only many of our KLAS ratings, but the amount of people that are filling out the surveys. Because what you ultimately want is feedback to improve. As I deep-dive into the KLAS surveys, as long as we’re getting feedback, we’re getting told where we’re strong and where we can improve and again, having some history with KLAS in my past, I’m pleased with where we start from here. 

In the state of an acquisition, it’s always an anxiety state for clients, but to be in some of those ratings, I feel that’s a place that we can improve on and it’s a goal. It’s the feedback loop that KLAS actually gets for you that you have to have as a trusted resource. That’s one of the ways I view it.

The company has, seemingly to me, pretty quietly moved into software clinical trials, laboratory information system, and anesthesia via acquisition. What was the attractiveness of those markets and how do those products fit in?

Each of them has a unique component to the story. The acquisition of the AIMS Anesthesia System starts to bring us into a perioperative state, starts to lean into the view of surgery and where there’s images. That documentation and that certification is an important asset to have. It also gets us connections to devices, which in many cases as you know, to complete a record, you have to have device connectivity.

On the clinical trials front, we have long seen a growing interest in imaging. As our portfolio stack has the image as its interoperable value point, the portal to clinical trials allows all radiologists that are looking at studies from around the word to view into clinical trials and to take full advantage of any trial opportunity that can lead to an opportunity for enhanced care. The etrials acquisition years ago was a thought-provoking one that recently has started to grow in our own portfolio. The interest level for radiologists to view and search for clinical trials within the portal gives us a great opportunity.

The last you asked about, lab, was really an opportunity for us to get data in a quantitative state so that we could link it to images, pull it through the devices, and start to really connect lab and lab information to the image. We think that’s important. We also looked out a little bit and see the digital pathology, digital oncology, and if you take the blood tests alone which are all on film and convert that to digital, you can quickly see the size and the capture rate of what would need to change in those business models. The laboratory information system is a way for us to walk into that industry, learn about the industry, and pull the image into that model.

If you look down the road three to five years, what, where do you hope the company goes or what changes would you like to have made by that time?

I said on the first day I started that I thought Merge had a head start over all of its competitors in the imaging space because of the acquisition and the strategic acquisitions it took on. I think there’s a billion-dollar opportunity here.

I’ve been part of two different companies as a part of a key leadership team to grow businesses. I think Merge has the culture, the portfolio, and with the stimulus reimbursement, interoperability, and connectivity, I think a marketplace has been created. Typically you can plan for two of those, but you need a third market to suggest that itself is available. That’s what I think we found in the connectivity play and the interoperable space. 

I continue to not only see Merge leading on the radiology and information technology side, but I also think you’re going to see much more consumer advocacy around health records, wanting their image locally or resident to their personal record. I think this radiation dosage is going to be a call to action on consumer activism. I think Merge is going to look at over millions of images being scanned and taking place a day as an opportunity to participate in a leading capacity in this industry.

Any final thoughts?

We continue to look at the current landscape in healthcare, healthcare IT, and look forward to not only this coming HIMSS, but also the next pronouncements on Meaningful Use Stage 2, Stage 3, the importance of the image. As we’re seeing not only on behalf of our clients, but on behalf of the marketplace, people are starting to realize that the most important piece of a record is the image. It’s the picture, it’s the view, and it tells a lot of the story that’s important to have if you’re going to set up a care plan or a treatment plan.

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From Mandrake: “Re: HITECH. I heard from someone that [vendor name omitted] is writing into their hospital contracts that if the hospital gets stimulus money, the vendor receives 10% of it. I thought these dollars were for hospitals, doctors, and patients, not IT vendors. I hope this is wrong, because it definitely isn’t right.” I e-mailed the vendor in question, which has not replied so far.

From Bobby Orr: “Re: HIMSS. Not only for vendors. Here’s an interview with a community hospital CIO who’s also a HIMSS board member.” Mass High Tech interviews Scott MacLean, CIO at Newton Wellesley Hospital (MA). It’s part of the Partners system, but he says neither his administration nor his docs view IT as anything more than a support function.

From QPFC: “Re: Epic. On Glassdoor.com, ex-employees have some very interesting things to say about Epic. Judy only gets a 58% rating.” Those things are fun to read, but most of the posters have a company axe to grind (and 140 comments out of an always-churning several thousand employees isn’t a large sample). A common thread is that the new grads Judy hires resent the work hours, the not particularly talented middle management, the obsolete technologies used there, and the fact that they leave Epic unqualified to work anywhere else. It might be worrisome that turnover is mentioned often, not a good thing when experienced Epic resources are hard to find and they keep selling more big sites, but all Epic really need is an endless supply of fresh, naive liberal arts grads and three months to train them. Candidates with those minimal credentials aren’t hard to find in this economy.

From IT Director/Informatics Professor: “Re: HIStalk. I really enjoy your blog (it’s the only one I read) and believe you provide a wonderful service to the industry, provide thoughtful guidance on an array of issues, and do so with humor, integrity, and grace. Great job!” Thanks. I need a little encouragement now and then and I appreciate yours.

From Unicorn Rider: “Re: Norton. Partnering with Humana to build one of the four ACO partner sites. They are also a ‘future’ Epic site, which must mean they’re getting ready to start their build.”

Sign-up for the HIStalkapalooza “I want to come” list continues. A few folks reported an error when they clicked the Submit button, so here’s my suggestion: go ahead and sign up again, even if you already did. We’ll de-dupe the list later. I’d rather spend the time cleaning up the list later than have someone miss out because of a technical problem (maybe we overloaded the site or something since lots of sign-ups went through just fine). Response has been, shall we say, brisk. Sign-ups will end shortly (maybe by Friday), so do it now. I always get e-mails right up until HIMSS from readers who claim they scrutinized HIStalk carefully, yet somehow missed the multi-paragraph announcement (with pictures and video, no less) that the sign-up was open. And just to be clear, you will not get an e-mail invitation directly just because you came last year – you still need to sign up.

Huguley Memorial Medical Center (TX) goes live on the Shareable Ink Anesthesia Record, the first of 34 hospitals served by NorthStar Anesthesia to implement the digital pen and paper solution. The company’s technology also powers the T-System DigitalShare ED solution, for which I found the new video above.

The Iatric Systems folks did a really good video parody of Ozzy Osbourne’s “Crazy Train” called “HITECH Train.” They asked my  permission a few weeks back to use HIStalk in the video and lyrics, so you’ll find it there. “I’ve read the objectives, I’ve read all the rules, all eight hundred pages, of Meaningful Use, I’ve read HIStalk, listened to Blumenthal, will we get incentives,  or nothing at all?” The HIStalk part is at 3:03 (the timer counts down instead of up). It may be a 30-year-old song, but I’m still air guitaring to it right now, and parody or not, Iatric’s version rocks.

Yet another study finds that evidence is lacking that EHRs improve outpatient care quality. The definition of “quality” is as slippery as always, in this case tied to simple indicator measures like documenting smoking cessation counseling and routine blood pressure monitoring. The EHR cheerleaders are crying foul since the data set was from 2005-2007, but it’s hard to believe that systems have really gotten hugely better since then (the better argument would be that the indicators themselves weren’t as well accepted that far back). Still, if EHRs can’t move the needle on simple, well-accepted quality measures, they aren’t likely to do much else, either. They’ll get credit down the road, though, since pay for performance will improve those measures coincident with increased EMR adoption (since government incentives simultaneously encourage both). My interpretation is that this study, among the majority of others that try to tie EHR adoption to outcomes, failed to find a correlation, but that doesn’t mean there wasn’t one, just that one wasn’t found using the measures identified. That would be slightly bad news for those with skin in the EHR game, but it’s pretty terrible news considering the billions of taxpayer dollars being spent without rock-solid evidence that patient care will improve in return. But hey, it’s stimulus money, and nobody’s holding anybody very accountable for how it’s being spent.

The Australian profiles New Zealand-based healthcare IT vendor Orion Health, which us running 22 major projects in 12 countries, including a big one in Singapore. The article has a tiny mention at the end that Orion partner Allscripts is vendor of choice for an 80-hospital state EHR project, announced in November. That’s a huge Sunrise deal.

Some updates / corrections to the unnamed reader’s list of new Epic sites sold in 2010. Johns Hopkins is evaluating, but has not committed. More reader-reported recent sales: Kadlec Medical, Resurrection Health – Chicago, Providence Oregon, Providence Washington, Owensboro, and Yale New Haven.

A few more Epic tidbits. The ones I can share, anyway (others I was sent are proprietary and I know Epic would not be happy to have them divulged):

• Epic managers are not allowed to know what their own employees are paid. Epic frowns heavily on sharing salary information.
• Epic does not negotiate price with prospects, but may consider looking at terms in some circumstances. You pay what they say, and even the method of setting the price (volume, whatever the market will bear, etc.) is secret.
• A new sale is celebrated by playing wedding music over the PA and customers are encouraged to send in a video skit or to be played at the monthly staff meetings.
• Epic will not budge on its principles even if a sale is threatened.
• Sales demos are exactly what you’d be buying – they do not demo future releases or vaporware. Demo people are key people with deep clinical experience and product knowledge, but the salesperson disappears as soon as the contract is signed and you get turned over to a project director.
• Epic employee churn is picking up, but technical support continues to be the best of any vendor (this comes from a large site).

EMR vendor gloStream offers practices a full refund on software and services if physicians aren’t back up to their usual full patient load within 15 days of the implementation completion. Sounds good, although I’d want to take a careful look at the wording of the agreement since I’m sure the company has to protect itself against lack of customer initiative.

eCareSoft, a Texas-based company affiliated with Mexico’s largest EHR distributor, launches its certified, SaaS-based inpatient EHR for small to medium hospitals. Details are skimpy (like exactly which modules are being offered), so it’s hard to say if it’s worth a look.

I can’t decide what to make of the response by HIMSS to the PCAST report. This part seems unusually frank for an organization mostly known for exuberant vendor cheerleading: “Most health IT systems are proprietary, do not adapt well to workflow changes, and have difficulty supporting interoperable exchange.” There’s a lot of technical discussion of meta-tagging data. HIMSS also expresses concern that PCAST pitches the idea that we don’t need a universal patient identified given all the pieces of information that can collectively identify a patient positively, but HIMSS says it’s not that easy (citing the fact that the only big EHR implementations in the country all have identifiers – VA, Kaiser, etc.) HIMSS also warns that tagging individual data elements isn’t the right answer, that you need the context contained in the original document. I wasn’t interested enough to scour the response in detail, but I found myself agreeing with the HIMSS position most of the time.

David Brailer will speak at a Brookings Institution discussion on personalized medicine and HIT in Washington, DC this Friday.

Quantros will implement its patient safety and compliance solutions at Oasis Hospital in the UAE.

The Burlington, VT paper profiles PKC Corp. the local 25-researcher company formed in 1991 by Dr. Lawrence Weed. His “Problem-Knowledge Couplers” match patient information to a medical database to generate diagnosis and treatment suggestions. IDX co-founder Rich Tarrant sits on its board.

Philips turns in weak Q4 numbers, mostly due to weak TV sales. Healthcare did OK, with earnings beating estimates slightly and up 15.5% from a year ago.

I ran across LifeBot, which offers telehealth and EMS applications, including its DREAMS ambulance telemedicine system developed with the US military, Texas A&M, and UTHealth (the program is led by world famous trauma surgeon Dr. Red Duke).

In Victoria, Australia, the overdue and over-budget HealthSMART project, which offers Cerner Millennium as its cornerstone clinical system, is rumored to be facing cancellation.

E-mail me.

HERtalk by Inga

From Evan Steele: “Re: Meaningful Use IQ Quiz. I thought you would find these stats on the quiz interesting. Before Mr. H mentioned the quiz on HIStalk January 21st, 692 people had taken it and the average score was 56.9%. After the mention, we had a surge of 164 quiz takers and the average score was 57.3%. Most of my blog readers are from the ambulatory side and I’d imagine that HIStalk readers are more from the hospital / CIO side. The conclusion is that the meaningful use knowledge of the ambulatory and acute folks is about the same.” Quiz here, if you haven’t seen it. If you care to annoy Mr. H, ask him to share my my MU IQ score.

From Svelte Dude”: “Re: Phreesia. Will name a longtime Allscripts/Misys director as VP of sales to run its patient check-in business.”

Clairvia says numerous academic medical centers have recently selected its Physician Scheduler, including Children’s Hospital of Philadelphia, the University of California Health System, and University of Utah Health Care.

UMass Memorial Health Care deploys Merge’s iConnect Access imaging distribution solution, giving affiliated physicians the ability to view medical images from their EHR.

Vermont Blueprint for Health signs an agreement with Covisint for its DocSite solution. Meanwhile, the Greater Tulsa Health Access Network selects Covisint’s ExchangeLink for its HIE infrastructure.

DiagnosisOne partners with ACS to deliver clinical decision support and lab data management solutions to ACS’ pharmacy benefits management and HIE solutions.

TeleHealth Services names Joel Harris VP of corporate development, tasked with identifying and evaluating potential M&A targets and managing product strategy. He’s a former senior director for Pfizer and spent eight years as TeleHealth’s VP of operations.

CCHIT grants ONC-ATCB 2011/2012 to Beth Israel Deaconess Medical Center (MA) under CCHIT’s new EHR Alternative Certification for Hospitals (EACH) program. The EACH program provides testing and certification for hospitals with self-developed software.

St. Joseph Medical Center (MD) selects ProVation MD software for gastroenterology procedure documentation and coding.

MedVentive president Nancy J. Ham joins the board of directors of NxStage Medical, a manufacturer of dialysis products.

Saint Francis Medical Center (NE) implements Interbit Data’s NetDelivery Integration Module, giving it the ability to transfer Meditech lab results to physicians’ EMRs.

The University of Louisville Physicians (KY) will roll out EHR to over 500 healthcare professionals as of February 1. Allscripts, I believe.

By February, all ER physicians at DePaul Health Center (MO) will be using scribes for electronic medical documentation. Administrators hope to improve staff productivity as well as patient satisfaction. Apparently patients were “annoyed” that doctors were sharing their attention with a computer.

Doctors Hospital of Sarasota (FL) chooses EXTENSION’s Cisco and smart phone-integrated healthcare team communications solution.

The US Information Systems Engineering Command awards Harris Corporation a one-year, $10.6 million contract to upgrade the communications and IT networks at 23 US Army Medical Treatment facilities.

HHS Secretary Kathleen Sebelius reports that last year, the government’s healthcare fraud prevention and enforcement efforts led to the recovery of more than $4 billion. In addition, the government filed criminal charges in 488 cases involving 931 defendants, 726 of which were convicted.

Sebelius also announces that an unspecified amount of new grants will be available to help states implement health insurance exchanges.

United Memorial Medical Center (NY) will replace its legacy document management system with Perceptive Software’s ImageNow ECM solution.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• OCHIN, an REC and non-profit provider of HIT systems and services to community based clinics, announces plans to resell Allscripts EHR and PM to Oregon physicians.
• Orion Health names Christopher Ward SVP of global marketing. He’s the former chief marketing officer for GE’s Healthcare IT business.
• Greenville Hospital System University Medical Center (SC) goes live on Holon’s Central Order Entry Pharmacy medication order management solution, which will integrate with the hospital’s existing Siemen’s Med Administration Check system.
• South Florida Health Information Technology Regional Extension Center (SFREC) selects Greenway’s PrimeSUITE EHR.
• GetWellNetwork announces its 4th annual user conference, GetConnected2011, which will be held at the Gaylord National Hotel & Convention Center in National Harbor, MD.
• Dr. Cynthia Taylor, an affiliate with Norman Regional Health System, credits eClinicalWorks after being recognized as the first in the nation to receive a reimbursement check from CMS for demonstrating meaningful use.
• Divurgent is co-hosting a cocktail networking event with VAHIMSS during HIMSS in Orlando.
• NextGen partners with Allina Hospitals & Clinics to improve care coordination for physician practices in Minnesota and western Wisconsin.
• Speaking of NextGen, here’s a cool YouTube video highlighting knowledge-base management (KBM) and meaningful use (MU).
• Nuesoft unveils its new logo.
• Nuance introduces Swype and also Dragon Medical 11.
• Imprivata reports 38% growth in its total bookings compared to the same quarter last year, citing demand for its single sign-on and access management solutions.
• PatientKeeper 7.0 earns ONC-ATCB certification as an EHR Module for CPOE, privacy, and security criteria.
• Sunquest is demonstrating its ICE solution (Integrated Clinical Environment) and the new CoPath Plus anatomic pathology specimen labeling and tracking solution at the Arab Health Exhibition & Congress in Dubai this week. The company also announces that its LIS has earned ONC-ATCB certification as an EHR Module.
• AirStrip has a demo of its cardiology app running on an iPad.

EPtalk by Dr. Jayne

The January/February issue of Family Practice Management arrived to a multitude of inboxes last week. It’s time for their annual “Survey of User Satisfaction with EHR Systems” feature. I encourage my physician readers who are members of the American Academy of Family Physicians to complete the survey. Those of you who work with real, live family physicians, please encourage your physicians to do this. It runs through March 31 and can be completed online, or alternatively, they will accept it by fax.

Historically the EHR I use in practice hasn’t done very well on this survey, but the number of respondents for the vendor has been low. Hopefully more people will participate this year. I do think it’s a good system and I’m tired of certain cranky physicians citing the results with their miniscule “n” number as the holy grail of EHR satisfaction data. Besides, they’re giving away an iPad and some other goodies, so it’s worth the five minutes it takes for family docs to register their opinions.

The same issue also has a timely (and physician-friendly) article, “Should Your Practice Participate in a Quality-Reporting Program?” This is a nice summary of how practices are handling four available quality reporting programs (including PQRI, now known as PQRS – what is up with that anyway? Did we not have enough acronyms? Or were they tired of people calling it PICK-ree?)

It looks at the costs of these programs, including staffing, data mining, etc. It should be required reading for anyone in healthcare that thinks Meaningful Use and other programs are just giving away free money. The data is surprising — several of the programs had potential costs that outweighed the financial incentives. Costs per full-time provider ranged from $133 to $11,100 during implementation. (Yes, that’s eleven thousand.)

Thanks to my FP buddies who always make sure I see these articles. I’m always interested in these types of articles in other specialty journals, so feel free to send them my way.

Dear Dr. Jayne,

What is most interesting to me is your IT education… or are you one of those quick learners who likes IT and learned on the job?

The IT Cowboy

Dear IT Cowboy (and I do love cowboys),

Like many other CMIOs, I fall into the quick learner category. Many of us who have been in this role for a while fell into it gradually rather than having a formal education. My medical school had a top-notch informatics expert who was a major influence. Plus, he had a really fun fourth-year elective that didn’t involve actual patient care, which was good for those of us who needed a break from the pleasures of the local psychiatric hospital and being tormented by burned-out residents.

My knowledge of non-clinical IT systems stems from an apparent affinity for “IT guys.” This is how badly medical training warps you — your life is so chaotic that you think someone who does critical systems support has a normal lifestyle. I’m probably the only physician you know who has ever been to the NOC on a date or been out with someone who was wearing more pagers than she was. (Thank goodness for the BlackBerry – so much more chic than the whole Batman Utility Belt pager ensemble.)

Like Anakin Skywalker, I was slowly drawn to the Dark Side. I decided I needed additional education if I was going to live up to the “I” in the title, and after thinking about how much medical knowledge I received in school vs. “the trenches”, I decided to take the hands-on route. I’ve bought many a beer while slowly extracting mounds of knowledge from IT staffers late into the night. I’ve bribed analysts to help me understand what’s going on in the code. I read scads of articles and IT publications and frankly, some of the words that come out of my mouth these days scare me. I’m talking things of the four-letter variety: DHCP, ODBC, ISDN, VLAN, CCOW, LEAP, and many more.

I’ve also learned a lot from vendors, especially working with development teams on creating clinical content. It’s given me a peek under the hood to better understand the limitations of the software so that I can better help my physicians prepare for impacts on patient care as well as to give useful real-world feedback to the vendor. Understanding the underbelly of EHRs gives me more credibility with vendor teams – I’m not just another doc crying wolf, I’m someone they can partner with to fix the issue. (Running my own mini-development shop for certain applications is also helpful — I understand the constraints of release cycles, testing, packaging, distribution, etc.)

There you have it, my IT education in a nutshell. I do hope we’ll be seeing you at HIMSS. Maybe I should ask Inga if she’d be offended if I had a “Dr. Jayne Loves My Boots” award. Wranglers optional, but preferred.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or which specialists are the nastiest? E-mail Dr. Jayne.

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