Monday Morning Update 1/24/11

From Tom Paine: “Re: reader comments. I appreciate that you don’t seem to censor.” Here’s where I’m torn: all those anti-technology, axe-grinding comments you see posted under a variety of names are coming from the same 1-2 trolls from Pittsburgh hospitals, sometimes posting as a doctor or nurse, who can be counted on like a fine Swiss watch to clog up every post with easily recognizable anti-HIT comments (software is dangerous, experimental, a government conspiracy, etc.) It’s not their argument that I mind, it’s the attempt to make their monotonic mantra look like a populist groundswell by near-constant posting. I resent the dishonesty and I sometimes delete their comments when I’ve had enough, especially when they start pestering Jayne or Inga.

From Linus Pauling: “Re: Epic. Support is going downhill fast with lots of defections and new customers. Look for KLAS scores to be affected. Hospitals are not happy getting a main contact who’s a 21-year-old straight out of college with an economics degree.” Unverified.

From The PACS Designer: “Re: Stage 1 Meaningful Use. CIO John Halamka and Robin Raiford of Allscripts have given us a handy matrix that defines the numerator and denominator required to measure compliance for the rules to achieve the minimum objectives for payment in Meaningful Use Stage 1. Here’s a link to the NIST testing site for MU validation.”

From Ulysses S. Federal Grant: “Re: salespeople on commission. eClinicalWorks does not pay commissions, either.” I like that approach. To do otherwise is to provide incentives for the wrong outcome, like most of medicine in paying for procedures instead of results: commissioned salespeople make more money for enticing someone to sign a deal and then moving quickly on to the next prospect no matter what the outcome. It’s not surprising that salespeople will promise almost anything knowing that they’ll make hundreds of thousands of dollars for getting someone to sign on the line which is dotted, even if it’s not necessarily in that prospect’s best interest to do so.

From Daryle Harmonica: “Re: EMRs. An meta-analysis study in PLOS Medicine (the open-access equivalent of NEJM) comes to the usual conclusions – the evidence of EMR benefits is lacking. Their methods sound pretty rigorous.” For those who don’t know, a meta-analysis is a study of studies, combining their results in a statistical way to reach a broad and possibly new conclusion. This one finds that, despite the theoretical benefits of digital technologies in healthcare, nobody has proven that they are risk free and cost effective, and recommends that technologies should be evaluated against a consistent set of measures throughout their life cycles to make sure they are providing benefit. I like that idea – hospitals rarely evaluate their clinical system projects at all and almost never publish the results when they do, but even if they did, the results wouldn’t be extensible because everybody is measuring differently. Maybe that’s something that ONC or FDA should do – come up with a standard set of clinical system quality metrics (uptime, user satisfaction, system-related clinical errors, etc.) and require annual centralized reporting that’s open for public scrutiny. The study also found that almost all published success came from big academic medical centers, but I would speculate that’s because community hospitals don’t write nearly as many articles as the publish-or-perish ivory tower types living off federal grant money.

From Uncle Fester: “Re: LSS. Lost in the Meditech acquisition news is that LSS’s C/S 5.6 product earned certification.” I didn’t realize that they have the exact same releases as Meditech, so LSS has certification for its MAGIC and C/S lines, with 6.0 next up.

From Buck S. Pearl: “Re: West Virginia Health Information Network. Moving ahead with Thomson Reuters as the prime contractor in their five-year HIE deployment. The company is involved in projects in NC and SC.” Unverified.

From Sgt. Schultz: “Re: Epic. I know nothing more than this except they have a product called SeeMyChart.” Epic files suit against Altos Solutions for trademark infringement. SeeMyChart is a patient portal into the company’s OncoEMR oncology EMR. I don’t know which product came first or who owns which trademark, but if it was Epic’s, I can see why they would claim the potential for market confusion.

From Bill@$200/Hr: “Re: Kettering in Ohio. Rumor is their Epic install is floundering, looking at delaying their second go-live at their largest hospitals. Local talk is there’s a real crisis of leadership, surprising given the sheer number of consultants involved.” Unverified.

I’m a little surprised that 15% of regular HIMSS conference attendees said they won’t attend this year, according to my latest poll. They won’t be offset by the 8% who don’t usually go but who will make the trip to Orlando. If the turnstile count is down, you heard it here first (I’m pretty sure that won’t happen, though). New poll to your right: have you or your employer been affected by a shortage of experienced HIT workers? I’m just checking again.

Welcome to Clairvia, supporting HIStalk as a Platinum Sponsor. The Durham, NC company was built around the concept of Care Value Management, which emphasizes improving patient care, quality, and financial performance by measuring the care needs of individual patients and then assigning those patients the appropriate level of caregiver resources to ensure the best possible outcome. It’s like a 21st century version of traditional patient acuity and staff management systems, with its tools used directly by clinicians instead of bean counters and focusing on the patient instead of rigid, cost-based staffing models. The bottom line is that it helps hospitals tie together care models to outcomes and to the patient experience, ensuring that patients follow an optimal track from admission to discharge with appropriately assigned resources throughout (i.e., get them from the ED to the right unit quickly and have a defined plan to encourage their progress from the expensive ICU to lower acuity units). I interviewed Beth Pickard, the company’s president and CEO, in December, where she explains why prospects are interested: “Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell.” Thanks to Clairvia for supporting HIStalk.

Weird News Andy was sucker for this news. ED doctors treating a woman for a mild stroke and temporary paralysis determine the cause: a hickey that was administered too close to an artery by her overly amorous lover caused a blood clot. She was successfully treated with an anticoagulant. Said one of the doctors with what sounds like a nearly-creepy familiarity with the pathophysiology, “Because it was a love bite, there would be lots of suction.”

I’m always on the lookout for projects that would benefit the little guy in the industry (both providers and vendors). One that came to mind was to develop a freely accessible database of what major systems each hospital uses. Right now, the only folks who know are KLAS and HIMSS Analytics and they aren’t going to tell anyone who isn’t paying big bucks. It would be a pain to collect and update the information, but instead of doing all 6,000 hospitals, I was thinking most people would care only about the 1,200 or so hospitals greater than 200 beds. I have no idea how to go about doing this or whether it’s even something needed, but it seemed like a good idea when it came to me in the middle of the night. I’m open for input.

The Atlanta business paper profiles Digital Assent, which has developed an iPad-based physician office check-in application to replace the much-hated patient clipboard. I didn’t see it mention on the company’s site, but the article says it also displays ads.

Austin, TX-based rehab and hospice operator Harden Healthcare says it will spend $10 million a year over the next several years on IT, including a move to electronic medical records.

The coroner’s office in an Indiana county is taking more than three weeks to issue a death certificate. The culprit: a legally mandated death certificate application that the coroner says is hard to use.

GE’s Q4 numbers: revenue up 1% (the first growth in nine quarters), EPS up 33%. The UK-based GE Healthcare made a billion-dollar profit in Q4, with revenue up 8%. For the year, GE Healthcare took in $16.9 billion and made a profit of $2.7 billion.

A nurse fired by a Florida hospital for looking at the electronic medical records of Tiger Woods is suing the hospital. Health Central says it has evidence proving that the nurse looked at the records three times in 10 minutes, but the nurse says the hospital didn’t secure its computer system, allowing someone else to check out the records when he walked away.

Beth Israel Deaconess Medical Center will buy out the remaining two years of outgoing CEO Paul Levy’s contract, giving him $1.6 million in severance for what continues to be portrayed as a voluntary resignation.

Odd lawsuit: the wife of an Air Force officer files suit against a VA hospital when an Air Force surgeon inserts 270 ml breast implants because the hospital was out of the 300 ml ones she wanted. According to the lawsuit, “Mrs. Haden was extremely disappointed by the size of her breast implants.”

Sponsor Updates

• AHA extends an exclusive endorsement to CareTech Solutions for data center hosting services.
• Overlake Hospital Medical Center (WA) will implement the full Medicity suite, including MediTrust Cloud Services, ProAccess Community, and the Novo Grid.

Epic Sales

Readers sent in quite a few thoughts about the Epic salespeople and sales process. Here are some of those that I found interesting.

• Epic has 6-7 salespeople, all of them women (the reader provided their names).
• Despite company growth, the sales team hasn’t gotten much bigger.
• Almost nobody knows an Epic sales rep, current or former. Even sales recruiters have never spoken to one.
• All salespeople are required to have done installation work at Epic. Epic does not direct hire people into sales.
• Epic does not do traditional marketing. They focus only on a few conferences and don’t run billboards, sponsorships, or ads.
• Salespeople do not earn commissions, although their performance is taken into account at appraisal time for raises and bonuses.
• CEO Judy Faulkner steps in herself for the big prospects or if it looks like Epic will lose the deal.
• Some folks have been forced out. They call it “flying too close to the sun,” with the sun being Judy.
• The job of the salesperson is less about selling and more about managing the process. Epic has separate teams for RFPs and demos, a legal team for negotiations, and budget/pricing teams for managing the implementation timelines and budgets. If sales needs help from anyone in Epic, that person is expect to drop everything and go to a customer meeting or do whatever is needed.
• Those PMs serve as product experts along with clinicians and developers, with much of their role being to demonstrate the philosophy and culture, not to be salespeople with a passing interest in getting a contract signed.
• The entire company makes the sale, not the salesperson. Customers get good implementation support, an individually assigned technical service rep, and a “customer happiness” rep who will escalate any concerns.
• Until 2009, Epic was making just 10-15 new sales a year and many of those were just for ambulatory or inpatient alone, but the percentage of enterprise sales has increased each year. In 2010, they supposedly made around 40 new sales (some of them listed below).

Reader-Reported New Epic Sales for 2010
Johns Hopkins
Catholic Health Services of Long Island
New Hanover Regional Medical Center
Ochsner
Moses Cone
Bronson
St. Joseph Michigan – Lakeland
Martin Memorial
Idaho – St. Luke’s
US Coast Guard
Provena
Aurora
University of Mississippi Medical Center
JPS Health Network
SUNY Upstate Medical University
LSU Health
Rochester General
ProHealth Care
Owensboro
Rockford
Sansum
Access Community Health Network
Bassett Healthcare
Stormont-Vail Health Care
Hurley Medical Center
Temple University Health System
Amphia Hospital (Netherlands)
Memorial Healthcare System
Orange Regional Medical Center
Tampa General Hospital
Wenatchee Valley Medical Center

HIStalkapalooza

The HIStalkapalooza page is live. It works a little differently this year to be fairer to attendees. Your signup gets you on the “I want to come” list. We’ll follow up with an official e-mail invitation to those we can accommodate, assuming there are more people interested than we have capacity (and if not, great, everybody will get an e-mail invitation). Signing up alone doesn’t guarantee a spot, just to be clear. I did it this way to allow a wider variety of people (especially providers in the trenches) to come since some big vendors were having a secretary sign up their entire HIMSS booth team of dozens of people, taking away spots that some poor programmer or nurse who didn’t pounce immediately lost as a result.

HIStalkapalooza is sponsored by Medicomp Systems, makers of such EMR tools as the MEDCIN clinical knowledge engine, the CliniTalk voice-to-data physician documentation system, and a new offering or two that I’ll be talking about later. I’m really impressed with their commitment to providing you with a good time at HIStalkapalooza. They have had first-rate planners (people who have worked on Hollywood award shows!), PR folks, and others who have put a lot of time and energy into making HIStalkapalooza an event that I think will be the talk of HIMSS. They totally get HIStalk and have been phenomenal in running with whatever harebrained ideas I came up with to make it fun and wildly different from the usual marketing-heavy, button-down HIMSS events. Thanks to Medicomp and particularly COO Dave Lareau for supporting the readers of HIStalk by producing HIStalkapalooza.

Just to reflect for a moment, as a hospital employee with limited time and resources, I couldn’t have done any of this without Medicomp (and kudos to event sponsors from prior years as well, Encore Health Resources and Ingenix, who also threw great parties). It’s amazing to see how the event has grown and to see how many companies want to sponsor it, especially since I insist that it be about the attendees and not the sponsors (no commercial pitches, no giant sponsor signs or booths, I control the agenda and approve all decisions, etc.) That’s a pretty big commitment for a company, especially knowing that most of the attendees will probably be from vendors, many of which are their competitors. I truly appreciate the support of both Medicomp and those who attend. For a  guy toiling anonymously and alone on HIStalk the other 364 days a year, it’s a little overwhelming to see it in person.

So what’s happening at HIStalkapalooza? It’s at BB King’s Blues Club at Pointe Orlando, just a few hundred yards up the street from the convention center, on Monday, February 21 from 6:30 until 11:30 p.m. Medicomp has bought out the entire facility (it’s pretty big), so it will just be HIStalkers there. There will be an open bar, IngaTinis, great food, a red carpet entrance, and professional videographers documenting the event so I can run some video here later for those who can’t make it (and stream it live to a huge on-stage screen for folks already in the venue to watch).

This is amazing: Inga and I desperately wanted athenahealth CEO Jonathan Bush to emcee the HISsies awards again (those of you who went last year understand why), but he couldn’t make it because he had scheduled a family vacation around his kids’ school break. Shockingly, he wanted to be with you HIStalk readers so badly that he rescheduled his vacation, so he’ll be chewing the scenery again and I can’t wait to hear what comes out of his mouth. We’ll also have an expanded line of beauty queen sashes since both men and women love wearing them. Inga has twisted my arm to shell out cash for some swell prizes for Best Shoes and HIStalk King and Queen (overall fashion and look, since Inga’s into that sort of thing, and as a guy I’m not entirely against having fashioned-up ladies around). We may have some special recognition for practicing doctors in attendance.

And for your HIStalkapalooza entertainment .. The Insomniacs, the award-winning, crowd-inciting, high-energy Left Coast Blues band from Portland, OR, which Medicomp is bringing all the way down to Orlando just for our event. Sample tunes here. A real band at a real music venue with a real stage and a dance floor … that doesn’t happen often at HIMSS. This is a full-length concert and the bar will be open throughout. I’m pretty sure that’s a formula for a good time to be had by all.

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