From KR: “Re: HIStalkapalooza. Let me be the first – this event has to be the highlight of the week! The awards, by Bush, were absolutely fantastic. Could not have hard a better MC. Thanks so much for a great event!” You knew it was going to be good if you watched JB waiting to go on – he was like a horse that couldn’t wait to run a race (if horses drank beer beforehand, that is). He was amazing, although he may cringe when he sees his words played back from the multi-camera video recording that was being made.

From Bobby Orr: “Re: HIStalkapalooza. Great time, big fan a good blues band, thank you. Largest  HIMSS ever over 30K attendees, but only about 9k providers is what I understood but I’ll leave that to the HIStalk  team to confirm the numbers.” They said 31K in the opening session, but I bet most weren’t providers. We’ll try to get specifics.

From West Coast Viewer: “Re: CHW. Ben Williams, CIO at CHW, has resigned, effective 4/15/2011.” Unverified.

From Rodgrigo Barnes: “Re: Pennsylvania Health Information Exchange. Medicity contract cancelled.” Unverified. I need to get clarification from Medicity, but the purported e-mail suggests that the state didn’t like PHIX’s strategic plan or its selection of Medicity, which the e-mail said AT&T protested. Also claimed is that the contract value was about was $31.7 million, only $17.1 million of which would be be covered by federal taxpayer dollars. I’ll get more information. It sounded like budget was the big problem.

From VIP CIO: “Re: VIPs. I had the same reaction as you to the article about ‘VIP Treatment.’ The first rule of being an executive is to appear to be getting less special treatment than you are actually getting. I am e-mailing you from the VIP lounge at HIMSS. It is pretty simple, but in the mad house that is HIMSS, it is a great perk. While the lines at the coffee vendor stands are 40 people long, I was able to come in and get a free cup of hot coffee in a china mug. There is soda on ice and water, too. There are nine tables and four workstations with Internet-connected computers and printers. It is kind of quiet, people are avoiding eye contact. One more thing — ribbons are for people that lack self-esteem. I agree CMIOs are major players, but they don’t need a ribbon to prove it. If they want recognition they can carry their medical degree. Nobody in the lounge is wearing a ribbon. Again, we know that it is not good to call attention to our special treatment. Gotta go, the massage therapist is here (just kidding).” I’m a little bit miffed – I pay the same dues and conference registration fees as CIOs, so why am I an inferior HIMSS member who doesn’t get the same perks?  

Thanks to everybody who came to HIStalkapalooza. Thanks, too, to Dave Lareau and Medicomp, their events and video people, BB King’s, the Insomniacs, our red carpet greeters, our shoe and King/Queen contestants, and Jonathan Bush.  I left early and will be up late, as usual, but everybody seemed to be having fun. Personally, I found JB’s beer-fueled riffs to be the funniest thing I’ve heard in a long time – better than MS3TK. Since I’m writing this after several beers, please forgive any slip-ups. I bet nobody else left the event to work several more hours — that’s my excuse.

The limo will run 9 a.m until noon or so Tuesday, cruising around I-Drive. Flag it down and get a luxury ride to the convention center. I’ve ridden in it a couple of times now and it was pretty cool. That’s the very sweet Jan above who was driving today, although I’m not sure we’ll have her again tomorrow.

Medicomp gave away iPads with its new Quippe product to physicians attending HIStalkapalooza. Drop by their booth Tuesday and take a 20-minute training session and you’re in drawing for several more (both physicians and non-physicians will be chosen). I didn’t explain it well, but just stop by and they’ll fill you in.

I’m going to save all the news and other items since it’s getting really late. Here are some random observations from the day, most of them about booths.

• I got nothing from the opening session. I didn’t thing the videos and a capella guys were all that interesting. Robert Reich was too basic and to general to hold my attention. I’m sure he’s really smart, but his talk seemed dumbed down for people who pay zero attention to economics and politics. Not much healthcare in it, either, although obviously Medicare expenses can’t keep rising and he said so.
• Actually, I did get one thing from the opening session: frostbite. My teeth were chattering afterward and every room I was in was just as cold. Floridians crank that AC down for sure.
• I went to two other sessions. Both were terrible. I didn’t learn anything after sitting in sessions all morning.
• The Onyx people had a pretty cool booth, with the ladies wearing red dresses and one wearing a Cinderella-looking outfit. I don’t get it, but it was cute.
• Ingenix had a huge booth with the logos of their acquisitions on the sign – Picis, Axolotl, Lynx Medical, A-Life Medical, HER, and Ingenix Consulting.
• MEDSEEK had a nice two-story model with a guy from The Apprentice doing something or other.
• iMDsoft had sleek version with lots of coffee urns.
• A couple of the Salar guys gave me a booth pitch not knowing who I was. They did a great job, which smaller companies often don’t – they had their story down pat, talked benefits instead of features, and referenced client sites.
• OnBase had its usual sports bar and that smarmy but funny card trick guy, neither changed in the last decade, it seems, but still cool.
• Walden University had a Kinect soccer game where you could try to kick goals over animated opponents.
• Nuvon had oranges as giveaways and a couple of other vendors had apples. Good idea for a health-oriented conference.
• Unity Medical had cool “cones of silence” that looked like old-fashioned hair dryers, which allowed people standing under them to hear the audio from their videos even with exhibit hall noise. They provide instructional and motivational health videos that seemed pretty cool.
• Sage used a red color as a theme quite effectively.
• Awarepoint did a good pitch when I dropped by anonymously. The guy qualified my interest and need very quickly, then gave some good examples of similar deployments. Nicely done for just a casual chat that I didn’t even ask for.
• EDIMS – had a nice setup and a big presence for a mid-sized booth.
• Allscripts had a massive spread using their new green color. Looked good.
• Emdeon had pretty cool orange shirts and a café table setup. They were talking health information exchange.
• Medicomp had their HIStalk sign front and center. They also had a two-sided theater, one playing a recorded demo and the other live.
• Elsevier had a water cooler, something simple that you don’t often see.
• InSite One had an incrementing counter of studies and images done.
• MEDecision had some cool light-up panels and a real Starbucks setup.
• ESD had the most unusual items – flip flops, fondue, and wheatgrass. Nice people, too. I think they may have been the most creative with the space they had.
• Epic put out signs covering their KLAS scores. The lovely Maggie noticed me checking them out, told me that was her job to publicize their scores, and ran back to get me a handout of every sign on their booth walls. Obviously their KLAS scores are shockingly good, lots of green in a sea of competitor yellow and red, but the fact she was so attentive and tasked with managing their score displays impressed me. They still had the fireplace, the wacky art, and Judy hanging out. They also had a sign for Canto, an iPad-based physician dashboard with dictation and messaging (new, I think).
• Nuance had a theater presentation about the new CAPD product built with 3M.
• Enovate had its usual carts, wall mounts, and articulated arms. Very sexy and smooth. Nice people, too.
• Somebody had mini Moon Pies, but my writing is too sloppy to decipher who (looks like Med Worth, but it could be anything).
• Rubbermaid had a cool water cascade right in the middle of their booth.
• Merge had a bunch of cool stuff – kiosks, the Tesla car that you could get your picture taken in, a wall of candy, and video games.
• Clairvia had coffee, a nice demo area, and their HIStalk sign on the table.
• Airwatch had cool management tools for mobile devices like IT shops use for PCs, allowing iPads, iPhones, and any devices to be secured, updated, and managed. They’re new to healthcare, but other clients include Walmart and Coke. This was one of the more interesting things I saw. I talked to the co-founder and he definitely had his pitch down pat.
• GetWellNetwork had their peds application running – very colorful and fun for education and applications.
• IBM had a ton of people visiting their booth. They were pushing the Watson connection.
• Microsoft also had a lot of people, demoing Vergence, HealthVault, and some other stuff. Their signs spelled HIMSS  as HIMMS, though.
• Vocera had our sign out. They also did a nice demo for me on the fly, under their own version of the cone of silence to allow you to hear the device talking.
• CattailsMD was giving away some kind of Buzz Lightyear action figure.
• AT&T had loads of people. I looked at Connect, a learning portal that also streams video. The coolest part is that the tool auto-indexes the audio track of a video, allowing it to be searched by any word without a transcription or manual keyword step. I didn’t know technology like that existed. You’d think YouTube would have it given that it’s owned by Google
• Perceptive had our sign out and was demoing their imaging application.
• Advisory Board had a big booth, ironically just two booths down from that of HIMSS Analytics where Dave Garets left to go there.
• PatientKeeper had a big rack of mobile devices and an effective slogan, “Reinventing CPOE.” Lots of people were checking it out.
• e-MDs had our sign out – thanks!
• Vitalz had a race car simulator.
• SIS used color extremely well, dressing their female booth people in light blue sweaters and the guys in blue Oxford shirts, both making the red and white SIS logo really stand out. They also had very cool theater chairs in the same red. Best use of color for sure.
• Wolters Kluwer had a golf simulator.
• Sunquest had a large booth with that green color that I really like. Thanks for the Chapstick – I needed some.
• McKesson’s spread was huge. It also had a giant electric billboard. There was nothing muted about the color or the design.
• Siemens had a booth that needed its own ZIP code. The wall of lights must have been 20 feet tall.
• Medicity had a nice crowd and an HIStalk sign right on their main podium.
• RelWare had the Back to the Future DeLorean, accepting donations for Team Fox.
• Cumberland Consulting Group had our sign out. They were way down on the end in the 6900 row.
• SourceCorp was giving away small wooden baseball bats.
• MobileMD had a foot massage machine. They also talked about their 100% “would recommend” HIE solution.
• Orchestrate Healthcare had some cool yellow colors, including fresh flowers and bags. They also had our sign front and center.
• Lockheed Martin had a huge liquid nitrogen tank that was pretty scary to behold. I think (and hope) they were doing something with ice cream.
• Billian’s had our sign out and was giving out flash drives, the only ones I saw.
• RelayHealth’s booth was lit up in pink and each demo station was surrounded by shimmering curtains. I might give them the Best Design award. They had a lot of people checking them out.
• Alert had a long booth that was kind of confusing, but they did have cute white outfits and were demoing in some language that wasn’t English. I thought it was interesting
• Pulse had a nice booth and a card guy.
• Pepid had the first guy I’ve ever seen doing a theater presentation who read directly from index cards and didn’t even try to hide that fact.
• Chipsoft had the cute yellow shoes again.
• HCA had a booth to recruit people in informatics, pharmacy, Meaningful Use, and Meditech.
• HT Systems (the palm reader people) was one of the companies in the New and Emerging Technologies section, with stand-up areas instead of full booths. Check that area out since those are the up-and-comers everyone says they want to support. Also there was My Health Direct. Both companies had their HIStalk signs out.
• ONC had a sizeable booth. They were giving away money (kidding).
• MED3OOO had a couple of really cool giveaways – little preloaded bubblegum machines and a nice computer cleaner with one gadget for the screen and another for the keyboard.
• Success EHR had the nicest people I ran across, two cute girls making fresh popcorn.
• MedAssurant was making fancy coffee like café con leche and café cubano.

That’s all I have time for tonight. Back at it tomorrow. Hopefully folks will send me pictures from HIStalkapalooza since I didn’t bring a camera. I believe Medicomp was planning to have video from tonight running in their booth Tuesday, so drop by.  

E-mail me.

HERtalk by Inga

Just a super quick post before I start my beauty regime for HIStalkapalooza!

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A couple of pics of the nicely presented food at the reception last night. It’s hard to cook for 20,000, but I guess it was tasty enough.The best part of the evening: hanging out with Mr. H and critiquing the whole affair. I then joined some friends for one glass of wine (the glass never went empty, so I am assuming it was only one glass). Regardless, I made it to bed probably too late, but was up at 6:00 a.m. and in time for my painfully early 7:00 a.m. breakfast. Fortunately I arrived in style in the HIStalk limo, the interior of which is probably bigger than the bathroom in my budget hotel.

I’ll provide more details on my day tomorrow, but wanted to share some additional photos from the day.

He wins. ‘Nuff said.

I am guessing that she was concerned she wouldn’t have time to change clothes before the party tonight, so she wore her gown to the booth. Sorry I don’t remember the vendor, but the girls were good sports.

A little business meeting with the HIStalk sponsor sign prominently displayed. Thanks, iMDSoft.

Merge bought me lunch.

I thought the skirt was a wee short, but this guy thought it was worth looking at more than once.

I sat on the floor for awhile recharging my phone. What’s up with the official “recharging stations” having no power connected to them? I did find that by sitting on the floor I was nicely positioned to check out shoe fashions.

Much, much more later, including HIT X 2.0, commentary on exhibits and vendors, and some gossip. Look for big announcements probably tomorrow from Microsoft, Cisco, and perhaps Gateway EDI.

E-mail Inga.

EPtalk by Dr. Jayne

I was dying to post pictures today, but with my employer locking down my Facebook, it was difficult.  Inga beat me to the knight in shining armor, but be on the lookout for lots of other photos as she and I cruised the exhibit hall together.  Let me tell you, we saw some prime photo opportunities.

My goal today was to visit all of HIStalk’s sponsors.  I didn’t make it everywhere, but I did make it to quite a few.

A couple of shout outs:

• Iatric Systems (3601) is offering a special drawing for HIStalk readers, but also has a guy shooting trick pool shots.  Pretty entertaining!
• Enterprise Software Deployment (2777) not only has a special reader drawing, but also was giving away flip flops and sports sandals and had fondue in the booth.  Perfect for a mid-day pick-me-up!

Keep your eye out for the autographed (by Mr. H and Inga) signs alerting you to vendors who are HIStalk sponsors.  Be sure to tell them you read HIStalk.  Maybe next year I’ll get here early enough to put my physician-esque scrawl on some of them.

I said I’d be visiting Merge Healthcare to check out their kiosk solution, and was happy to find their Wall of Candy as well as a nice demo of their product.  I was a little concerned by the sales rep scanning her own drivers’ license and swiping a credit card, but I guess they can control where it goes.  I wonder, though, does the kiosk come in hot pink or zebra stripe?  They also have video games, including Big Buck Hunter.  Good for a break when you’re tired of walking the floor.

I visited Surgical Information Systems and was pleased to see that this year, not only were they serving the IngaTini but also the InterOpTini which is more my speed.  They also had chocolate covered everything, and I am the kind of girl that appreciates that.  Thanks again for the hospitality!

FormFast has a great Indiana Jones “Peril of the Untamed Workflow” theme and was throwing fedoras into the audience, but I wasn’t lucky enough to get one.

The “Best Badge” award goes to the attendee who replaced his first name with “Talk To Me” in bold letters.  I didn’t fully appreciate the value of that badge until I was given the brush off by a couple of vendors. 

News flash – you might want to find out a bit about the prospects that stop by so that you can make an educated pitch to them.  And if you can’t answer the questions, find someone in your booth who can, or schedule a follow up.  Trying to “fake it” is just really a bad idea and we can tell.

I enjoyed seeing so many members of the armed forces at HIMSS11 today and wanted to take the opportunity to thank all of you for your service to our country and around the world.  We appreciate each and every one of you and the excellent healthcare you provide to our troops and their families.  Seeing you puts everything in perspective and is an excellent reminder for those of us that tend to get focused on what in comparison are some fairly petty issues.  We’re not trying to keep systems up while caring for wounded on the battlefield or anything like that, and you deserve our utmost respect.

The big ticket of the day was of course HIStalkapalooza, and major thanks to Medicomp for their support.  It was a great bash and certainly one to remember. Thanks to my many new friends, especially Evan – your velvet jacket made my night.

E-mail Dr. Jayne.

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The weatherman calls for no snow today. Oh wait, HIMSS isn’t in Chicago this year – happily since it’s 35 degrees there but in the mid-70s in Orlando as I write this Sunday. I got out for a nice walk Sunday morning and it was perfect – green grass, swaying palms, colorful flowers, and egrets strutting around the fake water features and tacky tourist shops.

HIMSS is on the old side of the convention center again this year after being one of the first to use the new side when it opened a few years back. I think the old side is actually better, or at least I saw no drawbacks as I looked it over Sunday morning. it’s a pretty easy walk to the convention center form any of the I-Drive hotels between Sand Lake Road and Westwood Drive, as sidewalks are wide and crossings well laid out. 

Just a reminder: I hired a limo to cruise up and down I-Drive Monday and Tuesday mornings, so if you want a ride to the Convention Center, flag down the car with the HIStalk logo on the side and it will drop you off (sorry, the bar is not stocked – maybe next time when I book the one with the neon, massive sound system, and stripper pole). 

Badge pickup was easier than ever. HIMSS had e-mailed a barcode and you just waved it under the imager and out came your badge. I guess it was embarrassing for such a pro-automation organization like HIMSS to be running a conferenced on paper handouts, packaged symposia CDs, and forms.

I was happy to find that the convention center still has free WiFi, although it will probably be iffy once the whole world piles on it Monday morning. I saw plenty of food stand options and a good amount of seating in those areas (there’s never enough, but Orlando isn’t one of the convention centers that has almost none). The HIMSS people were zipping along at alarming speeds down the hallways on Segway-type standing tricycles for no apparent reason.

It’s worth making time to don casual attire (you can buy hideous tourist shorts and tee shirts if you didn’t bring warm weather clothes) and hit the street for a stroll. The mini-golf places are doing good business and all the restaurants have their patios open, so if it’s not summer where you came from, it is here. They were almost all totally booked Sunday evening, with big groups using large tables and in some cases buying the restaurant out (like we’re doing for BB King’s Monday night).

I checked out Pointe Orlando and it’s infinitely better than it was a few years ago.  BB King’s looks very nice, like all the other restaurants in the complex. It’s an easy walk or very short cab ride from the convention center and the surrounding hotels. There’s a parking garage attached if you’re planning to drive to HIStalkapalooza (easy on those IngaTinis if so, which is why I mentioned walking).

I dropped by CIO Forum area at W330, which always has free food and other goodies that the non-decision making peons don’t get (or as today’s Healthcare IT News headline surprisingly said, “Senior execs get VIP treatment.”) They already know that and the rest of us don’t like to feel less than special, so maybe that article should have been tossed. The CIO agenda didn’t look all that interesting, but the room seemed full and I saw quite a few familiar faces.

Speaking of Healthcare IT News, which was never afraid to tread the feel-good, self-congratulatory side of HIT, it’s just as cheerleaderly now that it’s owned by HIMSS. I think I made the day of the girl handing them out by actually taking a copy, instead of doing like everybody else and body-Englishing away from her thrust-out copy or mumbling, “already got one.” The “news” part of its title could be debated based on what’s in this issue, especially when some of the articles are about some vendor’s exhibit or product and contain nary a discouraging word

There’s a little picture of David Blumenthal on the front page – honestly, has the man never had another picture taken than the cocked-head, slightly-smirky one that runs ever single time he’s mentioned? It actually appears at least three times in the same issue.

Two different people reacted separately to me about a well-known industry figure who I won’t name: “Man, that guy is weird.” I can’t say I’m shocked.

I saw Judy Faulkner walking around wearing a purple cast on her left arm. I felt sorry for her, not because of the cast, but she was like Brad Pitt trying to see a movie or get on a plane – people kept stopping her to introduce themselves or to pester her in some way.  

I saw some small vendor women dragging huge cases bigger than themselves. It must be a pain to set up the booths and then work the show. Somehow I don’t think HIMSS is a place where vendor people have a lot of fun.

This year’s sappy conference tagline: Linking People, Potential and Progress (I abhor the ever-so-trendy omission of the second comma – it makes it harder to read). They should have included the fourth, most-important P in the HIMSS vocabulary: politics. Once again all things Meaningful Use and taxpayer handouts dominate the conference. Do medical conferences obsess on Medicare payments?

The opening reception was no different than those from past years, other than drinks were unlimited (!!) and no tickets were required (thus squelching an entire secondary market for unused tickets). The drinks were cheap wine and horrible beer (Bud and two others that I’d rather not remember). There was the usual soulless cover band playing away in decoration-free room with an acoustics-killing concrete floor (insert my usual airplane hangar reference here) and allegedly ethnic foods that, while probably better than usual for the opening reception, were mostly harmless filler with no real distinguishing characteristics. Mostly it was a staging area for dinner.

HERtalk by Inga

It’s Sunday afternoon and my first half day of HIMSS is behind me. I sat in a few different sessions today, even though I wasn’t technically eligible to listen in on all of them. Fortunately HIMSS has cute college students assigned as doorkeepers. I just smiled at them, walked into room, and acted like I owned HIMSS.

Today’s highlight: Aneesh Chopra. OMG he is hot! He’s got a great face, but is also tall and lean. And as a speaker, he is dynamic and charismatic. I was ready to say “Hallelujah, I love technology!” just to see if he’d notice me. But I refrained myself. I also observed outside of the session and he is clearly the funnest- guy-in-the-room-type guy. Aneesh, if you would like an invite to HIStalkapalooza, drop me an e-mail. Better yet, just drop by the party and just tell them “Inga’s new heartthrob is here.”

I did actually listen to Aneesh, by the way. He and Farzad Mostashari (ONC Deputy) shot on how HITECH is driving innovation for the market. The soft-spoken Mostashari, poor thing, seems plenty smart and all, but Aneesh is a hard speaker to follow. Their presentation was geared to individuals that perhaps didn’t have a deep understanding of the current state of the HIT market and all the implications of HITECH. It was interesting enough, but I didn’t learn much new.

I had a Judy Faulkner sighting. She seems to be sporting a purple cast on her left wrist. Fell out of the tree house, perhaps?

I feel quite nerdy saying this, but I got all tickled each time I saw an HIT celebrity like Martin Harris, John Glaser, Ed Marx, Lynn Vogel, and Marc Probst.

Overheard: lots of ACO discussions. Based on the number of times ACOs were mentioned today (and I was not in an ACO-specific session) I think we’re going to hear a lot about accountable care organizations this week.

I am having serious iPad envy. Quite a number of people seem to have them in sessions and the units seem so small and easy to tote. I must go sign up for every single exhibit booth contest.

Also overheard: plenty of concerns about healthcare going bankrupt. Healthcare reform won’t be repealed because no one has anything better. Meanwhile, we are going to be in for some kind of serious hurt if we can’t figure out a way to control costs and improve quality. The musings aren’t necessarily original but are definitely prolific.

I am thrilled to be meeting up with Mr. H to go to the cocktail reception. Surprisingly I don’t think he and have even spoken on the phone, much less seen each other, since last HIMSS. So it is quite a treat to get to spend some time together critiquing the HIMSS experience. Then I must go to bed early tonight because tomorrow is going to be a long day before one long and exciting evening!

E-mail Inga.

EPtalk by Dr. Jayne

After another delightful trip on my favorite on-time airline, I have arrived at HIMSS11.  I daresay these flights are always a bit more entertaining and less annoying with a vodka/cranberry cocktail.  Although most airlines don’t have in-flight entertainment unless you’re flying cross country, we did have a bit of drama with two passengers being escorted off the plane before we even left the gate.

It seems like every year these events get busier and more over the top.  I can’t tell whether no one has noticed we’re in a recession or whether they’re just trying to stimulate the economy.  Although it’s been great comparing notes with Inga to make sure the fun parties are equitably distributed between the ladies of HIStalk, frankly putting my agenda together for the week has been a bit like preparing for an amphibious assault.

I’m traveling with my work BFF who commented, “I’m not sure we’re going to survive this trip.  I have visions of ‘The Hangover’…”  So if you see a sassy CMIO passed out in the convention hall, please find the nearest AED and follow the instructions when you open the cover.

I’m most interested in the physician-focused sessions, of course, but also those around interoperability and HIE.  I have an aggressive list of booths to visit – if you have a gadget that promises to make my physician world easier, more connected, or more fun, I will be stopping by –  so make sure you show the physician attendees some love, because you never know when you might actually be visited by Dr. Jayne or her crew.

Registration was smooth but I was disappointed by the lack of CMIO ribbons for my lanyard.  The opening reception seemed low key — reasonably good band and well-behaved attendees — but then again the week is early.  No dessert, though – and I am a chocolate girl – so we were forced out to the traffic of International Drive to hunt our prey.

The downside of the day was discovering that my hospital IT department figured out I had the Facebook app on my BlackBerry and blocked it, so there will be no updates from the convention floor unless an intrepid reader has ideas. I’d have a hard time calling and asking them to open it up.

I’m off to get my beauty rest so I can be at my best to walk the HIStalkapalooza red carpet Monday night.  I’m excited at the number of actual physicians on the list and can’t wait to see you all on the other side of the velvet rope!

Have a question about medical informatics, electronic medical records, or whether the paper on the exam table is really changed with each new patient? E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

From back in my days as a rock-n-roll sound engineer, I have always loved the set up/tear down times better than the actual show. Same goes for when we put on the “Pediatric Office of the Future” in the exhibit hall for the American Academy of Pediatrics’ annual conference; the behind-the-scenes stuff is so much more fun. At least, for me it is.

That’s why I finagled my way into the HIMSS exhibit hall floor today as all the vendors were still in their pre-show frenzy. The HIStalk press pass wasn’t powerful enough to open the exhibit hall doors until actual show time begins on Monday, so I had to do a little smooth-talking. (I’ve learned a thing or two about shows and how to … well, maybe I’ll get in less trouble if I just stop there.)

I sent Mr. H a few of the almost obligatory shots of the convention center and the gigundo HIMSS logo and signage now adorning the Orange County Convention Center (West Concourse.) I couldn’t help also including a few shots from the exhibit hall, like the one below:

It’s just a random shot down the main corridor, but if you’ve never seen the exhibit hall pre-show controlled chaos, well, your bucket list just isn’t complete.

You can’t see the madness here because they’re pretty far along in the set up process, but the frenzy of union crews and forklifts, rolling travel cases and hydraulic lifts, show folks and vendor reps all makes for one truly entertaining phenomenon. (Actually, tear-down is even more impressive because stuff just flies apart, into its assigned shipping containers, and then out the loading dock doors faster than you can say “accountable care organization.”)

Anyway, the show is huge as always, celebrating HIMSS 50th year (really?) and, so far, seems much better organized and technologically adept than any I’ve seen before. (The tech abilities of some conventions are weak, to say the least; HIMSS seems to be getting a good grip on the concept.) Yes, I may change my opinion of that once the busloads of people hit and the masses overwhelm the walkways and meeting rooms, but on this pre-show day, it all looks very well put together here in Orlando.

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Got to go to dinner last night with the good folks from Medicomp who are sponsoring this year’s already infamous HIStalkapalooza. I can say with 100% assuredness that if even a tenth of the event goes as they and Mr. H/Inga have planned, it’s going to go down in the annals of HIMSS history as one of the all-time great events ever. The team they’ve assembled is off-the-hook fun. The plans I’ve heard that Mr. H and Inga have set in motion are “memory book” material. I can’t wait. (I even brought my tux for Inga’s red carpet entrée!)

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There is just so much to see and to hear and to take in here. All the pre-HIMSS marketing almost dulled my sense of anticipation. (It’s just tooooo much.) But, here on the eve of show time, the news and the people and the techno-geekiness are starting to re-enliven my senses. I’m looking forward to the hoopla.

But, I have one last question for the pre-HIMSS Marketeers before I head off to the opening reception: just what the h*** is an “embargoed” press release? Really? Do marketing people actually think that labeling some PR shout out as “secret” will make press people think they’re getting in on some super special sneak preview?

E-mail Gregg.

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EHR Contracting Redux – Balance is Better

Hospitals and physician groups should review, research, and compare proposed vendor agreements during the EHR selection process. Too often, this critical step is left out of the selection process. Some prospects believe themselves to be too far down the road to back up and review their selection in light of unfavorable contract terms. Commencing review of contract terms after selection is extremely disadvantageous to the prospective customer.

Sometimes, however, it is not a factor of time or diligence, but rather market position, perception, or recognition that leads to the casual (non-diligent) review and treatment of a technology contract. For example, the small physician practice looking for EHR software may consider itself to be “mooing along with the other cattle," lining up for contracts and services from the EHR vendor selected by their affiliated hospital. They do not sweat over the EHR contract language because they assume the hospital and big practices have done the work, or if not, they are at least all in the same boat, which in my opinion is borderline negligent.

Next, some prospective customers do not raise important objections due to the “bigness” of the vendor involved. It is sad to agree that in many cases the little customer receives little attention. Important issues often get brushed aside with the somewhat careless, “We are too small to get concessions from the vendor” thought process.

Small HIT companies take similar risks in contract negotiations. They aren’t negotiating — they are jumping when the big prospect flexes. Some small-vendor executives courting the giant provider entities walk right over their poor sales folks’ backs on the way to the signing table, seemingly willing to sign anything asked of them.

Balance would be better. I’ve seen it too often when the big side does little or nothing contractually for the little side, yet cooperates when the other side is also a big player. Capitalism at its best? Survival of the fittest? Maybe so, but I dare to say that with the advent of HITECH and the injection of billions of dollars in reimbursement, this is not an absolute true free market at the present time. That’s OK, but from where I sit, the term “partnership” gets tossed around way too much without a corresponding balance in contract terms.

Commanding one of the most unusual perspectives in the HIT world through representation of hospitals, physician groups, and vendors, either directly or with select consulting firms, I find myself occasionally stepping back and taking a good hard look at the HIT acquisition process. This is one of those times.

Putting the above “Balance is Better” position into a practical example, let us consider the ever-popular “Limitation of Liability” language.

First, a quick lesson:

Indemnification (or “Hold Harmless”): This is when a party takes on legal / financial responsibility for a certain circumstance. For provider customers, determine what, if any, indemnifications are provided by your selected vendor (what they are agreeing to cover, or protect you from). Then determine what, if any, indemnifications the vendor requires from the customer (what they expect the customer to cover, or protect them from). Whichever side is providing the indemnification is legally on the hook for the costs if the circumstance comes to reality.

Limitation of Liability: Not the same as indemnification. Simply put, this is a declaration by a party that states, “I am not responsible for XYX.” Watch these carefully — VERY carefully. The heading for a contract section may read “Limitation of Liability” and include such limitations (often in ALL CAPS), but sometimes an indemnification of the vendor by the customer is also included, and as we all know, one of the things attorneys add at the end of a contract is a section titled “Headings not Controlling” (which to this day makes me chuckle … I sometimes ask to delete the title, which makes for an interesting conversation … but I digress).

Now, for the contract reviewer, look first at limitation of damages. Determine what the vendor disclaims. You will have no recourse from the vendor for these situations. Then look for indemnifications required from customer to vendor. These are critical, because it is not simply a matter of having no recourse, but rather an affirmative obligation that the customer is taking on. Finally, look for indemnifications from the vendor to the customer, which represent areas where the customer gains protection(s).

Prospective customers reviewing limitation of liability language will typically find an exclusion of all consequential, special, indirect, exemplary damages (think “over and above” the baseline direct damages). First question – is it mutual? If not, that is your first demand. Make the exclusion mutual. There is no reason not to request this. Fair is fair. There is also probably a limit on direct damages, which for perpetual licenses is usually the value of the contract, and for SaaS models, the value of one year of subscription fees.

If it were that simple we would be done, but it is not. Direct damages are fairly straightforward. It is the exceptions to the exclusion of all consequential damages that takes the time and expertise.

Carving out exceptions to the blanket disclaimer of consequential damages is part of the bargaining process. Arguably, whatever is good for one side should be considered for the other. The best example would be damages for a breach of confidentiality provisions, which the provider customer expects to be carved out from the disclaimer by vendor – meaning the vendor would be responsible for these damages.

Now here comes the balance part. The exclusion should then also be applied for customer’s breach of confidentiality regarding vendor’s material. Intentional acts or omissions and willful misconduct could collectively merit a mutual exclusion as well. Not all situations will be mutual however, and the best example would be damages for copyright / patent infringement, in which case the vendor should be willing to carve out an exception to the disclaimer on consequential damages.

In situations involving exceptions to disclaimers of consequential damages (which means where a party does agree it is responsible for these damages) it is important to note that intermediate levels of responsibility can be introduced. It does not have to be unlimited. Levels of applicable insurance coverage are often used as limits. This is all part of the negotiation process.

Once you have found all the limitations and indemnifications, map them out. Do the same for each vendor. Then compare. This should assist greatly in the selection process.

Projecting the total project cost is essential in any acquisition. It is critical that you note the potential additional costs (also known as risk) that you are taking on. This is an unavoidable exercise and enables IT leaders to make informed business decisions prior to executing the final agreement. Damages for which you may have no recourse and indemnifications for which you will be responsible are both critical components to risk assessment.

Now, if you’ve made it this far, here is your reward.

Amazingly, after a quick review of projects with which I have been involved over the past two years, I am stunned to report that the fairest (most balanced) contract terms regarding liability were those belonging to mid-sized HIT companies! Surprisingly, the very small companies and the behemoths act most alike in their attempts to disclaim most everything. The small because they have to, and the big because they can. Granted, this is by no means a comprehensive analysis of a majority of vendors in the industry, but it is an interesting slice.

What I think this means, to be philosophical about it, is that the medium companies have recently “made it.” They are very happy to be where they are and have not forgotten how they got there. They appreciate their position in the market and their balanced terms reflect their understanding and appreciation. Maybe I’m wrong, but it certainly made me feel good.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

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Edward R. Daihl is CEO of Surgical Information Systems of Alpharetta, GA.

Tell me about yourself and about SIS.

SIS was founded in 1996. We’re exclusively focused on the perioperative marketplace.

I joined the company in 2006 as a CEO, coming from various high-tech areas. My last couple of jobs were in the supply chain industry, CEO of a company called CAPS Logistics where we did everything from telling hotels where to put their new facilities to routing trucks for Walmart.

I’m proud of project we built that tracks wounded soldiers off the battlefield. We built a database that had 100% of all the transportation available to the military for taking patients to the hospitals and had 100% of the available beds and specialties by location and filled out a rule-based system for them. For example, if you had a broken back, you only landed once. We had soldiers that were landing up to three times with broken backs before they actually went into surgery before we built this system. I  got a lot of personal reward out of that.

I then had an opportunity to come and work at SIS as CEO and move into a healthcare field full time. I’ve enjoyed every minute of it.

Norwest Equity Partners acquired the company in January. Explain why one private equity firm would sell to another and how that affects the company and its customers.

Private equities usually have a goal of where they want to take the company. When they achieve that objective, they’re looking to move out. We had multiple strategic partners approach us unsolicited and ask to acquire SIS. We decided that we needed to do a formal process rather than just talking to one or two partners.

In that process, NEP decided to bid on the company and was the most aggressive bidder. What they saw was the potential to take us even further than it is today and keep us still laser-focused on the perioperative suite. They fully saw that 60% to 70% of the revenue in the hospital comes from the OR. They’re convinced – and so am I – that there’s a lot more for us to do in this marketplace, both here and internationally.

Looking at it from the outsider’s point of view, what is it that makes the business you’re in attractive and what will it take from your new partner to make it better?

A couple of things are very attractive about SIS. We are growing, and have historically grown, at a little bit over 18% in a marketplace that has a 9% growth. We were growing at twice the rate of the marketplace. We were #1 for 2010 in market share as far as new deals in the marketplace, at 21% market share here in the US. We’ve also developed a whole line of additional products that we’re just starting to field to the marketplace that will also drive up the revenue significantly. 

Last but probably most important is our position in anesthesia. We’re one of three companies that have an integrated anesthesia product with their perioperative suite. Epic, Cerner and ourselves are the only three. That leaves us as the only player you can go to if don’t want to implement someone else’s full enterprise-wise solution just to be able to put in the surgery and anesthesia solutions. 

The Millennium Report predicts a 27% compound annual growth rate for anesthesia information systems over the next five years. SIS is currently ranked #1 or #2 in KLAS for our anesthesia system, with over 94% of the respondents saying they’d buy SIS again. The combination of our position already established in the anesthesia and the rapid growth projected through the next five years was a significant reason for NEP’s investment in SIS.

What does the investment let you do now that you couldn’t before?

Two things fit the profile of NEP. Their mantra is about improving client satisfaction and significantly growing the company in the marketplace and gaining market share. I am working with them on a three-year strategic plan on how to significantly grow SIS faster than we have already, and we already are at two times the industry rate.

We will look at what can we do, what acquisitions we might want to make, what investments in technology that we want to make as an organization to enable us to grow more rapidly, plus how to improve our client satisfaction as we’re going. I really believe that that’s one of the key benchmarks for your success going forward. We have a 98% retention rate right now of our clients, but we want to improve client satisfaction even more and move forward.

Sometimes people overlook that private equity companies don’t provide just ownership, but also certain expertise and focus. What does NEP bring to the table?

Norwest has a very good research staff. We’re working on a strategic plan about adjacent markets we might want to move into. The data I need to make those decisions is available to me through them. They have a team that will work with me.

NEP will provide an executive member of my board who is an investor with Norwest and has been the CEO and chairman of a software firm that’s at $300-400 million a year in revenue. We have that expertise to bounce ideas off of and to work moving SIS even further.

The book The Ultimate Question talks about good profits and bad profits. Bad profits are ones that cause you to have lower client satisfaction. You need to run your company off of what’s called a Net Promoter Score, which is what percentage of your clients would say that they would recommend you to their best friend. You establish a Net Promoter Score goal of where you are and where you want to get to.

That’s one of the methodologies that NEP has used in several of their companies. We’re in the process of adopting it here. It requires to survey every one of your clients — not just paper surveys, but to physically calling them — and finding out what their satisfaction levels are and what you can do to improve.

We were doing our annual surveys with our clients, but we weren’t trying to develop a benchmark that we could say, “I’m improving every year.” I would just have a higher percentage of satisfied clients versus unsatisfied clients. Now we have a benchmark that will measure the whole company in improving client satisfaction.

When you look at your client base, what would you say are their most pressing issues in the OR/perioperative-type areas?

One is an ongoing shortage of staff. As you look at the increased volume that we’re getting in the surgery marketplace, there are fewer surgeons and nurses available to handle that volume.

The other is the reduction in reimbursement and the change in reimbursement rates. They need to be more efficient as an organization. You’ve got volumes going up and reimbursement going down, and then a shortage of labor.

There is a substantial market opportunity in anesthesia documentation, right?

Absolutely. From market reports and our own anesthesia advisory board where we have 11 independent anesthesiologists, we believe there’s only between 13% and 15% market penetration right now in anesthesia information systems. 

If you look at the pending Stage 2 of Meaningful Use, I don’t see how you can operate a hospital without having an anesthesia information system in place. You you need to track when you intubated the patient, what drugs you gave, what reactions you had to drugs, and be able to report that back in a digital format. I think that’s going to drive anesthesia adoption tremendously.

Would you say Meaningful Use has affected your business positively?

I’ll tell you truthfully, it’s been neutral in the mid term because everybody’s working on getting CPOE in place. That seems to be the highest priority for hitting Stage 1, which didn’t have a lot of things impacting the OR department.

But if you look at what’s coming in Stage 2, there’s a lot more specific items that will cause the uplift that’s going on in surgery and in anesthesia. The Continuity of Care Document, the CCD, is going to make our job a lot easier to integrate with all the HIS players in the marketplace.

You mentioned your two competitors with a single perioperative and anesthesia database. Both offer an entire hospital information systems, while SIS is a best-of-breed provider. What’s your take on integration and interoperability?

I think it’s extremely important. You can’t survive as a best-of-breed player unless you’re also the best in interoperability. That’s why three years ago we joined IHE at the highest levels. We’ve been demonstrating our ability to do discrete level transfers of data back and forth.

As a matter of fact, this year at the interoperability workshop at HIMSS, you’ll be seeing us pass discrete data back and forth between most of the major players, including Epic. We’ve been pleased to see that they’re having that open of an attitude. Epic wins a lot of deals in being the total solution for everything, but at the same time on the technical end, they’re actively participating in IHE. I think they see that it will not be a world that they’ll own 100% of every hospital they’re in.

You mentioned that you’ll have access to research to look at adjacent markets and other opportunities. Where do you see the future opportunities?

We’re going to stay laser-focused on the perioperative arena, but there are things right next to it. Like should we build out software that will aid cardiologists in particular, or aid organ transplants? I want to be the absolute expert in everything to do with surgery. 

We have had people ask us about moving our work flow product. KLAS tracks us in three areas; in our surgery product, in our anesthesia product, and in our work flow product, SIS Com. They’re all on the same database and all developed by us, but the SIS Com product can plug on top of anyone’s perioperative solution.

We’ve had people ask us about putting that on other vendor’s platforms and also taking that to other departments of the hospital. We’re looking at taking our product that’s based in the hospital, in the OR, and taking it more broadly across the hospital.

And then of course the whole anesthesia product line — moving into pain clinics, moving into mobile devices so that we can provide local anesthesia in what are not traditional locations.

Any final thoughts?

SIS is focused on the hospital OR. Quoting the CFO of one of my good clients, “The OR is the nuclear power plant of the hospital. If it’s going well, it provides all the electricity you need to make everything run smoothly throughout the rest of the hospital. But, if it blows up, you can’t run your hospital.”

We view the OR as the engine of the hospital. It’s also the area where you have the highest safety hazards. We look at improving the safety and improving the efficiency, and thus the profitability of our hospitals.

It’s been real interesting. In the last four years, we’ve added 53 new hospitals here in the United States. The #1 area we’ve grown in is an existing SIS hospital acquiring another hospital and putting SIS into that hospital. I really think that we impact the financial and performance and the quality of care delivered in a manner that’s helping our SIS-based hospitals grow in the marketplace, and us growing with them.

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From Klinger: “Re: HIMSS. Here’s a link to a HIMSS presentation (PDF) on its policy priorities for 2011.” It says only around 20% of hospitals are at or above Stage 4 in the seven-stage EMR Adoption Model. There’s more stuff on policy that didn’t really interest me too much.

From Allscripts Person: “Re: your ONC poll. This explains the biased results.” Apparently someone from Allscripts sent an e-mail to all employees urging them to vote for Stephanie Reel. From the e-mail included, “To show our support for her, we want you to visit the HIStalk Blog and vote for Stephanie Reel … She is currently in the lead – let’s make make sure she wins!” She’s got 62% of the vote so far. I think she would do a fine job just like she’s done at Hopkins, although all of the ONC-heads so far have been physicians and she isn’t one. She would be good at establishing consensus since she’s responsible for IT throughout Hopkins, not just Johns Hopkins Medicine.

From WildcatWell: “Re: Apple. Does not want to get anywhere near the liability threshold of having the iPad as the hardware interface of choice for true EMR/CPOE encounter usage.”

The VA and DoD are closing in on agreement to use a single electronic medical records platform, according to VA CIO Roger Baker as quoted by the excellent NextGov. The article quotes a source as saying the winner will probably be the VA’s VistA, with the loser being DoD’s AHLTA. That’s a huge decision and a likely windfall for the usual contractors who will have to tweak whichever system wins to appease the pouting loser. The chair of the committee says the departments spent a combined $10 billion to create the two systems, which I’d bet is a low number intended to hide the real cost (especially of AHLTA, which is surely one of the biggest HIT boondoggles in history).

IBM, Nuance, and the University of Maryland School of Medicine are working to turn the Jeopardy-playing IBM Watson computer into a physician’s assistant, analyzing real-time information against the literature and making suggestions. They’re hoping the computer can make sense of the hodgepodge of scanned and discrete data and make it all searchable.

Parrish Medical Center (FL) chooses McKesson’s Horizon Clinicals, HERM, ambulatory EMR, and RelayHealth solutions.

Let’s have a word about our benevolent and fun HIStalkapalooza sponsor, Medicomp Systems. They’ll be talking at HIMSS about Quippe, their just-announced Web-enabled, browser-based, interoperable EMR tool that gives physicians a touch screen interface backed by the MEDCIN Engine for handling the codes needed for compliance and reimbursement. Check out the video above of it running on an iPad and stop by Medicomp’s booth (#2231, I believe) to check it out, meet the party architects, and maybe see some video shot at HIStalkapalooza running from Tuesday on (you never know what people will do after a few IngaTinis). We have quite a few practicing physicians coming to HIStalkapalooza and Medicomp will honor them during that event (hint: make sure to show up). That’s Dave Lareau starting off the video – he’ll be your emcee and will oversee the red carpet interviews. I haven’t told anyone but Inga this, but I had a beauty queen sash made for Dave that says, “I Paid For All of This.”

University of Kansas Hospital (with the illogical abbreviation of KUHA) and CSC announce their development of the CareVeillance clinical surveillance tool, which analyzes data from multiple systems to provide alerts and quality metrics.

Dave Miller, executive director of application systems at the University of Chicago Medical Center, tells me that he has accepted the position of Vice Chancellor for Information Technical Services/CIO at the University of Arkansas for Medical Sciences in Little Rock. 

A report suggests that the HITECH gold rush is hurting the PACS, RIS, and CVIS markets as hospitals divert IT budgets to fund EHRs. It predicts that vendors of those systems will have to discount as they fight a share of a smaller total market, at least through 2013.

On the HIStalk Job Board: Project Manager – Healthcare Implementation, Implementation Consultant, Healthcare Informatics Analyst. On Healthcare IT Jobs: RN Clinical Informatics Transformation, Director Implementations EHR/PM, VP Business Development, Meditech PCM Implementation Analyst.

Ivo, Dana, and the Encore Health Resources crew are famous for throwing relaxing, no-pressure, open-ended social events (“Pub Nights”) at HIMSS, where the game plan is basically: (a) anyone who feels like it just shows up and eats and drinks for as long as they want to hang around, and (b) Ivo pays. Our pal Amy says you are all invited, every night at 9:00 from Saturday through Wednesday except Monday, at the bar at Tommy Bahama’s. It’s right up the street from the convention center and hotels at Pointe Orlando, the same complex as BB King’s (swanky in a tropical way). Encore isn’t exhibiting at HIMSS, but I’m sure they wouldn’t mind talking shop with prospects, old friends, and potential consultants about their offerings (IT planning, EHR implementation and optimization, analytics, and project management). I’m planning to be there at least one night.

More HIMSS fun: if you’re staying in a hotel on or near International Drive north of the convention center, be on the lookout Monday and Tuesday morning for a limo with my smoking doc logo on both sides. It will be cruising the circuit between the convention center and Sand Lake Road, offering rides to the convention center to anyone who flags it down. I thought that would be a nice gesture to the folks staying in the less expensive hotels up the street who don’t have the luxury of the short stroll over from the Rosen or Peabody (not to mention that it’s good HIStalk PR to have the logo riding around in plain sight). Take advantage of it so I’ll feel like I got my money’s worth. I’m not sure of the color, but it’s a 10-passenger stretch and I doubt there will be many of those on I-Drive early in the morning.

Merge Healthcare announces Q4 numbers: revenue up 139%, EPS $0.10 vs. –$0.03. I interviewed new CEO Jeff Surges a couple of weeks ago.

Welcome to new HIStalk Gold Sponsor CCT Solutions, Ltd. of New York, NY (and London). This is an interesting business: the company provides software training for big clinical system rollouts like CPOE, clin doc, bar coding, etc. They can provide a large number of instructors plus 24×7 on-site go-live support, which hospitals are rarely staffed up to effectively do themselves. They’ve handled some impressive volumes, training 16,000 employees of Continuum Health Partners and proving up to 500 support staff. Some of their other clients include Beth Israel Medical Center, Broward Health, and Albert Einstein Health Network. They’ll be at HIMSS and would be happy to chat. Thanks to CCT Solutions for supporting HIStalk.

I got an e-mail from Grady Memorial Hospital (GA) SVP/CIO Deborah Cancilla, asking for a “retraction of the information posted” in my mention that the hospital was laying off EMR contractors to address a budget shortfall. I replied that I really couldn’t retract anything since all I did was link to AJC, which quoted CEO Michael Young directly (“Part of the staffing cuts will likely include temporary and contract workers who were brought in to set up the hospital’s new electronic medical record system, Young said”) but I would update my post with whichever of the three possibilities she would verify as the problem: (a) the paper misquoted Mr. Young; (b) Grady changed their mind on the “likely” cuts; or (c) Mr. Young’s statement was incorrect. Michael Young e-mailed me that he misspoke – the cuts won’t affect the contract workers. Deborah also wanted to clarify that the $40 million cost for Epic is the five-year budget. I appreciate the updates.

Thanks to new HIStalk Platinum Sponsor InSite One, now a Dell company. InSite One focuses on cloud-based digital medical data management solutions: data archiving, disaster recovery, and digital health data exchange. The company’s cloud-based, intelligent vendor-neutral archive and its disaster recovery services are offered from within Dell’s Unified Clinical Archive solution, which allows clinicians to share patient information regardless of the PACS, modality, or application that created it. I interviewed Mitchell Goldburgh, who talked about infrastructure simplification, the company’s one-time fee per image that allows customers to stay current on technology without spending capital or managing infrastructure, and the 3.6 billion objects and 54 million studies they are managing in a single archive. I learned a lot from that interview. Thanks to InSite One for supporting HIStalk.

Telemedicine systems vendor New Mexico Software will offer second opinion teleradiology services directly to consumer, charging the customer’s credit card to have one of its remote radiologists review their digital images.

FDA relaxes its pre-market review standards for low-risk medical devices, such as hardware that stores glucose meter readings or that sends lab results to nursing stations.

I’m not sure whether I’ll do a Sunday update from Orlando as a substitute for the Monday Morning Update. I’m sure I’ll run something, provided my hotel’s Internet connectivity is better than the last HIMSS in Orlando, where I had to sit around with the convention center cleaning people until late to latch onto the free WiFi to write HIStalk once it became clear that my hotel’s connectivity was worthless. Safe travels to everyone. If you’re staying home and your bosses are allegedly working hard at HIMSS, feel free to goof off next week. We’ll have lots of updates from Inga, Dr. Jayne, Dr. Gregg, and me.

E-mail me.

HERtalk by Inga

From Henrietta Winston: “Re: HIStalkapalooza. Tell Inga my most special shoes are placed out by my suitcase – ready to be packed. Unfortunately, my footwear is not as snazzy as as hers ): but I will wear jewelry that will make her claws come out!” Thanks for sending Mr. H this warning so he can hold me back, just in case. I failed to mention this before, but bling is absolutely encouraged to finish off your outfit Monday night!

Another day, another data breach. Charleston Area Medical Center warns of a “security incident” affecting 3,655 patients. Apparently a hospital-generated spreadsheet containing names, birth dates, addresses, and Social Security numbers popped up when a patient’s brother-in-law was searching for her address. The hospital says the data was viewable for four months and the site was viewed 94 times before it was shut down. Most hits came from authorized personnel, but one came from India, another from Germany, and a third from a private proxy service designed to anonymously download information from a Web site.

Strong Q4 numbers from athenahealth: revenues of $69.4 million compared to $54.4 last year, an increase of 27%. GAAP net income for the quarter was $7.3 million ($.21/share) and non-GAAP adjusted net income was $98.8 million ($.28/share). Analysts expected earnings of $.20/share and revenues of $67.60 million. athenahealth also mentions that as of December 31st it had 3,348 active providers using athenaClinicals, including 2,383 physicians, compared to 1,471 providers and 920 physicians at the end of 2009.

No surprise here:  achieving Meaningful Use is the top budget priority this year for 75% of hospitals. Over half say physician adoption of EMRs is the biggest obstacle for achieving that goal. The same Imprivata survey found that physicians are using more mobile devices and about half of hospitals either use or plan to deploy virtual desktop infrastructure.

HITArkansas narrows its list of supported EHR vendors to 12 finalists, including Allscripts, eClinicalWorks, e-MDs, Ingenix, McKesson, and Sage. The REC is now working with the vendors to establish pre-negotiated and vetted contracts based on a negotiated base price.

Two thousand clinicians and staff at Genesis Healthcare (OH) are using BIO-key fingerprint biometrics to establish identity in Genesis’s Epic software for meds administration. Genesis will also deploy fingerprint biometric user logon with Vergence, the SSO solution from Sentillion.

Intermountain Healthcare (UT) opens its Homer Warner Center for Informatics Research, which is dedicated to optimizing the use of information in health and biomedicine. The center employs about 60 people, but Intermountain CIO Marc Probst says they could add a couple hundred more over the next decade.

As others have  mentioned, my inbox is overflowing with pre-HIMSS press releases. I’ve said this before, but it bears repeating: your company needs to work on its marketing pitch if takes a reasonably smart person (like me) multiple reads to figure out what exactly the company is trying to sell. KISS, as it were.

Ingenious Med introduces an iPhone/iTouch/iPad app that gives users access to the Ingenious Med charge and data capture platform.

I believe this would qualify for a bad day at the office. An ER patient uses a doctor’s stethoscope in an attempt to strangle his doctor. Apparently the patient became combative during his exam, and when the doctor tried to use the stethoscope, the patient attempted to wrap it around the doctor’s neck. Felony assault charges are pending.

I spent about an hour today attempting to map out my HIMSS game plan. I am sure that I am overly ambitious and I’ll run out of time and energy long before I’ve seen it all. I’m wondering if I will really make that 7:00 a.m. breakfast (what was I thinking?) and even an 8:30 start time Tuesday sounds torturous (post-HIStalkapalooza and all). Then there are the 900+ exhibitors to check out. And of course I’ll need to make time for a few HIStalk updates so readers at home can live vicariously through my adventures. I’m exhausted just contemplating it all.

By the way, I downloaded HIMSS11 mobile app for my iPhone and it’s pretty handy. The best part is the ability to search for the room number of individual sessions as well as exhibitor booth numbers. Far better than carrying a paper schedule – or asking for help.

See you in Orlando!

E-mail Inga.

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• Mediserve client Burke Rehabilitation Hospital (NY) becomes the first post-acute care hospital in the country to achieve HIMSS Stage 6 certification.
• MedCentral Health System (OH) selects MobileMD to provide health information exchange to its medical community using the 4DX HIE product.
• McKesson awards Peninsula Regional Medical Center (MD) its 2011 Distinguished Achievement Award for Clinical Excellence based on its use of Horizon Clinicals to drive improvements in care. Peninsula decreased its sepsis-related mortalities 37% since October 2009 and attributes its use of technology and process change for saving 77 lives.
• MEDSEEK announces an 833% growth in sales in 2010. MEDSEEK also introduces ecoSmartTM, a targeted marketing solution with predictive modeling capabilities to customize a patient’s online experience based on user behavior.
• ICA releases a series of white papers offering guidance on health information exchanges, including issues on interoperability, technology, Meaningful Use, and privacy.
• Ashe Memorial Hospital (NC) deploys PatientKeeper CPOE and PatientKeeper Physician Portal. The hospital will next implement PatientKeeper NoteWriter.
• Beth Israel Deaconess Physician Organization contracts with Ingenix for its Impact Suite of software. The Impact solution will provide analytics to measure clinical performance and reduce variations in care.
• Picis announces its Perioperative and Critical Care solutions version 8.3, which includes automated medication interaction checks, a content library, and a quality reporting portal.
• InSite One completes integration testing at the IHE North American Connectathon and the InDex technology passed testing for conformance to the IHE technical frameworks. You can experience more of InSite One’s technology at the HIMSS Interoperability showcase.
• Enovate announces its e900 series of wall arms that allow clinicians to maintain eye contact with patients while working on the keyboard.
• New Brunswick’s Stan Cassidy Centre chooses Orion Health Patient Portal.
• EDIMS says it experienced a successful 2010, which included  a sale to Saint Barnabas Health Care Systems, New Jersey’s largest healthcare system. EDIMS also signed a unique agreement with Clara Maass Medical  Center (NJ) to provide onsite medical services at Red Bull Arena.
• Greenway Medical collaborates with HP to offer practices EHR solutions running PrimeSUITE 2011 EHR and HP hardware. Also, Greenway client Children’s Clinic of Muskogee (OK) is the first pediatric practice in the country to qualify for Meaningful Use funds. The clinic’s four providers are set to receive an $85,000 check, which will be handed out at the HIMSS conference.
• Orchestrate Healthcare will give away a free Apple MacBook Air at HIMSS. Booth 6151.
• Philips introduces a Philips Recorder for iPhones and iPads, which turns the device into a wireless dictation dictation recorder and works with the SpeechExec Enterprise suite.
• Shared Health and Health Language partner to use HLI’s Language Engine in Shared Health’s web-based applications and products. In case you missed it, Mr. H interviewed George Schwend of Health Language here.
• UNC Hospitals chooses Carefx’s Fusionfx Physician Insight Plus performance improvement dashboards.
• John Muir Health (JMH) and MuirLab contract for AT&T’s HIE solution, Healthcare Community Online.
• Speaking of AT&T, its partnership with Vitality to make Vitality Glowcaps (mentioned in a previous HIStalk) wins the 2011 Global Mobile Award.
• AHA Solutions announces an alliance with HIT research and advisory firm CapSite, which offers hospital executives due diligence and RFP information from hundreds of vendors.

EPtalk by Dr. Jayne

The pre-HIMSS mailings have finally tapered off, but I did receive two fairly funny “personalized” emails this week. The first was from a vendor whom I’ve repeatedly told that I am not interested in meeting with, addressed to me but sent to my brand new administrative assistant, who dutifully replied on my behalf, not realizing this was bulk mail and that if they really had a relationship with me and had left me a voice mail as they stated in the e-mail, that they wouldn’t now be spamming her.

The second one was from a voice recognition vendor with minimal proofreading skills, apparently missing the fact that EHR had been changed to HER before bulking it out. I hope their product has better translation abilities, but we shall see.

The first reader has responded to my challenge to create a funny Xtranormal clip about implementing technology in the healthcare realm. Love it!

Friday is the last day for the RelayHealth Facebook contest. I’m delighted to see wine and chocolates making the list, as my Valentine’s Day was a little lacking in both and I’m looking forward to making it up. RelayHealth published pictures of the gift bags for participants on their site – tres cute – so vote for your favorites (although they didn’t post my shameless attempt at entering myself, I’ll be sending an anonymous helper to try to score a gift bag, so be on the lookout). If you’re stumped for something to suggest, drop me an e-mail.

I’m off to pack my suitcase and wondering if I can meet the fashion bar that Inga has certainly raised, but wanted to share some recent reader questions before I head to warmer climates:

Dear Dr. Jayne,

What’s up with all these CMIOs who haven’t seen a patient in years, walking around in white coats with stethoscopes for necklaces? Just curious.

Dean

Dear Dean,

This just may be one of the greatest mysteries in health care. One thought is that these physicians are locked in an internal struggle between losing their clinical identity and realizing that they have become far too fluent in Administralian. Maybe this is their way of subconsciously saying, “Hey, don’t forget me, I really still am one of you!” I can sympathize with them when they have to walk through the hospital and see their colleagues on rounds being “real” doctors, although that doesn’t justify the behavior.

Unfortunately, this condition has another insidious manifestation. This is where doctors insist on wearing the white coat out of the clinical office for no reason whatsoever. I can understand if you have an administrative meeting and have to run from rounding or seeing patients to another on-campus building, but that doesn’t explain why one of my colleagues insists on wearing the white coat to administrative meetings at our building, which is a six-mile drive from the nearest patient care facility.

Personally, I think it’s just a bit pretentious. And kind of gross — let’s carry all the germs from the clinical space into the administrative space. (Although, I guess that’s a good cautionary tale for my staffers who don’t want to get a flu vaccine because they don’t work in direct patient care – reminding them that they have to work with these chaps when they visit the IT shop).

I think the worst version of this condition is shown in those poor souls who wear scrubs (complete with surgical shoe covers) outside the hospital. Really, you couldn’t take two seconds to take the booties off? Or you’re willing to bring the contamination of the outside world back into the operating theater? Is it really that critical to let the world know you work in an operating room?

If any of my other CMIO readers have theories, I’d love to hear them.

Dr. Jayne

Dear Dr. Jayne,

Thanks for your comments on doctors using the computer in the exam room. My doctor has been using a computer for years. It is attached to a wall mount right inside the exam room door. He stands up to type on it while he is talking to me. He looks at me, answers questions, then looks down to look over the record or type in information. Why is this so foreign to people? We work every day with people who are putting information into computers, from airlines to the pharmacy. I’m glad he can look to see how I’ve improved my weight, HDL, etc. over the years without bringing in a five-inch paper record (which they never did before anyway, just why you were there today).

Betsy

Dear Betsy,

Thanks for your note. I agree with you, but it still seems to be a big deal for some people. I always enjoy when patients tell me they’re glad that we have the computer or comment on a way it’s made a difference in their health care. I think it makes it more real to be able to show patients graphs of their blood pressure, weight, lab results, etc. I’ve also used it to launch videos on patient care sites to teach patients how to do certain exercises I’m recommending, or to research bits of info patients say they saw on a Web site.

It’s funny how accepting this has evolved over time. When I started my first “paperless practice,” our health system newsletter ran an article about the transition and what made us different. The CMO of my hospital made a big deal of editing out the comment where I said I used the Internet to research health concerns while in the room with the patient. He thought it made me sound like I didn’t have all the answers and that patients wouldn’t trust a doctor that had to look things up.

Fast forward a decade and now we have savvy, empowered patients that understand that we can’t know everything and expect us to not only be using the technology to find the most up to date information, but pushing it out to them via secure portals.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or whether doctors would want their kids going to med school? E-mail Dr. Jayne.

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