Workforce management technology vendor API Healthcare announced this afternoon that it will terminate its previously announced merger with Kronos. API will exercise a right contained in the January merger agreement that allows either party to terminate if regulatory approvals were not obtained by mid-May. The Department of Justice had made a second request under antitrust laws.

API President and CEO J.P. Fingado stated in the announcement, “This process has been challenging, but it has also reaffirmed that our vision for healthcare-specific workforce management is solid. During the HSR review process, we heard the strong reaction of our healthcare provider clients from across the country as they spoke out with passionate support of our solutions, services and strategy.”

Fingado contacted HIStalk about the announcement, saying, “This may sound odd, but it is the right thing for our clients and employees, and that is what API Healthcare has always been about. I am very happy moving forward and very excited about our opportunities. We released ‘Synergy’ just before this all happened and now we can work even harder to roll that out to our existing and new clients. The support from our clients during this process has been amazing.”

Ezra Perlman of Francisco Partners care was quoted in the announcement as saying, “When we acquired API Healthcare two years ago, we saw the opportunity for long-term growth of a great healthcare-specific workforce management technology company. While the merger offer from Kronos certainly validated API Healthcare’s strong value proposition, Francisco Partners is looking forward to continuing to provide strong support to the API Healthcare management team and associates as they continue on their aggressive growth path as an independent company.”

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Top News

  The VA and DoD agree to “buy” rather than “build” a joint EHR in an apparent change in direction from their last announced plans. They will round out missing departmental modules by looking first at any available internally developed systems and will develop their own applications only as a last resort.

Reader Comments

From Professor Paul MD: “Re: Amazon cloud downtime. For those who didn’t know, their northern Virginia data center that hosts EC2 and RDS services went down hard for 24 hours last week and didn’t recover all volumes until late Sunday. A small company that apparently does ECG monitoring repeatedly begged for help on Amazon’s public online forum, bringing up good points on what to consider when hosting health apps on the cloud. I like the Halamka shout-out, too.” Someone immediately questioned why they would be running a mission-critical life-or-death system on the cloud, to which the original poster answered, “Well, it is supposed to be reliable.” One of several uncharitable responses was:

If you were smart, you would have a disaster recovery plan for just this kind of thing. Judging from your lack of said preparations, you lot figured the cloud never goes down, and got greedy by not wanting to spend money on hot standby machines on a different infrastructure. Good going. Hope none of your cardiac patients croak because you’re going to get sued into next week…

That news item does encourage good discussion. If your organization runs cloud-based apps, please share what actions you’ve taken, both contractually and technically, to prevent and mitigate outages. What happens if your Internet connectivity dies (killed in most cases by the proverbial cable-shearing backhoe excavating for some minor project outside your facility using erroneous city-produced utilities maps?) What is required to maintain a hot swap site? How often do you test? Send me what you can and I’ll share it here.

From Olivia: “Re: McKesson. Gio Colella and Pam Pure might have a different opinion about how big winning that patent lawsuit against Epic would have been. That was just a place to start. Think Kaiser. Then think about all the other vendors with similar solutions. That sure would have helped to justify the purchase of the original RelayHealth company, which happened not long before the lawsuit was filed. Another intriguing story for cocktails and dinner sometime.” Is that an invitation? 

From Puts and Gets: “Re: Cerner. More changes in the plastic hair lineup. The stock has had an artificial ride up since investors don’t have a decent, large-scale pure play in health IT, so they get the default money. They are going down the other side of that first roller coaster hill later this year.” I’ll steer clear of this debate and mark it Unverified.

 From NotAnEpicShill: “Re: Epic. Another Epic employee here. What Lucy Gucci describes may be true for some Epic employees, but there are plenty of us whose jaws drop when we see things like that on the Web. I myself work about 45 hours a week (50-55 a few times a year during a crunch) and have a pretty good balance of life to work.The same holds true for many, many people with whom I work. I just wanted to get it out there that though certainly not everything at Epic is sunshine and roses, the rumors of our misery are greatly, greatly exaggerated.”

 From Madrigal: “Re: Neil Pappalarado. Just announced at the Meditech shareholder’s meeting that he had a minor stroke last week. He’s still in the hospital, but is expected to make a full recovery.”

From Human Factors: “Re: ONC usability meeting. The general consensus was that EHRs are difficult to navigate, time-consuming, frustrating, cluttered and disorganized, and unsearchable. They lead to fatigue and ultimately burnout, do not adequately support disabled users, do not adequately support clinical workflows, and they disperse and bury critical information. Most of the discussion was around provider pleas to either make usability standards part of certification or mandate a common user interface. There was also a call for EHRs to be held to accessibility guidelines, to support easy data migration from one to another, and for vendors to be more transparent about their internal usability guidelines. A Cerner spokesperson contributed this interesting insight: ‘The tools [EHRs] are designed for the volume of documentation instead of the value of the information.’”

 From Private Pyle: “Re: ONC usability fireworks last Thursday. You have to listen to the recording and read through the testimonies on ONC’s site. The docs told vendors their systems sucked, then consumers told them they were disconnected electronically and don’t have the information they need to be an engaged member of the care team, the vendors whined about new requirements and said that certifying usability would kill innovation, and the usability experts tore up the crappy vendor systems. A heated exchange ensued. The vendors tried to use the analogy of cars and that it makes no sense to put parts from three different makers together, but the committee trashed that, saying monolithic platforms have such a high barrier to change that customers are at the mercy of the vendor. I truly believe the monolithic vendors will not disrupt themselves and we will see some serious challenges that will provide capabilities and price points that will destroy the current market.” I wrote a few thoughts at the end of this post about the meeting. Usability measurement and any new federal involvement in it is obviously a big topic that gets a lot of folks stirred up. Comments from all viewpoints welcome.

HIStalk Announcements and Requests

Readers occasionally tell me they’re having trouble reading HIStalk because of errors or slow load times. The culprit in 100% of those cases so far has been long-obsolete versions of Internet Explorer. IE is a far inferior browser to begin with (feel free to check page load times on any media-rich site if you don’t believe me), but it’s really trouble-prone in old versions. Here are some suggestions.

1. If you must use IE, upgrade if possible to the latest version your operating system will support – Version 9 if you have Vista or Windows 7, or Version 8 if you’re on XP.
2. If your computer isn’t in IT lock-down mode, download Firefox or Chrome, at least to read HIStalk. You can still leave IE on your PC for any purposes for which it’s required.
3. HIStalk is supported by the sponsors whose ads you see on the left, which means we all benefit when you read the site normally. If you can’t load the page, however, add /print to the link you get in the e-mail update to view a text-only version (so instead of this link, use this one instead, for example). Or, read via RSS reader (I use Google). You’ll miss a lot of other stuff, too, though – polls, links to the latest comments, upcoming events, etc.

I had to re-send an e-mail update that failed on the server for some reason, so if you got the same e-mail on both Friday and Tuesday, I promise I’m not intentionally spamming you. There was no way to pick up where it left off or to even tell how far down the list of 7,311 subscribers it got, so I started it over.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies says 13 new clients have signed up for its integration technology framework for delivering interfaces among hospitals, labs, and EMRs.

Huron Consulting announces its Q1 financials: revenue up 11.9% to $143 million and diluted EPS from continuing operations up 46.2% to $.19/share.

Keystrokes Transcription Service acquires competitor MTS of Texas, including its TxMTI online transcription school.

Oppenheimer initiates coverage of Cerner with an “underperform” rating, saying the company is “showing signs of age” with flat software sales even as HITECH brings buyers to the market, lower margins as services replace software sales, and a price-to-earnings multiple more appropriate for a software high flyer than a low-excitement services business. They also didn’t like the fact that the departure of COO Mike Valentine was announced on April 22 when the stock market was closed, saying “the timing of his departure is curious” unless he turns up almost immediately as CEO of a good-sized company (and if anyone knows where he’s going, let me know). 

EncounterPRO chooses Intuit Health’s patient portal to offer its 300 pediatric practice EMR customers.

Consulting firm Computer Task Group (CTG) reports Q1 numbers: revenue up 22%, EPS $0.17 vs. $0.11. Healthcare revenue was up 30%, mostly from big EMR projects.

Sales

The Metropolitan Chicago Healthcare Council announces plans to develop the MetroChicago HIE using Microsoft’s Amalga and technologies from CSC and HealthUnity Corp. Seventy percent of the hospitals in Chicago are participating, with the notable exception of NorthShore University HealthSystem.

The Missouri Health Connection picks Cerner to build a statewide HIE, although they’re still negotiating the price.

The Missoula, MT paper reports that St. Patrick Hospital, part of Providence Health System, is moving to Epic. Cross-town competitor Community Medical Center is implementing NextGen for outpatient and will add Cerner inpatient next year.

Dundy County Hospital (NE) purchases Healthland’s EHR for its 14-bed critical access facility, anticipating a Q3 2011 go-live.

Salina Regional Health Center (KS) will implement Summit Healthcare Downtime Reporting System as part of its disaster recovery strategy.

People

Ben Foster rejoins Huron Consulting as managing director of  its healthcare practice and will work with providers to improve their revenue cycle.

MetroSouth Medical Center (IL) names Steven H. Rube, MD as medical director of the hospital’s seven community health centers and CMIO for the hospital. He’s the former CMO and EVP of EmpowER Systems.

UC Health (OH) appoints Anil Jain, MD as the organization’s first CMIO and SVP. He was a senior executive and physician at Cleveland Clinic.

eHealth Initiative founding CEO Janet Marchibroda is named chair of the Bipartisan Policy Center’s Health IT Initiative. She has also worked as chief healthcare officer of IBM and was COO for the National Committee for Quality Assurance. BPC, a non-profit think tank, launched its health project in January, led by former senators Tom Daschle and Bill Frist and former governors Mike Rounds and Ted Strickland.

Robert Barber, 64, director of financial services at Carolinas HealthCare System (NC), was shot and killed last Friday morning by an unknown assailant in an apparent robbery attempt while walking outside a coffee shop near his home in Charlotte, NC. He was a retired Air Force Reserves colonel, held a doctorate in health administration from the Medical University of South Carolina, and was a part-time instructor for several universities. He had held several executive positions in his 19 years with CHS, including stints as CFO and CEO in affiliated hospitals, and was a former president of the North Carolina chapter of HFMA.

Government and Politics 

Norton Healthcare (KY) agrees will pay the federal government $782,842 to settle allegations of Medicare overbilling. Federal prosecutors contend that Norton submitted charges for evaluation and management services that were never performed.

Dartmouth-Hitchcock Medical Center (NH) will pay over $2.2 million to state and federal agencies for improper Medicare, Medicaid, and Tricare billing. The payment includes over $344,000 to a former Dartmouth-Hitchcock physician who blew the whistle on the improper billing, which allegedly included charges for services delivered by unsupervised residents.

The American Telemedicine Association (ATA) calls for CMS to remove restrictions on telemedicine for ACOs. Recommendations include more medical videoconferencing access in metropolitan areas, home-based videoconferencing, and delivery of therapy services via telehealth.

Other

Performance scores for the four top interventional lab providers tighten to within five points of each other, according to KLAS’s latest report. KLAS notes that GE,  Philips, Siemens, and Toshiba have slowed down the delivery of market-changing developments. In addition, healthcare reform and reimbursement pressures have resulted in increased provider innovation and the move toward multi-use labs.

A former employee of Carthage Area Hospital (NY) says its systems vendor CPSI was “thrown under a bus” when the hospital blamed the company for its billing problems. She says the problems started before CPSI was implemented, the hospital declined to send employees to Alabama for training because of the expense, and they replaced the business office manager who had received training right after they went live. 

  In case you have been living under a rock (or perhaps you’re just a normal guy) there’s a big wedding coming up Friday morning. I can’t decide if I will watch it live or set the DVR. Maybe both so I can relive the moment a few times. I did buy a special hat for the occasion, since I hear hats are an essential fashion accessory for royal weddings. And of course, some new shoes. Maybe Mr. H can come up with a Union Jack theme for next year’s HIStalkapalooza so I’ll have a chance to wear these beauties again.

Sponsor Updates

• Sunquest’s Physician Portal 5.1 earns modular  ONC-ACTB certification from CCHIT.
• Mark N. Bair, MD, R.Ph and Jordan L. Schlain, MD join Ingenix’s independent advisory board. Bair is and ED physician and CEO for Emergency Medical Services, Inc. in Utah. Schlain practices internal medicine and is medical director and founder of Current Health Medical Group (CA). 
• Culbert Healthcare Solutions completes the implementation of Epic’s ambulatory suite of products at the 200-provider Vancouver Clinic (WA). The project took less than 12 months to implement from kickoff to go-live.
• TeleTracking Technologies releases its Patient Flow Dashboard, powered by TeleTracking XT application, which monitors the real-time status of enterprise-wide flow operations.
• Capario names Stephen Garcia as CFO.
• Orthopaedic Surgery Associates (MI) selects SRS EHR and CareTracker PM for its 13 providers.
• Vocera Communications announces that its first quarter revenues grew 56% compared to 2010. Vocera also added its largest client to date, a Department of Defense hospital.
• The iDoc document imaging and management solution from CareTech Solutions earns certification as an EHR module.
• Aspen Advisors is highlighted by Consulting magazine as one of “Seven to Watch” consulting firms. The magazine cited the company’s doubling of headcount and revenue since 2009 and the fact that 40% of its employees have at least 20 years of healthcare experience.

Thoughts on ONC’s Certification / Adoption Workgroup’s April 21, 2011 Meeting on Usability

I haven’t had time to listen to the audio, but I got a few interesting nuggets from skimming the meeting materials:

1. What folks are calling “usability” is really more “suitability to task,” not just counting clicks and seeing if on-screen terminology is consistent, but measuring how long it takes to do common tasks. In other words, ugly screens don’t matter too much as long as experienced users can get their work done quickly and accurately.
2. Because of that, vendors are worried about new “usability” requirements that may go well beyond usability, not to mention the need to have a consistent, unbiased way to measure usability in whatever way it is defined.
3. To compare usability among products requires definition of a perfect EMR, which puts the government in the position of designing systems.
4. Vendors claim they have all kinds of formally trained usability experts who have design authority over applications, but customers don’t seem to think the final product reflects that fact.
5. Users working with the same application rarely agree on the number and significance of usability problems.
6. Any measurement of usability needs to take place in a real-life work setting, not in a lab.
7. Some safeguards built into EMRs would be considered negatives by usability experts, such as the requirement for providers to review existing patient data, avoiding the dangers of “auto-complete” functions, and inclusion of the government-required signoffs and notifications that users resent and don’t find useful.
8. According to one practitioner, systems don’t work as well as paper in her practice. Examples: ordering a routine mammogram electronically takes 10 minutes, entering a family history on paper takes 24 seconds on paper and two minutes in the EHR, systems don’t highlight important information from the electronic clutter they create, and EHR information (such as with scanned documents) may be “in the record” but not easily accessible.
9. A provider urged the government to require vendors to design systems around a common schema to allow easy switching from one product to another, and also to require them to follow an app store model that supports picking and choosing from among competing functions.
10. Several presenters said the government itself makes usability worse by requiring entry of generally worthless information, such as IV end times.
11. Jacob Reider MD of Allscripts admitted that as a frustrated EHR user in 2004, he wrote a blog post blasting Allscripts for designing a system that took 40 seconds to enter a patient’s blood pressure. He said “the president of the company that had developed the EHR I was using to request that I delete the post, as it was costing the company sales.” He went to work for the company 18 months later (he must have either impressed them with his insight or inspired them to put him on the payroll to keep him quiet).

And some interesting comment snips from ONC’s usability committee blog:

• If the Federal government wants to really accomplish they goals they list, every medical entity needs to be on the same system so it is seamless and information can be shared. Usability experts need to be brought in ASAP before the entire project fails. This should have been done before the project was ever launched!
• Developers tend to follow what they know, retreading what’s been done before and packaging it with sharp marketing.
• I truly don’t understand the arguments against standardization, when data exist to support it. Standardization has saved countless lives with respect to mission-critical systems, and EHRs are decidedly mission-critical systems. In fact, standards often originate as a response to accidents and disasters that occurred because of a lack of standardization. To say that having standards regarding font sizes, color contrast, and a host of other usability-related variables clearly related to human performance “stifles innovation” is a weak argument.
• The current failure to act responsibly on this and other safety-related issues in health IT is an important ethical question that needs badly to be publicly discussed. It is wonderful that ONC has raised the issue, but unfortunately, it is several years too late, as care delivery organizations are currently too busy installing what’s available today in order to get the stimulus money to really attend to usability; and vendors are too busy managing these new installations to invest in the sort of thoroughgoing redesign that is needed.
• I am horrified when I look at the design of HIT which violates standard, well-known usability principles. When I tried to publish a paper on a particular EMR design that was particularly horrifying, the lawyers stepped in and said we were not allowed to publish any screen shots (which would show the issues) as this **violated the contract with the vendor**. In discussions with them, the vendor argued that their design was user-centered because it was successfully transitioned from the company’s prior use of the software as a restaurant management system!
• I hate my wonderful EMR. It has decreased my efficiency, decreased my face time per patient, not eliminated errors and resulted in significant employee dissatisfaction. In addition, it is not information-ful: when I read outside records on a complex patient and have to wade through page after page of meaningless review of systems, immunization histories, pharmacy records, vital signs, etc., etc. and never find what the patient was really feeling or what the reasons for the referral are, I have just wasted another 10 minutes that I could have spent with the patient – finding out relevant stuff! However, all important components of billing and compliance have been duly fulfilled (excuse my misapprehension that this was supposed to have something to do with patient care).

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Lawson Software announced this morning that it has agreed to be acquired and taken private by Golden Gate Capital and software vendor Infor for $2 billion cash. Lawson has a significant hospital presence with products that include financial management, supply chain, human resources, the Cloverleaf integration line, a master patient index, and electronic health records.

Infor offers solutions that include customer relationship management, enterprise resource planning, supply chain, financial management, and workforce management. Infor CEO Charles Phillips was quoted in a statement as saying that the acquisition “will extend our existing portfolio, particularly in areas such as healthcare, public sector, manufacturing and human capital management.”

The acquisition is expected to close in the third quarter.

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In the last several weeks, tornadoes and other severe storms have ripped through various parts of the country. Based on a frantic phone call I received from a medical school colleague, this seems to be a good opportunity for a physician-friendly discussion of disaster preparedness for healthcare information technology. For those of you who are serious IT professionals, this may be boring, but on the other hand it may be a good conversation starter to e-mail (or even print if you have to) for the physicians in your lives.

Downtime and Disaster Recovery 101

The most important part of successfully dealing with an outage of your electronic health record is to have a plan. Most practices need both short-term and long-term plans, whether you’re in a well-known hurricane zone or tornado alley or not. Lots of things can happen: floods, fires, and earthquakes. No one is exempt and everyone needs a plan.

Downtime usually refers to a time when the system is unavailable, whether planned or unplanned. Downtimes can happen for a variety of reasons. Unplanned downtimes may include a local power outage, loss of Internet connectivity, or other nonspecific system issues that keep physicians from fully using the EHR. They may be limited — perhaps it’s just an outage of e-prescribing or faxing — or may affect the system across the board.

Limited downtime events often have simple workarounds. For example, if e-prescribing or faxing is down, one can always print prescriptions or documents, call medication orders to the pharmacy, or worst-case scenario (ugh) use a paper prescription pad and a pen. Loss of Internet connectivity can be overcome by using a cellular / wireless Internet card, provided the practice has planned ahead and such cards are available for use. If the local wireless network in the practice is out of commission, users may be able to plug in, assuming there are ports available.

For unplanned downtimes, unless they have in-house IT support 24×7, practices should ensure key personnel have checklists for troubleshooting issues and phone lists for Internet service providers, vendor help desks, etc. Make sure multiple people in the practice know how and where the information is stored — don’t count on a single employee to be the point of knowledge. Murphy’s Law dictates that if something goes wrong, it will go wrong when that employee is unavailable.

Planned downtimes are usually limited downtimes. This may include hardware upgrades, software upgrades, weekly or monthly maintenance, etc. When planning a downtime, physicians need to discuss their willingness to work without full access to the EHR. Many physicians may be willing to print summaries for patients who may be scheduled during an upgrade and ‘wing it’ for others. For some, being without data is unacceptable, and the office must be closed.

Careful planning can keep physicians from having to make this decision. Many vendors offer solutions where a copy of the database can be saved to a local computer and accessed in a read-only manner during an upgrade. There are several third-party solutions to this problem, and if you are interested in this for your practice, allow some time (often a few months) to make sure this is in place before a planned downtime.

Disaster recovery usually refers to a situation where something very, very bad has happened. This can include physical destruction of the practice, its servers, and its equipment due to a natural disaster. If the IT infrastructure is physically destroyed, it may be weeks before the practice can be up and running. Disasters can also occur due to poor planning, as my friend learned.

Practices need a plan to create backup copies of the data in the event of a disaster. If you use a Web-based or hosted EHR, often your vendor takes care of backups for you. However, you need to understand the interval at which backups are done. Daily, weekly, monthly? To determine how frequently you need to do a backup, ask yourself: how much data are you willing to lose? For a busy practice, backups should be done daily and practices should consider other strategies to continuously back up data throughout the day (but that’s beyond Disaster Recovery 101, so I’ll save the discussion of transaction log shipping vs. database mirroring for another day).

Backups should not be stored in the office. Think it through: if your office catches on fire and the backup copy is at the office, that’s not a great idea. Backups need to be stored securely under appropriate climate conditions — be mindful of temperature, humidity, etc. There is one important thing about backups that doesn’t cross most physician minds: the need to test the backup to make sure it works. Your IT professionals can do this by taking the backup copy of the database and restoring it to a test system, then checking it to make sure data is current and comprehensive.

Unfortunately, the solo physician who called me this morning learned this the hard way. When the power went out and the battery backup failed, the database was impacted. Her vendor recommended that they restore the database from the most recent backup. When this was attempted, the backup contained less than half the data they expected it to. Not a great situation. Although she was fortunate that the EF-4 tornado didn’t touch her building, it’s going to be a challenge to recover from the loss of so much data.

So physicians, heed this cautionary tale. Take a moment to discuss your downtime and disaster recovery strategies with your IT support staff, whether you work in a solo practice or for a large health system. Don’t be afraid of stepping on the IT team’s toes — many are proud of the downtime strategies they’ve created and will be happy to talk about them. If there is no written plan, make it a point to create and document the processes you need to practice should the system be unavailable. Make sure key staff have copies of the plan, and practice it. Use regular maintenance windows as an opportunity to practice what you would do if an unplanned outage occurred.

Preparing for system outages should be a regular part of the life of the practice, no different than fire drills, tornado drills, or the like. The odds of something bad happening may be slim, but if you’re in disaster’s crosshairs, you’ll be glad you took the time to prepare for the worst and to protect your patients and your practice.

E-mail Dr. Jayne.

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From A Friend: “Re: McKesson. Did you see they lost their appeal for patent infringement to Epic? The products affected are what is now called RelayClinical Communicator vs. MyChart.” I did see that, although the verdict was filled with a lot of legalese and dissenting opinions, which probably means the fat lawyer hasn’t sung yet. McKesson’s original patent was for putting visit-specific information on a Web page for patients, including offering online scheduling and refill requests. The judge found that Epic doesn’t make those capabilities directly available in MyChart, which requires patients to request the service and physicians to approve their request. On that basis, Epic is off the hook – for now. The ruling doesn’t really hurt MCK all that much since it only prevents them from insisting that Epic pay up.

From Cantankerous: “Re: videos on HIStalk. Is there a way to view them on the iPad?” I don’t think so. Apple refuses to work with Flash, which is how YouTube videos stream. You could use the YouTube app that’s included in the OS, but I don’t think you can do that without searching for the video all over again from YouTube. All of that’s good news for companies selling Android-based phones and tablets.

From Ishmael: “Re: Meditech 6.0. I was hoping for something that would improve my workflow, but all I got was a new graphical front end to the exact same functionality as 3.0 and 4.0 except that it now takes 50% longer to do it. Time is all I have and anything that takes it away without compensating me for it is my enemy. It’s not helping me, the doc who has to use it, and it’s taking nurses away from my patients so they can spend more time staring at a screen.”

From Outside Insider: “Re: iPad not being revolutionary. The device weighs just over a pound, you can access your network and systems, you don’t need an input device other than your fingers, and your developers can write apps that will let you access your data any way you want. Would you be as comfortable carrying around a laptop or rolling a PC on a cart? Those who don’t recognize the advantages to change are typically the last to implement and are behind the curve in realizing the benefits.” My iPad has a great screen and very cool apps written specifically for it, but I’ve found the iPod Touch to be the real game-changer since I don’t carry an iPhone. It’s always on and has a huge battery life and quick recharge time, so I check e-mail, CNN, and the weather last thing before bed and first thing in the morning. Sometimes I stream Netflix over it while sitting outside or in the kitchen. For both devices, the key to my satisfaction was to buy a cheap non-USB charger so I could top off the batteries quickly from a wall socket anywhere. The Touch costs only around $200 and carries no recurring expense since it hops happily onto the WiFi at home or work. My record still stands: I use the Touch all the time, and even though it’s primarily a music player, I’ve yet to play an MP3 on it.

From The PACS Designer: “Re: Microsoft Office 365 beta. Now that Microsoft has launched its online version of Office, those of you who could enhance your business practices by incorporating Office can contribute to further refinement of the Office 365 release by participating in the improvement process for this product, and also possibly improve your day to day operations for the future.” It starts at $6 per user per month, which is $6 per user per month more than Google Docs (although to be fair, you’d have to pay Google $4 per user per month for Google Apps for Business to get the uptime guarantee that’s probably not needed anyway). The Microsoft offering includes stripped down versions of Word, Excel, PowerPoint, Outlook, OneNote, and parts of SharePoint. Personally, I find Microsoft’s offerings confusing: there’s also Windows Live SkyDrive (free)and Office Web Apps, all to replace Office 2010 (which you can buy in a three-user license pack for $120 and with no stripping down or need for Web connectivity). I find Google Docs to be pretty clunky and not all that intuitive, so maybe that’s a market for whatever Microsoft ends up releasing. It should be most attractive to small business that haven’t already bought Office and don’t want to manage servers. Maybe I’m naive, but I just don’t see the average user needing to collaborate to an extent that e-mail doc swap doesn’t address, so I personally wouldn’t use either service enough to justify paying for it.

From GoTooSlow: “Re: Valley Medical Center, Renton, WA. Has signed with Epic to replace many modules.” Verified, apparently, since I found the above in the minutes from the hospital board’s December 13, 2010 meeting. It seems to me (without any hard data to prove it) that McKesson is losing more Horizon Clinicals customers to Epic as a percentage than any other vendor, which might have been expected given that those customers were the only ones with significant doubts that their vendor and product would get them ready for MU requirements in some survey I recall from a few months back.

From Lucy Gucci: “Re: Epic. They gave me a great start in healthcare IT (I didn’t exactly have recruiters pounding on my door as a fresh liberal arts graduate), but it’s truly a sweatshop for most people because of 70-80 hour weeks, lack of work-life balance, and travel. I got sick during a Monday-Saturday work trip and had to go to urgent care. The PA there said they see Epic staff constantly because they travel during normal appointment hours and need antibiotics since they can’t take time off to recover. In our March 2011 staff meeting, Judy spent five minutes going over the HIStalk awards and seemed to be tickled pink with her ‘industry figure with whom you’d most like to have a few beers’ award, although she said the would have to drink a chocolate milkshake since she doesn’t drink – at corporate events, we have ‘mocktails.’ As is obvious, sales are through the roof and we dread hearing the wedding music playing over the PA to indicate a new sale since Epic truly does not have the experienced implementation staff to support all the new customers. Experienced employees used to have two customers, now 3-4 are the norm. Please keep me anonymous – Judy warns us every single month at the staff meeting not to post anything about Epic to blogs.”

This weekend was an almost-first: I whisked Mrs. H away to a beach mini-vacation and didn’t touch the laptop until we got home. There was mango sangria, walking in the surf, watching a horrible Burt Reynolds movie (was that redundant? – well, it was Stroker Ace, which is bad even by low Burt standards, but I couldn’t look away given the mammoth thespian talents of Jim Nabors) while drinking wine in front of the TV with the sea breeze wafting in, and eating some excellent fish tacos and goat cheese with mango salsa (it was a two-mango weekend). I’m sunburned, behind in my work, and not a bit regretful about either. 

The feds aren’t exactly wowing those of us in the industry with their Medicare and Medicaid fraud-fighting record, with 95% of respondents saying they’re doing something less than a good job. New poll to your right: will the Meaningful Use requirements significantly improve patient outcomes and patient safety?

My Time Capsule editorial from 2006: Joe Sixpack’s Concerns About Privacy and Security Need to be Taken Seriously. A snip: “Odd, isn’t it, that a physical break-in seldom reflects poorly on the company being victimized, but an electronic one immediately triggers outrage and disbelief?”

Cerner COO Mike Valentine resigns the job he’s held for three years for unstated reasons, although the company claims it has nothing to do with its upcoming earnings announcement. He will be replaced by Mike Nill, EVP and chief engineering officer, who oversees the company’s solutions and technology management. Nill, who joined Cerner in 1996, holds a bachelor’s degree in computer information systems from Rockhurst University and was previously with Andersen Consulting.

In addition to the COO change, Cerner also announces that SVP Zane Burke has been promoted to EVP over the client organization that covers the Americas and the Pacific Rim. He joined Cerner in 1996.

More HIStory from Vince Ciotti.

The New Mexico REC accepts Sage Intergy Meaningful Use Edition as a qualified product.

Adena Health System (OH) chooses MedsTracker 5.0 from Design Clinicals for medication reconciliation.

The CDC-funded Lab Interoperability Cooperative is recruiting hospitals to participate in a program that will connect their labs with public health agencies as required by ONC’s Meaningful Use criteria. LIC will provide educational and technical assistance to at least 500 hospitals help them electronically transmit lab results. The underlying technology is the Surescripts Network for Clinical Interoperability. Participants include AHA, the College of American Pathologists (and CAP-STS – SNOMED Terminology Solutions), and Surescripts. A readiness checklist is here.

MedPlus puts a cool green bus on the road to demo its Care360 EHR. I should tag along since it’s as close to a rock star tour as we’ll get in this industry, although there was no mention of groupies or trashing hotel rooms.

Big Boston physician groups Atrius Health and Fallon Clinic are in talks to merge, with their common software platforms for EHR, PM, and patient scheduling being cited as a reason that action makes sense.

Banner Health and Poudre Valley Health System will participate in the Colorado RHIO, which awkwardly calls itself the CORHIO HIE since a substantial part of its name came from a fad that has already become passé.

Stupid: a former Ohio neonatologist pleads guilty to signing up for a child pornography Web site using a hospital computer. He has surrendered his Ohio medical license, was fired from his most recent job as a Massachusetts researcher, and will serve 27 months in prison.

E-mail Mr. H.

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