Real-time location system vendor Awarepoint announced this morning that it has acquired Patient Care Technology Systems (PCTS), a vendor of software that helps hospitals track people and physical assets. Terms were not disclosed.

Charlotte, NC-based PCTS has 60 hospital customers that include New York-Presbyterian, Advocate Health Care, Providence Health & Services, and Aurora Health Care. It will continue operating from its current office, with the PCTS executive team reporting to Awarepoint CEO Jay Deady at the company’s corporate headquarters in San Diego.

Deady was quoted as saying that the combined solutions will allow the company “to capitalize on an enormous untapped RTLS market” in which US market penetration is estimated at 10-12% and around 5% internationally. The company’s value proposition includes reducing medical equipment rental costs, reducing procedure time and nurse labor involved with in locating needed equipment, and ensuring that equipment is correctly reprocessed between patients.

We spoke to Jay Deady on Monday after running a rumor from RTLS Battle predicting that the acquisition would be announced this week. He said Awarepoint’s 93 hospital customers, having realized significant return on investment from the company’s asset management and tracking capabilities, were pressing the company to move quickly into patient workflow solutions that can support discharge planning and real-time monitoring.

“Integrating a workflow engine into our software and building out the workflow library was going to take 18-24 months,” he told us. “At our recent user meeting, our customers told me they are ready to go right now. Awarepoint and PCTS have three shared accounts — Christiana Care, Aurora, and Advocate Good Sam. I visited those clients and got rave reviews about PCTS’s workflow engine and content library. It just seemed logical to meet the needs of clients in accelerating to market and not taking two years to develop.”

Deady says that completing the transaction required “a very fast close” due to competing bids from private and publicly traded companies and a private equity firm.

PCTS’s relationships with other RTLS vendors will continue, Deady told us. “This is not a one-size-fits-all environment. We will continue to work with other technology partnerships. A lot of our clients were asking us about other RFID technologies, such as passive RFID for inventory tracking. PCTS has an RTLS integration engine and can integrate that in being able to play well in the sandbox with other active and passive players. That was a big decision point for us to merge with PCTS.”

Deady summarized the benefit to customers as being similar to the consolidation of hospital clinical systems starting in the late 1990s. “Customers don’t want to go to different companies for technology, inventory management, asset management, hand hygiene, and temperature monitoring. Up until a year ago, a hospital that wanted to deploy all these technologies would be doing business with seven or eight different companies. Our goal in merging with PCTS is to give them one place to go.”

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I try not to waste too much time on the Internet, but keeping an eye out for interesting stories on health and technology is an occupational hazard. How could I not read a piece with the headline Playboy Mansion Illness Traced to Hot Tub Bacteria when it crossed my screen? Apparently our old friend Legionella (the bacteria that causes Legionnaires’ disease) was found in a hot tub at the Playboy Mansion after scores of visitors were sickened.

As if a story about hot tubbing with Hef isn’t tawdry enough, epidemiologists were no doubt engrossed when the case was presented last week at the Centers for Disease Control’s annual conference in Atlanta. So what does this have to do with health and technology? Well, it seems that epidemiologists used social media to contact the 400+ people who were at a fundraising event where they came into contact with the bacteria.

In other news, the Associated Press reports that Odd Work Schedules Pose Risk to Health. From my experiences as an intern and resident, I could have written that one — it’s not good for the caregivers or their patients. According to Dr. Charles Czeisler, chief of sleep medicine at Brigham and Women’s Hospital in Boston, 30-50% of night shift workers admit to falling asleep at least once a week while working.

Although the article highlights findings related to recent issues with air traffic controllers snoozing on the job, the facts play to all of us in healthcare and IT, also. Czeisler states that taking work home on BlackBerrys and computers as well as the 24×7 availability of work and entertainment options contributes to sleep issues.

Somehow I missed this in my recent studies for my medical board recertification exam, but night shift workers are more likely to have chronic intestinal and heart diseases. Apparently, the World Health Organization has also identified shift work as a probable carcinogen. Not good news for those of us in the business of 24×7 technology and patient care activities, or the patients either. Having been sleep deprived for nearly five years during my training, I understand the near misses (and sometimes real misses) that can happen in the middle of the night when the thought process starts to get fuzzy.

These types of situations are great for employing technology as an additional safety net for our patients. Long hours aren’t going away (nor are distractions, overloaded schedules, nursing staff burdened with regulatory nonsense that detracts from patient care, or any of the other dozens of things that impact clinical decision-making). But well-placed clinical tools (like the Thomson Reuters tools mentioned by Dr. Gregg on HIStalk Practice)  can really make a difference.

Personally, I’d much rather have my anesthesiologist calculating drugs and dosages in a well-crafted electronic record than doing equations on the leg of his scrub pants (which, thank goodness, I haven’t seen in a long time). However, the systems have to be well designed, easy to use, and accurate if they’re going to make a difference. Users have to commit to attending training, using the system properly, and not short-cutting steps. IT teams have to keep the systems available (not to mention happy and healthy) continuously. Otherwise, make sure you have your scrubs on — and your favorite ballpoint pen.

E-mail Dr. Jayne.

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Carlos Nunez MD is chief medical officer of CareFusion of San Diego, CA.

What led you take the CMO position at CareFusion?

I was with Picis for almost 11 years. My title there was chief physician executive, which was essentially the CMO of Picis.

My background in medical technology and information technology goes back a little over 20 years, all the way to the time when I was still practicing medicine and even into my training as an anesthesiologist and as an intensivist. I guess being at Picis automatically type-cast me as being an informatics person, but my interest and my background really is more than just healthcare IT, but healthcare technology, of which I think IT is a very important part.

When you look at what’s happening in healthcare right now — I probably don’t have to tell you — healthcare is notorious for embracing fads. More than ten years ago, when the IOM came out with the report, To Err is Human, everybody was all about safety. When Leapfrog said CPOE was necessary, everyone was all about CPOE. A year or two ago, it was RHIOs. Six months ago it, was HIEs and Meaningful Use. Now healthcare reform has got everybody all in an uproar about ACOs.

When you see what’s happening in healthcare beyond the fads, and you look at the themes that have persisted for the last 12 years or so, it’s this focus on quality, safety, cost, and efficiency. Regardless of whether you’re talking about an ACO or an HIE or Meaningful Use, those are the themes that continue to rear their heads in everything that either is a fad or a discussion or the theme of the moment.

I think technology is perfectly positioned to help, specifically with American healthcare, but global healthcare deals with these challenges and attacks these themes. Looking at American healthcare in the context of healthcare reform right now, the challenges are the same. It’s decreasing levels of reimbursement and revenue to hospitals and the individual providers. Healthcare reform is trying to squeeze out $400 to $500 billion in savings from Medicare over the next ten years. The aging population, the decreasing resources — whether you’re talking about the nursing shortage or the shortage of primary care physicians to the consolidation of hospitals and practices — technology is perfectly positioned to help with a lot of these problems and changes.

When I looked at the opportunity at CareFusion, I found a company that I felt was perfectly positioned to address these challenges with a very, very unique set of solutions. What I did in my former company was focused on pure IT. It was software and solutions. But using that as an example, our software worked best when it was connected to an anesthesia machine; when it was communicating to a physiologic monitor; when it was getting information from a balloon pump or an infusion pump or a pharmacy system. There was more than just a pure healthcare IT play going on.

There was what I like to call this hidden kingdom of healthcare IT. That’s the medical technology. Information technology only works when it’s full of information, when it’s full of data. Most of that data comes from the patient. In the high-acuity areas of the hospital or in the areas of the hospital where patients are the most sick or most vulnerable, more often than not, that data is coming from a device. It could be coming from an infusion pump or a PCA pump. It could be from the pharmacy and the dispensing cabinet. It could be from the ICU, where the sickest patients are connected to all sorts of medical technology. 

When I looked at this opportunity, I saw a company that had products and services aligned with those same themes and those same challenges that healthcare faces. Medication safety and medication management, looking at infection prevention from the standpoint of central line or respiratory ventilator-associated pneumonia, supply chain management, portfolio IT assets, and most recently, the announcement that CareFusion is looking at ways to make hospitals a little more eco-friendly in dealing with the problems of hazardous waste disposal. 

Looking at their technology portfolio and their IT portfolio, I saw an opportunity to work for a company perfectly positioned to make a difference in those themes and in those areas where healthcare needs help.

Some would argue that healthcare IT is still enamored with IT basics, like having someone enter data and someone else pull it back out on the other end. On the other hand, companies like CareFusion were engineering-driven and not very good at developing software, where they were happy just to get relays to click and solenoids to move. Do you see those worlds coming together to help take care of patients?

I do. Before I took this position I was reviewing something that most of your readers are probably very familiar with, the KLAS rankings of the different IT solutions in the hospital space. My former employer had various solutions that were ranked in KLAS, so we watched these things very carefully. At the end of the year, KLAS puts out their Best in KLAS overall IT vendor rankings based on multiple products that KLAS ranks.

Probably no surprise, Epic was ranked Number One as Best in KLAS. Do you know who was Number Two? It was CareFusion, behind Epic by only two-tenths of a point. Number Three was more than four points away from CareFusion. I’m looking at this saying, here is a company that everybody thinks of as Pyxis machines and Alaris pumps who’s ranked neck and neck with the IT vendor that has taken the IT world by storm over the last few years. There must be a reason why.

As I learned more about what CareFusion does, I uncovered the reason. It is exactly what you alluded to with your question. The Holy Grail of what CareFusion is trying to accomplish is exactly what you say. When someone is adopting an information technology solution at the point of care, where someone is documenting care or making note of a lab result or entering something about a patient, how is that going to affect a drawer that opens or pump that’s infusing a medication or a fluid into a patient or a ventilator or some of the other things that CareFusion does? 

Here’s a scenario. Imagine you have a person who is on an anticoagulant and they’re getting PTT and INR studies done regularly. There’s an order to administer another dose of heparin or Coumadin. The nurse is going to follow the order. The lab results come back and their INR is therapeutic or maybe it’s even higher than what you would like. The nurse goes through the dispensing cabinet. They haven’t had a chance to go to look at the patient’s lab results. The dispensing cabinet says, “By the way, you’re about to take out that drug for a Mr. Jones, but I’ve just checked and the lab is saying that Mr. Jones’ INR actually is a little higher than you’d like it do be. Maybe you want to hold off on that dose. Call the physician.” That’s how that interplay needs to happen, and it already does. 

That’s what was surprising to me as I investigated what CareFusion was already about. The part of CareFusion that does a lot of their IT and analytics and surveillance was a company called MedMined that they acquired a few years ago. It was traditionally a company that did antibiotics infection surveillance in trying to improve antibiotic stewardship. It is now expanded throughout CareFusion’s different vertical businesses to provide notifications at the point of dispensing drugs or at the point of administration, regarding things beyond just antibiotic and infection surveillance, but looking at lab results, electrolytes, anything that could affect why or why not you’d want to dispense a drug. That’s just one example, but it’s a great example of that convergence between IT and devices. 

I spoke earlier about data coming from devices to the IT system. There’s an example of data living in an IT system like a pharmacy system or a lab system that’s now affecting the way someone interacts with the device that you wouldn’t traditionally consider part of IT. But think about it. I know you’re a fan of the Apple iPad, as am I. As a matter of fact, in your Monday Morning Update for just this past Monday, you had a little one-liner that AirStrip Technologies was shown in the very first iPad 2 TV commercial. The iPad is a device, the magical device that Steve Jobs has sold us all on. Incidentally, there are still lines every morning outside the Apple store in San Diego to get one, which is incredible to me. The magic of the iPad is it’s a beautiful device and the apps, the IT, and the hardware, together working in an ecosystem that’s very disruptive. 

Using the iPad example, look at how the iPad has just taken the medical world by storm. Doctors can’t stop showing up to work without their iPads. It’s caused CIOs even outside of healthcare, in businesses like here at Carefusion … our CIO’s got to figure out, “How do I integrate these iPads and these iPhones into our workflow? We’re a Windows-Exchange shop.”

It’s the same sort of revolution that I think it needs to take place. People need to recognize that all technology, not just pure information technology or software, is part of the information infrastructure of a hospital and a health system. It is that interplay between devices and information systems that will define how things become more efficient and adoption increases.

You’re right, we get really excited when we’re able to do very simple things. The adoption of technology and information technology in healthcare is behind many of industries. When you find the appropriate way to integrate information, data, actionable knowledge at the point of care, wherever that happens to be — whether it’s on the screen of a device or on the screen of a workstation — so that it’s less disruptive and more integrated into the very busy workflow of a nurse or a physician, then you’re going to see the adoption increase, the efficiency increase. Things like safety and quality should follow.

When people think of advances in banking technology, they don’t think of what goes on behind closed doors, they think of ATMs and online banking, the sharp end of the stick. In healthcare, nurses are the most vested at having tools, but nobody’s really doing much for them even though they provide most of the care.

Absolutely, yes. I’ll give you another example, because I had this conversation with someone here at CareFusion yesterday. It was the philosophical argument — where does certain information belong? Does it belong in the traditional IT system, or does it belong within a medical device or on a screen that’s part of a medical device? 

I said I don’t think that you can just make blanket statements like that. I think the information, the actionable knowledge that’s going to make a difference at the point of care — like you said, especially for the nurses who really feel the brunt of a lot of this — is wherever it best fits within the workflow.

I know we were talking about nurses, but I’m going to use a non-nursing example because this is off the top of my head. It’s what we talked about yesterday — the respiratory therapist. My former employer had an ICU information system, which is great. I’m an intensivist, loved it. Part of the feature set was that you could create customized flowsheets and a respiratory therapist could look at information on that customized flowsheet.

But more often than not, a respiratory therapist in the ICU walks right up to the ventilator. They’re used to having a clipboard sitting on top of the ventilator where they’ve got information about that patient and then a screen on the ventilator. They’re not going to want to change their workflow and have to go look into a screen.

Imagine if on that ventilator screen, you can see the blood gas results that you’re most interested in, or any other information that makes a difference. Maybe it does need to be on the information system screen. Maybe it needs to be on the ventilator. For me, it should just be integrated into the workflow that makes sense because the biggest problem is adoption — physician adoption, clinician adoption.

Getting people to adopt technology or IT or otherwise is difficult when you ask them to do more stuff. When it’s integrated into their workflow, then it becomes a pleasure to use this stuff.

I assume that the fact that CareFusion hired you is an indication that they’re interested in backing away from that engineering label and getting more into mainstream IT. How do you see that changing what goes on at CareFusion, especially when it comes to healthcare reform?

I think what CareFusion hiring me signals is that they want to take a balanced approach. Not so much that they want to try and become identified as an IT company versus an engineering company. I think they want to take a balanced approach that reflects some of the things that I have been saying — that there is medical technology and information technology working together can have a tremendous impact on quality, safety, cost and efficiency.

That’s the message that they’re trying to send, not just by hiring me, but by creating the portfolio of products and solutions that they have created over the last few years since they spun off from Cardinal. The way they go to market with these strategies and the integration that they are building between their different vertical platforms to show that there is this place where devices and software can play together and play together nicely, creating real benefits for patients and for providers and for hospitals.

I alluded to a couple of things about healthcare reform earlier. We talked about the fact that this is a plan that’s supposed to cost a trillion dollars. That’s what we were initially told — everyone knows that most government programs go over their initial cost estimates. But if we stick to that figure, a trillion bucks, roughly half of that is supposed to be realized through savings in Medicare and other CMS expenditures, Medicaid, etc. 

The ACO rules and regulations were just published. It’s like a fad. We’ve seen this before. You look at the HHS estimates for the adoptions of ACOs, and they’re saying that in their best estimate, somewhere between 1.5 to 4 million lives will be covered within the ACO model by 2014 with savings of roughly $500 million — with an M — dollars.

So they’re saying, “We’re hoping four years into the ten-year plan for healthcare reform we’re going to have maybe four million people in the ACO model.” That’s not even 10% of the roughly 44 to 45 million Medicare beneficiaries that are covered today. Savings of $500 million? That’s not even a drop in the bucket when you’re looking at half a trillion dollars in Medicare savings. 

It makes me wonder why we do this to ourselves in healthcare. Why we elevate these fads and get crazy over them without looking deeply into the facts and say, “Gosh, yeah, this is an interesting thing. Maybe it will end up leading to real savings and real changes in the way we deal with healthcare.” But in the end, it always goes back to the same things. It’s quality, safety, cost, and efficiency.

For me, healthcare reform represents one really important thing. Whether you agree with the way it was enacted, whether you agree with the provisions, whether you think the costs are right, or ACOs are great — and I’m not saying I have an opinion one way or the other — I’m just curious as to way everyone’s so crazy about an ACO model that we’re not yet sure will create significant savings.

What healthcare reform did is announce to the world in a very public way that the United States is finally acknowledging we can no longer afford the system that we have on the cost curve and trajectory that we’ve got. Not only does it endanger CMS and HHS, it endangers the entire federal budget. It endangers the economy of the United States as a country. It’s a very real problem and it’s a big, big part of the discussion that we now see around the Republicans’ new budget proposal trying to cut over five trillion dollars from the federal budget over ten years. This is a big deal. It could bankrupt our government and really make a huge impact on the American way of life, so we have to do something about this. 

Technology is the way that other industries have found the means to become efficient and look at ways to improve quality and safety while becoming efficient and spending less on the things that don’t matter — redundancy and paperwork and overhead and the things that don’t matter. There’s a way that we can refocus healthcare on taking care of patients. I think technology plays a huge part in that.

The last thing I’ll say on my little political diatribe. You know, we don’t have a healthcare system in the United States — we have a disease intervention system. Most Americans wait until something is broken or bleeding or falling off before they show up in the ED and get very expensive care for a problem they should have taken care of years or months before.

I think all of those themes that continue to merge about quality, safety, cost, and efficiency lead us to a remaking of this system in a way that keeps us healthier and tries to avoid getting to the point of disease intervention until it becomes more inevitable. And again, technology — and maybe not even in the inpatient setting — can play a huge role in all of that.

I think that’s what’s important about the ACO model or about healthcare reform or about Meaningful Use. It’s not the few million dollars in incentive payments here or there, or whether or not it’s going to be a million or four million lives covered in an ACO model. It’s the fact that we need to do something to move our healthcare system towards providing healthcare and using technology to become more efficient, to take better care of patients while not going broke in the process.

From my perspective — obviously I’ve got a very inpatient focus perspective as an anesthesiologist and intensivist — a company like CareFusion, from within their perspective mostly focused in the areas of the hospital where things like supply chain management and medication safety and infection prevention — it’s a really, really interesting place to be with all the stuff that’s swirling around.

If you looked out five to ten years, what should technology vendors in general and CareFusion in particular be working on to start to move the needle on patient outcomes and costs?

Five to ten years? Wow, I’m going say a word that is very overused in our circles, but I’m going to try and define what I mean by that. I think it’s a level of interoperability that makes sense.

It’s not just creating interfaces between different systems because they don’t exist now, and maybe we need to have everything tied together. It’s creating an interoperability between medical technology and information technology that provides actionable information at the point of care so that the providers who are being asked to do more with less can make the right decisions, can keep their patients safe, can deliver the highest quality care in a way that is most efficient and most cost effective.

I gave the example of the respiratory therapist or the nurse who’s trying to dispense a medication and it’s contraindicated because of a lab result. The examples go on and on from there, and maybe some of them are very, very clinical and safety-focused. Maybe some examples are more focused on collecting data for retrospective analysis. A patient who’s admitted for a non-infectious disease-related diagnosis and the Pyxis machine notes that they had a central line kit removed, and then three days later, the Alaris pump sends a signal that they’re getting an infusion of antibiotics and there’s no reason why they should based on their diagnosis. Do we now start to see markers for infection? Do they have a central line infection? Can the infectious disease nurse be prompted to go and check on that patient to see what’s going on?

The examples go on and on how you can start to tie devices and information technology to create an ecosystem that is much more efficient than what we have today. It’s not just creating interfaces using HL7 because we think it would be great to connect this system with that one. It’s really creating a web of connected devices and connected systems that allows us to be very efficient in delivering the safest, highest quality care that we can, and saving money in the process.

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From RTLS Battle: “Re: Awarepoint. Word is the company outdueled Merge to buy PCTS, a workflow software vendor in Charlotte, NC, with former Allscripts VP Jay Deady (Awarepoint CEO) beating out another former Allscripts VP Jeff Surges (Merge CEO). Deal to be announced next week. Wonder if they’ll split deep dish pizza in Chicago any time soon?” Unverified. PCTS offers the Amelior product line that includes ED and OR asset and patient tracking, hand hygiene systems, and temperature monitoring. They are a business partner of Awarepoint.  

From The PACS Designer: “Re: net collaboration. InformationWeek has compiled a list of the 15 Top Collaboration Apps that promote working together using the Internet. With all that is going on with Meaningful Use, this compilation of collaboration tools is good for institutions who want to progress to the next level of efficiency, which is meaningful structure.” Most of the apps listed involve some flavor of project management in what would have been called a hosted Intranet a few years ago (I guess that’s not a commonly used word these days). I notice that Cerner is listed as a user of Jive Engage (a social media monitoring tool) for its “social network experience,” since the whole point of social media is to sell stuff, of course.

From Katrina: “Re: Healthcare Informatics Executive Summit. I work for a vendor and registered, but was told I needed to either come up with $7,000 of program sponsorship or bow out, which I did. I’m warning other potential attendees about the small print stipulation.” The keynote speakers that Healthcare Informatics won’t allow you see for your $1,095 registration fee are Farzad Mostashari of ONC and Carolyn Clancy of AHRQ, both paid with your tax dollars, so that’s a bit insulting. Maybe you could just register as yourself at XYZ Consulting, pay with your credit card, and put it on an expense report. That brings up another gripe: the registration form requires entry of your job title and employer. Why should someone paying their own registration fee have to provide that information? If my employer isn’t willing to pay for my attendance, why should they (and the conference organizer) enjoy the benefit of having their name on my badge?

From KS: “Re: Epic. Consultant advertisements are popping up at MSN airport. They, of course, also spell it EPIC. Wonder what they think EPIC stands for?” Maybe they’re just shouting the name because they’re so excited about the money they’ll rake in if they can just find some consultants.

From Tango Charlie: “Re: Epic. Duke will announce next week and Wake Forest is suppose to go Judy, too.” Unverified. Duke is going with at least Epic ambulatory, it seems (and as history has shown, hospitals don’t often stop there). Wake Forest (above) was on the list of hospitals attending Epic training for unnamed modules a couple of weeks ago that a reader sent my way.  

Nearly two-thirds of respondents like the idea of biometrically verifying the identity of those claiming Medicare and Medicaid healthcare benefits. New poll to your right: how is the federal government doing against Medicare / Medicaid fraud?

My Time Capsule editorial from 2006: RHIOS Are Taking Away Resources From Better Projects. A snip: “Do you like insurance companies enough to let them control patient information?”

Three free press release tips for you PR and vendor types: (1) always put out press releases in PDF format rather than .DOC, for about a thousand reasons that I hope I don’t have to explain to people who supposedly are experts at media; (b) never put a press release out on a national wire service but not simultaneously on the company’s own site – isn’t that kind of the point? and (c) if you’re going to mention a hospital, include the city and state it’s in. I could add dozens more, but these came up today.

Above is the latest history (is that an oxymoron?) from Vince Ciotti.

Shares in for-profit hospital operator Community Health Systems drop 14% in after-hours trading Friday after the company announces it has been subpoenaed by HHS in conjunction with an investigation of its Medicare and Medicaid billing. Rival Tenet Healthcare, which in December rejected an acquisition offer by CHS, accused CHS of billing fraud in a lawsuit it filed against CHS. HHS wants to review CHS’s ED practices and the algorithms in its Pro-MED ED physician documentation software, which may test that company’s claim that it “Meets and exceeds all CMS Physician Evaluation and Management Documentation Guidelines, ‘maximizing’ reimbursement” depending on how CHS set it up.

CMS is threatening to stop payments to University of Chicago Medical Center after finding that conditions there pose an immediate threat to patient safety. A prominent patient died after a medical error involving a dialysis catheter-caused embolism. Not to be cynical, but oversight organizations react a lot more forcefully when patient harm involves someone wealthy, famous, or the subject of splashy media stories. I’ve worked in hospitals involved in high-profile medical error cases and it was obvious that organizations such as Joint Commission, state hospital inspectors, and HHS don’t like having the hospitals they oversee embarrass them in the press, so their reaction is sometimes overly hostile and critical. I would question the effectiveness of any watchdog group that pronounces conditions dire only after they read about them in the newspaper.

A Rhode Island physician will be in line Monday morning when CMS opens the virtual doors for Phase 1 of the Medicare ARRA incentives. Douglas Foreman DO, a family practice physician who uses the Ingenix CareTracker EHR and its Meaningful Use dashboard, says he has met the 15 Core requirements and seven of the 10 Menu Set items (of which five are required to qualify for the incentives).

UCSF says it’s turning on Epic outpatient, with a price tag of $160 million vs. the originally estimated $60 million due to an expansion of the project’s scope (there’s more to the story I can’t see since I don’t subscribe to the San Francisco business paper).

My new favorite iPad app: the just-released Bing search (the irony of a Google-competing Microsoft app written exclusively for an Apple device duly noted). Not only is it stunning to look at, you touch the microphone icon and can immediately speak your search terms with good accuracy.

The Florid-based developer of the Electronic Medical Assistant software for dermatologists gets a $4 million investment from the British company that owns the Speedo swimsuit product line. Modernizing Medicine was founded by a dermatologist and the co-founder of the Blackboard online learning system used by colleges. The EMA software costs $6,000 upfront and $650 per month. One of its users says he can create 30 notes in 25 minutes.

The military’s TRICARE system team announces that its Blue Button functionality has been expanded to allow users to download include lab results, patient history, and visit history.

A post on Geek.com nominates this as one of the most inopportune times for a Windows update. It’s a picture of a woman’s hospital monitor during labor taken by the dad-to-be, a computer science professor. Perhaps the hospital’s biomed folks should take a look at the device since enabling automatic Windows updates on an FDA-regulated system doesn’t seem like a good idea.

Michael Kirsch, MD, is a pretty funny writer (he even looks a tiny bit like Jeff Foxworthy). His list of Apps I Want includes: “Medical Coding App. This turns your iPhone into a high voltage device, similar to the Invisible Fences that are used to restrain pets to a given area. Tap the App and then place the iPhone in your front pocket. After seeing a patient, if you code higher than you should on your EMR, you will get a light shock. The intensity will increase until you have expressed remorse, atoned and coded properly. I expect that Medicare will provide incentives for using this technology in the coming years.” 

A $5 million malpractice judgment against a Canadian hospital is thrown out when the hospital’s lawyers notice that 321 of the 368 paragraphs of the Supreme Court justice’s ruling were copied directly from the closing arguments of the plaintiff’s attorney. There appears to be some legal debate as to whether the judge crossed some unspecified line or whether that simply means the plaintiff’s legal team did the job they’re paid to do – create sound, well-referenced arguments that, if they win, must have had significant influence on the verdict.

Bizarre: the Texas patient who received the first US face transplant obtains a restraining order and files suit against a British tabloid that insists he sold them his story rights for $2. The man, who lost his eyes in the accident that necessitated the surgery, admits that he signed a document from the company, which told him they wanted to write a human interest story to be run in a women’s magazine. The tabloid has created TV programs that include “Is This China’s Fattest Kid” and “Legless Dancer TV Hit.” Maybe the biggest question is why a face transplant warrants tabloid coverage. How big of a page-turner could it be, especially when Charlie Sheen is out there spreading his Adonis DNA?

The OR of River Park Hospital (TN) goes live on Shareable Ink after a two-week project (kickoff meeting to go-live). They plan to expand its use.

Former iSoft CEO Gary Cohen files proceedings to delay the $188 million sale of the company to CSC, saying the company is required to give his family investment group four weeks’ notice before selling it. He previously said he was considering making his own offer to buy the company.

NPR runs a fun piece criticizing ACOs that includes four ACO jokes: (a) I don’t know how to define an ACO, but I know it when I see it; (b) We have tried ACOs already — they were called HMOs; (c) The three greatest mythical creatures are the abominable snowman, the Loch Ness monster, and ACOs; and (d) the true meaning of ACO is Awesome Consulting Opportunities.

Rochester RHIO says it’s the first HIE to allow patients to upload their advance directives and healthcare proxies so they can be viewed in an emergency.

Everybody’s fighting to protect their healthcare profits, it seems. Case in point: for-profit ambulance companies are fighting with the powerful firefighter’s union over who gets to provide those ultra-expensive (and often Medicare-paid) ambulance rides when people call 911 for whatever conditions they personally deem worth spending someone else’s money on. It would be interesting to study the outcomes of ambulance-transported patients to determine how often their medical needs justified it.

In the UK, designated early adopter Pennine Care Foundation Trust pulls out of NPfIT after years of delays in adding mental health capabilities to iSoft’s Lorenzo.

E-mail Mr. H.

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I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2006.

RHIOs Are Taking Away Resources From Better Projects
By Mr. HIStalk

I’ll confess that I’m paying minimal attention to the RHIO craze. Everybody’s starting one, conferences are showcasing speakers who’ve done nothing more than announce theirs, and tiny grants are getting the whole industry atwitter. It’s like living the dot-com frenzy all over again, irrational exuberance and all.

I’m not against RHIOs, but they’re as annoying as CPOE was awhile back, taking resources away from projects that could provide more benefits to patients without the minefields.

I recently interviewed Denni McColm, an award-winning CIO of a 74-bed rural hospital no different than 80 percent of those out there. Oh, except that they’re 100 percent paperless and 100 percent CPOE, something virtually none of the celebrity CIOs and Taj Mahospitals have been able to accomplish. I’ll listen to her, thanks.

First, Denni believes that organizations should be banned from using the word “interoperability” until they can bring their own electronic information to the table. If your IT house isn’t in order, RHIOs don’t need you. Anything short of everyone contributing information equally will cause the whole concept to collapse like an imploded 1960s Las Vegas hotel, so paper jockeys need not apply.

Work instead on projects that will help your patients more than the begrudging swapping of routine lab reports with your cross-town competitor. Or, integrate all those systems you already have. Your admission ticket should be a checklist of what data elements you can supply electronically right now.

Second, Denni advocates a patient-centric RHIO model instead of the common payor-centric one. Do you like insurance companies enough to let them control patient information?

By patient-centered, I don’t mean personal health records. People are too irresponsible to reliably collect and store data with life and death importance. On the other hand, they could be given control over the trusted information generated by hospitals, physician practices, and other providers.

Suppose information resided in an Al Gore-type lockbox that contains everything from discrete electronic data to scanned documents fed over the Internet. Either the patient controls the key (similar to a password) or only they can initiate data delivery to a provider. If they don’t want you to see it, you won’t.

This model makes most privacy concerns go away. It avoids the largely unsolved problem of how you assign some sort of universally mandated patient identifier (aka “political suicide”) to sort out the throngs of people sharing the same name. The patient simply says, “send my data to Dr. Jones” and it’s done. They keep control and there’s no arbitrary “regional” service area beyond which lies a medical no-man’s land.

Maybe some RHIOs work this way. Like I said, I don’t follow them. And, if I can’t see a quick and obvious patient payoff, I probably won’t start following them any time soon. I’ve got plenty of challenges working on clinical system projects that will hopefully save lives right now.

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