From Former CIO: “Re: high price of Epic. In my experience, the price of Epic software is competitive with others (at least the big guys). The difference is that they drive the customer to look at the true cost of implementation and plan for the resources, internal and external, training, etc. The other vendors hope you won’t actually add it all up until you sign the software contract. This is the best part about Epic since it gets the organization to accept the budget, even if difficult. If you are not prepared to spend the money then they may walk away. In the end, Epic is not necessarily more costly than the others would be.” An excellent reminder that I often need. Software license fees are often nearly irrelevant to overall project cost, especially on the often-forgotten cost of internal labor. It would be interesting to survey recently implemented hospitals to find out how implementation budget overruns correlate to specific vendors.

From Judy: “Re: couldn’t resist telling you. I have yet to receive an e-mail from iHealthBeat, HDM, or whomever that had a news flash I hadn’t already seen on HIStalk. Time to unsubscribe from these eJournals promising the latest, greatest news. Keep up the good work (although I do worry about you, truth be told) and help me SIMPLIFY my life! You should have NO doubts about your impact on this industry and I am SO proud of you!! Really.” I’m moved by that. From my vantage point, HIStalk has been eight years (as of June 20) of long evenings and weekends in an empty room, seven days a week (check out the count of my “sent” e-mails above from my HIStalk-only account). Comments like this keep me coming back, even though I’ll probably wonder on my deathbed what the heck I was thinking in spending all this time on what is basically a spare time hobby. At the moment, I’m still having a ball.

From IT Director: “Re: Siemens. At the recent Siemens Medseries4 User Conference in Salt Lake City, it was nice to see a strong message from Siemens leadership that Medseries4 is a go-forward strategy for Siemens. A recently approved five-year development plan increases focus on development already well under way on both the Clinical and Patient Financials as well as a much anticipated ‘spruce up’ of the General Financials. Also touted was a commitment to enhancing the integration of surround applications such as Pharmacy and EDM. This, combined with UHS’s (Universal Health Services) recent commitment to install Medseries4 in all 106 of its newly acquired facilities is certainly a positive note for Medseries4 customers.”

From Your Favorite Uncle: “Re: Lakeland in Michigan — confirmed. They are going up with Epic ambulatory at the end of the summer and inpatient at the end of the year.” Thanks.

From Nasty Parts: “Re: TSI Healthcare in NC. I hear they have been acquired. They are NextGen’s largest VAR.” Unverified.

From HealthCareIdiotSavant: “Re: healthcare IT stocks. My broker has found nothing other than the usual suspects and none of them are rated all that good. Would be interesting to have your investment banker dude weight in on investing in a fund or a reasonable combination of individual stocks, wit no promises or guarantees, of course.” I actually have quite a number of investment banker dudes (and maybe some dudettes) as readers, so if any of them care to advise (anonymously if desired), I’ll let you know. As you’ve found, not all that many pure HIT plays are publicly traded, though.

 

Poll respondents: next year will be the big HITECH hump for vendors. New poll to your right: do you trust CMS to accurately collect and report provider and quality data?

My latest Time Capsule editorial that hasn’t seen daylight since 2006 and even then only to print newsletter subscribers: Hospitals Need to Learn from Failed Transformation Missions. A snip: “Sometimes imaginary victory is declared at the HIMSS conference, proclaimed by ventriloquist vendors whose lips barely move when their customer speaks.”

Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in April (sorry it’s a long list this time, but there’s always a lot of activity right around HIMSS). As a non-professional part-timer, I’m humbled to see this impressive roster of supporters, especially since it represents just a four-week period. Click a logo for more information.

 
 

 
 
 




 
 
 
 
 
 
 

Ohio Valley Medical Center (WV), embroiled in a lawsuit with its former CEO, claims he struck secret deals with doctors that paid them exorbitantly and also diverted all the money from its endowment fund. The health system is laying off employees and says it is “tens of millions of dollars in debt.” 

Congratulations to John Halamka, named a full professor at Harvard.

Healthcare Interactive, a Maryland-based vendor of something to do with the cloud that’s impossible to figure out from their buzzword-loaded Web site, looks to raise $10 million. Take your guess from this list of adjectives on their home page: suite, actionable, portal, stakeholders, transparency, engagement, cloud, and workflows. Or maybe this simple description from the CEO’s bio makes it crystal clear: “SaaS-SOA healthcare operating system (H-OS) framework leveraging an Inheritance-based Organic Network architecture using a unique combination of identity management, knowledge management and an application framework on a single cloud based environment.” Ready to sign up?

The next fun history lesson from Vince Ciotti, this time covering the 1960s development of “clinical” software, featuring Kelly Girls entering information dictated by nurses who didn’t know how to type.

Microsoft’s Bill Crounse, speaking in Hungary, gives examples of IT systems that are transforming healthcare: the Healthcare.gov Web site, NHS Evidence, and HealthVault. None of these have had any impact whatsoever on me or anyone I know (and Microsoft has a financial interest in at least two of the three), but I’ll give him the benefit of the doubt.

I’m intrigued by recent top executive hires by Siemens: John Glaser (Siemens Health Services Business) and Greg Sorenson (Siemens Healthcare), both brought in from non-profit Partners HealthCare with no business experience and immediately placed in CEO roles. Contrast that with GE Healthcare Systems, who chose as its top executive last week an internal candidate whose background is automotive, finance, and aviation with no healthcare experience at all. That’s a striking difference in philosophy from conglomerates that offer similar products and services. I have to say that as a customer, I like the Siemens approach a lot better — the idea that provider people who care enough about patients to work for a non-profit might bring something to the table that a circuit-riding GE lifer executive doesn’t.

Here’s the TEDxTHR talk of Ed Marx from this past Friday.

CMS gives General Dynamics a five-year, $95 million contract for claims processing support.

Clinical documentation system vendor Salar makes Fortune’s list of 100 fastest-growing inner city businesses with a 27% annual growth rate over the past five years. It’s in the Fells Point waterfront area of Baltimore.

Don Good, former NextGen Practice Solutions regional president, is named president of Talascend Healthcare, a newly created division of the technical professional placement firm.

E-mail Mr. H.

David Riley is president of Alembic Foundation.

Give me some background about yourself and about what Alembic Foundation does.

I’ve been in healthcare since 1976. I started out in nursing, and then eventually moved from nursing to medical training and became a primary care physician assistant in the Air Force in the early 90s. I went to med school to finish that out and then practiced primary care medicine in one of the Air Force clinics in Los Angeles for a couple of years.

Then they moved me to the Pentagon and got me involved in health information technology. I was brought there to specifically get electronic health record stuff off the ground for DoD. Spent a couple of years putting that acquisition together. In the first year of development, I was involved as an independent consultant after I left the military to get that rolling.

Subsequent to that, I stayed in health IT and informatics consulting and was brought to HHS in 2007. That was when we were starting up the NHIN, the Nationwide Health Information Network trial implementation. They put out an RFP on the day that I was brought in to organize the federal agency so that they could come up with a strategy for how they would be involved in the trial implementations and the go-forward strategy for doing an implementation of the standards and going into operations.

That’s when Vanessa Manchester was brought into the picture as my program manager. We stood up the CONNECT project as a part of that activity. We managed the CONNECT project for about two and a half years through the life of that contract and prepared the statements of work for the re-competition for that. 

We disengaged from ONC in November. When we started the CONNECT project as a software development project, we didn’t see a future where ONC would continually be involved in software development. It would eventually be rolled out to an open source community that would pick it up.

We did one year of development, released the software in 2009 as an open source, continued to develop it as the federal agencies were moving into production with it, and began to grow the community. By the end of September of last year, we had about 2,000 unique organizations that were either downloading it, using it, participating in Code-A-Thons, participating in training seminars, or just simply tracking it until their organization was ready for downloading and using the technology.

One of the things we were trying to do was to create an open community where the governance and the prioritization of features were a joint activity of the whole community. Up until then, the federal agency set the priorities. They were funding it, so they set the priorities, but we didn’t have a full open process where community members could participate in decision-making to the degree that you would normally see in an open source community. It wasn’t that the federal partners didn’t want that — they did want that — but they were just trying to figure out how to make the transition without causing problems from an operational perspective.

We had brought in Brian Behlendorf in late spring, May or June of 2009, as a consultant to help us figure out a strategy for building this open community and rolling it out to an open source community. We started the undertaking of a series of steps — they were small incremental steps. First, we made the tracker system available so people could report bugs and enhancements and make change requests from the community. Then we started opening up the development process and making it the backlog available so people could review that. The last step was transitioning it out to another organization from FHA [Federal Health Architecture] to a non-profit that would be able to grow the community and foster that. 

We had always hoped that perhaps somebody else would take on that job of doing that. But when the contract pickup hit in September on the re-compete, we realized that the community was in danger of diffusing all that energy that had been focused. We decided we would set up the foundation to do that.

Initially, we were thinking, “OK, we’ll take on the Aurion Project,” but we saw that there was this growing need among federal agencies to figure out how to engage open source communities. Not just simply to build software, but to actually build full up ecosystems where products and services would be developed around software projects, CONNECT being one. 

I think we’re also seeing the same kind of desire with the VA’s current open source EHR RFP that’s on the street now. Bidding will close on that on May 20 with contract award set for June 22. What they’re specifically requesting there is a custodial agent that can take the VistA code and handle growing the community in the open ecosystem around that. It’s a very similar kind of need. We saw multiple instances across federal agencies where they needed custodial agent services.

When we set the Alembic Foundation as a 501(c)(3) non-profit organization, the IRS requires you to define your tax-exempt purposes. There’s eight different categories. We selected four tax-exempt purposes. Our primary charitable purpose is defined as being the caretaker of the commons. This is where all this idea of custodial agency comes in — the idea that we create a common infrastructure that’s shared in terms of investment and it’s publicly available under an open source license, and then folks can move up the stack and focus on end user experience on the edge, building functionality, spend their money to build the infrastructure they can focus on the unique things that are value-added to the consumer. That was the model that we were looking at in terms of this idea of a shared commons.

We also have an educational tax-exempt purpose, where we’re looking at this idea of setting up a summer institute of informatics, kind of like Google’s Summer of Code, but it’s not just simply writing code. It’s more in the line of informatics, which is more than just simply writing software.

We also have a tax-exempt purpose that’s focused on scientific and technical research and development for basic applied and operational informatics research.

The fourth area is literary publishing, so that we can publish materials and manuals and how-to guides and all that kind of stuff around this idea of the commons and the informatics research that we’re doing associated with the commons. 

By focusing on transformation through disruptive innovation, using open communities and open processes in those communities to develop open technologies, this is how we plan to nurture and grow the commons. The CONNECT software in that community is the first instance of a community that we stood up with the purpose of continuing to evolve an open source product so that we grow the commons.

The idea now is that we can have full and open participation by government agencies and then private sector working together under a common governance structure, and then common ability to invest on both sides, either through contracts with the government or donations on the part of the private sector, or individuals or corporate sponsorships is one way of participating in that.

At this point there is no official relationship or financial backing from the government?

At this point for our end for Aurion, no, there is not. We brought the community over. We have a volunteer community for the Aurion 4.0 release that just occurred. We had 17 developers from five organizations that participated in implementing the software and building the software for this release. That’s a volunteer force.

What we would anticipate is that at some point down the line, federal agencies may or may not, depending on what their operational needs are, contract for specific features and functionalities. If the community process has set a priority and they have a priority that they think they need on a given time schedule, one way they can do that is either hire a contractor to do that and participate in the community, or they can hire the Foundation to do that. 

So there are multiple ways that they can participate. One is contract directly for services. Another is to hire a contractor who builds that service, and then if they want to contribute it to the community, they can do that. Or, they can have government employees that are on staff direct their focus to participating in the community.

We have about 100 unique organizations that attended the Aurion Town Hall Meeting, which was a couple of weeks ago. We began to review the draft charter. The way we are set up, the non-profit board of directors basically governs the corporate structure. They delegate to communities their governance structures through a charter, so there’s a way to delegate the governance down to the community’s level for the operational governance of communities. By doing that, we separate out the fiduciary responsibilities to the corporate board. 

It’s hard for government employees to serve on a private corporate board because it’s conflict of duties. What we’ve done is the things that would be conflict of duties are reserved to the corporate board, and everything else is delegated down to the community governance structure. Government people can participate as a governor on the board of governors of the community without having to worry about conflict of duties because of the way the duties are separated and split in terms of the corporate board versus the community board of governance. We did that intentionally so government folks can sit on the board of governors at the community level, whether it’s for Aurion or EHR or whatever projects that we happen to take on as we move forward into the future.

Just to refresh the memories of readers who may not be quite as familiar, describe in a couple of sentences what the CONNECT and Direct projects are and how they’re different, if you would.

CONNECT is focused on organizational health information exchange. This is where Organization A wants to send or receive personally identifiable health information from Organization B. 

You’ve got these legal definitions that are involved. Usually whatever Organization A is, it may be multiple organizations, but they’re bound together because they either have contracts or agreements in place. And then, everything else is defined as “them,” so when they want to exchange information with “them,” whoever “them” ends up being, they needed an ability to do that. 

That’s what the NHIN was about, was creating B2B interfaces — the business-to-business interfaces — for exchanging health information. That’s what CONNECT and subsequently Aurion is focused on.

Direct was really focused on provider-to-provider kinds of exchanges. It was like one step up above faxes, so the day Doctor A decides they need to send some information to Doctor B, they do business with them and they know their fax number and so they send it. The trust that’s there, there’s kind of an implied trust, because you’re somebody that I know and I refer patients to. There may not be formal, legal instruments of trust.

For example, at the business-to-business exchange that CONNECT usually is used at, organizations will sign a document like the Data Use and Reciprocal Support Agreement, or the DURSA, to be able to create the legal infrastructure for exchanging data. CONNECT is the technical infrastructure for the trust fabric.

Direct has an implied level of trust, because I know you, we do referrals. It’s a directed push of information, whereas up at the exchange level where CONNECT is applied or Aurion, you can push information, you can request and retrieve information, or you can publish and subscribe to information. We cover all three of those messaging paradigms in CONNECT, whereas in Direct right now, the message paradigm is push. They use secure SMTP for that transaction.

People assumed when you left the project that perhaps it was in trouble, but you’re saying the plan all along was to create an external group and the timing was right.

Well, yeah, the timing was kind of coincidental, I guess, with the contract’s hiccup. The plan was always to roll it out to some organization. We’d been looking at a number of different organizational models, like trade associations like 501(c)(6), and we’d even looked at Mozilla and Apache. Basically we were looking into different missions of these organizations to figure which if one of them could be a suitable home for the software and the community. 

From a licensing perspective, it wasn’t a licensing issue. Any one of those organizations could have probably been a home for it. The issue was the community and whether they had knowledge about healthcare in particular and health information exchange specifically.

We had thought that we probably needed to set up an organization or work with somebody to get a new organization set up to do that. When the acquisition hiccup occurred, it really created an impetus to make sure it was done right away. Because of this interregnum where no development at all was planned to go on until the contract issues were resolved, we realized that there was an opportunity to go ahead with the plan of setting up the organization and just making it happen. The longer we waited, the more danger there was that the community would diffuse away and we would lose the forward momentum that we had.

We just decided that if it was going to be done, the timing was now and nobody else was willing to do it. We gave it a lot of thought and consideration and thought, “OK, we’ll go do that.” That makes for an interesting next step in terms of the work that we’ve been doing. In some ways, it was just kind of opportunistic. We were trying to figure out how to gracefully transition and because of that hiccup, it became more urgent to get something stood up. We just took advantage of the opportunity in the sense of, “OK, we’ll go do it and we’ll do it now.”

You mentioned the VA’s project to assign a custodial overseer of VistA. Is that something the Foundation will be bidding on?

Yes. We’re planning to be a part of a good team on that. The RFP is out and proposals will be due in on the 20th of May and then contract award is expected on the 22nd of June.

How do you see that playing out? It seems like it’s not really clear how much is going to be built and maintained through open source versus how much will be commercial off-the-shelf software.

The recent announcement about the preference for COTS is interesting. From an acquisition perspective in the FAR and the DFAR, open source software is viewed as the equivalent of a COTS product. From the acquisition perspective, they could adopt the use of open source technologies and solutions and still be compliant with that guideline that they said they would prefer COTS solutions first.

It didn’t mean that they would necessarily license proprietary code. It doesn’t explicitly say that they’ll have a preference for open source, but certainly what they’re looking for are what are called non-developmental items, NDIs — things that they’re not having to invest a lot of money in doing development on. Open source is one way to do that. Proprietary products, combinations of those two … all are ways of putting together acquisition solutions that the agencies can go with.

The pendulum swings back and forth between whether we buy something that’s already built in the government, or we whether we build something. It depends on when the last successful project was. If they did a big project where they were building software and it got behind schedule and they had feature bloats and they weren’t able to deliver on time and were going over budget, suddenly the pendulum swings for preferring COTS, going out and just buying something like a lab system from Cerner or something like that, or an EHR from Epic.

Then when they do go down that path and they end up with implementation costs and they overrun budget or schedule and they get bad press or if the Congress is jumping down their neck, then they swing back to the other direction. I’ve been watching this for almost 20 years, this pendulum swinging back and forth.

What we’re trying to do is figure out a path forward where we can create open innovation, not just simply open source, but also working with proprietary vendors to do what Henry Chesbrough characterizes as an open innovation process, where they engage their users and people that have licensed their products to help evolve the products through an open process, even though it’s retained under proprietary license.

In my view, the path forward is engage the open source community, engage the vendors in this open innovation process, so that in the end, what we’d like to see happen is this investment in the common infrastructure that everybody can use move up the stack where the proprietary vendors are building that value added on the edges focusing on the user experience.

In the EHR world, usability and acceptance by the user is the piece that prevents a lot of them from achieving the market penetration that they would like. It’s getting the user experience right. There’s so many doctors and so many ways that they do things that it’s hard to address that when you’re having to build the infrastructure and shoulder the cost of that in addition to building usable applications.

If we all contribute and build what’s equivalent to the Defense Highway System, then I can use that to move fruit and produce and you can use it to move apparel and somebody else can use it to move steel. We’re all using that same common infrastructure that we paid for, in the case of the Interstate system, through taxes. It supports a lot of business models because that common infrastructure is there.

What we’re looking for is, what is that infrastructure in health IT that could be the shared investment that, if we got it in place, that could really spark the innovation that we want in terms of this rich ecosystem of applications that really are focused on the end user experience? Thereby you gain greater penetration into the marketplace of providers using these applications because they have the kinds of apps available to them at a price that’s more affordable.

If everybody’s not having to shoulder the cost of the infrastructure component, you’re not talking about million-dollar systems. You could actually literally end up with an app store built on the common infrastructure where apps may be as low as a couple of dollars, a la the Apple app store model. Or they may be a little bit more expensive if you get something that’s a real sophisticated decision support application, but it still wouldn’t be millions of dollars or tens of thousands of dollars for these apps.

They would be much cheaper. Therefore, you would be more likely to achieve a greater market penetration, but you’d also have more uptake. You’re not having to sell 10 multi-million dollar systems. Your apps are available out there, the distribution channel is a lot cheaper, it doesn’t take as much to get to the marketplace. You have 800,000 people using this app, or maybe 100,000 using that app. Even though it’s a lot cheaper application, you can still make money at it in the proprietary world as well.

Any final thoughts?

It’s a big vision. There’s a lot of work to be done. We’re just going to bite it off a little bit every day and see where we end up and see how much good we can do.  

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 March 2006.

Hospitals Need to Learn From Failed Transformation Missions
By Mr. HIStalk

Michigan’s Trinity Health has put its seemingly successful $315 million clinical system implementation on hold. The announced reason: it is fine-tuning its plan to drive clinical improvements and implement evidence-based medicine.

The industry has been hard-selling “clinical transformation” for years. Hospitals repeat the mantra dutifully, although none ever seem to declare themselves transformed. Like vendors’ claims of integration, it’s always just around the corner. Post-implementation hospitals aren’t necessarily improved clinically or financially. The only predictable transformation is that hospital dollars unfailingly get transformed into vendor dollars.

Who do you blame? Surely not all vendors and hospitals are incompetent. Is clinical transformation (assuming such a thing exists) simply impossible to manage successfully? Maybe the best analogy is the space shuttle.

The space shuttle orbiter is supposedly the most complex machine ever built, despite its now-antiquated technology (there’s a parallel right there). It’s not just a flying machine – it’s an industry of pork-barrel politics, fat-cat contractors, jobs, and national pride. Somewhere in the mix might be a smidgen of science that bears little resemblance to the original promise of an inexpensive fleet self-funded through technology commercialization. (Tang, anyone?) We walked on the moon, but settled for a scientifically irrelevant low-orbit taxi.

Like the space shuttle, clinical system projects rarely unfold as optimistically planned. They require painstaking planning, unerring execution, outstanding change management, and unwavering focus. None of these are strengths of the typical health care organization. Instead of a handful of astronauts, thousands of busy employees have to be convinced to change their comfortable routine. When the going gets tough, the formerly committed VPs disappear and leave the battle to the IT techies.

Sometimes the project explodes while you watch, like Challenger or Columbia. Even when it doesn’t, interest wanes once the flashy launch is over.

If the shuttle crashed 90 percent of the time it took off, would we keep launching and irrationally hoping for success? No, we’d send the engineers back to the drawing board, or maybe even get some new engineers, or ground the program. Or, perhaps we’d just declare the whole thing undoable and settle instead for a high-value subset of the grand plan more within the scope of our capabilities.

Where hospitals are different from the space program is that we don’t learn from the industry’s widespread failures. Hospitals quietly shell out precious millions and unreasonably hope that they’ll find the success that has eluded a long string of predecessors buying the same short list of products. Reality eventually sets in, expectations are lowered, and attention moves on to something else.

Sometimes imaginary victory is declared at the HIMSS conference, proclaimed by ventriloquist vendors whose lips barely move when their customer speaks. One thing is certain: you’ll seldom hear a discouraging word from consultants, member groups, or rah-rah magazines. They make money from the illusion of mass success.

We need success stories that go beyond a glitzy lift-off. We need someone to actually be transformed, not just implemented, and for those who weren’t transformed to tell us what went wrong. The path to clinical transformation is lined with the smoking debris of earlier missions, each of them offering lessons for those willing to listen.

Top News

VA CIO Roger Baker, who advocates an open source approach, tells a House committee that replacement of its VistA system with commercial software would cost $16 billion. But in a good example of bad timing, the GAO says the VA’s historically weak project oversight caused a $127 million appointment scheduling application to fail.

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Reader Comments

From Court Jester: “Re: Society of Hospital Medicine. Here’s a picture of the action at the SHM meeting.” The action looks a bit light, but perhaps the picture is deceiving. SHM expected 2,500 physicians to attend the four-day event in Dallas.

From Bmore: “Re: Johns Hopkins. I know they have an old version of Epic scheduling, but has Epic always been its own job category? Or is this a sign of something to come?” I’d speculate B, despite no announcement so far. One thing I’ve learned about Epic: there isn’t always that dramatic moment of taking the two vendors of choice down to one and then heading off for extended contract negotiations, followed by the big public lovefest. Somehow, everybody sees the Epic demos and just assumes it’s a done deal, often gearing up for the project even before a contract is signed. I thought Cerner’s Vision Center was the ultimate mass hypnosis selling machine until people started telling me about being bewitched by Epic, with any IT-advocated precautions thrown to the wind as the operational people salivate at kicking out the incumbent vendors at any price and maybe taking down what they see as an unresponsive IT department along the way. That may just be my inaccurate perception, so please weigh in if you’ve been run over by the Epic train at your place.

From BadgerGrandma: “Re: Epic. A few weeks ago, attendees at Epic training were told that this was the biggest week ever, with over 1,000 people onsite for training.” It would be an interesting case study to review how formerly tiny, privately held Trojan horse Epic came late to the inpatient game, then in less than 10 years, totally ate the lunch of everybody in their target market of large academic medical centers. Cerner gets an occasional sale and Allscripts is doing recently better than Eclipsys did at selling Sunrise (which isn’t saying a whole lot), but that’s about it, at least unless the only hope of a worthy contender (Soarian) can move from nice idea to significant sales. It violates every economic principle that competitors haven’t developed something equivalent or superior to Epic without its high price. They’ve just handed the market over to Judy without a whimper, with customers happily plunking down dozens or hundreds of millions of dollars, in some cases replacing systems whose contract ink is barely dry.

From Just a rumour: “Re: Epic. Heard that Lakeland in St. Joe, MI signed up. No reference on their site.” Unverified. Actually, I’ll call it verified since I found the item above in their physician newsletter.

From Rodeo: “Re: hospital hiring. Are they going crazy? I’ve had 10 calls and e-mails from recruiters who dug my resume out of the dungeon – it isn’t posted anywhere. Is May 1 a significant date?” My phone is ringing a lot too, and I dread new LinkedIn connection requests because they’re always from recruiters (my magnetism is apparently entirely occupational).

From Clyde Dale: “Re: Siemens. A. Gregory Sorensen, MD. Director, Center for Biomarkers in Imaging Associate Director, Martinos Center for Biomedical Imaging at Mass General. Going to Siemens to head up Med for US/ Canada.” Verified by Siemens.

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HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Practice Fusion, vendor of the free, Web-based EHR that Brown-Wilson’s Black Book ranks as the #1 EHR product in customer satisfaction among primary care specialties. The company announced last month that its product is now used by 80,000 medical professionals managing 10 million patients, with another one million patients being added monthly. They say “Live in Five,” meaning users can start charting within five minutes of signing up, using the provided test data for practice if they want. Total cost is $0, which includes patient import, specialty modules, lab integration, scheduling, billing, a connected PHR, e-prescribing, and free unlimited US-based support. Thanks to Practice Fusion for supporting HIStalk.

Here’s a Practice Fusion video I found on YouTube, with a user (and Desert Storm veteran – thanks for your service, Doc) doing all the talking.

I mentioned that I would be showcasing (at the suggestion of readers) small, innovative companies you might not hear about otherwise. Around 40 companies applied, my volunteer committee (provider, investment banker, financial services VP) chose nine to participate based on size and perceived level of innovation, and I have the first one nearly finished. The end result will be a company profile, interview, customer statement, and a pitch video. I was already overwhelmed, devoid of free time, and definitely not looking for new work, but this seems worthwhile.

The things you do for love (of HIStalk, hopefully): (a) sign up for e-mail updates to your right, giving me direct access to your brain jack so I can project my electronic power of suggestion; (b) send me news, rumors, secret documents, comments, and guest articles; (c) connect with HIStalk, Inga, Dr. Jayne, and me on your favorite social not-work; (d) peruse with wide-eyed wonderment the mosaic of ads of sponsors who support the “HIT information wants to be free” concept by supporting my endless toil, and who would greatly appreciate in return clicks and/or consideration if you are in the market for that which they offer; and (e) beam occasional positive karma our way since we don’t go public with our fears, mistakes, and disappointments, but we’re loaded with them just like everybody else. And for you, a double-barrel index finger point (I’m thinking Isaac the bartender on Love Boat since I’ll be mentioning Doc down the page) — thanks for reading.

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Acquisitions, Funding, Business, and Stock

Cerner will acquire Resource Systems, the 30-year-old Concord, OH company that sells CareTracker, an electronic documentation system for skilled nursing and assisted living facilities.

HCA launches Parallon Business Solutions, a business services subsidiary that will offer services for revenue cycle, workforce management, supply chain, and group purchasing.

Secure healthcare network vendor Ability Network (formerly VisionShare) closes on nearly $20 million venture capital, led by Lemhi Ventures and Bain Capital Ventures.

Cleveland Clinic spinoff Explorys closes $11.5 million in Series C financing. The company’s cloud computing data warehouse aggregates and curates EHR data from multiple systems to allow population analysis, with customers that include Cleveland Clinic, MedStar, Summa, and MetroHealth.

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Sales

Anthelio Healthcare Solutions (formerly PHNS) contracts with MedQuist to implement its DocQment enterprise platform at eight of its client hospitals.

The New York City Health & Hospitals Corporation signs a five-year, $20 million support contract extension with QuadraMed for the QCPR inpatient clinical system.

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People

GE Healthcare’s Health Systems division CEO Omar Ishrak is named chairman and CEO of Medtronic, replacing the retiring William A. Hawkins. He’ll be replaced at GE by Tom Gentile, moved over from GE Aviation. The division sells medical technology, such as CT, MR, life support systems, and home health. GE also announces that it has created a new business called Global Services that will take over GE Healthcare’s services strategy, to be led by North American services leader Mike Swinford.

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Announcements and Implementations

Business analytics software vendor SAS forms the SAS Center for Health Analytics and Insights, an internal incubator that will focus on applying analytics to patient data with the goal of improving healthcare quality and lowering cost. Areas of interest include evidence-based medicine and cost analysis. To which I’ll also add for you PR types: this is how press releases should be written — short, straightforward, chunked into easily readable paragraphs, and not turned into mind-numbing mush by overzealous, trademark symbol-wielding marketing people determined to collectively suck the life out of what started out as something interesting.

Corepoint Health’s integration engine receives ONC-ATCB Modular Ambulatory EHR and Modular Inpatient EHR certification.

Crystal Cruises goes live with Emergisoft Maritime, an EHR specifically for cruise ship crew and guests. I’m picturing the sleazy, shorts-wearing Doc from Love Boat (c’mon, you know you want to sing it with me: “Loooove, exciiiiiiting and new …”) having even more time to letch around with bimbettes half his age, apparently unrestricted out there in international waters of any ethical or legal concerns that would prohibit him from putting his smoove moves on patients.

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Government and Politics

CHIME and AMGA announce their opposition to several provisions in the proposed ACO rule. CHIME objects to a privacy provision that would allow patients to opt out of data sharing while maintaining their ability to see primary care physicians within the ACO. It also takes issue with the requirement that 50% of an ACO’s primary care providers must meet MU standards by the ACO’s second year. Meanwhile, AMGA says 93% of its members would not enroll in an ACO based on the proposed framework, which AMGA considers “overly prescriptive, operationally burdensome.” Top concerns center around risk-sharing, static risk adjustment, retrospective attribution, quality measurement, and minimum savings.

In the UK, Prime Minister David Cameron says the government may cancel some or all of CSC’s $5 billion contract to install iSoft’s Lorenzo. CSC has been threatened previously for missing deadlines, and if it finally gets the boot, only BT will be left of the original four big contractors (Accenture and Fujitsu already bailed and were fired, respectively).

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Innovation and Research

A University of Arizona study finds that 72% of the software used by retail pharmacies in the state cannot detect all significant drug-drug interactions.

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Other

Thirty-four percent of all office-based prescribers were using e-prescribing by the end of 2010. Cardiologists had the highest adoption rates (49%) followed by family physicians (47%.) Providers created 326 million e-prescriptions in 2010, up from 190 million in 2009.

The Triangle/Eastern NC Chapter for the Juvenile Diabetes Research Foundation recognizes Allscripts and EVP Diane K. Adams, who along with CEO Glen Tullman, has family members with juvenile diabetes. Allscripts has contributed over $1 million to JDRF since 2004.

Weird News Andy celebrates what he calls “the breast app ever!” A plastic surgeon develops an app that uses 3D imaging to allow prospective breast implantees to visualize their new protuberances, followed by easy posting of the “check these out” pictures directly to Facebook so that cyber-acquaintances, business associates, and elementary school aged nieces and nephews can weigh in on the proposed alterations.

This came in my work e-mail from some vendor. Somehow I don’t have a lot of confidence in their “HIPPA” wisdom.

SCI Solutions provides laptops and cash donations from its employees to a project run by some surfer buds (one of them SCI SVP Vinnie Whibbs) and some non-profits to provide resources to students and for community projects at Playa Gigante, Nicaragua.

The LBJ School of Public Affairs and the Patient Privacy Rights Foundation will hold the one-day Health Privacy Summit: Getting IT Right: Protecting Patient Privacy in a Wired World on June 13 in Washington, DC, a public forum to address health privacy. Speakers include quite a few folks from government and academia, along with HIT-recognizable names Barry Chaiken (former HIMSS board chair and Imprivata CMO), Mark Frisse (Vanderbilt), Deborah Peel MD (founder, Patient Privacy Rights), Joy Pritts (chief privacy officer, ONC), Michael Stearns (president and CEO, e-MDs), and Latanya Sweeney (the Carnegie Mellon professor who proved that it’s not that hard to re-identify de-identified data when you match it up to a second database). Registration is $100 general, $75 government or academic, and $50 for students. I’d go if it wasn’t tough to get time off from work on relatively short notice, so if you’re attending and want to report from there, do it.

A coroner in Australia rules that a woman’s death after gall bladder surgery was due to medical error. Her gall bladder had been removed 10 years before, but radiology staff misidentified intestinal gas bubbles, the surgeon overlooked the medical history entry about her previous surgery, and everybody noticed but nobody questioned the scar on her abdomen. She died of post-surgical sepsis. Her granddaughter says she hopes the medical system will change so that clinical documentation is shared among physician practices and hospitals.

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Sponsor Updates

• Onze Lieve Vrouwe Gasthuis hospital in Amsterdam deploys iMDsoft’s MetaVision to provide tele-intensivist monitoring.
• Moore Regional Hospital (NC) picks ProVation MD for gastroenterology procedure documentation and coding.
• CareTech Solutions launches iDoc Savings Calculator, which estimates savings from implementing its iDoc document imaging and management product.
• Universal American Corp., a Medicare health benefits company, collaborates with NextGen to offer participating physicians access to NextGen’s EHR in multiple markets
• The Texas e-Health Alliance appoints ICA CEO Gary Zegiestowsky to its board.
• The Centre hospitalier Pierre-Janet in Quebec adopts the Vocera voice communication system.
• DIVURGENT announces new hires: Matt Curtain (client services VP), Sarah Rourke (recruiter), and Christina Pena Jones, DHA, (nurse educator).
• Nashville-based iPractice Group will resell Greenway’s PrimeSUITE.

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EPtalk by Dr. Jayne

The Centers for Medicare and Medicaid Services (CMS) recently launched the first phase of its Physician Compare Web site, which is supposed to display physician address information, medical education, credentials, gender, etc. as well as whether physicians reported quality data to CMS.

Like any good Internet junkie, I of course had to search myself. Not surprisingly, my listing has errors, as does the listing which appears below mine alphabetically (it happens to be a former colleague of mine whose details I know as well as my own).

My listing includes a practice address where I haven’t provided patient care for more than four years, as well as practices where I have never provided care. There’s even a location listed for me that belongs to a practice that used to be owned by my group, but was sold more than a year ago.

This does not give me great comfort in the skills of CMS to accurately portray my ability to report quality data (especially since they can’t accurately portray my address). Phase Two of the site will launch later this year and identify whether physicians are e-prescribing or not. Quality data will be available by 2013. I hope in that time frame they can figure out where I practice.

Speaking of government, for those of you who missed it, Newt Gingrich is officially seeking the Republican nomination for President. Gingrich has been dabbling in the healthcare space for some time, largely through his for-profit Center for Health Transformation (CHT), so this should be interesting.

CHT has a white paper about Accountable Care Organizations that features some well-known examples of ACO-type organizations. It’s pretty basic, but a decent read for those that need a quick study of ACO 101.

Newt’s proposed healthcare reforms are detailed on his Web site and include rewarding quality care, incentivizing health behaviors, stopping fraud, and educating patients on price and quality. For those of us in healthcare IT, the good times will continue to roll as there is more and more focus on data mining to support these efforts.

By the time the 2012 election rolls around, I’ll be sick and tired of the politics along with everyone else. On the other hand, I won’t have to worry about having enough material for HIStalk. Round and round health reform goes; where it stops, nobody knows!

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Contacts

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

Termination Means Never Having to Say You’re Sorry, Right?

A good learning situation sprang to the forefront of my creative thoughts the other day. I was representing a great EHR vendor (a great client and a great EHR) in a substantial deal and ran into a surprising request from opposing counsel regarding the default / termination process and procedure. In the end, the issue was resolved quite simply and quickly by taking a different path, but I will save that for the end.

The provider / customer side did a very good job of establishing certain milestone events, such as the operational date for e-prescribing, the vendor’s EHR certification deadline, and go-live for the then-certified EHR. Kudos to them because they set the bar precisely where they needed it. The vendor realized the importance and accommodated.

You can guess where this is leading. Failure to meet a milestone event gives the client the option to terminate.

A very straightforward default procedure was included in the standard vendor agreement — one party provides written notice to the other regarding any alleged default, then the supposedly defaulting party has 30 days to cure the problem. If the problem is not cured at the end of the 30-day period, the party that alleged the default has the option to terminate the agreement.

Termination was specifically addressed to include terms such as:

• All licenses granted terminate and all rights automatically revert to the granting party
• Payments due at date of termination must be made within 30 days of termination
• Each party returns the other party’s confidential information, including the software and all associated documentation

Simple, no? No.

The other side wanted to bifurcate the issue and create two sets of “termination” procedures. The first (same as above) required that all licenses and rights granted under the agreement return to the grantor and the agreement terminates. Everything is over and done and the parties go their separate ways. The second proposed that there were conditions where the agreement could be terminated due to certain actions of the customer/user, but that the EHR software would remain in use by the customer/user.

It took two document turns, some polite but blunt e-mails, and two conference calls to assure the negotiators on the other side that there was no scenario under which the license could be terminated and the customer could retain use of the software.

For those of you shaking your heads in amazement, there was credible rationale behind the request, which was basically, “We understand the need to terminate absolutely in most situations, but we don’t want the vendor to be able to walk away for seemingly small issues that could rise to the level of default.”

The conversation between us attorneys at the end went very quickly. If I would add language stating that termination of ongoing maintenance support is at the customer’s option, and that terminating maintenance will not terminate the licenses and other rights granted under the agreement, then we would be all set and the default / termination provision would be acceptable as drafted.

That was it. All we needed was a clarification on maintenance cancellation and the whole issue was put away.

As for me, familiarity with an agreement sometimes begets a comfort that anyone picking up the agreement immediately adopts your perspective and interpretation of the terms and conditions. Not always the case — sometimes I need a reminder.

Lessons for the Day

In the SaaS model, there is no separate license fee and maintenance fee. Both are rolled into the recurring subscription fee. Termination means termination. Everything is over. No access to the software, no service, no maintenance.

On the other hand, in the perpetual license model, the ongoing maintenance features and obligations can be cancelled separately.

Note that I used the term “cancellation” to make a point. The customer in this model pays the fee for perpetual use of the software. Cancelling maintenance does not (should not) alter in any way or manner the license of use previously granted to the client. But general termination is the same in both models — terminate the entire agreement and you terminate use of the software.

Finally, what you believe is plain understandable language might not be to everyone. So keep the terms (and with respect to termination, options) clean and clear in your agreements. It saves time and money up front and in the long run by eliminating confusion.

Please note the above was intended to be short and sweet. There are many other issues that pertain to termination, such as transition services, data extraction, and historical system access — the list goes on. My point is straightforward. Keep it clean, clear, and above all, understandable. If termination, then XYZ.

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