Joel French is managing partner and CEO of SCI Solutions of Campbell, CA.

Tell me about yourself and why you joined SCI.

I’m an economist by training. I was an immature college kid. I went to school to play sports and chase girls and ended up learning about price and elasticity of demand a long time ago. I figured even a guy like me could do OK in healthcare. That was a long time ago.

I started in the physician business, back with a physician practice management company in the ‘80s. Learned that business a little bit and learned the health plan side and learned a little bit about finance. 

Jeff Anderson has been my partner in this effort. Now, along with John Holton, we’re leading SCI Solutions, along with NEA and The Wicks Group. We saw a couple of things here that we believed were unique. One is that there’s this collision point happening right now, where the line of demarcation between the financial and the clinical is blurring, and we think it’ll soon be eradicated. Reimbursement is very much an issue of clinical appropriateness, and both reimbursement and clinical appropriateness have become a matter of compliance.

The unique role that SCI has is we capture and digitize a transaction at its very point of origin in the ambulatory setting. Years ago, you might recall that The Advisory Board did a study finding that 80% of the controllable costs in healthcare hinged on physician behavior. Do you refer, do you admit, are you going to do a surgery, and so forth. We believe there’s a growing opportunity to infuse that referral transaction, or that ordering or scheduling transaction, with clinical intelligence; deeper, broader medical necessity reviews; smarter eligibility; and ways of looking at what’s the best way to take care a patient that may have a chronic condition or a comorbid condition, and what patients are eligible for, perhaps an episodic hip replacement program that might be in effect in that community. That was of high interest to us.

We were looking for a strong culture. We were looking for a business that had scale and deep, wide client footprint. SCI clearly does, with 450-some hospitals and something like 30,000 physicians. We were looking for a Software as a Service business model, so that from a vantage point of a client implementing, the capability was fast, it was capital-efficient, and it wasn’t a burden on them because they’re burdened with everything else right now. I could go on, but that’ll give you a snapshot.

The company now has a broader senior team and new investment. What are you going to do with your new capabilities?

The main thing is we’re going to help our clients navigate the transition that’s sitting right in front of them like a storm right now, particularly reimbursement reform. I was with nine clients last week in California, and without exception, all of them are worried about the legislative and regulatory burdens, both those that are in place and those that are coming around the corner.

For the average hospital, as you know, 40% of their net revenue is Medicare-dependent, and they lose eight cents on the dollar. And maybe something like 15% is Medicaid-dependent, and they lose 12 cents on the dollar. I was with a few clients last week where their Medicare exposure was 70 and 75%, respectively, so they’re very worried about this.

The company has had a 97% client retention rate that it’s managed over the years. It’s done a really good job. I think our big focus is helping our clients unlock the value of the existing infrastructure that they’ve implemented, the SCI infrastructure, to bring some working capital and liquidity to their business. Because if you think about it, most of these guys are somewhere on the horizon of laying down tens if not hundreds of millions in funds to automate manual processes, or to replace departmental systems with enterprise architecture systems.

That may be the right thing to do. For a lot of them, it is. I think that some of them are beginning to be worried that there may be an absence of measurable, risk-adjusted return on that capital, but what they know is they’re going to get depreciation on their P&L. They know they’re going to be guaranteed software maintenance expense that’s higher, and a bunch of IT FTEs running around. Potentially, if they use debt, some interest on that debt. 

At a time where you’re hiring physicians and your labor expense of net revenue has gone up and your reimbursement is going down, it doesn’t look very pretty on the horizon. Helping them unlock some working capital in their business and helping them be smart about how do they connect with patients in the community and non-employed physicians in the community — it’s a focus area for us and that’s been what the company has been known for.

Folks say the pendulum always swings back, and even though the emphasis is on clinical systems, it will come back to financial systems. Do you think that the timing is right to get in front of people that are locked into a project plan and have spent a lot of money to get a system, but knowing that at some point, especially with healthcare reform, they’ll have to look at their financial side?

No margin, no mission. I think the CFO job right now is arguably among the most important of any in a health system. I can’t imagine people that are – I guess I can, because I’ve met some — that aren’t thinking about what’s going to happen in the near future. Many of the leading prognosticators have talked about an acceleration of hospital bankruptcies. Folks that are going to have to seek merger partners on terms that aren’t commercially favorable to them because they haven’t gotten their cost at a level where they can break even on the patient mix with Medicare and Medicaid.

Somebody implementing a clinical system should be doing so for all the right reasons. You know, the surest path to long-term low cost is quality, like W. Edwards Deming said. I think he’s right, but there’s going to be a huge pivot away from simply automating stuff to generating business yield. I don’t see that right now. I see a bunch of organizations ramming in systems, ostensibly for incremental Meaningful Use reimbursement. Some of them are doing it really well. We’re going to find out.

As far as the plan to use the investment that you have, is it to build more product or to get the word out on the product that’s already available?

I think it’s to make sure that the current clients are realizing the full measure of value that they can. Our products in some respects are not like Microsoft Excel, where a typical client utilizes less than 50% of the capability. There’s an important question: how do we make sure that people are getting the value that they’ve already implemented?

Secondly, it’s to address those workflow adjacencies or business adjacencies that are literally right next to where our products are implemented, so that the physician referring a case or ordering a case can derive more benefit without us trying to take them very far afield from what they know and love about SCI.

I think the other thing is we’ve already built what you might think of as a pipeline of possible acquisition candidates that meet the fairly rigorous set of criteria in four quadrants that we look for. We’re well downstream with a handful of these now. We may or may not do anything there. It just depends on the timing and the terms and what’s best for the clients and the business and whoever our combination partner might be. But that non-organically growing business may be an option to us. We certainly have the access to capital. We also have the leadership team to grow a much larger business.

The two hottest areas that might have an impact on what you want to do would seem to be revenue cycle management and consulting services. Do those fit in to the kinds of things you’d contemplate as an acquisition?

No.There’s plenty of really good consulting firms in the market today and I’m not sure the market needs another one. I don’t see us trying to aggregate a bunch of billable FTEs. 

The focus is really helping our clients to better orchestrate patient care transitions and access. You know, if you have 16 million more Medicaid enrollees coming into the system, somebody’s got to figure out, where do you treat these people and how do you treat these people? They’ve just been going to the emergency department for primary care in the past. How do you intelligently apportion the ability to educate and care for somebody across a community?

The second is helping these clients align and link their reimbursement with clinical appropriateness and regulatory compliance. That’s the business we’re in, and that’s what we’re focused on.

It’s an unrelated question more about your history, but from your background from Motion Computing, do you think the iPad made their job tougher?

I’d learned a lot at Motion from my colleagues there and from the clients. I guess in a way it did, but the iPad has catalyzed, it seems, a big market shift. Gartner Research said the tablet category was a million units worldwide way back in ’03, ’04. I don’t recall the data offhand, but I think Apple may do – gee, you might have the numbers handy – 70 million iPads? I mean, it’s a big number, whatever it is. It’s catalyzed this shift from clamshell-type laptops to devices that can be used while walking and standing, which was Motion’s vision all along.

The question for Motion is, can they continue to succeed in the professional industries where the companies that like healthcare, where you have a toxic 24/7 environment with biologicals everywhere — blood, urine, the stuff that gives rise to nosocomial infections — and having devices that are sealed, durable, cleanable that can run the mainstream applications. I think it’ll be interesting, because what I’ve seen about the iPad is that it appeals to the docs that can buy it for 600 bucks. If they can get their apps to run on it, maybe that’s good enough for them. Time will tell.

Also from your background, I’m curious, if you were advising an aspiring entrepreneur who wanted to do some sort of a startup in a healthcare IT, either a products or services firm, what areas would you say look most attractive right now for a fairly quick payback?

I’m not sure anything’s easy. I don’t have any silver bullet answers, I’m sorry, I wish I did. I think that I would just say find a basket of clients that you trust and go listen to them, and see if there are some endemic unresolved business problems that the current set of suppliers couldn’t or haven’t remedied that you could carve out some advantage and protect that advantage over time.

But I don’t know. In terms of the business prospects areas or technology areas, I don’t have any easy answers for an aspiring entrepreneur. It’s all difficult. Some guys just get lucky or strike it right.

You mentioned that there are plenty of good consulting companies out there. You have a background in that as well. Are you surprised that big companies keep buying healthcare IT consulting firms?

No. Let the cycle continue.

Is that always going to be the case, with the big fish swallowing the smaller ones and then spawning more small ones?

Well, I don’t know if I could use the word always and I wouldn’t use the word never. Back in the day when there was just Superior Consultant Holdings and also First Consulting as the boutique domain experts in the market, everybody else was either Accenture and E&Y and so forth. We were the mid-market. If there was a publicly traded scale player that wanted to buy en masse a small little company with 100 people, it wasn’t significant to their earnings. They couldn’t put enough resources to work to make the business meaningful.

I think that’s what we’re seeing here, where entrepreneurs build up expertise, they deliver some modicum of scale – maybe they’re at 100 million or 200-300 million — and they become attractive to a larger organization that needs to do a scale buy and needs earnings. I think what happened when Superior was sold, First Consulting Group was sold, and Healthlink was sold to IBM.

It created a market gap, where entrepreneurs could take a company of 15 people, 30 people and bring it up into the several hundred people range so that they were now that new mid-market. I think we’re seeing that. Parker Hinshaw has done that at maxIT. The guys at Vitalize have done that. There’s other firms growing as well, as you know. You know this market really well.

Give me some predictions about either healthcare IT or healthcare in general that would span five to 10 years, things you’re thinking that would be surprising to the average person who doesn’t pay as much as attention as I’m sure you must.

I’m not a popular guy for saying this a lot, but, I’m a truth-teller. I think that there will be a growing number of hospital executives that are removed from their roles as officers because they either didn’t astutely apportion scarce resource or they couldn’t manage the financial enterprise successfully. The organization is either looking for new leadership or they’re looking for somebody to blame, one of the two. I think that will be true of CEOs, CFOs, CIOs, and a number of others.

People don’t like to hear that, but I don’t know how you go spend $70 million and don’t have an answer for what you got for that. I’m not sure how that’s OK with an organization running a 1% operating margin, triple-B bond rating, an 8% to 11% allowance for bad debt, and a ton of interest payments in an era where reimbursement reform is getting very ugly. But that is one point of view I happen to have. The guys that are on some of the boards that I’m on are asking questions today that they wouldn’t have asked 10 years ago.

If we look down the road 10 years, based on your crystal ball, how do you think the IT market will look different from how it looks today?

I don’t have a crystal ball and I wish I could think 10 years out. I’ll try, but there are some really smart guys that paid to do that and do it well. 

I think it’s fair to say that the data will be increasingly digital. We’ve seen that already. If you look at the HIMSS Analytics EMR Adoption Model – and I watch it every quarter – the pace of movement just in the last 18 months alone, it’s been very significant. The Meaningful Use catalyst has been effective, it seems. With digital data, you can do a lot more with it. 

I sit in a room with leaders and I ask, “Well, how many of you are profitable on your Medicare business?” No hands go up. “What about Medicaid? What percentage of your net revenue does that represent?” Fifty-five to 70%. “OK, so really, what you’re telling me is your commercial insurers are your source of profit. Is that true?” Yes, it’s true. “So they are your most significant trading partners, right?” Yes. “OK, so how many of you as executives have formed positive working relationships with your counterparts?” Blank stares.

I think the health plans are a wild card in this market. We see markets like Pennsylvania, where you see health plans and providers coming together. Humana just did that again. I think there may be employers that are contracting directly with providers. There may be providers and health plans that come together. We may not see significant distinction. I know there’s very few providers that have the balance sheet and the sophistication to manage risk at scale, but maybe they’ll learn.

Specialty inpatient capacity, such as fancy new buildings and lines of service, that healthcare systems have spent millions to build will be rationed or jettisoned over time, as reimbursement incentives recalibrate patient access and orchestration decisions in favor of lower acuity and cost of care settings, including the home.

Any concluding thoughts?

Thank you for what you do. Thank you for being an independent voice and having the immediacy of your publication. I appreciate that and I know a lot of others do, too.

Guys like me — and there’s lots of people like me — we have unfinished business in this market. These problems are worth solving. They are. Every year I age. As an athlete my entire life, my body doesn’t do what it used to do. My muscle memory is good, my mind can tell it what to do, but it doesn’t, so I need a good healthcare system and so do my kids. These problems we’re working on matter greatly.

I have never been more excited about this industry. I learn every day. After 23, 24 years of beating my head against this wall, I’m learning every day, and I’m so passionate about what we’re doing. I love working with like-minded people that are smarter than me, that I trust, and we can just get after one little problem at a time. That’s what we’re doing at SCI. That’s what John Holton is doing, and Jeff’s doing, and I’m doing, and the rest of the team’s doing.  We’re just being very narrowly focused  on those areas where we think we have a unique set of competitive advantages and we’re just trying to help those clients. That’s what I think we’ll be doing a year from now and two years from now if I get to live that long.

Top News

Prognosis Health Information Systems, Inc. signs a definitive agreement to acquire Creative Healthcare Systems, developers of the financial management and patient accounting system MedGenix. Prognosis will integrate MedGenix with its ChartAccess EHR. Creative Health CEO Steve Everest will stay on board to lead revenue management operations.

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Reader Comments

From A Vendor: “Re: Billians Health Data and HIMSS Analytics. Do vendor readers have an opinion of the superiority of one over the other as a source of hospital data? We’re interested both in the database and the networking potential of the organization.” Comments are welcome.

From Antoine: “Re: duplicate med alerts. I’m not sure I agree with your comments. A duplicate check is just a med-med check where the two meds are the same. Whatever deficiencies exist in duplicate checks should exist in med-med checks. The abstract of the article said the number of exact duplicates was high, which I assume is an error, unlike conditions where other factors are different.” The biggest different between duplicates and drug-drug interactions is that the latter are graded by severity at the database level, so they can be turned off en masse and unselectively to suppress noise. Those allowed to display are then almost always clinically significant. The former are triggered by partially or wholly identical drug codes in two or more active orders, but further refinement requires looking at order-specific information such as route of administration, overlapping times, and frequency, and if that isn’t done well, those warnings are rarely clinically useful. In the article, some of the duplicate warnings were appropriate, caused by issues in CPOE such as multiple providers not looking at each other’s orders and entering an exact duplicate. Even exact duplicates may or may not be significant: if one order ends tomorrow and the other starts the next day, the system needs to decide whether that deserves a warning. I have readers who work for vendors of the clinical databases that make these “alert or not” decisions, so I welcome their review of the article. But I’ll stand by my conclusion: duplicate warnings are fairly close to useless, at least as measured by the ultimate yardstick – how many times does the clinician ignore the warning and enter the order anyway?

From ADALMA: “Re: Allscripts. I’m an employee and had two flights cancelled because of the weather. My manager called to say family comes first and not to do anything to jeopardize my family or my safety.” Another reader sent over a company e-mail that, while mentioning safety a couple of times, didn’t explicitly say to take care of family first. I attribute that to the fact that it came from a marketing person, so naturally her focus is on the conference rather than general managerial advice. I’m sure interpretations of what’s between the lines of any e-mail vary based on the reader’s disposition, but it seemed fine to me and I wouldn’t be insulted if I worked there – the company seemed appropriately concerned for the well-being of its employees. I was more interested that the reader told me that company attendees share hotel rooms at the conference, so naturally I had to ask how that works – do you get to choose a bunkmate, and what if one of you snores, is hygienically challenged, or is unusually modest? Answer: you either choose a roomie or have one assigned, or you buy out their half of the room with your own money. Forced room-sharing to save the company money always seems a little bit creepy to me, but I can see why it’s financially attractive when you’re sending hundreds of people to one event (but I still wouldn’t like it). Feel free to send me your first-person stories about that arrangement since I’m sure lots of companies do the same.

From Big Fight Brewing: “Re: 3M. ICD-10 is pushing hospitals to computer-assisted coding. 3M is telling clients that their encoder (used by 4,000 hospitals) will not interface with any NLP or CAC solution other than their own. Big clients are not happy.” Unverified.

From Gilbert O’Sullivan: “Re: UNC Health. Announced to its IT employees Friday that Rose Ann Laureto will be the new CIO. Seems to be a good hire.” She is (or was, if the rumor is true) CIO at University of Illinois Medical Center at Chicago. JP Kichak was UNC CIO until recently and still is on his LinkedIn profile, so that’s all I know.

From TRL: “Re: Cedars-Sinai. Live on Stork and a new fetal monitoring system. I’m a consultant and leadership at Cedars-Sinai might be the best in the country. They demand near perfection, but those of us with high demand skills respect being asked to perform at our best. Far too many places are just happy to follow with some strange comfort that just buying Epic is enough. Make no mistake, Epic is good software, but implementation leadership is EVERYTHING when it comes to success.” Unverified.

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Acquisitions, Funding, Business, and Stock

Scotland-based charge master vendor Craneware announces financial results for its 2011 fiscal year: pre-tax profit grew from 2010’s $7.26 million to $8.65 million; revenues increased 34% from $28.4 million to $38.1 million.

Blackstone Group seeks a $1.2 billion loan to fund its $3 billion buyout of Emdeon.

India-based business process outsourcer Ajuba Solutions says US healthcare reform has boosted its business, encouraging the company to spend $5 million on technology and $5 million on a new building. It will hire 700 new employees.

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Sales

West Virginia Health Information Network selects Thomson Reuters HIE Advantage for its technology backbone.

Ardent Health Services (TN) expands its use of Surgical Information Systems solutions to include anesthesia documentation.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) select Merge Healthcare’s RIS.

PriMed (CT) expands its relationship with MED3OOO by selecting InteGreat EHR for its 28 locations and 75 providers.

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People

Brad Levin is named North American GM for Visage Imaging. He was previously with GE Healthcare.

Impact Advisors hires Michael Nutter as its director of firm culture and associate satisfaction, a position it also calls “happyologist.” He was previously with Florida Hospital.

 

Huron Consulting Group names Michael Cadwell and Andrew Schramm as managing directors in its healthcare practice. They’re from Ingenix Consulting and Tefen Management Consulting, respectively.

Lisa Crymes joins Bottomline Technology as director of healthcare products and strategy. She was previously with Emdeon.

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Announcements and Implementations

eHealth Global Technologies deploys Axolotl Image Exchange to provide diagnostic image exchange services for hospitals participating in HealtheConnections RHIO of Central New York.

The American National Standards Institute (ANSI) launches the  Permanent Certification Program for HIT that will accredit organizations that certify EHRs. The permanent program will replace the current temporary certification program in 2012. ANSI is accepting applications through October 7.

Allscripts reports that over 4,700 attendees are taking part in this week’s ACE meeting in Nashville.

Florida providers can now use secure email though the Florida HIE Direct Secure Messaging (DSM) service. The secure messaging service is the first milestone in the HIE’s $19 million initiative, which uses technology from Harris Corporation.

Addington Hospital says it will be the first in South Africa to implement Meditech 6.0.

Travis recently mention on HIStalk Mobile something that I hadn’t heard – Facebook allows drug companies (and only drug companies) to disable or edit comments left on their wall. Facebook announced on August 15 that it will no longer give drug companies that option except on pages created for specific drugs. Several drug companies have deleted their pages, while others allow comments if they adhere to stated policy. The reason for Facebook’s original special handling of drug company pages makes sense – if someone’s public comment suggests they’ve experienced an adverse drug event, the company might have to file a report with the FDA, at least in the absence of FDA policy that says otherwise.

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Government and Politics

US CTO Aneesh Chopra will deliver a keynote speech at the Consumer Electronics Association’s Industry Forum in San Diego next month. The press releases mentions the announcement of “a major, new digital health and fitness program.”

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Innovation and Research

Researchers at Tel Aviv University create a Facebook game that will help them understand how infections spread. PiggyDemic allows Facebook users to infect their friends, which the researchers say is how viruses really spread rather than being distributed equally across populations.

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Technology

Yale’s medical school will no longer provide printed course materials, instead giving students iPads and putting all the study materials on them. They expect to save up to $100K in annual printing cost plus the labor involved. “It really makes the curriculum imminently updateable,” the assistant dean was quoted as saying, although hopefully in his mind — unlike that of the reporter — he spelled it “eminently.” Students get an iPad, apps to manage the reading material and recorded lectures, and a gift card to buy a keyboard. Harvard Medical School isn’t quite there yet, letting students buy whatever mobile device they want and giving them the choice of paper or electronic course content.

Physical therapists at Banner Good Samaritan Hospital (AZ) are using video games to put rehab patients through painful exercises. Patients like Wii Bowling, but the hospital is experimenting with Microsoft’s Xbox Kinect since it covers the whole body.

SeeMyRadiology.com releases a free iPhone/iPad remote viewing tool for its medical image exchange.

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Other

Vince keeps digging deeper with his company HIStories, aided by readers who send him memory-jogging historical tidbits, so Gerber Alley turned into a two-parter, with Part I above. If you have Gerber Alley info to share (especially any photos of Urban Gerber, who died in 1984) it’s not too late to contribute to next week’s Part II. I love reading these, especially when I recognize someone’s name or picture. I’m thinking about starting an Healthcare IT Hall of Fame with a panel of voters to choose from the nominees. Wouldn’t it be cool to see them inducted at HIMSS or something? Everybody’s suddenly nostalgic about the history of Apple and Steve Jobs (justifiably), so why not our own industry, which goes back even further? Not to mention the “doomed to repeat history” thing.

In Taiwan, HIV-infected organs are mistakenly transplanted into five patients after a hospital staffer misunderstands “non-reactive” instead of “reactive” when the donor’s HIV test results are called in and not double checked.

Indianapolis Colts quarterback Peyton Manning delivers this great line to reporters after being peppered with a few too many questions about his May neck surgery and ongoing recovery:

“I don’t know what HIPAA stands for, but I believe in it and I practice it.”

Apple gives new CEO Tim Cook over $380 million worth of shares, awarded if he remains an employee for ten years.

El Camino Hospital (CA) hires celebrity nurse practitioner Nurse Barb, who seems to already be a hospital employee although it’s not exactly clear, to develop a televised health series and to increase its social media presence.

Weird News Andy was so moved by this story that he titles it, “Sheer brilliance of doctors” with only a tiny trace of his usual dry humor. An 86-year-old Arizona man drops his pruning shears while gardening. The sharp end sticks in the ground and the man slips and falls while picking them up, jamming the protruding handle through his eye socket and into his neck, pressing directly against his carotid artery. Surgeons at University Medical Center remove the shears and repair the damage with wire mesh, saving his eye and leaving him fully recovered other than some minor double vision. There’s plenty to dislike about the US healthcare system, but if you’ve got a lawn tool jammed into your skull, be glad you’re here.

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Hurricane Irene Updates

Forty-three patients from Johnson Memorial Medical Center in Stafford Springs, CT were transferred to other facilities when the hospital lost power from two separate power feeds Sunday morning. The hospital had switched to a backup generator, but it failed.

Staten Island University Hospital was one of several hospitals evacuated in advance of Irene. CIO Kathy Kania reports that the hospital sustained only minor damage, including water in “peripheral” portions of the IT department. All IT systems were restored to full operations between 1:30 p.m. and 9:30 p.m. Sunday.

In the mid-Hudson Valley region of New York, flooding and damaged roads are creating the biggest problems for hospitals. Bridges approaching St. Anthony Community Hospital are washed out, leaving the hospital on an island. Several parking lots at Bon Secours Community Hospital are under water and flooding on local roads is making it difficult for employees to get to work. Meanwhile, St. Luke’s Cornwall Hospital is fully functional, though relying on a backup generator.

Dorchester General Hospital (MD) was evacuated Sunday morning and 30 patients were transferred after wind and rain damaged the roof. By 2:00 a.m. Sunday, the floor was covered in four inches of water and water was pouring from the ceiling. The laboratory sustained the most damage, though the ED, operating rooms, central supply, some patient rooms, and the chemo unit were affected.

SCI Solutions offered its customers free appointment voice reminder calls before the storm hit, working with partner TeleVox. Patients with scheduled appointments got a telephone message of the hospital’s choosing, with one hospital’s chosen message being “Hurricane Irene may disrupt power at the facility your appointment is scheduled. Please contact the facility before you leave home to ensure your appointment is still possible and/or call Central Scheduling for information. Please continue listening for your appointment details.”

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Sponsor Updates

• maxIT Healthcare presents the Beads of Courage Beads in Space tour, which is traveling to 10 US cities in honor of September’s Childhood Cancer Awareness Month.
• Consulting Magazine includes Impact Advisors and North Highland on its list of 2011 Best Firms to Work For.
• Billian’s HealthDATA introduces HITR.com, a social networking tool for benchmarking hospital IT satisfaction, at an August 31 webinar.
• ESD rolls out its new branding and Web site at Allscripts ACE. Also at ACE: Awarepoint showcases its Patient Tracking Board solution and Allscripts unveils its Mobile EHR apps for iPad .
• GE Healthcare hosts a September 7 webinar entitled EMR & Quality Management.
• Central Maine Medical Center (CMMC) ranks among the nation’s 25 Most Wired and Most Improved following its partnership with The Huntzinger Management Group.
• Faith Community Hospital (TX) gets its Meaningful Use check using Prognosis ChartAccess. The 41-bed hospital signed a contract in October, started implementation in January, went live in March, and attested on June 5.
• PatientKeeper announces that its user group conference will be held in Denver September 18-20.
• Frost and Sullivan awards Merge Healthcare its 2011 Customer Value Enhancement of the Year Award for Medical Analytics.
• Imprivata announces that several organizations are have adopted its No Click Access solution for VMware.
• TeleTracking Technologies releases a white paper that lists the top 10 reasons that RTLS location accuracy in healthcare matters.

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Contacts

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

Hurricane Irene is this week’s big news, and I can’t help but think if Inga was on the East Coast this is what she would be wearing. All kidding aside, I’m glad to see friends and colleagues start checking in on Facebook and other social outlets to let people know they are OK.

Unfortunately, it’s not over yet. Air travel will likely be a mess most of this week.  Several friends can’t get flights until at least Thursday.

Once the winds are gone, flooding is the next problem. For those of you in affected areas, I hope your disaster recovery and business continuity plans are working without a hitch. For those of you who haven’t shared in the bounty of natural disasters we’ve seen in the US this year, it’s a good opportunity to review those plans and consider a drill.

Numerous East Coast hospitals evacuated patients. Others canceled elective procedures to reduce census numbers and make room to receive evacuees and potential casualties. Some suspended visiting hours or made arrangements for staff to stay in the facility after their shifts were over to prevent them from having to go out into dangerous conditions (not to mention that it might be handy to keep them in-house should relief staffers not make it in).

One colleague reported using her electronic medical record’s patient portal site to push messages to pregnant patients, instructing them what to do if they should go into labor during the storm. Another mentioned a communication from the Department of Defense’s TRICARE program saying that patients in affected areas may be eligible for a waiver of the Primary Care Manager referral requirement as well as emergency “refill too soon” procedures to ensure patients have needed medications.

Providers who personally experienced the impact of Hurricane Katrina in 2005 shared their experiences and recommendations over the last several years and it appears that many organizations took these to heart. I’m not seeing too many reports of hospitals that were severely affected, and I hope most if not all continue to remain unscathed throughout any flooding. It’s not looking good in Montpelier, VT where officials are considering flooding the capital to save a dam.

I’ve personally experienced some significant flooding and am a veteran of sandbagging. I’m always disturbed by the photos of people outside in the storms or defying evacuation orders. I hope folks in New Paltz, NY return to their senses. Due to the large number of people gathered to watch flooding, officials had to ban alcohol sales and order people off the streets.

If you’re among those impacted by Irene, the thoughts and prayers of the HIStalk team are with you. Stay safe.

E-mail Dr. Jayne.

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

With much of the Northeast exposed to potential disruptions from Hurricane Irene, I’ve created a page for reports from the field. Leave a comment on that post or send your updates and I’ll keep the page current. Many folks will read this Saturday evening or Sunday, so I’m interested to hear what’s going on. Above is video of Coney Island Hospital being evacuated.

From NoHelp: “Re: Dell Services. Has laid off over 20 folks in their Meditech Solutions Group, with more to come across the legacy Perot Systems Healthcare. With Berk Smith departing, Meditech is not letting up on the C/S 6.0, which is killing MSG. Without competition, they are not able to break away from Meditech and say no to them on deals. Dell is getting less and less interested in that business because it costs a great deal to run, with a very high exec in Round Rock telling me the ROI isn’t there. They will be evaluating whether to keep it running in January.” Unverified.

From Ima Peon: “Re: Allscripts. Just sent a message telling employees to come early to ACE or drive in case your flight is cancelled. Nowhere does it say to think about your own family to ensure their safety during the most serious hurricane to hit the East Coast in years.” The conference starts Monday in Nashville. Hopefully the message sender didn’t feel the need to state the obvious – secure your family first and then take whatever transportation is available (at whatever extra company expense is required) to get to ACE on time if at all possible. In the mean time, I’m watching The Weather Channel with fascination – I’m pretty sure those hyper-excited reporters talking live from one eroding beach or another are being overly dramatic. Mrs. H just noticed that one looked fine until he saw that the camera was on him, then suddenly did a hugely exaggerated “the wind nearly blew me away” stumbling move as he recited the cliché phrase, “conditions are deteriorating.” On the beachhead was TWC veteran Mike Seidel, who provided the funniest TV moments ever during Hurricane Andrew in 1992 when he tried painfully to address the non-English speaking Miami audience in the most deadpan, white bread, C-student Spanish imaginable. I’m pretty sure he would die of starvation in a tacqueria (which is where I had some stupendous carne asada tacos for lunch, in fact). I think most of his South Florida viewers were laughing too hard to evacuate.

From The PACS Designer: “Re: Steve Jobs. His outlook is grim in this photo, taken Friday. TPD is praying for him and will miss his elegant product introductions once he is no longer with us. Here’s a slide show on his best moments.” I’m not running the photo (which I suspect is fake for various reasons that I’ll explain if that turns out to be the case) since I’d rather not remember him the way he looks in it. I’ve worked with a few pancreatic cancer patients and their outcomes were all about the same – 6-12 months of a fairly normal pain-free existence with no change in appearance, then a very fast, somewhat merciful slide to the inevitable conclusion. His diagnosis was made in 2004, so he has already exceeded my best guess. Nobody who knows him seems to like him much, but they all respect him. An authorized biography is due out early in 2012, which may be too late for him to see, but I’ll buy it.

From Mavrikg41: “Re: Epic. [hospital name omitted] was rejected by Epic in the evaluation process because Epic thought [CIO name omitted] was ‘going to get in the way of the success of the implementation.’ They called that out in the report to the hospital’s executives as to why Epic would not be a good fit at [hospital name omitted].” Unverified. I’ve left out the California hospital’s name, but it’s a vendor low blow to call out an hospital executive by name to his or her peers as an excuse for turning down their dozens of millions of dollars. Unless Epic is trying to get the CIO fired, why not just politely decline the business without naming names? It does seem that Epic’s model is occasionally somewhat anti-IT, with a fair number of CIOs leaving somewhere between selection and go-live. Once the Epic train gets rolling in a given hospital, you don’t want to get in front of it since frontline executives seem happy let Epic 20-somethings tell them how to run their business (especially the IT part) instead of listening to their own vastly more experienced people. One might therefore postulate that Epic is often chosen in an environment where both the existing IT systems and the people who maintain them are held in some degree of contempt, rightly or not.

From King Biscuit: “Re: HIStalk. It’s very slow to load at times.” It’s nearly always the problematic Internet Explorer that’s at fault, usually long-obsolete versions like IE6 or IE7, but that doesn’t stop some readers from sending me nastygrams like the server is slow or that all readers are having the problem (neither is true). I’m even more frustrated since the buggy, bloated IE was causing some users to not be able to pull up HIStalk at all a few months back, with the only solution being to program around it in a way that slowed the site down for everyone. I tested from work Friday with IE7, Chrome, Firefox, and Opera (all except IE were fresh installs with caches cleared). IE took at least five times as long as all the others to display the main HIStalk page, often getting ridiculously hung up and throwing out errors when displaying components such as Vince’s HIStory slides, YouTube videos, and sponsor ads. It did better once the page had been cached: IE7 took 18 seconds to display the page, while the others were all basically instantaneous (that was again the front page that holds five posts – the e-mail link is to a single post, which comes up faster). I just tried it with a cache-cleared Chrome on a plain old broadband connection and I was reading the post exactly five seconds after pasting in the URL. Solutions:

1. Upgrade IE if you can. IE9 is current and IE10 is in beta.
2. Download any other browser and use it instead, even if only to read HIStalk.
3. Read the barebones version of HIStalk by appending /print/ to the URL that comes in the e-mail blast. To compare for yourself, try this page and then this one. You’ll miss some stuff, but the page will display quickly.
4. Read by RSS reader or on a mobile device, which again won’t display everything, but it will come up quickly.

I used to only dislike IE, but the frustration it causes HIStalk readers has made me hate it passionately as easily the worst browser available, with extra points for puzzling ubiquity. It’s good for one thing: after a fresh Windows install, use it to immediately navigate to Firefox.com to download a reliable, standards-based browser.

Listening: reader-recommended Pylon, an Athens, GA jangle-punk band started in the late 1970s and basically defunct after the death of their guitarist in 2009. Both REM and the B52s said  Pylon was the best rock band to come out of Athens, including themselves, although Pylon didn’t come close to their commercial success. Fun factoid: the female singer, known for her snarling vocals and dervish-like dance moves, is actually a shy, soft-spoken Southern belle who’s now a staff nurse at Athens Regional Hospital, which as the reader observes, would probably shock and maybe frighten her patients if they were to see Pylon’s old concert videos.

My last poll elicited a lot of votes but not a clear conclusion – 55% of respondents say Epic CEO Judy Faulkner doesn’t have excessive federal influence, meaning not many fewer than that think she does. New poll to your right: should Congress cut back on HITECH money as it tries to reduce the national debt? The poll accepts comments, so leave yours to argue your position.

My Time Capsule editorial from Independence Day weekend, 2006: Public Trading Leads to Trouble for Merge and Misys. The obligatory teaser: “Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.”

Intelligent Medical Objects announces the availability of a free standalone version of its IMO Problem and Procedure terminology products for the iPhone and iPad, giving users a portable medical code reference library.

HIMSS is whining that as the debt-happy Congress tries to make even a token effort to cut out-of-control expenses, they might touch its precious HITECH money, thereby forcing providers to actually buy their own business tools instead of charging them to every taxpayer without their consent. Thus the new poll I’m running.

More on the rumor that Epic implementers at Carle Foundation Hospital (IL) walked off the job just days before its go-live. What actually happened is that five of its eight outsourced trainers left. It had nothing to do with Epic, but rather the company to which Carle had outsourced training (I won’t name the company since I’m hearing only the hospital’s side of the story). The original reader’s rumor said their gripe related to not being paid, presumably by their own company, but I haven’t verified that.

Healthcare learning technology vendor HealthStream announces management changes: Kevin O’Hara, SVP and general counsel, has resigned effective September 16 to take a CEO position with an unnamed early state perioperative analytics vendor. He has been replaced by Michael M. Collier. SVP Eddie Pearson (above) has been promoted to SVP/COO.

Mike Sweeney, president of maxIT Healthcare, tells me that the company has made both the INC 500/5000 lists and Best Places to Work. He says they’re up to 850 employees and are adding 25-30 more each month. I’d say they’re either at or near the top of the independent healthcare consulting food chain now that many of their competitors have been acquired. I’m sure Mike’s getting lots of tire-kicking calls.

Scottish hospital revenue system vendor Craneware expects ARRA to give it a big US boost, with big numbers expected for Tuesday’s report. The CEO expects headcount to double to 440 in the next three years.

Baxter International will acquire Baxa Corp. for $380 million. It offers IV-related pharmacy systems often supported by hospital IT departments: the DoseEdge workflow manager, Abacus compounding software, and IntelliFill automated compounder.

Former HP CEO Mark Hurd, recruited to Oracle a year ago, made $78 million from his new employer in that 12-month period. That plus HP’s recent public floundering probably makes dealing with Larry Ellison tolerable.

UPMC announces fiscal year numbers: $9 billion in operating revenue, $406 million in profit, and $3.6 billion in investments.

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