The Red Hat folks e-mailed right before HIMSS, saying they are big HIStalk fans and asking to run a "Mr. HIStalk Shoe Shine Booth" from their booth. Darned if they didn’t, too, with real professionals buffing and polishing the shoes of attendees who sat high up in an old-fashioned chair right there in their booth. I didn’t know much about the company, so an interview seemed like a good idea. I talked to VP Dave Nesvisky, who’s been in healthcare IT for many years.
Tell me a little bit about you and what you do.
I’m fairly recent with Red Hat. I was brought on in September of ’07. The intent was to have my past experiences brought to bear Red Hat to lead a vertical team. To be able to go deeper into lines of businesses is to actually have people that understand those businesses. I’ve been in healthcare IT, sales, and sales management for about the past eleven years. Prior to that, I was working in the public sector sales and sales management for fifteen years.
I’m an old dog. I’ve been around 25 years in technology. I always joke with the young bucks in inside sales about selling 200 meg disk drives for $10,000 and mini-computers with a meg of RAM the size of a washer-dryer. They look at me like I’m talking about propeller aircraft and buggies and stuff like that.
Now I’m in infrastructure. I’ve been in databases and middleware applications. So I’ve seen quite a few things; had some good experiences and some good relationships. I thought I could help out Red Hat and they obviously thought the same thing.
Summarize the offerings are that are available for healthcare.
Most people, when they think of Red Hat, they think of Linux. Actually, we have a tremendous range of offerings for healthcare.
Our MetaMatrix technology can extract data from clinical systems to provide a single, real-time view of patient data. This is a horizontal product designed to federate disparate data models. Whether the data is stored in flat files, relational models, other types of data stores, the data models can be pulled to this central point in MetaMatrix and you can create new data models using the existing data models. You can synthesize data and repurpose it for new applications.
We think the opportunity in healthcare in unbelievable when you think about all these disparate applications, all these ancillary systems and so forth; and the opportunity to pull these things together to give more complete and comprehensive information at the point of care. It has tremendous opportunity affecting patient safety and accuracy. What’s interesting about it is it is not a data warehouse, so it’s not storing the information in the second place. You don’t have the synchronization of data issues between the source system and the second source. It really literally creates a virtual database and presents it to an application, but you can cache the information. If one of your source systems drops out for some reason, you have a contingency plan to get to it.
MetaMatrix is the crown jewel in our SOA platform, which also includes all the JBoss components, pieces of middleware, rules, web servers, portal development, and things like that. Dropping down below that is Red Hat Enterprise Linux, which has a lot of capabilities: virtualization, I-O management, and clustering, and also IPA, which is security to help with control and auditing for who has access to what systems and so forth. We’ve also added a high performance messaging component that was co-developed with a lot of partners called AMQP, which is a high performance messaging standard which can be easily adapted to handle HL7 messages. It’s a big stack.
So how do you go about selling this to a hospital?
Obviously the dynamic of healthcare is most of the applications that are run by IDNs and hospitals are purchased ISV applications. There are hundreds and hundreds of vendors that provide the technology to healthcare, so a lot of our focus is around working with ISV partners. You’ve probably read about the things we’ve been doing with McKesson, GE, CPSI, and Sentillion. There are literally dozens of companies that are adopting our technology to their work.
When you start talking about MetaMatrix, it gets interesting. It represents a tremendous opportunity for ISVs to take advantage of the technology and pre-integrate some of their products and repurpose some of their existing applications to offer their customers this new, synthesized clinical view. It’s also an opportunity for health systems themselves to take MetaMatrix and, if they have a robust enough IT staff, to take advantage of this technology on their own.
Most of what I’ve heard about Red Hat in healthcare has been because of McKesson. What’s the scope of that relationship and how interested is the McKesson client base in using Red Hat products?
McKesson has adopted what we’re referring to as the Red Hat Enterprise Healthcare platform, which is Red Hat Enterprise, Linux, the JBoss SOA middleware, and the Red Hat Network Management. So it’s the complete stack of Red Hat open source infrastructure. It’s now the standard platform for McKesson Horizon Clinicals solution suite and certified for all scales of their delivery. So, it’s not just for small hospitals — it’s certified for use up and down the line for them.
What are the benefits to McKesson customers?
They probably used some proprietary Unix boxes by the vendors that you typically see. There’s a tremendous cost advantage moving to Red Hat Enterprise, Linux, and JBoss in a suite like this. If you think about it, all these capabilities that we’ve packed in — it’s all open source software. There isn’t a license fee associated with any of the software.
We charge an annual subscription that covers maintenance and updates, much like other software vendors charge annual support. The difference is proprietary vendors charge an upfront license fee, so it’s a big capital expense.
Our software is designed to run on commodity X86 and AMD hardware, so you can shop for the most bang for the buck from a hardware perspective. Because all of our various components are integrated, like the virtualization and the clustering and so forth, we can offer a one-stop shop for training to get administrators and other users trained on the system at one place, at one time, whereas they would have to have hopefully one person, sometimes multiple people, being sent to different training classes by different vendors for all these different components.
On top of that, because of the possibilities in virtualization, they can cut down on their server count tremendously. The cost of the servers goes down because you use fewer of them. People are thinking green these days. It decreases power consumption; it decreases cooling requirements; it decreases requirements around floor space.
You’re getting a tremendous capital expense advantage moving to Red Hat because you’re not having to spend as much on the hardware and the infrastructure software. You’re gaining even more over time in operating expense savings because of training and because of all the power, cooling, and space requirements that you’ve reduced.
The beauty of it is that people aren’t sacrificing anything in the way of reliability and security. In fact, most of the articles that have come out, and most of the studies that have been done, have shown that, from the security perspective, open source software is usually more secure than proprietary software The reason is everybody can see the code bugs; they’re detected early; they’re fixed early; the ramp time between a problem and vulnerability being detected and being closed out in open source is dramatically faster than a proprietary system. And from a reliability perspective, people are consistently impressed with the uptime they are getting with the systems.
There was a study done by Florida Hospital. You can see they’ve had tremendous experience with the reliability of Linux. They are drawn in by the cost savings, but gained high reliability and availability.
What about relationships with other vendors?
We have a number of Epic shared clients. We have a very good relationship with InterSystems. We frequently do information sharing and joint engineering work with InterSystems to optimize Cache’ on a Red Hat platform. We have a number of clients that are running Epic in their shops on top of a Red Hat platform very successfully.
We talked about McKesson, but GE PACS has actually been on Red Hat even longer. In fact, if you look at a survey of the PACS vendors out there, most of them run or at least offer the ability to run Red Hat Enterprise Linux.
Has anyone run the numbers to know how much money clients are saving?
Some of the numbers are staggering. I’m almost reticent to talk about them because they almost seem ridiculous, but I think we can very comfortably say people will have life-cycle savings in the order of anywhere from 35-40% upwards of 50% on infrastructure by going to a Red Hat platform over a proprietary platform. I think that’s a very comfortable number.
I see 40% time and time again. That’s a lot of money. The beauty of it is that it’s good for everybody. Obviously it’s good for Red Hat because they are using our technology, but it’s great for the client because if they’ve budgeted 40% more, lets say, that 40% can certainly be applied to other projects. It returns an investment pool of the client that they can then use on projects that they want to use it on.
It’s great for the ISV, Independent Software Vendor, because a lot of times they are trying to fit into a budget. By offering an infrastructure that costs that much less, rather than them having to discount their software aggressively to meet the budget of the client, they can roll in with an infrastructure that’s every bit as secure and reliable as what they had before. They can discount, not their product that they make their money on, but something that’s basically just a cost item for them. You know, the hardware and infrastructure. And if in fact it’s returning an investment pool to the client, that vendor actually has a better opportunity to sell them maybe an additional application or two with their investment. So it works out to everybody’s advantage.
Hospitals have always been capital-constrained, so if you can move costs into the operational bucket, that should be popular.
That’s the big thing. It’s an operating expensive because it’s an annual subscription for support of the software.
Is the retirement of the DEC/HP Alpha, which was big in healthcare, going to provide opportunities?
Yes. That’s a great opportunity for us. Those were tried and true, very reliable hardware, but it’s cycling out. That’s where our opportunity come up. They lease their hardware and when their leases are up, they look at, "OK, what’s the latest and greatest? What’s faster and cheaper?" And where they are making that look, we have a great at opportunity to introduce them to what we’re doing and save them shocking amounts of money.
It is sometimes a chicken-and-egg sort of thing with a lot of the vendors because the client isn’t looking for Red Hat because their vendor doesn’t support it yet. On the flip side, the vendor isn’t interested in adding another platform because their customers aren’t asking for it. So we’re working on bringing both sides together.
A lot of our job right now is in education and explaining to people. Because they’ve come out of a very reliable environment with the Alphas and the HPs and so forth, they can’t afford to sacrifice reliability and security, so a lot of our job is explaining about open source and about Red Hat and giving them some proof points about reliability to get everybody comfortable with it.
How much technical training is needed?
It’s a very straightforward transition from Unix to Linux for the ISV applications. They make their migration in a very straightforward way.
Red Hat was #1 in value among CIOs in a recent survey, even beating Google. How do you use that to get people’s attention?
That’s exactly one of the points. Folks in healthcare want to know that it’s been done before. You talk about mission-critical applications; healthcare is the most mission-critical app. Hospitals don’t close. Things happen around the clock. They can’t afford to take a risk and I absolutely respect that. Demonstrating value and reliability that’s proven in other industries and within healthcare is really important. Having that CIO survey show that, four years running, we’re the most valued technology company, that says a lot. That resonates with them. They respect that.
Beth Israel Deaconess has gone with Red Hat. What’s their experience been?
Things are going every well for them. Dr. Halamka is a pretty vocal advocate of Red Hat Enterprise Linux. He’s got a great quote about finding an operating system without the virus of the month, without patches, without downtime created because of so much feature creep, and so forth. He was able to find that answer in Red Hat Enterprise Linux. He comes right out and says he’s getting the security, reliability, and cost reduction that he’s looking for. He’s going to be a speaker at an upcoming user conference that we’re having June 18-20 in Boston.
If a reader is interested in learning more about Red Hat, would the conference be appropriate, or is it geared to existing users?
I think it’s definitely a place for folks who are just starting to dip their toes into using open source in their environment. It’s definitely the place where you want to start. It’s where you can get all the information you need to have that happen and to really get some basic information abut open source, showing the reliability, showing that it’s a proven technology and not as risky as you might think.
It’s a good fit for both the business representative of a healthcare system as well as a technical person. Clearly a technical person would love it because they get exposure to some cutting edge technologies. We always trot out some new things there for people to look at. From the business side, it gives people the opportunity to ask the hard questions about, "How are you really using this?"
I always get a lot of questions about what’s going on in financial services because they have such high throughput and large-scale systems. We always have people representing these other industries that you can talk and share thoughts with.
What’s you sense about open source healthcare applications?
People are running open source and don’t even realize it, like Apache or Tomcat. They’re in everything. People are using open source all the time never thinking about it. It’s very reliable. Then when we raise the visibility of it up and say, "OK, these systems are going to run on Red Hat Linux" and they run them for awhile and they run great. All of a sudden, that opens the door to say, "We’ve had challenges with interoperability and other things. What else is out there?"
They’re willing to take a look at projects like WorldVistA. Open Health Tools is doing some great stuff. I would like to think that Red Hat has a position of thought leadership in open source; that our opinion is valued in the community. When we go out and tell folks, "It’s ready for prime time," we can help guide people and take advantage of their open source applications.
You mentioned the SOA in healthcare. Everybody talks about it. Do you think that’s going to make a significant difference?
Yes. If you asked ten people, "What is SOA?" you’d get ten definitions, anything from web services all the way up to full-blown architecture.
Every system in healthcare has some common elements that repeat from system to system. Whether it’s the core clinicals or what have you, there are always some components of it that repeat. The ability to take those repeating components or services and build new systems using them makes common sense.
The software we use is not a new concept. Its been around a long time. The difference now is, when you can take advantage of open source tools and look at the source code, you’ve got much better visibility into what you’ve actually built and the ability to share it. Before, people would build software, but it would be proprietary and enclosed. To be able to reuse that package, you had to guess what was in there.
With open source, you can look at it and understand exactly what it is, how you can repurpose it, and what pieces you need to change to take advantage of it. It gets you a huge head start on building new applications. It’s a terrific opportunity. Open source and open standards make the timing right for SOA to be a legitimate strategy for healthcare IT.
Most open source organizations don’t have the resources that Red Hat has to get that message out. Do you feel that Red Hat should advocate for them?
We do, because we believe in the open source model. There’s opportunities for the typical core ISVs that you see out there to take advantage of bits and pieces and embed it in their own applications. Just in the same way that McKesson is taking advantage of our technologies to build their applications.
I can foresee where some of these open source projects will move up the stack and take advantage of some of those components as they build the next generation of their product. I’m not speaking from absolute knowledge about McKesson’s strategy is, but in general, I see ISVs certainly taking a look at what’s out there. If it can accelerate their development cycle and allow them to deliver more software more economically, of course they’re going to do it.
The whole idea about open source is you’ve got lots and lots of contributors. You’ve got more people pouring their work into code than any individual company could possibly hire. You could big the biggest software company in the world and they don’t have as many developers as the open source world does. The whole idea is for large communities to come together and take advantage of what’s been built.
How would you say the culture is different at Red Hat from the healthcare vendors you’ve worked for?
One thing that’s pretty funny. We have an internal e-mail address called Memo List. Basically it’s just freeform. In any other company, there’s such a tight control around sending e-mails, their legal this and that. This memo list — people are asking questions about recipes and where to travel. It’s like a freeform forum inside the company that goes on.
There’s a tremendous amount of commitment and passion around open source. This place — you eat it, breathe it, sleep it. That’s everything here — the community involvement. Open source -– very, very passionate about it. In fact, we run all open source products internally. Stupid me, I had a Mobile 5 phone. I came in here and I said, "Can I get push e-mail for this?" They looked at it like it was some kind of Satan or something. They wouldn’t support that Microsoft phone. They were going to perform an exorcism on it, I think.
There’s just this unbelievable, single-minded purpose around advocating open source. So when you get back to your question about other open source projects and open source products out there, I’m just speaking from my perception of the company, we feel this obligation to help anybody that believes in open source to help them be successful. Red Hat has got 80% of the paid Linux market. With that kind of market share and brand visibility, we think we can help these companies become influential.
How many employees does Red Hat have?
I think we have about 2,500.
As far as healthcare then, what’s your structure going to look like to operationalize this vertical market strategy?
I’m working hard to hand select sales reps that have been in healthcare. That’s always the first question when you go into sell something in healthcare: "How long have you been in healthcare?" and "What do you know about healthcare?" Customers play stump-the-band with you to make sure you’re legit, because I guess they’ve seen companies come in and out of healthcare before. They want to make sure you’re serious.
I’ve selected some people for the team that have deep roots in selling in healthcare. They’ve been in the business north of 20 years in healthcare IT. They know what they’re doing.
On the product management side, we’ve got a mix of folks. Some folks that have deep healthcare subject matter expertise and other folks that obviously have deep Linux and middleware and product-specific expertise. We’re cross-training each other. We’re trying to build both strength and knowledge in healthcare inside the company, and at the same time, cross-training these healthcare veterans with a depth of understanding of open source and the Red Hat product line so we can hopefully present the best of both worlds to our clients.
Our solution architects, which are our technical folks, are typically doing the deep dives on technology with the clients. Explaining it, demonstrating it, and so forth. They all understand the technology very well. We’ve been spending a lot of time working with them; talking to them about healthcare and the unique requirements in healthcare IT; getting them in front of a lot of prospects and customers; letting them do a lot of listening to be able to a more relevant technology recommendation to them. The more they understand about healthcare, the better off they’re going to be and the better off everybody’s going to be.
Is there anything else that we should talk about or that you would like to mention?
I gave you the shout out that we’re HIStalk fans over here.
I appreciate that.
Hopefully you got a shoe shine at HIMSS?
I just had to walk by and talk it all in. It was kind of strange to see even my phony name up on a shoe shine stand.
Our Fake Inga was equally popular. People liked taking that five-minute break and getting a shine. It was great.
Anything else?
We’re delighted by the enthusiasm we’re receiving in healthcare. Frankly, the reason that pulled me into Red Hat is it just seemed like an absolute perfect fit. Here you’ve got this very reliable and secure and scalable environment that you can offer to an industry that’s always so cost-constrained at such a much more reasonable cost than what they’ve been used to paying. It just seemed like natural fit. And now, as we work with these ISVs, there’s obviously advantages to the as well.
The other thing that we didn’t really talk about, but that we’re very involved in, is working with standard bodies and groups that are working towards things. We are lending a point of view to that and encouraging those projects as well.
From Irwin M. Fletcher: "Re: degrees. Inga hit the nail on the head: if you could get HONEST responses from people, those with advanced degrees would say it was required (self-validating) and those without degrees would say the school of hard knocks is the best alma mater. An advanced degree isn’t as much about what you learn, but the personal and/or professional commitment you are demonstrating."
From Befuddled: "Re: Secretary Leavitt. Interesting that he is finally getting it and looking beyond EMR industry rhetoric. ‘I think it’s important to remember that the goal here isn’t [EHRs]. The goal is to transform the sector of health care into a system of health care, a system that provides consumers with information about the quality and cost of their care." Link. I take it as more of an endorsement of EMRs, but as a tool toward an end that doesn’t stop with checking off the "we’ve implemented one" box. His closing comment says so: "Health information technology is an enabler of better quality, lower costs, fewer mistakes and more convenience … The goal is the value that the records produce, not just the existence of the records."
From Concerned Customer: "Re: Merge Healthcare. Any news or rumors as to what will happen? They are our PACS vendor and things are not looking too rosy." The company’s market cap is less than $12 million, its auditors expressed doubt last month that it can continue without a cash influx, the low share price triggered a Nasdaq de-listing notice, and management has said they will consider "all strategic options" as they try to stop the bleeding with layoffs. A new report says that cash is down to $8.5 million on March 31 and the company has no credit to finance what it said was its only hope, a new teleradiology business. Also in Friday’s report is a statement that the company may be forced into bankruptcy on June 30 (headlines like those don’t exactly enthuse prospects). Shares dropped another 10% to $0.35 Friday. I would expect you’ll see worse support and development because of the job cuts, which nearly always drive off the best workers who have other options. Then, it’s wait and see as to whether they’ll limp into bankruptcy (which could last years), sell out to another vendor or to private equity, or start a long recovery. I’d like to say something reassuring, but these particular tea leaves are ugly. If you’re already a customer, though, I’d sit tight since you don’t have a lot of options anyway.
From Luvvin It: "Re: maybe it won’t be Allscripts-Misys. From the Telegraph: Software group Misys firmed 9¼ to 174¼p amid rumours of a possible bid in the range of 210p-220p per share."
From Samantha Sang: "Re: 1500s. Has anyone heard of any medical billing services or EMR/billing software able to fax all of the their 1500s? Seems like a cool and obvious idea, but I’d never thought of it until recently."
From Blogreader: "Re: advance degree. See this post." Link. Scot Silverstein doesn’t usually have good things to say about CIOs and IT departments, so if you don’t want to start your Monday morning sputtering and flinging your coffee at your monitor, don’t click the link. He often makes harsh observations from the context of "the IT people didn’t hire me, so they must be insular fools who hate doctors" angle, but he does make an occasional point.
I knew I was about to be embarrassed when the e-mail subject read, "A bit late, but thanks - Steph from Johns Hopkins." I had made a silly comment the other day about her HISsies CIO of the Year win awhile back, joking about not hearing from her (and having no reason to expect to since readers voted her in). She reads HIStalk, as I now know. Doh! She sent a gracious, fun, and appreciative e-mail that made me feel like a real doofus for shooting off my mouth. She says HIStalk is "superb," which makes me regret some of my more sophomoric writings (or maybe she was referring to those?) Anyway, my new BFF (as Inga says) Steph was ultra-cool about it, even signing off with "Listening: Memory Almost Full, Paul McCartney." She gave me a Listening! It made my day.
Speaking of HISsies winners, the 2006 Industry Figure of the Year writes about the 2007 winner: Justen Deal comments on athenahealth.
Idiotic lawsuit: a man drives his car through a chain link fence and into a river, trapping his 75-year-old mother-in-law underwater for 30 minutes before police and firefighters can get her out. The town honors her rescuers as heroes in a formal awards ceremony, but the woman and her family sue the town, a selectman, her rescuers, the police chief, an architect, an engineer, and her son-in-law, complaining that the area needed concrete barriers and the city should have had its own team of divers so she could have been rescued more quickly. She was quoted as saying family members commonly sue each other after accidents to collect insurance. She just settled for $870,000.
EHR Scope’s spring issue is now available, with articles on security, evidence-based medicine, and the usual comprehensive list of EMRs.
Inga and I have approved a bunch of LinkedIn requests, which we find fun (it’s like counting how many yearbook signatures you got compared to everybody else, although I suppose today’s high schoolers probably just text each other instead of actually placing pen to paper). One request had this comment, which says it all for me: "I totally dig your blog! I give it to my staff as assigned reading. Please connect with me so we can both pretend Linked In is meaningful in some way:)" I’m admiring my 72 high-powered connections and feeling pretty full of myself right about now.
Maryland’s Health Care Commission endorses two health information exchange proposals, one of them from Erickson Retirement Communities and Baltimore’s three largest hospital systems that would involve Microsoft, GE Healthcare, and HealthUnity.
The Tampa paper runs an article on the use of PatientKeeper’s Mobile Clinical Results on smartphones at Oak Hill Hospital via the company’s deal with HCA.
The mesmeric Gwen at HealthcareITJobs gets a lot of e-mail questions, one of which she told me about: "Is Mr. HIStalk happily married?" I was preening like a peacock for about ten seconds as I pictured a longing female aroused by my manly journalistic bicep-flexing. Re-reading, however, led me to a more likely interpretation: can that jackass’s wife really have tolerated him for all those years? I know — amazing, right? I’m shocked every morning when I reach over to Mrs. HIStalk’s side of the bed and find her instead of a note.
QuadraMed’s Q1 numbers: revenue up 21%, EPS -$0.02 vs. $0.03. I didn’t hear the conference call, but the message boards are reporting that QCPR is the focus and they’ll be selling off their pharmacy system (the old PharmPro, if I recall, which earned a mystifying #1 in KLAS at one point despite being one of the more primitive ones I’ve seen). They’re planning a reverse stock split.
The Irish Blood Transfusion service is ripped by auditors for buying the Progresa system that ran four years late and over budget before it was abandoned.
Friday wasn’t a good day for Central DuPage Hospital (IL). Backhoe operators took out an underground power line, leaving the hospital on generator for four hours. During that time, an electrical surge caused a computer monitor in an hospital office building to overheat, leading to an evacuation.
A reader suggested running a survey to see which hospitals have folks reading HIStalk. Those listed on the responses are here. What an impressive group you are!
E-mail me.
Art Vandelay on TCO (Total Cost of Onerous-Ship)
Kaiser’s announcement about its annual maintenance costs is déjà vu. I often feel it is the "total cost of onerous-ship" in my organization. Kaiser’s maintenance for HealthConnect is right in the middle of the range we see for TCO, which ranges from 20 to 36% of the cost of installation. (Before you fall off your chairs, I am very detailed in the costs I include, right down to power and cooling, percentage of time operations staff spend on monitoring, usage of tapes, and partial FTEs of support staff).
The wide variation in our TCO is driven mostly by the maintenance contract we negotiate with the vendor. The next largest driver is the human resources we need to maintain the application and supporting hardware. For example, clustered databases, redundant servers, and those with bi-directional interfaces typically require the most support. The rest of the costs are relatively minimal.
Two observations. Kaiser’s costs are not out of range by my calculation, but I would have expected more efficiency from their scale. Maybe their geographic distribution eats into their efficiencies. I would bet they will begin to look at more offshore support if their financial prospects don’t improve. They will likely also be eagerly awaiting Epic’s web browser client transition. That would hopefully move them away from one of the world’s largest Citrix farms.
Second, if users are looking for a real return on investment, the TCO can be a large hurdle to jump. In Kaiser’s case, the investment in the system has to cover the 25% maintenance (forever) and then be large enough to pay back a $4B investment in a reasonable amount of time. That can be a daunting proposition. By my calculations, a 50% annual ROI would break-even in 10 years when considering depreciation in the mix. A 50% annual ROI without depreciation would break-even in 7 years.
The PACS Designer’s Open Source Software Review
FileZilla is file transfer software for those who do frequent transfers. It uses File Transfer Protocol (FTP), which can be slow for large files over 10GB, so if you are transferring large files frequently, you would be better off with a Network File System software package. Setup can be tricky depending on your particular system’s configuration. Support from users appears to be good and recent posts of problems have been answered rather quickly. FileZilla is a software platform in the SourceForge.net community.
Features of FileZilla include:
Ease of use
Supports FTP, FTP over SSL/TLS (FTPS), and SSH File Transfer Protocol (SFTP)
Cross-platform. Runs on Windows, Linux, *BSD, OSX and more
Available in many languages
Supports resume and transfer of large files >4GB
Powerful Site Manager and transfer queue
Drag & drop support
Configurable Speed limits
Filename filters
Network configuration wizard
Remote file editing
Keep-alive
FTP-Proxy support
File sharing is becoming more popular in recent years, so saving time is important. It would be best to try FileZilla with a select number of users before deployment to a larger group.
TPD Usefulness Rating: 7.
http://wiki.filezilla-project.org/Main_Page
http://sourceforge.net/projects/filezilla
From Beantown Johnny: "Re: Nuance. Any truth to the rumor that there’s been a sales shake-up?" Not that I’ve heard, but I’m not well connected there. I always figure it’s safe to speculate on a sales shake-up since just about every vendor tinkers with that function now and then. That’s part of being in business and of being in sales. Life goes on.
From The PACS Designer: "Re: Oracle’s new offering. Oracle has released a large number of SOA solutions recently and now just announced another called Oracle Data Integration Suite. It offers a open, standards-based integration platform that connects heterogeneous data sources and applications." Link. TPD sure likes that Oracle stuff even though he’s an open source guy.
From Dr. CIO: "Re: advance degree. I don’t know why you are so hung up about advanced degrees. Personally, I would rather hire based upon experience and emotional intelligence rather than sheepskin. Example of no degree (undergrad) superstars: Gates, Ellison, Dell, Jobs … I rest my case." Well, that case you rested wasn’t made too well — nobody hired any of the folks you listed. We’d all agree that it makes little difference for entrepreneurs who start a company, but we might disagree on mid-level executives. Wanna bet that Microsoft, Oracle, etc. require advanced degrees for some jobs, rightly or wrongly, even though those founders don’t have them? And if your boss has one and you want to move up someday — think about it. I’m the poster child for educated but unmotivated, by the way, so I hear you. It shouldn’t matter, but then again, neither should good looks or connections.
From Brian Boyfanno: "Re: HIMSS. Can I sign up for your 2009 event now?" Jeez, didn’t we just have that? Nothing’s decided yet since it takes a sponsor, location, and all kinds of stuff. If there is an event, I’ll move you to the head of the line. I’m happy it’s already on your mind, though.
Johns Hopkins CIO Stephanie Reel is named as one of Maryland’s Top 100 women. I’m sure that’s a trivial honor compared to winning her HISsies CIO of the Year award a few years back. I expect she’ll e-mail her appreciation for that nearly any day now.
Listening: Awesome Color, Stooges-type (Iggy, not Three) psychedelic rock.
Did I maybe just forget that HIMSS has a CIO? Says it does here. I don’t know a lot of their folks.
Speaking of HIMSS, when did they get into the hard-selling, vendor-specific Webinar business? This one’s about PC FTP software, which seems like an odd thing for HIMSS to shill. Personally, I use FileZilla, which is free and works fine (my shillin’ is free).
I wasn’t interested enough to type the long organization names, but some group names a McKesson guy and a Wal-Mart guy as co-chairs of another big-named group. The press release is like a densely constructed stone wall that defies ocular penetration, but it’s got something to do with HIEs.
If you’re a LinkedIn user desperate for contacts, Inga and I approve all requests because we’re desperate for approval, too. Search on HIStalk and up we’ll come.
If you aren’t getting e-mail updates when I write something new, just plop your name and e-mail address in the Subscribe to Updates box to your right. You’ll impress your colleagues with your mastery of current HIT events.
Memorial Hermann will use OB waveform monitoring software AirStrip OB.
McKesson donates PracticePartner to Father Joe’s Villages, a non-profit supporting the homeless.
I’m really excited that just about all the healthcare IT vendors are turning in good numbers. It’s a tough market and apt to get tougher, but they’re looking good for now.
Former QuadraMed HR VP Donna Klein takes the same role at biologics company BioReliance.
Jobs: Technical Support Analyst (CA), Clinical Informatics and Physician Liaison (OK), Project Manager - Healthcare (GA). Weekly job alert signup.
IBM and Siemens will help hospitals reduce energy consumption, but only if they use MedSeries4, which should narrow the list down quite a bit.
I know it’s nerd heresy, but Microsoft and Yahoo don’t interest me much, individually or collectively. I’ve never used the search engine of either one, haven’t bought anything from either company in years (except for my $20 upgraded Yahoo e-mail account), and I could name a ton of much more interesting companies than those two wrinkling dowagers and their desperate, fumbling attempts to mate. At least that never-ending story is an alternative to the daily "gas hits a new high" headline.
Donal Quinn is named head of the diagnostics division of Siemens.
A UC Berkeley engineer moves most of the technology of medical imaging into a central server, allowing creation of a cheap, portable scanner that plugs into a cell phone. The scanner will be $1,000 and the whole setup around $70,000, making it viable in poor countries and rural areas.
The secret to running a health information exchange, according to two executive directors, is hitting up the state for money. The one from Maine says they’ll never be self-sustaining.
Bizarre lawsuit: a nurse brought in to fix Howard University Hospital’s ED after a reporter’s death there led to charges of mismanagement is suing the hospital for $4 million, claiming sexual harassment. She says the new doctor in charge of the ED referred to himself as "a pimp" and used unspecified derogatory terms for the ED nurses (that doesn’t take much imagination to figure out). She says he sent her flowers for a job well done, but signed the card BD, short for "Big Daddy," the name he insisted on being called by nurses.
And another: a patient hospitalized after her fourth suicide attempt is suing Medical Mercy Center-Clinton (IA) for worsening her depression. A nurse helping her to the bathroom allegedly told her, "You need to use a more lethal method. I’m sorry, I just hate it when people are a drain on society." The nurse apologized by letter, throwing water on the theory that doing so stops lawsuits.
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Inga’s Update
From Sparky: "Re: ASU WOW-mobile. It was wonderful to see my alma mater mentioned on HIStalk! I’ll take the opportunity to plug the ASU School of Computing and Informatics, which matriculated its first class of graduate students in biomedical informatics this past fall. The new program has recruited world-class faculty and is affiliated with the recently-opened Phoenix campus of the University of Arizona College of Medicine, the Translational Genomics Research Institute (TGen), and the Mayo Clinic in Scottsdale. Look for great research and great people coming out of this program in the near future.”
CSC opens First Consulting Group Viet Nam.
Sage Software’s profits beat analysts’ forecasts, up 9%, which matches its revenue increase. The company points out that the healthcare division that didn’t perform too well: revenues were down 11%, gross profit down 8%, and EBITA down 46%. Management says the numbers disguise a lot of the behind-the-scenes actions to turn things around. They have lots of physician users because of acquisitions, so it’s a big footprint.
Stratus Technologies names JJWild its Partner of the Year for the Americas sales region. JJWild has quadrupled their sales of Stratus’ ftServers to Meditech clients over the last year.
I voted for Mr. H as one of the “100 Most Powerful” in healthcare and hope you take a second to do so as well. He works hard and all he asks in return is that you read his blog. It would amuse him to potentially upset Modern Healthcare’s apple cart with a nomination.
HHS hands out an additional $600,000 to six new participants in the trial NHIN implementations. The new folks all represent good-size communities and include the Cleveland Clinic, Kaiser, HealthLink, Health RHIO, and Health LINC, and Community Health Information Collaborative
Picis announces the European launch of its Total Perioperative Automation solutions The Institut Mutualiste Montsouris has been working with Picis to customize the software for the French market.
I’m guessing that all those passionate Mac users out there will be happy to hear this news. EMR vendor Spring Medical Systems announces a new HL7 compliant interface with MacPractice MD PM’s system.
After reading about all the swanky new amenities at Henry Ford’s new West Bloomfield hospital, I am trying to narrow down what body-enhancing procedure I might have so that I can score a couple of nights’ stay. New rooms will have flat screen TVs, refrigerators, laptop computer tables, security safes, and a feng shui design to make patients feel connected to nature. Oh, and high-quality dining options, including 24-hour room service! Beats the Hampton Inn, for sure!
Eclipsys beat Wall Street’s expectation despite a Q1 net income that fell from a year ago. Due to some extraordinary costs, income was only $.01 a share versus $.04 last year. However, revenue was up 10%, and non-GAAP net income grew 25%.
There is a survey on the right asking if it is important that a hospital CIO have a Master’s degree in some field of study. I think we should have also asked if the responder had a Master’s – it would be interesting to see how that affected votes. I don’t know about CIOs in particular, but generally I believe having an advanced degree can’t hurt you. I think it can open doors (rightly or wrongly) and can be an indication of tenacity and ambition. It’s not a guarantee that a person is smarter or works harder than the next person, but if all other things are equal it, can’t hurt you. (And yes, I have an advanced degree and the greatest job ever… so there you go!)
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Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in October 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Big-company CEOs have healthcare on their mind. I know that because they keep insulting us in the national media. We’re too expensive and we underutilize technology, they’re telling the world. It’s our fault that jobs are moving offshore, not their own corporate greed or inefficiency.
My first reaction: who do they think they are? We’re getting lectures on innovation, productivity, and cost control from GM? If I wanted that kind of advice, I’d go to Toyota.
Unfortunately, they’re right. The healthcare price increase merry-go-round has to stop eventually. Most of the job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with their healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching the show from China or India by then.
Businesses want to force computers on us, dragging us kicking and screaming out of the dark ages. Unfortunately, software doesn’t automatically bring increased productivity and lower cost. If it did, all of those hospital dollars spent on Microsoft Office and Windows would have made us stunningly more effective instead of just giving employees something to screw around with as a pleasant productivity alternative.
I’d like to think that computerization can really reduce costs, but I haven’t seen it happen anywhere yet. I keep hearing about all of those showcase sites buying the latest and greatest, but the correlation to bottom line and quality outcomes is murky at best. Where’s the average 100-300 bed hospital that has seen its overall costs drop 30% because of software? You’d know them because every other hospital in town would be out of business.
Hospitals can cut expenses in three ways, all of them at their local level. They can manage labor, which is by far their largest expense. They can go after the utilization and cost of drugs and supplies. They can control physician practice variation. I’m glad I said “can” instead of “do” because, for various reasons, these things don’t happen. Software can’t fix them because they’re management problems, although given desperate enough circumstances, they could be fixed.
I’m glad much of our recent IT investment relates to patient safety and outcomes. I hope electronic medical records really do become a standard, with all the information sharing that the RHIO people keep yapping about. But when it comes to drastic cost reductions driven solely by buying and implementing software, I’d say that’s wishful thinking. There’s a lot of work to be done fixing the system and its underlying misaligned incentives before we even try to automate it. No business became a world-beater just by installing SAP, even if they were lucky enough to not be one of those that went bankrupt trying.
I do see a ray of hope in being called out by big-company CEOs. As hard as it is to have change forced on you, I think that time is here. I work in a hospital, but I’m also the occasional patient and medical bill-payer. When wearing those hats, I’m just as mad and frustrated with the system as those CEOs and I bet you are, too. Healthcare is too expensive, too bureaucratic, and too unimpressive in benefits delivered. As a software guy, I’m pretty sure that fix will take more than just people like me.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
From Devin Valencia: "Re: athenahealth. Not only did athena blow out numbers, they announced on the call they signed a national account with CVS/MinuteClinic." Q1: revenue up 36%, EPS $0.05 vs. -$0.55.
From Katrina Leskanich: "Re: TEPR. TEPR sent out an e-mail recently offering 2-for-1 registration and a free registration to anyone who previously purchased a ticket. Is there any question that they are having trouble drawing crowds? Attendance has been down for several years running and they look to be on their last legs."
From Moondogg: "Re: HIStech Report. It seems to be paid advertising." You’re partially correct. Vendors pay us to develop and conduct an interview with an executive about a specific product. I put it over there to make that clear. Still, we ask whatever we want and we conduct them just like our normal interviews, so vendors aren’t supplying the content. I think the result is a good read.
From Destiny St. Claire: "Re: Sage. I hear former Misys VP Jim Skladany is joining Sage as new West Coast VP of Sales."
From Visitor 211: "Re: layout. I noticed the banner ads go far down the page, beyond the article." We’re doing a little bit of redesign to improve the layout, so stay tuned. It’s definitely a (good) problem to have that many sponsors.
From Bradley Beeswax: "Re: Fletcher Allen. They’ve picked their man to run their $57 million Epic implementation." Link. Chuck Podesta, from Caritas Christi, is named CIO of Fletcher Allen Health Care (VT). He doesn’t have an advanced degree, I noticed, since that’s the hot topic here (and the subject of a new poll to your right).
My opinion: CIOs should have advanced degrees, not because the coursework will be used every day, but because it’s so easy to earn accredited MBAs and other degrees nontraditionally and inexpensively that I’m suspicious why a highly paid senior executive can’t be bothered to do it. A bachelor’s degree is like a high school diploma was 20 years ago and MBA studies have real-world relevance. Education is a standard bio entry and thus it drives first impressions. Heck, half the IT worker bees have advanced degrees these days. Still, I know exactly who’ll say what: CIOs without advanced degrees will say that nobody remembers their courses anyway, that hard knocks is the best teacher, and that they’re a shining example of why a bachelor’s degree is OK. Those with the degree will tell you how useful it is, why there’s no excuse not to get one, and how few hospital people make VP without a Master’s. Both will provide examples of great people without degrees and bad ones who have them. And in every case, whatever credential that person holds is exactly the minimum they would recommend for the job.
In Australia, Victoria’s Department of Human Services gets a bailout of $100 million US for its HealthSmart project, which is two years behind schedule and way over budget. Much of the core technology is Cerner Millennium, not that there’s anything wrong with that.
Jobs: HIT - Senior Internal Consultant (TN), Application Analyst II (VA), Soarian Clinicals Consultant.
Kaiser says its HealthConnect outpatient rollout is finished, with all 8.7 million enrollees having access, but inpatient is installed in only 13 of 36 hospitals. They admit to its $4 billion cost, which I believe was angrily denied when that number was first estimated by outsiders. Maintenance is $1 billion (!!). The hospitals and health plan announce a 64% net income drop in Q1 because of investment losses. Still, a $250 million quarterly profit for a "non-profit" in one quarter isn’t too shabby (imagine if they weren’t spending $1 billion on HealthConnect maintenance).
TriZetto’s CFO Bob Barbieri quits for "personal reasons" (probably because Apax had another "person" in mind to take his chair). I’ve never seen the "personal reasons" excuse laid on so strong as to put it in a press release headline, so naturally I’m skeptical. Maybe publicly traded company bean counters are too conservative for privately held companies.
McKesson’s Q4 numbers: revenue up 9%, EPS $1.05 vs. $0.85, beating expectations of $1.00. Technology revenue was up 19% to $806 million. Shares were up nearly 8% today. Nice.
A hospital information system company in India wins an IBM public sector award.
Say, wouldn’t it be a hoot if some anonymous blowhard was named one of the 100 Most Powerful People in Healthcare? You can nominate me here (by Friday). I’m sure the magazine people will squelch it, but what the heck. I’ll even helpfully show you what to fill in so the votes can be tabulated before being discarded scornfully - click the pic. I’m thinking I shouldn’t reserve the tux quite yet.
CMS is piloting PHRs in South Carolina.
Mobile systems vendor InfoLogix acquires Delta Health Systems, a cost containment consultant with an executive information system.
Strange: a woman Twitters her labor status in real time from a hospital.
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Inga’s Update
Members of the Connecticut State Medical Society can now receive discounted pricing for athenahealth’s PM service. Interesting to me is that the discount does not extend to athenahealth’s EMR.
VHA, Inc. claims to have provided member health organizations more than $1.3 billion in savings in 2007, which is more than any of its competitors. Revenues and operating income were up 7.5% and 8.3% respectively.
The 46-doctor Greensboro Radiology group will implement InterSystems Ensemble for its enterprise-wide integration platform.
The latest products earning CCHIT Ambulatory 2007 certification include Allscripts Touchworks 11.1; Cerner Millennium PowerChart/PowerWorks EMR V. 2007; Eclipsys Sunrise Ambulatory v. 4.5C (pre-market conditional certification); Healthport EMR v.9.0; and ChartMaker V. 3.0.5. Looking over the list of certified vendors, a couple of major players I’m not seeing include GE’s Centricity and athenahealth.
Privately held Greenway Medical Technologies announces a 52% increase in sales bookings for their fiscal quarter ending March 31st compared to 2007.
Concord Hospital in NH will use Juniper Networks for its network infrastructure. The network will include the connection of 11 total sites, including various healthcare centers, clinics, and physician offices.
CMS announces the six vendors participating in its physician quality reporting initiative. Allscripts, Anceta, Cerner, DocSite, eClinicalWorks, and NextGen are providing data pulled from EHRs to measure quality data reporting capabilities.
Intermountain Healthcare signs a multi-year agreement with Novo Innovations to enhance information exchanges between Intermountain’s hospital systems and physician practices without EMRs. Novo’s software is already being used to connect several affiliated practices with existing EMRs.
Japanese hospitals and clinics are not adopting medical records as fast as the government would like, with only about 10% of each automated as of February 2007. Thirty-one percent of the 400+ bed hospitals had an EMR, far less than the government’s 60% goal for that group. The primary barrier: cost.
Mediware reports more dismal financial numbers. Profits are down 62% from the same quarter last year and sales were down 52%. About the only thing upbeat was the CEO’s comment that the company was “executing plans to build a strong foundation for future growth.”
An Australian doctor recommends that the government pay up to $47,000 for kidney donations to resolve organ shortages. The rationale is that in the long run, thousands of lives and billions of dollars in care would be saved. Guess it would pay for a pretty nice vacation if anyone over here is interested.
I like the new health care van belonging to ASU’s College of Nursing & Healthcare Innovation. A $700,000 UnitedHealthcare grant paid for the WOW-mobile (stands for Wellness on Wheels) that will bring primary care services to underserved Arizona communities. The rest of the grant money, by the way, will be used for pediatric obesity and child-teen mental health programs.
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