From RJ McMurphy: “Re: putting HIMSS in perspective. Vendors representing half of the hospital HIS/EMR systems in America weren’t even present! If you look at the HIMSS Analytics report in Modern Healthcare for Jan. 2009, you’ll see Meditech with 26.7% market share, Cerner with 12.6, and Siemens with 9.5. That adds up to 48.7%. All three chose to opt out of HIMSS. Basically it’s become a hype circus — no buying influence really happens there. It was more important earlier in the market cycle when PowerPoint was the main operating system for EMR vendors. Now almost all buying is done by peer site reference and Internet data gathering. Organizations like HIMSS, KLAS, Gartner are trying to make themselves more relevant with lots of hype about trends, etc. The world has changed and I laud those three for opting out and saving their shareholders and stakeholders the cash!”

From Doug Dinsdale: “Re: Merge. Dr. Dalai challenges the CEO of Merge to explain why the purchase of Amicas isn’t going to ruin both companies.”

Cerner makes the S&P 500.

A reader sends this picture of a billboard one of his patients asked him about.

Haemonetics extends its $60 million offer for GlobalMed Technologies to give that company time to settle a shareholder lawsuit seeking to block the acquisition.

Tallahassee Memorial HealthCare (FL) chooses Allscripts PM/EHR for its 106 providers and 33 family medicine residents.

Singapore General Hospital wins the Microsoft HUG 2010 Innovation Award for “Best Use of Clinical Records – Inpatient” for its use of Eclipsys Sunrise Patient Flow, which improved bed placement time and reduced overhead.

A Weird News Andy find: a former dentist is accused of using paper clips instead of stainless steel posts inside the teeth of root canal patients, about which WNA says, “Maybe it’s for all those people who use paper to floss.”

More information on the HIMSS EHRA position on meaningful use is here.

McKesson announces a hosted storage option for Horizon Cardiology CVIS, with Cooper University Hospital (NJ) as an early adopter.

Software developed by Boston Medical Center, Northeastern University, and MIT that reduced readmissions by 30% is licensed for commercialization to Engineered Care Inc.

A new iPhone app called iResus walks users through emergency resuscitation, providing a metronome for timing chest compressions.

Nurse scheduling software vendor StaffKnex changes its name to OnShift. They apparently like conjoined words quite a bit.

Everything about this story is sad. A four-month-old Down’s baby dies in the UK after being given a tenfold overdose of the diuretic furosemide. The computerized warning issued to the doctor’s office is overridden by the receptionist. The pharmacist hears the technician questioning the dose with the prescriber, but doesn’t follow up. The neighbors of the parents, convinced they killed their own child, trash their house and steal all the baby’s belongings. Weeks later, the father kills himself by drug overdose. The coroner’s report finally came out this week, four years later, finding that the doctor and pharmacist were at fault.

Revenue cycle vendor Emdeon will acquire management consulting firm Healthcare Technology Management Services for $11 million.

At least somebody likes the proposed meaningful use criteria: AARP and Consumers Union.

Lexi-Comp releases its ON-HAND medical software for the Palm Pre and Pixi.

A KLAS report finds that 20% of smart pump buyers wouldn’t choose their current pump again, although 99% of CareFusion Alaris said they would. Still, the highest rated pump was the B. Braun Outlook.

Meridian Health (NJ) chooses CareAlign from Informatics Corporation of America to deliver an integrated clinical record to five hospitals.

MedFusion licenses LIS, molecular diagnostics, and AP software from Sunquest.

E-mail me.

Give me a brief history of PACS.

Well, for one, PACS finally works, so that’s a real good start. [laughs] Technology has finally caught up to the promises that were made over two decades ago about PAC systems allowing “any image any time, instantaneously,” although we’ve also become a lot more realistic on how we define instantaneously as well. Customers are also becoming much more educated, although the information they get from vendors is often biased towards a particular vendor’s PAC system. Unfortunately IT has very few resources for information, as most of this as been geared towards radiology.

Why is that?

Until a few years ago, radiology departments – heck, nearly all departments in the hospital for that matter — pretty much operated in a vacuum and made their own decisions. Now with the ultimate goal to have an EHR/HIE established by 2014, IT plays a much more important role in the decision-making process. Radiology still gets to call the shots on what works best for it, because like it or not, PACS still is a radiology-centric system, but IT needs to make sure it works well and plays together well with all the other clinical systems.

There aren’t a whole lot of IT specific resources available, but IT can get educated by going into the radiology community. I’ve had two series on Auntminnie.com titled “PACS Secrets” and “Building a Better PACS” that can be a good starting point. Start with the article titled “PACS and Marriage” and move on from there. It will no doubt bring you and Inga much closer together. [laughs]

Aunt Minnie’s PACS discussion forum is also an excellent resource. SIIM and the AHRA both have some incredible educational resources as well, although you usually have to be a member to access them. Many vendors and even HIMSS have begun virtual education using Webinars, though some are nothing but thinly veiled sales pitches — you have to look very closely at content. I also like Doctor Dalais’s blog as well – he is about a reverent as I am. [laughs]

What about RFPs?

RFPs are dramatically overrated. Now my fellow consultants might hate me for saying so, but a good technical spec that provides the vendor with a baseline to respond to send out to two vendors is about all you ever need. It need not be longer than six to ten pages tops and just needs to outline what you have, what you are looking for, and statements of a similar ilk.

I’ve seen RFPs that read like a New King James Version of the Bible and others that give so little information that they redefine worthless. One of my counterparts actually commented once: “Nothing like a meaty RFP to establish your creds” and I’m thinking, “For whom?” Shorter is always better with an RFP as long as all the information is there. Learn to KISS — Keep It Simple, Stupid.

Interestingly enough, vendors respond to 10-page and 100-page RFPs using the identical templated responses as well. That’s part of the problem we face today. Too many RFPs are being issued and questions are being answered without the right questions being asked orR answered, with the way the vendor answers more important that the question itself. A vendor also isn’t going to rewrite their DICOM conformance statement because you asked for something they can’t or don’t provide. But it is a nice try.

Is writing an RFP a mistake?

Not really, but it has also been my experience with any RFP — be it for a PACS, RIS, VNA, or whatever –  that what you see isn’t always what you get. Asking questions, even multiple choice questions, can still get you answers that don’t really address the client’s needs. A solid contract is much more important than the RFP.

Case in point: I recently had a client who did their own PACS RFP, a rather extensive, exhaustive document literally hundreds of pages long, with over 50 pages dedicated to the archive alone. The system they were buying was exceptionally large, addressed many sites, and cost several million dollars. I was engaged simply to do the contract review for them. When I added contract language relating to the archive being "vendor neutral" and containing nothing proprietary in it, the vendor balked.

We went back to the RFP response the client developed, and while the questions about the archive were properly asked, the way the vendor responded made Fred Astaire look like he had two left feet. Basically while they said they could do it that way they never said they did do it that way — and therein lies the issue — how you interpret a response? That is why I say for the most part, RFPs have very limited value. The contract is what you have to go to court with if need be, and is what needs to be made crystal clear.

Very few customers are also qualified by the vendors as to their readiness for PACS before the go into the RFP process as well. And who pays? The facility, by having to dedicate more internal resources on the project than they need to and also paying a consultant to go over mostly superfluous material. What you see is what you get- recognize that and you’ll save a bunch of time and money.

What if IT ran the RFP process?

It would only make it worse, in my opinion. IT understands IT and radiology understands radiology. This needs to be a team effort with everyone in the hospital working together.

The last project I got involved in where IT was in charge, I was ready to pull my hair out. The person overseeing the PACS evaluation process with IT in charge came to the facility from a Big Six consulting firm and had virtually no understanding of radiology. Process, on the other hand — my God, this person had process down pat. There was constant talk of putting information into this bucket and that silo. I felt like I was living in Hooterville and waiting for Lisa Douglas, Mr. Haney, Sam Drucker, and Arnold Ziffel (the pig) to show up.

We spent nearly a year going through a detailed highly scientific — by Big Six standards — statistical analysis of each of the four vendors being looked at closely, only to have the statistical difference be <0.02% between the top three vendors. I think four points separated them all out of 800+ possible points. But, by God, we did it scientifically. The funny thing was I told the radiology administrator this would happen before we even started, but alas, her hands were tied. This facility wasted over $100K in internal resources internally and nearly a year’s time getting back to their initial starting point.

So, no, IT should not be in charge. Again, this needs to be a team venture.

What are IT’s biggest mistakes relative to PACS?

Where do I start? Probably treating PACS the same way their do every other clinical system, although obviously there is some overlap. Radiologists need to feel comfortable with the workstation operation, so regardless of what IT thinks about the system, if the radiologists don’t like it the way the workstation operates or if they feel it will slow them down, they just won’t use it. And if they don’t use, it then that is just throwing away good money after bad. While no one part of the team should have over 50% vote, in the final decision-making process the system must fit the radiologists so unless you plan on changing radiology groups soon their vote means a lot.

I’ve seen a lot of mistakes made over the years, but thankfully, most were recoverable. One of my favorites was a CIO who insisted on entering into contract negotiations with two vendors at once. I said, “That’s not how it works in PACS” but we butted heads here big time. His thought process was that inviting both to the church it would make each work harder to be competitive.

In the vast majority of cases. this backfires big time. This wasn’t like The Bachelor where Jake had to choose between two of 16 beauties — will it be Vienna or Tenley? — to put a ring on their finger. This CIO wanted to take both to the altar in their gowns, bridal parties and families in tow, with the preacher looking at the groom asking, “Which of these women do you take to be your lawfully wedded wife?” Everyone will be shedding tears, but not everyone tears of joy. And I’ll be sitting there thinking, “Now what do I do now with this toaster and blender I got them as gifts?” That is such a waste of everyone’s time and money, but I, alas, didn’t call the shots.

What did you mean by customers being qualified?

An RFP or tech spec should never be put out on the street unless adequate monies have been both approved for the project and are available for release and a project plan has been developed. Most sites think nothing about putting something on the street as a feeler to test the waters on PACS costs. Unfortunately they either don’t realize (or don’t care) that responding to an RFP costs the vendors anywhere from $4,000-$10,000 per RFP in manpower costs alone. Following it up with on-site visits, customer site visits, etc. adds another $15-20,000 over the project term. So, you’re really looking at $20-30,000 for each RFP that is responded to. If a company has an outstanding track record, they stand to close maybe one out of three RFPs they respond to, so the first $60,000-90,000 of any PACS sales should be considered make-up revenue.

Maybe that explains why $15,000 workstations cost $85,000.

That’s a large part of it, but research and development and software application costs add to that bottom line cost as well. Vendors also need to make a slight margin on the sale too, but that’s all negotiable. [laughs]

Consultants don’t come cheap either, right?

The oats that have been through the horse come somewhat cheaper. [laughs]

There is a plethora of consultants out there today, many whose ink is still wet on the business cards they got at Office Max when they got laid off and figure, “If he can be a consultant, then by damn I can too.” Unfortunately, even the societies that deal with radiology and PACS that are supposed to look out for you don’t. All you need to do to be listed on most of these sites is join their organization or pay a monthly fee to be listed. Now there are disclaimers listed, but who really reads them?

Truth be known, there are less than a dozen of us who do PACS consulting on a full-time basis, not as a sideline business when we’re not out looking for a full-time job with a steady salary. But no one knows who they really are, so we all get a bad name when someone screws up. It’s the same way with IT consulting as well. That’s why I always talk with a client at length about their needs and the project before I even consider an engagement.

Three out of five potential clients who call me get their questions answered within the first hour of a phone call. We do that for free. One out of five potential clients I find I just can’t work with. They want to show me their watch to tell them the time. The remaining one out of five I end up engaging with in a project.

Sounds hard to make money turning away 80% of your prospects.

What we lack in financial input, we make up in volume. Eight customers a day and I can almost pay the phone bill! [laughs]

More than 90% of our end-user business is doing our quick and simple PACS Sanity Check. Most places are pretty sure what vendor they want or at least have it narrowed down to the two they want, so we look at the proposals a client has from the vendors, make sure they are indeed apples to apples comparisons and, if not make, sure they are by having them re-quoted, discuss the pros and cons of each proposal with the client, and then, once the client selects their vendor of choice, we help them with contract negotiations since the contract is unquestionably the most important part of any deal. No muss, no fuss, two weeks and $5K or less and they and we are both done. While all PACS projects are different, most of the things you do are the same and become templated, so why charge people out the wazoo to reinvent the wheel?

Because you can?

Hey now — you calling me a vendor? [laughs]

You’ve worked on a ton of PACS projects. How did they differ?

That’s like asking me how many women I dated in my youth that were different or what makes Inga so special. Why, everything about her, of course. [laughs] The answer, obviously, is all women are different, and while each has their own unique advantages and benefits, each also shares many common traits. The same holds true for PACS. All are different, but not necessarily from a system design standpoint. There are maybe a dozen or so templated system designs that vendors start with and then customize accordingly.

The politics or each site varies widely and is probably the most important issue to address. Frankly, designing a PAC system is like choosing from a Chinese menu — workstations from column A, servers column B, archives column C, etc. Put them together and you have the system design. Making it work is another story, although if you talk to vendors and customers alike, it all works together like magic, just like DICOM is magic and HL-7 is magic. Poof, it all works. Plug and pray, I mean plug and play. [laughs]

The concept of standards is advanced, but the reality is so far from the truth it’s not even funny. DICOM is the most non-standard standard ever developed, so much so that every vendor has to offer their own conformance statement  — this is what we agree to, this is what we don’t. Two vendors can consider themselves as DICOM-compliant, but if they don’t share conformance statements, it won’t work.

IHE, Integrating the Healthcare Environment, is the same way. It’s a great concept, but the execution leaves much to be desired from an ease of implementation standpoint. That is why very few vendors have adopted IHE. Ask around and you’ll see. That is also why VNAs, Vendor Neutral Archives, are growing in leaps and bounds.

It all seems to work at RSNA.

You also saw perfect images at RSNA and software that won’t be available until 2012 at the earliest. Anyone who makes the trek to Chicago knows RSNA is an acronym for Real System Not Available. Seeing it working and knowing what it took to make it work are two entirely different concepts. Yes, it all did work by 10 a.m. Sunday, but rest assured, it wasn’t all plug and play. But we are getting much better.

So PACS implementation schedules aren’t real?

I never said that. Just that implementation schedules are an approximation of when you can expect it to be in, not an etched-in-stone date and time. There is so much that can go wrong that you never expect.

I recall one engagement we did where we lost a month for one 2” hole in a wall. The problem was that none of us knew it was a fire wall. By the time we got the 16 different approvals needed to drill this silly hole, we lost 30 days. There are all sorts of challenges like that. Radiology Information System integrations also have their own set of challenges, requiring the RIS vendor, PACS vendor, and IT department all to be on the same page timetable wise. That almost never happens.

But it could.

When the moon aligns with Jupiter and men finally understand women, then, yes, it can happen, but you stand a better chance of winning the Lotto or Powerball than that happening anytime soon.

Managing expectations is a huge part of PACS. Unfortunately it’s also one of the biggest areas of failure that the industry has nourished.

PACS has been promoted as a cure-all for everything under the sun, but knowing what PACS can and can’t do is paramount to gaining wide-scale, facility-wide acceptance of PACS. Unfortunately there is so much misinformation about PACS that people have a hard time believing the facts.

I go crazy when people say PACS can reduce FTEs. Technically the FTE headcount may be reduced in the film and file room after a period of time, but the overall FTE budget ostensibly will remain the same. If the money coming out of your pocket isn’t different, then what’s the real benefit? The same holds true when people talk about time savings with computed and digital radiography, CR and DR, over analog film. Yes, the imaging process can be reduced by 40-60% over conventional film, but will you see a 40-60% reduction in FTEs or rooms required? No.

In generating a typical 10-12 minute chest film, you save the time associated with film processing and jacket merging, about two minutes on average. All the other processes — getting the patient in the room, positioning them, and even imaging them — remain the same whether analog, CR and DR. Ever been with a geriatric patient? It takes longer to get them in the room and positioned that it does generating the film, and that’s after telling him three times, “Turn to the left Mr. Jones — no, your other left” and then have him ask why he has to have this %&^*% x-ray when his #%^#&^ doctor doesn’t know what the ^&*(%*$ he’s talking about. In my next life I’m going to be a gerontologist. [laughs]

You’re on a roll.

There is massive confusion about CR vs. DR as well, and “pure” digital vs. analog vs. digital conversion. In a properly designed department, the difference between using DR and CR is about 30 seconds per procedure on a bad day. From a price standpoint, however, the differences are huge.

A single, moderate throughput CR reader costing $120K complete can be shared between two rooms, while DR is dedicated to a single room at a current cost of over $300K. $60K cost vs. $300K cost is a no brainer. Don’t have PACS? Even better — stick with film because your equipment cost is probably already fully amortized and we’re not Japan where they pay a premium for images generated digitally. The reimbursement for a general radiographic exam generated in analog or digital form, CR or DR, is exactly the same here in the US and it takes a whole lot of cases at $1.50 a case in film costs to justify either imaging modality on film costs alone.

I hear my detractors now — blasphemy! Burn him at the stake! What about tech costs? My answer: what about them? If you do two procedures per day or 30 procedures per day, one technologist should be able to handle it all. Volume increases? General radiographic procedures are generally declining in most facilities at a rate of 2-5% per year, with CTs taking their place. Even where there is growth, it’s in the low single digits. So why do you even need CR or DR?

There are a variety of arguments for CR in a PACS environment, but for DR to succeed as well, the price point needs to be comparable to CR or at the very most no more than 15-20% higher. Either that or HCFA needs to start reimbursing for digital radiographic procedures over analog, similar to what they are doing now with digital mammography.

You done yet?

Just call me Howard Beale. “I’m mad as hell and I’m not gonna take it any more!” [laughs] Ok, I’m done — for now.

What do you think are the biggest obstacles to future PACs growth?

Probably getting buy-in from all levels in a hospital. PACS is such a complex sale, yet more than 90% of the sales made today aren’t made based on what is the best technical solution for a facility, but based on political decisions. The squeaky wheel syndrome, so to speak.

Such as?

Ah, yes. Another thing no one wants to ever talk about in public, but we all know how politically correct you and I both are, so do I care? [laughs] We can spend days, weeks, months, or years doing technical assessments on a vendor, but if the chairman of the department doesn’t like the vendor you’ve selected, rest assured, it’s not going in. The same can be said for any number of key players on the “team” whose vote equals 51%. I’ve lost many a night’s sleep over situations like this one — not.

If that is the case, why even bother with an RFP?

I’ve asked that same question of my clients and was chewed out recently for asking if putting an RFP out on the streets was a CYA move for them. In hindsight, maybe I shouldn’t have e-mailed it, but … if the decision is made for a vendor already, let’s do a technical spec, send it out to the vendor of choice, and save a bunch of time and effort on our part, not to mention vendor’s time.

People will do whatever it takes to save their jobs.

Thank you for the reminder why I’ve been on my own for the past 25 years.

Are you this blunt with clients?

Clients pay me to provide them with informed, objective information and to get them the answers they need so they can make informed objective decisions. If they elect to make a decision that is politically motivated, that is their choice. I still get paid the same amount.

All I ask them is to give me the opportunity to protect them with a fairly tight contract so that when their choice fails, they have some recourse other than pointing to the consultant. Kevin Costner took the bullet for Whitney Houston in The Bodyguard. I’m not paid that much, nor are most of my clients as hot as Whitney either. [laughs] PACSMan singing: “And eye e eye e eye will always love you.”.

Isn’t it your job is to help them make the right choice?

If you want “the right choice,” call AT&T — I think they own the trademark on those words, although years ago back in 1986 one of my last “real” jobs, where I knew I’d have a paycheck from week to week, I tried to sell an AT&T PACS product called CommView that was anything but the right choice. My job and that of my counterparts is to get them information so they can make the final choice, not I. No consultant worth his or her weight in salt will make a vendor or product choice for the client.

Even if that choice is glaringly wrong?

Even if, in my not-so-humble opinion, it’s a wrong choice. There are no wrong decisions, just decisions whose outcomes you wish might have been different. I’ve dated enough women to know that. [laughs] The only wrong decision in PACS is not making any decision at all and playing catch up for the rest of your life.

I let my sons make most of their own decisions all the time as long as their lives are not in danger. It’s how they learn. Many are right. A few had outcomes that we wish had been different. We then discuss it afterwards what they could have or should have done it differently and what the outcome might have been had we done it differently.

Unfortunately, if you don’t go with what the department chairman wants or someone in administration wants, what was ostensibly the right decision will turn out as the “wrong” decision and can be just as devastating career-wise as blowing $2 million of the hospital’s money on a dead-end PAC system. End users need to take a combination of the Taco Bell and Nike approach — “Think outside the box” and then “Just do it.”[laughs]

Is there a  best vendor?

I wish there was a single vendor who was the best solution for everyone. I’d be working for them now. I wouldn’t last long in a structured environment, but it might be fun to try again.

Most vendors offer fairly solid solutions to customers’ needs. Finding sales reps who can properly articulate what those solutions specific to the client is another story, however. Vendor A’s products may “bring good things to light” but if they can’t articulate how their product meets their needs better than vendor B, vendor B will no doubt get the sale, provided of course that vendor B also has the political support behind them as well. There are no bad vendors or products — just lousy product specialists and sales reps and customers who don’t listen.

And politically correct consultants.

As Curly in the Three Stooges would say, “Why sointenly!!” I’ve had some great discussions with some on the men in my men’s group at church on how Jesus was both politically correct and politically incorrect depending on the situations He was in. I like to think I’m the same way. [laughs]

In this business, you have to believe in God because you’re always calling out His name in one way or another, thanking Him when things go right and invoking His name in so many different ways when things don’t. [laughs]Would you believe I run a sports ministry in my spare time for the past ten years now? If I were to hit the lottery, I’d probably be a stay at home dad with my sons, run the sports ministry full time, and do PACS consulting as a sideline.

From ZenSocrates: “Re: McKesson. Mike Myers, the McKesson executive responsible for the Clinical Documentation/Physician Order Entry product and a true pioneer of HIS, has announced his retirement for this July. The concern is that McKesson could not name a successor at the time of the announcement. As a customer, this concerns me greatly!!” Unverified.

From MckHappy: “Re: McKesson. McKesson and Jeremy Chandler are finally implementing the changes they had promised within the Horizon team. Mike Myers has announced his retirement effective July 1. Jim Nemecek is no longer VP over ambulatory. Cem Tanyel from Unisys will be named as the new head of development. Gerry McCarthy will add ambulatory to the physician solution line. The internal release focused on integration and eliminating the politics — errr, I mean development silos. Rumor going around is that portal and ambulatory development will be centralized in Boulder. The ARRA-certified release was shipped on-time to the pilot site last week.” Unverified, but if true, I wasn’t the only one observing the development silos and lack of staff stability.

From William Tell: “Re: HIMSS. I guess from what Lieber says, HIMSS is all things to all people.” An article quotes Steve Lieber as wanting to push into life sciences and payer markets, medical banking, PHRs, and workforce. I can only imagine the confusion as everybody tries to sell something to everybody else at the conferences. And in related world domination news, HIMSS Analytics is now working in Europe.

From Dickie Smothers: “Re: HIPAA. Check out 42 USC 1320d-6, which defines ‘A person who knowingly and in violation of this part … obtains individually identifiable health information relating to an individual …’ The term “person” is defined (in the main part of 1320) as an individual, a trust or estate, a partnership, or a corporation. I’ve read that because the above section applies only for a ‘violation of this part’, it only applies to those otherwise covered by HIPAA (since anyone else couldn’t ‘violate’ the provision). However, the HITECH changes in Section 13409 of the Act seem to broaden the applicability. Don’t think it was effective, however, last Thanksgiving. Nevertheless, a bright federal prosecutor could make a conspiracy charge or bribery charge stick if he/she wanted to. Just my opinion.” This relates to the story I mentioned in which a gossip site supposedly made 6,000 calls to the hospital Tiger Woods was in, trying to wangle his medical records from anyone willing to spill the beans for cash.

From Jack Flash: “Re: athenahealth. This is a very entertaining and insightful interview of a slightly buzzed Jonathan Bush at the HIStalk party. Greatest quote of the interview, on being asked about Healthcare Policy — ‘I love Obama’s package. He looks great.’” Definitely a fun watch.

From Radiology Ralph: “Re: DR systems debut of Unity CVIS. You mean DR Systems does something other than sue other radiology vendors for its ‘416 patent infringement? Go ‘Dominator!’” Just in case anyone doesn’t know the back story, DR Systems filed a slew of lawsuits in 2006 claiming patent infringement of a PACS reading station feature: eRad, NovaRad, Emageon, Fuji, GE, Philips, Siemens, Kodak, and others.

From Stifler’s Mom: “Re: Medicare. Good article on that 21% Medicare cut that happened, then got fixed, while we were partying in Atlanta. I don’t know how many doctors wandering the exhibits halls were leaving their wallets in their rooms, but I would have. Even with the ‘fix,’ if I were a doc, I’d be too nervous and reluctant to be spending any big bucks. No one at HIMSS was talking about a 21% pay cut in their already low Medicare reimbursement!”

From Meaningful Abuse: “Re: HIMSS attendance. If only 30% (~8,357) of the registrants came from healthcare provider setting, where did the other 70% (~19,500) come from? Isn’t this a healthcare setting information technology show? Only 11%(!) of the registrants were CIO/CTOs? Was that 11% of the healthcare provider attendees or 11% of the total registrants? Same question about CEOs… So, who do the vendors want to talk with? C-level decision-makers, not mid-level IT managers or staff. No wonder HIMSS vendors are chafed about the money they have to spend for their chunk o’ concrete.”

Several readers asked about the lyrics to Dr. HITECH’s Meaningful Yoose Rap. They are here and they are excellent.

Now that we’re over the HIMSS hump, I’m interested in doing some new interviews (with provider-siders especially encouraged). Or, your guest articles are welcome (more of those from providers would be especially welcome). I’m finally to the point that I can get to them.

The HIMSS EHR Association weighs in on meaningful use and incentives. That response wasn’t detailed, but it apparently urged simplification, reduced requirements for data collection, and allowing only one document standard.  

Not to be outdone, Markle Foundation has its say on the same topic. Some of their ideas: (a) set explicit health goals; (b) make the quality measures list more focused; (c) add new measures for priority health goals; (d) get rid of the all-or-none approach to incentives to encourage improvement without requiring hitting 100% of the proposed requirements; (e) streamline some of the calculation-heavy functional measures; (f) make electronic reporting requirements simpler; (g) focus on easy measures that improve patient engagement; (h) clarify that a secure download of patient information is acceptable; (h) get feedback into doctors’ hands quicker; and (i) clarify how hospital-based physicians can participate. I think they did a great job with good consensus and I would expect HHS to seriously consider their recommendations since they are less vendor- and product-centric and focus more on patients and providers. Kudos to them.

VA CIO Roger Baker lays it on the line for his IT staff: he’s happy to kill projects that miss deadlines or run into snags. That’s semi-good news for taxpayers, but the shining star of that policy cost a bundle, a failed patient scheduling application that cost $150 million.

In the UK, NHS’s medical director and NPfIT defender resigns his additional role as a director of an NHS software supplier after an anonymous blog commenter brings up the perception of a conflict of interest.

Jobs: EHR Business Systems Analyst (WA), Clinical Exec Physician – Sales Support (GA), Epic Revenue Cycle Manager (FL), Client Training and Support Specialist (MA). Some pretty good jobs are up on Healthcare IT Jobs, so take a look.

Akron General Health System signs an $11 million clinical systems upgrade contract with McKesson, including CPOE and Practice Partner.

A survey finds that 12% of employees knowingly violate IT department policies “in order to get their work done.” The survey appears to encourage outrage at irresponsible users, but IT policies that impede individual productivity in the never-ending quest for risk reduction should probably share some blame.

McGill University Health Centre launches its PHR, Unani.ca.

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HERtalk by Inga

After placing its EHR project on hold for a year, Sutter Health announces plans to spend $400 million and accelerate its Epic implementation over the next five years. Sutter intends to take five of its affiliated hospitals live on its Epic EHR in 2011. The health system has already rolled out EHR to the majority of its physician offices, as well as its Mills-Peninsula Health Services facility.

Preliminary registration numbers from HIMSS10 indicate attendance was up across the board. Professional registration grew 9% over 2009, though the total registration number was only 2% higher than last year.

The deadline to file comments on the latest meaningful use and certification criteria is now past, but not before multiple organizations filed last minute comments. CHIME, MGMA, CCHIT, and the AMA were just some of the many groups to submit public comments before the March 15th deadline.

CCHIT, by the way, says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on its Web site also indicates that CCHIT is “confident” about its prospects for becoming accredited. Meanwhile, Drummond Group reaffirms its desire to be certified as a authorized testing and certification body and is making internal preparations in order to be ready for EHR testing later this year.

Columbia Basin Hospital (WA) agrees to outsource its IT support to Phoenix Health Systems and implement Phoenix’s Total IT Solution service line. The offering includes the implementation of Medsphere’s OpenVista EHR.

Meridian Health (NJ) selects ICA’s CareAlign solution to connect its five hospitals and its affiliated healthcare companies.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers to $54.4 million. For the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

UMass Memorial Health Care selects Picis CareSuite for its five hospitals.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Holland Hospital (MI) plans to implement the InterSystems Ensemble platform as its enterprise integration engine. The hospital plans to connect multiple systems across the facility and integrate its EMR with affiliated physician groups.

St. Joseph Medical Center (TX) implements Webmedx’s dictation and transcription platform, apparently within three days of a crash of its legacy systems.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

HIT consulting firm maxIT and the the medical device experts at Anson Group combine forces. The companies sign a partnership agreement aimed at providing vendors and providers expertise in the implementation of regulated medical devices connected to EMRs. Sounds like great timing, given the recent attention on EMRs and their possible regulation by the FDA.

CareTech Solutions signs a five-year infrastructure outsourcing agreement with Sibley Memorial Hospital (DC).

BCBS of Minnesota makes a bit of a mistake, accidentally publishing a customer’s personal medical information it a handbook for 95,000 members. The woman is now filing suit for the breach of privacy and violation of the Minnesota Health Records Act.  Her attorney calls it “one of the most blatant and egregious violations of medical privacy” that she’s ever heard of.

E-mail a limerick to Inga.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! Cocktail hour in the exhibit hall is just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

From The PACS Designer: “Re: HealthVault. Microsoft’s HealthVault application is now ready so that we can create our own PHR along with one for other family members. TPD has posted previously about Microsoft’s Silverlight application which is now part of HealthVault. Also within HealthVault is their Sharepoint application. If you have a Windows Live ID or OpenID you can use either ID to sign up.”

My FDA regulation poll drew quite a few responses, most of which expressed a belief that FDA will indeed step in to regulate healthcare IT in some form. New poll to your right: when a vendor has good news to announce in the weeks before HIMSS, should they announce it immediately, hold it until HIMSS week, or announce afterward? Most vendors hold their news until Monday of the conference, which I think is nuts, but you decide.

Speaking of FDA, it has set up a network of 350 hospitals and asked them to report problems with systems such as CPOE, EHRs, pharmacy systems, PACS, and others under its MedSun medical device safety network, according to a Huffington Post Investigative Fund article.

Inga already referenced Dr. HITECH’s Meaningful Yoose Rap, world premiered at the HIStalk reception at HIMSS, but I’ll embed the video again just in case you missed it. In case you didn’t notice, this was a flawless live performance by Ross Martin, MD, best known until now for his amazing Interoperetta.

And speaking of Inga, she did a marvelous job while I was R&Ring, don’t you think? I never thought I would find someone who could step right in, but we’ve been working together for three years now and she has blossomed wonderfully. I will apologize in advance for the likelihood that I will repeat something she has already mentioned since I’ve been out of touch for a week. Stats-wise, February barely missed setting an HIStalk record even though it was a short month, with 88,057 visits, 120,075 page views, and 5,346 e-mail subscribers. March is trending up. You contributed to those stats, so thanks for that.

As for me, I am rarin’ to go, batteries fully recharged and ecstatic to be back. And listening: Apples in Stereo, Denver-based power pop.

Inga mentioned that I was elated that former HBOC chair Charlie McCall is headed off to prison, which is true. Finally I can quit gritting my teeth when inserting “alleged” in in describing the massive fraud with which his train wreck of a company blighted the industry (although McKesson gets an assist for corporate stupidity in buying him out). It now looks like the decks have been cleared for McKesson to sue him for restitution, which would win them points in my book.

Community Health Solutions of America signs up for MEDai’s Risk Navigator, a predictive modeling suite that identifies high risk patients and tools to manage them.

InterSystems acquires its Italian healthcare implementation partner Prosa.

Former Shands CIO Bill Montgomery is named CIO of Hospital Sisters Health System.

Interesting: when Tiger Woods ended up in a Central Florida hospital, tabloid site TMZ made over 6,000 calls to the hospital within a few hours, dialing every possible number trying to find someone who would provide information. It even offered bribes to hourly workers hoping to get his medical records, the hospital said. It worked — the hospital fired several employees who accessed his records. I’m pretty sure nobody’s HIPAA policies could withstand that kind of attack. Nor am I sure why trying to get someone to violate HIPAA isn’t itself a punishable offense.

I don’t know where Weird News Andy finds this stuff: a Dutch nurses’ union launches a national campaign to remind the citizenry that its members do not routinely provide sexual services to patients. The “I Draw the Line Here” campaign was created after a female nurse observed co-workers offering gratification to a disabled male patient, who then tried to dismiss her because she would not do the same.

CTIA Wireless 2010, in Las Vegas next week, is running an Everywhere Healthcare 2010 track with some good sessions.

Hopefully everybody’s Daylight Saving Time switch went OK.

The Nashville Medical Trade Center, hoping to become a center for healthcare industry events, tried to use the HIMSS conference as a launching pad to get business tenants, but doesn’t seem to have had much immediate success according to this article.

DR Systems will debut its Unity cardiovascular information system this week at ACC.

The unSummit on point-of-care bar coding will be May 5-7 in Atlanta. 

Deborah Peel, MD is the subject of the cover story in Managed Healthcare Executive called Locking down privacy: where do we draw the line? “All 55,000 pharmacies in the United States are data-mined daily, and our identifiable prescription records have been sold for over 10 years. The theft of prescription information is why Congress was persuaded to include the ban on the sale of protected health information in the HITECH bill. I think that the industry is in denial because there is a huge, essentially unknown data-mining industry for health information."

The guys from the Access barbeque team sent over this picture, which has convinced me they should set up the smoker in the parking lot of the Orange County Convention Center at next year’s HIMSS conference. Give a prospect a plate of pulled pork and a beer and he will listed to what you have to say.

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