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June 12, 2007 News 3 Comments

From Alias: “Re: comments. To read all the comments, you have to go to both sites (HIStalk and HIStalk2). Hmmm … I would not think that was intentional.” It was, actually, but as part of a bigger plan. I can’t just delete the original HIStalk and its four years of content and comments (they are vastly different platforms.) Also, I have issues to work out, like the e-mail updates. It’s complicated to explain, but mostly invisible to everyone but me. I’ve already changed www.histalk.com to take you to the new site. Continue to read whichever version you like and stay tuned for more improvements.

In fact: take the poll of which version you’ll read going forward. It’s to your right (only on the original HIStalk since I don’t have a polling application for HIStalk2 yet).

Also part of the plan: the HIStalk Discussion Forum. I’m still setting it up, but feel free to register and start reading and posting. Why not start by discussing today’s HIStalk? Inga and I will be frequenting there, so please join us. If you don’t wander over, Inga and I will just whisper conspiratorially among ourselves.

Father Pablo Martinez: “Re: data breach. Everyone starts to try and identify how the breach happened, who let it happen, what was breached, what are required to tell the state, the feds, the customers, etc. When NH-based Concord Hospital recently had a breach, it was their data but not their systems, and it brings up an interesting point – how do you guard someone else’s systems when they have your data? In the corporate world, you send out a small army auditors to periodically to review their business and accounting practices for any irregularities. Do hospitals need to do that? Their problem was with billing company Verus. Other hospitals reporting a Verus-related breach: Stevens Hospital and Kennewick General. The company turned off a firewall for maintenance.”

From Buck Ripley: “Re: Clarian. Any word on what system will be used as a replacement for Cerner’s Care Doc?” The hospital’s announcement said they were going back to paper while they wait for Millennium improvements. I can’t imagine running a standalone application, so that makes sense. I also wonder how jaded they are toward Cerner now. Probably not enough to replace everything, but I bet they’ve muttered about it. I haven’t heard if they have performance penalties in their contract. If not, they should have known better.

From Rose: “Re: GE. he latest PAG CIO meeting in Seattle had attendees feeling better about GE and the accquition of IDX Carecast than a long time. They have added well over 100 additional resources to jump start as well as build some basic development process and testing methodologies long needed for the Carecast product. Doing some creative things, but can they execute the needed catch up in time turn it around? The GE Energy guy brought in for the turnaround talks a good game and looks like he’s making the needed cultural changes. But, still many are looking around.”

Is Newt Gingrich’s Center for Health Transformation a free-thinking policy advocate, or simply a vehicle from which he lobbies publicly for his many high-paying sponsors? Says one open-government advocate: “It’s a phony think tank. He’s nothing but a corporate shill and everything he says about health care should be regarded with complete skepticism.” Of course, I’ve said pretty much the same thing here, despite my highly conservative views. Many positions for which he advocates directly benefit his sponsors, among them drug, medical equipment, and insurance companies. He left Congress in at least partial shame for similar activities. “He admitted he had failed to seek proper legal advice on using tax-exempt projects to advance his political goals and that inaccurate statements ‘in my name and over my signature’ had been submitted to the House ethics committee. He was reprimanded by the full House and assessed a $300,000 penalty.” HIT members of Newt’s for-profit: GE Healthcare, Siemens, Allscripts, Misys Center for Community Health Leadership, CHIME, Emageon, MedAssets, Quovadx, and others.

I see that 91% of you wouldn’t invest your retirement money in David Brailer’s equity fund, according to my reader poll.

Wanted: interview subjects (CIOs are especially encouraged.) Also, anyone willing to write regularly here along with Inga and me: CIOs, maybe a salesperson, a physician or nurse informatics person, or anyone with industry knowledge and easy, skillful writing. Where else could you get a ready-made audience for your industry expertise? E-mail me. It’s harder than it looks, but fun.

An interesting profile on NHS’s Richard Granger, described as “Short, stocky and pugnacious … focused but prickly.” He’s worried about iSoft, tired of criticism of Connecting for Health, and insistent that the project’s vendors aren’t enriching themselves.

Bizarre lawsuit: a cardiac patient’s angiograms are burned to CD, but mislabeled with another patient’s name before being delivered to the OR. The surgeon performs a triple bypass using the wrong images. The patient finds out afterward, gets mad, sues the hospital, gets a $140,000 settlement, and passes on the surgeon’s offer of $85,000 and takes him to court. The surgeon says he fixed her problem, but a cardiologist found she had 90% blockage in one artery and stented it. If you sell systems that are better than CD sneakernet, you might want to give the hospital a call.

Manual Lowenhaupt is named CEO of RFID vendor Radianse. MIT degree and Harvard MD, although long stints at Accenture (“thought leader”), Capgemini, and Deloitte take off some of that luster in my admittedly biased book.

Fun story: a programmer who wrote the operating system for the first portable defibrillator in the 1980s is saved by one last year when he collapses during a basketball game. The article brings up an interesting point: laypeople, even children, can save lives with automatic defibrillators, but in some parts of the country, even ambulances don’t carry them. That’s one of those translational research issues that plague US healthcare, I guess – convincing people to use stuff known to work.

DoD’s AHLTA EMR system (formerly CHCS II) is running in 138 military treatment facilities.

Henry Schein tries to expand its medical software line with an offer for Australia’s Software of Excellence International, which sells dental systems. I used to do business with Schein with all they had was a crummy paper catalog of medical supplies and drugs. Guess they’ve done well since the article mentions their revenue of $5 billion a year.

The Methodist Hospital, University of Houston, and Cornell’s medical school form the Institute for Biomedical Imaging Science, which will train scientists on biomedical imaging such as MRI, CAT, and nanotechnology.

Noteworthy Medical Systems will integrate DrFirst’s e-prescribing technology into its NoteworthyEHR.

It appears that the Patent Office has made a ruling on the patent suit involving VISICU. No official word yet. Could be good news for them, but you never know.

QuadraMed grants piles of shares as “additional compensation” to executives David Piazza, Jim Klein, Steve Russell, and Jim Milligan. I’m not clear on purchase vs. exercise price, but it sounds like free money for them after vesting. Shares are at $3.15, up exactly 50% from one year ago.

HIMSS and AMDIS (Association of Medical Directors of Information Systems) form some kind of alliance (that usually means HIMSS bought you or is about to).

Connecticut struggles to get accurate reports of Lyme Disease as its implementation of public health and biosurveillance information systems drags on. The problem: two big commercial labs have obsolete software.

Rumor is that First Consulting Group is going after some former employees who are starting their own outfit. Details, anyone?

News, rumors, pithy asides: e-mail me, or use the confidential Rumor Report form to your right.

Inga’s Update

So, I shared with Mr. HIStalk some personal opinions I had about the relaxation of Stark Laws, etc. Somehow that discussion turned into a request to share some of my “expert” opinions on the subject with readers. So, here are some musings …

When I first heard that not-for-profit hospitals could purchase EMR systems for physicians without risking their tax-exempt status, I thought, “Wow, great news for EMR vendors!” After a few weeks of contemplation, I have concluded there are a few ramifications that could muddy the waters a bit for vendors and perhaps cause frustration for many. For example:

n the short term, the relaxation of Stark laws may actually lead to a slowdown in EMR sales, because:

  • Hospitals are not known to move fast. It will likely take months for many hospitals to decide what type of incentive they can/want to offer and all the associated guidelines.
  • Many practices will not move forward on an EMR decision if they expecting to receive some sort of financial assistance from hospitals.
  • In more urban areas with multiple and competing hospitals, there may be more wide-spread slow downs as physicians wait to see which facility can offer the best incentives.
  • Some hospitals may decide that rather than allowing each physician select his own EMR, their incentives will include recommending and/or supplying the EMR solutions … back to the first bullet point that hospitals are not known to act fast.

If hospitals are selecting the EMR solution, look for the “name-brand” players, especially those that already have a footprint in the hospital space, to win more business than they might have if the practices were making their own selections. Because:

  • Hospitals are more conservative. They will not want to risk upsetting doctors across their community by promoting a small niche player that may not have long-term financial stability and/or the resources to continually advance the product offerings.
  • Hospitals are more likely to align with an existing vendor. If a hospital has Epic, Cerner, etc., then they have already formed an opinion of that organization and their products and support. They will likely hear their vendor stress that integration between the hospital and ambulatory products is easier with one vendor rather than multiple. Even if they are not totally happy with their hospital products, sometimes the known devil is better than the unknown one.

The EMR vendors must have an interoperability strategy, because:

  • Hospitals want to build ties to their physicians and want those ties to be hard to live without. They want physicians to believe their practice won’t run as efficiently without an interface to the hospital system. Thus, few hospitals will commit to an EMR that does not have a proven track record sharing data.
  • RHIOs are a hot topic. A physician’s office may be a huge proponent of a RHIO, but will have a limited voice and resources to push for a RHIO creation. On the other hand, hospitals can be key drivers in this movement. Traditional ambulatory care EMR vendors may need modify their message when working with hospitals to ensure they can address how their solution fits into the bigger RHIO picture. Having an alignment with at least one RHIO software vendors can’t hurt either.

Look for shrinking profit margins from EMR vendors. Because:

  • Many hospitals have been and will continue to negotiate big bulk purchases of EMR licenses at a discounted price.
  • Traditionally, EMR vendors have provided all the training and on-going software support for the physician offices. Look for hospitals to increase staffing on help desks and with training resources, since they are now able to provide this “benefit” to physicians. Training and on-going software support may not necessarily be profitable, but they can affect over all revenues.

All this being said … is the relaxation of the Stark laws a good thing for EMR vendors? As long as the interested parties understand that the floodgates for EMR sales and adoption are now suddenly open, then, I still say, “Yes, it is a great thing!”

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Currently there are "3 comments" on this Article:

  1. Must take into account the recent IRS ruling on hospital-provided EMR’s. As I understand it, the ruling

    1) forces outside practices which accept the systems to take the same system that the hospital already uses (or, at least, a system provided by the same vendor). So, if a hospital used Epic, the system provided to the outside practices would most likely also be Epic. That’s why this is advantageous to the hospital systems vendors and it’s one reason why we might see rapid consolidation of ambulatory EMR vendors.

    The flip side is that the doctors would have to accept a system that they might not like. Most of hospital HCIT vendors have less than optimal ambulatory offerings.

    2) So, what you say, it’s almost FREE to the outside practice. Well, there’s a catch, which is that the outside practice would HAVE TO SHARE ITS DATA with the hospital. Since these hospitals make good money selling the data, there are privacy concerns. Also, and probably more important, is the fact that hospitals could now comb through outside physician data. This could be used AGAINST the physician at some point (think lawsuits, reimbursement or P4P schemes, etc…).

    So, the question for the outside practice is: is it worth it to get an almost free but poor ambulatory EMR system, but to create privacy concerns for your patients, and jeopardize the future of your practice as your patient data becomes semi-public information? Somehow, I doubt it.

    OTOH: what would you do if you were a big hospital vendor and you saw this tremendous opportunity slipping away. I might partner with or acquire the best ambulatory HCIT system(s) I could find and integrate the same with my hospital offerings.

    So, unless the IRS ruling is changed or further clarified, look for bunches of new partnerships and/or acquisitions.

  2. With respect to original HISTalk and HISTalk2, the idea that there are two places for comments is less than ideal. Why not shut down original HISTalk (keep for archives only) and move the mailing list and link to HISTalk2? Everytime you add a new post to HISTalk 2, you could add a new post to HisTalk1 with just the link to HISTalk2. Any comments I add to a posting will be less-read because most will not read on both websites — I like to know my comments are read :-).

  3. Fan, you are reading ahead! That’s the plan, assuming the reader poll trend continues (showing a vast preference for HIStalk2’s format.) I just need to set up an e-mail alerting system. Actually, I could easily keep populating HIStalk with no work at all since it can read RSS feeds, i.e. it can be an automatically populating mirror of the new HIStalk2 if there’s a reason to do that (downtime, maybe, in case HIStalk2 gets trashed somehow?) The commenting capability in both HIStalk2 and the Discussion Forum are much better than under HIStalk, so it will definitely improve.

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