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July 25, 2007 News 9 Comments

From Ambulatory_Vendor: “Re: Sage. Fallout from the layoffs? We’ve been receiving calls from Sage customers who have been unable to get support for weeks.” Unverified. I’ll ask Inga to follow up.

From Judith Beasley: “Re: Soarian. 2005, zero sales. 2006, zero sales. 2007, no sales yet. Soarian development costs are now over $150 million per year. Siemens can and will continue bleeding for a long time. The Susquehanna CIO is now a Siemens employee. Guess that will keep vitriolic e-mails from showing up in HIStalk.” Unverified. If anyone has facts, please elaborate.

From Mia Hottie: “Just a clarification on the Cerner product I mentioned yesterday. It’s not the Visicu-like remote monitoring product, but rather the ICU EMR that would compete with Picis or Sunrise Critical Care, for instance. Cerner announced iNet at least five years ago and, as usual, it was a toe in the water and was never been completed or well done.” Thanks.

From ExCPRUser: “Re: CPR. The combination of an archaic architecture (remember UltiMumps?) and lack of any real integration among CPOE, nursing, and rad/lab will eventually sink them.”

From RonA: “Re: QuadraMed and Vista Equity Partners. Dumb and dumber. Dumb: QuadraMed admits they can’t deliver a clinical product, throws in the towel, and buys an orphaned clinical system. HDS, Per-Se, and Misys couldn’t sell it, so what makes QD think they can? Dumber: Vista Equity Partners buys the junkyard of legacy standalone systems for $382M. Do you really think Vista Equity will invest more in these products? Both of these are feeble attempts to add value to challenged businesses and then sell it to someone even dumber.” 

From Jeff: “Re: KLAS. I think KLAS bends over backwards to provide an impartial opinion, but the key is that KLAS is only one indicator anyone should use to evaluate a vendor. There are many ways to substantiate or repute what a KLAS report might contain, so rather then ‘crying wolf’ because a vendor is not getting a great ranking, include in your opinion other factors, like making some reference calls, talking with the vendor about their vision vis-a-vis yours, and going to trade shows to see how others view the vendor. KLAS may not be perfect, but it is a great starting point for anyone.”

From Rufus: “Re: Anne Arundel. Rumor has it that Anne Arundel Medical Center (Annapolis, MD) might be ripping out Meditech and replacing it with Cerner. Their relatively new CIO is an ex-Cerner employee. Seems like a giant expense and burden. Questions: 1) true?  2) why?” Unverified.

From The Shelton Shadow: “Re: Lawson. TSS has been investigating a new possible takeover candidate who is partially in the healthcare space. That  company is Lawson Software. Don’t know yet who the suitor is, but one sign that something is up is that they have disabled their ‘Partner Network’ on their website. Only time will tell if it is one of the big players in healthcare or a private equity group.”

From Russel Ziskey: “Re: Google and the advisory team. Add Intuit to the list of organizations that maybe doesn’t get it. They announced a product over a year ago and nothing is released. Their division GM, head of bus dev/ strategy, and head of product dev are all gone. Also, the issue is not one of needing an RN to help think through what to get. The truth of the matter is that there are too many vendors from too many different angles trying to solve a need that doesn’t exist (let’s leverage our EMR, our claims data, whatever to deliver a PHR to consumers so they will manage their health and we will get $$). The reality is that consumers say they want a PHR (you have to – it’s like saying you should go to church). But, do you go every Sunday? Adoption is low, no one will pay, and standards certainly do not help – each player tries to protect their own interests.”

Cerner’s Q2 numbers: revenue up 17%, EPS $0.37 vs. $0.29, meeting expectations. The stock was down over 4% today as financial types realized that Cerner’s $26 million in NHS revenue brought along a 0% profit margin and decided the company’s expenses were too high.

OK, it’s usually pretty quiet on HIStalk in the evening. Right now, there are 51 readers on, some who’ve been there for more than 30 minutes (according to my stats service). Visitors from the past week would extrapolate to 61,889 per month, with 112,000 page views. Obviously, this will be a record month. Who knew there were 2,000 people each day who care enough about healthcare IT to hang around some anonymous guy’s blog? Join me in giving yourself a round of applause. And if you want to connect with each other, give HIStalk Discussion a spin.

University General Hospital Systems (TX) signs an exclusive agreement with Calence for network services. The press release uses the word “luxury” and “five-star” a little more than I’d like for a hospital chain, even if they are for-profit.

This ZDNet editorial is critical of the single announcement that Misys is considering an open source EMR release. “Its medical records product was already being pressured by OpenEMR, a GPL product … The current Misys Web site is terribly opaque. If Misys wants to compete effectively in open source that will have to change fast. Open source is more than free code, it’s a transparent way of doing business.”

University of Florida and IBM announce standards-based middleware to connect home monitoring devices to physician offices. “It would then be possible to buy a device off the shelf and by dialing a 1-800 phone number establish a connection between the device and one’s doctor. ‘The device itself becomes a service,’ he said.”

Cardinal Health says it has developed a better outcomes model for pay-for-performance programs. The big improvement came from adding lab data to the mix, which predicted mortality better than any other indicator, up to 67 times more important than administrative data.

FCG and InterSystems will jointly offer integration and business services to hospitals in India.

News, rumors, privaty equity investment opportunities: e-mail me.

Inga’s Update

Mr. HIStalk suggested I try to track down a CPR client to find out their perspective on the sale of the Misys CPR product to QuadraMed. I was lucky enough to catch Dave Paulson, Manager of Clinical System Support for St. Francis Health System in Tulsa, OK. He admitted he had plenty of thoughts on the whole situation and took the time to share them with our readers. Thanks, Dave!

What are your thoughts on the sale of CPR to QuadraMed?

I was very involved with the Misys leadership when they initially purchased Patient1 from Per-Se four years ago. I met with those guys and asked questions. With the Per-Se management, they had ideas but not resources to move the product forward. We were thrilled to hear what Misys management had to say. The CPR product is our lifeblood. It does everything. It’s huge for us and we need it to be continually developed and moved forward.

Misys said they realized they would do three things with regard to CPR and its development. They said, “We aren’t going to be invited to the dance unless we move from a proprietary platform to Cache’. We aren’t going to be asked to respond to RFPs because we are not Web-based. And, we have all these Sunquest lab clients now asking for the total package – they want integration with that product set.” So, those were the enhancements to be pushed by Misys.

Where Per-Se was not interested in supporting a user group for feedback, Misys was. I was very, very involved. Misys came in, devoted a lot of resources, but, about six months or a year ago, they had leadership changes and they ran out of steam when it came to focus on the CPR product. It wasn’t like some vendors that talk about things and don’t deliver. Misys just stopped talking about anything. Releases were pared down and delayed. And now, Misys has decided to be physician-focused.

We found ourselves back to where we were in the Per-Se days, but we need the vendor to move forth and advance the product. If it had been McKesson or GE or someone with products in the space to have bought CPR, it wouldn’t sit well with us. But it seems like, with QuadraMed, here is a vendor that has focus and wants to move things forward. My understanding is that the vendor staff that works on CPR is hearing good things thus far. They plan to keep people and they do have a good staff. I have not heard directly from anyone from QuadraMed yet.

I have talked to several other key CPR users in the last couple of days. We were frustrated that the CPR focus seemed to have been lost. Now people are cautiously optimistic that this is a good thing. This vendor gives us more reason to feel at ease than others.

Has the product been stable for you?

I think the product itself is stable. The one thing we really saw Misys bring to the table was improved quality of code. It just really became an issue of, “When will the next release with functionality that we want become available?” I assume that the same folks that have been working with us for the last eight years will continue and we won’t start getting support from a group that doesn’t know the product. That remains to be seen

When did you get your last update?

I think the last major release we took was about a year ago and they haven’t had one available since then. The next major release had been scheduled for release in August 2007, but that has been pushed back indefinitely. The next major release was planned for late 2006, then pushed to August 2007, then we were told they were pulling two major components and didn’t have a delivery date. The release is smaller and we don’t know when it will be available. You can appreciate frustration of the user community with something like that.

How fully are you using the system in nursing and ancillaries?

About as fully as it can be done. 100% of nursing staff is using it. The whole closed loop medication management process is fully online. Our Heart Hospital component is doing full CPOE and all the major ancillaries are using the medical records module. Sometimes I hear people say they need to look into getting single sign-on. I say, “What you need is one vendor.” It has worked well for us.

What is the CPOE utilization?

It is fully utilized in our Heart Hospital. We have three hospitals in Tulsa with 1,000 beds and the Heart Hospital has been our pilot.

Are orders being sent electronically from CPOE to pharmacy?

Yes. CPR does that fully. We have closed loop medication management.

Any problems with downtime or response time? Is the system solid?

Very solid. Really, no issues with down time and response time.

Have you ever considered switching to another system?

Yes, we have looked at that. We have had administrative changes and new management has asked if this is the horse we want to be on long term. You have to consider the cost to replace all that functionality. I cannot even fathom it. To try to replace full nursing documentation, all three major ancillaries … I don’t even know how you would do it. I can’t even imagine.

What are the best and worst things about CPR?

The best thing is the integrated nature and ability to view patient data from anywhere. The thing we have really needed from the vendor and which has been delayed multiple times is an enhancement to the clinical documentation toolset. We need it to provide more efficiency for nursing and physicians. We need something more EMR-like.

Secondarily, the pharmacy module needs to be updated and was to be included in the next release. The pharmacy module was one of the first modules to be ported to the Web. Our pharmacy folks are just still waiting for the changes. When I talk to people at QuadraMed, I will say those two areas need to continue to see focus.

Would you recommend CPR to others as it exists today?

Yes. Come and look at it if anyone needs to see what I just described. Cerner is going to talk about it, but we are going to show it to you.

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Currently there are "9 comments" on this Article:

  1. RE: Everyone wants a PHR.
    The vast majority of people simply want 1) their medical record to magically appear at any clinic/er/hospital that they show up at, 2) hopefully have access to their medical record and the record of their kids and 3) for co-workers/neighbors to not know about a potentially embarassing medical problem. They don’t have a clue what a PHR is, but the words ‘personal health record’ sound like something that would get them the 3 things that they want. Unfortnately, big PHR vendors just don’t get that I don’t want to update my chart and drag it with me everywhere, I just want the clinic, hospital, er to do that (just like most people assume already happens despite the boring medical history forms you need to fill out).

  2. would a should a could a been. The St. Francis comments are about what I expected. Probably would get the same from Princeton, HSR, Forrest General and Arnot. I think Misys came close to making it work but just ran out of steam/$. CPR is a solid product but it takes a lot of cash to keep up with the big boys and the brits decided they didn’t want to invest that much. The Misys Connect strategy came about a bit too slow and the One Misys culture or the Medic/Sunquest synergy never happened. It was always us vs them (acute vs ambulatory) plus homecare. Really a sad story because there were and are a lot of great people at Misys and it should have worked. I think what is left of Misys Healthcare Systems will be sold off next year to one of the big boys who wants the physicians market share. I guess we have seen our last Hummer give aways at HIMSS. Imagine winning a Hummer and having to give it back because you are a govt. employee? Life is like that sometimes.

  3. Where are the funny complete-the-sentence nominations about Bush “performing surgery”? I’ve been waiting for it and could have stolen some of the material for last week’s debate…

  4. “Where are the funny complete-the-sentence nominations about Bush “performing surgery”?”

    Yes, inquiring minds want to know. Unless none of them made the decency cut. 😉

  5. RE: Anne Arundel – The CIO is an old VP at Cerner over consulting. Reference the link below for factual back-up.


    As for replacing Meditech…was this recently installed Meditech? If so, then that is a pretty dumb move to do as they never had any ROI yet. Replacing Meditech with Cerner itself…we need more reasons as to why they want to do that…beyond the CIO connections.

  6. Re Google Advisory Council
    Based on the composition of the advisory council it looks like Google is seeking influence to move policy and ultimately drive the PHR push that they have been expounding upon. For that, they do not need nurses nor medical librarians, they need talking heads that are well-known in the industry.

    But the $64,000 question is: “If they build it, will they come?” and I’ve yet to see any clear indications that PHR, which is so in vogue right now has any legs. Heck, just look at the still abysmal rate of EMR adoption, without the digital records, what will a consumer have in their PHR, an exercise log book? I just don’t see consumers entering in the data themselves. It must be automated and aggregated and for that to occur there are a whole slew of things that will have to happen first in this industry.

  7. Agree that Google seems to be looking for talking heads but one might assume they also want input on their solution, not just the concept, nor are they just promoting PHRs as a good concept. Thus engaging one less talking head and one more thinking head with some practical experience might have been wise.

    Even if Google were just interested in promoting PHRs as “good citizens” then might want practical sound advice from largest business group and IT users in all settings – RNs have earned at least one seat at the table and many are as or more articulate than the named committee members. If nothing else someone needs to keep the egos and talking head smoke blowers honest and on track.

    The medical librarian comment leads me to believe you don’t know what nurses do or how they play a role in IT or healthcare – or think they have anyting to offer even at the talking head level.

  8. RonA – check the scoreboard – Misys Lab is doing well in KLAS ratings. It still works well, performs well on mid-range hardware, has a plethora of interfaces, and is far from the bottom of the pile. It doesn’t run with a windows client and relational database but those that do usually don’t perform for larger organizations. IMHO, the Lab business for hospitals and their immediate ambulatory clients will continue to consolidate -> so the small environments referenced in KLAS ratings will continue to decrease or be outsourced.

  9. mia hottie – My comments were meant to simply enlighten others as to why Google may have put together the type of advisory panel they did. It’s not that I necessarily agree with their choices, but I do understand them and if I were in their shoes, probably would not have done much differently.

    Really see this advisory panel as structured to push policy and open doors and not about what their future service will offer. For that, agree, they will need other constituencies such as med librarians and RNs among others to assist with that effort.

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