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September 18, 2007 News 11 Comments

From The PACS Designer: “Re: Oracle 11g partitioning. Oracle has a new feature in Database 11g which they call Enhanced Partitioning. Through this new technique, you can create large object files (LOBs) for things such as resource scheduling and other institution activities. The LOBs can then be encrypted to protect them for HIPAA and other security purposes and also give management a view of the organization’s activity daily, weekly, or for other time periods. For example, you can create large object files for the summer vacation periods of July 1 to Labor Day for each year using Oracle’s new enhanced security option SecureFiles to do trend analysis on the efficiency of various departments during the peak vacation period of the summer.”

From Kesuke Miyagi: “Re: CCHIT. Here’s a chance for your readers to put their money where there mouths are and participate in the CCHIT public comment period. Stakeholders can share their opinions with the groups that are actively developing the 2008 certification criteria. I’m new to CCHIT, but have really been impressed at the openness and integrity of the certification development process.” Link.

From Yancy Derringer: “Re: Kaiser Permanente. Adrienne Edens is out at KP and replaced by Diane Comer, CTO from Firemans Fund. Looks like the second of mass changes by CIO Phil Fasano. He is a major proponent of outsourcing and Comer got all her name recognition from doing a major outsourcing at FF.”

From Rogue: “Re: Siemens MedSeries 4. It still runs on an AS/400, though ones much more powerful than those of yesteryear. You’d be surprised how it’s grown from green screen through Web-GUI to Web-capable. When I worked with it for awhile earlier this year, I was very impressed. One nice option – you own/manage the hardware or Siemens hosts it and all you need is a fat T1 or T3 line. Practical for the small IT departments.” Thanks for that update. I thought Siemens nearly sold it off a few times over the years and I’d heard nothing. I’m not claiming I hear everything, but it doesn’t seem like Siemens is very good at getting the word out.

From Ali Mills: “Re: MS4. Siemens has been investing in MS4 clinicals. Growth on top of 425+ customers, huge R&D, 21 new hospitals last year. MS4’s mantra is ‘three clicks to patient information’. MS4 beat out Meditech, McKesson, Cerner, and Epic at Texas Scottish Rite. IBM has pumped over $1 billion into iSeries (formerly AS/400) in two years. Glad to hear the story getting out.”

From Daniel Larusso: “Re: Epic. I’ve heard that when a new customer signs, there’s a mock marriage ceremony in Madison, complete with Judy in a white dress and with wedding cake. That’s just plain weird if true.” I’ve heard that, but not lately. Seems gauche to wear white in more than one wedding. Confirmation, anyone? Maybe some wedding pictures or the little happy plastic couple from the top of the cake?

From Terry: “Re: Craneware. The company has IPO’d in London.” Link. I’m familiar with their charge master maintenance product and it’s good.

This conference sounds cool: Transforming Healthcare through Health Information Technology, The Most Exclusive Summit for Healthcare Leaders on November 5-6. I got a flattering e-mail asking HIStalk to be a media sponsor, which caught me by surprise because I’ve never been asked. What that means: I let you know about the conference (which I would have done anyway) and they mention HIStalk (looks funny up there with all those real companies). What caught my eye in the first place: the speaker lineup, some of whom I’ve interviewed: Martin Harris of Cleveland Clinic, Danny Sands from Cisco, Don Holmquest from CalRHIO, John Wade from St. Luke’s, Holly Miller from UHHS, Neil Martin from UCLA, Jonathan Bush from athenahealth, Jeff McCaulley from Wolters Kluwer Health, Glenn Tullman from Allscripts, and Andy Eckert from Eclipsys, among many other big names from notable organizations. I’ve been to intimate conferences like these a couple of times and they’re a blast, with upscale amenities, personalized presentations, and casual access to industry bigwigs (it’s like a VIP pass to HIMSS). Sweet location, too: the five-diamond Peninsula Beverly Hills (great spouse trip). Another part of the deal was a discount for HIStalk readers: use code HISTALK2020 online or by phone and you’ll get a $750 registration rate. I put up a text ad to your right to remind you. Maybe you could write it off by turning in a first-person HIStalk report.

Clarification: I said that Visicu was dropped from the Inc. 500. True, but misleading. The original newspaper article said, “Other companies dropped off the list entirely due to going public, not being able to maintain the rapid growth or some other reason. That occurred to Visicu.” A couple of readers pointed out that the poorly worded sentence was trying to say that Visicu was dropped because the company went public, which I breezed right over.

Those who signed up for Brev+IT got it by e-mail Saturday. If you like what you see, sign up for your own free copy each week.

I knew Isabel CEO Jason Maude would respond better than I could to the reader who mentioned the lack of PubMed articles about the company’s diagnosis product. “So far, around 20 articles have appeared in peer-reviewed journals, including a study entitled ‘Validation of a diagnostic reminder system in emergency medicine: a multi-centre study’ which appears 5th on PubMed if you enter ‘Isabel’ as the search term. I would argue that Isabel is, in fact, one of the most validated healthcare IT products around. You can see the full extent of the published work on our website … in 10-12% cases that a physician uses Isabel, he/she is reminded of an important diagnosis that he had not thought of. When done live across three hospitals, it was found that, in 25% of these case,s it turned out the be the actual final diagnosis.”

Now here’s a story I bet you haven’t heard elsewhere. A reader clued me in that the ambulatory EMR products of several legacy vendors are not eligible for the Stark exception because their CCHIT certifications are over a year old (they didn’t earn 2007 certification yet, in other words). The only 2007 certified ambulatory products are Medent 18, eClinicalWorks, e-MDs, Greenway PrimeSuite, McKesson Practice Partner, NextGen, and Purkinje CareSeries. Hospitals can’t provide doctors with any other system under Stark unless they earned 2006 certification less than a year ago. That means you can’t, at this moment, give doctors Allscripts Healthmatics and TouchWorks, Cerner PowerChart, Epic Ambulatory EMR, GE Centricity, McKesson Horizon Ambulatory Care, Misys EMR, and Sage Intergy EHR, among others. Check CCHIT’s page for products with a date more than a year ago and not listed on the 2007 page. According to HHS, “The exception and safe harbor provide that EHR software will be ‘deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the [physician/recipient].'” Bet you won’t read that in the certification-bragging brochures, especially since these are the kinds of legacy vendors that hospital CIOs flock to.

Heard: Phreesia gets $10 million in funding. The company offers free (adware-supported) wireless touch-screen devices to physician offices that replace clipboard check-in forms for patients.

A eHealth Vulnerability Reporting Program study questions the security of EMR systems. Among the issues: systems allow penetration with standard tools, vendors don’t tell customers about security holes, and no industry watchdog creates and monitors standards.

Big employer healthcare coalition Dossia, after falling out with Omnimedix Institute, turns to Children’s Hospital Informatics Program of Boston to pick up development of its personal health record application. That’s Isaac Kohane’s shop. He e-mailed me once as an HIStalk reader, so maybe an interview can be wangled.

Everybody’s piling on the big guy. First Google threatened Microsoft Office by offering an enterprise version of Google Apps for a low price. Now IBM will offer a free download of Lotus Symphony, apparently developed from Star Office/OpenOffice.org. We old-timers remember the DOS version of Lotus Symphony/Jazz from the 80s, although not all that fondly.

Interesting thought: could MP3 recorders replace stethoscopes? Apparently the sound quality is higher, the files can be computer analyzed, and of course you have a digital record for later review (assuming legacy EMR vendors had a way to integrate MP3 files with other clinical data, that is).

Congrats to HIStalk reader (and occasional commenter) and Penn researcher Ross Koppel, PhD, who has published a new article in JAMIA on the unintended consequences of healthcare information technology. Ross and colleagues worked with AHRQ in developing guidelines for identifying those automation-induced safety issues. His 2005 JAMA article had vendors howling, mostly Eclipsys because the problems he catalogued were TDS-related even thought he was making a general point, but you’d be hard pressed to find anyone today who would disagree with the overall idea that HIT can cause new problems even as it’s solving others. My comments on a similar article remain the most-read HIStalk piece ever.

A hospital director in Japan who implemented the first hospital EMR system in that country has been arrested for accepting a contractor’s bribe of a plasma TV.

The CEO of the informatics group of Philips says the company may offer an EMR product, but only in Europe because competition here is too stiff (as Epic taught them). An acquisition is likely, he says.

Internet-based hospital report cards have old, incomplete, and conflicting data, a new study says.

Orion Health says the company is New Zealand’s largest developer of exported software.

E-mail me. I sound knowledgeable on occasion only because smart readers tip me off.

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Currently there are "11 comments" on this Article:

  1. Are you people serious? Judy in a white dress? Where do you get these things?

    It’s true that Epic plays wedding music when a new customer is announced because Epic and the customer are working together, and in it for the long haul. But that’s far from a mock wedding.

  2. RE: mock marriage ceremonies by Epic

    Wow, this is one of those rumors that starts with a shred of truth and expands quicker than a game of telephone in Kindergarten.

    When a new customer is signed, wedding music is played throughout the campus for 10-20 seconds, after which the customer or their sales person provides background information on the client, their values, what they purchased, and what their goals are. It’s one of the ways we keep everyone informed and involved about new customers and their goals.

    Judy isn’t usually involved, and as far as I know no one has every worn a wedding dress. As for cake, there is none – otherwise I would have some!

  3. I heard the 2007 CCHIT certification process was much more difficult than previous years, and that one of the reasons why so few vendors entered the certification process was because it was so difficult. In other words, that many vendors could “get away” with promoting their 2006 certification, leaving the impression that they were recently certified.

    Any truth in this rumor? I know the 2006 certified vendors insist otherwise, but I’d love to hear insight from someone with less “skin in the game”, so to speak.

    EMR Software Information and Resources,

  4. EMR Guy – good question. First, let me point out that the main primary area with more rigorous standards for CCHIT 2007 certification is inter-operability. But, to your main question, I did some spot checking just on some of the 2006 certified vendors and almost all have the 2006 certificate prominently displayed on their websites. Some exceptions: Eclipsys, Epic, and Misys. Don’t know if the decision to not mention certification was an oversight or intentional (perhaps by not mentioning CCHIT at all the vendors are hoping the CCHIT questions don’t come up. )

  5. One other thing to keep in mind about the CCHIT certification is how the testing periods are structured. The cycle goes from April to March. A number of the companies who are certified on the 2006 criteria did not complete certification until January or even April of this year. While it looks like they are behind, the reality is that for some, their certification is not even 6 months old. Vendors have another 6 months to certify with the 2007 criteria and I suspect that many are planning on testing, they are just waiting for the anniversary of their original testing.

    The rules for using the seal from CCHIT allows vendors to continue using the seal for 3 years as long as they keep up with the fees. In 2009, people can still be showcasing the 2006 mark for the originally tested product, even if they never retest with the new criteria.

  6. According to HHS, “The exception and safe harbor provide that EHR software will be ‘deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the [physician/recipient]. I am curious if this safe harbor is included in Stark III, which was released on 9/5/07? Many of the safe harbors we eliminated in this latest version of Stark/

  7. Regarding the mock wedding ceremonies at Epic….

    This is true, and the new campus has a small chapel specifically for this purpose. Judy wears a white dress complete with a veil. The groom is typically the customer CFO, and the bouquet is thrown to a crowd of consultants. If Cerner lost the sale, Neal walks her down the aisle and gives her away.

  8. Dossia looks to have learned from their previous mis-steps choosing a technology partner that has actually “walked the walk.” They’ll be adopting the Indivo PCHR platform with release of a beta PHR for early adopters among consortium employees later this year.

    They also announced that AT&T and sanofi-aventis have joined bringing the total potential consumers (employees, retirees & dependents) to 5 million.

    What I wonder is what does this mean to those independent PHR companies like WebMD, RevolutionHealth and those waiting in the wings, Microsoft and Google? Any thoughts?

  9. Siemens MS4: It is nice to know that Siemens continued to invest in MS4. I have been told that MS4 is relatively inexpensive (inhouse or hosted) compared to the monthly spend of other Siemens legacy HIS offerings (INVISION, Soarian..etc). It appears to me that Siemens hospitals looking to lower their HIS invoice have more options than ever and they don’t have to leave Siemens! Good news for hospitals…not sure if that will be good news for Siemens financially. I suspect the revenue from one EPIC, Eclipsys, or Cerner ontract is equal to many MS4 contracts.

  10. CCHIT certifications are by version by CCHIT criteria: e.g. 2006 version certified to 2006 criteria. There is a annual “maintenance” fee for the certification, which can be done twice (total of three years). Arguably, paying the maintenance fee “re-certifies” that version so that that 12 month window is met. This means, if 2006 version is certified and maintenance paid, that version complies with the safe harbor. If there are only minor changes to the 2007version, the process allows for a more simple certification under the 2006 criteria (essentially an affidavit). The way I read the read the regs, that would mean 2007 is certified. As it’s been explained to me, if you certify 2007 under 2007 criteria, the fee includes the maintenance for previous versions so that you’d have 2006 certified on 2006 and 2007 certified on 2007 (once it passed).

  11. The cost is considerable too. At 30k+ a pop, I’d look for most to certify when it makes practical sense. Those who happen to certify later in the year will benefit from “being current” in some ways, but it doesn’t mean anything except theycan do a bunch of blog entries and try to make it sound special.

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