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Monday Morning Update 10/22/07

October 20, 2007 News 7 Comments

Investors weren’t happy that Cerner missed Q3 revenue expectations and also lowered guidance last week, even though profit was up 34%. Shares dropped 9% Friday.

An anonymous source (someone affected) says that over 100 people have been laid off from Kaiser’s IT department.

Another source tells me that Bronx-Lebanon’s Eclipsys deal was booked at $32.5 million, to answer a reader’s question.

The fox joins the chickens: the SEC director who went after McKesson HBOC for fraud will quit to work for a private investment company as its general counsel.

News bits from Medicity: their client Delaware Health Information Network gets an NHIN trial implementation grant, Medicity’s headcount will have tripled in less than three years, its product suite now supports all LDAP-compliant directory services, and it just opened a new 24×7 Network Operations Center. I had missed that CEO Kipp Lassetter will be on a panel at the Collaboration Communications Summit in Beverly Hills (November 5-6), of which HIStalk is a media partner.

An interesting report (warning: PDF) called “The Relationship Between Electronic Health Records and Patient Safety”, from Canada Health Infoway. Overview: evidence that clinical systems improve patient safety is incomplete, clinical systems may have unintended consequences, implementation should be incremental to let providers adjust, and expectations must be realistic.

Don’t forget the poll to your right on PHRs. I’m interested to know who’s using them. I only know that I’m not.

Let’s hear it for those sponsors who keep the HIStalk well flowing. Click over and take a look, and if you’re their customer, please tell them you appreciate their support of HIStalk.

Design Clinicals, LLC


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Healthcare Growth Partners

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Noteworthy Medical Systems

Novo Innovations



Pring|Pierce Executive Search

SCI Solutions



Stratus Technologies

The White Stone Group, Inc.

Baylor Health Care is #15 on the 2007 Information Week 500, the highest ranked health care system at one spot behind Google.

Surely it’s not just me: spam filters are rejecting an awful lot of e-mails. How many times lately has something you’ve sent not arrived, or has someone sworn they sent you an e-mail that you never received? I suspect those server-based spam tools are too tightly wound to let all the real e-mails through.

Another odd Misys press release: its extensive research reveals that doctors don’t use EMRs because they’re expensive and hard to use. A shocker, I know, especially coming from a company often known for trying to sell expensive, hard to use products. Here’s the research methodology used: Misys watched a bunch of cheaper, better competitors brutalize it in the marketplace. Great conclusion, but too late to keep those horses in the barn.

A European project will monitor patients at home, using sensors that report environment as well as physiology.

As I already mentioned, Medsphere settled its lawsuit with the Shreeves. You have to assume that (a) either new CEO Mike Doyle said he wasn’t coming unless they took that blot off the company’s record, or (b) it was a Ken Kizer vs. the founders grudge match with no possible winners, so his leaving the CEO post was related in some way. It’s too bad the distraction couldn’t have been ended sooner. Medsphere already had enough challenges before the suit.

Here’s yet another smart card pilot for medical records. Seems like everybody’s been trying to make smart cards do something useful for 20 years or so now. This latest one at least carries more information than just a medical record number, but it’s really just a PHR on a card that the patient can’t update, i.e. like a floppy-carrying sneakernet. Siemens is paying for the pilot.

Cardinal Health’s Medicine Shoppe will run up to 500 clinics in India’s urban slums, complete with a pharmacy, lab testing, and a doctor.

CPSI’s Q3 numbers: revenue up 2.6%, EPS $0.30 vs. $0.32.

E-mail me.

Inga’s Update

John Hallock of athenahealth dropped me a note letting me know that athena had actually announced one other group live on athenaClinicals. FirstHealth Family Center in NC is up and running at its seven facilities.

Earlier this week Mr. H mentioned a Misys press release about EMRs that he said “contains no news.” Basically true, but I what I found interesting is that the article promotes hosted EMRs, an offering Misys won’t be selling until the iMedica arrangement is finalized (not expected until November), If I were a Misys prospect buying EMR today, I might be scratching my head asking why Vern is promoting hosted solutions when they aren’t selling one yet.

Columbia University’s physician group, the Faculty Practice Organization (FPO) of the College of Physicians and Surgeons, signs a management and consulting agreement with Greencastle Consulting. Greencastle will manage FPO’s roll-out of the Allscripts TouchWorks EHR.

Medical Economics has an interesting article titled “Avoiding EHR Sticker Shock.” It provides some insight as to why various solutions may appear to have such different costs. It also suggests some less obvious components the buyer should consider when calculating the total cost of ownership.

E-mail Inga.

Art Vandelay’s Thoughts on Worker Benefits and Technology

Art Vandelay is a hospital-based technologist and HIStalk contributor.

I find the move by General Motors (GM), now Chrylser/Cerberus, and the United Auto Workers (UAW) very telling about the future of worker health care benefits and soon, very telling about the future of consumer-centric health care technology. In the end-state of the deal with GM, the UAW will assume the responsibility for retiree health benefits over the next few years. Although many other businesses have begun to reduce or eliminate their retiree health care and pension exposure, this is the first major visible movement in an industry that has reacted with the speed of a tortoise in the face of major cost challenges.

The situation for GM is daunting. For every able-bodied worker, there are four retirees. This is basically the same demographic trend that many European countries and, to a lesser extent, the U.S. face. The obvious effect of this is a growing number of Medicare beneficiaries with fewer resources paying into Medicare, while healthcare costs outpace “revenue”, i.e. our tax dollars. The moves we see from the UAW will likely be the same we see in other slow-moving industries for employees and retirees, as well as with Medicare. Undoubtedly, the UAW will push health savings account and high-deductible health maintenance organization-based plans. Both options are associated with the “consumer-directed movement”, although there are varied findings about the effectiveness of these plans depending upon one’s viewpoint ( i.e., consumer cost, payer/employer cost, quality, satisfaction).

So what can we expect as technologists?

1. There will be an unprecedented, albeit slow-moving, pressure to provide information about (first) cost, (second) quality and (third) access to care in a consumer-friendly manner. I stress, in a consumer-friendly manner. How many of us have had to explain bills, referral and authorization requirements, and the provider industry’s broken processes to parents, friends, and relatives not “in-the-know”? We will be pushed as technologists to:

  • Provide natural language interfaces to knowledge bases of frequently asked questions, including providing our users with content management tools to rapidly add, edit and tag new consumer questions and our organization’s answers.
  • Partner more tightly with our clinical and administrative counterparts to understand and standardize our data as well as our competitors’ available data (likely facilitated by health plans).
  • Provide more data in real-time regarding cost, quality and access as opposed to data that are months or weeks old.
  • Provide analysis models taking the real-time data to predict cost, quality and access challenges before they occur.
  • Provide multi-factorial, consumer-friendly decision-making tools so they can use information to make educated decisions about providers and treatment options (perhaps with weighting or in conjunction with national benchmarks). Health plans will likely provide similar tools for treatment options (maybe competing tools with different outcomes) as well as tools to compare providers. Consider the challenges that group practices and other organizations with employed providers will face if they are compared to one another, as opposed to being compared as groups (everyone will want access to the provider with the best cost/quality outcome).
  • Work with health plans and the government to define normalized cost and quality information for reporting (expect registry upon registry to arise – all with slightly different data definitions creating different extract, transform and load (ETL) requirements).

2. There will be an unprecedented demand to drive the work of the key knowledge workers to other, less trained, or more focused but lower-paid resources. This will be seen in as increased demand for nurse practitioners and physician assistants in many additional care settings. Nurses will likely become the care coordination coaches for the inpatient experience, running entire teams of partially specialized resources. Other disciplines with limited use of technicians will likely develop the roles. These will result in rapidly changing staffing models. We will be pushed as technologists to:

  • Define role-based access relationships for users (consider this a wake-up call for those of us with applications that do not have fine-grained role-based access control).
  • Provide aids in applications to guide users through the use of a system or the execution of processes, including the integration and use of workflows.
  • Provide activity-based cost decision support to validate that these new staffing models make sense.
  • Provide interfaces or maybe even create web service-based mash-up applications to support these new processes.
  • Include these alternative providers in enterprise scheduling systems (or create and possibly host enterprise scheduling systems for our organization and our partners)

3. There will be unprecedented demand for personalization in consumer web sites provided by both providers and payers, dare I say the re-emergence of the portal. From a provider-centric viewpoint, we will be pushed as technologists to:

  • Provide tools that measure and deliver enhanced access (i.e., self-scheduling, virtual, remote or electronic visits).
  • Provide tools that measure and track progress towards our desired outcomes as patients (i.e., personal care planning tools, disease management tools). Unfortunately, according to recent findings, patients with chronic conditions are using the web less than those without chronic conditions.
  • Provide patient-access to their records.
  • Provide the ability for patients to estimate, pay, dispute, and view their bills on-line.
  • Remember that all our patients aren’t web savvy, have physical impairments or speak other languages. Some of us will be asked to provide access to these tools via telecommunications technologies ( i.e., voice XML – VXML) and other means that meet the patients’ requirements.

4. There will be unprecedented demand for resources to assist patients move through the complexity of the health care system. Call them care navigators, concierges, or coaches, these resources may be free or they may be paid third parties. We will be pushed as technologists to:

  • Provide tools to facilitate the communication between the care navigators and patients. Think internet-enabled call center tools (i.e., instant messaging, intelligent conversation avatars, call distribution and management software, referral management software, message tracking software). Customer relationship management (CRM) software will really come to health care to aid with the navigation, document the patient conversation, and to cross-sell our organization’s and partners’ services.
  • b. Provide tools that integrate the documented messages into the computerized patient record when required.
  • Provide tools that track and document patient and family preferences for care (i.e., locations close to work and home, preferred providers, preferred treatments, willingness to use alternative medicine and care extenders).
  • Provide the knowledgebases mentioned in #1 for these care navigators.

5. There will be unprecedented demand for computerized patient records that support outreach to affiliated physicians and data exchange. Eventually, when consumers wake up and payers listen to the demands of the consumers, some level of standards-based electronic data exchange between providers (think HL7’s Continuity of Care Record – CCR) will be required. Therefore, as technologists, we will be expected to provide computerized patient records for our organizations, our partner physician organizations, and ensure these applications support the CCR.

A change is upon us. There will be no shortage or work or demands for investment – can anyone say job security?

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Currently there are "7 comments" on this Article:

  1. Mr. Vanderlay’s analysis is very through. But I think it could be summed up in a few sentences. The healthcare gravy train is about to end. For decades healthcare benefited from unions getting employers to expand health benefits. Now the unions will have to live with the costs and they do not have unlimited funds to do this.
    Helathcare as an industry has grown for 5% of GDP in the 60’s to almost 15% today. That is phenomenal growth that any business would love tolive through. Managing a growth business is a lot easier than a stagnant or shrinking one.
    Now health care executives will have to make some very tough decions about effiacy, and efficiency. Issues they have been able to ignore for 50 years.
    In about three years it will be a whole new world of healthcare cost containment and I do not not think current management is at all ready for it.
    As with commercial industry, information systems will live or die on ROI.

  2. The PDF on the Canadian study of EHR’s is REALLY good. I am working with a system now that wants to provide a standalone EHR and are only focused on the technical challenges of doing so. No why’s or interest in what happens once the targeted groups of docs start using the EHR.

    The only driver appears to be creating some way to lock the docs to this particular system. A little scary and also sadly reminiscent of the practice buying disaster of 10 years ago with the same end in mind. A little scary. Why can’t we just focus on whether or not a given EHR solution and implementation actually makes sense within the context of providing an actual benefit to the patients and participating docs.

  3. Anyone that thinks healthcare executives have been able to “ignore” efficiency for 50 years hasn’t been paying attention since, at least, 1986. If you don’t believe it, go check out the bottom line figures for hospitals, skilled nursing facilities, home health and primary care physicians. Sure, some are making money – some are even thriving, but the industry is not awash in profits as HISjunkie implies.

    factor the increase for usage of services versus profits. BTW – the pharmas, device manufacturers, for-profit insurance companies, and specialists are the ones making money.

  4. I don’t understand HISJunkie or John Horton. My feeling is that if you want to debate efficiency or productivity, measure it precisely. An entity that makes money, loses money, grows, or stagnates can have examples of efficienty, productivity, as well as imbecilic waste. I don’t believe hospitals, SNF, and physicians have been the best examples of operational excellence. If so, they would be writing business best sellers and getting alot more publicity in business media. When I see “How to Run Your Business Like a Hospital.” on the NY Times Best Seller…then I think we can say their time has come.

  5. Re: Kaiser layoffs – maybe they’ve completed something big and are beginng the process of rolling people off one of the largest projects in US healthcare history.

    Maybe its time for Mr HISTalk to find out just how much is really done at this point? The numbers quoted at Epic’s UGM were pretty impressive if real.

  6. Re: Wondering’s boundless optimism about Kaiser and Madison. Maybe they’re in the process of reevaluating one of the largest blunders in US healthcare history. Maybe their flagship hospital on Sunset Blvd. in Los Angeles is going to be delayed more than another year because the inpatient side of the project is in shambles and they made no contingency plans for how to open the hospital with the legacy systems. Maybe the four (TOTAL, out of more than thirty) hospitals where inpatient is live are fed up.

    Maybe its time for Mr. HIStalk to find out just how much is REALLY done at this point, on the largest (spending) project in US (civilian) healthcare history?

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