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News 3/21/08

March 20, 2008 News 2 Comments

From Gail Kafka: "Re: P4P. Do you or your readers have any data on the Patient Reported Outcomes market and the IT providers in it? I rarely see articles on this topic unless they are from academia or IHI/IOM. If P4P comes to be, which seems inevitable with consumer cost and awareness increasing, then why isn’t there more chatter about measuring performance from the patient’s perspective?"

From Larry Lezure: "Re: Misys/Allscripts. It’s a reshuffle of the deck with two players holding bad cards. All they have in common is overpriced products and getting their asses kicked by eCW, which will benefit even more as they try to retire products. The most interest part of the story is currency arbitrage — a UK company getting a big discount because of the low value of the dollar against the pound." New poll to your right: is the merger a good idea? So far, 76% say no.

From Stan Zloty: "Re: Medcomsoft. I know eCW doesnt like athena’s EMR, but looks like Medcomsoft sure does." Link. The Canadian EMR vendor gives up on direct sales and seeks partners to create an athenahealth-like business model.

From Nicholas Birdcage: "Re: medical devices. With today’s mention of device connectivity as well as Isarona, any thoughts at doing a piece on the players in these market?" I like the idea, but would need some help since I haven’t followed it all that closely.

Intellect Resources will host a webinar on becoming an independent consultant on March 25 at 8:00 Eastern. They’re also starting e-mail newsletters for job seekers and employers, with sample issues coming soon.

I hope everybody made the transition off the old Blog City HIStalk site. Put your e-mail in the "Subscribe to Updates" box to your right if you aren’t getting an e-mail blast when I write something new. You can sign up for the Brev+IT newsletter over to your right, too. And in looking over there, I just realized that HIStalk’s fifth birthday is coming in June.

My editorial this week in Inside Healthcare Computing: "In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System." A CIO e-mailed me to say he liked it, so I’m relieved (I bet the free mags don’t work a Speedo reference into many headlines, at least unless it’s one of those lame puns they love).

The New England chapter of HIMSS will host a killer HIT forum (warning: PDF) in Norwood, MA on April 9. Speakers: Senator Richard Moore, Blackford Middleton, Karen Bell, Francois de Brantes, Girish Kumar, and Jonathan Bush (there are other big names, including CEOs). Frankly, I like the lineup better than HIMSS, plus it’s one big day for $80. I should have had an HIStalk bash there.

Maine Medical’s CEO, Vince Conti, quits for unnamed reasons.

More on Misys/Allscripts. Most of the UK analysts think Misys is paying too much, while most US analysts think Allscripts sold out too cheap. Since the deal has to be approved by shareholders, that could come up in the voting. And, it’s subject to Allscripts getting a better offer, which has happened with similar companies (iSoft, for instance). I doubt John McConnell would make a run of his own on MDRX, but I wouldn’t rule it out. I just have this vague feeling that it isn’t over yet, especially since the response from all camps has been underwhelming.

Stock and HIT expert Sonomaca had some good thoughts on the Allscripts stock message board. He says it will help Allscripts because the company can focus on long-term strategy and not quarterly results. Also, since the market seems unimpressed from the current share price, ValueAct Capital could buy up more of the company. From his calculations, Allscripts shareholders get a Misys Healthcare for four cents per share, based on the one-time dividend (or, looking at the other side of the coin, the market is valuing the combined company at just $4.40 per share, or 10x earnings). Maybe that’s why the Brits were howling.

And in more Allscripts news, former star customer Tennessee Oncology is suing them.

Orion’s Rhapsody integration engine will be used to integrate systems in Saudi Arabia.

A Minnesota hospital admits that a chart error caused surgeons to remove the wrong kidney from a cancer patient, leaving the patient with only its still-cancerous twin.

E-mail me.

Art Vandelay on Cerner

As Mr. HIStalk noted, Cerner is diversifying its revenue streams in a coming bear market. Cerner’s medical device and drug-development are long lead-time investments with major barriers to entry. The barriers include human capital, systems, and process & procedure knowledge to navigate regulations. They also have to handle new competitors. I see this strategy being copied by all the major clinical systems vendors.

The approach we will likely see from vendors will evolve to full venture capital investments. There is power in using some of the de-identified data that should be captured with the vendors’ systems to find potential investments. The vendors can then use the data to prove the value of further investment independent of the necessary FDA regulations (ex: 21 CFR 11). This could keep investors interested. To make this real for everyone, only organizations with "Stage 6" EMR deployment can reliably make this happen.

For Medical Devices, expect copycats to mimic Cerner’s CareAware or Cisco’s Cisco Compatible Extensions (CCX) strategies. Vendors will likely certify and partner as opposed to developing medical devices.

Is this a distraction from their core business? You bet it is. The vendors will view it as a necessary strategy to preserve their publicly traded prospects in a bear market.

What does this mean? Three things. First, R&D will be negatively impacted. The enhancements you expect from your vendors will be slower in coming. Expect the vendors to ask you to share the burden of investment for new functionality saying it is beyond standard maintenance arrangements. In other words, "great idea, you want the function, help us develop it (with your human AND financial resources)." Second, the privately-held companies will be even better positioned to weather the storm. Third, companies that are already diversified (ex: McKesson, Cardinal) have a chance to catch-up or pass their competitors if they focus their investments.

Inga’s Update

For the parsimonious (like Mr. H) here is a great list of free or cheap software products, with substitutes for such programs as Word and Adobe Photoshop plus anti-virus tools.

Time Magazine also published a recent article, Is shrink-wrapped software dead? which included a handy side-by-side comparison of the free solution versus the commercial option. The article’s title reminds me of the bright yellow tee shirt Jonathan Bush was seen wearing at HIMSS which said "Software Is Dead" – to the 4th power. Apparently Jonathan tried to convince his PR handlers to let him to wear the shirt for his CNBC interview conducted during the conference, but eventually was persuaded to wear a more Street-pleasing coat and tie.

I guess I didn’t sound pathetic enough when asking for advice on the NCAA basketball brackets. I had to fly solo on my selections and ended up picking Duke to take it all. I actually hope I am wrong because I have a favorite team I’d rather see crowned, but I wasn’t willing to risk my $10 bet on them.

From Nasty Parts: “I was one of the early guys calling the Misys/Allscripts merger. I’ve been talking to guys from both sides of that divide. Here’s the scary part: both of them think they are in charge. Could be a slow motion train wreck. Wait until the long knives come out and folks start fighting for their areas of authority -  it won’t be pretty. Plus, we are not even yet talking about product go-forward strategies.” If Nasty is right, maybe John McConnell was the smart one to get out of the way now.

From Poo Flinging Monkeys: “Most Allscripts folks feel like they are getting the short end of the stick, as the big M is generally seen as a dead carp around someone’s neck. There are a LOT of folks who migrated from Misys to Allscripts who groaned out loud at the announcement. The Misys folks are a bit relieved as the last few months and years really have been obviously leading up to SOMETHING, but nobody knew what. All knew Vern was coming in, stripping it down, and selling it off. Most think that Misys EMR should have died a while back. The Allscripts product will be the flagship EMR and there will be an obvious push to get the Tiger folks introduced to it. Big open market there. The Allscripts PM is okay, but generally not as shiny and end user intuitive as Tiger, so there will probably be a push to interface those 2 products while sun-downing the Misys EMR product.” Heard that Misys had a town hall meeting for employees today. I doubt that Vern has answers to all the questions, particularly the one that employees are asking most: how does this affect me?

And if you haven’t heard enough on the topic, check out Scott Shreve’s posting at Crossover Health entitled The Lawrie Dowry: Misys Acquires Allscripts in Rushed Marriage. Lots of interesting points out the new “Allscripts-Misys-I-am-NOT-giving-up-my-name Health Care Systems” company.

Minnesota law will require all healthcare providers to use an EMR by 2015. It provides six-year, no-interest loans to help providers get there. The first two loan recipients are Swift County-Benson Hospital and Mille Lacs Health System, which are borrowing a combined $2.3 million.

I haven’t heard if Dr. Peel is gnashing her teeth on this one or not, but genetic research company Perlegen Sciences announces a collaboration with an unnamed EMR vendor for access to the clinical treatment and outcomes data on about four million patients. The information will be supplied from the EMR vendor’s information warehouse. Perlegen will use highly specific inclusion and exclusion criteria to identify and develop genetic markets for predicting patients’ likely response to specific medication treatments. What I find curious is that the EMR vendor remains anonymous. If this particular EMR company believes providing the data is ethical and not in violation of any customer agreements, why not allow themselves to be named?

Duke University will implement Premise’s PatientFlow Platform to facilitate patient flow across its three hospitals.

Big controversy brewing in Texas over who owns the ankle. Seems like podiatrists and medical doctors are both claiming it’s theirs to treat and are going to court to let a judge decide. Lawyers for the podiatrists claim “you don’t have an ankle” because is really part of the foot…no foot, no ankle. Of course the orthopedic surgeons say that if ankles don’t exist then why do podiatrists want to operate on them. Quite the conundrum obviously. I have been told I have nice ankles and I don’t think my feet are nearly as attractive, so I’m thinking I will go with the MDs on this. If the podiatrists win then I’ll have one less appealing asset.

E-mail Inga.

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Currently there are "2 comments" on this Article:

  1. Couple of points on patient-reported outcomes (which are not concepts by any stretch):

    1. Only “patient-reported outcomes” utilized in P4P payment algorithms methodology are related to patient satisfaction measures. Usually only a very small percentage (10-15%) of overall P4P payment algorithm for physician and hospital P4P programs.

    2. Few other things on patient satisfaction – it is very important to note that patient satisfaction measures has not been proven in the medical literature to be linked to improvement in quality measures, there is a movement to adopt standardized reporting instruments (CAHPS instruments), and ultimately too to discern value of this measure to consumers given that patient satisfaction scores suffer from dramatic ceiling effect (e.g., really a difference between a doc with a 89% rating and a doc with a 92% rating).

    3. Patient satisfaction vendor market for hospitals is very mature and dominated by a few large firms including Press Ganey, NRC Picker, PRC, and a handful of other vendors. Pretty much the same for health plans although a few notable exceptions here recently including the Zagat/Wellpoint deal. Market for physicians is much smaller just because their isn’t a requirement by CMS to report patient satisfaction scores (in order to avoid a payment hit) and most physicians simply don’t want to pay a few hundred dollars out of pocket.

    4. Less familiar with market for patient-reported clinical outcomes. Pretty diverse range of applications though including in drug development and health plan programs. Usually most of these instruments are created by academic researchers, vetted through medical literature, and then applied in various situations. Good example is the SF-36/SF-12 that was created by John Ware and a few other researchers. SF-12 is probably the most widely used instrument for patient-reported health outcomes today. For example, Medicare (for managed care enrollees) , VA, and NCQA use this instrument to collect information on an annual basis. Go to QualityMetric (John Ware’s company) to see an example of a company in this space although I am willing to bet that others like Medstat (Thomson) also offer these services too.

  2. Re: P4P Patient Reported Outcomes: There is a solution currently available dedicated to measuring the value of care provided using a patient self assessment tool. http://www.pac-metrix.com. It is based on the Boston University Activity Measure for Post Acute Care. It is a patient self-assessment of three domains: Daily Activity, Basic Mobility, and Applied Cognitive. A patient can track their performance through recovery. The provider can manage and market their performance against national benchmarks. Financial measures are added to the clinical outcomes to track and compare the care efficiency.

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