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April 15, 2008 News 6 Comments

From Pretty Kitty: "Re: Fletcher Allen Health Care. It is a full Epic implementation, managed by CSC. It will take up to five years to complete."

From Inside Outsider: "Re: Vista vs. XP. Now is a great time to go over to the Apple store and see what the future looks like. If you need a Windows security blanket, you can run Parallels or Boot Camp and use Windows as well."  I wish the price was closer to my usual beige box PC. In fact, news came out today that a company is offering a $399 Apple clone with a lot more horsepower, at least until Apple shuts them down (which will probably be in the next five minutes).

Do you work for a hospital? Would you mind telling me (anonymously) your job title, the hospital you work for, and its location? I’m just curious who’s reading. The survey is here and it will take less than 30 seconds. Thanks.

Former Misys Healthcare CEO Tom Skelton ended up here. Don’t bother clicking  if you’re not running Internet Explorer since IT noobs built the site using Office (the HTML source is horrendously bloated) so it doesn’t work in non-proprietary browsers.

Listening: The Sword, Gods of the Earth. It’s like traveling back in time to a 70s arena and having Black Sabbath’s Tony Iommi steal your girl and break his guitar over your head during their War Pigs encore. I’m percussing with all four extremities.

Cardinal Health announces $1 million in patient safety grants awarded to 34 hospitals.

Burlington Free Press opines that Fletcher Allen’s $89 million EMR project (their figure) and an impending $32 million claims surcharge to pay for interoperability is good, but premature without a plan to protect patient privacy. Odd: ACLU was an interested party in Fletcher Allen’s certificate of need review.

Philips joins GE in having a bad quarter: flat revenue, profit down 28%. Unlike GE, though, healthcare was a bright spot, with sales growth of 5% and unchanged profit margin. Their problem was TVs.

Jobs: SQL Report Writer (MA),  Clinical Systems Analyst (WI), PathNet Consultant (PA).

E-mail me.

Art Vandelay on Converting to Epic

I am certain much less than $1B is going to Epic as part of the Sutter implementation. From their press information in 2004, it is one part of a $1B+ transformation. I have seen press about their underestimating the Epic install.

The cost of Epic licensing isn’t that high compared with other vendors (Meditech excluded). Big-money Epic installs are due to third-party services, the cost of the client’s staff (if tracked – it varies everywhere), the cost of the infrastructure, and supporting applications like Cache, Oracle, and Citrix. Add-ons from companies like Capsule, Ingenix, Zynx, and Sentillion need their own infrastructure. Those add on a few more million.

The most difficult parts to swallow with an Epic decision are:

1. They will tell it like it is if you don’t have the right quality and quantity of staff, if your support processes and tools are weak, or your training isn’t very good. Few people want the truth. Everybody loves the "high" of the "first hit" off the promise of the future without thinking about what it will take to get there.

2. They will tell you data conversion is possible. FORGET IT. You can do basic conversions like MPI, basic schedules, and possibly "flat" clinical results. Do not entertain the idea of complex data conversion (insurance, battery style micro-lab data, accounts receivable) without God-like patience, a fat wallet, and a healthy dose of contingency time. Epic’s M data structure is 10x more complicated than a flat file or relational format. I have never had the pleasure of trying M to M. I could only imagine how much balder I’d be.

3. Epic’s flexibility is a killer. It will be a long, expensive, and hard installation and support challenge if each hospital and clinic is allowed to dictate the full scope of decisions. Avoid this with a strong base install model, good governance processes, and negotiation of changes.

4. The recurring maintenance fees can be pretty high. Smart organizations spend more time negotiating the recurring costs, especially the transaction-based fees. Ongoing cost of ownership can be an eye-opener.

So – $1B isn’t going to Epic. The company’s total revenues in 2006 were $422M. The company supplying the consulting services is making the gold mine.

Inga’s Update

Hope everyone had a happy tax day. I had to write a check, so mine could have been better.

Another nice win for eClinicalWorks. Salud Family Health, one of Colorado’s largest FQHCs, will implement ECW for more than 100 providers.

The Defense Medical Logistics Support-Defense Logistics Agency awards $54.8 million of your money to CACI International. The five-year blanket agreement covers professional services and information technology solutions for managing medical supplies and services for military forces.

Microsoft wins Frost & Sullivan’s 2008 Global Healthcare Information Product of the Year Award for HealthVault. Frost & Sullivan said, “The HealthVault initiative is a definitive step towards making online sharing of personal health information a mainstream activity that has the potential to improve doctor-patient relationships.” Perhaps. However, how much value does such an award have when it comes from a company that announces 3-4 “awards” to various companies on a daily basis?

Greenway Medical says it’s now the largest integrated, single-database EHR/PM/interoperability solution provider for OB/Gyns, with more than 260 practices on board. That equates to 1,334 doctors, 7,921 users, and 532 sites.

The town of Middleton, WI wants a piece of the hotel business generated by visitors to Epic Systems. Epic apparently generates 60,000 room nights a year and Middleton wants to offer free shuttle service between the airport, Middleton hotels, and Epic to take advantage of some of that tourist business. To get from the Madison airport to Epic headquarters, you have to travel through Middleton.

Sage predicts its financial results will meet analysts’ estimates, though analysts are still concerned about the company’s North American growth. One of the financial experts noted the healthcare division is still facing “zero revenue growth and flat margins.”

I suppose we have all concluded that hospital staffers in Hollywood like to peek in medical charts to feed the country’s gossip fix. In New York, however, all one medical worker was concerned with was how those charts could make him a buck. A New York-Presbyterian Hospital/Weill Cornell Medical Center employee is charged with stealing nearly 50,000 patient files and selling at least a couple thousand of them. Apparently he got $750 for one sale of 1,000 charts, which included patient Social Security numbers but no medical data.

E-mail Inga.

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Currently there are "6 comments" on this Article:

  1. You don’t have to go through Middleton to get to Epic/Verona from the airport. In fact, that’s the long way around.

  2. Wow. Tom Skelton and Rich Goldberg – two members of the Pittsburgh mafia. They mightily struggled to deploy technolgoy at Misys and now they are consulting. All the best to their customers.

  3. Art has a “spot on” analysis of Epic above. The only disagreement is loading old data. It is time consuming but results can be loaded. It was not a small effort, but it did bring comfort to the clinical staff and keep them from going back to the old system to look at results. Epic says flatly that they will not convert financial data. Tried it at some early customers and it was a disaster every time. Surprise for us was not Oracle or Cache which are both high dollar, but Citrix. We found out and had to add on a complete Citrix infrastructure and that included a couple of FTEs to install and tweak it.

  4. That Frost & Sullivan Award is no big deal as they give out such awards in numerous industry sectors. What most do not know is that vendors actually PAY Frost & Sullivan to receive the award. While I typically do not like to trash industry analyst firms, F&S’s reputation in the analyst community is pretty low.

    As for the sale of those medical records, what I find interesting is that there appears to be little street value for actual medical info. What sells are addresses, social security numbers and phone numbers – all the info you need to set up bogus accounts. Maybe the only market for medical records is the celebrity market and all this privacy stuff is a bit overblown..

  5. John – I wish the inappropriae access was just for celebrities. Unfortuately, every day privacy issues occur in small community hospitals too. Don’t under estimate the current wife working in the business office who checks up on the ex-wife’s medical records as well as the entire ex-wife’s family.

    The difficulty in monitoring inappropriate access is wading through access logs trying to determine if it was within their job responsibilties to look at a particular patient. There are some electronic tools, but the whole process is time consuming. And then you deal with management who doesn’t want to admit there is a problem and deal with it.

    Just my two cents worth….Privacy is just not for the celebs.

  6. Medical data has tremendous value but it is already available for purchase legally. so you don’t need to stael it. Three States have attempted to block the sale of pharmacy records and were blocked by the prescription-data-collection firms IMS Health Inc., Verispan LLC and Source Healthcare Analytics Inc. filed federal lawsuits when States tried to pass laws keeping a doctor’s prescribing practices confidential. IMS ia a billion dollar a year company.

    Your RX history is now also being used as a surrogate for your medical history The founder of Next2Gen (now part of United Healthcare) brags in his resume about how so use someone RX history to determine their risk for property and causality insurance. So when you buy a new house and go to get insurance, guess what your spouse’s treatment for cancer or depression will influence the rate you get.

    “In stealth-mode, Nex2 built what is arguably the largest, near-realtime drug history databases in the world, with over 200 million American’s five-year running drug histories online (over 12 TB total). The databases are updated every 24 hours by every retail pharmacy in America via the PBMs” Nex2’s business was to take insurance underwriting (not just life, but also long term care, P&C claims, and individually underwritten health insurance) from 90 days to 10 minutes

    Unless you add “nosie” to the data-base there is no such thing as de-identified data.

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