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News 8/6/08

August 5, 2008 News 15 Comments

From Outside Looking In: "Re: Picis. I read your column with regularity and I also see that Picis is a Platinum sponsor. After their acquisition of Lynx, you would think they have one of the best ED products on the market, so why then do I hear that layoffs are imminent at this company? My source tells me they have had a mandatory non-client related travel ban for over a year as well as a hiring freeze. He says that while all of these bans are in place, they continue to hire senior VP of this and senior VP of that. Sounds like a case of too many chiefs and not enough Indians. Your thoughts?" We asked the company and received this response from Mike Mitsock, chief marketing officer: "We believe Picis does have the best EDIS on the market, in particular the most complete integration between clinical and financial functionality for the ED. According to Millennium Research (December, 2007 report), we hold #1 market share, which we view as validation of our vision and ability to deliver. As for the other comments, we do not discuss internal financial policies, but will always manage the business as efficiently and effectively as possible. We have hired 100 employees this year, at all levels, and we continue our hiring in areas of focused investment."

From The PACS Designer: "Re: mashups become RIAs. TPD has posted about mashups in the past and now those mashups are getting more robust by becoming Rich Internet Applications (RIAs). Even Bill Gates has been commenting on how they will evolve in the WEB Operating System (WebOS) to enhance the information presented. With the diverse number of silos in healthcare, the RIA experience would be a good way to unlock those isolated stores of patient data in radiology, cardiology, pathology, and other applications. The eXtensible Markup Language (XML) will play a key part in migrating these data stores to the WebOS." Link.

From Johnny Smooth: "Re: UHG. Was at the Healthcare Quality Conference yesterday in Boston. Got to talking to a United Health exec who informed me that they have signed an agreement with Google Health and have a pending agreement with HealthVault. This backs up UHG’s previous statement that member records would be made portable. Individual made mention that the Google Health relationship extends beyond just claims records transfer and includes a technology partnership regarding UHG’s OMX." 

From Lazlo Toth: "Re: TPD’s comments on Kensho. Actually the OVF standard didn’t come out of Kensho, it’s a formal standard adopted by the Distributed Management Taskforce and was developed by  Dell, HP, IBM, Microsoft, VMware, and XenSource (now Citrix). The standard is still a work in progress. The OVF standard only addresses the packaging of a virtual machine image and doesn’t address management of virtual environments. There are two important standards that address management of virtualization : libvirt and CIM. Historically virtualization vendors have been reluctant to adopt open management standards that break the bond between the hypervisor and management platform since it removes the vendor lock in. In many cases vendors such as Citrix and VMware have created their own APIs (XENAPI and VMWare API) rather than adopt standards that would allow cross hypervisor management. Libvirt and CIM (DMTF’s System Virtualization, Partitioning and Clustering schema) are two open standards that hold the promise of allowing hypervisor agnostic management. Today, IBM, HP, Red Hat, Sun, Novell, Futjitsu, Hitachi and many other ISVs and OEMs are contributing to the project. While Kensho has been announced the only details available are in the form of press releases and blogs from Citrix. We’re looking forward to seeing the project or product in September." I didn’t understand any of that except the list of vendors, but I’m humble enough to admit that fact and leave in all the juicy details for those who are better informed. I figured hypervisor was another name for Luke Skywalker’s googles.

From WirelessGuru: "Re: Sonitor. On July 15th, Sonitor Technologies laid off 40% of its worldwide staff, including four people in the US Largo Headquarters. The US staff is now down to three people. It makes you wonder how they will support their newly announced contract with 3M. Is a deal with 3M bigger than we think?" We tried to contact the company and didn’t hear back, but another source confirmed. I like the company (disclosure: they sponsor, but I’m talking about seeing their RTLS product at HIMSS, which was one of the coolest things there).

From Neal’s Pizza Guy: "Re: no pizza for you, Cerner! Any readers know if the head honcho at iSoft likes pizza?" Link. NHS may give iSoft some business via CSC now that Fujitsu has slunk off.

From Nep O. Tysm: "Re: recruitment. Here is how some HIT companies do recruitment. From a contingent recruiter to a potential candidate: ‘Eclipsys let me know yesterday that there is going to be a 2 week delay in moving forward on this VP position. A member of the Eclipsys’ Board of Directors referred a candidate who is being strongly considered for the VP of Ambulatory and eHealth Solutions position. I will keep you posted on the outcome of this interview process. Again, I am sorry for the delay, and thank you for your patience.’ I guess it helps to have friends in high places."

From EMR_Dude: "Re: CCHIT. You’ve had a number of interesting items about CCHIT EMRs lately. Here is another. I had a long discussion with the head of engineering for a major CCHIT vendor. His feeling is that CCHIT is holding back some innovation in the industry. He said that well over 50% of his resources go into CCHIT ever year and some projects get pushed to the bottom of the list due to lack of those resources. What you wind up with is a bunch of ‘me too’ vendors that all have pretty much the same features with little differentiation between them." I not so sure that wasn’t the goal. Commoditized functionality = commodity pricing = increased adoption. Theoretically, anyway, since EMR adoption hasn’t improved much.

Inga dropped this gem my way in an early morning e-mail salvo today: "Do you really think I’m neurotic?" To which I replied, "No, but I bet everybody thinks I’m paranoid."

Dewey Howell MD, PhD, CEO of Design Clinicals (disclosure: they’re an HIStalk sponsor, but this has nothing to do with that fact) has an excellent editorial in EHM. Snips: "How can you expect to impact patient care and safety if you don’t engage the entire team of providers using a comprehensive, multidisciplinary approach? Current CPOE systems don’t accomplish this. They are designed for docs. Period … I, for one, am weary of hearing that doctors’ lack of acceptance of computerized systems is the problem. It is often said that doctors ‘aren’t ready’ for systems or that it takes a cultural shift to get doctors to practice differently. If online banking or shopping took me twice as long as running down to the local branch or grocer, and at the end of the transaction I wasn’t sure if it really went through correctly, I would never become an adopter." 


Welcome to new HIStalk Platinum Sponsor TeraMedica of Milwaukee, WI. The company offers the Evercore Clinical Enterprise Suite, which manages and integrates clinical objects like images into the electronic health record (imaging experts like TPD can probably help me out with a better description). Their client list isn’t too shabby: Mayo, Marshfield, MD Anderson, Meriter, and UC Davis, to name a few (and check out their medical advisory board). Thanks to TeraMedica for supporting HIStalk and the folks who read it.

You’ll soon notice some minor changes in HIStalk’s appearance, so don’t be alarmed (smaller logo, tighter layout, smaller ads, etc.) Readers and sponsors alike have been asking for some tweaking to improve readability and page loading times, so we’re nearly there.

Jobs: Account Executive, HIS Consulting; EMR Software Staff Development, Principal Account Systems Engineer – Healthcare, Epic Ambulatory Trainers. Sign up for job blasts.

McKesson CIO Randy Spratt ticks me off with his keynote at LinuxWorld (do they really need for-profit vendor speakers who only offer Linux options on cheap servers?) US healthcare is a national tragedy, Randy opines without obvious original thought, but his novel solution is that the government should increase reimbursement (i.e., stick taxpayers) so that hospitals can buy software from vendors like the one that sends him a large paycheck (that being more important than hiring clinicians or providing charity care, apparently). He disparaged 30-year-old applications "written in MUMPS," omitting the fact that those products routinely kick the bejesus out of multi-heritage (aka, spit and baling wire integration) amalgamations of equally old and disparate applications ("integrated" and "developed" being unfamiliar concepts to certain vendors). Glass houses.

I’m feeling a slight pull to attend a conference, perhaps facing a twixt-HIMSS need for the PowerPoint-lit ballrooms and pointless glad-handing. Could be WHIT or CCS. Anybody going?

The outsourced IT shop at Children’s Pittsburgh is the first to achieve eSCM Level 2 certification. I don’t know anything about it, but I figure if cross-towner Carnegie Mellon is involved (they created the capability maturity model, I think) then it must be pretty good.


Premise CEO Eric Rosow and Team Freeman raised over $5,000 for The Jimmy Fund (Dana-Farber) in the Pan Mass Challenge this past weekend.

I don’t frequent many liberal sites even though I’m becoming a disillusioned right winger, but this editorial is pretty good (written by the president of AAPS, which I’ve barely heard of). "What all this medicine is breaking is the bank. Neither party is willing to admit that the federal government has made promises that cannot possibly be kept, and incurred debts that cannot possibly be paid. That’s not the fault of either party, both of which promised to just pay the bills and not interfere. It must therefore be the fault of those sending the bills. Accordingly, it is they who must be ‘fixed.’"

An interesting quote from the Eclipsys earnings call: "Q2, 2008 operating cash flows were negative $300,000, down $6.1 million over the same quarter of last year. We had negative free cash flows in the quarter of $10.7 million. Day sales outstanding were 80 days, up six days sequentially and seven days year-over-year. We believe this temporary increase is partly due to the transitioning of our billing function to India."

AMICAS Q2: revenue up 9%, EPS $0.00 vs. -$0.01.

Hartford Healthcare, parent of Hartford Hospital, chooses Allscripts for EDIS and EHR.

Big layoffs at Cape Cod Healthcare. Speaking of which, new poll to your right: is your employer laying off? The poll service now allows comments, if you’re so motivated.

Thanks to readers who read, commenters who comment, and sponsors who sponse. My pre-HIStalk life was pretty dull five-plus years ago (it’s no rave party now, but at least I can tell Mrs. HIStalk I’m working when I’m derelict in my duties to her as I bound off to my sanctum sanctorum to tickle the Logitech ivories).

E-mail me.

HERtalk by Inga

Last week Mr. H mentioned a couple of tiny ethical dilemmas we were facing. Here’s my two cents. Regarding the company that wants us to post a CEO commentary but supposedly has an anti-blog policy, I am going to give them a bit of slack. Perhaps it is the case of the right hand not knowing what the left hand is doing (is there an HR policy that marketing doesn’t know about?) Perhaps management does not believe all blogs are equal and HIStalk is considered an elite, more professional publication (my favorite theory). Perhaps they just made a judgment error. In any case, I would love to hear an official (even anonymous) response from this company.

Regarding the other company who offered up a CEO but could only deliver a marketing VP or GM, I think it was simply a case of a PR person unintentionally overpromising (surely you sales types know how that can happen). What I did find not nice was the company’s position that a mere blog wasn’t worth the CEO’s time. I wonder if anyone even asked the CEO’s opinion on the interview. My guess is that this CEO is so far removed from the day to day PR activities that said CEO is oblivious to the controversy. I’m blaming the handlers.

Wonderbread had mentioned that most docs didn’t seem concerned about sending claims off-shore for processing a la athenahealth. Wonderbread would rather keep things stateside if possible. I think finding an HIT company not sending some sort of work offshore is becoming increasingly difficult, though some companies are more open about the policy than others. Selecting a vendor based on whether or not some processes are outsourced internationally may not be practical any more. Which reminds me: I had to get help on my Dell a couple of weeks ago and simply judging from the very helpful gentleman’s name and accent, I’m pretty sure he wasn’t from Texas. Dell doesn’t advertise that its support comes from outside the country and I doubt knowing in advance would have kept me from buying my Dell. My open mindedness about the whole offshore thing might change if Mr. H tried to outsource me, I suppose.

Evangelical Community Hospital (PA) will provide Allscripts EHR for its 40 employed physicians and 60 affiliated doctors. Also, Hartford Healthcare (CT) has selected Allscripts EDIS for two hospitals and EHR for its 200 physicians in affiliated medical groups.

Those UCLA Medical Center employees are snoopier than we thought. The CA Department of Public Health announces that 59 more employees improperly peeked at patient medical records, bringing the total implicated to 127.

Here is a universal truth about shoe shopping: if you find a fabulous pair of $100 shoes for $23, you HAVE to tell as many people as possible. Like I just did. (The same formula works for $400 shoes, though my HIStalk gig does not afford such luxury … but I’m not complaining).

Going green is big at HP, where new technology has yielded energy savings about the same as removing 1.1 million cars from the road for one year.

The street seemed to like athenahealth’s earning report. Shares were up 21% Tuesday.

I’m guessing the street will also like the earnings report of Allscripts, which beat expectations by $0.02/share. Excluding non-recurring items, earnings were $.13/share; revenues rose 16.4% year on year, also above estimates.

Kaiser announces a 68% decline in overall income in Q2 compared to the same period last year. Operating income fell 43%, though operating revenue rose 7%. With capital spending and membership remaining flat, Kaiser is blaming the declines on market turbulence.

The HITransition folks have a new low-cost data service for providers, billers, and clearinghouses that need to add Provider Taxonomy codes to their billing databases. Provider Taxonomy is a standard code set that specifies a healthcare provider’s specialty or care setting in electronic health insurance claims and has been adopted by health plans as a way to resolve NPI ambiguities.

Microsoft researchers studied billions of electronic messages between 180 people and concluded that on average any two strangers are linked by 6.6 degrees of separation. (I guess if you are Microsoft you can afford seemingly frivolous studies.) Meanwhile, I am tingling just thinking how close I am to knowing George Clooney.

In one of those press releases that doesn’t say a whole lot, Nuance announces that almost 300 healthcare organizations in the greater NY metropolitan area use a Nuance solution. What I found most interesting is that one in 14 Americans live in the New York region. When you take into account the six degrees of separation thing, it made me realize that next time I go to NYC I probably can find a few hundred New Yorkers that I almost know to let me bunk in for a few days.

QuadraMed announces its Smart Identity Exchange (Smart I/X) solution is now generally available. Smart I/X is designed to help hospitals and HIEs identify, reconcile, and manage patient records across multiple data sources.

In the town made famous by Merle Haggard, DocuSys teams up with CPSI to provide Muskogee Community Hospital with DocuSys’ anesthesia information system. The physician-owned, 45-bed hospital is scheduled to open in early 2009.

D2 Sales lands a nice sale to UPMC, which will use the My Patient Passport Express kiosk for its patient check-in program.

A.D.A.M. names Dr. Alan Greene to the newly created post of Chief of Future Health, responsible for helping drive strategy for consumer-focused health initiatives. Am I the only one who thinks the title is a bit goofy?

Still haven’t heard too much about anyone’s summer vacation, although a reader did forward me this link about a traveling fellow named Matt. If you like the idea of seeing (or dancing around) the world or just want to smile, check it out.

E-mail Inga.

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Currently there are "15 comments" on this Article:

  1. Thanks L.T. for updating all of us on OVF as TPD certainly wants all who contributed to the OVF specification to be recognized for helping simplify virtualizations to speed their adoption. Just wondered, are you the Lazlo Toth that’s a comedian, or the geologist who hammered Michelangelo’s sculpture! Or maybe you’re the mathematician or really the journalist (now for HIStalk) mentioned in the Wikipedia!

  2. Dear Nep O. Tysm,

    What you say is so very true. We feel it here in the trenches at all levels. And it hurts so badly. Very senior experienced people in the company are managed by ‘no head or tail idea about healthcare’ friends of the management.

    Almost looks like the managment is operating high on drugs, w/o any clue about the ground realities.

    But somehow it all is seeming to work presently. . The numbers are better than ever before.And One does wonder if there is a method behind this madness.

    Maybe we all can learn , that at times a fresh perspective is a better than old age expereience.

  3. AAPS is the most libertarian right wing organization of doctors in the country.I don’t think MrHISTalk’s idea of liberal meets mine. Meanwhile Alan Greene of drgreene.com and ADAM fame, has been getting certified as an organic only eater. You didnt know that was possible, did you?

  4. ” if you find a fabulous pair of $100 shoes for $23, you HAVE to tell as many people as possible.” Call me sexist, Inga, but…

    A woman would tend to say “Wow, I just got $100 shoes for a mere $23.” Whereas most guys would tend to say “I’m glad I didn’t get ripped off paying $100 for $23 shoes.” Too fine a point? I think not.

  5. Several years ago Dell followed the trend and outsourced tech support to foreign lands, and I think they were truly shocked by the outrage of customers. Dell, up to that point, was still riding high as perhaps the best and most reliable computer maker out there – but the backlash from outsourcing was enough to destroy that very quickly – and they pulled support back. But, Dell, always creative, didn’t give up.

    When I re-upped my Dell tech support contract (few months ago), I was given the option to always have US-based help if I wanted it. I don’t recall if that cost me more, but I took it.

  6. My last company posted payments as part of our RCM service.. The current job market meant we had to pay some one 12.50 an hour plus benefits, so lets call it rounded $15.00 per hour total cost.. The company we out sourced too, was charging us (mind you with margin) $7.00 per hour.


    We cut our costs in half. Which was very good, for our bottom line. Not because we were reaping all the savings on a cost basis. In fact we were losing clients b/c we were over priced . We had to out source to save our business, and save our clients. We had to cut costs to cut price.

    Why we outsourced….
    1) To compete in the market

    2) Logistically we could not find people to work. People would not drive that far to work were we are.

    3) We could not move our operations of payment posting operations to a low cost of living locality.

    4) Finally, there are some jobs Americans will not do, well.

    Personal Comment:
    I wish we did not have to outsource b/c I have pride in America. I have pride in having a work family/community. But, I also like having a job and an income.

  7. TPD also welcomes TeraMedica, and am glad to see you advertise agnostic archive solutions to HIStalkers. TPD participated in his first agnostic archive solution almost ten years ago at the Cleveland Clinic and found that going agnostic is both a silo breaker and a great way to make an institution more efficient by reducing the overall cost of storing data and image files. The trend to go with agnostic archives will be accelerating in the years to come and also simplify the issue of DICOM and HL7 interfacing for everyone when it comes to storing image files and other objects. Once again, welcome on board!

  8. Pride in America

    Ditto to the all the sentiments in this blog and responses. Albeit national pats-on-the-back, let’s review how the global community observes our health system performance:

    Yeah! America is #1 in health spending per capita better than 191 other countries of the world. (300 million pats-on-the-back for our citizens)

    Yeah! American is #l in attaining the goal for the level of health responsiveness over 191 other countries health systems. I guess throwing money at the problem of access really works.

    Keep patting yourself on the back – – We deserve it.

    But how come America is #37 just one nation above Cuba #39 in the overall health system performance? Well I guess this points out that capitalism beats out socialism every time by a margin of 1 country. Oh BTW – that country between America and Cuba is our good friend Slovenia #38.

    But how come America is #72 in the level of health performance and our Cuban neighbors slip into #36 in the world of health performance? H-m-m-m-m. The level of Health performance has something to do with that confounded calculation for Disability-Adjusted Life Expectancy. They are always adjusting things in the world. Kind of sounds like Andy Rooney.

    I wish someone had the answers to the “but” questions and do something about improving our World Health Organization’s Ranking of global health systems. Of course, these statistics originate in the World Health Report Statistics 2000 Annex Table 1 and hopefully America will have addressed our world ranking by 2010 World Health Report Statistics and bet out Cuba. No disrespect to Cuba because I have many wonderful Cuban friends, but competition is competition in the healthcare market. Right guys?

    Please don’t shot the messenger 🙂

  9. Mr. Holt,

    You say “libertarian” and “right-wing” like they are objectionable terms!

    Nothing wrong with Libertarians. From looking at the site, I suspect that “free liberal” could be interpreted as “classical liberal.” They added the “classical” after FDR stole the term “liberal.”

    From what I have read of your work, I have a feeling that your definition of liberal is far to the left of what most of us would define as “liberal.” Today’s libertarians and conservatives are yesteryear’s classical liberals. Today’s liberals are yesteryear’s “progressives” in the Roosevelt and Wilson traditions. Such lofty forbears you progressives have.

  10. Although I agree with Dr. Howell’s general point about CPOE (i.e., that they are not designed to improve the whole process), I wouldn’t agree that they’re designed for doctors. They’re still not very usable for doctors. I think he goes on to make that point in his article, although he does lead with that statement. I think he and I would both probably agree that they’re even worse for nurses and other clinicians, though.

    RIAs, or at least the concept of a highly configurable UI that doesn’t depend on a massive single system in the backend, are probably the way the world *should* go, but vendors are completely not inclined to go in that direction. With the 10-year lag in health IT, we can expect to see this corrected around 2017.

    Looking at the agenda, CCS sounds better. The other one gives off that vibe that it will be long on promises and ra-ra speeches and short on useful information. Thanks for pointing it out, I actually may attend (it helps that it’s a 5-minute drive for me).

  11. Re: Nep. O. Tysm & Eclipsys Recruitment Practices….

    1. Multiple VPs and above keep getting announced….jobs were never posted, so were they created for these people? They seem to keep fragmenting leadership responsibilities just for the sake of hiring or promoting into these new positions.

    2. The entire company has been asked to watch expenses, but corporate overhead continues to grow. Andy has taken the charge to clean his own house…is another VP the way?

    3. Related, but unrelated…..Internal recruitment contractors are horribly inefficient, positions that are posted for mid to low level (read billable folks) take months to be filled.

  12. “We share your assessment of McKesson’s CIO Randy Spratt’s keynote at LinuxWorld. It is intolerable that we have a U.S. health-care system where avoidable medical errors are a given rather than a rarity. But, healthcare organizations cannot afford the clinical systems being offered by vendors of proprietary software systems like McKesson. Why is it that in 2008, approximately 75% of hospitals do not use advanced clinical systems to mange their care? Because they need affordable truly integrated solutions, not overpriced complex patched-together ‘Best of Breed” systems. They need an IT partner focused on results and that proves their value everyday, not a vendor who just sells technology. They need open solutions that free them to make the system work, not the vendor lock practiced by proprietary solution vendors. Taking the VA’s VistA system into open source is the disruptive innovation the other 75% have needed. How about a practical proven system that is a fraction of the cost, open and allows the customer to invest the money and time they save into getting the clinical transformation that we all need. With all due respect Mr. Spratt, it is the proprietary software business model that is 30 years old and not serving us well.”

  13. Re: athena offshoring to india – I recently read the post by wonderbread, as well as the reply from inga. First off, I never knew that athena offshored to india, and second od all, I have to disagree with inga’s reply about the good customer service from her dell rep in india. On several occasions I have had to call dell for my grandmother when her computer wasn’t working because she has a hard time understanding them, not to mention they call her back at very unreasonable times late at night due to the time difference. Seeings how my grandmother would be the typical patient demographic calling about her billing statement, do you really think this will be an easy process, and of benefit to patients like this whose physician uses athenas services?

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