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August 7, 2008 News 14 Comments

From Ringo: "Re: NHS. With all the problems NHS is having with contractors and ongoing problems with the software, I am surprised they aren’t trying to switch to Kaiser’s vendor. Did Epic turn down the NHS?" I haven’t heard, but I’d bet so.

From Inside Outsider: "Re: AAPS article. Must have been the title ‘The Free Liberal’ that fooled you. AAPS is no liberal organization. In fact, they are think that Rush Limbaugh is too liberal. Dr. Jane Orient is about as right wing as they come. She fronts about three or four conservative PACs that really do nothing more than push her agenda to keep government out of medicine. Her organization is run out of a one-room doctor’s office in Tucson that has not been updated since the 50s. The office consists of her, her mother, and her nephew. They sit all day and listen to Rush and other talk radio and mail out letters to doctors warning them of liberals. During the Clinton administration (remember the good ol’ days?), their sole purpose was to sue Hillary Clinton for every single thing she ever did." I can’t verify one way or another, but here’s an interesting analysis of AAPS that you may or may not believe.
From Brad Delp: "Re: AAPS article. Holt’s distaste for the free market notwithstanding, I think Jane Orient’s article raised some points we rarely consider any longer. Medicine did, in fact, exist in this country prior to massive government intervention. She does seem a bit scared of technology (I try to discourage the use of words ending in ‘phobic’). Those interested in another physician’s point of view on government and healthcare would enjoy Dr. Ron Paul’s ‘The Revolution: A Manifesto.’ For those unfamiliar with Congressman Ron Paul, he is a libertarian-leaning Republican presidential candidate. He is also a physician." I agree. RP is the only candidate to whom I’ve donated money, so I was sorry to see him drop out (this was after I took an online politics quiz and stumbled downstairs to announce, "Honey, I think we’re libertarians.") I liked the AAPS article too, if for no other reason than it nudges people to distinguish between "insurance" and "healthcare."

From PFS Guy: "Re: layoffs. I can confirm the ‘rumor’ of Picis layoffs. I received an e-mail today from a Picis employee who confirmed that he, and others, were laid off today." Condolences to those affected by layoffs anywhere. The poll on your right shows that 25% of the employers of HIStalk readers have laid people off within the past two months. It’s not scientific, but I don’t doubt it a bit.

From Steve Thunder: "Re: HRBs. Bill Yasnoff leaves a few important details out of his post on HRBs. First, he neglects to point out that he’s applied for a patent on the idea of health record banks. Second, while Bill says that several states are working towards this model, he also neglects to point out that he’s involved in all of these initiatives and that the states did so on the advice of his consulting firm. The reality is the HRB model has a lot of problems — there are huge bootstrap issues — providers won’t invest in the interfaces needed with HRBs until there are lots of patients who have them and patients won’t pay to play until providers are set up to provide info. Indeed, it appears that Bill has backed off his initial HRB plan: that patients would play a monthly fee and providers would be paid for each ‘deposit’ to the HRB. To present, Bill has relied on grant funding — it’s quite unclear that the model is sustainable (particularly with the new dependence on advertising, reminders and researchers paying for data)."

From Bumpy Jonas: "Re. HRBs. Non-profits don’t have to hire a for-profit company to run it. There is no reason the non-profit can’t do it themselves or hire a non-for-profit to operate it. Alternative models to advertising could also be other sources, such as employer funded or state grants. An alternative to paying the docs for data could be pushing the emerging trend of malpractice insurers providing discounts to docs that use an EMR to reduce their risk profile – that same logic is even more relevant for care history provided by a HRB to address the our chronic ‘discontinuity’ of care across setting and info silos. We can’t get it right within an info silo, so across silos is a huge opportunity to address high risk, ball-dropping areas."

From oneHITwonder: "Re: PHR. ‘Kaiser Permanente Oakland Medical Center is offering adult patients a free copy of their medical record on a small USB flash drive that can tap into their health history on any computer. A pilot program started July 15 and about 25 people a day are requesting the 1-gigabyte USBs, says Thomas Barbar, MD, an orthopedic surgeon who came up with the idea.’ Interesting approach to a PHR. (published in today’s California Healthfax)  Question #1: Will a provider be willing to access a flash drive that may have a virus (you just never know)? Question #2: If there is a full medical record on the flash drive, and the patient is only being seen for say an ingrown toenail, if the provider looks at the record to see medications, is he liable for reviewing the entire record?"

From Steve Aylward, General Manager, Microsoft Health & Life Sciences: "Re: HSG. Please allow me to clarify the previous comments attributed to others from Microsoft regarding support for the Microsoft Health Solutions Group (HSG) products. Support for our Health Solutions Group products is provided by dedicated support teams within the existing Microsoft support services organization. These employees have expert knowledge of the healthcare domain as well as extensive knowledge of the Microsoft technology platform and the Amalga products. The emerging Health Solutions Group products (i.e., Amalga) as well as those from the Health & Life Science Industry team will continue to utilize and leverage the infrastructure of our existing worldwide support organization."

From Shaker Man: "Re: UCLA. Does anybody know how the new earthquake-safe hospital did recently compared to the other hospitals in the LA area after the recent quake? The new hospital was designed to withstand a much larger quake, so what was the outcome?" Good question that I’ll throw out to you Left Coasters. For what it cost, you’d hope you could do a circumcision during the Richter-ing, which I vaguely remember from some movie or SNL fake car commercial.

From At the Office in August While Others Frolic: "Re: press releases. How ’bout a HIStalk contest to write the worst healthcare IT press release? One could model such a contest on the Bad Hemingway contest, requiring for example that press releases mention HISTalk and Inga in some way, and that the press releases be hilarious. You could also select some real releases as examples to get the HIS ‘hood started." I like it! How many rules could you break? I may crank one up myself if I get time.

QuadraMed gets a $15.8 million QCPR deal expansion with Daughters of Charity that includes care grid, orders, access management, decision support, nurse doc, chart management, scheduling, document management, CPOE, and other apps. CEO Keith Hagen uses the occasion to observe that QuadraMed has already sold more QCPR business than they paid Misys for the entire product ($33 million) last year. The Misys response: "Doh!!!"

In the UK, NHS finally replaces Richard Granger with the two big-bucks positions previously announced. Former Cadbury Schweppes CIO Christine Connolly is named CIO and former pension service CIO Martin Bellamy is now head of Connecting for Health. I like Christine because her former employer makes Stride chewing gum, which sponsored that superficially goofy but surprisingly moving video that Inga found featuring Dancing Matt traveling the world.


Fred Trotter is raving about ClearHealth’s GUI version of VistA, soon to be in Beta (screen shot above). They’ve just posted an online demo. "If you had asked me yesterday I would have said that it might be a good idea for Medsphere to buy ClearHealth. If you ask me today, I would say that it might be a good idea for ClearHealth to buy Medsphere."

Johns Hopkins develops a software prototype for remotely diagnosing traumatic brain injuries on the battlefield.

Medicity’s latest customer newsletter confirms the earlier HIStalk rumor: one of its five new customers is Dubai Healthcare City, where the company will install an EHR system and a patient referral application. I didn’t realize that Harvard Medical School will open a branch on the Dubai campus in 2011. The company also announced an 18-hospital results distribution contract with Adventist Health. Here’s Medicity’s new recruitment magazine (warning: PDF) that talks up the benefits of working there (the golf simulator and pool table isn’t exactly the kind of perks we hospital types enjoy, being more accustomed to a 20% discount on 50% overpriced portion-controlled mystery meat and the occasional chance to peruse celebrity medical records … kidding). Whoever did that magazine is a genius since I was ready to pack up and move to Salt Lake myself and I’m usually indifferent to anything that involves change or effort.

Correction: Eric Rosow’s Team Freeman raised over $50,000 for The Jimmy Fund in last weekend’s bike challenge, not the $5,000 I wrote earlier.

The Advisor Board Company’s Q1 numbers: revenue up 12%, EPS $0.36 vs. $0.38.

A computer magazine mentioned this freeware replacement for Windows Explorer, which is a zillion times better (multiple open windows, for example). It’s just a single 387K executable. Isn’t the idea of a no-DLL application both quaint and appealing, kind of like if Microsoft would finally admit that the Windows registry was a horrible idea? Hard drives are huge and cheap, so those old ideas are trouble-causing leftovers from the dark days of DoubleSpace.

Mike Gleason’s HIStalk article on EMR adoption was such a hit that it was summarized on EHR Decisions, CCHIT’s blog (I didn’t realize they had one until I saw the incoming link.)

Marty Jensen is peeved that Medicare got CMS permission to break its own rules on NPI. "Let’s put that into English for the benefit of the nontechnical reader — say a provider who is dizzied by the inability to get Medicare to pay any claims for the last three months: The same numbers that Medicare said you can’t use anymore as of May 23 — the ones that caused your 837 claims to bounce if they appeared anywhere in the claim — those are the same numbers that Medicare says are okay for it to send in its own 837s to its secondary payers."


The FBI raids three LA hospitals to investigate alleged Medicare fraud, in which hospitals allegedly paid shady recruiters to cruise skid row looking for insured homeless people to bill. The MD CEO of City of Angels Medical Center was indicted last week for fraud. Named in a new suit are several hospital CEOs, CFOs, and physicians. That might be a rallying call to pay caregivers for promoting health instead of cranking out the billable procedures. (photo above: San Francisco Sentinel).

Listening: Tift Merritt, probably more Inga’s taste than mine since Tift’s more mainstream than my usual fare, but I was in the mood.

Here’s the official word from RelayHealth on its just-announced agreement with Microsoft. "The initial RelayHealth-HealthVault integrated platform will bring to the market a new solution which makes RelayHealth an essential part of the HealthVault solution by positioning it as the physician-patient connectivity service. Microsoft HealthVault recognized RelayHealth’s proven ability to provide the means for hospitals, physicians and other affiliated providers to connect with patients and insurers, and collaborate with each other, in a safe and secure mode. The RelayHealth service makes it easy for physicians to electronically prescribe, review clinical data and share appropriate information with their patients or other clinicians efficiently. Hospitals and physician providers using RelayHealth, will be able to market HealthVault ‘enablement’, meaning their patients’ HealthVault PHR can automatically be populated if they so choose." Sounds to me like Microsoft is endorsing RelayHealth as its partner for getting hospitals and health plans to sign patients up for HealthVault, rather than the usual "our EMR now works with HealthVault" announcement from vendors.

Be one of the cool kids: sign up for HIStalk updates in that Subscribe to Updates thingie at the top right. You can sign up for the Brev+IT newsletter there too, although I’m beginning to wonder if it’s worth my effort to write since a lot fewer people signed up for it that get the HIStalk e-mail blast (about 1,200 vs. nearly 3,000, but stats show many of those aren’t opened). I’m open to suggestions on that, although I do like the smarmy and snarky personality I channel when I write it.

Cardinal Health, struggling a bit of late, is considering selling off its medical equipment business, which is a lot more profitable than what would be left (ho-hum drug distribution).

Harris County Hospital District announces that an employee lost a flash drive containing PHI on 1,200 patients, reportedly those with HIV. The county judge, who admits that punishment would deter future voluntary reporting (which is how this loss became known – the guy who lost it said so), still says he should be fired. As always, optimism was expressed that the thief is stupid and the drive was probably destroyed (thieves don’t usually do data-grade destruction, but you never know). Hey, how about a $10 reward for the drive’s return?

Microsoft ships SQL Server 2008. Free Express version here.

E-mail me.

HERtalk by Inga

From Dancing Queen: "Re: Shoes and dancing. While your blog content is informative as usual, I have to step back for a moment to comment on two things. 1) Love the Dancing with Matt link. It was fun and did make me feel good. Loved the music. 2) ‘Where In the Hell is Matt’- Should be replaced with ‘Where in the Hell did you get $100 shoes for $23?’ Maybe you could have a ‘Dancing with Inga and Mr. HIStalk’ at HIMSS next year in Chicago?” Hmmm, not a bad idea. Mr. H was mulling over an Inga kissing booth, but twirling around the McCormick Center could be fun, too.

From Sesame Street: “Re: athenahealth’s offshoring. Companies like Dell have slowed down their offshoring to India and started ‘nearshoring’ to Canada. Why? Because they knew how dissatisfied their customers were with their sub-par tech support. But there is a major difference between someone telling you how to run anti-virus scans in safe-mode and someone in India looking at your diagnoses and procedures. athenahealth and other offshoring billing companies are paying Indians $4/hour now, but as the Indian economy grows, their wages go up, so they go to the next developing nation."

From Indy Man: “Inga, what’s the latest in the device connectivity market? (Company) continues to feed off of their EMR provider partners but they do not appear to have the best overall product. (Another company) has device connectivity, vitals integration, HCIT monitoring, COW/WOW. monitoring and location, the ability to integrate disparate systems, as well as remote monitoring and troubleshooting.” I am unaware of this space, but flattered that a reader thinks I might be so well versed, even if I didn’t include the company names just in case there was a hidden agenda. If you are an authority on this subject, then perhaps you could advise Indy Man.

The board of Virtual Radiologic authorizes the repurchase of up to $8 million of the company’s outstanding common stock after last week’s earnings announcement (22% y/y increase in revenue) and share price drop.

ASP-based Clinix Medical Services acquires MedicWare EMR. Clinix provides PM services and provides billing services.

EMR software provider Noteworthy Medical Systems announces it has completed the acquisition of PM software vendor MARS Medical Systems, originally announced right before HIMSS.

Philips completes the previously announced sale of its 69.5% MedQuist stake to CBaySystems Holdings. Philips received $287 million for the transaction. Not so good for a billion-dollar purchase made just three years ago.

St. Vincent Health System (PA) is upgrading signs on for McKesson’s Horizon Clinicals Care Team release.

A survey finds that 80% of Americans believe the health system needs either fundamental change or complete rebuilding. There is also strong support (86%) for doctors’ use of computerized medical records. Most of the 1004 participants also support electronic access to test results (89%), electronic information exchange between doctors (89%), and electronic prescribing for improving patient care (71%).

The University of Puerto Rico hospital selects Healthcare Management Systems.

The ickiest news of the day comes from the BBC, which reports that numerous NHS Trusts have suffered invasions of rats, fleas, bedbugs, flies, and cockroaches. The story makes mention of maggots in a patient’s slippers, fleas in a neonatal unit, rats in the maternity ward, mouse droppings in a clinic, and wasps in operating rooms.

E-mail Inga.

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Currently there are "14 comments" on this Article:

  1. Brev+IT is great so please give it a chance to catch on. Although I’m a bit worried…either I’m dense or Mr. H. is schizoid. Didn’t recognize his “voice” at all in these snappy comments. I encourage HISTalk readers to check it out.

  2. Hey what’s with all the abuse? Americans think the world “liberal” means left wing, or at least left compared to Ronald Reagan. FreeLiberal is a classical liberal site, as in John Stuart Mill. I wasn’t saying anything good or bad about AAPS (which has some chops as the only medical society to protect many good docs railroaded by the DOJ for opiate prescribing), I was just saying that it wasnt a “liberal” site in the way that 95% of Americans understand the term.

  3. Re: Quadramed sales. As a Misys (now Quadramed) CPR user, the fact that they are making any sales as all is incredible! The weak user interface and even weaker decision support (are the CCHIT certified?) would turn most users off in a second.

  4. Come to think of it, I have not been seeing myweekend Brev+IT newsletter which I had switched to my personal Yahoo account because my work email account sent the it to SPAM. Now it must be that Yahoo is doing the same. Could that be the problem with readership stats?

  5. My apologies Holt. Since “right-wing” is used almost exclusively as a disparaging term, I jumped to conclusions. Unfortunately, these days liberal does mean left wing, again thanks to FDR. Americans (generally) are to the right of Europeans, and like Reagan, deeply suspicious of Euro-style socialism. Some of your published work (articles as well as posts here) indicate a further-left-than-most slant. If I have that wrong, and you are more of a free market guy, that’s great.

  6. That KP is offering a “PHR on a stick”, USB stick that is is nothing new. There are a slew of such offerings in the market today, though most require you to fill-out/self-populate the data fields. Big issue has typically been the fear of viruses, thus little adoption by physicians and the need of data self-entry is also a turn-off- just ask CapMed, an early PHR pioneer who still proffers a PHR on a stick .

    As for RealyHealth and HealthVault, looks like a good agreement for both parties, though not exactly unique as HealthVault has had Medem, another phycisian-consumer communication platform on board since the start. What RelayHealth brings though is substantially more physicians and subsequently consumers.

    And I guess I’m one of the cool cats still getting, reading and enjoying e-Breviate so please don’t toss it into the virtual trashcan.

  7. Here is someone you should consider interviewing on HISTalk if you haven’t already – his response to an AMDIS question on what would you do nowif you were a CMIO was one of many excellent and entertaining posts he has done:

    Subject: Re: “If I only knew when I started out as the CMIO”

    Sorry fellas, just a little attempt at some levity here:


    1. The best features are always in the next version of software,
    which is always one version above the one you just loaded in TEST.
    2. “We’ve got it on the list” is a euphemism for “It’s not getting
    3. Unscheduled downtime will most likely occur just before a
    meeting with a key physician when he or she just got off weekend call
    and the downtime caused him or her to miss their child’s game, play,
    4. When you are in front of the MEC, downtimes are your fault.
    5. Consultants and vendors will always tell you that other sites
    are working just fine.
    6. Nothing the vendor tells you matters because you have a “custom”
    build and deviated from their recommendations.
    7. No matter if you still practice or not, you never have any
    clinical credibility with an angry physician.
    8. ISD and administrators feel doctors are “unreasonable” because
    they want systems to work as fast as a Google search and to have no
    9. Give me a grizzled cynical IT veteran over a newbie promoting
    SNOMED any day.
    10. You always regret free software.
    11. I’ve learned more practical things on the AMDIS list serv than
    in college and med school combined!!

    Robert Murphy, M.D.
    Chief Medical Informatics Officer

    Memorial Hermann Healthcare System
    9401 Southwest Freeway, Suite 1022
    Houston, TX 77078

  8. Wompa1, let’s be clear, in terms of opinion I am on the liberal left, as Americans call it (although I have strong libertarian streaks such as free speech protections, opposing the war on drugs, , etc). I was just being accurate about MrHISTalks remaks. I believe in the free market where it works (computers, food, the stock market) and in regulated markets where they don’t–e.g. health insurance.

    Right wing in the American perspectives means Republican which means activist conservative (e.g. let’s invade Iraq, take away civil liberties, loot the Federal government, etc, etc, mixed with a heavy dose of Christian fundamentalism and actually pretty opposed to most principles of the free market tha John Stuart Mill or Adam Smith would approve of….

    AAPS is a weird mix of both Conservative & Libertarian (Classical Liberal) while sadly the last 8 years we’ve been suffering under an Administration delivering just the former.

    As for your comment about Americans being to the right of Europeans, I’d be more prepared to believe that if lower economic echelon Americans actually voted in numbers comparable to Europeans of similar socio-economic ranking. As it is only about 50-60% of Americans vote and younger, poorer and darker Americans vote at a much much lower level than that. I suspect that if they voted at the rates of their European counterparts (let alone Australian–where they HAVE to vote), the overall political results would be rather different.

  9. IT question: say you are a large publicly funded academic health center that is caught in the middle of an embarrassing funding crisis. You are also getting ready to open a major new building as part of your overall clinical campus to replace older facilities (inpatient mainly). Inside the crisis is a large project to implement an EMR from one of the mainstream vendors. Funding levels for the project are questionable as it is unknown how the opening of the new facility will impact the project.

    Your funding crisis is caused by weak internal controls over budget and expenses. No theft just poor management. To fix the problem, you need to focus on re-gaining control over this core management function. I know that the notion of EMR ROI has been beaten to death but is it logical to continue with this expensive project or would it be more prudent to simply put this project on hold for a year until finances stabilize and the institution can focus on adoption?

    Real situation, looking for the group’s thoughts. No sense in beating on the organization for the problem, as Gregg Allman sang they are well aware of them.


  10. Mr. Holt,

    Thanks for your comments. I am aware of the direction in which you lean politically, and I am not attacking you. I am always interested in civil discourse. We have had growing government regulation in the healthcare market for decades, and yet we are ever more unsatisfied with it! If something does not work, why try so hard to reform it? Why not tear it down?

    I must disagree with your analysis of the American political spectrum. Conservative and right-wing are not interchangeable terms, though they are often presented that way. Conservative and Republican are also not interchangeable. While some conservatives may be Republicans, the majority of Republicans do not qualify as conservatives, McCain included. Truly, it is our terminology that is at fault here. There are Taft Republicans, Goldwater Conservatives, Neoconservatives, Paleoconservatives.

    After reading more abut the AAPS, I might have to donate to them. I like their style.

    To your comments on the voting population of the U.S.: well, we really only worry about those who trouble themselves to vote, don’t we? Many of the European states, have a national holiday for election day. What an excuse for a day off. Motivated citizens will vote despite the obstacles. As for Australia: I did not realize they were so totalitarian. Compulsory voting? I can’t imagine such a thing in an ostensibly free country. Voting is no mark of freedom, many tyrants are elected by democratic means (Hitler, Hussein, Bush, etc.). Coerced voters will never think of anything other than themselves. No wonder Australia gave up its guns.

  11. prairiesky: I just got done leading a major system implementation that was happening at the same time as a hospital move at an AMC. It was so “fun” that I updated my “list of things you must never ever do, even if it means leaving the job” to include “doing a major system implementation at the same time as another major project that involves the same user groups”. Hospital moves involve everybody, and are highly disruptive, so they’re about the worst one to go alongside.

    As far as funding, I’m not even sure how a publicly-funded AMC could do a mainstream vendor EMR implementation at the same time, none of them have that amount of money! I didn’t have that issue, and I can’t imagine how much more difficult that additional challenge would have made it. Since the cost for training comes at the end, I don’t think you want to see that part get cut, or your system will fail. I recommend to delay.

  12. Wompa! I think we understand where we’re each coming from.

    However, reducto ad absurdum, if only one person bothered to vote, would it be OK for them to impose their will on everyone else. (I think there’s a new movie out about that.)

    Is it “not bothering to vote” if you fail a “literacy test” as was employed in the South in living memory? What about if you’re a “felon” as defined (wrongly) by the State of Florida and are denied the right to vote?

    So somewhere in here there’s a slippery slope.

    Of course, if I’m the only one voting, then this is all OK by me 🙂

  13. Our facility was to go live on Picis ORManager next week. We have had a ton of issues…the most disturbing is that the Picis PM just didn’t show up one day…no longer employed…Then, the replacement, didn’t make the next conference call.

    What in the world is going on there. We are pulling the plug on Picis.

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