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Monday Morning Update 12/15/08

December 13, 2008 News 17 Comments

From Orlando Portale: "Re: Being John Glaser. I like John’s recent post, but I’m disappointed that he left off one of his key phrases, ‘Core Nucleus’. Recently, we attended a meeting at Brookings Institution, where he must have said ‘Core Nucleus’ at least 30 times! The absence of ‘Core Nucleus’ from his post would indicate that it’s not in the ‘Core Nucleus’ of his lexicon; therefore, we may conclude that it is reserved for special circumstances where a distinct focus on ‘Core Nucleus’ is his wont." Well, you know star chefs sometimes leave out a recipe’s key ingredient just to make sure you don’t steal their thunder. I also was pleased to notice that some readers got in the spirit of his glossary by using his key words in their comments on the article, which gets them extra style points. Very cool (see?)

From oneHITwonder: "Re: HouseCalls. The MGMA listserv reports that HouseCalls is changing its business model from selling software to being an ASP only. They announced that, effective just three weeks from now on 1/1, they will no longer support anyone who already has their product. Even if you’ve already purchased it, you still have to start paying a monthly subscription fee. They didn’t even bother to contact users, apparently." HouseCalls is sold by TeleVox of Mobile, AL, which ironically bills itself as "high tech, human touch" despite apparently not bothering to let its customers know it was about to make them unhappy. Granted, subscription licensing is somewhat new to the industry, but let’s not be stupid about it.

From GE Kills Healthcare: "Re: departed executive. Yet another example that GE Healthcare folks can’t cut it in real HCIT organizations. Allscripts COO Ben Bulkley is odd man out at Allscripts after one year on the job. Tullman paid a huge fee to Heidrick to get him just 18 months ago." His LinkedIn profile shows him gone as of September and now an entrepreneur-in-residence at San Diego’s CONNECT, where he was already a board member.

I didn’t want to run a second e-mail blast since it’s the weekend, but HITMan Dan wrote a great HIStalk piece on some cool, cheap techie Christmas gifts (with pictures). Guys, surely your sexy lady craves a USB Aromatherapy Burner. Mrs. HIStalk will be so surprised when she opens that necklace-sized package, especially when she finds out how sensible I was in paying only $5.99 for her gift!

The Wall Street Journal quotes athenahealth CEO Jonathan Bush on why any government healthcare IT investment should not include subsidizing software, which he compares to propping up Big Three car makers struggling under an obsolete business model. "The damaging side would be if help from the government ended up in the form of subsidies for broken approaches that have not worked … then broken purveyors of the broken approaches would be able to live longer and not die. Software isn’t the dominant approach in financial services or retail banking or anywhere else, and it shouldn’t be in health care."

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I can never figure out how those wacky but wicked smart guys from Healthcare IT Transition Group make money since they give away a lot of stuff (I’m thinking they must have rich families who just let them do whatever interests them instead of working real jobs, kind of a dot-Mom thing). Their latest is a PC-based provider lookup offering, described by Michael: "Everybody wants some way to do provider searches, but we designed it with claims in mind. Say I’m a in hospital billing department looking up NPIs for physicians on claims, filling in missing (and now required) data on referring providers, secondary providers, etc. In a perfect world, my billing software would be smart enough to do that for me, but some systems are woefully sloppy about this. What we hear so far is that people are thrilled that there’s finally a tool like this." The download, with monthly updates, is free for your first state and $49 for each additional (I need to talk to the guys about value-based pricing since that sounds way too cheap, although in their defense, I see they are smartly offering a primo sponsor ad slot on the lookup screen, so some company will get their message on about a zillion desktops).

NHS executive David Nicholson finally admits that NPfIT isn’t really going so well. "If we don’t make progress relatively soon, we are really going to have to think it through again … We have said to Cerner and BT that they have to solve that problem at the Royal Free before we will think about rolling it out across the rest of the NHS."

The townies will fuss about this: Morgan Hospital and Medical Center (IN) will no longer draw labs for outside companies like LabCorp and Quest, saying the hospital was "unknowingly" giving its competitors a free service. The hospital defends its much higher prices (which cost one diabetic patient more than $400 extra out of pocket in one visit) by arguing they help cover unprofitable services and also provide higher value when results are posted to the hospital’s EMR. I’m beginning to feel really militant about the BS hospital pricing policies — the ever-increasing number of self-pay patients are supposed to swallow that aspirin with a phony $8 "list price" without a complaint while insurers get them for nothing. It’s as big a scam as the whole AWP pricing thing. Nobody pays list, other than those too poor to have an alternative. Hospitals whine about uncompensated care, but they screw cash-paying patients at every opportunity with a ridiculously high price-to-cost ratio. I don’t see how you can fix healthcare without fixing that. No wonder patients would rather go to India or Thailand to get the cash savings. One of these days I’m going to head over there for a first-person report on a medical tourism hospital.

Peter Witonsky joins medical device information integrator iSirona as president and chief sales officer, sliding founder Dave Dyell into the CEO-only position. I’ll throw out a guess that he’s Carl Witonsky’s son since he’s young and has a work history at Falcon Capital Partners, where Carl is the man.

Listening: new from Rise Against, hard rock with a punk edge (although their older stuff was harder). They’re from Chicago, so I’m thinking HIMSS should get them to do the opening song from last year’s conference, "This Is Our Time," previously warbled emotionlessly and repeatedly in Orlando by Disney day-jobbers, thankfully inspiring only a tiny bit of embarrassing execu-crunking. Also: Epica, Dutch goth-opera (try Track 2). I’m on record as not being against the idea of Simone Simons singing to me.

Open Health Tools Foundation announces a new project with Misys to develop server-based interoperability for HIEs.

Jobs: Director, Clinical Product Management (QuadraMed); Medical Director, Clinical Informatics (UW Medical Foundation); McKesson STAR Patient Accounting (Noesis Health). Weekly job blast signup is here.


I thought the osteopathic vs. allopathic (DO vs. MD) arguing was uneasily settled years ago, but it’s back at the University of North Texas, aka Texas College of Osteopathic Medicine, which is thinking about adding an MD degree to its DO curriculum despite the objections of the non-MD side of the house.

Everybody likes to weigh in on the "why doctors won’t use EMRs" issue, so here is my simplistic interpretation. Doctors, like 99% of people, want to be consumers of information, not creators of it. Develop systems that provide doctors with valuable data in the right context of patient care and you will sell lots of them, with appropriately positive patient benefits, since doctors are nearly universally in favor of delivering the best care they can. Develop applications that assume and require doctors to enter information for someone else to read and you will get kicked out of more offices than you can count. The model of forcing doctors to share their thoughts through manual electronic documentation is fatally flawed. There is no industry … none … where someone with the education and time value of a physician is expected to peck on a computer, especially in front of a client who’s only going to get seven minutes of time (I’ve never seen a CIO typing meeting minutes into a PC, yet they’re often the ones beefing about computer-avoiding doctors). There are no small business owners (doctors included) who will use tools they believe provide them no value; likewise, nobody would dream of trying to force those small business owners to use computers based on some kind of naive philosophic jihad against the inefficiency of paper-based recordkeeping. It’s no surprise that the best-selling physician systems involve practice management and billing functions that physicians don’t use personally (no different than in law and accounting office applications, in other words). It’s egalitarian wishful thinking that doctors will happily pony up to sit in front of a keyboard just because someone else thinks they should. On the brighter side, though, speech recognition is finally ready for prime time, better designed EMRs provide value to docs while still collecting information from them, and the "network effect" makes individually contributed information more valuable as more doctors interconnect.


Interesting: an Illinois children’s hospital (hopefully not the one the idiot governor was reported to have been extorting) reports the results of its FMEA on emergency IV meds, claiming the use of InformMed’s handheld calculator reduced emergency IV med risk by 88%.

Doctations will use clinical terminologies from Intelligent Medical Objects in its Web-based EMR.

Funny stuff from the Chicago Tribune’s media guy on NBC’s (owned by GE) moving Jay Leno’s cheap-to-make show to prime time: "NBC isn’t competing with ABC, CBS and Fox for the most viewers so much as it’s competing with GE Healthcare, GE Aviation and other parts of parent General Electric for the most profits." That’s true of GE Healthcare as well, of course.

AHA spends $4 million on lobbying in the latest quarter, some of it for "a better health information system."

Odd: Indiana driver’s license applicants can’t smile for their pictures any more because it interferes with face-recognition technology.

An Oregon Health & Science University employee’s laptop containing information on 890 patients is stolen from the employee’s hotel room in Chicago.

Forbes blames privacy laws for the failure of New York-Presbyterian to report the Plaxico Burress shooting to police, saying pressure to protect patient privacy may have confused them. "Privacy may be the biggest unfunded mandate of them all," it concludes, citing Modern Healthcare’s HIPAA cost figure of $43 billion over five years. The ED doctor who treated Burress without reporting it has been suspended. The hospital is getting some heat about its VIP policy from the local paper, which noted that Britney Spears was ushered straight to treatment in its ED after twisting her knee while filming a video in 2004, while everybody else waited for the usual hours

BlackBerry Bold Review


I’m not a big cell phone user and I’ve never owned a smart phone, so I’m either the best or worst person to review the new BlackBerry Bold smart phone. When AT&T offered to send a unit over for me to try, I figured it would be a good learning experience.

My first reaction (second, actually, after marveling at how small the box was) was how solid and balanced the Bold is. The next was that the display was shockingly high quality, like HDTV compared to analog. Video and sound quality are excellent. Watching a video on the Bold is like having a tiny DVD player in front of you (sorry for the stock photo above – I was taking a picture of the Bold, but my camera’s batteries died right as I was setting it up and the macro function was about as crappy as you’d expect for a $79 camera that I bought on sale at Circuit City, so welcome to Stock Photoville).

I didn’t really need a manual beyond the quick start guide. All the menus are clear and easy to navigate. A set of home icons takes you most places you’d want to go once you’ve got the Bold set up to suit you.

Connectivity is a strong suit, using regular cell, EDGE, 3G, and WiFi. It took seconds to have it running on my WiFi at home, bringing up Web pages very quickly. My Razr doesn’t connect from my desk at work because of low signal strength, but the Bold locks on every time (the only negative: I get a lot of HIStalk e-mails all day and the ‘vibrate’ frequency conducted to my body via the belt holster seems to be nearly identical to that of my stomach when it’s growling, so I keep thinking I’m hungry).

The browser worked just fine, showing full pages with amazing clarity and easy zoom-in by clicking the rollerball and fine-movement arrow pointer. Using it was entirely intuitive.

Big pluses: the keyboard is very well designed with a satisfying tactile feel. The rollerball is smooth and intuitive. Both are back-lit. No learning curve there.

The Bold works as a GPS, although I didn’t try that because the one in the car works fine. It has the usual camera and memory slot, of course, and a media manager application, voice command, etc. 

I connected to my e-mail accounts nearly instantly. You can open and even edit Microsoft Office attachments. I was waiting to have my car’s oil changed today and caught up on e-mail, checked the weather on AT&T’s MediaNet, approved some pending HIStalk article comments by clicking the e-mail link just like always, and read the headlines. There’s a reason people call it the CrackBerry. I’ve seen some of the really scary geeks at work carrying theirs into the toilet stall to prevent the "I need something to READ in here" syndrome.

Businesses will like the Bold, I think. It’s easy to use and is a taskmaster for its main business functions of calling, e-mailing, and texting. IT shops are already familiar with deploying and supporting BlackBerry devices as an extended PC desktop, with infinite enterprise configurability and security. The Bold is about as cool as you’re going to get without chucking out everything you know and like about RIM and going to the iPhone, which most folks seem to feel is superior for Web browsing, media handling, and availability of third party apps (your boss and your IT shop are probably just as happy that you do less of those activities on company time and equipment anyway).

Everybody wants an iPhone, of course, but businesses don’t usually take those decisions lightly (try to get permission to buy and connect a Mac to the network at most hospitals, no matter how arguably superior it might be). I think the Bold is like Hawaiian Shirt Friday at work — maybe not as cool as those iPhone-carrying 24/7 turtleneck-wearers, but still pretty darned cool for serious business.

I know some HIStalk readers are Bold and iPhone users, so feel free to comment. I’m a total noob with the Bold and am using it without connecting to the BlackBerry setup at work, so I’m missing part of the story.

Vendor Deals and Announcements

  • IntelliDOT announces that 17 additional Health Management Associates sites have implemented its CBPC solution.
  • Bon Secours health System (MD) completes its initial rollout of Vignette’s IDM to capture and digitize paper patient information and index the content for its EHR.
  • BCBS of Minnesota names Jay Levine its new CIO and Colleen Connors senior VP of human resources and facilities.
  • WellCentive Gateway announces the launch of two new HIT solutions designed to facilitate the sharing of patient data within a community.
  • Parmer County Community Hospital and Collingsworth General Hospital (TX) will implement an ASP hosted version OpusClinicalSuite at their rural hospitals. Funding for the project comes from federal CAH HIT grants.
  • Cancer Treatment Centers of America contracts with Sunquest Information Systems for the purchase of its Collection Manager software.
  • The Dossia employer coalition will allow MediKeeper’s PHR software to its employees.
  • The Daughters of Charity Health System extends its agreement with Perot System to provide full IT outsourcing services. Perot has provided Daughters similar services for the last seven years.
  • Former Midmark Diagnostic Group President Michael Paquin is appointed to the board of CardioComm Solutions. Yury Levin also joined the board of the cardiovascular technology company.
  • TeleHealth Services and Medcalm are partnering to release a new pediatric channel called Blue Monkey Planet. The channel will provide family-friendly wellness education content.
  • Vangent is awarded a government contract to support and develop an upgrade to the EHR system used by the Indian Health Service.
  • Patient Care Technology Systems announces that over 5 million ED patients visits have now been supported by its Amelior suite of products.
  • Zix Corporation is rolling out an e-RX to 200 primary care physicians in Texas.
  • Former AMISYS CEO Kevin Brown is named CEO of Casenet, a health insurance and managed care IS provider.
  • The University Medical Center of Southern Nevada is deploying (warning: PDF) the Horizon broadband solution from InnerWireless.
  • Scotland County Hospital (MO) is going live on Healthland’s EMR system.
  • Streamline Health Solutions is integrating its enterprise document workflow solution into the MEDITECH Magic HIS at Massena Memorial Health (NY).

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Currently there are "17 comments" on this Article:

  1. I also have a Bold and have been a power blackberry user for years. I love this device. If your used to the lighter and smaller “curve” model, you won’t like the size or weight. This device rocks…get one now…

  2. Re: doctors and EMRs – preach on, brother. It’s way too easy (and wrong) for non-clinicians to resort to calling doctors lazy or Luddites or whatever when they call out EMRs for what many are – just not up to snuff. Do you want your physician to click through drop-downs and free text entries, or do you want them at the bedside?

  3. Re: Aspirin for $8: I think hospital bills need a huge reform, but historically, you only get a bill for parts, never parts and labor, like at the car dealership. Since insurance negotiations dictate what a hospital is paid by a percentage of “list price”, prices have gotten skewed over the years, as hospitals have tried to maximize reimbursement. I do think it’s very unfair to make cash paying clients pay full “list”, but I don’t think that many do where I work. Unfortunately, what we see in the press is the $8 Aspirin. When was the last time you saw attorneys’ fees, auto dealerships’ service center fees, etc. exposed in the press? BTW, our hospital elected to NOT charge for aspirin, acetaminophen years ago, so we wouldn’t hit the “press”. How do you pay for $160,000 worth of acetaminophen per year?

  4. I don’t feel too sorry for Ben Bulkey. He was brought into Allscripts to cut expenses and improve operations. He delivered on those items and he was rewarded with a pretty good amount of stock compensation (which vested at the close of the Misys/Allscripts transaction. I don’t think Ben regrets his time with Allscripts.

  5. I like the “CIO taking minutes” analogy. Let’s run with that. I take lots of minutes as does every executive at Affinity and Ministry (including the CEO). But, we have created a system that makes it fast and easy to do so. Word is a ridiculous tool for managing agendas and minutes (think early EHRs). We have a database where any team member can submit an agenda topic without going through a secretary. The meeting organizer can easily sort through the submissions the night before and finalize the agenda to their liking. Minutes are easily written and the history of discussion is easily searchable (something that makes it worth the work of writing the minutes). We have put everything in place to make this work well.

    Less than 2% of physicians are against the concept of using a computer in the practice of medicine (and that number is quickly shrinking). Nearly all of them are against using a computer in a way that does not provide additional benefit, and they should be. But, like executives they will change their behavior when they have a compelling alternatives.

  6. RE: Uptake of EHRs.

    Why exactly are we expecting the clinician to rapidly take up use of these systems which, at this time are:
    1. Non-standardized
    2. Not required to use those standards that do exist
    3. Are only certified against extremely low qualifications (ex. Not yet required to provide a legally compliant HIPAA security audit capability, not yet required to retain the original version of an amended record, other examples upon request).

    If someone was promoting a new medical device that was not yet certified, it would be deemed irrational if not illegal to use it in patient care. Clearly non-uptake of EHRs, given the current state of the marketplace, is rational market behavior, not anti-technological prejudices. As in the UMiami $11M lawsuit loss largely due to defects in an Anesthesiology intra-op EHR, we’re only just gaining sufficient experience with these new tools to understand both risks and benefits.

    A 2006 study done for the Office of the National Coordinator for Health IT proposed that health care data quality would initially worsen with EHRs, in particular health care fraud. (already estimated at, conservatively, $200B annually in overt criminal diversion, entirely ignoring your average EHR-enabled practices’ upcoding skew)

    Congratulations to the rational analytic conservative majority among clinicians who know that these systems are not yet generally fit for use.


  7. I’ve worked with Ben and he’s an effective leader who exceeds his goals. I also know that he, as well as any other former GE Healthcare managers, can run circles around other the “real HCIT” vendors I’ve done business with over the past half dozen years.

  8. “GE KILLS HEALTHCARE” – I don’t see how this story has any connection to GE Healthcare. I think GE and it’s healthcare unit are amazing companies.

  9. RE: Odd: Indiana driver’s license applicants can’t smile for their pictures any more because it interferes with face-recognition technology.

    It will soon be illegal to smile in public for the same reason…

  10. RE: Jonathan Bush’s comments
    I’m pretty sure AthenaHealth doesn’t sell software, thus Jonathan’s comments regarding funding of software…just asking.

  11. There is nothing wrong with charging for aspirin, but there is no justification for charging above market rates for it, especially if a patient would be forbidden to bring their own at a lower cost.

  12. As an urban community hospital CIO, I recently acquired a MAC to attach to our hospital network because: a) Some of my staff as well as medical staff members are MAC users at home. They periodically experience technical issues when they access the hospital’s network from remote locations and I wanted to be able to replicate and resolve those problems; b) An oncology surgeon friend of mine who practices elsewhere and is a MAC user at home experienced frustration at his hospital’s IT department’s lack of MAC knowledge, so in the spirit of customer service I wanted to provide solutions to those who ask; c) I am a MAC lover — having used one for years in an earlier life as a hospital IT consultant — and was happy to find any excuse to install one at the hospital.

  13. ‘Everybody likes to weigh in on the “why doctors won’t use EMRs” issue, so here is my simplistic interpretation. …’

    ‘There is no industry … none … where someone with the education and time value of a physician is expected to peck on a computer, especially in front of a client who’s only going to get seven minutes of time (I’ve never seen a CIO typing meeting minutes into a PC, yet they’re often the ones beefing about computer-avoiding doctors). There are no small business owners…’

    Fact1: Data is best collected closest to it’s source.
    Fact2: Physicians are many times directly connected to patients.
    Fact3: Other clinicians are willing to place themselves next to patients and extract data without complaint; RNs, NPs, PAs, etc.

    Also, let me point out that business and medical practices are not equal so to compare them as you do is not correct. In other words, if data collection is what is required to oblige “do no harm” in the case of physicians or “holistic care” in the case of nurses, then data collection is what should be done. It is an ethical question, not a business question. You may be correct that keyboarding is a waste of time, but not because CIO’s and small businessmen don’t do it. Business-people have a different ethical framework you need to be reminded.

    Also, is it possible that if the education and time value for someone is too high for the task at hand then it would create a disincentive to do the right thing?

    Or possibly you think that aggregate patient data is unimportant.

  14. For anyone that knows Ben, knows he is a great leader and brilliant guy. He is gone to the detriment of Allscripts. He was one of the best people there. Ben is a brilliant guy that a lot of people liked working for.

  15. Tom Skelton and Rich Goldberg did not host any event in Raleigh ! Gotta love how a rumors get started.. someone must be bored …

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  3. For what it's worth, the VA currently releases C-CDA (or HITSP C-32...my memory fails me) via eHealth Exchange and has…

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  5. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

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