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December 16, 2008 News 14 Comments

From MM: "Re: EMR. $83 million for an EMR? Unbelievable! Who besides me thinks EMRs cost a little less than an order of magnitude too much? I don’t blame vendors entirely. I blame the conceptual model used in the industry (CDR-centric that duplicates data already available electronically). Epic has the right idea with regards to customizing a solution based on the unique systems in place at a given facility. They have the absolute wrong pricing model – $75+ million for an EMR! Facilities basically hand over to Epic all the financial gains of moving to an EMR to Epic. All vendors are trapped in their financial and conceptual models. What entity will drive innovation and disrupt the healthcare IT market with a new model? Comments welcome."

From Kenny Rogers: "Re: Novo Innovations. I hear it’s about to be acquired or maybe to acquire another company." Well, I’ve heard that too, with Medicity supposedly being the suitor. No confirmation yet, but I’m not sitting on it just in case it’s true and the real journalists scoop me because I’m stuck in some meeting at work when the news breaks or Kipp e-mails me. I was highly impressed with both Novo and Robert Connely when I interviewed him in 2006 (I guarantee it’s worth a read or re-read even now — I keep dropping hints that I’d like to have a redux with him). Medicity, of course, has rocketed out of relative obscurity to become a game-changer, which would only be enhanced with Novo’s smart agent technology to connect and synchronize multiple sources of information (hospitals, practices, etc.) Now I’ve been a loud-mouthed critic of RHIOs since the beginning, but it’s becoming clear that there are two dissimilar types: (a) the impulsive "let’s put on a show" kind where two life-and-death competitors in one market swear they’ll smoke the technology peace pipe, only to be quickly crushed by the reality of their intense mutual hatred and financial naivete; and (b) the kind that is more thoughtfully designed to have a broad participant base, a solid business model, and a quick path to actually moving data instead of endlessly arguing about the shape of the conference room table. Medicity is mostly associated with that second type, which not surprisingly, is more collectively successful. Novo made its name with individual non-RHIO groups that just wanted a slick, painless way to share information at a low cost. That’s a powerful match, if indeed the rumor is true.

From The PACS Designer: "Re: wireless mesh. Wireless access at times can be frustrating in that the signal gets lost when you are in a dead zone. Within institutions, it can be even more critical if a wireless disconnect occurs during a critical time of treating a patient. Now, a concept that has been around for a few years is starting to gain some traction and it is called ‘wireless mesh’. The wireless network consists of wireless radios that overlap each other, so if one wireless radio disconnects from users, another picks up the additional users, thus maintaining continuous wireless connection through a self-healing process. Also, placement of the individual wireless radios in both inside and outside locations can provide campus-wide service to users. Wireless mesh is also referred to as a ‘mesh cloud’ by some, as it is another cloud concept to consider for your work environment." Link.


From Slick Willy: "Re: Best in KLAS. Always interested in your take on it." Methodology arguments aside, the results are hardly shocking. Epic dominated all the big hospital categories (EMR, billing and patient management, pharmacy, and even radiology) and had its usual strong showing in ambulatory. I can never figure out USA and its wins in surgery and enterprise scheduling because I’ve never known anyone who uses it. athenahealth was #1 in practice management in the 2-5 and 26-100 physician categories, which is maybe a surprise move up the rankings rather like Epic a few years back. I suppose an outsider might be surprised that the big companies did poorly: GE and Siemens had one winner each (in PACS and lab, respectively), Cerner had zero, and McKesson two (Paragon for small hospitals and ERP, although the latter is a pretty big win against non-healthcare vendors like Oracle). Eclipsys had a win, but only for the EPSi decision support product it just bought. MEDITECH has the most customers, but no wins. Everybody must have waved their white flags and high-tailed it because Epic continues to take whatever business it wants, with these rankings giving it yet another selling point it doesn’t really need.

From Bobby Orr: "Re: GE Playbook 101. Acquire, re-org, and then lay off a few years later. Not good news for the former IDX team." He’s referring to the story I ran earlier that GE Healthcare will be cutting jobs here and there, most likely some of them in Burlington. Show of hands: who really respects what GE has done in healthcare IT? (I’m typing with two, so there’s my answer).


From Francisco Franco: "Re: BlackBerry. The Bold is a major winner. I have tried them all (iPhone, Tilt, Curve, Palm, Treo, etc.) going back 11 years now. And by the way, we are close to allowing Macs on our network here. VMWare Fusion is the answer." FF gave me some Bold setup tips, which I appreciate. That’s an interesting idea for the Macs using Fusion (above).

From Susan Sweet: "Re: layoffs. Just curious why you have not reported on the layoffs at the HCA corporate campuses in Nashville. I was one of 109 IT&S employees which were laid off on Thursday, Dec 4 and there have been continuing layoffs in the other corporate areas as well. Have I missed the news?" I missed it. HCA laid off corporate staff including 109 in IT, giving them the part-time option (80% accepted) that most likely means fewer hours and benefits. IT was hit the hardest of the 2,600 Nashville employees. Like several other companies that now regret it (the Chicago Tribune owners, for example), HCA got cute with a leveraged buyout and is getting eaten alive by the overwhelming debt it required ($27 billion in HCA’s case). There was a time in a go-go economy when leveraged anything was good — houses, cars, businesses. Not now. Everybody’s grandparents were right — borrowing money to finance today’s fun is a really bad idea (as Uncle Sam will probably find out the hard way).

GE sticks with its 2008 earnings estimates, but says it won’t forecast earnings at all going forward. Jeff Immelt says GE Capital will still make more than half its usual profit next year, about $5 billion, which is surely optimistic.

Microsoft will issue a critical Internet Explorer security update Wednesday following discovery of a vulnerability that lets hackers gain control of PCs without doing anything more than getting unsuspecting users visit infected Web sites.

Colorado Governor Bill Ritter brags on the Colorado RHIO, which kicked off its live trial two weeks ago. Despite having spent $8 million plus unstated private money, the RHIO says it needs more federal or private money to actually roll it out beyond the current three users: University of Colorado Hospital, Denver Health, and Children’s Denver. On the other hand, not asking for federal money is so 1990s.

Washington University and BJC HealthCare (MO) sign for the mdlogix Clinical Research Management System.

SCI Solutions rolls out its new Web site.

moreno  agarn

It’s corruption as usual in Chicago, according to claims: a Cook County commissioner (who kind of looks like Corporal Agarn from F Troop to me) reportedly leans on MedAssets to give part of its hospital billing contract to a minority-owned subcontractor run by the commissioner’s crony and campaign contributor, after which the crony’s firm bills MedAssets $40 per hour per employee instead of the agreed-on $17 per hour. MedAssets drops the subcontractor, so another pal of the commissioner, the hospital board’s audit committee chair, proposes that the board audit MedAssets after receiving only one bill. MedAssets is turning the matter over to its lawyers, eliciting an eloquent response from the commissioner: "He’s full of s— … "If [MedAssets President John Bardis] continues to imply those things and slander me, I will sue the s— out of him and go after him to the fullest extent of the law."


I poked a little fun at our pals at HIT Transition Group the other day, so Marty pokes a little back. I liked this better, though, being a fan of caustic cynicism: "And who wouldn’t want to be a bank these days? Remember when American Express was a credit card — er, charge card company? That was before last month, when the government started using the Fiscal Shock and Awe technique that proved so effective as a post-invasion strategy: throwing pallets loaded with cash at banks, no embarrassing questions asked. Amex was immediately pacified: Don’t call us a credit card company, call us a Bank Holding Company." He’s speculating that insurance companies will use health savings accounts to get into the banking business, also mentioned by Susanne Madden when I interviewed her. Insurance companies are like dowsing rods for dollars: if anybody’s got money, they’ll find it.

Congratulations to those HIStalk sponsors who won Best in KLAS, announced Monday morning: Allscripts (Enterprise EHR, ambulatory EMR 26-100 physicians); Greenway (PrimeSuite Chart, ambulatory EMR 2-5 physicians and 6-25 physicians, PrimeSuite Practice, practice management 6-25 physicians); Nuance eScription (back-end speech recognition); CareTech Solutions (IT outsourcing – extensive); Hayes Management Consulting (topping the list of professional services firms). Listed as Market Segment Category Leaders: Sunquest CoPath (anatomic pathology – over 200 beds); Sunquest Blood Bank (blood bank – over 200 beds); RelayHealth HTP RevRunner (revenue cycle – patient access); QuadraMed Pharmacy (community pharmacy – 200 or fewer beds); MEDSEEK eConnect Physician Portal (clinical portals); Allscripts Care Management (acute care discharge planning); Sentillion Vergence (single sign-on); Virtual Radiologic (teleradiology services). If you’re a sponsor and I missed your win, let me know. Surprising, isn’t it, how many HIStalk sponsored nailed their categories?

Lame duck HHS Secretary Mike Leavitt announces his own voluntary privacy initiative to the NHIN Forum, including what the press release calls the "Leavitt Label," his personal Good Housekeeping Seal of Approval. It’s one big-ass Label, given that the template (warning: PDF) runs 12 crammed pages of not-very-clear questions that would baffle the average citizen for whom it will supposedly benefit. Other than that, it was just a laundry list of the usual feel-good, detail-free principles that nobody could really be against, proposed by a political lifer in the last days of his four years as Secretary. Update: after sleeping on it, I’ve decided the questions are really pretty good since they are intended for vendors. The template is actually just six pages, plus another six of instructions. I’m still not sure about the ego behind pre-anointing it with the secretary’s name, but it may encourage some good conversations about disclosure.

IT people often call network stuff "plumbing," but this hospital CIO is the spokesperson about real plumbing. Kym Pfrank of Union Hospital (IN) extols the virtue of PEX plastic water piping in the hospitals big expansion project. The quote quickly segues into information about RFID badge tags, but then goes back into non-IT territory with talk about corridors and water pumps. That’s a busy guy.

PDA drug information provider Epocrates cancels its $75 million IPO plans. It’s already received $86 million in VC money. My April 21 comment when it was announced: "Clinical reference provider Epocrates, fresh off its iPhone stage time with Steve Jobs and apparently unafraid of a terrible stock market, files for a $75 million IPO. It’s profitable, anyway." I was actually being nice since I thought they were nuts, but then again I’m just a non-profit working stiff, not a captain (or even private) of industry.

Streamline Health’s Q3 numbers: revenue up 11%, EPS $0.00 vs. $0.00. A tiny company, but the guy running it (Brian Patsy) is supposedly interesting.

Christine Cournoyer, Picis president and COO, is elected to the board of BJ’s Wholesale.

Orchestrate Healthcare wins Best in KLAS for technical services, which I mention because they’re is running a text ad to your right to announce that fact here.

IT job prospects in North Carolina have gone "from bad to worse," the Raleigh paper says, reciting a litany of recent layoffs that includes Misys and Allscripts.

Odd: a Chicago company called Global Medserv Inc. (which I couldn’t find on the Web, but that is apparently involved in electronic medical records) offers to buy a failed but publicly traded golf course company just to get on the American Stock Exchange cheaply. I think the company may be DGF Medserv, a transaction processor that shares an address and telephone number with several chiropractic companies.

Siemens will pay $1.6 billion to settle charges of bribery and kickbacks to earn business. How good was the case against them? "We have been dealt with very fairly," its lawyer said contritely.

Royal United Hospital Bath, NHS Trust extends its IT management contract with IBM.

The US Postal Service is investigating an identity theft case at Saint Francis Hospital of Memphis. The police chief, himself a victim when someone charged $900 on a Wal-Mart credit card using his recently deceased wife’s name, says he heard that the breach occurred when a hospital employee allowed a family member to get on a computer.

If you care about uninformed public perception, you might be interested that the only healthcare companies to make the "Most Trusted Companies For Privacy" list are drug maker Johnson & Johnson and WebMD.

E-mail me.

HERtalk by Inga

From Mati Hara: “Re: holiday party? Thursday night at (a Raleigh restaurant), Tom Skelton and Rich Goldberg are ‘hosting’ — but not paying — for a reunion of old and new Misys folks, including some HR types, various sales talent, senior implementation folks, a few marketing people, and a couple of financial gurus. Hmm … could something be up?” Every month or so, someone sends over a rumor that these guys are buying a company, but so far we haven’t seen anything to suggest they are about to make an acquisition. But, who knows? Yule-time fest or job fair?

Community Care Physicians (NY), a 190-provider multi-specialty group, selects Allscripts Practice Management. The group is already an Allscripts Enterprise (formerly TouchWorks EHR) user.


The Hayes Management Consulting folks sent us an e-mail saying that, in lieu of traditional holiday cards, they are donating to the Toys for Tots Foundation and Susan G. Komen for the Cure. Of course, that totally works for me!

The VA renews its contract with QuadraMed for $23.4 million: $19.9 million in software fees, $2.6 million in services, and $900,000 for travel expenses. The VA uses QuadraMed’s Encoder Product Suite.

The Columbiana County (OH) health commissioner resigns after pleading guilty to theft in office, accused of charging personal items to the county health district’s credit card.

Maybe there is something in the water in Illinois. The HHS is investigating Northwestern Memorial Hospital’s business dealings with hundreds of affiliated doctors. Everyone is being tight-lipped about the whole thing, but the hospital is cooperating.

USA Today examines ways ERs are trying to solve overcrowding problems. Dublin Methodist Hospital (OH) uses CPOE to speed the orders and results process; Scripps Mercy Hospital’s (CA) computerized tracking system monitors patients and available bed space; and Hudson Valley Hospital Center (NY) registers patients at the bedside using a portable computer. Other hospitals are establishing fast-track areas staffed by mid-level providers who can handle minor issues.


A medical journal documents a new sleepwalking condition described as "zzz-mailing,” or e-mailing someone while asleep.

California announces the formation of the California Center for Connected Health, a new organization to boost services to patients in remote and underserved areas. CHCF is providing the center $5.5 million in initial funding.

A Michigan doctor and a pharmacist are charged with running a painkiller scam involving more than 200,000 illegally prescribed doses of OxyContin.

Siemens donates a Ysio digital radiography solution to Children’s Health Fund (CHF). Hospitals will get chance to bid on the system, with proceeds benefiting CHF. Bidding starts at $99,999 and closes December 18th at 5:00 EST.

Dennis Quaid and his wife agree to a $750,000 settlement with Cedars-Sinai Medical Center over the 1000-fold heparin overdose error that nearly killed the couple’s twin infants. Their lawsuit against the drug maker Baxter Healthcare is ongoing.


The former City of Angels (CA) hospital CEO pleads guilty to paying kickbacks in a Medicare and Medicaid fraud scheme. Dr. Rudra Sabaratnam admitted paying a co-conspirator about $493,000 to recruit homeless patients and take them to the hospital for unnecessary services. The “patients” were also paid small sums for pretending to be ill. Sabaratnam will pay $4.1 million in restitution and faces up to 10 years in prison.

E-mail Inga.

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Currently there are "14 comments" on this Article:

  1. Kind of hard for anyone to be best of KLAS like Epic when Epic insists on multiple Epic employees be in each department. What kind of a survey is realistic with this. Good Job to Epic for monopolizing hospitals in this manner. Great sales and retention strategy too.

  2. On Slick Willy’s comment about never figuring out USA and its wins in surgery and enterprise scheduling; don’t feel bad, nobody can.

    It’s a well kept secret, but the cat’s out of the bag. USA hasn’t received the memo yet telling them that they aren’t supposed to support their customer base. maybe someone should tell them.

  3. Epic’s fees include training, implementation, and an allowance for software customization. It’s more than just software that’s included in the announced fee.

    If you are installing all of Epic’s applications, you are buying more than just a electronic health record. I believe that’s true of most other companies products.

  4. Re: Re: EMR. $83 mil for an EMR solution could be quite expensive, even for an Epic implementation, if the only module implemented were EpicCare IP or Ambulatory. Does the $83 mil include rolling out Cadence (scheduling), Prelude/ADT, or Resolute Pro Billing or Hosp Billing? The EMR implementations that I have worked included Reg/Sched/Bill because in many cases the ROI on the EMR alone wouldn’t pay for itself in a short enough timeframe. To put it another way, health systems seem less willing to accept the EMR as “loss leader” for 3-7 years while they gang press physicians to drop dictation services et al. Instead, they hope that revenue cycle gains will pay for the entire project in a shorter time.

  5. Re: HHS announcement/privacy framework.
    At first I was alarmed at your comments but got to end and was relieved that you found the template not too onerous. I actually felt it was well put together, had good logical flow and asked some of the more pertinent questions that one should consider, from a policy perspective for consumer health records (access, & manage).

    Personally, I am thankful that the HHS didn’t get all prescriptive on us (like CCHIT appears to be doing) setting a broad framework for privacy and security of personal health information. Allows the market to develop and new approaches/ideas to flourish.

  6. Of all the captivating HIS-bits rendered in today’s HIStalk, the mention of privacy ratings for J&J and Web MD should be exemplary for all health web sites. If you need a briefing on the elements of the health web site, consult http://www.urac.org and comply with the (52) standards for accreditation for your enterprise health web site.

    Health web sites or more applicable clinical portals inter, intra and extra demands industry standards of participation throughout healthcare. Just think, another accreditation organization breathing down the neck of our U.S. Health system except that accrediting with URAC for your health web site is strictly voluntary but rewards like J&J and WebMD web sites, i.e., integrity is a priceless ROI. (Don’t know why J&J has not applied for URAC accreditation because all the essential elements for an accredited health web site are cursorily present; notice that on every web page the legal notice, privacy policy etc. are links available in the footer to the User.)

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  7. Hey Mr. HISTalk…
    There ya go again…beating on poor little USA.
    Just because you don’t use their products, don’t have their sales people pounding on your door every week and they don’t have a big booth at HIMSS ..you can’t understand them?
    It’s simply a great reliable product, not ‘mass’ marketed and user support that is clearly top flight. Maybe you ought to interview their President Larry Covington and he’ll tell you more secrets to KLAS success, or call their clients like Jewish in Louisville, Florida Hospital in Orlando, or Wellspan in Pa.
    And by the way did you notice how KLAS changed the rules of the game to be rated the number one vendor? Now you can’t get be considered for that award unless you have 3 applications. USA would have again been rated number one if that rule wasn’t changed in mid-stream. Looks to me like the little guy gets short changed again.
    Hey here’s another idea…maybe it would help you understand them if they took out an add in HISTalk???

  8. On EHR costs $83 Million plus, the cost will also include hundreds of mobile PC’s or WYSE terminals. Thousands of dollars for each one, including mobile stands and bar code scanners. Wireless networks, possibly mobile devices, dozens of Blade servers, Citrix licenses, Cache licenses, Crystal reports licenses and data warehouse databases. Imaging or blob servers. Interfaces to and from external or legacy systems. Importantly things like hot swap backup servers in case the main production servers go down. More powerful generators to cover the downtime requirements. Very high speed links between the sites that store the main server and the backup servers. It’s likely the $83 million was for a multi hospital group with more than 400 beds each, probably over 10,000 users.

    And we are not figuring in the savings. Electronic prescribing saves lives and law suits. CMS auditing is not only easier, but you have the tools to react and improve percentages, increasing reimbursement. There are a number of EPIC sites that are using the system to bring up their percentages close to 100%. Reduction of billing costs and errors. Increasing vaccination rates, I have worked on projects where we have taken vaccination rates to close to 100%. Research projects and clinical trials. Savings in drug formularies. Better tracking of infections. Cost means little without also quantifying the monetary and reputation benefits, along with quality of care improvements.

    Could it be done on the cheap? It probably could. However EPIC installation for the size of operation I assumed above can also be completed for far less than $83 Million. And in far less than 10 years. How much is waste? How much is bad planning in the $83 Million? A good consulting team can save you very large amounts of money with an EPIC installation. And here is another little thing, having worked on several installations, after they start using EPIC the Physicians who may have been skeptical, actually don’t mind using the system, which seems to be a hot topic here at the moment.

  9. Great to see that Skelton still thinks he matters to Misys folks. Otherwise, I would have thought his hubris was a thing of the past. I’m sure that the loyal current and former employees want to be reminded of the leadership that drove the company into the ground. And his sleeping wizard comes along for the ride as usual.

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