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January 20, 2009 News 9 Comments

From The PACS Designer: "Re: Microsoft Photosynth. TPD has been experimenting with Microsoft’s Photosynth and its 3D capabilities for photo collections. It appears to be a nice way to enhance the photo experience after using your digital camera. It could enhance your photo skill level and at the same change your perspective on creating better photos. Once you download Photosynth, you’ll have to reboot your system to activate the software and also obtain a Windows LiveID before you accessing the application." Link. It takes a bunch of digital pictures and turns them into something like Google Maps Street View, from what I can tell, allowing you to navigate around by clicking arrows (but obviously without a BIG bunch of pictures, you’re just jumping around jarringly). Maybe the technology could be used to create 3D images from plain old X-rays.

From Dillinger: "Re: medical weblog awards. How could Medgadget not even have HIStalk listed as a nominee in the informatics category?" Beats me, but I’ve long ago figured out that blogs giving other blogs awards is nearly always a ploy to get traffic to their OWN blog, hoping nominees will send their readers there to vote. HIStalk has been around since June 2003 with quite a few readers, so I’ll satisfy myself with that accomplishment more than having some other blog declare me a winner.

From Elsie EHR: "Re: TV knee-slappers about Jonathan Bush being the President’s cousin. According to a Chicago Sun-Times article, he and Barack Obama are 11th cousins." Link. The only good thing is that since their last names aren’t the same, it will sail right over the talking heads. That makes two reasons to be grateful that his first cousin has joined the ranks of the unemployed.

From Webbed_feet: "Re: OHSU. Article on the layoffs and IT restructuring." Link. Oregon Health & Science University will eliminate 60 of 400 IT jobs and reclassify another 80, giving employees the pure joy of interviewing against their peers to see who gets to stay on the payroll. The union representing IT (who knew?) claims the university just wants to change the employees from hourly to salary to avoid paying them overtime and differential.


From Microsoft Guy: "Re: dabbling in healthcare. You were puzzled about the value the Senate and NRC place on Microsoft’s input on healthcare IT when we’re ‘dabblers at best’ but then highlight the work we’re doing at MD Anderson a mere half-page later." I don’t know that selling a hospital copies of Visual Studio and Windows 2000 (!) qualifies the company to pontificate to Congress on lifelong wellness, healthcare reimbursement, and appropriate IT investments. All those millions of physicians, informaticists, nurses, management engineers, and healthcare executives out there go unheard so someone who’s never worked in healthcare can advise Congress on healthcare reform? That’s somewhere between arrogant and preposterous. Dabblers like Oracle and Microsoft pop in every now and then as the healthcare market opportunity looks more or less lucrative (see: Healthcare Transaction Base and Amicore, respectively). The rest of us have been here all along.

Obama mentions healthcare IT in his inaugural speech: "We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost." He gave a stirring, impressive speech (pretty similar to that of Jimmy Carter, in fact, so caveat emptor). The campaign and the fanboy fawning are over, so now he gets judged on actions just like his predecessors. I’m cautiously optimistic so far.

HISsies voting is now open. Thanks to those who nominated the slate you’ll see (some no doubt motivated by the not-so-subtle urging of their employer). Anyway, use your inaugural enthusiasm to get your participative democracy on. The future of The Pie is in your hands.

Jobs: Senior Application Analyst (Sibley Memorial Hospital), Clinical Pharmacist (MedVentive), Chief Applications Officer (Snelling Executive Search), Chief Technology Officer (Snelling Executive Search).

We’re finding a comfortable voice for HIStalk Practice, including regular interviews with private practice physicians and industry experts. We’re up to 300 or so subscribers and a few thousand visits, which isn’t bad for our first couple of weeks. Sign up there for e-mail updates if you follow the EMR market. We’ve already filled our two Founding Sponsor slots there and also added some Platinum ones, so we will announce those shortly. Thanks to everyone supporting us there by reading, commenting, and writing – like the early days of HIStalk, it takes awhile to build up a readership.

Have physician portals become obsolete just as hospitals finally get them up and running? Robert Connely of Novo Innovations (now Medicity) said so when I interviewed him in 2006: "If you’re a doctor with an EMR, you don’t need a portal. In fact, you hate the concept. You want to see the data in your own system … Your physicians are bringing on EMRs and you need another way to get data to them." Stephanie Massengill says pretty much the same thing in a new article: "It seems the time for portals has waned. The marketing value of them is dubious, as the physicians have found that always seeking information is time consuming and, therefore, have stayed away in droves." Not that you need a third opinion, but here’s mine: portals are exactly what you would expect hospitals to have come up with given that they see themselves as center of the data universe, in charge of the conversation with physicians, and pleased to offer a solution that could be checked off as mission accomplished while missing the mark completely when it comes to physician workflow ("if you want to use the data in our systems to help our shared patients, even though it doesn’t benefit you or your practice personally, dial in and look it up yourself, make a copy or manually enter it into your own system, then repeat for each competing hospital in which you practice.") Portals were a good 1.0 stopgap and surely will continue to provide patient value, but for the ever-increasing number of practices with an EMR, better integration tools are available than that busy guy or gal wearing a stethoscope.

Just in: HIMSS announces the winners of its industry service awards. Pat Skarulis of Sloan-Kettering is CIO of the Year, Rosemary Kennedy of Siemens wins the nursing informatics leadership award, and Brian Jacobs of Children’s National is named for physician IT leadership.

Consumers are interested in personal health records … or do actions speak louder than words? A new report (which I’m not about to pay for, so I’m citing only the press release) says that only about a tenth of those people who claim they’re interested are actually using personal health records. Not surprising: if you believe self-reported consumer surveys, Masterpiece Theater is the most popular show on TV instead of innumerable morgue yarns and junk reality TV.

Sheldon Tyndall is named interim IT director at Haywood Medical Center (NC). He used to be at West Georgia and McKesson.


Danbury Hospital announces HealthLink, some kind of RHIO/HIE. Seems like the lawyers should be all over that choice of name since it’s been used about a zillion times.

An interesting article in The New Yorker (thanks to SQL_Goddess for the link) postulates that healthcare reform successfully happened in other countries not because it was rigorously planned, but because it evolved from experience to address current conditions. "Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it … In designing this program, we’ll inevitably want to build on the institutions we already have. That precept sounds as if it would severely limit our choices. But our health-care system has been a hodgepodge for so long that we actually have experience with all kinds of systems. The truth is that American health care has been more flotilla than ship. Our veterans’ health-care system is a program of twelve hundred government-run hospitals and other medical facilities all across the country (just like Britain’s). We could open it up to other people. We could give people a chance to join Medicare, our government insurance program (much like Canada’s). Or we could provide people with coverage through the benefits program that federal workers already have, a system of private-insurance choices (like Switzerland’s)."


So where does this guy fit in when talking healthcare reform? Yelling, bearded, ubiquitous cheeseball infomercial pitchman Billy Mays ("IT’S NEW OXICLEAN DETERGENT — GET ON THE BALL") is hawking health insurance. I’ve seen the commercial dozens of times already, even though I don’t watch much TV. Of course, he doesn’t scream out how much risk you take on when you sign up for "affordable" insurance (its mini-medical plan pays just $100 per day for a hospital stay). You know hospitals and doctors are going to eat the balance when the "insurance" covers next to nothing and the "insured" can’t pay, which is sad because they at least tried to do the right thing instead of just dropping all coverage. As highly recommended as the ultra-annoying Vince the Slap Chop guy ("YOU’RE GONNA LOVE MY NUTS").

Hospital layoffs: Waterbury Hospital (CT), 160; Integris Health (OK), no number given; Inter-Lakes Health (NY), 15.

South Australia’s Department of Health plans to deploy an ERP system covering all of its hospitals.

E-mail me.

HERtalk by Inga

I’ve been glued to the TV all day and have gotten teary a few times. It’s been an extraordinary day. I keep hearing Lee Greenwood singing in my head. It’s great to see so much pride and optimism. Oh, and I loved Aretha’s hat!

The Pennsylvania Medical Society has followed Mr. H’s lead and is now twittering (OK, maybe they didn’t start just because we did, but Mr. H likes to think of himself as a trailblazer), I know there of a number of hospital CIO’s twittering – I wonder if there are any hospital systems?

Canadian EMR vendor MedcomSoft fails to reach an agreement with creditors and files for bankruptcy. The company is now in trusteeship. The press release warns that it contains "forward-looking statements." Hardly.


A hospital-owned clinic in rural Colorado prepares to close its doors, falling victim to difficult financial times.

Nuance Communications continues to bid for Zi Corporation. The current offer was scheduled to expire January 16th, but Nuance as extended it until January 30th. So far, Zi’s stockholders have indicated they aren’t interest in the $.40/share offer. Zi’s stock closed at $.39 on Tuesday.

In Washington, House leaders suggest a December 31, 2009 deadline to complete an initial set of HIT standards. Also under consideration: $65,000 per physician in provider incentives; payments for hospitals that become fully wired; and penalties for not adopting HIT beginning in 2016. Privacy advocates are paying close attention to make sure their concerns are not overlooked.


The majority of Americans don’t consider HIT spending a priority, which may not be a surprise given the turbulent economic times. A recent study by Kaiser Family Foundation and the Harvard School of Public Health finds that 79% of the 1,628 participants want spending for HIT to decrease or stay the same, dead last by far of all the healthcare spending possibilities.

Revenue cycle solutions are all the rage in Michigan, as hospitals attempt to maintain revenues. With rises in unemployment and uncompensated care, hospitals are seeking new tools to update their billing and collection procedures.


Anesthesiologists have a cool new iPhone application available to them. iAnesthesia provides case log tracking, drug calculations, and administration guidelines.

Tomball Regional Medical Center (TX) equips its physicians with real-time patient updates on their mobile devices. The hospital is sending critical patient information to physicians using Clinical Xpert Navigator solution from Thomas Reuters (the former MercuryMD MData solution).

Pathology Service Associates launches a pathology CPT coding services Web site, PathLab Coding Solutions, that will provide responses to coding inquiring and access to automated and online coding resources.

Parkland Health & Hospital System (TX) licenses Lawson Software to automate administrative processes, simplify reporting, and improve data access.

Andrew Bolles joins Zotec Partners as director of business development. Bolles most recently worked as a VP and national sales manager for Dominion Medical Management.

United Regional Health Care System (TX) activates multiple Eclipsys clinical solutions across 35 inpatient units and two locations.

Marion General Hospital (IN) selects MEDSEEK to develop and implement an enterprise-wide healthcare portal.

South Jersey Healthcare (NJ) chooses Sage’s Intergy EHR for its affiliated physicians. The health system will subsidize the cost of the EHR and interfaces to the hospital’s IS/HIE.

Hayes Management Consulting announces that MedicalEdge Healthcare Group is providing MDaudit software for its physician clients.

E-mail Inga.

Ricky Roma Responds

… to comments from his recent guest posting.


A few people asked about the Site Visit problem, especially with respect to compensation. These questions actually highlight the root of the problem. Yes, site visits are lengthy and expensive. Risky? Not so much. 

I completely agree there are plenty of opportunities for sidebars and candid discussion, but these are the customers that the vendor has hand-selected to show off. These are the customers that get things like the best PMs; customized software; direct lines to the vendor’s senior leadership; discounts all over the place; pizzas sent Fridays; paid trips and dinners out with their Inga wannabes at trade shows; and anything else they so desire. These site visit hosts do not generally intend to mislead their wide-eyed visitors — they are just the beneficiaries of a relationship that is rarely repeatable at scale (“at scale” being vendor-speak for “you”).

Are the hosts compensated? Abso-fugly-lutely. Do they get better service than the average bear? Of course they do! That is the very reason why you are being directed there, so you can be guided into thinking ALL of said vendor’s customers live in this state of perpetual bliss. If this utopian state is something that can, in fact, be delivered “at scale,” there is only one way to find out — do your evaluation at scale (“at scale” here being my speak for, well, “at scale”).

The remedy here is to stack up the references. Stay away from the airport and choose quantity over false quality. Use the phone and your Web meeting tool-of-choice. Also, do back channel references — ask one or more of your Good sales people from a different product category if he or she knows any hospitals using Product X and would they facilitate an introduction. The time invested in 5,10, 15 or more calls will pay much greater dividends than getting a fancy trip somewhere.

I would augment this recommendation by having key members of your evaluation team each make calls to their respective counterparts. Find hospitals that are much like yours as possible and avoid the eight-person conference call. Make them one-on-one instead. A direct conversation is much more likely to generate an honest answer than from a crowded conference room. Plus, think of all the new LinkedIn contacts that can be made!    

Make sure your team agrees on a basic set of questions (actual, real, usable functionality; implementation reality; support reality; hidden costs; etc.) so that you can compare notes on the same topics. Also, be sure to ask the classic, "Knowing what you know now, what would you do differently if you came to work for us on this project?” The Dark Side HATES all this and will work hard to discourage this type of enlightened behavior. We want you to follow our script in showing off our wares, not yours!

If you follow this process and have five or more of your team calling at least 5-10 references (more for bigger projects, fewer for smaller), you will have developed a powerful matrix of 25-50-100 or more interviews. This information will serve as a great big spotlight to illuminate the future path you will be headed down with that potential decision. THEN, if you really want to go see this s#@& running somewhere, hop on that airplane and go.

While you are there feeling like a big shot, insist upon dinner with your Good sales person and the company’s CEO (aka, Mr. Discount) and let the negotiations begin …

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Currently there are "9 comments" on this Article:

  1. Site visit problem is hilarious. Back channel references the vendors give you and go to sites they do not suggest is not a good way to view the product. Many times the reason those sites are terrible are they are not on the latest software, do not employ enough staff or are still stuck in doing things the old way instead adopting to efficiencies in the system. I had a client want to manually manipulate an HL7 interface that was installed at 200 other sites that this was not done. Their interface continually crashed and the data was wrong at this site. I don’t agree with this way of doing references but I do agree that 10 to 15 from the vendor suffices.

  2. Thank you Mr. HIS Talk for your response to Microsoft Guy! I’m sure many of us who have dedicated our careers to healthcare feel the same way. I sometimes get the feeling that healthcare is a downed animal and the hyenas are coming in for the feast.

  3. Response to Ricky Roma: While Ricky makes some good points – one-on-one calls are invaluable, he left some information out. Site visits can be used productively IF you know how to use them. If all you talk to are the IT staff and/or department heads, then yes, waste of time. They will most likely give you the company line (and yes, these sites do typically get better services, deeper discounts, and other compensation). What you need to do is ask that you get to spend time on the floors, in the business office, or wherever the product is used, WITHOUT the company’s representatives.

    Sure IT may still be chaperoning you around, but the random staff you get to talk to may not give two stones who this person is, and will almost always tell it like it is. These staff members, who use the products every day, are much less forgiving, and aren’t receiving any compensation for these site visits.

    If looking at a nursing system, ask to go on several different floors and flag down a random nurse to watch him/her use the system during the normal course of business. It is easy to keep a few people from ‘spilling the beans’ if you are on a very tightly controlled site visit, but once you get out of IT and into the business areas (again, without the company’s rep) it is very hard to keep people from giving you honest feedback.

    I do however agree, that more reference calls would to more to give you a true picture of how this may perform in your organization. But when making these calls, you also have to give weight to how they are using the system – Big J’s comments above are also applicable. I believe, as a company rep, it is my job to give the prospect an overview of the organization they will be calling into (point out that they have modified the HL7 interface, and the problems they are having).

    I firmly believe in letting my prospects talk directly to my customers without my direct involvement – if my products and services are not what is in the best interests of my prospects, then I would rather not sell to them. I want us both to be successful. You can chalk it off as altruistic, but that is how I run my business. I have nothing to hide.

  4. Inga…I’m totally with you about Aretha’s hat. It was as catching as her interpretation of our national anthem. Who else, but Aretha, could wear a shade of gray and turn it into something colorful? Finally, Detroit is right about one thing: Aretha’s voice IS a national treasure.

  5. Agree with Vendor Guy. I was an IT worker bee at a site visit site (we had 2 tours/month, free breakfast, snack and lunch…and a thank you basket at the end of the week, who knows what the hospital got in return…but who doesn’t like free food?!). One reason tours are limited to certain floors was due to clinical staff being preoccupied with taking care of patients and not appreciative of people in suits stopping them and asking computer related questions. We didn’t want to impact their jobs. We would also gear the tours to the floors most likely to match the speciality/workflow of the hospital taking the tour. The users were never asked to lie or brush things under the rug, but rather answer questions honestly. Luckily, most of our users were quite happy with our system.

    Also not mentioned, many people on selection committees are clinicians or managers who have limited exposure/knowledge in IT systems. Allowing them to see the system in use really helps decision making during the implementation phase.

  6. Can I have the choir and the entire congregation now say Amen to Mr H and Cowgirl in the Dust ?

    There are many people that do not thrist for Kool Aid.

    Customers have Business Challenges and Requirements. We try to map our requirements into high level functions Some sort of architecture ought to flow from the functions. What is the problem domain we are addressing etc.

    After that thought process you may start thinking about products that meet the requirements. We may think Active Directory when there is an LDAP requirement or we may think OpenLDAP.

    When the only tool you have is a hammer everything tends to look like a nail.

  7. Re: Site Visits….
    Think about this. You are told by industry ‘experts’ (and vendors) that you should be a partner with your vendor. Well if you really are a Partner (yes with capital P) then when somebody comes to vist you ‘the Partner’ are you likely to talk about the dirty laundry? No real Partner would.
    So the only site visit really worth making is the one you pick independently. And that’s hard to do when the vendor won’t share the full client list, so save your money and stay home!

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