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Monday Morning Update 2/16/09

February 14, 2009 News 6 Comments

From Barney Rubble: "Re: AtStaff. AtStaff, Inc. of Durham, NC laid off some 15% of its workers, including sales and marketing along with some other belt tightening (people)." Unverified.

From A-Fraud: "Re: Picis interview. Why not challenge Cozzens with [laundry list of company criticisms] … as a potential customer, we need to know this and Picis would not share this information with us!" The sender attempted to camouflage his or her information, but a little sleuthing revealed that it came not from a hospital or prospect, but from someone at Picis EDIS competitor MEDHOST (hopefully not encouraged by the company). Picis must be a formidable competitor if it’s come to that.


Mary Pettys, a software director for TriZetto, was one of the passengers who died in the Buffalo plane crash. Condolences.

Kaiser had a terrible 2008, swinging from 2007 net income of $2.2 billion to 2008 net loss of $794 million. Reading between the lines, investment losses were to blame, "marked down to current market values for financial reporting purposes." Interestingly, most of the press release brags on IT and HealthConnect, which is obviously a key strategy (as you would expect given the cost). Like everyone else, Kaiser will defer capital projects. An ominous sign: Kaiser’s total membership declined by 30,000 last year, the first drop in five years (maybe due to unemployment?)

I see that 113 people who attended HIMSS last year have completed the poll to your right. Results: only about half of them are going to HIMSS this year and 75% of respondents say their organizations will send fewer people this year. HIMSS may be getting a lot of early registrants, but it sure looks unlikely that attendance will match that of last year’s conference.


The CEO of Royal Free Hospital in England complains that its early adopter implementation of NPfIT’s Cerner Millennium costs it dozens of millions because of extra costs, lack of billing data, and reduced patient throughout. NHS says early adopters always have to spend and suffer more and that hospitals often fail to set adequate training budgets (all true in my experience). 

Listening: Flo Rida. If you already have a stripper pole and strippers in your house, this is all you need – they will instantly start gyrating since it’s a club staple, so I hear (I haven’t been in a strip club since they were dancing to Toto).

Jonathan Bush of athenahealth and John Glaser of Partners HealthCare will speak at the Transforming Healthcare conference in Boston the evening of Thursday, February 26. HIStalk readers get a discount – see the text ad to your right.

Cleveland Clinic strikes a deal with MinuteClinic to provide clinical consultations as backup to nurse practitioners in nine CVS store MinuteClinics, with integration of their respective electronic medical records, with patient-approved access to the clinic’s Epic MyChart information.

We did an "HIT Moment" with Vatsal Thakkar MD of NYU, who’s an actual user of the free Practice Fusion EMR. He has some quite interesting thoughts that are worth a read.

The drug industry got its hands into the stimulus bill’s earlier versions, creating a new lobbying group to make sure big pharma controls medical information and keeps provisions that require cost effectiveness out of any outcomes research. The drug makers don’t like the $1.1 billion earmarked for comparing medical treatments and want it removed, claiming it will lead to government rationing (the drug industry loves the "it’s expensive, but worth it" argument that it often makes directly to patients spending someone else’s money). An interesting quote in the article: "When the government’s Agency for Health Research Quality suggested in 1995 that there were too many unnecessary back surgeries, doctors and industry groups attacked the conclusion. Mr. Cannon noted that Congress at the time slashed the agency’s budget and stripped its authority to make medicare-payment recommendations. ‘They almost killed AHRQ,’ said Dr. Avorn. "The memory of their near-death experience hasn’t been forgotten."

Early reports are that privacy groups like the final stimulus bill, with ACLU giving its stamp of approval. No comment yet from Patient Privacy Rights.

BT’s earnings took a big hit after writing down the value of most of its big IT contracts, including its NPfIT ones.

Indian IT vendors are expecting to get contracts from HITECH. iSoft was named, which is strange since neither it nor parent company IBA Health sell into the US as far as I know, but maybe plan to do so.

Emageon gets the $9 million of escrowed money from Health Systems Solution for the latter’s failure to consummate the merger transaction with the former. In the meantime, the SEC, FBI, and IRS are investigating HSS’s parent company, Antigua-based Stanford International Bank, wary of missing another Madoff-type situation in which investors received abnormally high rates of return in what turned out to be a Ponzi scheme.

Merge Healthcare announces Q4 numbers: revenue down slightly, EPS $0.03 vs. -$0.28. With annual revenue tracking at $60 million, nobody’s probably paying much attention, but it’s at least a start toward some kind of recovery from three years or so ago when shares were in the high 20s vs. $1.65 now.

HITECH Provisions of the Stimulus Package
By Dr. Herzenstube

After reading through the entirety of the HIT language of the bill (title XIII, which covers all but the Medicare and Medicaid incentives), here are the bits I find most noteworthy.

  1. The bill seems to stipulate a role for a certification organization a la CCHIT. "The National coordinator, in consultation with the Director of NIST, shall keep or recognize a program or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle." (3001.c.5).
  2. However, that certifying body will not be the one to decide on the certification criteria. That will be the role of the HIT Standards Committee, with final say — at the individual criterion level — lying with the Secretary of HHS: "The National Coordinator shall review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee." (3001.c.1).

    …and the HIT Standards Committee will take its marching orders about what to focus on from the HIT Policy Committee. "The HIT Policy Committee shall recommend the areas in which standards, implementation specifications, and certification criteria are needed … and shall recommend an order of priority for the development, harmonization, and recognition of such standards, specifiations, and certification criteria." (3002.b.2.A)

    "…the HIT Standards Committee [shall] recommend to the National Coordinator standards, implementation specifications, and certification criteria…consistent with the latest recommendations made by the HIT Policy Committee.." (3003.b.1.A) (The bill also stipulates some areas that the HIT Policy Committee must address in some manner, e.g. segmentation of data to facilitate limited disclosures of PHI).

  3. 3008.b Implies that the AHIC Successor, aka NeHC, might serve as the HITPC or HITSC (although HITSP has developed many of the interoperability implementation specifications used by CCHIT, most CCHIT criteria relate to innate functionality of EHR systems, NOT interoperability features, and were developed by the CCHIT workgroups themselves. It will be a major shift to have CCHIT relegated to basically just a testing organization, with criteria developed by another entity).
  4. HIPAA will now apply to business associates of covered entities just as it applies to covered entities (13401.a)
  5. "Pay for privacy". Upon written request of the patient, disclosures to health plans for payment or health care operations must exclude any PHI pertaining "solely to a health care item or service for which the health care provider involved has been paid out of pocket in full." (13405.a)
  6. Accounting for all disclosures including for PTO. "An individual shall have a right to receive an accounting of disclosures … The Secretary shall promulgate regulations on what information shall be collected about each disclosure." (13405.c.1.B)

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Currently there are "6 comments" on this Article:

  1. If HIMSS wants to get attendence up at the Chicago convention, all they need to do is put someone on the speakers podium that will explain how you can get your share of bucks from the stimulus bonanza! I’ve seen it work for decades at HFMA.

    I bet somebody in the Chicago office is working on that right now.

  2. Sunquest Layoffs: Guess somethings never change. Adkin and his smiling yes man Smalling perfected he technique while at Misys. When will accountability be brought to the executive suite?

  3. Plz warn next time you include a link that contains nudity, (like the Flo Rida music). Some offices, like here in this children’s hosp, are extremely sensitive to sites like that one, and it could cause an employee serious trouble.

    Just a thought… thx

    [From Mr. HIStalk] Sorry — I didn’t notice! I just made sure there were MP3s there and didn’t look further since it was an official MySpace music page.

  4. http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&partner=rss&emc=rss&src=ig

    Above is a link to an NY Times article today (Mon, 2/16). It talks of how the Obama Administration is setting up the infrastructure for “comparative treatments” under Stimulus Bill funding. While it talks primarily of alternative medical treatments, why shouldn’t it include comparative research for the effectiveness of EMR products out in the marketplace? CCHIT and the new committee for certification of HIT products are fine, but don’t measure why there is so much “failure to launch” in the history of EMR—more than a 50% failure rate. We can’t afford to waste this funding opportunity for healthcare IT.

    KLAS measures vendor-provided practices but only surveys “successful” deployments…so where installations have failed, only partially succeeded or the doctors just plain quit, there is no data. With 300 vendors out there and so high a failure rate, shouldn’t some research be done on the broad market with some granularity?

  5. Wow… I see your counter is closing in on 2 million! Depending on current rates, you should hit the 2M mark between 2 and 4 months, maybe sooner. Got’cher noise makers handy?

    [From Mr. HIStalk] I was hoping to hit it by HIMSS, but I don’t think it will happen even with the spike in readers lately. Too bad – we could have celebrated it there!

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