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May 7, 2009 News 8 Comments

From Ellis Dee: “Re: ARRA. A hospital that has a large outpatient makeup but very little inpatient appears to get significantly less ARRA reimbursement for EHR since the calculation only mentions inpatient. I’d be curious if this is just a legislation snafu that will generate enough complaints to include outpatient. It seems EHR investments and continuum of care applies even more so to outpatient.”


From Roy G. Biv: “Re: HHS. Is it me or is the new health IT web site a little thin? For some reason, they also changed the domain from www.hhs.gov/healthit to healthit.hhs.gov. My take is they implemented a new portal vendor, while the last site was home grown and content managed by HHS directly. I included a link to the Internet Archive ( Wayback Machine ) of a cached version of the site a year ago – a lot more content – and bigger print.” Before, after. It looks like it might be portal software from the former Plumtree Software, which was bought by BEA, which was bought by Oracle (the software version of a Matrushka doll).

From Looking for Answers: “Re: Cerner. What is Cerner’s MPages, why are people so excited about it (to make a video), and does it give Cerner an edge?”

From X-Sage: “Re: layoffs. 1,000 layoffs announced by Sage in England during briefing on six-month financials earlier this week, with Sage Healthcare getting hit once again starting on Tuesday.” One reader put the healthcare cuts at 200 people with more to come. In the mean time, one stock analyst likes Sage stock OK, but says getting into healthcare was a mistake, especially now that Allscripts and Misys have merged to create a formidable competitor.

From Revenue Randy: “Re: Sutter EMR project. Get ready for Son of Sutter … Stanford Medical.”


If you’re a doctor shopper looking for OxyContin in Virginia, now’s your chance: the state database that hackers hijacked is the one that healthcare professionals check to identify drug-seekers. It’s now offline. Mr. Limbaugh, your prescription is ready.

Porter County, Indiana was sued last year for $3.4 million by a management software vendor that claimed Porter Hospital used its software without permission after the hospital was sold to for-profit Community Health Systems. The county argued that the new owner should have worked out a deal with the vendor, so they paid $200K to get out of the suit. Now the hospital has countersued the county, claiming a contract clause makes it the county’s problem. The county is threatening to counter-counter-sue the hospital for the $200K.

I’ll say this, having worked for a non-profit hospital bought by a chain: a former non-profit’s employees sleep behind enemy lines because everyone in the community suddenly hates you, even though you’re going to work in the same building with the same people. Appropriately so in my case: the company running my hospital was a truly impressive bunch of sleazebags and scoundrels who gravitated to healthcare only because the money was good and fraud wasn’t often detected. A classic line from our brand new 24-year-old hospital president in his first real job, speaking to our long-time CFO who predated him by decades: “We need to use less oxygen.” We snickered at his stupidity, but he went on to make dozens of millions running the slimeball organization, somehow avoiding jail time unlike many of his peers. If you were a patient in our hospital back then, I am truly sorry our management brought in clearly incompetent doctors whose only attribute was that they would take orders from a 24-year-old MBA using patients to rise through the ranks. I have a lot of stories, unfortunately.

The State of Massachusetts is considering ditching fee-for-service payments to doctors and hospitals and instead giving them a capitated yearly payment. This is an interesting thought: “… because doctors and hospitals would have to work together more closely to manage the budget, the hope is they will better coordinate care for patients, which could improve quality.” Catfight!

A WHO advisor provides an opinion on the US healthcare system, one question being what advice he would have for the President: “My advice would be to avoid a search for villains (e.g. insurance or pharmaceutical companies) or panaceas (e.g. the electronic medical record), neither of which will be very productive.  Instead, Americans need an intelligent public policy debate that both builds strong consensus for the goal of universal coverage and fosters understanding of the consequences of the structural fragmentation of the existing system and why this has to be addressed.  Expanding coverage without tackling this underlying problem will be very costly, so equal attention needs to be given to both fairness and efficiency if the U.S. is to move towards a system that is both universal and affordable.”

Non-profit Global Patient Identifiers, Inc. and software vendor MEDNET announce a partnership in which MEDNET will issue cards with GPII’s Voluntary Universal Healthcare Identifier and also donate in kind to GPII.


Not satisfied with wasting your personal time Twittering? Now you can reduce your company’s productivity as well with the aptly named Yammer, a near-clone of it aimed at private networks (it reminds me of the old Groove before Microsoft bought it). It might be useful, although I don’t see much benefit over a decent e-mail and IM system (why does everyone fret about blocking unnecessary e-mails when most people just delete them anyway?) The New York Times kind of liked it. It’s free to join, but to get more control and security features costs the employer $1 per user per month (so unlike Twitter, it might actually have a business model other than being sold).


Cambridge Consultants rolls out a Bluetooth-enabled inhaler that follows Continua standards in allowing inhaler usage data to be collected and placed into PHRs.

This sounds interesting: a Silicon Valley startup called PreviMed starts a Healthcare Innovations Lab to evaluate HIT innovations from the user perspective.


This is a big deal: Citrix announces the availability of its free Citrix Receiver for the iPhone, which allows running XenApp hosted applications (Cerner, McKesson, Microsoft, Oracle, and SAP are specifically mentioned).

Microsoft lays off another 3,000 employees with the likelihood of more to come.

Listening: Catatonia, alternative rock from Wales, defunct since 2001, with a startlingly pretty lead singer.

Two New Jersey men plead guilty to making $300K by stealing medical equipment from New York Presbyterian Hospital and selling it on the Internet. One was a hospital equipment specialist.

Like an ED on diversion, I’ve been too busy to accept new e-mails (or at least to reply to them). I always catch up eventually, though, even with the equivalent of at least two full-time jobs that are wearing me down steadily.

I think this is new, but I can’t tell since HIMSS doesn’t date its news items (damned annoying). They’ve got a simple online estimator of Medicare incentive payments under ARRA (if you’re a member, anyway).

I goofed: I said the Kingdom of Jordan is a Medsphere customer that was recently quoted a saying open source would cost them at least as much as commercial applications. I knew they were implementing VistA and found 2,000 Google hits linking Jordan with Medsphere (Medsphere proudly ran press releases announcing that the Jordan people were considering them). Medsphere lost that business to Perot.

Interesting details on the GE-Intermountain partnership. Development costs of whatever they’ve been working on since February 2005 are $300 million, with Intermountain paying $100 million and GE chipping in $200 million. Intermountain gets royalty payments (that makes them a vendor, so keep that in mind as they hit the presentation circuit and offer site visits). Brent James is a smart guy, but I would question whether this quote reflects reality: “"It means our ability to deliver good care is going to explode at the same time the costs are going to drop profoundly.” Duly noted: I will be watching for Intermountain’s quality numbers to ramp up and their costs (and charges) to fall precipitously. If either happens, that will be the first time an IT system ever had that kind of effect.

SAIC gets a $158 million contract to maintain and enhance some aspects of AHLTA and CHCS for the Department of Defense.


A security company sues the SEIU healthcare worker’s union (you Easterners know them as 1199) for not paying its $2.2 million bill. The surveillance and counter-intelligence group, made up of former FBI and CIA agents, was hired to spy on the union’s own members: to conduct surveillance of the union’s offices, to intimidate union members coming and going, and to protect SEIU’s visiting executives while they secretly met with hospital CEOs and legislators. At least that’s what the National Union of Healthcare Workers, a newly formed competing union, says (also accusing SEIU union bosses, shockingly, of pillaging union assets). SEUI is suing them, of course.

E-mail me.

HERtalk by Inga

Allscripts announces Cardinal Health is its latest Allscripts MyWay reseller. Interesting move on Cardinal’s part, especially since the spinoff of CareFusion suggested Cardinal was restructuring to increase focus on its core drug distribution business.

john h

A psychiatry fellow blogs on East Coast versus West Coast medicine. She observes that medical hierarchy is more obvious on the East Coast, e.g., doctors wear one color scrubs and nurses another. Though East Coast doctors are more blunt, they are not necessarily "meaner" than their West Coast counterparts. The most important observation: psychiatrists on the East Coast dress significantly more fashionably than those on the West Coast (see above – not a psychiatrist, but definitely one nicely dressed East Coast doctor.)

Eclipsys reports a first quarter loss of $.9 million or $.02 per share compared to last year’s $.3 million/$.01 share profit. Revenues came in above Wall Street expectations, however. Quarterly revenues were $130.2 million, with is above analysts’ $125.5 million estimate and about 5% higher than last year.

The 40 doctors at Lenox Hill Interventional Cardiac & Vascular Services implement Professional Intelligent Charge Capture by MedAptus.

This week I was having a battery problem with my laptop, so I gave Dell a call to diagnose the issue. While running diagnostics, we discovered that in addition to a failed battery, my disk drive had some serious errors and needed to be replaced. So, I pulled out the external hard drive that I have had for a year and half and never used – it was still nicely shrink-wrapped in its box. I feel as if I dodged a bullet and wondered how many times a day consumers and businesses lose precious data to hardware failures because, like me, they are too lazy to back up data?

API Healthcare announces three new hospitals and health systems are now utilizing its human capital management solutions.

An Australian hospital bans the use of its new EMR system after its second failure in three days, including a two-hour outage. An official is quoted as saying, "Staff report the electronic medical records system is so cumbersome that senior medical officers who previously saw 8-10 patients in a shift, are only getting through 5-7 because they spend so much time trying to access or enter information."

GE announces plans to invest $6 billion by 2015 on its "healthyimagination" initiative, aimed at delivering lower-cost medical equipment and care around the world, while increasing earnings at its medical systems and bioscience division. The strategy includes $3 billion in R&D on new medical systems and services, $2 billion in financing, and $1 billion for GE technology to support HIT and heath in rural and underserved areas. GE’s big plans for improving healthcare around the world almost makes me feel guilty for complaining about the $350 I just shelled out to GE to fix my broken oven.

Bridges to Excellence publishes a study entitled Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation. And we needed a study to figure this out?

Healthvision adds 10 international clients in Q1.

Cedars-Sinai Medical settles Ed MaMahon’s malpractice suit from last year in which he claimed doctors failed to diagnose his broken neck, discharged him without taking an x-ray, and later botched two spine operations.

Content management vendor Open Text enters into a purchase agreement for competitor Vignette. The total transaction price is about $310 million.

Perot Systems announces plans to lay off 450 employees to offset lower project-based revenue. The reduction is expected to save $30 million annually.

QuadraMed reports a first quarter net loss of $200,000, less than the $1.1 million loss reported for the same period last year. Quarterly revenue was flat at $35.1 million.

The Ohio Department of Administrative Services selects APS Healthcare to manage the provision of disease management and health and wellness services for 50,000 state employees.

As Mr. H recently pondered, had did we survive in the olden days when we only had three network channels to keep us amused?  For the curious (and non-squeamish) you check out Wired Science’s 10 best surgical videos. Really now, are our lives more complete once we can observe a a sex-change operation?

E-mail Inga.

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Currently there are "8 comments" on this Article:

  1. Well they have finally admitted just how cheap they are in writing!

    “Perot Systems announces plans to lay off 450 employees to offset lower project-based revenue. The reduction is expected to save $30 million annually.”

    Do the math… that works out to $66,666 per person for each of the 450 employees they laid off. By the way, that’s a whole lot of 6’s… hmmm…

  2. @Ellis: “A hospital that has a large outpatient makeup” – what is this? Are you talking about outpatient surgery, or outpatient-oriented services, like lab, rad, and pathology? It doesn’t really matter, though, you wouldn’t get money for either, only Medicare admissions will increase your amount. In general, the focus of this in ARRA is on outpatient, and the inpatient numbers are much lower by comparison. The most any hospital could see, assuming 100% Medicare patients (never going to happen) is just shy of $16M, about the same as only 360 outpatient physicians. If you meant outpatient surgeries, the physicians performing them would receive money under the professional part of ARRA.

    “It seems EHR investments and continuum of care applies even more so to outpatient.” – agreed, but they tied this to Medicare-reimbursable physician care episodes. Anything else would have meant a significant change to the way payments are made and I think they wanted to avoid that. Bad call for overall health care quality, but oh well.

  3. Re: Medsphere and the cost of open source

    (Setting aside the press release fatigue…)

    The actual point in yesterday’s report was the contention that open source software costs _more_ than other models. The comment was made by a high level government official 5 months into the project.

    Given the general nature of the comment and their reference to interfacing, I can only assume that the comment is about the cost of interfacing in general. This is actually an advantage of open source — proprietary vendors charge for every interface, open source systems grow a library of interfaces that are available to the community at no cost.

    The advantages in the areas of cost and ROI of open source systems have been reinforced by a recent study conducted three years after go-live at Midland Memorial. The total project cost was one third the cost of the replacement system from their existing vendor. The study also showed some compelling clinical results associating the EHR implementation with a decrease in hospital acquired infections (ventilator associated pneumonia and central line infections), among several other safety and quality measures. The assessment section begins on page 21 of this case study [1].

    Not only does the data support the assertion that the OpenVista system proved a cost benefit, but it also shows significant ROI from a clinical perspective.

    [1] http://tinyurl.com/dfdogu (PDF)

  4. Re: GE/Intermountain partnership. Interesting announcement. The partnership has been in place since 2005-2006. Why this announcement now? Also unless something has changed that I dont know about, the ‘pilot’ program at American Fork Hospital has the program running on IHC’s HELP system in the back end. So for $300M and 3+ years all IHC has is a new UI.

  5. The Allscripts-Cardinal arrangement sounds like an eClinicalworks- Sam’s “me too” deal. The difference is these lead swap things never work. The Cardinal guy won’t know enough to talk about EMR and he will be concerned if he looks stupid trying or if the Allscripts guy makes a bad impression then Cardinal risks losing their core business—why take a chance?

  6. Interested in more details regarding the post from Revenue Randy about Stnaford Medical. We here on the West coast are always ready to here what’s going on with that Epic client!

  7. Inga – not only hardware failure, but think burglary, fire, flooding, etc. Lots of ways to lose your data! And with more & more personal data being stored electronically (receipts, pictures, address books, etc), the loss potential is much greater now.

    I finally signed up for an online backup service last year. I selected iDrive, but there’s a host of other services like Mozy, Carbonite, etc. It gives me great piece of mind — I have a personal encryption key (so the data is encrypted before it leaves my PC) and it backs up my files nightly. I used to be nervous about using an online backup, but I’ve finally decided that the peace of mind of having an offsite, current backup outweighs the risk that my personal, encrypted data will be breached.

    (disclaimer: I don’t have any vested interest in these services – just a satisfied customer!)

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