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Monday Morning Update 7/27/09

July 25, 2009 News 26 Comments

Top Stories

  1. Enforcement of the Red Flags Rule starts this week. Providers who extend or facilitate customer credit (even doing nothing more than mailing bills after services are rendered, some attorneys have interpreted) are required to check patient ID to prevent identify theft, have a policy on handling questionable patient documents and patient complaints, and check to see that patients who claim insurance have proof.
  2. Bankrupt OB systems vendor LMS Medical Systems sells its its assets to the Canadian subsidiary of PeriGen for $3.5 million. McKesson bought the IP rights to CALM OB in April, relabeling the product Horizon Perinatal Care, but LMS supposedly kept the rights to support McKesson’s customers and to sell the product outside McKesson’s customer base. Perigen, renamed from E&C Medical Intelligence in April of this year, also sells OB risk reduction software.
  3. David Blumenthal of ONCHIT says he doesn’t have an opinion on whether health systems should comply with FISMA, the security guidelines for federal computer systems, to share information with federal agencies.

The Top Stories thing above is an experiment that a couple of readers asked for, putting the stories that I think are most important at the top. I like the concept, but I worry that people will infer that everything else is trivial, which it isn’t (I wouldn’t put it on HIStalk if I didn’t think it was important). What do you think, good idea or too enabling of skimmers who will miss important information? I will say that I get e-mails all the time from people who say, “Wow, I just read this and you should put it on HIStalk” even though I have already covered it in detail, so I already worry that some readers are missing good information.


From Dan: “Re: EMR powered by MS Office.” It’s CCHIT-certified gloStream, which we’ve mentioned in HIStalk Practice (in fact, I see that item is listed on the company’s News page, so that’s pretty cool). The user interface is Office-based (which I wouldn’t necessarily find advantageous if it uses Office 2007’s ribbon bar, which I spend way too much time whining about instead of just learning to love it or downloading this free utility to bring back the old menus).

From Otis Miman: “Re: Epic. Meditech hospitals in some areas are getting pressure to upgrade to Epic since physicians are using Epic in their practices. This seems like a tremendous cost burden to healthcare – to throw out a a cost-effective, integrated solution instead of a more expensive, non-complete HCIS and non-integrated solution. Having little or no competition in the marketplace is not a good thing.” Both Meditech and Epic, having sprung from related loins, have the same tendency to not want to play well with others, probably more so than any other HIT vendors. Epic is simply capitalizing on a stagnant HIT market that isn’t putting up much of a fight, although I think hospitals would be hard pressed to get ROI on the cost difference between Meditech and Epic (not many Prius owners are candidates to move to a Cadillac Escalade, not to detract from either system). Every vendor has a showcase site or two that has done great things with their system. They also have some real whiner customers who blame the vendor and vow to buy again from someone else, only to find that their failure cloud follows them. Which category a given site falls into is much more a function of their own abilities than those of their vendors. Anyone who is seriously considering buying Epic who hasn’t been on their current system for at least 6-8 years is demonstrating that they have no idea what they are doing (why didn’t they buy Epic in the first place if that’s what they wanted?) Big-name hospitals choose Epic mostly because all other big hospitals choose Epic, just like they used to buy Cerner and, before that, SMS. Theoretically, the march of the lemmings will eventually end since the market is ripe for new entrants, but so far vendors are just handing their customers over to Epic with heads hung. I don’t blame vendors for selling what customers demand – I blame customers for not demanding better, cheaper, and more open systems (and for being too easily influenced by what everybody else is doing).

From Looking for Answers: “Re: Cerner. I hear the Cerner PETA person wasn’t disgruntled, just looking to score points with his babe — though he does enjoy a good steak! ;-)” Reason enough, I say. 

From Eclipsys Watcher: “Re: Eclipsys. I’m hearing rumors of major organizational changes in the next several weeks with more layoffs, etc.” That’s usually a safe bet with most vendors these days, but especially unsurprising since a new Eclipsys CEO was brought in, presumably to make changes. And, while the excuses have changed, company performance hasn’t – shares are worth less now than 10 years ago and its limited clinical product line which, despite having CPOE and documentation that are among the best, still lags way way behind in new sales to Epic, Cerner, and maybe even McKesson. A strong CPOE and documentation system, integrated pharmacy, industry-leading EPSi, and what used to be a strong consulting practice – if none of that translates into sales and then financial results, you have to blame the corner office people. I haven’t been a big fan of most of the company’s management team once Harvey Wilson stopped being actively involved, but most of the folks I knew have been replaced, so maybe the new blood can shake the company out of its doldrums. I can’t decide whether getting into the practice EMR business is a logical extension or a distraction for them.


From The PACS Designer: “Re: Google Wave. As a software developer, TPD gets to see new and interesting applications in their early concept development stage. Google has an upcoming release of an advanced collaboration tool that combines e-mail with instant messaging and many other features in an application called Google Wave. It could be use in healthcare to improve communication amongst numerous caregivers and departments.” According to the demo, it was developed by the Google Maps people. Google has so darned many Web tools out there that I bet someone could write some cool hospital apps purely by mash-up. If I were Medsphere trying to get a foothold against legacy vendors, I’d look at that as an inexpensive way to interject some cool factor. An internal messaging app based on Gmail Chat? An Intranet based on Sites? Documentation via Forms? Social networking with Orkut or Wave? Dumping resource-intensive internal e-mail in favor of Gmail? All possible, all useful to customers, and all with a free backbone for vendors to use for their product extensions.

Listening: In This Moment, a female-led metal band now on the Warped Tour.

Jonathan Bush on Fortune, referring to Epic: “The Cleveland Clinic has software that they had to pay $200 million to get. It was written in MUMPS in 1974. There is nobody left alive who can write MUMPS any more. That’s the model … the curve of innovation, the disruptive technology engine in healthcare is broken.”

I’m a Tiger Direct junkie, but this deal is stunning even to me: Dragon Naturally Speaking 10 Preferred with a headset for $49.99 (it’s $118 on Amazon). The rebate ends 7/31. Amazon has a lot of reviews, the gist of which seem to suggest that some users will struggle to get it up and running, but those who do find it pretty amazing. It’s heartening to read the reviews of people who can’t type because of nerve disease, wrist problems, etc. for whom DNS is their lifeline. (Note: this version isn’t for use with EMRs – you would want to look at DNS Medical for that.) I keep thinking that maybe I’d enjoy dictating HIStalk, so I may get it. I know some writers who record interviews, then play them back into headphones while repeating what their subject says into Dragon so it can “transcribe”.

AT&T says the $300 subsidy it pays for each new iPhone it sells hurt its most recent quarterly numbers, but will eventually pay off in lower churn for its exclusive service. The carrier activated 2.4 million iPhones in Q2, many of them because of the new 3G S model.

Cardinal Health names Patricia Morrison as CIO after its spinoff of CareFusion and the Friday announcement that CIO Jody Davids was quitting. The new CIO has no healthcare experience, having been CIO at Motorola and Office Depot. That brings up an interesting argument: should hospitals do what Cardinal did and bring in IT leadership from another industry that’s more technologically advanced than healthcare, or is it better to get healthcare experience even though it’s a technologically backward sector? Who would you pick for CIO: a geek doctor who thinks 10-year-old, off-the-rack apps are cool or someone who knows nothing about patients, but who has vast experience with e-commerce, state-of-the-art infrastructure, and self-developed technology as a strategic differentiator? I waffle on that, I admit.

The results of my poll on CHIME’s new CHCIO credential: 9% think it’s a good way for CIOs to demonstrate competency, 13% say it’s a vanity credential, 33% say it has no relationship with competency, and 45% say it’s just another income source for CHIME (so, that’s 91% against). New poll to your right, for HIMSS members: should it devote fewer resources to Government Relations, more, or about the same?

I continue to be impressed with EHRtv. Check out its EMR Matters newcast. I don’t know how they get such dazzling video and audio quality with fast streaming, but I’ve never seen anything like it. There’s also an interview with Allscripts CEO Glen Tullman a few weeks ago that I hadn’t seen. I think it’s brilliant, much more interesting than sticking a $100 camcorder in someone’s face and asking a few trite questions.


Bill Stead of Vanderbilt and Informatics Corporation of America CEO Zegiestowsky talk about interoperability in this article. Here’s what Bill had to say about Vandy’s StarChart, now commercialized by ICA: “The simple idea was to assemble information from any source and to use computational algorithms to turn it into something that can be used. It has no boundaries and it’s analogous to what Google has done. Google answers questions by crawling over any number of sources of information — each of which are used for a single purpose but none having the original purpose of answering your question.” Bill’s the man, I say.

Housekeeping stuff: put your e-mail in the Subscribe to Updates box to your right (like 4,474 of your peers and despised competitors have done) so that you’re among the first to know when I write something new (remember Todd Cozzens of Picis at the HIStalk reception at HIMSS, asking for a show of hands of how many people run to the PC to read it as soon as the e-mail comes? Several CEOs raised theirs). It’s spam-free since I don’t use it for anything else and don’t make it available to vendors even though I get asked all the time. The Search HIStalk box lets you dig through the six-plus years of HIStalk to find whatever tickles your fancy: your name, your employer, or a vendor. Click the disturbingly green box to report a rumor to me, which I always enjoy. The links at the top of the page let you go do HIStalk Discussion, Industry Events (the HIStalk calendar), and also the Archives links to previous articles. You can e-mail me for anything else (interview ideas, guest articles, volunteering to write for HIStalk, etc.) Thanks to you for reading and to HIStalk’s sponsors for bringing it to you.

The HIMSS conference will go back to New Orleans in 2013. I’m surprised since I thought HIMSS was sticking with Orlando, Atlanta, and Las Vegas (which never seemed to pan out, actually). I figured the 2007 conference in New Orleans was strictly a one-time charitable, post-Katrina offering. I didn’t think it was all that great, so I can’t say I’m elated at the news (I miss San Diego and maybe even Dallas, which was at least cheap and had barbeque). Now that we’ve had a snowy conference in Chicago to keep attendees hanging around the exhibit hall, maybe HIMSS should have cut a deal with Detroit, Cleveland, or Pittsburgh, all of which could surely use the economic boost.

Bill Gates, speaking from India, says the American healthcare model is flawed because the government won’t adopt a national identity card, doctors aren’t allowed to share electronic medical records (?), and virtual visits are banned (?) He also predicts that cell phones will be used to test for diseases and that voice recognition will be big (maybe he got the Tiger Direct e-mail too).

The LA coroner’s office is investigating security breaches in which Michael Jackson’s death certificate was viewed “hundreds of times” by employees, some of whom were said to have printed it. They had blocked access to all but the highest-ranking employees, but later found a flaw that could have let others in. The chief coroner investigator says he thinks such violations are only internal policy violations and didn’t break laws, but my understanding that HIPAA is still in effect even when the patient is dead (although maybe coroner’s records don’t count since they become public documents when completed anyway).

HITSP’s Privacy and Security Workgroup wants EMR standards that include encryption, access controls, and audits. Deb Peel isn’t happy with their prioritization of patient consent management, which isn’t scheduled until 2015 and which she calls “foxes designing the hen coops.”

Bad news for hospitals: if CIT Group goes into bankruptcy, that could be one fewer line-of-credit vendor willing to loan money based on receivables.


Australia-based medical device vendor Applied Physiology gets $5 million in financing to launch its Navigator circulation guidance system, which turns information from cardiac monitors into graphical treatment guidance for doctors.

CPSI announces Q2 numbers: revenue up 11.2%, EPS $0.32 vs. $0.28, missing expectations for both.

The City of Los Angeles submits a plan to City Council to replace outdated e-mail technology (“the slowest, most inefficient, crash-prone e-mail system in the history of mankind”) with Google Docs. 

Odd lawsuit: an AIDS advocacy group sues the LA County Health Department, alleging that it isn’t doing enough to stop the spread of disease among porn stars.

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Currently there are "26 comments" on this Article:

  1. Ditto on the new format. Nice!

    >>> There’s also an interview with Allscripts CEO Glen Tullman a few weeks ago that I hadn’t seen. I think it’s brilliant, much more interesting than sticking a $100 camcorder in someone’s face and asking a few trite questions.

    I enjoyed the interview that he gave here most. Kind of reminded me of my daughter’s birthday party, especially the part with the piñata…


  2. I blame customers for not demanding better, cheaper, and more open systems

    MEDITECH already pays its people as little as possible – starting salaries 20-25k less a year than EPIC, in a market (Boston) with a cost of living substantially higher than Madison. How much cheaper do you think these products can be?

    And as someone who now works with both EPIC and MEDITECH I can say, without reservation, you get what you pay for.

    [From Mr. HIStalk] I hear you, but the question customers should ask: are they getting what they need? Not everybody needs Epic, but fortunately as you say, the cost nicely persuades those with less commitment toward less expensive, probably less comprehensive systems. And while I know it’s not exactly a fair answer, the “how much cheaper” question could be answered as: free. VistA is free. Google is free. It can’t be made much cheaper in the current model, but what I’m critiquing is the model that require upfront capital plus expensive labor plus ongoing maintenance plus third party technology costs (like Cache, Oracle, etc).

  3. I love whoever nom de plume is for using the nom de plume of …nom de plume.

    I also like the format of 3 leads. I hope it does not suggest other material is trivial….and it did not stop me from reading to the end…to the odd lawsuit.

    I’d suggest the porn stars form a group with the slogan “porn stars of the world unite, you have nothing to lose but your chains.” But porn stars unite for a living. And if they ditched the chains they would lose a large portion of their business 🙂

  4. Not everybody needs Epic

    True – at work we’ve said the difference between EPIC/MEDITECH is like the difference between a Honda Civic and a Boeing 777. If you need to get 4 people across town you go with the Civic. If you want to get 250 people across the ocean, you go with the 777.

    That being said, the risk for any decision maker going with the “Civic” option is a political/regulatory one. If we move towards salaried doctors, capitation and onerous reporting requirements, I have doubts that a vendor like MEDITECH has the intellectual capital required to navigate this more demanding environment.

    question could be answered as: free.

    Why would you expect Healthcare IT spending, as a percentage of revenue, to be so much lower than any other industry? Any number of industries, from banking to manufacturing to retail (walmart) have spent lavishly on IT and realised huge returns on their investment – why would healthcare be any different?

  5. Nobody left alive who can write MUMPS anymore? Mr. Bush, hyperbole does not become you.

    When you learn to program, you learn algorithms, approaches, ways of thought – you build a skillset that allows you to examine an implementation and recognize its rules, limitations, and advantages. Any programmer can write in any language; any good programmer can teach himself to write in any language well. As long as a programming language is still in use (as MUMPS is – see http://en.wikipedia.org/wiki/MUMPS_users), it’s learnable.

    MUMPS may not be the best language out there, but to say that no one knows how to write it is just silly.

  6. Agreed perspective.

    Whatever the validity of Mr Bush’s complaints against the EHR paradigm versus his SOA approach, I really wish he (like others) would stop trying to score cheap points by suggesting that the root of all the ills lies at the feet of the Mumps technology used in the EHRs simply because it’s been around for quite a while. Indeed, ironically, given that his service is effectively based “out there in the cloud”, the consensus of opinion is growing that the entrenched relational model actually doesn’t cut the mustard to meet the scalability and performance demands of such architectures, and we’re now seeing a renaissance of the schemaless hierarchical database. Of these, Mumps is one of the few actual tried and tested ones. So, Mr Bush, I’d suggest you need to be careful what you say: you could be the one with the unfashionable and inappropriate database technology for the market you’re in!

  7. The individuals who made the new CHIME certification are among our industry’s elite. Perhaps one of them can do an interview on the need for the certification on HIStalk? It would help the current perception of the certification.

  8. 1. I have run entire companies in California on M-systems. It works fine, is easy to learn and used extensively all over…the world.

    2. The new format is fine and even better better for lazy readers.

    3. I think all new CIO’s should get a baseline cholesterol and weight check. Most get super fat, arrogant, and unhealthy in their roles over time… Go to any HIMSS or CHIME meeting and have a look at the bloated and out of shape bodies and I’ll put money money that most are CIO’s or “IT Directors…also, do most CEO’s and COO’s have a “certification.” The whole idea is ridiculous! as well it’s pseudo-profession…

  9. CEO: “Let’s buy Epic.”
    Me: “We should get a better, cheaper, and more open system than that.”
    CEO: “Sounds good, what system has all three of those?”
    Me: “Umm…nothing.”
    CEO: “Epic it is!”

    Could be a joke, except that it’s not. If Epic was #2 or 3 in user happiness, then we could go with something else, but since user happiness >cost (if you have the money) >> open system, we’re stuck. My only hope is that we don’t have the money, but that’s kind of perverse, eh?

    Seriously, the market needs to step in here. The problem is that developing something with that much functionality would take years if not decades, and until you reach that level it’s very hard to sell your product (Eclipsys and Siemens, and a thousand smaller vendors can speak to this). And to preempt the inevitable comment, yes I’ve heard of Vista (see user happiness comment above).

  10. Epic was written in 1974? Or MUMPS was developed in 1974? Either way you interpret that Jon Bush statement is wrong and shows a shocking lack of HIT knowledge for a CEO of a company as large as Athena. This is no different than the CEO of Alaska Airlines saying (in reference to Automobile travel): “We’re talking about technology from the 1880s. And you pay 20 to 30 times as much for a car than you do for a plane ticket. There is no technological innovation in the transportation industry” (aside from air travel).

    Now, I get it that J.B. is just trying desperately to be dismissive of his competition. “Don’t buy that…it’s old”. But this logic that people tend to apply to MUMPS is just a total fallacy. It’s like me saying that Windows is from 1981, so athenahealth products run on technology from the early 80’s. Ditto with UNIX flavors or even just “the computer”. “The computer” – is just a difference engine! If you want athenahealth to store your vital information on technology from 1822, well then by all means buy their software.

    I think it’s telling that when people try to be dismissive of MUMPS the one and only argument they can make is that “it’s old”. Never that it’s too slow, or doesn’t integrate, is too expensive, doesn’t scale, has steep hardware requirements…all the barbs that big budget relational DB folks hurl at each other all the time.

  11. I have to concur with Mr H. why is it that the Healthcare Administration allows the market to be vendors competing to be the “Best of the worst” rather than truly differentiated providers? There are a number of potential axes to grind with regard to vendors but in this case the true problem doesn’t lay with the vendors but with what hospital’s are willing to accept. Vendors will always work to provide whatever the minimum acceptable level is and as long as we’re not holding them accountable for the Patient Safety problems in released code, inadequate notification, and generally poor performance what motivation is there for them to update their product? Look at the majority of the large vendor systems currently available they have huge client side packages when the majority of work is done via the server. If a concerted effort was made to stop slapping modules on and merely complete what they provide they could half the response time lag, half the size, and turnkey implementation capabilities.

  12. I like the new format! I appreciate reading the top stories before the reader comments.

    Listed below is the link for the CEO position for AHIMA (to replace Linda Kloss, who is stepping down).

    “The new CEO will be expected to bring an understanding of the HIM/HIT environment to the role, and the ability to partner effectively with key partners and alliances.” As in HIMSS and CCHIT? The link is listed on the HIMSS website under JobMine.

    In my opinion, the requested financial acumen in the candidate should probably have experience in the trenches wrestling with IRS violations!

  13. BlueDog, thanks for the link. What I find odd is the sentence in the job description, “Leadership experience managing a large, complex business enterprise…”

    According to Business Dictionary, “business enterprise”:
    In general, any endeavor where the primary motive is PROFIT and not mere employment for oneself and others.

    If they are a NONprofit and tax exempt, why is AHIMA calling itself a “business enterprise”? Why are they generating cash flows in excess of its operating costs?

  14. Epic vs. Meditech – One of the things that wasn’t mentioned is that Epic is extremely particular about their customers. There are quite a few cases of Meditech hospitals recieving no bid by Epic. Just because a site might think they “need” Epic, they might not have the ability to purchase it…

  15. Jonathan Bush on Fortune, referring to Epic: “The Cleveland Clinic has software that they had to pay $200 million to get. It was written in MUMPS in 1974. There is nobody left alive who can write MUMPS any more. That’s the model … the curve of innovation, the disruptive technology engine in healthcare is broken.”

    This is a pretty poor assessment of not only Epic, but any software. The current Iteration of epic software looks nothing like it’s original version and Mr. Bush’s comment implies that the software has remained stagnant since 1974, as opposed to being continually developed and improved. Fuzzy logic like this around an already convoluted industry does nothing but create knee-jerk reactions and sensationalism. It doesn’t surprise me in the least that this comment comes from an Epic competitor, but it does surprise me that he would paint software development in such broad, openly misleading remarks.

  16. Dear big name hospital CIO,

    why go through and expensive and time consuming process to pick a HIM system? It’s all a front! You know you won’t listen to your staff or recommendation from you clinician champions. You know you just want to go with the flow. You guys have been doing it for years!

    Yours Mr. HISTalk (the “ultimate insider” – Jonathan Bush)

  17. Mr. Bush seems to equate age with poor quality. Interestingly, MUMPS, SQL, C and UNIX all date back to approximately 1970. They are all alive today, all proven & indispensable workhorses in their respective areas.

    Also of that same circa 1970 vintage is the Boeing 747. I wonder if he flies in such a proven but obsolete aircraft.

    The wheel was invented a couple of years before MUMPS, SQL, C, UNIX and the 747. I wonder if Mr. Bush has given up on using such old technology.

    Or perhaps his message is different. I presume he was born before 1974, and his words were really a subtle hint to his employer about his being too old???

    Come now, Mr. Bush! What is the connection between proven and poor quality?

  18. Comments on “Top Stories”. It seems a subjective title. Perhaps an approach similiar to other blogs where each story is indexed to certain topics of greater interest to different readers would be a more valued apporach. (e.g. Epic posts, Meditech posts of greater interest to larger hospitals whereas the post on Applied Physiology would be of greater interest to Cardiac Program managers, Cardiologists, etc.). The user would then be able to permitted to sort by those of greater interest (rather than filtered) focusing them on things in order of that interest.

  19. Re: “…He also predicts that cell phones will be used to test for diseases and that voice recognition will be big.”

    Not to sound nitpicky, but you mean “speech recognition”, not “voice recognition”.

    Speech recognition = Taking acoustic input and determining what is being said.

    Voice recognition = Taking acoustic input and determining who is saying it.

  20. Re: Eclipsys Watcher

    Mr HIStalk, my experience is that most of the Eclipsys leadership has been replaced 4-5 times over since Harvey Wilson. Why should we think that this round will be any different??

  21. I wonder if Jonathan Bush realizes that one of the men who created the MUMPS language at Mass. General in the 60’s is still the leader of MEDITECH, e.g. A. Neil Pappalardo still runs MEDITECH and writes, along with thousands of other people, in the US, Canada, the UK, Dubai, South Africa, etc. in MUMPS decedant languages.

    Then there’s the company InterSystems, who’s entire product is based upon MUMPS technology & decendants. Hmm, last I checked, a large portion of the HIS market runs on this stuff. *Vital Signs check* Yep, I’m still alive too. And no, I was not alive when MUMPS was written/developed in the 60’s.

    I’m afraid Mr. Bush’s claim makes for a great soundbite, but that’s all it is.

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