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Monday Morning Update 9/21/09

September 19, 2009 News 8 Comments

From Carpluv: “Re: CCR. It has been reported that a group in Wisconsin has actually tested and exchanged CCR record from a different ambulatory EHR system. This is big news since hospitals tell doctors they have no interoperability unless they work through them. CCR and CCD are part of CCHIT certification and are certainly a component of future HIEs, but nobody really did it until this week. This reduces the drama and cost of interfaces on both sides and plays well in the small physician market.”

From Clint Gristwood: “Re: Epic. I consulted a friend and Epic employee when considering a job there. According to him, turnover is extremely high. In his trainee class of 20, only five or six were left standing after a few months. Responsibility and workload constantly accrue, and those who are struggling will only get buried. Most of the people who fail try moving into consulting or return to school for graduate studies. As far as the employment contracts, Epic cannot legally enforce them, but will try other tactics. One trick they pull is threatening to not work clients who poach Epic’s human capital. This puts a steep price on employers picking up talent out of contract.”

From Eli Cummings: “Re: Emdeon. I believe the stock analyst’s sour note on Emdeon should be taken with a grain of salt. Emdeon has a solid core transactions processing business that is unlikely to see an erosion of its recurring revenue anytime soon. This analyst previously worked at Leerink Swann, where he gained notoriety for making outlandishly bearish calls on healthcare IT companies. eResearch’s stock was devastated by a report of his, even though the thesis has yet to play out in fundamentals. Perhaps the fact that this analyst was one of only two analysts covering that company had to do with its precipitous decline. He launched a similar assault on Computer Programs & Systems (CPSI) with an Underperform rating, albeit less successful. After leaving Leerink, Bret Jones resurfaced at Brean Murray, completely turning around his opinion by launching with an Outperform on CPSI. Some stock analysts will go out of their way to craft outrageous statements if it gets them the limelight.”

From Rex Wife: “Re: smart phone software. Do you have a good list of healthcare software for the iPhone? It’s too hard to find the good stuff in the apps store.” No, but I could start one. Good idea or not?

I asked in my previous poll how much influence Dell will have now that it’s jumping into the practice EMR fray. Not much, according to readers: 62% said none and 31% said a little. New poll to your right: we keep talking about vendors as employers, so if you had an equivalent job offer from the ones listed, which would you choose?

Those computer programs that crunch through long lists of kidney donors and would-be recipients to find compatible pairs are very cool, making it possible for family members to get a transplant for a loved one even when their blood types are incompatible. University of Michigan announces that it has developed its own organ matching software. Profiled are two husbands whose tissue incompatibilities precluded donating a kidney to their respective wives, but the program matched them so they could donate to each other’s wives. Confusing, which is why it takes major software to sort it out when dealing with thousands of people and infinite possibilities.

Speaking of transplants, here’s a sad tale of family bickering: a man accepts $37,500 from his leukemic brother to donate bone marrow to him, but then backs out and says he’s too sick, claiming the money was a loan. In a statement to the newspaper, he said, “I did not make David ill, and I am not to blame for his illness” and suggested his brother find a donor registry or hit up their other brother. His brother responds, “If he knew he had this Wizard of Oz disease, this magical disease that he won’t disclose to anybody, then why did he take the money? And to say I loaned him the money, then, gee, it’s a coincidence that he needed money and I needed a transplant".”


Welcome aboard to new HIStalk Platinum Sponsor Apelon of Ridgefield, CT. The international clinical informatics company focuses on data standardization and interoperability. Its computer scientists, informaticians, and clinicians are involved with projects involving Mayo, CDC, NLM, Stanford, and many others. The company is heavily involved with deploying and maintaining terminology and vocabulary such as SNOMED CT, UMLS, RxNorm, ICD-9 and ICD-10, also working with US Cancer Institute, VA, FDA, NIST, ONC, the Social Security Administration, and Canada Health Infoway. All the work involving EMR deployment, interoperability, and data mining will require stringent deployment of expertly designed terminologies, so I’m sure their phone is ringing a lot these days. All that plus it’s their tenth birthday this month. Thanks to Apelon for supporting HIStalk and the people who read it.


The CIO of two hospitals in London is named in a whistleblower’s complaint for hiring a former colleague to do $3 million worth of no-bid consulting over six years. An internal auditor concluded, “The arrangement — and in particular, the dollars involved — begs the question as to whether LHSC should just be hiring TV (Tom Vlasic) as an employee, and stop paying the exorbitant per diem rates of a consultant. An in-house solution would most likely be more economical.” Nobody’s claiming the work was subpar, so at least the money wasn’t wasted. Also in question is whether the hospital should be working on regional integration projects (observations from the audit are above).

An LA Times article covering California’s 12.2% unemployment rate mentions a hospital IT guy who lost his job eight months ago. Shown are union members picketing Toyota for daring shut down their plant, which is full of all kinds of irony. Maybe we’ll all learn lessons about not getting too complacent about being someone else’s employee since it’s a voluntary arrangement both ways. Personally, I wish more people would hang out their own shingles instead of just looking for someone else to pay them since the idea of working for yourself is just as foreign (no pun intended) as paying your own medical bills. Small business is usually what keeps the economy moving, not multi-national corporations.

A VA inspector’s report finds that the Hampton VA Medical Center misdiagnosed a man’s stroke that left him permanently disabled. The former paramedic told the ED clerk that he was having a stroke and presented with classic symptoms, but was sent home. Also noted was that another patient’s lab result had been posted to his EMR, leading to the incorrect assessment that his labs were OK. The doctor, whose contract was not renewed, had copied and pasted results from another patient.

I interviewed Justin Barnes and Mark Segal, the chairman and vice chairman of the HIMSS Electronic Health Record Association, on HIStalk Practice.


I don’t think I’ve heard of Accretive Health, but a reader says their primitive and information-devoid Web site hides a powerhouse revenue cycle company. I found this Crain’s Chicago Business article (warning: PDF) on CEO Mary Tolan, who sounds like a fireball (the “happy, confident capitalist” fires the bottom 10% of company employees, or as she says, “invites them to their next career chapter that is not us”). It’s a $250 million company with former Secretary of State George Shultz on the board. Gearing up for an IPO, so I’ve heard.

Weird News Andy loves this, proclaiming “I’ve heard of inhaling your food, but your utensils, too?” A man puzzled by months of coughing spells and lack of energy sees several doctors who eventually figure out there’s something stuck in his lung. One offers to remove the lung, but he fortunately he seeks more opinions. Turns out he had a one-inch chunk of a Wendy’s spoon stuck there, apparently inhaled as he gulped down a drink. The doctor summarizes: “We’re looking at it and realizing that there are letters on it … We started reading out loud, ‘A-M-B-U-R-G-E-R,’ and realized it spelled, ‘hamburgers.’ Everybody was shocked. We had no clue why something that said, ‘hamburgers’ would be in someone’s lung." The patient is doing great, saying he can get around and breathe again.


Andy also noticed that two Central Florida hospitals have put up electronic billboards showing their ED wait times, updated every half hour.

Former Healthlink/IBM VP Stacey Empson joins Courtyard Group (or Couryard Group, if you believe the misspelled headline) as partner.

Two Johns Hopkins cardiologists write a Washington Post editorial extolling VistA as a cheaper, more effective practice solution that is “much more user-friendly than its counterparts.”

Boston Medical Center, a safety net hospital on such shaky financial ground that it could be closed, pays its retiring CEO $3.5 million on top of her $1.3 million salary.

Speaking of Hopkins, JHMI, MedStar, UMMS, and Erickson Retirement Communities are mentioned as the organizations behind Chesapeake Regional Information System for our Patients (CRISP), which is hopefully better at creating an HIE than it is at brute-forcing a cute and irrelevant acronym out of the uncooperative name it also chose. It’s getting $10 million in Maryland money to get going. Also mentioned is Baltimore vendor Salar Inc., which sells documentation and charge capture applications.

Former Cardinal Health marketing director Laura Bellon is named VP of healthcare solutions and strategy of Perceptive Software, makers of the ImageNow document management system.

Anesthesia systems vendor DocuSys raises $9 million in financing. It also says business has slowed and its plans to add 300 Atlanta-based employees to its current 55 have been postponed.

Allscripts shares hit a 52-week high on rumors it has signed a $20 million contract with North Shore Long Island Jewish Hospital. Market cap is at $2.69 billion, more than double that of Eclipsys and nearly half that of Cerner. Share price has nearly quadrupled in a near, so like all other investments you didn’t make, it was a natural.


Perot Systems gets its first international outsourcing deal, winning a 10-year contract with India’s Max Healthcare hospital chain worth $18 million. Perot will also deploy VistA there.

Someone goofs at Great Ormond Street Hospital in London, e-mailing detailed patient care complaints from the family of a teenager who died there to the local newspaper by mistake. It’s the usual story – the employee was trying to send an e-mail to someone by name, but instead got someone else with a similar name, in this case a newspaper reporter. The paper, showing restraint that would be surprising here, alerted the hospital and declined to disclose details about the information.

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Currently there are "8 comments" on this Article:

  1. Extolling VistA:

    From the article: “A cheaper and more effective solution is to adopt a standard electronic record-keeping system and ask that all health information software interface with it.”

    The model is all wrong. MDs need to view data and that DOES NOT require that the data be transferred between systems. Does “Google” make copies of data on the WWW? Of course not. Google keeps track of data (index or a directory of data) and how to reach it. It does not copy all the data on the WWW. When is healthcare IT going to adapt to a different model?

  2. <> This is VISTA, befuddling to the user.

    VISTA is a pedestrian set of HIT contrivances, prone to error.

    Cardiologists comment: <>

    The verdict is not in. VISTA caused heparin overdoses and more. The cover up of theses adverse events suggest that there are others being kept from view, as in the case described above.

    O’Bama spoke with Blumenthal (“more research is needed”__tons of it) and now realizes that HIT ain’t so easy, safe, or efficacious, which is why there was absence of stories of HIT miracles in his health care speech.

    The policy wonks and architects of HITECH (and O’Bama, and his cronies Tullman and DeParle) are praying (yes, Democrats pray also) that the $ billions for untested HIT gear do not evaporate as they did in the UK.

    Taxpayers, beware!

  3. Epic. Turnover is indeed extremely high. If you remain there more than 2 years you are considered a “senior” member of the organization…this mostly applies to implementors as TS and developers don’t have the same travel and billable time requirements.

    Their strategy to hire smart, young people straight out of college and pay them well (as far as new graduates are concerned) has worked for them for the most part because as the staff churns over new ones are always willing and able. Unless of course you are a customer paying top dollar for software support and your Epic contact is on their first install…they do have ‘mentors’, but newbies are encouraged to figure out stuff for themselves…pretty tough if you have no operational knowledge of healthcare…

  4. EPIC – no surprise there. Policy has always been just like the CPA/big 4 – hire three newbies, throw them into the fire and the one that walks out is the keeper. You’d think the clients would be screaming, but all I hear is a music from the love fest in Madison WI.

    Accretive Health – now there’s a name for a company. Accretive – the most overused word of Wall Street M&A people. (Can’t do the deal unless it’s accretive…)
    That’s forward thinking, you pick this name today, figuring that in 3 years or so, you sell out, and how can you NOT be accretive!

  5. Epic’s policies aren’t anything like the big 4 CPA firms. The policies are pretty much unlike any policies you find in a typical company.

    Will some people leave because they don’t want to travel – sure. That’s just part of life. Travel simply isn’t for everyone. Some switch roles, but many love project management and move on to do that sort of work in a role that doesn’t require as much or any travel.

    Will some leave with a chip on their shoulder because they didn’t realize the “work” part of “workplace” actually mattered at Epic? It’s a place with a short fuse for those who don’t meet a pretty high standard. Everyone is expected to work hard and do well.

  6. Accretive Health: My understanding, based on a presentation I saw by them, is that they are a mass-scale outsourcing firm for revenue cycle. Definately focused on the IPO.

  7. Wanted to comment on your Allscripts stock reference b/c back on 10/29/08 after you posted this “Allscripts CEO Glen Tullman and friends presided over the Nasdaq opening bell Tuesday. I say keep bringing him back since the Dow was up 890 and Nasdaq jumped 144. He just purchased an additional $511,000 worth of company stock, which represents a 17% increase in holdings to around $3.3 million” I bought some stock. So, thank you.

  8. Eli Cummings – if Bret is as lousy as you say then you shouldn’t have anything to worry about. Maybe you and HIStalk will save some column space for posts that don’t bash independent sell-side researchers trying to do their job. Or did you think that everyone would read your post, agree with you and drive the stock up for you? Maybe Bret Jones should respond with a post calling out investors who try to use the site to influence share prices….

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Reader Comments

  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
  • BeenThere: Partners will find the savings from their cuts of coders as fools gold. There are a lot of hidden costs running an outs...
  • JC: If there is not there can be. VistA has a reference lab interface that can create the manifests/labeling and such as we...
  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
  • Bob: There's no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of th...
  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...
  • Pat Wolfram: Such a refreshing article. Thanks -- there really can be a simpler version of an acute HIT implementation. But I do ...
  • Woodstock Generation: Bravo to HIStalk's Weekender recaps and other news/opinions. I read it first thing on Monday mornings..................
  • Veteran: #fakenews...

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