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November 4, 2010 News 14 Comments

From Elihu Smails: “Re: Citrix. I believe it’s responsible for many of our industry’s technology issues. Without their stepping in and serving up virtual sessions for EMR systems collapsing under their own client-server weight in the late 90s and early 2000s, the industry would have been forced to move to the Web and to modular platforms. I have nothing against their making lots of money, but for the sake of our industry, I wish they hadn’t saved the butts of the EMR vendors.” I couldn’t agree more. Citrix has customer advantages (security, low end user device requirements, central app management, remote capabilities, low bandwidth) but it did indeed let lazy vendors keep selling apps that were already long in the tooth and technologically overripe. Those systems work, but for dozens or hundreds of millions of dollars, you might expect a little more vendor capital investment. I always say that implementing Citrix is like eating at Denny’s: something nobody intentionally plans to do or is particularly thrilled about.

11-4-2010 9-11-00 PM

From DemoChic: “Re: social media policy. Not sure if other vendors have them, but here is NextGen’s, posted as it encourages users to post on Twitter and Facebook from their user group meeting.” The policy seems reasonable, asking that participants identify themselves, refrain from posting proprietary or defamatory information, and not contact other social media users through other means. Companies that don’t have such a policy can get some … ahem … ideas there. The meeting starts Sunday in Orlando.

From HIStalk Evangelist: “Re: my RN friend’s review of your site. She said this, which I found adorable: ‘Thank you for the HIStalk website … it’s very informative in a non-sterile manner.” Both the comment and the evangelism are cool – thanks.

From HIT in the Fog: “Re: Epic project at UCSF. We have had two people leave our 75-person team and the project is on schedule, under budget, and within scope. I’m not sure where the rumor to the contrary comes from, but it’s inaccurate.” Thanks.

11-4-2010 9-14-11 PM

It’s amazing how many fun people Inga and I get to meet by various electronic modalities. If you want to connect with us (other than via plan old e-mail, but we like that a lot too), my LinkedIn profile is here (flattering pic, don’t you think?) and Inga’s is here (hot legs!) The HIStalk Fan Club that Dann started is up to 1,177 members, so thanks for that – how many people can tell their moms they have a fan club? As a Round-Number Milestone Fixated American, I also notice that the HIStalk e-mail blast list has hit an even 6,400 verified subscribers. We’re on Facebook, of course, so feel free to Friend us or to Like HIStalk if you want to turn our frowns upside down.

Listening: The Greenhornes, a Cincinnati-based garage band whose members made up much of The Raconteurs. I like the sound. Their new album comes out next week.

The local TV station covers the Epic implementation at New Hanover Regional Medical Center (NC). It says the project will cost $56 million and generate $13.7 million in HITECH money.

11-4-2010 7-02-07 PM

A Catholic newspaper talks up the $450 million Epic system in place at the 28-hospital Sisters of Mercy Health System (AR). The corporate web site features MyMercy (their name for it) prominently.

Children’s Boston chooses the MetaVision anesthesia management system from iMDsoft.

CIO salaries: Packard Children’s Hospital at Stanford (CA), $700K. Medstar Health (MD), $642K. Saint Barnabas Health Care (NJ), $538K.

Jobs on the Sponsor Job Page: HIE Team Lead, Director Strategic Marketing Initiatives, Allscripts Consultants. On Healthcare IT Jobs: Cerner FirstNet Analyst, Electronic Clinical Applications Manager, Meditech Advanced Clinicals Consultant.

I doubt anyone cares much about Misys PLC these days (let’s face it, they added no value to the HIT companies they bought and sold), but just in case you do, the IRS rules that its sale of most of its Allscripts shares carries no tax liability. Shareholders will get their billion dollars.

Of all the things Weird News Andy could have observed about this story involving the use of mannequins to train nurses, he zooms in on the fact that the dummy’s hair looks like that of Rod Blagojevich.

11-4-2010 7-33-07 PM

Thanks to brand new HIStalk Platinum Sponsor Carefx. You may think of them as offering single sign-on, provisioning, and an enterprise master patient index. They do, but as the informercial guys say, “But wait – there’s more!” The Scottsdale, AZ company offers several products that help close information and workflow gaps among users of existing systems: BI dashboards, an eReferral portal, and the SOA-powered Fusionfx collaboration and patient information aggregation platform (a scalable community portal providing real-time queries to existing systems). You may remember that the company got an exclusive license from Cleveland Clinic this past May to market its dashboards covering core measures, mortality, physician scorecards, throughput, and patient experience. Inga and I thank Carefx for supporting HIStalk.

Steven Nickerson, formerly of Philips and McKesson, joins The Beryl Companies as VP of sales. The company offers a variety of services related to patient engagement and follow-up.

11-4-2010 7-55-26 PM

Ottawa Hospital engages the startup of three recent college grads and former game developers to develop physician iPad apps for patient information and lab results.

11-4-2010 9-15-42 PM

ONC wants input on consumer use of HIT and electronic health information to manage their health. Comments can be left (and read, surprisingly) on the Health IT Buzz blog entry called Strategy for Empowering Consumers.

Strange: a New York woman, upset over her father’s death due to heart failure, tries to hire a hit man to kill the two doctors and two nurses she says were involved. She is arrested by an undercover FBI agent posing as a would-be murderer after taking her $400 down payment. Not surprisingly, she’s having a psych evaluation.

I’ll be heading off to the mHealth conference in Washington, DC this weekend, weighing whether I’d rather pay $10 a day to use the hotel’s fitness center (Treadmill Timeshare) or turn blue for free while taking a chilly 4-mile jog around the National Mall, but at least getting to see cool sights while my nose hairs freeze. If you’re going, maybe I’ll see you there. If not, I’ll be posting from the conference each day.

E-mail me.

HERtalk by Inga

From Za: “Re: ARRA. Will ARRA be pushed back or repealed because vendors and thus providers will likely be unable to meet the required timelines? My guess Is Horizon Clinicals is a victim of ARRA and I suspect there will be others. The bulk of vendors are struggling with rewrites. ARRA upgrades will need to be implemented and there aren’t enough resources to get everyone up in the timetable.”  I would be shocked if the dates were pushed. Repeal flat out won’t happen. Then again, healthcare always seems to find  millions to spare when it comes to lobbying, so you never know. Based on the ONC-ACTB certification announcements to date, most of the ambulatory vendors seem to have their products ready to go, and in theory, the RECs will shoulder some of the implementation load for primary care providers. I’d say at this point that community hospitals are the ones most at risk of missing ARRA deadlines.

Speaking of community hospitals, KLAS finds that community hospitals with fewer than 150 beds are giving more consideration to the larger vendors than traditional community clinical IS vendors. Meditech remains the most-considered vendor for community hospitals, but providers are also taking more interest in Cerner’s hosted offering and McKesson’s Paragon, and to a lesser extent Epic.  KLAS does not mention this (probably because the report had been in the works for awhile) but I don’t see any of the “traditional” community hospital solutions (CPSI, Healthland, HMS, Keane, and Siemens MedSeries4) on HHS’s list of  ONC-ATCB certified products.

att healthcare

AT&T announces a new practice area called AT&T ForHealth, established to accelerate delivery of wireless and advanced networking services in healthcare. As I understand it, the ForHealth area includes an mHealth group handling HIE connectivity, disease management, and telehealth initiatives; a healthcare mobility team; and, a healthcare marketing group.

The VA awards QuadraMed a five-year, $211 million contract to implement its Quantim Coding, Compliance, and Abstracting solution for ICD-10 coding and compliance. The VA will also add QuadraMed’s Physician Query Tracking and Central Reporting tools, as well as rely on QuadraMed for implementation, technical training, and support services. The VA has been using Quantim since 2005.

Former Allscripts, Misys, and Eclipsys VP Mike Etue joins Ingenix as SVP of provider sales.

sandlot connect

Fort Worth, Texas-based HIE SandlotConnect says its exchange contains over 1.5 million patient records and connects more than 1,500 providers.

Boston-based Shareable Ink says it’s relocating to Nashville after securing $4.5 million in Series A funding from Tennessee investors. In case you missed it, T-System CEO Sunny Sunyal talks a bit about his company’s partnership with Shareable Ink in this interview posted yesterday.


Fairview Northland Medical Center and Fairview Lakes Medical Center (MN) go live on Epic.

A former UCSF Medical Center employee is sentenced to a year in prison for using the social security numbers of co-workers to complete online health surveys. Cam Giang received a $100 voucher to Amazon for each of the 382 online surveys he completed. Bet the shopping was good while it lasted.

The Alliance of Chicago picks Ignis Systems’ EMR-Link to provide EMR-to-lab connectivity for its 25-member community health centers.

pen bay healthcare

When its merger with MaineHealth is finalized next month, Pen Bay Healthcare (ME) will receive $3 million and an Epic EMR system.

Medical imaging management provider DICOM Grid secures $7.5 million in Series A financing. The investment will accelerate DICOM’s market expansion and product development.

In case you are still not catching all the hot news featured on HIStalk Practice, here are some of this week’s highlights: (a) workflow analysis, HIT integration, and specialty specific solutions contribute to quality and safety improvements in the outpatient setting; (b) why findings from a recent CompTIA study sound pretty weak; (c) a one-on-one chat with President Obama, who shares his opinions on the significance of IT in healthcare. OK, I made that last one up, but you never know what compelling news you might be missing if you aren’t tuning in.

Sponsor Updates

  • NextGen partners with InstaMed to offer providers InstaMed’s merchant processing services, including patient collections and automated posting into the NextGen PM system. NextGen also announces its NextGen Inpatient Clinicals version 2.4  has earned CCHIT 2011 Inpatient EHR premarket certification. Certification under the ONC-ACTB program is pending.
  • MidSouth eHealth Alliance (TN) extends its CareAlign system contract with Informatics Corporation of America to include the Middle Tennesse eHealth Connect HIE.
  • MEDecision presents its concept for advancing technologies that support patient-centered medical homes in a just published e-book, The Patient-Centered Medical Home: The Cornerstone of Healthcare Transformation. Download here.
  • FormFast announces a November 11 webinar featuring Barry Runyon of Gartner entitled World class doctors, world class treatment, broken workflow processes.
  • 21st Century Oncology (FL) chooses the Sage Intergy for its 90 radiation therapy centers in 16 states, noting its strengths in handling complex, multi-facility billing.
  • The OB department of Good Shepherd Medical Center (OR) selects the Access Universal Document Portal to electronically transfer perinatal documents from GE Centricity into Meditech’s Scanning and Archiving system.
  • Picis introduces LYNX I/Point, a new charge capture solution for hospital-owned infusion and oncology treatment centers.
  • United Hospital System (WI) activates multiple clinical components of  Sunrise Enterprise solutions from Allscripts, including CPOE, pharmacy, and ED. At both Kenosha Medical Center and St. Catherine’s Medical Center, 100% of ED physicians were entering orders electronically on Day 1.  In its next phase, United will deploy the Allscripts ambulatory EHR for its employed physicians.
  • Methodist Children’s Hospital (TX) says it saved $1.5 million in one year after implementing T SystemEV in the ED, which allowed it to speed up discharges and transfers, reduce paper chart management time, and improve infusion documentation for charging.

I noticed that I have almost 1,000 followers on Twitter, which I find a bit amusing and somewhat surreal. Mr. H has a few hundred more followers than me, though I have a few hundred more tweets. Quality tweets over quantity?


E-mail Inga.

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Currently there are "14 comments" on this Article:

  1. Agree 100% with the Citrix statement. It’s very hard to look at our Cerner system with its Windows 3.1 UI and not roll my eyes…

  2. Loved the LinkedIn profiles.
    MrHIStalk: I hope that my aimless wandering and limited ambition help me achieve even a fraction of your success. Maybe I need to invest in an elegant chapeau like yours. It could be gender neutral. (I was going to use “unisex”, but that would really date me.)

    HERtalk: Legs shegs…it’s all about the shoes! I yearn for the time when style trumped comfort.

  3. I wonder if that KLAS study you mentioned was funded by one of those non “traditional” vendors trying to find their way back to the smaller hospital market since Epic seems to be taking the large hospital market share by storm. The facts are this….anybody that has ever worked in a 14 bed hospital environment knows they want to get to an EHR, but have staff and funding constraints that won’t allow them to do so at a $3million+ price tag. So thanks to those “traditional” vendors small and rural hospitals have an option they can afford, manage and implement in time to actually have any hope of getting stimulus dollars. And oh by the way, they are guaranteeing certification and there’s no reason to believe they won’t get certified.

  4. Re: Citrix comments. I don’t agree with the demonizing or even marginalizing Citirx as a technology option. They didn’t design their product to “…save the butts of EMR vendors” though that might have been a tangential unintended consequence.

    Like probably many of your readers, I’ve witnessed it in use since the mid-90’s when it was primarily a technologists tool to remote into their network and troubleshoot other issues. Essentially it is remote desktop with nice front-end tools which make remoting into various locations quite effortless if configured properly.

    That larger vendors then decided to use it to distribute their applications to their clients desktop PC’s became a matter of best practice as the promise of true thin/web-clients never really came to fruition (the battle between web standards like java vs active-x were more responsible for that thanc choosing Citrix) and the fact that most web-clients lack the functionality to deliver the feature rich EMR clients that exist out there especially when more than “view-only” interaction is needed with the data as most true EMR’s require. Further, Citrix became a means to standardize client application delivery to environments where PC support is just not avaiable for lack of trained staff or because it is cost prohibitive like in many physician offices.

    So, I think one should be careful not to critique the technlogy (Citrix in this case) but rather more the implementation of it from site to site which would be more aptly characterized as a combination of technology chosen AND managing properly user expectations on how it should work in the environment it is deployed in. I’ve witnessed very succesful Citrix implementation for example in our Hospital and in a past employer’s manufacturing site (on a small and large scale). The drive of those successes is/was how those projects were managed.

    I’m sure we can find those who have done thin web-client only deployments with equal frustration why their system can’t do everything they use to do with their “thick-client” counterparts. Should they blame Microsoft’s Internet Explorer product or maybe even Netscape or the guys working at Arpanet, the forerunner of the world wide web for anticipating their needs better?

  5. Put the blame where it really belongs – with Microsoft.

    Microsoft has failed the professional industry because they actually proft from the consumers who end up with a trashed / slow / virus laden PC and throw up their hands and just buy a new one.

    This continual repurchase cycle fuels a huge part of the MS empire.

    Some people figured out Apple is somewhat better at allowing you to Instal and get this – DEINSTALL a program from your computer entirely.

    Because MS does not have the discipline to separate OS from Apps you’re forced into a thick client nightmare that simple is intolerable for IT shops of any size or you turn to Citrix or WTS. And oh yeah, MS profits indirectly from Citrix as well selling client access licenses and server licenses.

    They are winning financially on both fronts now.

    The real problem is coming through. MS certainly has the technology to compete with cool UIs but they don’t have the trust of their users to go back to thick clients where you need to run these new UIs because of the horse power and graphics needed to support them.

    And people still use windows programming because you simply can’t do all the things users want to do with even the most start of the art web programming at scale. Lots of circus tricks to be seen for sure, but not complex apps at scale yet.

    The tools are coming slowly, but anyone who’s really tried can tell you all that glitters is not gold. Web has a future, but you don’t get slick cool iPhone or iPad feel via the web yet. Even at it’s best its lame compared to what I can program on an iPod touch.

  6. I don’t agree with the demonizing or even marginalizing Citirx as a technology option. They didn’t design their product to “…save the butts of EMR vendors” though that might have been a tangential unintended consequence.

    Agreed. They made a useful tool; how it was used was not their major responsibility.

    Those ‘tangential unintended consequences’, though, are just another instance of the wicked problems that large scale HIT diffusion and the social re-engineering that goes along with it presents.

    You’d never know that hearing a major vendor CEO (e.g., Neil, Glen) speak, however. Nirvana is somehow always just around the corner.

  7. Seeing that stimulus number of $13.7 million for New Hanover hospital got me curious. That sounds like an awful lot for a 700 bed 3 hospital system in rural NC that won’t even be able to apply until at least 2012 since they have to implement the whole system. Does that sound about right? Where do those numbers come from? Are those numbers similar to what other hospitals expect to see? Anyone have any experience with similar quotes for their own hospitals?

  8. I am trying to understand the comments and criticisms about Citrix. We are using Epic in our hospital with the Citrix virtualization, and I have the Citrix Mac client running on my Mac at home and at work, the Citrix Receiver on my iPad, and the PC Citrix client running on the PC laptop at home. As a busy physician, it works great. Works better than the Javascript workaround through metaframewest, and gives me information that I need, when I need it. The other thing that is great about it is that when you turn it off, it is gone, no HIPAA-sensitive data on my laptop… or my iPad, either.

  9. Citrix enables hospitals to keep running 20, 30 year old software ; it allows vendors to keep from having to write new software (which they don’t do very well — e.g., Siemens Soarian Financials and now McKesson HERM fiascos).

    As far as I can tell, only software products from the big vendors depend on Citrix to work… new solutions from new vendors (e.g., less than 10 years old) all run over the Internet, via a browser. No Citrix required, no Citrix required on iPad, no Citrix required at home. It’s a joke; only in healthcare.

    Only in healthcare is a software product built in 2000 still considered new.

  10. Citrix…file under “what goes around, comes around”

    We all complained loudly back in the HIT dark ages about dumb terminals and the CIO glass fortress. So we jumped at PCs, client server, distributed processing and peer to peer.

    Then the CIO struck back…system (and users) out of control. Quick get terminal emulation (Citrix) in here. Turn those intelligent PCs back into dumb terminals! Lock down those wayward users.

    In the end, instead of buying $300.00 dumb terminals, we buy $900.00 PCs!

  11. I hope anyone who thinks today’s distributed architecture using Citrix is only an emulation of yester-year’s dumb terminals isn’t making purchasing decisions. If not implemented and managed properly, you quickly get a mess on your hands. If done correctly, it’s an indispensable tool that supplements and enhances your core business applications.

  12. Anyone ever wonder what’s the most common platform in finance/Wall St.? It’s not Windows and Citrix. Hint: it sounds like “eunuchs.”

  13. I noticed that the only critics of Citrix in this post are “techies” and/or non-clinicians. The one clinician (Dr. Tupperman) hit it on the money with his “…As a busy physician, it works great.”, “…and gives me information that I need, when I need it.” and “… when you turn it off, it is gone, no HIPAA-sensitive data on my laptop… or my iPad, either.” He’s the only one worth listening to on this subject (and I iinclude myself as one to tune out here too quite frankly..)

    We technologists have to stop looking at technology as something that was made for US to use and/or ‘play with’ but a privilege we get to configure for those we SERVE, our clients that use the system day to day. These users don’t typically bother reading our pompous posts about how much better Unix or Internet based applications are because they don’t care. The truth is those are technologies are just as prone to failure when improperly deployed by silo-ized technologists who only want to work on the ‘latest’ and ‘greatest’ stuff instead of the systems tht Dr. Tupperman and his peers need to provide appropriate care.

    I’m not a proponent for Citrix nor its critic. Instead I strive to be a proponent for the clinician. I suggest we technologists do some soul searching when we decide to villify any technology that at one time was designed to meet a specific need. It is just a matter of time before that which we promote will also be thrown into the mix of ‘has-been’ technologies. Let’s instead navigate our clients through the challenging times ahead and model what we do more as if we were a utility like a power company than a ‘cutting edge’ information service prone to failure. Doctors and nurses don’t come in each day and say a prayer the lights stay on. They shouldn’t have to for their patient information systems either…. After, all when was the last time a hospital complained about how that old coal fired power plan isn’t generating ‘clean’ power like the new solar panels I have on my roof at home…

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