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Monday Morning Update 11/15/10

November 13, 2010 News 7 Comments

From Simon Stiles: “Re: Georgia HIT Leadership Summit. It was a huge success in that it united the leaders and vendors to begin talking ‘collaboration’ to benefit the growth of both large and small companies that are part of the health IT cluster that has developed in Georgia. The organizers are focused on attracting and creating more HIT vendors in Atlanta and Georgia that will provide high-quality, high-paying HIT jobs, not to sell products. Success was measured by the number of participating companies (110), the number of speakers and panelists who agreed to future collaboration (100%), and the number of companies that are interested in ongoing events that bring Georgia’s HIT companies together (100%).”

From Jenny from Venice: “Re: you and Inga. Let’s hook up at HIMSS. I love everything you both do, I really do. Lurve you!” Thanks, but I ran your proposal up the Mrs. HIStalk flagpole and she didn’t salute. I can’t speak for Inga. I had to look up “lurve” since I wasn’t exactly sure what it means, so that’s probably a good indication that we wouldn’t have hit it off anyway.

From MarketWatcher: “Re: Merge and Fletcher Flora. That was a very quiet acquisition and and odd one at that. Insight?” Coming soon, quite possibly – I’ll be interviewing a top exec there shortly, provided I can figure out a time after work to connect (darned day job).

From Tony: “Re: HIMSS reception. Has the signup page gone up yet?” Not yet. Look for it in January.

Inga mentioned that Henry Ford Health System is working on rolling out a new version of its CarePlus Next Generation EHR. A reader tells me that the Web-based SOA system was developed by RelWare, which offers its commercial version of it under the EXR nameplate.

AMIA says it doesn’t like “hold harmless” clauses in vendor software contracts. At a reader’s suggestion, I e-mailed CEO Ed Shortliffe to ask if AMIA will put some teeth behind its proclamation by turning down the sponsorship of vendors who won’t go on record as saying they don’t use those. He hasn’t responded, but I’ll let you know if he does.

11-13-2010 5-41-21 PM

It’s close to an even split whether recent election results will reduce or delay HITECH payments. New poll to your right: have you personally seen a “hold harmless” clause in a HIT vendor’s software contract? They’re supposed to be everywhere, but nobody every provides an example. I know I’ve seen them in some old copies of contracts that I discarded a few years ago.

San Juan Regional Medical Center (NM) sends four tons of old computer hardware to a Canada-based company that takes electronic waste for free, pays a third party to process it, and donates the profit to Feed the Children.

A Tampa publication mentions the cost of implementing clinical systems at a couple of local hospitals: BayCare ($200 million) and Tampa General ($120 million).

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Four small, closely-located Texas hospitals (the largest has 45 beds) join to create a RHIO around the Prognosis ChartAccess EMR.

11-13-2010 7-13-45 AM

Cloud-based population data analytics vendor Explorys, co-founded last year by Cleveland Clinic, hires Anil Jain, MD of the Cleveland Clinic IT department as its part-time chief medical officer.  

The health authority of Norway signs a $120 million deal with IBM to provide a variety of services and to implement a custom logistics solution built around SAP.

Healthrageous, which offers consumer health solutions based on technologies developed by the Center for Connected Health at Partners HealthCare, is chosen as one of the 50 most promising tech startups. It collects health data from patient biometric devices, analyzes it, then sends out recommendations to the patient. I like the name.

Laboratory middleware vendor Data Innovations is sold to Battery Ventures. Old news from last month, but I missed it first time around.

 11-13-2010 7-36-36 AM

The government of Hong Kong invites proposals to develop a territory-wide platform for sharing electronic health records. More information on the project is available from the eHealth Record Office.

Newborn twins die of a IV-related medication error at a scandal-ridden UK hospital that is already under public inquiry for the unnecessary deaths of 400 to 1,200 patients.

11-13-2010 6-12-21 PM

The CEO of National Health Insurance Board of Turks and Caicos Islands has a financial interest in the vendor chosen to process medical claims there, critics claim. The CEO disclosed his “minority interest” in Mitan, but the company’s Web site lists him as founder, director, president, and CEO since 1999.

Odd lawsuit: the transplant center of Georgetown University Hospital calls a cirrhosis patient who’s on the liver transplant list to tell her that a matching donor liver is available for immediate transplantation. They didn’t call any of the emergency numbers she had given, instead leaving a message on her home answering machine. The woman, as it turned out, had a good excuse for not being home – she was an inpatient at the same hospital at that time. When her family found the message and returned the call, they were told that the liver had been given to the next patient in line. The woman died, her family is suing.

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mHealth Reaction
By Deja Vu All Over Again

For anyone who attended Web or Internet conferences in the mid-90s, your description of the market is a flashback. mHealth as a separate model does not make a lot of sense, which is why they are having a hard time trying to figure it out.

Like in the late 90s for eHealth, all those new mHealth corporate groups will be integrated back into the main lines of business. Mobility is just a different (and exciting) way to deliver much more interactive and innovative value for core health care processes. The dot-com bubble experience will keep the fervor in check this time around.

Having said that, mHealth will have profound changes in US health care over the next five years for the following reasons:

  1. Our 5-10 year industry technology lag sets up a great deal of potential disruption for mobile components as the current brittle systems start to move towards loosely coupled modular application platforms like in other industries. Many large HIT vendors are about to enter the SAP enterprise model death spiral.
  2. Historically institutions and "back channel" processes have been the focus, not mobile savvy consumer / patients who are rapidly becoming financially forced to be more engaged in their health.
  3. Care delivery transformation from payment reform and skill shortages will require fluid care approaches that require mobility, and
  4. Most care is now done in the home, but will move from routine to chronic disease management due to aging and the obesity explosion.

Note to bright-eyed entrepreneurs who have not been in the health care industry a long time: the existing HIT vendor mafia has always been much more effective in squashing innovation from disruptive outsiders to maintain the status quo than competitively innovating against each other. If you fashion yourself as David vs. Goliath, make darn sure that God is on your side before you start hurling rocks.

Therefore, there will be a great deal of opportunity for those niche companies that focus on meeting the needs above by complimenting the old guard entrenched HIT vendor systems, but with an eye towards explosive disruption when they are embedded, delivering value, and the market timing is right.

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Currently there are "7 comments" on this Article:

  1. To be fair Mr H, the careless reader may conclude that Healthrageous was chosen as one of the top 50 startups BY Connected Health which incubated it. Instead it was chosen as such by a panel of VCs organized by DowJones Venturewire

    Still not convinced about the name though

  2. AMIA says it doesn’t like “hold harmless” clauses in vendor software contracts.

    A Nov. 11, 2010 AMIA Board Position Paper actually stated that “hold harmless” clauses are unethical.

    The full position paper can be downloaded free as a PDF at this link.

    My own commentary is at this link.

    — SS

  3. RE: Hold harmless clauses:

    I’ve worked both sides of the street on this issue. From a vendor perspective they can never know how a client may implement, maintain or use a system. Even if the problem that gets the client sued isn’t the vendor’s problem the cost of defending a themselves can be huge and at the end the jury may not be sophisticated enough to know the difference.

    On the other hand not knowing how well a vendor manages their software development process and not having control over the quality process certainly made me push for at least a reduction in the hold harmless clause so that the vendor had some skin in the game.

    My advice – if you are a client at the very least you should understand how the vendor develops, tests and implements their systems before you agree to hold them harmless for any issues that develop with the software. You also need a very strong validation process in your facility before you bring a system live, or, upgrade to a new version of the software. Easier said than done but we’re not dealing with just a legal issue here.

  4. As a panelist at the GA HIT Leadership Summit, I was impressed by the size and calibre of the audience. I agree with Simon Stiles, this was not at all vendor focused but a well constructed agenda that appeared to have between 300 – 400 in attendance. Nice venue for hosting this event at the Fox Theatre. This was a great opportunity to bring people in the industry together and really hear from everyone.

  5. The iHealth Alliance, a coalition of industry stakeholders, has launched an electronic health record safety reporting Web site, called EHRevent.org.

    The site is designed to be a national system where providers can report safety issues related to the use of EHRs. Reported events will be confidential but used as the basis to generate other reports that medical societies, malpractice insurers and government agencies can use “to help educate providers on the potential challenges that EHR systems may bring,” according to the alliance. The Food and Drug Administration will use data collected on the site to assist in evaluating safety issues that may arise during the forthcoming widespread implementation of EHRs.

  6. Whether or not Dr. Shortliffe has any interest in putting “teeth” behind the Vendor TF recommendations is irrelevant. For starters, the TF Report tells us little beyond the Koppel / Kreda commentary in JAMA that inspired the TF’s creation. More importantly, the only TF recommendation that really matters is the one about having a “national discussion” around regulation. But that discussion window came and went at the HIT safety hearing this past February, and the opportunity to influence FDA regulatory stance towards HIT, for better or for worse, may not come around again for years. Indeed, the TF was used as cover for AMIA’s lack of preparation to provide a modern opinion on the question of regulation at the hearing, when Shortliffe falsely represented in both written and oral testimony that the charge of the TF included full consideration of the issue of FDA regulation, when in fact the TF charge was simply to review the non-disclosure and hold harmless clauses in vendor contracts. In so doing, AMIA let stand its published 1997 position which enthusiastically endorsed the FDA’s notion that if a clinician makes a mistake using HIT then it’s the clinician’s fault (a version of the “learned intermediary” doctrine) and told the FDA to back off, including a statement by the vendor association at the time (CHIM) that they were developing their own best practices and would create a voluntary compliance program (neither happened). Even more shameful than not telling the whole truth about its lack of preparation to weigh in on regulation is that Shortliffe himself actually scuttled a policy review on that very topic that had been scheduled to occur nearly 6 months earlier, at AMIA’s 2009 Fall Policy Meeting in DC, allegedly because he was worried about annoying AMIA’s vendor sponsors. This is not a proud moment for AMIA, and aggravates the omission of any mention of concerns about HIT safety and the need to fund further study of it (and possibly some additional regulatory infrastructure) in their January ‘09 Letter to Obama outlining recommendations for use of ARRA funds for HIT, either inadvertently for lack of awareness (unlikely) or intentionally for fear of spooking the funders. The combination of the omission of safety concerns from the ask Letter in 1/09 (AMIA wasn’t alone in that approach, btw) and the misleading testimony at the safety hearing in 2/10 may provide unfortunate ammunition to those on the Hill salivating over the $30B in planned MU incentive payments as a cost-cutting target (look at what a field day the anti-global-warming block had with some fairly innocuous emails suggesting something less than full disclosure of evidence not supportive of warming). Hopefully, ONC can figure out a damage control strategy while there is still time.

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