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January 4, 2011 News 15 Comments

1-4-2011 8-34-19 PM

From Stan: “Re: article in Applied Clinical Informatics on why people discount personal experiences with HIT. I think your readers might find the free download worth reading. Best regards from Switzerland.” The author, Jon D. Patrick from the University of Sydney, Australia, took heat for publishing user reports of ED system problems. His editorial says the problem reports of experienced system users are dismissed as unscientific anecdotes to protect IT interests, the organization’s investment, or its executives from criticism instead of treating those reports as an early warning system. While I don’t buy the idea that user IT perceptions should always be taken at face value, he’s right about the weird dynamic: the IT department and all the suits who signed off on the deal shoot the messenger because they are emotionally invested in it. They honestly believe that complaining users are troublemakers or fools who aren’t blessed with their big-picture vision (specific, serious IT problems are often dismissed on the basis of the greater good, of course). That’s like blaming a patient for daring to develop a post-surgical infection since it makes the surgeons look bad (which wouldn’t surprise me either).

From The PACS Designer: “Re: iPad 2. Sometime later this month, we’ll be seeing Apple’s next version of the iPad, being called the iPad 2 or 2nd Generation. Business Insider gives us an early look on what might be in the iPad 2 and what will probably be done to  the current iPad price. Sources in Japan are reporting that early production models seem to indicate that the iPad 2 will have two cameras, with the rear camera having the ability to record a movie when needed by users.”

1-4-2011 9-03-07 PM

From Healthcare Idiot Savant: “Re: Missouri State Senator Brad Lager from North Missouri (R-12). Recently started a new job — wait for it — in Government Affairs for Neal Patterson’s Cerner Corporation. Certainly there can’t be any conflict of interest there, right?” According to a bio in the KC business magazine, A bit of advice if you want to reach Missouri state Sen. Brad Lager: Try to give his e-mail inbox a break. ‘Between my Senate e-mail and my e-mail at Cerner, it’s about 1,000 messages a week,’ says the time-starved 34-year-old. As a measure of Cerner’s good corporate citizenship, the Northland medical software giant makes concessions to allow Lager the four-day legislative schedule he keeps from January through May. He’s back in the office at Cerner on Fridays as a senior strategic analyst in the Health-e Services group. I found some old documents that said Neal’s wife Jeanne donated $25,000 to his 2008 campaign for state treasurer.

From DigDug: “Re: taxes. We are hearing a rumor about tax changes for consultants who pay their own travel costs up front and are reimbursed by the client. There should be no tax implication, as the consultant is not claiming any deduction or tax relief for the travel, but we are hearing that the government now considers these reimbursements as taxable. Any insights?” I’ll use a reader lifeline here since I don’t know. Anyone?

From Lori: “Re: HIStalk. I’m writing to express how much I love and enjoy reading HIStalk! I stumbled upon it on Facebook and have been on it ever since! I enjoy looking at the industry as it continues to unfold. I’m able to do that now with HIStalk! Thanks again!” Thanks.

From NoName: “Re: evidence of an EMR implementation improving patient safety.” An article from East Carolina University and academic medical center Pitt County Memorial Hospital (NC) in Journal of Antimicrobial Chemotherapy finds that its inpatient Epic EMR implementation was accompanied by a 29% reduction in antimicrobial use. Clostridium-caused nosocomial infections dropped by 19% and MRSA infections went down 45%. The EMR doesn’t get all the credit, though: the article suggests that better pharmacist oversight of antibiotic usage, made possible by having immediate electronic access to patient information and orders, allowed them to intervene more effectively. However, order sets built into Epic did reduce the ordering of excessively high antibiotic doses. The good news is that all EMRs can support these efforts if hospitals use them appropriately, so not having Epic isn’t an excuse.

From Roy G. Biv: “Re: weird interview questions. One from Deloitte: how many ridges are there on the edge of a quarter? From my own experience, I’d say that’s about right as far as the average Deloitte consultant’s contact with reality is concerned.”

Listening: The Jessica Prouty Band, which I’m giving special attention since I know her mom, who spent time in HIT. This is a teen band, but you’d never know it since they play hard-rocking prog-metal (to my ear, anyway – think Within Temptation or Evanescence). They’ve toured, won a bunch of contests, and are playing Downtown Disney in California on January 15. I like their sound a lot.

I’m really excited to introduce a new HIStalker, DigitalBeanCounter. DBC e-mailed after seeing my cry for HIStalk help and will be doing some interesting things with us, starting with collecting and writing up sponsor news items in the Sponsor Update section. He’s got a ton of energy and a great attitude (the opposite of me, in other words). It’s great to have DigitalBeanCounter on our little team. I’ll hook him up with an e-mail address soon, but he was anxious to jump right in.

Speaking of which, thanks to the amazing people who e-mailed offering to help out. I’m still sorting through them, but as Inga told me, they’re all so good we want to work with every single one of them (seriously). My several hundred daily e-mail count has swelled lately to the point that I’m behind even after working through the holiday. Any perceived slight is unintentional – I just don’t have a lot of time left between my full-time jobs (hospital and HIStalk).

1-4-2011 7-56-03 PM

Former A.D.A.M. CTO Keith Cox is named (warning: PDF) CEO of the Health Information Partnership for Tennessee, which is using a $11.6 million federal grant to connect Tennessee’s RHIOs. 

Advocate Lutheran General Hospital becomes the second Advocate hospital to sign up for PerfectServe’s clinical communications system.

Reminder: HISsies nominations are open, so let’s have yours, please. Every year someone squawks when the final ballot comes out, claiming that I was clueless in omitting some obvious nominee for Best CEO or some other category. I remind them readers do the nominating – I just choose the most-nominated items for the ballot. For example, only one person has nominated Neal Patterson for the “Pie in the Face” award so far, so either Neal has changed considerably in your mind from his unbroken streak of past wins or everybody’s assuming someone else will keep the wheels of democracy turning.

I mentioned a new story about new Cerner contracts in tiny Idaho hospitals. Vince Ciotti of H.I.S. Professionals e-mailed me some thoughts and agreed to let me run them here.

Your Web site is so good and read so much, please don’t take this as a criticism, but as an attempt to set the record straight for your many thousands of readers…

Regarding your piece on Cerner’s $1.3M "deal" for a hospital in Idaho, I’ll bet that is capital (one-time) costs, which are rather low with Cerner’s "remote hosting" approach. This would include primarily implementation fees, and maybe some on-site hardware (e.g: med scanners).

Operating costs are another matter, since remote hosting (also known as ASP or SaaS) usually has a hefty fee per month for processing and storing data at one of Cerner’s two data centers in KC. It is probably six figures per year, and could approach seven figures depending on how many apps were purchased..

So, the TCO (total cost of ownership) over five years should be right up there with the fees most other large vendors charge (e.g.: Meditech, McKesson’s Paragon, Siemens Medseries 4, etc.) for a 14-bed hospital. The best bargains for such a small site are the "Big 3" in the small hospital market: CPSI, Healthland, and HMS. Their TCO over five years should be far less than Cerner, Meditech, McKesson, etc.

In addition, these small-hospital vendors have all apps a small hospital needs, including ERP, which Cerner usually turns to someone like Lawson or Microsoft, increasing their TCO even more. CPSI can even include an integrated PACS and Time & Attendance system, all extra with the "high-end" vendors like Cerner, Siemens, McKesson, etc.

Are the "high-end" EMRs any better? That answer could be a PhD thesis of 10 pages, but the bottom line is: one can achieve Meaningful Use with any one of them! Yes, Cerner probably has far more features than CPSI, but can a 14-bed hospital ever afford the IT and clinical staff to implement them? I doubt it…

This is not to knock Cerner. Millennium is an excellent clinical system, a worthy competitor to Epic in the large and Medietch in the mid-size hospital markets. But for a 14-bed facility, it’s like a newlywed couple starting out with a BMW. They’d be much better off with a Honda, and spend the difference on their kids (patients)!

Former Parkland Hospital SVP/CIO Jack Kowitt is named EVP of outsourcing vendor PHNS.

I mentioned a while back that I was surprised by a British survey that found that 84% of people there use their smart phones as alarm clocks. I bet they’re sorry now: a New Year’s-related software bug causes iPhone alarms to stop working at midnight, causing people to oversleep. At least most of them were off Saturday, I assume.

German mega-vendor CompuGroup acquires Belgian practice software vendor Belgiedata, continuing its worldwide expansion.

1-4-2011 9-50-27 PM

Care Innovations, a telehealth and independent living joint venture of GE and Intel, is operational with management in place.

Cleveland, desperate to replace lost manufacturing jobs, kicks off construction this month on the $465 million Medical Mart & Convention Center, hoping it can ride the coattails of Cleveland Clinic to bring high-paying jobs there (like every other city wants to do, but this one’s backed by clinic CEO Toby Cosgrove). Locals get stuck with the tab in the form of a quarter-penny bump in the sales tax. The project, which has yet to sign any tenants, will cost taxpayers up to $840 million over 20 years and competes with a similar project in Nashville that already has landed HIMSS as a renter.

Open source integrator EHR Doctors, which holds a contract to provide the Social Security Administration with its HIE platform for exchanging disability claims documents, says the agency has approved its C32 Continuity of Care Document.

AliveCor’s iPhone ECG is a snap-on back for the iPhone 4 that turns it into an ECG machine. Amazing, but not yet FDA approved. 

E-mail me.

HERtalk by Inga

From Bill Belichick: “Re: Meditech. They will be buying out ambulatory partner LSS and will oversee future product development and business planning. I believe it will most likely be announced by Meditech following their next board meeting this month. This will get Meditech right into the ambulatory market and add much credibility to the product line with the new Meditech branding. It will likely offer customers much more competitive pricing.” Unverified, that but sounds like a good strategic move.

amazon glowcap

Vitality’s GlowCaps are made available for $10 a cap on Amazon. The AT&T wirelessly-connected GlowCaps are intelligent pill vial caps that use light and sound as patient reminders. Adherence data is recorded each time the pill bottle is opened, then compiled as periodic compliance reports.


Telecare, a provider of wireless communication tools for chronically ill patients and their physicians, secures $4.46 million in a mixed securities offering. The company is headed by CEO and founder Jonathan Javitt, who has a pretty good track record of aligning with and/or building growing companies. Some of his previous enterprises include CodeRyte and Clinitek (now Siemens). He was also the founding national medical director and SVP for the United Healthcare division that is now Ingenix.

Imaging outsourcing firm Foundation Radiology Group raises $3.5 million, bringing its 2010 fundraising efforts to $9.5 million. The new funds come from Chrysalis Ventures and Health Evolutions and will be used for unspecified growth.

I’ve been amused and confused by all the responses to the Epic interview question about the cost of a pear. Mr. H and others used their programming logic to calculate the cost, based on the known prices for an apple, orange, and grapefruit. I would have replied totally differently, I guess, since I  have a much simpler sales brain and an IQ that’s a good 30 points lower than Mr H’s.  Anyway, I would have said that we don’t have pricing for the pear, then pose the question, “How much do you think the pear is worth?” Or perhaps, “If you are willing to buy all the fruit today, I am sure we can come up with a package price that would be acceptable.” Incidentally the question was originally posed to a project management prospect and not for programming or sales job. Maybe a PM would do a SWOT analysis on the pear to develop the right answer.

MEDHOST says that 12 facilities have now purchased OpCenter, the company’s executive decision support solution that was introduced a year ago.

charles christian

CHIME and HIMSS name Charles E. Christian the winner of their 2010 John E. Gall Jr. CIO of the Year Award. Chuck is CIO at Good Samaritan Hospital (IN).

Texas Health Resources acquires the 420-physician MedicalEdge Healthcare Group, which marks the second-largest purchase of an independent physician practice in the US. THR can now boast more physicians than its chief rival, Baylor Health Care System (620 versus 500). THR is where HIStalk contributor Ed Marx serves as CIO.

Patient flow software provider Central Logic hires Jeff Porcaro as VP of engineering and technical services. He previously served in senior management for Symantec and Novell.


I sent an e-mail over the weekend about the HIStalk-hosted, sponsor-only lunch at HIMSS and another just now about our other activities during the conference. If the e-mails did not find their way to the correct contact, let me know. And if you aren’t a sponsor, I bet you’re wishing you were because you just know that what we’re planning is bound to be fun.

ONC issues a final rule to establish the permanent certification program for HIT. For the permanent program, organizations must be accredited and authorized by the National Coordinator and must conduct post-certification surveillance. I didn’t look into all the nitty gritty details, but you can find more specifics here.


Four nursing students are expelled from Johnson County Community College (KS) after photographing themselves with a human placenta and posting the picture on Facebook. The school’s director of nursing said the students’ “demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.” One of the students is now fighting back in federal court, seeking an injunction against the school. The 22-year-old claims her future earnings from her chosen profession are at stake because of a “momentary lack in judgment.” As one who committed a least a minute’s worth of judgment errors at that age, I hope she is allowed to finish her degree.

In an another Facebook-related story, a thief displays more than a momentary lack in judgment by stealing a flat-screen TV from a gas station’s restroom (I will refrain from making comments about the stupidity of having a TV in a gas station restroom). A customer uses his credit card to pay for gas, then hides the TV under his shirt and takes off. The gas station manager uses the credit card information to look up the thief in Facebook and sends him a friend request. Thief accepts request, despite not knowing manager (clearly not the brightest bulb on the tree). Manager tells thief that if he returns the TV, he won’t call the police. Thief ignores the request and before long ends up in jail.


E-mail Inga.

Sponsor Updates by DigitalBeanCounter

  • Informatics Corporation of America is named a Top Healthcare VAR by Everything Channel’s CRN Magazine.
  • Cancer Centers of North Carolina – Ashville implements iKnowMed EMR. iKnowMed is a division of US Oncology, which is now a division of McKesson.
  • CynergisTek CEO Mac McMillan is presenting at the upcoming Security/HITECH conference sponsored by the SoCal HIMSS chapter. January 13th in Orange, CA, if you are in the area.
  • MED3OOO announces a strategic partnership to form the Jersey Health Alliance. The Alliance, which includes a network of physicians and hospitals from Hudson County, NJ, will utilize MED3OOO software, consulting, and services.
  • Cool video: Allscripts Android Patient File Overview.
  • Sentry will attend the seventh annual 340B Coalition Winter Conference in San Diego.
  • NTT DATA completes its acquisition of Keane.
  • Aetna completes its acquisition of Medicity.
  • Vermont Information Technology Leaders selects Greenway’s PrimeSuite as a preferred EHR partner.
  • Michigan Health Connect (MHC) chooses Medicity to carry out its HIE.
  • Nuance announces its Dragon Dictation voice technology is the secret sauce behind the LG Voice-to-Text app; offered free via the Windows Phone Marketplace.
  • AT&T ramps its their presence in the HIT space.
  • Payment Processing, Inc. partners with AdvancedMD, citing integration and security advantages.

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Currently there are "15 comments" on this Article:

  1. There are 119 ridges on the edge of a quarter.
    Ridges were put around the edges of coins (when coins were made of valuable metals like silver and gold) to prevent people from shaving small amounts from the edges of a lot of coins and melting down the shavings to sell, while passing off the modified coins as still having their face value. Some countries put different patterns of ridges around the edges so that blind people can tell the denomination of the coin.

    To me the question should have been what are the ridges for, not how many are there?

  2. “CHIME and HIMSS name Charles E. Christian the winner of their 2010 John E. Gall Jr. CIO of the Year Award. Chuck is CIO at Good Samaritan Hospital (IN).”

    Give me a break! CHIME and HIMSS are one and the same. They are in-bred organizations who “named” former HIMSS Chair Chuck Christian.

    Speaking of HIMSS in-bred orgs, David Blunenthal should just cut to the chase and announce CCHIT as THE permanent certification body. He doesn’t want to disappoint Karen Bell, or she just might send one of her EHRA “enforcers” to finish the job for him.

  3. Speaking of Blumenthal and individaul experiences (your lead story), he has depreciated these reports as anecdotes. Based on a link to the Mass DOH doctor website that you published (via comment), he may have an anecdote of his own bout EHRs and malpractice.

  4. RE: Central Logic hires Jeff Porcaro as VP of engineering and technical services –

    I thought Jeff Porcaro was the late great drummer for Toto


    [From Mr. HIStalk] Thanks for remembering! He was an amazing drummer, both as a studio musician and in Toto. Great drumming on Africa and Toe the Line, and I now know from Wikipedia that he did the drumming on Steely Dan’s Katy Lied and most of Michael Jackson’s Thriller. Died at 38 in 1992 of a heart attack triggered by accidentally inhaled pesticide. R.I.P.

  5. RE: Healthcare Idiot Savant Senator Brad Lager.

    Just what we need: Another politician taking instead of giving.
    Shame on him and shame on Cerner. This kind of stuff insults my intelligence.

  6. Re: permanent certification, I’ve created a bookmarked copy of the rule PDF over at our blog (http://www.occampm.com/blog/hitech/permanent-certification-program/). Something I found interesting in my first overview of the rule: the ONC really wants to make it clear to all that any additional certification a vendor goes through is simply gravy and not required by HITECH (i.e. CCHIT certification). The real question now, of course, is who the ONC-Approved Accreditor will be.

  7. Re : EPIC interview question.

    If this was a PM position the answer is clearly;

    1) Setup re-occurring meetings for the next 6 months. Book go2meeting lines for remote workers to “touch base”.
    2) Craft a time line and create Gant charts with defined (but spurious) goals. Make sure everybody is “on the same page”.
    3) Be sure not to allow the “scope to creep” to the price of apples and oranges. “Pick off the low hanging fruit first” (making sure to be clear, no pun was intended).
    4) Spreadsheets. Lot’s of spreadsheets.
    5) “Manage expectations” and encourage “blue sky thinking”.
    6) Get the programmers to write some code (organized in agile sprints) to determine the correct price for pears.
    7) Present your answer to management.

    Or would the answer just be;
    The cost of pears is dependant on the years crop and demand.

  8. To DigDug – this is nothing new. Basically the IRS says once the organization (consulting firm) knows that the consultant will be working at a site for 12 months or more, the employer (consulting firm) should add the reimbursable expenses to that consultant’s income and tax appropriately. Some firms abide by this, others don’t. Many of those that do gross up the consultant’s pay to make them whole which is expensive for everyone, especially the client who is paying the fees.

    See page 4: “Temporary Assignment or Job”, Examples 2 and 3.

  9. All Hat No Cattle: Glad you sent that bit of info in about coin ridges. I love that sort of trivia, and it’s the first I’ve heard of it. And I agree, they could have asked a more useful question.

  10. Re Missouri State Senator Brad Lager and his new job w Cerner…

    Reminds me of that old story about the fox guarding the hen house.

  11. Everyone knows when your at a job interview you’re supposed to display knowledge about the company your applying to.

    If the market value of an apple is 20 cents, and oranges cost 40 cents and greapfruits cost 60 cents, you can calculate the market value of the pear anyway you want. This pear’s price has nothing to do with its market value. It’s an Epic pear, and it costs 97 dollars.

  12. A state senator and advocacy for Cerner.

    Hmmm, and gee whillikers, between Nancy-Ann DeParle and this guy, pretty soon you might say Cerner has some influence on policy to spend taxpayers’ funds on HIT.

  13. RE: THR.

    THR is an Epic shop. However, there is talk that Medical Edge providers will stay on their Allscripts EHR Product instead of moving to Epic. Yet at the same time there is talk coming from leadership about systemness … the decisions being made make absolutely no sense and don’t mesh with what the leaders are saying. Money is being spent to hire people to perform some HIE magic – perhaps they think this will alleviate the incredibly bad move to consider leaving them on their own system? How well has that worked in the past?

    -Scratching Head in Dallas

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  1. Upvote for Living Colour. And I had lost track of them too, after their initial breakout success. "Cult of Personality"…

  2. The part that Gurley totally missed, and I as many others lived thru it, was that in the early 2000's…

  3. Does use of the "cloud" infrastructure mean that Oracle's newly transformative platform will be vaporware like many of Cerner's previously…

  4. To Code Spewer (above): 100% agree re CASE tool hype/hope, and long known - sadly ignored by IT - reality…

  5. Four points - 1. Is an "Epic" possible in today's regulatory world? 2. How many EHRs were there in 2009?…

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