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Monday Morning Update 1/24/11

January 22, 2011 News 24 Comments

From Tom Paine: “Re: reader comments. I appreciate that you don’t seem to censor.” Here’s where I’m torn: all those anti-technology, axe-grinding comments you see posted under a variety of names are coming from the same 1-2 trolls from Pittsburgh hospitals, sometimes posting as a doctor or nurse, who can be counted on like a fine Swiss watch to clog up every post with easily recognizable anti-HIT comments (software is dangerous, experimental, a government conspiracy, etc.) It’s not their argument that I mind, it’s the attempt to make their monotonic mantra look like a populist groundswell by near-constant posting. I resent the dishonesty and I sometimes delete their comments when I’ve had enough, especially when they start pestering Jayne or Inga.

From Linus Pauling: “Re: Epic. Support is going downhill fast with lots of defections and new customers. Look for KLAS scores to be affected. Hospitals are not happy getting a main contact who’s a 21-year-old straight out of college with an economics degree.” Unverified.

1-22-2011 1-55-58 PM

From The PACS Designer: “Re: Stage 1 Meaningful Use. CIO John Halamka and Robin Raiford of Allscripts have given us a handy matrix that defines the numerator and denominator required to measure compliance for the rules to achieve the minimum objectives for payment in Meaningful Use Stage 1. Here’s a link to the NIST testing site for MU validation.”

From Ulysses S. Federal Grant: “Re: salespeople on commission. eClinicalWorks does not pay commissions, either.” I like that approach. To do otherwise is to provide incentives for the wrong outcome, like most of medicine in paying for procedures instead of results: commissioned salespeople make more money for enticing someone to sign a deal and then moving quickly on to the next prospect no matter what the outcome. It’s not surprising that salespeople will promise almost anything knowing that they’ll make hundreds of thousands of dollars for getting someone to sign on the line which is dotted, even if it’s not necessarily in that prospect’s best interest to do so.

From Daryle Harmonica: “Re: EMRs. An meta-analysis study in PLOS Medicine (the open-access equivalent of NEJM) comes to the usual conclusions – the evidence of EMR benefits is lacking. Their methods sound pretty rigorous.” For those who don’t know, a meta-analysis is a study of studies, combining their results in a statistical way to reach a broad and possibly new conclusion. This one finds that, despite the theoretical benefits of digital technologies in healthcare, nobody has proven that they are risk free and cost effective, and recommends that technologies should be evaluated against a consistent set of measures throughout their life cycles to make sure they are providing benefit. I like that idea – hospitals rarely evaluate their clinical system projects at all and almost never publish the results when they do, but even if they did, the results wouldn’t be extensible because everybody is measuring differently. Maybe that’s something that ONC or FDA should do – come up with a standard set of clinical system quality metrics (uptime, user satisfaction, system-related clinical errors, etc.) and require annual centralized reporting that’s open for public scrutiny. The study also found that almost all published success came from big academic medical centers, but I would speculate that’s because community hospitals don’t write nearly as many articles as the publish-or-perish ivory tower types living off federal grant money.

From Uncle Fester: “Re: LSS. Lost in the Meditech acquisition news is that LSS’s C/S 5.6 product earned certification.” I didn’t realize that they have the exact same releases as Meditech, so LSS has certification for its MAGIC and C/S lines, with 6.0 next up.

From Buck S. Pearl: “Re: West Virginia Health Information Network. Moving ahead with Thomson Reuters as the prime contractor in their five-year HIE deployment. The company is involved in projects in NC and SC.” Unverified.

1-22-2011 1-21-04 PM

From Sgt. Schultz: “Re: Epic. I know nothing more than this except they have a product called SeeMyChart.” Epic files suit against Altos Solutions for trademark infringement. SeeMyChart is a patient portal into the company’s OncoEMR oncology EMR. I don’t know which product came first or who owns which trademark, but if it was Epic’s, I can see why they would claim the potential for market confusion.

From Bill@$200/Hr: “Re: Kettering in Ohio. Rumor is their Epic install is floundering, looking at delaying their second go-live at their largest hospitals. Local talk is there’s a real crisis of leadership, surprising given the sheer number of consultants involved.” Unverified.

1-22-2011 7-45-16 AM 

I’m a little surprised that 15% of regular HIMSS conference attendees said they won’t attend this year, according to my latest poll. They won’t be offset by the 8% who don’t usually go but who will make the trip to Orlando. If the turnstile count is down, you heard it here first (I’m pretty sure that won’t happen, though). New poll to your right: have you or your employer been affected by a shortage of experienced HIT workers? I’m just checking again.

1-22-2011 7-56-01 AM

Welcome to Clairvia, supporting HIStalk as a Platinum Sponsor. The Durham, NC company was built around the concept of Care Value Management, which emphasizes improving patient care, quality, and financial performance by measuring the care needs of individual patients and then assigning those patients the appropriate level of caregiver resources to ensure the best possible outcome. It’s like a 21st century version of traditional patient acuity and staff management systems, with its tools used directly by clinicians instead of bean counters and focusing on the patient instead of rigid, cost-based staffing models. The bottom line is that it helps hospitals tie together care models to outcomes and to the patient experience, ensuring that patients follow an optimal track from admission to discharge with appropriately assigned resources throughout (i.e., get them from the ED to the right unit quickly and have a defined plan to encourage their progress from the expensive ICU to lower acuity units). I interviewed Beth Pickard, the company’s president and CEO, in December, where she explains why prospects are interested: “Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell.” Thanks to Clairvia for supporting HIStalk.

Weird News Andy was sucker for this news. ED doctors treating a woman for a mild stroke and temporary paralysis determine the cause: a hickey that was administered too close to an artery by her overly amorous lover caused a blood clot. She was successfully treated with an anticoagulant. Said one of the doctors with what sounds like a nearly-creepy familiarity with the pathophysiology, “Because it was a love bite, there would be lots of suction.”

I’m always on the lookout for projects that would benefit the little guy in the industry (both providers and vendors). One that came to mind was to develop a freely accessible database of what major systems each hospital uses. Right now, the only folks who know are KLAS and HIMSS Analytics and they aren’t going to tell anyone who isn’t paying big bucks. It would be a pain to collect and update the information, but instead of doing all 6,000 hospitals, I was thinking most people would care only about the 1,200 or so hospitals greater than 200 beds. I have no idea how to go about doing this or whether it’s even something needed, but it seemed like a good idea when it came to me in the middle of the night. I’m open for input.

1-22-2011 5-51-55 PM

The Atlanta business paper profiles Digital Assent, which has developed an iPad-based physician office check-in application to replace the much-hated patient clipboard. I didn’t see it mention on the company’s site, but the article says it also displays ads.

Austin, TX-based rehab and hospice operator Harden Healthcare says it will spend $10 million a year over the next several years on IT, including a move to electronic medical records.

The coroner’s office in an Indiana county is taking more than three weeks to issue a death certificate. The culprit: a legally mandated death certificate application that the coroner says is hard to use.

GE’s Q4 numbers: revenue up 1% (the first growth in nine quarters), EPS up 33%. The UK-based GE Healthcare made a billion-dollar profit in Q4, with revenue up 8%. For the year, GE Healthcare took in $16.9 billion and made a profit of $2.7 billion.

1-22-2011 5-56-24 PM

A nurse fired by a Florida hospital for looking at the electronic medical records of Tiger Woods is suing the hospital. Health Central says it has evidence proving that the nurse looked at the records three times in 10 minutes, but the nurse says the hospital didn’t secure its computer system, allowing someone else to check out the records when he walked away.

Beth Israel Deaconess Medical Center will buy out the remaining two years of outgoing CEO Paul Levy’s contract, giving him $1.6 million in severance for what continues to be portrayed as a voluntary resignation.

Odd lawsuit: the wife of an Air Force officer files suit against a VA hospital when an Air Force surgeon inserts 270 ml breast implants because the hospital was out of the 300 ml ones she wanted. According to the lawsuit, “Mrs. Haden was extremely disappointed by the size of her breast implants.”

Sponsor Updates

  • AHA extends an exclusive endorsement to CareTech Solutions for data center hosting services.
  • Overlake Hospital Medical Center (WA) will implement the full Medicity suite, including MediTrust Cloud Services, ProAccess Community, and the Novo Grid.

Epic Sales

Readers sent in quite a few thoughts about the Epic salespeople and sales process. Here are some of those that I found interesting.

  • Epic has 6-7 salespeople, all of them women (the reader provided their names).
  • Despite company growth, the sales team hasn’t gotten much bigger.
  • Almost nobody knows an Epic sales rep, current or former. Even sales recruiters have never spoken to one.
  • All salespeople are required to have done installation work at Epic. Epic does not direct hire people into sales.
  • Epic does not do traditional marketing. They focus only on a few conferences and don’t run billboards, sponsorships, or ads.
  • Salespeople do not earn commissions, although their performance is taken into account at appraisal time for raises and bonuses.
  • CEO Judy Faulkner steps in herself for the big prospects or if it looks like Epic will lose the deal.
  • Some folks have been forced out. They call it “flying too close to the sun,” with the sun being Judy.
  • The job of the salesperson is less about selling and more about managing the process. Epic has separate teams for RFPs and demos, a legal team for negotiations, and budget/pricing teams for managing the implementation timelines and budgets. If sales needs help from anyone in Epic, that person is expect to drop everything and go to a customer meeting or do whatever is needed.
  • Those PMs serve as product experts along with clinicians and developers, with much of their role being to demonstrate the philosophy and culture, not to be salespeople with a passing interest in getting a contract signed.
  • The entire company makes the sale, not the salesperson. Customers get good implementation support, an individually assigned technical service rep, and a “customer happiness” rep who will escalate any concerns.
  • Until 2009, Epic was making just 10-15 new sales a year and many of those were just for ambulatory or inpatient alone, but the percentage of enterprise sales has increased each year. In 2010, they supposedly made around 40 new sales (some of them listed below).

Reader-Reported New Epic Sales for 2010
Johns Hopkins
Catholic Health Services of Long Island
New Hanover Regional Medical Center
Moses Cone
St. Joseph Michigan – Lakeland
Martin Memorial
Idaho – St. Luke’s
US Coast Guard
University of Mississippi Medical Center
JPS Health Network
SUNY Upstate Medical University
LSU Health
Rochester General
ProHealth Care
Access Community Health Network
Bassett Healthcare
Stormont-Vail Health Care
Hurley Medical Center
Temple University Health System
Amphia Hospital (Netherlands)
Memorial Healthcare System
Orange Regional Medical Center
Tampa General Hospital
Wenatchee Valley Medical Center


The HIStalkapalooza page is live. It works a little differently this year to be fairer to attendees. Your signup gets you on the “I want to come” list. We’ll follow up with an official e-mail invitation to those we can accommodate, assuming there are more people interested than we have capacity (and if not, great, everybody will get an e-mail invitation). Signing up alone doesn’t guarantee a spot, just to be clear. I did it this way to allow a wider variety of people (especially providers in the trenches) to come since some big vendors were having a secretary sign up their entire HIMSS booth team of dozens of people, taking away spots that some poor programmer or nurse who didn’t pounce immediately lost as a result.

1-22-2011 9-25-55 AM

HIStalkapalooza is sponsored by Medicomp Systems, makers of such EMR tools as the MEDCIN clinical knowledge engine, the CliniTalk voice-to-data physician documentation system, and a new offering or two that I’ll be talking about later. I’m really impressed with their commitment to providing you with a good time at HIStalkapalooza. They have had first-rate planners (people who have worked on Hollywood award shows!), PR folks, and others who have put a lot of time and energy into making HIStalkapalooza an event that I think will be the talk of HIMSS. They totally get HIStalk and have been phenomenal in running with whatever harebrained ideas I came up with to make it fun and wildly different from the usual marketing-heavy, button-down HIMSS events. Thanks to Medicomp and particularly COO Dave Lareau for supporting the readers of HIStalk by producing HIStalkapalooza.

Just to reflect for a moment, as a hospital employee with limited time and resources, I couldn’t have done any of this without Medicomp (and kudos to event sponsors from prior years as well, Encore Health Resources and Ingenix, who also threw great parties). It’s amazing to see how the event has grown and to see how many companies want to sponsor it, especially since I insist that it be about the attendees and not the sponsors (no commercial pitches, no giant sponsor signs or booths, I control the agenda and approve all decisions, etc.) That’s a pretty big commitment for a company, especially knowing that most of the attendees will probably be from vendors, many of which are their competitors. I truly appreciate the support of both Medicomp and those who attend. For a  guy toiling anonymously and alone on HIStalk the other 364 days a year, it’s a little overwhelming to see it in person.

1-22-2011 9-59-40 AM

So what’s happening at HIStalkapalooza? It’s at BB King’s Blues Club at Pointe Orlando, just a few hundred yards up the street from the convention center, on Monday, February 21 from 6:30 until 11:30 p.m. Medicomp has bought out the entire facility (it’s pretty big), so it will just be HIStalkers there. There will be an open bar, IngaTinis, great food, a red carpet entrance, and professional videographers documenting the event so I can run some video here later for those who can’t make it (and stream it live to a huge on-stage screen for folks already in the venue to watch).

1-22-2011 11-23-39 AM

This is amazing: Inga and I desperately wanted athenahealth CEO Jonathan Bush to emcee the HISsies awards again (those of you who went last year understand why), but he couldn’t make it because he had scheduled a family vacation around his kids’ school break. Shockingly, he wanted to be with you HIStalk readers so badly that he rescheduled his vacation, so he’ll be chewing the scenery again and I can’t wait to hear what comes out of his mouth. We’ll also have an expanded line of beauty queen sashes since both men and women love wearing them. Inga has twisted my arm to shell out cash for some swell prizes for Best Shoes and HIStalk King and Queen (overall fashion and look, since Inga’s into that sort of thing, and as a guy I’m not entirely against having fashioned-up ladies around). We may have some special recognition for practicing doctors in attendance.

And for your HIStalkapalooza entertainment .. The Insomniacs, the award-winning, crowd-inciting, high-energy Left Coast Blues band from Portland, OR, which Medicomp is bringing all the way down to Orlando just for our event. Sample tunes here. A real band at a real music venue with a real stage and a dance floor … that doesn’t happen often at HIMSS. This is a full-length concert and the bar will be open throughout. I’m pretty sure that’s a formula for a good time to be had by all.

E-mail me.

HIStalk Featured Sponsors


Currently there are "24 comments" on this Article:

  1. Hi,

    I just tried to register for HIStalkapalooza, and got a response that said “invalid form submission.” I wanted to make sure my registration actually got submitted. This will be my first HIMSS and I have to confess that the real reason I want to come is so I can attend HIStalkapalooza. I’m a big fan of your work.


    [From Mr. HIStalk] I let the Web people know. Several folks have said they got the same error, so I don’t know if it’s rejecting all submissions or whether it’s just overloaded. A test one went through yesterday, though. The good thing is that since we’re not trying to enforce a limited number of “I want to come” registrations, we can always advise anyone whose didn’t go through to do it again once the problem is fixed.

  2. How ignorant the techie perspective on commissioned sales people. Just like when politicians talk about patient saftey and quality of care…as if they knew anything about it.
    Stick to your keyboard you nerds.

  3. Gee the Koolaid for EPIC must be getting diluted. When IDX was signing 40 to 50 deals a year people started to say the same thing – quality of support is going down, the Kids are running the implementations. IDX also tried the model approach. Stay tuned for more challenges for EPIC – as they jam in more model systems – clients are going to wake up and say my software doesn’t work like my organization. CIO’s and the like need to stop jumping on the band wagon and take a good hard look at what they are getting from EPIC. Seems the tail (EPIC) is wagging the dog in most implementations. Is the ice cracking in Wisconsin? As for KLAS their credibility will be tested as they investigate the perceptions of EPIC in the market.

  4. “It’s not surprising that salespeople will promise almost anything knowing that they’ll make hundreds of thousands of dollars for getting someone to sign on the line which is dotted, even if it’s not necessarily in that prospect’s best interest to do so.”

    Wow is all I can say! Seeing that many companies support HISTalk and I guarantee those companies grew due to the efforts of sales professionals to the extent that they can advertise at all, I’m surprised at the negative comments. I need to defend my lowly sales brethren! Many of us are actually passionate about our jobs, because we have the ability to get to know a customer, understand their issues and then, if possible, discuss how our companies products can solve the issues our customers deal with every day. As professionals, we know, not every customer needs our solutions and we strive to make a positive influence so when our company develops a new product or service, we can return to that customer. Those who try to force something down a customers throats usually do not last for obvious reasons. And the same is true about selling futures or vaporware.

    As someone who has made a living for over 20 years in healthcare IT by, I dare say selling, I resent being categorized as someone who is motivated by only the almighty dollar. I had a family member die because of the inefficiency of our health system and feel blessed to be a part of the solution and spreading the same beliefs that many who frequent these pages do.

    I understand the perception, but please realize that there are many sales professionals out that who take a genuine interest in helping customers solve problems. Try to find them and those are who you should be buying from.

    [From Mr. HIStalk] I don’t think commissioned salespeople (whether it’s IT systems, timeshares, or cars) are predictably good or bad, any more than doctors who do too many imaging procedures are good or bad when someone has set the rule that the more images you take, the more money you make. I can say that as a customer, I’d feel better knowing that the person trying to sell me a system that will take years to implement has long-term skin in the game with me with aligned interests instead of getting a whopper of a check just because I finally signed a contract. I think Eclipsys had the right idea with the subscription model, where both customer payments and sales commissions were spread over several years, but it didn’t really work for them. For salespeople, it would be nice not to have their feast-or-famine fortunes determined by illogical prospects and hospitals that take forever to make a decision. I didn’t even bring up what’s sure to be another sore point: is it reasonable that a super salesperson makes multiples of the salaries and bonuses paid to the top-of-the-line clinical and technical experts who develop and support the products being sold?

  5. re: Tom Paine & Pittsburgh “trolls”

    Interesting, I have the opposite problem at HC Renewal, where I have to sometimes delete the comments of the pro-HIT-at-all-costs posters, usually from the Boston area (I don’t like the term “troll.”)

    The literature, though, is increasingly justifying the complaints of the HIT-critical crowd.

    Just the other day a new article appeared:

    Black AD, Car J, Pagliari C, Anandan C, Cresswell K, et al. (2011) The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Med 8(1): e1000387. doi:10.1371/journal.pmed.1000387.

    Text version at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387 .

    These authors did a meta-analysis of review articles and concluded:

    “There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology’s life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.”

    Greenhalgh’s meta-analysis article bore some similarities as well.

    While the study had limitations (they all do) and can be disputed, this now joins a growing body of literature that should raise some critical eyebrows. That is, could there be systemic problems not receiving enough attention?

    BTW lest anyone think I’m one of those “trolls” here, I’m near Philadelphia, not Pixburg (as we sometimes refer to the opposite end of the state).

  6. “I’m always on the lookout for projects that would benefit the little guy in the industry (both providers and vendors). One that came to mind was to develop a freely accessible database of what major systems each hospital uses. Right now, the only folks who know are KLAS and HIMSS Analytics and they aren’t going to tell anyone who isn’t paying big bucks. It would be a pain to collect and update the information, but instead of doing all 6,000 hospitals, I was thinking most people would care only about the 1,200 or so hospitals greater than 200 beds. I have no idea how to go about doing this or whether it’s even something needed, but it seemed like a good idea when it came to me in the middle of the night. I’m open for input.”

    Surprised frankly that HIMSS Analytics/KLAS monopoly on HIT adoption rates and patient satisfaction ratings has lasted as long as it has given the crazy fees they charge. Large vendors get hit with a price tag of $100k or more for access to HIMSS Analytics (just the US) which really doesn’t provide enough granular information when you drill down to the individual data points they collect.

    Both companies though are starting to realize that their model is under potential duress. KLAS has made a huge shift to focusing on report sales & expanding their coverage areas with mixed results from what I have seen.

    One interesting development is that Dave Garets has taken the HIMSS Analytics approach and has helped to create a 200-item questionnaire that is asking the right questions on granular HIT adoption from Advisory Board’s customers that HIMSS should be asking but isn’t right now. Dave Garets is presenting more on this at HIMSS. Definitely a session I plan to attend.

  7. I really dislike denigrating posters with words such as “trolls” especially when said demeaned posters provide citations. Many of them are physicians who not only have knowledge through a lifelong education but are in the trenches feeling the effect of the increased beaurocracy on their medical practices. “Trolls” is not only demeaning but inappropriate and ends up belittling only he who uses it.

    At emrupdate the webmaster also has for the past 2 years used that very same word, once even attacking me! Now he’s lamenting why discussions, as well as his overall readership has virtually dried up. In his most recent thread, lamenting his site’s ills, he again uses the word “troll” and wishes to make the site a virtual infomercial for the meaningful use, HITECH, and EHR with little opposing discussion. When I added my thoughts, my post got ignored and for the 3rd time I got kicked off. Does he never learn?

    Progress and fame is made through interaction from all sides of a subject matter, without any belittling attacks, and especially without censorship of posters who spend their time and energy to forward their views.


    [Mr. HIStalk] Al, there’s a difference between those expressing opinions (which are always welcome) and the classic definition of Internet trolls — someone who very intentionally posts controversial, argumentative comments strictly to get a rise out of other readers. In the example I mentioned, this is the same two people posting virtually the same commentary using multiple phony names and claiming to be a nurse or physician or sometimes a vendor, often insulting someone I’ve interviewed or quoted who went on record using their real credentials. You’ve seen them because I almost never delete their comments. Here’s my offer: they can write a lengthy piece expressing whatever point of view they like and I will happily run it as a mainstream HIStalk article, but if they’re going to claim specific credentials to bolster their arguments, I want to confirm that they are who they claim, which would require nothing more than an employer e-mail address.

  8. Thanks for posting that link to the PLoS article. For those that don’t know, PLoS is a set of online journals (different journals for different fields within medicine) created to be a sort of “open source” version of an academic journal. The articles are still reviewed and critiqued prior to publishing, but they’re trying to reduce the extreme cost and politics that have seeped into many academic journals. PLoS needs more support, and nothing is more powerful than to read and cite their articles.

    That being said, not sure I’d cite this one. Their methodology is fine, but even they admit they’re working with poor material. The authors note that many HIT studies are poorly done. In general, this is a problem in our field, partially due to the fact that we are dealing with evolving technology. Often times, an article from 5 years isn’t relevant today because the technology has completely changed. I look forward to seeing more in-depth analysis of systems once there has been full implementation and a chance for maturity to set in at many hospitals.

  9. re:PLoS- “I’m not sure I’d cite this one.” Isn’t that the point of the article? The US is gov’t is spending $20 billion on implementing HIT systems, when even a rigorous meta-analysis in a prestigious journal (not the first) can’t find good evidence to support it? I am as much of an HIT proponent as anyone, but if one substituted “[any brand name medication] on the quality and safety of [the condition it’s supposed to treat]” in the title, wouldn’t there be an uproar against the pharma industry for pushing an unsubstantiated product?”

  10. Re: Salespeople on commission. Tim, I am stunned! Do you think all salespeople regardless of product and situation should not earn commissions, or just sales people selling HIT solutions to healthcare providers? While I am a huge fan of HIS Talk, you really have missed the boat here. What you imply by your comments is that the healthcare HIT solutions sales rep has some kind of Svengali mind control over the provider buyers. The provider buyers are just like sheep who are easily led to do things they really do not want to do. After 25 years of selling HIT solutions, I can assure you that I never met any of these sheep, nor did I ever develop a Svengali like control over these buyers.

    I agree that not every product on the market is built well and does what the end user wants or needs. But some very smart people run hospitals and are clinicians. These same smart people have built and use incredible technology to improve our health and save our lives. But suddenly they lose all their intelligence and critical decision making ability when an HIT sales rep shows up?

    Nope, not buying this logic. I think we need to focus on another issue or reason when buyers buy things that are not in their best interest. The last time I sold something, it was a two way street and required two parties to both buy and sell and exchange money. And I never remember holding the hand of the buyer while they clutched the pen to sign the contract!

    [From Mr. HIStalk] I agree that it’s the provider’s job to sign only what’s in their own best interest. But I also wonder if the commission model is as ideal for what are marketed as long-term solutions and relationships as it is for selling hardware and one-off technology purchases. It is unusual in healthcare IT only because these are huge capital expenses with much of the money paid (to both vendor and salesperson) when the contract is signed, the code loaded, or the go-live switched flipped. Maybe my real discomfort is in having those solutions sold as big-ticket capital items instead of as a subscription, where expected benefits are timed to offset expenses. I’m sure opinions vary widely on that, but we would have a different industry indeed if software was paid for by the month instead of upfront, eliminating the lock-in that comes with having spent millions on something that isn’t working as expected. But I admit that my perspective is purely as a provider-side customer since I’ve never worked in sales.

  11. Michael,

    Not sure why everybody uses the Pharma industry to illustrate points but;

    Cerivastatin (100,000 deaths)

    Just to name some of the biggest recalls. They consist of hundreds of thousands of deaths and serious injury.

    Most made it years (if not decades) before there was enough data to pull them off the shelves.

    If you want to broaden the circle how about medical devices? Baxter has a large recall last yeah of infusion pumps. Dozens of devices are recalled each year and all this with FDA certification.


    What people seem to be calling for is FDA approval process. Even with that process dangerous devices and drugs go out with dangerous flaws. With drugs there is a balance between the good they can do and releasing them prior to having adequate data.

    Now look at software; lets say we go through FDA approval for a product. Is every update also to go through FDA approval? What about a update to fix a dangour flaw? Should we delay the update to fix the flaw? If any of these answers are no, then classifying EMR’s as medical devices is meaningless.

  12. Re: PLoS

    “That being said, not sure I’d cite this one. Their methodology is fine, but even they admit they’re working with poor material.

    To not work with what one has on matters of national import is cavalier. WHat’s the alternative? Wishful thinking, hope, keeping one’s finger’s crossed…and…improving the evidence base before deciding if it’s time for national rollout.

    Importantly, they also wrote:

    – Our greatest cause for concern was the weakness of the evidence base itself. A strong evidence base is characterised by quantity, quality, and consistency. Unfortunately, we found that the eHealth evidence base falls short in all of these respects. In addition, relative to the number of eHealth implementations that have taken place, the number of evaluations is comparatively small.

    This is a significant finding in and of itself in an environment where this technology’s being pushed strongly by governments.

    The authors note that many HIT studies are poorly done. In general, this is a problem in our field, partially due to the fact that we are dealing with evolving technology.

    That is a non sequitur.

    Often times, an article from 5 years isn’t relevant today because the technology has completely changed.

    I disagree. FOr instance, I invite readers to demonstrate which articles from this collection (excel spreadsheet) are not at all “relevant” to the study of HIT because “the technology has completely changed.”

    I look forward to seeing more in-depth analysis of systems once there has been full implementation and a chance for maturity to set in at many hospitals.

    Indeed, that is not the way human subjects research or clinical care works (and, in fact, to my medical eye appears a bit cold-blooded). I suggest a study of the phases of clinical trials in the pharma industry.

    — SS

  13. Blah writes:

    Not sure why everybody uses the Pharma industry to illustrate points but;

    Cerivastatin (100,000 deaths)

    Just to name some of the biggest recalls.

    You forgot to mention the thousands of compounds that never made it to market at all because of the mandated clinical trials and other review processes.

    For instance, with just one company, the three of Merck that failed in 2003 in late stage trials (MK-767 for diabetes because it was causing tumors in animals, “substance P” for depression because of lack of efficacy, and the third a urological drug whose designation I can’t remember).

    Most recently, it looks like the new Merck anticoagulant candidate Vorapazar won’t make it to market, either, because of excessive bleeding in clinical trials.

    In fact, most new chemical entities (NCE’s) and new drug candidates fail and never make it to market because of the governmental oversight.

    — SS

  14. MIMD for sure, now how would you answer my questions about EMRs and FDA approval? Would you hold up an important software update until the FDA approved it?

  15. Mr. HIStalk, I’d like to say that this is an especially good post, and it characterizes why HIStalk is a great and informative read. You are unafraid to speak your mind, while being sure that all sides are heard. Kudos for this one.

    First, you didn’t attack all parties with concerns about EMRs. As you clearly stated, you are only attacking the classic “trolls” who post identical commends under false names, including a memorable post on 10/26/10 when “Suzy, RN” posted under a false name and claimed to be an M.D. That is critically different from the posters who have real concerns and real arguments against the current HIS situation. Their opinions seem to be valued around here.

    Second, you weren’t afraid to say what many of us think about salespeople and incentives. And without your comment, we wouldn’t have that excellent post from Lou, which tempered (though didn’t change) my opinion of how salespeople work.

    Since there was a little outrage on this post, I wanted to chime in to say I think this is an excellent one, and I learned a few things. Keep the honesty, the respect for all honest comers, and the willingness to call people out coming.

  16. Mr. HISTalk-a couple of clarifying points. Sales people typically get paid as you suggested, in a way that aligns with the customer. In other words, if a software implementation takes three years to complete, the sales rep won’t get their final commission payment until payment metrics in the contract are completed, which typically mean final payment at go live. Second, it is fairly rare that a sales person will close more than one large deal per year, where they would have an opportunity to make significant money.

    Base salaries for sales people typically range from the low of $55k to the high of $120k-anything else has to be earned.

    [From Mr. HIStalk] Thanks for that information. I like that payment arrangement, especially if there’s some transition involved where the salesperson doesn’t just disappear once the contract is signed. Not that they need to have an ongoing role, but I would think it would be good for a company to continue the relationship, especially if the salespersonhad an incentive to stay in touch (perhaps add-on sales possibilities do that). Commissions must be feast or famine — are prospects better off dealing with the super-successful salesperson who won’t be desperate to close their deal with promises likely to be unkept, or would they be better off with someone desperate who might give a better deal just to get something signed? But I still wonder if commissions provide the right incentives for long-term, mutually beneficial relationships. Epic must not think so — do any other vendors pay salespeople straight salary?

  17. Blah says:

    MIMD for sure, now how would you answer my questions about EMRs and FDA approval? Would you hold up an important software update until the FDA approved it?

    You committed a logical faux pas, i.e, the composition fallacy, in attacking the FDA review process. It has saved far more lives by keeping dangerous drugs off the market, under the Federal Food, Drug, and Cosmetic Act (FD&C Act).

    However, for some reason health IT has received special accommodation under the Act, even though its supporters and manufacturers claim the tools/programs/devices/whatever you want to call them can have profound effects on medical care (the mfgs. claim beneficent effects, but of course if the tools are so very powerful, it follows they can have bad effects, too).

    That said, in answer to your question, you’d need to define “important software update.”

    Obviously there are practical limits to a review process, and no review process can be perfect. My view is that, as a start, new release versions should undergo extensive stress testing. How granular one gets regarding mandated review for smaller changes (e.g., a patch to prevent the patient misindentification problems that happened at Trinity Healthcare as mentioned a few months ago on this blog) is a complex question. Who does that review is another matter yet to be decided, but it should be a neutral party with expertise in testing tools (again, that word again) used in medical settings. That’s why FDA comes to mind to many who see review as important.

    — SS

  18. Re: your comment on censoring, I have made true comments about HIMSS, CCHIT, and the EHRA because I worked for HIMSS. I have many documents to prove HIMSS, i.e. Lieber et. al was never concerned about Patient Safety or Privacy & Security.

    A Congression Hearing is warranted to ask the following questions:
    1. Why did HHS approve CCHIT’s vapor-ware lab, and allow Pass-Fail certification, with no records kept.
    2. Why did HHS allow funding of CCHIT, who claims to have 21 people on staff, with no dusclosure as to who they are, their credentials, and their salaries. This includes all HIMSS contractors. HHS paid their salaries for 3.5 years, we tax payer’s have a right to know.
    3. Why does H. Stephen Lieber, who everyone knows has no technical or clinical expertise, allowed to have his staff and members on many HHS task forces & committees?

    Blumenthal has decided to limit the “temporary certifications” HE has approved. WHY?

    There are so many questions to ask, and Congress has been given a roadmap to discover the depth of the fraud by the EHRA to receive govt funding for the biggest clinical trial in history, without safeguards in place. Now the EHRA wants more govt hand outs to address Patient Safety and Privacy & Security. It’s too late, hundreds, if not thousands of patients, have been killed or seriously hurt.

    BTW, I’m not from Pittsburgh. I’m from Crook County.

  19. Mr. HISTalk-you are correct, sales reps make commissions on things like upgrades, new hardware, consulting services, new modules etc.. So, over the longer term they continue to be incented. Super sales reps are typically those who make their plan numbers year in and year out versus the one hit wonders who close a massive deal one year and famine for the next couple.

    In my opinion, the best salespeople are the one’s who strive to build long-term relationships built on bringing some gray matter to the table, honesty, and delivering on their committments. Where they fall short sometimes in when they company they represent can’t keep up with their committments-which happens more times than we would like.

    Epic’s model is radically different-I don’t think any other large IT vendors would want to hire Epic people and vice versa. As described, sounds like Epic has a variety of people that interface with the customer-not sure that’s a good thing. Who is the voice of the customer back to Epic?

  20. Re: commissioned salespeople

    Commission is a tried and true principle throughout sales in many industries. It provides incentive for the salesperson to try a little harder to close a deal and provide good customer service, sort of like tipping a server leads to better service at a restaurant. It’s naive to think that soft selling is different from putting people out there who have no idea what they’re doing and have no incentive to try to figure it out.

  21. As one of the “little guys” in the industry you mention when talking about the value of data (specifically vendor) of the 1,200 or so hospitals greater than 200 beds. We would definitely be interested in this key data and would like for it to contain current leadership information, C-Suite including the CMIO equivalent. In 2010 healthcare was experiencing the highest leadership turnover in a decade, this year may be just as bad. This would be very valuable data and informative to understand on so many levels. This is a great forum and there should be some way to collectively collect it.

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