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January 27, 2011 News 19 Comments

From Whillikers: “Re: vendor receiving a percentage of a hospital’s stimulus money. I don’t see this as necessarily wrong. We don’t know how the contract was worded – perhaps the vendor is sharing risk and reduced license and support fees in return for helping the hospital earn the incentive money, or maybe even faced penalties if they didn’t achieve Meaningful Use.”

From Arliss: “Re: managers not knowing what their employees make. I’ve worked in several large companies over many years and rarely knew what my reports made. Does it really make a difference? Middle management is middle management, sometimes just to manage process that happen to include certain assets called people.” I don’t know if it’s necessary to know, but you’d need a much better appraisal / rating system than places I’ve worked to take that out of the hands of managers. Epic supposedly fires the bottom 25% of its staff each year according to some of the comments I’ve seen, so I’m sure they do have such a rigorous rating system.

From Sporting Group: “Re: mobile app that rocks. Very cool development for first responders. I remember when this was an idea … how to locate AEDs and identify those with CPR training when someone drops with an MI.” The iPhone app, called Fire Department, asks when you first launch it if you’re trained in CPR and would be willing to help a stranger in need. When 911 gets an emergency call, the operator can send a push notification to those volunteers who are near the location, also telling them where the nearest automated defibrillator is. That’s brilliant if you ask me. As screwed up as America seems to be at times, its citizens will usually do anything they can to help someone in need.

From 70HourWeek: “Re: Epic work week. The long hours aren’t unique to Epic. I work 50 hours on a slow week. That doesn’t mean I like it, but our systems are constantly changing and our facilities are 24×7. Where we could improve is to recognize what we do and adopt truly alternative schedules and options to work from home. We all work long hours and are lucky if enlightened managers recognize the need for work-life balance. Epic does have a reputation for favoring young employees, which saddens me both that it exploits new hires right out of college as that it will eventually catch up with Epic.” I don’t disagree, except I’m always skeptical when someone claims consensual exploitation.

From InDenial: “Re: Epic. I keep reading that they set their price and don’t negotiate, but that’s not entirely accurate. I was previously with a large health system and Epic was definitely negotiating with us against their competitors. They didn’t get down the level of discount the others were offering, but they did make an aggressive offer that was much different from their initial proposal.” Unverified.

From Nasty Parts: “Re: eCW not paying commissions. Not true. HIStalk has a responsibility to publish facts and retract inaccuracies.” That statement, just like yours, came from a reader. I don’t claim that reader comments that I run, including yours, are 100% accurate, although they often are. In this case, Inga had confirmed with eCW, who told her that they do indeed not pay commissions, so I ran the item without tagging it as unverified. Several readers sent details indicating otherwise (such as precise commission percentages and specific salesperson income). Inga forwarded that to eCW, who then amended their previous statement to say that the company does indeed pay a few salespeople commissions (I didn’t understand or really care from their explanation which ones get commissions and which ones don’t). I believe I met the test of prudence in obtaining verification, even though it turned out to be incorrect.

From Natty Boh: “Re: Epic employee comments about hours, management, obsolete technologies, and lack of credentials to work elsewhere. How funny – this is EXACTLY what Cerner associates say as well, all except the ‘experienced Cerner resources are hard to find due to selling more big sites’ part).” I tried not to conclude from all the complaining that the upcoming generation of US workers are the marginally motivated, Facebook-obsessed, self-absorbed children of excessive privilege, instead choosing to believe that they’re doing exactly what I and everybody else should have done decades ago in refusing to sell one’s soul to an employer who sneers at paying 40 hours’ worth of salary for 40 hours’ worth of work. Sometimes all of that extra effort pays off, but generally you’re going to end up bitter after being stabbed in the back by someone with better connections, passed over in favor of a co-worker with less distaste for shameless up-sucking, or clueless management. Like the old saying goes, nobody’s epitaph brags on how many hours they spent at work.

Want to come to the HIStalk reception (aka HIStalkapalooza) at the HIMSS conference? Sign up now on the “I want to come” page since it will be turned off in a couple of days. People e-mail me every year after the fact claiming they didn’t know about the sign-up, which tells me right away they don’t really read HIStalk very carefully since I make a big deal out of it for precisely that reason. I can only reiterate: if you want to come, sign up right now, please. I’m especially reaching out to providers, who often get lost in the shuffle among all the vendors who attend – if you are a doctor, nurse, CIO, programmer, help desk tech, field support analyst, professor, or whatever you do for a hospital, clinic, practice, university, or agency, I will do everything I can to get you an invitation, which is why I changed the sign-up process. I’m not prone to hyperbole, so believe it when I tell you that it’s going to be the talk of HIMSS.

Listening: new from The Script, Ireland-based alt-pop. You’ve heard them but just don’t know it: play Breakeven on their MySpace page. It’s a little soft for me, but it’s pretty good and the new album is better.

1-27-2011 7-07-12 PM

CareTech Solutions opens a new $5 million, 30,000 square foot operations center and technology hub in Troy, MI to handle its growing business. The company has 1,100 employees, hired 200 in 2010, says it will hire more than that in 2011, serves 155 hospital customers, and expects to quadruple its business in the next three years.

EXR, the enterprise EHR from Reliance Software Systems (aka RelWare), is certified as a complete inpatient EHR and a module outpatient EHR by InfoGard. I don’t have a link, but friend of HIStalk Dann Lemerand sent over the press release. Dann started the HIStalk Fan Club on LinkedIn that’s now up to 1,328 members. I’m slightly embarrassed by having a fan club, but I can tell you without hesitation that it provides a psychological boost when I’m having a crappy day (which is thankfully rare since I have perpetually low expectations). I also admit that when someone wants a favor from me while claiming undying devotion, I often make less of an effort if they aren’t members.

Among the listings on the HIStalk Jobs Page: VP of Sales Central Region, Vendor Partner Product Executive, RVP Sales – Southeast Territory, Meditech ADM B/AR Sr. Consultant. On Healthcare ITJobs: Epic Cadence Application Coordinator, Pharmacy Informatics Specialist, Clinical Data Analyst, Epic ADT Consultants / Analysts. Lots of good jobs there from Vitalize, Marshfield Clinic, Joint Commission, Olympus, Ivesia, and other companies.

1-27-2011 8-27-47 PM

Ryann Winn, former IT director at Munson Health (MI), is named VP/CIO of MidMichigan Health.

CPSI’s Q4 numbers: revenue up 28%, EPS $0.61 vs $0.33, beating the bejesus out of consensus estimates of $0.43. The company also declared a dividend, although one might argue that in the rapidly growing HIT sector they might have been better off using the money to grow or acquire instead of sending out tiny checks that non-grandmotherly shareholders don’t usually care about.

The Methodist Hospitals (IN) is suing consulting firms FTI Cambio and HealthNET as well as Meditech for convincing the hospital to abandon its in-progress, $26 million Epic implementation and instead spend $16 million to replace it with Meditech to save money. Methodist wasn’t meeting its bond covenants, so it hired Cambio and subcontractor HealthNET to evaluate its Epic project. The two firms said it would cost $25 million more to install Epic, although the hospital says the real number was closer to $11 million. Methodist also claims that the consulting firms advised them to dial back their security protection, which led to a widespread virus infection. The hospital says it gave up on the Meditech implementation in 2009 after finding that data wasn’t being updated properly, which had forced employees to go back to charting on paper. Interestingly, the hospital claims its own CEO, CFO, and COO were also responsible because they were all Cambio employees. Methodist wants out of its Meditech contract and is asking for $16 million in damages. I guess the lawyers have to get involved when a tanking hospital has spent $42 million on two abandoned IT projects and is still stuck on paper, but I’ll also be interested to hear the other side of the story, which is probably just as believable despite being the opposite of this version. As for saving money with Meditech, I don’t doubt it a bit – I bet if you compared annual maintenance between Epic and Meditech it wouldn’t have taken long to cover that extra $5 million to switch.

1-27-2011 8-13-46 PM

The new 289-bed, $1.6 billion UCSF Medical Center at Mission Bay (that’s  $5.5 million per bed, $1,800 per square foot) requires an $80 million contract for wiring alone. It will have a wireless Distributed Antenna System to feed EMR access to touch-screen systems at each bed. The announcement says the new hospital will be a showcase for best practices, presumably not among them being building an affordable structure that won’t require the hospital to milk the healthcare system for generations to pay off the debt. I just don’t get why we need Taj Mahospitals when healthcare costs are already making the country non-competitive globally. I’ll bet money that their Edifice Complex doesn’t improve their patient outcomes a bit (and you don’t even need an EMR-type study to easily find that out).

I’m not going to harp on this, but it’s odd: the rags that e-mail out healthcare IT related news blasts don’t seem to have a clue which press releases they use as sources really relate to HIT. Case in point: Cisco is buying Pari Networks, which offers network management tools. So why is one networking company buying another hot healthcare IT news worthy of an e-mail? Those updates always have unrelated junk about some non-healthcare arm of Siemens, a non-HIT related acquisition by a vendor for whom healthcare is a small vertical (like Cisco), or some pharma executive’s promotion. If you get those updates (and actually read them), I bet you’ll find at least one “why should I care” story written up in breathy excitement in every one of them. If I’m wrong, tell me.

1-27-2011 9-53-38 PM

A string of medication errors at Seattle Children’s Hospital, two of which occurred in babies who died, cause the hospital to scramble to regain its credibility. Hiring the Institute for Safe Medication Practices to review their processes isn’t going to do it for them, as ISMP finds many problems, including a “culture of intimidation” in which doctors belittle nurses and senior doctors and nurses alike bully their junior peers. The day before the report was announced, the Department of Health found that the hospital may have killed a baby being transferred by regularly allowing transport nurses to give meds without a doctor’s order.

The former ophthalmology chair of Temple University School of Medicine is charged with insurance fraud by the Department of Justice, which claims he submitted more than $3 million in false charges for patients he didn’t actually see. DOJ says the doctor told employees to bring him the charts of patients seen by other doctors, which he would then alter to indicate that he had evaluated the patients.

E-mail me.

HERtalk by Inga

Mississippi Medicaid contracts with ACS for use of its State Level Registry solution to manage EHR incentive payment applications, including verification of qualified applicants and certified EHR use.

Telehealth provider Teladoc Medical Services secures a $4 million investment from Cardinal Partners and HLM Venture Partners.


Dana-Farber Cancer Institute (MA) selects Versus Advantages RTLS for patient tracking, room utilization, workflow optimization, and reporting. The system will be deployed at Dana-Farber’s new Yawkey Center for Cancer Care.

Three hospital companies and two hospital systems invest in the Heritage Healthcare Innovation Fund, a venture fund targeting healthcare services and HIT. The fund says it can place up to $10 million in early- and growth-stage healthcare businesses.


AirStrip Technologies appoints Alan W. Portela to its board of directors and to serve as the company’s senior strategic advisor. He’s the founder and CEO of Hybrid Clinical Transformation and the former president and current board member of CliniComp.

New from KLAS: providers are planning to purchase more diagnostic imaging equipment in 2011. Radiology departments anticipate spending about $200 million on equipment this year, 10% more than last year. Siemens and GE are the most-considered vendors in the space, but competition continues to grow. MRIs are the most discussed purchase, followed by CTs, ultrasounds, digital X-rays, and digital mammography.

Swedish Medical Center (WA) experiences a four-hour shutdown of its Epic EMR, forcing providers to use pen and paper to document. The system automatically turned itself off upon noticing an error that could have potentially corrupted data. During the outage, users across all Swedish’s campuses could see data, but not add or change anything. The health system is now exploring “more sophisticated levels of backup,” which might include a giant server in a different geographic location.

laurens county

Laurens County Health Care System (SC) chooses Summit Healthcare’s Summit Scripting Toolkit to automate billing and administrative workflow within its CPSI system.

I’ve enjoyed the dialog this week about HIT salespeople and commissions. I think Mr. H had it wrong, as many pointed out. Most companies don’t pay 100% of the commissions when the sale is made, and thus are highly motivated to make sure an implementation is successful. Car salespeople probably get paid 100% up front, but HIT is a different beast. Salespeople who are in it for the long haul will sell clean and earnestly work to make sure their solution fits their clients’ needs. Those that sell a “bad” deal and leave it to others to clean up lose credibility within their organization and find it difficult to get assistance on the next deal. Customers remember the sales rep who did them wrong and happily share their woeful story with potential customers. Other vendors also learn the names of “sleazy” sales reps and have no interest in hiring them after they’re fired from the  original company. Of course there are a few bad eggs in the business, but, I believe there’s honor in being a commission-based salesperson in HIT.  Every successful salesperson I’ve ever met works 50-60-70 hour weeks, which means they miss miss out on soccer games, birthday parties, and bunco (!) Base pay ranges from 40K to 120K (if you are a superstar.) That means that if you aren’t closing business, you’re not exactly making the big bucks. A big deal may pay a big commission check, but you may only close one or two big deals a year. In the ambulatory world deals are smaller, so a salesperson must close multiple sales a month. To be successful, a sales rep must effectively manage time and resources. If you are a sales rep working on commission, I salute you for your hard work and believe you when you say you’re committed to your customers’ success.


Hill-Rom posts 77% growth in its first quarter earnings and a five percent increase in revenue to $374 million. Revenue from the company’s North America Acute Care segment grew 6 percent to $218 million. Capital sales rose 12%, led by a 22% jump in sales for patient support systems.

Communicating via social networking leads to faster hook-ups, according to a new survey. To test the theory or to just make us feel desired, you can friend Mr. H, Dr. Jayne, or Inga on Facebook; additional foreplay opportunities are available by liking HIStalk. Find us on LinkedIn as well.

This week on HIStalk Practice: pay for performance programs don’t improve outcomes. Dow Jones files suit to allow open access of Medicare records containing provider payment details. Louisiana Medicaid issues the nation’s first EHR stimulus for an FQHC. Dr. Alexander says finding an EHR ain’t easy. Dan Nelson, a practice administrator for a family practice group, discusses his testimony before the HIT Standards Committee’s Implementation Workgroup.


Dr. David Blumenthal posts a new note on ONC site, noting plans to increase REC funding to $32 million and to award $16 million in new Challenge Grants to encourage HIE innovation.

I can’t believe WNA didn’t send us this story. The Florida Supreme court refuses to overturn a slander award against a hospital executive in favor of a surgeon. The surgeon had been denied surgery privileges at the hospital’s open heart institute. The hospital executive, in describing the surgeon’s skill level to another surgeon, said, “I would not send my dog to him for surgery.” A jury awarded the surgeon $5 million in punitive damages.


E-mail Inga.

Sponsor Updates

  • St. Patrick Hospital and Health Sciences Center (MT) contracts for the Meds Tracker medication reconciliation system from Design Clinicals.
  • Kansas Health Information Network chooses the CareAlign solution from Informatics Corporation of America for all of Kansas and parts of Missouri. It provides a provider and patient portal, secure clinical communication, interoperability, EHR Lite, population management tools, and a patient health record.
  • McKesson declares a shareholder dividend of 18 cents. Shares are trading near their 52-week high and are almost back to their pre-HBOC meltdown levels of 1998.
  • GetWellNetwork is named among Washington DC’s fastest-growing companies.
  • F.F. Thompson Hospital (NY) will replace its existing hospital information system with McKesson’s Paragon HIS.
  • Voalté releases a white paper called The Smartphone Tsunami – Will Your Hospital Sink or Swim?

EPtalk by Dr. Jayne

I’ve enjoyed reading some of the testimony from last week’s HIT Standards Committee Implementation Workgroup. My new crush is Robert Murry, MD, PhD, medical director of informatics at Hunterdon Medical Center (NJ). His testimony has given me a host of phrases I’ll be stealing when I next speak with hospital executives who continually expect their IT resources to deliver the impossible again and again. Among my favorites: doing an EHR upgrade in a large organization is like “upgrading the engines on an airplane while it is flying.”

Murry also goes on to say that by interfering with the go-live schedule and causing resource strain, “meaningful use has slowed down our implementation schedule, perversely having the opposite of the intended effect of rapidly rolling out robust EHR technology in our enterprise.” He lobbies for more clinical informaticists to “speak the language of physicians, understand their time pressure, perfectionism, and medico-legal stresses, but also able to understand IT, prioritize development and implementation resources, and construct the amalgam of workflow and software changes that is acceptable efficient in practice.”

CIOs and IT purists, take heed — you need someone like this in your organization, whether you call him/her a CMIO or not. You’re not just slapping a system in a doctor’s office, you’re potentially imploding their entire workflow. The last word: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Dr. Murry, if you’re out there, I hope to see you at HIStalkapalooza. I’m still working my way through a lot of the testimony, so if readers have other favorites, e-mail me and I’ll bump them to the top of my reading list.

Several people have written to follow up on my PQRI to PQRS comments, particularly on how the new acronym can be pronounced. Some of the suggestions are downright hilarious, but I’m too much of a lady to quote them, so feel free to comment below with your thoughts.

I’ve had a pretty harsh week at work, which has led to the need for an unusual amount of vegetative Netflix, Facebook and YouTube activities. I’m a big fan of www.xtranormal.com so thanks to Betty for brightening my day with this one (and yes, I think I did see this patient the last time I had office hours.)

Speaking of Facebook, I just passed the 50-friend mark. Not anywhere near Inga-like status, but it’s helping me feel part of the HIStalk universe. The friend suggestions I’m receiving look like fun people, so don’t be surprised if I start randomly friending you.


Have a question about medical informatics, electronic medical records, or how many pre-meds cheat on their chemistry labs? E-mail Dr. Jayne.

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Currently there are "19 comments" on this Article:

  1. It doesn’t matter if Meditech is less expensive than Epic, the real cost of these large, complicated IT systems lies in the implementation. The software cost is typically less than 20% of the overall project with labor being greater than 60%. If you are already well into an implementation, it is impossible to save money by starting over, even if the software is free.

  2. @InDenial: You’re completely right. The idea that Epic does not bend on price is a complete myth. As they move into smaller and smaller hospitals, they are getting aggressive on price. Especially when they want to replace an incumbent, they will drop the bottom out. They’re not telling the bigger hospitals, who seem to be buying it by default and don’t realize they can negotiate a steep discount. Epic will never walk away from a deal if they really want it. They’re just like every other company in that respect. In reading a lot of the material on HISTalk recently, it’s becoming pretty obvious that Epic is no different than every other HIT vendor, despite their attempts to appear unique. The only differences are that Epic has a marginally better product and the least experienced workforce in the industry.

    @Will Weider: You’re completely right. The fallacy in the hospital’s lawsuit is that they don’t realize the Epic implementation costs would have ballooned to much higher levels as well (apparently the consultant did know this). My guess is that this hospital is badly managed from top to bottom and would fail any IT implementation.

  3. Re: Fire Department iPhone App
    Did you know that this application was developed/engineered by college students and staff from Northern Kentucky University? Its another neat factoid from this mobile application’s story.

  4. re: NastyParts

    The consumer also has the responsibility to do their own homework, and not assume something posted on ANY website is factual. Kudos to HISTalk for taking the time to explain something that most of us already know.

  5. Hysterical that Mr H lambastes UCSF for their extravagance in erecting a “Taj Mahospital” (love the barb, by the way), but continues to fall all over himself pointing out the virtues of Epic.

    Hospitals who spend that kind of money on an HIS are largely irresponsible and stupid. No, Meditech (and some other new comers to the arena like Cerner’s Community HIS and McKesson’s Paragon) does not have the feature-rich physician tools that Epic does, but if you want feature rich, spend 1/100th that amount and go put PatientKeeper on top of your Meditech or Cerner (or McKesson) system.

    As some of your readers will undoubtedly tell you, Epic is not exactly feature rich in other areas that really matter like revenue cycle, HIM, Lab (awful), OR, etc. They have a great ED and great physician tools, but try to get any meaningful reports or information out of Epic. Can’t do it……. Sadly, consultants and administrators seem to have focused nearly all their evaluation criteria on those two facets.

    I think we’re going to all look back at this period as the time in which Epic bamboozled and bankrupted healthcare.

  6. RE: HIT salespeople… the cynical me would say the reason salespeople are not paid full commission on contract signing is to “entice” them not to leave the company. I know far too many salespeople who have had to leave money behind when they changed jobs. Just sayin’

  7. JustAFish hit on a good one:
    “Research shows that reward systems foster environments in which people cheat and steal”
    I agree, and have see it happen, just look at what our buddies on Wall Street did.

    Now think about what’s comming: P4P – Pay for Perfomance based hospital/MD reimbursement. CMS has several demonstration sites.

    If you think ObamaCare is turning the system upside down now, wait till you see what P4P will do!
    The moral : wherever you put the cheese the rat will find it..and cut every corner to get it fast.

  8. Is Methodist the first salvo in the HIT hype? Will the boards of the hospitals spending millions for EMR and so called improved technology start to sue vendors and everyone else when the outcomes do not meet the stated expectations? One has to wonder what the break even point is for patient care versus expense – and isn’t that what healthcare reforms is all about!

    Boy, I wish I was a lawyer – there is going to be a lot of money to be made!

  9. Glad to hear that people have debunked the completely bogus ‘we don’t negotiate on price’ Epic pricing issue. They discount on a community hospital and will continue to have to do as they try to move down the chain into 300 bed and smaller segment.

    Question is just at what their thresholds are for their individual reps, at what point it is mandatory to get kicked up to a VP or Sr. Executive for approval to offer a certain discount, and their absolute discounting threshold. I am sure they have these like every HIT and software vendor.

  10. Re: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

    I long ago had written that:

    “Healthcare IT is in reality a clinical tool that happens to reside on computers, not a management information system that happens to involve doctors.”

    That was circa 1999. It’s now 2011.

    Re: “CIOs and IT purists, take heed — you need someone like this in your organization, whether you call him/her a CMIO or not.”

    Agreed. CIO’s need to move out of the data processing era, andinto the 21st century.

  11. Inga, Your last assessment on commissioned sales reps was dead on. As for those quoting articles on reward systems, every part of your life is measured. Whenever it is, whether it is taxes or commissions, people will figure out how to “work” the system. They’re supposed to or those no reason to even have the system. The problems occur when the measures or rewards are poorly designed and/or adjustments are made to close the inevitably discovered loopholes.
    Most companies have learned how to effectively compensate sales reps and make sure that it motivates them to correct behaviors.

  12. I regularly work 60-hour weeks and Saturdays. I do it because I like making doctors smile when my code helps make their lives easier. I do it because I feel like my ideas can change how healthcare in this country is delivered. I do it because it’s rewarding when I can see my way through a seemingly impossible problem. I do it because it’s gratifying to earn the respect of the brilliant people who challenge me every day.

    Some of us like our jobs. It’s not impossible, it’s not confined to just one company, and it’s not as rare as you might think.

  13. Epic definitely negotiates, though they would probably say they don’t and just use a different euphemism to describe negotiating. Perhaps deal “rightsizing” or “affordability elasticity”. Yeah, I kind of like that last one. 🙂

    Mr. H, I don’t think I saw UCLA on your list of recent Epic customers and they are definitely headed down that road now.

  14. perspective is just the kind of dopey kid Epic is banking on. rock on kid, keep thinking you’re saving the planet or something to make you feel better while you’re stuck in the Verona office and all your friends are out enjoying their lives while actually advancing their careers at the same time. if you really think your code is changing the way health care is delivered, you don’t know anything about health care

  15. I work 50 hours on a slow week. That doesn’t mean I like it, but our systems are constantly changing and our facilities are 24×7.

    As a consultant, I’ve worked at probably two dozen hospitals, over the past 10 years, and I’ve hardly ever seen anyone work more than 40 hours/week on a routine basis. Given the current HIT market you need to find a new job.

  16. JoshfromNKU

    Thanks for posting, I’ll be adding your group’s app to TPD’s List of iPhone Apps in the next update. I’ll also include other CPR/Rescue apps in my listing from around the country when mentioned in HIStalk in order to possibly save someone’s life!


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