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News 2/2/11

2-1-2011 8-25-53 PM

From Former CIO: “Re: PCAST report. It seems the PCAST report has been glossed over or dismissed as a bunch of government mumbo jumbo. The HIMSS response is once again laden with not-so-hidden vendor protection. This blog note hits the nail on the head.” Vince Kuraitis describes the organizational reaction to the PCAST report, which basically says we’re going in the wrong direction with today’s HIT systems. Those criticizing its conclusions include the usual turf-protectors: HIMSS, EHRA, AHA, FAH, RSNA/ACR, and IHE. I realized that I hadn’t provided highlights of the PCAST report, so scroll down for my summary and you’ll see why those groups don’t care much for the recommendations.

From AZ: “Re: MyChart. Tucson Medical Center has launched it for Saguaro Physicians along with Epic’s MyChart Mobile App.” Unverified.

From Dolphins Fan: “Re: Epic. There aren’t many spinoffs in the Madison area. Either they retain top talent, people leave Madison to start their businesses, or they have one hell of a non-compete.”

Speaking of unsurprising reaction to political events, eHealth Initiative releases a statement (I don’t have a link) urging that House Republicans keep the HITECH feed trough full instead of exercising fiscal responsibility. “We realize that the Spending Reduction Act represents a principled stand against government spending, but we would encourage Members of Congress to not use the HITECH Act or any of its provisions as a target, as that will only create further uncertainty in the health care sector. Any attempt to repeal funding for health information technology would have severely negative effects on public and private progress now and in coming years.”

2-1-2011 8-28-05 PM

Management changes at enterprise visibility vendor Intelligent InSites: president and CEO Mark Rheault resigns and the majority owner, an investment company, puts one of its people in the interim role until a successor is found. That guy is Doug Burgum, who took over Great Plains Software years ago and arranged its acquisition by Microsoft.

2-1-2011 7-23-39 PM 

Thanks to Iatric Systems of Boxford, MA, joining HIStalk as a Gold Sponsor. The 20-year-old company has provided applications, interfaces and reporting solutions to over 900 hospitals (especially Meditech), has been recognized as one of the country’s fastest-growing companies, and has been named one of the top 100 businesses in the Boston area. Check out their YouTube channel, which features an interview with Denni McColm, CIO of Citizens Memorial Hospital (Stage 7 EMRAM, putting the tiny hospital in elite company), which used Iatric to integrate their Meditech systems with Google Health and a patient portal. They’ll be at HIMSS talking about interoperability, so plan to drop by, say hi, and thank them for supporting HIStalk. And of course for doing the cool HITECH Train parody video.

McKesson announces Q3 numbers: revenue flat, EPS $0.60 vs. $1.19. The company set aside $0.52 per share as a one-time expense for its continuing fight against drug Average Wholesale Price lawsuits that have already cost it a fortune. Without that charge, earnings would have been down but would have hit estimates and the company raised guidance for the fiscal year. Technology Solutions revenue was up 2%, but software revenue was down 2%. Still, that division made $106 million. It had $1.3 billion in unrecognized revenue, which could be great (lots of money coming) or terrible (it hasn’t been recognized because customer contract terms haven’t been met).

The McKesson conference transcript is here. John Hammergren says he doesn’t think ARRA money will be pulled out even if healthcare reform is successfully challenged, but that it doesn’t really matter at this point since customers are already committed.

2-1-2011 9-10-33 PM 2-1-2011 9-11-20 PM

HIMSS announces the recipients of its clinician IT leadership awards: Liz Johnson RN, VP of applied clinical informatics at Tenet (the announcement calls it “Tenant”) and Michael Zaroukian MD PhD, CMIO at Michigan State University. 

A hospital in Australia doubles its eye tissue donations by monitoring the outbound ADT messages of hospitals to see if any designated donors have died, allowing tissue banks to be immediately notified. The application was built using InterSystems Ensemble.

We sometimes do interviews on HIStech Report when companies want to use the final product in handouts or downloads. I recently interviewed Mitchell Goldburgh from image management vendor InSite One, just acquired by Dell.

Weird News Andy fingers those Down Under: an upcoming journal article finds that Australian medical students are performing exams (genital, rectal, and breast) on unconscious hospitalized patients who have not been asked for consent.

Open source EMR vendor Tolven gets profiled in an article covering venture capital in California. British publisher Elsevier gave the company $3.6 million from its venture fund. The article says the company had $1 million in sales in 2010 and expects $2.5 million this year.

The regular company e-mail from Kaiser Permanente CEO George Halvorson has some interesting 2010 numbers: members logged in to its site 62 million times to get information, patients viewed 25 million lab tests online, doctors conducted 10 million secure message based e-visits, patients had 8 million electronic prescription refills, and 2 million visits were scheduled electronically. He concludes that people want online convenience instead of driving and telephone.

2-1-2011 7-35-54 PM

Wolters Kluwers Health is supporting HIStalk as a Platinum Sponsor, so thanks very much to them. The company has quite a lineup of clinician-familiar names: Facts & Comparisons and Medi-Span (drug references and databases); the ProVation ClinicNote custom content and documentation solution for EMR vendors; ProVation EHR for ambulatory surgery centers; ProVation MD for clinician procedure documentation; ProVation Multicaregiver perioperative documentation system with monitor interfaces; ProVation Order Sets, powered by UpToDate Decision Support for CPOE and paper order sets; and the fabulous UpToDate evidence-based clinical decision support system. Clinical content and order sets are important for improving outcomes and meeting Meaningful Use EMR requirements, so give them a look. Thanks to Wolters Kluwer Health for supporting HIStalk. 

This happens all the time: a treatment assistant making $62,000 per year racks up $1 million in overtime pay over 12 years, making the state employee eligible for a pension (if you don’t work for government, you’ll probably have to look up the definition of that word) that will pay 50% more per year than he makes working. 

E-mail me.

PCAST Report Summary

This report was commissioned by the President and created by his Council of Advisors on Science and Technology (real scientists, not vendor people, HIMSS puppets, or the usual talking heads).

Healthcare IT’s potential:

But it isn’t working:




HERtalk by Inga

From Sales Professional: “Re: commissions. Every HIS vendor I’ve worked for (SMS, Data General, TSI, IMS, Eclipsys, HMS, McKesson, AGFA, and Keane) had commission plans that tied payments divided just as the license fees, i.e. you get your money when the client pays his bill. Albeit ‘golden handcuffs’ for the rep, this did link incentives for the rep to selling business that the company could install and get paid for. SMS, I believe, started this in the early ‘80s after a few reps got paid huge commissions and SMS could not deliver. After Sarbanes-Oxley, a lot of the bigger companies claim they need payment terms that the GAAP accounting rules can recognize, and most claim that a ‘holdback’ for post-live payments is NOT a bookable revenue item for them.”


DiagnosisOne appoints Kenneth W. Kizer, MD, MPH to its board of directors. He is former president and CEO of Medsphere Systems, the founding president and CEO of the National Quality Forum, and a former Under Secretary for Health for the VA.

Mediware Information Systems posts its Q2 numbers: net income of $1.73 million, compared to last year’s $783K; revenue of $13.2 million versus $10.8 million.


The board of directors of Harrison Medical Center (WA) approves a $7.6 million, 10,000 square foot data center to support the medical center’s new EMR (Allscripts Sunrise, I believe).

Venture capital investment for medical software and information services grew from $387.5 million in 2009 to $460 million in 2010. That’s a 19% increase.

NCH Healthcare System (FL) anticipates earning $11 million for its meaningful use of (Cerner’s) EHR.


Awarepoint says that 91 hospital sites contracted for Awarepoint’s RTLS products in 2010, a 30% increase over 2009. In addition, annual revenue growth exceeded 100%.

Newark Beth Israel Medical Center (NJ) licenses Meta Health Technology’s electronic clinical documentation improvement software.

The University of Texas MD Anderson Cancer Center purchases Carestream Health’s RIS system.

Streamline Health Solutions appoints Robert Watson as president and CEO, replacing founder and president/CEO J. Brian Patsy. Patsy retired at the request of the board and also resigned as a company director. Watson is the former president and CEO of DocuSys.


CareFusion names Kieran T. Gallahue chairman and CEO, replacing the retiring David L. Schlotterbeck. Gallahue was most recently president and CEO of ResMed.

Harold J. Apple takes over as CEO and president of the Indiana HIE. The HIE’s founding president and CEO J. Marc Overhage will remain on board as chief strategic office and national policy advisor. Apple is the former majority owner, CEO, and president of Vector Technologies.

Fifteen California hospitals adopt InQuickER, which facilities patient appointment scheduling for emergency rooms. Patients wanting to reserve a time in the ER typically pay a $15 to $25 premium for the service. At Lakewood Regional, the hospital pays $3,000 for the InQuick ER  service and charges patients $15 to schedule an appointment. Lakewood’s ER sets aside only one appointment per hour and patients must reserve their spot at least two hours in advance.

er visits

Speaking of ERs: between 2003 and 2008, the rate of ER visits in the US exceeded rates in both England and Canada.

OMG. It’s February and I am leaving for Orlando in 19 days. So much to do beforehand! I shared with Mr. H (who couldn’t even feign excitement) that I bought a new dress for HIStalkapalooza, but am still pondering over the shoe selection. Truth be told, I am afraid I’ll be “outed” if I were to were the fab shoes that would really make the ensemble. I am hoping that others attending will take their fashion selections as seriously as I am, especially since this year there are prizes involved. So ladies, find your best shoes and a sassy cocktail dress. And guys: women drool over men in tuxes, especially when the IngaTinis are flowing. And, keep in mind that it’s hard to look hot when you are wearing a shirt that screams your company’s name. Just sayin’.


Versus Technology introduces Enterprise View Mobile for use on the iPhone, iPod Touch, and iPad. The free application gives users access to patient, staff, and equipment locations on mobile devices.

Former Cerner COO Paul Black joins the board of Netsmart Technologies.

Poudre Valley Health System CIO Russ Branzell tells the local press that PVHS will spend between $30 and $40 million on its EHR investment (Meditech). He also admits that their EHR stimulus reimbursement will be “nowhere close to the investment we put in.”


E-mail Inga.

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EPtalk by Dr. Jayne

What a difference a year makes! This week, I spent time with a family member in a hospital across town, which incidentally has a large integrated clinical system different from my own. I was last there with another family member about a year ago, not long after the hospital went live.

At that point, the staff was still fairly hostile and frustrated, having just come off of weeks of training and feeling very stressed. Knowing that I work for a competitor hospital, and knowing what I do, many of them went out of their way last year to tell me how much they hated the system. This week was the completely opposite side of the pendulum. No one was saying anything about the system. I was puzzled: could it really be that good? Or had they just all been assimilated?

Being the investigator I am (probably watched too many episodes of “Quincy, M.E.” as a kid) I “accidentally” left my name badge from Enemy Hospital on my collar the next day, to see if anyone took the bait. Nothing. Finally, I asked the nursing staff what they thought. Had they reached Nirvana? Had all the issues been fixed?

The answers I received were what could only be described as a completely mixed bag. Although some of them feel that the system has changed for the better, others still perceive it to be largely the same as it was a year ago, but they’ve learned to use it as a patient care tool like any other. One self-aware nurse commented that she didn’t really hate the system at first, it was just the idea of it, and it wasn’t worth the energy to keep complaining about it.

That’s the central challenge of most of us that are in the implementation and support business have to figure out – how to determine which users are going to be like that nurse gradually accepting the system vs. which users are going to rage against it regardless. This is the magic of figuring out which of the 20% of users will ultimately need 80% of your attention, and finding a way to help them adjust.

One thing I found interesting about the experience was that only the health system-owned primary care practices are on the system, and they have no health information exchange with their community and subspecialty docs. The specialty physician caring for my relative walked in with a (gasp!) paper chart from his office, after walking it out the door and across the campus, sans audit trail, sans security, and with wild abandon.

After I recovered from the delirious thought that it would probably spend the night in the trunk of his car, mingling with other deviant charts, I asked him why he was still on paper and whether they planned to switch any time soon. It turns out they are, having finally succumbed to being purchased by the health system after a protracted battle with one of their major insurers.

It will be interesting to see how much difference the next year makes for them. They are not only losing their autonomy to a major health system (and boy, do I wish my system had snapped them up instead — his group is incredibly fun at parties) but also giving up their paper. Theirs is just one of thousands of practices that will go through one or both of those transitions in the next several years as Meaningful Use unfolds. I’m sure I’ll be offering them a shoulder to cry on at some point.

Speaking of crying, those were tears of joy as I responded to a deluge of Facebook friend requests last week. I was starting to have a bit of the winter hum-drums, but my new BFFs seem to be extremely entertaining. I also heard from the team at NextGen, vendor of the system used by my not-so-secret crush, Dr. Robert Murry. They’ve offered to put us in touch. Do I sense an interview in my future?

I’ve received several great “Dear Dr. Jayne” questions this week, but I am holding out for something sassy, so feel free to send those deep, dark questions my way!

Have a question about medical informatics, electronic medical records, or whether nurses ever yell at doctors? E-mail Dr. Jayne.