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August 9, 2012 News 8 Comments

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8-9-2012 9-21-00 PM

Allscripts reports Q2 results: revenue up 4%, EPS $0.04 vs. $0.08 (adjusted: $0.16 vs. $0.22), falling short of analyst estimates on earnings. The company raised earnings expectations for 2012 and says it will borrow money to buy back its own stock, sending shares up 18% on Thursday. Puzzling given the current lackluster results right there in black and white, but perhaps this was a relief rally since no new bombs went off like last quarter and pessimism was already built into the share price. Some highlights from the conference call:

  • Two new Sunrise clients signed on in the quarter, one of them in the UK.
  • The company says it continues to “make progress enhancing the performance and integration of our portfolio."
  • Sunrise Financial Manager is entering early adopter phase and is scheduled for general availability in Q4.
  • The company admits that upgrades have been spotty as some clients "experienced challenges."
  • Allscripts expects 4,000 attendees to attend the Allscripts Client Experience in Chicago next week.
  • The company says it expects to win more hospital business in the next year since unnamed competitors have "started to step away."
  • Glenn Tullman admits that some prospects were holding back in case more corporate surprises surfaced or the company turned in a disastrous quarter, but says "the selling environment is going to come back."
  • MyWay sales were announced as flat, with more of its users moving to Professional.
  • Allscripts Professional will have an iPad version released at ACE.
  • Glen Tullman describes Sunrise as "affordable, easy to install, and open."
  • Glen Tullman: "The open message is starting to resonate … paying these astronomical amounts to installed a closed system doesn’t make sense for the future … they simply can’t afford it anyway … healthcare is going to get squeezed … we’re in talking to a lot of customers, including some customers who are saying, hey, we have this big system that’s from a well-known brand and we can’t afford it anymore, so how can you help us take down our cost.."
  • More Glen Tullman: "And relative to population — health and population management, Humedica is our partner there. As full disclosure, we have an ownership stake in Humedica, that they’re known as industry leader in the space and we’re strengthening both our marketing and sales efforts, but we are also strengthening the integration between the products."
  • On the relationship with clinical research organization Quintiles: "But as we talked about creating a partnership to improve research, that benefits the clients, it benefits the patients and it benefits pharma "

Reader Comments

From Black Box CIO: “Re: HIPAA and business associates. We are working with a company on development work and they refuse to sign a BA agreement, even though they have access to patient information. They are not permanently storing information, but are running scripts, pulling and manipulating data, viewing data, and printing out data. Our risk director, attorney, and I think they are wrong and need to sign the BAA. Do you or your readers have an opinion?” Per HHS, if you’re disclosing protected health information to that company, you need to get a signed business associate agreement to protect yourself unless the company’s people are under your direct control (i.e., working at your site under supervision just like your own employee would) and their service doesn’t involve treatment, payment, or operations. The primary question is whether the company really needs live patient data to do their work – if they do because of your setup, then they need to sign a BAA even if it’s not their fault that you don’t have good test data (I bet if you told their competitor they could have the job if they sign a BAA, they’d jump all over it.) Obviously it’s in the company’s best interest to convince you to let them slide, but HHS is clear on the issue:

The mere selling or providing of software to a covered entity does not give rise to a business associate relationship if the vendor does not have access to the protected health information of the covered entity. If the vendor does need access to the protected health information of the covered entity in order to provide its service, the vendor would be a business associate of the covered entity. For example, a software company that hosts the software containing patient information on its own server or accesses patient information when troubleshooting the software function, is a business associate of a covered entity. In these examples, a covered entity would be required to enter into a business associate agreement before allowing the software company access to protected health information.

From Digital Bean Counter: “Re: personnel updates. Michael Streetman has joined WellStar as VP of IT. His LinkedIn profile does not yet show the update. I am fairly certain Michael is Jeff Buda’s replacement (Jeff left for Floyd Medical Center, as you reported).” Unverified.

From Love is a Drug: “Re: HIMSS. Continues to demonstrate a complete lack of leveraging basic online business and IT practices. First it was the horrible, long post-conference survey, and now this week it tested a listserv in production, filling by inbox with a dozen garbage messages. They’re not moderating the comments on their mHIMSS site, allowing search engine manipulators to post spam. The industry is lost if this is our leader.” I see they’ve added CAPTCHA spam protection to their commenting function and have removed the garbage comments that were posted earlier.

From Chester the Investor: “Re: technologies. Speech recognition came out of nowhere after many years of dormancy to suddenly be the hottest thing in the sector, as just about all the players were acquired over a short period. Is there a similar technology that will follow that trajectory?” Real-time location systems.

From Pilsner Paul: “Re: surveys. How can vendors influence surveys conducted by reputable survey firms? You say they do, but I don’t see how.” The best way of all is the method drug companies have been using for years to get positive research articles published: commission a bunch of them, then toss all the ones whose findings don’t match your marketing plan. Nobody knows that the one good research paper represents 50 that failed to prove anything positive and therefore never saw the light of day (note to self: why doesn’t FDA require all research to be registered with them in advance as with hospital IRBs so we see all the results, not just the favorable ones that get published?)

From Hurry & Wait LLC: “Re: Meaningful Use. I’m hearing that OMB now has the final rules from ONC/CMS. However, it may take until the fall of 2012 (think turkey and stuffing) for the final rules to be published. With that comes the requirement that the MU2 attestation period will be 90 days in Year 1.”

HIStalk Announcements and Requests

inga_small If work, vacation, or Olympics TV viewing got in the way of reading HIStalk Practice this week, here are some highlights: a UC Medical School physician says EMRs are expensive, take time to implement, and decrease office efficiency. CareCloud adds a VP of product management. AAFP supports new measures to reduce prescription drug abuse. Better economic conditions and new insurance plans that support preventative care services helped drive clinician visit volume up 5% in Q2. The ever irreverent Joel Diamond considers the meaning of “ACO.” Kyle Swarts of Culbert Healthcare Solutions tackles business intelligence and the need to create a body of knowledge. My fragile self-esteem gets a boost each time a new subscriber takes the required two seconds to sign up for e-mail updates, so thanks for taking the time to boost my mental health. Thanks for reading.

8-9-2012 7-03-41 PM

Thanks to the folks at Vitera Healthcare, sponsoring both HIStalk and HIStalk Practice at the Platinum level. I figured we’d made them mad since they previously sponsored awhile back, but apparently their was some mixup that they’ve fixed by rejoining the fold of happy sponsors. They’re talking about the newly released Vitera Intergy v8.00 if you’d like to click on over to reassure them that they made the right decision. Thanks to Vitera.

This is the point where I cheerfully warn anyone who doesn’t already know (noobs) that I’m always behind, so set your expectations appropriately for me to respond to e-mails. Picture your own full-time job, then another 4-5 hours of heads-down focus when you get home, plus all weekend — that’s pretty much my life right there. My “sent” folder has 25,000 e-mails, so that gives you an idea of how long it takes to work my way through my inbox, which usually has hundred of e-mails crying for attention. I try to catch up over the weekend, so wait until Monday at least before resending, which just makes the situation worse. After nine years of writing HIStalk, I’m cured of the shame of not always being able to keep all the plates spinning in the air at once, so now I just say that’s the way it is.

I know how to keep women happy and dewy-eyed satisfied, at least if the ladies in question are Inga and Dr. Jayne, who will reward your skilled electronic touch (male or female) with a rapt, smoldering gaze of longing and maybe even a more intimate connection if you play your cards right. Here’s the move: (a) sign up for spam-proof e-mail updates; (b) arrange to have your paths cross by surreptitiously seeking them out on the usual social not-working sites (Facebook, LinkedIn, Twitter) and connecting with them; (c) influence them through their friends by reviewing those shimmering sponsor ads to your left and possibly perusing the surprisingly robust Resource Center that has cool, searchable sponsor information and maybe even some videos and stuff; (d) stand out in their crowd of smitten admirers by sending news, rumors, guest articles, and anything else that demonstrates your wit, wisdom, and charisma since everybody likes someone who can make them laugh or feel special; and (e) feel free to tell everyone you know about your shared experience — the ladies have enough reader love to go around. We appreciate your attention in whatever form it takes and we reciprocate whenever we can.

Acquisitions, Funding, Business, and Stock

8-9-2012 5-51-26 PM

Shares of Accretive Health fell more than 14% Wednesday after the company reported earnings that missed expectations and lowered its revenue forecast. Shares are down 41% since April 24, the day the Minnesota attorney general accused the company of using overly aggressive hospital collection tactics. The company tried to put some positive spin on the glum report by announcing that it has signed a five-year contract extension worth up to $1.7 billion with its largest customer, which to the slight detriment of the big news, happens to be partial owner Ascension Health.

Meditech files its 10-Q for the most recent quarter. Revenue was up 9%, net income increased by about the same percentage.


8-9-2012 6-06-33 PM

University Hospitals (OH) names John Foley (West Penn Allegheny Health System) as CIO.

8-9-2012 6-07-43 PM

NaviNet appoints Frank Ingari as CEO, succeeding Bradley J. Waugh. He was previously CEO of Essence Healthcare, a sister company of Lumeris Corporation, which acquired NaviNet earlier this year.

8-9-2012 6-48-09 PM 8-9-2012 6-47-30 PM

Cloud computing vendor ClearDATA Networks hires Ralph Reyes (an early partner in KLAS) and Jonathan Russell (HMS) as sales VPs.

8-9-2012 7-34-22 PM

CareCloud names Edwin Miller (Cardinal Health) as VP of product management.

8-9-2012 8-31-45 PM

Old news, but I missed the announcement if there was one: Jacque Dailey, formerly CIO of UPMC’s Children’s Hospital of Pittsburgh, is now CIO at Highmark.

Announcements and Implementations

Regional Medical Center at Memphis (TN) completes its six-month implementation of perioperative and anesthesiology systems from Surgical Information Systems.

8-9-2012 6-44-09 PM

The local paper in Cranston, RI profiles the use of GetWellNetwork by an 11-year-old boy whose rare skin disease requires frequent hospitalizations and surgeries. His condition precludes the use of his hands, so he has learned to use Facebook, control on-screen entertainment functions, and peruse medical education content by using his feet on the touch screen (he says he got a ton of Facebook Likes when he explained how he was posting.) If you watched the video I posted a couple of weeks back from the GetWellNetwork user conference in Orlando, you saw him (Antonio Torres) speaking to the group.

Grand Itasca Clinic & Hospital (MN) goes live next week on Epic (or EPIC, as they apparently can’t resist shout it out proudly), provided by Allina.

The Phoenix business paper covers the work of Dignity Health and the Arizona State Physicians Association to create an accountable care organization with Vanguard Health Systems, which will allow independent physicians access to an HIE powered by Siemens MobileMD.

Government and Politics

CMS releases details on the Medicare EHR Incentive Program 2012 Reporting Pilot for eligible hospitals and CAHs.


The Geisinger-led Keystone Beacon Community (PA) will use Caradigm’s data-sharing technology to allow skilled nursing facilities to contribute their patient data to the HIE, even if the facilities do not have an EHR. The Caradigm “MDS to CCD Transformer” converts the minimum data sets (MDS) used by nursing homes into Continuity of Care Documents.

Columbus Regional Hospital (IN) blames its new EHR for temporarily doubling its average ED wait time to nearly five hours. Two months after the go-live, the average wait is still more than three hours, worse than before. The system vendor isn’t mentioned, but they were a Meditech site at one time.

A federal judge approves a whistleblower lawsuit against Florida Hospital Orlando and several other Adventist Health System hospitals in Central Florida. A former billing employee says the hospitals overbilled the federal government tens of millions of dollars in false or padded medical claims. The attorney for the plaintiffs says damages could exceed $100 million, barely containing his excitement over his mentally tabulated percentage.

8-9-2012 6-27-52 PM

CapSite’s 2012 US Medical Device Integration study finds that nearly two-thirds of 400+ bed hospitals recently bought such technology, with many of them implementing it right now. Cerner and Capsule were the most common vendors, with Capsule easily leading the pack in the 400+ bed range. iSirona is getting an equal number of looks from those considering vendors. The primary reasons for implementing medical device integration was to improve outcomes and efficiency. Of those big hospitals that haven’t bought yet, an amazing 82% say they’re planning to, most of them within two years.

8-9-2012 6-58-06 PM

A new KLAS report on hospital clinical system finds that when it comes to new wins, it’s pretty much all Epic with a bit of Cerner thrown in and everybody else eating their dust. There’s not even a clear-cut third-place winner for reasons spelled out in frank detail (remember, these are customers talking, not self-proclaimed experts.) Epic sold 54 hospitals of 200+ beds in 2011 and lost none. Biggest losers were GE Healthcare, McKesson Horizon, and Meditech (who lost more current product users than legacy product users.) Thanks to the folks at KLAS for allowing us to excerpt their report. Definitely worth a read if only to hear the customer-provided counterpoint to what some glass-half-full vendor CEOs are saying.

A federal monitoring team hits Parkland Hospital (TX) with scathing criticism about poor management and a quality culture that allowed patient-harming errors (and deaths) to occur. One bright spot: the report said Parkland was doing a pretty good job in enhancing its clinical systems (in other words, Epic is the best thing happening there, according to the report.)

A Reuters article frets that Obamacare will make it easier to identify and deport illegal aliens who seek medical care since they’ll be the only people left without an insurance card.

8-9-2012 6-30-04 PM 

The teenager accused of impersonating a PA at Osceola Regional Medical Center (FL) and performing CPR on one patient, blames hospital personnel for giving him the wrong ID card. He says it was the hospital’s “stupid” mistake and that whoever made the error should be fired “because apparently they are too ignorant to have that position.”

8-9-2012 9-04-08 PM

Strange: in England, an NHS hospital ED doctor who took a six-month paid sick leave for stress and then worked at other hospitals goes on trial for defrauding her primary employer of almost $50,000. She was turned in by her former boss (also her married former lover) after boasting of her “megabucks” and “stupid amount of dosh” on Twitter, catching the attention of the former boss’s wife. The doctor said she worked the extra shifts to keep her clinical skills current.

Sponsor Updates

  • Medicomp Systems announces its MEDCIN U conference October 14-16 in Reston, VA.
  • dbMotion and Allscripts host a free webinar September 18 on preparing for accountable care within the workflow.
  • Imprivata announces details of its HealthCon 2012 user conference November 6-8 in Boston.
  • Alere Health and AT&T partner to deliver DiabetesManager,  a mobile health solution powered by WellDoc for type 2 diabetes management.
  • Jay Savaiano of CommVault authors an article on big data in healthcare.

EPtalk by Dr. Jayne


It’s not just for pharmaceutical companies any more. ONC uses direct-to-consumer marketing to explain “how widespread adoption of electronic health records and other health information technology is giving our health care system a 21st century upgrade.” The animated video from ONC’s new Office of Consumer eHealth aims to “spark conversation” between patients and providers about leveraging technology. The opening slide shows various caregivers, including ‘my doctor’ and ‘my gynecologist.’ (last time I checked, gynecologists were doctors, too.) Some of the other graphics are downright goofy: a stereotyped female nurse in old-school whites and a cap and a hipster pharmacist who needs a shave.

All the health IT in the world can’t fix the fundamental problems: many people eat too much, don’t exercise enough, and indulge in habits with negative consequences. A Centers for Disease Control report published Tuesday corroborates this. The study was designed to assess the prevalence of walking, which was defined as “at least one bout of 10 minutes or more in the preceding 7 days” which is really quite minimal. Not surprisingly, one out of three US adults reports no aerobic exercise during leisure time and less than half report levels of activity meeting current guidelines.


In trying to convince patients of the importance of exercise as “medicine,” I started recommending the Presidential Active Lifestyle Award challenge program. Anyone age six or older can sign up for the six-week program and jump start their exercise plans. As an added bonus, those of us who weren’t proficient at the flexed arm hang or the shuttle run in middle school have another chance to earn a cool patch with the Presidential seal. The downside: the website is a little glitchy and they don’t have a mobile app. Perhaps the folks at ONC could help out.

I came across this publication in the AHIMA library: Ensuring Data Integrity in Health Information Exchange. It offers a good, high-level overview for anyone starting involvement with HIE. They address governance up front, which is unfortunately something quite a few HIEs fail to do effectively. This should be required reading for all tech people working on HIE projects so that they understand the big picture.


Thanks to Twitter to alerting me to this piece by Atul Gawande talking about how restaurant chains control quality, cost, and innovation. He wonders if health care can learn from the Cheesecake Factory. I found the discussion of “guest forecasting” and restaurant analytics fascinating and agree with Gawande’s premise. We need to be using aggressive analytics throughout healthcare and enable highly functional teams throughout the patient care space. He also talks about his mother’s knee replacement experience, which is timely for those of us with parents in the Medicare set.

Have an idea how long you have to spend on the treadmill to neutralize a piece of cheesecake? E-mail me.



Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

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Currently there are "8 comments" on this Article:

  1. RE: KLAS report

    Anyone know if the current offering for Meditech refers to 6.0? If so, does that mean Meditech lost 16 6.0 customers in 2011?

    That does not sound right but if true it is significant and not a good sign for the future of 6.0.

  2. I am glad you published this :”HIStalk Practice this week, here are some highlights: a UC Medical School physician says EMRs are expensive, take time to implement, and decrease office efficiency.”

    Gee, I sure did not see this coming!

  3. Re: BAA. They probably need a BAA. Their refusal to sign the agreement might not be so much about the BAA requirement but the terms of the BAA. Most healthcare facilities’ BAAs are full of so much liability shifting and onerous indemnification obligations that it’s crazy that anyone would sign them. The regulations give some guidance on what’s required. I’ll go out on a limb and guess they’ll probably sign it if it follows what’s actually required by law.

    Also, I can’t tell from the summary, but if you already signed a contract for services, and you didn’t bother to put the BAA in front of them during negotiations, that wouldn’t be the service provider’s fault.

  4. Just wanted to drop a line to Tim, Inga, Dr. Jayne, and Dr. Travis for all of your efforts in keeping HISTalk the stellar source of HIT information that it is! I would hope no one would be critical of your efforts. Quite the opposite, most of us are amazed you are able to expend the number of hours it takes to keep it going let alone respond to e-mails. Thank you – you all are appreciated more than you probably hear from us.

  5. All I have to say is the ‘analyst’ have very, very short-term memories with respect to Allscript’s past performance. I’m not sure where Glenn is getting his marketing G2 but I haven’t seen too many clients running to Allscripts and wanting to replace their current EHR vendor (e.g., Epic or Cerner). If they client has McKesson Horizon, they are being actively courted by McKesson to move to Paragon, or they have made their mind to move over to Epic. Also, I’m curious, like many readers, to know of the 25-35 clients with ADX 1.5. Too much smoke in this earnings call….

  6. “Re: HIPAA and business associates…

    And it is going to get more onerous for vendors under Stage 2 since ONC is proposing to move the Privacy and Security requirements over to HIPAA. Per my recent HISTAlk Readers Write piece: https://histalk2.com/2012/07/20/readers-write-72012/ the HIPAA Office of Civil Rights will require providers to:

    “Inquire of management as to whether a process exists to ensure contracts or agreements include security requirements to address confidentiality, integrity, and availability of ePHI. Obtain and review the documentation of the process used to ensure contracts or arrangements include security requirements to address confidentiality, integrity, and availability of ePHI and evaluate the content in relation to the specified criteria. Determine if the contracts or arrangements are reviewed to ensure applicable requirements are addressed”

    Basically the vendor in his signed BAA agreement must assure and prove they comply with the ONC privacy and security criteria. Given that, if a vendor refuses to sign a BAA, then implementing the vendors system would put the provider at serious risk for a HIPAA fine/penalty and their MU attestation at risk.

    In the past vendors, particularly smaller ones, could ignore the BAA or ‘dance around it’ but those days will end soon.

  7. Re: Dr Jayne
    All the health IT in the world can’t fix the fundamental problems: many people eat too much, don’t exercise enough, and indulge in habits with negative consequences


  8. Amazing that the analysts gave Allscripts a pass for missing because they didn’t miss by as much as the analysts thought? Why have estimates then?

    It is extremely hard to integrate products that were not designed originally to be integrated. And, folks seem to be leaving the Allscripts Enterprise EHR with regularity. Allscripts will have to backfill some of the recurring revenue they will be losing. I fully anticipate another miss next quarter and Tullman to still survive.

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Reader Comments

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