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November 10, 2012 News 22 Comments

11-10-2012 8-48-39 AM

From Winston Zeddemore: “Re: EHR incentive program. Purely from the perspective of economic stimulus, by any measure, the EHR incentive program is a complete failure. After nearly four years since the bill was signed, they’ve paid out only a third ($8.36B) of the $25B set aside for EHR adoption.” Thanks to our recalcitrant and justifiably skeptical doctors for finally forcing government to stop making it rain like a defensive back in a strip club. Economically, we now know that EMRs are even a tougher sell than we thought – thousands of dollars in bribes still isn’t enough to convince doctors to spend more of the one resource they have (time) to benefit everybody but themselves. However, it’s fairly early in HITECH and the money is flowing freely now, so eventual success aside, your argument holds true – HITECH as a quick-jolt stimulus program hasn’t worked out, but for a positive reason — its intended recipients were held to high standards before the taxpayer-written checks were mailed out. That’s another good thing  – the biggest concern about a stimulus-funded EHR program was that it would move too fast, causing doctor headaches and possibly harming patients along the way because of shoddy implementations of historically poor-selling products as everybody elbowed their way to the feed trough. As distasteful as HITECH is to many (me included), it’s working better than many other ARRA-funded boondoggles.

From Geek Chic: “Re: open source code for integration. Have any of your readers used an open source engine for HL7?” Leave a comment if you can help our inquisitor. Readers have mentioned using the Mirth engine in the past.

From The PACS Designer: “Re: RIS-teria. TPD has coined a new name for problems surrounding radiology information systems. While a RIS does a reasonable job of scheduling patients for studies, it is less efficient in dealing with the subsequent information flow. With the increased demand for better information to improve efficiencies, the RIS is lagging behind other systems due to the lack of adequate application programming interfaces (APIs). RIS-teria results from department managements quarreling on where to place new API’s, and who is going to provide the necessary funding. One solution is to do an upgrade to a RIS/PACS from the same vendor who can provide the necessary API software to communicate with other systems.” 

From RIP_IDX: “Re: GE Healthcare. Significant layoffs coming to GE Healthcare in Burlington this week (probably Wednesday). Not sure if it is going to be limited to just the BTV office or across GE-HCIT. Rumor is Centricity Business will be hit hard. Haven’t heard if imaging (also based in Burlington) will be impacted. In a completely coincidental move, employees have been reminded of the corporate policy prohibiting them from talking to the media.” Unverified and hopefully untrue. We’re getting close to that Thanksgiving to New Year’s period where companies show their hand as desperate, cold, and clueless by sending employees packing during the holidays.

From MaxIT Numbers: “Re: MaxIT. Bought by SAIC for $473 million. Last quarter’s revenues were $52 million, or $208 million analyzed. That’s a buyout multiple of 2.3 times yearly revenue. How many consulting firms saw this number and are considering selling? Does this multiple seem off to anyone besides me? They must be generating huge margins at the expense of their customers.”

11-9-2012 7-24-43 PM

Two-thirds of respondents believe that patient empowerment and mobile apps can will change the healthcare system. New poll to your right, requested by a reader: what’s your general opinion of the College of Healthcare Information Management Executives (CHIME)?

Here’s my latest Spotify playlist in case you’re interested exploring new music (although some of the “new” music is actually old but little appreciated). Examples of what’s on it: Metric, Chevelle, Hammers of Misfortune, Fitz and the Tantrums, The Czars, Curved Air, Marmalade, Hole, and After Forever. It spans more than 40 years and several genres, connected only by the thin thread of my common appreciation.

11-10-2012 8-58-34 AM

Some nuggets from the Allscripts earnings call Thursday:

  • Glen Tullman said drastically reduced earnings were caused by prospects delaying decisions because of the rumors that Allscripts was trying to sell itself, and also because of clients were waiting for new product releases. Ambulatory sales were hurt by the acquisition rumors and MyWay announcement. Professional services revenue slipped due to fewer sales and upgrades, but maintenance revenue increased. He repeatedly referred to the sales-impacting issues as “noise.”
  • The company had one new Sunrise sale in the quarter. The buyer was a three-hospital, 214-bed system.
  • Reaction to the MyWay announcement was “pretty positive.” Glen declined to give the MyWay customer count, but said it’s in the thousands.
  • Glen: “You’ve got some old systems out there that are harder to connect and harder to upgrade, and you’ve got a slew of new technologies starting to hit the market. That’s when whole sectors change. I think that’s our opportunity.”
  • Allscripts hasn’t seen lengthening sales cycles in ambulatory as other companies have said they’re experiencing.
  • The company expects “the vast majority” of MyWay users to move to Professional by the October 13, 2013 signup deadline.
  • Glen: “I think this is a big focus for us whether it be analytics, whether it be care coordination, whether it be interoperability, connectivity, and mobility. All of those will absorb a higher and higher percentage of our R&D budget, which continues to grow. And we think that we will have significant advantage. Some of our competitors are locked into architectures that don’t allow for the kind of innovation that we can bring. And with our open ecosystem that we’re creating, with all the third parties starting to develop on that platform, we think we can extend significant competitive advantage as those folks developed for us.”

11-9-2012 8-51-22 PM

A survey of “digital health entrepreneurs” by venture capital firm InterWest finds that the top three barriers to healthcare innovation are reimbursement (27 percent), government (19 percent), and Epic and Cerner (14 percent). The heel-nippers may pout that well-established and successful vendors won’t voluntarily move out of their way, but they’re also envious: companies they wish they had founded include AirStrip, Castlight, ZocDoc, Epic, and Google. The graphic above is their prediction of which of their brethren will be the next to go public.

11-10-2012 7-45-23 AM

A wood products company becomes the first business in Maine to use telemedicine in the workplace, offering its diabetic employees video consultations with the co-director of the diabetes center at Tufts Medical Center. The program gives employees access to specialists who aren’t available in the company’s rural location and eliminates the high co-pays that most employees couldn’t afford.

11-10-2012 7-58-14 AM

Massachusetts-based hospital drug supplier Ameridose, a sister company to the compounding pharmacy whose products have been linked to a national outbreak of fungal meningitis, lays off its 800 employees as the FDA reviews the company’s sterility practices. The director of the Massachusetts Board of Pharmacy has been fired for failing to investigate a sterility complaint against the compounding pharmacy. It’s an interesting juxtaposition of headlines on Ameridose’s site (above).

11-10-2012 8-03-30 AM

Nashville-based Dalcom Communications Systems, which sells a wireless patient communication and nurse alarm system, renames itself to Amplion Clinical Communications after raising $3.75 million in financing to expand sales.

Sen. Orrin Hatch (R-UT) raises concerns with HHS Secretary Kathleen Sebelius that Quality Software Services, Inc., which was awarded a contract worth up to $145 million to create an eligibility system for the federal health insurance exchange, has since been acquired by Optum, part of UnitedHealth Group. QSSI’s annual sales were $13 million before the deal. The federal official overseeing implementation of the health insurance exchanges resigned in June to take an Optum EVP job.

11-10-2012 8-11-08 AM

Release of information vendor HealthPort merges with competitor Discovery Health Records Solutions. The Atlanta-area companies will operate under the HealthPort name. HealthPort sold its IT-related businesses, which included the former Noteworthy Medical Systems, to Germany’s CompuGROUP for $24 million in November 2010.

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11-9-2012 8-41-27 PM 11-9-2012 8-42-07 PM

  • A four-part series by Karen Baker, MHS of the nonprofit Healthwise celebrates National Health Literacy Month with a discussion about how to engage patients in healthcare decisions. The organization took a team of 18 of its content producers to a scriptwriting camp led by an advertising copywriter, an actor, and a filmmaker to encourage them to break the rules in developing material that not only supports evidence-based medicine and behavioral change theory, but in a way that gets patients involved using plain language and taking the patient’s point of view. According to Healthwise Founder and CEO Don Kemper, “Medical gobbledygook robs people of their autonomy. Without understanding, they have no real say in their care. Plain language gives them back their say.”
  • Besler Consulting will exhibit at HFMA’s Region 9 conference in New Orleans this week, demonstrating its cloud-based BVerified solutions for transfer DRG, IME, excluded provider screening, and revenue integrity auditing.
  • CSI Healthcare IT revamps its job portal, which lists its several dozen open positions (direct hire, consultant, and contract to hire) for candidates with expertise in Cerner, Epic, McKesson, and Meditech.
  • An interesting blog post by Henry Sabia of Software Testing Solutions on the changing no-man’s land between the EHR and laboratory information system: “It seemed to me the consensus was that ‘LIS’ won’t be about one system doing everything. Thought leadership sees it as a spectrum of systems working together. Ironically, GenLab and Microbiology functions may leave the typical LIS applications to become part of the general EMR, but Blood Bank and Anatomic Path will most likely fall under the ‘specialty’ category and will require standalone systems. Seems to me that we will always have separate systems, but a game of Red Rover is happening with some of our functionality. The EMR/CPOE has called GenLab and Micro over. Will be interesting to see if/how they make it to the other side. Regardless of where GenLab and Micro may live, the need for functional and volume testing will be more demanding than ever. EHRs, EMRs, interfaces, and data integration are here to stay. Add new acronyms like LOINC and HIE, and the picture only increases in complexity.”
  • Velocity Data Centers President Steve Jacobs offers four concerns about healthcare IT moving to the cloud: data security, service levels, performance, and energy efficiency.


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

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Currently there are "22 comments" on this Article:

  1. Re: open source integration engine. We’ve used the MirthConnect open source integration engine since 2007. We’re very happy with it. We’re a small rural HIE service delivering clinical data to and from dozens of unaffiliated healthcare facilities using many different EHR, LIS, HIS, and RIS packages. Key MirthConnect tip: ignore the built in function calls and write your own filters and transforms from scratch. Yes it’s labor intensive, but there’s only so much you can do when the source data is so dirty and erratic.

  2. Geek Chic: Mirth is the go-to OSS solution for HL7 transactions and more, to be sure. Our crew has found it to be perfect for some things, non-functional for others…depends on what you are trying to do and the people at either end of the transaction.

    So, my generic advice to the vague request is to explore Mirth for sure. If you can offer more details, I can offer more advice.

  3. Re: Open Source integration — we have used the Mirth engine for several years and have found it to be robust and reliable. We connect our lab hub to over 100 labs using Mirth.

    You need to be cautious in looking at other Mirth Corp technologies; most are not open source. And the pricing for other services tends to be unrealistic. I understand that it can be tough to build a sustainable business model around Open Source, but Mirth Corp could greatly expand their reach with more reasonable pricing.

  4. http://www.washingtonpost.com/national/health-science/for-some-doctors-electronic-records-arent-a-miracle-cure/2012/11/05/f12c3400-f1fb-11e1-a612-3cfc842a6d89_story.html

    I appreciate Winton Z’s news, and I like your analysis even more. Others depicted in the WaPo report share your wisdom. Keep up the good work, Mr. HIStalker. What will it take to get health care professionals to embrace these modern health care managing devices?

    In my humble opinion, the doctors need to be assured they are safe, improve outcomes, and reduce costs. Thank you.

    Lurker for years

  5. Re: Consulting Revenues – The deal for some consulting companies is that if the transaction doesn’t generate 40% gross revenue, it isn’t work doing. Remember the client pays for travel, lodging, meals, so the difference between gross and net revenue is essentially a consultant health plan cost and a cost to process the consultant’s tax and payroll records. Some companies also have a ‘bench’ to store consultants between gigs.

    Hospitals hire consultants because they need the talent ‘now’, usually to rescue a failing project from the abyss. They are rarely in a position to negotiate hard.

  6. We are a multi-facility system with > 400 interfaces to most any type system/message you can think of. We currently are using an ESB that wasn’t meant for healthcare and have had to work hard to get it to handle HL7. Going open source is not my idea but I am being told to investigate options. Our biggest challenges are volume and translations since we currently use the engine to translate fields for the receiving system. I’ve been told Mirth might have the same issues. I’m curious what is non-functional with Mirth if you could elaborate.

    The names that have come up (from a department that doesn’t always deal in reality and never deals in integration) are Talend, WSO2 and FuseSource. I haven’t been able to find much about them through Google. Personally if we were going to switch at this point I’d prefer going with a tried and true HL7 engine and I’ve made that known. I still have to research the other options. I’d appreciate any input.

  7. GE layoffs are definitely coming. HC as a whole is going from 5 zones to three. HCIT is following suit.

    The business is actively planning the reorg/RIFs. Lists will be distributed on a need-to-know basis early next week. i.e variable comp group who need to administer payouts based on various state laws, which requires advanced planning .

    A truly dysfunctional culture as evidenced by the revolving management door, myself included, the attendant impact on morale and the lack of real product innovation possible inside a ROI model that is incongruent with the HCIT software market.

    It is hard to see so many talented and passionate people constrained by such a culture. In the end the top talent finds a more professionally rewarding environment to self-express one’s talents.

    What remains is mediocrity .

  8. I don’t think HITECH was ever really meant as a rapid economic stimulus, but more of a slow burning one. There was a graph I saw from the feds when it came out that showed when they expected each of the money buckets to pay out, and HITECH money was the last and had a substantial lag to it because the MU rules had to occur first. It also took a lot longer than people anticipated, and I imagine they’ll be pushing back the penalties sometime in the next couple of years to reflect that.

    @Geek Chic: I’ve never heard of the interface engines your people have come up with (I’m not an interface engine geek, though, just know the ones that came up often for us). Cloverleaf sells a relatively inexpensive interface engine that’s pretty good, although probably too small for you. Orion sells a powerful one (it was best in KLAS for a number of years, powers their HIEs, and is white labeled and used by some of the large EMR vendors) that isn’t too expensive. Oracle sells eGate (or whatever it’s called now, used to be from SeeBeyond and then Sun) that is okay, and can handle large organizations. If it were me, I’d go with Orion because it’s solid and easy to use.

  9. I’ve used Mirth exclusively for 6 years now. I consider it to be as tried and true as any of the non-OSS usual suspects, and I’ve used most of them. There isn’t any material functionality lacking. It was an easy decision for my shop to make. My only question would be volume. I’ve never had any performance issues, but your mileage may vary. It’s certainly worth a proof-of-concept for you to see if it scales well.

  10. I have heard good things about Mirth, and among the non-open source engines, I would also add Corepoint – they are actively involved in the actual HL7 process, and have the highest KLAS ratings in the last few years.

  11. MaxIT is a cash machine. They along with its sister firm Vitalize Consulting Solutions are both high margin firms. It’s one of the reasons both firms were purchase. Each firm presented themselves to their clients and prospects as private firms but in fact both were portfolio company’s of private investors. These firms are not alone in their ability to generate huge margin’s these days.

    Many consulting firms have come into existence in the last 4 years under the premise that they would be build to be sold. Some such as Encore, Santa Rosa, to name a couple. Both were build as investment vehicles that would be grown to a curtain size and then put on the auction block.

    Health systems would be better served to use smaller firms who are privately held by the principals that run them. The problem that many of the smaller firms face is that firms like MaxIT swallow up resources and constrain the market.

    At the same time MaxIT and other firms put policies and processes in place that also put the squeeze on the consultants who work for them. As an example of this MaxIT might contract with a health system for $60.00 a day for Per Diem for the consultants and MaxIT will only pay the consultant $42.00 a day. MaxIT makes $18.00 and the client isn’t the wiser.

    Another example is that Encore Health Resources is actually two companies. The primary one is the one the client signs a contract with and pays for services. Separately Encore created a separate staffing company that the majority of the consultants or Encorians as they call themselves work for and they pay that firm a management fee and also if they were every bought they could split the two firms and leave the consultants high and dry or just sell the staffing firm.

    The best things a health system can do to promote getting the best talent at the best price is to use a minimum of 8 – 10 firms and have them all compete for the consulting slots. Use standardize agreements with each of them and require them to not subcontract to each other or secondary firms. I’ve seen firms who are using consultants that are 3 times removed from their own firm in engagements so you can imagine that each firm is making a margin on the resource.

    Don’t get me wrong there are a lot of good, high quality consulting firms in the healthcare IT vertical. With HIMSS coming up I say to take a hard look at the consulting firms your organizations uses and if that firm that can spend a significant amount on a booth and the staff to go along with it along with “Pub” nights and other parties. You might want to reconsider who and how your organizations funds are spent as are those firms might be the ones to avoid. I’m just saying follow the $$$.

  12. @Geek Chic: We have a number of clients that are using Mirth and it works for them. We also have clients who are using Ensemble and Rhapsody, it all depends on your team, the amount of money you want to spend, your religion (Open Source) and the amount of transactions you’ll be doing.

  13. Jeeze, El Jefe, I haven’t seen any good OSS baiting since the 90s. I guess I should stop posting on this OSS WordPress site using my OSS Firefox browser running on my OSS Desktop.

    Anyway, Geek Chic, here are some more concrete notes from one of our guys using Mirth. Note the good and the bad.

    “Mirth Connect is:
    – free
    – in widespread use for clinical message processing, transformation, and routing
    – handles HL7 version 2.X — and reportedly 3 — message formats natively
    – represents messages internally as XML
    – supports JavaScript/E4X for transformations
    – offers numerous built-in inbound/outbound interface “connectors”, e.g. database, SFTP, web service (SOAP)
    – is Java based (cross platform)

    We use it on our hub systems to receive, transform, and route HL7 messages to/from [our EHR] and vendor systems.

    It’s pretty damn cool. Originally I’d intended it to use it on client systems as well but administering it at that level — e.g. ensuring the proper Java environment and supporting the JWS-based administration interface — proved troublesome.”

    I hope this helps.

  14. One last question concerning Mirth. Does it natively handle providing acknowledgements or did that have to be engineered? With our current ESB we had to create the framework for time-outs, retries and ack/nak so I’m wondering if we would have to do that again with Mirth.

    Again, thanks for all the great responses. I knew this crowd would be a big help.

  15. Mirth natively handles acks, retries, etc. Generally we have found it does a good job there.

    We built our own monitors to watch the number of messages in the retry queue, since that is the best indication of whether a connection is down (how many messages are queued up and how old is the oldest one). Mirth didn’t have that built-in.

  16. When consulting firms sell, they typically fall into one of two categories: A) Staff for hire, or B) IP-based consultants

    If you are a shop that basically gives clients extra hands and that is all, I don’t think you would see a multiple of 2.3x. The only exceptions would be if you have an incredible name or very long-term contracts that an acquirer can bank on enjoying.

    If you are one of the IP-based consultants with a distinct methodology or even proprietary software, 2.3x is not at all outside the realm of reason, and I could even see higher if your software is extremely “sticky” with clients.

    Not sure where MaxIT falls in that spectrum, but my guess is they either had long-term gigs signed or some IP that came with the deal to garner 2.3x.

  17. El Jeffe: Thanks for contributing…what, sarcasm? Maybe you were trying to be funny, I don’t know. But the ol’ “You get what you pay for” comment relating to OSS just dumbs it all down.

    I mean…you know there is free closed source software, right? Like, everywhere. So, are you objecting to software that doesn’t have a fee or software whose code is open? I can’t tell. Is that a Koolaid moustache?

    Actually, forget it. I should have learned to stop feeding the trolls years ago on Slashdot and Deadspin. Can’t believe I’m falling for it now. Reply away, I’ll just ignore you. I’ll get in touch with Geek Chic through Mr Histalk and you can return to your snark. But, hey, if you actually have any real experience with this issue, weigh in.

  18. re: Geek Chic – you have received some excellent comments so far; I thought the points made by Ken Willett were especially dead on. An open source approach requires you be comfortable with doing some of your own programming without a formal support organization behind you; rarely a successful option for a small integration shop found in most hospitals. Another commercial integration engine you might consider is Siemens OPENLink which is targeted solely to healthcare and has a long history in the industry. Good luck.

  19. DrM,

    You are correct in mentioning the industrial strength integration engines from full service integration companies.

    Oracle end of lifed eGate a little while ago, they now OEM Orion Health’s Rhapsody.

    Yo frankie, so much for your OSS eh?

  20. Given the high volume of recent comments related to Mirth Corporation, we think it is time to contribute our own comments. We understand that it is unusual for companies to successfully maintain both commercial and open source offerings, and we welcome the opportunity to clarify information specific to Mirth solutions.

    We agree that healthcare organizations should have world-class support and professional services available. This is why Mirth’s primary integration engine solution is offered under a commercial license, bundled with a comprehensive support offering. The commercial versions of Mirth Connect include enterprise extensions such as SSL support, role-based access control, and tools for handling CDA format messages. We additionally provide options for in-depth training and full-range professional services, including implementation, interface development, and hosting.

    Customers using Mirth Connect, either as installable software or as part of our ready-to-run Mirth Appliance platform, represent a wide range of healthcare organizations, many with a large number of interfaces and high message volumes in sophisticated enterprise-level deployments.

    For those not requiring enterprise-level features or commercial support, Mirth Corporation has chosen to also make our healthcare integration engine available under an open source license. Anyone may freely download Mirth Connect from the Mirth website, and many people have. Over 25,000 users are active in our open source community and provide a great resource for healthcare integration specialists and engineers. We are proud of the culture of sharing and collaboration that has evolved in this worldwide community of Mirth Connect users.

    While Mirth accepts suggestions and feedback from the entire user community, the Mirth Connect source code is maintained and managed by Mirth Corporation. Our next major release is coming out in a few months and reflects the collective wisdom of Mirth customers and open source users.

    We’d also like to address the remark about the pricing for our other HIE solutions. Mirth’s commercial offerings include an EMPI (Mirth Match), a clinical data repository with provider portal (Mirth Results), and a Direct HISP messaging platform with provider directory (Mirth Mail). They are engineered and priced to offer significant value to both public and private health information exchanges and health systems that need sustainable HIE solutions, and our customers using these solutions will attest to that.

    We suggest that the best way to validate our solutions is to simply call us. The Mirth team stands ready to answer any and all inquiries. Our contact information can be found at http://www.mirthcorp.com.


    Marilee Benson, VP of Sales

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