Monday Morning Update 2/9/09

From Doug DeCinces: "Re: E&Y. E&Y is shutting down its Health Sciences Advisory Services practice. At least 100 employees at all levels (partners and down) are losing their jobs." Unverified.

From Skeptic: "Re: TEPR. They’re claiming 800 registrants, which is pathetic even if the number is accurate. They’re also claiming that a common comment was ‘best program in 25 years.’" The only positive comment I’ve heard is that the weather was good. Now that HIMSS is eating the universe, it’s like the NIT basketball tournament once the NCAA expanded to 64 teams. If someone really wanted to offer a HIMSS alternative, it would need to be a lot cooler and a lot brasher. I’m thinking I’ll start a BIL conference or an unconference whose whole agenda is like the interesting, less commercial hallway meetings that are usually the best part of any conference. Those could be held at cooler, smaller, cheaper locations than the tired old Orlando-Las Vegas-Chicago circuit of mile-long convention centers and $15 room service burgers, like an HIT Chautauqua that leaves you educated, rejuvenated, and not embarrassed that your employer’s time and money were wasted.

From Kate: "Re: medDispense. Emerson (NYSE: EMR) bought them last month for an undisclosed amount." I confess that I didn’t even know that automated drug dispensing vendor medDispense was still around. Trivia: they started as a division of HCS, the Montgomery, AL software vendor who sold McKesson what is now Horizon Meds Manager. Emerson makes heavy duty commercial stuff like power plants and air conditioners. Not too successfully of late, apparently, since the company announced late Friday that it will axe 14,000 employees, more than 10% of its workforce, by October. The sale went through on January 15.

From Tarhill: "Re: HHS secretary. Has anyone heard if Newt Gingrich might be a candidate?" Well, like Daschle, he’s written books and held high political office. The similarities end there. Maybe he would be a good choice, but he brings a lot of baggage, is on the wrong ideological side, and would never fully trusted at the level Daschle would have been. The problem is that all the plans were built around Daschle, so he’ll be tough to replace even if the job is split into two (advisor and HHS leader). I hesitate to say this, but I’m not convinced he wasn’t the best choice despite questionable industry ties. Sure, it’s iffy that he was paid millions as a non-lawyer working for a law firm in ways that sure seem to indicate off-the-books lobbying, but if Obama wants political experience, every closet has a surplus of skeletons.

From Vendor Guy: "Re: QuadraMed. Heard a rumor that QuadraMed is getting to pull the plug on the old Compucare/Affinity product." Half accurate, as I suspected and Inga confirmed with a company spokesperson. QuadraMed recently notified existing Affinity Clinical customers that Affinity Clinicals will not be supported after 1/1/12. This is hardly a surprise: they were very clear with the QCPR acquisition that Affinity Clinicals weren’t up to snuff and that QCPR was a far better solution that would be the go-forward offering. However, the far, far more widely installed and much better Affinity Registration/Access and Revenue Cycle products aren’t going anywhere. See also the interview I did with CTO Jim Klein in HIStech Report: "We had to be frank with ourselves. The Affinity clinical system, unlike the patient accounting system, had not kept up with functionality. Both ‘build’ and “buy” options were viable, but people’s expectations about how the team could turn things around just screamed ‘buy.’" They’re offering deals and extended Affinity Clinicals support to customers who move to QCPR.

HIMSS just won’t seem the same without MEDITECH and Cerner there, will it? Maybe that’s a good thing. Past excesses at all levels (individual, business, and government) make it appropriate to tone down the boat show (and that MEDITECH, as the always-frugal but huge vendor, lead the way after Cerner). Non-conspicuous consumption is "in" again, thank goodness. The big question: will other companies follow their lead? My pledge: I will not criticize or allow criticism here of any company that decides to refocus their resources on something other than the HIMSS conference. Each vendor has to decide for themselves whether it’s worth it. Even if there’s little money to be saved by pulling out at this late date, I think both providers and vendors are cautious about appearing extravagant. I’ll be there, but I’ve always been a complete cheapskate, like subsisting at last year’s HIMSS on Subway sandwiches and going for the cheapest hotel on the bus route. I did buy a can of soda one day, but griped constantly about the cost to anyone who would listen.

Sisters of Charity of Leavenworth Health System (KS) sues Lawson Software for retiring "critical" applications it bought in 2001 for $1.4 million. Lawson says it will end support in May 2010 for employee time off tracking and medical supply inventory management. Their contract says they can exchange their applications for other similar ones for a nominal fee, but Lawson wants another $155K in licensing fees plus increased maintenance because their only other similar applications have additional capabilities.

A Sacramento publication (I’m guessing it’s one of those free counterculture weeklies that features wildly liberal articles, ads for sex chat lines, and good restaurant and concert reviews) takes on EMRs, managing to make Britney Spears the focus. Here’s a fun snip: "It [Kaiser] developed two versions before settling on its current HealthConnect project using Epic Systems software (which is quickly becoming the national standard for EMRs)." Popular, but a national standard? It may be an obscure publication, but Deborah Peel of Patient Privacy Rights found the article and left the only comment it has received, calling EMRs "dinosaur technologies" and urging readers to contact Congress to vote no on HITECH unless privacy provisions are added.

Clarian Health (IN) shuts down a $475 million construction project as part of an urgent cost reduction project that includes 10% pay cuts for VPs and efforts to renegotiate vendor contracts. More than 400 construction workers were immediately put out of work, some of them finding out only when they arrived at the job site Friday morning.

The University of Virginia Health System gets approval for a new $59 million EMR project. The vendor isn’t named, but I’d have to guess Epic given (a) the price; (b) the line about access to records anywhere on Earth; and (c) the fact that nobody’s selling any big deals these days except Epic (the hippie weekly may be right). I believe UVa was IDX/CareCast, so I assume GE Healthcare will be losing another customer.

Kaiser Permanente announces that a recently arrested non-employee had a computer file containing KP employee information, source unknown. They offered the usual free year of credit monitoring.

I’ve closed the two polls on economic conditions. Results: EMR vendor people say they’ve seen slowdowns because of the economy (68%) and because prospects are waiting to see if the government will help them purchase (11%). Only 21% say it’s business as usual with no slowdowns (it would be interesting to know which companies those are!) On the provider side, 54% of those considering an EMR purchase say they’re moving forward without planned delays, 38% say they’ve delayed their project because of the economy, and 8% say they’re waiting on possible government help. Respondent counts were 47 vendors, 26 providers. It appears that the possibility of government handouts isn’t holding many prospects back, but the economy definitely is.

New poll: if you went to HIMSS last year, what are your plans this year and what’s your employer doing? It’s awkward to phrase the question in a poll, but I did it this way: indicate whether you’re going or not, and then whether your organization is sending fewer people or not. People keep asking me how I think attendance will be; I can’t imagine it won’t be down, but conventions are like sporting events: fan-flation uses the most flattering number — turnstiles or ticket sales. I care less about announced attendance than what vendors tell me they’re seeing in the exhibit hall since, let’s face it, that’s the metric that drives conferences.

The Virtual Practice Project at Mass General is working on a medical kiosk that walks patients through touch screen-answered questions and checks blood pressure. The doctor in charge explains: "The way we deliver traditional health care is a bit antiquated. It’s based on face-to-face interaction between the doctors and the patient." I found this report (warning: PDF) which mentions that RelayHealth is providing some of the online visit technology.

The unSummit for Bedside Barcoding will be in Tampa May 6-8. Good agenda, good hotel, and CEUs for nurses, pharmacist, and lab techs. You save money by signing up by February 28.

Here’s a TV show that I hope has met its much-deserved demise: "Flip This House." When Joe Sixpack starts thinking he’s an expert in day trading, commodities speculation, and real estate investing, it’s time to run for the hills.

I think it’s obvious, but for any newcomers, you will want to read the article comments because some thoughtful conversations are to be found there. If you’ve clicked the e-mail link, you’ll see them automatically, but readers will post comments after you’ve read it. To see those, click the Home link at the top of the page, then click the "show comments" link at the bottom of the article. I’m pleased that folks comment quickly, knowledgeably, and respectfully, offering a nice mix of opinions (I don’t claim to be right all of the time and readers sometimes change my mind).

Also for newbies: add your e-mail address in the Subscribe to Updates box at the upper right of the page and you’ll get instant e-mail updates when I write something new (surely you want to be among the first to know — you should see the server drag when hundreds or thousands of people all hit the site at once when an e-mail update has gone out). The Search box does a Google custom search on HIStalk and HIStalkPractice combined, all 5.5 years worth (I may have mentioned your company, your boss, or you in those millions of words). Also, click that "Email this to a friend" graphic to alert some e-mail pals about an HIStalk article or click the horrid green Rumor Report box to tell me a secret.

One more update: someone asked for the "Print This Post" option that used to be here, so I’ve re-installed that function that I didn’t realize had gone astray. The link is at the bottom of each article.

Inga did a couple of cool interviews on HIStech Report. Our old friend John Holton of SCI Solutions provided his usual honest, experienced assessment of the industry ("PHRs are being developed by Microsoft and Google and others. It’s the way information will be stored and sent because no one really cares about your medical history except you.") She also talked to Bruce Cerullo of Vitalize Consulting Solutions, another friend of HIStalk who I had fun with at last year’s HIStalk HIMSS event ("Having really good people wanting to come under our umbrella is a win for them, a win for us, and a resulting win for our clients. I also think there will be a lot less job-hopping in general over the next 12 months. I believe we will see more stability among the consultant firms.")

Bizarre: Wuesthoff Health System (FL) is offering patients from competing hospitals $100 gas cards for a copy of their EOB. They want to see how they stack up on charges. Maybe they got the idea from Scott Shreeve’s Million EOB March.

Like it needed more bad news: Grady Hospital (GA) may be the source of four patients’ Legionnaires’ disease, which allows Legionella and attornii scumbaggia to thrive at the expense of normal species.

Four employees of Somerset Medical Center (NJ), one of them the hospital’s credit manager, are charged with altering patient bills to trigger $35,000 worth of refund checks made out to the four and sent to the same address. That doesn’t seem like a very smart plan coming from someone in management.

Idiotic lawsuit: a couple attacked and beaten in their home are treated at Stephens Memorial Hospital (ME). A security guard hears them talking about being attacked and calls police, who check out their house and find 95 pounds of marijuana, for which the couple pleads guilty. They’re suing the security guard and the hospital, claiming violations of HIPAA and state confidentiality laws, violation of privacy, and emotional distress.

E-mail me.

Report from the Field
Nick van Terheyden on TEPR

For those coming from the fully winterized East Coast and Midwest in February, any location that has a temperatures rising above 35° is going to be attractive, but Palm Springs would be hard to beat. Set in the shadow of the San Bernardino Mountains and weather that sat in the mid 70s and provided clear blue skies every day was a delight. The conference itself has clearly seen better days and estimates ranged from the “official” ~7-800, to my unofficial count at opening keynote of 4-500 to overheard “only 320 rooms sold." Whatever the number, it was small and often felt overrun with presenters and vendors.

AHIMA felt similar this year, with a distinct feeling that there were fewer attendees and several anecdotal stories of cancellations to save money. Even the RSNAathon was lighter than previous years, but with such large numbers to start with, the decrease has less impact. Fascinated to see how significant the effect will be on HIMSS.

The opening sessions were great, and like or not Adam Bosworth’s views on where to spend the $50 billion stimulus, he had a compelling story that was not about technology investment (surprising for an acknowledged pioneer of XML) but centered on incenting behavioral change in the US population to stop the epidemic increase in American waists. But it was the Illness in the Age of “e” hosted by Danny Sands from Cisco and his patient Dave deBronkart that stole the show.

In an emotional and graphic account, the pair detailed Dave’s experiences from the first incidental finding of an aggressive form of renal cell carcinoma through intense and “often severe and rarely fatal” side effects to the closest thing you can hope, for next to cured: No Evidence of Disease, or NED. Insisting on patient participation to help guide the process, even check for errors (he cited a recent case of wrong side surgery for someone with the same renal carcinoma where they removed the wrong kidney!) that would have easily been prevented with patient involvement. Nothing to bring home the relevance of what we all work for than hearing right from the patient’s mouth. Dave (@epatientdave) stayed the duration, shook up several other presentations, and joined the impromptu TweetUp by the side of the pool on Monday night with @alphabest @HealthITGirl and yours truly @DrNic1.

But no social networking presence from the Medical Record Institute, and as I pointed out in my Tweet, “It’s so Web 1.0…. no blog, no tweet, one month before presentations will be online." There was some activity as @Megan_maguire weighed in, but a little late. (unlike HIStalk and HIStalk Practice that have wrapped their arms around these media, use it effectively, and participate jacked in just like Neo from The Matrix – which is how I feel a lot of the time!)

The panel discussion with Google and Microsoft and MedCommons was a bust – and an education in panel techniques. Hearing three replies, all similar, to each question was uninformative and boring … sigh. The case is made — we need disruptive attacks to the current status quo and that needs to come from innovators who shake up the system and incumbents. PHI will play a role and the individual will become a key player. The recurring focus on the big cash supposedly heading for our industry was in many instances distracting and in some cases potentially detrimental since the likelihood that the cash will end up steered towards those with the best advocacy and influence in Washington places additional strain on the small upstart that is trying to disrupt the status quo.

The final panel discussions on Thursday were like many conferences — poorly attended, and at one point the panelists outnumbered the attendees. However — a gem from one of the discussions: "CCHIT certified EMR = unusable" … but you can *upgrade* to a non-CCHIT certified alternative.”

There was little traffic in the vendor area, which was located at the end of a long walk past all the educational sessions and had limited opening hours. The main topic of conversation was the likelihood of anyone returning to the show or if there would be a show to return to.

Sadly for this long time attendee, this year’s TEPR felt too much like an Irish wake without the alcohol. Much of the oxygen has been sucked out of the conference circuit by HIMSS, which is unfortunate since smaller conferences offer more opportunity to really meet colleagues and vendors and gather information in a practical learning environment.