News 5/8/09

From Ellis Dee: “Re: ARRA. A hospital that has a large outpatient makeup but very little inpatient appears to get significantly less ARRA reimbursement for EHR since the calculation only mentions inpatient. I’d be curious if this is just a legislation snafu that will generate enough complaints to include outpatient. It seems EHR investments and continuum of care applies even more so to outpatient.”

From Roy G. Biv: “Re: HHS. Is it me or is the new health IT web site a little thin? For some reason, they also changed the domain from www.hhs.gov/healthit to healthit.hhs.gov. My take is they implemented a new portal vendor, while the last site was home grown and content managed by HHS directly. I included a link to the Internet Archive ( Wayback Machine ) of a cached version of the site a year ago – a lot more content – and bigger print.” Before, after. It looks like it might be portal software from the former Plumtree Software, which was bought by BEA, which was bought by Oracle (the software version of a Matrushka doll).

From Looking for Answers: “Re: Cerner. What is Cerner’s MPages, why are people so excited about it (to make a video), and does it give Cerner an edge?”

From X-Sage: “Re: layoffs. 1,000 layoffs announced by Sage in England during briefing on six-month financials earlier this week, with Sage Healthcare getting hit once again starting on Tuesday.” One reader put the healthcare cuts at 200 people with more to come. In the mean time, one stock analyst likes Sage stock OK, but says getting into healthcare was a mistake, especially now that Allscripts and Misys have merged to create a formidable competitor.

From Revenue Randy: “Re: Sutter EMR project. Get ready for Son of Sutter … Stanford Medical.”

If you’re a doctor shopper looking for OxyContin in Virginia, now’s your chance: the state database that hackers hijacked is the one that healthcare professionals check to identify drug-seekers. It’s now offline. Mr. Limbaugh, your prescription is ready.

Porter County, Indiana was sued last year for $3.4 million by a management software vendor that claimed Porter Hospital used its software without permission after the hospital was sold to for-profit Community Health Systems. The county argued that the new owner should have worked out a deal with the vendor, so they paid $200K to get out of the suit. Now the hospital has countersued the county, claiming a contract clause makes it the county’s problem. The county is threatening to counter-counter-sue the hospital for the $200K.

I’ll say this, having worked for a non-profit hospital bought by a chain: a former non-profit’s employees sleep behind enemy lines because everyone in the community suddenly hates you, even though you’re going to work in the same building with the same people. Appropriately so in my case: the company running my hospital was a truly impressive bunch of sleazebags and scoundrels who gravitated to healthcare only because the money was good and fraud wasn’t often detected. A classic line from our brand new 24-year-old hospital president in his first real job, speaking to our long-time CFO who predated him by decades: “We need to use less oxygen.” We snickered at his stupidity, but he went on to make dozens of millions running the slimeball organization, somehow avoiding jail time unlike many of his peers. If you were a patient in our hospital back then, I am truly sorry our management brought in clearly incompetent doctors whose only attribute was that they would take orders from a 24-year-old MBA using patients to rise through the ranks. I have a lot of stories, unfortunately.

The State of Massachusetts is considering ditching fee-for-service payments to doctors and hospitals and instead giving them a capitated yearly payment. This is an interesting thought: “… because doctors and hospitals would have to work together more closely to manage the budget, the hope is they will better coordinate care for patients, which could improve quality.” Catfight!

A WHO advisor provides an opinion on the US healthcare system, one question being what advice he would have for the President: “My advice would be to avoid a search for villains (e.g. insurance or pharmaceutical companies) or panaceas (e.g. the electronic medical record), neither of which will be very productive.  Instead, Americans need an intelligent public policy debate that both builds strong consensus for the goal of universal coverage and fosters understanding of the consequences of the structural fragmentation of the existing system and why this has to be addressed.  Expanding coverage without tackling this underlying problem will be very costly, so equal attention needs to be given to both fairness and efficiency if the U.S. is to move towards a system that is both universal and affordable.”

Non-profit Global Patient Identifiers, Inc. and software vendor MEDNET announce a partnership in which MEDNET will issue cards with GPII’s Voluntary Universal Healthcare Identifier and also donate in kind to GPII.

Not satisfied with wasting your personal time Twittering? Now you can reduce your company’s productivity as well with the aptly named Yammer, a near-clone of it aimed at private networks (it reminds me of the old Groove before Microsoft bought it). It might be useful, although I don’t see much benefit over a decent e-mail and IM system (why does everyone fret about blocking unnecessary e-mails when most people just delete them anyway?) The New York Times kind of liked it. It’s free to join, but to get more control and security features costs the employer $1 per user per month (so unlike Twitter, it might actually have a business model other than being sold).

Cambridge Consultants rolls out a Bluetooth-enabled inhaler that follows Continua standards in allowing inhaler usage data to be collected and placed into PHRs.

This sounds interesting: a Silicon Valley startup called PreviMed starts a Healthcare Innovations Lab to evaluate HIT innovations from the user perspective.

This is a big deal: Citrix announces the availability of its free Citrix Receiver for the iPhone, which allows running XenApp hosted applications (Cerner, McKesson, Microsoft, Oracle, and SAP are specifically mentioned).

Microsoft lays off another 3,000 employees with the likelihood of more to come.

Listening: Catatonia, alternative rock from Wales, defunct since 2001, with a startlingly pretty lead singer.

Two New Jersey men plead guilty to making $300K by stealing medical equipment from New York Presbyterian Hospital and selling it on the Internet. One was a hospital equipment specialist.

Like an ED on diversion, I’ve been too busy to accept new e-mails (or at least to reply to them). I always catch up eventually, though, even with the equivalent of at least two full-time jobs that are wearing me down steadily.

I think this is new, but I can’t tell since HIMSS doesn’t date its news items (damned annoying). They’ve got a simple online estimator of Medicare incentive payments under ARRA (if you’re a member, anyway).

I goofed: I said the Kingdom of Jordan is a Medsphere customer that was recently quoted a saying open source would cost them at least as much as commercial applications. I knew they were implementing VistA and found 2,000 Google hits linking Jordan with Medsphere (Medsphere proudly ran press releases announcing that the Jordan people were considering them). Medsphere lost that business to Perot.

Interesting details on the GE-Intermountain partnership. Development costs of whatever they’ve been working on since February 2005 are $300 million, with Intermountain paying $100 million and GE chipping in $200 million. Intermountain gets royalty payments (that makes them a vendor, so keep that in mind as they hit the presentation circuit and offer site visits). Brent James is a smart guy, but I would question whether this quote reflects reality: “"It means our ability to deliver good care is going to explode at the same time the costs are going to drop profoundly.” Duly noted: I will be watching for Intermountain’s quality numbers to ramp up and their costs (and charges) to fall precipitously. If either happens, that will be the first time an IT system ever had that kind of effect.

SAIC gets a $158 million contract to maintain and enhance some aspects of AHLTA and CHCS for the Department of Defense.

A security company sues the SEIU healthcare worker’s union (you Easterners know them as 1199) for not paying its $2.2 million bill. The surveillance and counter-intelligence group, made up of former FBI and CIA agents, was hired to spy on the union’s own members: to conduct surveillance of the union’s offices, to intimidate union members coming and going, and to protect SEIU’s visiting executives while they secretly met with hospital CEOs and legislators. At least that’s what the National Union of Healthcare Workers, a newly formed competing union, says (also accusing SEIU union bosses, shockingly, of pillaging union assets). SEUI is suing them, of course.

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HERtalk by Inga

Allscripts announces Cardinal Health is its latest Allscripts MyWay reseller. Interesting move on Cardinal’s part, especially since the spinoff of CareFusion suggested Cardinal was restructuring to increase focus on its core drug distribution business.

A psychiatry fellow blogs on East Coast versus West Coast medicine. She observes that medical hierarchy is more obvious on the East Coast, e.g., doctors wear one color scrubs and nurses another. Though East Coast doctors are more blunt, they are not necessarily "meaner" than their West Coast counterparts. The most important observation: psychiatrists on the East Coast dress significantly more fashionably than those on the West Coast (see above – not a psychiatrist, but definitely one nicely dressed East Coast doctor.)

Eclipsys reports a first quarter loss of $.9 million or $.02 per share compared to last year’s $.3 million/$.01 share profit. Revenues came in above Wall Street expectations, however. Quarterly revenues were $130.2 million, with is above analysts’ $125.5 million estimate and about 5% higher than last year.

The 40 doctors at Lenox Hill Interventional Cardiac & Vascular Services implement Professional Intelligent Charge Capture by MedAptus.

This week I was having a battery problem with my laptop, so I gave Dell a call to diagnose the issue. While running diagnostics, we discovered that in addition to a failed battery, my disk drive had some serious errors and needed to be replaced. So, I pulled out the external hard drive that I have had for a year and half and never used – it was still nicely shrink-wrapped in its box. I feel as if I dodged a bullet and wondered how many times a day consumers and businesses lose precious data to hardware failures because, like me, they are too lazy to back up data?

API Healthcare announces three new hospitals and health systems are now utilizing its human capital management solutions.

An Australian hospital bans the use of its new EMR system after its second failure in three days, including a two-hour outage. An official is quoted as saying, "Staff report the electronic medical records system is so cumbersome that senior medical officers who previously saw 8-10 patients in a shift, are only getting through 5-7 because they spend so much time trying to access or enter information."

GE announces plans to invest $6 billion by 2015 on its "healthyimagination" initiative, aimed at delivering lower-cost medical equipment and care around the world, while increasing earnings at its medical systems and bioscience division. The strategy includes $3 billion in R&D on new medical systems and services, $2 billion in financing, and $1 billion for GE technology to support HIT and heath in rural and underserved areas. GE’s big plans for improving healthcare around the world almost makes me feel guilty for complaining about the $350 I just shelled out to GE to fix my broken oven.

Bridges to Excellence publishes a study entitled Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation. And we needed a study to figure this out?

Healthvision adds 10 international clients in Q1.

Cedars-Sinai Medical settles Ed MaMahon’s malpractice suit from last year in which he claimed doctors failed to diagnose his broken neck, discharged him without taking an x-ray, and later botched two spine operations.

Content management vendor Open Text enters into a purchase agreement for competitor Vignette. The total transaction price is about $310 million.

Perot Systems announces plans to lay off 450 employees to offset lower project-based revenue. The reduction is expected to save $30 million annually.

QuadraMed reports a first quarter net loss of $200,000, less than the $1.1 million loss reported for the same period last year. Quarterly revenue was flat at $35.1 million.

The Ohio Department of Administrative Services selects APS Healthcare to manage the provision of disease management and health and wellness services for 50,000 state employees.

As Mr. H recently pondered, had did we survive in the olden days when we only had three network channels to keep us amused?  For the curious (and non-squeamish) you check out Wired Science’s 10 best surgical videos. Really now, are our lives more complete once we can observe a a sex-change operation?

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News 5/6/09

From Seth Hazlitt’s Nephew: “Re: Sutter. The Sutter project situation reminded me of your Universal Rules for Big EMR Rollouts™, specifically number five: ‘All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and […] will vanish without a trace at the first sign of trouble, like when […] the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.’ Is Jerry Padavano still with Sutter? How long until Jon Manis vanishes without a trace? A year and a half ago, Sutter said it had already spent $500 million, up from the original projection of $150 million. By early this year, it was up to $1 billion. As of this point, what exactly did Sutter get for their $1 billion+ investment?” My Universal Rules piece was a pretty big hit, I have to say. As for Sutter, it’s hard to say other than I was incredulous when they first announced how much they were planning to spend, which turned out to be a small fraction of the final estimate. What healthcare needs are small, specialized systems that interact, but that can be customized and managed locally and individually without making the whole enterprise-wide deployment as vulnerable and as unintelligent as the lowest common denominator of the systems that make it up.

From Pat Cremaster: “Re: Sutter. They couldn’t fund the EMR because of stock market losses and the decision to fully fund employee pensions (too bad other companies make similar promises to employees, but rely on government intervention when their pension goes belly up). It’s also a shame that our healthcare delivery industry requires investment income to fund it.”

From Ian Miller: “Re: e-prescribing. DICOM and HL7 standards are available as free downloads, but the specification of NCPDP SCRIPT Standard for e-prescribing medication costs $655. Wouldn’t it increase adoption to let anyone (like an open source developer) take a shot at creating the e-prescribing killer app by offering the NCPDP SCRIPT specification for free?” I’ve never understood why organizations charge for that kind of documentation when e-mailing out a PDF costs nothing. I admit I’m suspicious about non-profit motives when I see that.

From Lisa Lopes: “Re: HIMSS conference proposals. It is a shame that one must submit them so far in advance. You really have to be thinking about it. So much can change in a year. I always liked roundtables, but there aren’t as many of them anymore. Panel discussions allowing for interaction between panelists themselves and with the audience, I think, are superb vehicles for communication of issues that healthcare IT professionals are dealing with.”

From Lazlo Hollyfeld: “Re: ARRA. After all of the talk about ARRA boosting health IT purchases, clinical spending looks like it will be slowing since everybody is waiting to see what happens over the next 9-12 months. On the other hand, waiting to purchase an EMR system until next year is going to cause some potential difficulty in getting up and running to get paid. Talk about your unintended consequences. Meanwhile, the revenue cycle management vendors just keep humming and moving along as profit margins continued to get squeezed along the entire provider spectrum.” 

From Tom Servo: “Re: Pam Pure. I heard she got a hefty severance package, like $6 million, and new bedrooms and a security system for her horse farm. Meanwhile back at the employee ranch, merit increases were eliminated, profit sharing was eliminated, hours were increased, the fear mentality set in, and people were replaced by terrible Indian outsourcing. Shades of the finance industry.”

From The PACS Designer: “Re: HIStalk’s top 2% ranking. TPD found a website called /URLFAN that rates the popularity of Web sites. Happy to report to Mr. H, Inga, and HIStalk readers that our Web site is in the top 2% of over 3.7 million websites at #80,672. Thanks go to every one of you who contribute to HIStalk to make it the site to go to for the latest health care information and reader comments and writings!” Link.

To think we missed narrowcast content like this when there were just three networks and no Internet: this Web page deals exclusively with hospital food around the world. You will be shocked that most hospital food is dietician-approved, yet thoroughly unappetizing. Captive employees, of course, are shafted by their hospital employer on overpriced cafeteria meals (and the minuscule employee discount is one of the first budget cuts made). The most heinous act you can commit in a hospital, other than abducting a newborn, is daring to refill your $1.75 waxed paper cup from the soda dispenser like every fast food restaurant lets you do, thereby costing a billion-dollar hospital operation a budget-busting three cents. Boot camp recruits and prisoners eat the same prepackaged food from the same soulless food service outsourcers, so it’s about what you would expect (maybe openly rebellious employees and doctors should be punished with a Nutriloaf diet).

Since we’re on the “how fancy do your hospital buildings need to be” debate, this story from India is interesting: Lessons From a Frugal Innovator, subtitled “The rich world’s bloated health-care systems can learn from India’s entrepreneurs”. Example: heart bypasses are done under local anesthesia, but they have triple the IT adoption of US hospitals. Columbia Asia, a US company mentioned here before that operates hospitals in poor countries, is featured. “Columbia Asia … left America to escape over-regulation and the political power of the medical lobby. His model involves building no-frills hospitals using standardised designs, connected like spokes to a hub that can handle more complex ailments … Its small hospital on the fringes of Bangalore lacks a marble foyer and expensive imaging machines—but it does have fully integrated health information-technology (HIT) systems, including electronic health records (EHRs).”

I doubt Medsphere will include this quote in its marketing materials even though it’s coming from a high-profile OpenVista customer. Jordan’s technology minister, when asked about using open source, said this: “It will cost you more, by the way. We are working in the hospital sector, using open source. I think that in the beginning, the cost will be higher. In the long run it could be better. You have to develop software to interface with the open source, which will cost you more.”

Shareholders of IBA Health approve changing the company’s name to iSOFT Group, reflecting the brand name of the product and company it acquired awhile back.

A newspaper editorial observes the institutional nonsense that pervades every hospital. “Part of the problem is the computer. If the medication isn’t listed there, you don’t get it. It might just need to be renewed or re-entered, as meds have a sort of built-in renewal date. ‘Would you please call the doctor and check?’ you ask. ‘I will put a call in,’ is the reply, which is code for you won’t be getting that medication for a good long time. If you hear, ‘the pharmacy will have to be called,’ then you might want to call a friend and see if they can bring you some Tylenol … Something has taken a nurse’s good judgment away and has allowed a computer to trump it; has allowed her to look directly at a new IV line and conclude, beyond reason, that there is no IV medication prescribed. Something has forced doctors to have fewer firsthand conversations with their patients, for shorter periods of time, and to share less information.”

John Halamka got a ton of press that proclaimed him a visionary for having a VeriChip implanted in 2005, but he finally admits everyone who hooted and howled back then about the lack of utility in having under-the-skin medical data was right. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.” One of my satirical news item on April Fool’s Day 2006 was this: “CIO Logs Full Year Without Showing Up at the Office. (BOSTON, MA) John Halamka, Chief Information Officer of CareGroup Health System, did not spend a single day at work in 2005, according to a Boston Globe review of expense records. Health system officials had no comment. ‘Check my vitae – I hold six positions in five organizations, plus I do a lot of speaking,’ Halamka stated in response to a reporter’s question. ‘I can’t say I started out planning to miss all of 2005 in that one job, but it just worked out that way. What I give them in quality more than makes up for any perceived shortfall in quantity.’ A CareGroup source told the Globe that discussions are underway to track Halamka’s location by the identity chip implanted in his arm last year. ‘I’d rig the damn thing up to a doggie fence and give him a few volts when he wanders, ‘ said the source.”

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HERtalk by Inga

Perot Systems releases its first quarter earnings: EPS $.24 vs. $.23 on $621 million in revenue, down from $680 million.

Harvard Medical School closes temporarily after a probable case is identified, an MIT student who picked up the virus while in Mexico and possibly shared it with colleagues at the Harvard Dental School.

SCI Solutions announces it has signed an agreement with Saint Thomas Health Services (TN) for SCI’s Schedule Maximizer and Order Facilitator solutions.

Medical transcription company Administrative Advantage selects the ZyDoc Medical Transcription platform.

Final attendance figures from HIMSS: 27,429 total registrants, down 6% from last year, and 907 exhibitors, down 4%. Over a fourth of attendees were first-timers, indicating a high churn rate.

The 60-bed Bates County Memorial Hospital (MO) selects the MedGenix financial and patient management system.

Authorities investigate a $10 million extortion demand for the safe return of over 8 million patient records and 35 million prescription records that were allegedly hacked from the Virginia Department of Health Professions computers. The FBI is assisting Virginia state officials investigate the incident that came after hackers infiltrated the Health Professions computers last week. They posted this boast on the home page: “I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.” This fool is going to be so easy to catch that it isn’t even funny. Hey, we’ve got your $10 million – where can we meet you?

The Robert Wood Johnson Foundation awards Project HealthDesign $5.3 million. The project, whose mission is to support the creation of a new generation of personal health records, is based at the University of Wisconsin.

MEDITECH adds Vitalize Consulting Solutions to its list of approved advanced clinical consulting vendors.

Virtual Radiologic receives FDA clearance for vRAD RACS, Virtual Radiologic’s own PACS solution. The company will roll out the software to its affiliated radiologists over the next several months, replacing the commercial software it licenses.

Some news in honor of Cinco de Mayo: thieves in Mexico realize that everybody is wearing blue surgical masks because of H1N1 fears, so they’re donning their own to blend in with the crowd when making their getaway.

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News 5/01/09

From Francisco Respighi: “Re: Sutter. Massive layoffs soon to be announced (by mid-May) at Sutter Health Information Services. According to an enterprise-wide communication today from Sutter CIO Jon Manis, the poor economy is to blame for the layoffs and the de facto termination of the Epic project. The economic downturn has in turn meant that affiliates cannot fund the adoption of the Epic EHR (an interesting spin, since it was Sutter Corporate, and not the affiliates, that mandated adoption in the first place). Officially, the Epic project is merely delayed at Sutter. However, the announcement then goes on to say that nearly all Epic staff will be terminated. Nowhere in the communication from Mr. Manis is the enormous cost of the Epic project itself cited as a root cause of the current fiscal crisis at Sutter.” Unverified. If you can confirm (say, with an electronic copy of the e-mail) then talk to me.

From Del Fuego: “Re: CCHIT. Bobbie Byrne has updated her LinkedIn profile to indicate that she works for CCHIT now.” Link. The pediatrician and former Eclipsys SVP is now clinical director at CCHIT.

From The PACS Designer: “Re: Twitter brain waves. Mr. H is skeptical about the usefulness of Twitter, so TPD wants HIStalkers to judge and comment about a University of Wisconsin participant in Epicland who used his brain waves to complete ‘GO Badgers’ by focusing on the R and S on the screen to complete the Badgers cheer! To complete the assignment, the participant focused on the letter N to complete the statement ‘Spelling with my brain’. The messages can be sent by focusing on ‘Twit’ at the bottom of the screen. Next, TPD wonders if he can spell a brainy ‘Faulkner’?” Link. At least we now know at least one Twit who thinks before Tweeting.

From Bogo Pogo: “Re: HIStalk. Any plans for a mobile version?” I confess that I don’t exactly know what that means. I can read HIStalk on the BlackBerry Bold and it reads fine, so I assume it’s hitting the WordPress Mobile plugin that’s been in place since the beginning. Is there something else needed to support mobile devices? Say, I could write the whole thing as a series of Tweets!

From James: “Re: Kaiser flash drive. The USB drive is password-protected (I got mine today) and the clerk gave me a wireless keyboard to enter my password twice. The data file is a PDF so almost anyone can view it if you have the password.” I’ve always been a big fan of using scanning and PDFs as a simple but highly cost effective (and paperless) electronic medical record. I like Kaiser’s approach.

Listening: great surf music from The Neptunes.

Just announced: athenahealth’s Q1 numbers: revenue up 41%, EPS $0.12 vs. $0.09, hitting earnings estimates.

Doylestown Hospital is featured on Apple’s iPhone 3G page for rolling iPhones out to docs, including giving them mobile access to Meditech. I got my Consumer Reports today and was amazed at how well Apple did in the computer reviews: #1 in all three laptop screen size categories, #2 in desktops, and #1 in support in both desktop and laptops by far (81% and 84%, respectively, blasting the #2 vendor with 55% and 61%, respectively). Of course, Apples cost twice as much, so you could buy two of anybody else’s and keep one as a spare for the same money.

Medicity and Intermountain Healthcare will host a free Webinar called “A Data-Driven Approach to Improving Hospital and Physician Care Collaboration” on May 14. And speaking of Medicity, the company’s new CMO, Gifford Boyce-Smith, will speak on translational medicine at the Delaware Health Sciences Alliance research conference next Wednesday.

McKesson employees in Carrollton, TX spent time putting together care packages and notes for wounded veterans in VA hospitals last week. Nationally, 14,000 McKesson employees created 16,000 of the packages.

David Blumenthal follows the current administration’s mantra: we believe in the free market in theory, but sometimes it doesn’t work and the government can manage it more efficiently (which generally means: Bush and his cronies were dangerous fools and anything Republicans advocated must be repudiated by expensive and massive retaliatory government intervention). Speaking Thursday about healthcare technology, he said, “It is clear that this field has not advanced (enough) … when left exclusively to the private sector so there is a public role” Sounds good, except when surveyed, the public didn’t give a whit about healthcare IT. Your benevolent government knows best, as it constantly reminds us.

I just realized that it’s almost the end of the month as I write this, so I checked the HIStalk stats (that’s Inga’s territory, so I generally stay out of it). Shazam! Over 90,000 visits and 126,000 page views for April, breaking the record set in March by over 15% and up 66% from a year ago. I can only say thank you for contributing to that number by reading. I can’t imagine the stats going up since surely it’s at the saturation point, but I was saying that a year ago. Maybe the industry is bigger than it looks sitting here alone and staring at a keyboard and monitor for hours.

CERN shares hit a 52-week high today, topping at $54.71 and closing at $53.80. Above is a five-year stock chart that you can’t read because I had to shrink it to fit, but it shows Cerner share price (blue), McKesson (green), Eclipsys (gold), and GE (red). Go Neal (he’s not just doing it for you – he owns $303 million worth himself).

Bored at work? Try Internet sensation Swinefighter. It’s lame, but addictive.

Jobs: Senior VP of Sales, Technical Project Manager, VP, Finance and Administration.

Consumer Watchdog says it has proof that Google used paid lobbying firms to try to influence the government on the economic stimulus act, which it speculates (without proof) means the company wanted the right to sell medical data. Google says it was lobbying to support healthcare IT standards and to protect consumer privacy. Consumer Watchdog says fine, prove it by releasing your lobbying records. End Act 1.

It’s like one of those cheesy used car companies that offers to loan you down payment money until your tax refund comes: IBM makes $2 billion available to customers who don’t have the patience for their government checks to arrive. Come on in, everybody rides!

Siemens announces Q2 numbers, with revenue and profit up big.

Another doctor criticizes electronic medical records in a national publication, Time in this case in a story called How to Fix Health Care: Four Weeds to Remove (Larry wasn’t one of them). One of the four weeds identified as choking off the medical garden is Computerize Everything. “It’s a complex topic that boils down to this: If we who do the medicine thought more computers would save us money, we’d buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country’s medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time-consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it’s pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.”

Sams’s Club says it’s ready to sell eClinicalWorks (although it manages to spell the company’s name wrong in the headline, putting a space before the “Works” part). I did a Google site search to find the page, which doesn’t come up in the site’s own search.

In Europe, Ronald Verni, former CEO of Sage Software, is named non-executive director of charge master software vendor Craneware.

An Ohio State University medical professor and cervical pathologist says his employer demoted him, cut his pay by 60%, and took away his laboratory after he publicly accused the university of botching tests for human papillomavirus. He’s concerned about the incorrectly diagnosed women, but the $100 million he’s suing for will apparently assuage his anguish. Since every TV addict in America feels qualified to judge people based on a superficial knowledge of whatever’s being judged, I’ll side with him since he sounds sincere and is amply qualified.

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HERtalk by Inga

From Newlywed: "Re: Nobel Prize winner’s survey on women and mood lifting. Heck yeah … I think he is dead on. For me, sex and eating … helllooo? Unfortunately, I travel for my job, so I don’t spend many nights at home for the sex with my perfect, divine husband. But man, do I get to eat!"

From Lynn Vogel: "Re: MD Anderson and facilities. Appreciate your comments re: importance of facility ambiance to patients. Cancer patients face significant challenges and in many cases truly ‘life or death’ choices. Notwithstanding Mr HIStalk’s views about the relationship between the egos of healthcare CEOs and their facilities, it is easy to dismiss the importance of surroundings in providing a supportive and comfortable environment in which such choices can be made. And I would venture a guess that those most critical of healthcare facilities are those who have not had to experience them from the patient’s point of view."

DocuSys and CPSI team up to install DocuSys’ anesthesia solution at at Muskogee Community Hospital (OK). I have actually been to Muskogee, the town that Merle Haggard was proud to call home. I am pretty sure I ate some ice cream from Braum’s. Ymmm.

Silver Hill Hospital (CT) signs a five-year agreement with Medsphere to provide implementation, training, and support of Medsphere’s OpenVista EHR.

Froedtert & Community Health (WI) signs up for Epic Systems’ Care Everywhere network. The Care Everywhere network is designed to connect EMR information between different Epic systems and as well as third-party EMRs. Froedtert & Community Health is the second health system to sign up for the network, which the health system claims cost them $60,000.

McKesson promotes Randy Spratt to the newly created position of Chief Technology Officer. Spratt will also maintain his current role as executive VP and CIO.

Note to all you road warriors: while in a plane, experts recommend you sanitize your hands before eating and drinking, after retrieving something from the overhead bin, or after returning from the restroom. A little Purell and you cut your chances of getting infected by at least 40%.

Virtual Radiologic posts first quarter net income of $1.39 million ($0.09 per share), compared to $2.00 million ($0.12 per share) in the prior year period. Adjusted net income was up 40% from last year, coming in at $2.51 million, compared to 2008’s $1.88 million. Revenues rose to $28.6 million for the quarter, up 23% from last year.

Online learning and survey vendor Healthstream releases their Q1 financials showing net income of $878,000 versus $66,000 last year. First quarter revenue grew 19% over the previous year to $13.6 million.

If you are considering bariatric surgery, here’s some good news. Individuals with bariatric surgery reduce the prevalence of disease by 25%, compared the morbidly obese. Also, the rate of post-surgical complications has fallen 21% since 2002. Overall complication rates have also dropped (from 24% to 15%). Fewer complications also translate into lower cost of care.

Merge Healthcare announces its third straight quarter of positive net income. For the first quarter, Merge had net income of $2.8 million compared to a $7.9 million loss a year ago. Revenue was up 11% from 2008.

Researchers at Brigham and Women’s Hospital (MA) and Massachusetts General Hospital find that the use of integrated computerized medication reconciliation tools and process redesign were associated with a decrease in the number of unintentional medication discrepancies.

E-mail Inga.

News 4/24/09

From Harry Reems: “Re: EHR certification. Do hospitals using an internally developed EHR have to get CCHIT or someone else to certify it to be eligible for HITECH incentives?” I’ll throw out a guess of “yes” given the inordinate confidence placed in CCHIT so far to decide whether a given product is one taxpayers should help pay for, but surely someone knows more than me.

From Eldridge Dickey: “Re: Dubai. I’m curious how bad things have gotten there after all the healthcare IT activity last year. Not much reporting in the mainstream news.” Ms. Adventure provided a bleak assessment in February, but has not sent updates since. First-person reports are welcome.

From The PACS Designer: “Re: VA private cloud. InformationWeek reports that the move to create ‘private clouds’ as a test bed for a cloud computing platform is gaining momentum among the advanced IT developers. Even the VA has started to experiment with a private cloud called ‘Health Associated Infection and Influenza Surveillance System’.” Link.  

An update on the federal raid at Siemens Medical Solutions in Malvern, PA. Nobody’s saying officially what the feds were looking for, but rumors are that it could relate to an earlier whistleblower lawsuit claiming that Siemens did not give the government its lowest prices. That would align with who did the raiding: the criminal unit of the Defense Department. It may be connected to the $267 million contract the company won just three weeks ago to sell imaging equipment to the DoD. There’s a lot at stake since supplier fraud falls under the Federal False Claims Act (aka qui tam), which calls for damages equal to three times the overcharge plus up to $11,000 for each individual “false payment demand,” meaning each bill, invoice, contract, etc. Every one of the biggest judgments and settlements under that act involved healthcare: Tenet ($900 million), HCA ($731 million), HCA again ($631 million), HealthSouth ($325 millon), and a slew of drug companies and miscellaneous specialty care organizations. Siemens has previously admitted and paid billions in damages for bribery, falling under the US Foreign Corrupt Practices Act since it’s a German firm. Interestingly, Siemens may have paid those big fines because the alternative was being banned from bidding on government contracts (the CEO of the company’s US subsidiary was reported to have said that he expects the company to get $75 billion of the $787 billion in federal stimulus money). All of that is unverified speculation, although I’m a pretty good speculator.

Listening: Garageland, defunct Pixies-like New Zealand indie pop.

Jobs: Meditech Financial/Billing Expert, McKesson Analysts, Senior Cisco Wireless Expert.

Housekeeping: if you want to get HIStalk before your competitors and co-workers, put your e-mail address in the Subscribe to Updates box in the upper right corner of the page (you should have seen the server load when I sent out the Siemens raid story, which thanks to a reader tip, went out here long before any of the industry press found it, probably by reading their own HIStalk e-mail update). The search box in the right column will dig through almost six years of HIStalk to find your name, your company’s name, or whatever industry term you like. HIStalk’s sponsors are an important part of the mix, so peruse their ads and check out what interests you (I need to thank Founding Sponsors Medicity and Nuance since I haven’t done that recently). And if you want to send me a rumor or something I’d find interesting, click the ugly green Rumor Report box to do that easily. Thanks for reading, by the way.

I get quite a few e-mails listing things individual readers love or hate about HIStalk (almost always the same things, just with opposing opinions). The best way to register your opinion is by completing my short, once-a-year reader survey. I’m not going to beige HIStalk down by turning it into a committee-run snoozefest that everybody tolerates but nobody loves since we’ve got plenty of industry choices for that, but I do reconsider my direction each year when the survey runs (it’s pretty much the same survey I’ve been using for years). Some are great ideas that are a bit lofty for a day-job guy, like undertaking major investigative reporting, convincing hospitals to provide detailed success stories, etc. (kind of amusing since people who work no more day job hours than me complain that it takes 10 minutes to read – it takes me FOUR HOURS to write it after I get home plus Inga’s time, so playing Woodward and Bernstein is probably not in the cards). Anyway, I promise to read and consider every survey response.

CPSI’s Q1 numbers: revenue up 2.1%, EPS $0.37 vs $0.32.

Hospital layoffs: Ministry Health Care (WI), 60 employees; Shriner’s (HI), 10.

The 21 horses that died during a Florida polo match suffered a medication error when a compounding pharmacy incorrectly prepared a vitamin product.

The King of Pork, Senator John Murtha of Pennsylvania, brings home the bacon to fund a desolate, barely used (three flights a day) airport bearing his name in the middle of Nowhere, PA: $200 million in earmarks for what watchdogs call a “museum piece” with fewer than 10,000 passengers a year (its only flights go to Washington Dulles) that will get a second runway, joining the $8 million air traffic system installed in 2004 that has never been used because there are no employees to run it. His Military Interoperable Digital Hospital Testbed, also in Johnstown, got $5 million of Murtha Money, which one might at least hope has something to do with the DoD-VA interoperability projects going on instead of just paying Northrop Grumman contractors to fly back and forth from DC on the taxpayer time (that’s probably the three flights a day).

Microsoft’s Q3 report: revenue down 6%, EPS $0.33 vs. $0.47, the first time the company’s quarterly revenue has ever decreased. Announced: no employee merit increases this year, no earnings guidance will be provided, and the upcoming quarter isn’t looking any better than the last one.

Healthcare Growth Partners releases its Q1 HIT transaction report (free PDF download). An interesting observation about recent M&A transactions: they involved either premium deals or fire sales.

One HIStalk reader always finds and sends bizarre healthcare news items, so here’s his latest. A male nurse whose former job was a stripper is suing his personal care home employer for sexual harassment, claiming he was propositioned, called a “pretty boy”, asked for lap dances and to provide bachelorette party performances, was slapped and pinched in the rear, and was referred to by elderly residents as “one of them go-go boys” and a “hootchie-kootchie dancer.” He claims he was fired because he’s a 55-year-old man who was not taken seriously by the mostly female nursing staff.

I’ve let Inga gradually do more of the research and writing for HIStalk Practice, so she posted solo last night while I attended to pressing day job duties. She’s cute and 1000 ccs of fun, but insecure: she e-mailed me almost immediately afterward to say, “I’m dying … was it OK?” Isn’t that adorable? I think she craves validation, so if you want to suck up shamelessly, she would probably be your immediate BFF.

Kryptiq sells its Choreo health plan contracting division to health plan software vendor Portico Systems to focus on its Connect IQ medical communications network.

Free Australian PHR vendor miVitals goes belly up for lack of funding because it has no partnerships like its big-name competitors, according to the Washington Post. With all the interest in PHRs (misplaced, I think), you would think its assets would be worth something. Perhaps this is the first of a wave of dot-com like PHR failures given that most of them don’t charge anything, usage is low, value is questionable even for free, and the big boys are using their clout. If you think doctors don’t like using technology that doesn’t fit their routine, try getting the average patient to do so.

E-mail me.

HERtalk by Inga

From John Moore: "Re: Health 2.0 conference. Health 2.0 remains an event that has a lot of cheerleaders, groupies, and technologists and unfortunately, not enough consumers/patient stories in how they are actually using all of these new Health 2.0 solutions coming into the market. The Health 2.0 companies who present don’t help their cause either, as virtually none of them presented any meaningful stats on consumer or clinician adoption and use of their technologies. That being said, there were some highlights including John Halamka, BIDMC and Roni Zeiger of Google Health talking through the problems of administrative data being exported out of a hospital to a consumer’s PHR, e.g., e-Patient Dave. Also, John Wennberg, lead author of the Dartmouth Atlas, gave a great presentation, best of show really, with real numbers about what is and is not working and some of the hard choices that need to be made, e.g., too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives."

Have an opinion on the how to define "meaningful use" in the HIT world? The National Committee on Vital and Health Statistics executive subcommittee schedules a gathering April 28-29 in Washington to figure it all out. The public is welcome and we’ve embedded a mole in the proceedings who will give us an update.

Ingenious Med, a provider of billing tools for inpatient physicians, raises $1 million in VC money to beef up its sales and marketing efforts.

West Penn Allegheny Health System files a complaint in US District against regional rival UPMC and Highmark, alleging conspiracy to protect one another from competition.West Allegheny’s chairman says, "We believe that for several years UPMC and Highmark have engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly." The financially troubled West Penn Allegheny announced operating losses of $9.1 million for the quarter ending December 31, leading UPMC to issue a statement calling the lawsuit frivolous and a  "tactic to divert attention from their own operating and financial difficulties." Can’t we all just get along?

Bate County Medical Hospital (MO) selects the web-based OpusClinicalSuite EMR for its 60-bed hospital.

Shameless plug: if you are not reading our new HIStalkPractice site, you are missing out. This week we had two excellent columns that are definitely worth a read. Dr. Gregg Alexander’s piece entitled, "Two Thirds of the NHIN by 2010 (or, Not Your Daddy’s CHIN)" is thoughtful, humorous, and well-written. Dr. Joel Diamond writes on the need to expand the use of natural language processing in EMRs, and throws in some hilariously immature humor in the process. We are also posting news and commentary twice a week on topics of particular interest to those in the ambulatory care space. Check it out and sign up for e-mail updates so you can keep up with all the cool happenings.

HIStalk sponsor MEDSEEK is hosting a free webinar April 29th discussing the patient-centered medical home and why it should be important to hospital executives. Here’s the link to sign up or learn more.

Valley Baptist Health System (TX) decides to outsource its IT services to PHNS and help the hospital complete its EHR implementation. The 10-year agreement allows Valley Baptist’s employees to remain as employees, but will be managed by PHNS.

An apparently confused city treasurer in Albany, NY sites potential HIPAA violations as the reason she cannot release copies of forgiven parking violations to city council leaders. Council members call the explanation "absurd."

Three ER docs and a computer guy rock Delaware in a band called Code Blue. Sounds like the perfect BFFs for Mr. H.

Gwinnett Medical Center (GA) contracts with InfoLogix to provide a wireless infrastructure assessment, followed by the development of a a customized mobile deployment strategy.

Random musing: the last couple of days I have followed Twitter, particularly noting the messages about the Health 2.0 seminar. At least half a dozen Twitterers were sending updates on virtually every word being said by the speakers. While at times interesting, I had to finally step back and ask myself if all these tweets were really adding value. I wanted to know what’s going on in the forest rather hear about every last tree. Am I the only one who feels that way? I’ve never been a huge fan of webinars or podcasts, probably for the same reason. In the past, I’ve worried if the problem is that I lack sufficient curiosity, but now I’m thinking the real issue is information overload.

Emergency room visits are up while the number of emergency departments are falling, according to a new Picis-sponsored study. As a result, patient satisfaction and ED performance have fallen over the last 10 years. The details are included in the final report, "Profiling Success: Managing Emergency Services in the Largest Health Systems,” which includes specifics on best practices from top performing hospitals.

St. Joseph’s Healthcare System (NJ) plans to implement the INFINITT Enterprise-wide PACS solution.

E-mail Inga.

News 4/22/09

From Susie Adamo: “Re: CCHIT. Definitely adding headcount. They just hired Bobbie Byrne, who is a pediatrician who recently left Eclipsys, where she ran clinical strategy.” Unverified – not yet reflected on her LinkedIn profile or on the CCHIT site.

From Stella Artois: “Re: Being John Glaser. I love the column. I had dinner with John one night, touched his shirt sleeve, and didn’t wash my hands for days (despite all infection control precautions). He is my idol and I do so love his latest inspirational post that I am handing it out to wannabe CIOs.” John’s postings may be less frequent as he starts his ONCHIT gig in a couple of weeks, so he may be busy and/or muzzled. I replied to his e-mail asking if he’ll get to bunk over in the Lincoln Bedroom, run up a big expense account tab, and enjoy the thanks of a grateful nation. He said he’s not sure about all that, but he’ll be able to to see the Capitol from his office window. Well, that’s fairly cool.

From The PACS Designer: “Re: Oracle buys Sun. Mr. H. and HIStalk readers know that TPD has been fond of Oracle for their focus on the healthcare space. Now, an Oracle-Sun Microsystems combination will bring a powerful offering of open software solutions that prospective customers can choose to meet their upgrade needs. Additionally, Sun Microsystems storage solutions can further enhance the performance when integrating numerous databases within the enterprise to create a neutral archive.”

From Californian: “Re: the data model that nearly killed Joe. It’s from Epic. Would you have the courage to publish this factoid?” Apparently I would. Still, to single out Epic wouldn’t really be fair since the problems he describes mostly involve (a) caregivers who didn’t use the system; (b) caregivers who didn’t deliver patient care all that well; and (c) caregivers who were using a system that they claim wasn’t designed well for their work (or could it be that their work wasn’t all that well designed and standardized that no amount of programming could support it?) and (d) caregivers dealing with patient information stuck in the the never-ending and very deep chasm between outpatients and inpatients (which are actually the same patients, of course) created by different billing rules (they don’t even speak the same language, such as “episodes” vs. “visits”). Nobody puts a gun to the head of a hospital and/or practice group to buy a company’s software, so if it doesn’t work well for their situation, I’d put the blame on the user for voluntarily choosing it. I wouldn’t be able to critique the data model without seeing it and neither would a patient who experienced what they felt was substandard care, no matter how technical their background. I doubt any hospital could say with certainty that they don’t have stories just like that one in their own place.

A Hartford Courant article points out astronomical non-profit salaries even while big company CEOs and Wall Streeters take their public lumps: UPMC’s CEO made $3.3 million in 2006 and hospital CEO Gary Mecklenburg made $16.5 million the year he retired. One state United Way CEO made $1.2 million in a year. From the article: “Every year I sit in editorial board meetings in which CEOs of nonprofit hospitals come to press their case for more public money. They want taxpayers — bus drivers, small-business owners and public school teachers — to send them more to cover the hospital’s charity cases. And every year I can’t help but think: Before you come asking for more public money, you need to reassess your own remuneration. Until top salaries are more in line with, let’s say, the salary of a U.S. Supreme Court justice, a position that currently pays $208,100 and has no trouble attracting top talent, the poor-mouthing is a little too self-serving.”

Is this reasonable? An uninsured man had what he admits was life-saving surgery. He couldn’t pay the bill, so the hospital turned it over to a collection agency. His only asset is his house, so he’s going into bankruptcy but will still have to sell the house to pay up. He calls it a “gross injustice” and wants people to demand “affordable health care”. If the hospital writes it off for him (not unusual when the press runs stories like this), someone else gets stuck helping the hospital make its margin. Should surgeons be paid less, or drug and supply companies, or hospital CEOs ($300K in this case), or nurses? The “healthcare should be cheaper” argument requires a corollary that “someone is overpaid,” so who? If someone asked him before the surgery, “You will die unless you’re willing to sell your house,” wouldn’t he have done it? Healthcare is run like a semi-business, but we seem to want it to be a charity again like it used to be (without the multi-million dollar CEOs plotting takeovers and layoffs, anyway).

HERtalk by Inga

From Large and In Charge: "Re: consultants. I have plenty of consultant names now. Thank you! More than I expected." 

From John T: "Re: ICE. So, now that there is a new acronym in the marketplace, ICA finally has a solid place in the market. We’re an ICE Vendor – pretty cool. Actually, downright cold!" In case you missed it, ICE stands for Integrated Community EHR.

Dr. Lyle, a regular HIStalk commentator has initiated his own blog entitled, The Change Doctor. His initial post focuses on the "Three Is" for EMR adoption. One likely to create some controversy is Dr. Lyle’s take on interoperability: "While many say that we don’t have enough, I’d actually argue that we are so obsessed with this issue that we are losing the forest for the trees. In other words, let’s get doctors using systems first, and worry about interoperability later."

Ontario Systems signs a multi-year contract with Memorial Sloan-Kettering Cancer Center, which includes the purchase of Ontario Systems Revenue Savvy software.

Montefiore Medical Center’s IT subsidiary Emerging Health Information Technology signs a multi-year hosting agreement with the North Shore-LIJ Health System (NY). Emerging will provide support for a portion of North Shore’s computer network.

The folks at Vitalize Consulting Solutions collected almost $2,000 for the hungry during the HIMSS conference. Vitalize accepted food donations and cash to benefit the Greater Chicago Food Depository. Wouldn’t it be great if more vendors used such creative "marketing ploys?"

2008 was something of an off year for Cerner’s Neal Patterson, who received 8% less compensation than the previous year. His total package — including base pay, stock options, use of the company aircraft, and other benefits — was approximately $3.5 million.

Perot Systems signs a multi-year agreement with The Christ Hospital (OH) to provide revenue cycle services.

RelayHealth introduces FastTrack5010, a online informational resource center to help health insurers prepare for and comply with new HIPAA 5010 transaction standards. The deadline for the new claim version, by the way, is January 1, 2012.

The FCC approves $35.6 million to fund the development for five telehealth networks to link rural hospitals in nine states. The Rural Health Care Pilot Program is allocating the money, plus an additional $10.4 million for the Alaska Native Tribal Health Consortium to connect rural healthcare providers.

EHNAC announces a new accreditation program for application service provider-based EHRs. The new ASPAP-EHR (catchy name) is seeking participants for both its ASP and HIE accreditation programs. Do we seriously need another certification program? And really seriously, enough with all the acronyms already.

The ever-turbulent MedQuist names Dominick Golio as CFO. Golio previously served as North American CFO for D&M Holdings.

The Children’s Hospital of Pittsburgh of UPMC celebrates the grand opening of its new campus with a ribbon-cutting ceremony. The first outpatients are being seen this week and the hospital officially opens May 2nd.

The New York eHealth Collaborative partners with InterComponentWare and Surescripts on a prototype project to facilitate prescription routing and the the delivering of  prescription histories.

Tenet Healthcare announces its preliminary Q1 numbers. Net income is expected to be $178 million compared to a $31 million loss in 2008. EPS is projected to be $.37/share compared to last year’s $.06/share loss.

TeraMedica Healthcare Technology and Compressus partner to offer an enterprise-wide solution to provide comprehensive clinical workflow, data management, and a unified view to the resident EMR system. Teramedica is a provider of enterprise imaging and information management solutions, while Compressus specializes in interoperability and workflow solutions.

The New York State Department of Health selects APS Healthcare and Thomson Reuters to manage its state Medicaid clinical practice utilization review program. The program examines how Medicaid patients utilize medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care.

The LA Times explores the huge industry of outsourced transcription to Asian countries. In the Philippines, 34,000 transcriptionists generated $476 million in revenue last year. Experts predict revenues to exceed $1.7 billion by the end of 2010. Most work costs $.10 to $.15 per line and is delivered within 24 hours. In the Philippines, a fast transcriptionist can earn about $6,000 annually, which is about three times a nurse’s salary. The median income for American transcriptionists is $31,250 a year.

Kentucky Lt. Gov. Dan Mongiardo proposes that Northern Kentucky University become a national laboratory for testing the financial viability of EHRs and is seeking up to $500 million in federal money to get it started. His proposal includes a study of how healthcare providers can set up cost-effective e-health systems. I suppose a good way to make it cost-effective is to have the government give you $500 million up front for an EHR. Mongiardo happens to be running for a US Senate seat that becomes open next year, so one has to wonder if his actions are at all politically motivated. Nothing like working to get a little extra pork for the home state!

I was flattered that Matthew Holt forwarded me an invite to the Health 2.0 conference that starts Wednesday in Boston. I won’t be able to make it, but if you are attending, make sure Matthew wears his Inga 2.0 sash.

E-mail Inga.

What Will Oracle’s Acquisition of Sun Microsystems Mean for Healthcare?
By Orlando Portale

Reading about the acquisition of Sun by Oracle yesterday brought back some fond memories for me. I recall a discussion that my team had while sitting in the lobby of Oracle’s headquarters in 2003. We were there to meet with John Wookey, the head of healthcare (now at SAP) to discuss how we would continue to align Sun and Oracle’s business development programs. 

While hanging around Oracle’s lobby, my team began discussing how a potential Sun/Oracle merger made a lot of sense. Our products fit together very well and both companies had a strong culture of innovation. We discussed how Oracle had embraced Java as its standard for software development and the many deals we had captured together. Unfortunately, the discussions didn’t go anywhere, although in hindsight, it could have been a game-changer. Better late than never, I guess.

In my view, the acquisition of Sun by Oracle is synergistic for the following reasons:

• Oracle invested millions in standardizing all of its applications to Java. Therefore, outright ownership of Java is a plus for Oracle. IBM has also embraced Java, but Oracle will have increased leverage over them.
• Oracle and Sun already have a large installed base in common. Many of the largest databases in the world run on these platforms.
• Sun recently acquired MySQL, the open source alternative to the Oracle database. Oracle can now control MySQL’s destiny and any negative revenue impact it could have had against its own flagship database product.
• Sun and Oracle have always been in the anti-Microsoft camp. Sun owns Open Office, a robust and cheap alternative to Microsoft’s cash cow. This represents another opportunity for Larry Ellison to stick it to Microsoft. In addition, there are opportunities for tighter Open Office integration with Oracle enterprise applications (e.g. Peoplesoft, Siebel), thereby obviating the need for third party Microsoft licenses.

What effect will the acquisition have on the HIS software vendors?

Cerner has a sizable installed base already on Oracle. Most of these systems are hosted on IBM hardware under the AIX operating system, and NOT on Sun Solaris. Cerner has always refused to support Sun’s Solaris OS. That may change now, if Larry Ellison drops a dime. During my time at Sun, I tried to broker a meeting between Sun CEO Scott McNealy and Cerner CEO Neal Patterson. McNealy was eager, but Patterson said he saw no reason why they should speak. "Open systems, Java, Solaris … who cares.” Hello Neal, it’s Larry calling.

With respect to Cerner and Oracle, here are three potential scenarios:

1. Oracle Wins/IBM Loses = Cerner + Oracle + Solaris OS
2. IBM Wins/Oracle loses = Cerner + IBM DB2 + IBM AIX OS
3. Status Quo = Cerner + Oracle + IBM AIX

Note:  Other vendors such as Epic have a MUMPS installed base and are mostly hardware and operating system agnostic. Therefore, I believe this acquisition will have a minimal impact on Epic.

The other area of interest for healthcare customers will involve the status of Sun’s SeeBeyond SOA/Integration platform. At one time, SeeBeyond held considerable market share in healthcare, particularly for  HL7 messaging and system integration. However, in recent years, Sun has let SeeBeyond slip by the wayside. Oracle could gain considerable traction in the healthcare space by bolstering investment in SeeBeyond. This is a particularly useful platform for enabling HIE/NHIN integration. 

What will Oracle do with Sun’s assets after the acquisition?

First 180 days:

1. Rapidly cut Sun’s sales, marketing and back office functions by integrating them into Oracle.
2. Consolidate the Sun software and R&D organizations into Oracle.
3. Create a separate hardware division. Consider either continuing the hardware business or divesting the assets to companies such as Fujitsu or Cisco.

Post 180 days:

1. Oracle will begin create tightly bundled system stacks which incorporate hardware and software components. Oracle will now have all layers of the systems stack under its umbrella, including the storage, server, operating system, programming language, database, Web services, etc. If Oracle goes to market with integrated system stacks, it could put considerable pricing pressure on its hardware competitors.
2. Integrate Sun’s open source cloud computing solution infrastructure with Oracle technology. These solutions are ideal for startup companies looking for cheap entry level systems.

What will be the potential impact on IBM, HP and Dell?

From a hardware stand point, HP and Dell may have the most to lose.  Today, both companies have captured significant revenues from their relationship with Oracle. If Oracle retains Sun’s hardware business and begins going to market with integrated hardware and software systems, it will find itself in a channel conflict with HP and Dell. Will HP and Dell be forced to work more closely with IBM to capture DB2 deals? This is problematic as well, given that IBM already sells competitive hardware platforms and can embrace a similar integrated system strategy. Should this scenario play out, clearly HP and Dell will be at a disadvantage by virtue of not owning the components of the software stack.

IBM will need to revisit its long-held Java strategy, including its heavy dependence on Java for the Websphere platform. IBM will seek assurances from Oracle that it will have equal access to Java in the future. Otherwise, the only other major development platform for IBM to embrace would be Microsoft’s .NET. A shift by IBM away from Java and toward the Microsoft .NET platform would be a monumental and costly move. In years past, when confronted with this situation, IBM would just release its own new proprietary competitive development platform, but IBM no longer has that leverage in the industry. Hello, Sam, it’s Larry calling again.

Orlando Portale is Chief Innovation Officer, Palomar Pomerado Health District, San Diego, CA, and former GM Global Health Industry, Sun Microsystems.

News 4/17/09

From Rick Weinhaus MD: “Re: Cheezborger and usability. I agree completely. I also found Dr. Bradford’s special article in January on usability, as well as the comments, right on the mark. The promise of EHRs to improve patient care, reduce costs, and minimize errors will never be fulfilled until the software becomes more usable. As a physician, I have had first-hand experience with several EHRs. On the basis of these experiences and my sense of what mental models I actually use in taking care of patients, I have proposed two EHR design idioms to improve work flow and reduce cognitive load. If any readers would like to see detailed descriptions including graphics, they are posted as threads on the EMR Update website.” Link 1, Link 2, Link 3. Jim Bradford’s excellent article is here.

From Pete Potamus: “Re: war game EMR predictions. How about making EMRs easier to use? This includes personalization by physician or nurse, select versus enter, dictate complex orders in ‘human’ terms; use voice recognition and personalization to present the order for review and approval. Physicians and nurses are busy people. Make it easy and they will use it. Design it so they do more work and they will resist using it. But who wouldn’t respond the same way?” I like the idea, but everybody says the same thing and the products are still never really retooled. Apple creates its own market every time it adds its considerable design expertise to otherwise pedestrian and commoditized products. Why hasn’t it happened with healthcare software? I see only two possible answers: (a) customers are buying anyway, so the redesign isn’t necessary to make sales; or (b) vendors don’t expect to get ROI from doing it even though prospects say they want it. 

From Val Kelly: “Re: Epic layoffs. The last number I heard was about 400 people who were asked to resign in January and February. It’s hard to say for sure since they were told not to talk about it.”

El Camino Hospital gets a second campus and CMIO Eric Pifer gets a hospital president’s job. Interesting financial tidbits: ECH has $400 million in cash and $1.1 billion on the books (note to self: recheck the definition of “not for profit”). Not to worry though – projections are that the new place needs a daily census of only 42 patients to throw off $11 million in annual profits … sorry, margin contribution … starting the third year.

Hedge fund Tremblant Capital discloses that it has taken a 6% stake in Eclipsys.

Listening: The Cliks, an outstanding hard-rocking Canadian band (which happens to be all-LGBT). I’m desk-drumming to Oh Yeah (seventh song down in the player). And I admit I don’t watch much TV, but I’m liking 30 Rock (smart women like Tina Fey are hot, yes?) and I’m enthralled with Brit talent show singer Susan Boyle (while the cynic in me says it could be a stunt since she surely had to audition in front of someone to get there, but watching the sniggering, superficial audience and judges reduced to slack-jawed awe and near tears is still priceless). I could get pop culture if I had more time.

The son of British TV magician Paul Daniels, an IT support manager with an NHS trust, is charged with fraud for allegedly engaging a company to perform phony IT work and skimming a fee in return for approving the invoice.

JPS Health Network (TX) mulls over a potential $150 million project to implement electronic medical records, hoping to suck up some stimulus money but still worried about the upfront cost. Nobody wins those deals except Epic, so you know they’ll be calling Judy if they get their nerve up.

South Nassau Communities Hospital (NY) goes live on the Forerun ED dashboard application commercialized from BIDMC.

It’s reader survey time! It’s a quick, non-annoying way for you to let me know how to make HIStalk better for you. Here’s the link. Thank you.

A reader asked if the HIMSS presentations can be downloaded yet. They were giving a link at the conference, but the member pages don’t show the 2009 files yet.

TeraMedica will partner with Compressus Inc. to create a workflow and data management tool that will make all of an enterprise’s imaging systems and databases available from a single worklist and will support data exchange.

Natividad Medical Center (CA) hires Kirk Larson from Cerner as CIO, intriguing the local paper because he stands to make more than previous CEO ($185K and up to a 30% bonus). Seems kind of rich for a 172-bed county hospital to pay up to $240K for a CIO to run what must be a fairly small IT shop.

Two companies selling MUMPS-to-Java conversion try to convince the DoD and VA to give them a big contract to turn VistA into a semi-new system that will run on something newer than aging DEC Alphas. The estimate to develop a new system: $15 billion (!). The estimate to convert VistA to Java: $125 million over 2-5 years, including replacement servers. The problem with that kind of porting is that all the internal expertise has to start over with a new language and database (and the fact that the resulting source code is next to unreadable and free of comments to provide documentation, at least in my limited experience). And I miss the Alphas, personally.

The local health district is trying to figure out who will help Petaluma Valley Hospital (CA) pay to replace its retired A4 hospital system with Meditech. Perot told them Meditech was a logical fit, which seems kind of self-serving since it owns the former JJWILD and needs work for those people. The hospital’s parent company has Meditech and PVH can jump on for $2.8 million, but they’re worried about parting ways when the hospital lease is up.

Bad Philips numbers have investors worried about GE’s, to be reported Friday. I’m not sure how anyone could expect good GE numbers given their big exposure to bad markets (construction, manufacturing, big-ticket healthcare equipment, aviation, and of course albatross GE Capital), but maybe they will surprise positively. The stock price is at 1995 levels, but then again the Dow itself is at 1997 levels.

Backup tapes from Penisula Orthopaedic Associates (MD) containing information on 100,000 patients are stolen from a courier’s vehicle.

This is an excellent first-person story by a technologist about how bad healthcare data models nearly killed him in facilities with supposedly state-of-the-art EMRs, leading him to conclude that any kind of nationwide health network will never work. HIT people should read every word since it dashes the notion that having an EMR means improving care. “Medical personnel at urgent care and the hospital who interacted with me all used a version of the same electronic health information system (the ‘system’). It became clear that everyone was fighting that system. Indeed, they wasted between 40% and 60% of their time making the system do something useful for them … I was in ER for 20 hours before being admitted to the intensive care unit (ICU) where I spent another 28 hours. Throughout my stay, I was hooked to network attached monitors that incessantly sounded alarms to which no one responded. I was asked 11 times to repeat my medical history, medication, and allergies to as many different medical professionals. I was seen by seven doctors each of whom asked me similar questions. Five doctors were never to be seen again. All doctors mumbled something about putting their findings into the hospital’s electronic records system – most did not according to ICU nurses. No one read my allergist’s detailed report about my condition and health history.”

Groups line up against the Australian government’s plan to use patient medical records to detect Medicare fraud. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see.”

Tech Mahindra acquires Satyam for $578 million, giving it 425 acres of land, 48,000 employees, and a big footprint (not to mention a reputation sorely in need of repair, but not unsalvageable). It’s hard to believe IBM didn’t beat that bid.

Odd lawsuit: a woman microwaving hair removal wax and apparently not following instructions overheats it, then spills it as she tries to take it out of the microwave. She was burned on the thigh and chest. She’s suing the wax manufacturer for $160 million.

E-mail me.

HERtalk by Inga

From Deborah Peel: "Re: stolen laptop at Moses Cone. The new security protections for health IT in the stimulus package require encryption of data, which will help prevent thieves from being able to use personal data in the future. But that is not enough to prevent future privacy violations like at Moses Cone. Strong state laws and medical ethics that require patient consent before medical records are disclosed were violated, but victims will have to go out and hire their own lawyers to sue hospitals and vendors to enforce these rights and protections. The stimulus package empowers state AGs to defend citizens’ privacy rights in HIPAA, but in 2002, HIPAA granted rights to hospitals like Moses Cone and over 4 million other ‘covered entities’ to disclose YOUR personal health information to outside vendors like VHA for any ‘healthcare operations’ or business use like ‘improving care’ or ‘reducing costs’ without your informed consent. Congress should have closed this giant privacy loophole in HIPAA, too."

From Large and In Charge "Re: EMR consultants. My large practice in the Midwest is looking at EHR options. Can you recommend any consultants?" If you are a consultant and/or have any names to recommend, let me know and I will forward to Large and In Charge.

The County of Los Angeles signs a contract for iMedConsent, an informed consent and patient education system by Dialog Medical. The product includes thousands of consent forms and patient education documents, plus provides digital capture of signatures and other annotations.

Allina Hospitals & Clinics settles a lawsuit with the state of Minnesota over high interest rates charged on medical debt. The not-for-profit Allina will pay patients $1.1 million to settle a dispute over whether the health system broke state law by charging patients double-digit rates on certain outstanding medical bills. Allina maintains its actions were legal.

Utah implements a new task force to stop the state’s pharmaceutical drug problem. The Utah Pharmaceutical Drug Crime Project will work to eradicate the selling, buying, stealing of prescription drugs. Utah, by the way, has the country’s highest rate of non-medical painkiller abuse. (Who’d a thunk it?)

The for-profit HCA expects its Q1 profits to much better than last year’s, in part due to higher inpatient volume and better controlled expenses. Pre-tax income is projected to be $600-$650 million for the quarter compared to $344 million last year.

I am wondering if Twittering is going too far? Do we really need our doctors Twittering during surgery?

Regardless of the answer to that question, I am loving Twitter and have decided there are really two types of users: The Tweeterers (those who use Twitter to send out information) and Tweetees (those who primarily follow others to glean information.) I suppose there are also in-be-Tweeters who do a bit of both. I am primarily a Tweetee, though I do send out the occasional pearl of wisdom. IngaHIStalk if you want to follow.

IASIS Healthcare (TN) contracts with McKesson for the Horizon Medical Imaging PACS solution. IASIS is a 16-hospital system with approximately 2700 beds.

QuadraMed announces an agreement with e-MDs to provide QuadraMed’s hospital clients with the eMDs EHR/PM software for its affiliated physician groups. Sounds like e-MD is looking for a way to compete head-on with ECW for the hospital-supported physician EHR deals.

Gateway to Care, a large FQHC system in greater Houston, selects Sevocity EHR as the system’s only funded EHR solution. Five of the organization’s health centers will implement Sevocity by August for over 200 physicians and other users.

So far this month, it looks like five new ambulatory products have achieved CCHIT 2008 certification.

I nominated Mr. H for this award, though its doubtful they would accept an anonymous blogger. But they should, don’t you think?

E-mail Inga.

News 4/15/09

From HIPAA Hound: "Re: another example of poor privacy practices. Perhaps more disturbing than the loss of the patient data was that affected patients were not notified of the compromised information for a full 30 days." Link. A laptop belonging to Moses Cone Health System (NC) and containing information on 14,000 patients is stolen from a VHA office in Georgia, which was doing quality analysis of the hospital’s data. The hospital said it regrets waiting a month to let the affected patients, employees, and the public know. The laptop wasn’t encrypted, of course, and the hospital didn’t say why sending the VHA a laptop was the best way to get them data. If anyone can think of ways to screw up that the hospital missed, please let them know. And in a similar story, Southwest Mississippi Regional Medical Center finally comes clean to patients after a PC used by the billing company of its radiology group is stolen — in February.

From Skip Stephenson: "Re: diagnosis code for a tree growing in your lung?" Link. Russian surgeons looking for a suspected lung tumor instead find a fir tree growing in the patient’s lung. Also from Skip: a surgery nurse at Dean Health (WI) is called out of the OR by her manager so she could be laid off. Now those are stories you won’t read elsewhere.

From The PACS Designer: "Re: native virtualization. As we hear more about the virtualization concept in daily media presentations, it appears that still more education is warranted since there are still doubts about its versatility. Sun Microsystems has just released a new open source software version for its VirtualBox. It will give experimenters the ability to apply ‘native virtualization’ to their installed systems using a desktop workstation" Link.

From Just the Beginning: "Re: Google Health. Blasted for data inaccuracy & raises questions about data exchange." Link. I don’t blame Google, at least not entirely. Hospitals are so terrible at capturing and exchanging complete, meaningful patient information that billing data is about as good as you can get (arguably better than nothing). Google’s mistake, if it made one, was either (a) not letting patients know that its information is suspect, or (b) trying to roll out a fully functional PHR knowing that it’s way too early to expect much in the way of available information except what the patient is willing to type in, so then dropping back to claims data to sex it up a little.

From Daryle Lamonica: "Re: eHealth Initiative. Interesting way to recruit a CEO. Saving executive search fees?" eHI e-mails out a notice of its job search, providing a direct link to its site to apply via its law firm.

From TrashTalker: "Re: the incestuous relationship between CIOs and their vendors. Sad but true. When is the healthcare industry going to wake up and kick these self-promoting, mostly non-tech CIOs out?" If you’re a Maslow’s Hierarchy of Needs fan, they are just attending to their basic and safety needs, thinking that buying the big-name products is not only safe, but also a better path to a future job should one be needed. And, buying same-vendor application clusters (all clinical apps, for example) from the same vendor provides that "one number to call" peace of mind even though it drives clinicians crazy to be overridden by a CIO looking out for #1. Every provider I’ve worked for, mostly big ones, encouraged clinician input into product selection, but then ignored it in buying more stuff from the same old underperforming vendor. The predictable result: low utilization ("you asked us what we wanted, we did the research, then you just ignored our recommendation and bought what you originally wanted").

From Hello Kitty: "Re: ACS. Rumor has it that while ACS Healthcare Solutions is announcing the Marin outsourcing deal, they are losing Southwest Washington and Princeton." Unverified.

From Cheezborger: "Re: ‘the power is in the network, not the desktop’. While I agree that there is power in simply getting data online now (e.g. access, potential for analytics, personalization, etc.) we can’t put the chicken before the egg. In other words, how do we think the data is going to get there in the first place? We often seem overly focused on the end effects of the EMR without giving enough respect to the concept of GIGO. If we can’t create an EMR that makes it easy to input and read data, then don’t expect too much from the output. While INTEROPERABILITY is a big buzz word due to this network effect concept, I’d strongly argue that the real key is USABILITY – we need systems that allow for easy interaction (better input of data, better display of data) before we need to worry about how they will share data. Said a simpler way, there is no payoff without use. What was so nice about Dale’s ‘story’ was the incorporation of both these facts — creating easier systems to engender utilization, then using the network effect to make the systems even easier and better to use!"

From Da Bear: "Re: Chicago. Chicago is the greatest convention city in the U.S. My company has also exhibited there annually at RSNA. But for crying out loud, can we settle on a month that is actually nice? RSNA is locked in the Daley Machine’s death grip and can’t move off their post-Thanksgiving date. HIMSS is under no such political obligation. Late May is usually wonderful."

From Bill Kinsella: "Re: Qualcomm video. Like the fake article Lyle sent you, the following Qualcomm (or is it??) video is worth a peek. I don’t know whether this was produced within Qualcomm or by a competitor." Link. "We came up with this idea to implant tiny base stations into thousands of pigeons and have them fly around and form a dynamic network." Pretty funny and very well done. Bill sent the YouTube link, but I found it directly on Qualcomm’s site, so they’re going all viral on us.

Now that we’re back into the usual post-HIMSS routine, we’ll get back to the interviews, HIT Moments, etc. If you know interesting people we should talk to, let me know.

Listening: new from Metric, indie/pop/new wave from Canada. Video here. Kind of a Throwing Muses meets the Pixies sound if you ask me. I like it very much.

University of Florida Physicians posts its Epic outpatient project Web page.

The authors don’t claim a high correlation, but this study suggests that states with strict privacy rules have a lower EMR adoption rate, but that the network effect means each hospital that implements electronic medical records increases the chances of others doing the same. I wouldn’t bet the farm on the privacy correlation since I can’t imagine hospitals sit around worrying about that, but certainly the lemming-like behavior of many hospitals makes the second conclusion reasonable.

New York City’s health department uses drug company marketing techniques, such as memorized pitches and free pens and condoms, to educate doctors on desirable practices.

Eric Fishman, MD (of EHR Scope, EMR Consultant, MCM-Medical Content Macros, and Dragon reseller) is the mastermind behind EHRtv, a wide-ranging series of professionally recorded interviews and tutorials by Dr. Eric himself. I’m enamored with the video quality, the layout, and the idea, especially since I saw him doing interviews for it at HIMSS. He captured some of the HIStalk reception and speeches, not easy since we had low light and iffy audio, and it’s a fun watch. He caught a nice speech there by Todd Cozzens of Picis.

Students from four big-name MBA schools participating in a "war game simulation" last week make interesting predictions: (1) EMR resistance will remain high, but P4P may help; (2) there won’t be enough HIT experts to implement all the EMRs being sold; (3) Allscripts and Epic will use cloud computing to drive down the cost of today’s client-server systems and make them affordable to small medical practices; (4) risky EMR implementations will push small medical practices to band together or merge; (5) Kaiser Permanente will take an active role in setting EMR-related best practices and standards; and (6) McKesson will use its logistics and value chain to increase its provider and payor IT offerings. I’ll say this: all sound reasonable, even when taking the dynamics of the organizations into account.

On HIStalk Practice, we’ve got a couple of docs sharing their thoughts about the HIMSS conference.

Excluding the university president and coaches, all of the 21 people at Ohio State University making more than $500K work for the medical center. The university claims that both the jocks and the docs are paid what the market demands even though the university’s own industry comparisons show it pays above its comparable peers in both categories. Isn’t that kind of admitting that nobody would want to work there if it wasn’t for the money? Seems like a trap hospitals everywhere have gotten into – paying more because they think they have to in order to get competent leaders (meaning: bribe them to leave somewhere else for a bigger paycheck just like when universities raid each other’s coaches). Once you’ve established yourself as a generous John, the best-looking hookers will always want more.

I’ve decided that since my day job title isn’t sufficiently lofty and I can hardly put HIStalk on my resume, I’m just going to start calling myself a thought leader and futurist. Those titles seem to be reserved for those willing to anoint themselves knowing that no approval is required, so I’m going to pad my resume. If anyone calls you to check, vouch for me.

ARRA is drawing companies into healthcare that have had zero interest previously, The Washington Post reports. Named: FreightDesk Technologies (cargo trackers turned Medicare auditors), RollStream (partner interactions), and the usual lame, just-started social networking startups (i.e., Web sites) masquerading as fervent healthcare consumer advocates.

Odd lawsuit: a woman dies a few hours after being sent home from a West Virginia hospital’s ED. Two years later, her husband gets an unsigned letter urging him to call an enclosed telephone number to find out what really happened to her. The ED doctor working that night calls back, saying nurses had killed his wife with an accidental overdose, that he had kept the original chart to prove it, and would testify on the family’s behalf. The doctor then allegedly changes his story, allegedly, telling the family there wasn’t really a medication error but he just wanted to get back at the hospital. In the mean time, the family found that the ED doctor had lost his privileges at another hospital, was not certified in emergency medicine, and had been the subject of review by both the hospital and the ED contract employer for poor care. The family is suing the hospital, the doctor, and the contract ED company.

E-mail me.

HERtalk by Inga

From Fisher of Men: "Re: changes at Sage. I hear Sharon Howard from Sage is no longer there and they have hired a new VP of Sales." Unverified, though we did ask Sage and she’ no longer listed on the Sage Healthcare site. The leadership page says Jason Dvorak, formerly of TeraMedica, joined the company this month as senior VP of sales.

From Prairie Statesman: "Re: Illinois. Sure, the weather wasn’t perfect for HIMSS, but at least our governor wasn’t asking for Illinois to be declared a disaster area." Prairie Statesman sent this link with a copy of the Florida governor’s request for federal assistance following severe storms earlier this month. I responded (I think rather cleverly) that Illinois seems to be recovering from its own disaster area, right in the governor’s office.

HIMSS releases attendance numbers from last week’s conference and the numbers are down only slightly from 2008. An estimated 27,500 attendees traveled to Chicago, compared to the 29,100 participants at last year’s Orlando meeting. HIMSS attributes the drop numbers to general economic conditions and fewer personnel staffing exhibit booths. Based on conversations I have had with various health systems, I would also say many organizations sent a smaller contingent than in past years. Apparently the figures are based on registrations, so it’s quite possible a number of organizations ended up not sending everyone originally registered. Regardless, I’d say the numbers are respectable.

This is undoubtedly one of the gutsiest PR moves I’ve seen in awhile. SRS announces that Valley Oak Orthopaedics (CA) de-installed a CCHIT-certified EMR and replaced it with SRS hybrid EMR. The legacy EMR is not named, but the administrator is quoted as saying, "We chose the SRS hybrid after the existing traditional EMR in our practice drained our productivity and became unusable." Obviously it would be fun to know who is being replaced. Will the unnamed vendor speak up or ignore SRS?

A consumer survey concludes that 55% of us want the ability to talk to our docs via e-mail, 42% want to set up a PHR, and 57% want to schedule appointments and complete other transactions online. I think the e-mail and transaction figures look about right. On the other hand, I question whether 42% of Americans really want to set up AND maintain a PHR every time they go to a doctor, get a test result, or add a new prescription. Not too many people have the time or discipline to keep that up. Great idea whose time has not yet come.

Lehigh Valley Health Network plans to leverage the training resources from Greencastle Consulting to enhance its EMR implementations process for its ambulatory care practices. I believe Lehigh Valley is rolling out GE Centricity.

The India tourism ministry is finalizing a plan that would allow medical tourists to pay for one medical treatment and receive a second, smaller procedure for free. That sounds even better than Nordstrom’s annual shoe sale!

Congrats to Jodi Amendola, CEO of Amendola Communications, for her appointment to the board of directors of The X2 Healthcare Network. Jodi’s company is a healthcare and PR firm and X2HN is a not-for-profit organization of women healthcare executives representing more than 50 companies. I don’t know Jodi, but she clearly must be cool and has the PR thing figured out because she lists the HIStalk Fan Club as one of her important professional social networking organizations.

Perot confirms the elimination of 30 to 40 jobs at its Plano, TX headquarters.

Mark Anderson mentioned the term ICE on HIStalk Practice last month, which was the first time I had heard it. It seems to be catching on since I’ve now heard others use the term. ICE is  an acronym for Integrated Community EHR (wow – an acronym that includes an acronym!) Essentially it’s a patient record produced from an IHE (integrated health network, yet another acronym.) BTW, all these acronyms make me LOL!

A federal judge sentences the former president of Roger Williams Medical Center (RI) to three years in prison for corruptly employing a former state senator to advance the medical center’s interest in the General Assembly. Supposedly Robert A. Urciuoli paid former Rhode Island state senator John Celona $260,000 in consulting fees in return for taking steps to support legislation favorable to Roger Williams and to kill bills deemed unfavorable. In October, Urciuoli was found guilty of 35 counts of mail fraud.

If you are a healthcare informatics specialist, you have one of the hottest jobs right now. According to the president and CEO of the American Medical Informatics Association, the recent passage of the ARRA legislation is creating a need for as many as 70,000 health informaticians.

E-mail Inga.

News 4/10/09

From Big Bird: "Re: AMICAS. They are closing the former Emageon headquarters in Birmingham. Many layoffs announced today."
 
From Leo Sayers Fro: "Re: I enjoyed Chicago much more than Orlando or Atlanta. Thoughts: (1) is Fourth Hanson Brother really saying that Linux has less capacity, is older technology, creates more pollution, and appeals only to hippies who are kidding themselves? Lots of enterprises employ Linux, although they do use some middleman like Red Hat. Lots of people say that Cache is older (and complain about old technology), but InterSystems is successfully supporting a lot of enterprises across industries in this big world. Old technology is not necessarily bad technology. Maybe Medsphere is the way to go given a lack of access to capital and given that lots and lots of residents like their VistA system. I would have a better idea if the VA and DOD were on the same page (and is there still a question about Medsphere truly being an open source participant?) (2) EMRAM Stage 7. Just how many Stage 7 users really use a unified medical vocabulary underlying their clinical documentation, thereby presumably allowing for meaningful analysis (and comparison) of clinical documentation? How many use LOINC for results, not only for clinical laboratory, but waveforms and imaging? How many fully leverage SNOMED? And how can you really determine efficacy if you really can’t evaluate outcomes fully? Are their cancer registries fully linked to their EHRs and data warehouses or their pathology reporting systems? And to think: a common medical vocabulary is a Level 2 requirement!"

From Vendman: "Re: GetWellNetwork. Johnson and Johnson to invest $25 million for a substantial ownership position." I asked Michael O’Neil, founder and CEO, and he says that’s not exactly true. J&J’s development corporation invested $10 million in the company in January, reported here, and has high expectations of its impact on healthcare. That’s it so far, although the companies continue to share ideas and discuss projects. Michael did mention that GetWellNetwork recently expanded its relationship with Catholic Health Initiative and added new accounts with Norton Healthcare and an Adventist hospital.

From The PACS Designer: "Re: ETIAM CD-in. When patients are at the ER with CD’s or DVDs from previous episodes of care, it is never easy to import the image files. Now, ETIAM has a new version of their CD-in solution with enhancements that make it much easier to do the importing of other institutions’ image files into your PACS archive." Link.

From Mark: "Re: CPOE – A New Conceptual Model. Physicians use the iPhone to dictate orders and approve the transcribed order; view clinical results; and dictate reports. Say ‘Potassium Replacement Protocol’, press Send, receive a text alert with HIPAA-compliant link, click on the link to review order, select Approve. Orders flow to appropriate systems and personnel. Fast, simple, and easy." Link to presentation. 

From Dodele: "Re: EMRAM Stage 7 all being Epic. Sounds great, but I believe there are only two that qualify as Stage 7. Still, kudos to Epic for having a system capable of getting them there." Correct: two organizations (KP and NorthShore) with 15 hospitals (12 and three, respectively). It still makes a killer ad for Epic.

From HIMSS Party Dude: "Re: HIMSS parties. Perot Systems and Dell get high marks, but the one that seemed to be most accommodating was Ivo Nelson’s Encore Pub Night at Fado’s. EVERY NIGHT he hosted folks at the pub to free adult beverages. I’m gonna guess that over 300 people were there on Monday night. Great concept – free beer, free food, come and leave when you want – EVERY NIGHT of HIMSS. Simple. And blue jeans are a welcome alternative to my stuffy suit." Sounds nice, at least if you like chain, Atlanta-based fake Irish pubs (and I’m not saying I don’t). Did you know there’s an entire company that builds fake Irish pubs in this country and others? We’ve probably got more Irish pubs than Ireland.

My only real meal in Chicago was here and it was outstanding (and this beer was mild but amazing).

IBM says China’s healthcare reform will create the need for at least $1.5 billion in software.

Medsphere, Midland Memorial Hospital, and David Whiles get some BusinessWeek love.

Listening: Carolina Liar, pop-rock MTV darlings from Sweden (despite the name). Also: obscure Philly hard rockers Automatic Black.

New poll to your right: if you went to HIMSS, would you like to see the conference return to Chicago at some point?

I’m still getting used to being home from HIMSS. Mrs. HIStalk opened the door for me this morning and I tipped her $1.

It was funny to hear several times at HIMSS and at the reception (Todd Cozzens asked for a show of hands) that many people jump on to HIStalk first thing in the morning or sit by the PC at the time they know I usually post. I don’t know what they’re doing (scooping the competition? hoping not to find their names mentioned?) but that’s pretty funny.

Premise, now part of Eclipsys, earns the Outstanding Portfolio Company award from Connecticut Innovations.

Heard at HIMSS and elsewhere, when some pompous ass was asked where he works: "Oh, I work for this little outfit you might have heard of called Oracle." Nobody should have so little self-identity that they can’t come up with something to crow about except who pays them. I heard it again from someone from a snotty university guy.

A reader asked if I’m convinced that it will be CCHIT alone doing the government’s EHR certification going forward. I am, given its clout, connections, head start, and performance. Anyone else feel differently? I know a different group could theoretically be named, but I don’t see that happening.

The Robert Wood Johnson Foundation announces a call for proposals due June 3 for $2.4 million in grants for Project HealthDesign: Rethinking the Power and Potential of Personal Health Records. Up to five teams will be funded for 24-month demonstration projects for up to $480K each. The topic is how Observations of Daily Life (diet, exercise, sleep, pain, etc.) can be used to infer how patients feel and therefore modify their treatments. I had a great idea for offshore call center operators to call patients and ask how they’re doing, but all Americans ever say is "fine."

GE Healthcare announces its Digital Day One program, a service to get Centricity Enterprise implemented in a year or less.

MEDSEEK will integrate 3M’s CDR and vocabulary capabilities into its community portal, providing comprehensive interoperability.

A new JAMA study finds that Leapfrog Group’s safe practices (CPOE, intensivists, evidence-based surgery referrals) are not predictive for patient mortality. "The results of this study support the concerns expressed by physician groups who have discouraged public use of quality measures that have not been fully validated." Leapfrog cranks out a press release (warning: PDF) questioning the number of hospitals surveyed and citing a study with different conclusions, but admits that process improvements don’t always provide better outcomes.

Incoming national coordinator David Blumenthal says that his office needs to tighten the EHR certification process to include usability and their capabilities to support HITECH’s quality and cost goals.

Jobs: Inside Sales Executive, Sunrise Clinical Manager Consultant, Business Development Executive.

Shared Health will make its HIE technologies available to hospitals in some way, but the press release is so self-congratulatory it never really says how (that I can tell, anyway). I was looking for "free" and didn’t see that.

IBA is looking for US distributors for its iSoft Lorenzo Health Studio, hinting that the Australian company would like to get some stimulus handouts like everyone else.

IntraNexus will remarket Mediware’s Ascend pharmacy system to round out its Sapphire HIS. Ascend was the system sold by Hann’s On Software, the California company Mediware bought in November.

Yale-New Haven’s CEO breaks the $2 million compensation mark in 2008.

Odd lawsuit: A Toronto weight loss surgeon who already lost his medical license after sexual abuse claims now faces a $12 million class action lawsuit along with the hospital that employed him. He pleaded no contest to sexual abuse that included a twin sisters on which he had performed bariatric surgery, reportedly telling them that it was every man’s dream to have sex with twins, which he did in his office along with using illicit drugs he told one of them to buy.

E-mail Mr. HIStalk.

HERtalk by Inga

From Dr. G: "Re: HIMSS/Ingenix reception. Thanks for the invite. Boy, you’ve really become the ‘Fantasy Girl,’ at least with Jonathan Bush!" Even though Jonathan’s comments weren’t exactly politically correct, I must admit I enjoyed being called "luscious".

From Smaller Vendor: "Re: HIMSS impressions. The show was okay – it was really more to meet with other vendors. The most exciting booth I saw at HIMSS was … not there. I was very pleased to see the many infrastructure offerings finally bringing true connectivity (Capsule, among others). The Microsoft booth — folks raved to me about the table demos — left me ho-hum (it was really just a new table-based display). As pretty as it was, it was in reality expensive and not high enough resolution."

From Spice Guy: "Re: reception. That was an interesting night! Was talking with Matthew Holt when ‘Shhhh Inga’ (Deborah Peel) came up. Interesting to eavesdrop on their interaction!" Matt Holt, who was wearing a "Inga 2.0" sash, had the opportunity to chat with Deborah Peel (adorned in a "Shhh, I’m Inga" sash.) Suffice it to say that Matt and Dr. Peel don’t see eye to eye on all matters of privacy, though both were perfect guests.

From C-Note: "Re: Ingenix reception. I spent most of the reception going around and accusing people of being Inga, all of whom were honored at the accusation and resulted in great conversation. One person even watched me carefully as I walked by, then as he got to the ‘toe’ part of his head-to-toe scan of me, he started shaking his head. As I made eye contact with him he grinned real big and said, ‘Nope, you’re not Inga – I can tell by the shoes.’"

I’m recovering from my post-HIMSS fatigue, wondering if my feet will ever return to their original non-puffy form. All in all, I thought the meeting was great: tons of informative topics, good speakers, and a fun city. I loved catching up with old friends, chatting with new folks, and spying on our sponsors’ booths. The HIStalk/Ingenix party was in a gorgeous location atop the Trump Tower and everyone seemed to be having a great time. I got invites to a couple of vendor parties and each was very well done in its own way.

Only complaints: I hate cold. I really hated having to pay $3 each day to check my coat. Wish the shuttle buses ran more frequently. Don’t understand why it has to cost at least $14 to get lunch at a convention center. I’d have liked a few more "surf the net" stations since I chose not to lug my laptop around (the iPhone is great for checking e-mail, but not writing anything of length.)

Probably not worth complaining about, but I didn’t win this cool scooter that a magazine was giving away.

Sunday morning, the Olympic International Committee toured the convention center. Everywhere you looked you saw dancing dragons, wrestlers, and tumblers. Also, these two adorable girls in Native American dress.

I spent a fair amount of time waiting for Starbucks coffee the last few days (not exactly a complaint since I did make a conscious choice to stand in the long lines.) I actually enjoyed the opportunity it gave me to talk with strangers about their HIMSS experience. One IT manager told me his large health system typically brings 30 or so people every, year but this year the employer only sent the five who had speaking engagements.

This year’s buzz words: stimulus, ARRA, meaningful use, and interoperability. The "also-ran" words were iPhone and mobility. In the mix you heard discussion about CCHIT and whether or not they provided the de-facto standard. According to CCHIT and all CCHIT-certified vendors, CCHIT is the inevitable standard. If you had a document management-only system or some sort of EMR-lite offering, you stressed the necessity of your offering to get ramped up. A reader shared that the CEO of a large CCHIT-certified vendor told an audience to expect only five major players to remain after everything shakes out.

I tried to check out as many of the smaller vendors as possible and MedKey PHR Systems caught my eye. I’ve said before that I don’t believe the public is ready to take the time to set up a PHR. However, if you are chronically ill, for example, I liked how this technology looked. The device is a portable and wireless PHR that can be worn like a medical bracelet or be on an insurance ID card or on a key chain. It is supposedly "completely" secure and password protected. Data can be synched with the integrated USB port, or wirelessly. I suppose if a big insurance company pushed the technology, the design is convenient enough that I think people would wear/carry it. Although there is still the question of who is going to input the clinical data.

eClinicalWorks and Sam’s Club release details of their new EMR program, which is targeted for the one- to three-provider space. Check out the Sam’s Web site to see of what is included in the offering.

Greenway Medical Technologies announces a strategic deal with Detroit Medical Center to provide PrimeSuite EHR to physicians across Detroit Medical’s nine hospital network.

Streamline Health Solutions reports a net loss of $146K for the fourth quarter and $1.4 million loss for the year. The company posted a net loss of $736K in 2007.

The Texas Senate is considering raising taxes on chewing tobacco and using the funds to help doctors pay off student loans. New physicians could be reimbursed as much as $160,000 for agreeing to work at least four years in under-served areas.

The University School of Community Medicine and IBM plan to build a primary-care medical home pilot project that connects clinical data between the medical school, 325 physicians, and other area care-givers.

Sprint Nextel and GE Heatlhcare sign a multi-million contract with Methodist Healthcare (TX) for a complete wireless infrastructure across its six sites. The setup includes integration with GE’s Carescape Enterprise Access.

My feet are recovering nicely, thanks to my new slippers from Chipsoft. As I was unpacking, I also found some a frosted Oreo, courtesy of HealthPort. Yummy. Next week, back to reality.

E-mail Inga.

News 4/3/09

From Cherry Forever: "Re: political appointments. For the HIT Policy Committee, Minority Leader John Boehner appointed Gayle Harrell. Speaker Nancy Pelosi appointed Paul Egerman. Incidentally, you can find this information if you do a search on ‘HIT Policy Committee’ in the Congressional Record." Harrell is a Republican member of the Florida House who recently railed against the stimulus bill. "One of the scariest provisions of the bill misuses the laudable goal of expanding electronic health records and spends $1.1 billion to create a new bureaucracy called the Federal Coordinating Council for Comparative Effectiveness Research. The intent is to use this new government bureaucracy and electronic health records to monitor the effectiveness of different health-care interventions and medications with the cost of treatment being considered as a factor in determining effectiveness. Such cost-based medical decision-making could eventually be used to allow the government to ration health-care goods and services. A congressional committee report stated that ‘more expensive (treatments) will no longer be prescribed’ as a result of such research." Paul’s an uber-Democrat and was co-founder of IDX and eScription (an interesting mix of social issues plus good old capitalism, the ideal combo if you ask me). If you Google him, the #1 hit is my 2005 interview with him, which was a blast to do.

From Don Frijole: "Re: Dell. Rumor, unconfirmed, that Dell will buy [big consulting firm] and announce acquisition next week at HIMSS. Hope Mr. HIStalk can get to the bottom of this one." The onset of HIMSS always starts acquisition rumors, sometimes true. If anybody has a Dell scoop, give it up.

From HCIT Girl: "Re: GE and Intel. The companies have scheduled a press conference in New York, hosted by Intel Chief Executive Paul Otellini and GE Chief Jeffrey Immelt, to discuss plans to work together to deliver health-care-related technology, including possible applications for health care IT and home health monitoring, according to people familiar with the situation. BTW, you rock Mr.HISTALK and Inga!" She sent that rumor Wednesday and this was announced Thursday: GE and Intel announce they are jointly developing products for remote health monitoring. The pair will invest $250 million over the next five years to develop new technologies in this area. Also, GE’s health care unit will take over distribution and marketing of Intel’s Health Guide home care product. Thanks for saying we rock (not in a chair, I hope).

From Irwin M. Fletcher: "Re: Sutter. Don’t know if you saw your mention in the SF Business Journal regarding Sutter Health. I looked at your site and couldn’t find any mention. The article is titled ‘Sutter Health to postpone hospitals’ and says, ‘But Fry and Chief Information Officer Jon Manis denied reports on the well-known HIStalk health-care IT blog that Sutter is giving up on its $1 billion Epic installation …’ So congrats on being well known!" Thanks – I hadn’t seen that.

From HIT Man: "Re: CMIO. The premiere issue of CMIO magazine is released. From working with many, it is evident that these folks think because they are MDs, they know healthcare IT. Wrong. So, take a look at this issue and notice the language they use. It’s like a bunch of hippies writing specialized articles for themselves. Simply another rag, at least this first issue. One of the problems with HIT adoption is physicians, and now we let CMIOs run HIT work (at least in some places). Amazing how much credential is given to those who effectively can’t even agree on standard dosages from practice to practice. I lament, but let’s empower the IT executive, not the MD that studied IT. Also, Halamka is quoted again. This guy is a relentless media hound. He really should be a PR consultant."

From The PACS Designer: "Re: JeOS. With all the virtual appliances showing up in the marketplace, there was bound to be an mini-operating system to enhance their use. Now, Ubuntu open source software has a Just enough Operating System solution (JeOS), which has been nicknamed Juice. This new solution is bound to show up in new virtual appliances to improve performance and free up valuable bandwidth for other uses." Link.

From Frankie Knuckles: "Re: Chicago food and drink. If you want to get out of the Trump hotel bar, there are a couple good spots close by. Emerald Loop is a pretty good Irish bar (owned by a Notre Dame grad, so you know it’s good). Their curry fries and a few Guinness are a fine meal. Across the street is the South Water Kitchen, with comfort food like meatloaf and fried chicken. And if you want to hang out at a real mobbed-up Chicago Italian place, head a few blocks east to Volare — some good people watching there, and good food too. Just don’t lean against the Cadillacs and Mercedes parked out front."

Other rumors heard: GE is going after a specifically named large ambulatory EMR vendor. Allscripts will announce a new iPhone offering. Cisco will be making an investment in a specifically named physician billing company. All unverified.

Allscripts reports Q3 numbers: revenue up 65%, EPS $0.09 vs. $0.12, but the numbers aren’t really apple-to-apples because of the Misys deal. Both earnings and revenue missed analysts’ expectations, but shares are up a little in after hours trading, adding to the nearly 4% rise before the market closed.

A former dialysis center nurse in Texas is charged with intentionally injecting 10 patients with bleach, killing five of them.

Listening: The Vincent Black Shadow, one of my faves, with a 2008 album I didn’t know about.

Several readers e-mailed to confirm the rumor reported here earlier that Eclipsys development SVP Joe Petro has left (he’s off the Eclipsys Web page, finally, and here’s the 8-K). Also gone, several of them said: Bobbi Byrne MD, SVP for clinical strategy. A reader reports, "The clinical solutions group now reports to Keith Figlioli, who reports to Jay Deedy. Not a clinical person in the hierarchy until you hit the fourth level in the organization."

HIStalk’s two millionth visitor arrived Wednesday afternoon, hailing from Johns Hopkins. March was a record traffic month as well, surprising to me since Inga and I took our respective spring breaks.

Meet Culbert Healthcare Solutions of Woburn, MA, just joined us as an HIStalk Platinum Sponsor. They do clinical systems consulting (strategic planning, EHR readiness assessment, selection and project work), revenue cycle (PM selection and implementation, billing and A/R outsourcing, and operational assessment), practice management (management, CBO, physician recruitment and retention), and IT (interim management, implementation, help desk, interfaces). Doesn’t matter if you work for an academic medical center, a community hospital, or a physician practice group large or small – they can help. Thanks to Rob Culbert and crew for their support.

Medsphere will show OpenVista 2.0 at HIMSS.

Microsoft launches a new low-end server family that can support up to 15 users for less than $1,000 in total hardware and software cost.

JAMA’s editors are on the hot seat after repeatedly calling a neuroscientist "a nobody and a nothing" and saying, "Who do you think you are? You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry." The editors were angry after the neuroscientist brought attention to the drug company ties of a JAMA article author, which JAMA reportedly ignored until it was run in a competing journal months later.

Jobs: MS4 Patient Accounting Expert, Compatibility Test Engineer, Cerner CCL Programmer, Training Consultant.

If you’re going to HIMSS, take a look at our Must-See Vendors List (which, entirely coincidentally, are HIStalk sponsors). If they’re cool enough to sponsor some anonymous blog, they’re worth a look.

I was always curious about McKesson Paragon, a highly regarded small hospital system that escaped what looked like sure sunset death years ago. We interviewed Paragon’s GM on HIStech Report. Products like that will be essential if we’re ever going to move the needle on small hospital EMR adoption (and since there are so many of them, to move the EMR needle in general).

I appreciate the support of new HIStalk Platinum Sponsor Virtelligence, a premier IT consulting firm offering solution advisory and IT consulting services to all types of healthcare organizations (which have given them a 95% repeat business rate). The company has won awards for being a great place to work (consultants average 15 years’ experience) and is listed in the 2008 Healthcare Informatics Top 100. Their "Why Virtelligence?" section of the Web site summarizes nicely: "Delivery-based contracts, low rates, fixed prices and pay on the results." Why not drop by at Booth # 2373 at HIMSS and check them out? 

I’m going to be running around in the cold Saturday and onward to tell you what’s going on at HIMSS. I’ll give you a scoop on the cool and the ugly booths, who’s getting traffic and who’s not, the certain acquisition rumors floating around, and whatever else catches my eye (and ear) as a non-profit hospital peon being ignored by the high-powered, self-absorbed suits. I’m your Everyman on the scene. Happy and safe travels to all.

HERtalk by Inga

From Dick Vitale: "Re: NCAA basketball pool. Is the basketball pool going to get a mention in HERtalk?" I’m blaming the pre-HIMSS rush for my failure to recognize one of our sponsors for inviting Mr. H and me to participate in their company basketball pool. My failure to mention these fun folks has nothing to do with the fact that for the second year in a row I am a loser. Dick, however, does point out that I am in the running for the Consistency Award because my total points/correct points are almost identical to last year (i.e., I am a consistent loser). Rather than hand over the pool winnings to the lucky winner, our gambling friends are giving 50% of the pot to a local charity for needy families. Nice.

From Dutch Treat: "Re: downing Heinekens. If you want something fun to cover while at HIMSS, there is a contingent of about 200 Dutch HIS and vendor people traveling over together for the conference. This is a fun group. I know a bunch of them. They are staying at the Hyatt and have already begun calling it ‘Holland town’ where they say they are having nightly cocktail receptions." "Fun" and "nightly cocktails". Intriguing. And with a name like Inga, I am sure that some of them might be fourth cousins or something.

Insight Health Services enters a seven-year agreement with Perot Systems to provide revenue cycle outsourcing, IT outsourcing, and other practice management tools for Insight’s free-standing imaging center facilities.

Like Mr. H, I was disappointed by the MyHIMSS09 calendar program. If only it would have had a nice, concise print option. I have now put all my picks onto one nice sheet of paper. I have a pretty nice balance between educational sessions, exhibits, and food and drink opportunities.

Hospital Rahway (NJ) is the third hospital in the Robert Wood John Health System to adopt Eclipsys Sunrise Acute Care.

AMICAS completes its tender offer of Emageon and now hold 88% of outstanding Emageon shares.

Capital Area RHIO (NJ) deploys Axolotl’s Elysium Exchange solution to facilitate secure sharing of clinical information.

Beaumont Hospitals (MI) expands its existing Agfa Healthcare IMPAX PACS to include IMPAX Cardiovascular.

McKesson’s Physician Alliance Program signs agreements with three hospital systems to provide their community physicians with EHR solutions. The announcement indicates that VARs will be responsible for selling, implementing, and supporting McKesson’s Practice Partner and RelayHealth solutions to the participating physician offices. Interesting that McKesson seems to be relying on VARS, rather than a direct sales/support team, though that model is similar to the way Allscripts is distributing its MyWay product to small offices.

The VA selects Picis to provide anesthesia record for five of its medical centers. The VA will use Picis’ Preop Manager, Anesthesia Management, and PACU Manager applications.

Nebraska Orthpaedic Hospital selects Surgical Information Systems (SIS) Anesthesia solution.

HIMSS attendees will have a chance to take a five-question survey about the economic stimulus and its impact on healthcare. Beacon Partners will conduct the electronic poll at their exhibit booth (4416) and real-time results will be posted on monitors. I’m stopping by because I want to be eligible to win one of the three iPod Touches they’re giving away.

MEDecision announces its intent to acquire HIE company HxTechnologies. MEDecision plans to inbed HxTI’s HIE technologies into is Alineo and Nexalign platforms.

Good news for all you Call of Duty 2 fans. A new study finds playing action video games may help adults improve their eyesight. In particular, such games can improve contrast sensitivity and benefit those with amblyopia (lazy eye syndrome).

If you originally signed up for the HIStalk/Ingenix reception and your plans have changed, please let the Ingenix folks know. I believe they may have a waiting list going and a few waitlisters are hoping to take any empty spots.

Marin Healthcare District (CA) signs a $67 million, seven-year contract with ACS to provide consulting and outsourcing services. ACS will implement an enterprise-wide EMR and provide revenue cycle services.

Heartland Regional Medical Center (MO) is considering outsourcing some technology services as it moves to Cerner’s EMR. The hospital’s CMIO says the hospital must spend millions upgrading computer equipment or outsource some in-house services. 

Kaiser opens a new hospital next to its existing flagship LA Medical Center. The $600 million, 400-bed facility is designed to withstand a major earthquake, features 85% family-friendly private rooms, and includes all the latest technology.

Surescripts names former Mastercard executive Harry Totonis as president and CEO. He replaces JP Little and Rick Ratliff, who have served as co-CEOs since RxHub and  SureScripts merged last year.

My next update will be coming direct from Chicago! I’ll be the one wearing a coat.

E-mail Inga.

News 4/1/09

From Tyrone C. Earl: "Re: Pyxis. 800 people laid off today. The regional manager came in today to tell us that one of the people was our PM for our go-live this week (nice timing). He said we had to wait two hours before we told anyone." The company just announced that it will eliminate 1,300 jobs when it spins off CareFusion. The announcement mentioned 800 layoffs, so maybe that’s not a coincidence.

From Eclipsys Layoffs, aka A Passage to India: "Re: Layoffs. Once again the ‘leadership’ at Eclipsys has cut 100 (give or take) positions. So what exactly have Eclipsys stockholders gotten from Andy’s multi-million dollar leadership team? Lower stock price, fewer sales, and an employee base that’s being slowly exported to India." Unverified, although someone I know got the axe and also gave the 100 number, mostly from development, and also said that development SVP Joe Petro resigned (but he’s still on the Web page, so I’m not sure about that). I would blame the economy more than the company.

From Alexander B. Fitzhugh: "Re: BearingPoint. Healthcare consulting (which consists of the Federal, Provider and Payor practices) is part of the Public Services business unit. The information in the link you provided is correct, Deloitte intends to buy PS. According to Kelvin Womack (VP and sector lead for Healthcare), almost all employees within Healthcare are going to move over to Deloitte."

From Anony: "Re: GE. Harrison Hospital (Bremerton, WA) selects GE Centricity for its 25 hospital physicians. Also purchased were 100 licenses for a community Stark offering and GE’s Health Information Exchange (HIE). Expect a press release in the next week."

From Kat & Mouse: "Re: McKesson layoffs. A good source states the layoff was around 600. The source was one of them, given severance and time to find new job. Source stated that McK had over-expanded last year – nothing to do with issues related to the stimulus." Unverified.

From Yancy Derringer: "Re: KPIT. Insiders say 400 more will be let go in June. The IBM announcement was rumored the day the new CIO came to KP because he did the same thing in his last two jobs (both outside healthcare) and the new VP he hired did the same." Props to Dr. Mark Craig, who rumor reported to me in October 2007, "The prevalent rumor is that the new CIO and his new hires are on an outsourcing train and the train is powered by IBM.”

From The Beeb: "Re: Second Life used to teach doctors." Link. Imperial College London’s interactive hospital simulation is used to teach third-year med students. The on-screen characters resemble faculty members, students review recordings of real-life patient breathing, and the game stops if students forget to wash their hands.

From New York Cynic: "Re: move. Lori Evans, 39, rising Health IT star Deputy Commissioner 4 NY Office of Health Information Technology Transformation has left after only 2 years and is positioning herself for her next move. Although she was anticipated to be CEO of the National eHealth Collaborative, this has been put on hold as the role of NeHC is in question under the stimulus plans policy committee. Her connections to the previous administration (Brailer) precludes any position with the current administration or ONC but watch for some serious re-branding to occur."

From People Love to Gamble: "Re: prize. What prize will you be giving to the 2 millionth visitor to the site? ;-)" I like the idea, but there’s no way to identify who the visitor is. And, it looks like I’m out of time to think about it since the magic number will be reached sometime Wednesday or Thursday at the usual rate. It’s a good time for me to thank the people who read and sponsor HIStalk. I remember with total clarity when I was thrilled to look at the e-mail list and see 31 subscribers (now at 4,000) and to see that long-awaited first thousand page views (now at over 3 million). I’m just as thrilled and surprised now.

Listening: Crack The Skye, the new release from Mastodon, the Grammy-nominated, 70s-sounding (Sabbath meets Green Carnation) new wave heavy metal that covers Stephen Hawking, Czarist Russia, and astral travel. Diggin’ it.

If you RSVPed and are coming to the reception Monday, we’ll probably start our little program at around 7:45 or so (the event runs 7 until 9). We’re playing it by ear, but I was thinking that leaving some networking time afterward would be fun since we may recognize a few people from the podium that you’ll want to chat with. And if you have signed up, please make sure to respond the confirming e-mail from Ingenix since we’ve got waitlisted people who would be happy to take your spot if you can’t make it after all. I’m heading out to Chicago early, so I will report from there starting Saturday evening, enjoying the snow and freezing (not).

Speaking of HIMSS, here’s our list of who you should see in the exhibit hall, those sponsors who keep the presses pressing right here. These are the cool people. Want a nice, printer-ready copy perfectly formatted for taking along? Here you go. Tell them thanks for sponsoring HIStalk, will you?

Among those companies making the short list to provide a new national pathology system for Wales: Cerner and InterSystems.

Over on HIStalk Practice, we did an "HIT Moment with …" Michael Stearns, president and CEO of e-MDs.

A nice piece on Cleveland Clinic’s HealthVault pilot, highlighting one hypertensive patient’s experience. Says a doctor there: "We’ve not been connecting as well as we should have. I think this is where the future is."

Nicholas Casabona is promoted to CIO of Winthrop-University Hospital (NY).

Rich Temple, CIO at AristaCare Health Services (NJ), tells me he’s signed a contract to implement business intelligence tools from ABS System Consultants as the Canadian company’s first US LTC customer.

Quest Diagnostics is quietly releasing a free iPhone application that will run the Care360 physician portal of its subsidiary, MedPlus.

E-mail me.

HERtalk by Inga

From Clueless: "Re: What to wear? Inga – can you advise re: dress code at the HIStalk/Ingenix soiree?" Good question. As Mr. H babbles on about recommends which education sessions to attend, I am glad that someone has the good sense to be asking the important questions. So, always start with the shoes. The weather on Monday is currently forecast for a high of 39 degrees and rainy, with snow and freezing weather by the evening. Clearly not conducive to high-heeled stilettos, which would be the preferred footwear for such a festive occasion. Unless you are staying at the Trump Hotel and simply taking an elevator to the party, such shoes will be a challenge. If you bring a large purse, you could always change out of your ugly shoes and into elegant footwear once you arrive at the hotel. But, gentle reader, I will let you figure that out those logistics. Once you settle on shoes, nothing else really matters. However, I will say that last year we had everything from lovely cocktail dresses and suits to those just-off-the-exhibit-floor khakis with tacky golf shirts that shout the name of one’s employer and are ill-fitting on 90% of all wearers. Don’t worry if you are appropriately dressed. We really just want you to have fun and say very loudly how much you love Mr. H and Inga. 

From Confused: "Re: Pink pants at HIMSS….Is this going too overboard? We want to stand out, but I think this might be pushing it. Currently we plan on wearing black t-shirts with the following logo and khaki pants. Your feedback is greatly appreciated." After suggesting to Confused that only real men can wear pink, Confused said that was enough of a challenge to his team’s collective manhood that they decided the pants were a go. I’m hoping they’ll show off the fancy pants at our HIStalk/Ingenix gathering.

From Pacstech: "Re: RealAge Response. Thought this might interest you. I thought the same thing as New York Cynic after taking their ‘survey,’ carefully opting out of any offers (many) to have them send me health related info." Pacstech forwarded us a copy of a note he received from the RealAge people, who claim the information people provide "is never shared" with advertisers or anyone else, though if you opt for e-mail offers, you will get links from advertisers. I asked privacy rights advocate Dr. Deb Peel for her take on the note and here was her response: "The most important point is how can we trust them or any other health-related website? They all say they never do anything wrong, but where is there any objective evidence, proof of what they say, or certification by an independent outside consumer-led certification organization?  No trust without verification. Those who handle Americans’ sensitive personal data all promise great things but when it comes to our MOST sensitive personal information (health information) we need verification. (We are trying to launch our privacy certification later this year.)" All I can say is that I took the RealAge test a few months ago and was pleased how it so accurately shaved several years off of my not-real age.

The ever-humble Mr. H hasn’t mentioned this recently, but it looks like HIStalk will hit the 2,000,000 visitor milestone by the end of the week. Mr. H is the genius behind HIStalk, so if you are a fan, send him a congrats, kudos, felicitations, or a thatta  boy. And thanks for reading.

Eclipsys announces that Lahey Clinic will implement the Sunrise suite of clinical products for its two-hospital delivery system. Lahey will also add Eclipsys’ clinical and financial decision support solutions.

West Carroll Memorial Hospital (LA) implements Healthland’s EMR solution for its 33-bed hospital.

Motorola and Vocera sign a joint marketing deal to offer the Vocera system on Motorola’s VoWLAN smartphones.

We interviewed Linda Peitzman, MD, CMO of Wolters Kluwer Health Clinical Solutions, on HIStech Report.

British doctors find that using maggots to treat leg ulcers is just as effective as using gel. Both are similar in cost, but the maggot alternative is a viable option for remote areas without access to good medical care. Unfortunately, the maggot treatment is more painful. Ick.

Suburban Hospital Healthcare System (MD) selects McKesson’s Horizon Clinicals and revenue management solutions.

An engaged front-line team, supported by an electronic health record and a clinical care registry, is credited with reducing the deaths of patients with coronary health disease by 73 percent, according to the results of a Colorado program piloted by Kaiser Permanente. The pilot care program linked pharmacists, nurses, primary care physicians, and cardiologists and included such tactics as proactive patient outreach, education, lifestyle adjustments and effective medication management.

AT&T and Mednet Healthcare Technologies partner to help doctors and patients remotely monitor heart arrhythmia through personal mobile devices. Using Mednet’s HEARTRAK External Cardiac Ambulatory Telemetry solution, heart monitor data is transmitted via Bluetooth-enabled cell phones.

Western Maryland Health Systems (MD) plans to implement Agfa Healthcare’s IMPAX Cardiovascular imaging and information management solution when it opens its new Regional Medical Center later this year.

Streamline Health Solutions announces that a "leading West Coast university-affiliated surgery department" will implement its enterprise document management and workflow solutions. The "unnamed" university is easy to identify if you view the link to the press announcement. This is the second time we’ve noticed Streamline declining to name their client in the actual release, but revealing it in the link. Perhaps they are intentionally revealing the client’s identify in this subtle way so people like me can feel like a smarty-pants.

Blood Centers of America endorses Mediware’s blood center technology product strategy. Member blood banks will now have access to special Mediware pricing.

Kaiser fires 15 hospital workers and disciplines another eight for peaking at octomom Nadya Suleman’s medical records. Suleman’s attorney suspects the employees were trying to find information on the sperm donor.

After paying contractors billions to create the DoD’s AHLTA military EMR system, officials introduce a plan to re-shape the system. The new strategy seeks to improve provider satisfaction, improve reliability, and strengthen data sharing throughout the DOD and the VA.

Oakwood Healthcare System (MI) selects PatientKeeper to streamline physician access to its clinical information.

E-mail Inga.

Mr. HIStalk’s Must-See Vendors for HIMSS 2009

Allscripts

Booth 1303

Contact:
Todd Stein, Senior Manager/Public Relations
312-506-1216
todd.stein@allscripts.com

The new Allscripts is the clear leader in software, services, information and connectivity solutions that empower physicians and other healthcare providers to deliver best-in-class patient safety, clinical outcomes and financial results. Nationwide, more than 150,000 physicians, 700 hospitals and thousands of other healthcare providers in clinics, post-acute care facilities, and homecare agencies utilize Allscripts solutions to automate and connect their clinical and business operations. Together with our clients, Allscripts is transforming our disconnected ‘healthcare’ system into a connected system of ‘health.’

Allscripts Says: Do you know why The Time Is NOW to adopt electronic health records? Learn more about the Stimulus incentives at the Allscripts booth (1303) at HIMSS. We’ll be talking about why you should begin taking steps NOW toward implementation.

API

Booth 2007

Contact:
Jim Klink, VP of Sales
262.670.2711
jim.klink@apihealthcare.com

API Healthcare is the leading provider of human capital management solutions to the healthcare industry including time and attendance, staffing and scheduling, patient classification, payroll, human resource, and business intelligence. Founded in 1982, API Healthcare has more than 600 installations in the North America, with clients ranging in size from 500 employees to more than 30,000 employees. The company’s Payrollmation® system has been rated by KLAS as the top time and attendance system for the last seven years.

API Says: As the experts in optimizing human capital management in the healthcare industry, we can help with some of your most pressing business concerns: minimizing labor costs, increasing employee satisfaction and improving patient outcomes.

ATT

Booth 612

Contact:
Tammi DeVore, Sr Healthcare Marketing Manager
206.422.2416
tammi.devore@att.com

www.att.com/healthcare

AT&T Mobility is the leader in healthcare communications, combining innovation and industry experience to use technology in new ways and in new places. We are committed to helping you transform healthcare delivery by wirelessly enabling clinician workflow. Using our ecosystem of alliance vendors, AT&T provides products and services that meet your goals of improved patient care and business productivity.

AT&T Says: Discover new ways to mobilize your clinicians, launch new telehealth solutions, and integrate devices within the Healthcare enterprise system. Interact with innovative technologies, speak with specialists and discuss unique solutions for your organization.

AT&T will demonstrate cellular and WiFi communication solutions for healthcare providers which enable delivery of real-time data via smartphones and other mobile devices. These solutions include Enterprise Paging, Results Reporting, Alerting, ePrescribing, Physician Portals, Homecare, Decision Support and Communications for healthcare professionals. All solutions serve to improve the quality of care and improve the efficiency of operations.

Caretech

Booth 7030

Contact:
Jody Meehan Director, Marketing & Communications
(248) 823-0900
www.caretechsolutions.com
jody.meehan@caretechsolutions.com

CareTech Solutions, Inc., an Information Technology and Web Products & Services provider for hospitals and health systems, is committed to creating value for clients through customized, flexible solutions that contribute to improving patient care while lowering healthcare costs. From implementing emerging technologies to supporting day-to-day operations, CareTech offers clients expert services across the entire patient data lifecycle.

CareTech Soluions Says: CareTech Solutions won a coveted 2008 Best in KLAS award for the IT Outsourcing (Extensive) market segment, as ranked by healthcare executives and professionals in the 2008 Top 20 Best in KLAS Awards report. CareTech’s Best in KLAS distinction follows the company’s achievement of market-leading overall performance scores in KLAS’ 2008 Extensive IT Outsourcing Study.

Cumberland Consulting Group

Booth 4475

Contact:
Jim Lewis
Managing Partner
(615) 373-4470
jim.lewis@cumberlandcg.com
www.cumberlandcg.com

Cumberland Consulting Group is a national technology implementation and project management firm serving ambulatory, acute, and post-acute healthcare providers. Through the implementation of new technologies, we help our clients advance the quality of care they deliver, and improve their business performance. Cumberland is also a great place to work, placing fifth on Consulting Magazine’s 2008 ranking of America’s Best Small Firms to Work For.

Cumberland Consulting Group Says: Learn about a new alternative. We are a relatively new company with an excellent delivery record and a lean operating model that allows us to deliver big company results at a very attractive price. Our clients appreciate our business approach and the small firm commitment and attention we provide. We love our work and we take the success of our clients very personally.

dbMotion

Booth 2603

Contact
Eclipsys Corporation
Three Ravinia Drive
Atlanta, GA 30346-2156
Toll-free: (800) 869-8300
PeakPractice Sales: 877-633-6683 x657

As The Outcomes Company®, Eclipsys offers advanced integrated clinical, revenue cycle and performance management software, clinical content and professional services that help healthcare organizations achieve improved clinical, financial and operational outcomes.

Eclipsys Says: Visit Eclipsys in Booth #2603, Hall A, during HIMSS09 to see how real organizations with real challenges are using our solutions to drive performance and improve outcomes. In addition to our Sunrise Enterprise ™ solution suite, we’ll showcase our Web-based Eclipsys Practice Solutions, the cost- and resource-efficient practice management and EMR solutions, along with our new Eclipsys Performance Management solutions—(Sunrise EPSi™, Sunrise Clinical Analytics™, Sunrise Patient Flow™) that create actionable information to guide the timely, enterprise-wide intervention critical to positive performance.

e-MDs

Booth 4459

Contact:
Andrea Lesh, VP of Sales & Marketing
512-257-5200
www.emds.com
sales@e-mds.com

e-MDs is a leading developer of healthcare software solutions, including clinical, financial and document management modules designed to automate medical practice processes and chart management. With e-MDs, medical practices can visit, code and bill with a single application. e-MDs – Charting The Future of Healthcare.

e-MDs Says: Come see the integrated EHR/PM solution Top Ranked by medical societies, including the AAFP and ACP, for its Functionality and Ease of Use. Get a hands on demonstration of the most flexible, scalable and user friendly solution on the market today, and ask about our “next generation” product line coming very soon.

Enterprise Software Development

Booth 7927

Contact:
Joseph Torti, President
5151 Monroe St. Suite 101
Toledo, Ohio 43623
www.enterprisesoftwaredevelopment.com
419-841-3179
jtorti@enterprisesoftwaredevelopment.com

Enterprise Software Development is a leading independent consulting firm dedicated to assisting healthcare organizations with their diversified business and Information Technology needs. Our services and solutions include IT management consulting, supplemental staff augmentations, clinical and system transformation, implementation and integration, as well as education and training in Cerner^®, Siemens^®, Epic^®, Eclipsys^®, MEDITECH, and McKesson systems.

Enterprise Software Development, LLC Says: Stop by and learn how our consultants allow your staff to focus on what they do best and help you make sure you have the tools you need to implement facility wide configuration, project planning, and training for executing your new or upgraded system. Our consultants can integrate with your staff at a professional level and compliment your team. We are a simple solution with a personal touch to your Clinical transformations.

GetWellNetwork

Booth 3413

Contact:
Michael Schram, VP, Sales
240.482.3200
mschram@getwellnetwork.com
www.getwellnetwork.com

GetWellNetwork works with leading hospitals to engage patients in their care. Transforming in-room televisions into an interactive resource, patients are invited to get involved in their education, safety, service, discharge preparation, and more. The result is first felt by patients, then measured in improved satisfaction, quality and operational performance.

GetWellNetwork Says: Stop by our booth at 11:15 am on Tuesday for a special presentation with Russ Branzell, Chief Information Officer at Poudre Valley Health System, and find out about the impact that Interactive Patient Care is having on their care process and IT operations.

Greenway

Booth 3910

Contact:
Rebekah Green, Marketing Analyst
866.242.3805
info@greenwaymedical.com
www.greenwaymedical.com

Greenway Medical Technologies is a leading provider of an integrated, single-database electronic health record (EHR), practice management and interoperability solution for physician practices and hospital community EHR strategies. Greenway’s CCHIT Certified® 08 ambulatory EHR solution, PrimeSuite® 2008, streamlines a practice’s clinical, financial and administrative processes while increasing practice profitability.

Greenway Medical Technologies Says: With the recent passing of the American Recovery and Reinvestment Act of 2009 “the stimulus bill”, physicians and medical practices have more incentive now than ever before to adopt an EHR solution. Greenway Medical solutions are designed to maximize return on investment while enhancing the quality of care physicians can provide their patients.

Healthcare Growth Partners

Booth 3081

Healthcare Growth Partners provides investment banking and strategic advisory services to small and mid-size, high-growth companies with an exclusive focus on healthcare information technology and technology-enabled services. With this focus, the firm leverages its experienced management team, strong execution capabilities, and deep network of contacts within the industry to provide efficient and high value processes for clients.

Informatics Corporation of America (ICA)

Booth 3476

Contact:
John Tempesco
Vice President, Client Services and Marketing
Main Office (615) 866-1465 – Cell (803) 351-8161
www.icainformatics.com
john.tempesco@icainformatics.com

Informatics Corporation of America (ICA) was created with nationally renowned Vanderbilt Medical Center to take innovative technology developed by Vanderbilt physicians to the broader healthcare market. Today ICA is unmatched in its ability to deliver a cost-effective, proven solution that leverages complete data across clinical settings to aid decision-making and improve patient outcomes.

ICA Says: Drop by the ICA booth and talk to Dr. Jonathan Anderson of the Health Information Exchange of Montana about how physicians use the ICA solution to improve care in northwest Montana.

Ingenix Consulting

Booth 626

Contact:
800-765-6897
impact@ingenix.com
www.ingenix.com
www.ingenixconsulting.com

Ingenix is a leading technology company working to improve healthcare through the power of information. Ingenix helps to enhance efficiency, accuracy, and quality in thousands of payer, hospital, physician, employer, and public sector organizations. Ingenix Consulting is a premier, data-driven health and human services consulting organization.  We have over 1,000 consultants with experience working with hospitals, physician practices, health plans, employers, government agencies and pharmaceutical companies.  This scale and exclusive health and human services focus set us apart.

Ingenix Says: See for yourself how our combination of information, technology and expertise can help you improve quality while reducing administrative burdens, meet the challenge of ever-expanding regulations, and thrive in a down economy. Stop by booth #626 to watch a presentation by one of our industry experts or to chat about your challenges.

McKesson

Booth 1213

Contact:
Joey Nord
McKesson
5995 Windward Parkway
Alpharetta, GA 30005
404-338-2414
Joey.nord@mckesson.com
www.mckesson.com/mpt

McKesson is a leader in software, automation, services and consulting to hospitals, physician practices, imaging centers, homecare agencies and payors. We also provide interactive connectivity services that streamline clinical, financial and administrative communication for healthcare stakeholders. The result? Care that is safer, more efficient, and better connected.

McKesson Says: McKesson experts will be available to discuss: healthcare IT incentives included in the American Recovery and Reinvestment Act and possible implications for hospitals and health systems; how IT can help improve care quality and productivity; eligibility and coding solutions that can positively affect cash flow and financial performance now; services to leverage existing IT and enable you to prepare for the Recovery Audit Contractor (RAC) program, manage the audit process and mitigate future risk.

Medicity

Booth 4443

Contact:
Greg Miller, Sr. Vice President Sales & Marketing
(801) 322-4444
www.Medicity.com
Sales@medicity.com

Medicity is the market leader enabling clinicians to access, exchange, share and collaborate with patient-centric clinical information located in disparate systems across multiple care locations. By leveraging Medicity’s Care Collaboration Platform, physicians, hospitals and Health Information Exchanges (HIEs) optimize clinical workflow, enhance patient safety and deliver cost-effective, efficient healthcare to patients and communities.

Medicity says: Medicity’s unique single point of access to clinical data, aggregated from disparate systems across care locations, empowers hospitals, health systems and HIE’s to deliver superior quality, more cost-effective, highly efficient and better coordinated healthcare.

MEDSEEK

Booth 1238

Contact:
Rich Grehalva, SVP Marketing & Consulting Svcs.
www.medseek.com
rich.grehalva@medseek.com

MEDSEEK provides healthcare organizations with enterprise eHealth solutions to fully engage and strengthen relationships with key constituents – physicians, patients, employees, and consumers. By connecting information and communities to foster an enhanced experience with the organization, hospitals will improve community advocacy, revenue and patient acquisition/retention, physician relations, and clinical decision making.

MEDSEEK says: Enhancing the experience is an expectation of all users within the healthcare community. A key to improving revenue while decreasing expenses is through the effective use of enterprise eHealth solutions. Visit us at HIMSS in Chicago to learn how we are improving the overall experience of patients, consumers, clinicians, physicians and employees, and to hear details about our HIE/RHIO solution.

NextGen

Booth 1242

Contact:
NextGen Healthcare Information Systems, Inc.
215-657-7010
http://www.nextgen.com/
sales@nextgen.com

Hospitals and practices use NextGen because we offer the market’s leading ambulatory EHR and practice management system, featuring interoperability with numerous inpatient systems, specialty content to ensure fast user adoption and standardized data capture, and enterprise architecture to support large, multi-specialty sites. Increase your operational efficiencies with a NextGen® system. Visit us at HIMSS booth #1242 and at the Interoperability Showcase.

NextGen Says: Learn from Next Healthcare how your hospital or practice can take advantage of reimbursements and grants that are available through the healthcare stimulus bill. Our government affairs department, and our grants and funding team are staying abreast of the latest developments. Grant money is now available for Indian Health Centers and for non-profit Community Health Centers. Find out how NextGen can help you.

Nuance

Booth 1448

Contact:
Elizabeth Swanson, Marketing Assistant
781-656-4300
elizabeth.swanson@nuance.com

The eScription platform from Nuance Healthcare is the leading software for computer aided medical transcription. With eScription, intelligent speech recognition software turns clinician dictations into formatted draft documents that medical transcriptionists-whether in-house or outsourced-quickly review and edit, often doubling productivity, reducing turnaround times, and cutting costs. Customers are continually satisfied with the eScription platform, resulting in a "Best in KLAS" award for the past five consecutive years!

Nuance Says: Come by the Nuance booth to see speech recognition solutions that can help your healthcare organization save costs and increase efficiencies such as the 5-time, Best in KLAS award winner, eScription.

PatientKeeper

Booth 2917

Contact:
Lauren Tilelli, Marketing Programs Manager
617-987-0465
www.patientkeeper.com
ltilelli@patientkeeper.com

PatientKeeper software improves patient care with a single information environment for physicians—available anytime, anywhere. We make this possible with integration technology that unites patient information across hospitals, physician practices, and communities. With PatientKeeper, hospitals and their physician communities are better aligned—to improve clinical efficiency, achieve patient safety goals and a healthier financial bottom line.

PatientKeeper Says: PatientKeeper says to stop by their booth to learn how you can extend your existing IT investment with hospital and community-wide connectivity – to improve physician affinity and establish a foundation for HIE. Also learn how PatientKeeper’s revenue cycle applications are helping facilities improve cash flow and uncover missing charges.

Premise Corporation   
(now part of Eclipsys)

Booth 2603 (Eclipsys)

Contact:
www.PremiseUSA.com
www.eclipsys.com

Premise Corporation, the nation’s leading provider of enterprise-wide, clinically focused patient flow solutions, is now part of Eclipsys – and Premise solutions are now Sunrise Patient Flow^TM. Endorsed by the AHA and used by dozens of top-ranked and magnet facilities, Sunrise Patient Flow is the only patient flow solution that provides automated workflow and communications coupled with clinical visibility in a single system – a unique combination that drives key performance improvements while also ensuring the highest quality care. And, now with more resources and a comprehensive portfolio of products, we’ll not only help you drive efficient patient flow processes, we’ll also help you achieve real outcomes in operational performance.

About Eclipsys
Eclipsys is a leading provider of advanced integrated clinical, revenue cycle, and performance management software, clinical content and professional services that help healthcare organizations improve clinical, financial, operational and client satisfaction outcomes. For more information, visit www.eclipsys.com or email info@eclipsys.com. For details on the Sunrise Patient Flow solutions, see the current Premise web site at www.premiseusa.com

QuadraMed Booth 2023

Contact:
12110 Sunset Hills Road
Reston, VA 20190
703.709.2300
http://www.quadramed.com

QuadraMed develops IT solutions that enable healthcare organizations to simultaneously improve the documentation, quality, safety, and efficiency of patient care along with coding, billing, and collections functions – from initial patient contact through discharge. QuadraMed’s Care-Based Revenue Cycle solutions help hospitals grapple with the business realities of healthcare: the need to achieve financial strength year after year so they can fulfill their mission of providing quality care.

QuadraMed Says: Take our survey at http://www.quadramed.com/himss09/ and receive a free gift!

RelayHealth

Booth 2051

Contact:
Janeen Cook
1145 Sanctuary Parkway, Suite 200
Alpharetta, GA 30004
770.237.7918
janeen.cook@relayhealth.com
www.relayhealth.com

RelayHealth provides you the ability to create a complete healthcare exchange connecting patients, providers, payors, pharmacies, financial institutions and pharmaceutical manufacturers. It offers interoperable, SaaS clinical, financial and pharmacy connectivity services which accelerate improvement in the quality of care, ensure financial health and create workflow efficiencies.

RelayHealth Says: Financially secure healthcare leader in search of providers looking to get connected. Should be open to long-term commitment to success and prepared to consider interactive solutions. Are you ready for a partner to rock your world? If so, visit RelayHealth at Booth #2051 and find out why you need to get Care Fully Connected.

Sage

Booth 4404

Contact:
2202 N. West Shore Blvd.
Tampa, FL 33607
813.202.5000
http://www.sagehealth.com

Sage Software provides solutions that allow practices to optimize the patient’s experience while enhancing the practice’s bottom line. Our industry-leading three-pronged approach includes products – including practice management, electronic health records and business intelligence software – thirty years of experience, and connectivity that enables electronic communication between practices and other providers, payers and facilities

Sage Software Says: Stop by to see how we connect practices to hospitals, laboratories, payers and patients. We’ll also show you how to make structured documentation look more natural and narrative.

Sentillion

Booth 743

Contact:
Jennifer Haas, Director, Communications
978-689-9095 ext. 262
www.sentillion.com
jhaas@sentillion.com

Sentillion has successfully combined patented technology with a deep understanding of the healthcare industry to deliver the most comprehensive set of solutions for single sign-on, identity management, clinical workstations and desktop virtualization. Sentillion is the only identity and access management company whose solutions are used daily by over 400,000 caregivers in leading healthcare organizations across North America and the United Kingdom.

Sentillion Says: We will be debuting several exciting new technology solutions and as part of this, guests will have an opportunity to win a Flip Video and other great prizes. Stop by and while you’re in our booth grab a drink (in-booth Happy Hours occurring Sunday-Tuesday, 4:30-6:00 p.m.) and pick up a Sentillion green fish plush toy.

Sentry Data Systems

Booth 7263

Contact:
John Peebles, CIO
800.411.4566
www.sentryds.com

Sentry Data Systems saves you time and money. Sentry offers healthcare business intelligence technology solutions that address a variety of operational, workflow, compliance, and financial challenges found within hospitals and pharmacies. These products include the hospital pharmacy management application Sentinel RCM™ (Revenue Cycle Manager), retail pharmacy transaction processing platform Sentrex™, and the healthcare business intelligence application HealthBIT™ (Business Intelligence Technology). These products run on top of Sentry’s healthcare cloud computing platform, Datanex™, which is available to independent software developers and other healthcare entities.

Sentry Data Systems says: TURN YOUR DATA INTO REAL TIME INFORMATION. In order to succeed and remain viable and competitive, hospitals and other providers need information to make decisions, which result in hard-dollars savings and revenue creation.

Sunquest

Booth 7522

Contact:
800-748-0692
www.sunquestinfo.com
sales@sunquestinfo.com

Sunquest Information Systems, Inc. delivers the market leading LIS and outreach solutions designed and implemented to fulfill the business objectives of today’s healthcare leaders. Built on the reliable technology required for mission critical applications, Sunquest solutions provide the foundation to optimize the healthcare experience; deliver safe, effective, and timely patient care; expand community reach; and transform the delivery of healthcare with predictive and personalized medicine.

Sunquest says: Sunquest proudly sponsors healthcare leaders speaking on the Five Rights of Laboratory Testing; how successful organizations deliver on the promise of safe, effective care; and what the future of healthcare IT might look like. Visit http://www.sunquestinfo.com/PressEvents/Pages/HIMSS09.aspx for the booth speakers’ schedule and to register for our limited seating breakfast presentation on Monday April 6.

TeraMedica Healthcare Technology

Booth 1248

Contact:
Katie Brahm-Barrett, Marketing Communications Manager
10400 Innovation Drive, Suite 200
Milwaukee, WI 53226
Toll-free phone: 866.290.8880
sales@teramedica.com
http://www.teramedica.com

TeraMedica Healthcare Technology’s Evercore ® – Clinical Enterprise Suite software solution connects images, documents, video, sound, or any other information to any EMR/EHR. Evercore provides vendor independence by connecting multiple PACS to any storage system, thus bringing an end to data migration. The solution also manages your data’s lifecycle with clinical-based policies.

TeraMedica Says: TeraMedica is Driven to Optimize – visit our booth #1248 to learn more!

– Driving increased referral revenue by enabling clinicians to work smarter and more efficiently

– Extending image content to the Personal Health Record and patient portals

– Enabling true control over clinical image content using clinically aware data retention policies

Vitalize Consulting Services

Booth 3055

Contact:
Cyndi Vely Cahill
Senior Vice President
610.444.1233 x103
www.getvitalized.com
ccahill@getvitalized.com

Vitalize Consulting Solutions, Inc. (VCS) provides a wide variety of clinical, business and IT solutions for healthcare enterprises across the United States and Canada. Our comprehensive range of programs and services includes system implementation, optimization, custom reporting, technology and integration, education and knowledge transfer in the Cerner®, Siemens®, Epic®, Eclipsys®, MEDITECH and McKesson solutions. Experience VCS. IT’s what differentiates us.

Vitalize Consulting Services Says: Be part of the solution at HIMSS. VCS recognizes that times are tough, so this year we are rallying our HIMSS audience to support one of Chicago’s overburdened food banks. Stop by booth #3055 to pick up a goodie and help erase hunger in the Chicago community.

Wolters Kluwers

Booth 1045

Laura Gilbert
Director, Marketing Communications
Clinical Solutions
612-313-1506
laura.gilbert@wolterskluwer.com
www.pointofcareapplications.com

From diagnosis and treatment to documentation and coding, Wolters Kluwer Health Clinical Solutions provides end-to-end software solutions and clinical content encompassing the full continuum of care under such universally recognized brand names as UpToDate®, ProVation® Order Sets powered by UpToDate® Decision Support, Medi-Span®, Facts & Comparisons® and ProVation® Medical.

Wolters Kluwer Says: Come discover how our software solutions – designed for clinicians, by clinicians – will streamline workflow, improve quality and safety, reduce costs and increase revenues across your organization.

News 3/27/09

From Skippy Van Oakes: "Re: Keith Hagen. Was the personal reason that he thought that QuadraMed shouldn’t be put up for sale? Chatter on the Yahoo! Finance boards would indicate a distinct possibility." The press release quote from interim CEO Jim Peebles made me wonder: "I am eager to focus on the ways in which the Company can further unlock its potential and increase shareholder value." His additional comments suggested more R&D and positioning for HITECH money rather than a change in ownership, but I understand those who assume quotes referring to shareholder value mean that all options are on the table. I like the company, QCPR is an excellent product, and they are a franchise when it comes to HIM technologies. Their only disadvantage is size compared to the competition. Some of the Yahoo posters took Oracle’s announced acquisition of Relsys this week as a signal of more healthcare interest, but clinical trials software offers a vastly different vertical sales opportunity than the average mid-sized hospital.

From ILoveLA: "Re: Cedars. I heard a rumor that the clinical project at Cedars-Sinai has been halted." I didn’t hear that, but I did hear they got rid of a bunch of Perot people and replaced them with Deloitterers. That’s not verified, but the source who told me should know.

From New York Cynic: "Re: RealAge. They just set back PHRs and online health information technology about a year." No doubt. Over 27 million people have taken the 150-question RealAge test on the Internet, which purports to calculate your biological age based on personal characteristics rather than date of birth, but was actually collecting targets for drug company advertising, including specific quiz answers and e-mail addresses. RealAge says it discloses everything and doesn’t let the advertisers have the data. Scumbags or not? I’m leaning toward no (the communication came directly from them and users should have expected the worst given the vague privacy agreement), but I bet smoke is coming out of Deb Peel’s ears for their using patient information to kick off personalized marketing blitzes. If we’re ever going to control healthcare costs, can we afford to let wiley drug companies hard sell to often clueless consumers and their customer-friendly doctors willing to oblige? Also gone unnoticed by most: RealAge is owned by Hearst (which paid $100 million for it in 2007), which also owns First DataBank, Zynx Health, and Medscape. This guy saw it coming: "I would think that the 8 million submitters of private medical information would feel a little uncomfortable when their data got acquired by a major publisher, but I haven’t seen any real journalists exploring that angle yet. Oh well, at least it wasn’t a life insurance company."

From Victor Franko: "Re: Emergisoft. Joe DeSilva was probably the best thing to happen to Emergisoft in its history. The company’s bottom line was better, the product was significantly improved, employees were motivated, and customers were happier than before he started. I’m disappointed that the company didn’t have the class to recognize his contributions."

From Bobby Orr: "Re: Eclipsys SCM. Look for announcement of a major SCM win at prestigious teaching and research organization in the Northeast."

From Cleon Jones: "Re: Sutter. A major obstacle in its implementation was organizational and process (making decisions upfront, defining realistic charters, establishing governance, and managing user expectations). They are prime time for a Federalist champion or a good organizational management consultant looking for a challenge. Their IT budget is allocation to individual affiliates and there is not tight corporate governance, so there is little corporate funding available. Consider the first implementation a prototype evaluation."

From Home Provider: "Re: medical homes. A report says their savings will be less than or equal to the monthly fees paid since they will be serving too broad-based a population." Link.

I’m hearing that Orlando Portale, CTO of Palomar Pomerado Health, may be under consideration by House Speaker Pelosi as her appointee to the government’s new HIT advisory board.

A UK hospital chooses MEDITECH v6.0 EPR, a big win given the hospital’s huge project budget and planned scope.

I’m hearing a little buzz that economic pressures are causing some vendors to claim they can’t integrate with third-party systems or, when that doesn’t discourage the customer, charging them a high interface fee plus annual maintenance. Apparently they would rather not share the sandbox play-time, so they are taking their ball and going home. The government and customers want interoperability, but it’s not in the best interest of vendors to allow too much customer independence. That will be interesting to watch. 

Bankrupt Nortel Networks, praying desperately for stimulus crumbs, will demonstrate some new IVR applications at HIMSS.

A UK hospital is chastised for scrapping PCs still containing patient medical records.

Health Robotics announces the early release of its ivStation Profile at a Dubai conference, a biometrically secured IV dispensing system similar to profile-secured dispensing cabinets like Pyxis. Gaspar DeViedma, formerly of Eclipsys, works for them.

HIStalk odds that Rob Kolodner will cash in on his ONCHIT stint by taking a high-level, mostly ceremonial vendor or lobbying job instead of heading back to the VA: eight to one.

McKesson is testing the UK HIT waters for a return following its failure to win NPfIT contracts in 2003, but also after project stumbles opened the field back up again.

Part 4 of our HITECH vendor question series is up on HIStalk Practice.

It’s hard to believe this survey’s conclusion, even though it does appear in JAMA. Only 1.5% of US hospitals have comprehensive clinical systems running in all units, with the number increasing to only 7.6% if you count just one or more units. CPOE for meds is at an embarrassing 17%, with 45% of respondents saying they have no plans to implement it at all. The decision support survey elements are skewed, obviously allowing respondents to count them as implemented even if not for physicians (example: only 17% do meds in CPOE, but 46% say they have drug-allergy alerts, obviously in the pharmacy system). You might argue whether some of the requirements to be considered "comprehensive" are really practical the way vendors have designed them (physician notes, drug-lab interactions, and nursing assessments), but those are not unreasonable criteria. The EHR-less hospitals blamed upfront cost nearly 3/4 of the the time, while a third questioned ROI and the abilities of their IT shops. So, smug hospital types snarking on poor physician EMR adoption have little to brag on since penetration may be higher in practices even though the excuses are the same. So, assuming Santa Obama defuses the major argument by using our money to buy EMRs, where will hospitals get all the IT and informatics resources? (not to mention that the ROI gets better when someone else pays, but the overall benefit doesn’t change). And if you thought the 1.5% number was appalling, consider this: having it running doesn’t mean using it to improve care or reduce cost, it just means it’s available.

New York Presbyterian gets a CNBC mention for using CPOE to reduce adverse drug events by 80%. Watch closely and you’ll see Eclipsys SCM on the screen.

At least this data breach involves paper: a Mass General billing manager leaves a stack of charge slips on the Red Line T, including treatment information (for an HIV-positive patient, in the newspaper’s example). That patient’s anger is the opposite of what we IT people usually hear: "I was really angry at first because I thought everything in the hospital was supposed to be electronic and things wouldn’t get lost, and to find out someone took their work home, private information wasn’t supposed to be taken home, … to find out it was left on the subway, that wasn’t cool. It wasn’t secure. It wasn’t in a briefcase. It was secured in a rubber band."

CareTech Solutions, ranked #1 in KLAS for extensive IT outsourcing, announces the launch of its US-based technical and clinical information system support for hospitals, including proactive system monitoring. Continuum Health Partners (NY) has already signed up.

An interesting quote on Wal-Mart’s selling of eClinicalWorks: "I often state that Wal-Mart is not a store, it is an Information Technology company. Their servers in Arkansas have the capacity to store everything on the internet two times over. It is in the area of electronic health records where they may have the most impact, through EHR software sales and applying EHR standards to millions of future customers in their health clinics. If it were king of Wal-Mart, I’d go ahead and store a patient’s records on their Wal-Mart Money Card. Why not? Wal-Mart may also become the largest referrer of medical care in the nation, by sending patients in their clinics to physicians when those patients have more serious healthcare needs. Ask a doctor, referrals are the lifeblood of a medical practice."

The rumors were apparently correct: IBM will fire 5,000 Americans and ship most of their jobs off to India, increasing the number of foreign workers it employs to even more than the current 71%. I guess that’s where the "I" comes from, leaving just a lot of BM to save healthcare now that Uncle Sam’s money has made it worth their time. So buying a US-made Toyota is not buying American but hiring IBM and its mostly offshore workers is? Rumor is Big Blue is smelling the pheromones of Satyam, too.

I had a good personal EMR encounter today. My doctor’s clinic uses them (Centricity, I think) and has integrated them nicely into the practice. I checked out the screens and they were very logical and easy to use. All my info was in there, easy to find, and even though the monitor was badly placed (on the desk, meaning his back would be to the exam table), he didn’t really focus on it until we were nearly finished. He would have use eRX on my prescription except I had no idea where we get them filled (that’s a Mrs. HIStalk task) so he printed off a quite nicely formatted copy. I don’t know how much work he has to do after hours (forgot to ask), but as a patient, it was definitely no worse than a paper chart and probably better. The assistant was pretty comfortable logging my vitals in there, too. Best of all, I left there better than I went in, always a crapshoot in our expensive but inconsistent healthcare system.

An interesting NEJM editorial by new ONCHIT David Blumenthal states his opinion that CCHIT’s certification is fine for covering basic capabilities, but doesn’t address user-friendliness or their suitability to meet HITECH’s quality and cost goals. Also, an interesting disclosure: GE’s paying him.

Sheldon Razin, chair of Quality Systems, Inc. (parent of NextGen), is awarded the 2009 Excellence in Entrepreneurship award from the Orange County Business Journal.

St. Mary’s Medical Center (WV) is lauded by the local paper for its use of APACHE in managing ICU patients. They credited it with saving 21 patients. I’m too lazy to look it up, but I seem to remember that Cerner bought it awhile back.

E-mail me.

HERtalk by Inga

From LTC: "Re: Twitter.Take a look at my page. I’ll shamelessly admit that I thought of your sexy LinkedIn & Twitter pic when I posted mine!" LTC includes the following in her bio: Driven hospital software seller by day, pastry chef wannabe with a shoe fetish nights & weekends. Obviously she’s now my new BFF.

Beth Israel Deaconess Medical Center (MA) reduces the number of planned layoffs from 600 to 150, following $350,000 worth of donations from department heads and various cost-cutting measures.The 13 medical department leaders pledged enough money to save about 10 jobs (very nice.) Beth Israel is also delaying raises, temporarily reducing benefits, and offer some employees early retirement.

Capario (the company whose name I still haven’t figured out, but I’m careful to include only one ‘R’) announces three new contracts with provider groups to help members reduce claims processing costs and improve RCM. In case you missed it, Capario was formerly know as MedAvant.

Mr. H just bought me some cool new software that improves my ability to post photos. I have it just in time for HIMSS, so please pack your camera and share your pics with us. We’d particularly love some shots from the HIStalk/Ingenix soiree, as well as any other parties you attend (since Mr. H and I haven’t been invited to many and we want to see what we are missing.) If the exhibit police don’t stop you, send us photos of your picks for best and worst booths. Of course, shots of fancy shoes are always exhilarating.

PinnacleHealth (PA) selects MobileMD to provide its HIE and Enterprise Access technologies and services.

Spectrum Health commits to a three-year contract with MEDSEEK to create an "interoperable eHealth ecoSystem." I think that is a fancy way of saying Spectrum is going to use MEDSEEK’s products to connect its hospitals, providers, consumers, and patients.

Grad student Valerie McCleary wins the 2009 Beacon Partners Scholarship, worth $7,000 and an all-expense-paid trip to HIMSS. She’s working on a Masters in Arts in Health Informatics and Information Management at the College of St. Scholastica.

The Louisville HIE picks 3M Health Information Systems to provide its EHR banking system and interoperability solution. InterComponentWare (ICW) will design and build the HIE network to provide free health record banking services to the greater Louisville area.

Faculty members from Wake Forest and Duke University collaborate on a commentary that stresses the need to clarify the legal ownership of patient records. In order to make use of potentially valuable clinical data for medical research or improving patient outcomes, regulators must create a new system of patient-initiated control of health records.

Pharmacy OneSource, a SAS solution-provider for pharmacy applications, announces two new hospital system clients. Lehigh Valley Health Network (PA) has implemented the Sentri7 and Quantifi systems and Bethesda Memorial Hospital (FL) is now using  ScheduleRx.

Allviant, a division of Medicity, joins the Arizona State University Center for Services Leadership. Allviant’s president Lilian Myers has also been named to the center’s advisory board.

The bankrupt BearingPoint consulting practice plans to sell substantially all of its businesses as part of a restructuring agreement with its senior creditors. No word on who’d like to buy the healthcare consulting segment.

FusionCIO interviews Kaiser Permanente CIO Phil Fasano and asks him about KP’s decision to outsource IT services to IBM. Says Fasano, "We spent an awful lot of time and energy looking at our operations and looking at organizations around the world that had capabilities that could partner with us and help us to really accelerate the high performing IT function that we have at Kaiser." Does that mean KP believed they weren’t getting it done on its own?

A CDW survey of HIT professionals finds that hospitals that spend 40% or more of their IT budgets on infrastructure have more providers reporting "outstanding" performance from their clinical applications. Hospitals spending less money had only 29% of their providers report outstanding performance.The survey also found found that 67% of respondents described applications as "critical" to patient care compared to 50% who believed infrastructure was critical to patient care. CDW sells infrastructure, as you might have inferred.

A NEJM article  concludes that putting more money into existing HIT may be the wrong approach for delivering long-term benefits. Instead, the authors recommend that HHS mandate development of a new platform that will support a variety of individual applications, making the data "liquid" and providing an easy way for providers to change systems. Good authors: Kenneth Mandl and Isaac Kohane, both MD/PhDs from Children’s Hospital Boston’s informatics program.

AARP publishes a list of top hospitals, based on surveys of physicians and various hospital ratings.The magazine also created an interactive map that lists the top-ranked hospitals by geographic area.

E-mail Inga.

News 3/25/09

From GoSox: "Re: ONCHIT. Glaser to take six-month post as Blumenthal’s operations guy." John had shared his plans with me earlier, so your rumor report was an excuse to pester him to say something on the record. He did: "I am planning to spend six months at ONC, beginning in early May, as a Special Advisor to ONC. I will retain my position as CIO at Partners and be on loan to ONC. I plan to work with ONC and the field to help develop the programs and plans needed to implement the healthcare IT portion of the Stimulus Bill. There are still some i’s to dot and t’s to cross so this is arrangement is not final. I look forward to the opportunity to work with the Federal Government and all of the healthcare stakeholders."

From Dwarf: "Re: rumors. A former employee says Medhost let 12 people go this week (unverified). Also, at a recent ENA conference, Emergisoft did not man their booth and sales people were allowed in to inquire about new jobs."

From The PACS Designer: "Re: Fugoo. TPD loves digitally connected solutions and now there is another one called Fugoo. This new solution is for a Digitally Connected Appliance or DCA. So, if you want to access your coffee pot to brew java via a wireless network, you add a Fugoo box to a coffee maker that is Fugoo-enabled. Only problem is there are no Fugoo-enabled devices that will be available until the holiday season later this year!" Link.

From CYA: "Re: escrow agreements. CIOs need to review their software escrow agreements (and review the whole contract while you are at it). Worried about a vendor? Pull the contract right now. It is prudent to demand a statement of financial viability. If you cannot get such a statement from a vendor, you will at least have on file that you requested it and were thinking proactively. Your CFO may need proof of your request in the event of an issue arising. This is simple CYA work that one health system is requiring as a result of a recent failed vendor and the fallout that ensued. Remember the old adage ‘no one gets fired for choosing IBM’. There are bound to be a few mid-and small-tier vendors that do not survive in this economy. Ask your account manager if there have been layoffs at their firm. If the answer is yes, dig deeper. Build a contact list of other client facilities (CIOs) in the event you need to learn how other IDNs are handling the issue of a closed vendor. If you enforced an escrow agreement in your contract, build in contingency plans for execution of this escrow NOW for vendors that may be on the rocks. In most situations, the language for these escrow agreements is boilerplate fodder without much in the way of specific step-by-step procedures. Ask yourself if you truly have the staff to maintain a system if a vendor closes (even if you do have the escrow). Once a vendor starts cutting staff (intel), it is too late to make an escrow agreement have any value in terms of how you actually implement what has been escrowed … you only become ESCREWED. Additionally, make certain you obtain the PERSONAL contact information for key IT personnel at your vendors. The vendor will not provide this, so ask these personnel (those you know) for it directly. If personnel are let go from a vendor due to layoffs, those personnel become your assets during a product transition wait period. If there are any others that have experience (pro and con) with the escrow process when a vendor has closed its doors, please chime in. Hopefully you do not experience this, but given the economy you need to make this often overlooked CYA process a top priority in your IT department."

From Pat Patterson: "Re: Carilion losing money. Holy mismanagement, Batman! This the same company that was profiled in the Wall Street Journal recently as a near monopoly. In their profile, WSJ showed how the Roanoke region’s insurance costs went from lowest to highest during Carilion’s domination and subsequent raising of rates."

From HIT Insider: "Re: Sutter. It’s my understanding that many of the hospitals are not planning on switching to Epic due to the high costs, and will stick with the original vendor. I think Eclipsys has a few clients in the Sutter Health universe. Not sure who else."

From Dock of the Bay: "Re: Sutter. I am not at all surprised. As an outside M developer, I was amazed at the costs involved. Almost reminded me of the TARP bailouts. The money never seemed to stop. The second thing that made a big impression on me was Epic and their lack of interest in working with outside developers. I’m not sure if they wanted all the money for themselves, but it made for difficulties when trying to support the project. As a fan of open source software, I think I would have been inclined to go with VistA (VA) and develop it for user needs and requirements. The cost of the basic software is certainly not an issue. Free!"

Monitor 3 reported over the weekend that Joe DeSilva, CEO of EDIS vendor Emergisoft, had left the company. I e-mailed a contact there for a statement. Newly announced CEO Jordan Davis, a former regional sales VP who took the CEO job Monday, e-mailed me that same day. "Thank you for your inquiry and the opportunity to address recent events. Much has occurred in our industry, and Emergisoft is certainly not immune to the pressures that other healthcare software companies and providers are experiencing. We have recently realigned the company to meet the challenges of our clients, our investors, and the economy. The tough decisions have been made, but they are now behind us, and they were designed to grow the company, not shrink it. Our realignment has strengthened the chief executive position, bolstered our financial structure, and positioned Emergisoft to efficiently deliver our CCHIT-Certified ER solution to our clients and to the market. Our commitment to superior client satisfaction is the primary driver in all we do, and that will continue. I look forward to meeting you at the HIStalk reception. See you at HIMSS, booth #8051." I admire that, actually, jumping right in there with a personal and straightforward e-mail, pitching the booth number, and mentioning the reception. I’m sure he would be happy to say hello if you’re inclined to drop by the booth.

QuadraMed President and CEO Keith Hagen steps down for personal reasons, replaced in the interim by James Peebles, a company director and industry long-timer. His stated goals are to increase R&D, get QCPR certified by CCHIT, and to increase shareholder value. A national search is underway for a permanent CEO. Also announced: CFO/SVP David Piazza will take on additional responsibility as COO.

An OB-GYN sues a Utah hospital, claiming the CEO forced him out and that nurses falsified charts to make him look bad. He also claims he dictated a chart note that contradicted the nurse’s fraudulent changes, but the hospital deleted it from the EMR. The HIPAA audit trail should prove it one way or another, and surely the hospital won’t publicly claim that its systems don’t have one.

Penn researcher Ross Koppel’s new JAMA article concludes that healthcare IT vendors enjoy contractual and legal protections that keep them out of trouble even when their products cause patient harm.  Anyone who has signed a vendor contract from either side of the table knows that vendors disclaim most responsibility, saying it’s the licensed user’s job to notice software or hardware errors and prevent them from harming patients (like when an allergy warning doesn’t display or a dose is calculated incorrectly). HIMSS unleashed a vindictive and wildly pro-vendor barrage against Ross in 2005 for daring to write an article describing patient harm that occurred with a hospital’s IT implementation, but I expect they’ve got bigger, multi-billion dollar fish to fry this time.

Listening: American Hi-Fi, excellent and refreshing pop-punk with highly melodic guitars, somewhere between the Pixies and Cheap Trick. My head’s tired from bobbing. Kind of like when Mrs. HIStalk sat me through the Mama Mia DVD last week, a truly horrible non-movie with no plot, no singers, and no problem keeping my attention because I really like ABBA music despite all the theatrical distractions (Slipping Through my Fingers and Waterloo were always my favorites, so now they are re-stuck in my head after decades because Bjorn and Benny are genius songwriters).

Ricky Roma’s piece drew some fun interest, as I expected. I hope his cheek is OK from having his tongue jammed in there for all that time. Agree with him or not, he’ll make you think.

Irritated sent over an internal sales memo from his or her big vendor employer, part rah-rah and part carefully cushioned reorg news. I’ve never worked in sales, but every announcement I’ve read says the same thing, so the vendor here makes little difference: we’re doing great but we have to cross the goal at the end of the quarter, we have to get at every deal table and fight for market share, we need to be more agile and show more knowledge in the sales process, we will move to regional sales teams with specialty team backup, and we must reduce sales cost by cutting duplication. The same thing everyone else is doing, in other words. They should bring in Ricky Roma.

GetWellNetwork adds two pediatric content suites to its PatientLife System, some of the eventual 160 educational titles that KidsHealth (part of Nemours) will create for PatientLife.

The folks at Clinical Architecture, who do clinical content and decision support consulting for vendors, are offering a free 15-minute consulting session at HIMSS. 

You may have noticed the cool magazine-style layouts that we make available as part of HIStech Report (like this PDF). A freelancer does these for me and he’s looking for more print publication and layout work. If you’re interested, let me know and I’ll connect you with him.

UpToDate clarified their subscription options for patients seeking evidence-based health information. Some topics are available via free online access, but the full version is available at $19.95 for a week or $44.95 for a month.

E-mail me.

HERtalk by Inga

California’s attorney general files a civil lawsuit against seven private medical laboratories, claiming they defrauded Medi-Cal of at least $100 million by regularly overcharging the state for tests by up to 400%.

Shands HealthCare (FL) selects Micromedex CareNotes System from Thomson Reuters to improve patient education across its eight hospitals.

Demand for drug and alcohol rehab centers is on the rise as the global economic crisis grows, with current or former financial professionals making up a good bit of the volume.

St. Mary’s Hospital of Michigan activates Eclipsys Sunrise Pharmacy in an on-time, under-budget project. 

Martin Memorial Health Systems (FL) adopts TractManager’s Conflict of Interest Disclosure Statement system to capture and track disclosures of board members, committee members, and physicians. Sounds like something our new administrator might want to look into.

Jackson Memorial Hospital (FL) notifies the public that a disk drive that contained the driver’s license information of 200,000 visits was stolen earlier this month. Authorities believe the theft target was the disk drive rather than the data (how do they know?)

PatientKeeper announces that its client base doubled in 2008 to over 30,000 users from new customers and expanded installations, triggering a 40% growth in head count and the hiring of two new executives. 

RSNA appoints Mark G. Watson to executive director, the position he has held on an interim basis since September. He’s been an assistant executive director for the last 15 years.

Fremont-Rideout Health Group (CA) selects QuadraMed for its revenue collection process. The three-hospital system is supposedly replacing applications from Allscripts-Misys and 3M Health Care with QuadraMed’s Revenue Cycle and Quantim Health Information Management solutions.

Nuance Communications summarizes the radiology workflow and productivity improvements at three different RadWhere installations.

Physicians Medical Group of Santa Cruz County (CA) implements Elysium Virtual Health Record from Axolotl.

A quick peek at the weather forecast has me convinced that spring has not yet made its way to Chicago. At least my version of spring.

One in five American workers are uninsured, according to a new study, a big jump from the one-in-seven number of the mid-1990s.

IV maker Hospira hopes to save about $150 million by eliminating 10% of its workforce over the next 24 months.

A California HealthCare Foundation report concludes that patient kiosks improve satisfaction by reducing waiting times and offering greater privacy and convenience, but less than 10% of hospitals have implemented them.

HIT vendors are experiencing above-market stock performance since President Obama’s election. Investors believe that the government’s economic stimulus plan will benefit companies such as athenahealth, NextGen, Cerner, and Allscripts.

Cleveland Clinic selects Infolinx WEB by Infolinx System Solutions for the tracking of study-related patient files. The solution includes RFID capabilities to manage paper records.

E-mail Inga.

News 3/20/08

HERtalk by Inga

From: Telephone Man. “Re: New iPhone OS. Yesterday Apple released iPhone OS 3.0. In the presentation at minute 43:35 Apple introduces J & J Life Scan, a Glucose monitoring device application. I would expect a flurry of healthcare iPhone applications (*cough,cough*) to come out over the next few months, now that iPhone 3.0 has been seeded.”  Agreed. In addition to the introduction of new applications, users like me will appreciate the little things such as the ability to cut and paste between applications, attach photos in text messages, and view email in landscape mode. Apple did not announce a release date.

From: John Boy. “I wanted to let you know how much I appreciate all the work you guys do in keeping us informed of all the happenings in healthcare. You’re like a reach arm for all of us out here and I can’t imagine how much time you put into it. I look at it every day to see what’s happening.”  Thanks. It does take some time, which is why I am not too surprised Mr. H (or perhaps Mrs. H) selected an Internet-less vacation destination.

Speaking of Mr. H, he’ll be back with the Monday Morning update sometime this weekend.

If you are interested in hearing what 12 of the leading EHR vendors are saying about the passage of HITECH, visit HIStalkPractice or click on one of the links to your right.  The two latest questions: “How is your company defining “meaningful use” of an EHR and how will ensure your customers can reach that level?” and “Providers will be required to implement ‘certified’ software to participate. Who should perform the certification and what criteria should they use?”

President Obama appoints David Blumenthal national coordinator of HIT.  Blumenthal is a Harvard medical professor and director of the Institute for Health Policy at MA General Hospital.

A Center for Connected Health study concludes that online diabetes management programs may improve the quality of care delivered.

Cumberland Valley Medical Services selects Advantedge Healthcare Solutions to provide medical billing and practice management services for its 23 employed anesthesiologists and CRNAs.

A study commissioned by the Pharmaceutical Care Management Association concludes that as e-prescribing rates rise, savings will more than pay for the $19 billion in economic stimulus adoption incentives. The report claims that if current e-prescribing rates were to double, it would result in a $22 billion reduction in drug and medical costs over the next 10 years.

Medsphere Systems invites 16 HIT consulting companies to participate in its new Medsphere University training and certification program. MaxIT is the Medsphere’s first “certified partner.”

Two studies by CSC conclude that financial incentives contribute to the overall HIT adoption rates. The analysis examined CPOE adoption rates among Massachusetts hospitals, the use of e-prescribing, and the use of EHR among ambulatory physicians. Adoption rates for these activities were significantly higher among Massachusetts providers than the rest of the country. The report attributes the success to the number of financial incentives available to providers.

Former Eclipsys sales executive Greg Lusch joins scanning technology vendor IBML as business development director for the healthcare market.

MedAptus raises $6 million in financing, led by Boston Millennia Partners. MedAptus intends to expand its Intelligent Charge Capture software offerings.

Google selects MIE’s WebChart Enterprise EHR for its two onsite employee health clinics.

Authentication and access management vendor Imprivata announces that Box Butte General Hospital (NE) has implemented the OneSign Platform.

The mayor of Monroe, LA is pleased by CPSI’s decision to open a new call center in his town. CPSI’s expansion is expected to create 100 new jobs over the next three years.

BCBS of South Carolina selects Med-Vantage’s HealthSmart Enhanced Provider Directory and Measures Exchange solutions to improve improve consumer transparency.

State lawmakers in Hawaii introduce a bill to build a statewide HIE that would be managed by a state coordinator.

Cardiovascular Specialty Services of North Texas (CSANT) contracts with Greenway Medical Technologies to deploy Greenway’s PrimeSuite and PrimeEnterprise EHR/PM solutions. CSANT is a 50 physician, 18-location specialty group.

MMR Information Systems partners with The Latino Coalition to offers MyMedicalRecords PHR in both English and Spanish. Felicitaciones!

McKesson Specialty Care Solutions introduces a fully integrated e-prescribing solution for oncologists and other specialty physicians to participate in Medicare’s E-RX incentive program. Using RelayHealth’s eScript, providers will be able to electronically file medication renewals and refills directly from McKesson’s Lynx Mobile solution.

Medical transcription service provider MxSecure successfully completes a document management software interface at Roanoke Neurological Associates (VA). The interface allows transcribed documents to be imported into the practice’s Allscripts document management system.

RCM vendor Medical Data Systems promotes Gene Schneider to chief operating officer.

Frost & Sullivan presents GE Healthcare the award for Growth Strategy Leadership of the Year, in recognition of the growth of its imaging informatics business since acquiring Dynamic Imaging.

Massachusetts General Hospital and North Shore Medical Center contract with BridgeForward Software to help with HL7/EMPI integration for a new ambulatory care center. Radiologists from both hospitals will use BridgeForward’s Viaduct platform to integrate reports from Massachusetts General’s RIS to North Shore’s PACS.

FQHC HealthNet in Indiana receives a $2.5 million grant to equip its 110 providers with the eClinicalworks PM/EMR solution.

Email Inga.

News 3/18/09

HERtalk by Inga

Kaiser Permanente plans to cut 860 workers at its data and IT centers as part of a $500 million outsourcing deal with IBM. Included in the seven-year deal, IBM will take over most of KP’s data operations, affecting about 700 employees.  Most of the affected staff is based in California, though KP also announces layoffs for 160 more employees across the country. KP CIO Phil Fasano says that about 40% of the displaced employees will find jobs within IBM. KP says that the average laid off employee will receive eight months worth of pay and benefits. Our condolences. fds

On HIStalkPractice, we just posted the first in a series of five questions posed to 12 vendor executives.  The topic centers on the HITECH stimulus package and its impact to electronic health record.  This first question:  What changes will your company or area make, both for the short and long term, in preparation for HITECH legislation?

As I was working on our Second Annual HIMSS Information Guide, I noticed that Vitalize Consulting Solutions is teaming up with the Greater Chicago Food Depository to raise food and funds for the Chicago needy. The Vitalize folks tell me they are taking monetary donations at the booth, as well as promoting a virtual food drive. They’ve also sent packages of soup mix to attendees around the country.  If you were a lucky soup mix recipient and bring it by Vitalize’s book (#3055), Vitalize will donate both the soup and one dollar. LOVE it.  Much better than all those trinkets that won’t fit into your suitcase. 

Johns Hopkins chooses the LiveData OR-Dashboard solution.

IBM announces a research project with Brigham and Women’s Hospital (MA) to create an online radiology theatre to allow teams of medical experts to simultaneously make rounds on a patient via a Web browser. Using live streaming audio/video, medical experts will be able to discuss and review patient data and post analysis.

The US DOD Military Health Systems commits to a $2.4 million deployment of VisualDX, a database created by Logical Images that includes 900 visually identifiable diseases and clinical information.

Virtua Health (NJ) selects Microsoft Amalga for its four-hospital system.

Blessing Hospital (IL) contracts with Eclipsys to deploy Sunrise Enterprise revenue cycle solutions and integrate them with Blessing’s existing Sunrise clinical solutions.

St. Joseph Medical Center (MD) brings in an outside “restructuring team” to manage the hospital, after the CEO, COO, and VP of operations take administrative leave. The executives took leave two weeks ago amid a federal investigation involving the hospital’s relationship with a physician group.

Heatlhcare management firm Beacon Partners hires former Poudre Valley Health System CIO Russell Branzell as a vice president.

A Deloitte Services survey finds that 56% of us want access to a online PRH connected to our doctor’s office and 55% want to communicate with our doctor via email. In addition, 68% of consumers are interested in home monitoring devices and 38% are very concerned about privacy and security.

HIE technology provider Accenx is now offering fully managed, remote hosting of Initiate Patient for its healthcare clients. OhioHealth is the first customer to use the combined solution.

Just exactly does this happen? A Shreveport, LA grocer finds stacks of medical records and MRIs in the dumpster at his store. The charts are as recent as 2006 and belong to a local doctor.

Email Inga.

Monday Morning Update 3/16/09

HERtalk by Inga

From: Sundance Kid. “Re: Anthony Rodgers joining the Office of the National Coordinator? Tony is a very HIT-savvy leader currently Director at Arizona Health Care Cost Containment System. One well placed call from Head of Homeland Security to Secretary of HHS and he is in!” Not sure if this means that Rodgers would want the DC gig.

From: Johnny B-good. “Re: Hospital CEO salaries. I hope that the same rules are applied to the Banking Execs who’s salaries I’m paying (unlike these Hosp execs.).”

USF Health and Allscripts initiate a pilot program called Paperfree Tampa Bay that aims to convert 100 percent of physicians in the Tampa Bay area to electronic prescribing. Program leaders view this as a first step toward the implementation of EHR in the region and is expected to create 100 jobs in the region. We chatted with Allscripts CEO Glen Tullman about the initiative, and have posted the interview on our HIStalkPractice site.

President Obama nominates NYC health chief Margaret Hamburg commission of the FDA.

HIMSS claims that total conference registration “parallels” last year’s record-breaking figures during the same time last year. The numbers suggest that those staying home to save money seem to be balanced by attendees making plans to learn more about how to get their share of the stimulus pie.

Here’s a study that many vendors may hope gets swept under the rug. Researchers from the University of Minnesota find that the use of HIT has little or no effect on patient safety. The AHQR-funded study also suggests it may be “too early” to judge HIT’s overall effectiveness.

Surgical Information Systems now integrates with Cardinal Health’s Pyxis Supply Technologies.

According to the local paper, Catholic Healthcare Partners (OH) is nearing a decision to invest $100 million over the next five years for an unnamed EMR. The organization includes 32 hospitals across the Midwest.

KLAS releases a report entitled “The Rise of eClinicalWorks: Separating Fact from Fiction.” KLAS examines why ECW is growing faster than any other EMR vendor and whether if it could sustain the grown and still provide effective support. While customers expressed strong satisfaction on functionality and cost, support was noted by many users as the worst aspect of their ECW relationship. Users also claim that integration with other clinical systems was a challenge.

MedAvant Healthcare Solutions changes its name to Capario to better reflect the company’s revenue cycle solutions and renewed focus on growth. OK, I give up. What does “capario” mean anyway?

Document indexing vendor InDxLogic names Susan Thomas to its board of directors. Thomas is the former Chief Medical Officer for GE Healthcare ITS.

Baton Rouge, LA implements a telemedicine program that allows ED doctors to begin testing patients as they are being transported by ambulance. Funds for the BR Med-Connect program came from the US Department of Homeland Security. Can someone explain the Homeland Security connection?

Ochsner Medical Center (LA) posts ER waiting times online, giving patients the chance to select which of Ochsner’s four hospitals can see them the soonest.

Current and former physician employees of Medical Edge Healthcare Group (TX) file a suit against the company, charging them of improper billing and practices that violate state laws prohibiting corporate control over physicians. The doctors say Medical Edge used “deceptive accounting practicing” and charged them unfairly for taxes, benefits and other expenses.

Fifty physicians are set to receive their first rewards for participating in New Jersey’s Bridges to Excellence Program, which is designed to recognize and reward providers that demonstrate safe, timely, effective, and patient-centered care.

Meridian Health (NJ) selects TeleHealth Services to provide television-based services in the patient rooms of three hospitals.

San Mateo County (CA) pays the federal government $6.8 million to settle charges that the county medical center intentionally inflated its numbers of acute care beds in order to receive bigger Medicare payouts. San Mateo claims that any overstatements were unintentional.

The American Hospital Association reports that 53% of all US hospitals reported overall losses in the fourth quarter of last year. The aggregated overall margin for the quarter was -8%, compared to a positive 5% for the same quarter in 2007.

Third-party benefits administrator First Service Administrators appoints CareMedic CEO Sheila Schweitzer to its board of directors. 

Mr. H is taking a few days off, so the posts this week may be short and sweet. Email me.

Readers Write 7/31/08

Mike Gleason on Reasons Small Practices are not implementing EHRs a fast as we would like

A little history on me so you don’t think I’m some new hire right out of training class.

I first started in this field known as HIT in 1984. After completing a run in Washington DC as a Manager of a third party maintenance company I decided the switch to hardware support for a small company, (who doubled my salary) would be a great move. The second week at my new company as the new hardware support guy, every software support tech quit. Yep, both of them. Not due to me, mind you, but due to “budgetary constraints” or some people would say bounced paychecks. I had already bought my groceries for the week and I was able to stick it out till new checks were cut next Wednesday. (One time where it paid to get a keg vs. 2 or three 12 packs). I figured, “How hard could it be to support Medical software” and cracked open the user manuals and then quickly developed a relationship with my vendors phone support. And like all pain in the rear VAR’s I eventually worked directly with the president of the company. (Articulate Publications, Medicalis and Dentalis) He was also one of the chief software designers. Back then CEO’s still knew how to code too. I think Bill Gates retiring has completed that run as CEO’s who also code.

My journey of 24 yrs has lead me through titles of account manager, territory manager, inside sales, regional sales manager, Project Manager, Implementation specialist and a host of other titles with 3 prominent HIT companies.

Being an EHR implementer for the past 7 years has given me (I think) a unique perspective on why Dr’s make decisions and defer decisions. It differs for most Physicians’ but I think I can provide a few reasons. I’m sure it applies to all of us as well.

1. Fear
2. Ego
3. Money
4. War Stories
5. No one wants to go first
6. Product not perfected yet
7. Waiting on Govt mandates
8. Waiting on hospital install or Stark gift
9. I have people for that
10. Change

Fear

We all have it but MD’s and Nurses often fear the EHR implementation more than taking a rectal temp. Doctors don’t want to appear inept in front of their patients, nurses don’t want to feel inadequate when they are used to getting what they need in a few lines in a chart. Both have invested years in education and residency training and this little laptop can erase all that prestige in one office visit. Many clinicians start off training with these fears.

A proper implementation can alleviate most of these fears. Small steps like outlining the install process. Training the practice to customize their EHR so they feel comfortable making changes. Implementing in phases to minimize the changes. Outlining workflow ahead of time and training to your workflow documents are a few ways to calm fears.

I also like involving all levels of the practice in the implementation; this allows the whole practice to own the process.

So not only MD’s, NP’s, PA’s, LPN’s, RN’s and MA’s but also the Ultrasound tech, The lab phlebotomist, front desk, surgery scheduling, office admin, billing, etc. Many times in small practices these are the same people.

Involving the billing office is key. This assists in customizing with proper ICD-9’s, CPT’s, admin codes, modifiers etc., a benefit not often felt till we start passing charges from the EMR to the PM charge entry. We need to build the EHR customization so we are billing properly to maximize reimbursement.

I also recommend to all my installs prior to go live to take live patient charts randomly from the day’s schedule and complete a few notes per day with the current customization on test patients. This helps in guiding where you might need to add or adjust your customization. I also recommend Faxing sample scripts and progress notes to your own fax machine if possible from these same test patients. Set up a test pharmacy with your fax as the pharmacy fax. Print the DME scripts and the referrals and make sure you are happy with how they look. Seeing the fax coming out on your manual fax goes a long way to calming fears.

In typing this paragraph I’m reminded of an event at an install 5 years ago. I was teaching a nurse class and we often pair class members according to computer confidence levels. Experts with experts, newbie’s with newbie’s etc. I was teaching what I refer to as a catch all class. All nurses thrown into one class. One nurse was really struggling and I was not sure if she was just a smart alec or really dense… After struggling through the class we had a lunch break. I asked the nurse that was slowing down the class if we could speak in private. We went to a conf room and when I asked if there was anything I could do to help her get up to speed…. she proceeded to tell me with tears in her eyes that she had feared this EHR for this exact reason. She’s had a learning disability since elementary school and it was causing her to drop behind the other nurses. She was the Lab supervisor and felt she was looking bad in front of younger nurses that were better at computer skills than her and were thinking she was slow. I told her I was sorry for not noticing and offered to teach her over lunch breaks the next 3 days. She came every day and we spent our lunch hour teaching her the EHR instead of hitting Chick-Fil-a. This gave her confidence and she was very adept at the lab functions and able to run lab audits etc. by the end of my week of training and go-live support. On my last day onsite I came early about 7:30am and she called me into the lab. She introduced me to her husband who had come to work with her that morning. He wanted to meet me, shake my hand and thank me for helping his wife out and for helping her confidence in her job. He let me know she had not been the same for the previous 2 weeks and was complaining and thinking of quitting and he knew something at work was not right. Once we started our lunch training sessions he said she would come home and talk about what they learned that day and they made dinner together while she talked to him and she was so proud of sharing what she learned. He then gave me a bottle of wine from their favorite local winery, told me how proud he was of his wife and shook my hand and told me thanks for taking the time to work with his wife. She was just all giggly and had to show him all the lab screens and how she could replace manual processes with the EHR. I was blown away. I never realized how such a small thing on my part could help someone so much.

I still have that bottle of wine unopened on my desk…along with a Viagra clock a Urologist gave me for helping him learn to e-prescribe 4 years ago. My desk is littered with little drug rep tokens that all represent specific people at clients who have said thanks for taking time to give them some extra support to alleviate their fears. Even transcriptionists have thanked me. I collect these drug rep freebies as a hobby and my clients often show their thanks by presenting me with their favorite drug rep pens, clocks, note pads etc. I’m very proud of my collection all proud EHR students. Knowledge is power and power goes a long way in alleviating fear.

Ego

Not all installs go well. Many physicians think implementing an EHR turns them into a transcriptionist and they went to school to practice medicine and not type progress notes.

Also not wanting to look inept in front of patients applies here.

Money

We all know the reason here. New EHR or college tuition. Many Doctors are faced with tough monetary decisions every day.

War stories

Every practice has colleagues, or neighbors who have had a failed EHR implementation. These failed implementations are the bad news that circulates 10 times more than the one good install. I’m currently working with a solo MD that is now on his fourth EHR since 2000. Wish me luck.

No one wants to be first

Being the first is often a drawback for many physicians. They want to see what other practices implement and then ask them how it went.

Product not perfect yet

You see it all the time. Wait and buy the third generation of the computer not the first version. Vista is a good example of this. Many physicians’ think the current levels of EHR’s are just not advanced enough for them yet.

Govt Mandates

Why spend the money until the Govt says I need to? We all know this has occurred now with the recent house resolution. First they provide incentives then they provide penalties. Smart way to do it.

Waiting on local Hospital or Stark donation

Many practices don’t understand that hospitals move in 2 or 5 year increments not quarterly. If you’re waiting for a hospital to make a decision will they cover your loss of incentives and pay your penalties between now and 2010?

I have people for that

And many are the MD’s relatives… My mentor back in 1984 explained the HIT market to me this way. A doctor is the only business person I know that will place their business success in the hands of a high school graduate rather than a CPA or MBA. Meaning many office managers or front desk managers in small offices, are high school graduates with little to no business experience. Not as true today as it was back in the 80’s.

Man, many of these Doctors are loyal to a fault. I know many clients who have called me asking for advice on how to catch an embezzling biller, office manager, front desk employee. Or worse, how can we find out how much they stole? I have seen all types: Changing check names, billing false claims, taking cash payments, writing off to collectors that are their family members and getting kick backs. Many doctors have little fiefdoms and they love being the overlord. This can often cause them to become detached from their day to day operations. They often think, Doctors see patients and dictates, transcriptionists transcribe, nurse gives injections and prep patients to maximize my time, and medical records handles the charts. Sometimes the wife as the office manager really helps in this instance. If they are spending too much money at the office they have less to spend at home.

Many Physicians’ are very proud of how they can provide a living for their employees. They often develop deep bonds similar to family ties with employees. If you are selling them on reducing FTE’s know that they may not want to get rid of their “Family members”. If you approach it with freeing up the Medical records clerk so they can attend MA school or Ultrasound school to become a revenue generator they are much more receptive. One of my first large installs (22 MD’s) back in 2002 had over 8 medical records clerks in one office. Five of the eight were related to each other and they were all related to the office manager. Today the medical records room is gone and one person handles all incoming faxes electronically and scans all incoming paper and handles all outgoing faxes of medical record requests. They now have over 75 MD’s on the EMR with 3 specialties. What happened to the family members? One manages the records requests, two are MA’s, one is an office manager of a new remote office and one is now a PA. Key is: THEY ALL STILL WORK FOR THIS PRACTICE.

Change

Many people fear it some embrace it. Why is there such disparity? If you fear change it may be due to lack of knowledge or lack of a comfort factor. Training and exposure to the new workflow as well as input into the new workflow goes a long way in alleviating fear of change. I’ll be the first to agree many nurses and Dr’s can write in a chart faster than they can use an EHR. Keep in mind they have used paper for hundreds of years in medical charts. Tough argument to win with a new client only interested in time factors of documenting the current visit. Just ask them to run a report of all patients they gave X injection to with Y lot number and you will win that argument. Graphing lab trends from the last 3 labs also helps win this argument. I often take before and after pictures of the practice and bring them out at my 2 month follow up to show them how many paper charts were just laying around in stacks. You would be amazed at the change in just 2 months much less 2-3 years on an EHR.

One Dr had a funny take on it. He had a nurse that decided to retire after 25 years of nursing at the practice rather than under go EHR training. I was talking to him about it and apologized for not doing a better job of getting her trained enough to stay.

His reply? “If I knew all it took to get her to quit was implement an EHR I would have done it 2 years ago when I bought the practice!” That made me feel better.

Workflow documents are key here. Making sure the Dr and Nurse can get their pre EHR duties done quickly and easily helps many clinical staff to buy into the process at go live.

There is a process all clients go through. Some take 3 months others take 6 some take a year or two.

Phase one is the Go-Live. You are basically shooting for 100% EMR documenting as the goal and if you hit it you’ve done your job as an implementer. You may leave the practice somewhat worried if they can keep it up.

Phase two is when they can see the same amount of patients per day pre EHR vs post EHR. This can take 3 months sometimes. You do still get those freaks that do it from day one.

Phase three is when the practice starts looking for new ways to maximize efficiency and use modules like reporting, PQRI, advanced customization, interfacing more office devices, implementing lab or radiology interfaces etc. Show me more that I can do with your EHR. They become an EHR user who does not know how they ever worked on paper. These are the golden reference site,

So I think the rate of adoption in a small practice is a combo of all of these and maybe a few we have not thought of. Just my take on it from someone who is immersed weekly with new installs at new clients.