Monday Morning Update 11/29/10

From Bit Byter: “Re: Samsung Galaxy Tab. I’m interested in it.” The new $600 iPad tablet competitor (discounted by carriers selling data plans) runs on Android, has a 7-inch touchscreen (the iPad is 9.7”), two cameras, integrated GPS, Flash support, the cool Swype typing system, Wireless-N, Bluetooth, and seven-hour batteries. It’s too early to say (or buy, probably), but it looks like a reasonable alternative to the iPad for anyone who wants one (just like there are many smart phones better than the iPhone in some ways, but that most people don’t want because they aren’t iPhones).

From Train Wreck in Progress: “Re: CONNECT. ONC can shuffle paper, but they are screwing up real software and progress in treating the CONNECT team like unloved stepchildren despite multiple awards and demonstrated progress in connecting VA, DoD, and Kaiser. It’s a sad day when initiatives like CONNECT are not celebrated, embraced, and supported. Doug Fridsma’s framework was attacked at the HIT standards meetings as not practical, yet he marches on.” The top two CONNECT consultant managers quit as the program stalls while GAO investigates a complaint from Harris, the incumbent contractor, over a new contract awarded to CGI. The open source CONNECT platform, which won WSJ’s technology innovation award for HIT this year, was developed by a group of more than 20 federal agencies to support secure healthcare information exchange among providers, insurers, government, and consumers. ONC standards director Doug Fridsma says ONC wants to make it easier for providers to exchange information directly through NHIN Direct.

From Capiche: “Re: ONC clarification. Any thoughts on hospitals and practices being required to implement all Core and Menu items?” It’s a ONC FAQ that seems to mix vendor and provider requirements in a confusing way, but I’m interpreting it as being applicable only to providers with self-certified, homegrown EHRs. To do that requires implementing all of the Menu set items even though as providers, they could qualify for MU by using a vendor-certified EHR to meet only five of the 10 menu set items. But another interpretation is that all providers must meet all 10 Menu items even though CMS requires reporting only five. Click the above image to enlarge and let me know what you think it means. Or maybe someone from ONC can clarify their clarification since it’s a pretty big deal if that latter interpretation is correct.

Hospitals may lock down their internal e-mail systems with malware protection and tools to prevent PHI transmission, but docs can just go to their Web-based e-mail on those same PCs and do whatever they want, so say 80% of respondents to my poll. New poll to your right, rekindling an old argument — who should be calling themselves “informaticists”? As usual, click the Comments link in the poll to support your position.

Listening: reader-recommended Ry Cooder’s I, Flathead. I haven’t warmed up to all the music yet, but I like that he’s a non-conformist roots music songwriter who doesn’t really care what the masses think. This one’s a third of a three-part concept album series dealing with the Southern California culture in the first half of the 20th century. The alternative to auto-tuned, air-headed, ad-packaged Barbies and Kens singing about lust. And Watching – one more thing I hadn’t thought of that you can do on an iPod Touch: stream your Netflix movies over WiFi, which I did this morning in watching MST3K while brushing my teeth in the bathroom, just because I could.

A five-year study using trigger tools (instead of unreliable self-reported errors) finds that hospitals have made no progress in reducing incidents that cause patient harm. Nearly one in five hospitalized patients were harmed by the care they were given; nearly two-thirds of their injuries should have been prevented; and those injuries contributed to their deaths in 2.4% of the cases. The article concludes that preventing mistakes isn’t rocket science since every hospital knows that they should be doing. The problem is that they aren’t doing those things consistently: handwashing, medication reconciliation, decubitus prevention, etc.

A good article with the great title of The Doctor-Patient-Laptop Relationship looks at how doctors typing into computers changes the doctor-patient dynamic. A past president of the Connecticut State Medical Society says medical schools in her day taught doctors not to see patients from behind a desk since it served as a barrier, but they aren’t teaching today’s medical students ways to keep computers from becoming an equally disruptive barrier. It makes an excellent point: writing makes no sound and people can do it while they’re talking, while keyboarding makes noise and requires most people to look at the keyboard and monitor. I was thinking about that and I agree: when someone’s typing, I usually stop talking because they won’t hear what I say anyway.

Politicians get involved in the plans by two Canadian hospitals outsource IT to Cerner. They don’t like losing local jobs and they also don’t like the fact that Cerner sells de-identified patient data from this side of the border. Meanwhile, the IT department’s “whistleblower” who heard rumors of the discussions and quit in protest says the hospitals are making a mistake in turning over system knowledge to contractors who will have the hospital over a barrel. Anything related to HIT is a touchy subject in Ontario after audits last year found that eHealth Ontario was wildly overpaying no-bid consultants who were filing padded expense accounts, kicking off a political scandal in which heads rolled. The papers are making a big deal about the fact that IT staffers weren’t consulted in advance of the outsourcing discussions, which is ludicrous – in what world does management seek the input of those who would be negatively impacted by one of the two potential courses of action?

Inga interviewed David Delaney MD, CMO of MedAptus, about revenue cycle management tools.

NEJM runs the case study of the Mass General surgeon who performed the wrong surgical procedure on a patient and went public afterward to help prevent errors elsewhere. The Swiss Cheese Effect was in full force, with several potentially minor problems adding up to one big one in which the surgeon performed a carpal tunnel release instead of a trigger-finger release. Contributing factors: (a) the patient did not speak English and the hospital had no interpreter available; (b) the surgeon did several hand cases the same day; (c) the nurse had not marked the planned incision site; (d) the OR suite was changed because other cases were behind; (e) the change in room also involved a changed in staff, including the nurse who did the pre-op assessment; (f) the change in rooms delayed the surgery, so the surgeon saw another patient while waiting; (g) the circulating nurse fell behind in her documentation to go find a missing supply item; (h) the patient’s site marking was washed off when the area was cleaned; (i) the surgeon spoke to the patient in her native Spanish, so the circulating nurse assumed that was the mandatory time-out and didn’t call for one; (j) the nursing team changed mid-procedure; (k) computer monitor placement in the OR forced the nurses to look away from the patient. The best takeaway came from another physician in the case review:

Surgeons need to take ownership of these policies. When the airline industry evaluates a crash, the pilot is not considered responsible except in two circumstances: the pilot was under the influence of drugs or alcohol, or the pilot did not follow protocol. All hospitals need to have a culture in which surgeons feel responsible for making sure the protocol is followed.

Another HIMMS sighting, as even trade show supply companies can’t spell it right.

Funny: Steve Wozniak, the goofball half of the founding team of Apple Steves, mistakenly says in an interview that Apple has acquired speech recognition vendor Nuance, sending that company’s stock on a tear. The Woz says he must have read something wrong.

A court rules that the Iranian government owes McKesson $44 million for illegally seizing its dairy there in the 1979 revolution. The company was Foremost-McKesson back then.

Here’s why you probably don’t want to buy penny stocks of companies more competent at selling shares than product. Shares in would-be HIT vendor Healthmed Services, which I mentioned last week along with pictures of its “headquarters”, go down just as quickly as they’d gone up when pumped earlier in the week. Share price was less than four cents on Monday, up to over 12 cents on Tuesday, now back to under four cents and dropping. Considering the company has zero revenue and prospects for earning any, even the current $7 million valuation is ridiculous. Penny stocks aren’t usually worth even a penny.

IT application coordinators and analysts working for Kaiser Foundation Hospitals get a $2.91 million settlement from Kaiser for being misclassified as salaried instead of hourly. The employees were part of the HealthConnect go-live team, which required uncompensated travel, overtime, and on-call support responsibilities.

In the UK, a hacker gets 18 months in prison for send spam-infected e-mails that allowed him to take control of the PCs of anyone who clicked a link. He bragged on being able to turn on the webcams of infected PCs and to browse their files without the knowledge of their owners. One of his targets was a hospital. About one in 250 of the spam recipients clicked the link. The man is a father of five, runs a computer security firm and did his hacking from his mother’s living room.

The founder of India-based Apollo Hospital Group judges healthcare ideas for a reality TV show about entrepreneurship, choosing Medsynaptic. The Pune company offers imaging solutions, including PACS, low-bandwidth teleradiology, and image workstations.

The South Asia president and CEO of GE Healthcare says the company’s “de-featured” (up to 40% less expensive) medical devices will improve healthcare efficiency, adding that “India will teach the world healthcare innovation.” GE’s healthcare business there is growing 25% a year and they’re planning to hit annual revenue of a billion dollars within five years.

Strange: a UK nurse who accidentally killed a premature baby by giving 50 ml of sodium chloride injection instead of the ordered 5 ml gets in more trouble when the dead baby’s parents find that she posted a Facebook picture of herself asleep beside the baby’s bed a week before the mistake. Afterward, she posted messages asking for friends to “wish her luck” in the inquiry, and when allowed to return to work after her suspension, posted a message saying, “Has had a fantastic day! Is goin 2 treat herself 2 bottle wine!” The hospitals says they knew about the posts.

The Australian government issues $55 million in grants for interoperability projects, or at least that’s what I assume the article is referring to with the term “personal e-health records.” The government is looking for vendor bidders, just in case you’re interested.

A patient sues Halifax Health (FL), claiming his ex-wife, a former hospital employee, provided information from his electronic records to a hearing officer in their divorce and child custody trial. The hospital had already fired her for accessing the records of another plaintiff, which one might assume is hubby’s new love interest.

Nuance will collaborate with Montage Healthcare Solutions to offer radiology users the ability to search their Powerscribe 360 reporting database using voice commands or keystrokes. They’re demoing at RSNA if you want to drop by for a peek.

Surely we can agree this is excessive: the CEO of 128-bed Sturdy Memorial Hospital (MA) is paid $1.18 million per year. You know the excuses: they have to dig deep to prevent her from leaving, the not-for-profit hit its performance targets that enabled it to bank a big surplus, etc.

E-mail me.

The Obligatory but Heartfelt “What I’m Thankful For” Thanksgiving Post

This will be one of those really rare times where I get all reflective and maudlin, it being a holiday and all. I was moved by Inga’s Thanksgiving post. I might have sniffled a little, but I did cook Indian food for dinner, so it could be that the oils from the chili peppers I was chopping for the aloo matar found their way from my fingers to my nose. That’s my story, anyway.

What I’m most thankful for is that I don’t have to think hard to come up with a “what I’m thankful for” list every day of the year. That’s the great thing about having low expectations and a cynical outlook. Any day above ground is a good day.

I love my day job and the hospital that pays me OK for doing it. It’s the best place I’ve ever worked. I’m just as happy when the alarm goes off Monday morning as when it doesn’t on Saturday.

I am thankful for my family and that I found a woman early who not only tolerates my eccentricities and insecurities, but appreciates them. We ought to be sick of each other after all these years, but the first thing Mrs. HIStalk said when she came home tonight, instead of complaining about the paint-peeling stench of my simmering chana masala that she detests, was that I looked sexy. That’s doubtful (especially since I had just sneezed violently from accidentally inhaling sinus-searing masala vapors) but characteristically commendable of her to say. She’s as cute to me as the day we met in college.

I’m happy that I’m healthy, protected by those in military service, and still moved by good music. I’m glad I don’t care much about money, power, and fame since I’d be worrying all the time about losing them even if I managed to get them in the first place.

I’m glad I started writing HIStalk way, way back in the dark ages of 2003. Nobody was reading and I didn’t care, but somehow it has improbably allowed me to meet some pretty amazing people who are trying to make a difference. Sure, and a few douchebags too, but that’s a small minority. We have our differences and our debates in healthcare, but we always end up on good terms.

I’m thankful for everybody who spends their valuable time reading what I write (even the music recommendations, especially the weird ones). I’m grateful that companies support HIStalk just because they appreciate my work and knowing that I’m still going to rag on them when they deserve it.

I appreciate everyone who takes the time to e-mail me, write guest articles, submit thoughtful comments, be interviewed, and tip me off to news and rumors. You make me look smart and your efforts benefit many.

I’m really thankful for whatever cosmic forces sent Inga my way. She keeps me sane and amused, balancing my negativity with cheery optimism and funny e-mails. The insecurity oozed from her early writing as she struggled to keep inside her tiny industry comfort zone. Now she’s confident, insightful, and eagerly read by her many fans (and just as insecure). You’d like her even more if you knew her in person.

I’m thankful that Mrs. HIStalk knows her culinary limits without me having to remind her, so I’ll be doing the cooking Thursday (after popping Zantac all night because the chutney for the samosas was a little too hot). She does make a mean pumpkin pie, though. I’ll just need to crank up the iPod while she’s watching those idiotic televised parades she likes so much.

Have a fabulous Thanksgiving, Black Friday, and the long weekend. And, in my final “what I’m grateful for” item, thanks for reading.

News 11/24/10

ONC invites the public to weigh in on personal health records as long as they do it by December 10.

A just-in report from Canada says that two hospitals there are talking to Cerner about outsourcing IT.

Central DuPage Hospital (IL), a long-time Lawson customer, says it has implemented Lawson Contract Management in less than four months.

Listening: new from My Chemical Romance, high-energy, defiant punk/pop with some nice hooks that provide a needed break from auto-tune singers and phony country warblers. Driving music.

St. Joseph Medical Center (TX) develops a 10-physician hospitalist program with Intercede Health, which includes the use of the company’s Order Optimizer software. It provides SaaS-based diagnosis-specific order sets and order set management tools, medication alerts, physician favorites, and a nine-week implementation time. That product is also available separately from a subsidiary.

In Ontario, Sunnybrook Health Sciences Centre partners with Telus Health Solutions to roll out a consumer health portal / PHR that will allow Telus employees to upload and enter medical information that providers can review. Its underlying technology is Microsoft HealthVault.

Happy birthday to Ed Marx, whose special day was Tuesday. You can post belated best wishes on Facebook.

Jobs on the HIStalk sponsor-only job page: Implementation Consultants and Project Managers, Director of Technical Readiness, Implementation Consultant. On Healthcare IT Jobs: Health Information Technology Support Manager, IS Senior Project Manager, Ambulatory EMR Implementation Specialist.

I received a nice response from AMIA President and CEO Ted Shortliffe about a reader’s question as to whether the organization will decline financial support from vendors who won’t go on record as not using “hold harmless” clauses in their customer contracts. He says AMIA’s vendor contracting task force received redacted contract copies and have no knowledge of how specific vendors are writing contracts. He mentioned that Senator Chuck Grassley had sent letters to vendors asking that very question, but he has not made whatever responses he received public. Ted says AMIA’s role is as an educator, not an enforcer, so it made strong recommendations. I can see that point of view: other than Epic, most vendors aren’t going to walk away from business if the prospect insists on removing clause like that one. Nobody makes customers sign on the line which is dotted.

Speaking of that, I’m amazed that hospitals allow vendors to provide the first draft of a contract, loading it with vendor-friendly boilerplate and making sure to look astonished and hurt at any suggestion from their “partner” that it be changed before they hand over their large check. Job #1 is to create your own contract draft and give it to the vendor as the starting point for negotiation. I’m thinking of starting a telenegotiating service where I whisper electronically in the ear of hospital and practice IT people, telling them what to say and how to use classic negotiating techniques to their advantage. Customers are always complaining about the bad deals they got without accepting blame for taking what was offered without a whimper. In negotiation, 80% of the money on the table is going to be split equally between the two parties. When you’re negotiating, you’re fighting for a bigger share of the remaining 20%.

Investment bank TripleTree will host a Webcast about cloud computing in healthcare on December 1. The panel includes top executives from Castlight Health, SCI Solutions, MedVentive, and Connextions. Two of those four are HIStalk sponsors (SCI and MedVentive), so tune in and support them if you’re so inclined.

Nuance announces Q4 numbers: revenue up 17.7% to $310 million, EPS $0.01 vs. $0.02 after some accounting adjustments. 

British company Cambridge Consultants announces the Minder smart device, which transmits medical data in real time to EMRs. It can also receive checklist information from providers to instruct patients. Technologies used: Bluetooth, Wearable Mobile device hardware, accelerometer, the Continua-compliant Vena platform, and input devices that include a blood pressure cuff and scale.

iSoft’s former auditors face misconduct charges over – what else – allowing questionable recognition practices.

Odd: Healthmed Services, which has staked its fortune on some kind of iPad-to-desktop communication tool for healthcare use, floats a bunch of press releases touting its vaguely described agreements with Facebook and Google. Its also-vague Web site features a video of President Obama and a lot of generic information about the vast healthcare IT market it plans to conquer. The company today announced a development agreement with Veritas Software Systems, which might sound like the big backup system vendor unless you recall that Veritas was acquired by Symantec in 2005 (and its name was actually Veritas Software Corp. – this particular company has no Web presence that I could find). It also announced this week a new Web-based practice management system called HealthTrac, with no details whatsoever. What’s really newsworthy about the company: (a) it just filed an 8-K disclosure that it paid a company $600K to develop its flagship product, armed only with an oral agreement, but that company is holding them up for more money; (b) the company’s stock was being pumped and dumped by cocaine-smuggling New York longshoremen (note this “monster pick” that ran up the price 93% on Monday, with 42 million shares changing hands); and (c) its SEC filings from August indicates that the company had zero revenue, had no expectations of any revenue, and was down to its last $52 in the bank. I Googled its listed address and came up with the Las Vegas building above from Google Maps, which I assume is a mail drop. The address it uses for its SEC filings is a one-person virtual office in California that’s currently for rent for a minimum period of one night (that photo is above, too). The CEO quit in August and the CFO was replaced. Shares are at $0.08, with a market cap of $14 million. Maybe I’ve finally found that HIT vendor who’ll have me on their board, enjoying the corporate headquarters any time I can come up with the daily rent.

Odd: Spirit Airlines refuses to give a surgeon’s pregnant wife water while their overheated plane is sitting on the tarmac, offering instead drinks for sale. He makes a scene and makes vague references to terrorism, his son kicks a flight attendant in the groin, the flight crew kicks the family off, the surgeon is suing for $11 million.

Attachmate acquires Novell for $2.2 billion, if there’s anyone left who cares. A Microsoft subsidiary chips in $450 million to get a bunch of Novell patents, leading to speculation that their interest is either in suing other companies or perhaps porting .NET to Linux.

I think we probably won’t have enough news to be worth posting new issues of HIStalk, HIStalk Practice, and HIStalk Mobile through the holiday, but I’ll have the usual Monday Morning Update. Inga has written a sweet Thanksgiving piece that I’ll run on HIStalk Practice and I may write one myself for HIStalk since we are both sentimental, dreamy-eyed romantics anxious to give our BFF readers a clingy holiday hug, just like the watch-those-hands Uncle Bill on the porch after a little too much spiked eggnog and cheap Thanksgiving wine. We’ve been ultra-busy with new sponsors, interviews, and party planning, so we will enjoy the short break. if you’re headed off to RSNA this weekend, travel safely and make sure to crack up your fellow airline passengers in the security line by loudly delivering a few carefully rehearsed jokes about TSA’s full-body scanners. Have a wonderful Thanksgiving.

E-mail me.

HERtalk by Inga

Fun fact: at Cerner’s on-site cafeteria in  Kansas City, color-coded serving tools prompt employees to notice good food choices. Green handles indicate a great choice (think broccoli), yellow handles suggest you might want to limit your portion (pimento-stuffed olives), and red handles (burgers and fries) mean you might want to make time for a workout after work (that is, if you can sneak out of the parking lot without Neal noticing).

Austin Regional Clinic (TX) implements Webmedx’s Enterprise5 platform for its outsourced transcription and speech recognition services.

CMS will give providers online tracking capabilities to check the status of their Meaningful Use incentive payments. The payment information will be available online once a provider is notified that they have met Meaningful Use requirements.

In an article profiling Epic, the story’s author notes that the company rarely advertises and doesn’t encourage media articles. Apparently the reporter had difficulty getting answers to some basic questions. After several phone and e-mail attempts, she was basically told no one was available to assist. Finally an Epic spokesperson told her that the company’s “managers and leaders were too busy to speak with newspaper reporters, even if the reporter in question was writing a major feature story about them.” I bet lots of companies wish they were that busy.

Meanwhile, another local publication points out that Epic makes financial contributions to over 100 nonprofits. The company also donates older computers to local school districts, supports the local public library, and hosts area high school graduations in its auditorium.

The US Bid Committee announces  that Cerner is now an official partner in efforts to bring the FIFA World Cup to the US in the 2022. The committee chair says that Cerner has “clearly demonstrated” its commitment to the sport “in their innovative web-based health surveillance system for professional soccer players in the United States.” I was aware of the Cerner / Kansas City Wizards connection but didn’t realize Cerner also has an “athlete-focused” solution that was launched earlier this year and is now used by all 16 Major League Soccer teams.

Microsoft’s Peter Neupert says the company is abandoning efforts to make HealthVault profitable because of the complexity of the country’s health system. Neuport told  the Financial Times that HealthValult’s benefit to Microsoft was simply to increase the brand relationship” by raising Microsoft’s image with customers as “important, critical and trusted.” Compare those thoughts to what Neupert had to say at HealthVault’s unveiling three years ago:

The way we make money is by encouraging online activity, and through our search application.We know that search is a big business, it’s an important tool, it’s where consumers are today. And by growing the overall search market and delivering more value to consumers, and delivering a better end-to-end search experience, that’s where we can make our money to support this effort.

Florida doctor Arturo Carvajal sues a restaurant after injuring himself while consuming an artichoke. The doctor claims the restaurant failed to “explain the proper method of consuming an artichoke.” Carvajal, a brain surgeon, ending up eating the entire outside of the vegetable, which caused him "severe abdominal pain and discomfort," ultimately resulting in "disability, disfigurement, mental anguish," and "loss of capacity for the enjoyment of life".  OK, Carvajal really isn’t a brain surgeon, but I thought that sounded funnier than family practice, which is his real specialty. Regardless, I hope he has better luck eating his turkey and that someone advises him not to eat the wishbone.

Sponsor updates:

• NextGen Healthcare partners with Scimage to release a jointly develop the NextGen Medical Image Integration Module. The new module will give NextGen EHR ambulatory users the ability to view images produced by any imaging modality or PACS from within the NextGen EHR.
• Eight MEDSEEK healthcare clients win a total of 14 awards at the Strategic Communications eHealthcare Leadership competition. The program recognizes outstanding health web sites.
• Consulting firm North Highland hires Rebecca Whitehead Munn and Brent Holman as account managers. Munn was formerly the SVP of sales and marketing for Consensus Point. Holman comes from a large for-profit healthcare system (which I assume is HCA since both Munn and Holman are based in Nashville).
• North Sunflower Medical Center (MS) will deploy a suite of McKesson products, including Paragon HIS, Practice Partner EHR, and RelayHealth claims and eligibility  processing solutions.
• Surgical Information Systems says its SIS Version 5 is the first perioperative system to be certified as a modular EHR.

E-mail Inga.

Monday Morning Update 11/22/10

From SpaghettiCode: “Re: GE. The recent reorganization confirms that they made a huge mistake with the $1 billion IDX acquisition. After many attempts to defibrillate the CareCast business, they finally orged the legacy business under the EMR side and key execs were moved out.” Here are snips of what I had to say about the acquisition in September 2005. I mentioned collaboration with Intermountain Healthcare as a positive (that’s gone nowhere that I’ve seen), although I was focused mostly on the inpatient apps:

If you’re an optimist, you might assume that a mega-conglomerate like GE will pump R&D into the old warhorse IDX products, make them wonderful in a way that a small player like IDX never could … Pessimists would ask for even one example where that has ever happened, including with prior GE acquisitions … Much of CareCast was written 20 years ago by that little band of Phamis employees in Seattle. Does it contain enough intellectual property or technical excellence such that a quick spit-and-polish treatment will make it a world-beater? I don’t think so, but maybe GE does … Conglomerates have a way of screwing up products (McKesson, Siemens, and maybe even Misys.)… IDX needed a white knight. It was devaluing itself day by day, with an embarrassing UK performance and no CareCast sales. The acquisition announcement mentioned that IDX needed a partner with global reach, but it had already created its own opportunity in the UK and blew it. Cerner and Epic were threatening to run the table on them … Somehow HIT companies seem to lose their passion when swallowed up by multinational firms selling everything from light bulbs to Jay Leno. That’s kind of sad, don’t you think?

From Boston Patient Advocate: “Backlash is building by patient advocates against self-appointed ePatients who make a living selling a modified version of their story. They often fail to mention that they misunderstood information they found online, weren’t really as sick as they thought, or that it was their doctors that found the correct treatment or gave them an RX for online communities. Then again, we love myths of the little guy in America.” I ignore news stories in which reporters try to mask their opinionated reporting with phrases such as "debate rages”, “some are questioning”, or “pressure is building”. In other words, I don’t doubt your sincerity, but I’d like to know specifics behind your “backlash is building” assertion. As we say in the medical world, “In God we trust … others bring your data.”

From The PACS Designer: “Re: Continuity of Care. TPD is happy to see that HHS has embraced the concept of Continuity of Care as it is laid out in the ASTM Continuity of Care Record (CCR) and requires providers to include it in their EHR certification submission request. Healthcare organizations will have to include the ASTM CCR in their discharge process to get their EHR certified, and at the same time, we’ll have a chance to transfer information between providers to help eliminate duplication of procedures and reduce medical errors.”

Eastern Maine Medical Center (ME), preparing for a three-day lockout of striking RNs by bringing in replacements, will shut down all of its clinical systems except the eMAR and go back to paper. Here’s a hint for those living near Bangor: go somewhere else if you’re sick this weekend. Or, if you’re one of those “EMRs are evil” naysayers, this is your rare chance to do some Maine-based medical tourism to receive critical, elective medical care at a paper-based hospital.

The usual list of stuff you can and should do here: (a) subscribe to the updates so you aren’t embarrassed by the idiot three offices down who learns breaking news before you and rubs your nose in it; (b) use the search function to amplify your HIT intelligence in real time; (c) Friend or Like us on Facebook or connect with us on LinkedIn so that we may both pretend to be more popular than we probably are in real life; (d) click some of the sponsor ads to your left to see what they’re up to; (e) visit HIStalk Practice and HIStalk Mobile to get mostly different news particular to physician practices and mobile health, respectively (and sign up for those updates, too, if you want to stay on top of stuff).

Listening: the remastered 1978 debut solo album of former Pink Floyd leader David Gilmour, recommended by a reader. I appreciate that: I really like his music and respect him for his charity work, but I never think to recommend his solo stuff, which at that early stage of his career was kind of Pink Floyd Lite (not necessarily a bad thing). He’s supposed to be reuniting with former bandmate Roger Waters at one live performance of The Wall, which is on tour now.

Forbes runs maybe the weirdest, worst HIT article I’ve seen, apparently intended to be a cheerleading piece for Allscripts. It claims that open source is about to make its healthcare debut, courtesy of Allscripts (meaning Allscripts Helios, previously Eclipsys ObjectsPlus, which has been around since the 1990s). It claims that many tech vendors have gone out of business because they “chose to cling to closed, proprietary software or hardware” (care to share names and proof of the cause of their demise?) It mumbles something about the need to interface a “computerized drug order system” to an EHR (huh?) It says Judy Faulkner’s statement that you can’t mix and match vendors is an Allscripts advantage, failing to notice that Judy’s company (whose industry-leading product is closed and proprietary) had pretty much killed Allscripts (nee Eclipsys) Sunrise single-handedly since to install Sunrise, unlike Epic, required mixing and matching vendors to cover the many hospital areas it doesn’t address. To top it off, the article uses the old Allscripts logo pulled from Wikipedia instead of actually checking their site directly to get the current one. All of this was a lame attempt to create an interesting, insightful article around an October press release in which Allscripts announced that it would create an apps store for the former Eclipsys Sunrise, which has nothing to do with open source in the first place since nobody’s seeing and contributing to anybody else’s source code (extensibility isn’t the same as open source). It’s just amazing to me how many people write authoritatively but wildly inaccurately about healthcare IT (usually spinning entire articles around press releases and a couple of Google searches) who have never worked a day in either healthcare or IT except as a cheap-seats spectator. Caveat lector.

A little more than half of respondents to my poll say they’ve seen “hold harmless” contract clauses, although I liked the excellent comment by NotQuite, who pointed out that a “hold harmless” clause is not the same as a “limit of liability” clause. I’m no lawyer, but that sounds legally insightful. Gotham City CIO requested the new poll to your right, for hospital people: does your organization block access to outside e-mail services by physicians using hospital PCs? They block access to Gmail, Hotmail, etc. at his place to prevent the possible transmission of PHI via untrackable e-mail services, which is apparently common in other industries. The new CEO is getting heat from the docs even though they can still use a dedicated PC in the doctors’ lounge or their own PDAs to get to those services. Feel free to add any comments to the poll that would help our CIO colleague.

Thanks to new HIStalk Platinum Sponsor Orion Health. The international company, based in Auckland, NZ and with US offices in Santa Monica and Boston, offers solutions that include an HIE platform, the Concerto Physician Portal with single sign-on to provide a single patient view across multiple clinical systems, the Rhapsody Integration Engine for inter-system messaging and integration, the Rhapsody Connect solution for connecting to public health agencies, and the Symphonia developers’ messaging system for rapid system integration. The company just reported an 80% increase in revenue for the first half of the year and has 22 HIE sites in 12 countries. In the US, Orion’s HIE solution was recently chosen by the Wayne State University Physician Group and Maine’s state HIE. Rhapsody 4 just came out with new support for SOA integration and Web services, with Philips choosing it as its integration tool. The company offers a much broader product line than I knew about (EHRs, registries, whiteboards, bed management, chart deficiency, etc.) so feel free to cruise over to their site to learn more. Thanks to Orion Health for supporting HIStalk.

McKesson’s Horizon Clinicals earns ONC-ATCB certification through Drummond Group.

Marty Mercer is putting together a HIT sales training class for newbies and is looking for input from industry long-timers. You can help out by completing his short survey like I did. He’ll send me the results afterward since I think they might be fun to review here.

Inga emulates Weird News Andy with this link: doctors warn of the psychological dangers of social networking after an 18-year-old boy’s asthma attacks are found to be triggered by looking at the Facebook profile of his former girlfriend. His mom measured his peak expiratory flow before and after.

The Rural Nebraska Healthcare Network starts construction of its Nebraska panhandle fiber optic network that will connect nine rural hospitals and their clinics.

Vendors beware: patent troll Acacia Research buys 11 patents for wireless physiologic monitoring. Let the nuisance lawsuits begin.

A company that has developed an electronic parking space finder wins at the IBM SmartCamp World Finals in Dublin, but a couple of HIT-related companies were in the hunt: CareCloud (Web-based practice management and revenue cycle tools for practices) and Sproxil (checks the authenticity of drug products via SMS messaging, primarily in developing countries).

Speaking of “cloud”, everybody’s hopping on that bandwagon with as much self-serving enthusiasm as they did previous sloppily defined fad terms (ASP, EHR, clinical transformation). Since HIStalk runs from a Web host, I think I should start referring to myself as a “the leading cloud-based business intelligence and collaboration platform for the healthcare technology and life sciences sectors.” I’m thinking investors will line up at my door dripping saliva at the chance to throw money at me. 

St. Paul Heart Clinic (MN) closes its doors, with its 36 cardiologists going to work for either Allina or HealthEast. A key reason, as explained to patients, was the ability to share a common EMR.

Orlando Health (FL) offers local medical practices a discount on GE Centricity.

Weird News Andy likes this story: the call center for TennCare is a women’s prison, as discovered and reported by the overly dramatic and pot-stirring local TV station anxious to use that “breaking exclusive” graphic typically rolled out when someone’s flat tire backs up traffic almost a quarter mile. WNA likes the eloquently expressed consternation of one Leon Rippy, apparently goaded randomly by the TV station to weigh in on the issue of the potential but entirely theoretical impact on patient privacy: “That ain’t good.”

Coliseum Hospital (GA) investigates a former employee who dropped by to attend a nurse’s birthday party, then logged into the hospital’s computer system with her still-active password and looked at patient information. She’s caught by hospital security, which was apparently more effective than IT security considering the terminated employee’s credentials had not been inactivated. Assuming HR let them IT, of course (and trusting the competency of any hospital’s HR department is indeed foolhardy).

A blog entry in The Economist says HITECH could be as big a bust as NPfIT in the UK, suggesting that France provides a better model:

Maybe the Americans (and the British) should swallow what the French would term their “Anglo-Saxon” arrogance, and look at France. A French citizen presents his credit-card sized Carte Vitale to the doctor or the pharmacist or the hospital and everything—for example, the date and dosage of a prescription—is recorded by a national computer system (which also usually deals with payments). Visit another pharmacy or doctor in another town, and the patient’s details are automatically available. Perhaps this helps to explain why the World Health Organisation in 2000 (the last time it did the exercise) put France at the top of its rankings for health care. By contrast, Britain came 18th and America 37th. Mind you, it may also explain why the French pop more pills than anyone other than the Japanese.

E-mail me.

Being John Glaser 11/10/10

Meaningfully Using Industry Buzzwords at Home

With the HITECH and ACA legislation and rules. many new phrases and words have been introduced and old ones have gained additional prominence. I have found that these phrases and words also have use in several situations at home. See some examples below.

Death Panel. Your sixteen-year-old son returns home drunk at 2 a.m. after a long Saturday night. He parks the car sideways on the lawn. You and your wife are sitting on the couch in the living room waiting for him. As far as he is concerned, you and your wife are a death panel.

Stimulus funds. Your spouse shows you the new clothes that she bought. You like the clothes, but are mystified by the apparent need for new clothes when the old clothes aren’t that old and you liked those too. Moreover, the clip-on tie you had in third grade is still good and forty years later you still wear it from time to time. You don’t realize that the household income is really a stimulus fund to keep retailers employed.

Data exchange and interoperability. Your daughter (a senior in high school) wants to spend the weekend with her new boyfriend, who is a freshman at a local college. You, recalling quite well what’s always on the minds of young males, say “No.” Your daughter protests, “But Dad, it’s not what you think. I will be staying at his cousin’s (who is a girl) dorm room. Nothing will happen!” You think – I don’t believe that for a second – and again say “No.” You and your daughter are engaged in data exchange, but there is no interoperability going on.

Certification process. The first time you met him, you instantly liked your daughter’s new boyfriend. The second time you met him, you engaged him a lengthier conversation and discovered that he is a moron. The third time you met him, he had been invited for dinner and was clearly stumped by the role of the napkin. You decide that you and your daughter need a new boyfriend certification process.

Meaningful Use. You notice a dead tree in the yard. You find your chain saw and install a new chain. You assure your wife that you know how to fell this tree so that it won’t hit the house even though the tree is close to the house. You miscalculate and tree branches take out the kitchen window. Your spouse is less than impressed. You are clearly not a Meaningful User of advanced technology.

Bundled Payment. You are arm-wrestling with a new car salesman over the price of a car. He mentions all of the features that come with the base price – seats, steering wheel, front window, headlights, and an engine. He informs you of all of the extras – roof, glove compartment, and radio. You want the extras for free. Plus you want a sun roof, Jacuzzi, and toaster. You and he are negotiating a bundled payment.

The great thing about words and phrases is that they have so many uses and meanings.

John Glaser, PhD, FCHIME is CEO, Health Services of Siemens Healthcare. He describes himself as an "irregular regular contributor" to HIStalk.

News 11/19/10

From Karen: “Re: Meaningful Use: Doctors Have No Choice. Written by my husband, but still true!” Jim O’Connor, MD of MDcohort makes the argument that Meaningful Use isn’t as voluntary as it sounds, offering as evidence: (a) CMS will start imposing penalties on EMR non-users in 2015; (b) private insurers will tie MU to their P4P programs; (c) MU will apparently be made a requirement for renewal of board certification; (d) states can impose their own penalties, possibly even requiring MU for medical license renewal.

Ed Marx has a lot of fans here, so if you want to read more from him, he has posted a special article about his relationship with his daughter on Texas Health Moms, a site managed by his employer, Texas Health Resources.

Listening: new from Guster, which I’ve mentioned before. Solid, harmony-driven alt-pop (kind of R.E.M.-y to me), but they’re also funny: they enlist fans to sell CDs and sometimes open their own shows in disguise. If you’ve heard any of their stuff, it was probably Satellite.

Timing is everything: just after Aurora Health Care (WI) announces plans to eliminate 175 jobs in a cost-cutting effort, the press gets wind of the $8.2 million its former COO was paid upon his retirement last year. They make the standard excuses (accrued benefits, they have to compete with for-profits anxious to hire away executives who have spent their entire lives in healthcare, etc.) but I note that they paid the CIO $739K and the CEO got over $2 million according to their most recent tax filings. They have 30,000 employees, so maybe that seems reasonable by inflated non-profit salary standards these days. We may suck at population health in this country, but we lead the world in the executive-to-grunt compensation ratio.

The Aurora guy, who wasn’t even the CEO, made even more than Cerner CEO Neal Patterson, who took home $3.3 million in 2009, a little less than he made in both 2007 and 2008. And speaking of Neal, I’m clearly not at his level of business acumen because this just seems weird: he and Cliff have renamed their soccer team from the Kansas City Wizards to Sporting Kansas City. They’re doing some kind of membership thing, apparently, but that name sure make a weird fan cheer.

Think this will reduce healthcare costs? Mayo Clinic is building proton-beam cancer treatment centers at its Minnesota and Arizona locations. The price tag: $370 million.

On the sponsor-only HIStalk Jobs Page: Director Technical Readiness, Implementation Consultants and Project Managers, Healthcare Consulting Leader, Account Executive. On Healthcare IT Jobs: Program Manager IT Implementation, HED AdminRX HArx Remote, Implementation Engineer – Integration, Epic Inpatient Opportunities.

A New York Times article describes the problems San Francisco Department of Public Health is having with its $11.2 million Avatar EMR from Netsmart. Conversion problems caused delays in Medi-Cal payments to individual therapists and some therapists and social workers are complaining that using the software is eating into time for patient care. A post-implementation audit showed that mental health services volume dropped by 55% and substance abuse by 32%, with the deputy financial officer concluding that, “It’s pretty clear none are getting Avatar.” A social worker agreed: “This is not the job we accepted when we chose to do clinical work for the city.”

Strange: a Walmart pharmacist is disciplined by the Maine regulatory board for dispensing zolpidem instead of Zoloft to a patient. Before his own drugstore went bankrupt, he was also found to have overbilled the state by $1.6 million. The odd part: he’s a state representative in line to become the next speaker of the House.

The VA will develop two prototypes of Aviva, a virtual implementation of its VistA system and its apparent replacement, according to its just-released Fiscal Year 2010 Performance and Accountability Report. I thought they already had demonstrated the prototype earlier this year, but maybe this is something new.

Verizon will offer free credentials to providers in starting in January that will allow access to its Verizon Medical Data Exchange. It offers a provider portal, a secure inbox, and connections to the Verizon Health Information Exchange.

E-mail me.

HERtalk by Inga

From MrSoul: “Re: Kindle It. Encourage your readers to tell the publisher of Connected for Health to publish in Kindle so we can read it on our iDevices! There is a link on Amazon to do just that and then they can have this great resource always on hand.” I would think a book like this would already be in digital format!

West Penn Allegheny Health System selects athenahealth’s RCM service for its 600-doctor physician organization. They are apparently replacing GE’s RCM product. On the EHR side, they use Allscripts.

Venture capital firm OpenView Partners makes a minority investment in Prognosis Health Information Systems. Prognosis CEO Ramsey Evans says that OpenView’s investment will allow the company to “move forward and take our business to the next level.”

North York General Hospital in Toronto goes live with 300 order sets, using tools from Zynx Health’s ZynxOrder and integrating them into Cerner EHR.

CMS says the error rate for Medicare fee-for-service claims in 2010 dropped to 10.5%, or $34.3 billion in estimated improper claims payment. That’s down from 2009’s $35.4 billion in payment errors. I guess we should all be thrilled that CMS is getting better, but I am stuck thinking about all the better ways that $34.3 billion could have been spent.

The Stone Center of New Jersey IPA signs a 15-month contract with iMedicor to connect its 120 urologists into iMedicor’s National Health Communications Network.

Central Maine Healthcare eliminates 20 jobs as a result of outsourcing its medical transcription to Precyse Solutions. Precsyse offered positions to all 20 employees, though only 10 accepted. The move to outsourced transcription is part of a $11 million cost-cutting initiative.

Health management company Continuum Health Alliance contracts with Ignis Systems to provide integrated lab orders management for its EMR application services.

The Indian Health Service (IHS) commits to a $3.3 million contract with Orchestrate Healthcare and Vangent to plan, implement, and support the national deployment of the IHS HIE, enterprise MPI, and NHIN capability. Vangent’s HIEOS open source software will be used to establish connectivity between IHS facilities and the NHIN.

Miami-Dade County Commissions tell Jackson Health System to cut ties with the company handling its international marketing after a recent report details excess spending for such things as flowers and birthday cakes ($7,000), local meals ($37,000), and limo rides ($12,000).  An additional $6,000 was spent on a Royal Caribbean cruise for five of the marketing firm’s senior executives and their families. Foundation Health Services was the organization handling the health system’s international marketing efforts. It’s a not-for-profit, so I guess the execs had to get their perks from somewhere.

Teleradiology service provider Century Digitec Services goes live on eRAD’s hosted teleradiology software platform.

A study of 15 IDNs leads the Government Accountability Office to declare that EHRs can improve the quality of healthcare, making patient information more readily available and improving communication and coordination between providers. Providers still face challenges in terms of maximizing their use of EHRs, including limitations on sharing patient records outside their health system.

New on HIStalk Practice this week: 15 HIT vendor execs share what their company is doing to help physicians qualify for Meaningful Use. Evan Steele of SRSsoft provides commentary on the Meaningful Use challenges for specialists. Fun details on the eClinicalWorks national user conference, including a party pic with a uniquely attired CEO Garish Navani. And, the EHRevent patient safety reporting system. There’s a bunch of other good stuff as well, none of which you will find on HIStalk. Make sure you remain smarter than your co-workers and take a read.

"But Inga,” you say. “I’m too busy, just give me the highlights.” For grins and because I believe it’s important stuff, here’s a short summary of what the HIT vendor execs had to say about helping providers reach Meaningful Use:

• Several are incorporating dashboard tools or similar reports to help providers assess EHR usage based on Meaningful Use requirements.
• Most are offering webinars; many are setting up regional meetings to educate users on what needs to be done; most have online tools available; and, most mention the option for personal assistance, either on-site or remotely.
• Only a couple mentioned working with regional extension centers to share expertise and help beef up local infrastructures.
• Allscripts and athenahealth remind users that they offer Meaningful Use guarantees.
• Not surprisingly, some of the vendors have nicely packaged answers, which to me suggests (a) the vendor has established a clear-cut plan,  or, (b) the vendor has a great marketing department, or (c) both.
• A couple are short on specifics and don’t say much more than vendors needs to help physicians in the process.
• Jonathan Bush of athenahealth wins the prize for the most entertaining answer.
• Evan Steele of SRSsoft  has the most unusual reply, saying the company has spent considerable time reviewing the requirements and are helping its clients make an informed decision as to whether participation is right for the individual practice.

Sponsor Updates

• Encore Health Resources had a contest to see who could do something creative with 100 Legos in celebrating the hiring of the company’s 100th employee. Above is one of the submissions by employee Paul Murphy, who went with a multimedia strategy with an Ivo bobble head approach. I was thinking that I could have cheated and added extra Legos and come up with something spectacular.
• Nuance Communications introduces Nuance Transcription Services, which combines the eScription speech recognition platform with medical transcription and editing services from two of Nuance’s newly acquired companies, Outsource Solutions and Encompass Medical Transcription.
• MEDecision earns NCQA HEDIS software certification for its Alineo Clinical Intelligence Rules 2.4.0 and 2.5.0 programs.
• CareTech Solutions launches CareWorks 4.0, which includes enhancements in audit reporting, directory utilities, and several mobile modules.
• Fast-growing EnovateIT will move its headquarters from Ferndale, MI to Canton. The company’s mobile and wall-mounted computer workstations are used a third of the hospitals in he US, with last years $19 million in sales expected to reach $35 million this year.
• dbMotion appoints Prematics president and CEO Keving Hutchinson to its board of directors.
• 3M Health Information Systems and IQMax partner to offer 3M’s coding and documentation tools using IQMax’s mobile healthcare platform.
• Hayes Management Consulting will provide its Legacy Application IT Help Desk services to Moses Cone Health System as they transition from GE Centricity Enterprise to Epic.
• South Australia’s Public Health System names Allscripts its vendor of choice to provide EHR to its 80 hospitals. The agreement to purchase Sunrise Enterprise 5.5 is subject to contract negotiations, with final approval expected during the first half of 2011.
• Sage is named a group purchasing EHR vendor by PA REACH, which will offer Sage Intergy Meaningful Use edition to providers at a discount.
• A new KLAS report on ED solutions names Epic and Wellsoft as tying for the top spot.

E-mail Inga.

CompuGROUP To Buy HealthPort’s Systems Business

Germany-based medical software vendor CompuGROUP Medical AG announced today that it will buy HealthPort LLC of Columbia, SC, the solutions business of HealthPort, for $24.3 million in cash.

The Alpharetta, GA HealthPort will apparently keep its other business lines, including Release of Information and auditing services, as they were not mentioned in the CompuGROUP announcement. The company was named as the top-selected RAC vendor in a recent KLAS report.

Rumor reporter Iggy told HIStalk readers in August that HealthPort was preparing to sell its non-ROI business, possibly in preparation for an Initial Public Offering like the $100 million one it cancelled last November, citing poor market conditions. Another rumor reporter Staff Infection specifically mentioned on August 11 that CompuGROUP was in talks with HealthPort.

CompuGROUP also announced its Q3 earnings today, reporting revenues of $102 million and operating profit of $24 million. The company has 3,000 employees and a market cap of $720 million.

CompuGROUP acquired Cleveland-based ambulatory systems vendor Noteworthy Medical Systems in February 2009. In September, CompuGROUP acquired the US-based Visionary Healthcare Group for up to $65 million, noting that gaining the PM/EMR vendor’s 10,000-physician customer base was a commitment to CompuGROUP’s plans to make the US a key market. CompuGROUP also announced this week that it had completed the acquisition of Swedish hospital EMR vendor Profdoc Care.

News 11/17/10

From HIPAA Police: “Re: spelling. You would think a group sending a mass e-mail pitching its market research services would spell HIPAA correctly.” You would indeed.

From Limber Lob: “Re: getting physicians to standardize processes. Princeton economist Uwe Reinhardt says that trying to get physicians to work together is like trying to get eagles to fly in formation.” I like that analogy a lot.

From Capone’s Vault: “Re: Motion Computing Mobile Clinical Assistant C5V. This is slick. The pressure will be on the iPad to match the healthcare-friendly features of this.” It’s a full tablet with a docking station, optional barcode scanner, camera, Gorilla glass breakage resistance, and hot-swap batteries. It weighs three pounds, can be disinfected, and can withstand drops (big thumbs down to the iPad in that regard). Sounds great, just a little bit expensive at the mid-$2,000 range, but IT-friendly. Motion was bad about not getting enough nurse input on their previous models, so I’ll withhold judgment until I heard from nurses who have used a C5V at the bedside.

From Randy: “Re: Connected for Health review. I am enrolled in a Health Systems Management class at Morehead State University. This book is required reading.” I’m glad to hear that – I bet its great for that. Another reader is using it in an informatics course for public health students they’re teaching. For those who don’t know, Morehead State is in eastern Kentucky. I went to a seminar at St. Claire Regional Medical Center once, which is how I knew. Thanks for the report.

From Duke Nukem: “Re: NEJM article saying doctors should beat hospitals to the punch in forming their own ACOs to protect their own interests. Harrumph – you mean the same way they protect themselves by walling off nurse practitioners and claiming medical expertise is required to deliver acupuncture? A hundred years ago, they were barely better trained than barbers and butchers.”

Microsoft says its genomic sequencing project with Seattle Children’s Hospital consumed $18,000 worth of cloud-based supercomputing resources compared to the $3 million it would have cost using traditional local hardware. It used the Windows Azure cloud computing platform.
 
Wake Forest University Baptist Medical Center is going Epic, I’m told.

Nuesoft’s IT and product groups throw down a pretty good Lady Gaga video spoof. It sounds a lot like her and many other singers today, i.e. heavy on the Auto-Tune, which I really dislike — think Cher’s Believe from 1998, which sounds kind of Peter Framptony like somebody’s singing into a keyboard (meaning you don’t really have to be able to carry a tune to be a “singer” with computer-perfect pitch – it just came a few years too late for Milli Vanilli, but in plenty of time for the cast of Glee). But I digress – it’s a pretty good video. 

A former Fallon Clinic (MA) doctor brags on the clinic’s EMR, but complains that his access to it was terminated when he left to join another clinic. His point: he can’t treat patients as effectively who have chosen to move with him since “their” information is being held captive by Fallon Clinic, who says they’ll mail him a CD in a few weeks. I think it’s a bit presumptuous to assume that his former employer will continue to let him use their systems and I assume the CD they’re sending will have the information about his patients in some standard format he can review. Beyond that, that’s why there are HIEs (other than to get federal money).

The OncoEMR oncology EMR by Altos Solutions becomes the first oncology-specific EMR to receive ONC-ATCB certification as a complete EHR, the company says.

Patient Privacy Rights releases an informed consent white paper and the results of a new patient privacy poll. The rags are picking up the poll result as big news since it finds that 90% of Americans want to be able to decide who can see and use their health information, but I should add a cautionary counterpoint that the questions were loaded with what the ever-witty Inga always calls bias of the “Do you like babies and puppies?” variety. For example: it asked lay people whether providers should be able to “share or sell your sensitive health information without your consent” and “Who should make the decision on whether corporations and researchers can see and use the information in your health records without your permission?” I don’t know how far that skewed the percentages that ended up in the 90s, but I’d say quite a bit. Still, I don’t doubt the conclusions, just the methodology. I’d also guess that quite a lot of Americans would divulge just about anything for cash (like those Brits and their passwords a couple of years ago), so maybe that’s the backup plan for those profiting from their data – just buy it from them and mark it up.

Stanford Hospital runs a pilot project in which cath and angiography patients are given iPads preloaded with movies, books, games, and Internet access to entertain themselves before and after their procedures. The hospital likes the idea because TV installation was going to be a pain.

Inga did her usual bang-up job with the latest installment in her ongoing Vendor Executive Series on HIStalk Practice. She asked 14 top executives to comment on a recent survey that found that about half of physicians in private practice expect their EMR vendor to help them qualify for Meaningful Use money. It’s always fun to compare and contrast their answers.

McKesson CEO John Hammergren comes in at #10 in the list of the highest-paid CEOs of publicly traded companies, bringing home $24.5 million in total compensation for the year ending September 30. The company declined to comment.

Vocera acquires two Tennessee hospital communications companies: Clinical Health Communications and Integrated Voice Solutions. Guille Cruze, founder of White Stone Group that spun off Clinical Health Communications, will run both organizations as a Vocera VP in charge of handoff communications products like the ones offered by those two vendors. I interviewed him back in January 2008. The companies have 30 employees and 150 hospital customers between them.

Bill Gates says robots will be the next big technology. Maybe he’s right: check out the Actroid-F from Japan, which the developing company will market to provide social services such as those delivered by hospitals. I creeped myself out when I realized that I was thinking that she’s pretty cute. I bet I’m not the first.

Healthcare is the #3 enterprise user of iPads, trailing only financial services and the tech sector.

Maybe the iPad will rank higher in healthcare in Australia, where Victorian Premier John Brumby promises that every state hospital doctor will be given an iPad if his party is re-elected. He says $12 million will cover it, but he seems vague about exactly what’s going to be running on those devices that will give doctors “easy access to time-critical clinical information,” not to mention who’s going to support them. 

In the UK, Portsmouth Hospitals NHS Trust wins a patient safety award for co-developing a PDA vital signs capture application.

Odd lawsuit: a prisoner serving 10 years for running over and killing a teenager on a bicycle while going 83 in a 45 mph zone is suing the dead teen’s parents, who he claims were negligent in allowing the dead teen to ride his bike without a helmet. He wants compensation for his “great mental and emotional pain and suffering.”

E-mail me.

HERtalk by Inga

UPMC says it will add 815 new full-time jobs, including up to 80 in IT. This announcement came following the release of UPMC’s first quarter financials, in which operating revenues grew by $77 million to $2.1 billion and profit increased $28 million to $93 million from July through October. The health system is on track to spend about $500 million on capital improvements this year, including about $100 million on its EMR implementation.

Former Sentillion and Microsoft executive Rick Dean moves to Humedica as VP of provider sales.

KLAS introduces an RSNA Resource Center that features several radiology-focused KLAS reports, including the Medical Imaging Buyers Guide. It’s free for providers and thousands of dollars for the rest of us.

Florida Hospital DeLand, which is part of Adventist Health System, goes live on Cerner CPOE.

Memorial Hospital (IL) selects Summit Healthcare as its integration partner as it migrates to Meditech 6.0.

Saint Luke’s Health System (MO) will implement the SeeMyRadiology.com platform to share medical images across the enterprise.

I’m guessing that Mr. H is the new BFF of Louise L. Liang. MD. In case you missed it, Mr. H wrote a terrific review of her book, Connected for Health, recommending that that basically anyone with an even remote interest in IT and healthcare read the book. The masses took the message to heart and from about 8:00 this morning until 3:15 this afternoon, the book has climbed from #2,223 on Amazon’s bestseller list to #218. It also moved from #90 to #8 on the Medicine bestseller list and from #4 to #1 in the Public Health category. Heck, Dr. Liang should buy Mr. H a Christmas ham. Speaking of Christmas, I’m putting the book on my list.

Preliminary data from HIMSS Analytics suggests that 22% of hospitals are capable of achieving 10 or more of the required core measurements for Stage 1 Meaningful Use; 40% have the capability to meet five or more of the menu items. HIMSS Analytics says it will provide quarterly updates on hospitals’ progress beginning January 2011.

Apple’s AppsStore rankings for the Top 10 EMR and Operational apps can be found here. Bedside by IMS MAXIMS tops the EMR and Operational apps list and ranks 150th in the overall medical category.

A spokesperson for Advocate Health Care says patients experienced little or no interruption in care despite an 11-hour computer crash that affected 10 Chicago-area hospitals. The health system’s Cerner system went down about 5:00 a.m. Saturday, requiring employees to take patient orders on papers and access records using backup computer systems.

Sponsor Updates

• Chandler Regional Medical Center (AZ) will implement the GetWellNetwork interactive patient care solution and integrate it with its Meditech 6.0 system.
• API Healthcare names Lisa LaBau COO. She was previously with Cerner and Dynamic Healthcare Technology.
• Precyse Solutions appoints William F. Bria II, MD, CMIO for Shriners Hospital for Children in Tampa, to its advisory council.
• Allscripts wins the 2010 Excellence Award as the fastest growing company by the North Carolina Technology Association.
• Baptist Health Care (FL/AL) executes an agreement with NextGen to deploy its EHR and PM solutions  for its employed physicians. Baptist will also offer system access for community physicians who choose to purchase the solution.
• CareTech Solutions added three new healthcare clients to its Web products and services division last month, including San Juan Regional Medical Center (NM), Southern New Hampshire Medical Center (NH), and  Wheaton Franciscan Healthcare (WI). The company also announces Version 4.0 of its CareWorks content management system for hospitals.
• CapSite will present at the 22nd Annual Piper Jaffray Health Care Conference, to be held November 30 – December 30 in New York.
• ICA earns a spot of The Nashville Post’s Fast 50 Award for being one of Middle Tennessee’s fastest growing companies.
• At its annual user conference last week, Nuance recognized 25 healthcare organizations for saving one million dollars or more on medical transcription costs as a result of implementing Nuance’s eScription platform. Eight other organizations were also recognized for their gains in medical transcriptionist productivity.
• McKesson partners with the Emergency Nurses Association to offer the ED Benchmarks Collaborative, a Web-based subscription service that helps EDs identify trends and compare their performance with that of other facilities.
• Ingenix CTO Art Glasgow will speak Thursday at a congressional luncheon on the state of HIE initiatives at the Institute for eHealth Policy in Washington, DC. It will be broadcast online for those who can’t make it to DC.

E-mail Inga.

Book Review: Connected for Health

I’m rarely a fan of healthcare IT books. My criticisms generally fall along these lines:

• The author isn’t original, authoritative, or knowledgeable.
• The book tells me nothing that wasn’t obvious or that I don’t already know
• Its content isn’t really “meaty” enough to get excited about.
• It uses too much material already available elsewhere, with lots of citations and excerpts that make it look like an imitative journal article.
• Whatever knowledge the author possesses isn’t generalizable to everybody else.
• The book is a chore to read because it’s written pedantically or without skill.
• It doesn’t deliver an end result that makes me happy to have spent the time and money to earn it.

Connected for Health: Using Electronic Health Records to Transform Care Delivery raises none of these criticisms. I found it to be fascinating and informative. It is easily the best work I’ve read on healthcare IT’s role in changing how healthcare is delivered.

I’ll try to keep my review short, but there’s literally something on every page that’s highly useful even to someone like me who’s been in the industry forever and thought they’d figured it all out by now. I’m pretty sure I’ll read it at least five times over the next few weeks since there’s a lot to absorb.

(By the way, if you teach any kind of healthcare or healthcare IT class, this would be a great course resource).

In the interest of disclosure, here’s all I have to share. A book PR company asked if they could send me a free copy in case I wanted to review it. I said OK, but didn’t commit to anything since I don’t like reviewing books (I almost always have lots of criticisms, but then I feel guilty for laying them out even though someone asked me to review their book honestly). I don’t have any connection to Kaiser, I don’t know any of the authors, and I didn’t even try to sneak one of those commission-paying Amazon links above just in case you click on over to buy a copy.

Now I’m not about to sell out my integrity for the price of a book, so rest assured that it’s the same old cynical, dismissive Mr. H talking. Keep that in mind because I’m about to turn into an uncharacteristic cheerleader for Connected for Health. I’m hoping this doesn’t taint my curmudgeonly image (or encourage other authors to send me books to review that I’ll probably not like).

Every hospital that’s using or planning to use clinical information systems should buy copies for every board member and executive. It’s that good. It sets the vision and perspective needed to embark on big-budget projects involving CPOE, nursing documentation, ancillary systems, and data warehousing. It doesn’t tell you what you should do, but it tells you what KP did. And a lot of what KP did and is doing is what everybody else should aspire to.

I think you’d have a tough time arguing why KP’s methods wouldn’t work in some form for other hospitals. Instead of having one of those dopey CPOE kickoff meetings where the winner of the “name our clinical system” contest is announced and everybody pretends they are committed to something they don’t even understand, pass out copies of Connected for Health (even better, do it well before any important decisions are made, like choosing a vendor or developing the project plan).

The book covers in perfect detail Kaiser Permanente’s HealthConnect project, the largest non-governmental HIT project in the world. You might think, “What does that huge organization and its $4 billion project budget have to do with my hospital?” Plenty, as it turns out. Most everything in the book is relevant to the EMR-type projects of even modest-sized organizations. Only the scale differs. The issues are pretty much the same everywhere.

Maybe the most important takeaway is that you’re wasting your money on software if you can’t back it up with the pieces that go with it. Hospitals where I’ve worked shot their wads buying an arguably overpriced clinical system, then ensured mediocrity by trying to run it as an on-the-cheap IT project. We didn’t have enough dedicated resources, we weren’t willing to pay community-based doctors for their time to help out, and we went cheap on end user devices and support resources. Maybe Kaiser did a lot more than a typical hospital could afford, but their results have been proportionately more impressive. They spent a ton of money, effort, and planning to go live, but then as the book says, “Welcome to the starting line.”

If you ask me, the foreword by Don Berwick (then of the Institute of Healthcare Improvement, now of the Center for Medicare and Medicaid Services) is worth more than the cost of the book. Don’s a quality and outcomes guy, not some IT geek doctor with four smart phones on his belt. He focuses on patients, not vendors and deals and Gantt charts. I could have worn out a highlighter marking the parts that had my head nodding.

Here’s a snip that struck home as I thought of all the failed, expensive implementations that are wasting the budgets and energies of hospitals looking for an electronic magic bullet to will absolve them of the responsibility to change themselves and instead just convince themselves that swapping out their data plumbing is the Holy Grail:

Without clear incorporation into the actual processes of care, and without the re-engineering of those processes, and without the changes in norms, capabilities, and culture to allow those new systems to take root, KP HealthConnect would become what far too many other health care organizations had already discovered in their own modernization journeys: the computerization of a defective status quo. Kaiser Permanente was not after a modern information system; they were after a modern health care system. Halvorson called building KP HealthConnect “laying tracks”, but he and I both knew that, in the end, it would be the trains, not the tracks, that mattered more.

Kaiser’s former SVP of quality, Louise Liang, MD, ran the HealthConnect project and edited the book (quite nicely, I should add, since I’m highly critical of editing in general). Its chapters were written by local Kaiser experts on everything to system selection to redesigning primary care. Every one of them is a gem, coming from slightly different perspectives, but with a lot of useful information from an organization that has actually done what all hospitals wish they could do.

Now a cynic (like me) might assume that some of the accomplishments might have been glorified a bit by the home team authors, and maybe they were (certainly anyone who has attended a “look what we did” presentation at HIMSS knows that reality and PowerPoints sometimes don’t intersect). KP probably struggled more than was detailed here, and most likely made some stupid implementation mistakes not listed and let politics and let executive egos drive expensively bad decisions that are regretted to this day but not brought up in polite company (like everybody else does, in other words).

I didn’t find that possibility at all concerning since the material has high value even if that’s true. If you’re a skeptic, just consider the book a picture of a desirable future state that Kaiser may or may not have achieved.

Besides, there are some KP warts in there. They had a terrible time getting regions to standardize (I loved this saying: No one is either so high in Kaiser Permanente that they can make a decision, or so low that they cannot veto a decision.) They wasted a lot of money on failed EMR projects. They had to fight human nature. They overspent. They first decided to expand the use of a homegrown system that one of its regions had developed, but then reconsidered when it fell short on its ability to turn KP into an enterprise-wide electronic backbone going beyond just automating clinic offices. They had to sell the vision to the board with the frank admission that KP was “betting the farm” that KP’s form of medicine was where the country was going and their existing systems couldn’t support the transition.

I found this tidbit interesting. They could find only two commercial vendors able to handle everything from medical offices to hospitals. Epic was named, but KP thought they were shaky because their hospital experience was limited back in 2003. The other vendor wasn’t named, but I assume it had to be Cerner, and whoever it was got axed because of inadequate ambulatory experience. Everybody always wants to know why the Epic wins big hospital deals – the book makes it clear from the customer’s perspective that it’s partly because of the company’s vision and leadership, but maybe mostly because their competitors aren’t very good, especially when it comes to connecting the multiple venues of care offered by larger health systems.

KP did a lot of upfront thinking about HealthConnect, which hospitals unfortunately rarely do beyond choosing their vendor. They brought in a wide variety of people to set the vision, not just for the Epic system, but for how care should be delivered. The items that group came up with in 2003 are pretty much dead on with what’s happening today. Their themes were: (a) Home as the Hub; (b) Integration and Leveraging; (c) Secure and Seamless Transition; and (d) Customization.

The book has a wealth of information about project structure, implementation, budgeting, and leadership. Maybe you don’t buy the vision thing (which probably means you shouldn’t be in charge of anything involving patient-centered IT) but these project details will make your time spent reading worthwhile.

The idea of a Collaborative Build was key, where HealthConnect would be built at a national level, but with some customizability allowed by each Kaiser region. The key point was: first standardize, then diverge. They knew that it would be much easier to force standardization and then relax it later as needed, rather than trying to tighten up after the fact (that’s a Management 101 principal that I’ve always embraced – start out as a tough guy, then loosen up later, because the opposite never works).

There is much detail on how KP identified and involved physicians of different capabilities (operational leaders, opinion leaders, and technically adept). They helped choose the system, develop the clinical content, and sell the idea to their peers (clinicians won’t necessarily be faster, but they should be better, they said).

I’m happy to see that a whole chapter was devoted to nursing leadership and impact. It talks about standardizing terminology, involving nurses in system decisions, and looking at specific goals for barcode medication administration and medication administration.

There’s a really nice chapter called Making It Matter that looks at value and quality.The best part was the description of how the goals of HealthConnect were aligned with KP’s commitment to members, something I have pretty much never seen by hospitals anxious to whip out their checkbook and get their CPOE implementation underway before everybody loses interest. KP knew exactly what it wanted to do in a big picture way: make clinical information available around the clock, deliver superior outcomes, become national leaders in patient safety, use patient preferences to make decisions, and several other very specific organizational goals. HealthConnect was the technology enabler, not the project itself.

An idea I really liked was called SmartBooks for Value Realization and Optimization, which was an extremely well developed list of 250 opportunities that each Kaiser organization (region, department, etc.) could use to improve performance by using HealthConnect. The book also has a lot of information about quality data, outcomes measures, and a full chapter on population health (nearly always ignored by four-walls-centric hospitals and health systems). When you see the scope of HealthConnect, suddenly it’s clear where the $4 billion went — most of it not into Epic’s pocket.

Kaiser took a creative approach to designing primary care services. They decided to design processes to meet the needs of their populations even if capacity seemed insufficient, expecting that they could increase capacity virtually by offering more services by telephone, group visits, and e-visits. They had to have a lot of confidence to go that route.

Everybody’s heard of Epic’s MyChart, which Kaiser calls My Health Manager. The book makes an interesting argument about personal health records: surveys that show low PHR use by consumers are asking the wrong question. Consumers will use them if their services are useful and of high quality, and KP’s patients are big users of patient-to-doctor e-mails, checking online lab results, ordering prescription refills, reviewing office visit summaries, and self-scheduling their appointments.

The book has a very nice summary called Refocusing on Systems Versus Individuals that lays out a hierarch of controls for reducing risk. It says that the most effective changes are, in order: simplifying and standardizing, removing opportunities for error, making it hard to do the wrong thing, making it easy to do the right thing, providing intrusive alarms and warnings, and using reminders and non-intrusive decision support. What doesn’t work as well: policies, procedures, and training. Surprised?

Just about every group involved with clinical systems that I can think of would get an immense amount of highly useful information from the book: clinical leaders, physicians, informatics people, and executives. Every group, that is, except one: the average CIO. Kaiser intentionally ran HealthConnect without much direct IT strategic involvement, correctly identifying it as a huge change project, not an IT project. IT’s job was to handle the infrastructure and technology components, not to convince the doctors to use order sets or demand that nurses scan meds before administration. That’s nearly always true of successful big-hospital clinical IT projects. People on the IT dark side don’t usually have a lot of credibility with clinicians, no different than a Mac-using surgeon who thinks he can educate the CIO on how to run a networking team.

If you’re a CIO who thinks you need to be in charge of anything that plugs into a network jack, you will probably be licking your wounds that it’s not Kaiser’s CIO or IT people bragging about their key involvement in the book. Those willing to look at the big picture and share project responsibility without feeling threatened will find it refreshing and enlightening. It isn’t that the CIO’s role was marginalized, it’s that KP let the operational and clinical leadership lead the changes, with IT providing the technical support to enable them. The CEO set the vision, paved the way with resources, and set up the means to collaborate across several regions. CIOs will still look darned smart among their executive, medical, and technical peers for having read this book.

I would consider Connected for Health essential reading for leaders of any hospital that has an interest in quality, data, clinical transformation, and yes, technology (and I would hope that every hospital falls into that category, or at least any that I’d want to be admitted to). The $40 cost of the paperback (the hardcover isn’t out yet) is just ridiculous. At five times that price, you would be getting a steal considering the ideas it has for projects costing dozens or hundreds of millions of dollars. If they packaged up a tenth of what the book covers into a two-day seminar, you would happily pay 50 times the price of a copy. If you are an enterprising consultant, you could probably make a handsome living for many years by just traveling around the country like a honeybee spreading pollen to grateful plants, sharing your purloined wisdom about strategic vision and IT’s role in quality and cost that’s all right there for the taking.

Like I said, I don’t generally like HIT books. I hit the HIMSS bookstore with enthusiasm, but I’ve been burned too many times. I recommend Connected for Health without reservation. It did for me what no book, presentation, or article has done recently: it got me excited all over again at the potential of IT to change healthcare in a way that actually benefits patients.

Monday Morning Update 11/15/10

From Simon Stiles: “Re: Georgia HIT Leadership Summit. It was a huge success in that it united the leaders and vendors to begin talking ‘collaboration’ to benefit the growth of both large and small companies that are part of the health IT cluster that has developed in Georgia. The organizers are focused on attracting and creating more HIT vendors in Atlanta and Georgia that will provide high-quality, high-paying HIT jobs, not to sell products. Success was measured by the number of participating companies (110), the number of speakers and panelists who agreed to future collaboration (100%), and the number of companies that are interested in ongoing events that bring Georgia’s HIT companies together (100%).”

From Jenny from Venice: “Re: you and Inga. Let’s hook up at HIMSS. I love everything you both do, I really do. Lurve you!” Thanks, but I ran your proposal up the Mrs. HIStalk flagpole and she didn’t salute. I can’t speak for Inga. I had to look up “lurve” since I wasn’t exactly sure what it means, so that’s probably a good indication that we wouldn’t have hit it off anyway.

From MarketWatcher: “Re: Merge and Fletcher Flora. That was a very quiet acquisition and and odd one at that. Insight?” Coming soon, quite possibly – I’ll be interviewing a top exec there shortly, provided I can figure out a time after work to connect (darned day job).

From Tony: “Re: HIMSS reception. Has the signup page gone up yet?” Not yet. Look for it in January.

Inga mentioned that Henry Ford Health System is working on rolling out a new version of its CarePlus Next Generation EHR. A reader tells me that the Web-based SOA system was developed by RelWare, which offers its commercial version of it under the EXR nameplate.

AMIA says it doesn’t like “hold harmless” clauses in vendor software contracts. At a reader’s suggestion, I e-mailed CEO Ed Shortliffe to ask if AMIA will put some teeth behind its proclamation by turning down the sponsorship of vendors who won’t go on record as saying they don’t use those. He hasn’t responded, but I’ll let you know if he does.

It’s close to an even split whether recent election results will reduce or delay HITECH payments. New poll to your right: have you personally seen a “hold harmless” clause in a HIT vendor’s software contract? They’re supposed to be everywhere, but nobody every provides an example. I know I’ve seen them in some old copies of contracts that I discarded a few years ago.

San Juan Regional Medical Center (NM) sends four tons of old computer hardware to a Canada-based company that takes electronic waste for free, pays a third party to process it, and donates the profit to Feed the Children.

A Tampa publication mentions the cost of implementing clinical systems at a couple of local hospitals: BayCare ($200 million) and Tampa General ($120 million).

How to be a HIStalk Meaningful User: (a) put your e-mail address in the Subscribe to Updates box to your right to join 6,419 fellow HIStalkers in receiving the latest news first; (b) use the Search box just below it at your leisure to find companies or people mentioned in HIStalk, HIStalk Practice, and HIStalk Mobile, up to 7.5 years ago in the started-in-2003 HIStalk; (c) peruse the ads of those brave companies that sponsor HIStalk, supporting an anonymous, cynical loose cannon who doesn’t always say nice things about this business we call show; (d) share your wisdom by posting your best comments or writing a guest article (provider people especially encouraged); and (e) tell your friends and least-hated enemies about HIStalk, allowing them to join the high-level HIStalk readership, of which a shocking 82% say reading HIStalk helps them do their job better. Thanks for reading.

Four small, closely-located Texas hospitals (the largest has 45 beds) join to create a RHIO around the Prognosis ChartAccess EMR.

Cloud-based population data analytics vendor Explorys, co-founded last year by Cleveland Clinic, hires Anil Jain, MD of the Cleveland Clinic IT department as its part-time chief medical officer.  

The health authority of Norway signs a $120 million deal with IBM to provide a variety of services and to implement a custom logistics solution built around SAP.

Healthrageous, which offers consumer health solutions based on technologies developed by the Center for Connected Health at Partners HealthCare, is chosen as one of the 50 most promising tech startups. It collects health data from patient biometric devices, analyzes it, then sends out recommendations to the patient. I like the name.

Laboratory middleware vendor Data Innovations is sold to Battery Ventures. Old news from last month, but I missed it first time around.

The government of Hong Kong invites proposals to develop a territory-wide platform for sharing electronic health records. More information on the project is available from the eHealth Record Office.

Newborn twins die of a IV-related medication error at a scandal-ridden UK hospital that is already under public inquiry for the unnecessary deaths of 400 to 1,200 patients.

The CEO of National Health Insurance Board of Turks and Caicos Islands has a financial interest in the vendor chosen to process medical claims there, critics claim. The CEO disclosed his “minority interest” in Mitan, but the company’s Web site lists him as founder, director, president, and CEO since 1999.

Odd lawsuit: the transplant center of Georgetown University Hospital calls a cirrhosis patient who’s on the liver transplant list to tell her that a matching donor liver is available for immediate transplantation. They didn’t call any of the emergency numbers she had given, instead leaving a message on her home answering machine. The woman, as it turned out, had a good excuse for not being home – she was an inpatient at the same hospital at that time. When her family found the message and returned the call, they were told that the liver had been given to the next patient in line. The woman died, her family is suing.

Sponsor Updates

• MedPlus announces collaborations with several regional extension centers that involve the company and its Web-based Care360 EHR .

E-mail me.

mHealth Reaction
By Deja Vu All Over Again

For anyone who attended Web or Internet conferences in the mid-90s, your description of the market is a flashback. mHealth as a separate model does not make a lot of sense, which is why they are having a hard time trying to figure it out.

Like in the late 90s for eHealth, all those new mHealth corporate groups will be integrated back into the main lines of business. Mobility is just a different (and exciting) way to deliver much more interactive and innovative value for core health care processes. The dot-com bubble experience will keep the fervor in check this time around.

Having said that, mHealth will have profound changes in US health care over the next five years for the following reasons:

1. Our 5-10 year industry technology lag sets up a great deal of potential disruption for mobile components as the current brittle systems start to move towards loosely coupled modular application platforms like in other industries. Many large HIT vendors are about to enter the SAP enterprise model death spiral.
2. Historically institutions and "back channel" processes have been the focus, not mobile savvy consumer / patients who are rapidly becoming financially forced to be more engaged in their health.
3. Care delivery transformation from payment reform and skill shortages will require fluid care approaches that require mobility, and
4. Most care is now done in the home, but will move from routine to chronic disease management due to aging and the obesity explosion.

Note to bright-eyed entrepreneurs who have not been in the health care industry a long time: the existing HIT vendor mafia has always been much more effective in squashing innovation from disruptive outsiders to maintain the status quo than competitively innovating against each other. If you fashion yourself as David vs. Goliath, make darn sure that God is on your side before you start hurling rocks.

Therefore, there will be a great deal of opportunity for those niche companies that focus on meeting the needs above by complimenting the old guard entrenched HIT vendor systems, but with an eye towards explosive disruption when they are embedded, delivering value, and the market timing is right.

News 11/12/10

From The PACS Designer: “Re: CCHIT’s EACH program. TPD is happy to see that the CCHIT organization has realized that many hospitals have custom EHRs, and now through their new EACH program, they will be able to get current hospital EHR configurations certified more quickly than going to an all new EHR product.”

From Mrs. Marine: “Re: Veterans Day. Many thanks for your gracious acknowledgment of our servicemen and women. My husband is a 20-year Marine and I still get a chill when someone goes out of their way to thank him (or me) for his service. I would also like to acknowledge the many companies in healthcare IT that provide opportunities to military spouses like me to achieve in our own careers in spite of the many challenges that a military life presents. I can tell you from my own experience that I am a better employee, wife, and mother because I have had the support of my company in every way. To Mac, Mike, Tom, and Clair — I will be forever grateful. To the industry, thank you for taking care of us…all of us.”

One more military note: congratulations to HIStalk pal Admiral Cindy Dullea, who retired from the Navy after 30 years of service last month. She is a board-certified informatics nurse and was Deputy Commander, Navy Medicine National Capital Area and Deputy Director, Navy Nurse Corps, Reserve Component. She continues as SVP of marketing at SCI Solutions, which has been a sponsor of HIStalk for most of the 7.5 years that I’ve been writing it.

Accelarad announces its Turbo Gateway DICOM image transmission technology, which it says will speed up image delivery to and from cloud-based repositories via the Internet by up to 300% (4.5 CT images and 9 MR images per second).

Wilson Memorial Hospital (OH) names Larry Meyers as CIO. He was previously IT manager with Children’s Medical Center of Dayton.

A study of 250 hospitals by CapSite finds that 25% plan to invest in new Vendor Neutral Archive solutions.

Jobs from the HIStalk Sponsor Job Page: Healthcare Consulting Leader, Channel Account Manager – Cerner, Product Manager – Mobile Point-of-Care Solutions, Senior Manager Segment Marketing. On Healthcare IT Jobs: Implementation Engineer – Eastern Region, Systems Analyst Programmer V, Cerner FirstNet Analyst, Interface Engineer.

PolyRemedy brings on two new executives: Jeffrey Tingle (previously with the Risk Management Foundation of Harvard Medical Institutions) as software development VP and Heath Umbach (from WebMD) as director of product management. The company offers a Personalized Woundcare System that allows clinicians to assess and document using Web-based tools.

Aetna’s incoming CEO says the company will enter the US HIT market to take advantage of healthcare reform. Earlier talk I’d heard pointed to mostly consumer-focused Web tools, but you never know who they might buy.

The Norwegian government will support the Maternal mHealth Initiative with a $1 million donation.

The Institute for Clinical Systems Improvement licenses Nuance’s RadPort radiology ordering solution to support a Minnesota initiative to ensure medically appropriate use of MRI, CT, PET, and nuclear cardiology tests. The state expects to save $28 million per year based on the success of a 4,000 physician, year-long pilot. Docs get the benefit of not having to get pre-approval for the tests as long as they complete the online information needed to generate a clinical appropriateness score using rules derived from the American College of Radiology’s Appropriateness Criteria.

Coro Health receives $2 million in funding from a former Walmart CEO to deliver music “prescriptions” to long-term care patients that can help with cognitive stimulation and socialization, claimed to improve memory, reduce medication needs, and improve mood.

One of the companies showcased to President Obama during his recent visit to India was Teleradiology Solutions, India’s largest teleradiology vendor. The company says its radiologists cover the night shifts of 100 US hospitals from Bangalore. They’ll be at RSNA.

Speaking of RSNA, if you’re going and want to provide updates for HIStalk readers, we’ll take ‘em.

I’ve been really behind after attending the mHealth Summit, trying to catch up at the hospital and at HIStalk Intergalactic Headquarters (an upstairs bedroom that I just painted because Mrs. HIStalk was tired of the crappy builder’s whitewash that we had never changed). I have new sponsors to announce, reception details to hint at coyly, and HISsies to get started shortly. I’m hoping to dig out this weekend in case I’m tardy with something you’re expecting from me. To those folks, thanks for your patience, and to everyone else, thank you for reading and thereby giving me an excuse to do something that at least passes for productive on occasion.

A Harris Interactive study finds that smart phone users don’t care whose brand name is on their apps as long as they are highly recommended and offer a good user experience.

This flies against everything I’ve been taught about medical errors: the systems and procedures at Seattle Children’s were not at fault in three serious medical errors, a state investigation concludes. Everything was in place to protect patient safety, it said, which is then puzzling as to how the errors could have occurred. It also doesn’t explain why the hospital revised its medication policies after killing an 8-month-old with a tenfold overdose of calcium chloride. The investigation now focuses on the individual caregivers, which often means they get all the punishment as rogue operators (which they sometimes are, but not usually).

A Massachusetts county sheriff faults a police dispatcher for the death of a woman who choked to death on a marshmallow. Her husband called 911, but the dispatcher didn’t give him instructions on performing the Heimlich maneuver or CPR during the 12-minute call.

An Associated Press article covers informed consent applications that allow patients to review the risks of their procedures using multimedia, even from their own homes. Mentioned specifically: Chicago-based Emmi Solutions, which sells such a system used by 100 hospitals. Also mentioned: Dialog Medical, which is used by all of the VA’s hospitals.

It’s shocking that Weird News Andy missed this story: a South Carolina man high on hallucinogens is arrested after attacking officers investigating a home burglary, resisting to the point deputies have to use pepper spray, nightsticks, and a Taser on him. He’s taken to the ED, where the doctor notices a computer mouse cable dangling from his nether regions. An X-ray confirms that the rest of the mouse was where you might expect. He doesn’t remember how it got there, which is quite a testament to the power of hallucinogens.

E-mail me.

HERtalk by Inga

From Saxifraga: “Re: Facebook fan. Do I win a prize for being the 1,000th person to like you on Facebook?” I’d send you some fabulous virtual gift if I had one of those goofy Facebook apps set up. Thank you, Saxifraga, and our other 999 fans for your support. Mr. H and I are feeling very connected these days and we’re always happy to friend you on Facebook and connect with you on LinkedIn. You can also join the HIStalk Fan Club on LinkedIn, be a fan of the HIStalk page on Facebook, or follow us on Twitter. Basically, we are trying to be very hip when it comes to social media. It’s satisfying in a pathetic sort of way.

A reader tells us that Saint Alphonsus Regional Medical Center (ID) went live on Cerner October 15th and has reached almost 90% CPOE adoption, also deploying SurgiNet and FirstNet across all its patient and ambulatory areas.

Henry Ford Health System (MI)  announces plans for a $5 million expansion of its Rochester Hills data center, which will create 20 to 30 jobs a year for the next several years. Its technical employees are focused on the rollout of CarePlus Next Generation, the newest version of the health system’s homegrown EMR.

Healthcare providers rely on vendors with which they have an established relationship when selecting a Recovery Audit Contractor (RAC), according to KLAS. The most-considered vendor is Healthport (23% of the time), followed by MediRegs (16%) and 3M (14%.) Of the 98 provider organizations participating, 92% said they already selected a RAC solution; more than half only considered one RAC offering.

VHA selects TeleTracking’s RadarFind and its RTLS network as an option for its 1,400 member hospitals.

Yuma Regional Medical Center (AZ) will use InterSystems Ensemble for the development of interfaces with its Epic EHR application.

The VA contracts with DSS, Inc. for its Mental Health Suite EHR, which it will implement in all 153 of its hospitals.

Accenture wins a 10-year, “indefinite delivery / indefinite quantity" contract with the CDC for information management and IT infrastructure services. The total contract has a ceiling of $4 billion over the life of the contract.

The president of GE Healthcare’s business unit predicts that his division will see 10% profit annual growth, mostly due to an increase in world demand on big medical equipment. John Dineen expects particularly strong growth from China, which could grow 20% a year through 2015.

Halfpenny Technologies names Gai Elhanan, MD, MA as the company’s CMIO. He was most recently chief of healthcare informatics at 3M Health Information Systems.

The American Medical Informatics Association declares that “hold harmless" clauses in contracts between HIT vendors and providers are unethical and that vendors should not be automatically absolved for errors or defects in their software. Instead, vendors and customers should share the responsibility for patient safety and error management. AMIA also states that safe and successful HIT systems require ethics education on the part of vendors and clients. Great recommendations, but I don’t see vendors rushing to ask attorneys rewrite their standard contracts.

CCHIT announces that it will offer a new EHR certification program for hospitals beginning December 15th. The EHR Alternative Certification of Hospitals (EACH) program is an ONC ATCB certification program that is designed for hospitals that have uncertified legacy software, customized commercial products, or self-developed EHRs.

MonteFiore Medical Center (NY) activates DaVincian Technologies’ GUARDIAN to streamline patient registration and scheduling and improve data accuracy.

Sponsor Updates

• The Methodist Hospital System (TX) engages MEDSEEK to create an integrated patient portal based on data from its Eclipsys inpatient system, NextGen outpatient program, and Medicity HIE.
• Informatics Corporation of America (ICA) promotes John Tempesco from VP of client services to chief marketing officer and hires Brian Higdon, formerly of Affinion Group, as vice president of client services. Former TeraMedica Healthcare Technology VP Sandra H. Lillie also joins ICA as VP of sales and business development. In addition, ICA adds three Vanderbilt University Medical Center officials to its board of directors.
• Bridgehead Software partners with Perceptive Software to offer a combined solution that includes Perceptive’s ImageNow enterprise content management application and Bridgehead’s virtualization storage solution.
• Picis hosts an audio conference November 16th featuring several HIE leaders discussing the financial, operational, and clinical considerations of establishing health information exchanges.
• MED3OOO is recognized by Everything Channel’s CRN Magazine as a Top Healthcare VAR.
• Gillette Children’s Specialty Healthcare (MN) chooses Carefx and Indigo Identityware for single sign-on, context management, and clinical workflow.

E-mail Inga.

News 11/11/10

From Icarus: “Re: HIMSS Middle East conference in Dubai. Over 400 attendees are here. Lots of interest from providers in Qatar, Saudi Arabia, Pakistan, and UAE. Vendors include Allscripts, Cerner, First DataBank, Zynx, InterSystems, GE, and Hospira.” Thanks for the photo.

From Matt Yourity: “Re: business models and mHealth. What will work is ‘mHealth Plus,’ apps that are integrated with a person-centric longitudinal health record (with clinical information, claims, patient-entered information, and data from devices). Apps can integrate with each other and with processes in a robust middle layer. The business model is that we’re all paying for the cost of bad behavior, so there’s the incentive. Cute apps built in a silo are not the future.” It struck me at the conference that mHealth is where HIT was 20 years ago – everybody building their own single-purpose app because it’s cool (and because they can) rather than thinking big picture with regard to integration and user convenience. That’s a function of maturity, I think, so hopefully the “cute app” state will go away when investors realize there’s no profit potential and they probably won’t get much patient or clinician uptake anyway. If your solution requires going to a specific product’s Web site, there’s a good chance it won’t fly. The mHealth people need to be put in room with the PHR people since both need some help. The mHealth projects seem to mostly involve people with no enterprise IT experience. They’re doing what spare bedroom programmers always do – building cool stuff that may not be optimal if it ever needs to scale or broaden.

From Hollis Figg: “Re: Dell. Roger Davis, SVP of physician services outsourcing from the former Perot, has left abruptly.” Unverified. His LinkedIn profile is unchanged.

From Scratching my Head: “Re: EHR certification process. Any consultants you’d recommend that can help vendors make sense of it?” I’m sure there are several. The one I know that’s offering that service is Frank Poggio from The Kelzon Group. You’ll notice his text ad running in the right column (which is how I knew he was working with vendors on certification). Others can comment on this post and I’ll waive my usual “no commercial pitches” rule.

From Jesco White: “Re: mHealth. Your report concludes that there is no money to be made, but the opposite appears to have been reckoned by Verizon. They are supporting a big Health IT event in Atlanta.” I should have qualified my assessment by saying that the cellular carriers and phone makers are fully intending to monetize mHealth in some way, perhaps my making it a value added service that either costs extra or results in higher service fees. They were the dominant vendors at the mHealth Summit. It’s the people writing apps that haven’t figured out a business model.

From Digital Bean Counter: “Re: TAG healthcare IT summit in Atlanta. Aside from a decent turkey sandwich, it was a letdown. McKesson took the cake for the most part. I was surprised that the Verizon and Intel reps knew little to nothing about HIT, let along whatever it was they were trying to sell. The summit was mostly around the hype of hiring new people. I was amazed at how many attendees were out of work, between jobs, or in school. Funny thing is, when the floor opened up for questions, panelist balked at the ‘why can’t I get a job when I have experience’ question. At least the eye candy was decent – the industry is still doing a great job at hiring pretty ladies to rep their respective companies.” Maybe that’s what the panelists didn’t want to say – you can’t get a job unless you’re cute.

From Lucky Tech: “Re: weird news candidate. What’s next – pregnancy testing via SMS messaging?” UK researchers are working on a smart phone app that will analyze urine to instantly diagnose sexually transmitted diseases.

From CIODude: “Re: IBM. I’ve had numerous meetings this week with with ex-IBMers. It struck me that the lead healthcare people at most of the major technology companies  are all people who left IBM. Neil de Crescenzo left and is now Oracle’s lead executive. Jamie Coffin leads Dell’s healthcare group and Doug Cusick who led IBM’s global healthcare team is now leading HP. The IBM/Healthlink execs are all at Encore. Who’s left? For the first time in my career, I can’t name a single IBM healthcare executive and I’ve been very active in this industry for many, many years. What’s going on at IBM where they can’t keep people?”

From Happy Valdez: “Re: LSS. At the Meditech CIO conference, rumors were swirling about LSS Data Systems being shut out and Meditech opening a partnership with eClinicalWorks.” Unverified.

I don’t usually post news on Wednesday night, but I’m way behind from being at the mHealth Summit this week, even though Inga skillfully kept things under control. I figure I might as well clean up my inbox now instead of waiting until Thursday evening. It will be back to normal Thursday night.

Listening: We the Kings, Florida-based power pop. They’re young, clean (no explicit lyrics), and cheery. Nice sound.

Google changed its appearance this week in honor of the 115th anniversary of the X-ray, Weird News Andy noted. He also brought up the fact that Google was caught (accidentally) sniffing personal information from WiFi connections, adding, “Just how do people trust their PHR on Google Health? I don’t.”

Thursday is Veterans Day, observed on November 11 as the signing of the armistice ending World War I, which took place on the 11th hour of the 11th day of the 11th month. This is a day set aside to honor all military veterans, living or dead (Memorial Day is for those who died in their service to the country, which I say because people often don’t know the difference). But the main thing you should do tomorrow is to thank those who have served, regardless of whether their orders involved something that you agree with (they don’t get to choose). Which I would like to do right now: thank you.

I’m pleased to welcome Thomson Reuters as a new Platinum Sponsor of both HIStalk and HIStalk Mobile. The company offers the Clinical Xpert solution suite, which delivers real-time data to clinicians via the Web and a variety of smart phones (Windows Mobile, Palm, BlackBerry, and the just-added iPhone/iPad/iPod Touch). Clinical Xpert has been the KLAS Category Leader for Mobile Data Systems for eight years in a row. It gives providers tools to improve quality and reduce cost without changing the underlying IT systems, including the pharmacist dashboard I’ve written about lately, a surveillance tool to prompt clinicians to intervene, the patient information app, a billing system (powered by Ingenious Med), and a handoff tool. Thanks to Thomson Reuters for supporting HIStalk and HIStalk Mobile.

Beryl adds two new regional VPs for its Patient Experience Group: Rick Jacob (formerly of CareTech Solutions) and Nicole Nicoloff (from Community Health Network in Indiana).

Weird News Andy notes that some Romans have put a halt to construction of a planned NHS Lothian primary care clinic in Scotland. They’re not walking a picket line, they’re dead – construction is delayed for at least six months after workers uncovered Roman artifacts from 140 AD, including skeletons and weapons.

Nova Scotia’s health minister denies the request of two large hospitals to change privacy laws to opt-out instead of opt-in, which would have allowed them to market to patients and families using information on file unless those individuals expressly declined. The hospitals said they would make sure not to send promotional materials to parents of deceased children, for example, but the health minister said they should stick to taking care of patients. The hospitals implied their marketing campaigns could have raised $40 million over the next five years.

Virginia Commonwealth University Health System chooses 4medica’s lab and anatomic pathology result viewing and exchange solutions.

Someone who should know tells me that the Kansas City paper had the story wrong in saying that Cerner and Pulse didn’t make the original HITREC cut there, but were added afterward because they are local. Here’s the real story, they say: the Missouri and Kansas RECs had different lists and came together in a complex way to arrive at a single list, but that list was only for negotiating purposes. Missouri’s list was the one in which docs and office staff scored vendor demos and both Cerner and Pulse made that list, which wasn’t intended to be a final preferred vendor list. The whole thing was a little too complex to hold my interest, but basically the paper was correct in saying that there were two lists, but incorrect in assuming that Cerner and Pulse were added to List A to create List B.

Another point of view from someone who knows the HITREC situation there says the news isn’t whether Cerner is or isn’t on the list, but rather that their Tiger Institute investment made it questionable at all considering the whole KC-MO joint process was killed off because of that. This person says Cerner has never said how much it’s spending on the Tiger Institute program since it would then be obvious what benefits they expect to achieve from it, so they just call it “cost neutral” and nobody asks further questions. There’s speculation that since the newly elected governor’s campaign organizer is a Cerner VP that Cerner will somehow take over the state HIE effort, especially since their big campus investment on the Kansas side gives them additional clout.

Someone forwarded an e-mail update from Shareable Ink to Inga that noted two events it mentioned as making “a big splash in the industry news over the past couple of weeks.” One was $4.5 million in new financing. The other was my interview with T-System CEO Sunny Sunyal, who talked quite a bit about the DigitalShare joint project between the companies. That was pretty cool to see.

Interesting: the DoD keeps finding reasons not to use the VA’s VistA system (arrogance seems to be the main one), but the Army is looking for someone to install WorldVistA in a military hospital run by Iraq’s government in Baghdad.

Sponsor Updates

• Blanchard Valley Health System (OH) renews its outsourcing contract with CareTech Solutions.
• An article by Maryland McCarty, IS director at Atlanta Medical Center, in the Atlanta hospital newspaper talks about its implementation of SCI Schedule Maximizer and Order Facilitator. The hospital says they’ll be at the forefront of patient scheduling, which will increase the use of their registration kiosks to reduce wait time. It also mentions that physicians can view availability in real time to make sure their patients get scheduled as promptly as they would like.

E-mail me.

Merge Healthcare Acquires Fletcher-Flora Health Care Systems

One day after reporting strong revenue growth for the third quarter and the appointment of Jeffrey Surges as CEO, Merge Healthcare has acquired Fletcher-Flora Health Care Systems, HIStalk has learned. The Anaheim, CA-based Fletcher-Flora develops and distributes a laboratory information system.

Merge reported $45.2 million in revenue for third quarter, compared to $16.9 million in 2009. Adjusted net income was $.04/share, down from $.06/share last year. Surges, who was previously president of sales for Allscripts, replaces Justin Dearborn, who will take up the newly created role of president and concentrate on Merge’s international operations.

From the mHealth Summit 11/10/10

One thing you can say about the mHealth Summit: they give you your money’s worth in terms of long days with minimal downtime. Today, for example: it was straight through from 9:30 a.m. until 4:30 p.m. with just one five-minute break (even the lunch was all presentations).

They just can’t figure out the whole refreshment thing, though: the one-and-only concession stand that had mile-long lines yesterday was CLOSED today. The only food in the entire building was two levels down at an overwhelmed Starbucks. Man, that was annoying – the food and drink markup is insane, but even then you can’t get anyone to simply show up and sell you the stuff.

I wanted a soda, but of course there are no machines in the building since that would compete with those kiosk people who couldn’t be bothered to actually show up, so I finally worked up the nerve to go outside among the boarded-up buildings and street people to find an incredibly dumpy place willing to part with a dented and off-tasting can of Diet Pepsi for $1.50.

I also noticed that many of the convention center outside doors were locked, the water fountains I tried didn’t work, and some of the bathroom faucets didn’t either, all of which makes me wonder how well maintained the place is. It’s not a bad-looking building and it’s comfortable and well laid out, but the iffy neighborhood on three sides, lack of maintenance, and signs pointing to non-existent food stands left a somewhat negative impression. 

The first speaker came out with his real-time streaming physiologic data displaying on the big screen, collected by a tiny Bluetooth-enabled monitor in his shirt pocket going to a cheap cell phone (blurry, artificially sharpened photo courtesy of the crappy iPod Touch camera). It was pretty cool, but the real-world problem is tougher: who’s going to read that data and react to it? He mentioned that doctors aren’t interested because they don’t have the time to watch data that’s usually meaningless, plus malpractice attorneys would have a field day dragging them to court if they missed something.

That’s the big unanswered challenge: the world is short nearly every kind of healthcare worker, so any mHealth solution would ideally reduce their workload, not increase it.

Ted Turner was an early keynote. I had a snarky comment involving his trying to coerce Hanoi Jane into having three-ways (since he got unwanted PR when she divulged that in her book), but I’ll let that pass. Ted was pretty cool, very low key. I actually thought his answers were all going to be of the yes-no variety until he finally got warmed up and started talking a little. I saw no evidence of the infamous “Mouth of the South” from his younger years (he’s 71 now).

Ted was kind of all over the place, most of it not health-related, but he was still entertaining. He of course gave the UN $1 billion and told a fun story about that. The US was refusing to pay $1 billion in UN dues, so Ted was going to pick up the tab, but the UN wasn’t allowed to take the money directly from him. He said he originally toyed with the idea of buying the debt from them for 80 cents on the dollar, then doing what the UN couldn’t do in suing the US for the unpaid balance, which would have netted him $200 million with minimal work. What he really did was to set up a foundation to support the UN and to do charitable work, some of which involves health (lots of it involves elimination of nuclear weapons and war, which as he cleverly points out, can make all the health gains obsolete if people are killing each other intentionally).

So I didn’t get much healthcare stuff out of Ted, but I loved this story that he used to illustrate the point that conventional wisdom is often wrong. After he started CNN, he also started The Cartoon Network, which everybody told him was stupid since the experts assumed nobody watches cartoons. He said that The Cartoon Network now draws an audience 2.5 times the size of CNN’s, but nobody admits to watching it. As he said, “Bugs Bunny is still funny.”

Carolyn Clancy of AHRQ spoke for a few minutes, but all I wrote down was a couple of not-too-interesting projects at Denver Health and Vanderbilt and this link to a list of innovative projects. She also said the mHealth should be part of Meaningful Use, but didn’t elaborate on that.

Several speakers made these points: the industry needs to move away from single-focus projects that try to beat out a competitor. The way to win is through collaboration. Nearly all of them seemed amazed at the number of attendees since I guess it was a pretty sparse band of research geeks that attended last year’s inaugural conference.

This was a good point made in a morning session. The goal of mHealth in developed countries is to increase the efficiency of care delivery that’s already happening. In developing countries, it’s to provide access to care that doesn’t exist, leapfrogging the phase we’re in here. An example given was SMS appointment reminders that can be cancelled by replying.

One of the best speakers was Patricia Mechael from Columbia, who did a Letterman-like list of things the industry needed to do to hold itself more accountable. As she said in calling for better outcomes research, sending a million text messages doesn’t necessarily change behaviors.

I went to a session in which technologies were shown that send information back to providers. The first was PhiloMetron’s PTMS, the “Patch That Measures Stuff.” This was pretty darned cool, a bandage-like disposable patch (seven-day lifespan) that can track several measures. The most interesting thing they’re working on (gathering the data for FDA review) is auto-sensing of calories take in and calories burned (don’t ask me how they do that – in fact, don’t ask them because they won’t say). They’re planning to use the patch to drive dietician counseling. A variant detects the formation of wounds, like pressure ulcers. The company says the patch can be sold for around $30 at scale, so for $1,500 a year, you are wired 24×7 like an astronaut or something.

A UCLA researcher reviewed his cell phone microscope for cytology, which was cool because to get the size and price down (it’s the size of a quarter, 35 grams, and around $10 to make) it has no lenses. It does some kind of cell-level shadow analysis that allows the cell image to be reconstructed on the back end by software running on a laptop or server. It was nearly perfectly accurate from the pictures shown. I think he said it could be used for water safety and field testing for diseases by experts (not regular citizens, in other words).

Vitality showed its smart pill bottle and the compliance improvements resulting from its use. That’s another of those problems technology alone can’t fix – if patients won’t even take their prescribed meds, then what do you do? At least it has a business model – drug companies make more profit when patients take more pills, so maybe they’ll pay for the gadgetry.

So then it was lunch with Bill Gates, which had people ganging up at the ballroom entrance well in advance. Bill would have felt the pressure to be highly informative and entertaining had he known how bad the lunch was given its $75 ticket price (which I hope went to Bill’s foundation and not the caterer). My table had a spirited debate about whether the hideous drink in the pitcher was iced tea or fruit punch, which was an equal split until I postulated that it tasted like really bad fake lemonade with really bad iced tea from concentrate dumped in.

Bill seemed genuinely humble and introspective, speaking clearly and patiently like a really good teacher. Maybe age does that to you since both Bill and Ted (no Excellent Adventure pun intended) were a lot less animated than in their youth. Bill is amazingly well versed in healthcare and his big thing is reducing mortality of children under 5, which means Bill is a vaccine man big-time. He likes the idea of registering all births so that vaccine reminders can be given.

I found this fascinating: you would think that saving all of those babies would increase world overpopulation, but Bill says no – studies have shown that there is no such thing as a country with good health and a high population growth. For some reason, saving those babies actually reduces the population. He also said that nearly all of the world’s overpopulation is coming from urban slums.

He also likes the idea of digital currency to avoid having the local despots stealing the aid money intended for needy citizens. Apparently it can be handled purely by cell phone.

He brought up again that you can send all the reminders you want and people can pass tests showing they understand what they should be doing, but that doesn’t mean they will actually do it. He proposed for obesity that cell phone sensors should detect a lack of movement, then shake to remind the person to exercise. If they don’t, he said, don’t allow them to make calls until they do five push-ups (pretty funny guy, that Bill). As he put it, it’s been shown that you can take someone who exercises 80% of the time and get them closer to 100%, but for the large majority doing 0%, reminders don’t seem to work.

He also mused that the problem with public health problems is that they take years to develop, which makes people ignore risky behaviors since the time between exposure and suffering is long. He said that it would be better if AIDS killed people instantly because they would have an immediate incentive to avoid risky behaviors (as he said, they would know from the piles of bodies outside bars and brothels not to go inside).

The moderator asked him to name one technology that will be the next big thing after communications tools. He said robots, saying that computers can already see, listen, and move around. He observed that it would be tough to program a robot to help an elderly patient out of bed and to the toilet, for instance, but once the programming was done, the robot would be tireless and consistent.

Bill Gates is the man. I thought so before, but now I’m convinced. Rubber chicken or not, I got my $75 worth.

Aneesh Chopra was next up. The US CTO is a White House position, which was obvious since much of his pep talk involved bragging on the Obama Administration’s healthcare IT accomplishments. He talked up the VA’s telemedicine projects, the Blue Button initiative, and Meaningful Use. He bragged on the wisdom of making EHR certification modular, saying it would allow niche vendors to complete in specific areas of functionality.

He mentioned something about Project SMArt, a universal API into legacy hospital systems that will be available in the spring.  I found its Web page here. Apparently that mention today was its coming out party, according to the page. It was mentioned previously as an iPhone-like front end to legacy systems and there’s a developer contest involved. This could be interesting, so we’ll see where it goes.

I met with Travis Good of HIStalk Mobile after the lunch and then called it a day since I had to meet someone. The conference runs through tomorrow, but like most conferences, I would expect the last day to be less interesting and less well attended.

My summary is this. mHealth is not very well defined. Is it doctors reviewing PACS images by smart phone? Personal health records? Sending SMS text messages to moms-to-be? Using mobile devices to function as remote microscopes and medical devices? Offering face-to-face telehealth consults? Remotely controlling medication dispensing?

This conference focused on global health, primarily patient education and reminders. Most of the rest of what you might logically call mHealth wasn’t really covered since this is a meeting of mostly researchers and public health people. There wasn’t much here for you if your interest is in medical services delivery (hospitals and practices).

If anything, that kind of global health work is probably more noble and impactful than trying to sell EMRs to HITECH-yearning providers who don’t really see reason to change. There isn’t much money in global health. The meetings tend to be academic focused – no motorcycle giveaways or bribes to visit the vendor booths. They also tend to involve countries other than this one, either (a) those that are well ahead of the US in that area or (b) those who can’t provide even basic medical care services to their citizens.

What will be really interesting is to see how next year’s conference shapes up (December 5-7, 2011). Will many of this year’s attendees decide that the content wasn’t relevant to their work, even if seeing Ted Turner and Bill Gates in the ads convinced them to show up this year? Or will word spread and the conference grow to cover more of what could be defined as mHealth? And most of all, will the realization that this kind of global health-focused mHealth is probably never going to be profitable leave it as the domain of grant-funded researchers running endless pilot projects that sound great but don’t impact outcomes?

Beats me. I’m glad I came this time, but I don’t think I’ll be back next year unless I’m somehow improbably more involved in mHealth than I am now. We have our own problems in hospitals and practices and it seems to me that the players, the methods, and the rewards are so vastly different that this group of mHealthers have nearly nothing in common with us HITers, so I found little to learn and little to offer that was relevant. I admire the work they are doing, though.

News 11/10/10

HERtalk by Inga

From Lars Ellison: “Re: ARRA push back dates and repeal. I agree with you 100%. Even with the shift of power in Washington, I do not think that Meaningful Use is going away. On another HIT front, we recently received ‘off the record’ confirmation from the Minnesota pharmacy board that the 2011 e-prescribing initiative would probably (leaning towards very likely) be pushed back to give dentists and doctors more time to comply with the initiative.” Lars is referring to Minnesota’s e-prescribing mandate requiring all providers and dispensers to “establish, maintain, and use” an electronic prescribing program by January 1, 2011.

Customer satisfaction with Siemens Soarian is climbing as customers report improvements in service and product quality, deeper clinical adoption by clinicians, and better interfacing with Siemens’ pharmacy system. Soarian still lags in CPOE adoption, though 23 hospitals are now on CPOE compared to three just two years ago. Soarian sales are still lagging due to lingering negative perceptions.

If this HIStalk thing doesn’t work out, being a social media manager for a hospital might be fun. Reportedly the demand for social media manager or interactive marketing specialists is on the rise as hospitals attempt to increase their social media presence and teach physicians and execs social media basics. The role is so new that it’s hard to pinpoint typical compensation, though one hospital recently offered job-seekers between $60,000-$80,000 a year. Eighty thousand AND you get to post to Facebook all day long.

The Cleveland Clinic plans to lay off nearly 200 employees from a variety of administrative and clinical jobs. The health system says the layoffs are the result of a challenging economy and restructuring.

CPSI announces the formation of its new IT Managed and Professional Services business unit. The division will offer managed IT and professional services for its existing hospital clients.

Emdeon reports net income of $3.73 million for the third quarter, compared to a loss of $7.21 million last year. Revenue was up 4.4% to $245.92 million compared to $235.46 million in 2009.

Several companies have sent notes asking if I’ll be attending RSNA later this month in Chicago. I’m not, though I think I’d like to go one day. I’m amazed that a conference for a single specialty could be so huge (60,000) and attract attendees from all over the world. The enormity of it intrigues me, though there is also the whole “Michigan Avenue shopping opportunity before Christmas” thing that sounds appealing as well.

“

Speaking of huge conventions, HIMSS is just over three months away. I have secured my travel arrangements, which include a hotel half a mile away at $125/night. That’s definitely cheaper than what I paid in Atlanta and Chicago the last couple of years. Thus, I’ll have more spending money for the important things like fashion accessories. And speaking of fashion, Mr. H and I are scheming a few new things for this year’s annual HIStalk reception. Without leaking too many details, the gracious and fun folks from Medicomp are helping us with a red carpet entrance, which will allow all divas, wannabe-divas, and “I want to hang out with divas” to make an appropriate entrance. The “Inga Loves My Shoes” sashes will be once again be awarded to worthy candidates, so don’t leave your hot shoes at home. New this year: we will be encouraging cocktail attire and will award AMAZING prizes to the best dressed guests. We haven’t figured out what those amazing prizes will be, but are happy for any and all suggestions. The party sign-up will be sometime in January, but it is never too early for fashion planning.

CMS is conducting final testing of its system to handle registration, attestation, and payments for providers participating in the Meaningful Use program. Registration opens in early January.

According to the local paper, Banner Boswell and Del E. Webb medical centers have completed their conversion to Epic EMR. An RN with Boswell was quoted as saying the system seemed complicated at first, but was “easy to learn.”

Update: A US District Court judge dismisses a false claims suit filed by whistleblowers against Midwest Orthopaedics at Rush, several of its physicians, and Rush University Medical Center. The lawsuit, originally filed by a hospital executive and a fellow surgeon, stems from accusations that Rush physicians routinely overbooked their schedules and relied on residents to perform surgeries.

University of Utah Health Care installs TeleTracking’s TransferCenter software to speed patient transfers.

Saint Barnabas Health System (NJ) contracts with InSite One’s InDex Vendor Neutral Enterprise Archive to connect its six hospitals into a single, long-term data storage solution.

Sponsor Updates:

• Sage Healthcare announces the addition of six new practices running its PM and EHR applications. The healthcare facilities represent over 150 providers.
• CynergisTek CEO Mac McMillan will be the keynote speaker at next week’s Mississippi Hospital Association HITECH seminar on security.
• Mercy Memorial Hospital (MI) selects several Allscripts clinical products, including Sunrise Enterprise 5.5, EHR and PM for its employed and affiliated physicians, and Allscripts Care Management.
• Community Memorial Health System (CA) purchases PatientKeeper’s product suite, including CPOE, Physician Portal, Mobile Clinical Results, and eSignature
• RelayHealth launches its new Payer Connectivity Services 5010 and Beyond Program at the Workgroup for Electronic Data Interchange 2010 Fall conference this week.
• Frimly Park Hospital (UK) says that within months of going live with Picis solutions, it has improved utilization of its OR suites by 5%.
• Methodist Children’s Hospital (TX) claims its implementation  of T SystemEV has allowed them to save $1.5 million in one year though improved documentation and increased efficiency.
• Children’s Hospital Boston plans to implement iMDsoft’s MetaVision Anesthesia Management System.
• Gillette Children’s Specialty Healthcare (MN) selects Carefx and Indigo Indentityware’s solution for secure identity management and context workflow. In addition, West Hertfordshire Hospitals NHS Trust picks Fusionfx to provide an aggregate view of patient information within a single portal.

E-mail Inga.

From the mHealth Summit 11/8/10

Washington, DC is pretty nice this week given that (a) it was a bit chilly and windy on Sunday but nicer today, and (b) it’s getting dark really early now with the time change (that’s not just Washington’s problem, but since I was here on the day of the time change, I’m blaming them). I like the city, to be honest, even though I loathe the politicians, lobbyists, lawyers, and federal contractors that crawl all over it.

I’m staying in the Grand Hyatt Washington, which hurts a bit less now that I’ve seen it than when I first saw that I would be paying $181 per night out of my pocket. It’s a really nice hotel, two blocks from the White House in Penn Quarter, just down from the main entrance to Chinatown and Verizon Center. It’s also close to lots of funky restaurants, which is a plus. Even the $30 per day self-park fee didn’t seem so bad once I saw what parking cost at the nearby open surface lots. It’s just a couple of blocks from the convention center, an easy walk across a parking lot and up one street.

A friend met me here Sunday, so we took a nice stroll by the White House and down the mall to the Capitol. I took her to Clyde’s of Gallery Place just down the street from the hotel for dinner, which is was what I modestly expected, but with low happy hour prices and a clubby atmosphere that made it quite nice — the $6 empanadas and mussels were good, the $2 PBRs were cold, and the pumpkin bread pudding was pleasantly fall-ish. If you’re looking for someplace cheap and unchallenging near the Convention Center, it’s a safe walk and it feels nicer than the prices would suggest.

About the conference: it’s rather the anti-HIMSS, which I’ll explain as follows. Suppose you really like Las Vegas, with the noise, the glitz, the fakery, the conniving thieves at every turn, and the general sense that lots of people there are expending their pent-up immorality a safe distance from home where nobody knows them. That’s HIMSS.

mHealth Summit has 2,400 attendees (less than a tenth of the HIMSS crowd), most of whom seem to be academics, global health people, federal workers, and people from other countries that are way ahead of us in mHealth (and that’s quite a lot of countries). Vendor presence is minimal. Many of the attendees are young and idealistic, trying to solve big world problems (hunger, infectious disease, etc.) instead of landing their dream job working for a vendor and walking around self-importantly with smart phone in one hand and a mirror in the other. It is, therefore, quite un-HIMSS like – serious people getting serious education mostly working for noble causes underwritten by government money.

Here’s the interesting part: as non-commercial as it is, you might not like it. I felt way out of my comfort zone not seeing the same faces, the neon sprawl of the exhibit hall, and the presenters claiming they had finally reached healthcare Nirvana just by implementing version 26.2 of some vendor’s 1980s clinical system. I recalled that old National Lampoon story about two guys who found an alternate universe version of Las Vegas where the slots paid out freely and the hookers and drunks were absent, but all they could think of was going back to the real, gritty, sleazy Vegas. That’s how I felt today – I kind of missed the debauchery and shallowness.

Logistically, everything was mostly very well done. This was a long day, with the first session starting at 9:30 a.m. and the last one ending at 6:30 p.m. (without those big scheduling blocks that HIMSS leaves open to force you to the exhibit hall – you had to really dig to even tell when the exhibit hall was open). Lunch was scheduled for an hour, but somehow the planners slipped big-time in offering  what was optimistically described as, “Lunch On your Own, concessions stands will be available.” Make that “stand” in the singular: 2,400 attendees were cut loose simultaneously from the one and only keynote, only to find ONE single-line concession stand from which to buy $9 salads and $7 sandwiches. It looked like starving refugees threatening to overwhelm a UN aid truck, to use a global analogy. The line was huge, even at the end of the scheduled hour, and people were still trying to get food well into the next session. The convention center had several signs indicating that food was available elsewhere, but I looked all over the building and there was none. Somebody really goofed. I could have quit my hospital job if I’d had a hot dog cart on the sidewalk just below the window where the line ran.

It was clear from the beginning that this conference was thinking bigger than HIMSS, which fixates on vendors and in-hospital productivity applications to the exclusion of population health. I sketched this on my agenda:

US hospitals < acute care services delivery < US healthcare system < US population health < global population health

HIMSS is mostly in the leftmost category and entirely in the first two (inside the walls of providers almost entirely because that’s the vendors that pay them richly). mHealth Summit is mostly in the rightmost category and entirely in the last two. If you don’t like hearing about charity-funded SMS messaging projects in Kenya and Tanzania presented by volunteers, you should probably stick with HIMSS.

The 2,400 attendees hail from 48 countries. There are 125 exhibitors, a couple of hundred press people, and a ton of poster presentations. The big sessions are in the ballroom, which was nice because it has tables in the round (a place for your laptop, in other words) and free (slow) WiFi.

This site has a lot of information about various mHealth projects. Also mentioned was this site, which will have a cool summer internship program up soon. I jotted down the Web address of this Hopkins-led global health program and this interesting health information project from the Bloomberg School of Public Health at Hopkins.

I liked this quote: “Global is not the opposite of domestic.”

HHS CTO Todd Park was one of the early keynotes. He was pretty good, although he went a little bit too fast for me to be able to follow him. He mentioned that over 100,000 expectant mothers have signed up for the Text4Baby service. He says HHS will be launching similar SMS messaging services for obesity and childhood health. He also said that the HHS-led change in reimbursement will make mHealth a viable business (a feeling not shared by any of the speakers I heard, but I digress).

The next session was a panel, with a couple of speakers standing out. A doc from India said mHealth is important because there’s no way they’ll ever have enough doctors to deliver the care that’s needed. They also don’t have enough broadband penetration, but they do have 675 million cell phones. Allen Hightower from the CDC gave a lot of information, but it sounded to me like they’re doing nothing more than collecting survey information in the field with smart phones. He seemed to bristle a little when the moderator summarized his talk in that way, but that’s what it sounded like to me.

David Gustafson from University of Wisconsin got spontaneous applause a couple of times for saying that mHealth is not ready to scale up because nobody knows what patients and families need and want, the available information is often conflicting and of unverified reliability, and the smart phone form factor has significant limits for many people (small screen and keyboard.) He said research is taking too long and needs to reach the field faster. He expressed his believe that mHealth should be regulated as a medical device (that part didn’t get him any applause – everybody else thinks it’s the Wild West, but will settle down on its own without getting the regulators involved).

Nearly every session addressed the mHealth business model, or rather the lack of one. You get the feeling that maybe it’s not really going to fly given these common speaker opinions that I wrote down:

• Nobody has any idea whether mHealth really affects outcomes because it hasn’t been formally studied.
• There is no business model for mHealth. Companies and programs are almost entirely funded by grant money or by governments that are in the healthcare delivery business.
• Most mHealth applications are interesting and cute, but they don’t fit into the workflow of clinicians or the lifestyle of people. If your app requires going to some dedicated Web site to see or input information, nobody’s going to use it (they didn’t mention PHRs, but all the arguments seemed applicable).
• Doctors either don’t know about mHealth apps or don’t recommend them because they might affect their incomes.
• The only commercially successful mHealth application is Nike Plus, which has two million users who share exercise data via social networking and apparently buy a crapload of Nike stuff.
• One speaker said the conference will be obsolete within three years because broadband will be ubiquitous and SMS messaging apps will be ancient history.

We’ll hear from Bill Gates tomorrow, but one speaker quoted Bill’s take on mHealth, which you might expect to be gung ho since he’s both a technology guy and a world health leader. He’s not fooled into thinking that sending SMS pill reminder messages will change the world, however. “Bathroom scales have been around a long time, but we still have obesity.” In other words, technology doesn’t automatically change behaviors, and it’s behaviors that are often the problem (people don’t take their medicines, don’t stop risky behaviors, and ignore advice). 

I jotted down a couple of interesting items. One researcher said there’s precious little research data on chronic disease management since it takes place in the home. She’s thinking that data sent in via mHealth apps in those homes could be very useful in looking at disease management. Also mentioned was that some countries (not ours, of course) are building a cloud-based PACS image sharing backbone for smart phones to avoid the cost of having each provider buying their own. And a third, which wasn’t surprising: most of the mHealth innovation isn’t happening in the US, but rather in China, India, and Africa (if you’re uncomfortable when anyone suggests that the US is not the world’s admired and envied leader in everything, that’s another reason to not attend this conference – the folks here are a bit more globally objective).

Probably the best speakers were Denis Gilhooly from Digital He@lth Initiative and Joseph Smith of West Wireless Health Institute. They both had short presentations in a panel discussion, but I thought they were objective and authoritative.

I wish the conference used the technology that Inga talked about from MGMA where you texted your questions to the speakers instead of hogging the aisle microphone. The conference allowed long Q&A sessions and as happens every damn time, eager beavers darned near sprinted to the microphones, droning on and on from their written notes, clearly in love with the sound of their voices that were wasting the time of a huge roomful of eye-rolling attendees who wondered if indeed there was a question somewhere in their long monologue (and for a couple, there clearly was not). Starting with the third session, I just started walking out as soon as Q&A was announced, which was for the safety of the microphone droners because I wanted to body-slam them Terry Tate, Office Linebacker-style.

The exhibit hall was low key, mostly non-profits it seemed, with a few vendors. The oddest was a lady in a rather lurid booth selling herbal products, boasting of such medicinal miracles as “Virgin – Again,” herbal Viagra, and “Cleavage Enhancer.” Either she showed up at the wrong event or she has insight into the particular needs of people who attend mHealth events. I can’t quite see strolling up among peers and casually asking for those products, which may have been a shared opinion since people were steering a wide berth around her booth as though there had been a chemo spill. The evening reception was in the exhibit hall, so maybe she’ll get some takers after the drinks have flowed for awhile.

So my takeaway is this: mHealth is not and probably never will be profitable. Insurance companies may pay a little something here and there for some simple apps that might save them a few dollars, but the bottom line is that even if mHealth apps improve health outcomes (which seems debatable), the funding model just isn’t there to turn it into a business. For that reason, it makes sense that the conference attendees are mostly global health people, who I admire (and would admire more if they would do more work in this unhealthy country instead of focusing only on everybody else’s). mHealth, like global health, is a worthy cause that makes a poor business for most of the people in it, who largely self-selected that calling without worrying about cashing in anyway. Kudos to them.

Tomorrow is Ted Turner, Bill Gates, and another long day of sessions. I’m leaving Wednesday morning, so that will be my last report from here.

The ConJoin Group Acquires PHNS for $250 Million

The ConJoin Group, an IT and business services company, acquires HIT services firm PHNS for $250 million. Private equity firm Actis backed the investment.

The new entity will keep the PHNS name.