News 10/6/10

From StateHIECoordinator: “Re: Iowa. The state has issued a Notice of Intent to Award to ACS for the Iowa Statewide Health Information Exchange.” SHIEC sent over the award letter that went out to the eight bidders. It includes technical scoring and prices, but I’m not sure if I should run that since it may not be public information. The selection went down to frontrunners ACS and Medicity in the “best and final offer” round, with ACS winning on price.

From Maladroit: “Re: book. You mentioned a book on healthcare IT and the future sometime in the last ear. I don’t remember much about it except it seemed like a great book to help me understand a CIO’s perspective as he/she thinks about maturing their tech org. Do you remember the book?” Hmm. I’ve mentioned a few books, but I don’t remember this one particular. It might have been Ed Marx, too, since he’s well read. Readers, if you know the book or have others to recommend on that topic, let me know and I’ll run a list.

From Wax On: “Re: medical transcription acquisitions. The big buzz among the MT community at the recent AHIMA convention in Orlando was about Nuance acquiring both OSi and Encompass Medical Transcription. And in another deal, Keystrokes acquired Chartnet.” I’m appreciating the irony that the hottest technologies in healthcare IT appear to involve transcription. Voice and paper are hard to kill for good reason.

From Ex-Employee: “Re: CareTech Web Division. All sales staff let go last week. Management plans to eliminate the Web division and focus solely on outsourcing.” Inga contacted the company for a response:

On the heels of significant growth in its Web products and services segment, CareTech made the decision to adjust its go-to market approach for the Web business with an emphasis on balancing its growth with providing the best delivery service. The decision involved a shift in resources, including a reduction in the area of Sales, and an increase in technical resources for the Web Development and Account Management areas. The company remains committed to its Web products and services business, and is especially looking forward to the opportunity to see current customers and meet new ones at the 14th Annual Healthcare Internet Conference where CareTech will have an exhibit and speaking engagement.

From Long Time Reader, First Time Writer: “Re: MU. Several CIOs I work with are gnashing their teeth because their vendors are telling them they’ll only apply to have their latest software version certified. Clients on the now-current version will have to pay the vendor for an upgrade and service fee to get on a ‘certified EHR’. Some have said they are being quoted months to get the upgrade because customers that signed lucrative contracts with the vendor’s service arm are moving to the head of the line. Love the blog BTW.” I guess I’m seeing it through the vendor’s eyes – ONC made them jump through hoops to get their products certified and to get them implemented by a firm date, so somebody has to pay and not every customer can be the first to go live. I’d blame the government for trying to tie something as complex as EHR adoption to something as desperately made up on the fly as economic stimulus. But if you have a particularly egregious vendor example, tell me since I’m sure some are milking it hard.

Ingham Regional Medical Center (MI) helped start and fund the Capital Area RHIO, but won’t participate in it. The hospital and its parent company will instead join Michigan Health Connect, explaining that, “A lot of the larger systems decided to go that route so they wouldn’t have to participate in different RHIOs and repeat the investment over and over again.”

Inga trumped Weird News Andy on this article, although she kept it at arms’ length when she sent it my way, saying it’s “a bit icky for my taste.” It’s a little raw for me too, but if you’re fascinated to know the “Strangest Foreign Bodies Removed From Patients”, many of which seem to involve unusual sexual practices, feel free to check it out. I did, but I think I regret it now.

ONCHIT puts up a Certified Health IT Product List page. It doesn’t include the CCHIT-certified products yet.

The Government of Queensland will implement (warning: PDF) the MetaVision Clinical Information System from iMDsoft in the ICUs of 14 hospitals.

Blessing Health System (IL) will implement Patient Condition Tracker from Rothman Healthcare Corporation within Allscripts Sunrise Clinical Manager. Their nursing school will also participate in research studies involving the system, which turns 26 measurements and observations from the EMR into a single number called The Rothman Index that allows early detection of patients going bad. I’ll have an interview with the co-founder up shortly.

Jack Kowitt, SVP/CIO of Parkland Health & Hospital System, e-mailed to say he was happy that I was puzzled by an ARRA comment attributed to him by the Dallas business paper since he was misquoted. The article said the hospital “won’t seek federal stimulus funds because its electronic records upgrades started before the stimulus bill was passed,” which I thought was odd since HITECH payments aren’t linked to spending. I indicated probable reporter error, which was the case according to Jack: “The question was whether we were using any stimulus funds to implement the EMR. The response was, since we have already implemented, we would not. It wasn’t about MU money, which we are aggressively pursuing.”

It appears that CCHIT’s initial press release that listed certified products was incorrect. ChartAccess from Prognosis Health Information Systems was listed under EHR Modules in the hospital domain, but the current product list shows it as a certified complete EHR in the hospital domain, the only one other than EpicCare.

I got an e-mail blast from a seemingly desperate free HIT magazine today, urging me to post five comments to their online articles to be eligible for a giveaway (so much for highfalutin’ journalistic integrity – what’s The New York Times paying for sending in letters to the editor these days?) Since it mentioned their expert bloggers, I thought I’d check out the competition for the first time. All the blog entries I saw except one seemed to come from other sites – they’re just reprinting them on their own site like they were written for the dead tree people. Maybe I’m an amateur purist, but both the comment bribe and the reposted blogs strike me the wrong way.

Inga contacted the folks at Infogard to get pricing information for their ONC-ATCB certification services. Drummond and CCHIT are pretty transparent about what they charge and were very nice to give Inga the information so she could put a comparison together for readers. Infogard sent her a curt reply: “Unfortunately, we will not be able to provide our price list.” We’ll make sure to help keep their secrets when their press releases come out by not mentioning them.

A Forbes blog riffs on a New York Times article about EMR vendor ClearPractice, which I didn’t realize was run by big-time VC guy John Doerr (Google, Amazon) and his brother. They also oversee a Medicare Advantage insurance plan. The Forbes writer isn’t impressed with ClearPractice or its iPad version called Nimble, although he’s focusing on the business success and not the innovation or potential:

While electronic medical records are a promising tool, the piece lacks context. For a company like Dr. Doerr’s to have been around for a decade and only have 500 doctors using the software basically means it’s failed. Check out this list of EMR vendors by market share based on physician usage. In a rapidly consolidating market there are at least 10 and probably 50 different vendors with more than 500 licenses. The idea that the Apple iPad will somehow, with an assist from stimulus funds, revive the fortunes on an individual EMR company is optimistic to say the least … The other thing that struck me is that the piece made no mention of the history of hubris when Silicon Valley tries to cure health care’s ills. Remember when Netscape founder Jim Clark devised Healtheon on a piece of paper? Or AOL founder Steve Case’s mostly expired Revolution Health?

Meditech got specific about its expansion plans Monday, announcing its intent to purchase 135 acres in a Freetown, MA business park and to build a 180,000 square foot office building for 800 new employees. A local politician estimates the company’s investment there at up to $100 million.

The University of Louisville School of Nursing gets a $792K HHS grant to develop nursing informatics education. They’ll buy simulation lab equipment that includes a patient simulator, iPads, and EHR simulators.

Interesting: a company uses Salesforce.com to deliver and analyze patient EEGs, looking for similarities in a database of known EEG irregularities to suggest psychotropic medications to doctors treating mental illness.

MedAssets is holding its Business & Technology Forum this week in Orlando.

Weird News Andy’s contribution this time around: “1/3 off healthcare ‘reform’ … I wish.” A report (warning: PDF) finds that HHS has already missed a third of the deadlines mandated by the Patient Protection and Affordable Care Act, with another 29 coming due in the next three months.

And speaking of government efficiency, health insurance premiums for 8 million federal workers will go up 7.2% in 2011, which the government spins by saying that’s less than increases in the private sector because of savvy negotiating.

A company brings social networking to crutches, allowing Facebook friends of the injured to create custom “skins” for their crutches. The company will offer advertising materials in the ED and expects to co-brand with healthcare systems.

The Institute for Healthcare Improvement releases a white paper to help hospitals manage serious clinical adverse events.

An interesting analysis: hospitals are buying up primary care practices to prepare themselves to become Accountable Care Organizations, which could be the end of the line for small, independent practices. Hospitals are looking at increasing PCP salaries like a Wall Street analyst looks at price-to-earnings ratios, knowing that internists and family practitioners generate hospital revenues at nine times their average salaries, while expensive specialists generate a multiple of only five times their salary. For industry noobs, it’s time for hospitals to get taken to those 1990s cleaners all over again, because:

1. Docs sell out precisely because they don’t want to work  as hard for their new hospital employer as they did for themselves (duh).
2. Hospitals are notoriously bureaucratic and inefficient managers, making them particularly unsuited for running a low-overhead medical practice in every way from EMRs to personnel policies to regulatory compliance.
3. Private practice docs hate and distrust everything about hospitals except the money they have and don’t usually change their opinions or behaviors just because they sell them their practices.
4. Doctors resent taking orders and being told how to practice medicine, especially from suit-wearing hospital MBA-types who fancy themselves business experts despite always having worked for a paycheck instead of themselves, making it likely all these deals will fall apart in 4-5 years like they did last time around, with the docs scrambling to start up new practices without the benefit of a location, an EMR, or patients that they sold away to the local hospital in a frenzy of co-opetition.
5. Patients aren’t much more enthused about hospitals than doctors are, so they aren’t exactly thrilled to see the big sign go up over their friendly little doctor’s office knowing it’s the same folks with ED waits, bad cafeteria food, and terrible parking.

E-mail me.

HERtalk by Inga

From RDU Dude: “Word on the street is that Vern Davenport has left Allscripts.” Portly Gentleman sent us a note on October 1 suggesting Allscripts would soon announce some executive changes. He named names (Vern’s being one of two), but we didn’t run them since it didn’t seem right until it actually happened. The company confirms that the former Misys president and Allscripts exec has indeed moved on.

Over 50 practices in Tenet Healthcare markets select MED3OOO’s InteGreat PM and EHR as part of a Tenet/MED3OOO community-based EHR partnership.

Hearst Corporation appoints Gregory H. Dorn MD, MPH president of drug database provider First DataBank. He most recently served as EVP at another Hearst company, Zynx Health, and replaces Donald M. Nielsen, MD, who becomes chairman of the First DataBank Advisory Board.

Omnicell acquires Pandora Data Systems, a provider of analytical software for medication management. The Pandora solution is used by several HIT companies, including CareFusion, McKesson, Cerner, and will continue to be operate as a stand-alone product. Omnicell’s comparable product is about twice as expensive, so there goes your cheaper alternative, most likely.

Epic wins a five-year,  $14 million EHR contract from the US Coast Guard, replacing a version of the Department of Defense system. That could be a notable Epic foothold in government down the road.

Penn State Hershey claims its use of CareAware technology has contributed to a 90% decrease in manual charting during surgical procedures. Providers now average one minute of charting during surgery, compared to 10 minutes before the CareAware implementation.

I love and appreciate all our sponsors, but this is funny. I received a note from one today (someone in accounting who has probably never heard of HIStalk) asking us to re-issue an invoice. The reason: they had asked to pay their sponsorship over several invoices, so dividing the total led to a per-invoice amount of xxx.1666 (infinite decimal). We invoiced xxx.17. They’re asking to correct the remaining invoices to xxx.16 so that the yearly total hits the amount exactly instead of being four cents over. Who else wonders how that accounting department handles client issues?

The Institute for Health Technology Transformation publishes a new report that examines the current EHR landscape. I can’t say I gleaned much new information, but was struck by the authors’ comment that the EHR “landscape” is still in its “infancy.” Given that I was selling EHRs (or EMRs as we called them in the old days) years ago, I’m thinking there must be some inverse relationship between EHR-years and dog-years.

North Kansas City Hospital deploys Cerner’s P2Sentinel auditing solution to address the hospital’s Meaningful Use Stage 1 access requirement.

Miami Children’s Hospital will spend $67 million to implement Cerner Millennium. The hospital will also extend a 50% discount to community physicians who wish to implement PowerWorks EHR in their offices. The hospital expects the government to provide $7-$8 million in stimulus funds once Millennium is fully operational.

Here is some not-so-pleasant news: at the current rate, 2010 could be one of the worst years ever recorded for mass hospital layoffs. Blame the increased demand for charity cases, the decline in reimbursements, and a reduction in elective procedures. As of August, 8,233 employees lost jobs in 102 separate layoffs, according to the Bureau of Labor Statistics. At the current rate, 12,349 jobs would be cut by December 31st, compared to 11,757 last year.

Six Texas pharmacies file a lawsuit alleging CVS Caremark of violating patient privacy laws and unfairly competing with its rivals. The complaint highlights Caremark’s plans to establish a data warehouse that includes the names, demographics, and drug histories of patients, plus Caremark’s Rx Review program that is designed to use patient data for direct marketing to patients and physicians.

Sponsor Updates:

• Allscripts introduces Mobile Homecare, a smart phone application for physical therapists, nurse assistants, and other clinicians caring for patients in their homes.
• API Healthcare signs up Halton Healthcare Services as its first Canadian client.
• Quest Diagnostic partners with HP to offer a preconfigured solution that includes Quest’s Care360 EHR and HP hardware, services, and financing.
• Wahiawa General becomes the first facility in Hawaii to implement Voalte’s iPhone solution.
• Detroit Medical Center selects the iDoc document imaging system from CareTech Solutions for its eight facilities.
• The Nashville Chamber of Commerce names Informatics Corporation of America to its Future 50 Award list for the third consecutive year. The award is presented to the 50 fastest growing companies in Tennessee.
• Catholic Health Initiatives expands its partnership with Allscripts to include Allscripts EHR and PM for all of its 1,200 employed physicians and 7,000 affiliated physicians. CHI is also adding Sunrise EPSi Performance Management solution for its 73 hospitals and will develop its own HIE with the Allscripts Community Exchange solution.
• PatientKeeper deploys its new physician documentation product, PatientKeeper NoteWriter, to Mercy Medical Center (IA) and Alegent Health (NE).

E-mail Inga.

Equifax Acquires Anakam

Equifax announced after the market close Monday that it has acquired authentication management vendor Anakam. The San Diego-based Anakam has a significant healthcare presence, with products addressing online identify verification, credentialing, two-factor authentication, inoperability authentication, and secure collaboration. Former HHS privacy and security advisor Bill Braithwaite MD PhD is the company’s chief medical officer.

Equifax had chosen Anakam this past January to provide authentication for its I-Card product. Anakam’s solution was chosen last month by Buffalo-based HEALTHeLINK as part of HHS Beacon Community demonstration project.

The Atlanta-based Equifax says it will market Anakam’s Identity Suite with its IDverifier service as a single, integrated two-factor authentication solution. Rajib Roy, President, Equifax Technology and Analytical Services was quoted in the announcement as saying, “With Anakam, Equifax will become a premier provider of cloud-based authentication solutions.”

Monday Morning Update 10/4/10

From D.B. Platypus: “Re: ACO. The NorCal HIMSS chapter sponsored a CIO forum on October 1. A speaker showed this video. It had everyone rolling on the floor in a fit of hysteria.” I like it, although someone sent Inga a similar video that we posted on HIStalkTV that I like even better. My newest oft-repeated monotonic mantra from that one involving orthopods: “There is a fracture. I need to fix it.”

From CPAhole: “Re: Allscripts/KLAS. I’ve worked with numerous Allscripts/A4 reps and they did as they were instructed, sitting next to their clients as they completed the survey. KLAS outed the company. Of course Allscripts will take the high road and say they have a better system, but what else would they say?” Unverified.

From Lemmy: “Re: another stolen unencrypted laptop. Here’s the CIO’s internal e-mail from Harvard Vanguard Medical Associates.” I don’t recall seeing this previously, but the purported e-mail says that a vendor-owned laptop containing urodynamic testing data was stolen on August 3. It contained minimal information (name, date of birth, physician, MRN, and testing data). Massachusetts law required encryption starting March 1, 2010 as I understand it, so that might be a problem.

From Elaine: “Re: HIEs. I’m a new HIE manager within our health system and am interested in any data sources regarding interoperability discussions or lessons learned.” I’m sure people are reading who know a lot more than me, so add a comment to the bottom of this post if you can help Elaine.

From The PACS Designer: “Re: iPad’s little sister. Apple is working on a smaller 7" iPad for release early next year. This little sister iPad weighs only 1.1 pounds and will have front- and back-facing cameras. This smaller sized iPad may be of interest to our heathcare colleagues if they can produce it with a case that can be disinfected.”

Listening: Delain, female-led Dutch symphonic metal. Also, reader-recommended Pretty Lights, Boulder-based electronica (two guys doing something between DJing and playing) with some impressive live performances that mix several genres, mostly hip-hop and and synthesizer. Not something I usually like, but it sounds good (probably even better as a soundtrack to romance, I’m thinking without much credibility).  

Meditech says it will expand again, adding hundreds of new jobs to be housed in newly built Fall River buildings. Sales in 2009 were $234 million, up 38% from the year before.

This week’s internal e-mail blast from Kaiser chairman and CEO George Halvorson says the company has donated its internally developed clinical terminology translation engine to the US government, accepted by HHS Secretary Sebelius, CTO Chopra, and National Coordinator Blumenthal. From the example he gave,the Convergent Medical Terminology utility can convert 75,000 terms back and forth, for example between ICD-9, ICD-10, and SNOMED. It will be distributed as open source by the National Library of Medicine. 

Drummond Group issued the first ONC-ATCB EHR certifications, but CCHIT trumps them on quantity, announcing Friday that it has certified 33 EHR products (19 complete systems, 14 modules) in the 10 days since its program started. I’m not sure that will instill confidence in folks who have always questioned the rigor involved since they can apparently crank out three per day including weekends, but there you go. HIStalk sponsors that have newly certified products are Allscripts, NextGen, eClinicalWorks, T-System, and Wellsoft.

Transcription service outsourcer iMedX acquires FORE Transcriptions. And transcription software and services vendor MedQuist gets $310 million in financing, mostly from GE Capital, with the resulting announced dividend causing shares to hit a three-year high (strictly by investors looking to get the dividend – otherwise, borrowing money to pay a dividend isn’t exactly a robust growth engine). What’s with all the sudden interest in transcription companies?

Nearly two-thirds of respondents say KLAS reviews aren’t useful to providers, although I’m sure many of those respondents work for vendors ranked by KLAS as lower than #1. New poll to your right, requested by a reader: providers, which department will conduct and submit your Meaningful Use self-attestations?

Longmont United Hospital (CO) says VHA’s PriceLYNX vendor price comparison tool paid for itself immediately when a vendor was caught overcharging the hospital by $120K and returned the money. The materials manager says the software will allow him to negotiate price reductions of 8-20%, saving the hospital up to $4 million over the life of the contract.

This BBC article on real-time computing is interesting and scary. It says 50 to 70% of banks use it to perform algorithm-based trading of stocks and complex financial instruments. The example given is in trading stocks of two oil companies whose share prices usually follow each other closely. The software can check prices every 10 seconds and blindly buy Stock A shares if Stock B moves up even a tenth of a point. SAP says that kind of situational analysis may be useful in medicine, such as in monitoring the blood glucose of diabetics. Let’s hope the medical application is dissimilar from that of the money changers, whose computer-assisted self-destruction may yet take us all down with them.

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates…but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

The Dallas Business Journal summarizes the “long, expensive, and full of twists” EMR implementation projects of local hospitals. The hospital costs and associated taxpayer-funded EMR bribes: Texas Health Resources, $200 million, $70 million; Baylor, $200 million, $45 million; Parkland, $70 million and no stimulus funds. Parkland said they won’t go after ARRA money because their upgrades were underway before ARRA was passed, which seems puzzling since HITECH money doesn’t require spending anything, just demonstrating Meaningful Use (unless the reporter or I misinterpreted).

University of Virginia Medical Center goes live with Epic in its 140 clinics, with the big house going up in the spring. Cost: $122 million.

You, looking at the monitor – sign up for e-mail updates, Friend or Like us on Facebook, send me rumors. That would make me happy.

The VA will test 20,000 thin client devices using desktop virtualization, hoping to reduce maintenance and energy costs of its 325,000 PCs.  

In Spain, Andalusia will require hospitals to record birth records electronically within the first 24 hours of life, giving the child full health benefits that are independent of the mother and allowing pediatricians immediate access to the records. The centrally maintained information will support monitoring of infant morbidity and prenatal mortality.

The Canadian Medical Association says the $500 million that the Canadian government will give Canada Health Infoway in 2010 to goose EMR adoption isn’t enough. CMA wants another $423 million, which it says will increase adoption to 100%, apparent embarrassed over the high EMR adoption rates of other countries (Netherlands 99%, UK 95%, Australia 95%). I guess they weren’t consoled by US adoption, which comes in at anywhere from 4% to 40% depending on whose definition and survey you like.

My Health Care Manager gets a $1.2 million NIH grant to develop a search engine for geriatric health issues.

The bailout-happy federal government agrees to throw taxpayer money in the general direction of Massachusetts hospitals, especially Boston Medical Center, giving them $335 million. Cynics like me might point out that Massachusetts leads the nation in healthcare (percentage of insured citizens, use of electronic medical records, fancy hospital buildings housing bowtie-wearing academic doctors) and yet (or more likely, because of) has the highest healthcare costs. According to the article, Sen. John Kerry strong-armed CMS and Don Berwick to use our money without consulting us first, which I guess we might as well get used to as healthcare “reform” starts tapping an already wildly indebted Uncle Sam, who gets a lot of his healthcare ideas from Mass, even the fantasy that reform will somehow lower costs while insuring dozens of millions of new people. Maybe Uncle should be looking at the sensible, practical middle of the country instead of the extremes on the ends. From its most recent federal tax records, BMC paid its previous CEO $1.3 million and she got another $3.5 million when she left last year right before the hospital’s big profit turned into a loss. Somehow, that doesn’t make me feel better about my involuntary donation.

E-mail me.

News 10/1/10

From Allscripts: “Re: the note from Clinical Wisdom on KLAS. We agree that there is a conflict of interest in having vendors pay large fees to the same company that is producing the ratings. We reached the same conclusion a few years ago and discontinued the practice. After our recent merger with Eclipsys, we inherited an existing Eclipsys contract that was in place with KLAS, so the information reported by the writer was technically correct. However, we have now canceled that contract and we do not currently pay KLAS anything. We realize that is counter-intuitive as we currently are and have consistently been highly rated across many product categories by KLAS, but ultimately we didn’t feel it was right to pay a firm that was also rating our products. Over the last two years, we have re-invested those dollars in a ‘Net Promoter Score’ process, which is widely considered across many industries to be the ‘gold standard’ for measuring customer loyalty. Using this rigorous, statistically valid methodology (developed by Satmetrix and Bain & Company), we get client feedback directly in a very methodical way and then act immediately on what we learn. The bottom line is that we agree with the Consumer Reports analogy from the writer – KLAS should provide a full accounting and disclose what they receive from every vendor. In that same light, we would encourage other vendors to disclose how much they are paying KLAS – complete transparency is critical when you’re talking about the core technology that providers use to make decisions vital to every American’s health.”

From Ben Cannoli: “Re: IOM’s study of HIT best practices. The IOM report is incredible even after a decade. I’m glad they are leading. HIMSS has been weak, negligent, and pathetic on this issue, but I don’t believe they can strong arm the IOM.” Inga mentions it below. The IOM gets an ONCHIT grant to look at how HIT affects patient safety. It will cover some industry hot buttons: surveillance and reporting of HIT-related patient safety issues, discussion of the possible roles of federal agencies like FDA or AHRQ, and impact of certification bodies and trade associations (HIMSS, you’d expect). I’d bet that Don Berwick made this happen. I don’t know how much they’ll get done for $1 million, but I’m interested to find out.

From Digital Bean Counter: “Re: real-time claims adjudication. Is it taking off yet? Any big players?” Little help, if you know.

From VaHooGirl: “Re: Martha Jefferson Hospital. No longer a rumor – they are merging with Sentara to become its 10th hospital.” Verified.

From TuTu True: “Re: Mrs. HIStalk. A source tells me that Inga is Mrs. HIStalk. Be honest – true or false?” False. And to answer the other occasional rumors: (a) yes, there really is an Inga – it’s not just me pretending to be her;  (b) yes, she really is a woman, and (c) yes, the Inga picture at the end of her posts really does look like her since I paid some offshore artist $15 to draw it from a photo.

From Luke O’Scyte: “Re: correction about the Canadian government spending $500 million on EMRs. Please replace ‘spending’ with ‘wasting.’ I’m highly skeptical of the value that will be generated from that half a billion dollars.”

From Portly Gentleman: “Re: Allscripts. A couple of executive suite offices are about to become vacant.” PG provided credible names and I’m sure his information is correct, but I feel funny about mentioning names of people leaving jobs. Watch for announcements early next week.

From MSFTGUY: “Re: McKesson Paragon. Just went live at 391-bed Lake Charles Memorial. Several big hospitals have gone live on Paragon this year. Maybe folks have a choice between a system that doesn’t work and is only 1/3 of an HIS (Cerner) and one that’s ridiculously irresponsible to purchase (Epic)?” I did some work at that hospital once. Nice folks. None of the systems you mentioned are for everybody, so it’s hard to criticize their choice, especially if it was a lot less expensive.

From Perineal Flowers: “Re: [name omitted] is one of two finalists to be CIO of Tenet.” I’m expunging the name since I’d sure hate to get someone fired if they don’t land the rumored new job after all, but I did manage to contact them. They humorously (or so I assume) told me the rumors also have them going to Allina, Duke, and Partners, all of which have open CIO jobs along with Tenet. I’m pretty good at reading between the lines, so I think there’s fire underneath that smoke. We’ll see from which direction soon, I’m betting.

Listening: The Tyde, obscure, Byrds-like LA jangle surf. 

A scrappy Austin-based non-profit investigative publication runs a pretty good story on the ongoing sale of de-identified hospital patient data by the Texas Department of State Health Services. Among their customers: GE and a company that runs background checks for border security. Deborah Peel MD was quoted as saying that a HIPAA loophole allows selling patient data to any entity that claims to be doing “research”, which isn’t defined. Now this is funny: the only parties that stay anonymous aren’t the patients, but rather the people who download the free data files covering 1999-2003. The article wanders all over the place and is predicated on your believing that de-identified data can be re-identified (which it definitely can to some reasonably high percentage, but some people refuse to believe that fact). If newspapers weren’t going broke, they should fund a re-creation of that experiment where patient data was re-identified by linking to common fields from other government-sold databases, such as driver’s license records.

Here’s another fun tidbit from the Austin article, even though I don’t believe its accuracy. The guy who wrote The Long Tail estimates that free EMR vendor Practice Fusion takes in $250 million per year from selling the de-identified patient data stored in its systems, dwarfing any possible revenue it could make by selling software. It cites a Practice Fusion job ad on Craigslist for a Data Sales Director, someone with experience creating “an aggressive data monetization strategy” who can pitch to “pharmaceutical companies, medical device companies, insurance carriers, government entities …” and “establish a fair market price for EHR data and negotiate effectively with buyers.” That position is still being advertised on Practice Fusion’s site, but the language has been dialed back a lot.

Cerner caves in to patent trolls Acacia Research (“research” meaning “writing threatening lawsuit letters to companies to see who will pay up”) and will pay that organization for the privilege of selling PACS, which Acacia’s often-waved patent claims they invented. Acacia’s strategy is smart: they threaten to sue, but offer a license for less money than it would cost to mount a legal defense. Most companies pay up and the threatened suits rarely go to court, although Epic mounted a swift legal counterstrike for being threatened. I never heard how that turned out, but it doesn’t matter – I still admire their willingness to fight for what’s right.

This is brilliantly funny: You may know Ross Martin, MD as the guy behind the HITECH Operetta and Meaningful Yoose Rap in his role as President of The American College of Medical Informatimusicology, although he has a less interesting but probably much more lucrative HIT consulting job. He writes a hilarious letter to the editor of The New York Times for not publishing a previous letter of his, threatening a class action suit by rejected would-be authors and signing it, “Yours in the quest for wealth creation through victimization, President, Literary Mediocrity Association.” They whittled his piece down to a paragraph, but they did run it. I think the HIStalk audience is more appropriate for his type of humor than that little New York paper.

WorkflowOne, which claims to be “the nation’s leading name in healthcare document management,” puts that leading name on a Chapter 11 bankruptcy filing. Premier just renewed its contract with the company, claiming that “no one is better prepared to help Premier members reduce costs and gain efficiencies across their entire print lifecycle than Workflow One.” Doh! Still, the company has big revenue and EBITDA, so I’m sure they’re not going anywhere. It seems odd that they even filed, frankly.

Lots of good jobs on the HIStalk Sponsor Jobs Page: Eclipsys Pharmacy Consultant, Natural (Software AG Product) Programmer Analysts, McKesson Workflow Clinician. On Healthcare IT Jobs: Product Manager, Lead Epic Analyst, Senior Clinical Systems Analyst, Solutions Marketing Specialist.

Sharp Healthcare chooses Aternity Frontline Performance Intelligence to monitor application user experience.

Vanderbilt launches its first preventive genetic screening program, testing all cardiac cath patients for clopidogrel metabolism problems and storing the results in their EMR so that a different blood thinner can be used if needed, avoiding expensive and dangerous blood clots. Several other drug-affecting genetic traits will be tested as well. Now that’s just cool.

Several national pharmacy organizations launch the Pharmacy e-Health Information Technology Collaborative, which will work to get pharmacist-needed functionality into EMRs.

CMIO interviews one of my favorite CIOs, Denni McColm, from 74-bed Citizens Memorial Healthcare in Bolivar, MO (the only one of very few HIMSS EMRAM Stage 7 hospitals, a standout on the list dominated by big, rich health systems). CMH has a bi-directional CCR interface with Google Health that Denni says will meet Meaningful Use requirements, saying interoperability doesn’t necessarily required an HIE. They’ll use Google Health to make sure patients who ask get a copy of their medical record within the MU-specified timeframe.

ChartLogic earns EHR certification from Drummond Group.

iSoft convinces its bankers to reorganize the company’s debt. Shares are still at 13 cents. You would think those two events might attract takeover interest, but the company’s chair says conditions remain “challenging.”

A Chicago cardiologist will pay $20 million and spend five years in prison for defrauding Medicare and private insurance of $13 million, turned in by another doc who gets $3.5 million as the whistleblower. The cardiologist submitted 14,800 false claims that added up to more than 24 hours a day of work from 2002-2007, so he enjoyed a lavish lifestyle until the case finally ended. When the Feds raided his house, they found $6.7 million in uncashed insurance company checks.

E-mail me.

HERtalk by Inga

The Allscripts/Eclipsys crew sent over an invite to EUN 2010 Outcomes Through Innovation, which is the user meeting for Eclipsys clients. Wish I could go because it’s in one of my favorite cities, San Diego. The event is October 10-13 at the Manchester Grand Hyatt.

The board of governors of Good Samaritan Hospital (IN) approves the $400K purchase of McKesson’s PACMED and MedCarousel pharmacy packaging systems. At the same board meeting, the director of IS says the hospital is on target to earn nearly $7 million in ARRA incentives over the next six years.

St. Vincent’s Healthcare (FL) extends its seven-year partnership with TeleHealth Services. The health system will implement TeleHealth’s TV and interactive patient education solution at St. Vincent’s and St. Luke’s hospitals.

I noticed that Intellect Resources posted this article about the current shortage of IT professionals in the Nashville area. Middle Tennessee is home to a number of large HIT employers, including HCA, HealthSpring, Cogent Healthcare, and ICA. Several companies are working with on training initiatives at area colleges to help increase the pool of professionals with both healthcare and IT expertise.

Merge Healthcare adds two new perioperative solution clients: Exempla Saint Joseph Hospital (CO) and Kalispell Regional Medical Center / The Surgery Center of Northwest Healthcare (MT).

If you are headed to the American Academy of Pediatrics show this weekend in San Francisco, say howdy to HIStalk Practice’s Dr. Gregg Alexander. He’ll be directing the Pediatric Office of the Future exhibit, which will showcase technologies available for pediatricians. Dr. Alexander is pretty darned excited by the project, as evidenced by his  latest Intelligent Healthcare Integration post.

ONC awards the Institute of Medicine a $1 million contract for a year-long study of HIT’s effect on patient safety.

The Tiger Institute for Health Innovation celebrates its one-year anniversary and provides an update of its work to date. The Tiger Institute is a partnership between Cerner and the University of Missouri Health System to create new technologies. So far UMC has implemented bar-coded medication administration and is rolling out CPOE in a couple of months (not sure why that would be considered innovative) and is working on several prototype projects, including a mobile app that allows physicians to review clinical data and give orders via smart phones.

CIGNA and St. John’s Mercy Medical Group (MO) launch a 12-month accountable care organization pilot program. The pilot will target patients covered by a CIGNA health plan and receive care from one of St. John’s 165 primary care physicians. Physicians have the potential to earn bonuses for meeting quality improvement targets and lowering medical costs.

Mayo Clinic and five other health systems form the Mayo Clinic Center for Social Media, dedicated to the use of social media to promote health, improve healthcare, and fight disease. The Center will offer educational conferences and webinars and develop social platforms to share training and resources. The website www.socialmediahealthnetwork.org will launch October 25.

Baptist Health (FL) partners with Vitalz to provide provider-to-provider portal services between 13 Solantic Baptist urgent care centers and 40 Baptist primary care offices.

Texoma Medical Center (TX) implements Skytron’s RTLS to track and manage 200 hospital assets. When reading the press release, I was amused that either the hospital or vendor thought it was noteworthy to mention that Texoma is also using the RTLS technology to monitor vendor sales rep visits.

This week on HIStalk Practice: BlackBerry thumb, cell phone elbow, and Facebook depression; medical students say having an EHR is a very important factor in their decision what to practice; Phreesia and a few first impressions.

Sponsor Updates

• Fred Castillo, VP of healthcare mobility sales for AT&T and Eleanor Chye, executive director healthcare mobility product management at AT&T will participate in separate panel discussions at the CTIA Everywhere Healthcare event next week in San Francisco.
• Methodist Hospital of Southern California goes live with API Healthcare’s Human Resources and Payroll solution.
• Sharp Memorial Hospital (CA) selects GetWellNetwork’s bedside education/entertainment system. GetWellNetwork’s patient education and communications tools will be interfaced with Sharp’s Cerner EMR system.
• Susquehanna Health (PA) plans will add the perioperative information management system of Surgical Information Systems to its three-hospital system. Susquehanna will integrate the SIS solution with its existing Siemens Soarian applications.
• Albemarle Hospital (NC) selects the Access Intelligent Forms Suite to bar-code patient forms for auto-indexing via a document management system into its Meditech EHR.
• Ingenix CareTracker earns CCHIT Certified 2011 Ambulatory EHR certification.
• Zac Fritz joins My Health Direct as SVP of sales and marketing.

Here at HIStalk, we love well-intentioned works of charity. Thus, I applaud Cincinnati Bengals wide-receiver Chad Ochocinco for promoting contributions to Feed The Children. Ochocinco has his own personalized “OChocinos” cereal and includes a Feed the Children phone number on the box. At HIStalk, we’re also about getting the little details right, so bummer that Ochocinco didn’t get Mr. H to proof the cereal box. Perhaps he could have caught a certain typo before the box it hit the production line. Mr. H likes the occasional smut reference, so I’ll mention that the Feed the Children phone number listed was actually a phone sex hotline. Oops.

E-mail Inga.

News 9/29/10

From Waterkeeper: “Re: CPOE reality. Another example.” A study finds that electronically preventing entry of CPOE orders for concomitant use of warfarin and sulfa drugs did great at preventing the potential drug interaction, but also delayed treatment in patients for which the simultaneous use was appropriate, causing Penn researchers to stop the study early as being unethical. Says the lead author: “[It] worked extremely well, but putting it in place actually hurt people … it’s naive to think that CPOE 1.0 is going to be perfect. This is a clarion call for continual evaluation of whatever we’re doing in terms of electronic interventions.” You’ve read it here in various interviews, but it’s worth reiterating: CPOE isn’t done just because it’s live and doctors are using it. That’s where the scientific work should begin, but unfortunately usually doesn’t as everybody declares mission accomplished and moves on to some other fire du jour that requires extinguishing.

From EMR Salvage Here, Can’t Bill There: “Re: downtime in Pittsburgh.” Included was an August e-mail to providers purportedly from Medical Service Associates, apologizing for problems in which a network failure led to the discovery that backups couldn’t be restored from either their own two backup systems or the two of their vendor. At the time of the late August e-mail, they still hadn’t restored anything from before the downtime. All unverified and most likely not the final word on the situation there, but my takeaway from experience is the same as always: backups don’t work at least half the time.

Inga e-mailed our sponsor contacts today about a little get-together we’re having for them in Orlando at HIMSS, separate from our Monday night HIStalk reception (nothing too fancy since it’s on a blogger’s budget, but sincere nonetheless since we really appreciate our sponsors). Response has been brisk, so if you’re the boss and haven’t heard about it, check with your internal person before we run out of space. If your company is on the fence about sponsoring HIStalk, we can probably make room if you sign up soon. Plans for the Monday night reception are progressing nicely as well. Expect a big evening that will go a bit beyond our usual food, drinks, and HISsies (running until late, so pace yourself). Stay tuned.

New readers sometimes get confused about who writes what on HIStalk, e-mailing the wrong one of us about something the other wrote. Here’s the deal: Inga writes the part starting with “HERtalk by Inga.” I write all the rest. I do most of the interviews, but I should mention that Inga did the most recent one with Doug Ardoin. And it’s all Inga on HIStalk Practice. Clear as mud, right? She and I are kindred spirits anyway, so we’ll figure it out.

Medical office patient check-in vendor Phreesia completes a $20 million Series D equity financing round. Jumping in is Ascension Health Ventures, the $325 million strategic healthcare venture fund of Ascension Health. 

Strange: a hospital trauma nurse gets a 2 a.m. call on her cell phone from the California Donor Network, with which she’s familiar because of her job. They tell her that her brother has died and they need her permission to harvest his organs. Agitated, she goes to her other brother’s house and they call their sister-in-law to console her, only to hear the sleepy voice of her I’m-not-dead brother asking what they want. The hospital had given the donor group the wrong contact information, that of a patient with the same name but spelled differently. The hospital can’t explain the mistake except to say that the information was wrong when they switched computer systems in 2005. The coroner’s office claims they would have caught the mistake before taking the organs of decedent with the wrong family’s permission.

HHS’s open source CONNECT program wins the 2010 Wall Street Journal Technology Innovation Award for health IT. Runners up are diagnostic image sharing platform vendor lifeIMAGE (I interviewed CEO Hamid Tabatabaie a couple of weeks ago) and Disease Precursor Identification from Ingenix, which identifies people at risk for chronic diseases. 

Munroe Regional Medical Center (FL) says it dropped ED-door-to-balloon time for heart attack patients to 48 minutes, below the national average of 62, by using incident command management software from LiveProcess to manage the Code Blue calls.  

A Weird News Andy find: NewYork-Presbyterian/Columbia University Medical Center admits that someone accidentally opened up a server containing ICU patient information to the Internet. A patient’s family ran across the information via a search engine and told the hospital. I can’t decide which is more annoying about the hospital’s name: that it’s absurdly long with dashes and slashes or that they insist on conjoining New York into a single word for no apparent reason. 

RIM previews its BlackBerry PlayBook tablet device. Like the Torch, I doubt it will generate much consumer interest, especially since it may work only on WiFi, not 3G/4G. That’s speculation since it’s not coming out until next year, making the video a bit premature in its lost cause of convincing iPad prospects to hold off. Businesses will probably like it, though.

The National Quality Forum endorses performance measures and preferred practices for care coordination. Among the latter is electronic medical records.

Ed Marx has updated his Tool Time post with responses to your comments.

Here’s another bad HIT press release, replete with enough odd phrasing, incorrect punctuation, and bizarrely missing information (like the names of the company’s president and the customer who are both quoted) to make it seem highly unlikely that the writer speaks English as a first language. Not that there’s anything wrong with that, but the company is in Minneapolis, where English is pretty common (albeit with a cute accent, like in this horrible, sappy movie that I just played from Netflix for Mrs. HIStalk while I pretended to watch while daydreaming).

The Canadian government will spend $500 million on EMRs in the next fiscal year, with $380 million of that going toward implementation.

ClearPractice announces GA of Nimble, which it says is the first comprehensive EHR for the iPad. It connects to the company’s cloud-based system by WiFi or 3G. Or maybe it’s not the first after all: an updated press release omits the “first” reference and fixes other unspecified errors in verbiage. The release came from a PR company, but it’s never encouraging (in a “Quality Is Job 1.1” kind of way) for a software company to let obvious mistakes get out the door. And in another tactical error, there’s a beautifully made demo video on their site (where I grabbed the screen shot above) that you’d be watching right now if they were smart enough to make it embeddable like everybody else does who wants widespread exposure for free (it’s called YouTube, people). Now I’ve lost interest.

Deborah Peel, MD of Patient Privacy Rights comments on an Information Week article about healthcare data breaches.

I don’t need a cell phone, but I’m thinking about getting the new model of the iPod Touch for running apps, checking e-mail where there’s a WiFi connection, and playing music and video. Good idea or not? I thought it was perfect until I read that Apple had to downsize the camera resolution from 5 megapixels to one to fit into the slim case. Still, it seems like a good deal for $299 for the 16 GB model.

Mohit Kaushal, MD joins West Wireless Health Institute of EVP of business development and chief strategy officer. He was a key player in developing the healthcare portion of the FCC’s national broadband plan, which includes mobile health, when he worked for that organization.

Bob Mitchell, former editor of the dearly departed ADVANCE for HIE, interviews John Glaser about his new job as Siemens Healthcare CEO.

Deaconess chooses Omnicell for medication management.

The Greater Dayton Area Hospital Association (OH) signs up with the HealthBridge HIE.

It’s funny today how many car problems are fixed with a software update. The same is true for implantable defibrillators, for which a new upgrade checks for electronic problems that indicate wire integrity problems that could cause patients to be shocked inappropriately.

Costs of Care, a Boston-based non-profit whose goal is to reduce healthcare costs by giving providers pricing information as they make medical decisions, announces a national essay contest. The best anecdotes from doctors, nurses, and patients illustrating healthcare cost awareness will earn $1,000 prizes. The judges are former HHS secretary Mike Leavitt, Atul Gawande, Tim Johnson of ABC News, the dean of the Harvard Medical School, and Mike Dukakis. Entries are due by November 1. The group, founded in 2009 by medical resident Neel Shah MD, plans to create smart phone and Web apps to provide pricing transparency.

A nurse at Seattle Children’s Hospital kills an ICU baby by mistakenly administering a tenfold overdose of calcium chloride. A 15-year-old died from a narcotic overdose at the same hospital last year.

InterSystems announces Cache’ 10, which adds database mirroring and a high performance solution for Java applications.

I’m totally behind, so be patient if you’ve e-mailed me. I’ll be vacating soon, which will dig the hole I’m in a week deeper, and then attending the mHealth conference to make the backlog worse, but my lack of timely response doesn’t mean I love you any less (that’s my go-to excuse when Mrs. HIStalk catches me paying insufficient attention to her or her movies).

E-mail me.

HERtalk by Inga

From Jellico Jerry: “Re: reality check. Loved your point today about Cerner and Epic, and which deals Cerner won vs. Epic. Cerner won sites with no $$ (UHS, Tenet). Although they are still significant wins, they are very different client bases.” In case you aren’t up to speed, KLAS recently reported that nearly 70% of 2009 hospital EHR purchases were for Cerner and Epic. A reader then noted that if one were just reading HIStalk, you’d think Epic had “cleaned everyone’s clock.” We countered saying Epic got the bigger, more lucrative deals that really count. Anyone who’s dealt with either or both companies knows that Cerner will darn near give the software away to avoid losing a deal, while Epic won’t discount a penny.

The Ohio Health Information Partnership (OHIP) names its five preferred EHRs from the 40 that were considered: Allscripts Professional; eClinicalWorks Unified EMR/PM Solution version 8; e-MDs Solution Series 6.3.0; NextGen Healthcare EHR; and Sage Intergy suite 6.0. Interestingly, OHIP requires that the selected vendors conduct all technical support within the United States.

Quality Systems, NextGen’s parent company, strikes a deal with Pricedoc.com to incorporate PriceDoc’s online search marketing tool into the NextGen Practice Management system. Pricedoc.com is basically a medical version of the travel site Priceline.com, giving patients the chance to name the cash price they are willing to pay for particular procedures or services. Sounds like the deal gives Pricedoc.com access to NextGen’s PM client base and Quality Systems gets a spiff when physicians and patients connect.

T-System releases DigitalShare, a new solution made possible through a strategic partnership with Shareable Ink. DigitalShare allows clinicians to document patient encounters on T-Sheets using Shareable Ink’s digital pen to capture the data. I first saw the technology at MGMA a year ago and made the Mr. H-esque observation/prediction that it would be great technology for the ER.

Lehigh Valley Health Network selects QuadraMed’s Quantim computer-assisted coding solution to help prepare for its ICD-10 transition.

Confer Health Solutions acquires MediHealth Outsourcing, an HIM and clinical revenue cycle company.

Providence Health & Services hires Summit Healthcare to provide dictionary management and data migration services as it moves to Meditech 6.0. Providence also purchases Summit InSync and Summit Scripting Toolkit technology.

GE was the overall leader in the US ultrasound market last year, according to Millennium Research Group. GE increased its lead over Philips and Siemens and now holds about 27% of the $1.2 billion US market.

Former Cerner Eastern US general manager Greg White is promoted to VP and managing director of the company’s Middle East, Africa, and India region. He replaces Rich Berner, who returns to KC as VP of client development.

Axolotl introduces Elysium Discover, a suite of reporting and analytic tools for HIEs.

Northwestern Medical Center (VT) goes live this week on its first phase of Meditech.

ChartWise Medical Systems signs a strategic agreement with 3M Health Information Systems to integrate 3M’s Grouper Plus Software the clinical documentation tool ChartWise:CDI.

Frederick Jelinek, one of the pioneers in the field of voice recognition, died earlier this month. I had never heard of him before reading this article, but he’s credited with enabling computers to understand English. While that accomplishment is significant in and of itself, Jelinek’s challenging background makes his work even more laudable. He was born in what is now the Czech Republic and his dentist/physician father died in a Nazi concentration camp. After his death, Jelinek’s mother moved her family to the US. He graduated from high school and took a job working in a factory to help support his family Jelinek later enrolled in night classes, studied engineering, and eventually earned a doctorate from MIT. He spent his career with IBM and Johns Hopkins University, creating the bones for today’s voice recognition systems. Isn’t that a great story?

Friday marks the first day of the hospital payment year for implementing certified EHRs and using them meaningfully. Guess it would help to have some certified EHRs out there.

Sponsor Updates

• eHealthAlign selects ICA as a strategic partner to technology and infrastructure for its multi-state HIE.
• maxIT Healthcare earns a spot on Modern Healthcare magazine’s list of Best Places to Work in Healthcare.
• Voalte VP Trey Lauderdale will participate in a panel discussion at next week’s CTIA Everywhere Healthcare event in San Francisco.
• MEDecision announces that its Nextalign iEXCHANGE 8.0 solution is now generally available.
• BridgeHead Software wins a contract with The Rotherham NHS Foundation Trust for healthcare data and storage management.
• Picis and The Sullivan Group (TSG) will integrate TSG Clinical Rules risk management solution with Picis ED PulseCheck.
• HealthEast Care System (MN) implements Ingenix Web.Strat medical coding technology, integrated with its McKesson HealthQuest billing system.
• EDIMS announces that its ED EMR clients can access the admission review service of Proven Healthcare Solutions, which offers a 30-minute guarantee.

E-mail Inga.

Healthcare IT from the Investor’s Chair 9/28/10

Capitalizing a New Venture: So Many Choices…

I appreciate everyone who reads, especially those who leave comments. A comment on my previous post asked, “Isn’t it ALL about the patient?” 

As I pointed out in my response, for better or worse, healthcare in America is all about entrepreneurship — from medical spas to physician-owned hospitals and imaging centers to million-dollar salaries for hospital execs (I agree wholeheartedly with Mr. H on that topic, btw) to software entrepreneurs like Neal Patterson (Cerner), Judy Faulkner (Epic), or Randy Lipps (who realized that supply storage could be improved while his child was in the hospital and so founded Omnicell).

Anyone in the healthcare system, from physicians to business people to lab managers, who realizes that the current system they are using or experiencing just isn’t working as well as it could or should can decide to take the risk and form a company, develop a product, and go to market. Even before ARRA, HCIT attracted more than its fair share of entrepreneurs. That’s what makes this sector my favorite playground.

That said, I think it’s more like the playground of my youth. Before safety was the law and springy floors and safety teeter-totters came into being, it has historically been an area where start-ups thrive, but a disproportionate amount of investment dollars have been lost. Never a dull moment.

Hopefully someone reading this has started or is thinking of starting a new venture. Let’s explore their options along the continuum to finance it.

Friends and Family

Just what it sounds like. It’s going to Mom and Dad, Rich Aunt Joan, Crazy Cousin Bill, your stoner college roommate who was employee #55 at Google, and all the other friends you ask to put money into your new venture.

This is clearly a mixed bag. While their terms will likely be the most generous and they’ll likely value your new venture at the level you think is fair, these shareholders can be demanding in a psychic way. Family gatherings could turn into business updates. You’ll get calls on nights and weekends.

There’s the risk of that feeling in the pit of your stomach that if it goes wrong, you’ll have to face these people for the rest of your life. Hmm, sounds like a more expensive form of capital then I originally thought.

Angels

“Angel” typically refers to high net worth individuals who invest in private companies for themselves, as opposed to within a fund.

Angel investing has been on an upswing over the past few years for several reasons. First, with the stock market’s mixed performance over the past five years, this class of investor is looking to enhance their returns with some non-traditional investments. More importantly, angels are filling a gap that has resulted from the decreased popularity of traditional venture capital (discussed below).

Angels are typically much closer to the friends and family investor. They also have some of the same pros and cons.

On the positive side, they’re typically easier on valuation and they’ve often been entrepreneurs themselves. On the other hand, they’re not professional investors and so might lack some of the dispassionate views that a VC can bring. While they might have run companies, they might not know healthcare or software at all and might insist that their great success running a plumbing supply business obviously translates to your venture.

Their lack of a traditional venture fund (and its limited partners) cuts both ways as well. Where a VC might care only about an ultimate sale (or IPO), an angel might care more about receiving cash distributions. If you want to invest for growth, that could be a source of conflict.

If you have a choice of angel investors, as the knight in Indiana Jones and the Last Crusade said, “Choose wisely”. Do they bring experience and industry knowledge and contacts, or are they just a source of funds? Whichever it is, would they answer that question the same way that you would? How active do they want or plan to be? Will they want a board seat? Even if not, what will they require for ongoing communication as well as general care and feeding?

The importance of clarity and alignment of goals, vision, and timing here simply can’t be overstated. More than ever before, angels are starting to organize around their activities. Many top-tier business schools and tech associations have formed quasi-official angel groups.

Venture Capitalists

Traditional venture capitalists (VCs) are professionals at investing in private companies. Typically structured as a partnership, the investors (limited partners) tend to be foundations, pension funds, endowments and often high net worth individuals.

Research (and my observation) shows that VCs can bring much more than capital to their portfolio companies. They typically have strong networks in the sector and a great ability for pattern recognition, often having seen similar companies grapple with similar issues.

One of the most successful HCIT entrepreneurs I know once told me that, after herself, she attributed her company’s success most to the VC involved. This clearly suggests that valuation (and even terms) shouldn’t necessarily be the key factor in selecting one’s financial partner.

Beyond that, however, I’ve observed a huge continuum of both personalities and skills. I’ve seen VCs add tremendous value and insight. I’ve also seen VCs where I’d suggest the entrepreneur sell a kidney on eBay before taking their money.

Another factor to consider is that different funds tend to invest at different stages of a company’s life cycle. Loosely defined, these stages range from: (a) a good idea and founder (Seed Stage); (b) great team and product (Series A); (c) proven product and critical mass of customers (Series B); and business seems to be working, but needs growth capital (Series C and beyond).

While topnotch venture capital funds are continuing to fund early stage companies (and HCIT is no exception), for multiple reasons (to be discussed in a future post), fundraising has become more of a challenge to earlier stage companies than ever before. Hence the significant growth in angel investors to fill the gap.

None of the Above

What other options might exist for funding early stage ventures? I’ve seen companies of all stages think creatively to help bridge funding gaps. Government grants (especially lately) are a source of capital. Sourcing expertise from academia can help reduce the burn (many business schools and engineering schools have programs for students to consult).

One of my favorites is customer or partner financing. Perhaps a distribution partner or a few customers will pre-purchase software licenses, allowing you to combine a revenue and capital event. This win-win scenario serves to both build a customer reference and development partner and help your balance sheet.

Many hospital systems now have internal venture funds as well. These range in terms of stage of company they invest in (some are more risk-averse than others), but can also provide an appealing imprimatur to the marketplace of both customers and ultimate investors.

As I said, even though I don’t guard the Grail, my best advice here is to choose wisely. From my research days to now, when I’m looking at a company, one of the first things I do is see how they’re capitalized and who their investors are. Whether it’s shallowness or just a lesson learned, I find that it can tell me a great deal about a company. Is this a fund with a reputation for thoughtful investing and management, or an investor that typically throws companies to the public before they’re ready to maximize their own returns? Are there angels involved with experience and reputations for success?

While perhaps not the best way, assessing the backers is sometimes an efficient way of coming up with preliminary judgments about companies and their management teams.

Thanks for reading, but I’m afraid I’ve run out of space before even getting to Private and Growth Equity investors (who are sometimes also known as leveraged buy-out investors). While I touched on this in my Take Private post, it probably warrants its own, so let me know if there’s interest.

In the mean time, I’ll be attending the Health 2.0 Conference in San Francisco. That will be the topic of next month’s Investing Chair post. If you’ll be there and would like to chat, drop me a note.

Ben Rooks spent ten years as a sell-side equity analyst covering HCIT and related sectors before spending six years as an investment banker where he closed transactions ranging from $40 to 365 million. Seeking to make an honest living, he then founded ST Advisors, LLC where he works with healthcare companies and their sponsors, most often on issues around strategy, financing, and outcomes/exit planning. After all this time, he still can’t wait for HIMSS!

Monday Morning Update 9/27/10

From Sara Dippedy: “Re: crass KLAS. Our company suffered for years under KLAS ‘extortion.’ If we didn’t pay to belong, we were relegated to an asterisked account, insinuating that we were hiding something. All it took was one ticked off IT underling to nail you with an anecdotal crack, even though they were often happy as a bird 24 hours later. Opinions vary due to overambitious vendor guarantees and unrealistic customer expectations. We need an independent, not-for-profit testing authority, like Consumer Reports.”

From EHR Geek: “Re: proctologist. Did I beat Weird News Andy to the punch?” You did. A New York proctologist is arrested at his oceanfront condo for submitting $3.5 million in false Medicare charges, including charging for 85 hemorrhoidectomies performed on the same patient and procedures adding up to more than 24 hours in a single day. My mind immediately offered several witty comments, but I’m sure yours has already done the same.

From Me So Corny: “Re: eHealth Align. The Kansas City HIE’s board approved signing with ICA’s CareAlign as its HIE solution on Friday. It will be announced this week.” Verified, apparently, since it’s on ICA’s Twitter feed.

From The PACS Designer: “Re: ResolutionMD Mobile. The reading of image files on the iPhone is getting easier with ResolutionMD Mobile. The app is free from the iTunes Store. One of the key features is the DICOM processing, and storage stays on the server with window and level manipulation residing on the iPhone.”

Listening: a 1995 CD from obsolete harmonic Canadian power poppers Zumpano. Sounds great.

The California Academy of Family Physicians will use (warning: PDF) a $145K grant from The Physicians Foundation to create an online EMR resource for physicians, including a readiness assessment and tools for EMR selection. “We liken it to changing the tires on a moving car. Our physicians struggle every day to keep the doors open and keep patients healthy. Look, the office doors are open, patients are coming in, it’s flu season — and at the same time you have to adopt an EMR?”

I ran across a cool open source laptop security app called Prey Project. You install its invisible client on your laptop or mobile phone. If the device is stolen, the app phones home via the Internet or text message, sends you its location determined from geolocation services, takes the thief’s picture via webcam, grabs a screenshot of whatever the thief is doing, and locks down the PC. It will look for any open WiFi hotspot if the device isn’t connected to the Internet. If you’re feeling vengeful, you can annoy the thief by remotely triggering an alarm or an onscreen warning.

Doctors in Australia are warned by the New South Wales medical board not to make “flippant and derogatory” comments about patients after a patient complains. Related: the Australian Medical Association questions whether it’s a good idea for doctors to accept the Facebook friend requests of their patients, saying it’s inappropriate for them to blur the professional-social line.

This week’s company-wide e-mail from Kaiser chairman and CEO George Halvorson makes the point that by collecting ethnicity information in HealthConnect, Kaiser can uncover important ethnicity-specific health risks. He makes an interesting point: since every Kaiser patient has the same coverage, treatment, and providers, the only variable is often ethnicity.

Lisa Busby, CIO of Inter-Lakes Health, is named interim CEO after Kevin Haughney quits.

A couple of readers offered software alternatives for mind mapping. Luke O’Scyte recommends for the iPad and iPhone Headspace ($3.99) and iThoughtsHD ($9.99). For the desktop, he’s trying the open source Freemind, which Les also recommends. Ben suggests the free XMind. 

The Health 2.0 conference will be held October 7-8 at the Hilton San Francisco. Companies sending speakers include O’Reilly Media, Microsoft, HHS, Executive Office of the President, Wired Magazine, The New York Times, Cerner, Google, Kaiser Permanente, and WebMD. Other events during Health Innovation Week include a developer’s challenge at the Googleplex, a REC/HIE summit, and HealthCampSFBay. Early bird registration ends Thursday. You can save an extra $100 by using code “HIStalk” when you sign up. I have no financial interest – I’m just being nice in mentioning it.

Epic UGM photos from Wisailer.

Hyland Software, the OnBase document management company, acquires Computer Systems Company of Cleveland, OH. CSC offers document imaging, revenue cycle, and OB/GYN workflow and EHR tools.

Northern Ireland electronic document management vendor Kainos wins its third NHS contract in the last few months.

The Government Accountability Office appoints 19 members to its Patient-Centered Outcomes Research Institute, which was authorized under the Patient Protection and Affordable Care Act. It’s a big deal: this group will get $500 million per year of the $1.1 billion in ARRA money set aside for comparative effectiveness research, including setting research priorities and overseeing clinical trials. CMS can use its results for what sounds like setting co-pays that will encourage more effective treatments. The dean of UCLA’s medical school will head the group.

A patient sues Medical City Dallas (TX) for mishandling her electronic medical records after being called by collectors claiming she owed money for psychiatric treatment. The hospital had mistakenly chosen her medical record for that of an uncooperative psych patient with the same name, then merged the two accounts. Afterward, the hospital sent her a letter saying they would fix the problem, she got more collector calls, and she found the same patient had been admitted again and the same mistake had been made.

Greenway announces the start of its two-day, regionally-offered Meaningful Use training sessions for customers.

It would be fascinating to know why (heavy vendor response?) 75% of readers wouldn’t use a free, ad-supported EMR. New poll to your right: are the product ratings offered by KLAS representative of product performance in a way that’s useful to providers?

An ISMP survey finds that providers are exasperated with never-ending drug shortages. For those unfamiliar, let me explain why that’s a big deal for hospitals. Sometimes there’s only one source of a given drug, meaning doctors are forced to order alternatives they don’t know much about, often drugs that are less effective or more dangerous. Nurse are suddenly looking at unfamiliar drug packages, increasing the chance of medication error. From an IT standpoint, systems have to be changed: automated dispensing cabinets have to be set up for the new item, CPOE and pharmacy systems may require modification, and any systems that read drug bar codes must be re-programmed. Imagine being a high-acuity patient and finding out that your anesthesiologist or surgeon can’t have his or her critical drug, which they know inside and out from years of predictable use, and instead will be rolling the dice on some alternative they’ve already judged inferior, all because a drug company is mysteriously out of the A-team product. Nobody seems to know why shortages happen, but speculation usually runs to the cynical in my hospital: scumbag pharma tactics, wholesaler market fixing, and hoarding by other facilities who hear shortage rumors (that hoarding is often by us, I should add, since we’re just as unhappy about running out of drugs as anyone else and we don’t hesitate to use our clout to jump the line).

The FCC opens up “super WiFi”, the white space airwaves formerly taken up by analog TV signals, a boon for wireless device and service vendors (including those selling hospital technology). An early adopter is rumored to be Microsoft, which supposedly needed only two towers instead of thousands of routers to cover 500 acres on its Redmond campus. Strange: country singer Dolly Parton filed a complaint – she’s worried about the effect on wireless microphones.

This should fuel the usual HIT takeover rumors: Oracle’s Larry Ellison says the company’s string of acquisitions will selectively continue with semiconductor companies and vendors of industry-specific software.

This is scary, especially since it’s probably true here: the #1 organization that graduating college students in Canada would most like to work for is the federal government.

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News 9/24/10

From Clinical Wisdom: “Re: KLAS. A friend told me that Eclipsys paid KLAS $300K per year. Can KLAS accept mega-bucks from vendors they evaluate without being influenced by their cash? Imagine Consumer Reports taking money from car companies. I think they owe those who buy their reports a full accounting of what they earn from vendors and what those vendors are promised.” We’ve been around and around the KLAS business model over the years. Providers don’t usually pay KLAS for the reports; they get them free in return for providing data, so they would not be surprised to find that vendors pay big bucks (i.e., it’s the HIMSS “ladies drink free” model). I asked Adam Gale in my 2007 interview if the company would be willing to have its survey and ranking process audited by an outside expert. He said yes, but that hasn’t gone anywhere as far as I know. He offered this comment when I asked if being paid by vendors is a conflict of interest:

I would say we have one of the world’s strangest business models, where internally, if you ask anyone at KLAS who our customer is, they’d tell you it’s the provider. That sometimes irks the vendors because they pay a reasonable amount of money to have access to the subscriber data. One vendor, as a mistake, sent us an e-mail intended to be internal that said, “Doesn’t KLAS understand who the customer is based on how much money we spend?” We hold that up and cheer. The vendor is not our key customer. The provider is. We frame every vendor question in terms of, “Will it help providers make a better decision?”

From Spell Czech: “Re: CareFusion Pyxis. Are they really struggling against Omnicell? I hadn’t heard that. Love the blog — been reading for a couple years now!” I’m sure Pyxis still holds most of the market, but it wasn’t long ago that they never lost customers. Both my current and previous hospital employers reconsidered whether Pyxis was worth keeping (clunky software, arrogance, bad support). In one case, we begrudgingly stuck with them because McKesson’s product wasn’t fully baked and Omnicell was struggling. In the other, we dumped Pyxis and never looked back. My conclusion is that, finally, Pyxis has some real competition from both of those now-acceptable alternatives and the market is reacting at least somewhat to that, even though those competitors share some of the same flaws (too many engineers making design decisions and worrying about moving parts instead of nurse-friendly software). I haven’t heard anything about Cerner’s entry into that business. Competition is good for everyone, especially the customer and patient.

From Mighty: “Re: ED denominator for Meaningful Use. CMS has finalized it, though I don’t see it mentioned in many places.” The CMS clarification says that only ED patients who are admitted as inpatients or who are treated as observation patients count toward the CPOE requirement and other parts of MU.  

From Computer Giant: “Re: UPMC. Can the EMRs not solve this problem?” That was tongue in cheek, in case you couldn’t tell. UPMC howls when a state report finds that flagship UPMC Presbyterian-Shadyside has a higher-than-expected mortality rate for CHF, septicemia, respiratory failure, and stroke. Their excuse is the standard: “our patients are sicker,” but when the state responded that everything was severity-adjusted, UPMC then commented that their younger patients throw off the stats. I’ve yet to see a hospital that took the news constructively that it’s underperforming. Be comforted: in their own minds, every hospital is above average.

From Peggy: “Re: Epic co-op. I love your site. I read it religiously! Our hospital is evaluating vendors to replace our clinical core and Epic is (of course) one of them. I’m interested in the consulting co-up you mentioned. Would you mind sharing more information?” I don’t have details, but I’m sure they will emerge publicly at some point.

From Slidell Computer: “Re: executive director of Physician Hospitals of America. She’s leaving. Rumors are circulating that changes will force physician-owned hospitals to sell out or close. Maybe she sees the writing on the wall.”

From Not Quite: “Re: GOP’s Pledge to America. It returns the country to the 2008 budget, ARRA stimulus money for EHR systems will end, and according to polls, the GOP will take over Congress. Shouldn’t all EHR purchases stop now since they won’t get their incentives?” I’ll stay out of the political debate since I distrust all politicians equally (except maybe Chuck Grassley and Ron Paul), but I would say that anyone buying an EHR solely because of Uncle Sam’s promised largesse should think twice even without the Pledge to America. CMS is like a devious cat owner waving a laser pointer around: they love to see providers jump around in reaction to ever-changing and mind-bendingly complex policies that address what initially seemed like simple, good ideas to make sure no payouts actually occur.

Wisailer, a reader attending Epic’s UGM, shared some of the interesting aspects from the meeting so far (his or her words, not mine):

• According to Judy, one of Epic’s goals is "to improve health care for the world," based on their estimate that 30% of the US population is covered by an Epic EMR.
• She says “do what Epic says" and your implementation will succeed.
• Epic has spent 66,000 hours on Meaningful Use, which Carl Dvorak seemed to imply has slowed down their transition to Web-based applications.
• The customer base is 224, up from 190 last year, and many of the sessions were oriented to new installations.
• 200,000 physicians use Epic.
• Vendor ally — boring. Lots of suites and pretty smiles. More consultants, fewer device and service providers.
• Swag consisted of pre-washed, BPA-free water bottles with special refill funnels at water coolers.
• The Haiku iPhone app will be extended to the Droid soon.
• Canto, a new Epic iPad application, will be released in the near future. LOTS of buzz about this product.
• Horse-drawn carriages are giving tours of the campus and bikes are available directly across from Epic Farms, thought by many to be the production source of Epic Kool-Aid.

The pic above of some of the Epic festivities, which looks like a more affluent, less crowded, and much colder (highs in the 60s this weekend) version of Woodstock, is from Dave Yost’s blog.

As Inga told me, we’ve been outed by Google. I set up HIStalkTV a few months back on a slow Sunday afternoon just to play around with posting HIT-related videos that I found amusing or useful. The site is suddenly popping up on search engines for some reason and readers are e-mailing us about it. It’s definitely beta and I haven’t really decided what to do with it if anything, but feel free to send me your thoughts. We even had one of our favorite PR people ask about sponsorship opportunities, which I appreciate even though I’ve given that zero thought.

I was motivated by Ed’s CIO Unplugged post about his use of MindManager for mind mapping, list making, etc. (maybe because he featured HIStalk prominently in the picture). I tried some of those programs years ago and lost interest, but figured I would look again since I really like the concept for creativity. I lost interest in MindManager again when I saw that it has become Visio-ized (tons of overly complex functionality added for corporations and priced accordingly — $349), so I found a simpler alternative that seems to work great: MindVisualizer ($79). I’m running the free trial and will probably buy it because it’s pretty darned slick. I used it today to make a few plans for the HIStalk reception at HIMSS and the tool didn’t get in the way of my thought process, which is the most important criterion.

This seems remarkably open minded considering the source: on the HIMSS blog, the senior director of federal affairs (Tom Leary) asks for comments on the federal government’s role in ensuring the safety of HIT products. Supposedly the only reason the FDA doesn’t regulate HIT today is because of some fancy, long-ago behind-the-scenes political footwork by various groups and vendors, so maybe HIMSS is considering taking an official position. Why not chime in?

A fun Medgadget post: the National Space Biomedical Research Institute has developed an astronaut EMR that combines a mobile monitoring device with software. The EMR is iRevive from 10Blade, which was designed for EMS users (you mean astronauts don’t enjoy the benefits of a certified EHR?)

Continuing my rant on badly written press releases, this HIE one speaks for itself. For the love of God, doctor and press release writer, take a breath! In addition to the hopelessly dense text, it starts off with (1) a mini-editorial; (2) a snooze-inducing history lesson; (3) a ton of quotes, apparently all so equally significant that none could be omitted to make it readable; and (4) in the VERY LAST paragraph, one long sentence that contains the only real news in all that fluff. There is a reason that companies pay experts to craft their communication instead of doing it themselves.

Precyse Solutions will unveil its new Automated Clinical Documentation software and Computer Assisted Coding software engine at AHIMA in Orlando next week.

Weird News Andy entitles this as “Half a woman is better than none.” Doctors in Canada take a drastic step to save a 31-year-old woman with untreatable bone cancer: they cut her body in half by removing her leg, lower spine, and part of her pelvis, then do a “pogo stick rebuild” in fusing her remaining leg back to her body. I wish I had her positive outlook: “I have no problem getting around. If I need to, I’ll crawl (up stairs) or scooch like a kid.” The most bizarre aspect of the story in my mind, however, was how the doctors described the size of the tumor: they said it was the size of a calzone.

Welcome and thanks to brand new HIStalk Platinum Sponsor T-System of Dallas, TX, which created and sells what is surely one of the most effective, well-accepted, and ingenious paper documentation solutions ever devised: the famous T-Sheets, on which over 30 million ED visits are documented each year. The company offers other versions for ED nurses, order sets, urgent care, and primary care, but I’m sure they would also want you to know about T SystemEV, the company’s emergency department information system (with modules for patient tracking, status board, nurses, physicians, and CPOE) that’s used by 240 hospitals. It offers comprehensive physician and nurse documentation, clinical content, a short learning curve (often just one shift, they say), status board, prescription writing, discharge instructions, CPOE, lab integration, real-time coding capture, and patient satisfaction and reporting tools. All are important for Meaningful Use, of course. Former McKesson MPT President Sunny Sunyal recently joined T-System as CEO, so I’d say he did his due diligence and liked the company’s performance and potential. Thanks to T-System for supporting HIStalk — Inga and I appreciate it.

All adult hospitals in Milwaukee County, WI will use My Health Direct for ED referrals to community health centers, courtesy of an agreement signed with the Wisconsin HIE. I interviewed Jay Mason, the chairman and CEO of My Health Direct, in June.

I was checking up to see what’s happening with long-time HIStalk bestie Scott Shreeve MD, formerly of Medsphere and now building Crossover Health, a member-based medical practice that will provide individualized urgent, primary care, and online health services from clinics in California (Newport Beach, Foothill Ranch, and Aliso Viejo). I didn’t think I’d be interested in the construction video above, but it’s pretty fascinating to see how that company and others are taking a very different approach to healthcare delivery for those who can pay for it themselves.

Some unusually juicy jobs on the HIStalk Sponsor Job Page: Sales Director, VP of Solutions Marketing, McKesson Consultants, Head of Quality Systems, Sales Director. On Healthcare IT Jobs, Senior Account Executive for VA, Sales Professional – North Carolina, Clinical Systems Analyst III, Epic Project Managers, Eclipsys Documentation Consultant.

Home care mobile solutions provider CellTrak Technologies announces the latest version of its smart phone system, which includes Android capability. It’s also sold in Canada by TELUS Health.

The US Army awards a research grant to InterSystems to look at its HealthShare platform to exchange data between Madigan Healthcare System (WA) and South Sound HIE.

Medical College of Wisconsin spinoff Imaging Biometrics gets an $800K NIH grant to develop its software that helps clinicians distinguish tumors from healthy tissue.

Odd: a woman’s iPhone is stolen while she is hospitalized and in labor.

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HERtalk by Inga

From Hamlet: “Re: KLAS, Epic, etc. KLAS found that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Reading HIStalk, you would think Epic cleaned everyone’s clock.” They cleaned a lot of the clocks that counted, i.e. the big, influential hospitals with lots of beds and big dollar volume.

From A-Rod: “Re: on the move. Long-time healthcare CIO Bob Kaplan has been appointed EVP and CIO of Audax Health Solutions in Washington, DC. Bob has been CIO of WebMD, NCQA, IFMC, National Preferred Provider Network, and PHP Healthcare Corp.”  According to the Audax Web site, the company is an early-stage startup developing products that “change how patients and providers interact.”

From Sunshiney: “Eclipsys wins. Mercy Memorial Hospital System in Michigan is replacing McKesson with Eclipsys and Sidra Medical and Research Center in Qatar picks Eclipsys’ inpatient EHR.” Both verified.

Capario promotes sales and marketing VP Jim Riley to president. He replaces Andrew Lawson, who will be moving to another company within Martin Equity Partners, the entity that owns Capario. Riley was previously VP of sales and marketing for Payerpath, where he also worked under Jim Brady, Capario’s executive chairman.

Saint Barnabas Health Care System (NJ) picks EDIMS and its EDIS software for its six-hospital system.

Scribe Healthcare Technologies introduces Scribe Mobile, a new dictation app for the iPhone, iTouch, and iPad.

Yet another entity announces its ICD-10 conversion strategy. Global IT service provider HCL Technologies will use Health Language’s Language Engine solution as part of its end-to-end ICD-10 conversion solution.

Central Jersey HIE Project selects Advanced Data Systems, Greenway Medical, and MDTablet as its recommended EHR vendors. Well, at least that is what I think was said in the HIE’s very rambling press release.

Holy Redeemer Health System (PA) will implement MobileMD and its 4D HIE technology to provide connectivity among the hospital, community physicians, and other area care providers.

This week on HIStalk Practice: InfoGard provides an update on when they’ll begin EHR certification and testing. A medical office janitor lands in jail after selling patient charts to a recycling company for $40. Theories on why medical office hiring is up despite declining revenues. A new study reveals the top EHR/PM companies in the ambulatory world.

A sign of the times: San Juan College (NM) says it will shut down its medical transcription program at the end of the school year. School administrators admit that computers are increasingly taking the place of traditional medical transcription, so the school will instead focus on modernizing its coding and HIT degrees.

The local press highlights Rapid City Regional Hospital and its migration to Meditech. The hospital has implemented bedside medication verification and is now moving to physician documentation. The transition is not without its opponents, including one neurologist who is apparently not a big fan of EHRs:

They are good for insurance companies and good for controlling data, but it’s not necessarily good for patient care. The travesty is, so far the systems are bad. You’re not talking to the patients. You’re talking to the computers. If the doctor has to type, they’re not going to add very much information. Either you input data or you take care of patients, but you can’t do both well.

KLAS finds that the oncology market has been mostly ignored by enterprise software vendors, with best-of-breed vendors dominating the market. Enterprise vendors are more focused on the medical, rather than radiation oncology market, and often vendors are less interested in functionality and more focused on integration with other systems. Epic is named the closest enterprise system to delivering an oncology solution. Cerner, Eclipsys, GE, Meditech, and Siemens offer varying functionality as well.

E-mail Inga.

UnitedHealth Group To Acquire A-Life Medical

UnitedHealth Group announced after the market close Tuesday that it will acquire computer-assisted coding vendor A-Life Medical of San Diego, CA. Terms were not disclosed.

UnitedHealth Group will add A-Life Medical to its Ingenix Health Care Delivery business, extending a strategic alliance formed between the companies last year to develop advanced coding solutions.

A-Life Medical’s products include the LifeCode natural language processing solution, which analyzes clinical documentation to identify diagnoses and procedures and recommend ICD-9 and CPT-4 codes to coders. Its Actus computer-assisted coding product will allow Ingenix to market services to providers transitioning to ICD-10 by the mandatory October 1, 2013 date.

The acquisition is UnitedHealth’s fourth technology-related buy so far this year, having previously absorbed Picis (high acuity systems), Executive Health Resources (medical necessity and compliance), and Axolotol (health information exchange systems).

News 9/22/10

From Medicament: “Re: Epic UGM. Announced attendance is 5,500 vs. 3,800 last year. Surreal. This panorama is from the auditorium just after Judy’s keynote.” If you are there, send me a report of any newsworthy developments. Sorry the pic is small, but that’s the point: the meeting isn’t.

From Neils Bohr: “Re: Accenture. I heard they got the HHS contract for use case for the Standards and Interoperability Framework last Friday.”

From Epic CoOp: “Re: Epic consultants. Given the huge demand, 20 of them are forming a consulting co-op to keep the cut that temp agencies take.”

From Blue Danube: “Re: video. Even though it’s an ad for Centricity, it paints a pretty accurate picture of primary care and the need for EMRs.”

Listening: new (released just today) from John Legend and The Roots, a collaboration between the modern R&B/hip hop singer (John Legend) and the Philly funk band (The Roots), updating socially conscious soul songs from the 60s and 70s. I can’t describe just how awesome this album is, sounding as fresh and uncomplicated as Motown circa 1968. If you don’t like soul or hip hop music because it’s over-produced, non-melodic, and fixated with trite subjects like lust or fame, let this rekindle your hope for the genre. I usually condition my recommendations knowing they aren’t for everyone, but this one’s for everyone.

UnitedHealth Group makes another buy, announcing plans to acquire coding vendor A-Life Medical. I covered it in a news blast here. UnitedHealth Groups is obviously on an HIT tear, bagging four companies so far this year. That’s a good reminder to sign up for updates using the Subscribe to Updates box on the upper-right of this page and/or to Friend/Like us on Facebook since I usually post new stuff there too.

The San Diego office of the FBI announces that El Centro Regional Medical Center (CA) will pay $2.2 million plus interest to settle Medicare fraud allegations brought forward in a former employee’s whistleblower lawsuit.

Rothman Healthcare hires Richard Sommer as CEO. I hadn’t heard of the company, so I checked it out. It markets products based on The Rothman Index, an automated system that collects 26 observations and results for each patient every hour and graphs the score so caregivers can quickly see who’s crashing. The trial was at Sarasota Memorial (FL). The Rothman brothers found the company after their mother died after post-surgical complications that were subtle and therefore undetected in the hospital. According to the company’s site, nurses at its first hospital site identified a patient going bad within five minutes of bringing the system up in test mode, reacting to a patient whose pulse-ox had dropped from 98% to 85% over two days without alarming anyone.

Jewish General Hospital of Montreal, Quebec will use education and clinical image sharing tools from Aurora Interactive to create an online pathology education network.

McKesson, HP, and Intel launch a site that mixes HITECH resources with preconfigured EHR hardware/software packages.

Transcend Services announces BeyondAlerts, which extracts clinical data from transcribed narrative to trigger provider alerts.

Panasonic will offer data encryption from Mobile Armor in its Toughbook notebooks and mobile clinical assistants. That includes self-encrypting Seagate drives, centralized management, pre-boot authentication, and auditing. Smart.

I made fun of a Brainware sales announcement a few weeks back because it didn’t name the customer (for contractual reasons, no doubt, but I still questioned the newsworthiness of an anonymous customer sale). They sent me their latest announcement this week, joking that this one names names, that being Gundersen Lutheran Health System (WI). Brainware and Ascend Software are providing the Brainware Distiller intelligent data capture tool along with business process automation for the health system’s Lawson accounts payable system. Brainware’s tools pull data out of unstructured sources such as invoices without templates or indexing. For AP, that means speeding up processing and providing a near real-time view into liabilities. It uses fuzzy search to assign GL codes and vendor numbers to non-PO invoices. Its Gateway product is a portal for vendors to check the status of their invoices online.

Since I shamed Brainware, let’s move on to the next poster child for bad press releases. Does this headline roll off your tongue? The Institute for Transfusion Medicine(SM) (ITxM)(SM) Deploying BIO-key(R) Fingerprint Search and Identification Solution for Donors and Patients. Marketing people can’t even introduce themselves without holding up little trademark and service mark signs. I guarantee that nobody could read this even 2-3 times and have the slightest clue what it’s about with all the unnecessary, lawyer-paranoid clutter.

Covisint, the portal vendor owned by Compuware, acquires DocSite of Raleigh, NC, which offers PQRI, registry, decision support, e-prescribing, progress notes, and integration tools. Roger Sterling tipped us off in the 9/1 HIStalk, although Inga couldn’t get Covisint to confirm.

Children’s Boston will use Allocade’s On-Cue Operations Management software in radiology. It pulls data from existing systems to create a rule-optimized patient itinerary and provides caregiver collaboration tools and business intelligence.

New Jersey’s HITREC contracts for physician practice consulting services from Nit Health. Being a hospital guy, I couldn’t help but think of small combs and Kwell shampoo.

Maimonides Medical Center (NY) goes live with InterSystems Ensemble for rapid integration and development, using it to develop new interfaces to/from Sunrise Clinical Manager.  

An interesting debate at the VA: should tech-savvy doctors be allowed to store limited patient information using cloud-based Web tools if they appear to be secure and if the VA’s systems can’t meet their needs otherwise?

A study finds that a heart attack risk calculator used by consumer health sites is not very accurate, misclassifying 15% of patients as needing medications when they really don’t (check out the screen shot I took above from the American Heart Association’s version of the calculator to see why that’s not too shocking). Epocrates is mentioned as offering physician treatment applications based on the flawed formula.

E-mail me.

HERtalk by Inga

From Heresay: “Re: certification pricing. I’ve heard CCHIT is charging $40-$60,000 for EHR certification compared to Drummond’s $20K.” If anyone thinks they have a solid handle on the pricing from the three ONC-ACTBs, please step forward. InfoGard has yet to publish any details, but here is how I am interpreting the pricing from CCHIT and Drummond:

• Complete EHR Ambulatory: CCHIT $34,300; Drummond $19,500.
• Compete EHR Inpatient: CCHIT $32,550; Drummond $19,500.
• If you don’t need testing for the full EHR and just need individual modules tested, CCHIT has assigned a per-module fee for testing that ranges from $650 to $2,000, depending on the module’s complexity, plus a $7,000 base fee that includes the mandatory security criteria.
• Drummond charges $11,500 for up to 19 modules, include the mandatory measures, or, $16,000 for 20 or more modules, including the mandatory items.

To summarize: Drummond is less expensive if you need complete EHR certification and testing. If you need module testing only, CCHIT could be less expensive. The CCHIT folks would probably add that their fee includes a comprehensive testing and certification toolkit for vendors, which they will sell to non-applicants for $1,000. Also, vendors with CCHIT 2011-certified products will not need to pay additional fees for the ONC-ATCB certification through CCHIT, though additional testing is required.

I happened upon this blog post by an Epic User Group Meeting attendee. He shares details of Sunday night’s round-the-campfire wienie roast, complete with s’mores, dogs, and employee-provided entertainment. Very cool. Epic is expecting over 5,300 customers to hit Verona this week for this year’s theme, “UGM: The Musical.” In addition to 300 educational sessions, the meeting will  feature Epic staff singing Broadway tunes, Les Feud game show, and a tug-of-war tournament.

KLAS finds that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Overall EMR sales nearly doubled last year in the 200+ bed hospital market. Meditech and Siemens saw limited growth and McKesson’s Paragon product outsold McKesson’s Horizon solution.

RCM company NHPN appoints David Garber SVP of managed care. Garber has held leadership positions in a number of managed care organizations, including CompServices and Coventry Health Care.

A third of office-based providers are now e-prescribing, according to Surescripts. However, only 12% of all prescriptions were written electronically last year. The number of providers using electronic prescribing grew significantly from 2008 to 2009, from 74,000 to 200,000, while the total number of e-prescriptions jumped from 68 million to 190 million. Massachusetts had the highest e-prescribing rate at 57%, followed by Rhode Island and Delaware.

Corey Hall joins REACH Call as EVP of medical informatics, coming over from the College of American Pathologists.

Sponsor Updates

• iMDsoft and Medical Web Technologies (MWT) partner to integrate their technologies. iMDsoft will offer MWT’s One Medical Passport pre-op workflow solution as part of its MetaVision AIMS product.
• Greenway Medical Technologies introduces its Allergy Module for PrimeSuite EHR, which includes injection record tracking, allergen testing, serum development, and lot administration and reporting.
• API Healthcare says that 35 provider and contingent staffing clients have gone live with its workforce management solutions this year.
• NextGen Healthcare provides VHA members special pricing on its clinical and financial software.
• Vanguard Health Systems deploys Medicity’s Novo Grid HIE technology to 850 physicians across four states.
• Parkview Medical Center (CO) selects RelayHealth’s RevRunner to improve its revenue cycle performance.

E-mail Inga.

Monday Morning Update 9/20/10

From Tobias Funke: “Re: interesting billboard. This is from Avera Health in Sioux Falls, SD.” That’s pretty cool – the billboard has a smoke machine behind it to extend the smoke into the sky. It drew lots of attention, both from passers-by who checked out the site afterward and the local fire department, who shut it down.

From The PACS Designer: “Re: Windows 1E9 beta. Just like Mr. H, TPD loves Firefox and avoids Internet Explorer. Well, now we have the Windows IE9 beta release, but you won’t be able to use it for Windows XP! It looks like a move by Microsoft to push more of us XP users to upgrade to Windows 7.” I’m still holding Vista against them. The decades-old Windows pattern is obvious: one really OS good release alternating with a bad one that causes endless frustration. My preferred browsers, in order, are Chrome, Firefox, Opera, and then IE (I don’t use Safari, so I don’t know where it would fit). Windows 7 is a winner, though, which is still not great consolation given that I paid for Vista instead of jumping right from XP to the next good version. I don’t think anyone would complain about moving up to Windows 7 if it didn’t require starting over for XP users — you have to have wasted your money on Vista to do a simple upgrade, or at least that’s what I recall when I last considered it. I suspect I’m like the typical XP holdout — not cheap, just not finding a good reason to risk problems knowing that Microsoft offers no help (in other words, have lots of time and a second computer to Google your problem just in case the first one is trashed because you’re on your own).

Former McKesson Provider Technology CFO Craig Niemiec is named EVP/CFO of US Preventive Medicine. I checked out that company’s prevention program and it sounds pretty cool: you pay $229 for the first year, complete an online health risk questionnaire, and then go to a local lab to have a panel of blood tests. The company sends your lab results to a PHR, you and your doctor get a custom prevention plan, you gain access to online dashboards and action programs, and a nurse advocate is available to help with health maintenance. Since it’s not tied to insurance or employment, nobody sees the information without your approval.

Job candidates with a CPHIMS credential would impress one out of five HIStalk readers if they were hiring. New poll to your right: would you use an free, ad-supported EMR?

Sonney Sapra is promoted to CIO of Tuality Healthcare (OR).

iOptimal announces the beta of iPad Hospital Toolkit, which it says requires no iOS programming and connects to standard databases to convert legacy apps to run on the iPad.

A third organization is approved by HHS to certify EHRs as an ONC-Authorized Testing and Certification Body: InfoGard Laboratories of San Luis Obispo, CA. They have many certifications and list extensive internal expertise (cryptography, security, systems architecture, etc.) that makes CCHIT’s credentials look a little anemic in comparison.

St. Edward Mercy Medical Center (AR) will go live on Epic September 26. The local paper’s article says Sisters of Mercy Health System, of which St. Edward is part, spent $450 million on Epic.

Siemens will make its IT Solutions and Services unit a separate company on October 1, having previously announced plans to cut 4,200 jobs there to set up a spinoff. That business covers a bunch of industries including healthcare, but I wasn’t familiar with the healthcare parts: content management, PACS data storage, identity management, and RFID. I assume this has nothing to do with Siemens Healthcare.

Cardinal Health sells its remaining shares in its CareFusion spinoff for $706 million. Some of the CareFusion medical device and technology brands include Pyxis, Alaris, AVEA, Jaeger, SensorMedics, V. Mueller, and MedMined.

England’s Connecting for Health wants NHS trusts to report their inventories of Microsoft licenses by October 1. Since CFH didn’t renew its Enterprise Agreement and their license count is fixed, that means trusts are own their own to budget and pay for their Microsoft licenses.

I’m not sure how this qualifies as defense funding, but Assistant Senate Majority Leader Dick Durbin brings home the Illinois bacon in getting $3.6 million in funding through the Senate Appropriations Committee for Children’s Memorial Hospital of Chicago to study regenerative genes. It’s great for wounded soldiers, so I guess you could squint a little at the tumescent federal budget and make it so. The Senate has to approve, but I think they are battle-weary themselves from approving endless federal handouts that, if you continue squinting, only slightly resemble a robust economy.

An interesting and cheap idea for practices interesting in reducing missed appointments: sign up for a Web-based virtual phone service and use it to send SMS reminders to patients.

Vecna Technologies signs a marketing deal with Cycom Canada to sell its QC PathFinder real-time hospital infection monitoring system to hospitals in Canada. The company, whose offices are in the DC area and Cambridge, MA, also offers a Web portal and patient self-service kiosks. Also, the medication delivery robot above. Their stuff looks pretty cool.

Former treasury secretary Paul O’Neill questions David Blumenthal after the latter’s EHR-love keynote speech at a patient safety meeting, asking him (I’m paraphrasing): if the government is so hot to spend billions on EMRs, then why not design a prototype and then refine it, creating a national standard? Blumenthal’s answer, also paraphrased: there’s a debate about whether the ideal approach is like the Internet, where competition took the basic structure of the Internet and turned it into something amazing, or should someone just set detailed standards centrally? He also touted certification. An interesting quote from the excellent Mass Device article, from Atul Gawande at an August meeting talking about reducing medical errors: “Ignorance remains, but we have a new kind of human failure that has emerged as important and that is what the philosophers call ‘ineptitude,’ meaning that the knowledge is there, but the individual or group of individuals fail to apply that knowledge correctly.”

A former Medco pharmacist nears the 80th day of his hunger strike protesting the mail order pharmacy’s requirement that pharmacists fill at least 50 prescriptions per hour, saying it causes medication errors.

The VA and DoD launch a fourth records-sharing pilot, this one involving the Spokane VA, Fairchild AFB, and Inland Northwest Health Services. The first three are in San Diego, Norfolk, and Indianapolis.

California Attorney General Jerry Brown wants to review the salaries of hospital executives, among several public positions that he thinks are overpaid. The healthcare example he gave was the CEO of Washington Hospital, who makes $847K. The hospital gave the stock answer about having to pay market salaries for the best hires, which always sounds lame to me. First, some of healthcare’s hires are clearly not the best people. Second, by that logic, you’d be paying teachers and ministers huge dollars if only they were lucky enough to have higher-paying alternatives. And third, I like the idea of offering less than market salary and seeing who really wants to help patients vs. themselves. If you can’t stand the idea of running a non-profit hospital for a paltry $500K, then don’t let the door hit you on your way out.

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Sponsor Updates

• T-System announces the six winners of its 2010 Client Excellence Awards.
• Medicity announces that Carolinas HealthCare has selected the company as its partner to build a multi-state HIE.
• Nuance will be at AHIMA next week.
• Baltimore-based clinical documentation vendor Salar is recruiting for a number of positions to support its growth: software engineer, RVP of sales, implementation specialist, marketing specialist, and others. I like these guys – their crew was having a blast at the HIStalk reception at HIMSS in Atlanta.
• A good Facebook to follow – NPC Creative Services. I read a lot of Facebook posts and theirs is always on point about HIT.
• HIS vendor IntraNexus will be at HISpro’s seminar for buyers in Dallas on October 13-14. That’s Vince Ciotti, who keeps the registration fees and hotel costs way down ($295 to register).
• I don’t remember if I’ve mentioned this: Quest Diagnostics and Surescripts will work together to create a service that will make lab and prescription information readily available to physicians. Quest is the parent company of HIStalk sponsor MedPlus, which offers the Centergy data exchange, ChartMaxx document-based EHR, and Web-based Care360 EHR that is used in more than 70,000 practices.
• Holon is offering downloable overviews of its offerings: central order entry pharmacy, results notification, workflow scheduling, pharmacy solutions, and others. The company offers the Holon Framework that includes solutions for data exchange, workflow, interoperability, and document management, all designed to enhance rather than replace existing systems.
• International informatics and medical terminology vendor Apelon will be at AHIMA, where Kathy Giannangelo will present on the state of standardized terminologies. The company’s expertise is in terminology asset management, data interoperability and integration, and data warehouse content and consulting.
• If you’re going to the Virginia MGMA fall conference in Virginia Beach next week, check out DIVURGENT’s presentation on tactical approaches to HITECH, delivered by partner Colin Konschak and client services VP Shane Danaher. The healthcare consulting firm will also be at the CHIME Fall Forum and VAHIMSS in October.
• Stockell Healthcare Systems offers several success stories about its InsightCS solution for patient registration, ADT, and revenue cycle management.
• Precyse Solutions will oversee transcription, medical records processing, coding, and storage for Benefits Health System (MT), taking over its 60 employees.
• Rechargeable workstations from Enovate are highlighted on the Web page of Children’s Hospitals and Clinics of Minnesota, which shows the amenities and benefits of its patient rooms. Cool idea: each room has a caregiver window so that nurses can check on the patient and perform documentation from the hallway without barging in.
• UC Irvine Medical Center gives credit to Surgical Information Systems for its best practices in patient handoff and communication that led to a successful Joint Commission survey.
• Order Optimizer has added a very well laid out Web page on Meaningful Use. It says its SaaS-based CPOE can be live in nine weeks with no capital investment and no impact on legacy systems, making it feasible to meet Stage 1 incentives within 90 days.
• MED3OOO offers free electronic newsletter subscriptions covering coding and compliance, clinical tools, and developing healthcare news.
• SRSsoft publishes its online EMR Straight Talk, with the latest entry being EMR Purchase – Caveat Emptor.
• Cumberland Consulting Group is growing and therefore looking for candidates at these levels: consultant, managing consultant, and executive consultant.
• Regulatory compliance consulting firm The Anson Group will present at the 2010 RAPS Annual Conference in San Jose next month. The company also offers technology commercialization services that can include licensing, sale, and partnerships, particularly with regard to products involving FDA approval and the resulting regulatory risk.
• I like the people at electronic forms management experts Access, being among the very few sponsor folks I’ve actually hung out with non-anonymously here and there. I’m still trying to get them to bring their award-winning Texas barbeque team to HIMSS in Orlando for your benefit as an attendee, since that part of the world struggles by with pathetic chain barbequed chicken of no particular regional specialty and therefore is generally unaware of the glories of Texas brisket and sausage (although I do like that of Cecil’s Barbeque on Orange Avenue even if they smoke it over hickory instead of post oak and/or mesquite). Anyway, Access has a blog here, which coincidentally gives HIStalk a shout-out in the latest entry.
• Informatics Corporation of America is offering an October 21 Webinar entitled Sustaining HIEs Through Leveraged Infrastructure – A Multi-Community Approach.
• Sunquest is at the pathology informatics conference in Boston this week and will head on over to CAP ‘10 in Chicago immediately after. Stop by and tell them you saw it on HIStalk.
• API Healthcare launches its Client Connections site, providing easy access to support materials, manuals, and training materials. It also offers clients the ability to network with each other and with API’s experts on workforce management technology. Clients can search the support database, review and enter support tickets, and receive e-mail updates when the status of their ticket changes.
• Enterprise workflow vendor FormFast offers a Webcast library covering EMR maturity and adoption, RAC audits, workflow applications, prescription printing, and others.
• The Sentinel RCM application 340b drug pricing application from Sentry Data Systems will be integrated with Omnicell’s WorkflowRX 7.0 software.
• EDIS vendor EDIMS will be at ACEP 2010 in Las Vegas next week. I’m sure they would appreciate a howdy from HIStalk readers also at the Mandalay Bay.
• Culbert Healthcare Solutions just won a “fast growing” award, so it stands to reason that they might want to talk to you if you’re an ace consultant (Allscripts, Epic, GE, integration, revenue cycle, PM, etc.) Info here.
• Interesting in outsourcing revenue collections? AdvancedBiller, a service of AdvancedMD, will match you with up to three AdvancedBiller partners, who will provide needs analysis and price quotes. Register here.
• TELUS Health offers an online demo of Telus health space, its HealthVault-powered consumer platform for Canadians that is the first to achieve Canada Health Infoway pre-implementation certification.
• SCI Solutions is making customer reviews of its access management services freely available online via Customer Lobby, including KLAS-like commentary and star ratings. I believe you can infer that they have little to hide about their ordering, patient scheduling, and revenue cycle applications. SCI was one of the first HIStalk sponsors and doesn’t really advertise much, so thanks to John Holton, Cindy Dullea, and Hans Morefield, some of the folks there that keep in touch regularly.
• Wellsoft announces that CCHIT has certified its EDIS v11 emergency department EHR, making it one of the first.
• EHR consulting experts Enterprise Software Deployment (Allscripts, Cerner, Epic, McKesson, Meditech, Siemens) brings on David Tucker as national sales VP. The company is growing like weeds and is on the lookout for both salaried and contract consultants – check out their job board.
• Software Testing Solutions has posted fun photos from their creative booth activities at SUG 2010. You can sign up for a variety of demos and classes for their application testing solutions for Sunquest, Eclipsys/Allscripts, and Epic.

News 9/17/10

From Bama Birdie: “Re: HealthSouth. Trinity Medical Center will relocate to its unfinished hospital on US 280.” This was the endlessly touted digital hospital that was to serve as the flagship for the HealthSouth rehab chain, to have been built by HealthSouth and Oracle. It was called the “hospital of the future” when construction began in 2001, which turned out to be apropos since Richard Scrushy’s $2.7 billion fraud scandal left it permanently unfinished. It was vaporware anyway, said HealthSouth’s CEO last year: “It was a pipe dream and a figment of the imagination. It never had a chance.” You would have believed otherwise given the gushy coverage by the bootlicking healthcare rags back in the day, which were apparently unaware that Oracle had pretty much nothing to offer hospitals despite periodic, uninspired healthcare waters toe-dipping.

From RegularReader: “Re: Broadlane. MedAssets buys competing GPO/services company Broadlane for $850M Tuesday and the Street doesn’t exactly love it. Stock is down approximately 10% since the deal was announced. Only time will tell how many jobs the expected $20M in 2011 expense-based synergies represents.” MedAssets shares closed Thursday at $18.54, down from Tuesday’s peak of $21.50.

From Willie Maquitt: “Re: Adreima. Where do companies come up with these names? How do you pronounce it?” Advocacy for Reimbursement Matters, like George “T-Bone” Costanza in Seinfeld, decides to give itself a contrived nickname, Adreima, maybe to celebrate its acquisition this week of eligibility vendor Hospital Inpatient Services. I’d say it “addREEmah”, but I hate it when companies make up a name of their own free will, then insist on shortening it. Why not just pick a short one to start with?

From Human Error, Here: “Re: Pittsburgh. The executive, who spent $10 million of taxpayer money on an emergency dispatch system upgrade (downgrade) when the county and city can barely afford to patch potholes blames human error for care delays.” The new system was missing addresses and landmarks, so dispatchers got confused when multiple surrounding towns share the same street address. A dispatcher who sent police to a cell phone tower instead of a house to check out a break-in was suspended indefinitely. I’m not sure if that’s better or worse than in Detroit, where ambulances don’t have computers or GPSs, ambulance response times are long, and firefighters and police officers aren’t allowed to help a victim until the ambulance gets there.

From TexLAHawk: “Re: JPS Health Network, Texas. Word is that Jamey Pennington has resigned as CIO. So basically a county facility that has historically had terrible management and clinical outcomes now is set to buy the most expensive, resource-intensive EMR possible without a CIO at the helm. Glad to see our tax dollars are hard at work!” I’ll guess the CIO part is true since JPS IT director Joe Venturelli sent a Rumor Report to mention that the book he wrote, The Informed Patient, is available on iTunes (or at least it claimed to be him) and mentioned his role as interim CIO. They couldn’t force the CIO to stay if he wanted to leave, of course, and I’m sure that he’s as replaceable as any of us.

Inga and I get occasional personal invitations to attend conferences of various kinds. Even though we rarely do so because that means arranging vacation days from work and all that, we do appreciate the offers. Thanks for thinking of us.

Capsule announces Mobile Vitals Plus, part of its Enterprise Device Connectivity solution. It’s a single, touch screen-powered, nurse-friendly device that captures vital signs and sends them to the patient’s electronic record. A video demo is here. Seems cool, but I’ll defer to the nurses (I’ll bet you rarely hear that from an IT person).

HIMSS 2010 Davies Awards winners, just announced: Sentara and Nemours, organizational; The Diabetes Center (MS) and Miramont Family Medicine (CO), ambulatory; Open Door Family Medical Center (NY), community health; and Wisconsin Division of Public Health’s Wisconsin Immunization Registry, public health.

Jobs: Clinical Systems Analyst III, EMR Implementation Specialist, Eclipsys Documentation Consultant, Allscripts Consultant.

I mentioned the Davies winners even though HIT awards are a waste of time if you ask me, so I might as well mention the hospitals just named to the InformationWeek 500: Banner Health (90), Caritas Christi (44), Children’s Omaha (184), Children’s Dallas (187), Cincinnati Children’s (13), CoxHealth (144), Geisinger (243), HCA (213), Heartland Health (118), Lifespan (74), Norton (157), OhioHealth (238), Parkland (143), Poudre Valley (224), Sparrow (22), University of Pennsylvania Health System (54), UPMC (5), and Wuesthoff (172).

The College of American Pathologists contributes to the first DICOM medical imaging exchange standard for pathology slides, a step along the way to full integration of imaging information with LIS information. 

At a meeting of the Health IT Policy Committee, Epic CEO Judy Faulkner says she is worried that the “government is going to get into the electronic health record design business,” apparently concerned that its future Meaningful Use requirements may be overly prescriptive. Members are also debating how HHS can give the industry a heads-up on the second-stage MU requirements given that they won’t have had time to understand how providers are faring with the first-stage ones by the due date.

LTC Patricia Ten Haaf, commander of the Army’s 452nd Combat Support Hospital in Afghanistan, leads a Lean Six Sigma project to upgrade its MC4 battlefield EMR. ED charting was cut in half when electronic notes replaced paper and nurses created 22 templates that reduced paper forms from nine per patient to two and shaved more than 10% of an admission duration. In the US Army photo above: SGT John Michel, SSG Brooke Stauner.

Free EMR vendor PracticeFusion had two revenue streams in its early business models: pushing ads and selling de-identified patient data. Above is how the first option looks — an ad running at the bottom of a PracticeFusion screen, courtesy of its announcement this week that it has hooked up with an ad company.

Munroe Regional Medical Center (FL) budgets $2 million to upgrade its McKesson Horizon Expert Orders system.

GE Healthcare announces that it’s working with Bassett Medical Center in a Smart Patient Room pilot to develop real-time monitoring of safety protocols such as hand-washing and falls.

Sentara chooses Omnicell for medication dispensing. I assume that means Pyxis was displaced, which is happening pretty often these days.

Teleradiology service provider Musculoskeletal Imaging Consultants introduces Virtual Viewbox, which presents multiple patient PACS records in a single display and allows side-by-side consultations (the company calls that “HITECH Teleradiology”). It runs on an iPad and is free, with a catch: the docs have to ask their imaging centers to use MSKIC for reading.

In England, the Morecambe Bay NHS Trust creates an ambitious improvement plan for its just-implemented iSoft Lorenzo system: “transact a day’s work in one working day.” There’s also a problem in that the system informs users that a patient is dead when in fact they are not.

E-mail me.

HERtalk by Inga

A Boston Medical Center insider confirms that the organization’s recent layoffs included a few IT staffers. However, they added that BMC sees its IT strategy as an integral component of the organization’s overall financial recovery. BMC is on track to implement a new GE revenue cycle system and is working towards qualifying for Meaningful Use incentives in 2011.

Wanted: 13 senior healthcare executives to work for free on CCHIT’s Board of Trustees and Board of Commissioners. Commission chair Karen Bell says CCHIT says participants will help in the development of new business strategies and programs. Application deadline is October 15th.

National Surgical Hospitals contracts  with Summit Healthcare to provide data normalization and clean up following its migration to the Meditech 6.0 platform.

This week on HIStalk Practice: Dell plans to integrate its Android-based Streak mobile device into its EMR technology bundle; providers may one day need EMRs to prove clinical competence when renewing their medical licenses; female physicians are slightly higher performing and producing better outcomes than their male counterparts; and, doctors are more likely to adopt EMR if their physician friends (and not just peers) do.

There’s now an iPhone app for real-time drug safety surveillance. MedWatcher tracks the latest drug safety updates based on FDA alerts, media, and other sources. The bi-directional app also allow users to report possible side effects.

Google unveils an upgraded version of Google Health that includes a cleaner interface and more focus on wellness. I took a five-minute spin, which was enough time for me to conclude that 1) there were lots of new options, nice graphics, and a handy dashboard, and 2) the iPhone app I have been using for tracking calories, exercise, and weight (My Fitness Pal) has more much built-in functionality and requires fewer keystrokes for data entry. Plus, it runs on my iPhone. Overall, Google Health is a more comprehensive tool and would be great for someone wanting to track chronic health conditions, but, I didn’t see enough there to make it worth my time.

Spalding Surgical Center of Beverly Hills installs the web-based MMRPro professional solution, allowing the center to digitize and upload medical records from treating physicians.

Claims clearinghouse vendor InstaMed raises $6 million in a new round of funding that includes both debit and equity capital. Investors have contributed $22 million to date.

Sponsor Updates

• MEDSEEK secures an 18-month engagement to develop and deploy a new consumer Web site for ProMedica Health (OH).
• Keane earns a #70 ranking on the InformationWeek 500 list of top technology innovators in the country.
• CareTech Solutions makes available the recorded Webinars from its eHealth Innovation Series.
• FormFast will demo its HIM workflow and document management tools at AHIMA in Orlando next week.
• VHA, Inc. will offer PrimeSuite, Greenway’s EHR/PM solution, to its affiliated physician practices.
• KronosWorks 2010, the Kronos user conference, will be held November 7-10 in Las Vegas, with former labor secretary Robert Reich as the keynote speaker. The $100 early registration discount ends October 1.
• I see Wellsoft EDIS is heading to the ENA conference in San Antonio Sept. 23rd, as well as the ACEP Scientific Assembly Sept. 28th.
• Voalté brings on five employees to support the success of its Voalté One smart phone system. The company has doubled its headcount so far this year.

E-mail Inga.

News 9/15/10

From Across the Pond: “Re: Alert Online Healthcare, Portugal. Delays all over the place in their first Netherlands implementation of their flagship hospital. It seems they couldn’t deliver the Dutch-specific adjustments in their software on time. Testing was delayed, causing the testing squad of physicians, nurses, and administrative staff to be sent home. Needless to say, the atmosphere is less than sparkling and vibrant right now.” Unverified.

From Nasty Parts: “Re: Sage Healthcare. A new sales approach.” Sage seeks 40 to 50 more solution providers to sell Intergy and Medical Manager, adding to its direct-only channel because it doesn’t have the resources to meet demand.

From Peony: “Re: WellStar. The former cardiology practice of fired CEO Dr. Simone was recently purchased by WellStar for a lot of money. I wonder if this had anything to do with him being fired?” Unverified. I assume that practice is WellStar Cardiovascular Medicine, the 30-doc group he founded. Showing him the door will cost the hospital group $1.8 million, though, since his contract guarantees a paycheck for two years if he’s canned. Ditto for the also-fired general counsel, who will get an $856K parting gift. What the hell are boards thinking when they sign these contracts?

From Cable Cutter, Here: “Re: Verizon. Verizon workers severed a fiber optic cable near Pittsburgh Monday afternoon, affecting businesses and hospitals from Pittsburgh to Steubenville, Ohio and cutting all IT and phone service to thousands. Several call centers were out and emergency calls from hospitals went unanswered.” Unverified. Frontier in Illinois, which took over the old Verizon lines, had the same problem, with hospitals forced to use cell phones for several hours. 

From Situation: “Re: MyChart. Now available on iTunes.” Here’s the link.

Related: Dean Clinic (WI) says it became the first hospital to offer Epic on the iPhone Tuesday. The lady in the pink top really chews the scenery with enthusiastic overacting.

From Cmon Man: “Re: FDA regulation of smart phone apps. Patient safety and innovation are intertwined. Usability and efficacy would be escalated by FDA regulation, contrary to the protests of the industry.” FDA is watching app stores for imaging-related smart phone software, saying that anything that sends images to a medical facility requires FDA approval. They also supposedly called out iStethoscope and Instant Heart Rate as apps that might pique their interest. They say they’ll be issuing guidance.

Cmon Man also weighs in on HHS’s spending taxpayer money to design a trademarked phrase and logo for Connecting America for Better Health, saying it’s cutesy, presumptuous, and expensive. He also finds it uncanny that “better health” is part of the name, making it reminiscent of the UK’s Connecting for Health flatlining boondoggle, or the “HIT Devolution” as he calls it. I guess I don’t agree about the cost since the pallets of stimulus cash being shoved out of the HHS plane make this a non-issue, although I agree with the assessment that government-run HIT projects that cost billions are almost always colossal failures. And if you’re going to spend all that money, you might as well give the project an identity.

From Pretty Kitty: “Re: CPHIMS. Tupelo Honey was right. I have come to believe the same and it’s apparent that even HIMSS isn’t investing much effort or support in it. Although I knew I had passed walking out of the testing center, it took two months to receive notification from HIMSS and a year to get notification to my company. Other than a hearty congratulations, the certification has meant nothing. I will not be renewing.” I think HIMSS does OK with CPHIMS, but the bottom line is that generalist certifications aren’t worth much to employers. You can be pretty dense and still pass if you’ve been around awhile and do well on multiple choice tests. But, feel free to weigh in on that survey to your right asking about the value of CPHIMS. It’s still more relevant than CHIME’s Certified Healthcare CIO program, which makes no sense at all (other than the “cents” the related revenue stream brings to CHIME and the anemic ego boost it gives CIOs sporting unimpressive educational backgrounds). If you can show me even one hospital CEO who will state in writing that they hired a CIO because the candidate waved a CHCIO paper in his or her face, I’ll say so publicly (and that would be a terrible reflection on that CEO). In fact, what’s next, a certified CEO?

Listening: new from Stone Sour, the Des Moines band with some Slipknot personnel overlap. And as an intermezzo sorbet, speed punk from Lazy Cowgirls.

Paging Dr. Pronovost: a survey-based study finds that about half of healthcare workers think it’s a good idea for patients to remind their caregivers to wash their hands, yet a third of those respondents say they would not personally appreciate such a reminder. A third also said they would refuse to wear a badge inviting patients to question their handwashing.

The New York Times agrees with my assessment of Hewlett-Packard’s board for firing CEO Mark Hurd on shaky grounds, then suing Oracle for snapping him up. Its conclusion: “The HP board can now lay claim, officially, to the title of Most Inept Board in America … The whole world will know Mr. Hurd walked away with $40 million of HP shareholders’ money, and joined a multibillion-dollar competitor with HP in its sights — and there wasn’t a thing HP could do to stop him. Confidence-inspiring, this ain’t.” It points out that California courts don’t buy the validity of non-compete agreements, which is what HP is suing Hurd over. McKesson CEO John Hammergren, formerly viewed as ept, is one of HP’s board members.

CapSite sent me a copy of their 2010 US Remote Radiology Study. The big players are Nighthawk and Virtual Radiologic, but their share is not very large. It’s still mostly a preliminary reads business, but remote radiology is chosen for other interesting reasons (cost savings, mostly, but also turnaround time). CapSite provides reports and services that help healthcare organizations make informed capital expenditure decisions.

Outpatient imaging center operator RadNet acquires Image Medical Corporation, which owns PACS vendor eRAD of Greenville, SC, for $10.75 million in cash and notes. The publicly traded RadNet, which has $500 million a year in revenue, is forming a software development team for its newly created radiology information technology division. They say they’ll save up to $20 million over ten years by owning their vendor, plus eRAD is bringing in $5 million a year in revenue.

Weird News Andy notes that the last person a surgeon would want to leave a sponge in would be a lawyer. Or a judge, as in this case in Florida, where a surgical sponge and its metal ID tag were repeatedly misidentified over five months as it became infected in the judge’s abdomen, measuring a foot long by a foot wide when doctors finally took it out. Neither the hospital or its owner, Tenet, responded to his questions about how they would prevent the same problem in the future. The judge settled with the hospital, but he’s suing the radiologists and surgeons.

Stuff you can do right here: (a) stick your e-mail address in that Subscribe to Updates box to your right so you’ll be the second to know hot news (after me, of course, since I have to write it); (b) use the Search All HIStalk sites to … well, search all HIStalk sites; (c) Like us on Facebook with that widget to your right or search us out (Tim Histalk and Inga Histalk) and Friend us to support our pathetic illusion of popularity and acceptance; (d) send me a scandalous rumor via the garishly green but soothingly secure Rumor Report box; (e) add your two cents’ worth by leaving a comment or writing a guest article. And indulge me as I profusely thank the companies that sponsor HIStalk, which I think you’ll agree even though you may complain about the number of ads, do perform a service in bravely supporting an anonymous, abrasive, and hard-working blogger who toils by night after sometimes crappy days in the hospital (not usually, fortunately) to bring you news and opinion you wouldn’t hear otherwise (at least until tomorrow when the next rag or blog passes it off as their own creation). Mostly, thank you for reading.

eHealth Ontario signs a $46 million contract with Canada-based CGI Group to develop and manage a diabetes management portal.

Modern Physician names Amazing Charts CEO Jonathan Bertman, MD as its Physician Entrepreneur of the Year. He says he got into the EMR business because of the money, buying Visual Basic for Dummies in 2001 to create a simple, easy-to-use EMR that costs $995 upfront and $500 a year for maintenance (he says, “I like having a car and a house, but I don’t think you need to extort money from colleagues just because you can.”) I’m not sure I’d want him as either a doctor or a vendor given his admission that “In between patients, I would literally run back to my office to write code”, but I assume he’s got people to do that now since the company is up to 30 employees and 3,500 customers and has won some awards. I like his marketing pitch: “Is Amazing Charts crap? Um. No. But don’t take it from us. Try it yourself. As we’ve repeated ad nauseam, you can try it now without any payment or even giving us your name.” In a sideline business, he’ll also sell you a Male Genitalia Guide for $12, which he notes makes a great stocking stuffer (the guide, not the genitalia). Bet you can’t get that from Allscripts or Epic.

Dubai is having an mHealth Conference and Expo this week. Not to be confused with the mHealth Summit in Washington, DC in late October, or the mHealth Ecosystem in Chicago in December, or the mHealth Summit in Washington, DC in early November. The last one is most notable in my opinion because (a) Bill Gates is speaking; (b) the Foundation for NIH is involved; and (c) I’ll be attending and reporting (anonymously and at my own expense and taking time off from work, just in case my mentioning of it is suspect). It’s got a global health emphasis, of which I’m a fan.

The New York State Department of Health funds $109 million worth of HIT grants for 11 organizations, hoping to build an IT infrastructure to support the patient-centered medical home model of care.

A Mayo bioinformatics researcher gets a $3.1 million NIH grant to develop an EMR that will tie drug response to genomic information.

Odd: a hospital in India buys an MRI machine, but shuts it down a month later when it fires the only doctor who knows how to use it. He was on contract from a private lab and was accused of sending patients there instead of doing the work at the hospital. The hospital can’t get radiologists for the “meagre salary” it offers.

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HERtalk by Inga

Kadlec Regional Medical Center (WA) will deploy Wolter Kluwer Health’s Medi-Span for its Epic EMR.

Also integrating with Epic: Mediware and its HCLL blood transfusion management software.

HIE vendor Availity extends a multi-year contract with Prematics for e-prescribing services and the Prematics Care Communication messaging service.

3M Health Information Systems says its ICD-10 Code Translation Tool is now fully integrated with its medical vocabulary server, the 3M Healthcare Data Dictionary.

Benefis Health System (MT) outsources its HIT functions to Precyse. Sixty Benefis employees, including those in IT, transcription, coding, and medical records, will be offered jobs with Precyse.

Corepoint Health and IPeople partner to offer a bi-directional interfacing solution for Meditech hospitals.

Boston Medical Center will lay off 119 people, including 44 nurses and 30 managers. The hospital is attempting to reverse its projected loss of $175 million for the year. Dartmouth-Hitchcock (NH) will eliminate 300 jobs to stave off its $50 million deficit, but hopes to avoid layoffs.

I see Praxis EMR  is applying for HITECH certification through the Drummond Group. I can’t help but wonder if CCHIT is second-guessing its decision to wait until September 20th to announce its final certification and testing plans.

HIT purists: move to the next item while I share healthcare fashion news with our more couture-conscious readers. I do wish HIT involved more fashion-related stories, but this is about as close as it gets. Cleveland Clinic premieres a new Diane von Furstenberg-designed hospital gown that features an elastic waistband (which I don’t think is particularly fashionable, though better than the Johnny gown), wrap-around closure, and a wide V-neck. There’s also a “signature” von Furstenberg element: a bold, graphic print that incorporates the clinic’s logo. Some male patients think it’s too girly-looking, but I bet the Voalte guys would wear it.

AHIMA comments on HHS’s proposed rule-making for HIPAA privacy, security, and enforcement. Key concerns/questions: allowing individuals to restrict the release of certain health information to health plans compromises data integrity and could affect reimbursement; it’s unclear how best to cover costs for the release of information within the context of privacy and security regulations; should consumers have the right to decide if their health information should be transferred to a new entity when the ownership of a health organization changes; and, further clarification is need regarding the definition of “agents” as it relates to covered entities and who should be covered.

The Reading Hospital and Medical Center selects TeleHealth Services and its TIGR interactive patient education and entertainment system.

Mr. H isn’t too big on surveys that include lots of percentages that are suppose to indicate certain things, probably because his analytical mind finds too many flaws in their methodologies. However, my simple mind spent years calculating things like my percent over quota or what my commission percentage would be when I closed the next big deal, so I have an affinity for percentages. That’s a long way of saying I liked reading that 62% of CHIME member respondents are optimistic they’ll qualify for Stage 1 HITECH stimulus funds. However, a bit of Mr. H has rubbed off on me because I question what that figure really tells us about anything. CHIME says 152 of its 1,400 members took part in the survey. Heck, if I knew I was nowhere close to qualifying, I would have ignored the survey too — that’s like salespeople not turning in their forecast when they know they won’t make their numbers. Also, CHIME members as a whole tend to be some of healthcare’s top-tier CIOs, so you would expect this bunch to be ahead of the curve compared to the rest of the industry. So my take on these results is that perhaps the survey provides insight into how CHIME members are positioned, but I don’t think you can extrapolate the results.

Sponsor Updates:

• Hayes Management Consulting announces a new EMR Conversion and Migration Management service.
• Sunquest Information Systems releases its Diagnostic Intelligence BI solution, which provides lab managers a dashboard view of their financial, clinical, and operational performance.
• MEDecision makes the list of the 100 Best Places to Work in Healthcare by Modern Healthcare magazine.
• Cass County Memorial Hospital (IA) begins implementing the e-MDs EHR/PM solutions across its 11-provider practice. e-MDs says an endorsement by Iowa’s HITREC helped seal the deal.
• RelayHealth expands its portfolio of HIE options with the introduction of its Connected Orders solution. St. Luke’s Health System (MO) is live on the program, which allows physicians with or without EMRs to electronically order tests, meds, patient care, and referrals. 
• Picis says it implemented its LYNX revenue management solution at 29 US healthcare facilities in the second quarter.
• Orange Regional Medical Center (NY) hires Orchestrate Healthcare to provide implementation and migration services for its Epic EMR rollout.
• EMR vendor SRS will offer its customers an integrated PACS solution from Medstrat, which specializes in orthopedic PACS.

Odd: Skyridge Medical Center (CO) briefly closes its ER after a patient knowingly brings in a radioactive rock. A hazardous materials team later it was determined the rock’s radioactivity was relatively low and posed no danger. No word on why the patient was carrying around a radioactive rock.

For some reason, images of dogs and fire hydrants came to mind when I read this story. A gynecologist uses a cauterizing tool to brand the patient’s name on her removed uterus. He says he “felt comfortable putting her name on the uterus” since the patient was a  “good friend.” The patient says she never met the doctor until the first consult and she’s suing. Her lawyer called the branding “inexcusably bizarre behavior.”

E-mail Inga.

Monday Morning Update 9/13/10

From Slinky Nighty: “Re: JPS in Fort Worth. They have definitely chosen Epic. They attended the Epic Texas Collaborative meeting this past quarter and are moving forward and looking for assistance.” Thanks for both the info and the name imagery.

From Old IS Person: “Re: Siemens. They’ve started a second help desk for radiology and PACS products, so those of us with multiple products are supposed to use two different systems just to report problems.” Don’t get me started on vendor help desks. Like the one from one of our key vendors who brags on how fast we’ll hear from an analyst, but it takes days to weeks to get anything other than the automated e-mail response that says “I have your case and I’ll get to it when I get to it” (I’m paraphrasing slightly). Not that it really matters since 90% of the time, the answer is, “Oh, we know about that problem and it’s on development’s list,” which paraphrases into, “It’s kind of a pain for us to fix that, so we’ll just add it to an Excel worksheet that nobody ever looks at.” Do some of the issues vendors ignore in this way endanger patients? No question. I bet if they were forced to go public with their open issues list they’d be a lot more responsive.

From Tupelo Honey: “Re: CPHIMS. I got an e-mail from HIMSS asking them to send me a glowing letter about all that having CPHIMS has done for me, which is mostly nothing. I am guessing that not so many people are signing up or renewing.”

From The PACS Designer: “Re: OpenMRS. TPD has posted about the third world medical record system called OpenMRS and how it was being used in Uganda, where Brigid O’Gorman is presently trying to educate their countrymen. Now they have improved their Web site and expect to release a new version OpenMRS 1.7 soon.” I noticed they’re having their Implementers Group Meeting in Cape Town, South Africa this weekend (group pic above).

From EHR Geek: “Re: HISsies. PLEASE do those again! The ones you posted today are still relevant and hilarious! ROTFL!” Thanks. I’ll try to crank out some cynically funny stuff again since I miss doing that, although someone always complains if I write anything that isn’t just a bullet list of facts addressing only those precise news stories that interest them personally. Meanwhile, you can check out the 2006 HISsies recap or one of my phony news items, of which here are a couple for old times’ sake.

HIMSS Announces 2008 Conference to Be Held in Baghdad
(CHICAGO, IL) HIMSS has announced that its 2008 Annual Conference & Exhibition will be held in Baghdad, Iraq, following a successful 2007 stop in New Orleans. Steve Lieber, CEO of HIMSS says that HIMSS has learned that it can benefit disaster-stricken cities by flying in planeloads of attendees with large expense accounts, a concept first tested by bringing conventioneers to New Orleans shortly after it was virtually destroyed by Hurricane Katrina. "We’ve proven that we can all have a great time at a site mostly known for death, civil disorder, and senseless violence. We’re going to have a blast in Iraq, no pun intended," said Lieber. HIMSS sources indicate that the surprise speakers for the "View from the Top" session may be Saddam Hussein, Donald Rumsfeld, and Neal Patterson.

Hospital Trainer Collapses During Class
(DAYTONA BEACH, FL) Todd Cleaver, a 41-year-old computer trainer at Halifax Hospital, was stricken this morning with an apparent heart attack while leading a computer class for nurses. He is reported in stable condition and is expected to recover. Debbie Dallas, a registered nurse attending Cleaver’s electronic clinical documentation course, said he was working with her one-on-one when he collapsed. “He was starting to tell me how to make a flowsheet entry and I just reached over and did it correctly. Then, he was going into switching between Windows tasks and minimizing windows, and I showed him I could that, too. That’s when he went down.” Cynthia Roda-Tiller, education manager for Halifax, says she believes that Cleaver suffered a strong physiologic reaction upon seeing a nurse use a computer intuitively. “Usually they just stare at the screen like it landed from Mars or they start clicking everything in sight like it was Whack-A-Mole. You’re thinking, ‘they let you use medical equipment?’ I’d like to think I could have handled it myself, but it’s making me shake even now. I’m not sure I even believe she’s really a nurse, at least not one I’d want working my bedpan.”

Somebody must have gotten to the Forbes writer who wrote a generally negative article called Bribing Doctors To Go Electronic. Its implications: North Shore-LIJ and Allscripts are struggling with their $400 million to implement EHRs for 9,000 doctors, it’s taking doctors longer to get their work done, they’re pawns of the government, EHRs are a tough sell culturally, and community docs don’t like hospital-hosted EMRs because they don’t trust hospitals. Careful readers may have noted that he talked to a grand total of two docs (both recently implemented) in writing the lengthy piece. Now he’s backing off in a mea culpa that says he wasn’t trying to write a definitive article on the value of EMRs and that those complaining early adopters recognize their value because they volunteered. I guess the two pieces cancel each other out, other than the time it took to read both.

As New York, Nashville, and Cleveland race to book tenants for their medical trade center buildings, the Nashville group says it’s not worried despite not signing anyone except HIMSS for its 1.5 million square feet of space scheduled to open in 2013. Reason: it says HIMSS will bring 85 to 125 companies to lease space in their building, with a handful taking up to 15,000 square feet.

Hey, it’s only $20 million, which is a HITECH rounding error, but ONC throws more money at RECs, this time as a little extra to help critical access and rural hospitals.

Stanford’s Lucile Packard Children’s Hospital appeals the $250K fine levied by the state’s health department when the hospital waited 11 days before reporting a stolen PHI-containing laptop. They fired the employee who took it home against policy.

Ivo Nelson, chair of Encore Health Resources, joins the board of Health Care DataWorks. That’s the Ohio State spinoff whose CEO is former OSUMC CIO Herb Smaltz.

The Bethesda Hospitals’ Emergency Preparedness Partnership (Hopkins Suburban Hospital, National Naval Medical Center, and NIH) chooses Versus Advantages RTLS for patient tracking in emergency care areas during mass casualties. The Versus product met its requirement for 95% accuracy down to the room level and also links patient information to location for emergency responders.

Not many folks think that the average EMR will give providers enough information to manage population-based risk. New poll to your right: if you were filling a position, what impact would a candidate’s CPHIMS credential have on your decision? Tupelo Honey wants to know.

Ken Rardin, former CEO of Merge Healthcare, IMNET Systems, and a couple of non-healthcare companies is named CEO of telemedicine provider REACH Call of Augusta, GA.

This could make a an interesting novel: the former CFO of Danbury Hospital pleads not guilty to scamming the hospital by approving phony invoices for contract management software from a software company he ran from his house. He adds witness tampering and harassment to his list of charges after e-mailing the hospital president begging him to make the charges go away despite a hospital-requested court order to keep him away for fear he would go postal. He closed his plea with, “I got no place else to go (quote from An Officer and a Gentleman)” The judge nearly put him back in jail for that, but the man’s attorney made a convincing argument: “He would have to be a total idiot to do this again.” Ever the CFO, he showed up in court with a sports coat over his jail coveralls.

One of two winners of IBM’s SmartCamps start-up competition: CareCloud, a Miami company offering physician practices a $499 per-doc-per-month practice management system with social networking thrown in and revenue cycle services optional. I’ve mentioned the company a few times previously when they won an award and were pitching at the Health IT Venture Fair at HIMSS. Points off for their latest blog entry extolling the virtues of Twitter, which they summarize in a grammatically incorrect manner as, “… us enlightened folk know that the conversations on Twitter are insightful and illuminating.” They must be living in an alternate Twitterverse than the one I’ve seen, which combines the worst aspects of text messaging and Facebook but at least allows only 140 characters of time-wasting, stream-of-consciousness preening (if they would ration the number of tweets like they do the number of characters, they’d be on to something). Do we really need to hang on the every un-profound word of vapid celebrities, self-appointed pundits, and a guy having a heart attack?

Here’s another example that healthcare is different when you have money: a new startup called ExpertConsensus will take your tough medical problem to a group of big-name doctors who will teleconference and make their collective recommendations. The company’s minimum charge: $20,000. I hated that concept until I thought about it: they’re offering convenience for those willing and able to pay, but patients on a non-$20K shoestring could find these docs on their own and pay just a consultation fee to get the same opinions (or pay Cleveland Clinic a few hundred dollars for an electronic second opinion, which I can’t believe isn’t more popular than it seems to be). ExpertConsensus offers other services seemingly unrelated except for their common denominator of buck-making opportunity: research reports, care management, on-site clinic setup, physician referrals, wellness, and personal health records.

Louisiana doctors will have to pay back $17 million in Medicaid overpayments because the state’s Department of Health and Hospitals just now got their computers programmed to handle budget cuts that went into effect 13 months ago. Said one doc who says the cut will put him out of businesses, “We’ll gut it out and when it’s obvious that we aren’t making ends meet, we’ll all retire.” I need to give docs some PR advice for those situations where they’re complaining about making less money: don’t say “retire,” but instead say “find another line of work.” People hearing “retire” assume that means you’ve milked your medical practice to the point of not needing to work any more, which doesn’t exactly bolster the “we’re poor” argument.

Interesting: doctors at McGill University in Montreal administer anesthesia electronically for a surgery being done in Italy, a pilot project for “teleanesthesia”. They managed the patient using video cameras and remote dosing computers that make up what they call “an anesthesia cockpit.”

I’ve written before about the UK’s hospital radio stations, charities run by volunteers and featuring patients and family requests. London’s Radio Marsden, which runs 24 hours a day for patients in two cancer hospitals, will move its service to the Internet this month to allow patients, friends, and families to listen together. I’m listening to Bowie’s China Girl on it right now, followed by the Talking Heads doing Burning Down the House and an announcers’s suggestion that patients ask for hospital pens and paper to write letters home. Hot on their playlist based on patient requests and favorites: Lady GaGa, 30 Seconds to Mars, Alicia Keys, Kinks, Billy Ocean, The Clash, and The Saturdays, among others. It’s kind of addictive.

Former Sun CEO Jonathan Schwartz, who replaced Scott McNealy for a short time before selling the company to Oracle, gets involved with a healthcare-related startup, Picture of Health. He’s not saying what the company will do. 

A hospital ED patient is arrested for assaulting another patient and then pulling a knife on an ED nurse. The man’s occupation: minister.

E-mail me.

A Mr. H Book Review
Safe Patients, Smart Hospitals
By Peter Pronovost, MD, PhD and Eric Vohr

A reader asked me to review this book, so I bought a copy. I interviewed Peter a couple of years ago, before he won the Genius Grant. It’s still one of my favorite interviews, with this as my favorite quote from it:

That’s the tension that we have. How much evidence do I need to give up my autonomy? We’re still uncertain about that. As an industry, healthcare is grossly understandarized. Compare that to pilots who have to use checklists or they won’t be flying. Healthcare is still very much like the Wild West or like Chuck Yeager in The Right Stuff, where we have this cowboy mentality and we’re just beginning to accept that standardization is a key principal to making care safe.

That frames up the book nicely.

My first thought when seeing the book (published just this year) was, “Hey, I get it, providers need to make lists … why do I need to buy the book since I already know the ending?” There’s a lot more to it than just making lists, however. The book is really about translational medicine, rigorous measurement of healthcare quality, and the patient harm caused by the toxic culture of hospitals and physicians. Here are the takeaway points.

• Doctors and hospitals harm patients because of poor communication, not following rules that are indisputably beneficial to patients, and not using proven research in their treatments.
• Culture dictates that doctors and hospitals pretend that they don’t mistakes and to avoid admitting them when they do.
• There is no wisdom of crowds in hospitals. Doctors are trained to be sole decision-makers and to lash out if anyone questions their decisions. Not to mention that Peter’s background is in academic medical centers, where the problem is tiny compared to community hospitals with their non-employed doctors who are always complaining to administration and trying to get employees fired for looking after the best interests of patients.
• In terms of communications, even on his own rounding team, only 5% of residents and nurses could articulate the care goals for a patient who had just been the topic of a 15-minute team discussion. You wonder what they would have concluded without the team discussion and armed only with a paper or electronic medical record, given that academic medical centers are a small percentage of hospitals and others don’t do that kind of rounding at all.
• Overworked doctors will break rules for a single patient if they think the greater good is served. Every doctor knows to wash their hands before and after seeing each patient, but only 30% actually do it because they’re busy or supplies aren’t available.
• Communication in the OR is especially bad, where the nurses know everybody’s name but the surgeons see just a sea of scrubs and have no interest in names and roles. The pecking order is inviolable.
• Some tasks or procedures can be summarized into a checklist of no more than 5-7 evidence-based items, no different than a pre-flight checklist. The list can be developed locally to encourage ownership.
• Even though Peter’s work has saved thousands of lives and hundreds of millions of dollars, most of that came from just one checklist (central line placement) out of thousands upon thousands of medical procedures and tasks. That’s either a wide-open field or a depressing commentary on modern medicine, depending on your perspective.
• Non-clinicians, like administrators and probably IT executives, aren’t usually comfortable getting out on the floors but can play a big role on offering a fresh perspective for problem-solving and in understanding how projects are financed, staffed, and run.
• Doctors practice as they were originally taught in school using the “see one, do one, teach one” model that tells them to ignore everybody else’s opinion and go with their own. Good teamwork means a nurse doing what the doctor says. Doctors are not taught to communicate or to manage stress. They do not have time to keep up with the literature. There is no standardization, even within one organization. Residents make mistakes because they don’t want to look stupid by asking questions.
• Checklists worked in aviation because the industry admitted that pilots make mistakes and took the attitude that every crash is preventable. That hasn’t happened in medicine, where hospitals and doctors refuse to admit that they are not infallible. Even Hopkins (arguably the best hospital in the country) defended its catheter infection rates (among the worst in the country), using the “our patients are sicker” argument. After using Peter’s methods, their infection rate dropped from 19% to near zero, saving an estimated eight lives and $2 million.
• Quality requires central analysis of data. You don’t know what’s working without data. No other industry would tolerate healthcare’s sloppy data practices.
• Making the list is easy. The hardest and most important parts, which hospitals always want to skip, are evaluating the culture, making sure every patient is treated using the list, and measuring the results.
• State-wide projects don’t always work. They took shortcuts, made data reporting voluntary, and let turf wars (infection control docs vs. intensivists) compromise the plan. But in Michigan, their infection rate dropped from 2.7% to zero when they swallowed their pride and followed the plan.
• Medical research gets all the funding, while patient safety research hasn’t. Part of healthcare reform is creation of the Office for Patient Safety Research.
• The only profit to be made in patient safety is for insurance companies.

I extrapolated his thoughts into IT:

• Peter said in my interview that errors will go up when CPOE is introduced because it’s a change, nothing is standardized, and CPOE is set up to look like the paper it’s replacing.
• Decision support is the real value of CPOE, but it’s not usually added until afterward.
• Every hospital has to develop its own clinical decision support rules, which is like each airport having to build its own air traffic control system.
• IT systems can support enforcing the lists and reminding providers about them.
• Use shared decision support rules to begin standardization and using best practices.
• Look at data collection, reporting, and transparency. Peter found that virtually no hospitals have the right information in their databases to be able to know their infection rates.
• Use these methods for IT project rollouts and maintenance to reduce mistakes and to remove vendor and IT pressure to do something harmful.
• Find ways to get research into practice. Why is research a science, but the practice of medicine is an art?
• For vendors, build support for lists and reminders into applications, where they can be cued by workflow.

It’s a bit disconcerting to see just how inconsistent healthcare delivery is. It’s based on science, but often is a long way from being delivered in a scientific way. The major point of the book is that nobody’s head is big enough to hold all the information about medicine and research findings, so practitioners often are endangering patients by what they don’t know or don’t practice.

Few would doubt that the book outlines incredible opportunity for improvement in every kind of patient care setting. We’re talking saved lives, not just saved dollars. The good news is that’s exactly what computers are good at. Giving providers access to lists, providing immediately usable reference material (how-to videos, audio instructions, etc.), linking to the evidence, and offering collaboration platforms could all be key elements in implementing the quality measures called for in the book.

This is an excellent book, although it will make providers question their core beliefs about the healthcare system they work in. It’s pretty screwed up, as we know, and getting worse. The goal isn’t perfection, it’s improvement, and that won’t be easy (if it were, everybody would already be doing it). Are there enough providers who can look beyond the knee-jerk reaction of just making a Pronovost list and claiming mission accomplished to actually improve healthcare quality? Maybe or maybe not, but if enough at least try to tackle their problems in a rigorous way, they’ll probably avoid killing a few patients.

News 9/10/10

From A. Nonnie Mouse: “Re: Kadlec Regional Medical Center (WA). Turfing McKesson inpatient and GE Centricity and moving to – surprise! – Epic. The number of Epic customers in Washington and Oregon make Epic CareEveryWhere something of a de facto HIE.” Unverified, but the hospital is running Epic recruitment ads, so your information may well be correct.

From FortWorthFan: “Re: JPS Health in Fort Worth, TX. I noticed they are hiring Epic Revenue Cycle analysts, but I don’t recall ever reading that they selected Epic as their replacement clinical system.” I’ll guess they’re going Epic since this position listing seeks Epic clinical analysts. From this job opening, it appears they are seeking a CIO as well.

From Tina LaBoeuf: “Re: HISsies. I miss your hilarious write-ups of the awards announcements that went away when you started the awards party :(” Tina’s comment sent me to the search function to find and relive those moments. I did find them amusing, especially since I mixed in actual winner quotes with my phony recap. You can read it here if you enjoy these snips from 2007, featuring as host my alter-ego, former HIT sales jock Billy “Biff” Jutjaw:

Imagination at Work? Must be talking about their Carecast guys porn-surfing at their desks! Zow! Rimshot! BA-DUM-PAH. GE guys … hey Jeff … we need one of your lightbulbs over here … yeah, a replacement for that faulty one that went off over your head when you bought IDX! Owwww! But I kid. What a great evening! What a constellation of industry stars! What a rack on that broad at Table 3! … Say, Chuck, let’s see who’s here. Hey, are we in the Ying or the Yang side of the house? Judy must have been having a Woodstock flashback when she laid this place out. Where did she get compost-powered PCs, anyway? That Kool-Aid they drink here must have been from Ken Kesey’s original recipe! … Yeah, it’s like a CHIME meeting – you can’t swing a golf club without hitting two CIOs and four sales VPs clinging to their underbellies like remoras on a shark. … Come on up here, Howard Messing. Nice suit! Must be nice to keep getting awards for doing nothing! But I kid, old friend. MEDITECH was an established company when some CEOs were still backdating options in Monopoly! Booyah! Boston community swimming pools always hate it when MEDITECH starts hiring because they take all their lifeguards! Kapow! You know the first thing a MEDITECH employee says after getting home from work? "Mom, is dinner ready?" BAD-DUM-PAH. I’m like butter, baby, I’m on a roll!

Listening: new from singer-songwriter Sara Bareilles, thoughtful pop-tinged heartbreak music if you’re in the mood for that sort of thing. Watching on Netflix streaming: Studio 60 on the Sunset Strip, a stupendous 2006 dramedy series about a Saturday Night Live-type program (think 30 Rock played mostly straight with an amazing cast).

An expert tells South Shore Hospital (MA) that 800,000 patient records that were on lost backup tapes of their Meditech system can’t be easily accessed, so they decide against sending out breach notices to individual patients. They’re just going to run newspaper ads, which given the state of American intellect and newspaper circulation these days, means about a hundred people will see them, especially if they ads don’t appear in the sports or entertainment sections. This is the incident where the hospital paid Iron Mountain to destroy the tapes, only to find out afterward that the company subbed the work out to another company and lost the tapes in shipping.

In England, the dismantling of NPfIT appears to be underway, as the government cuts its total cost by $2 billion to $17.5 billion and decentralizing the project. Said the co-director of the Royal College of Physicians Health Informatics Unit, “One of the dirty secrets of the NHS is the regrettable state of medical record keeping. Earlier reports have shown that this compromises patient safety and clinical care. If IT in the health service is going to regain the confidence of the medical profession, then more emphasis has to be placed by the Department of Health on making sure that the new systems accurately capture the dialogue between doctor and patient. Everything else flows from getting that right.”

Speaking of NPfIT, an NHS Foundation Trust invites bids for a new patient care and e-prescribing system, opting out of NPfIT’s iSoft Lorenzo option because of concerns it’s not ready for prime time.

The latest ISMP Medication Safety Alert (from Institute for Safe Medication Practices) has a fascinating article about why the CMS rule requiring hospitals to administer drugs within 30 minutes of their scheduled times endangers patients. ISMP only posts excerpts online, but it was truly revealing as real-life nurses (thousands of them, in fact) describe why it’s unreasonable to meet that goal. The IT-related gist: we’ve put in eMAR and bar-coding systems and written cool “overdue” functions for clinical documentation systems, but hospitals have done nothing to address the challenges of nurses trying to meet a staggering variety of patient needs without turning into medication-pushing robots. This is one of those areas where non-clinical IT people would struggle with the idea that it’s not just calculating a “med overdue” time and dinging the nurse on a report. Everybody in involved in any capacity with clinical systems should read the full text of this article – it is a tremendous eye-opener for folks who’ve never trodden the uncarpeted areas of the hospital where the real work gets done.

Athenahealth CEO Jonathan Bush tends to be a “love him or hate him” kind of guy, but he’s still eminently quotable either way. He was definitely wound up for The New York Times. On why the company was in the birthing center business in the early days: “You know, Bush family noblesse oblige. I wanted to take advantage of all this education and support I’ve had and do well by doing good, and health care seemed like a place that no one else in my family had been much. A new approach to health care seemed to me to be the oil fields of 1997.” On the company’s competitors: “We are the only cloud-based service in an industry segment full of sclerotic, enormous, personality-free corporations that have been in business making 90 percent margins doing nothing for decades and decades.” On the cost of healthcare reform: “Oh, it’s going to go through the roof! It’s widely accepted that this is not a cost-reform bill — it’s an access bill … Eventually, consumers will need to eat a big part of their health care cost, because health care will fundamentally consume the entire G.D.P. in the not-too-distant future.”

It’s interesting that WellStar Health (GA) apparently fired its CEO after it was fined for excessive Medicaid billing, but it named the CFO as the interim president. Wouldn’t the CFO be the person most accountable for billing mistakes? Mostly unnoticed: they fired their general counsel as well. And from an IT standpoint, the CEO blamed their billing system (McKesson Star, I think). Does it get the axe, too?

We like Encore Health Resources a lot since they threw one heck of an HIStalk bash in Atlanta this year (as many of you told Inga and me afterward and we saw first-hand ourselves – that’s Ross Martin in the pic). Dana and Ivo are fun at work too, apparently — the company is named as one of Modern Healthcare’s Best Places to work in Healthcare 2010. That’s pretty cool for a new, small consulting firm.

Jobs on the sponsor job page: Project Manager – Healthcare Implementation, Eclipsys Activation Consultants, Technology Account Executive. On Healthcare IT Jobs: Metadata Administrator, McKesson Horizon Consultants, IT Applications – VP. That reminds me to mention that I made a Google Gadget that you’ll see to your right that has tabs for the Events Calendar, Healthcare IT Jobs, news headlines, and posts from HIStalk Mobile. I did that for two reasons: first because the WordPress events widget wasn’t displaying the calendar entries correctly, and second because I was looking for an excuse to build something.

I always like to highlight badly written press releases, so it’s imperative that I recognize this gem from a home monitoring technology company, which leads off with: “Cytta Corp’s CEO Stephen Spalding is pleased to announce that, after a series of well received presentations and demonstrations, Cytta has been invited to provide its first major proposal to a major healthcare payor/provider to develop an individualized monitoring system.” It’s a penny stock, but the price would need to go up fivefold to actually reach a penny, closing today at $0.0018 for a market cap of $1.83 million, doubling in price since April.

The North Carolina sheriff’s association proposes that the state give its members access to its doctor shopper database of known drug seekers, saying they “can better go after those who are abusing the system.” Privacy advocates are less enthused by the idea.

iMedicor launches its National Healthcare Communications Network, which offers practices secure messaging, peer collaboration, referrals, and CME. The company changed its name from Vemics last year, which seems like a good idea since that sounds like worm medicine. According to the site, it costs $24.95 per provider per month. It looks pretty cool to me. I can think of several business models that would work if they get enough subscribers.

Jim Bradley, former CEO of RXHub and Abaton.com, is named chairman of the board of e-health connectivity vendor VisionShare.

Let’s hope they aren’t big cloud computing or ASP users. Local hospitals (along with everybody else in four Tennessee counties) lose their Internet, cable TV, and telephone access for two days when some goober takes a shot at a bird sitting on the only cable line connecting that area to the rest of the world.

E-mail me.

HERtalk by Inga

Streamline Health Solutions releases its Q2 numbers: revenue of $4.7 million (15% better than last year) and a net loss of $76,000 (versus an $18,000 loss last year). The company attributes the higher loss to increased investments in marketing and hosting operations and the reinstatement of bonuses. Streamline also announced the promotion of Gary Winzenread from SVP of product development to COO.

CIO C. Martin Harris, MD of the Cleveland Clinic and former FTC commissioner Deborah Taylor Tate join HealthStream’s board of directors.

Hard to believe, but registration for HIMSS11 is now open. If you are a HIMSS member and pay before December 7th, registration is only $695. Mr. H and I are already strategizing about all the fun HIStalk-related things we’ll be doing. If you have ideas, let us know.

HHS unveils CuidadodeSalud.gov, a Spanish-language website to provide consumers with public and private health coverage options.

Mediware doubles its fiscal year profits to $3.24 million. Revenue for the year grew 17% to $47.6 million.

KLAS adds five new members to its advisory board, including HIStalk’s own Edward Marx, CIO at Texas Health Resources. Other new members include Alastair MacGregor, MD from Methodist Le Bonheur Healthcare, Kara Marx of Methodist Hospital of Southern California, Dan Morgan from Bay Medical Center, and HCA’s Noel Williams.

Forbes magazine profiles North Shore-Long Island Jewish Health System and its $400 million effort to help 9,000 employed and affiliated physicians move to Allscripts EHR. Though North Shore is taking advantage of relaxed Stark laws to subsidize up to 85% of system costs, so far only 175 of the system’s 7,500 community physicians have signed up. The health system’s chief executive admits there’s been resistance around “cultural stuff,” including concerns about North Shore’s hosting of the EMR data and discomfort with having to make work flow changes.

Wayne State University Physician Group (MI) chooses Orion Health Rhapsody Integration Engine to help create patient data exchange between their offices and other providers and facilities.

McLeod Health (SC) contracts with Merge Healthcare to integrate Merge’s cardiology workflow solutions with McLeod’s existing radiology product.

Perioperative employees at Southwestern Vermont Medical Center explain to the local press how their Picis system works, noting it “soothes some of that anxiety” felt by family members while loved ones are in the operating room.

Stamford Health System (NY) says its MedAssets Charge Capture Audit tool helped recapture $1.9 million in lost charges last year. It will also use group purchasing contracts, consulting services, and BI tools from MedAssets.

St. John’s Hospital (IL) selects Amelior Tracker from Patient Care Technology Systems for automated medical equipment tracking.

HHS awards a $980,000 grant to the University of Kansas Medical Center, University of Missouri, and University of Oklahoma to create the Heartland Telehealth Resource Center. The center will help physicians treat rural patients using telehealth technology. Almost 90% of the counties in those three states are considered rural with limited access to healthcare.

Sponsor Update:

• The Massachusetts eHealth Institute (MeHI) REC releases a list of certified EHR vendors and Implementation and Optimization Organizations. EHR vendors include Allscripts, eClinicalWorks, eMDs, Greenway, MedPlus, NextGen, and Sage. Implementation organizations include Culbert Healthcare Solutions, eClinicalWorks, eMDs, and MedPlus.
• San Juan Regional Medical Center (NM) will use the Universal Document Portal from Access to share information between its MetaVision ICU system and Meditech CIS. San Juan also uses the Access Portal to interface perinatal documents from its GE Centricity system into Meditech’s scanning and archiving product.
• Bridgehead Software and Dell introduce an enterprise medical archiving solution that combines Dell hardware with Bridgehead’s healthcare data management software.
• Nuance Communications introduces Dragon Medical Enterprise Network Edition for  large practices and hospitals. The new release includes a centralized management console and enhanced support for Citrix-based EHRs.

Medical office employees in Colorado smell a strong odor and discover the source is a dead animal stuffed into a filing cabinet. The clinic owner believes the incident was the result of a break-in, likely by a former employee. He does not indicate whether or not he suspects the prank was some sort of statement about the clinic’s need to move to an electronic filing system.

E-mail Inga.

News 9/8/10

From HIT and Hockey Fan: “Re: Bobby Orr will enjoy this. Use meaningful useful EHRs (Epic in the office) to win a night at the UPMC Health Plan’s luxury box at the new Pittsburgh Penguins Arena. If successful in enticing the doctors to provide care as defined in the letter, UPMC Health Plan and UPMC will be paid a bonus from your tax dollars by CMS, which will more than cover the cost of the luxury box for the entire season.” I think I’ve mentioned before that I was UPMC’s box suite guest once at a Steelers opener at Heinz Field, which was somewhat wasted on me since I don’t get the point of watching someone else play sports (especially millionaires), but the atmosphere was interesting. There was lots of food, drinks, and nattily attired male UPMC executives talking shop and watching the game on the TV monitor while their carefully coiffed wives chatted harmlessly in the living room area. Just outside our hermetically sealed and climate controlled luxury digs were people (their patients, most likely) cheering, waving Terrible Towels, and actually paying attention to what was happening on the field. It was pretty enjoyable once I got over the irony of a non-profit hospital system spending money to support a billionaire’s sports team. 

From Ricardo: “Re: Napochi. I’m curious about your impressions. Someone sent me a link and they are new to me.” Never heard of them. They sell PM/EMR, but they don’t call them that exactly. The company has offices in Alabama and China (there’s an odd pairing). Their Web site isn’t ready for prime time if the number of placeholder pages is any indication. They claim 300 hospital and practice customers, but I bet most of them are in China (just guessing).

It defeats the purpose of a survey asking about compassion and spiritual beliefs when an atheist blog urges its readers to barge in and vote predictably, so take the above results with a truckload of salt. Before the ballot box stuffing commenced and real HIStalk readers were voting, it was running about 50-50. New poll to your right: is the typical practice-based EMR capable of collecting and presenting the information needed for practices to assume and manage population-based risk?

University of Mississippi Medical Center chooses Epic for a $36 million project. They expect Uncle Sam to pay $20 million of that in HITECH money.

A University of Rochester Medical Center doctor loses a flash drive containing the PHI of several hundred patients. In typical horse-left-barn fashion, the medical center vows to start using encryption. Maybe losing a drive is the best thing that ever happened when it comes to information security — embarrassing publicity apparently launches more encryption projects than any kind of thoughtful planning and it only takes one episode per hospital.

Healthcare Innovative Solutions (HIS) is supporting HIStalk as a Platinum Sponsor, I’m happy to announce. The Seville, OH company provides clinical systems implementation, process optimization, CPOE and EHR consulting, medication safety, order set, and clinical decision support services. They also do HIPAA security, strategic planning, selections, and HIE work. Here’s a white paper (warning: PDF) describing their CPOE work at Mercy Health Partners (OH). I ran across this profile and video about founder Daniela Mahoney, RN whose story is quite interesting and worth watching. Inga and I thank Healthcare Innovative Solutions for supporting HIStalk.

AMIA is offering prospective corporate members free attendance at its Industry Day, held during its annual conference in Washington, DC on November 15. They have a few spots left.

Misys shareholders won’t get their $1.2 billion in Allscripts stock proceeds immediately, as the IRS evaluates whether Misys is on the hook to pay $170 million for what may be interpreted as a material reorganization of its corporate structure.

Scotland-based charge master vendor Craneware, flush with cash after a good year, is on the hunt for acquisitions valued at up to $30 million. Nearly all of its business is in the US and the company is looking for a bigger piece of the healthcare reform pie.

mdHub launches the mobile version of The Little Blue Book, the physician directory formerly distributed on paper by WebMD. It also includes pharmacies, hospitals, and health plans. I don’t exactly understand the pricing model, which is based on regions, but I’m sure you can figure it out if you’re interested.

Everybody’s getting into the physician recommendation business, apparently. A reader says Angie’s List (of which she’s not a member) has sent several solicitations about doctor ratings, some of which seemed curiously timed to her Google search activity. I can’t imagine paying for reviews, but apparently some do (and some complain about the result, Google tells me).

In Canada, Northeastern Ontario Network (NEON) adds six new hospitals to its Meditech hosting service, bringing the total to 19.

WellStar Health System (GA) fires its CEO following settled charges of Medicaid overbilling, which he had blamed on its billing systems.

New CMS head Don Berwick plans to start using his agency’s $10 billion innovation money to fund 100 to 300 sites testing new models of patient care, which I assume means accountable care organizations.

Google is looking for volunteers to translate chosen healthcare articles into Hindi, Arabic, and Swahili on local language versions of Wikipedia.

Big German healthcare software vendor CompuGROUP will purchase Visionary Healthcare Group, which includes Visionary Medical Systems, a Tampa, FL PM/EMR vendor. The company’s first US investment was majority ownership of Noteworthy Medical Systems 18 months ago. I think it’s safe to assume that more acquisitions will follow.

HP’s board fired CEO Mark Hurd even after finding that he violated no company policies, triggering a severance payout worth up to $40 million. Oracle hired him on Labor Day as co-president. Now HP is suing him, claiming he violated his confidentiality agreement by going to work for a competitor. HP doesn’t like Oracle now that it sells its own servers, courtesy of its acquisition of Sun last year.

A British study finds that pharmacists could reduce nursing home medication errors by over 90% if put in charge of the process. The study found that 70% of patients had at least one medication error on any given day.

New Zealand will pilot e-prescribing next year.

Thinix releases a touch-friendly, iPad-like user interface for Windows-based virtual desktops, providing as a press release example a nurse working both remotely and on the desktop.

The former president and CEO of Perceptive Software, acquired by Lexmark in May, explains why the $280 million, all-cash deal makes sense using a healthcare example. That’s not surprising since Perceptive always had a fairly strong healthcare presence with its ImageNow scanning and barcoding products. 

England-based Avia Health Informatics PLC announces executive changes to support its plan to enter the US market with its odd lot of products sold under the Plain Healthcare and Odyssey brands: ship telemedicine, patient symptom self-assessment, paramedic fall evaluation,  prison healthcare, and nurse triage.

Exciting, to me anyway: the sequel to Wall Street hits theaters September 24. No Bud Fox, but GG’s back 23 years after the original.

E-mail me.

HERtalk by Inga

Mount Kisco Medical Group executes an agreement to deploy NextGen’s EHR, PM, and Patient Portal for its 230-physician practice. Looks like they are replacing Misys Vision and EMR.

Nassau University Medical Center (NY) adds Streamline Health’s Enterprise Health Information Management suite to integrate with its existing Eclipsys Sunrise Clinical Manager. Nassau already utilizes Streamline’s accessANYware product.

ASC software vendor AmkaiSolutions completes a $3 million round of Class E equity financing. The company plans to pursue “a broader sales and marketing program.”

Central Texas Medical Center (CTMC) goes live on CPOE. CTMC is part of Adventist Health System, so I assume it’s a Cerner install.

Data point: more than half of the 354 million doctor visits each year for acute medical care are not with a patient’s primary physician and more than a quarter are in hospital ERs.

Emdeon announces plans to acquire Chamberlin Edmonds, a provider of government program eligibility and enrollment services. The $260 million purchase expands Emdeon’s offerings for hospitals.

Medical scribe is one of the hot, up-and-coming healthcare jobs that has become especially popular with young medical and nursing students. The pay isn’t exceptional — $8 to $10/hour — but the job gives scribes the opportunity for up-close exposure to physicians providing patient care, particularly in the ER. Several enterprising companies are establishing offices close to major universities in order to attract ambitious pre-med and nursing students. The scribes receive basic training on medical terminology and coding before hitting the front lines.

University of Utah Medical Group selects Practical Data Solutions to migrate its data warehouse and analytical reporting to Epic. The academic health system goes live on Epic November 1st.

Carestream Health acquires Quantum Medical Imaging, an x-ray imaging provider with a strong base of community hospitals and smaller clinics.

Catholic Health Initiatives (CO) hires Sheryl Rose for the newly created position of Chief Information Security Officer.

A George Washington University ER physician initiates a study to see how accurately ER docs and PAs diagnose wounds from patient-generated cell phone images. Five months into the study, the data indicates a 90% accuracy rate. And, accuracy increases with better quality images.

Sponsor Updates

• Carolinas HealthCare System selects Medicity to help build a multi-state HIE that encompasses the health system’s 32 facilities, plus community physicians and other caregivers.

• Mayo Regional Hospital (ME) chooses Sage Intergy EHR of its eight physician practices.
• Across the pond, King’s College Hospital goes live with iMDsoft’s MetaVision in its critical care unit.

E-mail Inga.

News 9/3/10

From Bobby Orr: “Re: the new Allscripts. They rang the Nasdaq bell. Hopefully it’s not too late to have a real challenger to the mighty Epic.” Glen has rung that bell a few times, I found by Googling. Since I couldn’t find a picture from this week and their Web site seems to be down, the one above is from one of the several previous “new Allscripts”, this one from 2008. I’d like to think it’s not too late to compete with Epic either, but I think it is, at least if the goal is to match up head to head. The Eclipsys clinical apps are better in some ways, but prospects are eating up Epic’s “one record” pitch and looking that the avalanche of new Epic business compared to long, slow decline of the Eclipsys Sunrise customer base. On the other hand, those Eclipsys apps have never been in better management hands than they are today now that the acquisition is finished, so maybe Glen can turn it around. When I asked him about that, he was pretty confident that Epic is vulnerable, but then again, former Eclipsys SVP (now Allscripts president) John Gomez said the same thing right before a stunning string of Eclipsys showcase accounts announced plans to displace Sunrise with Epic.

Speaking of Allscripts, here’s an insightful comment from quadwatch on the Yahoo stock board: “We are seeing what drove this merger — Eclipsys’ inability to compete with a weak ambulatory product and Allscripts’ lack of a hospital system. Given MU requirements for hospitals (in particular, CPOE adoption) the reality is you have only three products with proven adoption rates that don’t make a new purchase a crap shoot for the CIO: Epic, Cerner, and Eclipsys. It becomes a Epic-Cerner race if the facility has employed MDs or is looking to establish a community model. This one of the most logical mergers that I have seen in this segment.”

And while I’m quoting from stock boards, here’s another excellent one from my favorite industry analyst, sonomaca, on Glen’s bell-ringing: “Not surprised he decided to go and ring the bell. This is his triumphant return to control of MDRX. He’s proven himself to be a master of the game, starting with the secondary offering back in 2000 which ultimately saved the company. You’ve got to marvel at how he took a near-bankrupt MDRX in 2002/2003 to the top of the heap in 2010. Amazing. My guess is that, in the end, ECLP will be integrated without too much trouble. In the next couple of years, US market share will be pretty well divvied up between Epic, Cerner, Allscripts, and some of the lumbering giants like McKesson. No doubt, GT is already thinking ahead. And, what’s ahead are myriad tuck-in acquisitions and, most importantly, overseas.” Above is the ten-year share price, peaking at something like $80 in 2000 and bottoming out at less than $2 just three years later, now back to $17. Glen was CEO that whole time and before. He’s got $19 million worth.

From Price Checker: “Re: UPMC. I love this creative, airline-like a la carte approach to paying for the EHR at this paperless hospital.” UPMC, like other hospitals, is charging patients a “facility fee” for being seen in a physician practice it owns, even though patients may not even know that UPMC is involved. The patient profiled in the article noted that the reception area bears a plaque thanking the donor who paid for it, making her wonder why she has to pay again. She had no choice since UPMC threatened to turn her account over to a collection agency, but she vows to steer clear of that doctor and building for her future medical needs.

From The PACS Designer: “Re: Apple TV. Apple has announced their latest Apple TV configuration containing a faster custom built processor called the ARM A4. With a hookup to an HDTV, could medical image viewing find a place in the home viewing schedule? Only time will tell if it catches on with practitioners! This iTV device also has an Ethernet port and 802.11B/G/N Wi-Fi for streaming.” I’ll say that my Roku box was a game-changer for me. I haven’t watched a minute of DirecTV or even DVRed stuff since I got it – everything else seems so primitive compared to free, on-demand Netflix streaming. I’ve discovered great TV shows and movies I would never have found otherwise. I think I saw there’s some kind of medical channel on there.

From Mya: “Re: weird medical news stories. Did you hear about this one?” Sad: a female doctor, apparently drunk, tries to break into her former boyfriend’s house while he is there. He leaves out the back door to avoid a big fight, but in the meantime, she climbs on his roof and tries to slide down his chimney. Three days later, someone checking on the man’s fish notices a smell coming from the fireplace and finds her dead a couple of feet up the chimney, where she had died of asphyxia.

From Irving R. Levine: “Re: EHR vendor. We’re converting from [vendor name omitted]. They don’t understand why an IT shop needs access to clinical data in the SQL tables, so we can’t access our clinical data on our servers on our network without using their UI. They also don’t understand why we want to do our own backups instead of using their service.” This kind of issue is going to pick up steam as people starting switching out EMRs. Small practice vendors don’t usually understand clients with real IT people on board, so they distrust their intentions in a rather parochial manner. Like Bill O’Toole said in his HITlaw, if it’s important to you, get it into the contract.

The proposed Healthcare IT site on Area 51 (geeks know what that means) needs reader commitment to move ahead, being 15% of the way there so far. If you’d like to see an place to have HIT-related questions answered by experts (or to answer questions if you’re the expert), then sign up.

Marty Larson is named executive director of the Greater Dayton (OH) HIE.

GetWellNetwork will announce that it has developed the first digital care plan for reducing admissions for pediatric asthma, including multimedia patient and family education covering triggers, medications, and equipment.

Jobs on the sponsor job page: Technology Account Executive, Epic Certified Consultants, Account Manager, Eclipsys Orders/Results Analyst. On Healthcare IT Jobs: Cerner SurgiNet and Power Orders PMs, McKesson HEO I-forms Consultants, Development Manager, Epic Report Writer/Programmer Analyst.

Listening: reader-recommended The Sensational Alex Harvey Band, 70s glam rockers from Scotland. The namesake died 28 years ago, but even though he hasn’t been reincarnated, the band has. He was quite a showman.

HIStalk stats for August: 102,047 visits, 145,694 page views, and 6,114 verified subscribers. All are new highs. Thank you for reading.

Metropolitan Health Networks and Senior Bridge start a year-long pilot project to evaluate the use of telephone-based telemedicine and specially trained staff to manage 100 Medicare Advantage patients who require frequent hospitalization. Each individual is assigned a nurse and a social worker to work with the patient’s physician to develop a care plan and to conduct in-home assessments for safety and patient evaluation.

This is ingenious: Kerry from Network Management Solutions of Garner, NC e-mailed to tell me he’s figured out a cool way to use his iPad. He downloaded the free Remote Desktop Lite app (which also works with the iPhone) and remotes into his home PC, meaning he can run all of his Windows apps on an iPad from anywhere. That sounds like it might have some possibilities for small-scale hospital or practice apps, as long as each iPad user has a dedicated PC to remote into (it’s like a poor man’s Citrix farm, although the non-poor man might run Citrix Receiver to run apps directly from a Citrix server). I bet the wheels are spinning in the heads of some readers even as we speak.

Why haven’t EHR vendors done this? A chiropractic software vendor partners with the creator of the Facebook Fan Page Generator to get its customers into social networking and promotion, or as the press release says, to create “an automatic new patient referral generating machine.”

The Community College of Allegheny County (PA) will offer free, non-credit HIT classes to qualified applicants, courtesy of $16 million of federal taxpayer money.

The presentation was from an Australian HIT executive, but the message is familiar when it comes to IT challenges in hospitals: IT gets heat to finish projects even with insufficient resources, they patch old systems together instead of buying new ones, and the IT people don’t have the clinical knowledge to run the systems used by clinicians. But it was an audience member who got big applause for describing health department IT procurement practices: “[It’s like] taking a 17-year-old and letting them buy any car they want, with any sized engine. We get clinicians to dream up what they want, then they go and buy it without even thinking about whether it will or won’t work. We have people who don’t know what should and shouldn’t be used, who have the power to make the decisions on buying".”

Odd lawsuit: a surfer hospitalized in Hawaii after a shark bite claims the hospital posted his picture of his leg wound on the Internet. He’s filed a suit alleging HIPAA violations and several more potentially lucrative charges.

More iSoft struggles: the company’s major shareholder says it will decide in April 2011 whether to unload its shares.

I haven’t quite decided whether to do a Monday Morning Update. If I don’t, or if you won’t be around to read it even if I do, have a wonderful end-of-summer holiday (just my US readers, I keep having to remind myself since that’s not all of them). I will be laboring on Labor Day in any case since I am extremely behind, so as Inga suggests below, you can always send us a Facebook or e-mail message if you are feeling lonely, unappreciated, or unfulfilled. 

E-mail me.

HERtalk by Inga

From KP Duty: “Re: Sutter’s iTriage app. Looks like a great tool for consumers, except for one thing (disclosure: I’m with Kaiser Permanente). When I clicked on the Find Emergency Department link to see the EDs closest to my house, is it a coincidence that the largest Kaiser Medical Center in Northern California is absent? I would have to drive by this large and well-established facility with its gigantic emergency department to get to the one listed. To be fair, I put in the address of one of the other Kaiser hospitals and it came up in the right order.” Is it a conspiracy or a bug? I’ll go with bug since I did a spot check on a couple addresses and KP sites definitely popped up prominently.

In what may be the first of similar announcements, ChartLogic reports it has applied for EMR certification with Drummond Group. I reached out to ChartLogic and asked them why Drummond was selected over CCHIT. Here’s the reply from Eric Sorenson, ChartLogic’s VP of marketing:

Our choice for Drummond over CCHIT came down to timing. We believe we are ready to be certified today. CCHIT has indicated that they will launch their program on September 20, and begin receiving applications then. Additionally, they’ve previously indicated that they will give certification priority to their CCHIT 2011 and their “Preliminary ARRA” certified products. We believe this would push our testing date and certification to a date much later than desired. Conversely, Drummond has indicated that they are taking applications immediately, and can begin testing within a few weeks. They have no backlog. We believe this will give us the best opportunity to be certified immediately. CCHIT has a 5 year head start on marketing their products and services, so we weighed the value of a certification with CCHIT vs. Drummond and felt we could overcome any of possible difference in marketing value by being one of the first companies certified, if not THE FIRST. Additionally, Drummond has been certifying other software for a longer time than CCHIT, so we agree with ONC and don’t believe their lack of EHR certification experience is likely to cause us problems in the certification process.

Southwestern Vermont Medical Center says it spent $1 million on its Picis periop system.

Valley View Hospital (CO) goes live on Meditech 6.0.

Actor Michael J. Fox will provide a keynote at HIMSS11, sharing his experiences as a patient and telling healthcare IT experts how IT impacts healthcare. Sadly, he’s got the dreaded Thursday a.m. slot, which means only 200 people will be in the audience. What I want to know is whether Jonathan Bush will try to schedule a meet-and-greet with his look-alike.

Memorial Hermann (TX) selects FairWarning to monitor patient privacy.

Former Streamline Health and Misys VP Scott Boyden takes over as VP of new client sales at TSI Healthcare. Kermit Copley also joins the company as CFO.

Hoag Hospital (CA) opens its new $84 million, 154-bed facility in Irvine. That’s $545,000 a bed if you are the calculating type.

HHS names its final two Beacon Communities: Greater Cincinnati HealthBridge and Southeastern Michigan Health Association. HealthBridge will focus on pediatric asthma and adult diabetic care, while Southeastern Michigan will concentrate on diabetes care and prevention.

UnitedHealth Group is loaning $10 million and donating another $1 million to help rural hospitals improve their HIT and add EHRs. Between this program and the recent Ingenix acquisitions, it sounds like UnitedHealth is trying to unload some cash.

This week on HIStalk Practice: Dr. Gregg Alexander shares the EHR-laced lyrics of some of his soon-to-be-hit tunes; Jonathan Bush tames an octopus; and an Iowa REC shares the cost of their consulting services (between $300 and $2,000 for two years’ worth.)

Stanford Hospital and Clinics commits to a seven-year agreement with Accenture to take over some  of Stanford’s IT functions. Accenture will manage applications and infrastructure and provide data centers, network, help desk, and device support. We said this was happening a couple of weeks ago, courtesy of a reader rumor from Scatman Crothers.

Memorial Hospital at Gulfport (MS) lays off 47 workers, including 10 nurses. The staff reductions are part of cost-cutting measures to offset an $11 million budget shortfall.

The Massachusetts attorney general recommends that the board of Beth Israel Deaconess Medical Center do “some soul-searching” about CEO Paul Levy’s ability to lead the hospital.This follows her office’s conclusion that his long-time personal relationship with a female employee “clearly endangered the reputation of the institution and its management.” Board chair Stephen Kay responded by saying, “We are having a great year. We have more patients than we’ve ever had before. He’s made some wonderful alliances with some quality places. He has great credibility. He’s a national leader.” I’ll bite my tongue as it relates to this toxic topic.

Sponsor News

• Enterprise Software Deployment (ESD) ranks #561 on Inc.’s list of the 5,000 fastest-growing companies. ESD, by the way, just hired former maxIT director David Tucker as its national VP of sales.
• MetroSouth Medical Center (IL) goes live with iSirona’s medical device integration solution, transmitting data from over 100 GE Unity Network devices.

If you have a three-day weekend, I hope you are not in Earl’s way and are able to enjoy the fruits of your labor.  And if you are laboring, remember you can always sneak into Facebook and drop us a note.

E-mail Inga.