Monday Morning Update 8/9/10

From Your Name Here: “Re: Community Health Systems. Medicity wins VOC, beating out RelayHealth.” Unverified.

From Scotty B: “Re: ACE. I guess you scared the cardboard Mr. HIStalk into hiding today.” The vendor who misappropriated my Smoking Doc logo at the Allscripts user meeting demonstrated at least a little bit of creativity in acknowledging their transgression. Two readers with what I assume are tongues in cheeks are urging me to sue them.

From Lem Hewitt: “Re: ACE. I wish you would go to Epic’s UGM and do a similar report.” Now that would be interesting — I’m kind of embarrassed that I’ve never thought of doing that. Lem generously offered to cover the hotel costs using his Marriott points. I’d have to swing some time off from the hospital and probably find a customer willing to let me pose as their fake employee. Something to think about although there’s not much time left.

From Dirk Squarejaw: “Re: speakers. Do you know of any dynamite speakers for a CIO-type crowd?” I get asked this question a lot, so I’m appealing to readers to suggest outstanding speakers they’ve heard. The criteria: (a) inspiring; (b) unbiased; (c) not the HIMSS semi-celebrity types who charge thousands of dollars, like the guy who sawed his own arm off or Dana Carvey; (d) not just canned speech-readers riding the rubber chicken circuit. Ideas? I should disclose that I’ve been asked a couple of times to do keynotes, but I always decline – I have nothing insightful left to say that I don’t say right here, so I’m leaving it all on the field, as the jocks say.

From Ollie: “Re: mobile healthcare. I was getting blood drawn at Emory Midtown and saw an infectious disease MD tapping away on an iPad in the Starbucks line. I asked how he liked it using his Cerner PowerChart EMR that way. He said it loves it, it runs great, he places orders, does documentation, etc. He was happy to share and smiling when he said it. An MD reviewing an EMR, maybe even placing orders, while in line to get coffee … what is the world coming to?” That’s pretty cool. As much as we debate software usability, mobile device capabilities are right up there when it comes to physician satisfaction — just like it is in the consumer world, where the same old e-mail app takes on another dimension when you can use it untethered.

From Geri: “Re: objectivity. How do we know that an anonymous Mr. HIStalk doesn’t have interest that conflict with those of his readers? I’m not accusing, just asking.” Here’s how I would judge anyone running a site like HIStalk: (a) do they have a hidden agenda, like owning stock in a particular company or profiting in some undisclosed way? I have no way of proving it, but I don’t. (b) are they pitching their own profitable endeavors such as consulting, speaking, or landing a board gig? (c) do they shill out every possible revenue source, such as spamming readers with sponsored e-mail blasts? (d) have they ever actually worked in the field, particularly on the non-profit side, or did they just cruise in and hang out a shingle proclaiming to be an expert? and (e) does the author try to use his or her readership to make themselves more famous and influential? Feel free to judge me on any of the above — you have seven years’ worth of evidence to review. Staying anonymous keeps me honest — there’s no way to cash in even if I was tempted, i.e. there’s no such thing as an anonymous celebrity. It’s a fair question, though, and there’s more information on my About HIStalk page.

Listening: new from the highly regarded Arcade Fire.

It appears that we remain collectively unconvinced that HIEs can figure out how to support themselves financially, like trust fund babies who struggle when daddy’s money (or Uncle’s in this case) is gone. New poll to your right: if you were seeking hospital care, would you care whether a hospital is on the Most Wired list or not?

Tucson Medical Center’s CEO talks a lot about its Epic implementation in her blog entry about upcoming layoffs that were triggered by a 10% drop in inpatient volumes. One the one hand, “While costly, the investment was worth it because, as we were told by Epic last week, we are far ahead of other hospitals in terms of system optimization,” but reading between the lines, she seems to say that the labor needed to implement it caused the hospital to miss its productivity goals.

Kaiser reports Q2 numbers: $11 billion in revenue and $313 million in operating income. They, too, talk a lot about Epic / HealthConnect, saying that members exchanged 5.3 million messages with their providers in the first six months of the year.

Looks like the Sunny Sanyal rumor was on the money. He’s at T-System now. Thanks to You’ll Know Who for the original rumor and Mark for telling me about Sunny’s updated LinkedIn profile (done since my original report, apparently, since I checked it originally and it was unchanged).

Somebody breaks into a Texas allergy clinic and steals four PCs containing PHI, although as one of the docs said, “We’re an allergy clinic, so I don’t think there was anything embarrassing taken.” The clinic complains that it cost them $15,000 to send the mandatory breach notification letters to its 25,000 patients, more than the cost of replacing the computers.

A reader sent over a note about the death of Christopher Heller, MD, FACS, a co-founder of hospital software vendor MIDAS+. Condolences can be sent to his family via this e-mail address or left on the obituary page.

Encore Health Resources announces its EHRight solution, which helps map EHR technology to the MU requirements, match clinical data elements to quality measures, and assess EHRs.

Medicare’s fraud contractors, which cost taxpayers more than $100 million per year, come under the gun of Senator Chuck Grassley, whose investigation finds that they take six months to send their cases to law enforcement and only seven percent of the suspicious billing they identify is recovered. Also noted: the Program Safeguard Contractors are poor at identifying new fraud trends. The Obama administration, of course, says it will fix everything, with the only announced change so far being to give the groups a new name.

The travel habits of athenahealth CEO Jonathan Bush are profiled in the Watertown section of the Boston paper. “I literally rent [an] airplane every Tuesday morning, and I hit five cities by Thursday night, every week. I’m cold calling . . . That’s my life now. It’s like any government fiscal stimulus thing — it’s a gold rush.”

Sharp Community Medical Group signs up for the just-announced Collaborative Care Solution jointly sold by IBM and Aetna. I’m not entirely clear on exactly what it is, but it sounds like analytics. I’m always skeptical about IBM’s healthcare intentions even when insurance companies aren’t involved, so I’ll assume it’s a repackaging of a hodgepodge of its existing technologies that will tap into insurance company billing data for clinical purposes (always questionable), with a key motivator being getting stimulus money. Reference is made to HIE-type services as well. They say it will cost less than $1,000 per doctor.

The Milwaukee paper writes up AskHermes, software developed by University of Wisconsin-Milwaukee researchers that uses natural language processing and artificial intelligence to review medical case descriptions to recommend treatments.

A study looks at telepsychiatry, in which patients are interviewed on camera with the resulting video analyzed later by psychiatrists. I found that of minimal interest, but that announcement (and a couple of unrelated ones that talked about video recordings of patient encounters, including remote ICU monitoring) suggest that the multimedia EMR is finally at hand.

Oracle’s punishment if found guilty of defrauding the government by overcharging it for software could reach $1 billion. Imagine being the former Oracle employee who is the sole whistleblower in the case.

Ingenix releases a version of its CareTracker PM/EHR with specific functionality for Federally Qualified Health Centers.

Incoming medical students at the UC Irvine School of Medicine will receive an iPad preloaded with mandatory course materials and hundreds of medical applications. Interesting: they’re ditching the sage-on-the-stage lecture model in favor of student-controlled learning. That’s the big announcement if you ask me.

MedAptus announces GA of the new version of its Intelligent Charge Capture system, which runs in the iPhone and iPad.

MEDecision releases Alineo 3.0, the new version of its case, disease, and utilization management system.

eHealth Insider reports that NPfIT is about to be scuttled as part of its decentralization, even losing the Connecting for Health name in a program to cut its massive costs. The government is putting CSC on the hook to reduce its costs dramatically and the Microsoft enterprise licensing deal has already been cancelled.

Odd lawsuit: the widow of comedian Bernie Mac sues his dermatologist for not recognizing his symptoms of respiratory failure. The doctor says he told him to get to a hospital and he did.

E-mail me.

Final Thoughts – Allscripts Client Experience 2010

I have to say that I enjoyed ACE a lot, although I can’t pinpoint what I liked about it specifically. I think it may have been that, unlike HIMSS, the attendees had modest egos. I saw no one pontificating, traveling with a sycophantic entourage, or working their pectorals with a foot-long string of “I Love Me” badge ribbons. These are mostly frontline people from practices and hospitals, i.e. my kind of folks. I liked the Allscripts people, too. The logistics were manageable, the lunches and opening reception held in the Hub with vendors was a smart idea, and there were plenty of essentials at hand (restrooms, break-time snacks, and entertainment).

One more full disclosure item: I take my “everyman” role seriously, so I turned down an e-mailed company invitation to meet personally with Glen Tullman. I appreciated the offer, but it wouldn’t be right to claim to be objectively reporting “from the ground” and while meeting personally with the CEO. I came and went anonymously.

Friday’s sessions may have appeased the person I talked to who felt the conference wasn’t detailed enough. In looking back, Thursday’s meetings were heavy focused (intentionally, I’m sure, to accommodate one-day attendees) on Meaningful Use and product roadmaps. Friday moved into deeper topics at a product level. My favorite was one from ColumbiaDoctors on their Enterprise implementation — it was candid and informative about the challenges of changing the culture of a huge organization that is quite set in its ways (one of the more interesting presentations I’ve ever attended, actually). They used the classic commercial above, which even though I’d seen it before, made me inadvertently laugh disturbingly loudly a couple of times, probably jolting the adjoining attendees into thinking a psycho had crashed the session. I think I was overly caffeinated from the readily available soda from the break.

Most impressive to me, however, was that Glen made good on his promise to fix the breakfast line problem. It was gone Friday morning. I had a feeling he was serious when he announced in the opening session that he had designated a team to make it happen. Now if only he had a similar chance to re-do the Friday night bash, which involved moving from a huge line to get into the House of Blues to multiple huge lines to get food and more huge lines to get drinks (guaranteeing that either your drink was warm or your food cold in your unsuccessful quest to enjoy them simultaneously as they raced from opposite directions toward room temperature). The house band was OK if you like Top 40 covers (I abhor them, but these guys were adequate) and they had karaoke (I’m not a fan, but that Chris dude who knocked out a deadpan but flawless “Baby Got Back” with beer in hand might have changed my attitude). It was fun, just a little too packed.

I checked out a demo of the patient portal (Allscripts / Medfusion / Intuit). Well, sort of — they were running screen shots instead of a live demo, which I hate with a passion (I always assume that either the demo people or the product are untrustworthy when they aren’t willing to risk showing it live). It looked good in the screen shots, anyway, showing functions for patient communication, scheduling and charging for online consultations, pulling EMR data into notes for patients, scheduling appointments, and placing incoming patient communication into the chart. I’m a little surprised that Allscripts is trusting another company to provide such an important part of its offerings. I’m just guessing, but I bet Allscripts had a strong interest in acquiring Medfusion before deep-pocketed Intuit came along to push the price into the stratosphere so they could latch onto the financial transaction possibilities it creates.

I saw Enterprise running on an iPad in the Innovation booth. It was really cool — clearly the iPad is just the right size to balance portability with screen real estate. I still can’t figure out how I’d comfortably hold the thing for extended periods, though.

A complaint I heard more than once from both Enterprise and Professional users: Allscripts has experience in implementing all kinds of specialties, yet each implementation starts over from scratch. The plea was to use the content and knowledge from one implementation to expedite future implementations. I’ve complained to vendors about that before — as long as a new client is willing to take the risk of using someone else’s ideas and the old client doesn’t mind, it sure would be nice to start with a non-blank slate and piggyback on their experience.

I talked to an Enterprise customer who was not only happy with the product, but very satisfied with Allscripts support. She said the case backlog was ridiculous at one point, but the company brought in some new leadership and added resources to the point where she’s getting quick callbacks from people who know what they’re doing.

Funny, but even though the presentations talked a lot about Meaningful Use, I didn’t hear it mentioned much by the attendees. Either there’s just no collective experience to make it worth discussing or practices aren’t all that interested in it. I’m almost concluding that it’s (b). Those of us in the industry who talk about it knowledgably and constantly may be overestimating the HITECH knowledge and interest level that’s out there in the real world. And these are the practices astute enough to send people to a national user meeting, not the average small-practice customer.

I wandered into the area where sessions for users of Allscripts hospital products were meeting. I had to wonder if they felt like orphans since so much of the emphasis was on practice-based PM/EMR. I didn’t connect with any of them to ask. I don’t know if the Eclipsys users will be rolled into the next meeting, assuming the acquisition goes through.

Las Vegas is my least-favorite city. It’s sleazy, tacky, and not even cheap any more. Fake beaches in the middle of dull desert moonscape, fake cleavage, fake celebrity chef restaurants (think your local mall’s food court at 10 times the price), and shows that (as Mrs. HIStalk points out) mostly involve aged celebrity tweeners too passe’ for Hollywood and a only a small step above Branson. I caught the 5 a.m. shuttle and even then the casino had plenty of people (families with small children, two-fisted drinkers, and groups of scantily clad women whose motivations were not clear, making for an interesting but depressing mix). The airport was a madhouse, although kudos for having free WiFi good enough for me to stream Better Off Ted while waiting for my flight. I’ve been to meetings there maybe 4-5 times and am always happy to leave. It was a good setting for ACE, though, since the deals were good and the logistics were outstanding.

When it comes to Allscripts, it came across as a bigger and more polished company than I anticipated. It’s growing fast, maybe a little too fast to stay connected with its customers in the same ways, but scaling well in general and trying to add technology to replace some of the “just call me directly” type of contact that’s no longer feasible. I don’t know how a salesperson would figure out which of the many overlapping EMR products to push at a prospect, a situation that will be more confusing when those from Eclipsys are brought into the fold.

Customers seem to be adapting to the idea that their vendor has changed since they signed up, which is always a challenge (it’s like getting married, only to have your new spouse gain weight, join a cult, and start sleeping around). Unless someone like Oracle buys the company, Allscripts seems early in a lofty trajectory given its ambitions and footprint and it appears to be executing pretty well, with the Eclipsys acquisition being a crucial test. Thanks to the folks there for inviting me to attend without even asking to influence what I might say.

News 8/6/10

From Astonished: “Re: University Medical Center of Southern Nevada in Las Vegas. They have selected McKesson over Epic as VOC.” Oh, my. They should print up a lot of signs now that say, “Remember, this one was cheaper.”

From Patty: “Re: your logo’s head. I spy your cartoon likeness at the MBA HealthGroup booth at ACE. Your head is smaller than I imagined it would be.” I checked it out during the opening reception and you are right — they apparently lifted my logo’s image, which cost me a pretty penny to have custom drawn. They need to do something clever to placate me, so I’ll go by their booth again Friday to see if they’re creative enough to have come up with something. Stop by and ask them. I take enough heat from literalists who don’t get the intended irony of the pipe-smoking doc.

From RumorReporter: “Re: Eclipsys and Allscripts. Word on the street is that once the merger is completed, all finance functions will be relocated to India. So who is coming out on top here?” Unverified. It’s probably not a big deal (if it’s true) as long as it’s the grunt stuff that makes up a lot of what finance does.

From You’ll Know Who: “Re: Sunny Sanyal. The former McKesson Provider Technologies president now the CEO of T-System.” Unverified.

From PrettyKitty: “Re: Epic Beaker LIS. After a four-year project rolling out Epic to 10 of their hospitals and replacing existing systems in an effort to standardize, Sisters of Mercy Health System is developing Epic’s Beaker lab application for their next two hospitals to be implemented in the second quarter of 2011. They had been retaining and integrating the previous lab systems — Cerner and Meditech — but have been told that Beaker is ready. They are in the selection process for a Blood Bank system since Epic will not offer that.”

From Dino: “Re: Kaiser. They say they have 99.96% availability. At least now we know that $5 billion doesn’t even get you five nines of uptime. They have come a long way from aiming for 99.7%, though! Remember that Oakland forced Pleasanton to come up with a ‘revised systems availability formula’ a few years ago — a formula that would have made Arthur Andersen blush. It basically only counts the power being off in the data center as downtime. Still, if you’ve got $5 billion and some change, you can get a nice, fully (and somewhat frequently) functioning EMR than can help improve and save lives. We just need to get the cost down and the reliability up, and then we’re good to go.”

From Allscripts Client Experience 2010

I’m in Las Vegas, checking out ACE 2010 as an attendee. Full disclosure: Allscripts invited me and comped the registration and hotel, but I’m paying otherwise. I’m still anonymous to them and I told them I was going to report what I saw and heard objectively. I don’t usually go to user meetings, but I knew the timing would be perfect to hear what people think about Meaningful Use and PM/EMR systems.

Note: the questions I asked were opened ended, such as, “What products do you have and how do you like them?”, so I was not asking leading questions that were positive or negative. Still, I can’t say for sure that the comments I got were representative of the Allscripts customer base. And keep in mind that I have no hands-on experience with any Allscripts product, so I’m just a wide-eyed noob at this conference.

They say 3,500 people are attending, which I believe since at least 3,000 of them were in the Starbucks line at 7 a.m. due to logistical challenges that I don’t need to explain since we attendees heard the gracious Allscripts apologies all day, from Glen Tullman on down. But no kidding, that was the longest line of people I’ve ever seen, at least 2-3 hours’ worth snaking back hundreds of yards (you people are seriously hooked on caffeine), and the buffet lines weren’t much shorter. It didn’t bother me since they had fruit and drinks in the meeting area anyway, so I was just as happy with a protein bar and a Diet Pepsi.

Some observational bits:

• Half the attendees were first-timers, the registration person told me.
• The lunch buffet was the best I’ve ever had at a conference. In fact, the overall meeting logistics were outstanding, from the handouts to the music to the friendly Allscripts people always willing to guide folks to their meeting room or connect them with an Allscripts contact.
• On the other hand, I don’t want to see another orange shirt for a year or two.
• A couple of users told me their Patient Portal (which I was told is the former Medfusion, but I don’t know that for sure) attempted implementations were disappointingly unsuccessful. They liked the promise of the portal, but said it was not ready for prime time. That’s a problem since it’s basically required to meet MU requirements. It’s obviously a key part of the Allscripts strategy (and an expensive recent acquisition for Intuit), so getting those problems fixed is key. There were demoing some pretty cool online payment functions.
• Related to that, several users said their main gripe with Allscripts was releasing and pitching products that aren’t ready (not uncommon for vendors in general).
• One user said the QA of Allscripts is much better than before.
• I saw a couple of iPads in use.
• Glen is an excellent speaker. Most of those I heard were good, except one who inserted the dreaded conversational crutch “sort of” every 2-3 sentences. Nuance was in the Hub and I wanted to ask them to use their speech recognition capabilities to set off a siren each time she did that, which should provide operant conditioning to help her stop. This is a near-epidemic – when I edit my interview transcriptions, I have to exterminate dozens of “sort ofs” in probably half of them.
• The biggest news to me was the announcement of the Allscripts Referral Network, a service that lets users of Allscripts products communicate with each other. People seemed to be pretty happy about that announcement, including a practice manager and a consultant I talked to. Glen said they’ll open it up to users of other vendors’ EMR products by the end of the year.
• Odd products that had surprisingly fanatically supportive users that I talked to: Homecare and Tiger.
• I wanted to look at Payerpath, but I forgot to stop by. Maybe tomorrow.
• A couple of people said they felt the meeting felt more like a heavily orchestrated cheerleading session and sales opportunity than something geared for their benefit. Hopefully they’ll get more out of it in the remaining sessions. I saw some very meaty sessions on the agenda, especially in the more specific technical and product tracks, so I’m pretty sure there are nuggets to be mined through careful session choices.
• I went to the Professional roadmap meeting. A show of hands made it clear that even though MU awareness is nearly universal, very few attendees are really ready for Meaningful Use. Based on the graph shown of client release levels, a great percentage of Professsional’s 2,000 sites will need some serious upgrading. Most are on Version 8.3 and down.
• I saw one person wearing a badge that said “No Hybrid EMR”.
• I got no indication that MyWay is on the outs. They showed its MU deliverables and I spoke to several users who love that product, including some surprisingly large ones (one Enterprise EHR customer said semi-seriously that they were considering replacing it with MyWay). I think it’s a keeper for the company.
• I asked one somewhat unhappy Enterprise user what they would be using otherwise. They hated Epic and said the product to beat was Greenway. Another liked Sage Intergy, saying it was truly integrated between PM/EHR instead of the “two screens” method of visual integration.
• I talked to a handful of Enterprise users. That group seems to be the least happy with Allscripts, with gripes that include unresponsive support, lack of proactive contact from reps, the cost of buying the Stimulus Pack vs. Analytics (Allscripts was a bit evasive on pricing, turfing users off to their reps, but promised to make it right for customers who have purchased previous products), database bloat caused by the technical method of updating physician notes, and some obvious residual bad feelings from the premature TouchWorks Version 11 upgrades that caused significant practice disruptions. It’s always hard to keep the bigger customers happy, I guess, but Allscripts needs to do some work to delight that constituency again from what I heard.
• I got the sense that all of the Allscripts growth has strained communication capabilities (reps not calling back, no direct access to support people, etc.), which may explain some of the new customer tools that Glen introduced.
• One person bragged on how great their remotely performed upgrades are, with everything done overnight or over a weekend by Allscripts.
• Glen showed an “upgrade wizard” thingie called the Upgrade Enablement Center that was explained further in the Enterprise MU session. It was created for migrating Misys users to Professional, with parts of it used by the customer and parts by Allscripts, but they said there’s work remaining for it to be finished. They said they had cut migration downtime from 4-6 days to 4-6 hours with the tool. One user said they had experience with it and thought it was great.
• One Enterprise customer said they have no worries about meeting MU requirements since their doctors happily enter their own orders.
• Glen also announced a new Web service that allows customers to one-stop-shop a lot of Allscripts services and communicate with each other.
• Allscripts announced a new Web-based project management tool, where a client chooses their desired date for a the Stimulus Set upgrade and the application backs them into a schedule that Allscripts can work from.
• Eclipsys was barely mentioned, probably since it’s not a completed transaction yet.

As someone with no skin in the game but a lot of conference experience, ACE is fun and well run. The company has obviously grown hugely and has a pretty big vision, although with a few inevitable rough spots in execution that are probably inconsequential in the big picture. I’d like to hear from my fellow attendees who are real customers, though, so please leave a comment if you’re at ACE. You know how conferences are – you can ask a bunch of people and all will report different conclusions.

News 8/4/10

From HIStalk Junkie: “Re: Alert Medical. The company has hired and fired several chronically underfunded US ‘consultants’ / salespeople, preferring to pay straight commission. Some have said they won’t pay for even basic tools for understanding the US market. I have run into them in several countries. They hired a very smart fellow who was at HIMSS looking for a US partner to ‘invest’ in the chance to represent ALERT. Sounds to me like they want to sell their US marketing rights. They have no revenue cycle product, but a very pretty clinical product” Unverified, although I do remember that someone told me that before.

From J.G. Giant: “Re: odd but true. In keeping with the season, I thought you would appreciate this. Keep up the excellent work!!!” I wonder if these providers use EMRs?

From Hitchens: “Re: Meditech. I work for a Meditech partner and I hear they are looking at offering Allscripts for certain interfaces. Also, this may be Step 1 in a buyout of Meditech by Allscripts, as Meditech’s founders have been looking for a few years to exit and the $$ now is so high.” Unverified. Seems unlikely, but it’s a crazy industry right now.

From LISales: “Re: Epic Beaker LIS. Word on the street is that they have one SMALL site using the system within the Wisconsin area, but nothing major yet. I’ve also heard that they are beefing up the development team while including the licensing right to the module within ALL of their enterprise licensing agreements. Also heard is that the functionality is being somewhat oversold compared to actual capability with no desire to develop certain aspects of a full-scale laboratory’s needs, Blood Bank to name but one.” Unverified.

From UKnowMe: “Re: business associates. What training are consulting firms using to ensure their employees take appropriate measures with regard to PHI?”

From Kermit: “Re: NHS. Britain is proposing a shake-up. Here’s one article.” The new government changes its mind about its pre-election promise to leave healthcare alone, planning a reorganization of NHS. The goals are to move central control back to doctors, cut out administrative layers, and give patients more say-so. Here’s an interesting (condescending) quote from a research group about giving doctors control of the equivalent of a $3.4 million annual budget each to pay other providers:

It’s like getting your waiter to manage a restaurant. The government is saying that GPs know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.

From The PACS Designer: “Re: OneNote on WP7. As we learn more about Windows Phone 7 (WP7), it appears Microsoft will be pushing the use of MS Office OneNote for mobile users with its scheduling, meeting notes, and To Do List features, among others in the application.”

From Cassie: “Re: Mercer does it again! Apparently Mercer lost another piece of IT equipment in the great state of Idaho, this time for St. Al’s hospital ,therefore losing numerous employee data. Supposedly it’s been missing for months (and is still missing) and Mercer is just now telling St. Al’s staff.” Verified. Mercer lost a backup tape in March containing information on 1,000 employees of St. Alphonsus.

Watching (instead of Listening this time): Better Off Ted, a just-cancelled, brainy comedy from my streaming Netflix recommendations (rightly so — I love it). What’s not to like about a soulless, thoroughly evil and Dilbert-esque conglomerate (its motto: Money before People, and check out the amazing phony commercials) and the ever-luscious Portia de Rossi? It rounds out my personal TV triumvirate that includes Arrested Development (there’s Portia again) and 30 Rock. All are on Netflix, so I can watch whenever I have time (which is rarely).

Surescripts will announce tomorrow that Microsoft HealthVault users will be able to download their pharmacy prescription history into their PHR.

mHealth Summit books Bill Gates as a keynote speaker. I’m thinking about attending since I need to get out from behind a desk more often.

RIM announces the BlackBerry Torch 9800 and BlackBerry 6 OS, offering a slide-out keyboard, a touch screen, and a 5-megapixel camera. I think it’s safe to say that iPhone and Droid users won’t be interested, but it might keep some non-corporate BlackBerry users in the fold for awhile longer and placate the business user suffering from iPhone envy. The Torch will cost $200 with a two-year AT&T contract.

Weird News Andy packages this story with a pun: “He asked the nurse if he could use her needle and thread and thought she said ‘suture self’.” A man with a leg cut waits an hour to be seen in an ED in Sweden. He becomes impatient, notices the “needle and thread” in the room, and sews the cut up himself. Unappreciative hospital employees reported him for using hospital equipment without authorization.

Thanks to Neil Versel at FierceHealthIT for saying nice things about Inga and me in mentioning our little link exchange project. I like that he envies “the Cult of Mr. HIStalk,” which I’m pretty sure is apocryphal, but it still makes a good fantasy for my next dull hospital meeting. He does seem to harbor some doubt that I work in a hospital, but I assuredly do, full-time and mostly happily. My self-selected theme song is Rush’s Working Man.

A hospital in Australia says its upgraded Philips Intellivue Clinical Information Portfolio has reduced ICU costs by 20-25%. If provides clinical decision support, a patient summary, clinical guidelines called “care bundles”, order management, ICU scores, digital picture documentation, analysis and reporting, and wireless access.

Keane Optimum 3.1 earns CCHIT Preliminary IFR Stage 1 certification as an inpatient EHR.

July’s HIStalk stats for those scoring at home (you know who you are): 97,368 visits, 138,957 page views, 5,941 e-mail subscribers. As always, thanks to my readers and sponsors. Back in the old days, I wrote HIStalk without either and would do it again, but it’s a blast knowing someone’s actually reading.

VMware will co-market Imprivata’s authentication and single sign-on products with its VMware View virtual desktop.

Boston-based SV Life Sciences, which has invested in six HIT companies, plans to fund more healthcare IT startups, with a primary interest data mining solutions. Its investments include Vitalize Consulting Solutions, Phase Forward, and eMed Technologies.

GE and Intel form a 50-50 joint venture to start a technology company that will target telehealth and independent living, extending their alliance from last year. That squares them off solidly with Philips, it would seem.

Orion Health announces GA of Rhapsody 4, a new version of its integration engine. Features: secure Web services, support for lookup tables, a monitoring API, Web-based monitoring tools, and a drag-and-drop user interface for analysts.

The Singapore Ministry of Health awards Accenture a contract to implement its national electronic health record system, scheduled for initial release next year. 

A New York Times investigation finds that at least 400 patients in eight hospitals have been overdosed on radiation during CT brain perfusion scans. The FDA was unaware of the problem and doctors and hospitals missed symptoms such as hair loss in the irradiated areas. GE’s equipment wasn’t the problem, but two hospitals said technicians confused a feature that raised radiation levels and thought it lowered them, saying the feature was “counterintuitive.” Interesting: Cedars-Sinai, one of the hospitals named, overdosed a member of its board of governors, who left the board when she found out. The best comment came from a plaintiff’s lawyer: “What is amazing and seems painfully obvious is if someone walks in with a band of hair missing around the entire circumference of their head, you would ask the question: Have you had a CT scan? Not ‘What did you eat for breakfast yesterday that would cause your hair to fall out today?’”

E-mail me.

HERtalk by Inga

A bi-partisan group of legislators introduces the EHR Incentives for Multi-Campus Hospitals Act, designed to ensure that multi-campus hospitals receive their fair share of economic recovery dollars. The way the law is written, multi-campus hospitals receive the same dollars as a single hospital despite higher implementation costs.

Advocate Health Care (IL) is deploying Fusionfx physician portal from Carefx Corporation at its recently acquired Condell Medical Center facility. Condell is also in the process of migrating from McKesson Horizon to Cerner.

The 100-physician Manhattan’s Physician Group selects ITalagen to host, support, and manage its EHR.

Corner Children’s Hospital (IL) plans to integrate its EpicCare inpatient clinicals with GetWell Town, a pediatric interactive patient care solution. The connection will support the bi-directional flow of patient information so that nurses can order educational material specific to a child’s diagnosis, then document progress in the patient’s record.

The local paper highlights the transition of Doctors Hospital (TX) to Cerner EHR and its desire to automate 300 community physicians.

Fremont Area Medical Center (NE) advances its HIE plans, signing a contract to implement Lawson Enterprise Exchange.

I don’t love Las Vegas, though I usually find a one-or two-day visit  is pretty fun. I had hoped to trek to Sin City this week to attend ACE with Mr. H, but alas, “real” life is getting in the way. In exchange for keeping the home fires burning, I’m thinking Mr. H should waste at least $20 in quarters playing the slots on my behalf. If you are one the 3,000 attending, feel free to send me some pics.

OA Centers for Orthopaedics (ME) chooses the SRS hybrid EMR for its 41-specialist practice.

Greater Baltimore Medical Center (MD) picks eClinicalWorks to provide EMR and PM to its 100 employed physicians.

Scott Bagwell takes over as SVP of sales and marketing for Passport Health Communications. Bagwell held a similar position with McKesson Pharmacy Systems and RelayHealth Pharmacy Solutions.

Q2 results for Henry Schein: earnings up 14%, though North American medical sales fell 0.4%. Total revenues of $1.85 billion exceeded analyst expectations.

Marion General Hospital (OH) implements GE Centricity Enterprise via a remote hosted delivery option.

A new eHealth Initiative survey on HIEs finds that the number of exchanges is growing, with at least 73 of 234 total HIEs now operational and transmitting stakeholder data. This is up from 57 last year. Sustainability continues to be a challenge, although 107 report they aren’t dependent on federal funds. Another challenge: addressing government policy. Participants also say the HIEs are helping reduce staff time and redundant testing.

Speaking of HIEs, the Electronic Healthcare Network Accreditation Commission (EHNAC) names the Utah HIE the first entity accredited through the HIE Accreditation Program.

From another local paper: the soon-to-open Mills Peninsula Medical Center (CA) will have no paper records. The new Sutter Health facility is replacing Peninsula Medical Center, which runs Epic.

Finally, Nielsen Co. says Americans spend 23% of their online time checking out Facebook, Twitter, and other social media sites. Which reminds me: Mr. H and I would love to suck more time out of your day, so feel free to friend us on Facebook and become a HIStalk fan.

E-mail Inga.

Monday Morning Update 8/2/10

From Capillary: “Re: Allscripts. The CEO announced last week on the earnings call that the company was chosen by the Indiana REC, but the selections have been announced and Allscripts was left off. Anyone know what happened?” Allscripts confirms that you are correct. They have apologized to the REC for the unintentional miscommunication. The vendors chosen by the Indiana HITEC as appropriate for small and rural providers are athenahealth, iSALUS, and MDLand.

From UK Watcher: “Re: Aspira. Aspira is/was the UK feeder to IntelleHealth/iCapital, the consulting entity working some of the Cerner projects in the Middle East. Many of the recruits that they had secured in the UK were from Cerner UK and had been moved to the ME anyway. Will be interesting to see what happens to their tax-free and prior negotiated packages with the ‘new’ boss.”

From Privacy NOT: “Re: security breach. The Achilles right heel of HIT is failed privacy. The Achilles left heel of HIT is failed safety and efficacy. The rotator cuff tear of HIT is failed usability.” I don’t know about all of that, but it was in response to news of a stolen laptop from Thomas Jefferson University Hospital in June. The laptop was password-protected, but was not encrypted (I swear the hospital laptop encryption rate must be even lower than CPOE adoption, but in this case, it the employee’s personal laptop and storing PHI on it violated hospital policy). Laptops apparently aren’t encrypted at Texas Children’s Hospital either, as the hospital admits after the theft of a doctor’s laptop containing patient information.

From Smart Room Needed Here: “Re: UPMC. Hospitals should get their employees to watch the monitors.” A patient’s family sues UPMC Mercy Hospital, claiming he suffered permanent brain damage after choking on a clogged tracheotomy tube for 40 minutes before ICU nurses answered the cardiac monitor alarm. And in other UPMC news, it creates a VP of community relations position for a state senator who’s quitting. The closed UPMC Braddock Hospital is in his district, leading an official with Save Our Community Hospitals to state, “… Sen. Logan worked to ensure UPMC’s objective of closing and demolishing the hospital. Now we know why. Mr. Logan has received his ’30 pieces of silver’ as payoff for his work on UPMC’s behalf.”

A reader asked me to put together a list of some of the music I’ve recommended over the years, so I compiled and posted a list here. And in digging back through those archives, I dug up an old favorite to revisit: Nine Black Alps, hard rocking Brits.  

As hospitals issue press releases congratulating themselves on being Most Wired, most HIStalk readers think awards of that type mean nothing, while the majority of the remainder think they’re just self-promotion for magazines and CIOs. New poll to your right: will state HIEs be viable once their stimulus money has been spent?

Speaking of Most Wired, AHA says the criteria have been toughened up, requiring hospitals to at least claim (on the self-reporting survey) that they are actually using technology. So, if you are among the Most Wired skeptics who think it means nothing, imagine what it was like before (those old and now-suspect awards still pepper CIO resumes, I’m certain). If this were an art contest, it has gone from (a) who owns the most paintbrushes, to (b) who uses the most paintbrushes, but is still far short of actually evaluating (c) whose painting is the best and whether having the most paintbrushes made any difference. I was in charge of completing the survey for a Most Wired hospital for several years (I have a Most Wired Winner shirt somewhere) and even my hospital made fun of it given our hopelessly outdated and seldom-used clinical systems back then. I suspect that we and our fellow award-seekers were as optimistic as a vendor’s RFP department in our responses.

Are patients better off in a Most Wired hospital and can it be proved that the technology is responsible? No on both counts.  As I always say, if you are a good hospital, judiciously deployed IT can make you a little bit better. If you’re a bad hospital, all the technology in the world probably won’t help you improve (and may well increase your level of suckitude). If you are marginal, you might see improvement, but I wouldn’t count on it.

The folks at FierceHealthIT and I are swapping links for a few weeks, so you’ll see their headlines to your right and mine on their site. It’s a trial to see if we send each other readers. If not, we call the experiment quits.

Scott Storrer is ousted as CEO of MEDecision, replaced after just eight months by un-retiring founder David St. Clair (above) until a permanent replacement is named in six months or so. David’s blog entry on the subject is here.

Q1 numbers from NextGen parent Quality Systems: revenue up 24%, EPS $0.42 vs. $0.36, missing on consensus earnings.

A reader sent over workshop documents from a July 27-28 invitation-only meeting involving the Institute of Medicine and ONC, addressing the role of technology in continuous healthcare improvement. Some of the issues discussed: what can IT do to improve health and healthcare by 2020, what are the rate-limiting issues, how can data be used, how can innovation be fostered, how can healthcare cost be reduced by technology, how can disease management be improved by technology, how can consumers be engaged, and how can a global public network be created? Some familiar names were on the participant list: Molly Coye, Bill Bria, Mark Frisse, John Halamka, Rob Kolodner, Marc Probst, Stephanie Reel, and Paul Tang (familiar names not on the list were yours and mine).

UMass Memorial Health Care will announce Monday that it has chosen the Symedical terminology management and interoperability tool from Clinical Architecture to create a central data repository with a single terminology set.

HIStalk sponsor jobs: Interface Analyst, Epic Clarity Analyst, RVP Sales – Southeast, New England/NY, and Mid-Atlantic Territories.

McKesson’s Q1 numbers: revenue up 3%, EPS $1.10 vs. $1.06. My interpretation of nuggets from the call transcript: (a) Health Solutions and RelayHealth did fine; (b) Provider Technologies (the hospital technology part) underperformed, with revenue growth slowing to just 2% and profit down 7%; (c) they’re spending a lot of money on Horizon Clinicals and Horizon Enterprise Revenue Management, taking an $8 million accounting hit on HERM amortization during the most recent quarter alone; (d) John Hammergren says the company is interested in global acquisitions, but is often named just to increase the price that someone else eventually pays; (e) MCK isn’t seeing an increase in technology purchases by physician practices, but Hammergren says it’s because those practices aren’t yet paying attention to HITECH; (f) the company is confident that its products can get providers to Meaningful Use. My cheap seats analysis: Horizon Clinicals and HERM are struggling, which is hardly news other than it’s McKesson saying so (indirectly).

HHS withdraws HITECH’s breach notification final rule after reviewing the public comments. Organizations involved in a privacy breach would have been allowed to decide on their own whether to notify patients or just keep them secret. That’s significant given that the rule had already gone to OMB. A replacement rule will be issued “in the coming months.”

DrLyle weighs in on Meaningful Use on HIStalk Practice. A snip: “To correctly measure many of these details (e.g. give clinical summary to 50% of those who ask) we would need to figure out a way to keep track of who ‘asks’. That seems like a strange request for structured data and certainly should not be what a doctor is spending his time doing.”

Dossia Consortium names Jim Hansen, former CEO of the Kansas City-based CareEntrust HIE, as VP and executive director.

TriHealth and University of Cincinnati will spend up to $100 million each on clinical systems, with Epic being a candidate in both (I’d say shoo-in given that TriHealth already uses Epic in its physician practices). Also named as local hospitals bringing up Epic and spending more than $50 million each to do so: Mercy Health Partners, Cincinnati Children’s, Christ Hospital, and St. Elizabeth.

A senior at University of Maryland who created the DoseSpot electronic prescribing system is named a finalist for an entrepreneur award.

Doctors and nurses in Thailand wear black lab coats to protest a draft law that would allow patients to be immediately compensated for medical malpractice from a special fund. A medical union representative says, “It means our staff would have to be extra careful during work, which would decrease efficiency.”

An Alaska clinic becomes the first US site to use ALERT Clinic software, which I assume is from the Portugal-based ALERT that made a mini-splash a couple of years ago at HIMSS (I think I recall cute booth staff in red-striped white jumpsuits, but I could be wrong), then seemed to disappear without a trace. Everybody (me included) was impressed by what we saw, so I don’t know what happened. I pegged them as a hot new entrant.

A hospital employee is fired for posting a Facebook comment about the suspected killer of a police officer that she treated, saying she hoped he rotted in hell. The hospital said she violated HIPAA even though she didn’t mention the name of the suspect or her hospital.

A Stanford Medical School professor and novel writer worries about letting technology interfere with patient-physician relationships:

Rituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation. The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault, you know, tell me that that’s not a ritual of great significance. And if we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is a transformation? It’s the sealing of the patient-physician bond.

Hospitals in Victoria, Australia will arm 500 doctors and nurses with iPads in a pilot program.

Boy Scouts at this year’s Jamboree at Fort A.P. Hill, Virginia have access to AT&T WiFi and a wireless EMR system used by its 20 medical centers and team of EMTs. Next thing you know they’ll be using a GPS to track snipe.

Standard Register’s healthcare revenue fell short of expectations in Q2, mostly because of cheaper document management solutions.

The former CEO of Baltimore-based insurance company CareFirst BCBS, recipient of a contested $18 million severance package, joins Healthcare Interactive as an advisor. The company offers healthcare performance management systems of several types.

E-mail me.

News 7/30/10

From SnagMonkey: “Re: confirmation of Providence Oregon’s transition to Epic.” He (or she) sent over the July 19 internal announcement. GE Flowcast, GE Centricity, McKesson Horizon Clinicals, McKesson Star, and pretty much all the unnamed ancillary systems will be shown the door. Implementation starts in January, the first go-live will be in 2012, and the project will be finished 30 months after it starts. Thanks for the scoop.

From Girls Just Wanna Have Fun: “Re: acquisitions. Hold on to your hat the next six weeks. Lots about to start shaking loose. Can’t say more, but August and early September will be the most active HIT M&A announcement months in a very long time.”

From TooLate: “Re: iSoft. Massive cuts continue and positions will be eliminated. Major shifts, consolidation of leadership, off-site London meetings are more frequent, and more stock will be issued. Sound like everything is being done right except fixing the actual problems — product and leadership. Can’t wait to see this annual report.” Shares are at less than 14 cents US.

From ThinGreenLine: “Re: management changes at Meditech. It was previously announced that Steve Koretz would assume all installation and support responsibility for 6.0 product line. Now Joanne Wood will assume same for all Magic and Client/Server products. Joanne being promoted to Senior VP. Two new VPs promoted under her, Leah Farina and Helen Waters. Leah has her roots in the HCA group, while Helen came from sales. This is the change Howard Messing hinted at in his interview with you.” Verified by Howard. That’s Joanne above.

From MaxPayneUK: “Re: Apira. Closes operations and gives all employees to IntelleHealth, which insists that new employment contracts be signed. Not sure how that happened without violating labour laws, but there you go.”

From Jenny Penny: “Re: Jay Deady. Cheers Across Atlanta may be thrilled that he’s leaving Eclipsys, but as much as an ass as he can be, I challenge anyone who has ever worked for him to debate that he challenged them to do their best. He is super duper intense about work – certainly no dumb slacker like many HIT sales guys.” Ouch!

From Buck S. Pearl: “Re: West Virginia Health Information Network. Five vendors still in the running to run the state’s HIE: Thomson Reuters, CSC, Deloitte, Medicity, and HealthBridge. The selection deadline was June 30, but they are re-evaluating functionality (which probably means they don’t have enough money to buy what they want). They are also negotiating with NaviMed and Quadax for a separate claims and eligibility portal, with one or both offering it to the state at no cost to open up the chance to sell other services to providers (clever buggers).” Board meeting minutes are here (warning: PDF). I knew Thomson Reuters jumped into the HIE game in December, but it still seems odd to see their name among those others.

From Laboratorian: “Re: Epic’s Beaker laboratory information system. Anyone know much about it? Are its big new clients implementing it?” Beats me. Anyone know?

From Jimmy DeLorean: “Re: posting the Monday Morning Update on Sunday. It’s always great feeling like I’m getting Monday’s news a day or two early.  ;)  But, you certainly have earned more than a few Saturdays off, and I’m sure Mrs. H appreciated having your undivided attention for the weekend. How you’ve managed to hold down two full-time+ jobs all this time and still have a personal life (and sleep) is a remarkable feat, though. Someday you’ll have to write a book on time management and life balance, even if pseudonymously.” Thanks – that made my day. I like having a few readers who get antsy when I don’t post until Sunday afternoon since it makes me feel needed. Mrs. HIStalk did indeed appreciate my attentions (and vice versa).

From Loyal Reader Kathy: “Re: Meaningful Use. Since you put together such a great spreadsheet over New Year’s, I thought someone ought to do it for you for the final and give you a little time for Mrs. HIStalk.” Kathy did a great job putting together the final rule information, including both the requirements and the quality measures (download it as Excel since it won’t look right otherwise — it has two tabs). Very cool, thanks! UPDATE: Scribd has some Facebook auto-login crap that isn’t obvious, so if you’re not on Facebook, download from here or here instead.

Listening: new from Asia, back with the original members (Palmer, Howe, Downes, and Wetton). I’ve got tickets to see them live soon.

Q1 numbers from The Advisory Board Company, the new home for much of the former HIMSS Analytics management team: revenue up 18%, EPS $0.29 vs $0.27. Market cap is $682 million.

pMDsoft announces its native iPad charge capture application.

Weird News Andy goes non-weird in finding this: Americans are consuming fewer healthcare services, according to financial results of publicly traded healthcare-related companies. Evidence: fewer elective procedures performed, increased numbers of high-deductible insurance plans, fewer new prescriptions for maintenance drugs, and (of course) increased insurance company profits. Athenahealth was quoted for its observation that the number of claims per physician and the average value per visit dropped over last year. The WSJ article seems optimistic that consumers are getting smarter, but I’d bet they’re just holding off until they get those shiny new insurance cards courtesy of healthcare reform.

St. Vincent’s HealthCare (FL) signs a deal with CVS Caremark’s MinuteClinic to provide medical staffing and to work together on disease management. The organizations are integrating their respective EMRs to share histories and visit summaries.

Cerner’s Q2 numbers: revenue up 13%, EPS $0.65 vs. $0.52, guidance raised. Shares jumped a little (one-year CERN against the Nasdaq above, with Cerner in blue). I’ll repeat what I said earlier this week: it’s one thing for Epic to take some business away from Cerner, but Neal’s always going to book great numbers, keep shareholders happy, and let everyone who wants to ride the Ferris wheel with him do so by purchasing shares. Millennium may have fierce competitors, but the company is doing just fine.

Speaking of Cerner, the earnings call transcript is here. It’s mostly the usual hack phrases used by executives and analysts (traction, footprints, give some color around), but there were a few interesting points. They’ll open a Vision Center in Europe. They don’t sound like they’re doing too well (my read, anyway) in the small hospital and physician practice markets. They expect 75% of their clients to earn full HITECH payouts. They’re going after revenue cycle services with RevWorks. One analyst asked directly about Cerner repeatedly losing against Epic in academic medical center sales, which COO Mike Valentine deflected by bragging on CERN’s success with for-profit hospital chains because of Cerner’s predictability and ability to scale (he also referenced HIStalk indirectly, saying “So we added 15 new footprints this quarter. In more than half of those we competed against the firm that you mentioned that gets mentioned a lot on the HIT blogs, and that’s good. We’re like the strong silent type. We’re going to continue to compete with them.” I snorted Diet Pepsi with Lime out my nose when I read the part about the “strong silent type” given Cerner’s notorious (over) marketing machine (i.e, the Vision Center), but that probably resonated with the stock guys as being humble. Neal dropped by for his usual one quick comment at the end, obliquely mentioning the acquisition of Picis by Ingenix (United HealthCare) and implying that they see opportunity in the platform that digitization enables.

CPSI’s Q2 numbers: revenue up 22%, EPS $0.39 vs. $0.32, beating consensus estimates of $0.36 and providing in-line guidance. In the 8-K, they mention that fired former CFO Darrell West not only charged $55,000 to a company credit card to pay his taxes, he cashed in almost 5 million membership reward points for personal benefit.

IBM will sell and implement the “smart room” developed by UPMC, which involves staff-worn ultrasound tags that trigger the display of role-based clinical information on the monitor when they enter the patient’s room.

Paris-based Cegedim acquires Pulse Systems, vendor of the CCHIT 2011-certified Pulse Patient Relationship Management ambulatory EHR, along with solutions for e-prescribing, practice management, revenue cycle management, and patient self-service. Cegedim sells life sciences technology and is a pretty big deal with 8,600 employees and annual revenue of $1.2 billion (a little smaller than Cerner). They make it clear in the announcement that their interest is ARRA money. It also says that Pulse is profitable on annual revenue of $16 million, that Cegedim will pump another $13.5 million into the company, and that the value of the acquisition won’t exceed $58 million.

The former chair of the British Medical Association’s IT group urges doctors not to upload patient records to the Summary Care Record, saying it’s unsafe and should require patients to opt in instead of opt out. He’s setting up his EMR to prevent uploading unless patient consent has been checked off and is telling his peers to contact their EMR vendors to make the same arrangements.

This interesting article describes the advanced status of EMRs in Finland (91.1% penetration and a national health network), but calls out the pitfalls: it’s still hard for individual systems to communicate with each other, each local jurisdiction has different privacy rules, and the only way to transfer information when a patient moves to an area that uses a different EMR is to print everything out. I may need a site visit to Helsinki since I’ve not been for a few years and I like it there.

EyeHealth Northwest chooses NextGen’s PM/EMR for its 30 providers.

Free EMR vendor PracticeFusion launches its Research Division, which will publish lists of top-prescribed meds by specialty (which was in the announcement) and sell de-identified patient data (not announced, but that’s been the company’s stated plan, along with advertising to doctors, from the beginning — how else can they give away an EMR?) Some of their arguments on the Research Division page for providing patient data are a bit lame: (a) it’s a public health service; (b) it’s a research service; (c) Kaiser and the VA do it, so why shouldn’t we? (d) and lamest of all, under the category of Social Responsibility, “To keep this information from medical researchers would be a disservice to the safety and advancement of medicine in this country.” If you’re going to sell patient data, just say so — don’t try to make it sound noble.

Guess who’s an HIT demo dolly? Todd Park gets the thrill of having the leader of the free world pitch the site he built. Pretty cool. The President isn’t a Mac man, apparently.

United Health Group is rumored to be buying Executive Health Resources for $1.5 billion, making it part of Ingenix. The Newton Square, PA company staffs hospitals with Physician Advisors to maximize reimbursement, improve efficiency, and improve quality of care.

Mediware renews its agreement with William Blair, which includes exploring “a variety of strategic alternatives to enhance shareholder value.”

Odd lawsuit: a former nurse manager sues Halifax Health (FL) for discrimination after a failed romance with a radiology manager. She provided evidence that included a receipt for a romantic couples massage, but she dumped her beau after discovering she wasn’t the only co-worker with whom he was consensualizing. She says she was harassed after the breakup, including being asked by HR to dress as a go-go dancer during the employee banquet and having one of her patients delayed in radiology for no reason.

E-mail me.

News 7/28/10

From Gregarious: “Re: HCA. They are doing competitive pilots of Meditech 6.0 vs. Cerner, possibly as a move toward displacing the long-term HCA / Meditech relationship.” Verified. HCA will run a Cerner pilot in at least one hospital sometime next year. Meditech 6.0 is a big step from HCA’s Magic (pretty much starting over), so it makes sense to test the waters. The wild card could be how the hosting models compare. Several HCA hospitals have reached EMRAM Stage 6 on Magic, which ironically makes it harder for HCA to switch since you’d need heavy clinical usage from Day One to avoid moving backward. Any change (even to 6.0) will be painful.

From BeCarefulWhatYouWishFor: “Re: Epic. They are about to pick up another large academic facility in Nebraska. You can only imagine who is going to have the LastWord now.” Unverified, but thanks for the excellent punmanship in any case. As a couple of readers pointed out, it will be interesting to see if Epic can scale its model up to cover all these big implementations going on at once. A CIO reader who knows both systems says Cerner requires clients to take ownership of the design and use outside consultants, while Epic offers a more turnkey implementation at a higher price. It’s also interesting that Epic doesn’t offer hosting and Cerner is runnin hard with that offering, so that’s a key differentiator to some prospects.

From SnagMonkey: “Re: Epic. Not officially announced, but all Providence hospitals and hospitals in Oregon will convert to Epic.” Unverified.

From You’ll Know Who: “Re: Epic. Not only is Epic replacing Eclipsys and Cerner at sites, they are likely removing 30+ year old financial systems from McKesson, such as HealthQuest or the old Ibax product. That again highlights the lack of success with the ‘new’ Horizon ERM. It would be interesting to hear which products the CIOs looked at.” My ears are open if anyone wants to share.

From Ragnar Danneskjold: “Re: your comments about Cerner and corporate bureaucracy. Man, can you turn a phrase! I’m going to have that framed and put on my office wall (and then wonder why my career is not going anywhere :-)). Been loving your work for many years now. I don’t know how you do it, but keep on doing it.” Thanks.

From Cheers Across Atlanta: “Re: Eclipsys. Jay Deady announced today at the Eclipsys sales meeting that he will be leaving concurrent with the Allscripts acquisition.” Unverified.

From Reddy Kilowatt: “Re: PM/EMR in Asia. I’m looking for information (Web sites, articles, databases, etc.) on penetration in the smaller private practice market.” I have readers there, so if you know some sources, let me know.

From Anonymous: “Re: Merge Healthcare’s ortho imaging products. I’m surprised you didn’t catch wind of this.” I did, earlier this month when a reader tipped me off that Stryker was selling its imaging division (i.e., ortho products) to Merge.

From Lori S: “Re: AirStrip Technologies. They will announce that their cardio and critical care apps have received FDA approval, setting the bar high for other vendors.” Verified. The news just came across the wire Tuesday evening. AirStrip users can monitor patients in real time from their iPhone, iPad, and other mobile devices. That sound you heard was change jingling in the deep pockets of GE, Philips, etc. as they suddenly think AirStrip Technologies looks like something they’d like to get their hands on. I interviewed co-founder Cameron Powell, MD in February.

SRS will offer customers its hybrid EMR bundled with practice management and scheduling systems from Ingenix, calling it SRS CareTracker PM powered by Ingenix. SRS will also offer its EMR customers a migration path to the Ingenix CareTracker EHR. That’s interesting — Ingenix has been promoting CareTracker much more heavily recently, plus rumors suggest that the company won’t stop its HIT-related acquisitions with Picis.

I’m a sucker for hospital music videos, so here’s one from Lake Pointe Medical Center in Rowlett, TX, a top-rated Tenet facility celebrating its 5-Star Patient Satisfaction Rating for the full year of 2009.

Marshfield Clinical lists its CIO job. An advanced degree is not required.

Monday Morning Update 7/26/10

From Gamara: “Re: Epic. Random stuff found in Googling Epic.” Good sleuthing, although some have turned up previously The following organizations appear to be going Epic: Stormont-Vail HealthCare (KS – above), University of Colorado Hospital (CO), The Mount Sinai Medical Center (NY), Maricopa Integrated Health System (AZ – old), University of Miami Health System, South Broward Hospital District.

From LookingForAnswers: “Re: Epic. They’re winning deals like Cerner did 15 years ago when they were small. Cerner seems to be a revenue-churning machine that the public can participate in by buying stock. The only people who benefit from Epic are the owners and/or Judy. Which company has made more millionaires? Which company will change the face of HIT for the long run?” Here’s the real question: why can’t Cerner, with all its billions in market capitalization and name recognition, compete with Epic for new sales? As has been asked of other Goliaths (Microsoft, GM, Dell, GE, etc.) how could Cerner, given its ample lead time and resources, let the once-tiny David called Epic beat them year after year? My theory is threefold: (a) even entrepreneurial big companies naturally evolve into highly ineffective corporate bureaucracies that are motivated by fear and executive entitlement, the antithesis of innovation; (b) publicly traded companies let their numbers drive their business instead of vice versa, and (c) corporate Darwinism would have Cerner just buying Epic outright, but Judy throws a wrench into that evolution by refusing to sell the company.

But all is not lost: we don’t know Epic’s profitability, so Cerner may be beating them where it counts. And we know that Cerner has built a business that could weather Neal’s transition or sale to another organization, but we don’t know that with Epic. What I care about most is why Epic beats Cerner for every important deal, which would seem to indicate that Millennium isn’t up to the task. In other words, a $6 billion market cap company with a single, fairly low-rated product line that’s getting hammered by a smaller and much higher-rated competitor should think about developing a better product. Here’s another way to look at the value of ongoing R&D: the only company that beats Cerner consistently in new sales is also the only one with a newer product.

From JA: “Re: Epic. More details on the Yale and Epic adventure.” Yale Medical Group describes their plans for Epic, also mentioning that a CMIO will be hired who will share time with the School of Medicine and Yale-New Haven Hospital. The specific Epic features that seemed to seal the deal were the obvious ones: ambulatory-inpatient integration and MyChart, areas in which Millennium is clearly inferior.

From Dave U. Random: “Re: Epic. Google RGHS+Epic.” Rochester General Health System has chosen Epic.

From SEC Fan: “Re: University of Michigan. CareWeb does many things well (less than they claim), but they have installed Eclipsys Sunrise over the last five years for inpatient. Interesting that after 3+ fails at EMR, they get one right and now replace it.” Thanks for reminding me. That’s another big Eclipsys loss to Epic, six years after the contract was signed and less than two years after Sunrise went live at UM.

From The PACS Designer: “Re: Windows Phone 7. The mobile phone marketplace will have more competition soon, as Microsoft has announced the beta for Windows Phone 7.” It had better be good if it’s going to displace the iPhone, Android, and BlackBerry this late in the game. I don’t see Microsoft as being good at come-from-behind victories; it’s better at running a prevent defense to protect the leads it generated a couple of decades ago. On the other hand, Windows 7 was a hit, so maybe they’re finally getting it.

From Vendor CEO: “Re: HIStalk. I have really enjoyed watching your progression. It’s kind of like watching the New York Times and Murdoch sites (HIT rags) try to get customers to pay for their sites while hordes of readers are rushing to all the free specialty news sites (HIStalk). Fascinating!” Thanks. Maybe I’m the open source alternative, a marginally skilled but enthusiastic spare bedroom pseudo-journalist trudging home to a PC after a long day at the hospital.

Listening: new from Grand Mal, which sounds like the Rolling Stones playing a smoky New York club in 1973.

Tom Ogg is named CIO of Akron Children’s Hospital, coming from Oakwood Healthcare Systems (MI).

Stuff you can do here: (a) put your e-mail in the Subscribe to Updates box to your right and be the first to know; (b) use the Search All HIStalk Sites box to dig through all HIStalk-related sites, including the 7+ years since HIStalk has been around; (c) send me your secret information and rumors via an anonymous Rumor Report, the lifeblood of HIStalk; (d) Friend or Like us on Facebook; (e) support my sponsors by giving their ads an occasional look and click; and (f) send in a pitch-free Readers Write article.

Not many readers think the final Meaningful Use requirements are too hard for providers to meet, but beyond that, it’s pretty much even as to whether they’re too easy or about right. New poll to your right: who benefits most from Most Wired-type awards?

A reader mentioned a JAMIA article last week, eliciting only a general reply from me since I didn’t have access to the full text version. Thanks to the folks at AMIA, who read my comment and hooked me up with anonymous access to their site so I can give a better answer next time around.

This from Weird News Inga: a medical practice sues its landlord over rights to a meteorite that crashed through the roof and into their examination room. The landlord claim it belongs to them, but the doctors say the landlord plans to renege on their promise to sell it to the Smithsonian for $5,000. The doctors say they’ll honor that deal and send the money to Doctors Without Borders for Haitian relief.

These rumors come up all the time, but once again Oracle comes up as a potential acquirer of Cerner. An Oracle VP supposedly claimed the company will spend $70 billion on acquisitions over the next five years, which always leads to talk about vertical markets such as healthcare, which means Cerner.

Duke University researchers develop software to predict MRSA drug resistance, offering it free to researchers.

Interesting: All Children’s Hospital (FL) will become part of Johns Hopkins Medicine (MD). In related news, the governor of Maryland wants to position the state as a health IT leader, citing a statewide HIE, EHR implementations, and recruitment of HIT professionals.

E-mail me.

News 7/23/10

From Erin: “Re: Medicity and Axolotl. I heard a rumor that both were on the sale block with active participants. That sure would give a new stimulus to the HIE market.” Unverified. The rumors I’ve heard say that Raymond James is shopping Axolotl, with a possibility that RelayHealth will be announced as the buyer soon. Medicity is getting feelers, supposedly, but it’s going to take some serious cash to get their keys and I’d expect the company to do some acquisitions of its own to raise the stakes. It’s a pretty great time to be in the HIE business since everybody wants government money, connectivity, and control of massive amounts of data. The proposed Ingenix acquisition of Picis may be the first signal that insurance companies (like Ingenix parent UnitedHealth Group, market cap $35 billion) are putting their smartest guys in the room on the problem of how to position themselves for healthcare reform.

From Dan Mann: “Re: Epic. Signed LSU’s 10 hospitals.” Unverified, but this is getting ridiculous. Does any vendor other than Epic ever sell a full system to a 400-plus bed hospital these days?

From Flynn: “Re: Most Wired. Why haven’t you mentioned the winners?” Because I don’t care. Hospital IT is not a competitive sport, other than for magazines hoping to sell ads, their vendor advertisers hoping to sell systems, and their participating CIOs seeking a career-enhancing resume credential. Filling out a survey of what you’re doing with computers doesn’t impress me nearly as much as proving your technology-driven superior patient outcomes and lower costs. Unfortunately, the winners can’t usually do that (and in fact, the relationship often seems to be inverse).

From Kelly: “Re: Mike Cottle. The IT director at the former Sumter Regional Hospital has taken an IT director job at Newton Medical Center (KS).” I interviewed Mike after a tornado destroyed his hospital in 2007.

From Laura V: “Re: Picis. What’s up with your sponsors getting bought?” Inga and I were just talking about that. I’m not claiming a relationship, but companies that sponsor HIStalk seem to have a great track record in being acquired under favorable terms. We like to take a small amount of credit for their success even though we usually lose a paying sponsor, so our celebration is short lived. I did get some nice e-mails this week from some investment banker types who appreciate what I do, so thanks to them.

From Ted Nugent: “Re: Ingenix. The Picis acquisition implies they’ll be doing other acute care deals soon. Healthland or SIS, perhaps? Both have a book out.” Unverified. It’s funny how you’ve never heard a phrase, then suddenly you hear it from a bunch of different people. “Have a book out” means a company is seeking a buyer, as I now smugly know.

From Briana: “Re: CPHIT, CPEHR, and CPHIE certifications. Are they worth pursuing? Do hiring managers care? I have 25 years in healthcare IT.” You’ll get different opinions, mostly depending on whether the person you ask holds certifications, but I consider these (and any other certifications, whether it be CPHIMS, certified healthcare CIO, etc.) mostly a waste of time and money unless you have no other credential and are desperate to hide a lack of experience or formal education. I’m not trying to be harsh, just realistic: non-technical certifications don’t mean anything except as an income source to those who offer them, some of which are purely for-profit companies exploiting career insecurity (lack of a degree, lack of work history, lack of US experience, etc.) If in doubt, read a bunch of healthcare IT job listings and count those that require or favor certification (the military is a possible exception since they do in some cases). Nobody’s going to hire you just because you wave some credential they’ve never heard of. We’ll know the industry has lost its mind if it requires a 25-year HIT veteran to prove they didn’t snooze through it by passing a multiple choice test. But certification can’t hurt, so if you don’t mind spending the time or money, do it with appropriately modest ROI expectations.

From Safety Not: “Re: JAMIA article on unintended consequences of e-prescribing. It is not known whether there are advantages over paper in the real world of medical care.” I didn’t see a full text link, but the abstract says the problem is allowing prescribers to enter free text instructions, basically turning e-prescribing into a clipboard with the same inherent risks. I wouldn’t take that as being indicative of a problem with those systems, but rather how they are deployed.

Listening: Scarlet Storm, “female-fronted symphonic gothic metal.” Found them accidentally, like them.

Inga did her usual bang-up job in collecting the thoughts of over 20 vendor executives on the final Meaningful Use rules (and in doing so, earned herself the night off from HIStalk). Some of them are really insightful, offering a fresh take that providers should notice. You can’t ask executives a question without expecting a little sales pitch and she got some of those, but I think every person she interviewed gave some good perspective or advice. Definitely worth a read. You’ll make Inga happy if you add your e-mail address to the Get Instant Updates box while you’re over there since she’s passionate about tracking her stats (she’s insecure in the cutest possible way).

Q2 numbers from athenahealth: revenue up 28%, EPS $0.04 vs. $0.06, beating expectations. Shares are up 7% in after hours trading as I write this.

Microsoft’s Q4 results: revenue up 22%, EPS $0.51 vs. $0.34, beating expectations. Good numbers, helped by Windows 7 and Office 2010.

Weird News Andy goes all culinary in his observational humor, asking of Terra Haute Regional Hospital, “Does their cafeteria serve Haute cuisine?”

Doctors in Australia complain about the new EMR installed in two hospitals, saying that it’s “unfriendly and wastes a lot of time” and “is an awkward electronic and written hybrid.” I can’t swear to it, but I think it’s Cerner, although the doctors say it’s an old version of whatever it is. “It is a US developed system, but in the US they are using version 11 while we are using version three.”

Confirmed: University of Michigan signs with Epic, ditching its homegrown CareWeb. The price was quoted at $20 million, but I would be shocked if that’s all it will cost (although that’s probably software only). The article also said that UM will be eligible for only $2 million in HITECH money, which also sounds way too low for a 930-bed hospital system.

Jobs: QA Engineer, Clinical Product Analyst, Project Manager – Physician Liaison, Web Application Developer.

Tim Thompson’s former CIO job at Methodist Houston is posted. Like many or most CIO jobs, this one requires only a bachelor’s degree and experience.

North Shore-LIJ chooses Skire Unifier for managing its capital projects. I’ll be honest: I hadn’t heard of it, but several big hospitals apparently have.

Harvard Medical School toughens up its conflict of interest rule for faculty, prohibiting them from shilling drugs and accepting free meals and trips. Their consulting and board income is also limited and payments of $5,000 or more must be reported on the school’s Web site. My hero, Senator Chuck Grassley, is largely responsible since he investigated some Harvard docs for taking Pfizer’s money (an excerpt to his letter to Pfizer’s CEO above).

GE Healthcare and Boeing are fighting over a section of the communications spectrum. Boeing uses it to test planes; GE wants it for patient monitoring.

WNA competitor Guy ran across this story. A woman who had just delivered a baby is visited by a group of women who enter her hospital room, shut the door, and start beating her up over comments she made on Facebook. People who’ve never worked in a hospital would be amazed at how often human drama unfolds right in the rooms. I’ve taken guns away from patients, watched a newly delivered 12-year-old mother hitting on a hospital security guard, and declined the offer of patients to share their recreational drugs. There’s a reason they put metal detectors and police officers at the ED door — hospitals are one place other than the driver’s license office where community demographics are proportionately represented.

E-mail me.

Ingenix To Acquire Picis

Ingenix announced this morning that it will acquire Picis, the Wakefield, MA-based vendor of high-acuity systems for surgery, anesthesia, intensive care, and the emergency department. Terms were not disclosed.

The announcement describes the strategy behind the acquisition:

Ingenix is best known as a leader in health intelligence and analytics throughout the health care system. The combination with Picis significantly strengthens Ingenix’s position in the delivery system, where Ingenix serves nearly 6,000 hospitals in the U.S. with consulting, technology and outsourcing solutions. Picis will extend Ingenix’s capabilities into the high-acuity information systems market.

Ingenix CEO Andy Slavitt was quoted as follows:

This marriage of ‘health intelligence’ and clinical workflow will provide substantial value to patients, physicians and hospitals. Tremendous opportunities exist to use information and technology to modernize the high-acuity area, delivering better care and greater efficiency to these high-volume areas of the hospital, where resource consumption is often at its greatest. Working with Picis’ world-class senior leadership team and talented employees, we believe we can make meaningful change in this critical segment of health care.

I spoke Wednesday morning with Todd Cozzens, Picis CEO and vice-chairman, who explained the rationale behind the acquisition.

”I’m happy with it –  this is a great home for Picis,” he said of Ingenix. “These guys are at the epicenter of what’s happening with healthcare. They know all aspects of reform – data mining and data analytics. Winning the game in reform is about having the best health intelligence. Ingenix has bought into the strategy of hospitals becoming high-acuity centers that need data to drive decisions and to understand the supply chain.”

Cozzens will serve as chief executive of the Ingenix high-acuity business. Most of the Picis management team will transition as well. Operations will remain in Wakefield.

Cozzens says the acquisition was driven by capital requirements. “The minimum market cap to be a serious publicly traded company is now at $1 billion,” he says. “It would have taken 3-4 years for us to get there.”

News 7/21/10

From News This Week: “Re: sale. One of your quoted CEOs will announce the sale of his company on Wednesday and hold an all-employee meeting on Thursday. A solid acquisition that will give the company extensibility internationally, although you will scratch your head for 3-4 months on what the purchaser is doing until the strategy emerges over the fall of 2010.” That’s Picis, I assume, although I don’t have solid information on the acquirer if it’s them (one reader says Ingenix, another says it’s a less obvious but unnamed player).

From Htx: “Re: Tim Thompson, CIO at The Methodist Hospital of Houston. He’s leaving to return to Florida.” Unverified. UPDATE: verified – he will be announced as the new CIO of BayCare (FL), Lindsey Jarrell’s old job.

From Cabrini Green: “Re: HIMSS Analytics Europe. HIMSS Analytics staff visited Germany to meet their new colleagues. The picture is funny — it looks like Steve Lieber and Jeremy Bonfini are holding hands.” It does, even though they aren’t.

From Elsie EHR: “Re: IBM. Who remembers ten years ago when IBM (along with Pfizer and Microsoft) sunk a chunk of change into an EMR called Amicore? Amicore was acquired by Misys in 2006, and of course Misys was acquired by Allscripts last year, which will merge with Eclipsys this year. Golly, I can hardly keep my dance card straight!”

Also from Elsie EHR: “Re: Aprima, formerly iMedica. I wonder if they will go after the Allscripts MyWay customers since MyWay and Aprima are the exact same product?” Careful … I don’t have confirmation on the rumor that Allscripts will sunset MyWay in 2012, so I assume it’s not true. Also, just to clarify, MyWay was the same product as Aprima only when that deal was originally signed in August 2007 (see my interview with Michael Nissenbaum, president and CEO, for more background). Since then, Aprima has continued to develop and sell the product separately from Allscripts, so they are no longer the same product even though much of their DNA is identical.

From UK Horlicks: “Re: British Medical Association. It has recognized Horlicks, the drink for HIT, with the slogan, ‘A drink other than Kool-Aid for HIT.” BMA demands that the government suspend access to Summary Care Records, saying it is unreliable since doctors aren’t keeping the uploaded patient records current.

From Anesthete: “Re: University of Michigan Hospitals. Recently signed with Epic to provide enterprise clinicals and financials in a plan to achieve MU.” Unverified. I mentioned that Hurley, which is affiliated with UM, had signed on, but that’s all I know. UM used to have a homegrown system that someone was trying to sell as I recall, but I never heard much about it.

From Zooey Rice: “Re: Amalga. A user of the Microsoft Amalga HIS says the company will exit the HIS market to concentrate on other things, like HealthVault or UIS. Love reading you every morning — smells like … victory.” Verified. Microsoft will announce Friday that its Health Solutions Group will discontinue sales and development of Amalga HIS to focus on Amalga Unified Intelligence System (the former Azyxxi). I didn’t really understand why they bought it in the first place considering it was a Thailand-based product with one notable customer, medical tourism hospital Bumrungrad International in Bangkok. Hanging the Amalga name on it was just plain confusing since in the US, Amalga was just the former Azyxxi product. My comment in 2007: “I don’t know why Microsoft wants to be in this business either, although maybe Azyxxi needs a little brother.” More from the company:

Amalga HIS, based on technology acquired from Global Care Solutions in 2007, is a traditional hospital information system designed to address all of a hospital’s transactional and reporting needs. Working with customers over the past three years, we’ve learned that an all-encompassing solution is not optimal for meeting the varied and dynamic needs of health organizations around the world. As a result, this approach is not well aligned to Microsoft’s broader health IT strategy moving forward. We will continue to develop and sell a RIS/PACS solution based on Amalga HIS and will look at other opportunities to leverage Amalga HIS functionality on the Amalga UIS platform.

HSG will continue to support our customers’ use of Amalga HIS through sustained engineering and support services for at least five years. We are working with each Amalga HIS customer to address their short and longer-term needs – moving them forward to HIS version 6.0 or identifying partner solutions that, together with Amalga UIS, could meet their requirements. Amalga UIS, based on the Azyxxi technology, is a highly flexible solution that enables healthcare organizations to reengineer workflows and get information to professionals when and where they need it.

From Cassie: “Re: St. Luke’s Health System in Boise. They’ve had a data breach in which a significant number of employee records, including SSNs, have gone missing. They are trying to squash the news report, especially given the other recent news from them.” Verified, but it wasn’t the health system’s fault. Mercer, the HR consulting people, loses a St. Luke’s backup tape when moving to a new office. St. Luke’s was in the news last week when its data center lost power, forcing clinicians back to paper.

Listening: Built to Spill, Boise-based, mature, Northwest-style indie rock.

Allscripts’ Q4 numbers: revenue up 14%, EPS $0.10 vs. $0.09, guiding up. The company beat expectations on both revenue and earnings for the quarter, but fell just short on consensus yearly revenue. CORRECTION: Allscripts actually slightly beat yearly revenue expectations – it was the company’s 2011 guidance that came in slightly low in the range of expectations, an announced $780 to $790 million vs. estimates of $787 million. All of these numbers exclude the impact of the Eclipsys acquisition. The conference call transcript is here.

Apple’s Q3 numbers: revenue up 61%, EPS $3.51 vs. $2.01, handily beating estimates. The company sold 3.3 million iPads, 9.4 million iPods, 8.4 million iPhones, and 3.5 million Macs in the quarter. Market cap is $229 billion, $6 billion more than Microsoft, and shares are naturally up on after-hours trading.

Iowa’s HITREC names e-MDs as a preferred EHR vendor.

ONCHIT is looking for a policy analyst to focus on consumer e-health.

Weird News Andy is reduced to puns in describing medical technology put to a seedy use — MRIs of food. Obviously fixated, he adds, “The one I found most interesting was the watermelon. The way the seed groups spiral puts to rest my sleepless nights wondering about their seemingly random distribution.”

HCA Midwest names Sarah Bloom as CIO.

Kingman Regional Medical Center (AZ) chooses SIS for periop.

Another backup tape mishap: South Shore Hospital (MA) determines that backups with 800,000 patient records were lost by the shipper on their way to destruction.

Epocrates files for a $75 million IPO, the same amount it planned to raise in its aborted 2008 attempt. Sales are at $100 million, but the company lost money in the most recent quarter. It plans to bring out some kind of EMR application for small practices this year.

Confirmed, thanks to a reader’s forwarded company e-mail: Kate Kervin joins NextGen as  SVP of marketing and product management, leaving Siemens. Brad Block of IBM (and former Doylestown Hospital CIO) is hired as VP of NextGen Consulting.

Minneapolis-based HealthPartners will use a mobile healthcare communications platform from Toronto-based Diversinet, starting with a two-way secure messaging system for discharged patients with chronic illness and women with high-risk pregnancies.

New Hanover Regional Medical Center (NC) chooses Perceptive Software’s ImageNow for scanning and approval of invoices, integrated with Lawson.

SAP partners with a consulting firm to develop financial and logistics applications for under-400-bed hospitals.

Jersey City Medical Center (NJ) rolls out the Isabel diagnostic checklist system.

Iron Mountain announces its EMR Enablement Solution to help hospitals organize and digitize paper records. It sounds like a marketing repackaging of existing offerings.

Small practice EMR vendor Patagonia Health gets a startup grant from a technology accelerator in its home state of North Carolina. Its product went GA on March 31. Former Misys software director Ashok Mathur is a co-founder.

This fun article profiles some doctors who write medical smart phone apps.

MedPATH Networks announces a marketing agreement with a digital rights vendor to commercialize security technologies that are used for military EMRs, including a secure information exchange based on NHIN standards. I haven’t heard of any of this, but it sounds interesting.

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HERtalk by Inga

HIMSS names three additional finalists for the Davies Awards, including Open Door Family Medical Center (NY) in the Community Health Organization category and Sentara Healthcare (VA) and Nemours (DE) in the Organizational category.

Beaufort Memorial Hospital (SC) says the installation of MEDHOST in its ED increased gross revenues by $1.3 million increase and saved $240,000 annually by replacing dictation with electronic charting. And, Tenet Healthcare has contracted with MEDHOST to add the Care Clock application, which enables hospitals to automatically post current ED wait times to their Web sites.

New from KLAS: a report on homecare finds that three of the top four rated homecare systems are sold by best-of-breed vendors. The top-rated vendors were Homecare Homebase, Delta, and CareAnyware. Meanwhile, Meditech clients find that PTcT is outdated and difficult to use, with 40% saying they’re considering a switch.

HHS wants to use ARRA money to develop a national inventory of research on the most effective treatments and medical interventions. The information would be available as a searchable online tool for physicians and the public.

Huntington Memorial Hospital (CA) selects the Allscripts Community Solution to power its HIE. The Community Record solution is powered by dbMotion. Centra (VA) also plans to implement the Community Exchange platform as well as provide Allscripts EHR for 70 staff and affiliated providers and Allscripts Homecare for its home health nurses.

Globally, wi-fi technology in healthcare grew 60% last year. The US healthcare market will add more than 500,000 additional networks this year, representing a 50% jump over last year.

Giant Mr. Whale has apparently found a new home at Epic’s headquarters, according to the artist. He (Mr. Whale) looks like a happy guy. The artist has a link on his Web site to more attractions on the Epic campus. I think my favorite is the subway.

ITalagen and Medificiency form a partnership to promote a physician practice solution that includes Allscripts EHR and ITegen’s medical billing services and IT support.

No surprise here: an survey finds that EHR implementations are the top priority among the HIT crowd, with 85% saying they are in the  midst of an EHR project or plan to start one within 18 months. More surprising: of the 110 professionals surveyed, 13% reported using Epic, 11%  Cerner, and 8% Siemens. How “random” are these results if Meditech or McKesson weren’t named?

I must ask Matt Holt if this qualifies as Health 2.0. A 64-year-old Pennsylvania woman avoids dialysis after finding a donor kidney via Facebook, getting 197 responses to her plea.

Philips Healthcare’s second-quarter sales were up 4% over last year and second quarter earnings were $280 million, compared to $198 million. CFO Pierre-Jean Sivignon said the US healthcare market was “bouncing back” after a period of financial crisis and regulatory uncertainty.

E-mail Inga.

Monday Morning Update 7/19/10

From Friend of Tim: “Re: Yale New Haven. They’ve signed with Epic and the CIO is out.” Verified. Health system SVP/CIO Mark Andersen confirms that YNHH signed a contract with Epic this week (no surprise there – I said months ago that they were going Epic if they could find the money and Mark confirmed). They just brought up Eclipsys Sunrise CPOE and pharmacy a couple of years ago and were also running nurse and physician documentation, so Eclipsys loses a high-profile customer. With the Epic deal done, Mark will be leaving in a couple of weeks after 13 years there. He’s always been gracious and quick in responding to my questions. I wish him the best.

From CP Uh-Oh: “Re: Chicago CPOE error detailed in a Friday happy hour e-mail blast.” The purported e-mail from a Chicago hospital radiologist:

We have discovered a systems issue that may convert CPOE orders for CT examinations without IV contrast into CT examinations with IV contrast in Radiant. I have asked all Radiology Faculty and trainees to be particularly cautious in protocoling CT contrast examinations, and would like to enlist your assistance in carefully checking contrast CT orders. In addition, until the problem is solved, it would be prudent to call CT to verify that contrast will not be administered to at risk patients. Your support is appreciated.

From CPAhole: “Re: Allscripts MyWay. I heard they’ve said they won’t support ICD-10 in MyWay since it will be sunsetted in 2012.” Unverified. I’ll be incognito at the Allscripts user meeting August 5-7, so if I don’t hear anything before then, I’m sure I will there in Las Vegas. Inga and I speculated when the merger was announced that MyWay was the square peg in a round hole, but we were just guessing then, too.

From A Once-Burned Skeptic: “Re: IBM’s $100 million healthcare investment. This strikes me as funny. Didn’t IBM invest roughly the same amount a few years ago by buying Healthlink, which had doctors and nurses focusing on healthcare transformation? If IBM would have simply retained the talent they had from that acquisition, they would be well positioned to do exactly this right now. Call me a skeptic on IBM’s interest in healthcare.” Everyone should be skeptical since companies like IBM and Oracle are always immersing themselves in healthcare for a couple of years, then losing interest after spending a ton of money with little to show for it. IBM couldn’t keep Kaiser as a customer for its expensive custom software development once Epic got traction, blowing through $400 million of Kaiser’s endless fortunes before they were replaced with Epic for $2-4 billion. I’m not sure how its $400 million deal with UPMC turned out. Healthcare IT is one of those things that seems to work backward from nearly every other product: the bigger and more diversified the company selling it, the less impressive the result.

HIStalk readers would have voted Don Berwick into his CMS administrator job given the chance, but only barely. New poll to your right: are the final Meaningful Use requirements for providers too easy, too hard, or about right?

Ed Marx has added his responses to your comments on his Strategic Plans – Getting to 2.0 post from last week. Want him to write about something specific? He would be pleased to hear from you.

CapSite will announce Monday that Saint Like’s Health System (MO) has subscribed to its service, which offers line-item pricing breakdowns from healthcare IT contracts and proposals in 60 categories.

Everybody, me included, is sick of hearing about Meaningful Use now that the regs are final. I think a few more practices in the 1-5 doc range might be interested with the bar lowered a bit, but I’d still bet most of them will run the numbers and pass, at least for now. The final MU requirements, as flexible and less demanding as they may be, still aren’t worth meeting in strictly financial terms, so that means hospitals, large practices, and tech-savvy small practices will get most of the checks. The great majority of practices and hospitals are small (1-5 docs and <100 beds, respectively) and I expect they’ll look at the ambitious timeline, the cost, and the stress on already-stressed doctors and simply say no to Uncle’s strings-attached cash (I’ve always called that my “Free Kittens” theory). We’ll see how accurate all those surveys have been that claimed the only thing holding docs up was upfront EMR cost.

Another new Epic site: Hurley Medical Center (MI).

Apple’s response to its embarrassing Antennagate iPhone 4 problems have been quite un-Apple like. I can imagine an HIT vendor faced with angry customer backlash over a CPOE bug reacting the same way in sequence: (a) it’s your fault for using our product incorrectly; (b) it’s actually not a problem, but a minor bug that makes it look like one and we’ll fix that eventually; (c) we’re not really sure if it’s a problem, but the best option is for you to spend your own time and money adding on a third-party solution; (d) OK, it might really be a problem, but it hasn’t been reported much, so it’s not a big deal; and (e) OK, it’s definitely a problem, but it’s the entire industry and not just us and everybody needs to do a better job.

GE’s Q2 numbers: revenue down 4%, EPS $0.30 vs. $0.27. Jeff Immelt says healthcare orders, along with oil and gas, were “particular bright spots.” GE Healthcare’s revenue and profit were up, at $4.1 billion and $661 million, respectively.

Verizon announces the Verizon Health Information Exchange, offering a clinical dashboard, patient index, and secure messaging. The MedVirginia RHIO has signed on, presumably meaning that its original (struggling) vendor Wellogic is out. Verizon’s offering runs on the Oracle Healthcare Transaction Base, which I thought had fizzled out years ago after the usual big splash followed by corporate indifference. Just in case it isn’t obvious, Verizon’s healthcare interest surged recently when taxpayer wealth was redistributed to make it more lucrative. Since HITECH, the company has announced services for security, telehealth, and physician data sharing.

A fun story: the guy responsible for killing a proposed Anthem Blue Cross 39% medical insurance rate increase in California is a work-from-home actuary who did part of his analysis from a hospital bed. California law requires the state to accept insurance rate hikes as long as the company proves it’s spending 70% of the premiums to pay medical claims (obviously that idea contains endless misaligned incentives that help keep healthcare costs rising). Hired by the state to double-check the insurance company’s numbers, the actuary found obscure mistakes in some of its inflation projections. Anthem and its corporate parent WellPoint claim appreciation for his diligence and express their relief in being able to hit the state up for less money (anybody buying that?) They resubmitted an increase request for half the original amount and then tried to hire him. A consumer group said, “He slew the giant. It was David versus Goliath, except David was armed with a calculator rather than a slingshot.” His tiny company also offers hospital services, including provider contracting and medical management reviews.

More only-in-California goofiness: 1,000 nursing union members picket the $3 million house of billionaire Meg Whitman, former eBay CEO and current candidate for governor. They’re upset at her promises to cut the state’s budget (including their pensions) even though it’s running a $20 billion deficit. She’s even in the polls with Jerry Brown even though she’s never held office and doesn’t even vote all the time. She’s spending up to $120 million of her own money to gain the seat.

St. Luke’s Health System (ID) loses power for 24 hours, forcing it to go to paper when its backup power systems also fail. My experience with backup generators is about the same as with data backups: they work about 80% of the time, which means IT is going to look really stupid in 20% of the unexpected disasters.

E-mail me.

News 7/16/10

From Lumpy Rutherford: “Re: Kate Kervin. Moved from Siemens to NextGen as SVP of marketing and project management, started this past Monday.” Unverified. Neither her LinkedIn profile or the NextGen executive page says so, but that doesn’t mean much.

Listening: Margot and the Nuclear So and So’s, polished, sweeping indie rock (or Indy rock, since that’s where they’re from). They are amazingly good.

IBM will spend $100 million over the next three years on healthcare transformation projects: creating evidence-based protocols, simplifying healthcare delivery, and studying the shift to an outcomes-based reimbursement model. The company says it will hire new people, among them doctors and nurses working on the front lines.

Fujifilm will commercialize the iPhone-based stroke diagnosis application developed by a hospital in Japan. Physicians are using it to review CT scans remotely.

I was talking to the new crop of residents at my hospital, most of whom were unimpressed (justifiably) with our clinical systems. I asked three of them which systems they had used that were better. Two said Epic and one said Eclipsys. I didn’t disagree.

OB-GYN EMR vendor digiChart brings on former McKesson sales VP Bob Allen (sales) and former Healthgate CTO Stephen Faris (R&D).

The number of Americans who support President Obama’s healthcare reform package: 36%.

Camden-Clark Memorial Hospital (WV) signs up with Eclipsys for what sounds like all Sunrise modules plus EPSi. Camden-Clark is also connecting its 70 owned or affiliated physician practices, which run the Allscripts Professional EHR, using Eclipsys HealthXchange (which is Medicity).

Scottish charge master software vendor Craneware says its sales reached a record $54 million in the year ended June 30.

Healthcare Growth Partners releases its Q2 report covering HIT-related capital markets, mergers and acquisitions, and capital funding.

Weird News Andy delivers this story about a woman pregnant with two babies that aren’t twins. She has two uteruses (uteri?). Or as WNA says, quoting Homer Simpson, “It’s uterus, not uterme.”

Dan O’Neil let me know that he’s taking a job with consulting firm Arcadia Solutions, leaving his CIO slot open at Quincy Medical Center in Boston just in case you’re interested.

Eclipsys shareholders will vote on the company’s planned acquisition by Allscripts on August 13.

Jobs: Senior DBA and Storage Engineer, Web Application Developer, Lab Systems Project Manager, Project Manager – Meditech Conversion.

Australia’s Lingo Systems will give away $1 million worth of software licenses as a promotion for its SMS message-based hospital staff scheduling system. Nurses indicate their availability on a Web page and are texted when the hospital needs one of those shifts covered. The first nurse to text back “yes” gets the shift.

Disciplined nurses are using multi-state licensing agreements to keep delivering care after misconduct. Recordkeeping isn’t up to date, so nurses disciplined in one state sometimes have clean multi-state licenses. One Wisconsin nurse who was fired and later convicted of stealing Dilaudid said, “When I went to go for the job in North Carolina, looked at the status of my license, and it was still active. That kind of surprised me, so I figured I would take it."

HHS launches a Meaningful Use Web site that includes the final EHR incentive details and final EHR standards and certification criteria.

Hospitals in Greece were overcharged for medical equipment by Siemens, prosecutors say, with some hospitals paying more in annual maintenance than the equipment was worth.

The iSoft tailspin continues: two of its Australian executives quit and the company downgrades its expected revenue based on NPfIT delays. Market cap has shrunk from $1.5 billion to $170 million and an Australian publication says iSoft has cut 600 jobs and will eliminate another 500 by the end of the year. Private equity firms are poking and prodding, of course (who wouldn’t at that price?)

Announced this week and darned cool: Google’s App Inventor for Android lets non-programmers build apps for Android phones using predefined controls. Some of the available tools can access a GPS sensor, automatic texting, and interact with Web sites. Brilliant. Somebody build something cool for healthcare and write up your experience – I’ll run it here.

E-mail me.

HERtalk by Inga

From Ed Marx: “Re: final Meaningful Use regulations. I am pleased with the compromise reached by CMS/ONC. The program remains as designed, an incentive, not a give-me. It strikes a strong balance between a stretch goal while being realistic with industry current state.” I had asked Ed to share his initial, high-level impression of the final rules. It’s interesting to note that several months ago, Ed expressed concern over the preliminary measurement requirements, believing they represented a “high hurdle” for many organizations. 

From Really?: “Re: final regs. They lowered the bar so much that my four-year-old could achieve Meaningful Use! The government might as well hand out money to everyone.”

From Chicago Skyline: “Re: The fine print. In talking to a few folks, vendors seem to worried that they will need to include in their software the reporting tools for the meaningful use metrics. In other words, the software must have a report that shows what percentage of all meds were electronically prescribed. What do you understand?” Just when I thought I was nearly an MU expert, I have to punt. I didn’t have time to look through the fine print today, but maybe someone who has can chime in.

From CheerLeader: “Bravo! Hurrah! Well done, Inga! Great work on your synopsis — I actually have something to pass along to by C-levels that they will understand.” You would think that after 3-1/2 years of doing this I would no longer be surprised that people really do read what I write. If you are more interested in how the final regs affect Eligible Providers, check out the summaries posted yesterday on HIStalk Practice.

Wellsoft wins a couple of EDIS deals in Canada. Kingston General Hospital and Hotel Dieu Hospital, which share hospital information systems and IT support, will jointly implement Wellsoft.

Westbury Hospital (TX) is implementing ChartAccess EMR from Prognosis for is new 137-bed facility.

Healthcare providers are generally still confused about certification requirements for ambulatory EHRs, according to a recent CapSite survey. Two-thirds of providers consider certification to be a very important element in their EMR evaluation process and more than half think that CCHIT certification is a requirement to receive stimulus funds. Sixty-nine percent weren’t aware the feds would be accrediting other organizations beside CCHIT. If I handled marketing for CCHIT, I’d figure out some sneaky way to leverage this last data point with vendors. Nothing like a little fear to scare a physician away from an otherwise good purchase decision.

Sharp Healthcare (CA) selects Allscripts Community Record, which is provided in partnership with dbMotion. Sharp uses Allscripts EHR for its employed physicians and has deployed Allscripts’ Care Management and Referral Management applications. The Community Record will connect the Allscripts systems with third-party clinical applications to create a single community patient record.

CAP STS signs a collaboration agreement with the Barcelona-based healthcare consulting firm Gesaworld. The two organizations will provide consulting, training, and implementation services for HIT standards.

Trace Devanny won’t be unemployed more than a weekend. The former Cerner president is taking over as CEO for The Trizetto Group, effective July 19th. Trizetto founder and current CEO Jeff Margolis will remain chairman of the board. Devanny will be based in Greenwood Village, CO, which will also become Trizetto’s new headquarters.

Home health and hospice software provider HealthWyse partners with ZirMed. HealthWyse will combine ZirMed’s claims management tools into its clinical and financial information system.

IOD Incorporated, a provider of release of information services, is infused with $35 million of growth equity from LLR Partners, a PE firm.

A reader sent over a note suggesting he had some “scoop” from the AMDIS Physician-Computer Connection Symposium, which is going on right now in Ojai, CA. Unfortunately he was in a hurry (something about a blackberry martini reception) and so far all I’ve gotten was this picture. I’m not sure who the speaker is, but the crowd looks totally engaged. I await rumors and/or martinis.

E-mail Inga.

News 7/14/10

From CernerDoesItToAnutherExec: “Re: Trace Devanny. He’s leaving Friday. He was shipped by Neal to France early this year, which is like getting dead fish in the Sopranos. Unlike the last 5-7 execs, it looks like Trace left on his own.” Too bad I don’t usually post news on Monday since that’s when this came and I’d have had a scoop. As I said on February 12 when Cerner announced his transoceanic relocation, “It seems curious that Cerner would allow its president to live and work overseas when only a tiny bit of its business comes from there, so I’m guessing there is more to that story.” It was nice timing to release not-so-positive company news on the day of Meaningful Use’s rowdy debutante ball (and not only just ahead of the earnings announcement, but “to pursue other opportunities” that apparently start just three days from now – hmmm). They’ve already removed him from the Web site. Neal will now hold all the Cerner titles – president, CEO, and chairman of the board. His Pie is secure.

From Jacob Black: “Re: Daniel Barchi interview. I guess Epic has a very closed system like Apple, but the similarities stop there. I think one of the problems with HIT today is that there are too many Microsofts raking in the implementation fees and we desperately need an Apple to shake things up. I think we’ll see one arrive in the next 24 months, and when it does, it will be a game-changer.”

From Dr. Boogie: “Re: Gibson General Hospital, Indiana. Medicare fraud.” The fired hospital CFO goes whistleblower.

From Ms. MarCom: “Re: Meaningful Use. All I can say is WOW. You have totally blown away any publishing competition this morning, both from a posting standpoint and from a speed of analysis standpoint. WOW! Great job!” I replied back to Ms. M that I would treasure her nice words, especially if I got fired for spending a couple of hours digging through the MU rule instead of working for the hospital whose clock I was on at the time. I don’t know if my employer would buy the industry service argument that I had rationalized. Our only plan for the day was that Inga would sit in on the Webinar, so it was impromptu.

From Ivo Nelson: “Re: consulting company life cycle. I’m going to take offense to your comments regarding your life cycle for consulting firm buy-outs. What you failed to mention was that some of us build our businesses on delivering for clients. That delivery creates trust that leads to more business. It takes years, if not decades to build the level of trust needed to be in the ‘inner circle’ of the CIOs. Most of them aren’t stupid and don’t just buy the current consulting fad; rather, they hire firms they trust and respect knowing these decisions can be career-limiting if it leads to a bad implementation. The reality of our business goes well beyond the spin. In my world, there’s an intermediate step that few of the hundreds of consulting firms that start up in this space ever achieve — that is widespread respect and trust that only happens through the grind of delivering on projects year end and year out. Trust doesn’t happen through spin.” Ivo knows I was being tongue-in-cheek. He’s right that a consulting company doesn’t grow enough to be an acquisition target unless they do things very, very well, like he did with Healthlink and is doing again with Encore Health Resources. My ribbing was aimed more at the companies (usually hardware vendors) that buy them thinking it looks like easy, high-margin money compared to moving iron.

And now, the obligatory Meaningful Use news and reaction.

Notice that during the press release (video above) that Kathleen Sebelius started off by botching the name of CMS, calling it the Centers for Medicaid and Medicare Services (backwards). That makes about as much sense as making its acronym CMS instead of CMMS, but I can’t swear I’d say it right either if facing a ton of cameras.

Inga has collected some thoughts and comparisons about the proposed vs. final Meaningful Use rule. She’s Meaningfully Used up, so help her out by adding a comment to that post with anything she missed.

Everybody with skin in the Meaningful Use game will be cranking out press releases extolling their love or hatred for what’s been passed. Thos who love it so far: Allscripts, AARP, UnitedHealth Group, Medsphere, AHIP. Those who hate it: American Hospital Association. I’m sure PR people are proofing a lot more press releases yet to come. In fact, CHIME issued a press release that said they are “actively reviewing the changes” and will publish its summary “once CHIME has thoroughly reviewed the 864-page rule.” I shall alert the media. Oh, wait, they already did.

Don Berwick’s first day on the job involved participating in the Meaningful Use press briefing. He reminded everybody about President Obama’s goal to for every American to have electronic medical records by 2014, which was probably a mistake since, like a lot of other ambitious administration goals, it’s clearly not going to happen just because of some stirring oratory. Inga speculates that the President rushed Berwick’s confirmation through so DB could look authoritative on his first day and use the opportunity to meet and greet. To me, he comes across as likeable and sincere.

Announced: the House Ways and Means Subcommittee will review the guidelines next Tuesday.

Check out Page 34: “We expect to update the meaningful use criteria on a biennial basis, with the Stage 2 criteria by the end of 2011 and the Stage 3 criteria by the end of 2013.”

My reaction to the rule: it’s a nicely done compromise. The really contentious areas were scaled back, and even in areas that weren’t, thoughtful rationale was provided. Breaking out the requirements into the mandatory vs. elective requirements was a great idea. CMS was smart to start tough in the proposed rules and then ease up after taking public comments into account. Some folks will still think the bar is set too high, but nobody’s putting a gun to anyone’s head to take the thousands to millions of otherwise free taxpayer dollars. If you don’t like the gift horse, don’t ride it.

What’s the biggest surprise in the final Meaningful Use guidelines? That doctors don’t have to actually enter any orders to meet the CPOE requirement. Anybody allowed to write orders can do it for them. That should goose the medical scribe job market. I think CMS got a little too user-friendly with that change since the next most important number other than overall percentage of orders entered via CPOE is the number that are entered directly by the physician instead of entered on their behalf as verbal or written orders by nurses (which opens the door right back up to transcription errors – the whole “readback” thing is lame). Also, anybody who implements clinical decision support thinking that the nurse will sift through the on-screen warnings and pass the important ones to the doctor knows how poorly that works.

I loaded the government’s PDF to Scribd as soon as a reader sent me the link this morning (thanks!) I see that file has received 2,177 reads so far. I don’t think HIStalk will set a one-day reader record, but it’s had 6,000 visitors so far (early Tuesday evening Eastern time). Needless to say, MU interest was high.

I e-mailed John Glaser to get his thoughts since he was instrumental in putting MU together. He thinks the best part was that they listened to industry concerns about flexibility and setting the bar too high. I told him he should get a completion bonus of the billions, of which he humbly suggested 1%. He also offered this piece:

The Big Day

On Tuesday (7/13/10) the final Meaningful Use regulation was released as was the final Standards and Certification Criteria regulation.

Arriving at the release of these regulations took time and an impressive amount of work. The regulations appeared 17 months after the passage of ARRA and 14 months after the first meetings of the Policy Committee and Standards Committee. Hundreds of hours were spent by volunteers of the Policy and Standards committees and their workgroups. Thousands of comments were written by organizations and individuals and read by dozens of federal staff. Some very large number of blog comments, articles and white papers were prepared by consultants, academics, vendors, practitioners and others. And an incalculable number of hours were devoted by staff at ONC, CMS, OMB and other federal agencies and departments.

All of this resulted in over 1,000 pages of regulations. Regulations that will bring tens of billions of dollars into healthcare and promise to significantly improve the care of patients. Healthcare in this country was forever changed on Tuesday. Those of us who work in the industry have not seen a day as momentous as this and may not see one again.

There are many individuals whose efforts brought us to this point. David Blumenthal. Farzad Mostashari. Tony Trenkle. Paul Tang. Jon Perlin. John Halamka. But I wanted to single out one person – Janet Marchibroda.

Janet was the founding CEO of the eHealth Initiative (eHI). For many years the eHealth Initiative has brought together a diverse group of stakeholders to develop strategies, author example policies, compile lessons learned and provide education to further a vision – significant improvements in care through the adoption and effective use of interoperable electronic health records. Years before there was an ARRA, eHI and Janet were relentless in their pursuit of this vision and they were remarkably effective in bringing their ideas to Congress, the Executive Branch, state governments and the industry. While not the only voice in the early days of this undertaking they were an exceptionally effective voice. You could clearly argue that Janet and eHI are one of the primary reasons that HITECH was included in the ARRA legislation in the first place.

Congratulations Janet. This day must be very sweet.

I hear that Eric Rose, medical director of McKesson Physician Practice Solutions, has signed on with Microsoft’s Health Solutions Group to work on global health technology offerings. 

A reader tells me that a Vermont hospital’s practice EMR has been down for two days so far after its vendor tried to apply an upgrade, apparently mistakenly loading the 64-bit version instead of the 32-bit. They had to go to backup, and everybody could have predicted what happened next: the backup was no good. I guess downtime doesn’t get you Meaningful Use credit.

St. Joseph Health System (CA) chooses periop and anesthesia systems from Picis for its 13 facilities. A couple of readers have sent over positive rumor reports about Picis lately, so without my speculating about the details, I expect to hear news shortly.

Listening: The Doors, because I was watching the mediocre, Johnny Depp-narrated When You’re Strange on Netflix and got stoked about them all over again (actually, it was pretty good other than Johnny). May favorite Doors tunes: Crystal Ship; Yes, the River Knows; Not to Touch the Earth; The Unknown Soldier; and When the Music’s Over. Mr. Mojo Risin’ has been dead for nearly 40 years, but his digital detritus remains vibrant and essential. We should all be so lucky.

Consumer Reports says it can’t recommend the iPhone 4 because of its notorious antenna problems, saying Apple should fix its own phone instead of telling owners to buy themselves a case (or use duct tape like CR recommends) to prevent touching the antenna and thereby drop signal strength. The iPhone scored at the top of its ratings otherwise.

If you clicked the e-mail link to read this post, you’ll notice a single sponsor ad at the very bottom, right before the comments. That was the brainchild of a couple of readers who felt guilty that they don’t always look over the ads in the left column, but who said they’d pay significant to attention to a single strategically placed one. All sponsor ads get an equal chance – it’s a random display for each page view. Thanks for the idea and for supporting HIStalk’s sponsors.

Speaking of sponsors, thanks to new HIStalk Gold Sponsor My Health Direct. You’ll recall that I interviewed CEO and Chairman Jay Mason a few weeks back. The best way to describe the company’s offering is as “OpenTable for Healthcare”, a SaaS application that connects patients (usually ED ones) with provider appointments in the community. The system searches open provider appointments and manages the mix of low-paying reimbursement those providers are willing to accept. It also increases compliance with follow-up visits since patients leave the ED with a firm appointment. Thanks to My Health Direct for supporting HIStalk and its readers. And in case it looks suspicious, I promise there was no discussion about sponsorship when we did the interview. I often interview somebody who is then overwhelmed by the “hey, I saw your picture on HIStalk” feedback they get afterward from the very cool HIStalk readership, so they send the marketing people my way.

Weird News Andy loves his UK stories, of which this one is big: NHS will restructure and take hospitals out of the system, eliminating all 10 strategic health authorities and the 152 primary care trusts in favor of local control answering to an independent NHS board. Their private income was previously capped. From the video: “Our guiding principle will be no decision about me, without me.” Sounds like the opposite of what we’re doing here. I wonder if Don Berwick admires them more or less now?

Interoperability vendor Holon announces GA of its Medication Management Solution, which accepts electronic or scanned orders and routes them via a workflow scheduler.

Healthcare claims processor and cost management vendor MultiPlan will be acquired by private equity investors in a deal valued at $3.1 billion. You just know you’ll see more of this as investors lick their chops at the profitable administrative overhead sure to be introduced by healthcare reform (irony intentional). Surely nobody thinks insurance companies and their lobbyists will voluntarily find another line of work.

Iowa HITREC chooses Greenway’s PrimeSuite EHR.

Dentrix Enterprise Dental Practice Management earns certification as an electronic dental record solution for the Indian Health Service.

Kronos introduces its new Rich Internet Applications. I had to look that up – it means Web apps that work like desktop apps by using browser plug-ins or virtual machines. Gmail is an example.

It’s not exactly poverty-vowing nuns running hospitals: Wayne Smith, CEO of publicly traded hospital operator Community Health Systems, took home $17.8 million in compensation last year.

E-mail me.

Inga Compares the Preliminary Meaningful Use Rule to the Final

This is a first pass at trying to catalog the changes in the final rule. Your comments and observations are welcome!

CPOE

Preliminary rule

• Practices: use CPOE for orders involving medications, laboratory, radiology, and referrals.
  Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer.
  Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.)
  Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Final rule

• For practices and hospitals: more than 30% of unique patients with at least one medication in the medication list have at least one medication ordered through CPOE. The denominator is no longer total orders generated. Lab and diagnostic orders eliminated from the CPOE requirement. Any licensed professional can enter the order. ED orders count toward the inpatient total for CPOE.

Clinical Checking of Orders

Preliminary rule

• Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Final rule

• The EP/eligible hospital/CAH has enabled the drug-drug, drug-allergy, and drug-formulary check functionality for the entire reporting period. Any EP who writes fewer than 100 prescriptions during the EHR reporting period is exempt.

Problem List

Preliminary rule

• Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT.
  80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).

Final rule

• At least 80% of patients have at least one entry or an indication that no problems are known. Data must be recorded as structured data . Coding doesn’t have to be done concurrently – the codes can be added later by anyone.

E-Prescribing

Preliminary rule

• Practices only.
  Must send 75% of non-controlled substance prescriptions electronically.

Final rule

• Threshold dropped from 75% to 40%

Active Medication List

Preliminary rule

• 80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Final rule

• Unchanged.

Medication Allergy List

Preliminary rule

• Longitudinal with allergy history.
  80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Final rule

• Unchanged.

Demographics

Preliminary rule

• Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth.
  Hospitals: all of the above plus date and cause of death if applicable.
  80% of patients must have demographics recorded as structured data.

Final rule

• Threshold dropped from 80% to 50% .

Vital Signs

Preliminary rule

• Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse.
  80% of patients aged 2 and over must have blood pressure and BMI entered.
  Children 2-20 must have a growth chart.

Final rule

• More than 50% of patients 2 years and older must have height, weight, and blood pressure recorded as structure data. EPs who believe that measuring and recording height, weight and blood pressure of their patients has no relevance to their scope of practice can be excluded. For MU purposes, providers do not have to maintain BMI and growth charts, although certified EMRs are required to do the BMI calculation and display growth charts with structured data.

Smoking Status

Preliminary rule

• Record if current smoker, former smoker, or never smoked.
  Must be recorded for 80% of patients.

Final rule

• Must record at least 50% of patients 13 and older for smoking status.

Clinical Decision Support Rule

Preliminary rule

• Included five measures beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.

Final Rule

• Implement one clinical decision support rule relevant to specialty or high clinical priority for EPs, or one clinical decision support rule related to a high priority hospital condition for hospitals. Also must track compliance with that rule.

Record Advanced Directives

• This is a new one not included in the preliminary rules to prove meaningful use. Hospitals must record at least 50% of inpatients 65 years old or older an indication of an advance directive status.

Structured lab results

Preliminary rule

• Display results, translate LOINC codes, allow maintenance based on new results.
  Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Final rule

• Threshold reduced to 40% of clinical lab test results.

Patient Lists

Preliminary rule

• Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Final rule

• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Report Quality Measures to CMS and States

Preliminary rule

• Calculate, display, and submit quality measure results.

Final rule

• Clarification: this is for hospital quality measurements. For 2011, provide aggregate numerator, denominator, and exclusions through attestation. For 2012, measures must be electronically submitted.

Patient Reminders

Preliminary rule

• Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Final rule

• Reminders must be sent to at least 50% of patients age 50 or over that are seen by the EP.

Insurance Eligibility

Preliminary rule

• Allow user to record and display based on eligibility response from insurer.
  Must cover 80% of unique patients.

Final rule

• Requirement withdrawn for Stage 1 but look for it in Stage 2.

Submit Claims

Preliminary rule

• Must submit 80% of all claims filed electronically.

Final rule

• Requirement withdrawn for Stage 1 but look for it in Stage 2.

Electronic Copy of Health Information to Patients

Preliminary rule

• Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary, but not procedures. Must provide an electronic copy of health information to requesting patients within 48 hours.

Final rule

• Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies,
  discharge summary, procedures), upon request. Discharge summary and procedures are for hospitals only.  Must provide to at least 50% of requesting patients within three business days.

Electronic Copy of Discharge Instructions 

Preliminary rule

• Hospitals only.  Must provide electronically to 80% of discharged patients who request them.

Final rule

• Threshold reduced to 50%.

Timely Patient Access to Health Information

Preliminary rule

• Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability.
  Must provide to 10% of unique patients.

Final rule

• Practices must to 10% of its patients within four business days of being updated in the EHR, subject to the EP’s discretion to withhold certain information.

Clinical Summary of Each Office Visit

Preliminary rule

• Practices only: diagnostic results, medication list, procedures, problem list, immunizations. Must provide for 80% of office visits.

Final rule

• Provide clinical summaries provided to patients for more than 50% of all office visits within three business days.

Access to patient-specific education resources

• Another new item that was not in the preliminary rules. Use EHRs to identify patient-specific education resources and provide those resources to the patient if appropriate. Both EPs and hospitals must provide patient-specific education resources to at least 10% of patients.

Information Exchange

Preliminary rule

• Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary. Must conduct at least one test of information exchange.

Final rule

• Exchange key clinical information among providers of care and patient authorized entities electronically. Both practices and hospitals should exchange problem list, medication list, medication allergies, and diagnostic test results; hospitals should also exchange discharge summary and procedures.

Preliminary Rule

• Compare and merge two or more medication lists into a single list that can be displayed in real time. Must be performed in 80% of encounters and care transitions.

Final Rule:

• Threshold is reduced to 50%.

Submit Data to Immunization Registries

Preliminary rule

• Must conduct at least one test of submitting information.

Final rule

• Perform at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, hospital, or CAH submits such information have the capacity to receive the information electronically).

Submit Lab Results to Public Health Agencies

Preliminary rule

• Hospitals only. Must conduct at least one test of submitting information.

Final rule

• Perform at least one test and follow up submission.

Submit Syndrome Surveillance Data to Public Health Agencies

Preliminary rule

• Must conduct at least one test of submitting information.

Final rule

• Perform at least one test and follow up submission.

Protect Electronic Patient Information

Preliminary rule

• Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures.
  Must conduct a security risk analysis and implement security updates.

Final rule

• Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies.

Meaningful Use – Final Version Full Text

Meaningful Use – final

Click the Fullscreen link at the top to read more easily.

We will be adding comments to this post as we find important facts in the long document. Feel free to add your own findings or thoughts.

Monday Morning Update 7/12/10

From Holy Smoke: “Re: Cerner. Misidentification incidents have been reported with Cerner PowerChart and Millenium in hospitals in Indiana, Michigan, and others after a Cerner upgrade. Entries are placed in the wrong electronic chart and reviewed data is for the wrong patient.” Unverified. I saw nothing in the FDA’s Maude database, so if it’s happening, customers should file an experience report.

Former Cerner COO Paul Black, now working with a private equity firm, is named board chair of Truman Medical Centers (MO).

Lots of us may benefit from the redistribution of taxpayer money into our healthcare IT pockets, but our taxpayer side apparently wins, as almost 2/3 of readers say they wouldn’t have voted for HITECH had they been given that chance. New (similar) poll to your right: if you’d had the chance to vote on Don Berwick’s nomination to CMS administrator, would you have voted for him?

Health officials in Canada’s Northwest Territories say they’ll start enforcing medical faxing policies requiring cover sheets and pre-programmed telephone numbers after patient information was faxed to the CBC in at least four separate incidents. A recent embarrassing incident had led to a temporary ban on medical faxing except in emergencies. This caused big problems for pharmacies, who were given no advance notice that the 30-40% of their business that involves faxing would be shut down.

Doctors in Taiwan are taking iPads to the bedside, using them to show patients their diagnostic images right in their beds.

Bruce Greenstein, a Seattle-based Microsoft managing director of worldwide health, will become secretary of Louisiana’s financially struggling Department of Health and Hospitals after incumbent Alan Levine quits to go back to the private sector. Levine was previously CEO of Broward Health (FL).

Senator Richard G. Lugar of Indiana pitches HIT during a stop at Union Hospital East and at the remarkably coincidentally named Richard G. Lugar Center for Rural Health, which does some small telemedicine projects. The article mentions some of the hospital’s technologies: smart beds, patient tracking systems, bar code scanning, electronic inventory, and and Vocera communicators.

Inga and I are thinking that we need to get our ears a little closer to the ground with all the healthcare IT news that’s breaking this summer (mergers, Meaningful Use, etc.) We’re thinking of anonymously crashing the Allscripts user group meeting in Las Vegas the first week of August since that’s a pretty big one that should give us lots of insight beyond just Allscripts news. Inga always does MGMA. I usually only go to HIMSS, but I’ve got a lot of time off at work and figure I might as well do something useful with it. We will report the rumors and trends from wherever we end up.

Struggling Grady Memorial Hospital (GA) is criticized for giving its CEO a $291K bonus on top of his $615K salary. The board says he put the hospital into the black and met his performance targets, but it’s still getting $80 million per year from taxpayers. And in Calgary, the CEO of Alberta Health Services earns $744K in 2009 while the organization failed to meet many of its goals and ran a $885 million deficit.

More on Don Berwick’s Institute for Healthcare Improvement. Tax records indicate that it took in $43 million last fiscal year, of which Berwick was paid almost $2.5 million, although $1.4 million of that looks like vested benefits from the previous seven years and his base salary plus bonuses was $621K. Nothing unusual or extravagant that I can see.

As a comparison, HIMSS reported $41.4 million in revenue, about the same as IHI, according to its most recent tax documents filed in May. Only $5.3 million of that came from member dues, while the annual conference raked in $18.9 million. Steve Lieber received compensation of $731K (CEO). Other salaries are above: Dave Garets (former CEO of HIMSS Analytics), Carla Smith (EVP), Norris Orms (EVP/COO), Jeff Kenjar (EVP Sales, HIMSS Analytics), Mike Davis (former EVP, HIMSS Analytics), Kelly Laidler (senior director, sales), and Jessica Daley (sales director, HIMSS Analytics). The Advisory Board must be paying Garets and Davis really well since they walked away from some pretty big salaries. HIMSS isn’t big on technology, apparently, having spent $675K on IT, a paltry 1.6% of expenses.

Former Columbia HCA president and Florida gubernatorial candidate Rick Scott challenges the state’s “millionaire” campaign finance law, saying it restricts his free speech by giving his opponent matching state funds once Scott spends $24.9 million. Scott has spent $20 million so far. His opponent’s campaign manager said, “It should come as no surprise to anyone that Rick Scott, a man who oversaw the most massive Medicare fraud scheme in history, just can’t seem to play by the rules.”

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News 7/9/10

From Sturges: “Re: The Berwick saga is a great view into just how political healthcare is right now (and will be through 2012). It obviously will be a big topic in November, a key part of the Berwick opposition in the first place. It also will command big attention next year as Congress takes on the deficit. The upshot is cuts for hospitals on the spending side in ’11 and a much more political environment for the rule-making process on the regulatory side in ’11-13. Mr HIStalk for Congress? Your slogan can be, ‘I think it’s crap, too’ or, if we need something more positive, ‘Yes we can — anonymously!’” Don Berwick was the right person for the job, I’m convinced (though why he’d want it is beyond me) and even though people don’t want to hear it, some kind of financial allocation (“rationing”) is unavoidable given the way the current and previous administrations have put the country deeply into debt to preserve the illusion of prosperity. It’s political poison to cut healthcare and entitlements, but Berwick is right — we don’t have a choice, especially now that the government controls so much of healthcare delivery and payment.

Speaking of Don Berwick, this article says he makes almost $900K running IHI and listed more than a dozen current jobs on his ethics filings, but most of them are voluntary or honorary, including compensation-free positions at Children’s Boston, Harvard, and Brigham and Women’s that the White House describes as “essentially honorary professorships.” The article suggests that the White House inflated his credentials with those positions, but I don’t see it that way — it looks like they just wanted to include everything whether they were required to or not. It does mention, however, that in taking the CMS job, Berwick’s annual salary will drop to $165K for running a $800 billion organization. That sounds like public service to me.

From TooLate: “Re: iSoft. To make cuts to UK staff — sales and marketing, product strategy, and implementations.” The company looks to be an acquisition target, which means slashing expenses to make short-term numbers attractive. It announces a $30 million credit facility from an obscure US investment fund, which the company will use to replenish the cash it spent on 2010 acquisitions (which didn’t help much given that shares are still at or under 20 cents).

From Lemmy: “Re: E&Y. From this job posting, it does appear that your rumor that they are trying to rebuild their healthcare consulting business is correct.”

From HITInsider: “Re: Eclipsys. It joins Epic as the only vendors with CCHIT Certified 2011 Enterprise certification.”  

From Wildcat Well: “Re: Tim, ol’ boy. ARRA, HITECH, and now $1B for broadband initiatives including health centers. Comcast. Microsoft. All talking. Time for the adults to take over. Most EMR vendors could be an afterthought. Buy stock.” I keep getting rumor reports about EMR executives talking shop with the cable operators, but I don’t have details. Not that I wouldn’t enjoy having some, mind you.

From Frank Poggio: “Re: A Meaningful Ruse. As a follow up to by February Readers Write piece, note today’s announcement: The Centers for Medicare & Medicaid Services has issued a proposed rule imposing a 0.25 percentage point reduction to the fee schedule increase factor for outpatient hospital services. If you do not met meaningful use criteria, which most providers won’t per the recent Glaser interview, you get a reduction in this adjustment. Let’s see, that’ll be 0.33 times -0.0025 = +0.000825 increase! Or is it 0.66 times -0.0025 = -0.000166 decrease? Seems to me either way you come out better.”

From HCDude: “Re: KLAS report on professional services firms. New players are entering the market. It doesn’t look like all the acquisitions done by IBM, CSC, and ACS worked. One of these days, the big boys will realize this is a cottage business where big companies just don’t ever seem to get it.” KLAS says all those acquisitions drove the principals to leave and start new companies, bringing people with them. They specifically mentioned Encore and Santa Rosa, started by former executives from Healthlink and Superior, respectively, saying that while Encore didn’t make its list because it wasn’t consider by prospects often enough, it still earned as much attention as CTG. This life cyle is obvious to old timers who have seen it time and again:

1. Sales-savvy former consulting company executives start their own consulting company.
2. They cherry-pick the good consultants who want a change, offering clients the same people and services at half the price the big boys charge since they have low overhead and no shareholders.
3. They build up the business, finding some niche for which providers are willing to pay.
4. They dress up the offerings by claiming to be in “life sciences” (i.e., make it sound like rich drug companies and foreign genomics rock stars are beating their doors down).
5. They wait for some industry development that makes consulting look like a hot industry that will never fade (data warehousing, CPOE, Meaningful Use, ERP, etc.)
6. They sell out to a cash-rich, often plodding big company that’s tired of low-margin hardware sales which thinks consulting looks easy and profitable and which is too lazy and impatient to start their own consulting organization, preferring instead to pay a ridiculous premium for a company that basically does little beyond reselling the bodies it employs at multiples of what it pays them.
7. The former consulting company executives, flush with cash and quickly fatigued by corporate BS, leave the stifling bureaucracy claiming they will retire or pursue non-competitive interests.
8. Go to #1.

From The PACS Designer: “Re: Scribus. TPD has been testing open source desktop publishing software called Scribus. It’s kind of like Visio, which has been around for a long time, but has more robust features.”

Listening: The Smiths, influential early 80s Brit indie pop featuring Morrissey on vocals. Still sounds good.

McKenzie Medical Imaging (OR) wins NueSoft’s Make Software Sexy video and photo contest, featuring user submissions with employees wearing free company tee shirts. I may steal that idea.

Proposed HITECH-related HHS modifications to HIPAA (warning: PDF) would expand the right of patients to access their own information, restrict some types of disclosure, and expand rules to cover business associates. AHIMA releases a statement supporting the change (one paragraph) and pitching itself and its members as being essential to further discussions (three paragraphs). We asked privacy advocate Deborah Peel, MD of Patient Privacy Rights for her reaction:

What we heard in the remarks of Secretary Sebelius, OCR Director Verdugo, and the National Coordinator for HIT Dr. Blumenthal is a very significant and welcome major change of direction at HHS and ONC. Several VERY strong, positive comments were made today in the press conference announcing the NPRM today by Sec. Sebelius, OCR Director Verdugo, and Dr. Blumenthal which support the patient’s right to privacy and consent. Sec. Sebelius said. “It’s important to understand this announcement [of NPRM, a new Web site, and other new initiatives] are part of an Administration-wide commitment to make sure no one has access to your personal information unless you want them to.” Then during her remarks, OCR Director Verdugo said, “The benefits of health IT will only be fully realized if health information is kept private and secure at all times.” And finally during his comments, Dr. Blumenthal stated, “We want to make sure it is possible for patients to have maximal control over PHI.” And he referred to the Consumer Choices Technology Hearing last week, which demonstrated consent tools enabling patients to make choices about how their information is used and disclosed from EHRs and for HIE.

The great news from the press conference announcing the NPRM was the very CLEAR language, from the Secretary of HHS, to the Director of OCR, to the National Coordinator for HIT, that supports building Americans’ rights to consent and control over PHI into electronic health systems and data exchange. We hope the details in the NPRM actually do give Americans the kind of control over sensitive personal health information that will enable them to trust health IT systems and data exchanges. We will share our analysis of/comments on the NPRM as soon as we have it.

Royal Philips Electronics announces that President and CEO Gerard Kleisterlee will step down in April, announcing that it will nominate former Philips board member Frans van Houten to replace him.

HealthcareMegaMall is running a text ad here announcing a September 1 go-live, but I know nothing about the company. A Google search finds this press release, which describes it as an online marketplace for sharing information, comparing products, and viewing demos (including HIT products, apparently). They’ll also communicate with providers and advertise both in print and electronically (so I guess that explains the ad).

On HIStalk Mobile, we review ReachMD, which offers medical CME via the iPhone.

Jobs: Cerner SurgiNet and PowerOrders PMs, Manager, Clinical Informatics, Senior Software Engineer, Cerner Clinical Analyst.

Weird News Andy finds this story of an enterprising London hospital that “generated substantial income” by renting out an empty patient unit to a film company that used it as a location in a big-budget porn movie.

Gwinnett Hospital System (GA) expects to save $300K per year and speed up its revenue cycle as a result of its medical records digitization project involving EDCO Group’s Solarity technology.

Baltimore’s mayor will announce as the city’s new health commissioner Dr. Oxiris Barbot, a pediatrician whose credentials include creating an EMR for New York City’s school health system and developing disease management and public health programs. The search committee was led by Michael Klag, MD, MPH, dean of the Baltimore-based Johns Hopkins Bloomberg School of Public Health and a member of HHS’s HIT Policy Committee.

Two Australian hospitals will implement an ICU EMR system from Vision Software Solutions of Queensland. I can’t say for sure, but I’m guessing it’s actually the iMDsoft MetaVision system since Vision is (or was at one time, anyway) a distributor for it in Australia.

I don’t recall if I already knew this, but apparently Resurrection Health System (IL) is going Epic, based on this job listing.

Cal eConnect, the group created to oversee California’s HIE projects and to spend $39 million in federal money, hires Carladenise Edwards as CEO. She was formerly HIT coordinator for the state of Georgia, an HIT advisor to former Florida Governor Jeb Bush, executive director of South Florida Health Information Initiative, and owner of a consulting company that sold services to Florida’s state government.

Strange: hospitals in China, reacting to a rash of patient deaths due to suspected medical negligence, hire local police officers to “improve relations” between doctors and patients. Critics say hospitals are cozying up to police to get them to arrest people who complain about their medical services. State-run media coined the phrase “hospital troublemaker” to describe unhappy family members who display banners, set up altars, or abandon the corpses of their deceased family members, any of which could get them locked up.

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HERtalk by Inga

The 120-provider Physicians Alliance (PA) plans to implement Allscripts EHR, which will connect directly to its existing Allscripts Vision PM system. Allscripts execs, by the way, are meeting with bankers to secure up to $720 million to finance the buyout of Misys Plc’s ownership stake and the purchase of Eclipsys.

Physicians running Advanced Data Systems PM/EHR will soon be able to connect to the Jersey Health Connect HIE using RelayHealth’s HIE tools.

Ochsner Health System (LA) says it is now connecting thousands of community physicians to Ochsner’s patient medical records using Orion Health’s HIE technology.

Speaking of HIEs, KLAS says only five vendors are considered in more than 10% of purchasing decisions: Medicity, Axolotl, RelayHealth, ICA, and Epic (the latter in Epic-to-Epic exchanges). Cerner, dbMotion, GE, InterSystems, and Orion rounded out the top 10.

The Santa Cruz HIE implements Anakam Identity Suite into its Axolotl Elysium Exchange to provide secure access to health information.

Dr. Bill Tierney is named CEO of the Regenstrief Institute, taking over for Dr. Tom Inui on October 1.

Christ Hospital (NJ) selects Allscripts reseller ITelagen to provide EHR and PM for the hospital’s affiliated medical practice.

Health Net agrees to pay $250,000 to the state of Connecticut to settle a HIPAA violation case. The suit stems from the theft of a disk drive that contained financial and medical data on 1.5 million consumers, 500,000 of them from Connecticut. The deal also includes two years of credit monitoring, $1 million of identity theft insurance, and reimbursement for the costs of security freezes.

Industry veteran Mark Trigsted is named EVP of healthcare for Diversinet. Trigsted must have friends all over HIT, having worked previously at 1-800-Doctors, Sysware, HEALTHvision, Sunquest, Oacis, McKesson, and GE Medical.

EDI testing service QualEDIx names Larry Watkins EVP of healthcare strategy and business development.

Six orthopedic surgeons from Rush University Medical Center (IL) are under fire for violating Medicare rules. The US District Court says the physicians routinely overbooked their schedules and relied on residents to perform surgeries. A fellow surgeon and a former hospital executive filed the suit.

E-mail messaging between patients and providers improves the quality of care provided, according to a Kaiser Permanente study. Patients with diabetes and/or hypertension were found to have statistically significant improvements in HEDIS scores when patients and physicians communicated via e-mail and were 7-10% less likely to schedule an office visit.

Elsevier launches Top Doc, an iPhone app designed to help medical students and residents improve with visual diagnosis skills. The $15 app includes quizzes with more than 600 questions and allows user to determine the correct diagnosis by viewing actual photographs. You can even have your grade posted to Facebook. Kind of cool, but I’ll stick with Scrabble.

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