News 4/15/11

Top News

Healthcare IT is one big reason that private practice docs are taking down their shingles and going to work for hospitals, according to experts interviewed by The New York Times. Unlike the Hillarycare era, there’s no turning back this time since reimbursement is encouraging that kind of vertical integration. The predicted result: less competition, leading to higher prices (although Kaiser is a mentioned as a disrupter in offering cited higher quality at lower cost). The experts seem pretty sure that quality will improve (like in Mayo or Kaiser, with salaried physicians), but not so sure costs won’t go even higher.

Reader Comments

From Hypocrisy: “Re: Judy Faulkner. She was quoted as saying at an ONCHIT Policy Committee meeting, ‘What is showing up in blogs — I have seen and sometimes been told about this — is that we have to be careful of an apparent conflict of interest. That is if, in fact, the primary spokesperson for PCAST does have products that would benefit tremendously by this, do we get into — and I know we’re not supposed to judge — the uncomfortable position of an appearance of conflict of interests.’ She’s apparently talking about Microsoft’s Craig Mundie, discussed a lot on HIStalk as a PCAST committee member. Presumably she does not see a conflict of interest herself in serving on the committee.” I didn’t see the quote, but it’s interesting if accurate. Just to clarify for those who don’t follow the confusing cast of government players, Judy wasn’t actually on the PCAST committee that made recommendations to the President that pretty much had HealthVault or Google Health written all over them – the only for-profit company employees on it were Craig Mundie from Microsoft and Eric Schmidt from Google. Judy is on the HIT Policy Committee, which has for-profit members from Kindred Healthcare, WellPoint, Gastroenterology Associates (a private doctor), and Epic (Judy). I wouldn’t think she carries the level of influence over that group that some have said Craig Mundie had over the PCAST report.

From Ludacris: “Re: rogue Meaningful Use. A vendor is e-mailing consultants offering a ‘private label’ EHR they can sell under their own name for a split of the revenue.” The company’s address appears to be a mail drop and the principals aren’t listed, although I found the CEO’s name elsewhere. The vendor’s Version 1.0 product is certified as a Complete EHR Ambulatory and the offer claims companies that want to private label it get their own name on the list of certified products. I suppose ONC didn’t address that issue – where the same product could be sold by multiple vendors under multiple names, each rightfully claiming to be offering a certified product. Certification was intended to reduce buyer risk, not buyer confusion, and some would argue that it has accomplished neither.

From Dingin: “Re: Epic. You mentioned Oakwood and Singing River. Both were at a recent class in Verona, along with others you probably already knew about: Nebraska Medical Center, Providence Anchorage, Contra Costa, Norton, MUSC, Wake Forest Baptist, University of Cincinnati, and Driscoll Children’s.” I confirmed with MUSC that they’re going only with the ambulatory products, dropping McKesson Practice Partner since it doesn’t work well with MUSC’s TELUS Oacis Health Data Warehouse, but keeping Horizon Clinicals on the inpatient side.

From Lorenzo: “Re: ICA. What’s going with them? Rumors of problems.” Not so, according to our Informatics Corporation of America contact. “We have just won Wyoming Medicaid HIE through our partnership with ACS, just selected as VOC with Central IL HIE, and we are hiring as fast as we can to keep up with recent wins of Middle TN eHealth Connect and KHIN. We’ve grown by 100% since the beginning of the year and we expect to grow by another 50% by year’s end in employees. Our funding is solid through our primary owners and we are working as hard as ever to meet customer demands. Go-lives of major clients are scheduled over many of our clients in the near future. Nothing could be further from the truth.”

From HISwalk: “Re: magazine. Does anyone else think this slide show paints a ridiculously rosy picture of several vendors given their current situations?” I’m not a fan of online slideshows when a simple list would have been much easier to read, but this one’s OK (the information it contains was provided by Vince Ciotti’s firm, so I’d trust it more than if the usual sideline reporters undertook their own analysis). I would say the list contains some opinion, some analysis that’s not quite current, and focuses on revenue (which was the point) and not necessarily profit or market trends. I don’t link to other HIT sites or rags since I don’t use them as sources, but you can probably Google your way to it if you’re determined to check it out.

From FACA: “Re: ONC Policy Committee. There’s a Webcast meeting on EHR usability and accessibility on April 21 at 9 a.m. It’s a public hearing, so questions are welcome.” The agenda is here. The presenter list is interesting. For some reason, the government, like others, capitalizes Epic (Epic does not spell it EPIC).

HIStalk Announcements and Requests

This week exclusively on HIStalk Practice: PracticeWise, a new  column by practice consultant Julie McGovern (who stirs up some discussion in her first post). Reefdiver weighs in on the value of certification in the EHR selection process (readers are opinionated on that topic, too.) KLAS  extends a free offer for HIStalk Practice provider readers. AMA tells CMS what physicians find most burdensome. Dermatologists ask patients for fashion advice. Americans want their physicians to use EMRs. So far, only six states have issued MU incentive checks. In honor of Leonardo da Vinci’s 558th birthday and because it makes me happy, please sign up for the e-mail updates while you are catching up on the latest HIT ambulatory news.

On the sponsor-only job board: Clinical Project Specialist, Software/Implementation Engineer, Healthcare Implementation Project Manager. On Healthcare IT Jobs: EHR/ePM Implementation Project Administrator, Coordinator Clinical Trials.gov, Project Manager – NextGen, Software Product Development Manager.

Acquisitions, Funding, Business, and Stock

Allscripts CEO Glen Tullman earned nearly $8.5 million between June 1, 2009 and December 31, 2010. That breaks down to $4.1 million for the 12 months ending May 31 and $4.5 million for last seven months of the year.

Streamline Health Solutions reports Q4 earnings: a net loss of $1.8 million compared to a profit of $1.6 million a year ago. Revenue fell from $6.3 million to $4.9 million.

In India, Michael Dell chats with local reporters on a number of topics, including healthcare IT:

We are #1 in healthcare IT globally. We acquired a company called InSite One, the leader in cloud-based archiving of medical images. We have taken that expertise all the way back to our product groups and created new offerings. IT in the healthcare industry is siloed. The CIO can’t make them work together. We have created vendor-neutral archives by speaking to medical equipment makers. We capture all the data and store locally or in our cloud archive.

Add Medicomp Systems to the long list of EMR vendors that have been sued by Prompt Medical Systems over the years. PMS has no Web presence, so I assume its primary output is legal rather than technical. It appears to be the brainchild of Bernard Milstein MD, an ophthalmologist, UTMB professor, and founder of The Eye Clinic of Texas who patented the use of CPT codes in computer systems in 1994 (even though AMA holds the copyright to the CPT codes themselves). He appears to be backed financially in his litigation lottery by an investment banker and securities company founder. None of the previous cases made it to court from what I can tell, so I’m sure PMS is banking (no pun intended) on the EMR vendors paying them to go away rather than risk being tied up endlessly in an expensive legal action.

Sales

The US Military Health System selects Mediware’s blood transfusion management system for 68 military health sites worldwide. MHS will also deploy Mediware’s LifeTrak and InSight to track donor records and product inventories in 28 blood donor facilities.

Palomar Pomerado Health (CA) chooses GSI Health’s HIE solutions to connect PPH hospitals and affiliated physicians.

Cooper University Hospital (NJ) awards a contract to MedQuist for computer-assisted coding technology and outsourced coding services.

Girard Medical Center (KS) signs with Cerner.

Regional Medical Imaging (MI) chooses Merge Healthcare’s radiology information system, expecting to receive $600,000 from Meaningful Use incentives for its 13 radiologists. Merge says 90% of radiologists are eligible for MU money and it will pursue certification for its RIS to help them earn it.

Announcements and Implementations

Kaleida Health (NY) says it is actively adding EMR capabilities across it hospitals and clinics. Its $20 million Cerner implementation should be complete by the end of 2012.

Tift Regional Medical Center (GA) goes live with RTLS temperature monitoring and asset tracking from AeroScout.

athenahealth creates a “burn unit” to handle physician practices that have been burned by old EMR systems and are looking for new solutions. CEO Jonathan Bush says about 35% of his company’s new EMR clients are replacing old EMRs.

ODIN announces EasySpecimen, an RFID-based pathology specimen management system, licensing the technology from Mayo Clinic.

England’s Department if Health announces completion a project to move all prisons to a single electronic medical records system, allowing them to transfer records when inmates are moved. The article takes jabs at NPfIT, saying the prison system has more detailed information than NPfIT’s Summary Care Record.

Government and Politics

CMS’s healthcare fraud enforcer (a pediatrician and lawyer) says he’s going to crack down on criminals, many of them working out of South Florida, who are scamming Medicare and Medicaid for up a quarter trillion dollars per year. Much of his arsenal involves smarter payment software that can detect fraud more quickly, needed since the fraudsters are using electronic billing systems to commit their crimes. Says one expert, “The crooks know now that these computerized payment systems are their best friend. They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it’s just a pack of lies.” An irony: Florida Governor Rick Scott was CEO of the company (Columbia HCA) that admitted to extensive Medicare fraud, costing the company $2 billion to settle.

ONC’s got some job openings for a program manager and three policy analysts.

Innovation and Research

CalPERS claims its integrated healthcare pilot saved $15.5 million between January and October 2010. Pilot participants include Blue Shield of California HMO, Catholic Healthcare West, and Hill Physicians Medical Group. The organizations’ combined efforts led to a 17% reduction in patient readmissions, a half-day reduction in the average LOS, and a 50% drop in stays of 20 days and longer.

West Wireless Health Institute awards its $10,000 developers’ challenge prize to a skin cancer detection app. The physician developer, who is a veteran and a melanoma survivor, created the iPhone app for his own self-examination.

Other

CIOs say their organizations will qualify for Meaningful Use incentives, but not as early as they predicted a few months ago. In an August 2010 CHIME survey, 28% of responding CIOs predicted qualifying for funds by April 1 compared to 7.5% of CIOs participating in a survey last month. About 32% of the CIOs expect to qualify by September 30, 2011 and an additional 58% anticipate Stage 1 qualification by the end of the 2013 fiscal year. Only 26% of community hospital CIOs believe they will qualify for stimulus funds by September 30, 2011.

Strange: a “stunning blonde” in her 20s, bidding over the Internet, buys more than $50,000 worth of items ranging from a stuffed owl to furniture at an auction in England. The auctioneer called her to arrangement payment, only to have the telephone answered by a doctor, not surprising since she’s a hospital inpatient committed under the Mental Health Act. Her credit checked out, but the hospital won’t let her pay, so the auctioneer says he’ll sue the hospital.

Umass Memorial Healthcare pulls 10 employee kiosks out of service when they discover that anyone walking up to the kiosk could view pay stub information from the previous user. The IT people changed the software and removed bank account information, then put the kiosks back out.

Associated Press gets punked: a couple of anti-corporate troublemakers float a phony press release with GE’s name on it, saying the corporation will donate its $3.2 billion tax refund to the US Treasury since the American public is upset at learning that GE paid no taxes on $14 billion in profit. AP ran the story without doing anything more than clicking on the link to the convincing-looking but phony Web site, only to pull their news item down less than an hour later.

A reader sent this in for Inga and her shoe-loving followers.

Sponsor Updates

• Advanced Endoscopy & Surgical Center (NJ) contracts with Wolters Kluwer Health for its ProVation MD procedure documentation and coding software.
• Design Clinicals and the AHA are hosting a Web demo April 21 entitled Electronic Medication Reconciliation: Achieving Stage 1 Meaningful Use and Full Compliance Joint Commission Standards with MedsTracker. 
• Concerro creates a cute video that compares workforce management tools to paper-based systems, à la the Mac versus PC commercials.
• eClinicalWorks announces that 2,000 practices have successfully upgraded to Version 9, eCW’s ONC-ATCB  certified MU version.
• Access announces a new version of its e-Signature solution to help providers create paperless registration and bedsid consent processes.

EPtalk by Dr. Jayne

This week marks the 150th anniversary of the start of the American Civil War. What does that have to do with healthcare IT, you ask? Maybe more than you think.

I was listening to NPR when Adam Goodheart, author of 1861: The Civil War Awakening, was interviewed. Charleston, South Carolina (which I’d love to visit if the right invitation presents itself) was the scene. Miscalculations on both sides about who would flinch first ultimately pushed events past the point of no return.

Towards the end of the interview, Terry Gross asks, “Some states today want the right to basically be able to nullify federal legislation in their state and not obey it. For example, not to follow the new health care policy that Congress passed. Do you see that as like a contemporary expression of similar divisions dating back to the Civil War?”

This was just a tiny part of the interview, but it really struck me about how divisive things are in health care politics right now. I certainly don’t think we’re on the brink of Civil War, but we are a house divided.

Acceptance of recent federal legislation is love/hate. There’s confusion on whether Meaningful Use will be repealed, revamped, or replaced. For the first time, I recently heard physicians (who had previously stalled on implementing an ambulatory EHR because they weren’t sure the Meaningful Use final rule was ever going to be final) state that they were holding off on going paperless because they feel healthcare reform (and the accompanying MU legislation) will be repealed.

I think many people agree that this train has somewhat left the station. There’s no guarantee that it might not stop somewhere along the tracks, but it already has pretty good momentum. (Anyone seen the movie Unstoppable with Denzel Washington? Watched it recently — a good diversion from reading yet another stack of documents about forming an Accountable Care Organization.)

It will be interesting to see how quickly challenges (to not only federal, but various state legislation) make it to the United States Supreme Court. Given the current makeup of the Court, I wouldn’t lay odds on any outcomes just yet.

Most large healthcare organizations that depend on Medicare payments aren’t willing to take chances or play the game of wait and see. They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot. Whether incentive legislation will be repealed or only partially implemented, we don’t know, but I’m pretty sure the Centers for Medicare and Medicaid Services won’t forget the idea of cutting reimbursements by using lack of technology as an excuse (at least not any time soon).

A lot of people are excited about the billions of dollars flowing into the health IT industry. I envision industry lobbying that will rival Big Pharma in intensity and scope if the effort to repeal recent legislation gains any serious traction. There are plenty of consultants waiting to deal with the things that happen when physicians and hospitals select and implement hastily, not to mention vendors that will be poised to sell replacement systems as the industry consolidates.

There you have it. If you’re ever confronted with an SAT-style question asking for a modern-day analogy to the Civil War, please feel to plagiarize, no citation needed. And if you can recommend a conference that will give me an excuse to visit South Carolina, let me know.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

News 4/13/11

Top News

  UnitedHealth Group unites its health services businesses under the Optum brand and renames Ingenix to OptumInsight. In addition, Prescription Solutions becomes OptumRx. UnitedHealth says the brand unification makes it easier for the market to understand the company’s full capabilities and helps align market engagements. I say the name change makes it easier for me to be confused and I’ll need awhile to align the name in my head. Mike Mikan will serve as CEO of the Optum group, while the CEOs of each company will remain the same.

HHS launches a $1 billion patient safety initiative aimed at making hospital care safer, more reliable, and less costly. The Partnership for Patients is a public-private collaborative and will work to decrease hospital-acquired infections 40% and reduce hospital readmissions 20% by the end of 2013. If successful, HHS predicts $50 billion in Medicare savings over the next ten years.

Reader Comments

  From P. Cockroft-Gault: “Re: open source biology. Love this guy’s drive and motivation.” Stephen Friend, MD, PhD, a former Merck SVP of cancer research, quits his job to start a non-profit to turn genomic analysis into a “wisdom of the crowds” type project, putting more intellectual horsepower behind unlocking genetic secrets and making the results non-commercial. “Our hallowed academic institutions have become factories for people who are trying to keep their own employment, their tenure … the whole reward structure keeps people from sharing the data that makes that connection …We’ll make it or not depending on whether our community of interest goes viral,” he says. In the TEDx talk above, he says the era of defining a disease by its symptoms is over since much more information is available at the molecular level.

From Veronica: “Re: Epic. Judy’s making noise in Wisconsin.” An article says the Greater Wisconsin Committee PAC is funded by children of George Soros, labor unions, and “Madison liberals who don’t unionize their own companies” (that would be Judy).

From Harold: “Re: John Caswell. I thought it would be nice if you mentioned his passing. He was with Compucare/QuadraMed for more than 28 years and will be missed by many in the industry.” Sorry it took so long to get this up, but I was waiting on confirmation from QuadraMed since I found nothing online. John David Caswell, 53, died on April 1, 2011. Details, guest book, and memorial contribution information can be found on the funeral home’s site. They did a nice job on his tribute video, set to Steppenwolf’s Born to be Wild. Condolences.

From Ling Cod: “Re: Black Swan moment. That book suggests that humans are wired to explain complex, chaotic events with simple theories that make them sound plausible even though they don’t predict anything (like reasons that stock markets crash). I challenge your readers to think about the Black Swan moments that may affect the alleged rapid adoption of EHRs and the possibility that, within a couple of years, providers will find the compliance wasn’t worth the aggravation. Possibilities: (a) some or all of the stimulus could be revoked, or (b) CMS may make EHR adoption mandatory with no further incentives if you want Medicare / Medicaid money.” The gauntlet has been thrown down. Feel free to add your thoughtful comments or submit something to me directly. The Black Swan reference, by the way, is the title of a book taken from the fact that experts had all kinds of convincing reasons that swans are always white (chief one being that they’d never seen a black one), which sounded great until a black swan was found.

HIStalk Announcements and Requests 

Listening: Royal Hunt, a Danish progressive band. Hits the spot in a Dream Theater kind of way.

Bored? Feeling as though the whole world is a tux and you’re a pair of brown shoes? My suggestions: (a) put your e-mail address in the Subscribe to Updates box to your right and feel immediately spiritually connected to the 7,288 folks who get my spam-free e-mail updates the instant I write something new; (b) do all those friendy / likey / connecty things on Facebook and LinkedIn, which will let you ride the vast social network that Inga, Dr. Jayne, and I enjoy (not really since we’re anonymous, but we get some superficial satisfaction as long as we don’t think too much about it); (c) send me news and rumors suitable for mongering; (d) peruse the sponsor ads to your left or their links to your lower right and investigate their offerings while feigning deep interest; and (e) use your considerable interpersonal influence to send new readers my way by telling people how the information you regularly glean from HIStalk has made you wealthy, self-actualized, and simply irresistible. Thanks for reading.

Acquisitions, Funding, Business, and Stock

EMR/PM provider ClearPractice forms a strategic partnership with Prognosis Health Information Systems. The companies are collaborating to offer an integrated SaaS-based EMR solution for rural and community hospitals and their affiliated physicians.

A quote from the CEO of Aetna provides some insight into the company’s $500 million acquisition of Medicity:

We recently bought Medicity, a health information exchange (company). We’re using that as a platform to create a data exchange. We will shift risk (financial responsibility for medical costs) to the provider system. We’ll provide them cover with capital as re-insurers. We will be the Intel-inside, if you will. We have dozens of these conversations going on with major systems. We spend $400 million a year on new developments: We are as much a health information technology company as an insurer.

Sales

The VA selects Authentidate Holding Corp.’s Electronic House Call solution as part of its home telehealth program.

The 49-bed Seymour Hospital (TX) purchases ChartAccess EHR from Prognosis.

Oakwood Healthcare (MI) signs a $60 million Epic deal, at least from what I can tell from the half-sentence teaser that Crain’s Detroit Business allows non-subscribers to read.

Methodist Dallas Medical Center chooses RemedyMD for its joint registry.

People

The Indiana HIE hires James S. Hill as VP of sales, tasked with managing sales operations, including market competitiveness, pricing, and strategy. I have to admit I was surprised the HIE world has matured enough to warrant a VP of sales.

Resurrection Health Care (IL) names Bradley Howard, MD its first-ever CMIO to lead its Epic EMR implementation.

Kent McAllister joins fellow Sage Healthcare alum Lindy Benton at Medical Electronic Attachment / National Electronic Attachment (MEA/NEA). McAllister, a former VP of client solutions for Sage, is MEA/NEA’s new CIO. Benton is Sage’s former COO and now serves as MEA/NEA’s CEO.

Healthcare analytics vendor Sg2 names Steve Lefar as president. He previously founded compliance and risk management software vendor MediRegs (acquired by Wolters Kluwer in 2007) and was an Allscripts SVP before that.

Capella Healthcare (TN) names Alan Smith as VP/CIO. He was formerly with Vanguard Health Systems and Cerner.

Announcements and Implementations

El Centro Regional Medical Center (CA) implements eMix for the secure transmission of radiology images and patient reports.

Dell launches a mobile clinical computing solution for Meditech. The product leverages technology from VMware and Imprivata’s OneSign SSO technology.

Here’s what happens when you let HITECH drive your IT projects instead of common sense. Carthage Area Hospital (NY) replaces its Meditech system with CPSI, saying it had to “move quickly to ensure we would receive the $2.8 million in stimulus funding.” So quickly, in fact, that they didn’t have time to train staff or work out billing kinks, resulting in a flood of complaint calls from patients. They say they’ll get everything fixed within a few months.

Government and Politics

The Foundation for the National Institutes of Health brings in HIMSS to help it run the mHealth Summit conference, the third of which takes place in Washington, DC in December. I have mixed feelings about that. I went to the last one and while it wasn’t nearly as fun as the HIMSS conference, it was refreshingly wonky and geeky, with mostly academics and non-profit developers sharing ideas with barely a break between sessions and a small, low-key exhibit hall. I’m sure the HIMSS involvement will bring the glitz, vendors who will dominate the entire conference, and the booth babes. I may go since I haven’t been to anything this year other than HIMSS and I like to get out of the house on occasion.

A proposed but floundering bill in Florida would require insurance companies to cover telemedicine services.

Innovation and Research

HCA Johnston-Willis Hospital (VA) wins a patient care innovation award for its Cancer Survivorship Program, which includes specialized software developed with Varian Medical Systems to generate care plans, schedule visits, and create a comprehensive summary based on evidence-based care. Above is their quite nicely done Pink Glove Dance.

Technology

 

Nashville Medical News profiles Shareable Ink, which moved its headquarters from Massachusetts to Tennessee a few months ago. Shareable Ink President and CEO Stephen Hau provided this comment on the local tech talent pool:

We’ve built an impressive team in Nashville with top-notch, local talent. On the technology front, there are strong candidates in Nashville, but they are few and far between. While I’m not worried about finding the next five strong engineers, sourcing the next 50 will be a challenge.

Other

In honor of National Volunteer Week, 15,000 McKesson employees will build 28,000 care packages for deployed military in Iraq, Afghanistan, and other regions. The initiative is in affiliation with Operation Gratitude and is part of McKesson’s annual Community Days corporate volunteer program.

Singing River Health System (MS) seeks to borrow $37.5 million to upgrade its EMR. Jackson County supervisors are considering issuing a bond to finance the purchase.

Occasionally readers will forward me photos or links of interest. I enjoy most of the items, especially since I work out of my house and some days those e-mails are my only link with the “real” world. Quite often the submissions have little to do with HIT, but serve to assure me that I am not the only one who reads the stuff I write.  Thus, thank you to the thoughtful HIT traveler who enjoyed this bottle of wine and thought of me. Good to know I am not the only one who believes shoes and wine are two of man’s best creations.

Here’s the latest installment of Vince Ciotti’s HIStory.

Fortune’s list of “ridiculous job interview questions” includes one from Epic: “You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?” Pretty easy, and not as ridiculous as my favorite ones, from Intel (“Explain quantum electrodynamics in two minutes, starting now”) and Capital One (“Using a scale of 1 to 10, rate yourself on how weird you are.”)

Sponsor Updates by DigitalBeanCounter

• Consulting magazine names Aspen Advisors one of “Seven to Watch” in 2011 and beyond. Mr. H interviewed Aspen’s founder and managing principal Dan Herman earlier this year.
• Clairvia adds Care Value Analytics, a new tool that aligns data from individual patient experiences with an organization’s clinical and financial objectives.
• Capario partners with Data Media Associates to offer customers customized patient statements, statement mailing, and a  payment portal.
• Hawaii’s Public Safety Department selects eClinicalWorks for its EMR at its seven correctional facilities.
• Bridgehead Software will provide data backup and protection solutions for The London Clinic.
• MD-IT merges with MDnetwork.
• Brad Swenson, VP and national healthcare leader for Winthrop Resources Corporation, is participating in the American Bar Association’s Spring Meeting this week in Boston. He’ll serve on a health law roundtable.
• PatientKeeper releases a white paper entitled Toward Meaningful Usability: Five Keys to Creating Physician-Centric CPOE.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

Monday Morning Update 4/11/11

From Man on the Street: “Re: Association for Clinical Documentation Improvement Specialists conference in Orlando. They expected 575 attendees for their fourth conference and actual attendance was 660. An overwhelming majority of attendees are either on Epic or say they’re moving to Epic.” MOTS included some photos, which I always like.

From Ogie: “Re: ISH. Acquired by PwC.” Unverified, but I’m really hating those company names. They aren’t universally recognized brands like GE or IBM, so hacking down a perfectly good and understandable name into gibberish doesn’t seem like much of an accomplishment, especially if your name (like that of ISH) results in a scattershot of unrelated Google search hits.

From EMRconsultant: “Re: acquisition. A Minnesota / Louisville-based HIS is being acquired soon.” Unverified.

From The PACS Designer: “Re: Nimbula Director. It’s a new class of cloud infrastructure and services system (IaaS) that provides a flexible and secure public cloud with advanced data center security tools.”

It’s the weekend (at the time I’m writing this, anyway) so that means less formality as I use the “old” format instead of the new one. It feels like Hawaiian Shirt Friday.

My Time Capsule editorial this week, once again from 2006: Do Technology Surveys Rate the Hammer or the House? These are fun reading for me since I wrote them so long ago it’s like reading someone else’s work.

Results of my Quick Poll on the departure of John Gomez from Allscripts: 39% of respondents said it will have little or no long-term company impact, 30% said it will have some, and 31% said it will have a lot. I’ll be running these polls when big news comes up. Poll results plus the usual reader comments will provide a quick and interesting industry reaction to events.

Congratulations to Boston, hereby officially named the Capital of Healthcare IT (as it should be, in my opinion). Perhaps I should start a drive to have it commemorated with a monument or something, maybe on the Meditech campus. New poll to your right: should Medicaid and Medicare require biometric identity verification of patients seeking healthcare services?

Kaiser CEO George Halvorson talks up the new Care Connectivity Consortium it formed with Mayo, Geisinger, Intermountain, and Group Health to share patient data. I’d say it’s more of a demonstration project than a true patient benefit since those organizations probably don’t have many patients in common. Here are some excerpts from George:

We are all using our EMRs to improve care and support the delivery of care. We are all learning how to use that wonderful new tool — and we are all interested in sharing what we are learning with the world … The problem with electronic is that when patients go to different doctors for their care, they still tend to have separate records — and that can create electronic silos instead of paper silos … So we are now committed to creating similar linkages with the new set of elite medical groups to create a process that works first for our patients and then — if we do it well — for the world … This is important work. If someone doesn’t figure out how to create links between electronic medical records, those records will not be linked. It will not be done until someone does it. Who better than us to do it? We are patient-focused and we know what can be done and we know what should be done with an EMR. Almost all other care sites are just getting their toes in the water. Some are getting their feet wet. We are swimming. So this is a good contribution for us to make. Instead of keeping our advances and our learning secret and special only to us, we are sharing what we know because we want care to be better for everyone.

By the way, I can’t find a Web site for Care Connectivity Consortium, which seems strange. I searched and careconnectivityconsortium.com is not registered, although the .org variant was grabbed by an anonymous registrant on the day of the announcement.

I ran across a copy the IRS form for HIMSS for 2008, the newest one on file so far. Steve Lieber’s total compensation: $731K (slightly out-earned by Dave Garets, who was running HIMSS Analytics at the time). I’ll have to remember to check back to see if they file a new form soon. The annual conference represented $19 million of its $41 million total revenue.

Those DoD people just can’t stop disagreeing with decisions made elsewhere, but at least they’re finally willing to make fat cat contractors rich in ways other than developing custom software. The VA announced plans to move forward with developing an open source system to be shared by both organizations, but DoD says they’ll look first at commercial software and will consider in-house development only as a last resort.

Six-campus, 305-bed Central Texas Hospital (TX) chooses inpatient EHR and revenue cycle systems from the US affiliate of Mexico-based eCareSoft, expecting to meet Meaningful Use requirements for 2011-2012. eCareSoft says small hospitals can go live on its products in 120 days.

Merge Healthcare appoints Cheryl Whitaker MD, MPH, FACP as its first chief medical officer. I assume that’s the same Cheryl Whitaker, MD who, along with her physician husband (there’s an interesting story and comments behind that link), is a close friend and advisor of the Obamas, not that there’s anything wrong with that. Merge is in Chicago, a city known mostly for dead people electing ethically challenged politicians, at least until the apotheosis of its junior Senator Obama.

The local paper in Middletown, OH runs down the status of electronic health records in local hospitals: West Chester Hospital, implementing Epic. The Fort Hamilton Hospital, implementing Epic. McCullough-Hyde Memorial Hospital, live on CPSI. Atrium Medical Center, live on Epic. Mercy Hospital Fairfield, live on Epic.

Shares in for-profit hospital operator Community Health Systems gained only 9% from 2008 to 2010, but CEO Wayne Smith’s total compensation nearly doubled in that period, rising to $21 million in 2010.

E-mail Mr. H.

Mostashari Named ONC Head

Farzad Mostashari, MD, ScM has been named National Coordinator for Health Information Technology effective immediately, according to an announcement on the ONC Web site and ONC’s Twitter feed. He was Deputy National Coordinator for Programs and Policies under David Blumenthal.

Mostashari was previously with the New York City Department of Health as an assistant commissioner. He holds a medical degree from Yale and master’s in population health from Harvard.

News 4/8/11

Top News

I’ve run reader-provided hints over several months that Allscripts EVP/CTO John Gomez was planning to leave the company. That became official on Wednesday, when Allscripts announced his resignation, effective May 31. He’ll be available to the company for 18 months afterward as a consultant. An internal e-mail from CEO Glen Tullman says that Gomez wants “to focus on a number of areas outside healthcare and perhaps running a company himself.” Allscripts shares dropped 6.8% on Thursday following that news and a downgrade by Auriga, which expressed concerns about his resignation, the level of attrition of Eclipsys employees after the acquisition, and recent KLAS rankings of the Allscripts Enterprise ambulatory product.

I’ve been planning to use quick polls to gauge industry reaction to major news, so here’s your first opportunity to weigh in. Feel free to vote and add your comments.

Reader Comments 

From Year of the Cat: “Re: John Gomez. This could really hurt Allscripts. It’s a very sad day for HIT as one of its most innovative minds exits.” He was arguably their least-expendable employee, at least to anyone interested in the former Eclipsys Sunrise and how it will integrate with other Allscripts products. I hope he’ll stick with the industry in some capacity. It wouldn’t surprise me if he doesn’t start his own company since he’s entirely capable, he has great vision, and his developers have always been able to run circles around just about everybody else’s.

HIStalk Announcements and Requests

I mentioned using polls to get a quick read on industry reaction to major news. I’d also like to get comments from a fixed group of readers like Dr. Jayne does with her Medicine Cabinet. When something big happens, I would e-mail that group and ask for their comments, which I would then run (anonymously) at the next opportunity. If you are a provider CIO, CMIO, or other provider C-level reader and would like to participate, let me know.
I see that CCHIT’s Sue Reber, writing for the organization’s EHR Decisions site, mentions my January 2006 editorial that I ran here recently called CCHIT Should Provide More Information to Purchasers. She even found humor in my making fun of their name almost before the ink was dry on the incorporation papers (“whose phonetic sounding-out always gets yuks from the watercooler crowd”) by adding her own observation that it is “an elegant name with initials not even a mother could love.”

On the Jobs Page: Inside Sales Executive/Telesales, Clinical Software Instructor, Healthcare Implementation Project Manager. On Healthcare IT Jobs: Client Relationship Manager, Healthcare Software Product Manager, Test Analyst.

Acquisitions, Funding, Business, and Stock

MyHealthDirect closes $4 million in a Series B investment round. Arboretum Ventures and Chrysalis Ventures provided the funds, which will be used to expand sales, client services, and technical resources. The company’s Web-based solution allows hospital EDs and other high-acuity providers to search open appointments in the community to generate a patient referral.

CVS Caremark signs a deal with Advocate Health Care and its physician group that will install Advocate physicians as medical directors in 23 MinuteClinic locations in the Chicago area and Bloomington, IN. The organizations will integrate their electronic medical records systems.

CareFusion acquires Vestara for $17 million. The Irvine, CA company offers a drug disposal system that reads drug NDC bar codes and provides advice on how to dispose of the products to conform with all laws and regulations. CareFusion will rebrand the offering as Pyxis EcoStation.

Sales

Henry Ford Health System (MI) selects Health Care Compliance Strategies’ COI-SMART system to manage its conflict of interest disclosure process.

Allscripts will outsource its Sunrise hosting to Xerox subsidiary ACS in a 10-year, $500 million deal. Allscripts expects the business to grow rapidly and needed outside expertise to manage it. My insiders tell me that Allscripts did a good job in being fair to their existing employees so that they’ll be offered their same jobs, pay, and benefits by ACS. While ACS will run the operation, an Allscripts governance team has control. The only casualties so far appear to be some members of the Allscripts remote hosting management team, with a couple of folks already gone. In an interesting twist, Allscripts remote hosting personnel in India are being told they will be let go if they don’t find another position within the company since ACS will not be using offshore resources. I mentioned on January 21 that ACS was being brought in for a role somewhere between oversight and total outsourcing.

Rush University Medical Center chooses Zix for secure e-mail.

Open source software vendor Mirth Corporation launches its InformaCare care management platform for Patient Centered Medical Homes and ACOs. It originally developed the cloud-based product for Pfizer more than ten years ago for Florida community projects and has licensed it back for a wider release.

People

Former Carestream Health GM Todd McNitt joins DICOM Grid as SVP of sales and marketing.

Nuance names Stefan Herm as VP and managing director for Europe, Middle East, and Asia. He comes from McKesson, which of course amused me endlessly since his last name is the same the acronym for Horizon Enterprise Revenue Management.

Insurance company Arcadian Health hires Prudence Kuai as CIO. She was previously with TriZetto.

Government and Politics

“The eHealth boondoggle continues,” according to one Canadian official voicing his objection to the the $673,000 paid to former health deputy minister Ron Sapsford in 2010.

UK Secretary of State for Health Andrew Lansley says fast broadband will improve NHS’s quality and efficiency by enabling greater use of telehealth, mobile computing, and access to information.

Proposed legislation in New York would require Medicaid recipients to have their palms scanned to receive services, saying the identification technology would cost $20 million to implement but would save $5 billion a year while being no more intrusive than electronic toll road payment systems. The state dropped a finger scan requirement in 2009.

Innovation and Research

A four-member Brigham Young University team makes the finals in Microsoft’s Imagine Cup 2011 student competition with their ultrasound application. It allows physicians to download images and them move them to the cloud for collaboration, lowering the cost of medical imaging so that third-world countries can afford to use ultrasound technology. They built their prototype for less than $8,000 using a Microsoft tablet and an ultrasound probe. You can vote for them (or one of the other healthcare-related entrants) here.

Technology

The iPhone is the mobile device of choice for healthcare providers, according  to analysis by the online medical journal Bulletin Healthcare. Almost 30% of healthcare providers access daily medication information with mobile devices and over 90%  of the devices are iPads or iPhones. ER docs and PAs are the biggest mobile device users.

Medicomp has created an online demo of its MEDCIN-powered, browser-based, iPad-ready Quippe EMR documentation system. Sign up and you can play around with it online, provide feedback, and keep yourself busy until the software development kit comes out next month.

Skype has many uses, including for telemedicine and allowing overseas military personnel to watch their babies being delivered stateside. Still, I found this fascinating: police officers are using it from their patrol cars to connect with judges to get warrants issued, especially in time-sensitive cases such as DUI where blood alcoohol levels need to be drawn quickly. One of these days I’m going to sit down and make a list of potential healthcare uses (like checking drugs remotely, walking someone through a procedure, etc.)

Verizon and MEDfx launch a Richmond, VA-area pilot program in which a medical practice scans the paper documentation of diabetic patients and sends it to a physician portal for widespread access. The practice, Dominion Medical Associates, is still paper-based, so the records can be printed and stored in their charts and later migrated to an EHR. The project uses both The Direct Project and NHIN Exchange technologies from ONC.

Other

From KLAS: one out of five community hospitals will switch EMR products within the next couple of years. McKesson and Meditech C/S clients have the highest level of confidence that their vendors will get them to Stage 1 MU by 2013. Healthland and Siemens MS4 clients are the least confident. McKesson was the highest rated vendor, followed by Meditech and Cerner.

Microsoft adds former HHS Secretary Michael Leavitt to the agenda for its Connected Health Conference.

Sponsor Updates by DigitalBeanCounter

• FormFast will host an April 19 Webinar on best practices in hospital process improvement, featuring hospital panelists.
• BridgeHead Software and Laitek Inc. form a strategic partnership that leverages Laitek’s PACS data migration services with BridgeHead’s data and storage management tools.
• Forbes profiles Medicomp Systems and its Quippe tool.
• The University of Kansas Hospital Authority will implement McKesson’s PROmanager-Rx automated medication dispensing system.
• The Ohio State Medical Association (OSMA) will offer Greenway’s PrimeSuite 2011 EHR in its Preferred Partner Program.
• Arkansas Department of Health chooses AT&T’s TotalMobile solution to help gain efficiencies in the transmission of flu vaccination records across the state.
• Health Language signs an agreement with the Chicago-based BCBS Association (BCBSA) to facilitate ICD-10 transition.
• Navicure and the American Academy of Professional Coders (AAPC) form a strategic alliance to educate the industry transition to HIPAA 5010 and ICD-10.
• TeleTracking Technologies joins the American Hospital Association.
• Several 3M products, including ClinTrac and Health Data Management, earn ONC-ATCB certification as EHR Modules.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do your patients know or care about IT?

Curious George

Dear George,

Some patients are openly curious about the system we use and how it integrates with the hospital and other offices. I’ve found, though, that many patients just assume that we’re fully integrated, and because we’re computerized, that I can see everything in every chart of every physician they’ve ever visited.

I remember when HIPAA first came to pass how concerned everyone was about the records release provisions.

(Don’t get me wrong, some consultants still play this game. Even though a release is not required for us to collaborate on the treatment of a patient, they demand one before sending consult letters. That’s usually the last time I’ll send a patient to one of those types, unless they are something really special in which case I’ll call them personally and re-educate them on HIPAA and what a pain their staff is causing).

What struck me funny at the time was that patients already thought we had all the information, whether from an active consultant or from an old chart 15 years ago. Many had no concept of what HIPAA was designed to do or how it would impact access to information. When asked to sign releases, they were surprised to learn that we didn’t actually have everything at our fingertips.

If I thought the desire for information sharing was high then, it’s even higher now. With the advent of Web-based patient portals, electronic refill requests, e-visits, and more, the expectation on many fronts is that we have 24×7 access to the patient’s chart.

When seeing colleagues’ patients in the hospital, physicians used to be able to plead ignorance because the paper charts were locked up at the office. Now patients expect cross-covering partners to have in-depth understanding of what’s been going on with their care. Although a bother to some of my peers, personally, I think this is a really, really good thing.

I remember being petrified taking weekend call, having to talk to my partners’ patients and knowing absolutely nothing about them. Now, I can keep my secure VPN connection and pop into the EHR when someone calls at 4:30 a.m. with questions about whether they really need to go to the Emergency Department or whether they can wait until the office opens in the morning. Those of us who use nurse triage services can allow them to have limited access to charts. Reducing the number of people in the Emergency Department who don’t actually need to be there is a significant cost savings, which all of my patients definitely care about.

Ten years ago, I was one of the first in my area to trade e-mails with patients. At that point there wasn’t a tremendous interest in it and we actually ended up stopping. (Despite the Mother of All Disclaimers, patients e-mailed inappropriately about urgent issues and the hospital felt the risk was too great).

These days, many health systems and private practices are marketing their services around technology and improved access to physicians and care teams. And if you’re still not convinced that patients care about IT, check out the video below.

Dr. Jayne

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

News 4/6/11

Top News

Practice Fusion closes $23 million in Series B financing, bringing the company’s total funding to $30 million. This round was led by Founders Fund, an initial investor in Facebook whose managing partner is PayPal founder Peter Thiel.

Five health systems (Geisinger, Group Health Cooperative, Kaiser, Intermountain, and Mayo) are holding a Wednesday morning news briefing to announce that they will share patient information among themselves under the umbrella of Care Connectivity Consortium. I see that Kaiser trademarked that name this past February.

Reader Comments

From Mariann from Brooklyn: “Re: Siemens and Epic. This sign makes me think I’ve discovered a secret partnership being formed in rural Ohio. I thought you might get a kick out of it.” Sometimes Epic Technologies press releases throw me off until I recall that Epic Systems doesn’t issue press releases, but there was a company in the Middle East once actually named Epic Systems that had Inga convinced she had uncovered something important.

From Thera-Pissed: “Re: MDs liking to fix stuff and move on. I have seen 40 years of over-trained, egomaniac, car mechanics hustling as MDs and whipping up their minions with their stethoscope. I say put ’em all on salary and disband the AMA. Let the Nurse Practitioners do all the caring, helping, relationship, boring ‘diabetes and high cholesterol’ stuff.” 

HIStalk Announcements and Requests

Welcome to Capario, sponsoring both HIStalk and HIStalk Practice at the Gold level. The Santa Ana, CA company’s revenue cycle portal provides a validation engine that gets claims paid on the first payer submission 90% of the time. It works with existing practice management and billing systems, allows quick location and resubmission provides workflow and analytics tools to improve cash flow, and offers a dashboard view of the entire revenue cycle. Capario just launched a Customer Resource center with best practices and tools for claims management and revenue cycle management. The company was the highest-rated indirect clearinghouse in KLAS’s 2010 ambulatory clearinghouse report, scored at 88.8 on a 100-point scale by its users. We ran an HIT Moment with CEO Jim Riley on HIStalk Practice a few weeks back, who offered practical information about RCM vendors, 5010, and ICD-10. Thanks to Capario for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

ED charting provider Forerun raises $2 million in Series C financing to bolster its technology development and fund commercial deployment of its FlexChart product.

Cerner Chair and CEO Neal Patterson earned $5.1 million in compensation in 2010, up from a mere $3.3 million the year before. That includes $1 million in salary, $1.3 million in cash-based incentives, and $121,777 in “other compensation.” It’s good to be Neal. And probably Mrs. Patterson.

Allscripts shares hit a 52-week high today, with MDRX closing at $22.71 and a market cap of $4.29 billion. CEO Glen Tullman holds $34 million worth.

Harris closes on its acquisition of Carefx.

iSOFT founder Gary Cohen says he may up the ante to acquire the struggling Australian healthcare software company, hinting that he’ll place his own bid against the $188 million offer of CSC. I interviewed him a year ago at iSOFT’s invitation (they must have liked how it turned out since they ran a copy directly on their site). I thought he was quite frank and cordial and I enjoyed talking to him, although he tried to minimize the effect of NHS on the company’s fortunes and that didn’t seem to be how it turned out.

3M acquires unspecified “intellectual property, trademarks and products” of Zargis Medical, which develops FDA-approved software to analyze heart sounds, one version of which works over the Internet (like a cross between an electronic stethoscope and telemedicine).

Sales

Hamlin Memorial Hospital (TX) selects Prognosis ChartAccess EHR.

Ochsner Health System (LA) announces plans to deploy Epic’s EMR across its eight hospitals and 38 health centers, having hired 60 FTEs for the implementation.

Trinity Mother Frances Hospitals and Clinics (TX) contracts with Epic. Implementation is targeted for mid-2012.

AtlantiCare (NJ) selects the Elsevier/MEDai Risk Navigator predictive analytics solutions for patient population management and clinical and financial tracking.

Central Texas Hospital picks eCareSoft’s inpatient EHR and RCM technology for its 305-bed, six-hospital health network.

Armstrong County Memorial Hospital (PA) chooses the Unity CVIS solution from DR Systems.

People

CareFusion announces the departure of COO Dwight Winstead on June 30. He has held that job CareFusion separated from Cardinal Health in September 2009.

Adventist Midwest Health names Joe Granneman to the newly created position of CIO.

athenahealth names Todd Rothenhaus, MD as its first CMIO. He was previously SVP/CIO of Steward Health Care (the former Caritas Christi).

Announcements and Implementations

Dartmouth-Hitchcock Medical Center (NH) goes live on its $80 million Epic system.

Sutter Health (CA) will invest over $50 million to help independent physicians implement Epic under its Sutter Community Connect program. Sutter will pay up to 85% of the software and implementation costs.

The Colorado RHIO HIE goes live following the first transmission of patient data by Boulder Community Hospital. Four additional organizations have also signed up to share data.

Harris County Hospital District (TX) goes live with the PatientSecure palm vein scanning system, putting out some fun facts from their 3.4 million patient database via Twitter and Facebook: (a) patients share  the same first and last names 249,213 times; (b) over 75,000 first name/last name pairs are shared by more than five patients; (c) two or more patients have the same first name, last name, and date of birth nearly 70,000 times; and (d) 231 patients named Maria Garcia have the same birth date.

Government and Politics

Doctors in Las Vegas are declining to treat chronic pain patients after a DEA task force arrests an internist for prescribing medications that led to a patient’s death in 2007. He’s been charged with murder under a Nevada law that says that covers death caused by “a controlled substance which was sold, given, traded or otherwise made available to a person.” Peers concede the internist made mistakes in prescribing too many drugs for the patient, but argue that it’s not a criminal issue, especially since the DEA based its murder charge on information provided my a lawyer who was suing the doctor for malpractice.

Innovation and Research

Apixio lends it financial support to the Center for Biomedical Informatics Research at Stanford University. Dr. Nigram Shah, an assistant professor of medicine, is investigating the impact of utilizing clinical data to enhance quality of care.

Kaiser Permanente opens the Center for Total Health in Washington, DC. They will use the center, located next door to one of their hospitals, to show off their innovations (including IT) to politicians and the public.

Non-profit healthcare IT incubator RockHealth opens for business in San Francisco with volunteer mentors that include the co-inventor of Guitar Hero and the co-founder of genomics firm 23andMe. Among its partners are Mayo Clinic, California HealthCare Foundation, Microsoft, and Qualcomm, with medical partners Mayo Clinic and Cincinnati Children’s Hospital. Selected startups get a $20K grant, access to capital, mentorship, and Silicon Valley office space. The organization was at SXSW last month.

Technology

CNN Nigeria covers the counterfeit drug trade there, showing local authorities using technology from Sproxil that puts ID numbers on scratch cards attached to the drug package that are texted by cell phone to verify the authenticity of the drug. The drug companies cover the cost of the service since they obviously have an incentive to prevent counterfeit versions of their products.

InVivoLink releases an iPad app that lets orthopedic surgeons analyze their practice patterns, view implant information, and view procedures over a secure network.

Israel-based eWaveMD will debut its new Virtual Medical Consultation platform in Europe this week. The company has previously developed EHR software, a free PQRI software product, and software used by three of four HMOs in Israel.

Other

Healthcare added 36,600 jobs in March, including 10,200 in hospitals. Total hospital employment: 4.7 million.

Texas County Memorial Hospital (TX) CEO Wes Murray complains about having to spend $88K for a GE Centricity upgrade, saying the version they bought in 2007 was not Meaningful Use ready because “GE was developing new versions of the software that they wanted everyone to purchase.” He says 3,200 hospitals are in the same position and that “GE is manipulating the system for their benefit.” The CFO piles on, expressing unhappiness that the new version requires a larger server than that of the hospital’s inpatient system. I don’t mean to be cynical, but surely GE wasn’t promising in 2007 that the then-current Centricity version would meet MU requirements that weren’t released in draft form until December 2009. Nobody likes an unplanned IT capital expense, but I would be surprised if someone at the hospital didn’t misunderstand.

The latest installment of Vince Ciotti’s HIStory.

Laurens County Hospital (SC) warns patients to follow the road signs and not their GPS if they need to get there in a hurry. Reason: city planners disagreed on the demarcation point separating Highway 76 into East and West addresses, so GPS map-makers were equally confused. The hospital says it sometimes gets calls from lost delivery drivers.

Johns Hopkins Hospital will dedicate the most expensive building in Baltimore history next week, its $1 billion clinical structure. It has two towers, one named after the deceased president of the United Arab Emirates and the other after the mother of New York Mayor Michael Bloomberg.

Sponsor Updates

• PatientKeeper names three new regional VPs to its professional services organization, including former Halifax Health (FL) CIO Lori DeLone, former Bassett Health (NY) CIO Joe Diver, and Bill Dwyer, a former manager at SMS/Siemens and Eclipsys/Allscripts.
• Navicure and the American Academy of Professional Coders form a partnership to develop educational resources to help practices practices transition to the HIPAA 5010 standard and ICD-10 code set.
• iMDsoft and its clients report improvements in care and efficiency through the use of iMDsoft’s clinical information systems and the MetaVision Event Manager. Examples: Massachusetts General Hospital saved $700,000 over 16 months through the use of drug optimization prompts during long surgeries. Lehigh Valley Hospital (PA) increased compliance with perioperative temperature management from 60% to 92%. Henry Ford Hospital (MI) increased its organ donation rate from 64% to 86%.
• Baptist Healthcare System (KY) selects T SystemEV for its five hospitals EDs.
• Hayes Management Consulting is hosting an MDaudit software user group meeting April 13 in Orlando.
• Williamson Medical Center (TN) chooses ProVation Order Sets as its electronic order set solution.
• Saint Barnabas (NJ) will replace several legacy medical imaging solutions with McKesson’s Horizon Medical Imaging PACS.
• 3M Health Information Systems releases its Healthcare Data Dictionary and Enterprise MPI as Web-based applications. The products include APIs to integrate with other applications.
• GE Healthcare and AirStrip Technologies team up to put GE’s MUSE Cardiology system onto iPhones and iPads via the Airstrip Cardiology mobile device.
• MED3OOO is ranked 41st on Pittsburgh Business Times Top 100 Privately Held Companies in Pittsburgh, based on 2010 revenue.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

Monday Morning Update 4/4/11

From Outside Looking In: “Re: Ann Lazerus. The president of the Siemens MS4 division is retiring. MS4 had 500 clients at its height, but Siemens is trying to woo them to the less proven and less stable Soarian. An executive was quoted as saying Siemens will bid Soarian down to 100 beds. MS4 support has been cut back, MS4 executives aren’t even bothering to contact their assigned clients because they’re competing with their Soarian counterparts. ,Once MS4 clients see the price, 90% of them don’t even bring Soarian back as a finalist. If Siemens wants Soarian opportunities from MS4 and Invision clients, they should keep current promises and not make new ones.” Unverified.

From Palomar: “Re: sponsors. Surely you have run across some that were problems. Need to know!” Only one has ever really ticked me off and that was mTuitive in 2006. They begged to have their small Gold sponsorship fee broken down into quarterly payments, then stiffed me after paying one of the four payments due. They were high maintenance to boot, making excuses about not paying, pestering me to sit through a never-ending demo, and even expressing astonishment after they broke our gentlemen’s agreement that I wasn’t giving them enough exposure on HIStalk. I’m nearly always unbiased, but in this case, I’m always happy to ignore their good news and highlight that of their competitors (like Mark Twain said, never pick a fight with a man who buys his ink by the barrel). Other than mTuitive, every company has been great to work with.

From The PACS Designer: “Re: Chrome 10. If you’re a Chrome user, Information Week has published the screen views of the mostly minor changes that improve Chrome 10’s performance. Philips and Siemens are members of the Healthcare IT Workgroup for Chrome 10, Microsoft IE9, and other browsers, along with Cisco and many other IT vendors.” I have to say I like Firefox 4.0 better than Chrome at the moment, but not by much.

From Sick of Snow: “Re: Bayonne Medical Center (NJ). The CIO has been replaced by a hired gun from Network Infrastructure Technology out of New York.” Unverified. Dimitri Cruz was the CIO and still lists the CIO job on his LinkedIn profile.

From MaxPayneUK: “Re: CSC’s purchase of iSoft. What, exactly, will they get? Perhaps a chance to purge the UK management cupboard, a ready-made client base for Lorenzo, and a chance to jettison some of the acquisitions made — and still pocket some change. Nah, can’t be that easy.”

From Seekhau: “Re: [company name omitted]. I heard they’ve signed the agreement to acquire [company name omitted]. Closing will be in the next two weeks.” I already knew about that one and mentioned it (in redacted fashion) previously (since one of the players is publicly traded). I’ll characterize it as somewhat interesting, particularly with regards to the previously signaled strategy of the acquirer.

Two-thirds of respondents said Epic wouldn’t be a good choice for DoD when I ran that poll a few months ago. This time around, 58% said VA/DoD should choose a commercial system instead of building their own open source system. New poll to your right, sure to stir up some civic competition: which city has the strongest claim to call itself the capital of healthcare IT?

Listening: The Kooks, cheery British pop. The heavy Brighton accents (like dialed-back Cockney) annoyed me a little until I realized I should commend them for not adopting fake American ones just for singing, the kind that disappear when talking (Jagger, Robert Plant, and just about everybody else from there trying to cash in with US hits). It balances out, though, as frothy US celebrities like the Michigan-raised Madonna trot out pretentious, comically phony generic Brit accents (at least she lived in London for a while).

Welcome to new HIStalk Gold Sponsor Winthrop Resources of Minnetonka, MN. The company helps organizations make technology financing decisions (operating leases, sale-leaseback, etc.) allowing them to remain independent of technology providers, to refresh technology when needed, and to preserve cash. Winthrop believes that spending cash or expensive bank financing to buy technology assets doesn’t make sense since those assets lose value quickly, require increasing expense to keep running, and need to be upgraded and changed to support organizational goals. The company just earned its HFMA Peer Review Designation and makes its healthcare experts available to help understand the forces in the healthcare and technology markets that affect healthcare strategies. Thanks to Winthrop Resources for supporting HIStalk.

I’ve always wondered why readers send me “hey, did you see this?” news items that I’ve already mentioned prominently. Now I know: they’re speed-reading and missing stuff. I thought I had put in plenty of obvious clues and humor in my “I’m quitting” April Fool’s post to accentuate the joke, but some folks skimmed right over that and e-mailed me to express their sorrow that I’m hanging up my keyboard (or e-mailed Inga to tell her she could do better than to run away with me and my made-up millions — gee, thanks). My summation: (a) I’m not leaving – despite brutal hours and occasional annoyances, I’m having the time of my life; and (b) while Inga is indeed quite the package, when it comes to Mrs. H, to quote the old commercial, I think I’ll keep her. I’m disappointed that nobody seemed to notice that the name of the band Inga and I are starting is an an anagram for “April Fools” (the former chocolate magazine reporter turned healthcare IT expert is true, however). I’ll think positively in assuming that the well-wishing readers were just going along with the gag. Fight the urge to skim HIStalk – it’s not like a newspaper that makes more important articles huge, so you’re guaranteed to miss something important if you just scan down the screen.

Next up in my “time capsule” series of editorials you’ve never seen since they ran in a newsletter you didn’t get: my January 2006 take on the then-new CCHIT. I couldn’t wait to make fun of their name, which I now note happened in the first sentence.

The VA issues an RFP to launch the project to develop an open source replacement for VistA. It seeks a Custodial Agent to create and oversee a structure that will certify the open source code base, certify proprietary software that can work with it (that could be huge), and allow individual users to get their enhancements certified and distributed. The criteria weighting for the award are, in order, technical, price, past performance, and veteran’s involvement. Sounds great in theory, but you can pretty much bet the same dozen or so fat contractors will be elbowing each other at the trough. It looks like the Wisconsin politicians came to the party too late to push Epic as an alternative to custom development.

Saturday’s New York Times has a great article called The Rise of Desktop Medicine, which says it makes sense for doctors to spend time in front of computers as well as patients. It observes that “bedside medicine” identifies and classifies diseases by symptoms and clinical findings, while “desktop medicine” identifies conditions that can be addressed to improve a patient’s health without necessarily calling them diseases. Example: treating high cholesterol even though the patient has no complaints or symptoms. The role of the computer is to look for opportunities for improvement and tap into outcomes information to determine which treatments will work. It cautions, however, that drug companies and others have a vested interest in convincing doctors to treat numbers that really aren’t diseases themselves, so the doctor’s job is to figure out what’s best for the patient. A great quote: “If doctors change simply into some kind of hybrid of a financial analyst risk broker, we will have lost an essential part of what doctors should be doing.”

Epic’s April Fool home page wasn’t quite as good as the classic “our first press release” one from last year, but it was still pretty funny (click to enlarge).

GE gets some not-so-good press for managing to pay zero federal taxes on its $14.2 billion in profit. The New York Times says the company has steadily trimmed its tax percentage to a far lower rate than most companies, using a combination of lobbying, “innovative accounting,” and moving profits offshore to avoid US taxation. “GE’s giant tax department, led by a bow-tied former Treasury official named John Samuels, is often referred to as the world’s best tax law firm. Indeed, the company’s slogan ‘Imagination at Work’ fits this department well. The team includes former officials not just from the Treasury, but also from the IRS and virtually all the tax-writing committees in Congress.”

Elmhurst Memorial Healthcare (IL) chooses Merge Cardio and Merge Hemo from Merge Healthcare for its new hospital.

AirStrip Technologies gets a spot in the first iPad 2 commercial.

It’s getting ugly between WellStar and its fired CEO, as the Georgia health system reacts to its former CEO’s claim that he was unjustly terminated, producing what it says is evidence that he was fooling around with the health system’s EVP and general counsel and refused to stop even after being warned. Some of the evidence involved supposedly coded messages he sent to the EVP, such as “GNSD” (good night, sweet dreams) and referring to her as his “neutron girl” (that doesn’t sound much like a smoking gun to me, but I’m not a judge). The CEO finally had to fire the woman, who then claimed he sexually harassed her and that WellStar sexually discriminated against her. If you sell luxury cars or gated community houses in Atlanta, you might want to stick your flyer under the wiper blades of cars parked outside the law firms involved.

Speaking of Atlanta, Grady Hospital CEO Michael Young leaves to become CEO of PinnacleHealth in Pennsylvania. That impinged on my consciousness only because he e-mailed me a few weeks ago to clarify statements he made about cutting back contractors on Grady’s Epic project, which I had quoted.

Big financial news from Pink Sheets traded PHR vendor MedeFile: the company’s annual revenue was up over 800% (to $134K) and operating expenses were slashed, leaving the company with a loss of only $2.5 million for the year (I was being sarcastic, in case that isn’t clear). It actually looks pretty cool, but nobody’s all that interested in PHRs, even free ones like theirs isn’t.

I seem to be citing The New York Times endlessly today, but here’s another good article on what new doctors want. The answer: predicable hours working salaried jobs for big corporations, specialties like ED that cater to their short attention spans (anything but primary care, quoting one doc in saying, “I like to fix stuff and move on”), and letting hospitalists handle their inpatients instead of being called out.

Don Berwick’s NEJM article about the proposed Accountable Care Organization rules says IT has a central role “in enabling the organization to manage population health and receive feedback at the point of care.”

Mediware will acquires the assets of Atlanta-based alternate care software vendor CareCentric, which include applications for home medical equipment, infusion, and home health. I love this article about CareCentric CEO Darrell Young, who had a long history working for HBO & Company (including a stint as president and CEO) up until McKesson bought it. When he went to CareCentric many years ago, it was such a “train wreck” (his words) that he used the company’s exhibit space at two major trade shows to simply hang an “Under Construction” sign and put out tables and chairs for attendees to eat their lunches. When asked if he thought that would make the company look bad, he answered, “How, exactly, could we look any worse?” When asked about how he would improve the company’s legendary poor customer support, he said, “Well, it has gotten much easier now that we have 700 customers to support instead of 2,500.” I bet he would be a fun interview.

Culbert Healthcare Solutions is profiled in the Boston Business Journal. I don’t have a subscription and therefore can’t read it all, but the part I can see says 2010 revenues were up 77% and headcount by the end of this year will have tripled in two years.

Nuance shares rise after an analyst says the company will be Apple’s voice recognition partner for the next-generation iPhone.

E-mail Mr. H.

CSC to acquire iSOFT for $188 Million

Computer Sciences Corp. announced this morning that it will acquire Australia-based iSOFT Group Ltd. for $188 million, a 24% premium to its last traded share price on the Australian Stock Exchange. 

Michael Laphen, chairman, president, and CEO of CSC, was quoted as saying the acquisition is a critical step in the expansion of CSC’s global healthcare IT business. “The combination of these companies will further establish CSC as an innovative leader in global healthcare IT,” he was quoted as saying in the announcement.

The 3,300 employee iSOFT, reeling after a series of delays in its Lorenzo platform in the UK’s NPfIT project and the resulting decimation of its share price, is CSC’s subcontractor in NPfIT. The purchase of iSOFT by its largest customer was widely anticipated.

The announcement says that iSOFT’s products are used by 8,000 hospitals and clinics in 40 countries.

The sale is subject to approval by shareholders and regulators in Australia and the UK.

GE Healthcare Names De Witte CEO of Healthcare IT

GE Healthcare announced this morning that Jan De Witte will lead the company’s healthcare IT business as its president and CEO. He replaces Vishal Wanchoo, who has been reassigned to GE India as vice president of growth initiatives.

De Witte was named president and CEO of GE Healthcare’s Performance Solutions division when it was created this past June. He will continue in that role as the company combines its healthcare IT advisory and technology services under a single reporting structure.

John Dineen, president and CEO of GE Healthcare said, “Having a single leader like Jan De Witte lead both businesses sends a visible signal to our customers that GE Healthcare is dedicated to growing its IT and solutions offerings, providing them with a unique partner that can deliver the strategic advice they need with outstanding technology. Jan’s extensive experience with technology across global markets makes him the right fit to lead and develop the growth of these two businesses.”

The Performance Solutions business is GE Healthcare’s 150-employee services arm, which offers process improvement and technology optimization consulting based on Lean and Six Sigma methodologies.

The 46-year-old De Witte was named an officer of GE in 2007. He has a masters degree in management and engineering and a Harvard MBA in marketing and operations management.

News 4/1/11

Top News

HHS posted proposed ACO regulations today. We’re working on an interview that will address the IT implications, but in the mean time, you can review the proposed rule and the HHS fact sheet.

Reader Comments

From Court Jester: “Re: Nebraska Medical Center. I hear they signed with Epic about a month ago and are unplugging GE. The primary reason Epic was selected over Cerner was its interface capabilities. They’ll be kicking things off in May.” UNMC published an announcement on its Web site in November confirming Epic as the vendor of choice.

From Steel Curtain: “Re: MED3OOO. Rich Goldberg is leaving his business development job at TeleTracking to take over as president of MED3OOO division CPU Medical Management Systems.” Unverified, although he’s no longer listed on TeleTracking’s site. The move would not be a huge surprise since MED3OOO has filled its executive team with a number of former Misys VPs over the last couple of years.

From MrSoul: “Re: IE6. This is a great tool as we watch IE6 sloooooowly fade into HIStory.”

From Pescetarian: “Re: Seattle Children’s. Dumping Microsoft Amalga for Tableau Software. The press releases three years apart are eerily similar. The hospital was a lighthouse reference for Microsoft in their own back yard, but implementation was terrible, maintenance was almost impossible, and clinicians hated it.” CIO Drex DeFord didn’t confirm that, but was diplomatic in telling me that they’re still working on Amalga and its small base of users, but are always looking for business intelligence opportunities that will put information into the hands of end users.

From Cray Zee: “Re: Trinity Health CMIO. Mike Kramer, MD has left the building.” Unverified, but the provided memo looks authentic. They wish him well, but immediately pledge undying love to their Cerner-powered Genesis project (seems strange that they would need to defend it). It’s a really ambitious project, not quite Kaiser-sized, but in the neighborhood.

From Art Glasgow: “Re: Duke. Mr. H, I thought I’d confirm your note regarding me joining Duke Medicine. I’m scheduled to start around May 1st and am excited and humbled at the prospect of joining such an esteemed institution.” Art is leaving his Ingenix CTO job to become CIO of Duke Medicine, which we ran as a reader rumor earlier this week. He replaces Asif Ahmad, who left Duke last June to take an EVP job with US Oncology. Thanks for the confirmation.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, debuts Pretzel Logic, his new column on technology decision-making in medical practices. Epocrates introduces a mobile and Web-based EHR. HIMSS and MGMA offer a privacy and security toolkit for small provider organizations. A mainstream journalist attempts to explain the EMR industry — and does a pathetically poor job. The success of the ACO-like Atrius Health. Come visit and stay for awhile.

Listening: new from Whitesnake (yes, you read that right). I had mental pictures of hair-transplanted, shirtless-and-Spandex guys in their 60s leaning into a single microphone for yet another round of their coy, unskilled Reagan-era poser ballads, but it actually rocks out quite nicely with excellent production. David Coverdale sounds better now than then (just do yourself a favor and don’t Google his ex-wife and car-gyrating video star Tawny Kitaen for a current picture). Makes me want to load up the Jag with beer and tramp-stamped bleach blondes and head off to Rocklahoma.

Welcome to new HIStalk Gold Sponsor UltraLinq Healthcare Solutions of New York, NY. The company offers a FDA-approved, Web-based ultrasound and image management system that lets physicians review exams from anywhere, including on its iPhone app. The physician does their interpretation using auto-populating review worksheets, the reports are distributed through a variety of ways, everything is stored and universally accessed from a secure Web site, and they handle all the infrastructure. The system is low cost, secure, flexible, and portable. Thanks to UltraLinq for supporting HIStalk.

On the HIStalk Job Board: Social Media Manager, Clinical Business Analyst, Regional Director Centergy Sales. On Healthcare IT Jobs: McKesson PM – CPOE, Application Programmer, Cerner Clinical Analyst, Senior Clinical Analyst IT Implementation. I know the job market is good because my work phone rings off the hook from recruiters.

Make me happy: (a) drop your e-mail in the Subcribe to Updates box to your right so I can tickle your e-mail ivories with HIT love; (b) send me your rumors, news, incriminating photos, and secret documents by clicking the garishly green Rumor Report button; (c) acknowledge the great society that lets you read HIStalk free because of the largesse of sponsors listed to your left, who are more likely to continue that support if you click around a little and maybe buy some stuff from them; (d) find Inga, Dr. Jayne, and me on LinkedIn and Facebook and click the correct buttons to boost our fragile egos; and (e) give yourself one of those pistol-pointing gestures in the mirror for reading and contributing here in whatever way makes you (and me) happy.

Acquisitions, Funding, Business, and Stock

VisualMed Clinical Solutions issues a press release saying it will launch a “new initiative” in the marketing of its EHR product in the US, following a two-year interruption. The company says that the 2008 financial crisis left many institutions without resources to implement systems and “all decision making was entirely suspended.” Its chairman believes that the time is now right for a re-launch, given that the recovery is underway and government incentives are in place. I found the message curious, to say the least, so I did a bit of digging and found a June 2010 press release that bragged of $2.6 million in new orders. At that time, the company credited ARRA for the the boost in sales and market interest. The chairman was quoted as saying, “thanks to the new reforms, our time has come.” Finally, I went back and found a July 2008 press release saying the company had completed restructuring and planned to focus on the “more promising” markets of oncology, Internet, and private clinics. Nothing like having a consistent vision and marketing message.

Sales

Winthrop-University Hospital (NY) signs a seven-year order for cloud-based RIS/PACS and archiving services from Carestream Health.

People

Don Claunch, CIO of Wyoming Medical Center (WY), will take over as interim CFO.

Announcements and Implementations

Marfraq Hospital in Abu Dhabi launches its Cerner EMR following 12,000 hours of training over the last month.

North Kansas City Hospital migrates to Corepoint’s Integration Engine.

Strong Memorial Hospital (NY) at the University of Rochester Medical Center launches Epic EHR. URMC’s Highland Hospital will go live in June. Outpatient services are scheduled for the summer of 2012.

The two big Orlando hospital systems, Florida Hospital and Orlando Health, start a one-year data sharing project via the Central Florida RHIO.

Virginia Commonwealth University Medical Center goes live on the Central Logic ForeFront patient flow system.

Government and Politics

Victoria’s troubled HealthSMART project will need $200 million to finish the job, well over the original $360 million estimate.

Technology

If the rumors prove true, Google will be opting out of the health business. However, Cerner is looking forward to working with Google on its “fiber community” pilot. Google selected Kansas City this week as its pilot for a one-gigabyte-per-second broadband network. Other enthusiastic KC folks include representatives from the University of Kansas Hospital and KU Medical Center, who believe the faster network will help with telemedicine and transmission of medical records.

An editorial by Murray Feingold, MD mentions the mixed reviews of “the menage a trois in the examining room” – doctor, patient, and computer, but says it’s doctors using them incorrectly that make patients feel ignored. He closes with wise advice: “The use of a computer will be successful only if the doctor remembers that the patient is the most important person in the examining room, and not an inanimate computer.”

Other

ICSA Labs awards ONC-ATCB certification to its first three products.

Passport Health Communications becomes the first RCMS solutions company to achieves full accreditation with the HIEAP EHNAC.

A California health clinic that caters to the porn industry announces the possibility of a criminal breach into its medical record database. Personal information on as many as 12,000 current and former adult film performers may have been exposed. The uncovered details include HIV status, STD test results, and the actors’ “real” names. Mr. H, Dr. Jayne, and I are particularly empathetic about the last item.

Mark Rogers MD, a member of the Public Health Trust that oversees the rapidly flat-lining Jackson Health System of Miami, resigns with a warning that the Trust is incapable of saving it from failure. His final recommendations include bringing in an outside CIO.

It’s April Fool’s Day Friday, so I’m wringing my hands in anticipation to see if Epic will come up with another world class spoof on their home page. But to amuse you in the mean time, here’s a phony press release from Concerro. Call me peurile, but I love that stuff when it’s done well.

Sponsor Updates

• Allscripts ED, McKesson’s Horizon Lab, and Design Clinicals’ MedsTracker all earn ONC-ATCB certification. Allscripts ED product qualifies for complete EHR certification, while Horizon Lab and MedsTracker achieve modular certification.
• Congrats to ESD, which celebrates its 21st anniversary on April 1.
• Thomas J. Niehaus joins Encore Health Resources as EVP for client services. He’s the former president of CTG Healthcare Solutions and spent nine years with IBAX. We reported this a month before the announcement.
• Medical Center of Plano (TX) selects ProVation MD Software for gastroenterology procedure documentation and coding.
• Sayre Memorial Hospital (OK) will convert its ED from the T-System’s T-Sheets paper documentation system to T-System’s EHR.
• Blue Cross and Blue Shield Association names Health Language its preferred vendor to help BCBS companies transition from ICD-9 to ICD-10.
• Stephen Newman MD, COO of Tenet, leads a MED3OOO one-hour webinar on physician affiliation.
• Bridgehead Software is conducting its annual Data Management Survey, which looks at data and storage management trends year over year. Random respondents will be chosen to win an iPad, GPS, or Amazon gift cards.
• The Network Health health plan chooses MedVentive as its technology partner for Web-based performance analytics that will enhance its care management, outcomes, and finances.

EPtalk by Dr. Jayne

The American Medical Association announces the 2011 AMA APP Challenge, calling for medical students, residents, and physicians to submit their ideas for “innovative medical apps” to impact clinicians’ daily lives. Ideas will be scored on usefulness; appropriate fit with the AMA and its mission; innovation; suitability for app format; and being representative of the submitter’s expertise. Sorry to all the great coders out there, but you have to be a physician, resident, or student to submit (so go ahead, convince your CMIO or CMO to let you be his/her ghost writer!)

Personally, I’d like to see a knock-off of Urbanspoon , the app where you shake your iPhone to receive restaurant suggestions. You could input symptoms and shake it to view different possible diagnoses. Much more fun that the clinical decision support apps that are out there.

What’s your favorite medical app? Send me suggestions and I’ll check them out and report on the coolest.

Abbott Laboratories receives FDA approval for a blood testing system that transmits results wirelessly, allowing caregivers to remain at the bedside. The device does basic blood chemistry testing and blood counts as well as blood gases. I’m disappointed that future generations of medical students will be denied the opportunity to take the blood gas sample from the patient, place the syringe in a Styrofoam coffee cup filled with crushed ice, and run through the halls of the hospital in the middle of the night to the lab and back.

Wednesday was National Doctor’s Day. I’m sad to say I didn’t get invited to any celebratory lunches in the doctor’s lounge this year (cutbacks, I’m sure). Thanks to Inga for recognizing it on HIStalk Practice! Doctor’s Day has been celebrated on March 30th since 1933, when Eudora Brown Almond, wife of Dr. Cha Almond, commemorated the anniversary of the first use of anesthesia in 1842. She and the ladies of the Southern Medical Association would place flowers on physician graves. The day was officially recognized in 1958 by the US House of Representatives and by President George H.W. Bush in the 1990s. Even though you’ll be a day late, show some love to the docs you love (and be thankful for that anesthesia!)

Reading one of my specialty journals, I was surprised to notice that there were more ads for EHRs and technology products than for drugs. I don’t recall the balance being tipped before. There were also two paid advertisements from CMS – one for Meaningful Use, another for the HIPAA 5010 EDI standards. I wonder how many physicians are familiar with 5010 compared to Meaningful Use? The 5010 is mandatory January 1, 2012. If your billing system doesn’t support it, if you don’t have a plan to test it, or you don’t know what it is, time’s a-wasting.

I’m embedded in a practice this week, which is always interesting. It’s extremely challenging to try to train physicians, let alone having them retain the information. I wish there was a better way to help my colleagues understand the following:

• You actually need to show up for training.
• Checking e-mail or playing on your iPhone does not constitute “participation.”
• Your trainers are professionals who put a lot of blood, sweat, and tears into their efforts. Show them some respect.
• You don’t need an MD behind your name to be able to train EHR. Playing the “no one can understand how complex my specialty is” card just makes you sound whiny.
• If you don’t understand, or need more practice, speak up. Ignorance is NOT bliss where patient care is concerned.
• The EHR is not going away and complaining about it is not constructive. Your trainers didn’t select it, but they do have a vested interest at helping you use it the most efficient way possible.
• Yes, we did bring all this food, primarily to get you to show up. Apparently many physicians still operate under Residency Rules: see a donut, eat a donut. You know who you are.

A Special HIStalk Update from Mr. H – 4/1/11

It’s harder than it looks to continually create HIStalk. I’ve worked on it several hours each day, seven days a week since 2003. It has been my hobby, my passion, and my unintended business for all these years. It defines me more than anything I’ve done, maybe because the time and energy it requires precludes me from doing anything else. For that reason, I always thought I’d just keep doing it forever.

I was wrong. It’s time for me to move on.

I’m weary of the grind. I write from the time I get home until bedtime, rush home to conduct interviews after work, and spend the whole weekend doing everything from browser debugging to invoicing. I’m tired of the never-ending criticism about the site layout, the number of sponsors I have, and my perceived bias for or against certain vendors. Unlike every other blogger in history, I’m not allowed to help an out-of-work friend or make a music recommendation because someone is sure to launch off on me for daring use a couple of dozen words about something that doesn’t fit their personal interest profile.

I started HIStalk as a place I could muse and amuse a little. It’s become so serious that I’m not having fun any more.

Timing is everything. I can’t legally divulge details, but a certain member organization that runs a big conference reached out, wondering if I’d be interested in being acquired. I always say no, but they caught me in a weak moment. Their offer was, to say the least, significant (I can’t divulge the number, but it has six zeroes and the first number is bigger than a one). I think you would do the same if presented the opportunity to be set for life and to be free to do whatever the heck you want instead of what someone else demands.

You’ll see the changes coming here soon. I’m here for the transition until that "wish him well in future endeavors" announcement is made. In the mean time, I’m planning the next chapter in my life and I can’t wait.

Inga really is a woman, as I’ve had to defend to skeptics more than once. In fact, she’s a wonderful woman. Our relationship has grown from terse, pure-business e-mail exchanges to a lot more, resulting in full-on passion at HIMSS. We never meant for it to happen, but we were destined for each other, it seems. I can think of nothing but having her as my soul mate. Mrs. H and I will be parting ways so that Inga and I can head off to the beaches of Mexico to start a new life together, where we’ll be forming the band we’ve always dreamed about, the Frail Loops (think Pink Martini meets Insane Clown Posse). We’re still trying to loosen up Dr. Jayne to get her to join us down there.

We’ll keep reading HIStalk, of course. My replacement is an esteemed industry reporter who won an award for hard-hitting industry analysis at her last job at a chocolate magazine. The site will finally receive that big makeover everybody wants, fancying it up and loading it down with industry-sponsored podcasts and white papers so it looks more credible. There will be no more objectionable material for readers to complain about, like pithy dismissive asides, scandalous reader comments, or contrarian conclusions. The new HIStalk will offend no one.

We may do a little bit of consulting if the acquisition money runs low. Inga is working on a design deal with Jimmy Choo and considering starting a tequila brand like Sammy Hagar did, calling hers Ingatini. We may run a for-profit HIStalkapalooza in our trademarked counterculture way — you’ll have to bring us cash, liquor, food, and iPads to be allowed in. We’ve kept quiet about a planned member organization we may start with the working name of Have Electronic Records, but Sacrificed Solvency (HERSS).

But it won’t be anything like the work we’ve been doing all these years. Like Hollywood types, we need a break from being wealthy, adored celebrities (of the anonymous kind, in our case). Inga’s going to be a great mom to those babies from Cambodia we’re adopting next week. We’re naming them Neal and Judy.

It’s been a great eight years. The record shows I took the blows and did it my way. Thanks for the memories.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

News 3/30/11

Top News

From Quilmes Boy: “Re: Google Health. Just heard a rumor that they are not pursuing development or sales.” Unverified, but strongly suggested by the Wall Street Journal as CEO Eric Schmidt steps aside as CEO to make way for co-founder Larry Page. If they back out of Google Health, that ought to have a major effect on … well, nobody. PHRs are the consumer versions of EHRs — potentially useful technologies that, rightly or wrongly, aren’t all that attractive to their target audience in their current form.

MedQuist (MEDQ) announces that it will voluntarily delist its stock from Nasdaq in April, saying MedQuist Holdings (MEDH, the former Cbay) has bought up 97% of the shares anyway. I suppose it’s just a way to cut the administrative cost involved with keeping two publicly traded entities going.

Reader Comments

From John’s Boy: “Re: Partners HealthCare. Announced today that acting CIO Jim Noga, formerly CIO for Mass General and its physician organization, will be promoted to CIO.”  Unverified, but John’s Boy helpfully included what looks like an internal e-mail announcement to that effect.

From Duke_ACC_Champs: “Re: another champion coming to Duke. Warrior Art Glasgow takes the health system CIO position.” Unverified. He is CTO for Ingenix.

From Siouxsie: “Re: Costco. You can buy everything there, even an EHR." Next time at Costco, I can pick up a set of tires, a five-pound bag of shredded mozzarella, a hot dog, and a copy of Allscripts MyWay (via Etransmedia). In fact, since they already have a pharmacy and a contracted optometrist, I’m surprised they haven’t stuck a doctor back there by the cigarettes and beer.

From GearShifter: “Re: browser. In our IT shop, we’d love to run IE9, we’d settle for IE8, but a couple of HIT application vendors require that we run the older versions of IE for their app to be supported or in some instances run correctly. Don’t always assume it’s IT keeping you down — sometimes it’s that shiny app someone selected.” Good point. I remember fighting those battles over Windows versions – one vendor requires the latest and greatest, while another refuses to certify its application on anything developed in the last five years. Even though the major browsers assume you will always want the newest version, you would think there would be a way to have multiple versions co-exist for situations like these (or to use Citrix or some kind of virtual desktop instead). I can understand requiring IE for official work use since it’s free and ubiquitous. As long as the desktops aren’t locked down, users can always grab their own copy of Firefox or Chrome to steer clear of interfering with the standard browser. And I’ll timidly suggest this: Apple doesn’t have that problem since it controls its entire proprietary hardware and software package. If you want that kind of Apple-like hospital system where there’s only one call to make and one neck to wring, your only choice is Meditech.

From Kid Rock: “Re: Allscripts. There are many things to look at when looking at the value of corporation (and earnings is just one of them – bear in mind that free cash flows and the determination of what should and shouldn’t be discounts are judgment decisions as well). Allscripts had a big investment year. Should the cost of goodwill and capital investment in buying Eclipsys be held against them? I’m not so ready to discount Allscripts.” I said pretty much the same thing. The best time to micro-analyze current financials to predict the future isn’t a few scant months after completing a big acquisition and a skillfully led untangling from a not very competent foreign parent company.

From Alhambra: “Re: your poll on who owns patient information. Unfortunately, that may be one of the major reasons we will have difficulty in attaining true record interoperability. The financial industry has made much more movement in the use of technology without any concern of data ownership.” I was thinking after the poll that people often don’t own all the information that pertains to them. Companies buy and sell e-mail addresses and detailed demographic information from those fake “registration cards” that everybody fills in after buying something that clearly doesn’t need to be registered, like a blender. Nobody complains about companies profiting from selling that information, which isn’t even de-identified. Ample precedent seems to exist that just because information pertains to you doesn’t mean you own it – school transcripts, driver’s license records, criminal history, credit history, etc. I’d be surprised if the lawsuit against Walgreens is successful for that reason. I think they have little to fear as long as there’s something in their Notice of Privacy Practices that covers that situation under the super-broad “treatment, payment and operations” blanket (which technically isn’t even necessary for de-identified data), which doesn’t even require them to give you an accounting of disclosures if you ask. Plus, how can a patient prove their de-identified information was sold?

From All Hat No Cattle: “Re: this paper. Interested whether you think the issues raised will generate much discussion.” Only the abstract is free, but from that, I’d say maybe a little. The “unanswered questions” about EMRs include clinician liability for reviewing a glut of electronic information and overrriding alerts, the lack of a way to report EMR software problems, and the lack of alignment of who pays for EMRs (in both money and time) vs. who benefits from their use. Neither the questions nor the lack of answers are new, but the further the practice of medicine moves up the food chain from small practices to bureaucratic government, insurance companies, and mega-corporations (both for-profit and not-for-profit), the less anybody’s going to worry about the individual clinician who’s on the wrong end of these issues. Unless you’ve gone off the grid with a cash-only practice, your soul has already been sold and resistance of many kinds (EMR among them) is futile. He who provides the tools makes the rules, and let’s face it – patient benefit aside, organizations love EMRs because they allow the executives to monitor and enforce compliance with corporate policies that may or may not be in the best interests of patients and providers. I’d like to be more positive, but medicine seems to be turning into one big 1990s-style HMO where nobody’s happy except big companies and their Wall Street investors romping happily through big profits fueled by delivering as little care as possible. What everybody doesn’t like about EMRs is no more than a symptom of the underlying problem.

From American_Idle: “Re: St. Raphael’s. Due to happen, surprised it took this long. Major Epic consolidation will result in many redundancies. St. Raphael’s HIS is very patchwork.” Yale New Haven Hospital considers buying its neighbor, Hospital of Saint Raphael.

HIStalk Announcements and Requests

My talented offshore programmer/DBA developed an elegant workaround to the bug that was causing some readers to have problems viewing this site using old versions of Internet Explorer, like IE6. Everything should be working correctly now.

Ed Marx has added an updated to his Leadership Equations post from last week.

Acquisitions, Funding, Business, and Stock

Physicians from Cleveland Clinic will provide updates and reviews of medical content for First Consult as part of a strategic relationship between Cleveland Clinic and Elsevier. Elsevier offers First Consult as an evidence-based resource tool for providers at the point of care.

Elsevier also just announced free access to both First Consultant and MD Consult from all IPs originating from Japan. Elsevier wants to make the resources easily accessible to clinicians caring for earthquake and tsunami victims.

Charge capture vendor Ingenious Med gets $3.25 million in funding from Council Ventures, which assigned the resulting board seat to HMS co-founder Tom Givens.

Sales

Amerinet selects 4medica as a healthcare IT supplier. Members of the purchasing organization are eligible for preferred pricing for 4Medica’s inpatient and ambulatory EHR products.

Emerson Hospital (MA) purchases the Pinpoint RX system from Centice, which chemically analyzes prescription drugs and automatically links to the relevant Medi-Span drug information.

University of Michigan Health System’s new C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, opening in November, will implement GetWell Town, the interactive patient care solution for pediatrics from GetWellNetwork. The system has been installed in over 20 pediatric hospitals. Also new from GetWellNetwork: Carroll Hospital Center (MD) chooses its interactive patient care solution, which will integrate with the hospital’s patient management, CPOE, pharmacy, nutritional, and other systems to handle patient education, service requests, and patient-clinician communication.

People

Lake Regional Health System (MO) promotes Scott Poest to CIO.

Announcements and Implementations

Rutland Regional Medical Center (VT) goes live on its $15 million EHR system March 1, which it hopes will qualify it for $5-$6 million in EHR stimulus incentives.

Government and Politics

The government of South Australia is cutting 100 healthcare IT jobs as it consolidates hospital IT functions into a centralized statewide structure.

Poor-performing VA hospitals are shaping up after the Department of Veterans Affairs starts publicly posting outcomes data.

Innovation and Research

Kaiser hoped its contest for ideas of how to build 100-bed hospitals of high quality (“innovative use of technology and facility design to improve access to care and foster collaboration and team care while remaining efficient and affordable.”) would generate 25 solid entries, but they’ve received nearly 400 so far from 21 countries.

Technology

Apple says it sold out its annual developers conference in under 12 hours. Tickets for the June 6-10 conference went for $1,599 each and are now selling as high as $4,599 on eBay and Craigslist. Crazy.

Other

Thomson Reuters names its 100 Top Hospital award winners, based on outcomes. The top four teaching hospitals are in Chicagoland: NorthShore University, Advocate Illinois Masonic, Advocate Lutheran General, and Northwestern Memorial.

Above is the next installment in Vince Ciotti’s look-back series called HIS-tory.

HIMSS Analytics says Meditech owns the largest chunk of the hospital EMR market, with its 25.5% share (1,212 installations) beating Cerner (13%), McKesson (12%), Epic (9%), and Siemens (8%).

Another benefit of EMR: speeding the pace and cost of clinical trials. Medical centers and pharma companies recognize that EMRs provide better tools to quickly and accurately find qualified patients to recruit. With EMR, recruiting the required number of patients for large trials can be reduced from years to weeks.

NextGen Healthcare and its parent company Quality Systems, Inc., recently challenged their employees and clients to raise $20,000 for The St. Baldrick’s Foundation to fund childhood cancer research. They exceeded their goal, raising $28,000. As a result, 15 NextGen/QSI leaders have shaved their heads, including  QSI President Pat Cline. Personally, I think bald is hot.

I got an e-mail blast from LinkedIn celebrating its 100 millionth member and noting that I (as real me, not as Mr. H) was among the first million people to join (in fact, I was around #100,000). I also noted while checking that out that the LinkedIn HIStalk Fan Club that Dann started is up to almost 1,500 very cool members.

Flush with being recognized by LinkedIn as an early adopter, I signed up for Amazon’s just-announced Cloud Drive. You get 5 gigabytes of free cloud storage for files (documents, MP3, video) and unlimited access from any computer, including a Cloud Player. Buy one Amazon MP3 album and they’ll raise your free capacity to 20 GB for the first year.

Sponsor Updates

• PatientKeeper appoints Chris Stakutis , previously with Computer Associates and IBM/Tivoli, as VP of engineering. 
• Wheaton Franciscan Healthcare (WI) picks CareTech Solutions to provide SEO services for its www.mywheaton.org website. CareTech also announces that it has added two new Web Content Management System. CareWorks Fundamentals and CareWorks Fundamentals Amped are lower-cost, standardized packages for hospitals with limited marketing budgets.
• Ozarks Medical Center (MO) picks ProVation Order Sets as its electronic order set solution.
• CynergisTek earns Gold partner status from FairWarning Inc., for its commitment to providing expertise and value to the healthcare community and for its consistent sales success.
• GE Healthcare introduces Centricity Research, a clinical research management solution.
• Wayne Memorial Hospital (NC) is implementing Ingenix’s LifeCode computer-assisted coding solutions, which apply NLP capabilities to identify diagnoses and suggest appropriate medical codes.
• Medical Society of Virginia will offer its members PM/EHR software and services from Sage Healthcare, which will include discounts, certification guarantees, and free upgrades.
• HT Systems signs two new customers for its PatientSecure palm vein scanning system: Altoona Regional Health System (PA) and El Centro Regional Medical Center (CA).

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

Monday Morning Update 3/28/11

From Kip Keino: “Re: Ultimate Software. I heard a rumor they are for sale. They are an HR Payroll Saas Provider with significant healthcare presence.” I haven’t mentioned them since way back in 2004. Rumor is they’ve hired an investment banker to get the sale underway, although the company officially denies it. With a market cap of $1.5 billion on a couple of hundred million in revenue (and a PE ratio of 740!), I’d say it’s strongly possible, especially with Oracle and SAP flush with cash and a lot of hatred for each other.

From Dabney: “Re: WellStar. Lots of speculation why CIO Ron Strachan departed. This article in the local paper says he was fired and speculates why four senior execs, including the CEO, have been fired over the last six months or so.” The attorney representing the former medical group president and former CIO says they came to him about unspecified work issues. They were marched off the property by security this week. The article suggests the firings may have been related to a possible whistleblower lawsuit. The five-hospital Marietta, Georgia system paid the state $2.7 million last fall to settle improper Medicaid billing charges, which was followed by the firing of CEO Gregory Simone.

From The PACS Designer: “Re: lino – Online Stickies. TPD has found an application called lino -Online Stickies that provides sticky notes for your iPhone or iPad. It seems to be an application that could help practitioners through the posting of reminders during clinical rounds.”

From GI Doc: “Re: NEJM article. What do you think of it? It’s certainly a laundry list of problems in healthcare IT, but all I can see are a lot of vague prescriptions based on wishful thinking about how to solve them. But it sure puts the author in a position to say ‘I told you so’ about just about anything that can and probably will go wrong in the future.” It’s hard to believe this compendium of trite EHR observations warranted NEJM real estate. How many times do we need to read that healthcare IT has potential, but more work is needed to make it perfect? I’m as cynical as anybody, but those who use lack of perfection as rationale for doing nothing annoy me. I can’t think of any other industry that has argued so hard against using computers, although I’d support more government standards and even internal, IRB-type oversight within a given institution since I’ve worked in enough well-intentioned IT shops to distrust their project objectivity vs. patient safety (and some hospitals stupidly let their IT department single-handedly run projects that directly affect patients, which makes as much sense as turning them over to the departments that oversee electrical and plumbing). I’ve concluded that almost no one is objective about healthcare IT: the same person is nearly always for it or against it and will argue their position endlessly. Someday they’ll figure out that IT is neither good nor bad, so it deserves neither universal accolades or criticism — it’s just a tool that can make outcomes and cost better or worse depending on who’s using it, what they’re using, and how they’re using it (no different than a paper chart, an antibiotic, or a scalpel). Technology alone rarely makes sucky providers better or excellent providers worse.

I’m running the first of my “time capsule” editorials I wrote for an industry newsletter over several years (odds are you haven’t seen them since it was a boutique-type publication with a limited, high-level audience and no free subscriptions). I didn’t want to send an e-mail blast because some high-strung reader was sure to complain about the two seconds required to delete it, but the first is Is Forcing Physicians to Use Computers a Flawed Paradigm? I wrote it in 2006, but I’ll be surprised if it doesn’t still trigger some impassioned comments.

Listening: The Golem, a rock opera new on CD from Black Francis (aka Frank Black of the Pixies).

Nobody in my most recent poll thinks EMR vendors own the patient information stored on their systems, but that hasn’t stopped companies like Cerner and Practice Fusion from selling it. Beyond that, a full 29% of readers think the provider owns the data, not the patient. New poll to your right: should the VA/DoD replace VistA with an internally developed open source system or go with a commercial package, such as Epic’s? I’ve asked a similar question before, but I’m curious to see what readers think now as the Wisconsin politicians try to steer the government toward Epic.

A few readers have reported sudden problems reading HIStalk using older versions of IE. I’ve got a programmer trying to code around an IE design limitation that plagues no other browser (Firefox, Chrome, Opera, etc.) Microsoft fixed it all recent IE versions, but “don’t make us work harder” IT shops often lock down IE to old versions, frequently IE7 (released over five years ago) but sometimes even IE6 (released 10 years ago). Internet Explorer 9 is the current version, as of a couple of weeks ago. I would explain the nature of the bug, but I doubt anyone really cares other than me. My guy’s pretty close to a fix, I think. If I wasn’t already an IE non-fan, this would do it.

T-Mobile, soon to be part of AT&T if regulators approve, makes two healthcare-related announcements. GeaCom’s Phrazer, a video-powered translation product (video above, which would have been a lot more effective edited down to two tight minutes since it meanders painfully), will run on its network, as will wireless sensor-based monitoring from BeClose.com.

ONC posts its five-year strategic plan and invites public comment. The bullet points: (a) continue pushing Meaningful Use to increase adoption and information exchange; (b) reduce costs by improving population health via technology; (c) update the government’s approach to privacy and security; (d) give individuals access to their health information;  and (e) use healthcare information to improve healthcare knowledge.

The Motley Fool uses Allscripts as an example of why investors should ignore a company’s earnings (which are subject to accounting decisions) and instead look at its free cash flow (operating cash flow minus capital expense) from high-quality sources, ignoring that produced by items such as not paying suppliers or increasing accounts receivable collection in a non-sustainable way. It says 29.2% of Allscripts’ operating cash flow comes from “questionable sources,” such as stock-based compensation and related tax benefits. I’m not sure I buy the argument, at least as long as a company generates consistent earnings, but I suppose you could consider free cash flow an early warning system for earnings that could be threatened down the road. Not to mention that Allscripts had a high capital expense that brought down its free cash flow number, which could be a great thing if it’s using that capital to expand to increase future earnings (and not to mention that who knows what any of this means with the Eclipsys acquisition still fresh).

AssureRX Health gets $11 million in Series B financing, with additional investment from previous shareholders that include Cincinnati Children’s Hospital and Mayo Clinic. The Mason, OH company’s GeneSightRX test helps doctors dose drugs based on a patient’s genetic makeup, initially covering psychiatric drugs.

A report by the Nashville Technology Council concludes that the city is “the Silicon Valley of healthcare IT” based on the number of open IT jobs there. I’d say the methodology was shaky at best: a company checked national and local job portals and counted the open tech positions in Middle Tennessee, finding 925 open positions. I don’t know that I’d consider open jobs as a strong indicator of a city’s influence or appeal, although Nashville certainly has some big companies (mostly for-profit, but not all) that influence healthcare in ways sometimes good, sometimes not. Having no state income tax certainly helps in recruiting people and companies.

And speaking of Chamber of Commerce-type bragging, Georgia says it’s the #1 state in terms of healthcare IT revenue at $4 billion. It helps to have McKesson Provider Technologies in your back yard since I’d bet at least 25% of that figure is theirs, not to mention that many companies have Atlanta regional offices but not their national headquarters (like San Francisco-based McKesson and the former Eclipsys, now part of the Chicago-based Allscripts). Still, companies boost local payrolls and the tax base with a local presence, even if all the big decision-makers live elsewhere. Above is a map of Atlanta company offices from TAG Health (click to enlarge).

Voalte’s nurse communication system gets coverage on the Tampa TV station. It’s a good piece, although the talking head TV doctor wearing a gratuitous white coat in the TV studio (with a Fox 13 logo on it to boot) is a bit much.

Boston’s mayor welcomes NaviNet to the city and its new headquarters. It wasn’t  big move for the company, which offers provider-insurer connectivity, eligibility, PM/EMR, and patient communications — they relocated from Cambridge (1.8 miles from their old address to their new, according to Google Maps). Note to Nashville and Atlanta: according to Hizzoner’s fightin’ words, “Boston is unquestionably the country’s premier location for healthcare and technology innovation.”

Hello, Becker’s ASC Review: e-prescribing is not the same as inpatient CPOE.

A report says that Dutch technology vendor i.Know has been acquired by Intersystems. The company’s healthcare offering turns text-based information, such as clinician documentation, into structured data to create a physician dashboard for the patient. You can play around with a demo on their site at least theoretically, although all I got was a black screen.

E-mail Mr. H.

News 3/25/11

Top News

iSoft suspends trading in its stock and puts itself up for sale. That probably forces the hand of primary contractor CSC to buy the company itself given its own commitments to the UK’s NPfIT project (although you never know – Cerner might give iSoft a look given its global ambitions). Just about every vendor and consulting company involved with NPfIT, including NHS itself, has suffered despite the billions the British government has spent on its ambitious but largely failed centralized healthcare IT strategy.

Reader Comments

From Hate Manual Entry: “Re: JarDogs. A large medical practice is exiting their selection of JarDogs as their preferred vendor of portal services as the company is unwilling to sign a BAA agreement. Their stance is that they do not have independent access to the patient data. As a subsidiary of Springfield Clinic, one can only assume they are receiving poor legal advice from the practice perspective vs. a software vendor. Who would sign without a BAA in place? Mr. HIStalk, do you know anyone in high places at JarDogs to confirm or deny this stance?” The company’s response: “To date, Jardogs has not lost any FollowMyHealth deals as a result of a BAA issue.”

From Epic Interest: “Re: VA and DoD. Here’s the letter from the Wisconsin congressional delegation. You can see here that besides Epic as a company and Judy as an individual, her husband Gordon has been keeping up with her political donations penny for penny. The PCAST report listed only four institutions as health IT success stories – the VA and three Epic sites.” All the recommended sites use Epic, of course. Judy gave $349K and Epic another $726K in political contributions, but that was over a 13-year period. I don’t know that $82K per year in donations buys a lot of clout these days, but having thousands of taxpaying employees surely does.

HIStalk Announcements and Requests

The new format stays, with the voting 62% to 38% in favor. Old-schoolers can still look forward to a more informal and category-free Monday Morning Update.

This week on HIStalk Practice: a PCMH pilot results in lower costs and better outcomes. The SoloHealth kiosk is coming to a grocery store near you. Kaiser Permanente Hawaii sees an uptick in patients using online tools to schedule appointments and communicate with physicians. The owner of storage units holds medical records hostage over unpaid rent. One hundred percent of readers say they love or like the news presented on HIStalk Practice, so we promise it’ll be a good read.

Tonight’s post will be a bit shorter than usual since I’m taking Mrs. HIStalk to a concert (I’m dressed in all black and scowling so I’ll look emo-intense, which I’m sure will amuse her). Your regularly scheduled verbosity will return with the Monday Morning Update.

On the Jobs Board: Implementation Tester, VP/Director, Microsoft Alliance, Regional Director of Enterprise Sales. On Healthcare IT Jobs: Cerner Clinical Analyst, IT Systems Analyst, Eclipsys Clinical Consultants, Clinical Informatics Specialist.

Acquisitions, Funding, Business, and Stock

Fortune Magazine publishes its annual list of World’s Most Admired Companies and HCA is named best medical facility. McKesson was the overall leader in the healthcare wholesalers category, while Henry Schein took the top spot for social responsibility and global competitiveness among healthcare wholesalers.

Publicly traded EMIS, the UK’s largest EMR vendor, shuts down its operations in Canada without having established significant market share there. The company blames the lack of national standards that fragments the Canadian market into 10 provinces that each have their own certification requirements.

People

Good Samaritan Hospital (IN) promotes Chuck Christian from director of IT to CIO.

Announcements and Implementations

Southeast Texas Medical Associates reports that its use of IBM business analytics has helped doctors identify trends and assess treatment protocols, which in turn have reduced the number of patient hospital readmissions by 22%. In addition, physicians have reduced the required time to evaluate patients’ data prior to treatment from an hour to a second.

The South Florida REC says that more than 1,000 physicians have signed up to receive EHR adoption and implementation services.

Maine Primary Care Association (MPCA) partners with Arcadia Solutions on an initiative to gather and standardized electronic PHI for evidence-based decision making. MCPA is connecting 19 community health centers to a centralized database for aggregate reporting.

The REC PaperFree Florida updates its list of qualified vendors.

Innovation and Research

The engineering school at UC San Diego announces a call for entries for its Southern California Healthcare Technology Acceleration Program (it would have been acronym heaven if they’d used “uptake” instead of “acceleration.”) Three to five programs will be chosen that can lower the cost of an area of California healthcare by greater than 30%. They will receive mentorship and up to $100,000 in funding, with suggested areas including chronic disease management, reduced procedure cost, and telehealth.

Technology

I feel like I have a new PC with all the speed I’m getting. Reason: Firefox 4.0 (super fast) and a much-needed upgrade to Yahoo Mail, which had slowed down to the point of being nearly unusable. Now if someone could just fix Netflix streaming, which is dog-slow now that everybody and his brother has signed up.

We might have guessed right on the supposedly big announcement from billionaire Patrick Soon-Shiong. Most of what he had to say at the CTIA conference seemed to be pie-in-the-sky predictions about personalized healthcare, but he mentioned object recognition (like that developed by the computer game company he just invested in) as having medical application.

Other

LinkedIn membership hits 100 million this week. Sounds like a great reason to link up with Mr. H and Inga. Or if you rather, friend Mr. H, Inga, or Dr. Jayne on Facebook. Or just like HIStalk. LinkedIn, by the way, says nine percent of its members are in the high-tech community, though a mere 74 individuals are Elvis Tribute Artists.

I’ve griped before the some of the allegedly HIT-focused news blasts have unrelated stories that seem to indicate a lack of reporter knowledge about healthcare IT. Example above, from the loftily titled Health IT Strategist (I never see much of anything strategic in their headlines, but whatever). So I wondered why I hadn’t heard of Teleflex, which earned a big mention here. Reason: the “medical technology” it wants to focus on (the reason it’s selling its boat steering products division) has nothing to do with IT – they sell catheters, ventilation supplies, and laryngoscopes. Just what strategically thinking CIOs are worrying about these days.

Sponsor Updates

• Six oncology treatment centers add IntelliDose software to their Allscripts EHR to handle oncology-specific functions. Allscripts and Intellidose signed a partnership agreement last year.
• Sunquest Information Systems announces three enhancements to its ICE 5.0 Solution Suite, which is principally intended for use in primary and secondary care NHS Trusts.
• Baycare Health System (FL) selects Medicity’s HIE solutions to connect with community providers and to share patient data. McKesson’s Practice Partners, Allscripts and GE Centricity are among the first EHR applications the HIE will integrate.
• The 17-provider Orthopaedics East & Sports Medicine Center (NC) selects SRS e-prescribing application as a first step towards full EHR adoption.
• AT&T partners with BlueLibris to provide wireless connectivity for a wearable, personal monitoring device that provides near real-time monitoring of patient physical activity.
• HMS clients Rockcastle Regional Hospital (KY) and Breckinridge Memorial Hospital (KY) are awarded incentive checks for their EMR adoption. Rockcastle received a check for $630,000; Breckinridge for $194,000.

EPtalk by Dr. Jayne

According to a recent Intuit Health survey, offering e-mail and online payment would boost collections. American Medical News cites patient confusion as a frequent cause of delayed payments. Additionally, physician practice spending on bills and attempts to collect would be reduced. Surprisingly, the study notes that half of patients still pay with paper checks. Although I agree in principle, I think that before practices and health systems deploy these systems, key players need to enroll themselves and try it out first hand.

There are winners and losers in the game. My last experience with the online bill pay website at a large academic medical center (which shall remain nameless) was somewhere on the scale between “exasperating” and “who are they kidding?” Luckily since I’m a patient at a practice with a topnotch patient portal, I’ve experienced the other end of the spectrum, completing their new patient questionnaire from my sofa rather than in an uncomfortable waiting room chair.

USA Today features hospital robots used to transport everything from pharmacy supplies to linens. Units are programmed with hospital floor plans and use sonar, infrared, and laser sensors to avoid people and obstacles. This isn’t a new concept – one of the hospitals associated with my medical school had one. It wasn’t sophisticated (running along a painted line on the floor and beeping at you when you were in its way) and only operated during the night shift.

HealthDay highlights a recent study  which concluded that text messaging can help heavy smokers quit. Text reminders to document cravings, smoking, and mood were seen to be “as effective as more costly and harder-to-use handheld devices.” I wonder if I can get a grant to do a text message study reminding compulsive text messagers to close their phones and enjoy the spring weather?

Low-tech but fascinating. Most physicians have war stories about the most interesting cases they’ve seen. Some take it a step farther and collect medical artifacts. Personally, I have a collection of medicinal alcohol prescriptions that were written during Prohibition. I used to be a patient at an ophthalmology practice where the physicians had a curio cabinet of items they had removed from patients’ eyes – metal fragments, projectiles, and even fish hooks. Chevalier Jackson MD practiced in the late 1800s and early 1900s and kept a collection of foreign bodies swallowed by patients during his career. Over 2,000 items are on display at the Mütter Museum in Philadelphia, with a slideshow available for the curious.

Social media fans take note: The Dayton Business Journal reports that 41 percent of people turn to social media for healthcare information, with 94% of them leveraging Facebook for medical advice. I was starting to feel pretty good about my Facebook following until I saw that the Centers for Disease Control and Prevention has 80,000 fans and the American Cancer Society has 226,000. Regardless, you can still friend Mr. H, Inga, or Dr. Jayne.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

News 3/23/11

Top News

Politicians from Epic’s home state of Wisconsin urge the VA and DoD reconsider their plans to develop an open source replacement for VistA, asking for “appropriate consideration” for “commercial EHRs.” Epic admits it provided information to Wisconsin’s members of Congress as well as to those from other states, although a company spokesperson stresses that it does not hire lobbyists. Expert Tom Munnecke was quoted as saying, “The open-source VA VistA model was always under attack by those who wanted to lock the government in to their proprietary architecture. The VA showed repeatedly that an open model was superior.”

The Alembic Foundation announces its formation as a nonprofit that will build and manage open source technologies that empower citizens. Its first project is Aurion, which will extend the work of the CONNECT project as a private sector custodian. David Riley and Vanessa Manchester, Alembic’s president and COO, respectively, helped develop CONNECT for the Federal Health Architecture as independent contractors before starting Alembic. They also mention a keen interest in Personally Identifiable Information.

Reader Comments

From Frank Poggio: “Re: Medicare Payment Advisory Commission’s recommendation of a 1% physician pay increase. If a doc gets payments of $400k per year from Medicare, that means they will get a $4k increase in payment if volume and mix stay the same. But .. CMS has never accepted the MPAC recommendation without lowering it, so probably will be more like 0.5% (a $2,500 increase). Now if the doc does not do the EMR dance and misses MU, they will get hit with a 33% reduction in his/her Medicare adjustment, reducing the $2,500 by $800!! In other words, if I do not spend $40k+ on an ambulatory EMR (not including installation, training, etc.) it will cost me $800. Sounds like a no-brainer to me. Forget the $800 and do it when you are really prepared and ready to, not when the government says JUMP!”

From Nolan Smith: “Re: Duke CIO. Duke University Health System has picked a new CIO. Look for an announcement soon.”

From Lazlo Hollyfeld: “Re: NHIN Direct. I give the federal government credit. I never throught they would get this far. Gradually added vendors and now have almost every important ambulatory EMR vendor. I do wonder, though, why athenahealth is MIA, especially since Bush takes every chance he gets to bring up the ‘walled garden’ analogy of his EMR competitors?” ONC announces that 60 organizations (including the vendors on the list above) will support the Direct Project’s protocols, which will allow simple EHR-to-EHR messaging and secure e-mail (using the provider’s Direct Address) to replace paper and faxes.

HIStalk Announcements and Requests

Several readers suggested holding off a couple of weeks before deciding whether to make the “new” format (this one) permanent, so here’s your last chance to vote.

I wrote some pretty good editorials for Inside Healthcare IT over several years because I wasn’t as busy with HIStalk then and I have a desperate need to be loved (it must have been that because I worked cheap). I’ve reacquired the rights to the large collection (something like 175 editorials) and will start running them occasionally on HIStalk. They’re fun to read because they cover what was big news at the time (much of which still is), not to mention that I wrote them on a tight deadline that made me usually go way over the top in both subject and style (the title of one of my early ones: Just Back From HIMSS? Finish Implementing Yesterday’s Fads First.) I ran a few of them here years ago, but most haven’t seen the light of day unless you were a subscriber to that newsletter.

Acquisitions, Funding, Business, and Stock

Xerox-owned Affiliated Computer Services (ACS) will acquire CredenceHealth, a provider of clinical surveillance software, and will integrate its clinical surveillance tools into ACS’s Midas managed care solutions.

Cerner shares hit an all time-high this week, closing Tuesday at $107.80 and giving the company a market cap of $9 billion. Neal Patterson holds $459 million worth.

A Kaiser Health News article says that insurance companies are investing in less-regulated businesses to keep their profits high, potentially also giving them control over more of the healthcare system. Mentioned: UnitedHealth Group’s acquisitions (including Picis), Aetna’s purchase of Medicity, and Humana’s acquisition of clinic operator Concentra. Former ONC head David Brailer is quoted: “If you’re a health plan, you either become a care delivery system or an information services company. The traditional business is dead.” 

Apple sues Amazon, saying the company improperly used its trademarked “App Store” name. Some EHR vendors have used that name as well, so this is probably a good reason to stop.

A class action lawsuit trial against Tenet Healthcare starts Monday, brought by people inside Memorial Medical Center, a New Orleans hospital it owned in which 45 people died following Hurricane Katrina in 2005. The suit claims the hospital had inadequate backup electrical systems and wasn’t prepared to handle a disaster. Tenet is alleged to have initially turned down the hospital’s requests for supplies and evacuation helicopters. Doctors at the hospital have already admitted they intentionally killed suffering patients with drugs in the four days it took for help to arrive.

Sales

United Hospital (MN) chooses Isabel Healthcare’s diagnosis support system to integrate with its Epic EMR.

The Military Health System awards Evolvent seven new task orders, including a transition from ICD-9 to IDC-10 code sets and 5010 updates.

People

John Schrenker, former CIO of Lakeside Health System (NY), will run the new online master’s degree program in health information administration of Roberts Wesleyan College.

Announcements and Implementations

MidMichigan Health goes live on Cerner after spending 398,000 person-hours preparing, not including the time of Cerner employees or that of contractor Deloitte Consulting. The total project cost for MidMichigan’s four hospitals: $50.1 million.

Banner Health (AZ) will spend $200 million to upgrade its Cerner systems in 23 hospitals, expecting to recoup $125-$150 million from federal EHR incentives.

Henry Ford Health System (MI) goes live on its $100 million CarePlus Next Generation EHR at its Ann Arbor location. Henry Ford’s IT team, including six executives and 150 programmers, spent six years developing the system, which is sold commercially by Reliance Software System (RelWare) as EXR.

Innovation and Research

athenahealth VP John Lewis says that his company is “definitely considering” retooling its product to work on Safari and Mozilla browsers and not just Internet Explorer, but notes it would require “a big chunk of additional cost in research and development.”

Other

I mentioned Vince Ciotti’s HIS-tory presentation at HIMSS. He’s putting together a version for HIStalk, the first installment of which is above. Assuming SlideShare works, anyway, not a given since they seem determined to mess it up by grafting it onto Facebook and Twitter. My first choice was Microsoft’s Windows Live SkyDrive, but I couldn’t get it to work right.

The new $1 billion children’s hospital in Victoria, Australia will open in November using software applications it previously described as “old and outdated” and potentially dangerous to patients. The hospital had turned down the government’s HealthSMART system to go its own way and requested $24 million to buy an unnamed US system, but the new government forgot to budget for it.

Two New York men are arrested for selling oxycodone out of a Lickety Split ice cream truck. Kids would buy their frozen treats and grownup addicts would line up make their purchases, turning the truck into a $1 million a year business. They pair will be giving up their mobile freezer for a different kind of cooler.

Sponsor Updates

• Cumberland Consulting group promotes Elizabeth Durst to executive consultant.
• Sage Healthcare finalizes a uniform community health center contract with the Texas Association of Community Health Centers.
• California Health Information Partnership and Services Organizations (CalHIPSO) identifies eight vendors to participate in a Stage 1 contract negotiation process: Allscripts, eClinicalWorks, GE (Practice and Advanced Systems), Greenway, NextGen, athenahealth, McKesson (Practice Partner), and e-MDs.
• Quest Diagnostics launches a 12-week, 10-city Care360 EHR Road Test tour to provide live demonstrations of the Care360 EHR software.
• Fujifilm Medical Systems and Nuance Communications partner to sell Nuance’s PowerScribe 360 dictation system to Fujifilm’s base of radiology customers.
• MD-IT posts a product video to YouTube.
• Consulting firm asquaredm offers a free guide called The Physician Compensation RVU Fallacy: Part 2.
• Health Assocation of New York State (HANYS) expands its relationship with RelayHealth as its preferred partner for revenue cycle management solutions for its member hospitals and health systems.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

Monday Morning Update 3/21/11

From Holly: “Re: Patrick Soon-Shiong. Maybe his healthcare announcement, if there really is one, will involve his recent investment in online game developer Fourth Wall Studios. He mentioned healthcare in his statement about that investment. ‘As I work with new technologies for healthcare and medicine, I see more and more parallels with what’s happening in entertainment; for example, the rapidly accelerating use of mobile devices and social media platforms, and the use of novel algorithms to create machine vision.’” Machine vision means applying computer algorithms to extract information from images that can be used to measure or control a process. It’s usually mentioned in a manufacturing context, but it sounds like PSS has something different in mind. That doesn’t sound like technology that would interest a wireless conference crowd, though.

From Kittery: “Re: Allscripts. Notified employees this afternoon that product strategy will move under President Lee Shapiro. It previously reported to John Gomez. Rumors abound that Gomez’s departure is imminent and the company is enticing his direct reports to stay. The e-mail also said that Lee Shapiro will lead its international business, which will focus on English-speaking countries where it maintains a footprint. It did not include the Middle East, where the company recently walked way from the largest deal where they were vendor of choice.” Unverified. I’ve heard the Gomez rumors over several weeks, but that’s all they are so far.

From The PACS Designer: “Re: Apple’s iOS 4.2 Personal Hotspot. Another feature of Apple’s iOS 4.2 is the availability of a Personal Hotspot that others nearby can use to connect to the Web. With this iOS 4.2 feature, the iPad was capable of averaging just over 1 Mbps on downloads and uploads using a 3G network. InformationWeek has an evaluation of the pluses and minuses of this feature.”

From Swedish Meatball: “Re: Swedish. See attached regarding planned affiliation between Swedish Medical Center in Seattle and hospitals on the Olympic Peninsula in Washington State. As affiliates, the hospitals will be using Swedish’s existing Epic EMR. Swedish already has a contract in place with The Polyclinic to share its Epic EMR.” Internal documents from Olympic Medical Center suggest that the EMR was an important part of the decision, along with clinical integration, collaboration on support services, and ACO.

From An HIStalk Fan: “Re: my MBA class’s Google survey. I had a dismal 38 respondents, but due to your efforts, I exceeded my goal with 551 respondents. Thank you. I do want to share that I have a better appreciation for the work you, Inga, and Dr. Jayne do for us readers. As a nurse, I know what it means to have a thankless job and your HIStalk work is definitely right up there in my book. The negative comments to my one open response survey question flabbergasted me. I’m sure you have had your share and I hope the naysayers never distract you from the truth, which is, WE ALL LOVE YOU, MR. H! I also wanted to provide you the results of the survey.” I’m occasionally amazed at how ill-mannered some people get over something trivial (like getting a second e-mail blast in one day or my mentioning my out-of-work friend). It used to bother me, but I’ve distilled my reaction as follows: (a) if I’m not getting readers worked up in ways both good and bad, then I’m not doing my job; (b) I don’t know the commenter and they don’t know me, so it’s not really as personal and hopefully it’s just Internet rudeness they wouldn’t exhibit in person; and (c) a few people in any given subset of the population have serious issues, and if blasting me by e-mail keeps them from expressing their inner rage in more harmful ways, then that’s OK, I can take it (although I always ask myself why they’re reading if it bothers them all that much). It’s also not a thankless job – I get thanks all the time and appreciate that. I uploaded the PDF results of your survey here.

From Dale Sanders: “Re: from The Onion. You are going to love this!” Dale’s right – I love The Onion and I’ve previously observed, as they do here, that oil change places keep better records about your car than most hospitals keep about its driver.

Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry

KETTERING, OH—A comprehensive digital cataloging system that keeps track of its customers’ car maintenance history, oil-change needs, and past fuel-filter replacements puts Karl’s Lube & Go’s computerized record- keeping an estimated six years ahead of the medical industry’s, sources confirmed Friday. "We figured that a basic database would help us with everything from scheduling regular appointments to predicting future lubrication requirements," said the proprietor of the local oil-change shop, Karl Lemke, who has no special logistical or programming skills, and who described his organizational methods, which are far more advanced than those of any hospital emergency room, as "basic, common-sense stuff." "We can even contact your insurance provider for you to see if you’re covered and for how much, which means we can get to work on what’s wrong without bothering you about it. The system not only saves me hundreds of thousands of dollars per year, but it saves my customers a bundle, too." Lemke added that he also routinely and politely inquires about his customers’ health and well-being, which puts him roughly 145 years ahead of the medical industry

We still can’t collectively decide whether free government money has too many strings attached. New poll to your right: who owns patient information in EHRs and other provider systems? A simple question that I suspect does not have a simple answer.

We already mentioned that the press release touting a $3,500 EMR report fails to mention Epic. It also misspells Eclipsys, which for some reason is as vexing to writers as Misys was (Mysis, anyone?) The report may be amazing, but I’d have a tough time writing that check based on what I’m reading here.

Speaking of lame press releases, here’s one from Avaya, touting the results of its booth survey at the HIMSS conference (one could argue that the survey itself was lame considering it was conducted at the Avaya booth with no respondent pre-qualification or demographics noted and only 130 responses received). Not only are the results startlingly mundane (hospitals buy IT to improve patient care, clinicians are busy) but the press release segues directly to a product pitch, ruining the perception of the 1% of readers who might have thought they spotted a tiny glimmer of objectivity by virtue of squinting their eyes and reading really fast. Not surprisingly, some of the rags and sites dutifully reported the results as though they were meaningful. I’m hoping we weren’t one of them since Inga loves writing about surveys and I usually limit her to one per post or I just edit them out. Companies do self-serving, statistically unsound surveys because they know lazy writers will run the company-friendly results unchallenged, adding their own catchy headline and dramatic summary in hopes of being mistaken as having commanding industry analytical skill.

Welcome to new HIStalk Platinum Sponsor Logical Progression and its flagship product, Logical Ink. The Cary, NC company has offered mobile documentation solutions for years, leveraging tablets, digital ink, and a pen-based interface to give clinicians a user interface that’s as natural and easy to use as paper. They convert paper forms to mobile applications that physicians and even patients themselves complete just like they would on paper, adding their own free-form notes, drawings, or signatures (data capture from handwriting recognition is supported). The resulting documentation is validated, digitally signed, and sent to clinical or enterprise content management systems. Sample solutions include admissions, informed consent, progress notes, radiology, and anesthesia record. The company owns all of the technology it uses, so it provides total system support and OEMs its technology. Refreshingly, it offers detailed and complete pricing information in the clear on its Web site. Thanks to Logical Progression / Logical Ink for supporting HIStalk.

Here’s a demo of the Logical Ink consent app for the iPad.

I’m still working on the idea of giving small, innovative companies exposure on HIStalk. I have experts in place to do the vetting and ideas of how that exposure will look. We’re working out the details and will be taking submissions soon. I think it’s going to be tremendously fun, so stay tuned.

Canadian surgeons are using Microsoft’s Xbox Kinect in surgery to allow them to manipulate medical images via gestures without breaking scrub. They say it can save up an an hour in complex surgeries that would otherwise require leaving the sterile field and scrubbing in again, saying it works like a car GPS in allowing you to keep driving while you get oriented.

Montana governor Brian Schweitzer urges state lawmakers to reconsider their decision to make Montana the only state to reject HITECH EHR money. The legislature has voted four times to deny the state’s HHS department the authority to accept an estimated $35 million in federal money to distribute to hospitals in the state. The governor, a Democrat, says the money would reduce healthcare costs and increase jobs. Republican lawmakers say they’re drawing the line on out-of-control federal spending, with one saying, “Every one of those federal dollars that we spend, a taxpayer somewhere has to come up with.”

Thomson Reuters is helping out folks in Japan by providing free access to the radiation exposure content in its Micromedex Poisindex. All clinicians in Japan and everywhere else, whether they are Micromedex subscribers or not, can review information on evaluating and treating radiation exposure.

Speaking of the situation in Japan, hospitals are struggling. Some are without utilities, one has 10% of its staff missing, another used the last of its rice and limited patients to two meals per day, and physicians and employees can’t get to work because of fuel shortages. “It’s as if some enemy is starving us out,” one hospital official said.

Cooper University Hospital (NJ) is using iSirona’s solution to send monitor data directly to Epic, which the hospital says saves each nurse about an hour per shift.

I mentioned that only one of the educational sessions I attended at HIMSS was any good, that one being about bedside barcoding. It was excellent and very well received. I didn’t have presenter information, but it turns out it was Charles Still of Southwest Vermont Medical Center. He e-mailed me to let me know that he offers a more in-depth Webinar version of the same presentation a few times a year for $149 per attending site to offset some of his conference expense. The next session for Technical Device Considerations for EMAR/BMV Systems Implementation is April 14, with a limit of 24 participants for the 90-minute class.

A research study published in JAMIA finds that electronic medical records systems improve quality of care of HIV/AIDS patients in developing countries by sending clinicians automated reminders of overdue CD4 blood tests. The system used was the open source OpenMRS.

GhostExodus, the 26-year-old who who posted a YouTube video of himself hacking into computers and the HVAC system at W.B. Carrell Memorial Clinic in Texas, is sentenced to nine years in federal prison. He seems more stupid than dangerous.

E-mail Mr. HIStalk.

News 3/18/11

Top News

A lawsuit against Walgreens focuses on the selling of medical information gleaned from patient prescriptions. Previous lawsuits focused on patient privacy violations, but this one charges Walgreens with depriving patients of the commercial value of their own prescriptions by selling their de-identified information to drug companies for marketing purposes and keeping the money for itself. The plaintiff argues that Walgreens doesn’t own the information, so it shouldn’t be selling it. The suit cites a 2010 SEC filing by Walgreens that lists “purchased prescription files" as an intangible asset worth $749 million.

Senator Sheldon Whitehouse (D-RI) introduces legislation that would expand EHR stimulus incentives to include eligibility for behavioral health, mental health, and substance abuse treatment professionals and facilities.

Harris Corporation and Johns Hopkins Medicine announce a joint venture in which Harris will develop medical image management solutions for Hopkins that it will then commercialize.

Reader Comments

From Stephen Yoder: “Re: appointment scheduling. I’m an applications specialist with Cerner and Epic experience and have also worked with a Mammo RIS from a small company called PenRad. It does something that Cerner and Epic can’t – it allows scheduling two or more successive appointments ordered by one provider from different locations (or organizations) and then correctly routes the signed results via fax back to the location from which they were ordered. Those other systems send everything to one location, or require entering dummy doctors. Faxing isn’t going away and neither is FNPs, PAs, and MDs working on multiple locations. Comments welcome, even statements that I’m silly for expecting the big dawg HISs to perform as well at a specific task.” Unverified. PenRad is the #1 KLAS-rated mammography information system, according to the company’s site.

From Lamprey: “Re: CTIA. The wireless conference is hyping the conference in saying that healthcare billionaire Patrick Soon-Shiong will make some kind of major announcement during his keynote.” He’s buying lots of companies (and a chunk of the LA Lakers) so that could be the case, although I don’t know why he’d tip his hand to a conference organizer in advance. He’s made other big announcements about healthcare, society, etc. that haven’t amounted to much so far. We’ll seen next Wednesday.

From Mr. Sandman: “Re: Qatar. Two big deals are going down, with Sidra and Hamad Medical Corporation choosing systems. These are right up there with Cerner winning Abu Dhabi awhile back and the Dubai meltdown where Epic won and then had the contract cancelled. Eclipsys won the Hamad bake-off, but last month Allscripts told Hamad they were withdrawing. That’s walking away from possibly the biggest deal Eclipsys ever had as vendor of choice, essentially giving Cerner the business and a major foothold in the Middle East. I don’t know if Epic will jump back in due to the huge expense involved and their experience with Dubai.” Unverified.  

From Former Eclipsi: “Re: new Allscripts India-based offices. Not sure why they are referred to as new. Eclipsys was doing development and support for Sunrise at that same Pune location and Allscripts has been in Bangalore for almost that long.” I wondered that, but I assumed they were moving additional services there. I heard from someone who should know that the offshoring works well to eliminate the US-based resources from doing drudge work, but things go downhill fast when problems go off script (this person swore that a senior Windows engineer in India had to be walked through finding the Windows Start button). Eclipsys had apparently replaced all of its American remote hosting help desk analysts with India-based staff, resulting in some clients demanding that their calls not be routed there after service problems (not unheard of with offshoring in general, sometimes for good reason, sometimes not).

From Perry Natal: “Re: Inova Fairfax. Any idea why they de-installed GE Centricity and switched to Epic?” Here’s the much-appreciated response from Inova SVP/CIO Geoff Brown:

We have not deinstalled GE Centricity and switched to EPIC. As of 3/16/11 we do not have an agreement with anyone other than GE and McKesson as our core HIS vendors. We did conduct an assessment of our current and future state requirements which led us to issue an RFP to GE, EPIC and other vendors. The catalyst for this centered on our 10 year projected business plan goals and objectives. Drivers included health reform / mu, aco, enhanced analytics requirement, 5010 / icd-10, ambulatory & inpatient system interoperability, physician, patient care and patient experience requirements. I won’t hood wink you because we are strongly considering our options but as of today while rumors are swirling nothing has been finalized. If something should happen I’ll be happy to update you.  Obviously I’m a fan of HIStalk and have found it viable as a useful source for information and insight relative to industry activity.    

From Will Weider: “Re: Ministry Health Care. In response to the earlier post, we are running a system selection process to choose a single HIS with a single patient database. Today our hospitals run eight HIS instances, and we want to simplify this environment and improve the patient experience. Thus far the selection is limited to our two incumbent partners, Meditech and GE. We have not made a decision and we have not made a commitment to upgrade to GE Centricity Enterprise 6.9. Regarding HITECH EHR Incentives, our current plan is to certify ourselves using our combination of EHR technologies, rather than rely on a single certified EHR.” I’ll call this “verified” since Will is the CIO.

HIStalk Announcements and Requests

Listening: I can’t get enough of Deer Tick (goofy name aside), which I know I just mentioned, but I’m hooked. It’s the best thing I’ve heard in months and I’m playing it constantly. This song is amazingly good and world-weary considering the band is made up of kids in their early 20s (and a little Googling raises the strong possibility that the hard-miles singer is the son of Rep. John McCauley Jr. of the Rhode Island House of Representatives). I’ll be shocked if they don’t blow SXSW away this week.

The first day of spring is Sunday, just so you know. I’m definitely spring feverish.

On the Job Board: Regional Sales VP- West Coast, Account Manager, Content Writer/Media Specialist. On Healthcare IT Jobs: Physician Informaticists, RN Systems Analyst, Marketing Technology Programming Analyst, Implementation Consultant.

Acquisitions, Funding, Business, and Stock

Document management vendor Accentus acquires speech-to-text technology vendor Mrecord. Accentus acquired two transcription-related companies in December.

Sales

Franciscan Health System chooses TeleHealth Services to provide interaction patient education and entertainment services at its new St. Elizabeth hospital in Enumclaw, WA.

The board of directors for Sharon Regional Health System (OH) approves a five-year, $13 million Cerner purchase. The health system also hires Donna M. Walters as senior director of IT to lead the EMR project and other IT efforts.

Also choosing Cerner: Sheridan Memorial Hospital (WY), in a $9.8 million deal. The hospital’s CFO anticipates receiving $3.1 million in stimulus funds after its August 2012 go-live.

The William W. Backus Hospital (CT) will use a charitable foundation’s donation to fund a two-year extension of its subscription to MyHealthDIRECT, which allows referring non-emergent ED patients to the appropriate level of care by searching the open appointments of community-based providers.

St. John Providence Health System (MI) selects Intuit Health to provide a patient portal to its physician practices.

St. Peter’s Hospital (MT) picks SeeMyRadiology.com for the sharing of images with patients and physicians.

Georgia Hospital Association signs a purchasing agreement with Prognosis Health Information Systems that gives members special pricing for the ChartAccess Comprehensive EHR. The solution includes hosting on a shared server at Georgia Hospital Health Services.

NextGen reseller TSI Healthcare partners with The Center for Arthritis and Rheumatic Diseases (TX) for the NextGen EHR, PM, and Patient Portal solution.

Creative Testing Solutions (FL) picks Mediware Information Systems’ LifeTrak software to manage blood testing procedures.

Pine Rest Christian Mental Health Services (MI) chooses CareLogic Enterprise EHR for its 18 behavioral health facilities.

UMass Memorial Health Care (MA) selects Informatica EMR Data Migration Foundation as a key component of its five-year, $140 million upgrade of core clinical and financial systems. UMass is implementing Siemens Soarian clinicals and financials.

People

Healthcare portal company Omedix hires former IntraNexus VP Tom S. Visotsky as VP of sales and marketing.

Insurance industry business intelligence vendor Intelimedix names Michael A. Newman as chief informatics officer. He was previously VP of medical informatics at BCBS Florida and was already on the board of Intelimedix.

Announcements and Implementations

Orlando Regional Medical Center and MD Anderson Cancer Center Orlando go live with PerfectServe’s clinical communication system.

EChart Manitoba, the first province-wide EHR system in Canada, goes live on the first stage of its $22.5 million EHR sharing project. IBM is the project manager for the initiative and dbMotion is providing the software platform.

A data review by Curaspan Health Group finds that 168 eDischarge customers studied in 2010 saved an average of $1.5 million each by having a preventable readmission rate of 14% vs. the national average of 20% .

Evangelical Lutheran Good Samaritan Society will collaborate with WellAWARE Systems, Phillips Lifeline, and Honeywell HomMed in offering wireless sensor technologies to help senior citizens live independently at home. They will study the effectiveness and cost benefit of sensor technology, personal emergency response systems, and telehealth applications.

Baltimore’s technology incubator and its graduate company WellDoc are named finalists for incubator and incubator graduate, respectively, of the year. WellDoc develops chronic disease management applications.

Government and Politics

The second most highly paid local government official in California is the CEO of Palomar Pomerado Health at $1.15 million, according to a review. Eight of the top 20 mostly highly paid employees are hospital executives. At number one was an administrator from Bell, California, population 37,000, whose exorbitant employee salaries triggered the salary review in the first place. The former Bell administrator (now facing charges) made $1.25 million. A similarly outraged article in the New York Post lists the salaries of state hospital executives, with the top end exceeding $3 million.

Technology

Doximity launches its smart phone application for physician collaboration and networking (text messages, photos, telephone dialing, physician locator, provider lookup).

The Toronto paper mentions Ottawa-based Epiphan Systems, which sells a video “frame grabber” used for remote medical image viewing, but also distance education, security monitoring, and navigation. Henry Ford Health System is named as a customer, which uses the company’s $700 device to capture 30 frames per second video from a laparoscopic tower on a standard laptop via USB, where it’s converted to MPEG-4 video and e-mailed as an attachment.

Other

The EMR market was valued at $15.7 billion in 2010, but no single company dominates the market, according to Kalorama Information. It calls Cerner, GE Healthcare, McKesson, and Siemens “established hospital IT giants” and says Allscripts will build share this year. The press release does not mention Epic as one of the big players. Buy your copy for only $3,500 and maybe you can find out why.

Now for something completely non-HIT related: the average women owns 17 pairs of shoes, yet only wears three of those on a regular basis. She also purchases (only) three pairs of shoes a year. I can confirm that I am well above the mean. The editor-in-chief of ShopSmart provides an excellent analysis of why women love shoes:

Shoes never make your butt look big, you don’t have to worry about squeezing into them if you’ve put on a couple of pounds, and they can instantly make you feel sexier.

The photos above, by the way, were sent by readers who support my shoe fetish.

The former CEO of closed Parkway Hospital (NY) is charged with bribing a state senator to help him acquire to other hospitals. He was working with John Krall, CEO of HIT vendor Pegasus Health Restoration, to re-open Parkway. Krall says he has $70 million of capital to reopen the hospital and will serve as its CIO. A community board member wasn’t impressed that Krall declined to name his funding source, saying, “He just came out of the blue. You can’t just come and open a hospital.”

I don’t usually do this, but I thought I’d mention a friend of HIStalk who happens to be a marketing executive looking for a gig. She’s got senior-level HIT experience in working with brand image, brand awareness, social media, PR, product launches, etc. She got our attention as a sponsor contact and definitely raised the visibility of the company she worked for. I offered to forward to her any inquiries sent my way.  

VisualDX diagnostic decision support software outperformed ED docs in diagnosing cellulitis, according to a research study that also found that 28% of admitted patients with cellulitis were misdiagnosed in two hospitals.  
 

Sponsor Updates

• United Medical Centers (TX) will implement Sage Intergy for its eight-practice community health centers.
• Desert Sun Gastroenterology (AZ) selects ProVation MD software from Wolters Kluwer Health for its gastroenterology procedure documentation and coding.
• ProHealth Solutions, a new ACO formed by ProHealth Care hospital system (WI) and the Waukesha Elmbrook Health Care IPA, selects MedVentive Population Manager and Risk Manager.
• Microsoft says that since its purchase of Sentillion in February 2010, deployment of Sentillion products has expanded to 575,000 total users across 220 organizations. Over 50 new customers signed up for Sentillion products in 2010 and Microsoft is now distributing Sentillion solutions in the Asia Pacific market.
• Medworxx will distribute perioperative and critical care systems from iMDsoft’s MetaVision suite in Canada and iMDsoft will offer the Medworxx patient flow, compliance, and education systems outside of Canada in a just-announced reciprocal distribution agreement.
• Several applications of 3M’s eHealth Documentation Solutions are awarded certification as EHR Modules.
• MedAssets announces that it will market the PatientSecure palm vein biometric system from HT Systems to customers of its Access Integrity suite, giving patients faster check-in and more accurate medical records retrieval.
• CEO Jennifer Lyle of Software Testing Solutions will participate on the Meaningful Use panel of the iHT2 Health IT Summit in Atlanta next month.
• Workforce and incident management systems vendor Concerro announces a joint marketing agreement with Sydion LLC, which offers tracking technologies for emergency response organizations.
• Healthcare Management Systems earns ONC-ATCB certification for its HMS Ambulatory EHR, following the recent certification of its inpatient EHR and EDIS.

EPtalk by Dr. Jayne

Despite the spring flowers peeking through after the long winter, my week started with more snow. A bit depressing until the FedEx driver appeared with a package destined to lift my spirits.

The RelayHealth “gift basket to welcome Dr. Jayne” contest goodies had arrived! Chocolate, red wine, great hand cream, and fuzzy slippers. What more could an overworked CMIO want? As an added bonus, the “basket” is a waterproof nylon cooler/tote with an integrated bottle opener which will be great for my local Concert in the Park series this summer. (Yes, dear readers, I do have a life outside health IT, although sometimes it doesn’t feel like I do).

Mr. H alerted me over the weekend to an article by David Blumenthal in Health Affairs. I’m not sure he ever sleeps, but I’m glad when he makes sure I don’t miss interesting things in my ever-expanding inboxes, whether electronic or paper. After snuggling up with the aforementioned red wine and fuzzy slippers, it was an interesting read.

The subtitle is a little underwhelming: “The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Results.” Where’s the flash and bang? I’d love to see something more like “A Review of the Recent Literature Shows HIT is kicking ass and taking names.” But then again, that kind of concrete statement would require a lot more data than what we have here.

The first thing you note is that all four authors are currently or formerly with the Office of the National Coordinator (although they did list Blumenthal last). Nothing like a little potential author bias to start an article out right. I’d have been more impressed if the same data and conclusions were arrived at by someone independent, such as a university. Although the authors state that over 92% of recent HIT articles were positive, they recognize the cold hard reality that providers are unhappy with EHRs and adoption is a significant barrier.

Building on two previous studies which looked at data from 1994-2007, they examined the months between July 2007 and February 2010 using the same methods and selection criteria. Ultimately they looked at 154 studies (with 100 of those studies being from the United States). Outcomes were ranked as positive, neutral, mixed-positive, and negative based on the proportion of improvement in at least one aspect of care vs. whether any aspects were negatively impacted.

I give them full credit for noting their limitations. The first is publication bias, where negative findings aren’t published as often. The second is weighting all studies equally – independent of study design or sample size. These are very real concerns when performing a meta analysis, whether looking at EHR outcomes or some other parameter.

Reaching the lengthy section on statistical hypothesis testing, I felt myself slipping and had to self-medicate with some of the RelayHealth chocolates, STAT! That got me through to the Discussion section, which was more relevant for most of us. The authors validate what some IT departments seem to forget: “that the ‘human element’ is critical to health IT implementation.” One tidbit that most of us already know is how strongly correlated provider satisfaction is with negative findings.

One key finding is that the data hasn’t changed much from the previous reviews. There’s no real benefit to being an early adopter and slow-moving groups are seeing the same outcomes. For those of us that live every day on the bleeding edge, that’s not a big comfort. Maybe we need to remember The Tortoise vs. The Hare.

I think the best thing they clearly stated that I wish I could make required reading for every CIO, CMIO, CMO, and physician champion: negative findings can be a good thing if they’re used to figure out how to do health IT better / faster / stronger / safer. My spin: don’t take criticism personally – use it to do your job better.

If we’re ever going to get to that “Healthcare IT is kicking ass and taking names” article (which I will happily co-author under my real name with any of you) we need more studies on how to address the challenges we all face and what training and implementation strategies make for the most successful outcomes.

Have questions about CPOE, clinical decision support, or which shapes of chocolate candies have the best middles? E-mail me.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

News 3/16/11

Top News

Allscripts opens two offshore development centers in Pune and Bangalore, India that will provide customer support and other services.

Golden Gate Capital offers to acquire Lawson Software for $11.25 per share, but significant shareholder Carl Icahn suggests that the company shop around for the highest bidder (probably hoping to bait Oracle and SAP into a bidding war).

Reader Comments

From Yeah But … “Re: Ministry Health Care in Wisconsin. They were already a GE Centricity Enterprise customer. They will be upgrading to version 6.9 this year, which is the MU-certified version. It is true that GE has not had many new customers. In the past two years, they have made a small number of sales of the ASP version of Centricity Enterprise. Despite this, their total number of customers has dropped to around 27 on Lastword / Carecast / Centricity, down from 55 when they bought IDX.” Unverified.

HIStalk Announcements and Requests

It’s just me (Mr. H) today since both Inga and I are on our respective spring breaks, although most of mine will involve working on HIStalk. Dr. Jayne pitched in to help cover by writing a great piece for HIStalk Practice called Meaningful Use: 15 Things Your Practice Can (and Should) Do Now.

Listening: Deer Tick, no-nonsense, hard-living Americana rockers from Providence, RI. They’re good.

I’ll probably run a Readers Write Wednesday evening, so now’s your chance to get something to me that will appear quickly since I have just a couple of submissions so far.

Acquisitions, Funding, Business, and Stock

The Greenville, SC newspaper writes up VidiStar, which sells a PACS system and Web portal for remote reading of digital images. 

The Wall Street Journal profiles Castlight Health, started in 2008 by Giovanno Colella MD (founder of RelayHealth) and Todd Park (now CTO of HHS). The company, which helps consumers understand the costs of their care, has attracted $81 million of capital funding so far, including an unnamed amount from Cleveland Clinic.

People

Streamline Health names Rick Leach, formerly with A.D.A.M., as SVP/chief marketing officer.

Announcements and Implementations

Children’s Denver (CO) will implement RemedyMD’s OutcomeTrack disease registry and outcomes tracking solution.

The local paper mentions the federally funded, six-month HITECH Workforce program offered by Indian River State College (FL), adding that Martin Memorial Health System had to fill almost all of its 60 Epic project positions internally because they couldn’t find anyone else.

Government and Politics

Dr. HITECH (aka Ross Martin MD of The American College of Medical Informatimusicology) releases the production video of The Meaningful Yoose Rap. You saw the live debut of the song at last year’s HIStalk reception at HIMSS in Atlanta, now check out the video, apparently filmed on location in Washington DC, including in front of the Capitol and HHS headquarters. Video credits here, lyrics here. Ross has kind of a Marky Mark thing going on that’s pretty cool. He’s obviously musically brilliant, like you didn’t already know that from his amazing Interoperetta. He also has some kind of HIT day job, but hey, we have plenty of people who do whatever that involves but not many who can entertain the industry.

Sponsor Updates

• Quality IT Partners is celebrating its 10th anniversary.
• MEDecision will incorporate Health Language Inc.’s Language Engine into its health management portfolio to help customers with the transition to ICD-10.
• Dutch imaging solutions distributor Fysicons signs a deal to incorporate imagine viewing tools from Merge Healthcare into its EVCOS Web viewer for the BeNeLux market. The company is also reviewing Merge’s vendor neutral archive and kiosk products.
• Technology from Carefx will be used by Northgate Managed Services to develop a clinical portal for a group of UK hospitals in a $10 million contract that Northgate just won. 
• Capario announces that VP Angela McKenna has been appointed president of the executive committee of Cooperative Exchange, an association for healthcare transaction clearinghouses.
• Zynx will offer content from Thomson Reuters Micromedex in its evidence-based order sets.
• Main Line Health (PA) is implementing eClinicalWorks for its affiliated physicians.

Other

I was thinking about paper towel dispensers while in the airport restroom today, the kind where you wave your hand in front of the red light to have it dispense some preset length of towel. Some machines give an impossibly short length while others are more generous, leading me to speculate that they are networked devices using artificial intelligence (maybe adopted from slot machine technology) to determine the optimal mix of how much to dispense initially vs. how likely you are to begrudgingly accept the too-short length and leave with still-wet hands vs. just waiting until the red light comes back on to request another round by re-waving.

A UK woman dies of breast cancer after a doctor says her breast lump is benign, but then sends two appointment notices to the incorrect address, typing 16 instead of 1b for her street. Nobody followed up from the doctor’s office.

A family physician urges the same female patient to seek emergency care on two different occasions, once for an aneurysm and another for uterine swelling, after reviewing mislabeled CT scans belonging to other patients. The doctor says her actions were correct based on the information she was given, but the jury finds that she should have known the CT scans were someone else’s. They award the patient $75K for emotional distress. The two hospitals and the radiologist had already settled.

E-mail Mr. HIStalk.