Obama Names Berwick as CMS Head, Using “Recess Appointment” Authority

President Obama today named Donald Berwick to head the Centers for Medicare and Medicaid Services while Congress is recessed, allowing Berwick to bypass nomination hearings and Congressional voting. The move also avoids public debate of the administration’s healthcare reform law before the midterm congressional elections.

Berwick, a Harvard Medical School professor and president of the Institute for Health Care Improvement, would have faced questions about previous comments in which he praised Britain’s government-run National Health Service and stated that healthcare rationing is inevitable.

Sen. John Kerry (D-MA) said, “Republican lockstep stalling of Don’s nomination was a case study in cynicism and one awful example of how not to govern. When these federal programs were in trouble, they denied the administration the capable guy the president had chosen to oversee them. The president did the right thing making this a recess appointment”

A statement from Sen. Mitch McConnell (R-KY) said, “As if shoving a trillion dollar government takeover of health care down the throat of a disapproving American public wasn’t enough, apparently the Obama Administration intends to arrogantly circumvent the American people yet again by recess appointing one of the most prominent advocates of rationed health care to implement their national plan. Democrats haven’t scheduled so much as a committee hearing for Donald Berwick but the mere possibility of allowing the American people the opportunity to hear what he intends to do with their health care is evidently reason enough for this Administration to sneak him through without public scrutiny."

Sen. Max Baucus (D-MT) who chairs the Finance Committee that would have overseen Berwick’s nomination hearings, was was quoted as saying, “Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee – and answered. Despite the recess appointment, I look forward to working with CMS as they implement health reform to deliver the better health care outcomes and lower costs for patients we fought to pass in the landmark health reform law.”

News 7/7/10

From GladToBeLongGone: “Re: Sentillion. You should check with your sources at Sentillion or now the marketing leadership of HSG of Microsoft in Andover about some recent changes in personnel with one of the key players leaving, which they are keeping hush hush.” I did check. Microsoft confirms that it will announce today that former Sentillion president Paul Roscoe has resigned as GM of worldwide sales. Steve Shihadeh will take over as GM of North American sales, reporting to Peter Neupert.

From Boboloo: “Re: Stryker Imaging Division. It’s being sold to Merge Healthcare.” Unverified. Stryker focuses on orthopedic PACS, including CR, HDDR, OrthoPad EMR, and NetPractice PM.

From Sabrina: “Re: Ernst & Young. They are trying to restart their healthcare consulting business. VP/MD Bill Fera of UPMC is moving there. Guess the Capgemini non-compete ran out.” Unverified. E&Y sold their consulting business to Cap in 2000, which then sold everything but life sciences consulting to Accenture in 2005.

Reminders of stuff you can do: (a) the search box to your right covers HIStalk, HIStalk Practice, and HIStalk Mobile, so it will dig through millions of words at your command; (b) sign up on each site to get updates when we run something new; (c) Friend or Like us on Facebook; (d) send us your guest article, interview idea, or rumor; and (e) support our sponsors so they will keep supporting us. Oh, and (f) give yourself a little wink in the mirror like Inga would do if she were with you, just because we’re crazy about our readers.

CCHIT responded to a reader’s question about its commissioners, trustees, employees, and consultants. Its Web site is current with regard to commissioners and trustees, it says. It does not publish the names of employees. Specifically, Linda Kloss of AHIMA is a trustee, while Steve Lieber of HIMSS is not. Update: I should have noted that while the site lists Linda Kloss as AHIMA CEO, she stepped down from that role last November.

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HERtalk by Inga

Access acquires the intellectual property and contracts of Formetta. Access is the developer of the Access Enterprise Forms Management suite and Formatta is a provider of on-line forms and workflow solutions.

The University of Texas MD Anderson Cancer Center says that 28,000 patients have accessed their medical records on its year-old portal, with 40% of referring community physicians tracking the progress of their patients online.

Kansas City’s Swope Health Services selects eClinicalWorks EMR/PM for its 200-provider FQHC.

University HealthSystem Consortium partners with AcuStream to offer a co-branded version of AcuStream’s RevBuilder service to UHC members.

Last week I was on a field trip of sorts, hanging out in a hospital. The level of automation at this community hospital was pretty typical: clinicians still rely heavily on paper charts despite having a clinical system (CPSI) in place. Providers enter orders into the system (though not at the point of care), which are then available to the pharmacy, lab, etc. The hospital uses a Pyxis CUBIE system for medication administration with individual stations at each nursing pod. (I actually asked the nurses to give me a demo of the Pyxis system, but they looked at me like I was some sort of drug seeker.) I was reassured to learn that the hospital and community physicians were able to see one another’s record. All and all, their IT usage at this stage won’t qualify them for Meaningful Use money, but it seems to be serving their needs.

Here’s something I’m all for: software that simplifies medical terminology so that clinical information is better understood by the masses, suggesting plain-English replacements for jargon. That topic reminds me of the time a male doctor once suggested I had cellulitis. I almost slapped him.

Capital Health Systems (NJ) contracts with Aprima for EHR, PM, and RCM solutions. The health system manages 13 practices with 49 physicians.

A HealthPartners Research Foundation team wins a five-year, $3.7 million NIH research grant to develop and implement an EHR-based clinical decision support system to help reduce patients’ risk of heart attack or stroke.

HIMSS names CynergisTek CEO Mac McMillan as chair of its Privacy and Security Steering Committee.

A former VP from Beverly Hospital (MA) faces charges of commercial bribery and felony larceny. Paul Galzerano is accused of accepting kickbacks in the form of cash and services in exchange for awarding contractors lucrative hospital contracts. In addition, Galzerano allegedly placed valuable hospital-owned antiques in his own home. Prosecutors believe the schemes netted him almost $500,000.

The CDC awards the Association of Public Health Laboratories $2 million to provide technical assistance in advancing the electronic exchange of laboratory data. That’s chicken feed compared to the $800 million in loans and grants the government will spend to bring broadband to underserved Americans, including $17.7 million to the Iowa Health System.

Patient Safety Technologies (PST) closes on $6 million in private placement financing to be used to fund working capital and continued growth. The company also names a new president and CEO plus four new directors. PST has quite a complicated history, so if you care to read the tale of a suffering company, here’s a recap.

A class action lawsuit is filed in connection with a patient privacy scandal at University Medical Center (UMC) in Las Vegas. A former UMC employee was paid $8,000 to fax information on over 55 patients involved in traffic accidents. The lawsuit claims UMC “recklessly” distributed news releases that indicated when credit monitoring would end for affected patients, thus alerting would-be privacy thieves.

The 24-bed Lower Umpqua Hospital (OR) agrees to spend $560,00 for an EMR, which includes $332,000 for software from Healthland.

Nebraska Orthopaedic Hospital makes plans to implement Wellsoft’s EDIS.

Dell’s strategy to increase its healthcare presence seems to be making an impact. Its service division, which includes the former Perot Systems, accounted for 13% of Dell’s first quarter revenue and helped sustain the company’s 17.6% margin. In addition, the services unit is fueling sales for hardware, including a recent $3.5 million order from Methodist Hospital (TX), which has a services agreement with Dell.

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Monday Morning Update 7/5/10

From Cherry Capri: “Re: MMRGlobal. Docs are required to inform patients when they refer them to a facility in which the doctor has a financial interest. Do physicians also have to disclose to patients that they get a kickback if the patient upgrades to MyMedicalRecordsPro?” I’d guess they aren’t doing that since they also don’t disclose financially beneficial drug company ties, but maybe they’re supposed to.

From Jerry: “Re: how to add an HIStalk icon to the iPhone desktop. Click the icon at the bottom left of any Web site and click the Add to Home Screen button.”

From Barry Zuckerkorn: “Re: EMR patents. There are several. How can HIT vendors sell EMR systems without infringing? Or are they paying royalties to all these guys?” Good question. I’m surprised that patent trolls like Acacia Research Corporation, which routinely shakes down HIT vendors, haven’t jumped on this. I notice that Acacia just lost a case against Red Hat and Novell, which it ridiculously sued for infringing its patent for network-based desktop icons. The only surprise there is that Acacia actually took it to court since they specialize in “license fees” that costs less than a legal defense, making it teeth-grittingly easier to just write them a check to make them go away.

We talk a lot about CPOE applications, but the survey shows what we all really know: when it comes to CPOE success or lack therefore, the customer should get the credit or blame, not the company that wrote the software they use. Hospital culture and leadership are the most important, 79% of you say, with just 7% of readers saying it’s all about the application. New poll to your right: if you as a citizen were allowed to cast a ballot for or against $20 billion in federal spending for HITECH EMR incentives, how would you vote?

TPD has updated his iPhone healthcare apps list, which now numbers more than 200.

Jobs: Senior Software Engineer, Manager Clinical Informatics, Epic Ambulatory Trainers, Cerner Orders Consultant.

CPSI fires suspended CFO Darrell West, saying it has confirmed that he charged $55,000 to a company credit card to pay a personal tax bill. You’d think a CFO should have (a) known that he would get caught, and (b) calculated the net present value of years of lost income vs. $55K now and realized what a bad deal that is. Former CEO David Dye is brought back as interim CFO.

Weird News Andy deviates from his core competency in finding this article, which he says isn’t weird, just cool. A laid-off software engineer whose three-year-old son has cerebral palsy is shocked by the “stone age” devices that therapists were using to train him. Being a MS in software engineering from the best school in the country for that field (in my mind, anyway — Carnegie Mellon) he buys a Mac Mini, signs up for Apple’s iPhone developer program, and creates TapSpeak Button. It allows pictures to be uploaded and then pressed to play recorded messages. He’s selling quite a few at $10 per copy.

HHS CTO Todd Park on the now-open HealthCare.gov that helps people find medical insurance:

You know, I think everyone, I would presume, is in favor of better informed consumers. Everyone’s in favor of healthy Americans, everyone’s in favor of more functional marketplaces. I mean it’s not a political thing, it’s an American thing.

Britain’s NHS spent $2.4 billion on IT in the most recent fiscal year, most of it on NPfIT. The NHS spending that’s making headlines, however, is $10,500 in grants to teach unemployed women how to be stand-up comics.

Here’s another case, this one in Ireland, where critical patient lab results were recorded in the computer but were not seen by the physician in time to prevent a serious mistake.

Private equity firms are checking out iSoft, rumor has it, now that its share price has been beaten down. Among those supposedly interested is General Atlantic, whose other healthcare holdings include Emdeon and CompuGROUP.

The new president at University of Illinois announces his intention to run the organization, including its hospital, as a single university. He describes the Chicago hospital as “dilapidated”.

The ACLU sues Rhode Island’s state health department, claiming its not-yet-live Currentcare HIE will not adequately protect patient privacy. And in Alaska, ACLU sues the state’s Department of Law for failing to ensure the privacy of medical records that were seized in a raid on a midwife’s office, brought to light when an officer with the Ketchikan Police Department taunted a patient’s daughter by saying her mother had been treated for a sexually transmitted infection.

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News 7/2/10

From Jack Ripert: “Re: Cisco Pad. Apparently it will run Android. This may have killer healthcare application if done right.” Cisco will launch its Google Android-powered Cius tablet PC next year: smaller and lighter than the iPad and with two cameras, USB connections for external devices, and an easy tie-in to Cisco’s Telepresence videoconferencing system. They’re shooting for an under-$1,000 price. IT shops aren’t crazy about supporting Android, but they probably like it better than Apple and Cisco carries a lot of CIO clout, so this could be a big deal in hospitals, at least those prepared to wait for it. Those with long memories will recall that Cisco sued Apple over the use of the iPhone name (Cisco was selling a $12 iPhone), then settled with Apple and gave them the name (reported here in January 2007).

From I Have Friends in Military: “Re: AHLTA. To be declared a failure and replaced.” Unverified. That would be huge (and expensive) news if true, but I’m a doubter. Confirmation, anyone?

From Big Dave Brewster: “Re: [HIT publication name omitted]. Looks like it’s going toes-up.” Another HIT rag that I won’t name apparently goes on death watch. They’ve laid off the editor and no ads are displaying on the site (no loss from what I can tell from online stats – it looks like it’s only drawing a handful of visitors each day). Someone said management had already decided to run only advertiser-friendly stories to try to keep the money coming in. Something’s wrong with the cost structure if you can’t make a living charging high five figures for a yearly full-page ad and nearly that for an online ad that nobody will see.

From Denise: “Re: most overused press release buzzwords. You’re gonna love this one.” Right you are, Denise! It’s a press release word frequency list, with the most common being (1) leader; (2) leading; (3) best; (4) top; (5) unique; (6) great; (7) solution; (8) largest; (9) innovative; (10) innovator. Now if some would just write a Word add-in that would count these in a document, I could run a Buzzword Bingo game using real-life press releases and make it part of the HISsies awards.

From Texass Longhorn: “Re: Dell. I didn’t know that we at UTex could come up with a math problem so difficult as to bring down a Dell computer.” It was probably trying to calculate Texas football coach Mack Brown’s $5 million salary. Dell, stung by complaints and lawsuits about widespread failure of its OptiPlex PCs three years ago because it used cheap (and leaky) Asian capacitors in 11.8 million of them, is surely embarrassed by this New York Times story. When UT’s math department complained about failing Dell PCs, the company blamed the university for overworking them with tough math problems. An interest fact: the legal firm defending Dell from huge lawsuits over the problem had 1,000 of the bad PCs itself; Dell stiffed them too. Who would have guessed that 90s darlings like Dell and Microsoft would be struggling?

From Del Taco: “Re: CCHIT. Can you please shed some light on who the actual commissioners, trustees, and staff are at CCHIT since Mark Leavitt’s departure? Its Web site is out of date. How many HIMSS employees are still considered as staff of CCHIT? There should be more transparency if CCHIT intends to apply for more government grants.” I e-mailed your questions to both Sue Reber and the press contact at CCHIT Thursday morning. No response yet, but I’ll let you know one way or the other.

Welcome to new HIStalk Platinum Sponsor Capsule Tech, a leading provider of medical device connectivity. The company, operating in 27 countries and 600 hospitals, offers the vendor-neutral, 510(k)-cleared Capsule Enterprise Device Connectivity Solution, which allows connecting any medical device to hospital information systems. Part of that system is Capsule Neuron, a touch-enabled bedside platform for managing device connectivity that adapts to the environment it’s operating in. Our long-time HIStalk friend Ann Farrell of Farrell Associates will be co-presenting Capsule’s July 21 Webinar on medical device integration and its impact on patient safety, care outcomes, and meaningful use, so I know it will be good. Thanks to Capsule Tech for choosing to support HIStalk.

CynergisTek announces three new products for small healthcare organizations: IT support services, e-mail, and HIPAA/HITECH security compliance review.

A reader e-mailed me about the cool Mass General ED finder for smart phones. I agreed it’s cool, but opined that they’ll be sued in no time since any obsolete information is going to make someone needing an ED unhappy about being led to a closed one. Another reader noticed that problem when he tried the app: it highlighted EDs in his area that have closed. Its database is from 2007, he believes. They’d better have a lawyer review the disclaimer extra carefully.

MedAptus is awarded a patent for its automated process for capturing professional and facility charges in outpatient settings.

Showing the new HIStalk mobile display is as pointless as showing a fancy TV’s picture in a TV commercial, but just in case you don’t have a smart phone and wonder what it looks like, here you go (thanks to Inga for the early morning screen shots). Several readers e-mailed to say they love it, so thanks for that. One reader suggested creating a downloadable launcher for BlackBerry, iPhone, and Droid to avoid having to go to browser bookmarks, so if anyone knows how to do that, let me know because I don’t.

Speaking of smart phones, strong rumors say Verizon will start selling iPhones right after Christmas.

BJC HealthCare (MO) signs a $49 million, 12-year agreement to migrate 11 of its hospitals to Soarian Financials. Also, Platte Valley (CO) and Kingman Regional Medical Center (AZ) each signed multi-year deals for Soarian Clinicals.

The healthcare industry spent $8.2 billion globally on handheld devices last year. Kalorama Information predicts sales will grow 7% per year for the next five years and physicians and hospitals purchase new IT systems.

Results of the investigation into $11 million worth of delayed charges at University of Iowa Hospitals and Clinics: budget cuts left them with only one person to perform the required manual record review to document the appropriateness of cardiac cath charges, so it didn’t get done. Doh!

API Healthcare issues a set of best practices to help hospitals deal with nurse shortages.

AMIA names Jonathan Grau as VP of corporate relations.

Family doctors in the UK say they will not allow the medical records of themselves or their families to be stored on the troubled Summary Care Record, citing privacy concerns.

An interesting All Things Considered story on athenahealth, which processes 30,000 pounds of paper per month. A fun Jonathan Bush quote: “Because what healthcare really is is this awkward word slapped on top of a million little tiny markets.” An interesting factoid: New York Medicaid, among the worst claims payers, requires claims to be filed on special forms that must be ordered from Albany, then hand signed by the doctor.

Encore Health Resources announces two new hires: Julie Morrison (CSC, FCG) as client services executive and Paul Murphy (KSA) as services area leader for IT strategy.

HIStalk readership easily set a new record in the normally slow month of June. The tally, for those scoring at home: 101,652 visits and 139,766 page views (up 50% over a year ago). Most of that wasn’t because of the Allscripts or John Glaser news since those days were up only a few thousand visits. The e-mail list has 5,746 verified subscribers. Thanks to everybody who made that possible: readers, sponsors, authors, interviewees, commenters, and of course my trusty companion and kindred spirit Inga. It was fun writing HIStalk back in 2003 when nobody was reading, but I admit it’s more fun now.

Weird News Andy notes this story: in preparing for the rollout of its Healthcare.gov portal, HHS gets all cool and takes over a dormant @healthcaregov Twitter account, but forgets to clear the favorites list. As a result, HHS’s list of favorite tweets include several about P. Diddy and the vodka he was pitching a year ago.

Cash-bleeding West Penn Allegheny Health System will lay off 1,500 employees and cut back operations at West Penn Bloomfield. Considering the big money UPMC makes, that looks like an area ripe for consolidation if you don’t mind the idea of UPMC having no competition (like it really does anyway).

FormFast will offer a July 13 Webinar on avoiding HIT contracting pitfalls.

Rockford Health System (IL) chooses Epic, the same system used by its potential acquisition partner, OSF HealthCare.

If anyone still cares about The Leapfrog Group, it expresses concerns about those CPOE systems it’s been bugging everyone to buy for years. Leapfrog’s tests find that CPOE (actually its decision support component, which isn’t distinguished separately) misses a lot of really dangerous orders. CEO Leah Binder says, “The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth.” I agree, but wasn’t Leapfrog perpetuating that myth by making CPOE adoption one of its Leaps without really getting into the nuts and bolts? Above is a snip from a 2000 press release, which shows unconditional CPOE love.

A Florida county’s EMS department pays $500K for 911 software that claims to predict where the next emergency call will come from based on historical data. Paramedics say it wastes their time sending them to areas waiting for calls that never come.

ProHealth Care (WI) plans to replace multiple modality-based software applications with McKesson’s Horizon Imaging PACS, Cardiology CVIS, and Study Share case collaboration tool.

Adventist Health System signs up with Lexi-Comp for drug data. I guess they didn’t like Cerner’s Multum product even though they’re running Millennium.

Software Testing Solutions will demo two new products at the upcoming SUG 2010 meeting for Sunquest users: Application Monitor and Calculation Extractor. Product data sheets are here.

The ever-optimistic MMRGlobal predicts massive MyMedicalRecords and MyMedicalRecordsPro sales increases, with the business model being the 35% skim that doctors get for convincing their patients to upgrade. The company says that “can result in substantially more income to doctors than the $44,000 in government stimulus programs.”

Norton Brownsboro Hospital (KY) connects its GetWellNetwork system to Cisco Unified Communications, allowing patients to send messages to their nurses.

WellPoint notifies 470,000 of its insurance customers that their medical records and credit card numbers may have been exposed in a March breach cause by a problem with its online insurance application system. A customer noticed that she could see other people’s information by tweaking the browser address of her own. She let WellPoint know — by filing a lawsuit against them.

Another breach: Siemens Medical Solutions USA FedExes several CDs full of unencrypted patient information to its billing client, a New York hospital. The CDs fall out of the envelope during transit, apparently, and FedEx assumes they were trashed. The breach affects 130,000 patients.

I’m skipping town for the holiday and haven’t decided if/when to do the Monday Morning Update, so for those who start e-mailing me when the withdrawal symptoms hit late Saturday afternoon (yes, I’m pleased to say those people exist – maybe they’re the same ones who keep track of the readership stats), be prepared for these eventualities: (a) I don’t publish the update until late Monday afternoon; or (b) I bag it entirely. The only HIStalk that will get my undivided attention this weekend is Mrs. HIStalk, but I’ll probably sneak back sometime Monday for some PC intimacy. I hope everyone has a happy Independence Day.

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News 6/30/10

From The PACS Designer: “Re: Yoono. Yoono allows you to connect to all your social networks and instant messaging services in one place.” Guess all the good domain names were taken if Yoono was all that was left. I gave up on Twitter about five minutes after I tried it. Recruiters have run everyone off from LinkedIn. Facebook is pretty cool, but trending up on self-conscious constant users trying to impress their phony online friends with minimally clever observations. Still, Inga and I like it when someone Likes or Friends us on FB because we’re just as vain as everyone else when it comes to public displays of fake affection, the electronic version of the Hollywood air kiss.

From ExER: “Re: Betsy Hersher. It seems she’s back in the recruiting business. Her picture and references are gone from CES Partners and she’s working with former employee Bonnie Siegel on a search.”

From GladToBeLongGone: “Re: you won’t run this, but word is that Mr. Big Yahoo whose name sounds like his initials at a company being acquired is already looking for a new gig. This should be good news for all the sales people at Newco since the guy who should get the top job doesn’t have that incredible ego.” I expected that — the coattails he rode in on are long gone.

From Medsync: “Re: baby pool. Join the pool on the arrival of the Blumenthal twins, Meaningful use and Certification.” Someone set up an online “when will the baby be born” contest. Funny. The MU draft went out right before New Year’s, as I well know since I worked frantic hours summarizing it here, so maybe the final version will come out this holiday weekend and mess up another holiday for me.

I’m in solo mode again as Inga takes a bit of me-time. Here are a few quotes from her e-mails to me today to tide you over (feel free to guess the context): (a) “Seems to be a lot of interest in porn stars these days”; (b) citing readership increases since she came on board, “just saying … I’m sure your work contributed to that growth as well”; (c) with a forwarded press release of dubious value, “Hmmm …”; (d) when testing a change I had made in the HIStalk display on smart phones, “We have been re-mobilized.” She’s a bit terse from her iPhone, but always entertaining.

Listening: new from The New Pornographers, indie pop from Canada.

Back in March, I dug out a juicy nugget from an internal VA report: it was scrapping a $150 million patient scheduling system without ever bringing it live. The GAO weighs in with its official report (warning: PDF), pegging the cost at $127 million and saying “VA has not implemented any of the planned system’s capabilities and is essentially starting over.” The contractor that developed the system with “a large number of defects” walks away with $65 million. GAO finds much to criticize about the VA’s involvement: lack of competitive bidding, sloppy specs, unreliable status reports, and lack of action by project oversight groups when the project started tanking. They made the same massive mistake they made with BearingPoint in the also-failed, $472 million CoreFLS — they just gave the incumbent contractor more work orders against an existing maintenance contract instead of bidding it out. All of this started coming out a couple of years ago in various reports, which got a few VA bigwigs fired and some politicians fired up to hold VA accountable. The contractor is not conspicuously named in any of these documents, but it appears to have been Southwest Research Institute of San Antonio, a non-profit bringing in $564 million per year. It was founded, oddly enough, by an Texas oilman named whose last name was Slick.

A Compuware survey attempts to make a point about clinical system response time, but I’m not going to bother with the results because their methodology was terrible. They scrounged up 99 respondents to take their survey, all from social networking sites and with no apparent attempt to qualify the respondents by the system they use, their roles, etc. Given that the company is in the infrastructure business, you will not be shocked to learn that they conclude that clinicians taking Twitter surveys aren’t happy with response time. (note to self: develop a Twitter-based CPOE system and go public fast).

A Dr. HITECH contribution for Independence Day (please, can we avoid calling it the Fourth of July?) Ross Martin, MD, MHA re-imagines a National Anthem that’s easier to sing and allows variations (hopefully better than those godawful hack jobs done to the Star Spangled Banner by “Nashville recording artists” and diva-lites before NASCAR races). You can vote for Ross’s version.

A new KLAS report covers cardiovascular information systems. Its conclusion: they suck. Every vendor except Philips and Digisonics gets a lower client satisfaction score than last year, making the CVIS segment one of the worst. Those vendors: Agfa, Fujifilm, GE, HeartIT, Lumedx, McKesson, Merge, ScImage, Siemens, and Thinking Systems. KLAS says 30% of respondents are hoping to dump their vendors, concluding that they “fail to deliver on integration, functionality, and service expectations.”

I installed a new smartphone display format for HIStalk, HIStalk Mobile, and HIStalk Practice. If you’re a mobile user, it should be fast, sleek, and easy to read.

I liked HIT better before the politicians got involved and vice versa. Dr. Ron Kirkland, a self-styled conservative Republican running for Congress and former chair of the American Medical Group Association, bragged on AMGA’s political involvement in getting HITECH passed. Now that he’s running for office, he hates HITECH, saying the country is going bankrupt because of “the bailouts, the ridiculous stimulus plans, the outrageous farm subsidies to big corporations, and yes, even the small incentives for electronic medical records. We must end them now!” In the mean time, his 120-doctor clinic will lap up $4 million from the HITECH feed trough. A bang-up reporting job by Andis Robeznieks from Modern Healthcare. You can tell the real journalists like Andis from the posers: Google their subject and see how often (95% of the time, in my experience) they obviously just saw a press release, e-mailed a couple of people for vanilla quotes, and wrote it up cleverly like they sleuthed out real news.

Ed Marx always updates his CIO Unplugged posts with responses to reader comments, which he’s just done for his CPOE adoption one.

I’ve mentioned business analytics vendor Qlik Technologies a couple of times going back to February 2006. It’s doing an IPO valued at around $700 million.

Mass General’s Emergency Medical Network develops an ER locator app that covers the entire US.

Misys PLC CEO Mike Lawrie says that even though the company will cash in most of its Allscripts shares, it remains committed to Misys Open Source Solutions. It’s an odd press release: he made the quoted announcement at a company sales conference, not generally perceived as the best venue to deliver objective news.

IASIS Healthcare extends its plans for McKesson Horizon Clinicals, committing to physician documentation and CPOE in its 16 hospitals.

University of Tennessee Medical Center chooses GE Centricity Perioperative.

Industry longtimer Bettina Dold joins transcription vendor Acusis as director of product development. 

Australians won’t be able to review their medical records online for at least two years, the health minister says.

Sponsor news:

• IntraNexus has a shiny new Web site, which I notice includes a handy features and benefits list for each application in their SAPPHIRE lineup.
• Bayonne Medical Center (NJ) goes live with Picis ED PulseCheck two months ahead of schedule, integrated with Meditech.
• Hoag Memorial Presbyterian Hospital (CA) chooses Medicity as its HIE partner, signing up for ProAccess Community, MediTrust Cloud Services, and the Novo Grid.
• St. Cloud Medical group (MN) signs up for Greenway PrimeSuite for its 55 providers, including its patient portal and mobile version for hospital rounding.

Samsung launches its Android-powered, 4G-capable Epic smart phone on Sprint, which I’m mentioning only because I’m sick of hearing about iPhones.

Conmed (seriously) gets a $9 million, five-year contract to provide services to the City of Roanoke, VA, including implementing an EMR for its jail.

The FBI is brought in to investigate a hacker’s demands for data ransom after claiming to have penetrated the Texas Cancer Registry. Seems suspicious: the firewalls are intact, only one message was sent, and no proof was provided. It sounds like it could be an employee trying to coax more budget money from the state with a false alarm, but I’m sure the Fibbies will figure it out.

Former McKesson VP Mikael Ohman is named COO of T-System.

Odd lawsuit: two former porn stars are suing a clinic that provides medical clearance for the adult film industry, saying its release forms allow disclosure of their health information to almost anyone. I never thought of porn stars as being particularly protective of their anatomy and physiology, but I guess they’re like the rest of us.

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Monday Morning Update 6/28/10

From MaxPayneUK: “Re: iSoft. Shares hit 17c AUS – penny stock range. Directors and CEO reportedly selling off shares and rumors of massive layoffs in the UK and India have come up. ANZ MD sacked – will the UK MD be next? Too right!” Shares dropped to as low as 13.5 cents Friday when CEO Gary Cohen sold some of his, saying he had no choice due to margin calls. Denis Tebbutt, managing director in Australia and New Zealand, has been replaced. Wanna buy a train wreck cheap? Someone could pick iSoft up for a song, disengage from its money-losing UK business, and still become the non-US world’s biggest healthcare IT player.

I appreciate the support of CapSite, new to HIStalk as a Platinum Sponsor. CapSite is a healthcare technology research and advisory firm that offers an easy-to-use online database of evidence-based information to support healthcare technology capital expenditures. It provides the always-elusive pricing transparency (i.e., “Am I getting a good deal compared to hospitals like mine?”) by offering line-item details from contracts and proposals, broken out into software, hardware, and services. Its scope includes healthcare IT, imaging equipment, and medical devices. CapSite offers services to vendors as well, helping them understand pricing, competitive positioning, and industry trends. They’ll give you a live demo if you ask nicely. Thanks to the folks at CapSite for supporting HIStalk and its readers.

Orlando Health (FL) signs a deal with Health Care DataWorks for an enterprise data warehouse.

Finally, a meme (and a background buzz) even more annoying than Meaningful Use: vuvuzela.

The MyMedicalRecords people seem to be desperate to make something happen with the PHRs that nobody wants (including free ones, and theirs runs $100 per year), so their latest attempt is to run a commercial during the Daytime Emmy Awards (honoring the best of Unemployment TV). Last time I checked, the money-losing company had a dozen or so employees with microscopic revenue going down instead of up and with an odd D-list celebrity board of advisors that includes former astronaut Buzz Aldrin, former politician Dick Gephardt, and former boxer Sugar Ray Leonard. I was going to include their commercial video here, but it doesn’t work unless you manually switch to HD mode, so I’ll just link.

John Glaser e-mailed to confirm that he’s moving from Partners HealthCare to Siemens, where he’ll be CEO of its healthcare IT business, reported here first thanks to a non-John tipster (if you haven’t signed up for updates, do it now to avoid future in-your-face gloating by those who have). John will have held three big jobs in one calendar year: Partners CIO, ONC advisor, and now vendor CEO. Some are speculating that his move was due to announced Partners cost cutbacks, but he tells me he was just getting restless after 22 years at Partners and his ONC stint stimulated his desire to try something new. Congratulations to him. I always say the best times to take risks are in your 20s (no money, no kids, no clue) and your 50s (money, kids grown, ready for deferred excitement). If he wanted a tough job, I think he found it.

Singapore’s national EHR project chooses its vendors: Accenture, Oracle, and Orion Health get the $144 million USD deal to tie together Singapore’s EMRs to meet its “one patient, one record” vision.

We’re firing on all cylinders on HIStalk Mobile, double-teaming mobile health news with Travis (MD, MBA, software developer reporting news and opinion) and the enigmatic M (who’s contributing app spotlights and iPhone news). Sign up for the e-mail list over there and jump in with comments or guest articles if you are so inclined.

This is encouraging: nearly 2/3 of readers say their doctor used an EMR in the exam room during their most recent visit (mine did too, by the way). New poll to your right: which factor most directly affects a hospital’s adoption of CPOE?

MIT researchers develop a $2 cell phone add-on called PerfectSight that will let patients, particularly those in developing countries, check their own eyesight. Also using consumer technology to create diagnostic tools: Rice University, whose biomedical engineers worked with MD Anderson to rig a $400 Olympus digital camera and special dyes that can detect cancerous cells in the cheek, which could make it possible for non-pathologists to perform portable cancer screening.

The FDA and FCC will meet in July to “identify regulatory challenges” with mobile health devices and ensuring their safety and effectiveness. A UK article says the FCC is interested in reports that wireless broadband could interfere with medical equipment, saying that GE Healthcare has asked for increased regulation to avoid interference to its hospital equipment.

Raj Toleti, who founded kiosk maker Galvanon and content management company Cytura in the Orlando area, joins another Orlando kiosk company, PatientPoint, as CEO.

The West Virginia Health Information Network outsources its entire six-person payroll, including its CIO, in a no-bid contract with a research institute. They say it’s cheaper because the employees don’t receive state benefits and that its structure could change anyway.

E-mail me.

Report: Glaser to Leave Partners, Head Siemens Health Services Division

An internal Partners HealthCare communication indicates that CIO John Glaser will be leaving that organization in mid-August to become CEO of Siemens Health Services Division. He will presumably replace former Siemens CEO Janet Dillione, who resigned on April 1 to join Nuance as EVP and manager of its healthcare business.

According to the communication, Deputy CIO Mary Finlay will also leave Partners to become a professor at Simmons College.

I’m attempting to confirm with John Glaser directly and will update this post if I’m successful.

Update 6/25/10

John confirms the above.

News 6/25/10

From Robert Simplicio: “Re: Stack Overflow. The hugely popular programming Q&A site now has a community-driven system to decide whether to create a new site or not. It’s staging a healthcare IT version. To continue to the next step, it needs followers and questions. I can’t think of anything more relevant to your readers, myself included. This could save us all a great deal of time.” It’s a great idea. Click here to check it out and give it some support. This would be a free site that’s platform/system agnostic, so healthcare techies should be all over it.

From Blue Mist: “Re: Duke University Hospital. CIO Asif Ahmad has resigned.” Verified. He’s going to US Oncology.

From JoJoBoston: “Re: GE. Kent Rowe, GM for Centricity Business (the old IDX Flowcast), has resigned. He was one of the last main IDX players left. GE looks to be smothering the product, which once had 85% of the academic medical plans.” I asked a GE spokesperson, but they don’t respond to personnel-related inquiries. I thought our earlier Allscripts acquisition rumor made sense. Maybe there’s a connection.

From Capezio: “Re: Cerner. Your comment from the KLAS CPOE report was a bit off the mark.” Probably so: I said Cerner has low CPOE adoption, but with a third of its clients doing CPOE, that’s actually pretty good. It still has more hospitals live on CPOE than anyone else and KLAS says its adoption rate is growing at 30% per year.

Healthland provided this response to LouisvilleLouie’s Tuesday report that CEO James Burgess has stepped down:

James F. Burgess, chief executive officer of Healthland since 2007, resigned from the company for personal reasons on June 17, 2010. John Trzeciak, Healthland board member and operating advisor for Francisco Partners, is serving as interim CEO. Trzeciak has an extensive background in executive leadership with a variety of healthcare IT organizations. A search is underway for a permanent replacement for Mr. Burgess. For Healthland employees and customers, it’s business as usual.

Listening: Crowded House, a long-gone and perpetually underrated Aussie band now trying to make a comeback with their thoughtful and intelligently crafted pop that reminds me more than a little of the Beatles. Excellent. And also unrelated, Amazon has dropped the price of the Kindle to $189 after BN brought out a WiFi-only version of the Nook for $149, so I bought one as a gift for a special lady. It’s pretty cool.

On the Sponsor Jobs Page: Vice President, Business Development, Vice President, Solutions Marketing, Meditech Consultant – Long Term, Epic Certified Clinical Documentation Consultant. On Healthcare IT Jobs: Clinical Pharmacy Specialist, McKesson HED Consultant, Cerner FirstNet Consultant.

Universities and hospitals in Memphis are connecting to Oak Ridge and other research centers via 10-gigabit-per-second connectivity and Internet2.

McKesson’s John Hammergren banks $35 million in proceeds from selling shares.

Microsoft announces that HealthVault is now available in the UK, three years after its US debut.

Indian companies are seeing gold in the US healthcare reform bill, specifically in business process outsourcing, reading diagnostic images, medical tourism, and drug manufacturing. Also mentioned is that because the bill limits offshoring, Indian companies are opening offices here and also buying domestic companies.

Motion Computing announces its J3500 tablet PC for healthcare and other vertical markets that require a rugged device. It’s way uglier than an iPad and quadruple the price (it starts at $2,299) but it’s tougher.

iSoft shares drop to $0.19, down nearly 75% in the past six months. The company had planned to make some US acquisitions (I’ve heard a couple of names), but that’s probably not going to happen with that loss of equity.

Interesting lawsuit: the CEO of Tallahassee Memorial Healthcare (FL) subtly tinkers with the formula approved by the hospital’s board to calculate his retirement benefits and submits it in his employment contract. The hospital’s board chair now admits that he “signed it, as was his custom, without reading it.” The CEO retires and the hospital is shocked to find that it’s stuck with paying him $614,000 per year for the rest of his life, triple the expected amount (even that amount sounds wildly generous – who gets a guaranteed lifetime pension of $160K per year on a $380K salary?) The hospital doesn’t want to pay, so he’s suing them. And in Ohio, a hospital CEO forced into retirement from his $530K job after highly paid family members were found on the hospital’s payroll faces another charge – shipping hospital baby formula to his daughter.

HHS CTO Todd Park says his team is working startup-like hours to launch the HealthCare.gov consumer insurance site by the legally mandated July 1 live date.

Strange, especially in this economy: 90 union construction workers at Central Washington Hospital (WA) walk off the job because two Port-a-Pottys of the 24 on the job site were dirty and one was out of toilet paper. Maybe they had to get in the iPhone line.

E-mail me.

HERtalk by Inga

Franklin Wood Community Hospital (TN) selects GetWellNetwork to provide patients with its bedside interactive learning tool. Among other functions, the GetWellNetwork system noteswhen patients finish their prescribed educational content and documents that information into the hospital’s Soarian EMR.

Money can’t buy you love or the the world’s best healthcare. A new Commonwealth Fund report ranks the US last for healthcare outcomes compared to six other industrialized countries despite its per capita cost of $7,290. The next biggest spender is top-rated Netherlands at $3,870. The US ranked particularly low in efficiency due to high expenditures and administrative costs. Other contributing factors included low scores on IT usage, re-hospitalization, and duplicative medical testing.

Nuance Communications buys the IBM spin-off Shapewriter, a continuous touch application that allows users of mobile devices to type by swiping their hands across a keyboard instead of hitting individual keys. I’ve never seen a similar app and I thought the online demo looked cool. I’m not sure if Nuance plans to add it to any HIT applications or if it even really does make input faster, but it looks sexy.

Speaking of Nuance, the company announces the winners of its 2010 eScription Million Dollar Awards. Twenty-two organizations were recognized for saving one million dollars or more on medical transcription using the eScription platform.

Over on HIStalk Practice, Dr. Joel Diamond weighs in on e-prescribing. Joel is a regular 2010 Renaissance man who not only writes blogs, but also serves as CMO for dbMotion and still manages to practice medicine a few days a week. Plus he’s got a great way of getting his point across while also making me laugh (I doubt I am the only one.) Here’s a sampling:

A colleague of mine told me of the time he once prescribed drops for a baby with an earache. The instructions were: “Put two drops in right ear every four hours” with right abbreviated as an R with a circle around it. The mother returned when the child did not get better. She showed the doctor the baby’s wet rectum as evidence of complying with the prescribed treatment. It turns out the pharmacy printed the instructions as “Put two drops in R ear every 4 hours”.

Even  though I just got back from vacation, I’m already thinking about what I’ll do for my next trip. Denver at the end of July sounds pretty inviting, especially if you’re interested in hearing  some experts chat about HIE adoption and implementation. The Institute for Health Technology Transformation is hosting a Health IT Summit July 27-28 and has lined up an impressive list of speakers and moderators, including John Moore of Chilmark Research, Lisa Khorey of UPMC, and Mary Anne Leach of The Children’s Hospital.

Design Clinicals contracts with ExitCare to enhance patient education features in the MedsTracker software. ExitCare will interface its ExitCareEDTM and ExitCareIPTM products with the Design Clinicals’ MedsTracker application. MedsTracker, by the way, was recently certified to connect with the Surescripts e-prescribing network.

Forerun, Inc. plans to incorporate Anoto Digital Pen technology into its Forerun Chart program for EDs.

Automated telephone reminders can increase colon cancer screening rates by 30%, according to a KP study.

Sad: the administrator and associate administrator at Central Louisiana State Hospital resign following the deaths of three patients from food poisoning. The cause of the outbreak was tied to improperly stored chicken salad. Another 54 patients and staff members were sickened.

Also sad: that the world needs this type technology. Baptist Memorial Health Care completes installation of RF Technologies’ Safe Place Infant and Pediatric Security Solution at eight hospitals. The system prevents abduction of infants by sounding an alarm and locking all doors if a baby is moved without authorization.

A medical technologist who worked worked at a couple different hospitals in Newark, DE, is arrested for stealing men’s shoes. Police discovered 3,900 shoes that were presumably stolen over the last 20 years. I thought I might have found a sole-mate (sorry) until I read more details about him. I mean, I could never go for a guy who just boxes up all his shoes and leaves them in his basement.

E-mail Inga.

News 6/23/10

From LouisvilleLouie: “Re: Healthland. Rumor has it that Francisco Partners, owner of Healthland, has parted ways with Healthland CEO James Burgess.” I’ve tried to verify this rumor with no luck so far. He’s supposedly moving to the board of T-System, another FP investment. I’ve heard that FP is gearing Healthland up for an IPO.

From WisconsinBiker: “Re: Aurora Health Care Milwaukee. The longtime Cerner Millennium user will be switching to Epic.” Unverified, but WB’s Rumor Report included an authentic-looking message from Aurora President and CEO Nick Turkal, MD explaining that they’ll transition over three years after determining that “Epic offers the best solution” based on performance, user friendliness, reliability, and support, not to mention all the other swell organizations that have already chosen it (and also not to mention that Epic’s in Wisconsin, it pretty much owns that market, Aurora’s competitors are using it for interoperability, and Aurora was already using Epic on the ambulatory side). If the message is legit (and I strongly suspect it is), Cerner might want to pull down its self-congratulatory Aurora case study.

Here’s a telling newspaper story and quote from Aurora CIO Phil Loftus from a year ago when Froedtert and other area hospitals started linking up via Epic’s Care Everywhere:

The problem, however, is that the hospital systems are not using the same electronic medical system manufacturers. While Froedtert has chosen Epic, other hospital systems have opted for other providers such as Cerner Corp., Kansas City. While competing companies using different computer software wouldn’t normally be an issue, it is an issue in the health care industry where patients can move between hospital systems. “It’s very important to find the tools that can connect the organizations,” said Philip Loftus, chief information officer and vice president of information systems for Aurora. “There is a big Epic population and we are going to have to figure out a way to integrate that with the Cerner population.” Loftus sees the importance of interoperability daily because while Aurora uses Cerner, Aurora Advanced Healthcare, a group of about 300 physicians that Aurora acquired last year, is on the Epic program. Loftus said Cerner has yet to develop a product like Care Everywhere. He is hoping Epic’s Care Elsewhere, which is not yet available, will eventually allow various software programs to connect, regardless of the manufacturer. “We are very committed to opening up our records to other hospital systems,” Loftus said.

Healthcare security vendor CynergisTek partners (warning: PDF) with NitroSecurity, Inc. to offer a fast-response security event monitoring solution that incorporates log management, database activity monitoring, application data monitoring, and intrusion prevention.

In Australia, a newspaper speculates that the Premier of Victoria’s hospital press conference was moved because he was embarrassed about medical staff complaints involving the hospital’s Cerner EMR. Senior medical staff sent a letter Friday to executives at 330-bed The Alfred, claiming that “it will only be a matter of time before we see catastrophic and perhaps fatal outcomes.” Among their complaints: doctors can’t find available PCs, the system is slow, and record scanning isn’t being performed correctly (those are mostly not Cerner’s problems from what I can tell). The hospital says the complaints understate the benefits the Cerner system offers over paper records, but admits that outpatient appointments are being pushed further into the future as a result of the implementation. Clarification: this is not Victoria’s $314 million (USD) HealthSMART system that’s running years behind schedule and millions over budget, although it, too, runs Cerner.

Here’s a fun interview with Partners CIO John Glaser. An interesting point: he says Congress never expected a majority of hospitals and physicians to qualify under Meaningful Use and that it was intended to stimulate EMR uptake, but not cover the whole cost. He also predicts that “some states will screw it up” when it comes to HIEs and says that the biggest weakness of the government’s plan is not putting enough money into the Regional Extension Centers. The story of why he got expelled from his Jesuit high school is a big bonus. Definitely worth a read.

Free EMR vendor Practice Fusion claims its user count grew by 72% in the first half of this year, capturing 7% of the total ambulatory EMR market. I think I’d want to see more information on what constitutes a user versus a tire kicker, so maybe that will be forthcoming.

An IDC Health review of HIE vendors (warning: PDF) finds that Medicity earned the highest possible rating in nearly all of the criteria that involved market fit and likelihood of a positive customer experience. It also notes Medicity’s 700+ hospitals. It has been 18 months since Medicity acquired Novo Innovations, with 25% of Medicity’s customer base now running the full integrated HIE platform. It has also accounted for every sale so far in 2010. I just searched the KLAS database (the free part I can see) and for some reason they still have the Novo Grid as its own product, but it’s pretty much one company and one product as far as I know.

It looks like new HIMSS EVP John Hoyt will have a VP reporting to him, as HIMSS posts a VP of Healthcare Organizational Services job. It’s called a “concierge service so that it’s an easy decision for them [CIOs] to renew their organizational membership and to grow our influence with that community.” It also involves pitching HIMSS Analytics to CIOs to get them to do the survey and to “help sell CIOs on extended benchmarking engagements.” Basically, the job involves selling HIMSS stuff to CIOs, with sales experience mandatory. It’s a nice business model: hospitals pay for their executives to be HIMSS members, which also then makes them prospects for sales pitches from both HIMSS vendor members and HIMSS itself. That’s like a rube Florida tourist offering a free weekend stay and a Chili’s gift certificate to a timeshare salesperson. 

Speaking of HIMSS Analytics, it announces HIMSS Analytics Europe. I didn’t know this that I recall: HIMSS apparently very quietly and very recently bought The Hospital IT Network, with which it had worked previously, and is now turning it into the new organization. The Hospital IT Network, like HIMSS Analytics, sells hospital information to vendors.

Don Berwick takes heat in his confirmation for CMS administrator because of comments on record in which he extolled the virtues of healthcare rationing and Britain’s NHS, about which he said, “… any healthcare funding plan that is just must redistribute wealth … please don’t put your faith in market forces.”

According to e-Health Insider, InterSystems will win the laboratory information system business in Wales, with its TrackCare product beating out Cerner and iSoft.

This is one of those times where I beg forgiveness in being way far behind and thus tardy in e-mail responses. I’ve been super busy, but I’ll catch up soon – promise.

E-mail me.

HERtalk by Inga

Gardner Family Health Network (CA) selects NextGen’s EHR and PM, as well as the QSI Dental System. Gardner is a five-location, 50-provider FQHC.

Thomson Reuters chooses MedAssets’ Contract Manager program as the preferred contract management solution for its hospital client, replacing Thomson Reuters’ Ascent software, which will be discontinued at the end of 2012.

Beaufort Memorial Hospital (SC) claims to have increased gross revenue by $1.3 million within a month of implementing MEDHOST’s EDIS, mostly through better E&M coding and IV infusion charge capture.

Another cool iPhone app in the works: Emerging Healthcare Solutions hopes to sell 1 million downloads of the e-911 app within its first year of release. The app automatically delivers medical information to first providers or physicians when 911 is dial from the patient’s iPhone. If you are an Emerging shareholder, you’ll be able to download the app for free (currently trading at a mere $1.02/share).

The US hospital market for claims management/EDI represents almost a billion dollars in new and replacement business, with $150 million in spending projected over the next 18-24 months. That according to a new CapSite Consulting study.

RelayHealth introduces a new claims and remittance management solution for hospitals and health systems. If you’re at HFMA in Vegas, you can stop by RelayHealth’s booth #437 and check out RelayFinancial Assurance Pro.

Emdeon pays $18.9 million for Chapin Revenue Cycle Management, which offers a proprietary contract management system that calculates reimbursement.

Riverside Health System (VA) implements Zynx Health’s ZynxOrder evidence-based order sets. The order sets are integrated with Riverside’s inpatient EHR (Soarian Clinicals, I believe).

Speaking of Soarian Clinicals, Siemens says its latest version is now in GA. The new release incorporates electronic medication reconciliation, provides new CPOE capabilities, and offers the ability to create a continuity of care document.

MediConnect Global announces that its MediConnect PHR (formerly known as PassportMD) supports iPad/Phone/Touch devices, as well as Android and WebOS mobile operating systems.

Picis names six hospitals as winners of its 2010 Customer Recognition Awards.

In case you missed it, we just posted our latest HIT Vendor Executive question. Check out what industry leaders how to say about the Allscripts/Eclipsys transaction and some of its broader implications for the HIT industry. You won’t see most of the news from HIStalk Practice repeated on HIStalk, so sign up for e-mail updates while you’re there.

CCHIT chair Karen M. Bell, MD says her organization will, not surprisingly, apply to be an ONC Authorized Testing and Certification Body (ONC-ATCB) now that ONCHIT refused its request to be grandfathered in. The Drummond Group doesn’t officially announce (again) that they are in, though their recent EHR Blog posts suggest they’re still committed.

University Health System (TX) CIO Bill Phillips tells the local paper they’ve spent about $25 million rolling out an EHR over the last five years. The health system, which uses Eclipsys Sunrise on the inpatient side, has also automated its clinics and runs 99 real-time interfaces.

Heathcare systems and vendors were well represented in Computerworld’s 100 best places to work for IT professionals. A few that stood out in my mind:

• #36 – Lehigh Valley Health Network (PA) employees are encouraged to participate in community service activities throughout the year, usually on company time. For $3, employees can pay to wear jeans on Fridays and have the funds go to disadvantaged children in the community.
• #27 – Kaiser Permanente (CA) encourages employees to submit ideas for technology projects to improve quality and service. If the suggestion is accepted, Kaiser’s Innovation Technology Fund will move the idea into production. Twenty-seven projects were seeded through this program last year.
• #30 – OhioHealth is all about hosting social events like picnics, holiday meals, and golf outings, plus an annual all-staff meeting with entertainers and games. Of course, I like parties.

Plastic surgery, anyone? An enterprising physician develops a new iPad application that includes hundreds of before-and-after photos by type of operation and details on the various procedures. Now that would be a cool thing to analyze over my next chick lunch.

E-mail Inga.

Pssst, Here’s an Excuse for you CPOE Vendors: The Problem Isn’t Your Product, It’s Your Choice of Customers

By Mr. HIStalk

KLAS just released its CPOE Digest 2010. It’s a pretty fun read, although not too encouraging. A full 86% of US hospitals fall short of even the paltry 10% CPOE adoption rate that the proposed Meaningful Use rules would require.

That’s probably why hospitals are whining (while looking the gift horse in the mouth) about the modest conditions that are attached to the millions in free taxpayer money they’ll get for merely using the systems they already own.

The KLAS report seems to send this message to hospitals: you’re in trouble if you’ve chosen a crappy CPOE vendor.

Everybody would agree that the whole CPOE issue is vexing. It’s healthcare IT’s Vietnam, having dragged on for years without progress while experts opine, outsiders roll their eyes, and boatloads of cash exchanges hands in a failed attempt to turn the situation around. Technical superiority is getting its butt kicked by a committed and stealthy enemy called paper.

Until Meaningful Use, hospitals had pretty much given up on CPOE. It’s like naively buying a fancy new car without doing your homework, then finding it so annoying and unsuitable that you just put it up on blocks in the back yard and cover it with a tarp so you don’t have to be visually reminded of your bad decision every time you go out.

So news from the CPOE front is not so good. But I might quibble with KLAS’s implication that it’s all because of low-quality CPOE software.

KLAS correctly observes that some CPOE products are majorly screwed up when it comes to usability and integration. The vendor names are hardly shocking: (a) smallish vendors whose customers didn’t really care about CPOE anyway, and (b) mega-corporations who dabble in HIT not because they care about patients, but because they run their business like an unfocused mutual fund and needed sector diversification.

But then you have Epic, which shames everyone by throwing off the grading curve. While the also-rans are locked in a desperate struggle for tiny percentage gains to their scores in the low 70s or worse, Epic surveys the spectacle from rarefied heights and splatters the heads of the combatants below with its droppings pretty much whenever it pleases.

Epic’s software is better than most (although a strong argument could be made that Eclipsys Sunrise has better CPOE). However, it’s naïve to think that Epic’s software is THAT much better. Or, that hospitals can move their CPOE needle by just doing a mating dance with Judy.

Epic’s secret sauce, I think, has a second ingredient: its choice of customers.

Epic knows that most hospitals don’t have the right stuff to handle big projects, especially those involving IT. They are indecisive, change-resistant, and unable to move beyond the tactical to the strategic. Epic sends those prospects away to fail under a competitor’s watch. That vendor cashes their check, but gets dinged in the KLAS report because the good customer predictably turns into a bad user.

(If you believe that software alone drives CPOE adoption, consider this: would you instantly whip out your hospital’s checkbook for a system that boasts nearly 100% CPOE utilization at every one of hundreds of hospital sites? You won’t need the checkbook – just order your free CD copy of the VA’s VistA).

One way Epic ensures that its customers are committed is by charging them exorbitant prices. Hospital C-levelers to get uncharacteristically involved in a so-called IT project when it’s costing them $50 million or more.

But more importantly, those high prices pre-qualify prospects. Badly run hospitals don’t usually have $50 million burning a hole in their pockets. Or, they may back down from their lofty ambitions, recognizing that deep in their DNA, they don’t have the right stuff to make expensive IT work. They fold their cards and slink away to a lesser-heralded and cheaper vendor rather than confidently throwing their big chips into the Epic kitty.

(I once had a sweet, competent employee who was also recruiter for a cult. She tried to get me to attend an introductory class, surprising me when she said it would cost me $100. The reason, she explained, is that free classes attracted mostly people without commitment who weren’t likely to join. Not to mention that prospects with $100 probably had more assets worth swindling once their brains had been programmed).

The KLAS report talks about vendors, but I think the real issue is one that should resonate with us IT people. It should also make hospitals think twice before dumping their current CPOE vendor to chase the Holy Grail of a higher-rated one (even Epic).

It’s PEBMAC — problem exists between monitor and chair. It’s not what you have, but how you use it. Much of the Epic ballyhoo is because they sell only to hospitals already qualified as having a high probability of success – they have enough money and motivation to want to undertake an Epic project in the first place.

Monday Morning Update 6/21/10

From The PACS Designer: “Re: World Cup apps. Some HIStalkers may want to watch the results of World Cup Soccer as it proceeds through to the final game. The viewing can be done on your mobile device with various apps that have been designed just for the event.” I don’t know anything about soccer except it’s something US kids seem to play until high school and then forget about until the World Cup, but someone sent the picture above from Cape Town, which is pretty cool.

From Buck S. Pearl: “Re: West Virginia. Governor Joe Manchin dedicated his most recent weekly column to the $6 million regional extension center called WVRHITEC (catchy!) The state HIE has been awarded $11.3 million in funding and plans to choose a vendor by the end of the month. In 2006, the state funded an almost $100 million install at WVU Hospitals. Do you think Epic will play well with the HIE vendor?” The state seems to have its act together. Let’s hope they can get Epic connected since the value goes way down without WVU.

From Sorry, You’re Dead, EMR Said: “Re: unintended consequences or befuddled users?” A UK hospital scheduler refuses to make an appointment for a cancer patient, saying their records show that he’s dead. NHS authorities tries to reassure the public that its Choose and Book scheduling system is the fastest way to schedule an appointment, but in the mean time, hasn’t yet found one for this patient.

Readers believe the biggest beneficiary of the Allscripts acquisition of Eclipsys will be Eclipsys customers, according to my previous poll. New poll to your right: did your doctor use an EMR in the exam room during your last visit?

Listening: Killola, quirky LA punk led by actress Lisa Rieffel. They’re DIYers: they book their own shows through e-mail and sell albums on USB flash wristbands.

ONCHIT issues rules for its temporary certification program, intended to set up non-profit Authorized Testing and Certification Bodies (ATCB) to certify EMRs so that HITECH money can be handed out even before a permanent program is developed (ONCHIT says that won’t be until January 1, 2012 at the earliest). It was too dry for me to read, so let me know if it contains anything interesting (the PDF is here). Organizations will spend about $75,000 to apply to become an ATCB, with their authorization lasting two years until the permanent rules are finalized.

Dennis Sato tells me he’s serving as interim CIO for Hawaii Health Systems Corporation, where he used to work.

The Walgreens drug store chain uses technology to increase business, offering a mobile site, an iPhone app, and text messaging for special offers and “your prescription is ready” alerts.

Strange bedfellows: the highest paid University of California employees are athletic coaches and brain surgeons.

HHS posts the agenda for its June 29 hearing on privacy and security tools in Washington, DC, which will features demos and panel discussions.

Jobs on the HIStalk sponsor job board: Eclipsys Activation Consultants, Epic Certified Clinical Documentation Consultant, Cerner Ambulatory Consultant.

InformationWeek says Newt Gingrich’s endorsement of EMRs is cause for optimism, apparently not noticing that his somber pronouncement fortuitously came at a rollout bash for a new EMR offering from GE Healthcare, which is a Platinum Member of Newt’s very much for-profit think tank, Center for Health Transformation. According to CHT’s site, its Platinum sponsors enjoy “limited access to Newt Gingrich on your company’s strategy” (maybe his appearance was their freebie for the year), the chance to pay more money to sponsor other stuff, and the chance to chair project advisory groups and influence white papers. Needless to say, Newt’s in favor of a free market approach to healthcare.

I’ve been busy with HIStalk Mobile lately, putting in a new layout and bringing on a primary editor, Travis Good. He’s finishing a dual MD/MBA program, earned an MS in decision and information sciences, and has experience developing software and designing enterprise architecture. Thanks very much to its Founding Sponsors (AT&T, Vocera, Voalté, and 3M) and Platinum Sponsors (Access and PatientKeeper). If you’re a provider, I’d like to hear your experiences with mobile technologies.

People drawing HIT-related paychecks like the artificial demand created for it by spending taxpayer dollars, they say in a HIMSS briefing during National Health IT Week. More interesting to me was that none of the three members of Congress that HIMSS expected to speak actually showed up, saying their full attention was needed to address the Gulf oil spill. Its 183 partners (mostly vendors) claim this purpose:

National Health IT Week is a collaborative forum, now in its fifth year, of assembling key healthcare constituents—vendors, provider organizations, payers, pharmaceutical/biotech companies, government agencies, industry/professional associations, research foundations, and consumer protection groups—working together to elevate national attention to the necessity of advancing health IT.

Reminders: HIStalk, HIStalk Practice, and HIStalk Mobile each have their own content, readership, and e-mail alerts, so sign up on each site for the latest. The Search function to your right, however, covers them all, clear back to 2003 when HIStalk emerged (at least slightly) from the primordial ooze. Inga and I update Facebook when we post something new, so Friend us or Like us with the widget to your right to connect. Your guest articles and interview suggestions are welcome for all three sites, as are your clicks on the ads of those nice sponsors who keep the lights on and the keyboards clacking. Thanks for reading.

Merge Healthcare signs a distribution deal to bring its eFilm Workstation image viewer to Brazil.

Bon Secours Health System (VA) rolls out Epic MyChart for physician and patient access.

Note to these two vendors: both HIMSS 2009 and 2010 are over, so you might want to stop paying for Google ads pitching your booths.

Cisco, CareFusion, and Medtronic sign on as technology partners with the non-profit West Wireless Health Institute of San Diego, a medical research organization founded a year ago with a $45 million donation to promote wireless health to reduce costs. The billionaire namesake founder is fascinating: he came back from a tour in Vietnam, spent seven years as a hospital administrative assistant, started a telemarketing company, and got really rich. That inspires my own entrepreneurial vision for healthcare: hire a boiler room full of over-caffeinated telemarketers to cold-call patients during dinner to remind them to take their meds, eat less, and get off the couch, then sell the whole business to an insurance company.

Health workers in Malawi use free SMS messaging software to track TB outbreaks, saving money and allowing twice as many patients to be treated. They bought recycled cell phones at prices ranging from $15 to $50 each, a GSM modem for $200, and a donated Compaq laptop. The software is from FrontlineSMS:Medic, a non-profit started by Stanford students that recently received a Google charitable grant.

This interview is a good introduction to insurer UnitedHealth Group’s telemedicine initiative. Patients go to a clinic, where an employee sets up the session with the remote physician using two-way video. The company says they’re paying doctors the same rate as they would for a face-to-face visit.

Sponsor news:

• NextGen Healthcare opens registration for its 2010 user group meeting, to be held November 7-10 in Orlando. It drew 2,700 attendees last year.
• Keane’s Healthcare Solutions Division will announce a partnership with Ormed Information Systems, Ltd. this week at HFMA to offer Keane Optimum clients a full ERP solution.
• Vocera is offering a June 24 Webinar describing its work in reducing communication breakdowns in VA healthcare facilities.
• The Voalté One hospital communication system is now available on the BlackBerry as well as the iPhone.
• A European Journal of Anaesthesiology article concludes that use of decision support in iMDsoft’s MetaVision doubles adherence to guidelines involving prophylaxis of post-operative nausea and vomiting.
• TELUS Health Solutions donates its Assyst Rx Pharmacy Management System to the pharmacy school at the University of Toronto for teaching hands-on skills to pharmacists trained outside of Canada.
• e-MDs will be at NYMGMA later this month.
• Vitalize Consulting Solutions was named as a Top 100 Healthcare IT Company by Healthcare Informatics.
• Hayes Management Consulting will offer a June 22 Webinar on keeping historical data when migrating to EpicCare.
• Sunquest is supporting the SUG 2010 meeting, to be held in Tucson July 12-16.
• Sentry Data Systems will be at HFMA’s ANI conference in Last Vegas this week, exhibiting in Booth 609.
• Dentrix Enterprise offers free Webinars to introduce its electronic dental record.
• The Anson Group adds Patrick Mooney, formerly of Eli Lilly and Company, to its team of life science consultants who work with healthcare IT regulatory requirements, including those of the FDA.
• FormFast is offering a July 13 Webinar called Cloud Computing: Advice from a Top Legal Expert.
• An Ingenix Consulting article called Intervention Valuation: Translating Innovation into Payer Value, is available on its site.
• CynergisTek CEO Mac McMillan is interviewed in an article about security threats from used copy machines.
• Consulting firm Virtelligence will be at Epic’s User Group Meeting in September.
• 1450, Inc. is offering a 25-minute Webinar on using Dragon Medical with or without an EMR on several dates through August.
• Enterprise Software Deployment had activations last week at Children’s Alabama and Yale New Haven.
• O’Toole Law Group offers its legal consultation to hospitals migrating to Meditech 6.0. 

The local paper profiles Smile Reminder, a Utah-based company formed in 2000 to send text message appointment reminders to patients. It’s grown to 60 employees, servers 10,000 doctors and dentists, now does patient-doctor communication, and just signed a deal with GE Healthcare (details not provided). It charges $299 per month per practice and claims to drop no-show rates by up to 80%. It suggests interesting customer retention services: sending birthday greetings, offering last-minute cancellation appointments, embedded refer-a-friend links, and sending surveys.

The Senate votes to rescind the 21% Medicare payment reduction for physicians, but too late to stop CMS from applying the cut to checks for services rendered June 1 and after. The House will take up the issue this week.

Just for fun, I’ll leave you with a great Monty Python OR sketch, including “the machine that goes ping” and a clueless hospital executive. The inside joke: Graham Chapman, who plays the doctor, really was one.

E-mail me.

News 6/18/10

From I Told You So: “Re: patients accessing their own records. One in a thousand did. ‘Wicked problems’ were prevalent.” Researchers find little benefit with England’s Summary Care Record and the patient portal view of it. Only one in 1,000 patients who were invited to open an account bothered to do so; many of them tossed the informed consent letters into the trash unread; and those who used the portal found it pretty much a waste. What the researchers found evidence of: improved quality in some visits. What they found no evidence of: improved safety, faster visits, number of referrals, more personalized care, increased patient empowerment, better management of chronic conditions, improved health literacy, positive impact on data quality, and reduced cost.

From Samantha: “Re: Inga. I saw this and just had to ask – is this what Inga’s been up to lately?” Could be — those shoes look familiar. It’s a cool pinup calendar an agency designed for a medical imaging vendor. Inga is still cavorting beachside, although apparently with connectivity since she checks in periodically.

From Winston Zeddemore: “Re: software usability. Software used by 911 operators in Pittsburgh is a likely contributor to the death of a three-week-old.” A 911 operator keys an @ sign instead of # to indicate the apartment number address given by the frantic mother of her dying daughter, which is a reserved keystroke that the software uses as a command to change the address. The software moves to the next alpha address, the misrouted paramedics take an extra seven minutes to arrive; and the baby dies an hour later. They don’t know if the delay contributed. Implementation of the $10 million system is scheduled to be finished in August.

From Mr. Science: “Re: Howard Messing of Meditech. He’s now the chairman of the board of the Museum of Science in Boston.” Funny – I had just gotten off the phone with Howard when your Rumor Report came through. I could have asked him about that, although he’s a man of few words. I’ll have the interview I was doing with him up shortly.

From p_anon: “Re: Atul Gawande. He gave the commencement speech at Stanford’s School of Medicine last week.” It’s excellent. Here’s a snip:

Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.

From Techsan: “Re: Epic. I can confirm that Epic is supplying new customers with their interview tools, which I understand are self-developed, and recommending hiring college grads to staff projects. One of our clients just completed using the tool for internal candidates and will be interviewing college grads soon as they near the beginning of their implementation. I am also working with a new Epic client and Epic made the same suggestion.” The debate rages: are inexperienced youth the best choice for implementing sophisticated clinical systems? You can’t argue with the results – Epic’s implementations almost never fail and those of their competitors often do despite having lots of experienced hands on deck. I’ll make the argument that Epic’s methods make it not just possible, but desirable to use easily managed, job-appreciative noobs who don’t bring any preconceived notions or egos to the table (not to mention “experience” that’s mostly with bad vendors or hospitals). As a non-noob, I’m as threatened and offended by that fact as anyone, but you can’t argue with Epic’s results and it’s never Epic’s implementations that are implicated in the patient-endangering case studies you read about. Plus, it gives them endless scalability because it takes little time to bring in a fresh wave of troops. I think it’s brilliant as long as it continues to work.

Listening: The Young Veins, dead ringers for the cheery Help-era Beatles, but from Topanga, CA and featuring two former members of Panic! at the Disco.

Someone sent me a copy of the just-released CPOE Digest from KLAS. I’ll keep it high-level since they’re charging vendors $14,850 for a copy and I only glanced briefly so I wouldn’t be tempted to spill the beans, but I was looking to see how specific vendors did. Providers get the report for $980, by the way, and for those in the market for a system, I’d say it’s worth every penny since there’s a ton of detail.

• Cerner – CPOE adoption fairly low but growing, but not so good with physician documentation.
• Eclipsys – has a higher percentage of its customer base using CPOE and making progress in pharmacy and the ED.
• McKesson Horizon – shallow CPOE usage even where it’s mandated and prospects are steering clear (and customers are considering defecting) because of worries they can’t get to Meaningful Use with it. Complex to maintain (iForms). Good with bedside barcoding.
• Meditech – OK in CPOE, very strong in bedside barcoding.
• Soarian – the weakest of all vendors for CPOE adoption. Too many marginal implementation people. Great at barcoding, poor in physician documentation.
• Centricity – decent CPOE usage, but it’s still the bottom-rated EMR.
• Epic – nothing you haven’t heard a zillion times before. It’s light years ahead of everybody, with huge CPOE utilization (over 90% in both inpatient and clinics). The score difference between Epic and its competition is shocking.

Ed Marx is always diligent about updating his CIO Unplugged postings to address any reader questions or comments. He’s done so with last week’s staff retreat one.

This CBS Evening News video shows the security exposures inherent in copy machines, which have hard drives that retain digital copies of everything scanned. Machines purchased used contained everything from police records of sex offenders to a New York insurance company’s machine that contained 300 pages of patient records, one shown redacted on the screen bearing the Montefiore logo.

A couple of readers e-mailed me their displeasure about an extended outage of all Intuit Web sites. The online versions of Quicken, QuickBooks, and TurboTax became offline versions when something went wrong (Intuit isn’t saying what). Most importantly to the hospitals, Intuit’s QuickBase project management software was unavailable. It’s not cheap: the lowest monthly price is $299 and goes up from there based on the volume of users, data records, and data storage.

Weird News Andy adds to his body of literature about people who suddenly start speaking with a foreign accent after some medical event (this is his second report of that phenomenon). A Canadian woman thrown from a horse suffers brain damage, temporarily loses her ability to speak, and then regains it but finds she suddenly has an Irish/Scottish combo accent, including the unintentional use of words she had never used such as “brilliant” and “wee.” Maybe I have a wee bit of that since I notice I’ve said “brilliant” a couple of times.

Financial Times says big NPfIT contractors like iSoft and BT got burned for their involvement, but upcoming NHS cutbacks could create a new breed of emerging vendors. Listed: Emis (practice EMR); System C Healthcare (hospital systems, including EMR, patient management, and departmentals); Iris Software (custom development), and INPS (practice PM/EMR).  

Speaking of NPfIT, the head of one trust that opted out of it says it “put back the contribution of IT in the NHS by more than ten years.” His trust, which he calls “one of the bad boys who left NPfIT,” passed on CSC and iSoft’s Lorenzo system, choosing Meditech 6.0 instead in a $60 million project (sounds way high for Meditech).

And speaking of iSoft, its reassurances didn’t help as the stock keeps diving (now at $0.25, but only after a big run-up on Tuesday), layoffs are reportedly being planned, and executive chairman Gary Cohen, who I interviewed in April, relinquishes that role to focus on his CEO responsibilities.

Jobs: Senior Project Manager – East, Clinical Pharmacy Specialist, Soarian Clinicals – Plan of Care, Business Systems Analyst.

I got a copy of an Eclipsys customer e-mail describing how the company will handle enhancement requests going forward and I have to say it’s smart (I probably think so because I’ve advocated something very similar here in the past). Instead of the idiocy of requiring requestors to show up at the user group meeting and then taking a show of hands that rewards the rich hospitals that send lots of attendees, the Eclipsys method first involves an internal selection of the best ideas, which then move to the Invest stage. Each client organization gets $500 in Eclipsys Bucks to allocate among all the enhancements they like best, making it easy and fair for Eclipsys to simply choose the ideas that get the most support. Customers are forced to think like the vendor – do they spend their Bucks on several little changes, or shoot the whole wad on a big change and hope that’s enough to get it approved? One refinement might be to get $500 in Veto Bucks so the practical hospitals can kill off all the lame, site-specific monstrosities that the big academic medical centers always demand that will spoil everybody else’s workflow, but maybe that’s a 2.0 project.

New officers for the EMR vendor trade organization that HIMSS runs: Epic EVP Carl Dvorak (chairman) and NextGen VP Charlie Jarvis (vice chair). Carl says he’s excited to lead efforts related to open standards, which is probably driving Glen Tullman up a wall given his comments about Epic’s lack of openness in my interview yesterday.

Best Buy donates its Geek Squad service to Children’s Hospitals and Clinics of Minnesota, providing and supporting Skype, web conferencing, and video games for the families of patients.

The 45-year-old billionaire founder of Salesforce.com will donate $100 million for a new children’s hospital at UCSF.

The federal government sues Oracle for fraud, claiming tens of millions of dollars in overcharges (illegal ones, not just the usual high Oracle prices). A former Oracle employee turned whistleblower claims the company intentionally hid discounts it gave to big customers to avoid giving the feds its best price.

Cambridge Memorial Hospital (Ontario) uses out the Information Builders WebFOCUS BI platform to develop an ED tracking board application.

EnovateIT expands its mobile and wall-mounted workstation into overseas healthcare markets, citing similar demand to the US as EMRs replace paper.

AT&T issues an apology to iPhone fanatics like Inga who had problems trying to get their latest toy (what recession?) Sales were ten times higher than for the 3G last year and they ran out. AT&T says they received 13 million visits to their site in a single day by people checking their upgrade eligibility.

A Madison, WI law firm gets a $1.2 million NIH grant to create an application that will check patient eligibility for government programs. I don’t quite get the business structure: the law firm (ABC for Health) is a non-profit that connects families with healthcare services, but the grant went to its for-profit subsidiary called My Coverage Plan, Inc. I guess they plan to commercialize the result. It actually sounds pretty cool for what it costs, given the huge money being thrown at less obviously beneficial HIT projects (at least if you like the idea of government paying for software to identify more people for which it can pay for healthcare).

 
A vendor demonstrates a 3.7 ounce smart phone that also contains full ECG capabilities at a Singapore trade show. The owner touches their fingers to the phone, their reading is sent to a 24-hour, clinician-staffed center, and within minutes they get a text message back with the results. $100 covers the device and 10 ECGs per month (do people really need all those ECGs?) The vendor, EPI, also offers virtual health records; a global physician network; and a health suite that measures blood pressure, blood glucose, and cholesterol.

The new Kosair Children’s Medical Center (KY) chooses GetWellNetwork’s pediatric health information solution, GetWellTown, for patient education, discharge planning, and patient workflows.

Versus Technology and Iatric Systems partner to bring real-time location system capabilities to Meditech.

Insurance company Wellpoint, most known for cancelling the medical insurance of newly diagnosed breast cancer patients, will offer video chat house calls starting in the fall.

Botswana opens a 200-bed digital hospital that includes an EMR, PACS, a wireless network, cart-mounted PCs, wireless telemetry, and VoIP telephones. I’m not sure its American consultants did them a favor by introducing Western methods: “For example, the notion that in the outpatient setting you get triaged by a nurse, seen by a doctor, then down to lab and radiology for tests, then back to OPD to checkout is a completely different process for them.” I bet they had some really primitive ideas before, like making the freely mobile employees come to the ill patients instead of vice versa.

The suspension of CPSI’s CFO until a misappropriation of funds investigation is complete hurt the stock a little today, with shares down 8.3%.

You can’t make this stuff up: one of the several ambulance-chasing “breaches of fiduciary duty” law firms trying to work up a class action investor lawsuit against Eclipsys is Bull & Lifshitz, LLP.

E-mail me.

CPSI Places CFO on Leave, Suspects Misappropriation of Funds

Small hospital IT vendor Computer Program and Systems Inc. of Mobile, AL filed SEC documents last night indicating that VP/CFO Darrell West has been placed on administrative leave pending an investigation into suspected misappropriation of company funds. West is suspected of using a company credit card to pay a $55,000 personal tax bill.

CPSI’s Audit Committee is conducting an internal investigation and has authorized engagement of a forensic accounting firm. The company says it expects the matter to have no impact on previously reported earnings, its financial position, or results of operations.

The publicly traded CPSI has a market capitalization of $467 million. Shares closed Wednesday at $42.55, with a 52-week range of $32.78 to $50.05.

News 6/16/10

From Maeby Fünke: “Re: Epic. I hear it’s telling new customers they don’t need to worry about staffing or hiring consultants — they are providing them with a test they can administer to college grads to determine if they have the aptitude for this type of work. Does anyone know if it’s something they created or bought commercially?” If anyone has a copy, I’d be interested in seeing it just for fun.

From Expert Witness: “Re: UPMC. Doctors and nurses do not speak to patients any more. All done by clicks, cut, and paste. If the computer says it’s right, it must be.” The family of a deceased UPMC Passavant patient files suit against the hospital and her doctors, claiming her home med methotrexate was incorrectly entered into her medical history as taken daily instead of weekly. Nobody caught the mistake when she was transferred to a specialty care center, so she was given the drug daily for 16 days until she died. If that’s found to be true, the hospital will learn a harsh lesson about the importance of medication reconciliation, not to mention that surely ample warnings were issued by its clinical systems (Cerner, I assume). It’s not a new problem.

From GenX’er: “Re: Ingenix. Former Misys VP Art Glasgow was named CTO of Ingenix. The announcement says he’s consolidating IT across the business. Big job.” Verified. He was promoted from SVP/GM of health information networks at Ingenix, where he’s worked since November 2008 after stepping down as Payerpath GM for Misys.

From Down Under Deepwater Horizon: “Re: Myki. Myki, my mates, is the failing, money-devouring ticketing system for public transport in Victoria, which has blown A$ Billion.” Hospitals in Victoria, Australia complain about the government’s $280 million (US) HealthSMART system, four years late and way over budget like the Myki system DUDH mentioned. Hospitals are being stuck with the tab for HealthSMART, which I mentioned in 2008 when they scrapped their first attempt after bring up zero hospitals on Cerner Millennium. It’s supposed to connect hospitals and provide e-prescribing capability. The government refuses to give a completion date or confirm the amounts that hospitals are being charged.

Listening: Broken Bells, new melodic indie rock from a couple of guys from Danger Mouse and The Shins. Also, my old favorites, The Vincent Black Shadow.

Chris Longhurst, MD is named CMIO of Lucile Packard Children’s Hospital at Stanford. 

An SIS survey finds that 92% of hospital executives rate the success of their perioperative departments as important or extremely important to overall hospital success, with quality and financial performance being their key concerns.

Vermont Information Technology Leaders names athenahealth as a Preferred EHR Partner.

Welcome to new HIStalk Gold Sponsor Diligence Analytics. Led by President and Chief Research Officer Wendy Shellhorn, PhD, MPH, MEd, the Tampa, FL-based company provides professionally conducted research and analysis services to healthcare and HIT. That includes surveys and data analysis to help clients make smart business decisions, bridging the gap between small businesses and their larger competitors. We thank Diligence Analytics for choosing to support HIStalk after what I’m pretty sure was a thorough analysis.

Inga’s taking a much-deserved break to bronze her loveliness and rest her creative mind in a tropical location, but she must be thinking about HIStalk since we’ve exchanged more e-mails today than when she’s on the job. She’s fussing, though: she’s trying to score an iPhone 4 online and can’t get through. It’s not just her, apparently.

Cooper University Hospital (NJ) goes live with iSirona’s software-based solution to integrate patient information from medical devices with its electronic medical record. Cooper VP/CIO Mike Sinno will talk about the project in a June 30 Webinar.

GE Healthcare announces Centricity Advance, an SaaS solution for small practices that includes PM, EMR, and a patient portal. It must be a pretty big deal: among the “thought leaders” discussing EMRs Tuesday night at the National Press Club with GE were Newt Gingrich and Peter Basch, MD.

Quality IT Partners releases a new white paper, What Every Healthcare Organization Should Know about Deploying IT when Planning and Designing a New Healthcare Facility.

CareTech Solutions, owned by Compuware, Oakwood Healthcare System, and Detroit Medical Center, names two DMC executives to its board: president and CEO Michael Duggan and EVP/CFO Jay Rising. DMC just signed an agreement to be purchased by for-profit Vanguard Health Systems, clearing the way for the required legal reviews.

 
Photo: Cpl. Tyler J. Hlavac, USMC

Corpsmen with the 4th Marine Logistics Group are trained to use the AHLTA EMR on a Symbol MC70 mobile device in preparation for deployment to Afghanistan. They will use it to upload combat casualty information to AHLTA’s clinical data repository and to access treatment guidelines for biological, chemical, and radiation attacks.

eClinicalWorks buys 100,000 square feet of office space in Westborough, MA, making room for the 100-200 employees it will add to its current 1,100-employee headcount in the next year. The company’s revenue exceeded $100 million in 2009.

Roadside Medical, a health services company for truckers, will open three new clinics, all of which will feature iPads, telemedicine, and an EMR. Some snooping uncovered their technology partner: TeleMedExperts, which uses the TotusMedica.US PM/EMR.

Daniel Barchi, SVP/CIO of Carilion Health System (VA), e-mailed to let me know about its Epic go-live. “We have an incredible group of IT and clinical folks who just wrapped up one of the most aggressive simultaneous hospital and physician practice EMR implementation in the nation. Without hiring any external consulting company, this amazing group of folks simultaneously over two years converted eight hospitals and more than 100 physician practices to a single EMR for all clinical documentation, finances, and orders.” The photos above are from the last hospital go-live at Bedford Memorial Hospital, 23 months after the first big-bang go-live at 800-bed Carilion Medical Center. They trained 8,000 users, converted from nine EMRs plus paper, and hit 92% CPOE adoption. Nice work.

DIVURGENT Healthcare Advisors is offering a webinar this Friday called Meaningful Use Monitor and Gap Analysis Tool.

Nuance announces Enterprise Turbo Speech 8.1, the background speech recognition component of its Dictaphone Enterprise Speech System.

HHS will convene a Consumer Choice Technology Hearing at the Grand Hyatt Hotel in Washington, DC on June 29 from 8:00 a.m. until 5:00 p.m. I don’t have a link, but it’s a demonstration of several privacy technologies by the Privacy and Security Tiger Team of the HIT Policy Committee. Deborah Peel, MD and David Kibbe, MD are among the panelists who will discuss the demos.

Mass layoffs by hospitals are affecting more workers than at any time except right after Hurricane Katrina-induced closings.

iSoft reassures investors after its share price drops by half in the last couple of weeks, saying any inferences that its Northern Cluster NPfIT contract is in jeopardy are incorrect. That’s a three-month share price chart above.

Continua Health Alliance is creating a library of open source utilities that will help mobile health developers create applications for personal health devices and health records.

Varian Medical will move its employee applications from BlackBerry to the iPhone, saying iPhone OS 4.0’s security and management capabilities appear to be adequate.

A study finds that doctors will use even unproven technology as long as they get paid to do so. Mentioned specifically is computer-aided breast cancer detection, for which the manufacturer successfully lobbied Congress to mandate Medicare coverage despite lack of proven superiority and the large number of false positives it issues.

Greenway launches BlogEHR, which features the company’s executives writing about healthcare IT.

Cerner earns an award for encouraging healthy lifestyles for its employees. Except when Neal had the fitness center locked down during working hours, anyway.

E-mail me.

Monday Morning Update 6/14/10

From Nikki Sevven: “Re: Eclipsys. I’ve talked to a lot of clients and they all think the Allscripts acquisition is great. The turnover in management at Eclipsys has been a big concern and their perception is that Allscripts has better leadership and execution. Also, the lack of a good ambulatory product has taken Eclipsys off a lot of hospital short lists. Eclipsys users believe the inpatient products are good, but the company has been lacking an end-to-end strategy that could compete with Epic.” Despite my initial cynicism and concerns about product overlap, I’m starting to take cautious sips of Glen’s Kool-Aid after talking to some Eclipsys customers. Everybody knew that Eclipsys was struggling and someone would have to buy them eventually, so it’s not terrible news that it’s now and it’s Allscripts. The road is full of potholes, though, and Allscripts management will be tested while Wall Street watches intently to see if performance matches hype. There’s still a rumor that Microsoft will swoop in post-merger and buy the whole thing, which would not be good, but I wouldn’t worry about it yet. Eclipsys has some good products in Sunrise, the old EPSi, the old Bond Clinician, etc. but like Nikki says, its revolving door management has always been suspect and its execution clumsy. Any outcome was likely to have been painful to Eclipsys customers in some way, but this one’s probably the least so since Allscripts needs both the customer base and the products for its own success.

From Lars Poker: “Re: Allscripts. Glen pulled off one heck of a coup. He bought his company back and got Eclipsys in the bargain!” He sure did. Glen’s got some shrewd board room moves, which was evident in the equally complex and multi-player Allscripts-Misys merger. Everybody seems to miss that important point: deporting Misys will help Allscripts immensely. Another often-missed point: Epic was stifling the prospects of both companies since nobody does outpatient-inpatient integration better, so this was pretty much the only option on the table to develop a counterattack before hospitals lock in with their long-term dance partners. I still think it’s late in the HITECH game to be trying to create an Epic competitor, but we’ll see. I’ve said it before: Judy Faulkner was either darned lucky or darned smart to start Epic on the outpatient side and then move into inpatient, which the good old vendor boys had great fun with until she starting beating them like a drum.

From UKnowMe: “Re: HISEA. Do you know who the members of the Healthcare Information System Executive Association are?” I admit that I hadn’t heard of it. Some Googling turned up the fact that it’s 30 or so CIOs who meet twice a year for some unnamed purpose (whatever it is, I bet vendors are buying the drinks). Those whose names turned up include Marc Probst from Intermountain, Bert Reese from Sentara, and Bill Montgomery from HSHS. Maybe someone will tell me more.

From The PACS Designer: “Re: MeeGo. TPD has been using a Windows 7 netbook for awhile and noticed that a new application, MeeGo for netbooks, has been announced. MeeGo v1.1, whose development platform is specifically targeted toward netbooks, will be released in October and will include support for touch-based devices.”

Listening: Ride, British psych/guitar pop styled after My Bloody Valentine. Long defunct: they broke up the band in 1995, but it lives on in the digital promised land.

Rob Sumter is named COO/CIO of The Regional Medical Center at Memphis (TN). 

Inga was talking to an A-list CIO and big Allscripts customer about the merger news. She asked if he got a heads up from Allscripts. He said no — the first he heard of it was from HIStalk. Inga was amused, I was pleased.

Speaking of Allscripts, Chief Innovation Officer Stanley Crane dropped me a note in response to a reader’s question about the company’s remote access solutions. Stanley says Allscripts Remote covers several mobile devices, including iPhone, BlackBerry, iPad (just released this week), and Android (hitting the street in a couple of weeks). These connect to Allscripts Enterprise EHR and Professional EHR, with connections to MyWay and Misys EMR being tested now. They use the connection called UAI (University Application Integrator) that he and I talked about at length in our May 2007 interview, which I enjoyed enough to want to do it again (coming soon).

We heard that some Eclipsys customer CIOs and CMIOs convened a meeting last week with Allscripts to discuss integration of the two vendors’ products (they didn’t know about the acquisition, obviously, but talk about a timely thought!) I heard that Steve O’Neill, VP of IS at Hartford HealthCare, was there, so I asked him about it. They talked about using the open integration tools (UAI and Helios) to help hospitals with their integration challenges in creating a complete acute care and ambulatory solution that appears seamless to the user, with several of the hospitals there (including Steve’s) volunteering to be pilot sites. He was happy with the result, obviously even more so now that the acquisition has been announced.

Speaking of which, I asked Steve what he thought about the acquisition. He says Hartford is excited about the news and anxious to continue working with Allscripts on the integration. Obviously he likes that option much better than dumping Eclipsys and starting over. The hospital is also building an open source HIE using Misys Open Source Solutions (MOSS), which is another key corporate integration project. That’s a hugely important vote of confidence: Hartford has used Eclipsys Sunrise for years, and if I remember right, was the development site for the Premise throughput product that Eclipsys bought.

Congratulations to our CIO blogger par excellence Edward “Ed” Marx of Texas Health Resources, named by Texas Governor Rick Perry as chair of the Texas Health Services Authority Corporation. That group is coordinating development of an electronic health information infrastructure for the state.

Thanks to the folks at MedPlus, a new Platinum Sponsor of both HIStalk and HIStalk Practice. The Quest Diagnostics company offers innovative interoperability solutions that include the Centergy suite of integration solutions (community sharing of clinical data, including data exchange, ambulatory EHR, clinical portal, patient portal, and document management), ChartMaxx document management and imaging (2009 Best in KLAS in that category), and the Web-based Care360 suite that’s used by 70,000 practices, including modules for Labs & Meds, ePrescribing, EHR, and Mobile. Fun facts to know and tell: MedPlus software has connected 160,000 doctors, 100 EMR vendors, several big HIEs, 100 hospitals, 300,000 administrative users, and a total of over one million clinicians. As if that weren’t enough, they are now much-appreciated sponsors of a couple of marginally interesting blogs that I’m too modest to name, for which Inga and I thank them.

Here’s Aaron’s word cloud of the proposed Meaningful Use rule. I think the two biggest ones pretty much say it all.

I took some scorn from a couple of readers when I truthfully said that in the three hospital systems I’ve worked for that were choosing a clinical system, doctors and nurses didn’t get their top choice in any. The results of last week’s poll suggest that it’s not just me: around 38% of respondents say the medical staff and nurses have the most influence, but over 55% said IT or Finance are the primary decision-makers. New poll to your right: who will benefit most from the proposed acquisition of Eclipsys by Allscripts? I know we’re talking a lot about that, but acquisitions always make conversation (unless you work at either company and are sweating over your employment prospects, always an ugly by-product of corporate copulation).

I was chatting with an acquaintance from Telus Health Solutions, of which I’m rather a fan since its Oacis solution comes highly recommended by Frank Clark of MUSC (they use the physician portal and are rolling out a new Oacis Health Data Warehouse). Oacis is up to 200 sites now, but what I found interesting was that the company let customers convince them to create a high-availability option for its Oacis Clinical Data Repository. They did, but booked zero sales as a result: the base product requires no archiving steps and never goes down, so nobody felt the need to buy a specific HA version. I’d say that’s an expensive but effective testimonial.

Colchester East Hants Health Authority (Nova Scotia) uses Access Intelligent Forms Suite to barcode forms scanned into Meditech Scanning and Archiving, printing admissions forms packets and pre-filling the forms from Meditech.

University of Virginia Health System will switch its clinics to Epic in September, the first phase of its $122 million project. Inpatient goes up in March of next year.

The Clinical Pharmacology drug information database is now available for smart phones, with a available.

Dr. Sam and the Managed Care Blues Band (Sam Bierstock, MD) has a new CD called Healthcare Reform Blues. I’m head-bobbing to the title track. Sam says it’s free to anyone who can prove they’re in the country illegally.

Inga and I frequently make fun of badly written and no-news press releases, Web sites with spelling errors, and poorly prepared interview subjects. We’re happy to offer you a solution for avoiding our snarky wrath: NPC Creative Services, LLC, which has joined our merry band as an HIStalk Platinum Sponsor. The company offers a full range of media and PR services, specializing in working with healthcare IT and technology vendors. They create media relations programs, write press releases and white papers, and handle trade show media relations. They also develop content such as product profiles, presentations, and newsletters. Some of their work is described here. Inga and I hear from PR people occasionally since we are unqualified pseudo-journalists who somehow got on various contact lists — we are much more receptive to professional, fun, and skilled creative types who know what they’re doing (Mitch and Liz Roop from NPC fit that description). I’m not saying we’ll pay more attention to your press releases just because NPC writes them better than most, but I’m not saying we won’t, either. Thanks to NPC for supporting HIStalk. Maybe we’ll convince them to do a PR campaign for us.

Castlight Health, the former Ventana Health Services that was started by RelayHealth founder Giovanni Colella and HHS CTO/athenahealth co-founder Todd Park in 2008, raises $60 million from investors, adding to its previous $21 million. One of those investors is Cleveland Clinic. The company’s Web site works with companies to provide their employees with views of their health benefits and costs, highlighting out-of-pocket costs and steering them toward cost-saving opportunities. It lets patients search for medical providers by price, which the company finds by reviewing explanation of benefits forms. Todd told me about it when I interviewed him (still one of my favorite interviews) in September 2008, or at least I assume it was the same project even though he referred to it as Maria Health:

I have recently got involved in another venture which was mentioned in the Washington Times article, called Maria Health, which I’ve started with Giovanni Colella, who was CEO of RelayHealth and then Sapient before that. Our venture capitalist is Bryan Roberts of Venrock, who is one of the lead VCs behind athena. It’s actually a consumer-oriented company. It’s super duper early so I can’t really get into specifics at this point, but generally speaking, it’s a company that’s seeking to take an athena-like approach to helping healthcare consumers navigate an increasingly complicated healthcare system. It’s got a great team, veterans of athenahealth and Yahoo who are part of it. It’s off to a great start. It’s too early to talk a lot about, but it’s been a ton of fun for me to learn more about the consumer space.

The VA announces the 26 winning ideas in its IT innovation competition. It’s hard to evaluate them given only their titles, but some are easy to figure out: including patient pictures in CPRS, using touch screen software for nurse triage, and rolling out wireless and hands-free voice communications. And speaking of Todd Park, he was one of the judges.

Catholic Health Initiatives announces a $1.5 billion project to upgrade clinical IT in its 72 hospitals, planning to hire at least 200 people, most of them to be based in Denver. Key partners are Cerner, Meditech, and Allscripts. if you ever wanted to move to Denver, this is a once in a lifetime opportunity.

Informatics Corporation of America will host a Thursday webinar called Five Key Elements to a Successful Clinical Information Implementation. I’m thinking there should have been “System” before “Implementation”, but I’ll go with the announcement’s wording.

The Daily Mail documents conditions in the Chinese plant (aka “the i-Nightmare factory”) that makes components of the iPhone and other consumer devices and which has had a rash of employee suicides. The company’s response: they brought in monks to exorcise evil spirits, installed nets around the dormitories the employees were leaping from, appointed “spotter teams” to watch the employees and ship troubled ones off to a mental hospital involuntarily, and forced employees to sign a contract saying they won’t kill themselves and giving up their legal rights if they do (tick, tock). But as I always caution when talking about a so-called sweat shop: ask the employees before unleashing the moral outrage whether you’re doing them a favor by having their employer shut down. Sometimes a sucky job is better than none. 

Sad: a patient being being transported by ambulance dies when a software glitch causes its onboard oxygen system to fail.

Starting Monday, all Virginia Beach (VA) ambulances will carry a tablet PC that allows them to communicate with any Sentara hospital. They say it’s the first program of its kind.

Five California hospitals are fined $675,000 for electronic privacy violations, with UCLA’s Ronald Reagan Medical Center getting hit with a $95,000 penalty for employee snooping in Michael Jackson’s records.

Strange: a woman with an old shoulder injury and no insurance can’t get a specialist to see her, so she shoots herself in the shoulder in hopes of getting treatment. It didn’t help: the local hospital fixed the wound, but left the old injury unrepaired.

E-mail me.

News 6/11/10

From Vic Damone: “Re: Eclipsys Helios. I think that this is a capital idea. No company today can meet all needs of the enterprise. Look at all of the Microsoft-based products out there or, perhaps even more similar, look at all the add-on products for an iPhone. Even in the Epic world there has been a lot of custom development, either by Epic or sometimes by the client. There was none in the Eclipsys world, at least on the Sunrise side.” Agreed. It’s cool. Cerner has something similar, giving clients access to the code hooks to customize and extend their apps. As a customer, you definitely want that.

From CPAhole: “Re: Allscripts. Over $650 million of Goodwill and Intangibles, most of which should be written off as the products are abandoned. That does not include at least $50 million in acquisition costs associated with the Medinotes/Bond acquisition. There will be many past sins buried in the Eclipsys reorganization costs.”

From PACSman: “Re: Allscripts. Glen Tullman was the mentor to Michael Ferro in Merge Healthcare’s takeover bid of AMICAS. IMHO, Merge will be the next Allscripts acquisition IF they can stay alive for the next 6-12 months.”

From Lederhosen: “Re: Eclipsys and HIEs. HIE strategy eludes me totally on both vendor and client side. Is it really sustainable? Why do two or more competing health delivery organizations want to participate? How many interfaces need to be supported? We’re still struggling just to get EHRs up or just trying to get a provider to use a PC.”

From Wildcat Well: “Re: Philadephia. Why was an EMR/PHR guy called up for a fourth presentation to Comcast’s top brass?”

From Fan # 2333787: “Re: eClinical Works. Has Sam’s Club quietly discontinued their partnership with eClinicalWorks? The link that they originally publicized is now redirected to their main page and a search brings up nothing relevant.” eCW will provide an official response to your question, but advises in the meantime that some of the Sam’s Club health offerings have been moved under Walmart Health and Wellness. More to follow.

From GoGreen: “Re: Dale Sanders. You were interested in how Northwestern University’s school of medicine CIO Dale Sanders ended up in the Cayman Islands. Please send Inga there to get a first-hand report. Many thanks for your excellent site!” I’ve been to the Caymans several times and I’m pretty sure I remember seeing telephones there, so instead, Inga could call him from home while she stands in a sandbox wearing a bikini just to get the island flavor. I’ll pay for her braids. 

Inga and I appreciate the support of Stockell Healthcare Systems of Chesterfield, MO, a brand new HIStalk Platinum Sponsor. The company’s tagline is The Revenue Cycle Information System Company, including its InsightCS suite that streamlines patient access, reduces payment delays and denials, manages payer rules upfront, and submits cleaner claims with better point-of-service collection. Specific solutions include revenue cycle management, patient access, patient accounting, order management, reporting, worklists, and business intelligence, all built on the .NET framework and using scalable Microsoft technologies such as SQL Server and Reporting Services that lower the cost of ownership. We thank the folks at Stockell for supporting HIStalk.

This is a fun idea: Hilo Medical Center (HI), which converted from paper to Meditech in May in a project it calls Health Connect, names its Health Connect Baby, the first newborn brought into the world using its new EMR.

I said in 2007 that I thought Second Life was clunky and pointless despite all the hospitals and webheads raving about how transformative it was going to be for business and consumer commerce. Maybe in a virtual world, but in the real one, Second Life parent Linden Labs is tanking. Predictably, Second Life proved to be as pointless for corporations as it was for everybody else, although the article mentions that Children’s Memorial Hospital (IL) is doing something that doesn’t sound all that useful on it. My words from 2007: “I tried Second Life once and was bored after a few minutes of fumbling around, but apparently it’s quite the hit, especially for nerds whose First Life isn’t what they’d hoped.” Twitter will be next, I predict, like any other tech fad that’s overrun with spammers, corporate marketers, and creeps.

HIMSS promotes John Hoyt to EVP, Organizational Services, which apparently includes running HIMSS Analytics since Dave and Mike bailed bailed for greener ($$) pastures. I know John from his Martha Jefferson Hospital CIO days. Hospitals considering Cerner knew to call him about the rampant performance issues Millennium was having back then in his little hospital. On site visits, I thought the hourglass was a screensaver.

The Minnesota nurse strike happened Thursday, with 12,000 of them walking off the job at 14 hospitals. The planned sympathy strike in California was blocked by a judge. Agencies charged up to $2,000 and more to provide replacement nurses for the day, including an extra day of orientation. Want to bet that some of the strikers came back as agency nurses for the day, covering a different hospital to avoid detection? Seems suspicious that the strike was supposedly over the nursing shortage, yet replacements were found.

Now I’m really glad I moved HIStalk to a new server last week. The Allscripts-Eclipsys news sent traffic through the roof, with over 8,200 visitors on Wednesday alone. Without the new hardware, you’d have been looking at the same hourglass as those early Millennium clients. Of course, HIStalk reported it first, thanks to Inga being up and about in the middle of the night on Twitter and Facebook (insomnia, she claims) and readers who e-mailed me from Europe and elsewhere, allowing me to send out the blast well before 7 a.m. Eastern. A reader comment: “Thanks for the excellent coverage that HIStalk provides. I got a call from an investor advisory company asking me to do a conference call about the merger. Not having seen the news, I was blindsided, so while the person was talking, I quickly turned to HIStalk, got the general info, and sounded completely informed and up to date!”

I always urge readers to put their e-mail addresses in the Subscribe to Updates box to the right. Signups were heavy Wednesday, so I’m guessing my dire warnings were accurate: know-it-alls who got the Eclipsys news before daylight Wednesday because they’re on the list must have started contacting colleagues to smugly tell them the news. That’s what I would have done.

Holon gets a double welcome: one as a new Platinum Sponsor of HIStalk, but a second as a new entrant into healthcare IT. The Atlanta-based Holon (from the Greek holos, or “whole”) offers its Holon Process Adaptability Interoperability Framework, an enterprise application integration (EAI) platform that supports interoperability, data exchange and translation, workflow, a rules engine, and document management capabilities. The hardware- and software-agnostic solution lets hospitals extend and enhance their existing systems without resorting to point-to-point connections, thereby easing the transition to CPOE and challenges with Meaningful Use. Obviously there’s a lot of interesting detail on their site, particularly on the downloads page. The company is new to healthcare, but its parent and executives have a long history of providing tools to accelerate workflow and enhance business processes (not to mention that some of its execs have deep healthcare roots). Thanks to Holon for choosing HIStalk to get the word out.

Our own Dr. Gregg Alexander uses Eclipsys PeakPractice in his practice. His thoughts on the Allscripts acquisition are on HIStalk Practice.

Texas Medical Institute of Technology is offering a free Webinar on bar coding solutions from pharmacy to bedside, with speakers that include Charles Denham, David Bates, Eric Poon, and some other high-profile presenters. It’s next Thursday, June 17, at 1:00 p.m. Eastern.

TPD is updating his iPhone Apps List, so let him know (through me) if you’ve seen something interesting.

Jobs: Ambulatory EMR Administrator, Clinical Process Consultant, Soarian Clinicals – Plan of Care, Soarian Pharmacy and MAK.

A New York Time article says rural Iowa clinics are the first in the US to use telemedicine and telepharmacy to remotely dispense abortion pills.

An employee of Phoenix Health Systems, contract IT services provider to Salem Hospital (OR), is arrested for allegedly causing $200,000 worth of damage to a hospital administration building by stuffing a drain with paper towels and leaving the water running. I guess he wasn’t clever enough to be a hacker.

The VA announces an $80 million technology competition for solutions to its biggest problems, targeting areas such as telehealth and clinical applications that integrate with VA systems.

I really like this article: librarians at the William H. Welch Library serving the medical school, public health school, and hospital at Johns Hopkins University are transforming themselves into “informationists” who work side-by-side with researchers and students to help them find the information they need. The goal is to shut down the central library, which is scarcely used in an electronic information age, and to make “the library be wherever you are.” I’ve always said librarians and HIM people should be the stars of the healthcare information age, except nearly all of those I’ve known are quiet and passive. I’m not judging — IT and finance people are often like that, too since that’s what draws them to those fields instead of being salespeople or entrepreneurs.

A strange new medical research finding: almost 8% of people studied had sexsomnia, a propensity to have sex while sleeping. It was three times as prevalent in men (insert your own punch line here).

E-mail me.

HERtalk by Inga

From Joe: “Re: EMR warning, in response to Suzy RN. Although you make some great points, I believe you are directing your ire in the wrong direction. It would be Dr. Blumenthal’s evangelism that is creating plenty of angst and running our patient care quality and integrity of our physicians off a cliff, But, this is not a message he invented. He is, like a good soldier, merely working hard to promote the message from the White House and with the WH’s CTO breathing down his back and insuring he stays on message. Our industry must take our messages of caution and slowdown to Secretary Sebelius and 1600 Pennsylvania Ave.”

Like unsavory ambulance chasers, several law firms commence investigations into “possible breaches of fiduciary duty” and other violations associated with the Allscripts/Eclipsys acquisition. Must we?

WakeMed Health and Hospitals adopts Clinical Xpert Billing, a charge capture solution from Ingenious Med and Thomson Reuters.

mPay Gateway announces the general availability of its Advance Payment Plan, an enhancement to its point-of-care product that allows physician offices to establish patient payment plans.

I’ve spent the last couple days talking to all sorts of people about the Allscripts and Eclipsys. In general, people tell me they believe it’s a good move and especially beneficial to Eclipsys. Allscripts brings a strong management team with a proven track record of merging companies and products. Allscripts also has one of the strongest marketing machines in HIT. Allscripts has a strong ambulatory EHR solution (or three or five) which will appeal to many health systems in Eclipsys’ sweet spot. Meanwhile, Allscripts increase its chances selling EHR to more of these large health systems. Of course there are many unknowns and uncertainties (what products, management structure, integration, company cultures etc.) but I don’t see the move as some disaster waiting to happen. In fact, it might actually work out pretty well on several fronts. It will be fun watching it unfold over the coming months.

Emdeon taps Franklin Baumann, MD as chief medical officer to provide clinical oversight and strategic planning for Emdeon’s Interactive Care Management suite. He has served in clinical leadership positions at UnitedHealthcare, Dreyer Medical Clinic, and Rush-Copley Medical Center.

Colorado Casualty Insurance files a federal lawsuit that contends it’s not liable for reimbursing the University of Utah for $3.3 million in costs associated with a 2008 data breach in its hospital. The case is related to the theft of backup tapes containing PHI for 1.7 million patients, which were stolen from a private vehicle belonging to an employee of a secure storage company. This may be a case to watch.

RealMed signs a multi-year claims processing agreement with UHealth, University of Miami Health System, and the UM Miller School of Medicine.

Henry Ford Hospital (MI) names Dr. John Popovich its new CEO and president. Popovich, a pulmonary disease and critical care medical specialist, has been with Ford since 1975.

Siemens Healthcare enters an agreement with SSI Group to resell SSI’s ClickOn LinX technology for claims editing and transmission.

Start-up company Healthrageous secures $6 million in Series A financing for its personalized health technology platform. The solution was developed with Partners Healthcare Investors’ Center for Connected Health.

Dell continues to make hay in healthcare, inking a deal with Stellaris Health Network (NY) for hosting of its Meditech system, disaster recovery, and network and application support.

I was fascinated by this article that highlight the success of electronic health records in a small town in Spain. They informed citizens via radio announcements that they could electronically schedule appointments and renew prescriptions. Patients asked doctors if they could use it, which led physicians to adopt it. Doctors and pharmacists are encouraged to manage drug costs. Not sure how much of the Spanish approach could be translated to the US, but perhaps there are a few gems there worth stealing.

A few sponsor updates to round out your week:

• Mary Staley-Sirois joins DIVURGENT as a principal responsible for leading the company’s clinical transformation practice.
• Rich Fishback, formerly with Thomson Reuters and MercuryMD, has joined Salar, Inc. as RVP of sales for the Southeast, where he’ll lead sales efforts for the company’s electronic documentation and charge capture solutions for hospitals. 
• North County Health Services (CA) selects Sage Intergy’s EHR, practice management and community health center modules for its 53-provider practice.
• Ingenix completes a system-wide rollout of enhancements to its CareTracker EHR, providing physicians the capability to demonstrate Meaningful Use.
• Caritas Christi Health Care (MA) deploys MedAptus’s Intelligent Charge Capture suite.
• MED3OOO signs a multi-year agreement with RealMed to provide claims processing.
• maxIT Healthcare announces creation of a new healthcare management consulting division, led by former Dearborn Advisors SVP/Partner Reese Gomez.

E-mail Inga.

Industry Reaction – Allscripts To Acquire Eclipsys

We have industry reaction to today’s announcement. Let’s start with some random thoughts from Mr. H and Inga.

Some thoughts about Eclipsys

• Above are the two-year share price graphs, with Eclipsys in red and Allscripts in blue. ECLP shares are trading at about half their 1999 price.
• Phil Pead’s background is selling companies, which Eclipsys has desperately been trying to do for many years with no takers (allegedly). He’s been with Eclipsys for almost exactly one year and surely gets the credit for finally finding a buyer.
• Eclipsys started with a relatively small number of big academic medical center clients on the old TDS platform and has struggled to convince them to upgrade to Sunrise (a product it acquired) instead of choosing a new vendor.
• Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner.
• Nearly 40% of ECLP revenue supposedly comes from about 20 big customers, with one of those contributing about 10% of the company’s revenue. That one big Eclipsys customer is supposedly North Shore – Long Island Jewish, subject of a September announcement involving its $400 million effort to connect its 7,000 doctors and 13 hospitals with … wait for it … Allscripts. Surely that customer and its Eclipsys relationship had a large impact on the Allscripts acquisition interest. Obviously Allscripts needs to keep NSLIJ very, very happy.
• Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance.
• Eclipsys ran through a long line of executives whose tenures there were unremarkable.
  
  

Some thoughts about Allscripts

• Some of the announcements referred to the deal as a “merger” and some Eclipsys communications implied that Eclipsys was the acquirer, but that’s spin: this is an outright Allscripts buy.
• The new company will have a large footprint, but that’s usually more about sales than it is product performance, integration, or customer satisfaction.
• Glen Tullman is a more competent executive than anyone who has ever run Eclipsys. As was the case with the Misys merger, he gets operational control.
• It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago. Companies should be focusing on execution in the heat of HITECH, not trying to bolt two companies together.
• Allscripts will have an even larger roster of competing practice EMR products. Surely they will not all be go-forward products, especially the Allscripts version of MyWay that Aprima (formerly iMedica) sold them while keeping their own rights to it, then vastly improving it to sell under their own name.
• A minimally appreciated benefit of the deal is that Misys, always a stiff and awkward US healthcare IT player that didn’t seem to have its heart in anything but UK banking software, is out of the picture. That should be greatly beneficial to Allscripts.
• We checked the registration date of the new site OneAllscriptsEclipsys.com. It was May 6, two days after Eclipsys announced results.

Thoughts about today’s conference call

• It was touted that both companies run on Microsoft platforms, but the key is whether Allscripts is good at integrating products.
• Glen Tullman says there is little product overlap, but they company will have four PM/EMR products plus Tiger, which is already being retired.
• Sunrise Ambulatory wasn’t on the slides of the combined solution set that we noticed.
• Assuming Peak Practice and MyWay are similar and PeakPractice is the sexier one, will they retire MyWay? It’s sold through the reseller channel, which will make some folks unhappy if so.
• Allscripts needs top-line growth, so the (theoretical) combined market gives it a way to (theoretically) grow.
• Dumping Misys allows Allscripts to control its own destiny, including investing in technology to a degree that Misys was unwilling to do.
• The combined company will enjoy an 8-10% growth rate, the company says, which doesn’t sound impressive if we really are starting the “single fastest transformation in HIT.”
• Helios was mentioned more than once as a go-forward product. It’s the recently announced Eclipsys capability to open up Sunrise to independent developers.
• The usual synergies were proclaimed (firing redundant managers and back-office employees, cutting the cost of running two publicly traded companies, streamlining sales and marketing).
• Allscripts shares were down nearly 10% today. Misys shares were way up on the news it was cashing out. Eclipsys shares were up around 3%. Investors don’t seem to like the deal so far.

Unanswered questions

• What will the go-forward ambulatory products be?
• How will key Sunrise customers react to having their vendor absorbed into a larger entity that has historically had less focus on hospitals?
• What’s the HIE strategy — Medicity, dbMotion, MOSS, something else?
• Will Allscripts EHR clients with IDX financials be a big target for Sunrise?
• What happens to the arguably most valuable Eclipsys executive – John Gomez?
• What’s the benefit of the acquisition to Eclipsys and its customers?
• What happens to sales of both companies now that the merger has been announced, yet won’t be consummated for months? Prospects hate uncertainty and HITECH forces them to decide somewhat quickly.

We hand-picked some of our readers with deep expertise to provide their analysis, some of which we agreed to run anonymously.

Jeffery Daigrepont, SVP, The Coker Group

It’s an interesting merger, but not a surprising development in that Eclipsys and Allscripts were the few remaining vendors without an alignment strategy to the opposite side of the coin. This announcement comes not long after NextGen acquired Opus and Cerner’s more aggressive move into ambulatory. 

Vendors are clearly getting prepared for hospitals getting back into physician employment and their desire to have a single vendor solution. Therefore the market is wanting to have “one throat to choke” when it comes to selecting a vendor for all of its integration needs. I also think Epic is dominating the inpatient space because they have been so far ahead in offering a true integrated solution for several years now. The other inpatient vendors are having to play catch up and it’s faster to merge than try to build. 

The market should expect some clunky workflow for several years while they try to blend together their platforms, although I am sure the spin machine will sell this as one patient record harmonizing seamlessly across every location of care. The press release is already indicating ONE unified record. I just wonder which of the eight EMRs will emerge as the system for housing the ONE record.

It’s also worth pointing out that both vendors have made past unsuccessful attempts in crossing over own their own. Eclipsys acquired Bond Medical a couple of years ago and has not been successful getting it off the ground. Allscripts tried the same with some inpatient technology as well. Neither could penetrate this market.

It’s also going to be interesting to see how the company operates in terms of where and how they focus their attention. For example, Meditech, Cerner, HealthLand, etc. can offer both inpatient and outpatient technology, but no one will ever accuse these of being ambulatory vendors. Vendors will generally tilt in one direction and will also focus their time and efforts accordingly.  

As for the market’s reaction, it’s going to be interesting to see how this ONE new company can manage so many overlapping products and solutions in this new age of certification and system compliance standards. The timing of this merger is interesting because it comes on the heels of Meaningful Use. Does anyone really believe they will keep all of their overlapping systems up to certification? I suspect they will start commercially discontinuing products that are not considered modern, such as all of the Misys baggage on the Allscripts side. 

After this merger, the new company will be trying to support eight EMRs systems and five practice management solutions with a sprinkling of inpatient technology. I could be wrong with this count, but it’s fair to say they have a boat load of duplication, the most of any vendor in the market. Customers buying from this new company should seek protection from their system being discontinued in the next couple of years as they move to their dream of ONE record.

Hospital CIO and Eclipsys Customer

Sounds like Glen Tullman pulled another fast one. This is the same type deal he architected with Misys. Glen controls the management suite, where all the real decisions are made, and the other company controls the board room. 

Non-Competing Vendor CEO

This is an Allscripts response to the NextGen inpatient deal. Allscripts was probably feeling pressure to have a complete solution for the bundled payment/ACO market. They were probably feeling they couldn’t live up to market expectations. This will provide enough accounting confusion for the next several quarters to hide any shortfall in organic performance.

Bill O’Toole, O’Toole Law Group

This is a great move for both companies. Allscripts has proven itself in the ambulatory world. Physicians on a selection team for an HIS at their associated hospitals will look favorably on the new combined company based on their prior experience with Allscripts. Eclipsys gets a new image, sort of like your father’s Oldsmobile being merged with the Corvette. No offense intended to Eclipsys, but in my days at Meditech I was surprised if they were up against us as a finalist. I believe the growth of the combined company will greatly exceed the individual growth expectations of the separate companies.

Investment Banker

The combined business looks great on paper with little overlap in capabilities (PeakPractice being the biggest one) and a substantially bigger platform. The challenge will be integration, of which this will be the largest attempted in this industry for a while. Even though they have a highly talented team, the challenges will be significant.

I would ask why two companies that have strong growth opportunities on their own (as they have constantly communicated to investors) would see the need to take on massive integration risk in a market that presents once in a lifetime growth opportunities.

Eclipsys Physician Practice Customer

I don’t think this’ll have a major impact on my little neck of the trenches for the foreseeable future. These acquisitions / mergers aren’t shocking given that we all know they’re going to happen in this period. I’m guessing bigger ones are in the works even as we type.

Though their press release really doesn’t address it (nor does it address the plans for the “Helios” platform which I hope continues), I know that they’ve recently sold millions of dollars of PeakPractice (originally, Bond Technologies’ “Clinician”) to some large companies and I was told the PeakPractice development team would be receiving even greater resources now. Of course, things do change, including corporate direction, but personally, I’m not worried about my software yet.

Todd Cozzens, CEO, Picis

There is an increasing trend for general practitioners to be employed by hospitals, but an opposing trend that specialist areas like emergency and anesthesia are outsourcing physician services.  So net/net, though on the surface it makes sense to combine the two areas, there is no real market force pushing for an end-to-end hospital-to-physician EHR. To the contrary, the one thing that really is taking off with lightning speed from ARRA is interoperability within and outside the hospital enterprise.

I can cite 10-15 real examples of systems already pushing CCDs among disparate EHRs, for example. Hospitals just aren’t in a position for wholesales swapouts of their IT systems across the board — it’s too disruptive and expensive. The new interoperability mandates will allow more modular approaches to building out EHRs.

With regard to the high acuity market, the merged entity will have an ED product from Allscripts, an ICU product from Eclipsys, and I assume they will acquire an OR product. So they will look like a company that’s serious about high acuity, which I think is good because it endorses our long-held belief that hospitals are becoming big high acuity care centers as the population ages and needs these services more and less acute services move out.

That’s where it stops. Our high acuity suite has been integrated and developed now for seven continuous years, has much deeper functionality, and is much more intuitive than a loose patchwork of independent applications. Our investment in analytics and interoperability with the big EHRs is starting to really pay off as well as we are the go-to, embedded high acuity enterprise suite for a growing number of IDNs. The proof? Tell me which HCIT other than us has taken on over 100 net new hospital customers in the last two years. Not even Epic has done that.

Is it too late in the HITECH game to be making a major acquisition? No, I think they’re trying to build a sort “shadow” Epic and it does make sense, as I said, on the surface. This deal definitely helps Eclipsys a ton more than Allscripts, however. And don’t forget the last time a physician-focused system company took over an in-hospital EMR vendor — IDX taking over Phamis and the subsequent sale of that mess to GE. That was a Harvard business case on how not to execute post-merger.

What happened there is that selling small ticket items to docs is totally different than mega-systems to mega IDNs — it’s kind of like Cessna buying Boeing. And then you have all these legacy technologies and systems — Allscripts with 3-4 legacy physician systems and all the legacy technology still embedded in Eclipsys. Any customer that thinks some sort of new, singular, integrated, magical, cloud-based, miracle hospital / physician solution is going to suddenly appear on the market in the next 5-7 years from this entity will be seriously misguided. Huge execution risk here. Good time to be a duct tape and bailing wire salesman, however.

All the market dynamics are in place for further consolidation. ARRA HITECH and healthcare reform — the perfect storm. I don’t subscribe to the idea that it’ll be Google or Oracle or Microsoft that will drive the consolidation. I think it’s more than just a technology convergence. I see much grayer lines between payors and providers and enabling technology providers that make the system much more transparent for the three P’s – payors, providers, and patients. 

Margin pressures are already forcing payors and providers to both to think very differently. The two things that healthcare reform were supposed to fix — cost and quality — aren’t going to improve at all for the vast majority of patients, providers, and payors. Something has got to give, or else healthcare passes 50% of our GDP by mid-century. If you look at other industries that had this pressure, it was things like supply-chain integration and other forms of co-opetition among former adversaries that drove change and finding ways for all to make money. It’s actually a time of huge opportunity.