News 5/7/10

From Sea Pea Oui Couvert: “Re: say it’s not true. This is not supposed to happen when the entire hospital is wired. Millions spent on EMRs, yet they forget informed consent and then cover up the adverse events.” UPMC’s transplant program is cited by state health department inspectors for violating federal regulations, including failing to document organ and blood matches before transplant procedures were started. The state got suspicious when UPMC reported only one adverse even in a year.

From A Tax’ing Employee: “Re: our CEO at Sunquest. He just moved to Tennessee for what I heard were ‘tax reasons’.’ He has never lived in Tucson for the same reason. Is that fair that he is allowed to live anywhere to dodge taxes and we are not?” Unverified. If it’s my money as a customer or shareholder, I’m cynical about work-from-home CEOs unwilling to relocate to the home office. It’s their call, though, and I’m probably more old school in that regard given today’s virtual organizations.

From The PACS Designer: “Re: iPad’s booming sales. Apple has sold one million iPad’s since the recent launch, the fastest sales results ever for Apple. As we head toward the middle of this year, it will be interesting to see if there will be any waning in the monthly sales figures for the iPad Wi-Fi version now that the iPad 3G version is available for sale.”

Several dozen provider organizations, including AHA and AMA, offer HHS their comments (warning: PDF) on Meaningful Use. They and I agree on the parts we don’t like:

1. The all-or-nothing approach, where you either meet all the criteria or get nothing (actually, I’m OK with that part as a taxpayer footing the bill).
2. The aggressive timetable for complex applications such as CPOE and medication reconciliation that aren’t usually front-loaded in implementation projects.
3. The overall short timeline.
4. The underrepresentation of small practices on the HIT Policy Advisory Committee.
5. The two EDI-related non-clinical requirements for eligibility and claims.
6. The definition of a hospital using Medicare provider numbers.
7. The parts I immediately pounced on when the proposed criteria were published  — manual chart pulls are required to arrive at a denominator for electronic performance metrics, such as the percentage of orders placed via CPOE.

Weird News Andy uncovers a gem: two employees of Olive View-UCLA Medical Center are placed on leave after complaints to Joint Commission that they are running a beauty salon out of the hospital’s NICU. They were giving manicures and eyebrow waxes to co-workers, with one complaint alleging that a doctor “had a French manicure right on the high-frequency ventilator.” WNA also likes this research finding: dark chocolate can protect the brain in stroke patients, which means I’m set in an emergency because I like to keep some of the good stuff (more than 50% cacao) around.

Listening: the new CD from just-reunited Hole. Courtney Love doesn’t do it for me and I was hoping to hate the new music, but the band kicks it even though they’re all suing each other and membership changes hourly. I’ll be playing this quite a few times, I suspect.

McKesson signs an exclusive deal to eventually manufacture, implement, and support the i.v.STATION Robot and i.v.SOFT Workflow Engine from Italy-based Health Robotics. It’s pretty hot stuff.

If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here’s a shout-out to the one group of professionals (both male and female) that hospitals can’t run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time:

The only critical people involved in patient care are nurses … My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center … Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn’t that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren’t really all that much worse when it came to living and dying. If I’m sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.

Business Week frowns at hospitals that use technology to determine whether patients can afford to pay their bills. Apparently the business publication does not like the idea that customers may actually be expected to pay for the services they consume. I clicked its Subscribe Now link and, given that philosophy, was shocked to find that their subscriptions are neither free nor payable at the reader’s discretion.

Jobs: Epic Inpatient EMR Manager, Eclipsys Physician Consultant, Senior Applications Analyst – CPOE, Epic Clarity Report Writers.

ONCHIT announces $220 million in grants to establish 15 Beacon Communities that will prove the value of HIT. I don’t exactly get that since the message is that they wouldn’t have bothered without the $15 million taxpayer gift (which doesn’t make a strong case for proving value at all), but I gave up long ago trying to dissect the particular pallets on which taxpayer money is being parachuted down over the countryside into greedily outstretched provider and vendor arms. Even the City of Tulsa gets $12 million in federal money to screw around with electronic medical records and see if anything good happens.

I see that Google now has the Google Apps Marketplace that offers third-party add-ins to Google Docs and relate apps. One I noticed contains administrator tools for rolling out Google Apps to the enterprise.

Maybe the doc-in-the-box trend died and I never noticed: Florida Hospital’s Centra Care walk-in clinics now take online appointments, saying it will significantly cut down on wait times. Meaning that if you just show up, which was the whole point, you’ll sit around like you would in the ED except instead of a seriously injured trauma patient holding you up, it’s somebody healthy enough to have made an advance appointment. That and posting ED wait times to troll for non-urgent patients makes me wonder what the heck providers are thinking out there.

Inspectors from the VA find lots of problems with the brachytherapy program at the Philadelphia VA Medical Center, among them a VariSeed radiation treatment planning PC that was unplugged for over a year despite regular clinician reports that it wasn’t working. It also wasn’t running on the hospital’s secure network and was used by employees to get on the Internet. 

Merge Healthcare’s Q1 numbers: revenue up up slightly, EPS -$0.04 vs. $0.05. Now they’ve got a couple of hundred million dollars worth of AMICAS acquisition debt to service on top of that. 

E-mail me.
 

HERtalk by Inga

From Celtic Fan: “Re: athenahealth. Don’t know if you saw this article about athena wanting to increase its profile to compete better with the HIT Big Boys. Buried in the end of the article is some information on a new product called ‘athenaCommunity.’ Bet the privacy rights folks won’t think much of it.” athenaCommunity is slated to launch later this year, with discounts for providers willing to share patient data with other providers. Hospitals will pay athena a small fee to access patient insurance and medical information. I asked privacy guru Dr. Deborah Peel what she thinks about the idea. Celtic Fan predicted correctly:

This is an ABSOLUTE nightmare—it TOTALLY violates medical ethics and the patients’ rights to privacy — not to speak of Americans’ well-known constitutional rights to privacy. Physicians who go along with that could well violate state licensing laws which often require adherence to the AMA’s principles of Medical Ethics, as well as violate many state laws that REQUIRE informed consent for disclosures of many kinds of information, from genetic tests, to mental health information, to STDs, to addiction treatment information. athena and all the many vendors who coerce doctors to disclose patient health information without consent will have NO liability. Who do you think the patients will sue for violating their privacy? Their doctor, of course, who chose to use an illegal, unethical EHR system. athena will not pay for this massive privacy disaster —their doctor/users will.

British Columbia’s Interior Health Authority begins its Meditech 6.1 migration with technical assistance from Summit Healthcare.

IBM’s Integrated Health Services division launches a multi-year research project to determine how different actions may affect health. Big Blue will combine and analyze data from a wide variety of sources, looking for cause-and-effect relationships. The project will initially focus on childhood obesity.

Kronos reports second quarter revenues of $177.9 million, a 10% increase over last year. EBITA increased 28% to $41.3 million.

Data storage company Iron Mountain urges CMS to consider expanding Meaningful Use guidelines to include subsidies for digitizing paper records. Iron Mountain’s efforts remind me of similar pleas from the transcriptionist organizations, who think digitized transcription records should be recognized in the final Meaningful Use equation.

I’ve yet to venture to the Apple store to actually touch an iPad, though a field trip does seem to be in order. This HIT writer observed a in-store demo, of sorts, where a Genius was educating a group of healthcare providers on a variety of healthcare-specific applications. Sounds like Apple wants to assure a  piece of the healthcare pie.

Clarian Health is changing its name to Indiana University Health next spring, in part to reinforce its partnership with Indiana University and the IU School of Medicine. Clarian owns or is affiliated with more than 20 hospitals and health centers in Indiana.

PatientKeeper presents Oakwood Healthcare System (MI) with its customer innovation award, recognizing the more than 1,000 users (600 of them physicians) who are using the company’s patient portal since its December introduction.

Hospital CIOs rank EMRs and CPOE as their top IT priorities for the next two years. Other high priorities include database initiatives, bar-coded eMARs, and hospital expansion. Among hospital IT managers and directors, EMR was ranked a mere 7th, far below PC refreshing, security initiatives, and CPOE. Another interest data point: the majority of hospitals were either developing telemedicine programs or already had something in place.

Albert Santalo, founder and CEO of the Web-based practice management company CareCloud, is named the Best Up and Coming Technology Innovator by the Great Miami Chamber of Commerce.

York Memorial Hospital (PA) selects Recondo Technology’s SurePayHealth solution for revenue cycle management.

The Texas Health Services Authority hires CTG to help plan the implementation of statewide HIEs.

Here’s a fun fact to share at your next cocktail hour. By 2020, the amount of digital information created within a year will reach 35 zettabytes. If you put that amount of data onto DVDs, they could be stacked halfway to Mars, making them quite inconvenient to access from your couch.

Gartner reports that Dell has gained the largest market share in HIT, making it the world’s largest provider of HIT services in the world. The ranking is based on 2009 revenues generated by both Dell and Perot Systems.

The 130-provider Jackson Clinic (TN) plans to move from its Misys EMR to Allscripts EHR, integrating it with its Allscripts Vision PM.

Siemens Healthcare appoints former Quest Diagnostics VP John Nosenzo to the newly created role of VP of Zone Customer Relations. Nosenzo will manage the company’s national accounts team and all zone general managers.

Odd: a GE Healthcare employee, having dinner with co-workers, is hit by a stray bullet. The 17-weeks-pregnant woman was sitting outdoors when she felt something hit her in the side. When she stood up, a bullet fell out. It came from a handgun fired from a shooting range that was about a quarter of a mile away. Fortunately, she was only bruised and scratched on her abdomen and both she and the baby are fine. An attorney for the shooting club says a member was at fault for shooting at an unapproved target (clearly).

Researchers at Brigham and Women’s Hospital find that using bar-code technology with an eMAR substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events. The hospital documented a 41% reduction in non-timing admin errors and a 51% decrease in potential drug-related adverse events. Naysayers, feel free to send in your comments pointing out that just because A and B happened together, it in no way implies that A caused B or B caused A — as Mr. H always cautions. I’m just glad someone is taking the time and energy to try to figure out if all this technology really does save lives.

E-mail Inga.

News 5/5/10

From Newsies: “Re: Radianse. The RTLS vendor has filed for Chapter 11 bankruptcy as of April 20.”

From Take the Time: “Re: Neal Patterson. The latest kudos.” Neal makes the Forbes list of best-performing bosses and rightly so: quibbles aside, there aren’t many executives who have transitioned successfully from scrappy startup founder to big-company CEO and kept investors financially happy most of that time. He’s a HISsies pie-in-the-face regular, but if I was investing my money in healthcare IT, he’s the guy I’d trust it with. That’s CERN (blue) vs. the Nasdaq (green) above, just in case you’re a hater.

Eclipsys announces Q1 numbers after Tuesday’s market close: revenue down slightly, EPS $0.09 vs. -$0.02. Shares are up a little in after-hours trading. In other Eclipsys news, E-Health insider reports that the company will take Sunrise Clinical Manager to the UK, offering it to trusts looking for an alternative to NPfIT’s systems.

Dr. Dalai and anonymous contributors document what they say is the end of AMICAS as Merge Healthcare does its best to screw it up after buying it. I’m linking to his main page since he’s running new pieces, so read back a couple of articles for the whole story. It’s big business as usual: layoffs of all the people that made the acquired company successful, forced relocations resulting in resignations, and apparent mothballing of previously sound products. He summarizes with a plea to Merge executives:

Bottom line is this: your actions are destroying AMICAS. If you don’t reverse what you are doing, you have just flushed $250 million down the toilet. Don’t do it to yourselves, don’t do it to the AMICAS people, and don’t do it to me and the other AMICAS customers.

I see that some new jobs have been posted on the HIStalk Job Board, so feel free to cruise over and see if any of them look interesting. Each job lists the number of times it has been viewed at the bottom of the page, so you can see which ones are hottest. I should mention, since a couple of folks have asked, that while everybody can view available jobs, only sponsors can post them.

Small-practice SaaS EMR vendor ClearPractice names pharmacist and former NotifyMD CEO Gary Ferguson as CEO. The company offers its entire suite for $425 per month, including revenue cycle management, help with stimulus funding paperwork, and CMS approval as a preferred provider for patient registry. I don’t know much about the company, so that’s just me reading the press release to you in an authoritative, yet know-nothing voice like a clueless TV news anchor.

A couple of readers e-mailed me noting quotes from both Steve Lieber of HIMSS and David Blumenthal of ONCHIT in which they discounted EHR safety issue reports. Blumenthal called such reports “fragmented” and “anecdotal”, not surprising given the lack of a central, well-publicized reporting mechanism for such problems. One reader also noted that problem reporters are often seen as troublemaking whistleblowers rather than staunch patient advocates, not to mention that some vendors prohibit such disclosure in their contractual language. My response to one e-mail was that we need this industry’s equivalent of the Institute for Safe Medication Practices to take up the banner of centralizing problem reporting and disseminating those reports out for everyone’s benefit. After all, the FDA’s medication safety track record wasn’t very impressive until ISMP got involved. Plus, you would think vendors would prefer that to FDA oversight.

Thanks to new Platinum Sponsor FormFast of St. Louis, MO. The company’s healthcare solutions include forms automation, document management, and workflow automation that help eliminate the paper chase. Specific solution examples include RAC tracking and response, admissions, bar coding, positive patient ID, cancer staging, patient self-service portals, e-signature, on-demand document printing, and importing documents into the EMR and saving the cost of preprinted forms, imprinters, embossers, and labels on the way to becoming paperless. The company is offering a free Webinar on May 25 at 11 a.m. Central, a Forrester Research update on Microsoft’s healthcare strategy called SharePoint 2010: What Value Does It Bring to Hospitals? Three attendees will win an iPad, just in case you’re interested. Thanks for FormFast for supporting HIStalk.

Revenue cycle services vendor Accretive Health sets its IPO price at between $14-16 per share for 13.33 million common shares for a market cap of $1.44 billion. The company had $510 million in revenue last year, which you’d never guess given its crude Web site and the fact that you’ve probably never heard of it except maybe when I mentioned their IPO plans back in the fall.

McKesson’s Q4 numbers: revenue up 2%, EPS $1.26 vs. $1.01, but falling short of analysts’ expectations on both revenue and earnings.

athenahealth CEO Jonathan Bush has told me that he started his internal company blog using HIStalk as a model, so now he’s got a customer-facing version as well. Unlike most CEO blogs, it’s actually interesting and sounds like someone other than a marketing department committee talking.

Smartphone application developer Voalté announces seven new hires.

I’m streaming Netflix like a madman using my new Roku box as a defensive move to Mrs. HIStalk’s usual BBC and dancing shows, so a couple of old movies inspired this week’s guest editorial in Inside Healthcare Computing, an opus I called Healthcare IT Leadership Lessons Learned from R. Lee Ermey. Spoiler: I make a convincing argument that Neal Patterson’s famous “tick, tock” e-mail was cribbed from one of R. Lee’s profanity-laden monologues in Full Metal Jacket. I don’t think a Pulitzer is in my future, but at least I snickered while I was writing it.

All the big hospitals in Madison, WI run systems from next door neighbor Epic, so now they’ve decided to share ED records in a pilot project that runs through July.

Brigid O’Gorman, a Connecticut College pre-med junior and captain of the women’s hockey team, wins a $10,000 grant from Davis Projects for Peace to implement electronic medical records in Uganda. The money will go towards four computers, solar panels to run them, two printers, software, a laminating machine, and an external hard drive. The college will contribute $3,000 to allow her to spend eight weeks there to set it up and help transfer information from the paper notebooks carried by patients into the computers. I like her spirit: “I’m not a wiz at the computer, but I figured I could get a system and teach myself how to input the data before I go.”

Mississippi Baptist Health Systems says it has saved more than $4 million by switching to Symantec for storage, backup, and archiving of its 130 terabytes of data.

This was probably embarrassing: Canadian EMR vendor Medworxx issues a corrected press release about year-end earnings when it notices that the date was given as December 31, 2010 instead of 2009.

A couple of recent journal articles try to peg CPOE and EMRs to mortality and cost, at least in the minds of the headline writers. As I always caution, just because A and B happened together in no way implies that A caused B or B caused A, even though folks looking for someone to agree with their anecdotal beliefs will always drag those articles out as evidence.

Surgeons at Children’s Hospital of Pittsburgh are using a video-over-IP system to monitor progress of cardiac transplant procedures from any VPN-connected PC using a zero-footprint software video player. The Haivision Furnace system lets surgeons know when it’s time for them to jump in to do their part.

E-mail me.

HERtalk by Inga

From Sean Fitzpatrick: “Re: Paul Levy’s lapses of judgment. I’m with you on your observation. It’s too easy to write off the little lapses, which typically reveal underlying bigger ones.” I was glad to see a number of readers agreed with me. Apparently the BIDMC board did as well, fining Levy $50,000 for his “poor judgment” and saying it will also consider his “serious lapse” when determining his next pay package (which is over $1 million now). Board member Patrick Ryan is apparently not pleased with the outcome (not harsh, enough I suppose?) and announces his resignation.

From Madrigal: “Re: Meditech. Thought you’d like to know that Howard Messing has been promoted to CEO (his new title is president and CEO). His previous title was president and COO. Neil Pappalardo’s title is now chairman (it was chairman and CEO)” Unverified, though we heard this report from a couple of readers. The company’s Web site still lists Pappalardo as chair and CEO and Messing as president. One in-the-know person suggests the change means little in the short term and is more of a symbolic shift of official responsibilities.

Lucile Packard Children’s Hospital (CA) reports a 20% drop in mortality rates since introducing CPOE, giving it the lowest rate ever observed in a children’s hospital. Until Packard published its findings, no hospital has been able to show reductions in medical errors and mortality from using CPOE. The hospital, which spent $50 million on its EHR project, attributes its success to a careful and well-planned implementation.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Pantain Holdings Berhad, a 1,500-bed, 10-hospital network in Malaysia, selects Eclipsys Sunrise Enterprise. John T. Mather Memorial Hospital (NY) also plans to add multiple Eclipsys Sunrise products to create a single EHR across multiple venues of care.

Washington County Hospital (MD) replaces 40 interfaces with Corepoint Integration Engine. The hospital runs Meditech and connects to referring physician offices.

Doctors from Catholic Healthcare West will serve as medical directors for 10 CVS Caremark MinuteClinics in the Phoenix area. The new CVS/Catholic Healthcare West alliance includes plans to eventually integrate EMRs.

The 54 providers at Syracuse Orthopedics Specialists (NY) and New York Spine & Wellness Center choose Allscripts to provide EHR and PM across their 11 locations.

Chatham County Safety Net Planning Council (GA) goes live on its HIE, leveraging technology from Orion Health and Initiate Catalyst Patient Registry.

Mark R. Briggs, the former COO of Carefx, takes over as CEO of HIE vendor VisionShare. He was previously with NaviNet, QuadraMed, and LinkSoft Technologies.

Fort Healthcare (WI) will partner with Cerner to create a connected health community through the use of Cerner Millennium solutions. The hospital, ambulatory surgery center, and specialty clinics will implement more than 20 Millennium products and use Cerner for IT management services.

Senior Lifestyle Corporation selects the selection and hiring solution of Kronos to manage the end-to-end hiring process.

MedLink partners with iMedicor to integrate iMedicor’s information exchange portal with the MedLink TotalOffice program. The combined solution will facilitate secure messaging and clinical data exchange. TotalOffice users will also have access to iMedicor’s ClearLobby drug and medical device information platform.

Healthcare analytics vendor Outcomes Health Information Solutions appoints Gary Velasquez CEO. Former Ingenix CIO Jim Egan is also hired to serve as the company’s CIO.

Ingenix and Health Language, Inc. launch Ingenix Global Code Manager to translate between ICD-9 and ICD-10 coding systems.

Mediware releases Q3 numbers: revenue of $12.8 million compared to $10.2 million last year, net income $891,000 vs. $483,000.

E-mail Inga.

Monday Morning Update 5/3/10

From BestofBreed: “Re: Merge Healthcare. Laid off 80+ people Friday.” I heard that from more than one reader. The Amicas acquisition closed Wednesday, so they obviously didn’t waste any time addressing redundant positions. Steamin’ Pyle says rumor has is it that no years-based severance was offered to the expungees, meaning nobody is supposed to get it in the future.

HIStalk sponsors have posted quite a few jobs on the new Job Board, so you might want to check it out. Healthcare IT hiring is definitely picking up.

Sam Patton is named chief quality and regulatory officer of medical device integrator iSirona.

Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm. New poll to your right for those working in a provider setting: which systems will your organization buy within the next two years?

CHIME sends comments to ONCHIT on EHR certification, expressing concern that certification capacity needs to be adequate to handle the rush of vendors that will be trying to get their products certified at the first opportunity. It also says any program that monitors real-world EHR performance (presumably including any new FDA oversight) should not not be “overly prescriptive”. You’d think CHIME was supporting its 70 big vendor members instead of its 1,400 CIO members with those comments, but that’s the HIMSS model at work.

David Blumenthal, speaking at a Boston conference, says that reports of EMRs causing patient harm have been “anecdotal and fragmented” and should not affect their aggressive rollout.

Sentry Data Systems has an upcoming Webinar on decreasing data center costs by using cloud computing.

Columbia HCA and Solantic founder Rick Scott announces his candidacy to become governor of Florida. His campaign site says things were great at Columbia/HCA when left, but fails to mention that he was fired after the FBI raided its hospitals and the company was charged with the biggest healthcare fraud scandal in US history, eventually costing Columbia/HCA $1.7 billion in fines. His FAQ makes that travesty sound like a valuable lesson learned under fire that makes him a better candidate for public office:

Since I’m not a career politician or a political insider, I’m going to lay it out for you as simply as I can without spin or fancy words. Let me start by being crystal clear about this… I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader. Lessons I will bring to the Governorship with your support and vote.

An audit finds that University of Iowa Heart and Vascular Center failed to bill patients for $11 million worth of charges in November. Officials claim it wasn’t their new Epic system that was at fault, but declined to speculate further until an investigation is complete.

The usual housekeeping facts: put your e-mail address in the signup box on each site (HIStalk, HIStalk Practice, and HIStalk Mobile) to receive instant updates when we run something new. The “Search All HIStalk Sites” box to your right lets you search all those sites at once. Check out the industry event calendar, where you can also post your event for free. The hideous green  “Report a Rumor to Mr. HIStalk” button lets you send me anonymous, secure information, including any attachments that you might want to include. Please support HIStalk’s sponsors by checking out their ads to your left and clicking on those of interest – Inga and I appreciate their support. And lastly, I thank you for reading, writing guest articles and comments, and making those 3 million HIStalk visits possible by spreading the word. The incredible support I get from sponsors and readers keeps me going through all those after-work nights and weekends when I’m lashed to the keyboard.

The VA says it has figured out the problem responsible for incorrect data displaying when its employees accessed the DoD’s AHLTA system: an interface server change from a single to multiple processors. The description sounds as though it was a transaction timing issue, but that’s just my guess. VA and DoD are back to fax and e-mail for patient information inquiries until a fix is installed.

Carolinas HealthCare (NC) announces several changes in top management, including bringing on Brent Lambert from Carilion Clinic as VP/CMIO.

An ED nurse at Tomah Memorial Hospital (WI) is arrested for using patient information to divert narcotics logged out for 600 patients. The hospital has notified the patients that their information was breached but probably not exposed, other than they were charged for drugs they didn’t receive and will be credited (not that patients usually care since they aren’t paying with their own money anyway, so they probably won’t get a refund).

Shares in athenahealth dropped 18% Friday and bounced off a 52-week low after announcing a surprise Q1 earnings shortfall after the market close on Thursday. One analyst said the company missed expectations in nearly all areas, while another termed its Q1 performance as “disastrous”. Market cap is now under $1 billion.

Odd lawsuit: a woman trying to kick her husband as they walk along a Chicago street loses her balance and crashes through the window of a beauty salon. She admits to have been drinking beforehand, but is suing, claiming the business and building owners knew that drunk pedestrians on their way to or from Cubs baseball games could fall through the window. She’s also suing the hospital that treated her, insisting that a radiology tech stole her BlackBerry and $6,000 worth of jewelry while preparing her for an MRI.

E-mail me.

News 4/30/10

From The PACS Designer: “Re: cloud printing from Chrome. Google has in development a new application that will give Chrome users the ability to send documents to the cloud for printing by a wireless network or cloud-aware printer.”  

From SantaBarbaraLocal: “Re: Santa Barbara Cottage going with Epic. It’s actually Sansum Clinic, which is adjacent to the hospital, that has signed with Epic.” A couple of readers confirmed. That makes more sense than the hospital replacing Eclipsys.

From Brit: “Re: NHS projects in the South. They are being delayed even further because the government bureaucrats are getting cold feet about using Cerner’s Upgrade Center in KC. They have asked BT to build an equivalent center in London, which will push projects out by months and cost the taxpayer tens of millions of dollars more.” Unverified.

Nashville Medical Trade Center gets its first anchor tenant — HIMSS, which will make the facility the year-round home for its Interoperability Showcase. The company developing the $250 million facility says it will try to entice vendors who are HIMSS members to lease space by offering them discounts. HIMSS will now literally be even closer to its high-paying constituents.

Q1 numbers for MedAssets: revenue up 18%, EPS $0.09 vs. $0.03, beating estimates.

Weird News Andy felt bad that I missed the 3 millionth HIStalk visitor, so he “went into my time machine” (which probably means he Photoshopped the above since the next-to-last zero looks a bit clipped) to commemorate the moment.

The National Association of Healthcare Access Management conference starts in Orlando’s Marriott World Center this weekend. The folks from SCI Solutions will offer a Stress Free Zone on Saturday afternoon at 4:30 before the exhibits open, with free drinks and massages.

If you clicked the Like button on the HIStalk Facebook widget to your right, thanks! Inga and I don’t get to know who’s reading all that often, so that’s pretty cool.

Also announced after the market close: athenahealth’s Q1 results: revenue up 33%, EPS $0.01 vs. $0.04. News that spending was up 72% without immediate growth wasn’t taken well by investors, with shares dropping 15% in after-hours trading.

Cerner’s Q2 results, announced Wednesday: revenue up 10%, EPS $0.59 vs. $0.49. Bookings were at an all-time high. Pretty good considering that their hosting services cut into the hardware revenue. New services are mentioned, including running IT departments and revenue cycle services. ProFit finally gets a mention, although not by name, with “great progress” claimed. Oddly, Cerner will resell Pyxis while selling its on RxStation medication dispensing cabinet, also planning to tie into Alaris smart pumps with its medical device hub.

Jobs: Eclipsys Physician Consultant, Soarian Clinicals Consultants, Chief Information Officer.

A flash drive containing information on 25,000 patients turns up missing from Our Lady of Peace, a Kentucky psychiatric hospital. Like everyone else who gets burned, they vow to start encrypting.

The folks from CattailsMD responded to the rumor Alphonso’s rumor from Monday that the project is in trouble and executives have moved on. The leadership changes did occur, with Bob Carlson taking a different role and Paul Olinski retiring, but they say the EMR is now used by more people outside of Marshfield Clinic than within, they just released a dental module for it, and an external customer will implement it using an accelerated go-live process to reach Meaningful Use.

DPS Health, UCLA, and a South African women’s organization announce a study to look at the effectiveness of using text messaging for peer support of people with Type 2 diabetes.

Nuance deploys its eScription computer-aided transcription solution to four NHS trusts in the UK as a pay-per-use SaaS offering.

RTLS vendor Awarepoint announces management changes: the CEO has been replaced, former McKesson executive Ben Sperling is brought in as VP of business development, and former UCSD Medical Center associate administrator and Awarepoint client Thomas Hamelin is hired as SVP of business process improvement.

The CEO of Telus, interviewed on Bloomberg TV, explains the importance of healthcare to the company’s business and why it may pursue telecommunications acquisitions to support it.

Vish Sankaran, manager of the Connect gateway to NHIN for ONCHIT and former Brailer guy at CareScience, resigns. He was program director of the Federal Health Architecture program. His LinkedIn profile says he’s interested in job inquiries, so I’m betting he got one from one of the usual government contractors.

A group offering free clinics staffed by volunteers was founded by Stan Brock, a guy who wrestled animals on TV in Mutual of Omaha’s Wild Kingdom in the 1960s, just in case you were parked in front of the three-channel black and white back then. I like this guy: he decided to leave TV in 1985 “to make people better”. Here’s a snip from a newspaper profile:

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

The British University in Dubai will host that country’s first national meeting on health informatics on May 5. The one-day program is free.

A Maryland startup will commercialize the Blink lab monitoring software for critical care developed at University of Maryland, Baltimore.

Park Nicollet Health Services will pilot diagnostic software from Zipnosis, a Minneapolis startup run by a co-founder of MinuteClinic. Patients pay $25 online by credit card, take a five-minute automated interview online, a clinician interprets the results, the patient gets an answer back (diagnosis, treatment options, and prescriptions), all within an hour. Park Nicollet will get a cut of the revenue.

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HERtalk by Inga

From NoPollyanna: “Re: mobile healthcare apps. I was searching for information on healthcare systems using mobile marketing — find a doc, directions to office, ED info and wait times. Didn’t come up with much outside of appointment reminders by phone. Is this still just a ‘nice to have’ or is there more happening here?” NoPollyanna is looking for apps that help healthcare systems extend their brands. Suggestions? As for advertised ED wait times, do they have an effect on patients choosing an ED vs. their primary care provider?

From George Stephanopoulos: “Re: EHR implementation blogs. Another to add to your list of ‘EMR journey’ blogs. From the URL, it appears CCMH is implementing the hosted Cerner application suite.” The blog’s author is the CFO at Carroll County Memorial Hospital (MO) and says the hospital is going live in about six months. I had to register on what appears to be on a Cerner-hosted site to request access. I’ve got to hand it to Cerner for figuring out a clever way to get some new leads.

I have been pondering Mr. H’s “so what?" comment in regard to Paul Levy’s "lapses of judgment in a personal relationship.” So, perhaps it does not affect his ability to lead the health system. Then again, what other lapses in judgment might he have had? What future lapses, either his or others, might be brushed under the rug?  Rightly or wrongly, we want our leaders to be role models, at least professionally. An inappropriate work relationship bleeds into the professional world and creates potential for an imbalance (or abuse) of power. I’m not suggesting anyone be fired, but some official reprimand by the board might be appropriate.

Sinai Medical Group (IL) is implementing NextGen’s EHR and PM products and expects to go live in August. Sinai’s faculty group practice includes almost 200 physicians.

HP announces plans to purchase Palm for approximately $1. 2 billion cash. I read the opinions of a couple of pundits who suggest HP was interested in getting its hands on the Palm webOS to run future tablet products.

Billing service provider Healthcare Billing Consultants (PA) selects Sage’s Intergy practice management and analytic tools for their 80 providers.

Medical & Surgical Clinic (TX) commits to Allscripts’ EHR for its 31 physicians.

CareFusion and Cerner announce they will integrate the CareFusion Pyxis systems and Cerner’s CareAware solution. Cerner will also resell the CareFusion Pyxis dispensing technologies to its existing EHR clients,which seems odd since Cerner was offering a competitive product at one time.

Health reform legislation will increase the IT needs for a number of government agencies, including HHS, the IRS, and state and local governments. Job security if you are in IT, I suppose.

GE Healthcare teams up with Ascom Wireless Solutions to launch a wireless, hospital-wide message system that allows clinicians to receive clinical text-messages and alerts throughout their facilities.

Earlier this week I mentioned that we’d like to find a hospital and/or physician office willing to share their EMR selection and implementation journey. I should have explained that a bit better. As opposed to connecting with a entity that has already implemented an EMR, we’d like to find someone just starting the process who would be willing to provide periodic updates. If you have a candidate, let me know.

Ten of the 13 most-considered enterprise business intelligence solutions in healthcare come from industry-agnostic vendors, according to a new KLAS report. Healthcare provider executives ranked Dimensional Insight the top vendor, followed by Information Builders, and McKesson.

St. Joseph’s Regional Medical Center (NJ) deploys Infinitt North America’s Enterprise PACS. Infinitt migrated over 30 terabytes of image and patient data in less than five months.

UNC Health Care (NC) engages MEDSEEK to establish a patient portal that will combine EMR and administrative data from UNC’s Siemens system and its other HIS products.

A NYC grand jury indicts two former executives from New York-Presbyterian Hospital and two contractors for participating in a mail and wire fraud scheme. The hospital officials allegedly received payments and gifts in exchange for awarding contracts to certain companies. The questionable contracts totaled more than $42 million.

A former researcher at the UCLA School of Medicine is sentenced to four months in federal prison for snooping in medical records. The research assistant, a licensed cardiothoracic surgeon in China and a US immigrant, claims he did not know it was illegal to look at the confidential medical files of his co-workers or celebrity patients. He’s now sort of a celebrity, too, since he’s the first person to be sentenced to prison for violating HIPAA’s privacy provision.

Chesapeake Regional Information System for Our Patients (CRISP) selects Axolotl to provide the core infrastructure for its statewide HIE.

Thanks to the Brits, we now have a better idea of the risk factors that predict future professional misconduct by physicians. Doctors who are male, from lower socioeconomic groups, or had academic difficulties in medical school are more likely to be misbehaving doctors.  I think someone needs to do a follow-up study to determine the risk factors that predict misbehaving boyfriends or husbands.

And, thank you Weird News Andy, for referring me to the www.ifshoescouldkill.com website. OMG.

E-mail Inga.

News 4/28/10

From Harpo: "Re: Halamka’s CEO. Accused of hanky panky with a staff member, but he apologizes and will stay on. Being the most visible and transparent hospital CEO is great, but I didn’t see this on his blog yet." Beth Israel Deaconess CEO Paul Levy admits to "lapses of judgment in a personal relationship" that were first reported to the hospital’s board by anonymous letter. My reaction: so what? He’s human. People sure love to throw those stones.

From Epic Watcher: "Re: Santa Barbara Cottage. Heard from two folks they’re going Epic, although I’m not sure whether inpatient or ambulatory." Maybe someone will report back. I know they’re Eclipsys on the inpatient side and I doubt that’s changing, but you never know. 

From Don Diego: "Re: ADVANCE for Health Information Professionals. Dead." According to the company, they’re shutting it down "due to unfortunate conditions in the market."

From Ex-Cerner Guy: "Re: quick login. Several of my clients experimented with HID Proximity Cards for speed, security, ease of use, and then cost. Speed was instantaneous, security was 100% (they added a fingerprint pad), and ease of use was great. Everyone remembered to bring their ID card and right thumb with them. As soon as the user was more than 10 feet from the workstation, they were logged off. Re-login would bring them to the screen they left. The item that was rated #4 in importance quickly became #1, as the support time and costs became insane due to each non-hospitalist needing a level of customization the facilities were not prepared for. I loved the solution, as did the CIOs and CMOs. CFOs killed it, and probably correctly. Time-and-motion study for typing vs. swiping and pressing did not support the cost model in 2006."

From RedDog: "Re: Northeast Georgia Health System. New CIO and hear the consulting company is leaving as well. A totally fouled up RIS/PACS install in December is the catalyst. Epic is being talked about in the admin suite." Unverified.

From Partial Eclipse: “Re: West Penn-Allegheny. Delaying its go-live of Eclipsys Sunrise because of excessive costs and the shrinkage in CMS payments.” Unverified.

Listening: In This Moment, alt-metal with an angry-sounding female lead who looks like an angelic supermodel.

Texas Health Resources and Children’s Medical Center Dallas will exchange patient information via their common Epic systems. THR also plans to do the same with UT Southwestern and Parkland. 

Macquarie University Hospital in Sydney, Australia and the Australian School of Advanced Medicine will implement iMDsoft’s MetaVision (OR, PACU, and ICU) when the new hospital opens in June.

A new Medicity brief called Key Components of a Successful HIE Strategy covers best practices in deploying a "future-proof" HIE.

McKesson says it will adopt its Paragon HIS for the British market, hoping to offer an alternative to its long-in-the-tooth TotalCare and Star systems for hospitals opting out of NHS-offered systems due to implementation delays.

Speaking of McKesson, it announces availability of 12 new templates for chiropractors for its Practice Partner, Medisoft, and Lytec MD physician systems. Back-crackers get a rebate and the templates for free.

I put a "Find us on Facebook" widget to your right that offers the new "Like" button. Click it and Inga and I will have a tiny bit of our insecurity relieved at least temporarily. You are all so cute in your FB pictures that it makes us proud to have you as readers.

Mike DeSimone joins MedVentive as VP of business development.

The Platinum sponsor-only jobs page is in full swing with 34 jobs posted, so you might want to check those out. Inga will be her usually cheery self in hooking up sponsors to use it as a free benefit of supporting HIStalk.

Neither Inga nor I were home Sunday afternoon to take a screen shot when the HIStalk visit counter rolled over to 3,000,000, darn it. A visitor from Epic was the 3 millionth visitor since June 2003.

GE Healthcare and Ascom Wireless announce plans to tie GE’s patient monitors into Ascom’s VoIP, pager, and DECT handset communication systems.

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From BowerSocks: “Re: giving back. Just wanted to say I didn’t know about the Cerner Diabetes Initiative. We are always looking for great places to donate and I think both the Diabetes Initiative and the First Hand foundation sound awesome.”

Picis implements 53 new US healthcare facilities using its LYNX E/Point revenue management solution for the ED.

Catholic Healthcare East (PA) selects Zynx Health’s evidence-based order sets and plans of care solutions for 18 of its hospitals.

SCI Solutions releases an EMR-enabled version (v6) of its Order Facilitator order management tool. The new version includes the ability to capture H7 order transactions sent from a physician’s EMR to a hospital’s Order Facilitator database.

Oroville Hospital (CA) claims to be the first hospital to implement VistA without the help of outside consultants. The hospital is halfway through the implementation process and is relying on its internal IT group for all customization.

The executive director of the Rochester RHIO says the organization is “no longer an experimental pilot service.” The four year old RHIO now includes participation from 15 hospitals, 866 physicians, and 225,000 patients.

San Juan Regional Medical Center (NM) contracts with Perceptive Software to use the ImageNow document management and workflow system. San Juan will integrate the ImageNow application into its existing Meditech system.

The GetWellNetwork folks tell us they are hosting their  Third Annual User Conference later this week in National Harbor, Maryland. Keynote speakers include The Studer Group’s Brian Robinson and Gerard van Grinsven of  Henry Ford West Bloomfield Hospital.

The Electronic Healthcare Network Accreditation Commission appoints four new commissioners to serve through 2012.

The Alaska EHR Alliance selects e-MDs and Greenway Medical as the “best choices” for the state’s healthcare providers. ACS Healthcare Solutions was the managing consultant for the selection process, which lasted eight months and started from a pool of over 250 EHR vendors.

Thomson Reuters will integrate its Micromedex clinical decision support and CareNotes patient education content within the M2 HCIS.

Beacon Partners is named to the Boston Business Journal’s 2010 Pacesetter list, which recognizes the 50 fastest growing private companies in Massachusetts.

The first of three Thomas Jefferson University Hospitals (PA) goes live on Wellsoft’s EDIS.

Mercy Hospital of Portland (ME) selects Allscripts EHR for its 58 employed providers. The physicians already use Allscripts PM product.

I came across this blog today, written by the CIO of a hospital that’s in the midst of selecting an EMR. So far they have eliminated Cerner and now they are giving Meditech Magic a good look. The post brought to mind something Mr. H and I have discussed a number of times: finding a hospital and/or physician practice that’s willing to share their EMR selection and implementation journey over a period of time. If you’d care to volunteer your insights on behalf of your organization (fame could be yours!), or if you’d like to share any recommendations, please let us know.

Newly posted on HIStalk Practice: the latest question in our HIT Executive series. Check out what several EMR vendors and consultants had to say about the HITECH Act’s short and long-term effects on innovation. Spoiler alert: the answers range from yes to no to maybe.

Thanks to folks at Vitalize Consulting Solutions (VCS) who shared the the news that HIMSS and Modern Healthcare named recipients of their 2010 CEO IT Achievement Awards. The two winners are Peter Fine, president and CEO of Banner Health (AZ), and, David Bernd, CEO of Sentara Healthcare (VA) — and a VCS board member.

E-mail Inga.

Monday Morning Update 4/26/10

From Alphonso: “Re: CattailsMD. The Marshfield Clinic’s CattailsMD project is in serious trouble and may be dead. Senior leadership for the project has been let go or moved to ‘new opportunities’ inside the organization (Bob Carlson and Paul Olinski). Project has gone nowhere for the past few years.” Unverified. I’m not sure why they had a booth at HIMSS or why they would try to commercialize their own product in the first place since that hardly seems core to their mission. Their own use of CattailsMD seemed imperative to them, so I’d be surprised if it’s being allowed to fade.

From Wade Wells: “Re: log on. What’s the fastest, most secure way to log on to PCs in health institutions? We key in our usernames and passwords, but with the rollout of clinical systems and speed being an issue, I’m interested to hear of others’ experiences. Some are suggesting card readers, biometric, etc.” Thoughts?

From Mad Max: “Re: WellPoint cancelling insurance for newly diagnosed breast cancer patients. This ought to be criminal activity. Please keep this story in the public eye and drive those insurance actuary slugs back under the rocks where they belong.” It’s the age-old debate of whether healthcare should be a noble calling or a cutthroat business. It’s in the same vein as to whether Cerner should use its legislative clout to squash competitors – who decides where good business yields to compassionate care? Meanwhile, HHS secretary Kathleen Sebelius asks WellPoint’s $13 million-a-year CEO to voluntarily stop the cancellations, noting that the practice will “soon be illegal” (which obviously reinforces the concept that it’s legal now). The company’s response claims that computer algorithms aren’t used for that purpose, that one patient who complained isn’t a WellPoint member, and that they’ll divulge specifics about her case that proves their side of the argument if she’ll sign a HIPAA waiver.

From The PACS Designer: “Re: iPad review. Another more complete test review of the iPad as a business tool comes to us from InformationWeek’s Fritz Nelson.”

The sponsors-only job board seems to be working fine, so I’ll consider it open for business. It has quite a few job listings already, thanks to volunteers who helped out by testing. This is a lightweight replacement for the job listing topic in the discussion forum. It’s not as fully featured as Healthcare IT Jobs and, unlike that site, it’s open only to HIStalk Platinum and Founding Sponsors (and is free to them).

I gave the iPad a quick grope yesterday. As you’d expect from Apple, it’s very sleek and has great graphics, with a display size that seems perfect for Web browsing or running apps. On the other hand, I’d worry about dropping it since there’s nothing to grab onto. I wouldn’t pay $499 for it since I could buy a full-feature Wintel laptop for less (with a real keyboard and everything). Travelers with computer needs mostly involving entertainment would probably like it, although they’d need to add on a data plan and even then I’d probably stick with an iPhone. Apple is selling a bunch of them even though they don’t really replace anything, though, so I will defer to public opinion.

Thanks to those who responded to my little survey about what hospitals readers are from. I’ve posted the list of organizations (without the job titles). 

Half or fewer doctor will get the HITECH money they expect, said 78% of readers. Only 9% think most of the doctors will get the full payoff. New poll to your right: are you personally aware of a situation in which a healthcare computer system directly caused patient harm?

EHRtv posts over 40 video interviews from the HIMSS conference.

The FDA will step up its oversight of IV infusion pumps, citing 10,000 complaints, 79 recalls, and at least 710 known patient deaths.

McAfee apologizes for its antivirus fiasco that took down computers all over the world, blaming its poor testing. A hospital reader’s comment you may have missed suggests VIPRE Antivirus from Sunbelt Software as a superior alternative.

Brigham and Women’s will freeze hiring and cut its operating budget by 3%, but says those actions are unrelated to the decision by Harvard Vanguard Medical Associates to shift its referrals to Beth Israel Deaconess Medical Center instead. BIDMC implies that its shared EMR access was a key factor in that decision.

An MIT mobile health group says open source mobile platforms are important for affordability and accessibility, making its first choice Google Android and eventually Symbian.

MedQuist completes its acquisition of Spheris.

A problem with the patient verification software used by Australia’s Medicare service causes several hundred errors, the significance of which is disputed. The software vendor had urged the agency to notify the 2,700 affected medical practices in February and March when the problem was found, but the agency declined.

This sounds like something Oracle would do: a formerly free Sun plug-in for Microsoft Office that allows saving documents in OpenDocument Format will now cost $9,000 for 100 users plus annual support, now that Oracle owns Sun.

Odd lawsuit: a Connecticut woman is charged with impersonating a nurse and forging prescriptions for narcotics while employed in a physician’s practice as an RN. Prosecutors say she spent $2,000 to make up a “Nurse of the Year” dinner in her honor from the Connecticut Nursing Association, an organization that she also made up. She sent her boss an invitation on fake letterhead to be a guest speaker at the dinner, which he did.

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News 4/23/10

From Reader: “Re: McAfee bug. Multiple hospitals (U of Michigan, Rhode Island Hospital System, Upstate University Hospital in Syracuse) report being affected by buggy McAfee security release. 1000s of computers down, emergency patients diverted and surgeries being postponed.” I know first-hand since it nailed our place, too, with all kinds of disruptions and “everybody get off the network NOW” emergency messages. McAfee wasn’t much help, being slow to post the problem and a tricky solution. It’s a great time to be a competing antivirus vendor.

From LeapFrog: “Re: Allscripts. I am hearing rumors of a joint GE and Allscripts user conference in June. What does that mean?” Inga tried to tracked this rumor down, reaching the conclusion that a joint meeting is unlikely given the short time frame. However: (a) the Allscripts sales meeting is in June; (b) Allscripts might like getting its hands on an inpatient product like the old IDX one that GE has botched, despite lofty Intermountain partnership announcements; (c) a new Allscripts sales director came from the old IDX group; and (d) GE’s IDX failure might make it happy to get rid of that product. All speculation, but not too far out there as rumors go.

From Dr. M: “Re: Meditech. The iPad runs Meditech using the Citrix connector.” Dr. M supplied the photo above. Another reader cautions that just because apps run in Citrix Receiver shouldn’t be construed to mean that vendors have released specific iPad clients or, until they do, that the Citrix versions are fully usable. The reader says some apps look good and navigation is OK, but typing is slow on the on-screen keyboard.

I’ve confirmed a couple of reader-reported rumors. You’ll Know Who reported yesterday that McKesson Provider Technologies had replaced Sunny Sunyal as president with McKesson Automation’s Dave Souerwine, which was confirmed today on the MPT site. In the Cheap Seats told you on March 29 that Merge Healthcare had acquired anesthesia EMR vendor Docusys, which I’ve finally confirmed through independent sources. Thanks for those reports!

Greenville Hospital System goes live with SabalRx, which routes medication orders to the proper dispensing location and technology based on location. I’ve never heard of Sabal Medical, the press release isn’t very good, and the “About Us” on the company’s Web page doesn’t say who “us” is, so that’s all I know.

Listening: Material Issue, long-defunct Chicago-based power pop.

This sounds like a bad idea: Medical College of Georgia will consolidate management with its hospital and physician group, with the just-hired college president (a doctor and scientist) also serving as CEO of MCG Health. The college’s CFO and CIO may also serve dual roles.

A New York Times article lists the downside of electronic medical records: odd computer placement in the exam room, the need to type instead of listen, an overwhelming amount of information for the doctor to review (like “having a 2-year-old in the exam room”), difficult to use systems that were designed for charging and not treating patients, and the failure of those systems to convey complicated information in an easily understood “story” form.

Another blow to iSoft and NPfIT: northern trusts scheduled to implement iSoft Lorenzo can now opt out and instead run McKesson’s Totalcare instead, courtesy of a new $55 million contract signed last week. Three of the trusts will stick with McKesson Star for some time. Reader UKMaxPaying thinks Cerner may be well positioned to take advantage of the mess and also calls attention to another Lorenzo go-live delay at Morecambe Bay, rumored to have been rescheduled from early May to the end of May.

Sage Healthcare is sponsoring the Texas Health Information Technology Summit, which started Thursday in Dallas. Everything you need to know about the agenda is contained in the prominent explosion-shaped graphic that says, “Learn how to get your $44,000”. I know a handful of the speakers, but not most.

CPSI announces Q1 numbers: revenue up 4.7%, EPS $0.27 vs. $0.37, missing analysts’ expectations and its own estimates.

The Huffington Post Investigative Fund continues its coverage of electronic medical records. In an article on patient harm, it cites 18 voluntary reports to the FDA involving Cerner software, one of which involved a patient death after “an unplanned hospital wide CPOE and electronic record breakdown.” A second article calls attention to a lack of FDA oversight, with its example being a GE Healthcare imaging system that reversed the patient’s image, causing the surgeon to operate on the wrong side. It concludes that a new oversight group might be formed by ONCHIT, with providers held accountable for reporting problems as a condition of receiving stimulus money.

Italian vendor Health Robotics says it’s now the largest American IV robotics vendor after signing 15 new contracts for i.v.STATION, i.v.SOFT, CytoCare, and i.v.Room of the Future as well as some beta contracts with big-name hospitals like Brigham and Women’s, Cleveland Clinic, Duke, and MD Anderson.  

Jobs: Allscripts Consultant, Integration Engineer, Senior Product Marketing Manager, NextGen Consultants.

The Birmingham paper profiles MedManagement, a 110-employee local company that offers advisory services and software, now offering Medicare admission help to hospitals. I like the poster in the background of the CEO photo, titled “Between a RAC and a Hard Place.”

Harvard-affiliated Massachusetts Eye and Ear Infirmary alerts several thousand patients that a laptop containing their information was stolen from one of its doctors who was lecturing in South Korea. They were able to detect it through its LoJack “phone home” feature and determined that someone installed a new OS without the software needed to read the information. They then sent a LoJack command over the Internet to trash the laptop’s hard drive. That’s pretty cool, although they still should have used encryption.

Strange: a British doctor labeled as a “Jekyll and Hyde” drives 800 patients away from his practice in four years by being rude to them during surgeries and focusing on his computer instead of them during consultations. And in this hardly shocking development: his wife, also his practice manager, was equally rude to his employees.

Reuters reports that WellPoint, the country’s largest health insurance company, uses software to target newly diagnosed breast cancer patients for the purpose of finding excuses to cancel their medical insurance.

Ideal Life, a Toronto company, says its wireless home monitoring devices (blood pressure, scales, blood sugar) are the first that are easy and affordable for remotely managing chronic disease, establishing two-way communication between patients and providers that can include motivational messages or tips. That along might not have earned the company an HIStalk mention, but this did: the CEO’s prior job involved the company that sells Teddy Ruxpin and Funoodles.

The outgoing CEO of Sage will get a $32 million parting gift.

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HERtalk by Inga

From NoPie: “Re: Cerner. I am a Cerner employee. I would like to point out that the McKesson Diabetes Initiative posted on the website yesterday is somewhat old news when compared to what Cerner has been providing for free for many years. There is no place I would rather be able to call home for my career. While others may read this e-mail and consider me just another person drinking from the ‘Cerner Kool-Aid’, we really are devoted to promoting a change in what Neal likes to call ‘the middle’ of healthcare.’ How refreshing to find someone from the vendor world who is willing to stand up and say they are passionate about their employer. I happen to like Kool-Aid every once in awhile, as long as it’s made with real sugar. I see on the Cerner Web site details of their Cerner Diabetes Initiative, which pledges to invest $25 million over 10 years for an online diabetes management tool for diabetic children. And, the Cerner-founded First Hand Foundation is a 15-year-old program that provides assistance to children with health-related needs. To date, the foundation has given $12 million in funds to children across 70 countries. Big kudos.

Allina Hospitals and Clinics (MN) selects Language Access Network to provide video language interpretation services to 11 of its hospitals.

University Hospitals (OH) launches Siemens Soarian Financials at Case Medical Center, completing University’s enterprise-wide deployment.

Edwin Miller, formerly with Artromick and athenahealth, joins Curaspan Health Group as VP of product management, along with three new sales executives.

Quality Systems, the parent company of NextGen, shuffles the roles of several executive leaders. Tim Eggena moves from executive VP of NextGen Practice Solutions to the newly created role of executive VP of R&D for NextGen’s ambulatory products. Monte Sandler takes over as EVP of Practice Solutions after serving as NextGen’s VP of account management. Finally, Donn Neufeld is now EVP of EDI for NextGen and QSI, in addition to SVP and GM of QSI’s Dental unit.

Kentucky Governor Steve Beshear announces the official launch of the Kentucky Health Information Exchange (KHIE), which currently connects six hospitals and one clinic. The Kentucky Department for Medicaid Services will also begin data exchange with the facilities.

Robinson Memorial Hospital (OH) selects Eclipsys Sunrise Enterprise as its integrated EMR solution.

Cullman Regional Medical Center (AL) will deploy MedAssets’ revenue cycle solutions for its 145-bed facility.

EDIMS will incorporate Callibra Inc’s Discharge 1-2-3 solution into its ED EHR product.

Harris Corp wins a $72 million contract to update the VA’s billing and collection operations.

University Health System (TX) implements InfoLogix’s HealthTrax mobility solution for its hospital and 20 clinics.

Brandeis University starts an online master’s degree program in health/medical informatics.

McLaren Health Care Corporation (MI) contracts for McKesson Paragon. PHNS will implement six more of McLaren’s hospitals, adding to the two already running Paragon.

Researchers from Henry Ford Hospital release details on their use of electronic medical records during last year’s Detroit Free Press Marathon. Using laptops and a Web sites, medical team members were able to coordinate patient care in real time, as well as help family members locate injured runners. Researchers say the solution also provides data to identify injury patterns and thus improve preparations for other large sporting events. There’s got a be a clever pun to tie the Ford/EMR/road race thing together, but it’s just not coming to me.

Franciso Partners expands its HIT holdings, making a significant capital investment in T-Systems. Founders Woodrow “Woody” Gandy, M.D. and Robert Langdon, M.D will remain on the board, with FP operating advisor John Trzeciak taking over as president and CEO. The company also owns QuadraMed, Healthland, AdvancedMD, and API Healthcare.

EMH Regional Healthcare System(OH) selects Allscripts EDIS for its three emergency rooms.

E-mail Inga.

News 4/21/10

From You’ll Know Who: “Re: McKesson. Pat Blake (Pam Pure’s replacement) just announced that he has moved Sunny Sunyal to the dreaded position of ‘strategic initiatives’ and will move Dave Souerwine into the MPT President role. Dave is moving from Pittsburgh, where he ran Automation (home of the cabinets and AdminRx).” Unverified. No changes on the Web site yet. Obviously this would be huge news if it’s true. Update 4/21 1:00 PM Eastern: McKesson’s Web site has been updated, verifying the rumor as reported and giving Dave Souerwine’s start date as MPT president as April 10.

From Dmitri: “Re: Advisory Board. Dave Garets and Mike Davis, the band formerly known as Gartner Group’s non-physician Thought Leaders and HIMSS Analytics, are duplicating the Gartner model of research reports, access to analysts, targeted benchmarking services, and targeted consulting services. Interesting move in that they will bring a wider than just IT view to provider-side IT.” ABCO stock has recovered nicely from its March 2009 dip to less than $15, climbing back to $34.30 today for a cap of $530 million.

From amMUSEd: “Re: MUSE. It looks like only 100 or so customers are attending out of Meditech’s 1200ish installed, less than a dismal 10% attending their premiere conference. I wonder if all the confusion around the migration to Focus 6.0 has scared them away or whether the economy is just killing the event? Thoughts?”

From Gary Playa: “Re: recall. Did you see this?” I’m not familiar with the process or the site, but it appears that Picis has recalled its Caresuite version 5.1 modules for anesthesia, PACU, and critical care in Canada (which if I remember correctly, regulates medical software much like the US FDA regulates drugs). I found a long list of health-related recalls of many types on Health Canada’s site, so I’d take this more as an interesting observation of how Canadian medical software regulations work than anything specific to one vendor. I don’t see why we don’t have something like that in the US.

From Certifiable: “Re: Cerner. A rare big-hospital win of Cerner over Epic: Northwestern Memorial in Chicago.” I should mention that well-placed sources suggest that Cerner is not, in fact, at the Yale-New Haven table as a reader reported earlier. The hospital will either find the money for Epic or stick with Eclipsys.

From HIS Junkie: “Re: CMS. Stop the implementations  … just of the presses: ‘Medicare payments to acute-care hospitals for inpatient services will decline by 0.1% or $142 million in fiscal 2011 under a proposed rule issued by the CMS.’ Since the MU penalty is tied to the Medicare adjustment, that means if I don’t meet MU criteria, they will reduce my adjustment by 33%. So as a math major I know 33% * -0.1 = +3.3% increase! Really though, with CMS wanting to cut doc payments by 21% and now hospitals 0.1%, do we really expect there to be MU bonuses at the end of the EMR rainbow?”

A Calgary radiology professor’s company gets Health Canada approval for its iPhone medical image viewing application, now being tested at some American sites.

Speaking of Apple, its stock is flying after announcing a 90% increase in net income for Q2 with an amazing 8.7 million iPhones sold in the quarter. The three-year-old iPhone revenue contributed 40% of Apple’s total. Apple’s market cap is at $222 billion, not far behind Microsoft’s $275 billion.

Weird News Andy has competition from Bizarro Jim, who notes this story from Ireland in which a surgeon who mistakenly cut off a patient’s testicle instead of just the cyst growing on it was also charged with injecting himself with meds intended for a patient. Not to be outdone, WNA parries and thrusts with this story about a British woman with Foreign Accent Syndrome – following a severe migraine attack, she suddenly starts speaking with a Chinese accent, about which the inquisitive and insensitive WNA queries, “How does she ask for an Advil now?” And this, about which WNA  expresses hope that it isn’t near the food court: a mall celebrates Colorectal Cancer Awareness Month by erecting a 40-foot-long Coco the Colossal Colon that visitors can crawl through.

Apparently everyone wants to be WNA: EHR Geek finds this story about a 10-year-old boy who is nearly struck by a laptop that fell from a medical helicopter leaving the local hospital. EHR Geek wonders if there are HIPAA implications.

Kaweah Delta Health Care District (CA) will roll out 100 iPads within the next few weeks, loading them with e-mail, medical image viewers, and EKG viewers, all running under the Citrix virtual desktop. The hospital also says that 20 docs have already bought their own.

The National Cancer Institute will release a lightweight oncology EHR based on HL7 CDA, giving oncologists a way to push oncology encounter information through a Web interface that could send it to PHRs, to other providers, or directly to consumers. SAIC and Microsoft are providing assistance. NCI says it will meet Meaningful Use requirements, but whether it does or not, it sounds like a fantastic idea to me. Onc records are complex and vital from one visit to the next.

Indiana-based cardiology EHR vendor GEMMS will expand its headcount of 40 to more than 100 within the next five years, with hiring starting immediately.

The Securities and Exchange Commission launches an investigation into Jackson Health System (FL) to determine whether purchasers of $83 million worth of its A+ rated bonds were defrauded since the hospital announced a surprise $244 million loss right after the sale.

The Leapfrog Group selects Quantros to administer its online Leapfrog Hospital Survey, replacing Thomson Reuters.

A Canadian Medical Association article says lack of national standards is hurting EMR adoption:

Several physicians and academic experts say the political will to implement national standards appears non-existent. EHR vendors are fuming. Health Canada stepped into the fray by introducing new certification and licensing requirements, some of which are fuzzy. Canada Health Infoway, meanwhile, has thrown its hands into the air and says it has no authority to compel provinces to comply with national standards. And federal Auditor General Sheila Fraser will again wade into the murky EHR waters on Tuesday by updating a November 2009 report that concluded Infoway has had little success in removing interprovincial barriers and, therefore, little “assurance that EHR systems will be correctly implemented.”

The CEO of Westchester Medical Center (NY) is fined $3,000 for letting Cardinal Health, which runs the hospital’s pharmacy department, pay for his hotel and limo at a conference.

E-mail me.

HERtalk by Inga

From ImageThis: “Re: voice recognition. Love to awaken every day to read the HIStalk news, very useful and insightful. As a vendor, I was intrigued by the recently mentioned study on PACS and was wondering what sort of voice recognition tools hospitals will be buying for imaging. Appreciate any feedback.” I’m sure that we have readers who can discuss this more authoritatively than me, so I will defer to the voice/imaging gurus.

Lourdes Hospital (KY) says that 100 affiliated physicians (80%) have adopted the hospital’s Web-based clinical portal. Two years ago, the hospital contracted with ICA to aggregate electronic healthcare information for physician online access.

Emdeon reports that the electronic medical claims adoption rate is now 85%. Electronic remittance adoption stands at 46%.

Clinics of North Texas select Allscripts EHR and PM for its 35-physician group.

Like this: McKesson employees from 130 different locations will create 32,000 Stop Diabetes care packages to distribute to fourth- and fifth-grade students. The initiative, which is intended to encourage healthier eating and more active lifestyles, is part of McKesson’s annual Community Days corporate citizenship program.

GE Healthcare says it added 12 new Centricity Perinatal clients in Q1, on top of  its installed base of 1,500 hospitals and health systems. GE also just announced its overall Q1 numbers, which included flat sales for its US Healthcare division. Healthcare as a whole had a “strong quarter” with $3.8 billion in orders, up 5% from the previous year. Overall EPS was $.16 with revenue of $36.6 billion.

eClinicalWorks makes the annual Boston Business Journal Pacesetters list of the 50 fastest growing private companies in Massachusetts. eCW ranked number nine, based on revenue growth.

Radiology services provider Optimal IMX implements MobileMD’s HIE technology to provide HIT connectivity between its client facilities and the physician community.

MediConnect announces 20% growth in first quarter revenues, compared to Q1 2009. The company also recently completed its acquisition of the PassportMD PHI portal.

Physicians working in hospital-owned outpatient facilities will be eligible for stimulus incentive payments, assuming they demonstrate meaningful use of EHRs. Congress passed a new bill which gives more physicians the ability to quality for funds, including an additional 13-17% of family physicians. Physicians working primarily in the ER and in inpatient settings are still excluded. Meanwhile, Congressmen Patrick Kennedy and Tim Murphy introduce legislation allowing behavioral, mental health, and substance abuse treatment provides to qualify for meaningful use of EHRs.

Health Care Systems Inc. (HCS) intends to join the Helios by Eclipsys application development program and integrate HCS’s Medication Reconciliation software.

Texas Health Presbyterian Hospital-WJN hires PHNS to provide IT services.

Happy anniversary to HIStalk sponsor Stratus Technologies, which celebrates 30 years in business on May 5th. To mark the milestone, they found the client that has been running its high-availability Stratus server the longest with no unscheduled outages. The winner was a Michigan manufacturing firm that’s had the same server since 1993. In case you don’t recall what you were doing in 1993, note that Clinton was president, Intel shipped its first Pentium chips, and Whitney Houston topped the charts with “I Will Always Love You” (I am sure someone finds this last fact significant). Highmark has also been running a Stratus server for quite a while: the company installed its EDI server 2001 and hasn’t rebooted in four (!) years.

Michael Ball, PhD, joins BridgeHead Software’s executive team as SVP, North America. Before Bridgehead, Ball oversaw marketing, product management, and professional services for InfoMedics; he also spent time with Ardais Corporation as VP of sales and marketing.

Royal Philips Electronics releases its Q1 numbers, which included $270.8 million in net income, compared to last year’s $79.5 million loss. The Healthcare division grew equipment orders 20% over last year, though US orders rose only 7%. Most of the growth was driven by sales of clinical and imaging systems.

E-mail Inga.

Monday Morning Update 4/19/10

From MisterEd: “Re: Yale-New Haven. The bulk of Cerner management is on site with CIO Mark Anderson. Epic’s not a sure thing yet.” Given Cerner’s ongoing dismal sales performance against Epic, plus the fact that YNHH has already been talking up Epic, I’d say Cerner’s chances are minimal, even though they offer the software for free to try for a rare big-hospital win. If I were YNHH, I’d consider Cerner only if I couldn’t find the money for Epic.

From The PACS Designer: “Re: iPad productivity apps. The iPad may not be on your list of must-haves, but you might change your mind if you saw some of the productivity apps for the iPad. TPD thinks that IT personnel may like a feature such as server management that Rackspace has designed for the iPad.”

From Dr. M: “Re: iPad. We found out that the iPad runs Epic! I am going to have to get one! Blanked out the patient and physician names.” Looks good on there, I have to say.

From Gotta Love Neal: “Re: Cerner. Is Cerner planning to manipulate HIT regulation to block small companies and upstarts from entering the market? This Duke distance MBA paper by a Cerner strategist provides a clue.” The PDF has been pulled down, apparently (the paper’s a year old) so the link is to a cached image of it I found. I wouldn’t put too much stock in an MBA paper that isn’t part of company policy, but here’s the part Gotta Love Neal called out, which doesn’t seem far from how it actually played out:

In the current environment, much of the strategy concerning the ARRA stimulus package depends on the details of government regulation. Specifically, the outcome of the definition of “meaningful use of EHR” will greatly impact the strategy that Cerner should adopt. The higher the regulatory burden placed on vendors the greater the advantage is to incumbent vendors. Therefore, it is a critical time to influence the direction of regulatory decision regarding “meaningful use”. In the coming months as Congress and Health and Human Services decide the details of the regulations, Cerner should invest resources to understand the direction of proposed regulations and partner with other incumbent firms to lobby the government to raise the regulatory hurdles as high as possible. Using the Healthcare Information and Management Systems Society (HIMSS) classification scheme for EHR adoption, Cerner should influence policy makers to set the meaningful use bar around stage 4 of 7 stages. This level would encourage even large academic hospitals, which currently average stage 2.5 adoption, to adopt new technologies to qualify for government incentives. It would also erect significant barriers to entry for new firms and encourage small, less technically capable and financially limited firms to exit the market. The message to government officials must not appear to be for the purposes of establishing barriers to entry, rather, it must suggest that meaningful cost savings and quality improvements cannot be achieved without a high standard of “meaningful use.”

Listening: Phoenix, indie pop from France. They’ll be at Bonnaroo and Lollapalooza. I’m not a big pop fan, but I like this OK.

VA renews its agreement to use McKesson’s InterQual evidence-based clinical content application.

I’m looking for a couple of HIStalk sponsors to test a sponsor-only job board that I had built. If you are interested, let me know.

An article in the just-published issue of Lancet looks at diabetes screening criteria using the Archimedes large-scale modeling tool that reviews EMR data such as physiology, disease, and interventions. The authors claim that a randomized clinical trial to generate the same information would have required following one million people for 45 years. It’s the first Lancet article based on a mathematical model rather than a clinical trial.

Thanks to the 191 hospital readers who have completed my three-question survey so far. If you haven’t, would you mind doing a quick, anonymous response for me? All it asks is your job description, employer, and employer’s location. It helps me understand who is reading. Thank you.

Forget my last poll in innovate HIT vendors since unknown pro-Eclipsys parties spammed it. New poll to your right: how many docs who buy EMRs will get all the HITECH money they’re expecting? Note that you can also leave comments on the poll itself, just in case you’re trying to sway someone.

Off topic: I’ve seen the future of TV and it’s not TV. Netflix now offers free, unlimited streaming of a pretty large library of movies and TV shows with any level of its traditional DVD-by-mail subscription. $8.99 per month gets you a free DVD that you swap out by mail as often as you like, but the streaming is the real draw. All you need is an WiFi capable DVD player, a videogame system (Wii, PS3, or XBox 360), or a $100 Roku HD streaming video player and you can watch a ton of video on demand 24×7. It’s fast, reliable, has some nice features like creating your instant queue on the Web, and is pretty high quality. I’m thinking about getting the Roku box since I played around with it this weekend and was instantly hooked. You don’t need cable or dish, you don’t need to buy channels you don’t watch, and you don’t have to watch commercials.

Nashville-based onFocus, which offers performance tracking systems for healthcare management, raises $3 million in Series C funding.

Oracle buys pharma drug development software vendor Phase Forward for $685 million, expanding its health business unit and possibly signaling its interest in other healthcare-related acquisitions.

Interesting: how hacker-resistant are implanted patient technologies such as insulin pumps? In a laboratory experiment, researchers used a computer and radio to access a cardiac defibrillator, killing the simulated patient. Some devices have a 15-foot wireless range with unencrypted signals. They’re talking about tattooing the embedded passwords onto the skin of patients so that caregivers could take control if needed.

We’ve got fresh news and interviews over on HIStalk Mobile for those who care about smart phones, mobile healthcare computing, and similar topics. It has its own e-mail list, so drop your e-mail address in the Subscribe to Updates box at the upper right of that page to jump on.

Doctors in Queensland, Australia are threatening to strike over underpayment caused by implementation of a new payroll system, specifically the Infor WorkBrain workforce management application. Experts from IBM, which managed the implementation, are being brought in from Canada to try to fix the problem.

Debra Medina, a libertarian activities, former medical billing company owner, former nurse, and former candidate for the Texas governor’s seat, shows up at a state committee meeting on health information exchange with a camcorder, apparently to call attention to privacy concerns.

Australia’s plan to issue a national healthcare identifier to all citizens starting July 1 is criticized by a senator, who notes that just 10 weeks out, the legislation hasn’t been introduced and vendors haven’t been chosen.

HHS’s open source Connect project that facilitates connecting IT systems to the Nationwide Health Information Network is named a finalist for an award recognizing innovative technologies that improve citizen services.

eClinicalWorks, in need of space for expansion of its headquarters, tentatively plans to stay in Westborough, MA with a move to another in-town site.

E-mail me.

Responses to Reader Question – Will Hospitals Offer Practice-Based Physicians A La Carte Systems or a Standard Enterprise Model of Software and Devices?

Response 1

I believe most will select a "standard" set of systems they feel they can support with their staff and if they have enough influence/control over their staff physicians, they’ll get majority buy-in; especially if they are leasing it at a "reasonable" price. I also think many physicians who admit the majority of their patients at a facility that offers that option will be very tempted because the research is already done and they can blame the facility and it’s system(s) if anything goes wrong and expect the facility’s support staff to resolve the problem without having to beef up their office staff substantially (or sufficiently). That could be a double-edged sword for the facility if they bite off more than they can chew and don’t set proper expectations or possibly don’t write a good contract and SLA. Otherwise, they have standardization and can brag about it. Obviously all this assumes the hospital/facility has done proper due diligence in selecting their vendors and already has good contracts and SLAs. I’ve heard and read of many multi-facility environments that have tried to support multiple systems and almost always talk about trying to migrate to a single set of favored solutions. Right or wrong, most view supporting multiple systems as more costly in the long run and it tends to spread the staff expertise too thinly. Moreover, they want to consolidate their IT operations and usually think they can reduce the headcount through "operational efficiency". It sells well to management but usually doesn’t work out as well as stated.

Response 2

think that the hospitals will offer a standard physician office rollout package, not an a-la-carte selection. After all, if the hospital has to support the physician users, they will want to keep things standardized. Trying to figure out which office uses which applications/features is too difficult.  The hospital’s support staff is probably already stretched too thin to take variability into account. Another consideration is pricing for the services offered. I think hospitals will want to keep this simple as well, so a standard package fits better for the pricing side.

How to Not Suck in an Interview
By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make this editorial available from its newsletter.

I do a lot of interviews for HIStalk. Like a mother who loves all her children equally, I like to think that they’re all good, but let’s be realistic: I know that some of them have been spectacular duds.

Those clunkers sounded good on paper as I planned them, a no-holds-barred discussion with some vendor executive sporting a big title and enviable credentials. The end result, however, was about as exciting as uncomfortable first date conversation involving the weather. I swear I could hear the crickets chirping while I yawned through yet another boring, pedantic answer to a question that I hadn’t actually asked.

It’s especially hard with HIStalk because I run the transcripts of my interviews verbatim. I don’t edit out endless pontification, question-dodging, or rambling answers that tumble off the page like a jackknifed truck full of bricks. If someone says “sort of” every other sentence (and it seems that’s about half the people I interview these days), those warts are going to be out there for the whole world to see unless I’m so annoyed by the result that I break my own “no editing” rule.

It’s not like I don’t warn my interview subjects. I tell them to keep their answers short but animated, illustrate concepts with stories, fight the urge to constantly brag about the company and its products and instead let their answers do the talking, and to speak like a human and not a brochure.

They don’t always listen. They nearly always regret it afterward. And even if they don’t, I do, because readers usually complain.

My Rule #1 is this: when talking to vendor people, I will almost never interview anyone other than the CEO. Some of the worst interviews I’ve done were with VPs, usually because they were (a) clueless; (b) responsible for only a limited part of the business and therefore not really conversant about the big picture; or (c) so scared of being corporately backstabbed that they wouldn’t say anything that deviated from the marketing-approved talking points.

I don’t like interview subjects who over-prepare, which is why I won’t let them see my questions in advance. I want spontaneous answers and the chance to make up questions on the fly based on previous answers. I know I’m in trouble when I hear papers shuffling on the other end since that always means my subject is frantically digging through a stack of carefully scripted notes to find an answer that absolutely nobody will want to read because it’s … carefully scripted.

Executives also sometimes don’t prep, just getting on the phone at the time the marketing person told them to. Since they don’t have a clue about my audience or my own level of understanding, they sometimes dumb down their answers like I was from the local hippie weekly paper. No, I do not need to see your stick figure drawing of what CPOE is, thanks.

I learned the hard way to never allow a second person to sit in on the interview, even if the company is run by two inseparable and equal partners who can’t bear the thought of not speaking as one. It drives the transcriptionist crazy, they end up constantly enhancing each other’s comments pointlessly in an effort to wrest equal air time, and readers have no clue who’s talking and why it took two people to have so few original thoughts.

I’ve also learned by bad experience to never let the interview subject see the transcription draft before it runs. It’s tempting because they might catch a glaring transcription mistake caused by poor audio (usually because they insist on being interviewed on their cell phones), but their insecurity always moves them to convene an impromptu review panel, always led by a marketing person who insists on sticking trademark symbols on everything and making irrelevant punctuation changes (I always put a comma after the second item in a three-item series and no, I don’t care what reference says otherwise since I can find at least one that says it’s OK).

The answer to the first question sets the tone. I tell the subject that I’m going for about 20 minutes and will ask maybe 6-8 questions. The message is clear – don’t prattle on. Several years ago, in one of the worst interviews I’ve done, the guy hadn’t come up for air 10 minutes after I’d asked my usual “tell me about yourself” icebreaker question, still blabbing endlessly about his wondrous experiences at a bunch of companies. I’m pretty sure readers would rather draw their own conclusions about his abilities instead of listening to him recite them.

So my interview advice is succinct: develop a rapport with the interviewer, talk just enough, and always be fascinating. Heck, if you can do that, you’d make a great first date for someone, too.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

News 4/16/10

From The PACS Designer: “Re: Google Documents. In a challenge to Microsoft Office, Google has expanded its online document offerings. TPD has been using the Google spreadsheet application for some time and now will be testing the new features as well as the usability of Google Presentations and Google Drawings.”

From Rysanwss: “Re: Yale-New Haven. An EVP made a formal announcement to the IT staff that Epic is in their future. No signed contract yet, but they are close.”

From Jobs: “Re: Apple iPad unpacking video. A staple of Star Trek movies is a long, slow tour around the exterior of the ship, showing the exquisite detail of nacelles, the phaser emitters, the gentle curves of the saucer section, etc. This scene is ‘trekkie foreplay’. The iPad video is the Apple version.”

O’Connor Hospital (CA), Orlando Health (FL), St. Vincent’s East (AL), Huntsville Hospital (AL), and UC-Irvine (CA) are recognized for excellence at the annual conference of Surgical Information Systems.

Sad news: Steve Tanaka, CIO of Palomar Pomerado Health (CA), drowned last week while on vacation on Costa Rica. He was 50. The hospital has created the Steve Tanaka Award for Excellence to honor his work and memory.

This story doesn’t inspire much confidence in healthcare IT security. Auditors reviewing the security of electronic patient records of Vancouver Coastal Health Authority found so many vulnerabilities in every area that they buried the report for six months, fearful that anyone reading it could start digging through its systems. “No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time. Almost all users have some access to confidential information about all clients in the database. Many clients’ full health information is accessible to a large number of users.”

Software developed at Brigham and Women’s Hospital to optimize the schedules of astronauts based on their sleep rhythms may have a role in healthcare, with potential use in creating employee schedules, predicting low-performing times to avoid errors, and using light therapy to  change natural sleep cycles. I found a free beta download here.

From Weird News Andy, who comments on his find as <predictable>The thought of an implantable chip just gets under my skin.</predictable>. PositiveID (formerly VeriChip) strikes a deal with the International Maritime Medical Association to offer its PHR to seafarers. WNA also found this story about the theft of 57 hard drives from BCBS Tennessee, now estimated to include records of 1 million patients.

Jobs: Cerner Build Specialist, Senior Product Marketing Manager, Regional VP Sales – HIT Consulting, Anesthesia Product Specialist.

Epic CEO Judy Faulkner will receive an honorary Doctor of Science degree on May 14 from her alma mater, the University of Wisconsin-Madison.

Sheehan Medical Cork Medical Centre, the first new private hospital to open in Cork, Ireland in 30 years, awards its IT contract to Meditech. The company has several other Irish clients.

Dennis Quaid has produced and narrated a documentary called “Chasing Zero: Winning the War on Healthcare Harm” that will air on the Discovery Channel next Saturday, April 24. It was inspired by the near-fatal heparin overdose given to his infant twins at Cedars-Sinai.

An Army doctor faces court martial after refusing deployment orders to Afghanistan, stating his belief that the orders are illegal because President Obama was not born in the US and therefore cannot serve as his commander-in-chief.

University of South Florida will hire 100 “e-ambassadors” for its stimulus-funded PaperFree Florida electronic medical records initiative.

Christoph Lehmann, MD, a Johns Hopkins neonatologist, is chosen as founding medical director of the Child Health Informatics Center, an American Academy of Pediatrics informatics group created in October 2009. That group will design a prototype model electronic pediatric health record.

A former medical records clerk of St. Peter’s Hospital (NY) is arrested for stealing patient information and shopping online using their credit card numbers. He was caught after ordering merchandise and forgetting to change the default shipping address, sending a package to the house of one of his victims, who realized someone else had ordered it using his credit card.

Oppenheimer upgrades shares of open source vendor Red Hat to outperform, while UBS flags the company as a compelling takeover target.

Odd lawsuit: the sister of a man accused of beating his parents to death sues the hospital for negligence in the death of their mother, claiming “wrongful death”.

E-mail me.

HERtalk by Inga

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Enterprise Software Development changes its name to Enterprise Software Deployment to better reflect the company’s evolved breadth of EHR implementation services. You can check out their good-looking new logo and ad to your left.

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

I don’t think I’d be starting a career in PACS sales any time soon, assuming the results of this CapSite Consulting study are accurate. Currently 96% of hospitals have already own PACS solutions and only 17% of the surveyed hospitals have plans to buy a new or replacement system. The biggest imaging IT spend in coming years will be for image archiving and storage, plus voice recognition tools. Almost half of hospitals with PACS cited functionality as the biggest weakness of their PACS.

CareTech Solutions doubles its number of Web Products and Services clients in fiscal year 2010, now serving over 150 hospitals.

Cardiology Associates (AL) picks Allscripts’ EHR for its 38 providers.The practice will tie the EHR into its existing Allscripts PM and document management systems.

Complete Women’s Imaging (NY) selects Merge Healthcare to provide a diagnostic imaging workflow solution, including Merge’s Fusion RIS/PACS MX.

Desert Orthopedics (OR) plans to implement SRS hybrid EMR for its 10 physicians.

The Heart Hospital of New Mexico chooses TeleHealth Services for interactive patient education services.

IDC Health Insights takes a peek at 14 HIE vendors and provides assessments on their offerings (for $4,500, you can get a copy of the report and fill us in on the details). For the most part, the 14 vendors were the ones I would have expected (Axolotl, dbMotion, Medicity, etc.) One surprise vendor was eClinicalWorks. I knew they had an HIE product, though it’s not heavily promoted. On the other hand, I know other ambulatory vendors like NextGen and Allscripts are trying to establish an HIE presence, yet were not included. A quote:

Typical of nascent markets, the HIE vendor market is volatile with new entrants and market consolidation. We can expect dramatic changes in the next 12 to 18 months as HIE technologies become a commodity and dominant players acquire their way into a crowded market currently made up of many small, privately held vendors.

The California Telehealth Network awards AT&T a $27 million contract to build a telecommunications network to connect hundreds of providers throughout the state.

Spheris wins court approval to sell its assets to fellow medical transcription vendor CBaySystems Holding for $116.3 million, which includes $98 million cash.

Here’s a good tax day story for you. The president of a San Diego medical billing company pleads guilty for failing to pay $2.5 million in employment taxes, even though the taxes had been withheld from employees pay checks. Anthony Vacchi, Jr faces up to five years prison.

E-mail Inga.

News 4/14/10

From Dr. Know: “Re: California Nurses Association. We have been rolling out an electronic health record system and have been confronted with growing resistance from the nursing staff, which is heavily unionized. They continue to refer to this document (warning: PDF) published by the California Nurses Association, which says, ‘Don’t Automate.’” The union’s flyer says that healthcare IT is driven by the desire of employers to control workers, that EMRs are used to spy on employees, and that technology is intended to homogenize health professionals and patients like interchangeable machine parts. I don’t disagree with all of it, but it’s pretty over-the-top.

From Minute Man: “Re: Leagcy Health. Dick Gibson MD, senior VP and CIO of Legacy Health System in Portland, OR who spearheaded the purchase of Epic, has been let go. In addition, Carol Edwards, VP of information systems with 20+ years at Legacy Health, was let go at the same time. They both left at the end of March. The Epic implementation has encountered significant costs overruns and delays. The project manager is a consultant who has no prior Epic implementation experience. Interestingly, the same consultant managed the Cerner implementation at Legacy, which is being replaced with Epic.” Unverified.

From The PACS Designer: “Re: iPad first look. If you haven’t purchased and received your iPad yet, you may enjoy the arrival experience by viewing Fritz Nelson’s iPad delivery and first use out of the packaging in his review for InformationWeek. Also, the Apple Insider has a full review of all the features available on the iPad.”

The Methodist Hospital (TX) enhances its online patient experience by launching distributed authorship of content for Web visitors from MEDSEEK.

A hospital in Thailand says it will be among the world’s best after an IT investment of $1.5 million. It will run PeopleSoft financials and HR.

Vanderbilt researchers present a paper describing the privacy method they developed that generalizes genomic data in EMRs to prevent linking patients to their genetic profiles.

I closed out the poll to your right because it was getting spammed hard by respondents (or automated scripts) choosing Eclipsys as the most innovative vendor. The polls usually get around 200 votes and this one was up to 688, with Eclipsys getting 528 of those. You can decide whether you believe that result.

Healthcare Growth Partners releases its HIT market report for Q1 (warning: PDF).

The Wall Street Journal writes up HIEs, profiling the data sharing of Children’s Denver, Kaiser’s Colorado physician group, and Exempla, all of which use Epic and share information.

A doctor and EMR consulting company vendor criticizes Canada Health Infoway’s multi-billion dollar EHR project, citing low physician adoption. Among his criticisms: the “unconscious patient in the ED” is rare and hard to justify as a necessity; investments have been focused on hospitals instead of doctors’ offices where most care is provided; EMRs don’t help with referrals or consultations, which still require paper; and privacy issues and local legislation prohibits the free flow of information that the system was built around.

Speaking of Infoway, the specially created pension plan of its CEO has accumulated $1 million in benefits after six years on the job, not bad for running an organization with only 200 employees.

It’s not just medical doctors who suffer through EMR implementations – veterinarians have similar concerns. “They really pushed big at the conferences. They knew that they were going to be bought and had to make their numbers look good. I just don’t think they were ready to take on a practice like ours.”

The mother of a nationally known activist who died at UPMC Shadyside blames the hospital’s “unreliable and insufficiently tested” computer system, saying its faulty records resulted in his being given soup too soon after surgery, leading to his asphyxiation. She also claims the hospital released his information to a congressman without permission.

If you work for a hospital or health system, please complete my three-question anonymous survey: your job title, the name of your employer, and the location. It’s nice to know who’s reading.

A primary healthcare center and ED launch what they say is the first HIE in Georgia, with the organizations sharing medical records of uninsured patients to streamline delivery and reduce duplication of services.

E-mail me.

HERtalk by Inga

From CowCHIT: “Re: Karen Bell. She was just named Mark Leavitt’s replacement at CCHIT. Don’t know her myself, but … she can’t be any slimier than Leavitt seems.” Sounds like a glowing endorsement. She was most recently SVP of HIT services for Masspro, and before that was director of the Office of HIT Adoption and acting director of ONC. Because of her previous association with ONC, she’ll be unable to lobby for CCHIT in front of federal officials until November 2010.

e-MDs announces it has increased its employee count by 36% over the last year and experienced a 36.5% increase in organic sales since the start of 2010.

CliniComp says that three more US Army and Navy facilities deployed the Essentris EMR during the first quarter of this year.

CynergisTek launches its HIPAA/HITECH Security Compliance review solution for hospitals that qualify for SHIP grants from the Office of Rural Health Policy.

Eclipsys announces the release of Sunrise Enterprise 5.5, which the company says includes significant EHR updates. The new release includes Helios, the new Eclipsys open platform strategy that allows third parties to natively integrate their applications.

The Children’s Hospital at Montefiore (NY) will implement GetWellNetwork’s GetWellTown, the pediatric version of its Interactive Patient Care program.

Foundation Radiology Group appoints Tom Skelton CEO. Last month a reader tipped us off that Skelton was leaving MED3000, where he served as president of technology services.

HIE Health Advancement Collaborative of Central New York signs a multi-year agreement with Axolotl for its Elysium Exchange suite.

Thomas Jefferson University and Jefferson University Physicians select Allscripts and dbMotion to provide an integrated and interoperable EHR and population management solution.

Eight thousand Vancouver Coastal Health (BC) employees are now live on workforce management solutions from Kronos, including time and attendance and employee scheduling.

Catholic Health Initiatives chooses RelayHealth RevRunner for patient eligibility verification.

David Blumenthal wins his second big award in just over a month. In early March, Blumenthal won top HISsie honors as HIStalk’s Healthcare IT Industry Figure of the Year. He has now been named the Most Powerful Physician Executive in America by Modern Physician and Modern Healthcare readers. I’m sure the latter award, while not as prestigious as a HISsie, will still be coveted.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. I’m assuming I am just too old / uneducated and/or poor since I don’t have one. Mostly I am PHR-less because it seems like far too much work to maintain. However, just today I was thinking that it would be kind of cool if I had a PHR. I’m trying to buy health insurance and am needing to provide the evil insurance company TEN years’ worth of medical history. As in, every antibiotic for every strep throat or bronchitis attack, every outcome to every dermatologic encounter, and every little medical incident that I have either forgotten about or don’t care to share. Seriously? I have a new theory about why so many Americans are uninsured but that’s all a can of worms I don’t care to open. Suffice it to say that maybe – maybe — I’ll start looking into using a PHR.

A man sues medical device maker Stryker, claiming its artificial hip destroyed his sex life. He alleges that while having an intimate moment with his wife, the act was interrupted because the squeaking made her start laughing (how insensitive). About 750 individuals have also filed lawsuits, including a fellow who put a video of his squeaky hip on YouTube. If you check out the video, let me know if you think this guy is wearing Superman pajamas.

E-mail Inga.

Being John Glaser 4/12/10

Working with ONC on HITECH: Some Observations

I have spent a large portion of the last eleven months working with the Office of the National Coordinator for Healthcare Information Technology (ONC) to develop the regulations and grant programs that resulted from the HITECH legislation. This time and this work have led to four major observations.

The Power of Meaningful Use

For decades, the healthcare information technology industry has tracked adoption. How many hospitals have adopted CPOE? What is the adoption rate of personal health records?

While adoption is a measure of industry uptake of a technology, it has an obvious flaw. Adoption does not mean that providers are using the technology or that care is being improved. Adoption does not, per se, lead to complete problem lists or providers doing a good job of managing the health of their patients.

Meaningful Use is a very potent idea. It says that if our goal is care improvement, adoption is only relevant if the technology is used well.

Meaningful Use also stops short of initially basing incentives on changes in care outcomes. While providers must report quality data, early stages of Meaningful Use do not require that specific improvements in care occur. It was understood that broad care improvement will take more time than is likely to be achievable under the initial HITECH timetables. And it was understood that while EHRs are an essential foundation for care improvement, additional factors must also be present.

Most importantly, payment reform must happen — reimbursement that explicitly rewards providers for improvements in care quality, safety, and efficiency. The recently passed Health Reform legislation begins the process of the implementation of payment reform for federal programs.

Meaningful Use moves the industry away from a focus on adoption, but does not overstep that movement by leaping all the way to outcomes.

The Joint ONC/CMS Approach to Regulation/Rule Development

After HITECH passed. there was a need to develop the regulations (also known as rules) that translated the legislation into specifics, e.g., what are the specific things a provider would have to do to be considered a Meaningful User?

As it writes rules, the government must follow a core protocol. Those who are drafting the rule cannot talk, outside of government, about the draft language. The draft rule must be reviewed and approved by several government departments such as the Office of General Counsel. And the government must ask for comments, on a draft of the rule, from the public and it must read those comments.

While it followed that protocol, ONC (and CMS for Meaningful Use) made a critical strategic addition. They leveraged the Policy and Standards Committees (which were open to the public) to develop recommendations of the rule content. The Meaningful Use Work Group defined an approach to the 2011 (Stage 1) objectives and measures. The Certification and Adoption Workgroup developed recommendations for a new EHR certification process. The Workgroups of the Standard Committee developed recommended data, transaction, quality measures, and security standards.

Most of the time, government does not do this. Generally government staffs do not precede rule writing with external committee (and public) input.

Why did ONC do this?

First, the rule content is likely to be better if it is based on the contributions of individuals who represent the broad spectrum of stakeholders in healthcare. These individuals “live” the delivery, financing, supplying, and management of care every day. And their experiences and knowledge cannot help but make the rule better. Moreover, the discussion of rule specifics from different perspectives helps to ensure that the rule balances, as well as it can, the variety of stakeholder interests.

Second, it is good government. Good government is transparent. Government is put in place by the people and it exists to serve the people. The people should be able to “drop in” on regulation deliberations and government should minimize the times it closes the doors.

Third, it is a terrific example of risk mitigation. It is very difficult to develop, for example, the specifics of Meaningful Use in a way that understands the complexity of healthcare; its current reality and its aspirations. By seeking the advice of experts through Committees and Committee testimony and inviting the comments of all, the Government is asking about areas where the proposed rule may have unintended consequences or could lead to sub-optimal outcomes.

Fourth, it helped the industry know, as early as possible, the direction that the rules were likely to take. The recommendations of the Committees were presented in the summer of 2009. The draft rules were unveiled in the winter of 2010. Through its use of the Committees, ONC was trying to give the industry as much of a lead time as it could.

The Complexity and Scope of the Challenge

HITECH has resulted in two classes of ONC efforts: definition and implementation.

HITECH required that specifics (and hence rules) be defined for

• Meaningful Use
• The data, transactions, and measures standards needed for health information exchange and quality reporting
• Certification standards and the certification process, and
• Privacy and security.

While essential, rules are not enough. Other actions are needed if we are to have the broad achievement of Meaningful Use by providers across the country.

Most of the care in this country is delivered by small physician groups and hospitals; they do not have an IT staff. Regional Extension Centers have been established to provide necessary support to those providers.

A health information exchange infrastructure needs to be in place to support the secure movement of data necessary for the care of an individual patient and the management of populations by public health organizations. Funds have been given to the states to establish this infrastructure and a plan to establish an over-arching National Health Information Network (NHIN) is being developed.

The country will need to increase the size of the work force available to support the broad achievement of Meaningful Use. Funds are being awarded to educators to provide necessary training and curricula.

Beacon communities will help us understand how best to leverage the technology to improve the health of a community and will teach us how to address important issues of governance, data use, and coordination of care.

Advanced health information technology research centers (SHARP) will provide ground breaking research into the critical areas of security, new architectural models, decision support, and secondary uses of data.

These implementation activities are breathtaking in their scope and sophistication. And the activities are the result of a very astute assessment of the range of “levers” that should be applied to achieve Meaningful Use.

However, initiating that many diverse initiatives that individually and collectively have a significant impact on multiple parts of the industry comes with some risk.

It is not possible to launch this much activity of this scope with this many actors and have great certainty about the outcome. This uncertainty will be magnified by the actions of the private sector — hospitals, health plans, suppliers, and others that are engaging in a diverse array of often very imaginative implementation activities.

The ONC implementation plans are very good plans. But they bring complex and substantial change to the industry. Change of this magnitude will bring very real progress, but it will also bring a period of time that is likely to be bumpy.

When significant change is introduced, one plans as well as one can, ensures that one has a realistic appreciation of the uncertainty, and preserves the agility to change course as needed. And, most importantly, one makes sure that there is ongoing dialogue with all stakeholders about issues, answers, and progress.

The Caliber of Federal Government Employees

Perhaps like many of you, I might have had this mental image of a typical government employee — a person with a rubber stamp in their hand and a scowl on their face. That mental image is wrong.

The people I worked with at ONC, CMS, NLM, NIH, FDA, DoD, VA, and a host of other government agencies and departments are exceptional. They are very smart and skilled. They work incredibly hard. They feel a sense of urgency. And they care deeply about making the country better. They listen thoughtfully to the comments, testimony, feedback, and articles from those who care about healthcare because they want to get it right.

They made me proud of my government because my government (and yours) is them.

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 4/12/10

From Thad: “Re: Allscripts. Word is that an inside e-mail leaked out to a wider audience of employees than planned. It mentioned the pending merger of Allscripts with Eclipsys.” Inga tried to chase this rumor down, but of course nobody’s saying anything to confirm or deny. Several people have told us Microsoft will make a move on Eclipsys very soon, but I’m always skeptical about Eclipsys rumors because they come up every year or so. But if you asked me if either event is possible, I’d say yes, even though I don’t see the value in either scenario. ECLP announces results on May 4, which may or may not be relevant.

From J-Hi: “Re: meaningful use. Does anyone know a source that lists the 25 objectives and the comments submitted to CMS for each?”

From Tangelo: “Re: AFCEA military HIT conference. Between the speakers from HHS, VA, and DOD and the large government contractors lining up to suck on the HITECH teats, it’s embarrassing to see how disconnected they all are on the real issues of implementing HIT (meaningful use and HIE) at the community level.”

From PortlyChap: “Re: QuadraMed. Quadramed lost the last of its Affinity clients in Kentucky recently. Pattie A. Clay Regional Medical Center in Richmond recently signed a contract with Meditech. The only other Kentucky Quadramed Affinity client signed a contract with Meditech in December 2009.” Unverified.

Transcription provider Transcend bids $78 million for the bankrupt Spheris, slightly upping the $75 million offer on the table from CBay and Nuance. And in another interesting development, Oracle CEO Larry Ellison is apparently protesting the potential sale of Spheris to that second group because Oracle is a Spheris bankruptcy creditor and he doesn’t want its software transferred to the new owners. The auction for Spheris starts today (Monday).

I’ve almost finished getting the new search engine running. There’s a new “Search This Site” box to your upper right if you want to try it. It indexes all HIStalk-related sites in one search (HIStalk, HIStalk Practice, HIStech Report, and HIStalk Mobile).

I did a survey two years ago in which I asked readers who work for hospitals to tell me their position and where they work, just to give me a feel for who’s out there. I shared the list of hospitals here. It’s time for an update! If you work for a hospital or health system, please complete my survey that asks only three anonymous questions: your job title, your employer’s name, and the city/state it’s in. Thank you.

Opinion is mixed on the likely impact of the iPad on healthcare, which is still pretty good considering it’s primarily a consumer device. New poll to your right: which of the big hospital systems vendors is the most innovative?

Clarian Health Partners (IN) chooses MedVentive for its Clarian Quality Partners clinically integrated network, where its product will be used to analyze patient data for quality analysis and care improvement opportunities. Clarian Health Ventures will also invest in MedVentive, jumping into an oversubscribed $10 million Series C funding round that raises the company’s total to $18 million.

Not much has gone right lately at Miami’s Jackson Health System, so maybe this was inevitable. Its Lawson payroll conversion causes most of its employee paychecks to be incorrect, although by minor amounts. Lawson says the problem was in the system it replaced and its amounts are correct; the hospital says the new checks underpaid employees for working overtime.

Some of the rags got irrationally exuberant over the marginal news that McKesson will sell its Asia-Pacific subsidiary to Medibank. The editors should have known better – all that subsidiary does is run healthcare-related telephone hotlines and call centers in Australia and New Zealand. Impact in the US or to McKesson’s bottom line: pretty much zero.

I notice that Cerner shares are on a solid rise lately, including a 2.4% jump Friday. You could have doubled your money if you’d bought in exactly one year ago. Neal’s stake is worth right at a half billion dollars.

Misys turned in pretty good Q3 numbers Thursday, with its Allscripts ownership stake offsetting a soft market for its banking software.

A small but interesting study in Australia finds that informed consent delivered interactively via computer with illustrations and quiz questions improves patient understanding and turns the usual “sign here” paper process into a valuable educational too.

I really enjoyed the discussion about which systems a 200-bed hospital should consider. Here’s the next reader question that would benefit from your feedback: when hospitals are rolling out systems to physician practices, will they offer a menu of a la carte system and implementation options, or will the hospital offer only a standard enterprise model of software and devices? E-mail me your thoughts and I’ll compiled them as a follow-up.

St. Francis Hospital (OH) implements the Priority Consult patient navigation system for its breast care patients. The company, which I hadn’t heard of, has software to support patient-focused nurse navigation models for spine centers and breast care, facilitating intake, triage, and care coordination.

Pardee Hospital (NC) replaces its two forms management solutions with Access Enterprise Forms Management when it finds the original systems couldn’t product a patient wristband barcode small enough for newborns.

Justen Deal follows Canadian HIT more than I do, so he caught this story that I would have missed. Quebec’s opposition party says its EHR project is dead last in all of Canada. The pilot, due to be completed in 2008, “still isn’t working” even though all of Quebec was supposed to be live this year. It appears that 75% of the original $563 million budget has already been spent, critics say it’s going to cost at least $1 billion, and everybody who originally supported it is trying to distance themselves from it. Justen always cites my 2007 Universal Rules for Big EMR Rollouts, saying they should have read them up there, so I’ll repurpose below just in case anyone missed them the first time around.

Speaking of which, I love this Toronto Star article, Malawi’s $1 Million eHealth Miracle. It points out that while Ontario was spending $1 billion on eHealth with “almost zip” results, dirt-poor Malawi has the records of 1.1 million patients accessible in 10 locations throughout the country, thanks to a computer network put together by a non-profit created by a Canadian aid worker and his wife for a total cost of $1 million from their office above a 7/11. He bought obsolete computers from eBay, converted them to touch screens, and developed the patient registration app, which uses “health passports” that cut the hours-long lines. “It’s hot, dusty and hydro is intermittent. Health clinics are in the open air with no doors. We needed a computer system that would work in those conditions and be used by people who don’t have computer skills. The system works on the premise that if you can work a mobile phone, you can use a touch-screen computer.”

A Harvard research team finds that electronic medical records haven’t had much impact in improving care or reducing costs. The authors seem to begrudgingly acknowledge that there’s no turning back now that the government is throwing endless money at EMRs, acknowledging that meaningful use requirements will at least encourage them to be used and not just purchased.

Central Washington Hospital gets a local newspaper writeup for its Cerner go-live. I’ve been there – nice place, lots of apples at the right time of year.

E-mail me.

Mr. HIStalk’s Universal Rules for Big EMR Rollouts (From 2007)

1. Your hospital will pledge to make major process changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

4. You’ll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You’ll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you’ll refused to apply them because you’re scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

News 4/9/10

From Iommi: “Re: Advance for Health Information Executives. Have you heard that it’s shutting down?” A couple of readers, at least one of whom should know, told me it’s going down the tubes. It’s not a great time to be in the print publication business.

From RadioGuy: “Re: meaningful use and images. Can you comment on this article?” The Medical Imaging and Technology Alliance lobbies to have EMR integration of medical images included as a criterion for meaningful use, starting in 2013. Its white paper is here (warning: PDF). I can’t say I have strong feelings about the issue, so here are my off-the-cuff reactions: (a) MITA is a medical imaging vendor trade group, so that obviously influences their point of view since getting on the list would boost sales (although that’s arguably no more biased that having EMR vendor groups involved); (b) meaningful use was intended to increase EMR adoption, but I would think imaging doesn’t require that kind of incentive; (c) both doctors and patients clearly benefit from image availability, a case not so clearly made from EMRs, so misaligned incentives aren’t in play like they are for EMRs. Bottom line for me — it’s just trade group noise, albeit with some good underlying points.

From Kalispell: “Re: 200-bed hospital. Nobody mentioned Eclipsys because it’s not possible to use them for all solutions. I worked until recently in an Eclipsys hospital and pharmacy, radiology, and ambulatory are very weak. It’s not integrated like Epic or Cerner, say from radiology to SCM. Eclipsys doesn’t see billing as a primary role, so ancillaries will run into billing issues.” Unverified. I’d still rank it #1 for CPOE and clin doc, though. Another reader says Eclipsys doesn’t price Sunrise cheap enough for a 200-bed hospital.

From Arclight: “Re: you scooped the Miami Herald. An article popped up on the Miami Herald’s breaking news page 20 minutes ago about the death of PC inventor Ed Roberts. Breaking news? Really? Three days after it was posted on HIStalk? I have no idea how you manage to track and tabulate the freakish amount of data you condense for your loyal readers, but please keep up the good work. Your site should be required reading for anyone remotely connected to the HIS industry.” Thanks. I’m glad Ed didn’t go unnoticed. He may not have profited from the industry like Bill Gates, but he made it possible. 

From Diego: “Re: meaningful use final rule. Any idea when it will be final?” The comment period ended three weeks ago, but I don’t know how long it takes to review and incorporate those recommendations. Someone out there probably does and can share.

 

From Mark Moffitt: “Re: CDR/HIE model.” Image above – funny! Just in case the parody isn’t clear, it makes fun of reposing a local copy of patient data that’s already available at other locations, the equivalent of Google’s actually storing Web content rather than simply pointing to it.

Larry Nathanson MD, a BIDMC ED informatics doc, reviews the iPad for clinical app use, saying it lives up to high expectations and makes the iPhone seem “slow and inadequate.” He says it renders browser pages as fast as a laptop, supports easy typing, and hits close to the claimed 10-hour battery life. His only concern for ED use is durability. A commenter also reminds that Citrix Receiver and LogMeIn are both available for the iPad, allowing it to be used as a remote PC with full capability. Their ED app is Forerun EDIS, co-developed by BIDMC.

The usual reminders: put your e-mail in the Subscribe to Updates box to your right to get instant notification when something new is posted here (some of the 5,450 subscribers are probably your most feared competitors and you don’t want them to know first, do you?) There’s a search box over there too (and a new one coming – I bought a new search engine and am finishing up the installation). Your news, rumors, and opinions are always welcome (and will stay anonymous if you want). Make sure to read the interesting comments posted after each article and feel free to add your own. You can post your industry events to my calendar, catch up with mobile healthcare computing on HIStalk Mobile, and help me out by perusing the sponsor ads to your left and click those of interest. I genuinely appreciate your taking the time to read HIStalk.

NHS scales back its contract with BT, limiting the number of London trusts that can get Cerner and RiO. Scrapped: an ambulance solution and the previously acclaimed Map of Medicine visual care planning tool.

A reader sent a link to the full text version of the Health Affairs article in which David Brailer interviews David Blumenthal (ONCHIT-1 and ONCHIT-3, respectively). I notice Brailer’s bio omits his main credential that got him the ONCHIT job in the first place – starting up the Santa Barbara Project, a failed RHIO that started the whole interoperability craze, but died an ugly death without having ever exchanged even a single byte of information. Anyway, the article is definitely worth a read. Some snips:

• A good Blumenthal quote: “The purpose of health information technology is to support health reform, and it is part of that larger puzzle. It is not a stand-alone goal or an end in itself.”
• Interesting trivia: Blumenthal says it was Congress, not his office, that coined the term “meaningful use".
• Blumenthal says his office is working with other countries to begin discussions about international standards for sharing healthcare information.
• Brailer asks about lessons to be learned from NHS projects in England and gets an excellent and insightful answer. “One thing that is quite clear to me as I sit in the Hubert H. Humphrey Building in Washington is that no country — none of our Western peers — has attempted to create electronic health information for a country as large, diverse, complicated, wealthy, and dynamic as the United States.We are trying to create a nationwide, interoperable, private, and secure health information system for a country that extends from the Bering Straits to Key West, with more than 300 million people who by history and tradition and culture value local autonomy and need autonomy in order to manage their diverse local situations. And so that’s the tradition we inherit, that’s the method that we have to use, and we are working within those constraints.”

People mistakenly think the VA’s VistA was cheap to create since internal programmers did some of the work. It wasn’t, but it provided good ROI: a study by the Center for IT Leadership says VistA cost $4 billion over 10 years, but returned savings of $7 billion. The conclusion is that the VA spent more than a similar private sector organization would have, but got higher adoption and better care as a result (and low cost isn’t much consolation if you can’t get those things, of course). Nearly all the cost savings came from a reduction in duplicate tests and medical errors. And the good news, of course, is that your hospital can get that $4 billion system for $0 from Medsphere or some of the other companies that offer it license-free.

Listening: Metric,female-fronted indie from Canada, reader recommended. It’s so cool that readers suggest something I like about 80% of the time, which is saying a lot since I dislike 90% of what’s out there. Metric is a keeper. Try Satellite Mind on the player.

Catholic Health Services of Long Island files a certificate of need to spend $144 million on Epic for its five hospitals. It hopes to save $40 million a year in addition to the HITECH incentives, expecting length of stay to drop by a half-day.

The CIO of CMS says that companies that ask to link to its systems have such primitive IT security that it’s “almost embarrassing” and those systems are loaded with “basic amateur problems.” She says these are big-name companies, not mom-and-pops.

E-mail me.

HERtalk by Inga

From Cherry Blossom: “Re: Apple OS4. If you thought iPhone and iPad was big in healthcare, just wait until this summer. We haven’t dug into the guts of OS4, but if they can deliver on half of they have promised, the chains have been removed from developers and we are going to see some AMAZING apps.”  Well, I hope you are right in terms of improvements for app developers. In terms of simple end-users like me, I was glad to see that OS4 will support multi-tasking. The addition of unified e-mail is also a plus and something I’ll find handy as I float between my Inga World and Real Life. Bummer that Flash still is not an option, though.

HCA is preparing to file for  IPO that could yield $2.5 to $3 billion. About three years, ago HCA went private in a $33 billion leveraged buyout; an IPO would allow HCA pay off some of its ginormous $25.7 billion debt.

Allscripts releases its third quarter numbers: revenue of $179.9 million versus last year’s $160.7 million, which beats analyst estimates of $175 million. Profit came in at $18.5 million versus last year’s $13.3 million. Bookings grew 25% to $105.5 million.

I chatted with Allscripts CEO Glen Tullman a few days before the earnings’ announcement and he shared some thoughts on the Allscripts-Misys merger, one year later. He also provided his impressions on a few competitors (he believes Epic is “anti-innovation”), on industry consolidation (he sees “substantial” consolidation ahead). and Regional Extension Centers (he’s a fan).

MedQuist continues to lobby the Washington crowd to ensure that transcription is an acceptable method for getting information into EHRs.

Speaking of transcription, a reader sent over a newsletter by John Suender, who our reader claims is “THE guru of medical transcription M&A.” Suender speculates on what will happen with Spheris, which is in the midst of seeking bidders for a bankruptcy sale. His prediction: the most likely bidders are MedQuist, Nuance, and Transcend. He also estimates the new owner will pay around $125 million.

RelayHealth earns certification for its Payor Connectivity Services from the CAQH Committee on Operating Rules for Information Exchange (CORE) Phase II. The CORE certification means that RelayHealth’s provider customers can securely process electronic queries within 20 seconds and receive consistent patient administrative information.

Streamline Health Solutions announces Q4 net income of $1.59 million compared to the previous year’s net loss of $145k. Revenues came in at $6.28 million vs. $3.38 million.

Streamline Health also shares news of a new contract with East Orange General Hospital (NJ), which will implement Streamline’s health document workflow solution integrated with the hospital’s GE Centricity system.

Quality Systems makes Forbes annual list of America’s 25 Fastest-Growing Tech Companies, coming in at #23. I noticed that Red Hat also made the list at #19. To qualify, companies must have at least $25 million in sales, plus sales growth of at least 10% over the latest 12 months.

Doctors Hospital at Renaissance (TX) selects Encore Health Resources to provide project management, consulting, and advisory services for its implementation of Cerner clinicals.

HEALTHeLINK, the Western New York Clinical Information Exchange, selects Anakam Identity Suite to provide its authentication and identity management solution.

QuadraMed announces the general availability of its ICD-10 Simulator, developed to help coders prepare for the transition to ICD-10. Quantim ICD-10 Coding Simulator duplicates the ICD-10 coding environment to facilitate training. (Someone will need to explain what “Quantim” means.)

Central Washington Hospital goes live on its $22 million Cerner EHR.

Congrats to TELUS, parent company of HIStalk sponsor TELUS Health, for winning the 2010 Freeman Philanthropic Services Award for being the top philanthropic organization in the world.

Hennepin Healthcare System (MN) licenses Mediware’s Insight performance management software solution for its 900-bed hospital and clinic system.

E-mail Inga.

News 4/7/10

From Dirt Farmer: “Re: iPad in healthcare. Since it’s a closed system, some non-Apple proprietary CPOE, EMR, and imaging apps may not run on it. Therefore, its use might be limited. Flash doesn’t work on any Apple device, but an Adobe rep tells me the company hopes to announce a relationship in 2011.”

From Jerry: “Re: system for a 200-bed hospital. No mention of Eclipsys. Is there a reason?” I don’t know much about their capabilities outside of their obvious strengths in CPOE and nursing documentation — the hospital was looking for a soup-to-nuts solution that covered everything from billing to ancillaries. None of the respondents mentioned them, either. If you work in a hospital of that size and are running an all-Eclipsys lineup, why not send me a little writeup of what you’re doing and how it’s working? I’m interested.

From Werner: “Re: system for a 200-bed hospital. Why didn’t Eclipsys show up? A very nice solution especially if looking ahead to meaningful use AND they have a remote hosted solution. What about OpenVista, a proven solution for smaller facilities and no major license cost (of course , except for ISM & extensions)?” Eclipsys, see above. I had OpenVista on my list originally, but couldn’t decide if it made sense for a hospital that needs a full set of applications and potentially a lot of hand-holding for implementation and maintenance, even if OpenVista would have minimal licensing costs. I could be persuaded, though.

From Midwest CIO: “Re: system for a 200-bed hospital. The way you phrased it, their only option is Paragon. It’s all Microsoft, so it’s easy to find resources to support it and it has a long life in front of it. I would put Keane on par with Paragon with respect to clinical functionality.”

The local newspaper writes up the Paragon go-live of Auburn Memorial Hospital (NY).

University of Medicine & Dentistry of New Jersey’s behavioral care organization chooses DSS to implement its vxVistA, an open source variant of the VA’s VistA.

A Harvard doctor creates an iPad application that allows him to monitor patient breathing via an ultrasound sensor he invented. He sees potential for using it to check asthmatic patients in their homes and to monitor sleeping infants.

The Army’s MC4 group is piloting a new version of the Theater Medical Data Store (TMDS) in Afghanistan that can also display the service member’s pre-deployment medical history from AHLTA.

Former RelayHealth VP Bob Katter joins First DataBank as VP of sales and marketing.

Lee Memorial Hospital (FL), expecting ARRA money to cover up to $40 million of its $70 million Epic implementation cost, finds that it isn’t eligible for up to $10 million of that taxpayer-funded windfall because it shares a Medicare provider number with its physician group. Congressman Connie Mack IV, who opposed the stimulus bill and yet is appalled that LMH might get less of it, says the hospital “shouldn’t be penalized for CMS’ interpretation of the definition of a hospital.”

HHS secretary Kathleen Sebelius visits Cincinnati Children’s Hospital Medical Center, admiring its $47 million Epic system and its patient portal.

Which reminds me: whatever happened to White House healthcare reform director and former Cerner board member Nancy Ann-DeParle? Healthcare reform was a hot topic, but I don’t recall seeing her name even once in the past several months (and a Google search backs me up on that).

Jobs: Epic Inpatient EMR Manager, Cerner Orders Consultant, EMR Implementation Specialist.

Health Affairs devotes its entire April issue to healthcare IT topics, although only subscribers can see most of it. It didn’t sound all that interesting, although I would have read David Brailer’s interviewed with his eventual ONCHIT replacement David Blumenthal (although I doubt anything controversial was said).

Odd medical problem: a man orders his favorite restaurant sandwich, the five-meat, three-cheese Wicked, except with double meat to celebrate his son’s performance in a talent show. His mouth locks up trying to take the first bite, at which time he begins punching his own jaw trying to loosen it up. He required surgical repair of double dislocation of the mandible.

E-mail me.

HERtalk by Inga

From Marge Schott: “Re: Streamline Health. In an SEC filing, the company said it won’t be renewing its contract with its sales SVP Scott Boyden. Probably a cost cutting move since Streamline continues to lose money.”

Centegra Health System (IL) says its Kronos workforce management software has saved the system over $1.6 million in labor costs. Centegra uses time and attendance and employee scheduling solutions, which have helped eliminate agency use and reduce overtime by 30%.

Blessing Hospital (IL) and University Health System of San Antonio earn Magnet Recognition by the American Nurses Credentialing Center for excellence in nursing and for providing high quality patient care at all levels of the hospital. Both facilities use Eclipsys.

Speaking of Eclipsys, the company is selected  by The Methodist Hospital of Houston to provide its HealthXchange product. HealthXchange, which is powered by Medicity, will connect Methodist’s acute care EHR with a network of disparate EHRs used by affiliated physicians. 

Picis extends its Microsoft Gold Certified Partner status with specialized competencies in business intelligence and data management solutions.

MedQuist partners with Artificial Medical Intelligence to provide computer-assisted coding within the MedQuist CodeRunner coding workflow platform.

HealthPort announces a money-back guarantee that its EHR software will meet certification requirements for Meaningful Use. Nothing against HealthPort, but I am done mentioning any of these money-back guarantees. I’ll quit worrying that there are still naive providers out there who believe that just because their software is “guaranteed” that they will be “guaranteed” stimulus money.

Thumbs up to Virginia, which becomes the 12th state to require health insurers to cover telemedicine services provided through interactive audio, video, or other media.

Auditors for LSU’s charity-run hospital system finds that its clinic overpaid an outside patient billing firm almost $350,000, while about $8.2 million in patient services were never billed. On top of that, LSU Interim Public Hospital has lost track of movable property originally worth $3.8 million. The overpayment occurred in 2007 when billing firm Healthcare Financial Services double-billed an invoice, both of which Medical Center of LA-NO paid. Less than half the money was recouped two years later. Of the $8.2 million never billed, about $1 million is still recoverable. Not surprisingly, leaders say new checks are being put in place.

AnMed Health (SC) picks Allscripts EHR for its 60 employed physicians and 40 affiliated physicians. AnMed currently provides Allscripts Tiger PM in a hosted model for the physicians and will offer the EHR through a similar setup.

Mercy Health Systems (PA) plans to implement NextGen EHR for its 70 providers across 31 locations. Later in 2010, Mercy will also deploy NextGen Health Information Exchange. The providers have used NextGen Practice Management for almost four years.

John Muir Health (CA) notifies almost 5,500 patients of a potential data breach following the theft of two laptops from a physician office. The hospital says the laptops were in a locked and guarded building and were password protected,  but did not have data encryption. Encryption software is now being installed on all the health system’s laptops.

Evolvent Technologies awards Harris Corporation an 10-month follow-on contract for ongoing enhancements to the DoD’s Healthcare Artifact and Image Management Solution (HAIMS) system.

Unity Medical says it will pilot its new Medical Video jLog for the Apple iPad at Florida Hospital for Children at Walt Disney Pavilion and St. Luke’s Health System (ID). The company provides short interactive videos that provide patients with an explanation of common procedures and treatments.

Passport Health Communications launches eCare Patient Access Suite, designed to help hospitals improve workflow and increase revenues.

E-mail Inga.

Monday Morning Update 4/5/10

ONCHIT announces $60 million in new grants (sounds like chicken feed in these stimulus-happy days, doesn’t it?) University of Illinois at Urbana-Champaign will look at security, Universe of Texas Health Science Center will study patient-centered cognitive support, Harvard takes on application and network architectures, and Mayo will review secondary use of EHR data while maintaining security and privacy. The last one sounds the most interesting to me.

Merge Healthcare sells $42 million of stock in a private placement to help pay for its proposed acquisition of Amicas.

Former QuadraMed VP Chris Callahan joins Sunquest as VP of product management.

Bill Gates composes a fascinating remembrance of Ed Roberts, inventor of the Altair computer and therefore the father of the PC, who died last week at 68. Of course, Bill and Paul Allen kind of screwed Ed legally to get the rights to sell BASIC to other companies even though they had sold Ed an exclusive license, but I guess Bill’s being sentimental now that he’s earned billions from it. I knew but maybe you didn’t that Ed was a country doctor in Georgia, having gone to med school at 41 and finishing first in his class after selling out his computer business in 1977.

Next, on a very special episode of Weird News Andy: two North Carolina doctors are reprimanded for performing a C-section on a woman who wasn’t pregnant. A resident misdiagnosed her “false pregnancy”, the docs tried for two days to induce labor without success, and they finally opened her up only to find no baby. Nobody had bothered to verify that she was indeed pregnant. In their defense, the resident supervision was complicated and false pregnancies are apparently quite believable without diagnostic verification.

Most of us agree that patients should control the use of their health information, although the question of “to what degree” would likely be more contentious. New poll to your right: what impact will the iPad have in healthcare?

CMS auditors conclude that “alarm fatigue” caused by incessant monitor beeping contributed to a patient’s death at Mass General in January. They also found that the patient’s bedside crisis alarm had been turned off. In response, the hospital has disabled the “off” buttons, put more speakers in nursing stations, and assigned nurses to watch monitors full time. While they were there, the Medicare inspectors also wrote up privacy violations, including having patient names on whiteboards and positioning in-room video monitors so that they were visible to visitors.

A two-year-old dies from a heparin overdose at Nebraska Medical Center. The hospital implements the usual after-the-fact changes that sound good, but really aren’t sustainable even for high-alert drugs like heparin: requiring a second nurse to verify the dose, having pharmacy observe the initiation of the bag, and turn on a hard stop on the infusion pumps.

Nuance announces availability of Dragon Dictation for iPad, available for free from the Apple App Store. It supports dictation and sending e-mails by voice.

E-mail me.

Recommended System for a 200-Bed Hospital with Minimal IT Resources

A reader asked me about which systems I would recommend for a 200-bed community hospital with minimal IT resources. Specifically mentioned were McKesson Paragon, Meditech 6.0, and Cerner Millennium. I assume the hospital wants a broad set of applications ranging from revenue cycle to CPOE. My answer, in essence, was this:

• I would definitely choose Paragon over Cerner, especially if there’s no legacy billing system that will be retained (Cerner ProFit is still problematic, I think). McKesson has done a good job in bringing Paragon back from its near-death experience and the field reports, while limited, are good. I think Cerner would be overkill for a 200-bed hospital.
• However, if billing isn’t important, then Cerner’s remote hosted product should at least be considered, even though it’s probably far more complex and than a 200-bed hospital would need. Cerner is notorious for coming well down from list price when pressed since they aren’t selling many new customers, so I wouldn’t pay much of a premium for it. It would also offer a lot capability for the future.
• Meditech 6.0 is a bit of an unknown since it’s new, but if CPOE is a criterion (as it probably should be), that’s the Meditech version they would want. Company performance has slipped a bit, but they are still eminently solid.
• I mentioned that CPSI is strong in that bed range, but that I don’t really know too much about their products.
• I suggested that for a different perspective, the hospital might want to take a look at IntraNexus Sapphire, which offers something a bit fresher than those obvious choices even though it’s not a big company like the others.

So I would rank them Paragon, Meditech 6.0, and remotely hosted Cerner. I didn’t rank Sapphire, but I would still give it a look.

I got 25 reader responses, summarized as follows.

• Most respondents, especially the CIOs, suggested Meditech.
• One comment said that Meditech is straightforward and easy to manage, with 6.0 getting good reviews. That reader also asked me about CPOE adoption. The HIMSS Analytics presentation at HIMSS showed a definite improvement in physician adoption under 6.0 vs. Magic. I think CPOE is important even though Meaningful Use so far requires only 10% penetration, so I don’t know if choosing Magic would make sense.
• A hospital CFO recommended Meditech without hesitation based on personal experience in three hospitals of under 300 beds, where Meditech replaced Siemens, McKesson, and Cerner. He said that Meditech beats Siemens and McKesson on functionality and cost (he didn’t name the specific McKesson product line, which could be Paragon, Series, or Star).
• A consultant also recommended Meditech, saying it’s generic, easy to install, requires minimal training, and requires low maintenance.
• A CIO said it’s Meditech hands down, “not the most advanced, but it will keep you out of trouble.” That’s a solid point – nobody fails with Meditech, so they get an implicit cost advantage due to reduced risk.
• An IT person from a 100-bed hospital provided an informative comment about Meditech C/S, to which the hospital had migrated two years ago from best-of-breed systems. They are very happy to have traded interfaces for integration. Putting in Meditech increased the IT staff from five to 10 employees.
• A CIO recommended Meditech, but said it won’t be cheap and 6.0 may still have kinks. He says Paragon’s functionality is a step up from Meditech, but that CPOE may not have been released yet. He also made a good point: Meditech is so widely deployed that it’s much easier to find independent implementation people.
• A consultant recommended CPSI, Healthland, and Meditech on the basis of integrating administrative, financial, and clinical applications without a lot of IT overhead. However, she also cautioned that prospects should push hard to get Meaningful Use criteria in the contract. She observed, correctly I think, that it’s amazing that big vendors can’t seem to figure out how to scale their pricing and delivery to serve this large market of small hospitals, although lower price points may have cooled their interest.
• A CIO had this interesting comment: “An affiliate relationship with an existing Epic customer. You get all the benefits of Epic without having to host.”
• A hospital IT director suggested the resource issue should put the hosted Cerner suite at the top of the list.
• One reader suggested two systems that I hadn’t thought too much about: CPSI and Siemens MedSeries4. I always forget that MS4 is still around, although I would certainly find out about CPOE usage.
• A reader suggested Paragon, noting that it’s being installed in larger hospitals and doing well.
• I liked this perspective from an IT director in a hospital of similar size and IT capabilities. She said they realized that their functionality requirements weren’t much different from those of bigger hospitals and the smaller vendors backed out for that reason, so they are looking at Millennium or Siemens Soarian and options for a quick build, remote hosting, and possibly outsourcing some of the application support to the vendor.
• A hospital IT project director suggested QuadraMed QCPR, saying it hasn’t been well marketed but noting that it has lots of functionality for both inpatient and outpatient clinicals as well as ancillary departments. She also noted its track record in big hospitals, its recent award in Saudi Arabia, and its configurability and rules engine.
• A consultant says his company usually recommends Meditech and Paragon and can host either. He does not recommend Siemens because the contracts are too restrictive.
• A hospital analyst suggested Cerner.One reader ranked them as Paragon, Meditech, and CPSI.
• A consultant said his choices in order would be CPSI, Paragon, and as a low third choice, Meditech.
• One reader gave his picks as MedSeries4, Meditech, and Paragon, all from larger companies with a better chance of survival.

Thanks very much to everyone who took the time to respond. This is excellent information for the reader (and for me). We ought to do this more often.

News 4/2/10

From The PACS Designer: “Re: Wall Street Journal iPad review. TPD has always admired Walt Mossberg’s technology reviews and he’s done another good one on the Apple iPad. The iPad is thinner than a netbook and weighs only 1.5 pounds. Walt was able to get eleven and a half hours on the battery before needing a recharge! If you want to be the first to have one, get in line early as supplies are limited due to production being offshore.”

From anesoptime: “Re: Epic. Go to epic.com today, April 1st. I’ve worked with many of the big EMR vendors and many niche vendors. This is one of the many reasons I will only work on Epic projects and for Epic clients. They have a sense of humor and they do everything first class or at least put their best foot forward.” Lots of folks e-mailed me about Epic’s brilliant home page replacement, full of phony April Fool’s news (click the image above to enlarge it if you missed it). More than one person was fooled by the “Company Reveals Plans to Go Public” headline, I’m told. Also on the page: Epic Issues First Press Release; Epic Offers Training Course in Cow Chip Throwing, Suggests You Duck; and Epic Offers Organic, Home-Grown Carrots as an ARRA Alternative for Docs. Truly inspired, irreverent, and right in character. They are the Google of HIT. Apparently the employees didn’t even know about it.

From zaphod bebblebox: “Re: CSC. Ouch! CSC and iSoft again miss a go-live date at critical first major activation site amidst comments of failed data loads and in excess of 100 software errors. CSC have been told by NHS that they will not receive expected substantial cash payments associated with this milestone and their hoped for contract reset will not be signed.  Both CSC and iSoft had previously told analysts that they were expecting these payments for their end of quarter results and that they would meet this milestone. More importantly, Morecambe Bay Trust have decided NOT to go-live on the software at any forseeable date.”

I just ran an interview I did Wednesday night with Gary Cohen, executive chairman and CEO of iSOFT. I asked him about the critical Morecambe Bay go-live. That’s important because it was announced today that the NHS-mandated deadline has been missed, meaning that primary contractor CSC will not be eligible to get a renegotiated deal and, in fact, may be in danger of being replaced (although in the UK, “with whom” is always a good question since all the usual contractors have already bailed). Judging from the rhetoric, I’d say it’s an NHS bluff, especially considering that the trust itself has some responsibility for its own state of readiness. Still, it puts the heat on CSC contactor iSOFT and its Lorenzo system, also discussed at length in my interview.

Listening: Michael McDermott, reader-recommended Irish-American folk/pop music. I like it.