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.

News 3/31/10

From Stifler’s Mom: “Re: Medicare. Doctors to take a pay cut. Tricare’s getting cut too.” AMA’s president decries the 21% Medicare pay cut that will hit doctors on April 1. It’s a Catch-22 situation: more patients will be insured under healthcare reform, which will eliminate the need to use hospital EDs for basic care, but the scarcity of primary care docs coupled with reduced payments means those patients will wind right back up in the ED because they won’t be able to get appointments otherwise. As long as Medicare richly rewards procedure docs while stiffing PCPs, there will by the law of supply and demand be way too few PCPs. Just giving everybody an insurance card isn’t going to solve that problem. Let’s hope Don Berwick can blast through the bureaucracy, not only at CMS, but throughout the federal government. If anyone can, I’d say it’s him. Personally, I can’t believe he took the job and I’m sure he didn’t do it to fulfill a long-held hope of becoming a bureaucrat.

From The PACS Designer: “Re: Apple’s iPad release. The wait is over. Saturday will usher in the iPad era for Apple. There will be many reviewers to tell us what they think of their new business and play tool. One of our own, the esteemed Dalai, will give us an early indication of its usefulness when he gets his iPad via a shipper from China and starts to play!” I got Mrs. HIStalk a netbook for traveling and I kind of like that, too. It will fit into a mid-sized purse, weighs next to nothing, has a battery life of over 10 hours, and hops onto a wireless network easily. It’s running Win 7 Starter, is fast, has all the hard drive you’d ever need, and sports the usual array of external ports. The keyboard feels pretty good and the display is just fine. It comes with Microsoft Works, which can read and write Word files, but I’ll hook her up with Google Docs. It’s pretty cool for less than $300.

The Charleston, SC business paper writes up Carolina eHealth Alliance’s project, in which 11 hospital EDs are exchanging information using technology from TELUS Health.

Tressa Springman, CIO of Greater Baltimore Medical Center, writes an article called Improving Clinician Communication that describes that organization’s rollout of the TeamNotes clinical documentation system from Salar, which they integrated with their incumbent EMR. “Too often, hospitals are forced to implement technologies to meet an externally mandated deadline. These are the situations where teams are faced with short-changing the required thoughtfulness of the good design, resulting in a bad system that needs to be reworked. In contrast, I feel very good about our implementation of Salar’s clinical documentation at GBMC, because I feel that we are doing it for the right reasons, at the right pace and in a quality manner driven by a high degree of physician engagement.”

Walt Disney Pavilion at Florida Hospital for Children rolls out GetWell Town from GetWellNetwork, offering patient education, entertainment, and Internet access. The company will announce an agreement tomorrow with Child Health Corporation of America that will make GetWell Town available to its 40 leading children’s hospitals.

East Orange General Hospital announces that it will implement GE Centricity Enterprise. This is an interesting quote: “East Orange General Hospital, under EOGH President Kevin Slavin, started community meetings regularly. In one of the meetings, a GE representative happened to be there and they helped introduce the system to the hospital.” Nice work by the salesperson who “happened” to show up and pitch product at a community meeting. They earned that big commission.

A reader asked me which full hospital information systems a 200-bed hospital with light IT resources should look at. I gave my answer, but I’m curious: what would yours have been? E-mail me your thoughts and I’ll compile them here and share what I said.

A doctor who made $1.5 million writing over 100,000 prescriptions for online “patients” he hadn’t examined gets five years in prison.

A good idea from HHS’s Adoption/Certification Workgroup: put feedback buttons on EHR screens so clinicians can report problems. It’s not a new idea and some systems have them, but they all should if you ask me.

E-mail me.

HERtalk by Inga

From Bad Blake: “Re: Scott Freeman. The former territory vice president at McKesson Physician Practice Solutions, has accepted the role as head of business development for Zynx Health out of Los Angeles.” I see that Scott lists the new job title in LinkedIn, even though someone else is credited with the BD title on Zynx’s website.

From Clareece Jones: “Re: Berwick over CMS. Great news for patient safety.”

Saudi Arabia National Guard Health Affairs wins the Excellence in Electronic Health Records Award for its use of QuadraMed CPR. The award, which was presented at the Arab Health Exhibition and Congress, is given to the healthcare providing making the most innovative use of EHR to reduce error and increase safety and efficiency.

A Connecticut radiologist who was terminated from his physician group accesses a hospital’s computer system and looks at images and personal data for 957 patients. The doctor then allegedly contacted some of those patients and encouraged them to seek service at a different hospital. Apparently after the doctor left the staff at the original hospital, he hacked into the DPAC system using other radiologists’ passwords. The state attorney general is investigating. If I were investigating, the first thing I’d ask is how the heck did the doctor have access to all those passwords.

Eclipsys partners with Rothman Healthcare Research to build Rothman’s Patient Condition Tracker Solution software on the Helios by Eclipsys open architecture platform. The integration will give Eclipsys hospital clients the option to use Rothman’s application in an integrated environment without needing to develop an additional interface.

CPSI’s CPOE, E-Mar, and pharmacy applications achieve “approvable” status from the Ohio Board of Pharmacy. The designation means the software can be installed in Ohio hospitals without further inspection from the Board of Pharmacy.

You can find the list of Thomson Reuters 100 Top Hospitals here. The ratings are based on public information and assess hospitals’ performance in 10 different areas. Thomson Reuters claims that more than 98,000 additional patients would survive each year if those patients received the same level of care as ones treated in Top 100 facilities.

Frederick Memorial (MD) expands its relationship with MEDSEEK to develop a comprehensive eHealth ecoSystem. I believe that is a fancy way of saying that Frederick will be combining its existing MEDSEEK physician portal with a consumer-facing Web site.

eClinicalworks says it has implemented 2,000 providers across 400 independent practices in New York City over the last two and half years. Another 600 providers and 100 practices are in the implementation process.

And in the Midwest, physician network Advocate Physician Partners partners with eClinicalWorks and will recommend eCW’s PM/EMR to its 2,600 independent physicians.

North Florida Surgeons selects Allscripts EHR/PM solution for its 34-provider practice. The practice’s CEO says that a key reason they selected Allscripts was the availability of Allscripts Patient Payment Assurance module to to calculate patient responsible amounts and secure payment authorization prior to surgery. I mentioned this in HIStalk Practice yesterday and the Allscripts folks told me that this particular module, which is offered in partnership with mPay Gateway, is proving to be a big competitive advantage.  I suppose that serves as a good reminder that clinical software is not the only thing providers are worried about these days.

Speaking of Allscripts, the former Healthmatics division president David Bond and ISTA CEO Kernie Brashier join Navicure as VP of sales and CTO, respectively. Less that a year ago Mr. H mentioned that Bond had started a social networking site for teen athletes, which I guess wasn’t as fun as the RCM biz.

The North Hawaii Health Information Exchange (NHHIE) is leveraging Wellogic technology to connect the North Hawaii Community Hospital, the Hawaii IPA, and independent physicians, as well as labs, pharmacies, and other care providers.

The chairman and CEO of MMR Information Systems tells an HIT investment forum that the company expects that by year end, over one million people will use MyMedicalRecords PRH and MyESafeDepositBox services. I just wonder who all these people are, since I don’t know anyone who actually maintains a PHR.

The trustees for St. John’s Medical Center (WY) approve a $1.2 million software purchase to expand the hospital’s EMR system. I believe that St. John’s currently uses McKesson’s Paragon. The local paper was a bit short on specifics, but it sounds like St. John’s plans to add e-MAR functionality.

Mr. H is graciously allowing me to take Thursday off. Best wishes if you are celebrating Passover or Easter this week. I’ll be feasting on malted eggs, and if I’m lucky, a dark chocolate bunny.

E-mail Inga.

Healthcare IT from the Investor’s Chair 3/28/10

March 2010 HIMSS Health IT Venture Fair, a View from the Room

Now that the dust from HIMSS2010 has settled, all the follow-up e-mails sent, and the trinkets and swag carefully filed away, I wanted to delivery my (sorry) overdue thoughts on the Venture Fair that was held on the Sunday before the full festivities got underway. Truthfully, I think Mr. H’s primer on common mistakes was outstanding, but he asked me to share my thoughts from the room and the day in general.

Overall, I think the event was both well done and well organized (though how there turned out not to be enough books which listed the companies and their business summaries was an annoying mystery). I’ll first note that the Venture Fair is primarily sponsored by companies looking to service the attendees, and that’s also how the panels were developed. That’s not necessarily a bad thing, as the would-be entrepreneurs could well benefit from hearing the views of practiced attorneys, bankers or recruiters who can provide critical advice and services to companies of all stages.

A key challenge of the day, however, is that there are really two customers/stakeholders in attendance — entrepreneurs and sources of capital. For the former, I’m sure the three panels were invaluable and I hope they paid close attention to them. For the latter, let’s just say I saw a lot of wandering eyes and smart phones being none-too-surreptitiously used. Financial sponsors were there to see potential investments, and many likely could have been on the panels themselves.

I thought the most interesting and helpful panel was the one that combined entrepreneurs with bankers and lawyers to talk through issues such as types of financing, sources of capital, and how valuations are typically determined. The candor of both the agents (Healthcare Growth Partners) on why or why not to engage them and the entrepreneurs on mistakes they’d made (MEDecision) were thoughtful and sometimes things that can only be learned the hard way (i.e., consider where a potential investor is in their fund’s lifecycle).

A panel discussing legal issues around intellectual property and risk management trended towards the arcane to me (HIPAA galore), but many audience members seemed to find it more relevant. The lunch discussion on how early stage companies can work with the Office of the National Coordinator was also likely helpful for companies interested in dipping their toes into the taxpayer trough for funding.

Bottom line, much of the morning could have been called “An Introduction to Venture Financing 101”, and for most early stage companies, this fairly quick and easy way to gain knowledge about sources of funds, types of investors, use of an agent, and the highly critical difference between terms and valuation (plus the ability to ask questions), was time well spent. I’d encourage entrepreneurs seeking knowledge in these areas to consider attending in the future.

After lunch, with a rousing “Play Ball”, the pitches began. Each company was given the podium and the PowerPoint projector to provide a 15-minute or so introduction to and overview of their business and prospects. Each investor, incidentally, was given a blue dot sticker for their name badges to facilitate the speed dating. After the presentation, the investor left the stage and the room, and in many cases, the swarms of funders followed for outside conversations. I’m sure it was a tough call – “If I follow this guy to impress him and potentially have a call option on funding, do I miss something even better?” I confess I missed a few presentations myself for sidebar chats with friends and colleagues in attendance.

Overall, I have to say the caliber was mixed, as is often the case for events such as this. Rather than comment on all 21, let me hit a few high points directly, a few lower points more obliquely:

• Projections – Show Some Realism. With very few exceptions, the projections were overly aggressive, in some cases approaching absurdity. Yes, I know you’re a growth company, I know investors like to see a “hockey stick” income statement, but in my experience, a bit of realism goes a long way towards establishing credibility. I hope I’m wrong, but I just can’t see the company that projected over $120 million in Year 5 revenues hitting their forecast. Other noteworthy five-year forecasts ranged from $36 million (with 83% EBITDA margins), $42 million, and a company with a product still in alpha reaching $47 million in three years. As Grace said on LA Law, “Goes to credibility your honor”. That said, I actually liked that particular company’s concept and management team.
• · Exit – Be Thoughtful. As a good friend of mine who’s an active banker in the space says, “Where there’s outside capital, there’s a need for liquidity”, and that’s always something both investors and entrepreneurs should bear in mind. This, too, goes to credibility: for example, saying “An investor in [XXX] can expect to see a return of 10 times their investment in three to five years.” Well, maybe they can, depending on the value and terms, but I was surprised to see that very sentence on a page that (as each page did) listed the two sponsoring law firms. Similarly, one company predicted the exit would be via sale to a Fortune 500 HCIT Company. I’ll personally go out on a limb here and say I don’t think McKesson will bite (but again, hope I’m wrong).

Broad Categories – Investors are Careful. Apologies if I sound jaded or am fighting the last war, but I’m sure I’m Little Mr. Sunshine compared to many in the venture community. Here are a few of my views and biases:

• I think the office-based physician market ship has sailed and I’d be loathe to fund a start-up with simply a better mousetrap. I’d want to see significant sales before investing, so friends and family or Angels might be the best road to pursue. Exit will be a challenge. While I maintain EMRs have destroyed more venture dollars than anyone will admit, I confess I’ve been wrong here before (but was right more often).
• I think the RIS/PACS software area is even more difficult. Most of the larger players filled their dance cards during the days when Merge, Amicas, and Emageon were high flyers instead of one small-cap company.
• Maybe I’m missing something, but I’ve yet to see a PHR with a remotely compelling business model. More scarily and interestingly, I’ve yet to meet more than one person who actually uses one. If any readers who use and maintain a PHR for themselves or their family would indicate in the comments section below, I’d be grateful. Incidentally, the concept of sample bias suggests if the readers here don’t, not many random people/patients will.

A Few Stand-Outs. If I had a checkbook, I’d likely want to have a conversation with a few companies. Before naming them, I want to remind readers that: (a) I might have been out of the room chatting with someone or attending to imperatives like coffee, so might have missed the best in show, please don’t be offended if it was you; (b) ST Advisors, LLC has not done business with any of the companies mentioned, but that could change (old banking habits die hard); (c) I’m just a guy with an opinion. I have a space limit of only five so, without further ado and in alphabetical order:

• EDMIS. Despite an absurdly sized booth at HIMSS for a company of its size and focus, I think the ED is an area that needs fixing more than most and point solutions can work particularly well in that environment.
• Logical Images. A unique idea that brings visual diagnostic decision support for clinicians with a subscription model. Projections that appear realistic suggest thoughtful management. Sadly, the company appears to be only seeking strategic investors. I’d pay extra attention to exit, however.
• MedCPU, Inc. Appealing model that “rides on top of existing hospital systems to bring real-time decision support and brings evidence-based medicine to the point-of-care. “ Also a team with a track record, which is always a huge plus in my experience.
• YourNurseIsOn.com. Despite a name that, frankly, reeks of 1999 and projections that I’d dial down, I like businesses that solve a real and difficult problem like the nursing shortage. I saw the company at Health2.0 (where it was also one of the standouts), and like how the story evolves. My primary concern would be around entry barriers (i.e., what’s proprietary about its offering?)
• Prodigo Solutions and Sentient Health. I missed part of their presentations, but I continue to find supply chain and related areas interesting as well. Lots of money floating around, not enough attention being paid, multiple buyers for an exit, and a tendency towards high recurring revenue models all appeal to me.

As ever, thank you for your attention and comments, please drop me a note if there’s a topic you’d like me to address or have questions for Ask the Chair.

Ben Rooks
The Chair

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

Monday Morning Update 3/29/10

From Lazlo Hollyfeld: “Re: MedPlexus bought by GE. Now granted they likely had a pretty small install base (my bet is 300-350 providers max) but what is going to happen to practices on these ambulatory EMR systems that are inevitably scooped up by larger vendors or more likely left on their own when the tide of HIT stimulus funding inevitably reverse itself in another 18-24 months?”

From In the Cheap Seats: “Re: DocuSys. I hear its was purchased by Merge Healthcare who also bought Eko, a competitive Anesthesia EMR vendor last year. They just finished acquiring Amicas as well.” Not yet announced, but sources tell me the deal for Merge to acquire the Atlanta-based anesthesia systems vendor was signed this weekend. Maybe its tagline was a hint.

From patientsmatter: “Re: Yale-New Haven Health System. I had dinner with an executive clinical leader there last week, where it was said that today the system has three different EMRs in place, but there is a 90% chance they are scrapping them all and choosing Epic.” From my previous reports, it’s almost a done deal if the health system can work out the financial issues.

From Anodyne: “Re: Iowa Health. After more than five years of slogging through a statewide implementation of Allscripts, Iowa Health is changing vendors to the darling, Epic.” Unverified. They were already Epic on the inpatient side, right?

From Consuela: “Re: QuadraMed. Laid of 32 yesterday, mainly accounting and compliance.  Makes sense due to being private and not needing the Sarbanes and SEC stuff and basic accounting functions can be handled by the VC company.” Unverified, but you are right — that would off some relief from the overhead of being a publicly traded company that wouldn’t affect customers anyway.

From Dos Equis: “Re: HIPPA. You have to love that after almost 15 years, Health Data Management misspelled it that way in the survey they sent to readers today.” Not to be overly persnickety, but they also misspelled HITECH right next to it, going lower case for some reason even though it’s an acronym. But it’s probably not the editorial people who created the survey, so I don’t read too much into it.

From UDontKnowme: “Re: Epic’s turnover. The 5% estimate is conservative. Turnover rate, specifically within implementation is well above 5% and is in more to the tune of 15-20%. The average tenure for implementation is about two years. Also, the plan for hiring 500 over the summer is in fact, lower than previous years’ summer hiring plans.”  

From JoseMama: “Re: Peel’s WSJ editorial. It’s valid to critique whether we’re doing enough from a privacy standpoint, but her point of view lacked context. Are your medical records safe on a physical shelf? Or being shuttled around in a truck from facility to facility? And at least when UCLA Medical Center workers looked at Octomom’s medical record, they could track who did it and fire them.”

From Matics: “Re: informatics. You had a post by Indra Neil Sarkar, director of biomedical informatics at the University of Vermont, that ‘There are only about 2,000 to 5,000 of us who are formally certified informaticians.’ Formally certified? Certification in medical informatics does not yet exist. Perhaps he meant postdoctoral trained and/or MS/doctoral degreed?”

  

Picis CEO Todd Cozzens writes an unusually frank criticism of healthcare reform, nearly all of which I find myself agreeing with:

Most of us who live and work in the healthcare world know that something had to be done about the uninsured, the pre-existing condition denial and other key inequalities in our system. What many of us are upset about is that bill that was cobbled together in order to get rushed through ahead of the next election, is not a cohesive, logical plan where increases in care and coverage are met with responsible funding and cost containment. The sum of these parts is an incongruous amalgamation of special interests, one-off provisions, unbridled future costs and somewhere buried deep inside are some good things for patients.

News 3/26/10

From Soft Sales: “Re: Microsoft Amalga. Robert Seliger, former CEO of Sentillion, will take over sales. This was announced internally on 3/15.” Not exactly, but close. Per my Microsoft contact, former Sentillion president Paul Roscoe will lead the sales organization of Microsoft Health Solutions Group, integrating the sales teams of HSG and its recent Sentillion acquisition. Steve Shihadeh will report to Paul. This is quite interesting — obviously Microsoft had a lot more respect for Sentillion than just buying its single sign-on and context management technologies. Putting someone with healthcare sales experience in charge is a good move if you ask me — we’re not talking shrink-wrapped retail sales here.

From UKnowMe: “Re: CSC. Is it putting itself up for sale? Or at least its healthcare biz?”

From All Hat No Cattle: “Re: NIST. Looks like they are still disregarding system usability.” NIST’s Health IT Standards and Testing page outlines its testing programs, none of which appear to involve usability. Of course, there’s already a measure of that: low adoption.

From OhWell: “Re: Epic installs. UKnowMe is right, Epic is selling like mad. Rumor has it that Epic is looking to hire 500+ people by the end of the summer. So much for experienced implementers or even experienced advisors with the time to focus on each install.” People have been saying for years that Epic, like Cerner and everyone else before it, will eventually hit a wall. It hasn’t happened yet, but competitors are hoping they’ll run out of steam. Of course, they aren’t really doing much to give Epic a run for their money, either.

From Mark Moffitt: “Re: HISsies award for service oriented architecture as the most overrated technology. I’m a big advocate of web services, aka SOA, as a catalyst for change in HCIT. That being said, I have to agree with the award above. Vendors may be embracing SOA under the hood, but very few vendors expose services so customers can take advantage of the technology. As a result, the impact has been muted from a customer perspective. Until vendors make services available to customers and other vendors, like: get_data(patient, med_list) or: go_do_something(patient, order, md), the HCIT public will continue to view SOA as an ‘overrated technology.’ I continue to plead with vendors to expose services. Unfortunately, I  get the response, ‘When customers start demanding it, we will provide it.’ Well, I’m demanding it. How many more have demanded it and gotten the same response? Or they offer it but not to customers, only partners that don’t provide a competing product. The push back I hear from vendors is ‘we don’t want to be held liable.’ Really? If I repair my car and install brakes incorrectly, have an accident and crash into another vehicle, is the victim going to sue Ford, or Toyota, or GMC and win? I don’t think so. A simple release agreement that relieves a vendor of liability is all it takes. I’d like to hear from vendors on this topic.”

Inga’s been busy again, as you’ll see tomorrow when she posts our latest executive Q&A series entry. A dozen or so industry executives answered this question: “Now that the ONC has announced the initial grants for Regional Extension Centers, what will be the effect on EHR selection and implementation for both the industry and your company in particular?”

Listening: Luscious Jackson, reader-recommended, all-female pop with hip-hop influences. Defunct for a few years, but I’m pretty crazy about them.

UCSF names Elazar Harel as vice chancellor for IT and CIO, which includes dotted line responsibility for the CIO of UCSF Medical Center, fresh off a failed Centricity implementation.

Dave Garets and Mike Davis, the two top guys at HIMSS Analytics, start their new gigs with The Advisory Board Company on Monday. HIMSS says it will replace them.

Richard Ferrans MD, CMIO of Memorial Hospital of Gulfport (MS) will talk about the Mississippi Coastal HIE in a Medicity Webinar on Wednesday, April 14.

DEA publishes an Interim Final Rule on e-prescribing of controlled drugs (warning: it’s a 334-page PDF). There’s the usual 60-day comment period. I haven’t studied it yet, but if anyone wants to summarize whatever is interesting in all those pages, feel free to send me your thoughts.

Researchers in France begin a project to identify patients at risk for hospital-acquired infections by scanning electronic medical records with a Xerox text mining tool called FactSpotter.

Sisters of Charity Health System (OH) names Robin Stursa to the newly created position of VP/CIO. She was previously at Saint Vincent Health System (PA).

An opinion piece by Deborah Peel, MD of Patient Privacy Rights called Your Medical Records Aren’t Secure runs in the Wall Street Journal.

There is no need to choose between the benefits of technology and our rights to health privacy. Technologies already exist that enable each person to choose what information he is willing to share and what must remain private. Consent must be built into electronic systems up front so we can each choose the levels of privacy and sharing we prefer. My organization, Patient Privacy Rights, is starting a Do Not Disclose petition so Americans can inform Congress and the president they want to control who can see and use their medical records. We believe Congress should pass a law to build an online registry where individuals can express their preferences for sharing their health information or keeping it private. Such a registry, plus safety technologies for online records, will mean Americans can trust electronic health systems.

Bonnie Siegel, formerly of Dorenfest and Hersher Associates, joins HIT executive search firm Sanford Rose Associates.

UC Irvine researchers are developing Telios, a Web-based telepresence system that will offer videoconferencing and remote patient monitoring tools.

Ironic beneficiaries of healthcare reform: offshore business process outsourcers, which are even more attractive when administrative cost-cutting gets serious.

A tidbit from the trial of the former CEO of University Medical Center (NV), accused of squandering $11 million on no-bid contracts: one contractor got $850K for producing a 30-minute PowerPoint describing an IT system the hospital already owned.

Red Hat announces Q4 numbers: revenue up 18%, EPS $0.12 vs. $0.08.

E-mail me.

HERtalk by Inga

Earlier this week, Mr. H mentioned that The Kansas City University of Medicine and Biosciences and its former president are suing one another. A local paper points out that former president Karen Pletz is now better known than she was before the firing. That’s because there are plenty of people (like me) who are drawn to the salacious aspects of the story. On the one hand, we have the medical school, which claims Pletz abused her expense account, racking up $2.3 million in food and travel charges.Then we have Pletz, who counters that she’s a victim of conspiracy, aimed at making her the scapegoat for a board that was paying her a huge salary ($1.2 million a year) and approving hefty entertainment expenses. Someone’s hiding something and it all makes for a juicy trial.

Another not-for-profit hospital system agrees to be acquired and transformed to a for-profit entity. Caritas Christi Health Care says that private equity firm Cerberus Capital Management is buying the six-hospital system for $830 million, which includes $430 million to pay off debt and $400 million on major improvements, such as upgrades to IT systems.

Masonicare Healthcare Center (CT) agrees to deploy MED3OOO’s InteGreat EHR for the physicians serving its facility.

Vanderbilt University Medical Center selects Accelarad’s SeeMyRadiology.com service, giving orthopedic surgeons the ability to exchange medical images in real-time via the Web or a mobile device.

Allocade, a developer of patient flow software, closes a $5 million round of VC financing led by VantagePoint Venture. Allocade intends to use the money to expand operations to meet the increased demand for its On-Cue solution.

The ONC appoints Aaron McKethan and Craig Brammer as the new program director and deputy director of its Beacon communities project. The project will award about 15 grants to non-profit organizations or government bodies to help them achieve meaningful use of their EHRs. McKethan is a research director at the Brookings Institution’s Engelber Center for Health Reform and Brammer is a project director at Cincinnati’s Aligning Forces for Quality.

CareTech Solutions and ForeSee Results announce they’ve formed a strategic partnership to provide CareTech’s hospital clients with an online customer satisfaction measurement and monitoring tool.

ICA vice president John Tempesco is named a Fellow of the American College of Healthcare Executives.

Sermo and athenahealth release results from a Physician Sentiment Index that indicates doctors aren’t too happy with the business of medicine. A couple of the more disturbing findings: 59% of physicians think the quality of medicine will decline in the next five years and 64% agree their clinical decisions are being based more on what payors are willing to cover than what they think is best for their patients. Sermo CEO Dr. Daniel Palestrant explains the results in more detail in this CNBC interview.

March 25th is National Medical Biller’s Day, according to the American Medical Billing Association. Thank you, billers, for keeping the money flowing!

Sixteen Harris County Hospital District employees who were fired for HIPAA violations in November get their jobs back. Hospital district administrators reassessed the intent of the violation and reinstated the workers’ jobs, though no back wages will be paid. The firings occurred after one of hospital’s medical residents was shot in a grocery store parking and became a patient at the hospital. The medical resident survived.

GE acquires MedPlexus, an EMR PM vendor that targets the 1-10 physician practice market. My first thought was why would GE make this purchase given that they already have the Centricity product? However, if I recall my ambulatory EMR history correctly, Centricity EMR is not truly integrated with a practice management product, but interfaces with either the Centricity Practice Solution (the old Millbrook product) or Centricity Enterprise (the old IDX software). MedPlexus, however, appears to be a fully integrated PM / EMR / patient portal solution. It’s also a hosted product, which is possibly a more attractive and affordable solution than GE’s traditional client/server options. And, Centricity EMR has not had stellar KLAS ratings in the last couple of years, so perhaps GE needed a fresh option.

CentraState Healthcare System (NJ) contracts with Design Clinicals to implement MedsTracker patient medication management. CentraState went live December 7th and says they’ve cut medication reconciliation time from about three minutes to one minute 38 seconds.

Dell unveils its Medical Archiving Solution, which is based on its upcoming Dell DX Object Storage Platform. Dell hopes the new technology will appeal to hospitals needing to increase storage for growing EMR and digital imaging systems.

Huntsville Hospital (AL) selects MedAssets’ RCM solutions for claims management and claims audit and resolution.

E-mail Inga.

News 3/24/10

From Lee H: “Re: Marshfield Clinic. Bob Carlson is out of the CIO role after just a year. The previous CIO is back for the interim.” Unverified. Bob’s still listed as CIO on the clinic page, but not on his LinkedIn profile. The former CIO was Carl Christensen, moved to CTO last April.

From T. Corolla: “Re: HIStalk. I started reading you the day the blog hit the center column of the WSJ. There are a lot of blogs and there is a lot of criticism of the healthcare industry flung about. I’ve been in it for 35 years and I don’t have time for people who bleat just for the attention. The WSJ article gave you credibility. So I’ve been reading and recommending HIStalk ever since. It has been the single most helpful glimpse into this world. I get sick of the self-gratifying vendor claims and the paid endorsements. I want to know if a product is useful, if the people behind it are honest, capable and knowledgeable, and where it has been deployed. I want to know if promise didn’t pan out. When it is a success, I’d like to know what made it successful. I want to know about what other organisations are doing. I want to be told a straight story. A little humour helps because this is a crazy world and we all need a laugh. You and Inga do that well. What you both do is valuable to me. Thank you for doing it. And thank you for doing it so well.” And thank you for those extremely kind words, which I hesitate to run because it appears immodest, but I conveniently justify it with the rationalization that I’d run them even if they were critical. Since I’m feeling nostalgic, above is my very first HIStalk post from June 30, 2003.

From The PACS Designer: “Re: Windows 7 sales soaring. As we move toward the middle of this year, it looks like Windows 7 is going to be a huge success. The increased sales are from desktop users who want the latest and greatest from Microsoft.” I’m actually running the beta of Office 2010 and it’s pretty good, at least for the minimal uses I have for it. Ever notice that each Microsoft software release goes toward more muted colors? I like that since, taking a cue from car makers (maybe not the best source of inspiration) it makes the old model look gaudy and cheap by comparison. I also noticed that WinXP support ends on July 13, meaning you’d better either be planning to go with Win 7 or to install XP Service Pack 3.

From UKnowMe: “Re: Epic. It seems just about every week I hear about another organization that has selected Epic. How in the world are all of these implementations going to be staffed with experience people? Consulting firms and hospitals are already killing themselves trying to keep up. What will the market look like 3-6 months from now?” Probably about the same — experienced people pitching engagements, newbies actually running them.  

Listening: Brendan Benson, pretty good power pop if you’re in the mood for something peppy. I’m kind of not, so I’ve moved to Nightwish, dark Finnish operatic metal.

The Kansas City University of Medicine and Biosciences and the former president it fired in December exchange lawsuits. They allege fraud; she claims wrongful termination; the lawyers squeal with delight.

Trinity Health (MI) chooses workforce management solutions from Kronos for its 46,000 employees.

It’s Weird News Andy’s moment in the sun, about, as he calls it, “not the sharpest knife in the drawer.” A teenager working in an Internet cafe is assaulted by gang members who accuse him of cheating in a video game. He ends up with a 10-inch kitchen knife shoved completely through his skull, sticking out of both sides of his head. He strolls into the local hospital, where employees thinks it’s a teenage prank with one of those Halloween knives until he collapses. Luckily (or maybe not, depending on your perspective) it didn’t hit anything important and he’s fine. And in a rare double header, WNA says of a boy with a record 31 fingers and toes who’s having some of them removed, “Inigo Montoya must really hate this kid.” I just saw Princess Bride again last week, so I got it right away. Incontheivable!

The State of Massachusetts, drooling at the prospect of federally fueled HIT dollars, will hold the Governors National Health IT Conference on April 29-30 in Boston featuring Governor Deval Patrick, Kathleen Sebelius, David Blumenthal, John Halamka, Marc Overhage, Paul Tang, and Micky Tripathi. Registration runs $350 for non-profit employees and $500 for for-profit. Unfortunately, I expect the HIT benefits listed in the headline above are in order of importance.

The New England chapter of HIMSS will hold its annual public policy forum next Wednesday in Norwood, MA.

iMDsoft gets its first sale in Denmark, with Gentofte University Hospital choosing MetaVision clinical information system for its brand new ICU. The company also announces that Dominion, an IT solutions provider in Spain, will distribute MetaVision in that country.

The fired CEO of University Medical Center (NV) goes on trial, facing charges of giving no-bid contracts worth $10 million to acquaintances. One consulting company had no other clients and was housed in the garage of the owner’s mother. The CEO blamed the computer system for his need to stop providing monthly financial reports, after which the hospital was found to have lost $50 million in the previous two years.

I installed a cool iPhone theme on HIStalk Practice just to make Inga happy, so if you read it on a smart phone, it’s going to be fast and cool. I’ll put it on HIStalk when I get some time. 

BusinessWeek speculates that if Google or Microsoft makes a bid for Nuance as has been rumored, the healthcare operation, which makes up 44% of sales and includes Dragon Medical and eScription, could be split off and sold to an acquirer such as Cerner, HP, or IBM.

A university in Switzerland is examining bodies using a virtual autopsy robot based on MRI technology and topography software, which also makes a copy that can be studied later.

A man is arrested in Australia for posing as an female nurse in suicide chat rooms and persuading at least five people to kill themselves in front of a webcam while he watched.

In the UK, The Guardian claims that the $20 billion NPfiT project is closed to going down in flames, besieged by missed deadlines and flagging support. iSoft’s Lorenzo was supposed to be live this month under threat of replacement.

E-mail me.

HERtalk by Inga

TriZetto Group signs an agreement with 3M Health Information Systems giving TriZetto the right to include the 3M ICD-10 Code Translation tool with several new services for payers under its TriZetto Advantage 10 Services family. Initially TriZetto will integrate the 3M technology in a provider contract modeling service and ICD-10 translation mapping service.

Consulting firms Deloitte, ACS, and CSC hold the largest share of clinical implementation engagements, according to a new KLAS report. When acting as the lead on clinical engagements, ACS, CTG, and Deloitte earned the overall highest performance ratings, winning higher rankings than past leaders like IBM and CSC. In addition to full service firms, companies like maxIT Healthcare and Vitalize were noted for their experience and solid team of skilled consultants.

Newark Beth Israel Medical Center launches an enhanced version of EDIMS EHR in its emergency department. The latest release includes an RCM module, CPOE, and improved physician and nursing documentation tools.

Vitality will rely on the AT&T wireless network for its Vitality GlowCaps product, intelligent pill caps that fit on standard prescription bottles and use light and sound reminders to remind patients to take medications. If patients don’t comply, they’ll receive a phone call or text message reminder.

Lake Region Healthcare (MN) selects Allscripts EHR and PM solution for the 50 affiliated providers at Fergus Falls Medical Group.

The Mayo Clinic enters into a collaboration with VitalHealth Software to develop an EMR specifically for primary care physicians. The technology platform, which will launch later this year as a SaaS offering, is based on several years of development and implementation design within Mayo’s primary care practices. VitalHealth is a joint venture between the Mayo Clinic and the Netherlands-based Noaber Foundation

The Alaska Native Medical Center selects Cerner’s HIS solutions, including registration, scheduling, and CPOE. An October 2011 go-live is planned.

Hudson Headwaters Health Network (NY) adds  athenaClinicals for its 100 providers. Its 12 health centers already use athenahealth’s RCM service.

Psychiatric facility Silver Hill Hospital successfully implements Medsphere’s OpenVista EHR.

Chamberlin Edmonds and Associates introduce PinPoint, a Web-based patient eligibility screening application for hospitals.

East Carolina University’s Family Medicine residency program selects Retasure for retinal risk assessments.

Excellus BCBS awards 48 New York hospitals over $22 million in quality improvement incentive payments. The program targets improvements in clinical outcomes, patient safety, patient perception of care and patient satisfaction, and efficiency.

Disturbing: two armed gunman in Maryland storm a medical office training class and rob 15 students. Tuition was due that day, so each student was carrying $440. Despite the arrival of police and SWAT teams, the robbers got away.

NorthBay Healthcare (CA) implements 250 ZynxOrder evidence-based order sets within its Cerner Millenium CPOE.

Medical ID theft is definitely not funny, but I found a bit of humor in this story. A patient discovers a $12,000 charge on her healthcare credit card for a a liposuction procedure. She never had the procedure, though someone else did using her identity. After contacting the medical practice and police, she waited at the clinic for the impersonator to show up for the next appointment. Do you think she was able to identify the thief by her svelte thighs?

E-mail Inga.

HIStalk 2010 Reader Survey Results

I’m heads-down most of the year trying to keep up with my day job and HIStalk. Once a year right after HIMSS, though, I like to run a reader survey and study the results so that I don’t lose the big picture. The time it takes for readers to fill out the survey is well spent since Inga and I plan the whole next year based on what readers tell us.

In the interest of transparency, I like to share what readers have told me. Here are some tidbits from the 2010 survey.

• The most common age range for readers is 41-50, followed by 51-60. Those groups summed up to 63% of readers. That might surprise some folks who think that only newbies read blogs.
• HIStalk’s readership has a lot of industry experience, with 41% having at 20 or more years and 74% having at least 10.
• Provider employees with IT purchasing influence make up 36% of readers.
• Readers are on the site often, with 38% saying they read whenever the e-mail comes, 23% daily or more often, and 98% more often than weekly. A full 92% said the frequency of new posts is about right, although a few suggested more frequent postings.
• While 63% of respondents get the e-mail blast when I write something new, 37% don’t. I’m a little surprised that folks read without getting the blast since that’s a sure way to be the first to know.
• For the question of the degree to which HIStalk influences reader perception of companies and products, 64% said some and 30% said a lot. Six percent said none at all.
• The most valued HIStalk features are (in order) news, rumors, Inga, and humor. Several respondents volunteered they liked my music recommendations, which I didn’t think to list separately.
• I asked whether readers have a higher interest in companies mentioned in HIStalk. An amazing 85% said yes.
• When asked whether readers were more interested in companies that sponsor HIStalk, 38% said yes.
• I asked about HIStalk’s influence on the industry. 12% said not much, 52% said some, 32% said a good bit, and 4% said a lot. If I were a vendor, I’d spin this to say that 88% of readers say HIStalk influences the industry.
• This is my favorite stat every year: when asked whether HIStalk helps you perform your job better, 82% of readers said yes. I could throw out all the other results and be happy with just this one, especially since it was at 65% a couple of surveys ago and I was pleased enough with that.

I asked what topics I should be covering more of. Some of the themes:

• Usability
• Niche vendors and emerging companies
• Implementation stories and case studies. Some suggested covering these by individual vendors to help others who are making selections.
• Index comments by vendor and/or hospital. I really like that idea. Maybe I should hire someone just to parse out the individual mentions and put them into a database or something.
• Write more about how individual hospitals expect to benefit under ARRA (or how they won’t).
• Get product reviews from real users, verify the submitter’s identity, but then run it anonymously. I really like that idea too.

I asked what one thing I should change. Some comments that represent major themes:

• Readers Write seem like PR pieces. Sometimes they do indeed. Please feel free to post comments saying so since that’s the best method I know to discourage self-puffery under the guise of sharing information. Someone had a good idea – require them to contain at least one negative point about whatever topic they are about.
• Ads take a long time to load on mobile device. Hint: add /PRINT/ to the link and you’ll get the text-only view that should work great on a smart phone.
• Fewer flashing ads. I don’t limit those (yet), but sponsors who want to score points with readers might want to eliminate the animation. This is the most common plea for change.
• Nothing. I like your format – some of the articles are more applicable to me than others, but other readers would pick the opposite. I can sort. Thanks for that. It’s hard to pick out the stories that have the broadest interest.
• More Inga but everyone probably says the same. They do indeed.
• Consistent organization and outlining of the post so I can find the parts I care about faster. That’s hard to do within a single posting given the breadth of topics.
• Open up the waiting list for your HIMSS reception so more can get in! It gets booked up so fast that I always wonder how many people would come if we didn’t have to cut it off. In the mean time, it’s fun to have it be a hot ticket.
• Can’t think of a thing. HIStalk is the best! Thank you.
• I love HIStalk — don’t change! Thank you.
• Shorter reader writes. I keep telling authors to keep it to 500 words if they want to hold reader attention. It’s hard for them to edit their own stuff, I guess, but it would take me a lot of time to do it for them. But prospective authors take the hint – less is more.
• Take a day off! Good idea – I did!
• Several readers said to publish more rumors no matter how wild and unlikely, while others said don’t publish unconfirmed rumors.
• When I first started reading, you walked a line between irreverence and curiosity. Now it seems more like cynicism and disdain. More than anything I’d love to see that curiosity come back. You might be right there. I will work on that.
• Have Monday morning update come out on MONDAY. Great idea, other than my employer would like me to actually do stuff for them on Monday. I usually write it and send it Saturday evening or Sunday since there’s no chance of interesting Sunday news anyway. I could hold the e-mail blast until Monday morning, but readers starting e-mailing me Saturday evening if they don’t get it (which I think is cute, especially when they are worried about me).
• Have something completely new 5 days a week. Long-time readers may remember that I experimented with that in 2005, writing Monday through Friday. It took a lot of time, but even more importantly, one reader was dead on when he told me that HIStalk wasn’t “special” when it hit his inbox every day.
• The world needs more Inga! It really does.
• No more warning about PDF links. That’s certainly easier for me, although if I were reading on a mobile device, I wouldn’t want to click a blind link to some 10-megabyte PDF.
• I would either adapt, add to, or begin an alternative, which includes more weight from the sustainment side. Includes honest opinions, real stories, the truth, about vendors and consultants. I keep coming back to this as an excellent idea.

I then opened it up for any general comments. Here are a few representative ones:

• Keep up the great work! I have no idea how you keep up with everything and then tag it with a great opinion. You make my job easier and and my life more fun! PS: keep Inga around forever!!!
• You do good work and you are very widely read in our industry. I appreciate that you don’t take yourself too seriously. I appreciate that you don’t take rumors too seriously, at least not until there is something to back them up.
• I respect and admire what you’ve been able to accomplish in this industry. Often, I get the news I read on HIStalk 2-3 days before I get it in any other forum! I also appreciate the way you wait to confirm some of the "iffy" news! Thanks and keep at it!
• Not additional thoughts just keep up the fair, honest and direct communication flowing.
• It rocks. Keep it up. At times I get more direct (speak: non-marketing) info than any of the paid research services I use.
• HIStalk has become my lunch reading. You do a great job with it – thank you.
• Good format – its easy to scan and read while listening in on that boring meeting or phone call. Good info overall. As a vendor, I like to see how my software, and my competitor’s, are viewed by the providers and buyers. What are the challenges, the risks they face, what influences how well a product is received and reviewed. For all of us NOT associated with Epic, we are hungry for any insight and help with decoding the provider’s and CTO’s mind.
• Don’t stop doing it – I know it’s a second job for you. HIStalk is the one fact check site I trust to winnow thru the vendor-based marketing crap out there and the big iron IT company’s PR spin. It’s almost as good as a free KLAS analysis.
• I’ve been a follower for a few years now. Stopping by is part of my daily routine, and when it comes to my doing research, HIStalk is on the short list of Internet stoops I hit immediately. I appreciate insight, attitude and opinion free of the general bullshit that tarnishes so many blogs. Keep on doing what you’re doing. I really appreciate it. Seriously.
• Straight forward, no nonsense, sometimes funny, usually very well written, brainy (and probably pretty) female accomplice. What else is there?
• Maybe I shouldn’t admit this, but HIStalk is the only such newsletter I read. I’m in Univ/Hosp research IT (very different from clinical IT), so I don’t relate to a lot of the pure hosp news items – nevertheless, I never miss my daily HIStalk. I think the attraction is partly news, but also that readers can respond anonymously or not – and that you don’t bow and scrape to anyone, esp. sponsors – and I almost always learn something new.
• Nice job as usual … the blog seemingly gets better over time. Great content with professional and humorous delivery … Keep up the great work.
• Keep up the good work. I know how widely it is read. Is there some way to direct writings or advice or commentary specifically to "the workers"? the in the trench folks who I think see all this news and commentary as flying by over their heads far removed from them.
• Love it, thank you for all of the hard work!
• Great blog. I really appreciate the great reporting and knowledge. You’re appropriately suspicious of rumors, and you seem to have a great understanding of what news would be interesting to report. I’m a huge fan and recommend that everyone I know read. (Of course, they all already read you, so I can’t claim to be much of an additive evangelist.) It’s just really, really good. One of two blogs I read regularly (and the other one is a Michigan football blog).
• HIStalk is a great source for breaking information and juicy rumors that come out eventually in the traditional trade rags.
• I am constantly amazed at the breadth of information that jumps out of these pages. I learn more about the industry and movement within it from HIStalk than all the other subscriptions I have. Heck, you have published information about changes within my own company before we were informed of them. The recent articles on EMR allowed me to view the effort through the eyes of various leaders, which was enlightening. I look forward to finding 5-10 minutes to browse the information every day — one of my routines now.
• Just that this is my favorite blog, but I must confess the other blogs I routinely look at are the MTV Jersey Shore and The Real Housewives from Bravo tv.
• To the extent you can bring on more people to write (e.g. more Inga’s and HIStalk Mobile types) – that would be outstanding (and know you’re pursuing this).. and find some way of provoking more CIOs to weigh in… and encourage people to divulge product differentiators and pricing… Thanks again – you’re the highlight of my day and have helped me a better HIT professional by 10x.

Thanks to everyone who took the time to respond.

Monday Morning Update 3/22/10

From kITty: “Re: Detroit Medical Center. Sold to Vanguard Health Systems.” DMC signs a letter of intent to sell out to the for-profit Nashville chain, with the hospital’s CEO saying, “The nonprofit hospital model is killing health care in the city of Detroit.” It will be interesting to see how a for-profit operator can improve a situation in which the local economy is wrecked and the hospital is burdened with charity care. I assume from my long-ago, not fondly remembered experience in working for a for-profit hospital chain that the bean counters will run wild trying to cut costs and manipulate the patient mix for maximal profit, which is of course what for-profit companies do to benefit their shareholders, hopefully not at the expense of their customers (patients).

From mrsoul: “Re: today is Certified Nurses Day. Unlike CPHIMS, you actually have to verify education and experience BEFORE you can take the board exam. Re-certification does take effort and diligence. I am a CPHIMS too; but, I can tell you the RN-BC from ANCC testifies far more effort and experience to my peers. Happy vernal equinox!” Friday, March 19 was the day to recognize certified nurses, including those holding ANCC’s informatics nursing credential. If you are a board-certified RN, a belated happy Certified Nurses Day to you.

Trident Medical System (SC) goes live in the ED with Oacis HIE in a Carolina eHealth Alliance-sponsored program that connects 11 EDs. Trident is Columbia HCA’s hospital group and Oacis HIE connects their Meditech systems with each other and those of MUSC.

John McConnell, who made a couple of kings’ ransoms in selling out Medic Computer System and A4 and then bought golf courses, gets back in the software business. He’s buying a golf club management software vendor. Allscripts probably won’t be buying this one from him.

Parrish Medical Center (FL) claims a 31% reduction in mortality and a 77% drop in non-ICU code blue calls as it uses Clinical Xpert CareFocus from Thomson Reuters in a Six Sigma project involving its rapid response team. The software identifies patients at risk through an ongoing review of meds, results, vitals, orders, and other clinical data.

A few housekeeping reminders: drop your e-mail in the Subscribe to Updates box to your right to be among the first to know when I post something new. The Search box plows effortlessly through the nearly seven years’ of HIStalk to find mentions products, companies, and people. Click the ugly green Rumor Report button to send anonymous news my way, including any attachments. Add your industry events free to the HIStalk Calendar. If you want to look back on previous articles, use the search box or the Archives page. Please remember to support the companies that sponsor HIStalk by poring over the ads to your left occasionally and clicking those that interest you (and the text ads to your right as well). If you want a cleaner, leaner view of a post for printing or mobile viewing, click the View/Print Text Only link at the bottom of it to get a nicely formatted, print-ready version of just the article itself.

Readers generally agree that companies aren’t doing themselves any favors by holding their press releases until HIMSS week, along with everyone else. Make the announcement before the conference, 68% of you said. New poll to your right: what influence does the HIMSS annual conference have on hospital IT buying decisions?

I notice that the visitor count will hit 3 million before long, so I assume Inga is preparing for her usual celebratory pomp and circumstance. She loves watching that counter.

TPD has updated his excellent list of healthcare iPhone applications with many new apps.

The acquisition of QuadraMed by Francisco Partners has been completed.

An interesting perspective from Indra Neil Sarkar, director of biomedical informatics at the University of Vermont College of Medicine, on the role of informatics related to EMRs:

AMIA is making very good headway in this community. There are only about 2,000 to 5,000 of us who are formally certified informaticians. Someone at a medium-sized hospital might have the title informatician, but they are really IT and not informatics. And if there is one term I have an issue with, it’s ‘health-IT,’ it’s the misnomer that we’re stuck with.

Informaticians need IT, but if you ask me to fix something on my computer, I am not a hardware guy. It’s a way of thinking. Many informaticians here fell into the field by accident. I grew up with computers and had strong ideas about the role of computers in microbiology. I am not a physician but I have a lot of interest in medicine. I had the notion I would spend most of my time in the lab using a computer on the side, but I have a dry lab, I don’t maintain a wet lab.

Creating data is not the problem; it’s understanding the data, and that is where AMIA fits in with its history. Its main meeting is more oriented toward electronic health records. This meeting is, ‘Let’s take EHRs and basic bioinformatics for granted. Now what can we do with the data?’

The Las Vegas newspaper reported on confidentiality breaches at University Medical Center a few months back, but this seems to stretching the point: an investigative piece reports that hospital managers don’t have good records of who has keys to the shred bins. The maximum fine for that egregious act: $400. Must have been a slow news day.

CHRISTUS Health engages MEDSEEK to develop its consumer portal and will eventually implement the company’s eHealth ecoSystem.

E-mail me.

News 3/19/10

From Ex-Cerner Guy: “Re: CPSI. I prospected heavily in Mid-Atlantic and Mid-West regions, and can vouch for the need for a CPSI or Intra-Nexus. Quite a few Meditech sites were looking around and they were only getting called back by the McK Paragon types. There is definitely a market and some pent-up demand.”

From Dan D: “Re: Tom Skelton. He has left MED3OOO for another opportunity.” Unverified.

From RJ McMurphy: “Re: putting HIMSS in perspective. Vendors representing half of the hospital HIS/EMR systems in America weren’t even present! If you look at the HIMSS Analytics report in Modern Healthcare for Jan. 2009, you’ll see Meditech with 26.7% market share, Cerner with 12.6, and Siemens with 9.5. That adds up to 48.7%. All three chose to opt out of HIMSS. Basically it’s become a hype circus — no buying influence really happens there. It was more important earlier in the market cycle when PowerPoint was the main operating system for EMR vendors. Now almost all buying is done by peer site reference and Internet data gathering. Organizations like HIMSS, KLAS, Gartner are trying to make themselves more relevant with lots of hype about trends, etc. The world has changed and I laud those three for opting out and saving their shareholders and stakeholders the cash!”

From Doug Dinsdale: “Re: Merge. Dr. Dalai challenges the CEO of Merge to explain why the purchase of Amicas isn’t going to ruin both companies.”

Cerner makes the S&P 500.

A reader sends this picture of a billboard one of his patients asked him about.

Haemonetics extends its $60 million offer for GlobalMed Technologies to give that company time to settle a shareholder lawsuit seeking to block the acquisition.

Tallahassee Memorial HealthCare (FL) chooses Allscripts PM/EHR for its 106 providers and 33 family medicine residents.

Singapore General Hospital wins the Microsoft HUG 2010 Innovation Award for “Best Use of Clinical Records – Inpatient” for its use of Eclipsys Sunrise Patient Flow, which improved bed placement time and reduced overhead.

A Weird News Andy find: a former dentist is accused of using paper clips instead of stainless steel posts inside the teeth of root canal patients, about which WNA says, “Maybe it’s for all those people who use paper to floss.”

More information on the HIMSS EHRA position on meaningful use is here.

McKesson announces a hosted storage option for Horizon Cardiology CVIS, with Cooper University Hospital (NJ) as an early adopter.

Software developed by Boston Medical Center, Northeastern University, and MIT that reduced readmissions by 30% is licensed for commercialization to Engineered Care Inc.

A new iPhone app called iResus walks users through emergency resuscitation, providing a metronome for timing chest compressions.

Nurse scheduling software vendor StaffKnex changes its name to OnShift. They apparently like conjoined words quite a bit.

Everything about this story is sad. A four-month-old Down’s baby dies in the UK after being given a tenfold overdose of the diuretic furosemide. The computerized warning issued to the doctor’s office is overridden by the receptionist. The pharmacist hears the technician questioning the dose with the prescriber, but doesn’t follow up. The neighbors of the parents, convinced they killed their own child, trash their house and steal all the baby’s belongings. Weeks later, the father kills himself by drug overdose. The coroner’s report finally came out this week, four years later, finding that the doctor and pharmacist were at fault.

Revenue cycle vendor Emdeon will acquire management consulting firm Healthcare Technology Management Services for $11 million.

At least somebody likes the proposed meaningful use criteria: AARP and Consumers Union.

Lexi-Comp releases its ON-HAND medical software for the Palm Pre and Pixi.

A KLAS report finds that 20% of smart pump buyers wouldn’t choose their current pump again, although 99% of CareFusion Alaris said they would. Still, the highest rated pump was the B. Braun Outlook.

Meridian Health (NJ) chooses CareAlign from Informatics Corporation of America to deliver an integrated clinical record to five hospitals.

MedFusion licenses LIS, molecular diagnostics, and AP software from Sunquest.

E-mail me.

News 3/17/10

From Harvey: “Re: CPSI. The small/rural hospital market has been dead money for years. However, the QSII/Opus deal may mark the start of a land grab there. Rumors are that Francisco will either IPO or sell Healthland this year, which tells you that there is demand for assets in this sector. My guess is that almost everything’s for sale in that space, including HMS and the indifferently-managed CPSI. Would love to see an interview with Francisco’s Ezra Perlman. He’s been a major mover and shaker, but rarely discusses HCIT publicly.” I agree (and I would be up for that interview). I overheard conversations at HIMSS about that largely untapped small-hospital market and some interesting players were named as being well positioned, such as IntraNexus.

From ZenSocrates: “Re: McKesson. Mike Myers, the McKesson executive responsible for the Clinical Documentation/Physician Order Entry product and a true pioneer of HIS, has announced his retirement for this July. The concern is that McKesson could not name a successor at the time of the announcement. As a customer, this concerns me greatly!!” Unverified.

From MckHappy: “Re: McKesson. McKesson and Jeremy Chandler are finally implementing the changes they had promised within the Horizon team. Mike Myers has announced his retirement effective July 1. Jim Nemecek is no longer VP over ambulatory. Cem Tanyel from Unisys will be named as the new head of development. Gerry McCarthy will add ambulatory to the physician solution line. The internal release focused on integration and eliminating the politics — errr, I mean development silos. Rumor going around is that portal and ambulatory development will be centralized in Boulder. The ARRA-certified release was shipped on-time to the pilot site last week.” Unverified, but if true, I wasn’t the only one observing the development silos and lack of staff stability.

From William Tell: “Re: HIMSS. I guess from what Lieber says, HIMSS is all things to all people.” An article quotes Steve Lieber as wanting to push into life sciences and payer markets, medical banking, PHRs, and workforce. I can only imagine the confusion as everybody tries to sell something to everybody else at the conferences. And in related world domination news, HIMSS Analytics is now working in Europe.

From Dickie Smothers: “Re: HIPAA. Check out 42 USC 1320d-6, which defines ‘A person who knowingly and in violation of this part … obtains individually identifiable health information relating to an individual …’ The term “person” is defined (in the main part of 1320) as an individual, a trust or estate, a partnership, or a corporation. I’ve read that because the above section applies only for a ‘violation of this part’, it only applies to those otherwise covered by HIPAA (since anyone else couldn’t ‘violate’ the provision). However, the HITECH changes in Section 13409 of the Act seem to broaden the applicability. Don’t think it was effective, however, last Thanksgiving. Nevertheless, a bright federal prosecutor could make a conspiracy charge or bribery charge stick if he/she wanted to. Just my opinion.” This relates to the story I mentioned in which a gossip site supposedly made 6,000 calls to the hospital Tiger Woods was in, trying to wangle his medical records from anyone willing to spill the beans for cash.

From Jack Flash: “Re: athenahealth. This is a very entertaining and insightful interview of a slightly buzzed Jonathan Bush at the HIStalk party. Greatest quote of the interview, on being asked about Healthcare Policy — ‘I love Obama’s package. He looks great.’” Definitely a fun watch.

From Radiology Ralph: “Re: DR systems debut of Unity CVIS. You mean DR Systems does something other than sue other radiology vendors for its ‘416 patent infringement? Go ‘Dominator!’” Just in case anyone doesn’t know the back story, DR Systems filed a slew of lawsuits in 2006 claiming patent infringement of a PACS reading station feature: eRad, NovaRad, Emageon, Fuji, GE, Philips, Siemens, Kodak, and others.

From Stifler’s Mom: “Re: Medicare. Good article on that 21% Medicare cut that happened, then got fixed, while we were partying in Atlanta. I don’t know how many doctors wandering the exhibits halls were leaving their wallets in their rooms, but I would have. Even with the ‘fix,’ if I were a doc, I’d be too nervous and reluctant to be spending any big bucks. No one at HIMSS was talking about a 21% pay cut in their already low Medicare reimbursement!”

From Meaningful Abuse: “Re: HIMSS attendance. If only 30% (~8,357) of the registrants came from healthcare provider setting, where did the other 70% (~19,500) come from? Isn’t this a healthcare setting information technology show? Only 11%(!) of the registrants were CIO/CTOs? Was that 11% of the healthcare provider attendees or 11% of the total registrants? Same question about CEOs… So, who do the vendors want to talk with? C-level decision-makers, not mid-level IT managers or staff. No wonder HIMSS vendors are chafed about the money they have to spend for their chunk o’ concrete.”

Several readers asked about the lyrics to Dr. HITECH’s Meaningful Yoose Rap. They are here and they are excellent.

Now that we’re over the HIMSS hump, I’m interested in doing some new interviews (with provider-siders especially encouraged). Or, your guest articles are welcome (more of those from providers would be especially welcome). I’m finally to the point that I can get to them.

The HIMSS EHR Association weighs in on meaningful use and incentives. That response wasn’t detailed, but it apparently urged simplification, reduced requirements for data collection, and allowing only one document standard.  

Not to be outdone, Markle Foundation has its say on the same topic. Some of their ideas: (a) set explicit health goals; (b) make the quality measures list more focused; (c) add new measures for priority health goals; (d) get rid of the all-or-none approach to incentives to encourage improvement without requiring hitting 100% of the proposed requirements; (e) streamline some of the calculation-heavy functional measures; (f) make electronic reporting requirements simpler; (g) focus on easy measures that improve patient engagement; (h) clarify that a secure download of patient information is acceptable; (h) get feedback into doctors’ hands quicker; and (i) clarify how hospital-based physicians can participate. I think they did a great job with good consensus and I would expect HHS to seriously consider their recommendations since they are less vendor- and product-centric and focus more on patients and providers. Kudos to them.

VA CIO Roger Baker lays it on the line for his IT staff: he’s happy to kill projects that miss deadlines or run into snags. That’s semi-good news for taxpayers, but the shining star of that policy cost a bundle, a failed patient scheduling application that cost $150 million.

In the UK, NHS’s medical director and NPfIT defender resigns his additional role as a director of an NHS software supplier after an anonymous blog commenter brings up the perception of a conflict of interest.

Jobs: EHR Business Systems Analyst (WA), Clinical Exec Physician – Sales Support (GA), Epic Revenue Cycle Manager (FL), Client Training and Support Specialist (MA). Some pretty good jobs are up on Healthcare IT Jobs, so take a look.

Akron General Health System signs an $11 million clinical systems upgrade contract with McKesson, including CPOE and Practice Partner.

A survey finds that 12% of employees knowingly violate IT department policies “in order to get their work done.” The survey appears to encourage outrage at irresponsible users, but IT policies that impede individual productivity in the never-ending quest for risk reduction should probably share some blame.

McGill University Health Centre launches its PHR, Unani.ca.

E-mail me.

HERtalk by Inga

After placing its EHR project on hold for a year, Sutter Health announces plans to spend $400 million and accelerate its Epic implementation over the next five years. Sutter intends to take five of its affiliated hospitals live on its Epic EHR in 2011. The health system has already rolled out EHR to the majority of its physician offices, as well as its Mills-Peninsula Health Services facility.

Preliminary registration numbers from HIMSS10 indicate attendance was up across the board. Professional registration grew 9% over 2009, though the total registration number was only 2% higher than last year.

The deadline to file comments on the latest meaningful use and certification criteria is now past, but not before multiple organizations filed last minute comments. CHIME, MGMA, CCHIT, and the AMA were just some of the many groups to submit public comments before the March 15th deadline.

CCHIT, by the way, says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on its Web site also indicates that CCHIT is “confident” about its prospects for becoming accredited. Meanwhile, Drummond Group reaffirms its desire to be certified as a authorized testing and certification body and is making internal preparations in order to be ready for EHR testing later this year.

Columbia Basin Hospital (WA) agrees to outsource its IT support to Phoenix Health Systems and implement Phoenix’s Total IT Solution service line. The offering includes the implementation of Medsphere’s OpenVista EHR.

Meridian Health (NJ) selects ICA’s CareAlign solution to connect its five hospitals and its affiliated healthcare companies.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers to $54.4 million. For the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

UMass Memorial Health Care selects Picis CareSuite for its five hospitals.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Holland Hospital (MI) plans to implement the InterSystems Ensemble platform as its enterprise integration engine. The hospital plans to connect multiple systems across the facility and integrate its EMR with affiliated physician groups.

St. Joseph Medical Center (TX) implements Webmedx’s dictation and transcription platform, apparently within three days of a crash of its legacy systems.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

HIT consulting firm maxIT and the the medical device experts at Anson Group combine forces. The companies sign a partnership agreement aimed at providing vendors and providers expertise in the implementation of regulated medical devices connected to EMRs. Sounds like great timing, given the recent attention on EMRs and their possible regulation by the FDA.

CareTech Solutions signs a five-year infrastructure outsourcing agreement with Sibley Memorial Hospital (DC).

BCBS of Minnesota makes a bit of a mistake, accidentally publishing a customer’s personal medical information it a handbook for 95,000 members. The woman is now filing suit for the breach of privacy and violation of the Minnesota Health Records Act.  Her attorney calls it “one of the most blatant and egregious violations of medical privacy” that she’s ever heard of.

E-mail a limerick to Inga.

HIMSS10: Party Like It’s 1999

By Mr. HIStalk

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

Healthcare is different, everybody says, Well, it sure is when it comes to throwing the excessive bacchanal that is the HIMSS annual conference.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! Cocktail hour in the exhibit hall is just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

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.

Monday Morning Update 3/15/10

From McMessy: “Re: McKesson report. The author of the report states ‘this channel check is not inconsistent with other checks we have made on MCK and its HCIT products.’ The client in the report indicated that its HERM implementation process started more than a year ago and may take another 18 months to complete. The hospital also said they are currently at HIMSS Stage 6 but that there are about seven Stage 1 criteria that the hospital still does not meet. Ouch!! Another ringing endorsement for HIMSS Analytics! Don’t you need to meet all the Stage 1 criteria before you can get to Stage 2-7?” Not really surprising considering the science fair of wildly different products that share the Horizon Clinicals nameplate, running decentralized development shops for what should be a single product suite, and never-ending employee turnover. But, it works fine in some places and some of their competitors have similar problems.

From The PACS Designer: “Re: HealthVault. Microsoft’s HealthVault application is now ready so that we can create our own PHR along with one for other family members. TPD has posted previously about Microsoft’s Silverlight application which is now part of HealthVault. Also within HealthVault is their Sharepoint application. If you have a Windows Live ID or OpenID you can use either ID to sign up.”

My FDA regulation poll drew quite a few responses, most of which expressed a belief that FDA will indeed step in to regulate healthcare IT in some form. New poll to your right: when a vendor has good news to announce in the weeks before HIMSS, should they announce it immediately, hold it until HIMSS week, or announce afterward? Most vendors hold their news until Monday of the conference, which I think is nuts, but you decide.

Speaking of FDA, it has set up a network of 350 hospitals and asked them to report problems with systems such as CPOE, EHRs, pharmacy systems, PACS, and others under its MedSun medical device safety network, according to a Huffington Post Investigative Fund article.

Inga already referenced Dr. HITECH’s Meaningful Yoose Rap, world premiered at the HIStalk reception at HIMSS, but I’ll embed the video again just in case you missed it. In case you didn’t notice, this was a flawless live performance by Ross Martin, MD, best known until now for his amazing Interoperetta.

And speaking of Inga, she did a marvelous job while I was R&Ring, don’t you think? I never thought I would find someone who could step right in, but we’ve been working together for three years now and she has blossomed wonderfully. I will apologize in advance for the likelihood that I will repeat something she has already mentioned since I’ve been out of touch for a week. Stats-wise, February barely missed setting an HIStalk record even though it was a short month, with 88,057 visits, 120,075 page views, and 5,346 e-mail subscribers. March is trending up. You contributed to those stats, so thanks for that.

As for me, I am rarin’ to go, batteries fully recharged and ecstatic to be back. And listening: Apples in Stereo, Denver-based power pop.

Inga mentioned that I was elated that former HBOC chair Charlie McCall is headed off to prison, which is true. Finally I can quit gritting my teeth when inserting “alleged” in in describing the massive fraud with which his train wreck of a company blighted the industry (although McKesson gets an assist for corporate stupidity in buying him out). It now looks like the decks have been cleared for McKesson to sue him for restitution, which would win them points in my book.

Community Health Solutions of America signs up for MEDai’s Risk Navigator, a predictive modeling suite that identifies high risk patients and tools to manage them.

InterSystems acquires its Italian healthcare implementation partner Prosa.

Former Shands CIO Bill Montgomery is named CIO of Hospital Sisters Health System.

Interesting: when Tiger Woods ended up in a Central Florida hospital, tabloid site TMZ made over 6,000 calls to the hospital within a few hours, dialing every possible number trying to find someone who would provide information. It even offered bribes to hourly workers hoping to get his medical records, the hospital said. It worked — the hospital fired several employees who accessed his records. I’m pretty sure nobody’s HIPAA policies could withstand that kind of attack. Nor am I sure why trying to get someone to violate HIPAA isn’t itself a punishable offense.

I don’t know where Weird News Andy finds this stuff: a Dutch nurses’ union launches a national campaign to remind the citizenry that its members do not routinely provide sexual services to patients. The “I Draw the Line Here” campaign was created after a female nurse observed co-workers offering gratification to a disabled male patient, who then tried to dismiss her because she would not do the same.

CTIA Wireless 2010, in Las Vegas next week, is running an Everywhere Healthcare 2010 track with some good sessions.

Hopefully everybody’s Daylight Saving Time switch went OK.

The Nashville Medical Trade Center, hoping to become a center for healthcare industry events, tried to use the HIMSS conference as a launching pad to get business tenants, but doesn’t seem to have had much immediate success according to this article.

DR Systems will debut its Unity cardiovascular information system this week at ACC.

The unSummit on point-of-care bar coding will be May 5-7 in Atlanta. 

Deborah Peel, MD is the subject of the cover story in Managed Healthcare Executive called Locking down privacy: where do we draw the line? “All 55,000 pharmacies in the United States are data-mined daily, and our identifiable prescription records have been sold for over 10 years. The theft of prescription information is why Congress was persuaded to include the ban on the sale of protected health information in the HITECH bill. I think that the industry is in denial because there is a huge, essentially unknown data-mining industry for health information."

The guys from the Access barbeque team sent over this picture, which has convinced me they should set up the smoker in the parking lot of the Orange County Convention Center at next year’s HIMSS conference. Give a prospect a plate of pulled pork and a beer and he will listed to what you have to say.

E-mail me.

News 3/12/10

HERtalk by Inga

From: Scoopy Sales “Re: Janet Dillione’s resignation. I see HIStalk scooped everyone on this and the ‘news professionals’ are just now reporting the story.” Ha! Mr. H will like that comment. Thanks again to the reader who tipped us off last Friday about Dillione’s resignation as CEO of Sieman’s HIT division.

From: PACSMan “Re: Dillione. I know you had run this yesterday but this confirmation came across just now. The timing is beyond strange- she gives a press conference 3 weeks ago, speaks at HIMSS and even has the damn thing podcast and now eaves to ‘pursue other opportunities’ after 27 combined years at SMS and Siemens. Something gives here- and I bet it ain’t pretty a ’tall….”

From: Mrs. Kravitz “Re: McKesson report.The recent Leerink Swann HC equity research report reads badly for McKesson. After talking to a CIO at a large client base they are pessimistic on McKesson’s ability to get to Stage 1 meaningful use; HEMR and Horizon Clinicals v10.3 still not GA despite representation to the contrary.” I don’t have access to the report. If you have an opinion, chime in.

I noticed that ComputerWeekly also  picked up a reader-supplied rumor, this one about a recent director-level resignation at iSoft. ComputerWeekly actually quoted HIStalk, then added iSoft’s confirmation that Keith Kirtland left for “personal reasons.”

Five Alegent Health hospitals implement Design Clinicals’ MedsTracker for electronic medication reconciliation. The CMO claims that an impressive 100% of the hospitals’ admissions and discharges were reconciled electronically on day two of the go-live.

The ONC publishes its proposed rule establishing two certifications programs to test and certify EHRs. CCHIT will not be granted grandfather status for testing, though they will likely be one of only a few organizations ready and able to qualify under the new program. Organizations wanting to qualify as an “ONC-Authorized Certification Body” for the “temporary” program would be required to submit an application and demonstrate its competency to test and certify EHRs. The temporary program could make it possible for full EHRs and EHR modules to secure certification as early as this summer. The temporary program would expire the first quarter of 2012 and replaced with a permanent program run by an outside certifying organization.

Children’s National Medical Center (DC) plans to implement Streamline Health’s Audit Integrity Manager Solution.

St. John’s Hospital – Eureka (CA) deploys Order Optimizer’s web-based clinical platform, allowing physicians to use evidence-based protocols at the point of care.

I see the folks at EHRtv have begun posting their vendor executive interviews from HIMSS. Dr. Eric Fishman poses some great questions to leaders from Nuance, M*Modal, Allscripts, Eclipsys, and NextGen in these face-paced and engaging spots.

The 17-physician Mountain Region Family Medicine (TN) completes its installation of Greenway’s Prime Patient EMR, with deployment assistance from BCTI and OnePartner.

Detroit Medical Center awards MedQuist a contract for transcription outsourcing services. Medquist will provide ED documentation at six of the health system’s facilities.

Rush University Medical Center (IL) agrees to pay more than $1.5 million to resolve a federal lawsuit. The suit alleges Rush violated the False Claims Act in connection with improperly designed leasing arrangements with several physicians.

DR HITECH live at Max Lagar’s in Atlanta, rapping about Meaningful Use. Doesn’t get better than this!

Weird News Andy sends over this story, which is actually more disconcerting than weird. The NHS, as it continues to create its national database of patient medical records, is suppose to give patients an opt out option before their information is added. Instead, doctors claim the government is rushing the project through and  patient information is being uploaded before  patients have a chance to object. Doctors also claim the government is not adequately educating patient on the database project, nor making the opt out option easy enough for patients to select.

The VA is busy working on Aviva, the next-generation version of its 20-year-old VistA EMR. Aviva is designed to be Web-enabled, modular in design, and capable of easy data exchange with other EMRs. Peter Levin, CTO for the VA, compares the project to “trying to replace a tin can on a string with a cell phone system.”

A former MedAssets contract employee, who used a fake identity to get her job, is accused of accessing the financial information of up to 2,400 patients. UTMB was a MedAssets billing service client at the time and Katina Rochelle Candrick is believed to have gathered social security numbers, dates of births, and credit card information on UTMB patients. Candrick has since been arrested.

In case you missed the actual HISsie Awards presentation, check out the presentation we ran at the reception last week. It’s loaded on SlideShare and apparently the transitions only work if you download it to your system. You’ll want to download it to fully experience the fun – as well as identify the winners and see the pie hit the face of a certain CEO. There is likely some way to post the slide show and have the transitions work correctly, but I am too lazy and too short on time to figure it out.

Provena Health (IL/IN) signs a seven year agreement with ARAMARK Healthcare. ARAMARK will provide clinical technology services for Provena’s six hospitals.

The folks at Surgical Information Systems asked me to let readers know they’ll be at the AORN meeting next week in Denver. If you’re attending, check out their session “Creating a Unified PeriAnesthesia Medical Record to Improve Clinical, Operational, and Financial Outcomes.”

Inova Health System (VA) names Ryan Bosch, MD, FACP, MBA its first Chief Medical Information Officer. Before joining Inova, Bosch worked as Director of General Internal Medicine at George Washington University Medical Faculty Associates.

Stemp Systems earns Preferred IT Vendor status from eClinicalWorks.

The public continues to weigh in with opinions on the latest meaningful use definitions. CMS posted a few additional comments last week and folks are still concerned that the bar is set too high, especially in the early years. The note below questions the exclusion of CPOE in the ED when measuring the total percentage of electronic order entry in a hospital:

The current proposed definition of meaningful use seems to exclude the use of CPOE in the ED as a measure of determining the current percentage of electronic order entry within the hospital setting. That doesn’t make a lot of sense if the purpose of the graduating meaningful use criteria are intended to promote and reward a hospital’s progress in deploying CPOE. Many hospitals will start with the ED to deploy CPOE because of it’s complexity and workflow. The current proposed definition will not recognize those organizations who are making good progress with CPOE simply because they may have started in the Emergency Department. That seems counterintuitive and not within the original spirit of advancing CPOE deployment to 100% within several years. In other words, who cares where an organization starts its deployment as long as progress and total percentages are actually achieved.

Mr. H is back home sometime this weekend. As gratifying as it is to know that HIStalk can stay afloat a few days without him, no one will be happier than me to have him back in charge, especially since he makes HIT so much more fun.

E-mail Inga.

News 3/10/10

HERtalk by Inga

From: Sioux Supporter “Re: Janet Dillione. I can confirm that Janet Dillione has resigned from Siemens. No announcement of new role or firm, but the announcement was made Friday.” Still unconfirmed, though a few readers have sent note with similar messages.

From: Big Mouth “Re: iSOFT. iSoft loses another senior executive from it’s flagship business unit. Just confirmed from internal source that Keith Kirtland, UK&I Commercial and Sales Director resigned earlier this month. This is the 4th sales director in as many years and is expected to have a destabilising effect on both the Wales Lab deal and overall sales in the UK for this troubled NPfIT supplier. In February,  iSOFT reported significant drops in both revenue and profit.  This resignation will certainly impact 2nd half results.”

From: Beauty “Re: Press Releases. To Beastly – I see you are putting the spin on the negative. Any which way you slice it – too many press releases = too little bang…leaving out ‘for the buck’ cuz we know you are still pulling down the bucks. Too much noise at HIMSS…and those who would be interested are too busy ‘doing’ HIMSS. As for me – I deliberately launched product before HIMSS…with press release…specifically to avoid the noise and being one of the 100 needles lost in the haystack. Hmmm – opinion of the those who are in the business of press releases…or those of us targeted by the press releases?  Listen to your audience. Let’s have a HIStalk vote on this one!” Personally I am just happy that it took less than a week for me to finally weed through all those releases.

From: William Tell “DoD and VA disconnect. Nice to know CPOE and electronic records are going to solve everything . . . as if.”

From: Curious “Re: Promise Healthcare. I am curious about your opinion of them.” Alas, I have no opinion since I know nothing about them. In the absence of the ever-wise Mr. H, perhaps readers can weigh in.

From: Emily Dickinson “Re: Medical Manager execs guilty. Two former executives of Medical Manager Health Systems Inc. have been convicted of federal securities fraud after a two-month trial in U.S. District Court in Charleston, SC.” The company’s former VP and COO John P. Sessions and former president John H. Kang were found guilty of conspiracy to commit mail, wire and securities fraud for their part in a scheme to inflate Medical Manager’s earnings by more than $16.8 million between 1997 and 2003. Sentencing will occur at a later date.

From: Mr. H “Re: Charles McCall heading to prison.That news made my day.” Really? I get one email from Mr. H in four days, and this is all he has to say. What’s up with that?

Quest Diagnostics and Surescripts team up to form an integrated service that combines lab and prescription information available to connected physicians. I suppose that means that if my grandmother in Washington goes to a doctor in Florida, the Florida doctor might be able to access Grannie’s lab and prescription data. Now we are getting somewhere.

Surescripts, by the way, reports that e-prescribing rates tripled from 2007 to 2009, with an estimated 18% of all eligible prescriptions now being sent electronically. The number of prescribers routing prescriptions doubled from 2008 to 2009, and now includes 25% of all office-based physicians.

Huntington Memorial Hospital (CA) plans to offer HuntingtonRx, a branded version of Allscripts stand-alone e-prescribing solution, to its 1,000 affiliated physicians.

Five hospitals select Summit Healthcare as their sole integration partner to assist with migrations from current Meditech platforms to Meditech 6.0.

Annapolis Pediatrics selects Sage Intergy suite to automate its clinical and financial operations. Annapolis Pediatrics is a four-location, 21 provider group.

Trinity Health (MI) deploys Medicity’s Novo Grid solution, establishing an HIE between almost 1,000 affiliated physicians. The headline of the press release claims this first stage took “9-1/2 weeks,” which happens to be the same amount of time it took Kim Basinger’s Elizabeth to walk away from Mickey Rourke’s John.

Sisters of St. Francis Health Services (IN) select Epic for its 13-hospital system.

Northwest Hospital & Medical Center (WA) contracts with dbMotion to create an interoperable patient record for both in-hospital and ambulatory care providers.

UPMC introduces an EHR application that runs on a BlackBerry smartphone. The program leverages the interoperability platform created by dbMotion and provides a single view of key patient data from multiple information systems.

Henry Schein launches ConnectHealth, which partners companies in the EHR, medical device and computer services sectors. Specifically it sounds as if the new program leverages Henry Schein’s partnerships with several vendors to implement EMR in physician offices. Partner vendors include Allscripts, Midmark, Welch Allyn, Siemens, Dell, and Medline.

The nice folks at Bridgehead Software have invited me to visit their booth at the World of Health IT event in Barcelona, March 15-18. Bummer that I have a manicure scheduled during that time so I will have to miss the event. If you are attending, visit the Bridgehead team at Stand #841 and sign up to win an iPad.

Speaking of Spain, Gestion Sanitaria de Mallorca in Palma selects Orion Health technology to serve as the backbone for its EHR. The EHR solution will be the first for community care in Spain.

We have a new interview on HIStalk Practice with Dr. Joel Feinman of Valley Medical Group in Massachusetts. He’s an EMR proponent on many levels, but especially in terms of providing patient care: “I don’t see how you can do that anymore without some kind of electronic system that actually works.” Check it out and sign up for e-mail updates while you are there.

Today I joined a conference call with the wonderful sponsors of last weeks HIStalk reception. After accounting for walk-ins and a few no shows, total attendance was about 430, making it our biggest bash ever. Thanks again to Encore, Evolvent, and Symantec for making it such a great event.

General Dynamics Information Technology hires Raymond Sullivan to serve as VP of HIT Solutions, tasked with business development for the federal government and commercial health organizations. Sullivan was previously executive director of the VA’s Office of Information and Technology.

Hospital nurses estimate they spend a quarter of their 12-hour shift on indirect patient care. Wow. While not providing direct patient care, nurses are working on regulatory requirements, handling lots of paperwork, and securing needed equipment and supplies. Solutions recommended by surveyed nurses include more ancillary staff support, better hospital-wide communications technology, and reductions in redundant regulatory requirements.

Anne Arundel Medical Center (MD) implements Corepoint Integration Engine to facilitate a migration to Epic’s HIS and improve clinical data exchange with community physicians and patients.

In what could be the greatest news of the decade, a report in the Archives of Internal Medicine finds that normal-weight women who drink a light to moderate amount of alcohol appear to gain less weight and have a lower risk of becoming overweight and obese than non-drinkers. On that note, I’m off to find a cocktail.

E-mail Inga.

HITlaw 3/9/10

Non-Compete Agreements

Non-compete agreements (NCAs) are designed to prevent individuals from leaving a company with valuable information and then using that information in a new job with a competitor of the company to the detriment of that original company/employer.

Sounds reasonable on its face. On the other side, what if you are the employee that with no malicious intent whatsoever, elects to change jobs and move on to bigger and better things? You should be free to do so, right? If on exiting your current job you are presented with the NCA that you signed when starting (and may have forgotten or misplaced) and you are a valuable developer, your soon-to-be former employer may be dropping more than a subtle hint in your lap.

So what is fair and reasonable in light of the two justifiable yet opposing positions?

This is the essence of the determination that courts must make in cases involving NCAs. In general terms, in order for an NCA to be “reasonable” it must protect an employer’s legitimate business interests while not unduly restricting the employee’s ability to work elsewhere. Other key considerations are length of time and geographical area (historically). The first part, protecting legitimate business interests, is satisfied if the employee involved had access to trade secrets of the former employer. Further, if the employer uses NCAs for only certain employees that have access to confidential material or trade secrets, they strengthen greatly their likelihood of support from the courts. As for length of time, six months to two years depending on the situation, is usually found to be acceptable. Anything longer than that would require a stiffer business reason for the restriction. Finally, geographic scope is considered. In the technology industry however, geographical area could include the entire US market. There has been some relaxing of the geographical scope restriction, which is why I used the parenthetical “historically” above.

Note that the NCA is a contract. All contracts must have “consideration”, or something of value, offered by each party and consequently accepted by the other party in order for the contract to be valid. If the NCA was a condition of employment at the point of hiring, then the promise of a job fills the consideration requirement. Introducing the NCA in an existing employer/employee relationship is different. Some courts have held that continued employment is sufficient consideration. In other cases, the execution of the NCA in conjunction with a raise or promotion has served to establish that sufficient consideration is present to enforce the NCA. An employee faced with the new (post-hiring) NCA requirement may not have any reasonable opportunity of negotiation. Some may however. If the employee is a valued software scientist, then ideally that individual could seek a severance package, providing an amount of money sufficient to offset the period of time in which they are prevented (by the NCA) from working in the same field for a competitor. As a general statement, the employee should always review the NCA carefully, even seek legal advice, in order to determine the restrictions imposed and the reasonableness of those restrictions.

The employer should make sure it is seeking to protect a legitimate business interest, and NOT just that it does not want competition. Lack of a justifiable business reason could be argued in the case of an employer having all employees sign an NCA, regardless of position, from receptionist to software engineer. Limited duration and geographical area are also helpful. An NCA of unlimited duration, where the employee can never work for a competitor, would work against the employer. In short, if the employer is careful to make the NCA as tight in scope as possible, in order to make the burden on the employee as little as possible, then they are in much better shape if the NCA is contested. If an NCA is too broad and lacks a sound business reason, its enforceability is strongly suspect.

Where a valid NCA exists, the new employer may also be susceptible to legal action by the former employer. Employers that lose key personnel to competitors often bring action against both the former employee (for violation of the NCA) and the new employer (for tortious interference with the prior relationship evidenced by the NCA). It is not unheard of for a new employer (that lures the key employee away) to belly up and take care of the employee’s anticipated defense, legal bills, and settlements with the former employer. I am not trying to scare people, but it should be understood that if an NCA is valid and you breach it, you are potentially liable for damages to your former employer. In addition, the former employer could seek an injunction preventing you from working for the new employer while the case is decided. Finally, if everything goes the former employer’s way, you could still be prevented from working for the competitor into the future. If you are the employee considering a job change and you asked directly if you signed and NCA, then obviously you must reveal the fact. If not asked and you do not volunteer the information, and the former employer sues the new employer, then the easiest way for the new employer to reduce its exposure is to terminate you. Not a welcome thought.

An interesting twist to consider is the situation where the employer terminates the employment relationship. Assuming that the NCA is valid and reasonable (see above), and would probably be upheld if the employee were the one terminating the relationship, then the issue really comes down to a restriction on the employee’s ability to make a living when the employer terminates employment other than for cause. Keeping in mind that we started with the assumption of a valid NCA, then strictly speaking, the employee is not free to ignore the NCA and the former employer could sue the employee, but then the court would have to look at the fact that the employee did not leave voluntarily and determine the reasonableness of limiting that individuals livelihood. My point is that being “let go” does not nullify the NCA, but enforcement by the former employer will be more difficult than if the employee left on their own.

Note that NCAs should not be feared, but they must be understood. In the HIT industry companies invent things and they try to sell more of these things to the industry than their competitors. They have a right to protect their inventions, know-how, trade secrets and customer bases. Anyone seeking to join such a company really should understand this going in. That said, it is not reasonable to expect a person to work for only one company in a given industry for their entire career. Some do, most do not. There is also the consideration of the type of work that the employee performs. The software scientist should have far more expectation of restriction on the ability to switch to a competitor than an administrative staff member.

Final Comments:

NCAs are not bad. If a company has something worth protecting, something essential to its business that if shared with a competitor would be damaging to its business, then they should be able to protect it. I don’t know how an employee would consider it “OK” to take that information elsewhere. I know it happens, but that does not make it right. Separately, we are all free to work wherever we choose. Absent the malicious factor, people should not be restricted from working for a competitor.

The problem is that you cannot unlock the brain of a software scientist, extract all they have learned at your company, then let them go on their way. Knowledge is retained and there is nothing we can do about that. I once saw it referred to by a BIG hardware/consulting company as “intellectual capital” (and I knew it was time to put that file down for the day). So even if nothing is physically removed, the secrets go right out the door in the scientist’s gray matter. Keeping them from using that knowledge to a competitor’s advantage is fair. Keeping them from earning a living doing what they like is unfair. It is a balancing act, a weighing of the consequences to each side, and a determination of fairness that the courts must perform when ruling on NCAs.

Please understand that even though I expound on valid or enforceable NCAs above, you must note that certain states basically do not permit NCAs (like California), others do but only in limited circumstances (New York and Virginia), while in others enforceability depends on the circumstances. This article has focused mainly on the individuals involved in the technology aspect of healthcare. Many states (like Massachusetts) clearly prohibit by law NCAs for physicians and nurses due to the fact that such agreements restrict a medical professional’s right to practice and also limit the patients’ right to choose their caregivers.

The NCA issue is heating up. Legislation has been proposed here in Massachusetts that would dramatically restrict NCAs by instituting strict guidelines, brightline determinations (clear “black & white” language) as well as safe harbor provisions. One very interesting aspect of the proposed legislation is that it would protect the employee residing in Massachusetts, even if the employer is not located in Massachusetts. I am watching closely as the bill winds its way through the legislature.

Finally, if you are faced with a situation involving an NCA and have serious concerns, please consult with an attorney or your local US Department of Labor office.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

Monday Morning Update 3/8/10

HERtalk by Inga

From: HIS user “Re: Rumor. (The CEO for the HIT business unit) of a (large, international technology company) has resigned. Heard from multiple direct sources at the company. Was announced there Friday.” The CEO was at HIMSS and had a press conference as recently as Monday. I sent a note over the weekend to the company but not heard back. If it’s true, I suspect the company will share the news Monday.

From: Bean Town Gal Re: Highlights. “We attended the HIStalk party and it was a highlight of HIMSS. Nice to be in the fishbowl; surrounded by friends and competitors — and truly enjoying it. Great vibe — thank you to the sponsors — the spinach & artichoke dip was yummy, GREAT to sit down and rest the paws after a very long day …. but most of all, the intrigue and credibility that you & Mr. HIStalk create, will keep us coming back again.  Truly appreciate what you both do. Kudos and …. Love the shoes.”

From: Beastly “Re: Press Releases. As PR professionals we are compelled to issue press releases when our companies bring new products to the market that are worthy of acknowledgment. A true PR professional knows the difference between newsworthy and wasting a journalist’s time. We also have an ethical responsibility to advise our clients if and when their perception of news doesn’t merit coverage. Issuing press releases about non-news compares to the ‘boy who cried wolf,’ syndrome. For many within the healthcare industry, HIMSS is our Super Bowl. The opportunity to showcase the products we developed, believe in and are proud of. The media and most importantly our customers expect to see us with our best game. Companies don’t indiscriminately issue press releases – they plan product releases so that they coincide with HIMSS. If a product is ready two months before HIMSS, the HIMSS exhibitor companies traditionally wait for HIMSS to show and announce it.  And if the product won’t be consumer ready until a few months after HIMSS, the exhibitor will often develop a mock-up or engineering sample so it can be shown to the audience at HIMSS. The majority of us aren’t trying to waste your time; we’re inviting you to share our exuberance.”

From: Pat Avatar “Re: HITmen event. I was unimpressed with the “boys club” HITmen event. I think it was very unimaginative. Same people named over and over. A while back, Colin Powell was quoted along the lines of if any area was in need of imagination, it was healthcare. If we keep trotting out the same handful of people – we are truly in trouble. Enough of Tullman, Bush, the government appointees who are elevated only by title and not by progress, Halamka, and the usual short list. Why not have someone meet the challenge of recognizing the worker-bees – the ones really getting the job done – while the same people are the headliners. Besides, Inga and I are going to take over the world of healthcare and get something done.”

Note sure that I am going to take over the world of healthcare (or that I want to) but I am taking over HIStalk for the week. An exhausted Mr. H is taking took some well-deserved time off and hopefully cleansing his mind of the HIT world. If you have any news to share, be sure to send it my way since Mr. H is avoiding e-mail this week.

Last week MS HUG and Microsoft announced four winners of its annual Innovation Awards. SingHealth earned honors for the best use of inpatient clinical records use for levering its implementation of  Eclipsys Sunrise Patient Flow and CADI Scientific. Other winners included Brigham and Women’s Hospital, Doylestown Hospital, and Premera Blue Cross/Get Real Consulting.

Former McKesson Charles McCall is sentenced to 10 years prison and ordered to pay a $1 million fine for his part in a $8.6 billion fraud scheme.

Medicity and Emdeon collaborate to create the first “converged national HIE, leveraging Emdeon’s network of payers, providers, and pharmacies and Medicity’s iNexx Health 4.0 platform.

The Advisory Board Company enters an agreement to acquire Concuity, the healthcare-focused RCM software and services division of Trintech Group. Price: $34.5 million.

The Wall Street Journal reports that shares of Nuance Communications rose 5.7% Friday on rumors that Google is interested in buying Nuance Communications. There are lots of reasons why such a marriage would not make sense, but an acquisition of Nuance would certainly help Google increase its presence in the healthcare space.

McKesson is named the “World’s Most Admired” company in healthcare wholesalers sector in a survey by FORTUNE magazine and the Hay Group.  McKesson also made Corporate Responsibility Magazine’s list of 100 Best Corporate Citizens.

Start queuing up at your local Apple store: the Wi-Fi-enabled iPad goes on sale April 3, with pre-ordering starting March 12th. Suggested retail prices will range from $499 for the 16B model to $699 for the 64GB. The 3G equipped models will hit the market in late April, though you can also pre-order starting March 12th.

Lumetra PSO agrees to provide iSOFT’s AIMS incident management software to US healthcare organizations.

Bridgehead software unveils preliminary results of its Data Management Healthcheck 2010, reporting that only 6.5% of respondents use cloud storage as the destination media for their organization’s data. Only 33% say they are planning to adopt a cloud storage strategy for any data over the next 12-24 months. The biggest concern is security and availability of data using a cloud strategy.

A couple HIMSS education sessions I missed: “A Big, Hairy Audacious” CPOE Goal, and, It’s More than Pizza! Improving House Staff Adoption of CPOE. I wonder if the presenter for the second one got any snack tips from Mr. H.

Former RelayHealth COO Jeff Bairstow joins Journal Register Company as CFO.

RWJF awards over $2.4 million to five research teams studying how patient-recorded observations of daily living can be captured and integrated into clinical care.

Wellmont Health System (TN) names Kent Perry CIO and VP and Dr. Troy Sybert chief medical information.

Verizon Business launches The Verizon Medical Data Exchange, a platform that gives transcriptionists an interoperable tool for sharing digitized patient notes.

A fan files suit against the Kansas City Royals after being hit in the eye – by a hot dog. The team’s mascot (Sluggerrr) regularly fires hot dogs into the crowd, but one last year hit John Coomer in the eye, resulting in a detached retina and cataracts.So far his medical costs have exceeded $25,000. It’s unclear whether Cooner actually ate the errant hot dog.

E-mail Inga.

Merge Healthcare To Acquire AMICAS

AMICAS has agreed to terminate its previously announced agreement with Thoma Bravo and instead has entered into a merger agreement with Merge Healthcare, the company announced this morning. Merge will acquire all outstanding shares of AMICAS in an all-cash deal valued at $6.05 per share, a 35% premium to Thoma Bravo’s offer and a 39% premium to the average monthly share price.

"We are very pleased with this significant positive step toward successfully combining these two great companies," said Justin Dearborn, Merge CEO.  "Merge and AMICAS have strong histories of innovation in medical imaging software, experienced employees and engaged customers.  As a combined company, our suite of health IT solutions will encompass a broad range of medical and biopharmaceutical imaging solutions to meet the needs of today’s medical imaging providers.  In addition, Merge’s OEM and CAD technologies, international and eCommerce distribution channels, and additional market segments such as clinical trials provide new opportunities for AMICAS products and customers. On behalf of everyone at Merge, I look forward to welcoming and working closely with the AMICAS team."