From HIMSS 3/2/10

HERtalk by Inga

From: Soda Pop Man “Re: HIStalk reception. All those who attended can attest, all proper propers belong to Ivo, Inga, and Mr. H for organizing an exceptionally fun evening. Great job, guys, a truly fun time…thank you!”

From: Evan Steele “Re: Sashes, strangers, and shoes. Thank you for a GREAT evening at Max Lager’s!  The sash was perfect (“HIStalk Certified” made for a great conversation piece)! Although I am not the type who easily mingles with strangers in a room, I found the HIStalk readers very approachable and I had some great conversations.

This will be a quick post as I have an 8:15 meeting (what was I thinking?) HIMSS has been predictably fast and furious with big crowds and lots of walking. Here are a few random impressions from Monday:

• Overheard in the ladies’ room: “Where the heck is the coat check?” I, too, had problems finding one. I am sure there’s at least one but the place is so huge that I wasn’t going to walk from one Hall C to Hall A just to dump my coat.
• I was a little bit disappointed with my interoperability booth tour. My presenter had some microphone problems so I couldn’t hear very well. And, too much time was spent with the overview of the whole interoperability concept, rather than demonstrating how it all worked. Still, it’s impressive that something like 70 vendors participated.
• The Blue Cat booth is offering a roller coaster-type experience, if you like that sort of thing. If you like eye-candy, they offer that as well.
• Hexaware had a unique booth concept with lots of plants on the ground, making the booth look a bit like a garden. They were promoting their green theme.
• Actuate is handing out $5 Starbucks gift cards, if you spend a few minutes chatting with them, like I did.
• I sat in on a Sage presentation in hopes of winning an iPod shuffle. I lost but the presentation was good (short and to the point.)
• I’ve noticed that the booths with the most activity are the HIE vendors. I rested my weary feet a bit and listened to an Ingenix presentation. When I stood up to leave I noticed there was a crowd three deep standing behind me. I saw similar crowds at Medicity, Axolotl, and dbMotion.
• PatientKeeper, Nuance and RelayHealth seem to have much bigger booths than in previous years.
• Chair massages can be found at DCS, which was near the McKesson booth
• As I walked by Bottomline Tech at about 3:45, folks were queuing up for cocktails. I waited until 4:00 and got an “Inga’tini from SIS. Highly recommended.
• Mr. H mentioned that the Google booth appeared slow. Not when I went by. Although I can’t figure out what they are offering that makes the crowd so curious.
• Chetu has a couple of gorillas in their booth. One of the guys working the booth told me they had wanted the gorillas to walk the floor wearing a Chetu sign. HIMSS nixed that idea. Apparently HIMSS thought some company might conclude that if one vendor could have gorillas walking around, then it would be acceptable to send forth girls in bikinis.

And, of course, the HIStalk reception was incredible. Thanks to all who attended and definitely to our hosts. Amy Glass with Encore rocks! Jonathan Bush was an incredibly funny announcer, which I believe our EHR-TV folks caught on tape. Yes, the very down-to-earth and friendly Judith Faulkner did stop by and even wore her sash that said, “No Pie for Me.” We awarded a couple of bonus sashes for great shoes. I checked out the shoes of both recipients and agree they were worthy of recognition. I’m hoping someone snapped a photo of the winning shoes.

I have lots of photos to post and will get to those in the next couple of days. More later!

E-mail Inga.

From HIMSS 3/1/10

From Kermit Randa: “Re: today. Long day of goodness sharing the critical importance of the OR in the current healthcare economic and IT landscape. The reception is a welcome end to a long day. Nicely done! Who can argue with beer, great apps, and a little John Cougar?! Thanks for all you an Inga do! Hope she stopped by the SIS booth for an Inga-tini!” I totally forgot that she told me that SIS has created a specialty drink for her, apparently available in their booth. She is enthralled with the concept of alcohol on the show floor, so I’m sure she has tried it already with a report forthcoming.

From Jack: “Re: camera cable. You should get an Eye-Fi.  It’s an SD Card that has built in WiFi capability and will upload images automatically.”

From Festus: “Re: partners. Seen on booths in the exhibit hall, ‘your partner in meaningful use’. A lie on two accounts. As discussed before on HIStalk, rarely is a vendor ever your partner and does anyone really believe they will help them use technology in a truly meaningful way?”

It was so cool to see everyone at the HIStalk reception this evening, so thank you so much if you attended, including our insiders who work on the sites who had a chance to be recognized. Thanks to Jonathan Bush for handling the HISsies announcements, to John Glaser for his video acceptance as CIO of the Year (I’ll post the HISsies winners when I get time), to Ross Martin, MD for his excellent world premiere of Meaningful Yoose Rap (you would not believe the government approvals he had to get to do it), to our sash wearers, and for Encore, Evolvent, and Symantec for putting it together (especially Amy Glass on the Encore side). I’m sure I’m forgetting people, but like you, I’ve had a beer or two too many (if you didn’t try the Max Lager’s Red, it went down pretty smooth). And how about that bagpiper! Thanks to Deborah Peel, MD from Patient Privacy Rights for staying over an extra night just to hang out with us, to Inga for all the work she did to prepare for the reception, and to those many people in the audience who work for companies that sponsor HIStalk, HIStalk Practice, and HIStalk Mobile and who chose to spend their evening with us. It’s just 364 days or thereabouts until the next one in Orlando!

I need to get the scoop on this since I left the party early. It appears from a reader’s cell phone pic just sent that Epic’s Judy Faulkner showed up and is pictured with Jonathan Bush from athenahealth. Big props for her if she did since I know she basically never does that sort of thing even though I asked her and she said she might. More to come.

And Dr. Gregg Alexander snapped this one of the B52s at the Eclipsys party. Love ‘em.

Speaking of Symantec, the company announces a cloud-based storing and data sharing environment for healthcare.

Dell announces that it will offer EMR hardware and consulting services in affiliation with the AMA.

Microsoft announces HealthVault Community Connect, which allows hospitals to make EMR data available to patients or to share the information with other providers.

I didn’t go to the opening keynote because I didn’t really want to get up so early, but it apparently talked up 4G quite a bit. Sprint CEO Dan Hesse says it can take health care out of the 70s, which could be argued.

I think we reported this as a rumor back in November or something, but Sisters of St. Francis chooses Epic.

Bassett Healthcare (NY) chooses PatientKeeper.

Voalte asked me to pass along that you iPhone users can stop by their booth to charge up.

I’ll add a few booth reviews and that’s all the time I have tonight since I have to get up early. And I’m exhausted since I remember now why hate the GWCC exhibit hall (Hall C is way separate from A/B and I never did find the secret passage that connects them, even though I’ve used it in years past and I even asked a security guard to point it out). As a result, I didn’t see much in Hall C.

• Several sponsors had their autographed We Power HIStalk signs in their booths, so thanks for that.
• Virtelligence had theirs front and center.
• Cattails MD from Marshfield Clinic had a pretty substantial booth.
• OnBase had the sports bar and that amazing card trick guy again.
• Not much changed with Epic’s booth,including the fact that Judy was in it most of the time.
• EDIMS had a video game.
• Eclipsys had a nice, open booth.
• Kronos staffed theirs very well, making it easy to get someone.
• Allscripts had lots of orange and looked good.
• Microsoft’s had a decent crowd, but not as much as last year from what I could tell.
• API’s was kind of skyscrapery, which I liked.
• GE’s was sprawling and divided up into sections.
• I’ll award NextGen the best booth award with its bold, purple cylinders and arches.
• McKesson had the usual blue and orange, but a whole separate sub-booth for Paragon.
• The Alert people from Europe had females some pretty impressive pants that I can’t really describe.
• Sentillion’s was labeled as “A Microsoft Company”
• RelayHealth’s was nicely done in McKesson colors, very open.
• Google’s was tiny and kind of dead.
• iMDsoft had a giant John Glaser photo.
• MEDSEEK made the best use of a reasonable space with some good design and an upstairs area. They attached their HIStalk sign directly to the podium, which was cool to see (Inga fretted that she told Kinko’s to go one size bigger than 8×10 and the next jump was apparently pretty big).
• Rel Ware had what was apparently a full sized Back to the Future DeLorean. Pretty cool.
• Chipsoft had the yellow wooden shoes again, still my favorite giveaway.
• eClinical Works had their sign out – thanks. So did Greenway.

HERtalk by Inga

Greetings from Atlanta!

I arrived at the convention center mid-day Sunday lurked around a few meetings and looked for famous CIOs. I realize how nerdy this is, but I was thrilled to catch a glimpse of a few CIO superstars like Bill Spooner, John Bosco, and Ed Marx as well as vendor big-wigs like Glenn Tullman, Sunny Sanyal, Judy Faukner.  We are definitely in the land of HIT rock stars.

If you are not a rock star but want people to think you are, HIMSS has made available a plethora of extra ribbons to adorn your name badge. I gave Mr. H one that says "PMP" and told him it could be a good conversation starter since from afar the mind automatically wants to insert an "I".

Mr. H and I had an HIStalk executive board meeting Sunday afternoon and voted to continue the blog. Since he was designated CEO of HIStalk for the HITmen event, he graciously awarded me the title of President. My mother would be proud.

When the meeting was adjourned, we joined a relatively small crowd at the opening reception. I suppose it is difficult to create an ambiance with a warehouse-like room that has concrete floors and open rafters. There was a live band, but the acoustics were so bad I couldn’t tell you what they played or if they were any good. Mr. H reminded me how crowded the reception was last year as people tried to avoid walking in the Chicago snow storm. I’ll take the sunshine of Atlanta.

Today’s agenda includes CCHIT town hall meeting and checking out the exhibits, including the interoperability booth. Then a bit of primping and on to Max Lager’s. I promise to keep good notes and share details of the day, especially for those of you keeping the lights on at home.

E-mail Inga.

From HIMSS 2/28/10

From Zale: “Re: Eclipsys. I wonder if anyone at either Microsoft or Eclipsys knows that Bill Gates demoed an early version of Sunrise Clinical Manager at HIMSS in 1995?”

From Sheri: “Re: clinicians and IT people. But if you combine the best of both worlds – the experienced Clinical Analyst — you get a great opinion. Clinicians don’t know what they don’t know about IT. Experienced clinical analysts have one foot in both worlds and can make really good decisions about the solutions that will work for the clinicians. You just have to hire the right people and get out of the way.” Sometimes, as long as the analyst remembers that as soon as they cross the dark side to IT, they need to consult the still-practicing clinicians before making decisions. Most of the ones I know are excellent, but a few think their decades-ago practice makes them even more expert than those still working. But I agree in general and at least the CAs always put the best interests of patients first. 

From Diamond Jim: “Re: drink beer, get CME.” Strange — attendance at the HIMSS opening reception earns CME/CNE credits. Somehow I don’t think patients would be comforted to know that. I really did get some good education from some of the HIStalk pals Inga and I hung out with there, though.

It was strangely quiet and low-key at the convention center today, but you could smell the money. New exhibitors, new attendees, and lots of expensive advertising stuff were obvious. It looked nice outside, but with temps in the low 50s and lots of wind, it wasn’t really all that comfortable. I had forgotten until someone mentioned it about the weird layout of the exhibit hall, with the two unconnected halves that mean some vendors paid big dollars for Siberian real estate.

Speaking of that real estate, I was explaining to someone that it’s not enough to be willing to pay big bucks for booth space – you have to earn the right to spend that money by first accumulating HIMSS points. I’m not sure they believed me, so here’s the proof.

Like I always say, it looked like the Marines laying in supplies for the siege at Khe Sanh. Trucks, cartloads of food and drinks, and vendor shipments were everywhere. Everybody was dressed casually, which will be in contrast to the dolled up crowds tomorrow.

The opening reception was surprisingly uncrowded, with no drink lines at all (I only drank, but the food lines didn’t look much longer). The atmosphere, of course, was like taking an aircraft hangar, putting a small band at one end of it and leaving them to compete with their own echoes, and sticking up a few palm trees with Christmas lights on them. I’ll stick with my prediction of 30,000 attendees, but 90% of them weren’t at the opening reception for some reason.

Strangest line overheard, this from a supposed HIT journalist: “What does CIO stand for?”

Two acquisitions will be announced tomorrow morning, sources tell me (although one may be delayed until later in the week). One involves an imaging vendor, the other a document company.

My cheap hotel has slow wireless and I forgot my camera cord, so I”m working without much technology support. Luckily Inga is handy with her iPhone. She also brought me barbeque sauce, so anything she does is fine with me.

GE makes some announcements early: a clinical knowledge platform, eHealth solutions, and HIE improvements.

A reader snapped this candid photo (looks like a phone one) of Epic’s Judy Faulkner behind a coffee urn that looks like a 1950s sci fi robot or spaceship. I swear the woman never ages. I tried to get her to come to the reception tomorrow night and she says she “might drop by”, but I’m not holding my breath. If she does, we have a sash for her.

I’m counting on my fellow attendees to keep me abreast of rumors and news. Photos would be nice since my camera is useless without the cord. Send me anything interesting.

Monday Morning Update 3/1/10

From Skippy: “Re: Nuance. It will announce acquisition of Language & Computing either today or Monday.” Unverified, but interesting timing considering both the typically Monday-heavy announcements at the HIMSS conference and this announcement: the Justice Department drops its antitrust investigation into Nuance’s 2008 acquisition of Philips Speech Recognition Systems.

From Delta Dawn: “Re: KLAS. You’ve laid out the issues regarding the benefits and limitations of KLAS information before. With their new vendor rating coming out at HIMSS, it seems like a good time to dig a little deeper. IF KLAS is really an unbiased source and is providing an unbiased scorecard, then they should have no problem revealing how much each vendor pays them. To spare them the trouble, I’m attaching the table here. Also, any vendor who uses KLAS data should be required to publish how much they are currently paying KLAS.” According to the table, KLAS scales pricing to annual organizational revenue, ranging up to $175K per year. My only reaction to that is that I wished I had thought of the business model myself. Everybody gripes about KLAS for one thing or another, but everybody continues to participate, so they are simply meeting a demand and pricing their supply at what is apparently an acceptable point. I like the listed add-on service of meeting with vendor executives for a brain dump, which sounds more like the business model I would have created. My variation would be to have the engaging organization’s executive write me a frighteningly large check and then take me to a long lunch somewhere that serves beer and hopefully barbeque and after a couple of rounds of each and with no advance preparation whatsoever, I would spill everything I know, including some of the more scandalous stuff readers have sent me that I can’t run on HIStalk for reasons that mostly involve libel and possibly stock market manipulation. I’m pretty sure KLAS doesn’t do it that way, though.

From Skeptic Shock: “Re: SIIM. Funny how they send out an e-mail about their one and only HIMSS presentation after the Readers Write article by Mike Cannavo. Looks like SIIM and HIMSS both read HIStalk. My hopes is that more IT folks will come forward and express their opinion that enterprise multi-modality, multi-disciplinary imaging is a major component of the EMR and can bring down a hospital’s efforts if not handled well.” Future collaboration is mentioned between the groups. I believe we need more PACSMan in the HIStalk future since IT people need more knowledge about imaging and related applications. Plus, as one reader pointed out, he’s just as cynical and abrasively outspoken as me in his PACS circles (in a heated moment, one executive screamed that he was the Antichrist, apparently, which is the coolest thing I’ve ever heard). That’s the guy you want telling you about imaging.

Want to see Sen. Chuck Grassley’s letter to Kathleen Sebelius urging FDA oversight of healthcare IT? Sure you do. A snip: “… I have been surprised by the lack of discussion about patient safety concerns … they [clinicians] tried raising their concerns to hospital administrators and/or to the HIT vendors, but told me their concerns were often ignored or dismissed.” He cites a 1997 JAMIA article that observed the lack of FDA oversight and the 1996 counterproposal from a group of vendors who presumably were trying to avoid it. He asks HHS directly whether FDA oversight should be revisited, and if not, how does HHS plan to oversee the safety of HIT and ensure that vendors follow quality process. Also included is a letter to Steve Lieber of HIMSS, asking him to clarify the HIMSS position on FDA oversight, recommendations going back to the CHIM days of a “code of good business practices” for vendors, and the HIMSS position on vendors reporting safety issues and notifying users of potentially safety issues. The Senator wants an answer by March 10, with interesting timing in sending HIMSS the letter right before the annual bacchanal begins. A reader comment suggested that the Feds will have folks observing the conference to see exactly how taxpayer money will be spent, but that’s unverified.

Here is my modest proposal to improve HIT patient safety in hospitals: let clinicians appoint a committee of nurses, doctors, and pharmacists (and any other caregivers you like) to independently make decisions about user IT communication, vendor priorities, and training needs, all with no IT people in the room and no IT veto power. I’ve been in those conference rooms a zillion times on both sides of the table and, as much as the IT people have the organization’s best strategic interests in mind, they are the de facto partners of the vendor in getting the system implemented, running, and hopefully accepted. They do not have the knowledge or the objectivity to decide whether a particular problem is OK to work around or whether the users need to know about it even though it’s embarrassing (any more than having drug company reps participate in a formulary committee meeting). IT people will dominate those meetings if they attend, so the decisions need to be made without them present unless the clinicians need them, like a jury left alone to deliberate until they send out for information. Just my opinion as an IT person.

AMA will offer Ingenix CareTracker EHR through a new AHA solutions platform being beta tested in Michigan. The announcement will come sometime Monday.

Salar (pronounced SAY-lar) is a new Platinum Sponsor of HIStalk, so thanks to those folks in Fell’s Point in Baltimore (a great area for eating and drinking when they aren’t getting blizzards) for supporting us. I interviewed company president Todd Johnson this week so that’s a good overview, but here’s the summary: Salar’s clinical documentation system TeamNotes works with core clinical systems, providing tools for documentation, physician charge capture, patient handoffs, quality reporting, and team collaboration. Customers include places like Johns Hopkins, UPMC, GWU, etc. I have to say I enjoyed reading their recent “Dear Physicians” blog entry that says it so well I can’t even excerpt it and do it justice (rare for me since I enjoy excerpting). I would seriously drop by Booth 2644 at HIMSS and check them out since they sound kind of dangerously disruptive in a good way. Thanks to Salar for the support.

CCHIT is rearranging some of its work groups, according to an internal communication a reader sent over. Oncology and Women’s Health are new specialty EHR certifications and CCHIT is looking for volunteers. Under way for later this year are long term and post acute care, dermatology, clinical research, and behavioral. Most of the main groups are on hold until meaningful use standards are finalized, which CCHIT says will happen by summer.

Cumberland Pediatric IPA (TN) chooses Informatics Corporation of America’s CareAlign data analysis and reporting tool.

Obviously we have some HITECH skeptics in the ranks. New poll to your right: with all the sudden interest in patient safety oversight of healthcare IT, do you think the government will mandate some degree of FDA involvement?

The Encore folks have been working incredibly hard to finish up details for our reception Monday evening. I’m sure nobody’s naive enough to think that you just book a facility and show up, but the amount of detail that requires attention is surprising even to me. Of course, if it all goes perfectly, everybody will just enjoy themselves without noticing those details specifically. I’ll say this: I certainly never expected to have an HIStalk specialty drink designed and named, but I’m looking right at it. Inga and I got the guest list and, as we digested the Who’s Who list of attendees (no kidding – lots of star power), she e-mailed me her one-word reaction: “Surreal”. To which I replied back with a line from That Thing You Do: “How did we get here?” It’s an early St. Patrick’s Day theme, so feel free to wear green if you like, although I don’t think they bought my idea of green beer.

Speaking of events, a couple of readers are looking for fun events for Tuesday and Wednesday evenings, so I told them I would deputize them as HIStalk roving reporters if anyone knows of cool stuff. Inga and I got a lot of invitations, but I didn’t save mine.

Shares in athenahealth dropped over 15% Friday on the announcement that its Q4 report will be delayed pending completion of an audit and a review of service revenue accounting procedures. If the company decides to implement an accounting change based on the assumption of ongoing customer renewals, it will have to restate earnings. You may recall my recent mention of an independent organization that gave ATHN a 99 rating for accounting and governance (meaning very conservative), so this is one manifestation of that, but one with a negative shareholder interpretation: they are considering a change to even more conservative accounting practices, but that might mean lower paper profits. I would think that’s good news if I were buying the product or the stock, but both markets have minds of their own.

Ohio State University Medical Center will bring its 617-doctor affiliated private practice into the university, with the stated primary incentive being the ability to implement a complete electronic medical record.

This is probably an important case to watch: the federal government files a fraudulent billing lawsuit against a Florida cancer clinic because its physicians billed for services delivered while they were out of the country. Regardless of what the clinic was up to, it brings up the question of exactly what constitutes supervision in an ever-connected age. Is value added by having the doctor physically standing there, and it insurance paying for that standing around or the oversight that can be equally well provided from anywhere?

I’m receiving powerful psychic emanations that Microsoft will make an interesting product announcement Monday morning. 

I’ve been overwhelmed lately, so I forgot to mention this like I promised. The Fierce people are having an executive breakfast Tuesday morning at 7:00 at the Sheraton Atlanta and are offering HIStalk readers a discounted rate of $50 if you enter the code TALK on the online registration form.

Former Cerner COO Glenn Tobin joins coding solutions vendor CodeRyte in a newly created COO position.

Sage announces its meaningful use guarantee.

Greenway donates several of its applications to Northern Kentucky University to be used in training students in the university’s health informatics programs.

A Florida health network reports the results of its year-long study of the Patient-Centered Medical Home model: hospital days dropped 4.6%, admissions were down 3%, costs swung around 20% to the positive compared to the market in general, and quality metrics improved.

I will be posting daily from HIMSS, of course, perhaps with some of Inga’s usual entertaining insights (like where to get margaritas in the exhibit hall). If you aren’t going, I will try to give you the on-site flavor. If you are, safe travels.

E-mail me.

HCIT from the Investor’s Chair 2/26/10

The end of 2009 brought a few company announcements that were particularly relevant to the investment community. Noteworthy among them were the sales of enterprise vendor QuadraMed and radiology systems vendor Amicas to private equity (aka PE, buy-out or leveraged buy-out – LBO – investors). When a public company is sold to an investment firm rather than another company in the same or adjacent sector (such as Sentillion’s sale to Microsoft or CareMedic’s sale to Ingenix), it’s known as a “take-private” transaction.

When this happens, private equity investors, usually acting with the existing management team, are making the assumption that they can purchase the company at a premium to its current stock market value, make some changes over the course of a few years, and then sell it to another buyer at a premium to what they paid. Sometimes this is likely “Greater Fool Theory”, but in many cases, it’s quite logical. Readers who’ve not had the sometimes dubious pleasure of being involved in a process like this might wonder how it happens and what’s the thinking behind it.

In my decade as a research analyst, I rarely heard a CEO say they thought their stock was fairly valued, and never heard one say it was overvalued — at least where anyone could hear them. This is because (a) they typically own a fair amount of said stock (or options); (b) they’re inherently optimistic by nature (if not outright promotional); and (c) the same reason that my mom thinks all her children are both bright and attractive (well, perhaps she really is right). In many cases, the company has lost much of its sell-side analyst coverage, perhaps missed a few quarters’ earnings estimates and has become a “single digit midget”. All the while, its CEO and the board are thinking their stock is worth more than that silly stock market is willing to pay for it, and time passes. And more time passes. And still, the stock is worth less than they think it is.

Clearly, it’s time for Action! At some point, they start to realize that if the stock market isn’t according them their “fair” value, perhaps another entity will. It’s time to call the bankers (or start returning their calls). Much like with an IPO (discussed in previous posts), the bankers show up and, using a dazzling array of PowerPoint and spreadsheets, confirm that, why golly, yes, your stock is undervalued! Clearly a transaction is called for: it’s time to find a buyer for the entire company. In some cases, incidentally, the bid comes unsolicited, as PE firms have people whose primary job is to call companies to convince them to go private, but even then, some form of sale process is usually required to ensure a fair and appropriate price is paid.

Rather than enumerate yet another type of banking process for a posting (but readers can request it for a subsequent post if interested), let’s skip that process for now and assume that no strategic buyers have opted to participate (at least at as high a value). What motivates a private equity investor to outbid a strategic buyer? A few key elements typically underlie their analysis.

• Being public is expensive, often costing smaller companies over $1 million to cover their SEC requirements, insurance policies and Sarbanes-Oxley compliance costs, etc. Once private, all these costs fall straight to the bottom line.
• Public markets are notoriously short-term focused. Many believe (I among them) that, freed of the requirement to manage on the instant gratification of a quarterly basis, company performance is likely to improve.
• Sometimes it is best to take a hiatus from the public markets for other reasons. Emdeon used its “private time” to make substantial improvements to its operations, management, and other areas. TriZetto Group is moving to more of a subscription model. Netsmart Technologies did something or other. Etc.

A few questions leap to mind, however:

• If there are changes that should be made, why hasn’t management already made them to benefit current shareholders rather than the new private investors?
• Did the fact that typical senior management parachutes (inherent in change of control transactions) would inflate — plus their stock would now be worth more, plus they’re likely to be re-loaded with new equity — impact their decisions?
• What drives the new investors’ confidence that they’ll be able to sell later to a strategic buyer, when they presumably just outbid all of them?

All good questions, but, at the end of the day, two groups of smart PE investors looked at both QuadraMed and Amicas and decided that they could make a good return on their money by purchasing these companies, so clearly their spreadsheets, extensive diligence and planning supported them. I’ll note that, besides the suppositions made above, their math was definitely helped by the fact that their fund likely only put up around 20-25% of the money; the rest was borrowed, substantially magnifying their returns (hence the term leveraged buy-out) and, further helping their math, significant transaction and management fees are often imposed on the newly acquired companies for the privilege of taking the money — often these fees run in the millions.

What about all the lawsuits that have been flying though? It seems that each company has been hit with about a dozen lawsuits (or threats), from apparently the same firms. It appears inevitable that, despite the fact that an auction was conducted, a bevy of class action lawyers will invariably announce investigations “on behalf of shareholders” alleging the unfairness of both the amount being paid and the process that was run. In my view, while the threat of these might be important to preserve the integrity of a process, the reality is 90% or so are merely opportunistic behavior on the part of the law firms. As a review of the proxy statements for either Amicas (also available in a nifty PowerPoint summary) or QuadraMed show, efforts were taken to ensure a fair price was paid.

In the case of QuadraMed, a fairly broad auction was conducted, which included a sizable number of PE firms and four unnamed strategic buyers. While Amicas responded to in-bound, apparently unsolicited interest, the agreement with the buyer allowed them to actively “shop” the bid to see if a higher bidder would emerge. Presumably, none did. By the way, as a student of the sector, I think these documents make for an interesting read, but that could just be me. For example, QuadraMed has apparently tried to sell a number of times over the past few years to no avail. It would also be interesting to contrast Amicas’ slightly gloomy assessment of risks on its slide deck with its no doubt more bullish one that was likely given to potential investors a few weeks earlier.

Also, every time a public company is sold, its board is required to seek a Fairness Opinion to ensure a “fair” price is paid. A Fairness Opinion is provided by the seller’s investment banker (typically the one who ran the sale process — and who stands to get a very sizable fee upon its success — but I’m sure there’s zero conflict of interest there). In a Fairness Opinion, the bankers assess and determine that the amount being paid is “fair”. How? By looking at how similar companies are currently valued in the public markets, what price (and what multiple of sales and profits) similar companies have sold for, and by using a discounted cash flow analysis (DCF) as an additional check on value, as well as what kind of premiums to current share price have been paid for similar public company sales.

It’s actually a fairly rigorous analysis, and each firm has a special committee that vets it prior to issuance, as the issuing firm has some potential liability (which is part of why the fee for the Opinion is determined by the size of the transaction). Then again, the AOL-TimeWarner merger was considered “Fair” as well so, as the programmers can attest, Garbage In, Garbage Out. For more detail, please check the proxy links above, or just drop or post me a note.

And so, the public markets bid au revoir to these two players, wondering only if they’ll resurface as strategic sales (like Healthvision, nee Quovadx — generating an outstanding return for Battery Ventures) or IPOs (like Emdeon). The final question, of course, is what does this mean to users or customers? It could well be a positive. As suggested, assuming responsible behavior on the part of the new PE firms, freed of the pressure and scrutiny of public investors, they’ll both be able to focus more on running their business, supporting customers and developing new products — just like companies are supposed to do.

Post script: the action continues on Amicas. Readers of “the tape” will note a minor battle underway between Amicas and its competitor, Merge Technologies. After I submitted this to Mr. H, Merge has announced that it was bidding 13% more than the PE firm Thoma Bravo to buy Amicas. “Not so fast”, Amicas responded later that day.  “Do you really have the dough?” The plot has thickened with accusations flying both ways and a Massachusetts Supreme Court enjoinder on having the shareholder meeting.

Theoretically, regardless of management’s preferences on the outcome, the board has a fiduciary responsibility to accept the highest quality bid. With the stock trading today between the Thoma Bravo bid and the one from Merge, the outcome appears uncertain, and will be likely continue to be played out on the tape and in the courts. In the meantime, I can only observe that this minor drama seems to support that the market is setting the prices here somewhat efficiently, notwithstanding the complaints of the class action bar “representing” QuadraMed’s shareholders. Clearly when someone else wants to buy a company, they can emerge and do so.

Ask the Chair

What do investors do at HIMSS?

Aside from walk around looking for cool trinkets?

HIMSS is always great for the investor community. Most of the larger public companies in attendance have analyst meetings, or at least booth tours. It’s a chance to talk to current and potential clients of the firms one covers. There are parties to attend and for both investment bankers and private investors (VC and PE) and a virtual feeding frenzy of business trolling opportunities.

Speaking of which, Mr. HIStalk’s discussion of the HIMSS Venture Fair beat anything I could have done, but I will be attending and sharing a write up a week or so after, so watch this space for post-HIMSS thoughts.

See you at the HISTalk party, please come up and say hi.

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.

News 2/26/10

From Wrangler: “Re: is Inga a man?” An online article suggests that perhaps Inga is a man writing as a woman. I couldn’t wait to tease her about that, but she had already seen it and responded back that a couple of readers have e-mailed her with the same suspicion. Let me forcefully allay that speculation: Inga is most definitely female, and a quite striking example if I may say (not only at least as cute and charming as her avatar suggests, but darned smart and caustically funny in our offline e-mails). So let’s treat the lady with some respect, OK? She’s the queen around here.

From Olivia: “Re: karma. With hard times and cutbacks around him [vendor exec name omitted] goes out and buys a $450,000 Maserati, parking on the corporate lot (and taking several spaces) for viewing by the layoff-ees exiting the building. Need I say there was a small round of applause that swept the building when news traveled that he’d hit the back of another vehicle and smashed its pretty little face. He has to be the most hated exec in the EHR industry – I’ve never met anyone about whom 100% of people say he is truly insufferable.” I hope he closes the Maserati’s gas cap tightly because the sparks from keys repeatedly meeting paint could present a fire hazard.  

From Lee Minors: “Re: first step of Microsoft purchasing Eclipsys?” Microsoft will integrate parts of Eclipsys Sunrise Enterprise with its Amalga UIS. The press releases talks about an open platform and the pretty cool MLMs and ObjectsPlus components that are exposed for customer self-development (not all inpatient EMR vendors offer something like this, but I’d find it hard to justify buying one that doesn’t). I don’t see any clear-cut evidence of further Microsoft interest at the moment, but its recent Sentillion acquisition started out this way and I’m hearing the rumors, of course. Thanks to Eclipsys for offering me personal, pre-announcement access to its very tippy-top management to discuss the strategy behind the move, which I had to unfortunately decline because I was occupied with stuff at the hospital. As I e-mailed Inga afterward, “One of these days, it will hit me how strange that is — telling a billion-dollar company that I unfortunately don’t have time to talk to their top executives.” Darned day job. Even without the briefing, though, I like the move.

From Connie: “Re: HITMEN. You didn’t mention the TV series behind the theme. It’s Mad Men on AMC, based on early 1960s Madison Avenue advertising men. There have been two seasons and it’s wonderful!” I knew that but forgot to mention it. I haven’t seen the show — I guess my DirecTV package doesn’t have AMC because I keep scanning the DVR list to record it and it never comes up.

From Byter: “Re: Quality Systems acquires Opus Healthcare Solutions. From the SEC 8-K, they paid $12 million in common stock plus up to $14 million in future shares subject to performance.”

From PACS All Mighty: “Re: Merge. Given the odd but always entertaining history of Merge, Amicas, Emageon, Cedara, eFilm, etc. and their oft-crossed swords of mutual conquest, an Auntminnie.com forum writer SlingshotPM  calls this “Efilmergemedeageonicas – a seamless and fully integrated solution that capitalizes on the synergy of integrating a best of breed technologies solution to the radiology workflow paradigm.’ Clearly the GE, Philips, McKesson, and Siemens big dogs would love to see all these yapping Chihuahuas go away.” Speaking of Merge, the company is suing its former CEO and CFO for the $880K it spent defending them on accounting fraud charges, plus the $3 million it shelled out to settle the class action suit that resulted. Also speaking of Merge: the company gets $200 million in bridge financing to support its $248 million offer for Amicas.

First time I’ve seen this: advertising for Epic people for “a massive healthcare project” on Craigslist.

I interviewed the folks from DIVURGENT for HIStech Report, including former BayCare CIO Lindsey Jarrell, who just joined the company.

Listening: Tarja, the operatic former lead singer of Finnish symphonic metal bad Nightwish, which just may teleport you to a winter’s evening in Finland spent on a bear skin rug in front of a fireplace (hopefully not alone).

I interviewed iMDsoft CEO Phyllis Gotlib a couple of weeks ago, so it’s fun to have the company back, this time as an HIStalk Platinum Sponsor. iMDsoft has big plans for expanding its US market, which should be made a lot easier by already having a Who’s Who of top US hospitals as customers (BIDMC, Lehigh Valley, Mass General, Henry Ford, Barnes-Jewish, Johns Hopkins, etc.) Its flagship product is the Metavision continuous patient record for ICU, anesthesia, and acute care, along with solutions for electronic dashboards, remote intensivist monitoring, and mobile clinician access. Drop by Booth 8633 at HIMSS and tell them you read about them in HIStalk. Welcome and thanks to iMDsoft.

Several HIStalk sponsors have swapped out their ads on the left with HIMSS-specific ones, so give them a look and click on any that move you.

Thanks to the one and only PACSMan Mike Cannavo for his guest article this week. Mike doesn’t know who I am, but we hired him at our hospital to help with a PACS selection years ago. He’s one of those guys who knows more people in his first hour on site than you do after years of working there, and seems to be reverentially quoted by all of them constantly. The best I could do to compete was to remind everyone that I signed off on the contract to bring him in.

Medical University of South Carolina will deploy the care continuity module of the Oacis data aggregation solution of TELUS Health Solutions. It creates a portable care record that can be printed, faxed, e-mailed, or sent to an EMR as an HL7 message. I think I got an early copy of the announcement because I don’t see it on the Web yet. I respect and like Frank Clark of MUSC as much as any CIO anywhere. We chat occasionally, so I asked him about Oacis a couple of weeks back (they use it because McKesson’s Horizon portal isn’t so great for academic medical centers). Oacis is still a big piece of their strategy, providing viewer capability as a front end for Horizon Clinicals. He was remarkably frank (no pun intended) and modest when I interviewed him a couple of years ago, including giving me a nice overview of Oacis.

3M Health Information Systems releases its Mobile Dictation Software for the iPhone. It was already available for BlackBerry and Windows Mobile.

ONCHIT is Tweeting. Or at least has the capability.

Here’s an amazing video of a new Enovate computer wallstation. I wasn’t paying too much attention until the guy started moving it up and down the wall electronically with one finger; then, it turned itself off and closed its own keyboard tray and shut down when the user walked away.

We’ve got an interview with Paul Brient, PatientKeeper president and CEO, on HIStalk Mobile. We will have daily updates there from HIMSS, so if you are interested in mobile healthcare computing, signed up for the e-mail updates and get the scoops (we will get first crack at a few of those, I think).

Order Optimizer is a brand new HIStalk Platinum Sponsor, so thanks very much to those folks. It’s the first inpatient system certified by CCHIT as meeting preliminary ARRA 2011 standards for CPOE and decision support. The SaaS sytem was developed by the hospitalists of Intercede Health and provides comprehensive support for evidence-based admission orders. It contains over 180 evidence-based order sets and a merging engine that helps doctors create evidence-based treatment plans. Admission orders can represent up to 70% of the total during a patient visit and the product focuses on those, so the company says hospitals can get Order Optimizer up and running within weeks with no capital expense, giving much of the benefit of CPOE without requiring 100% physician adoption, reducing time, risk, and cost. It was a finalist for the 2009 Microsoft Healthcare Innovation Award. Thanks to Order Optimizer for supporting HIStalk.

Charge master applications vendor Craneware announces six-month results: revenue up 25%, earnings up 36%.

PatientKeeper and and EMPI vendor NextGate announce a partnership to integrate their technologies to enhance PatientKeeper’s HIE capabilities.

Mayo Clinic will conduct a one-year study to determine if home monitoring technology from GE and Intel can reduce hospitalization and ED visits of patients with chronic disease.

HIMSS says it expects 28,000 at the conference next week and all the hotels are full. Atlanta weather for Sunday: lows in the low 30s, highs in the low 50s, sunny. Getting cold by Tuesday, in the upper 40s with a chance of snow (can’t HIMSS go anywhere without the snow following?)

I’ll be writing as usual Saturday and then daily from Atlanta. You are my eyes and ears, so let me know if you learn something that others would like to know.

E-mail me.

HERtalk by Inga

Healthcare execs say their biggest hurdle in EHR adoption is lack of internal resources, according to a Beacon Partners’ survey. I was surprised that only 25% of the execs believe their organization won’t fulfill the first meaningful use deadline with most feeling comfortable with their progress. Even more surprising to me was that a whopping two-thirds of the 168 surveyed were not familiar or had little knowledge of Stark.

In yesterday’s HIStalk Practice I mentioned that HIMSS has a new HIT Buyers Guide just for HIMSS. It’s free to providers, though not vendors nor consultants and I assume not bloggers. When I am told I can’t have something (unless I pay a bunch of money), why do I feel I must have it? Anyhow, a kind reader shared these reflections:

A good number of vendors aren’t going to like this guide because no one wants to see anything less than an A by their name. A few categories have no vendors earning an A and most categories are littered with Bs and Cs. I even noticed one F. Even industry darling Epic made a B+ in one of its categories. If I were a buyer, I would be seriously depressed by the lack of low-risk choices.

Sunquest Information Systems extends its relationship with two customers who are expanding their use of Sunquest’s anatomic pathology solution. Massachusetts General Hospital is installing Sunquest CoPathPlus and Bon Secours Health System (MD) is adding Sunquest CoPathPlus at three facilities.

Praxis EMR selects MedUnity as its exclusive provide of HIE and fax services.

MD Anderson Cancer Center (TX) deploys LodgeNetRX Interactive Television System throughout its 11-building campus.

The Voalte One solution is now offered on Blackberry smart phones, in addition to the iPhone. The pink pants guys say they will be showing off both versions at HIMSS, booth 2407.

OakBend Medical Center (TX) successfully implements McKesson’s Paragon HIS, along with AcuDose-Rx medication dispensing cabinets. The hospital CEO says 100% of the nurses were using the system the first day of go-live and 100% of the physicians were using it within three months.

Beth Israel Deaconess Healthcare selects MedAptus’s Professional Intelligent Charge Capture technology for its 170-physician hospitalist group.

Five years after first implementing Allscripts’ practice management system, the 70-provider Mid-Michigan Physicians decides to add Allscripts EHR.

The Oregon Department of Human Services contracts with Netsmart Technology to implement Netsmart’s Avatar EHR and PM software at Oregon State Hospital and other state behavioral health facilities.

athenahealth announces it will postpone the release of its Q4 and 2009 year end financials in order to allow additional time to complete a year-end audit and conduct an internal accounting policy review. The delay is in connection with an internally-initiated review of its accounting policy for the amortization period for deferred implementation revenue.

Medsphere Systems appoints Michael Previti as VP of national sales. He was previously VP of provider sales for Initiate Systems and also did stints at both Cerner and McKesson. I see that former Picis exec Doug Schumann also just joined Medsphere to head up implementation and training, and, Health Data Sciences alum Carol Somer is the new director of marketing.

In September 2008 Mr. H mentioned that Pegasus Imaging Corporation filed a lawsuit against Allscripts, claiming  intellectual property infringement over licensing fees for a Pegasus development toolkit. I don’t recall ever hearing more about the lawsuit so I assumed that it was settled privately, as most lawsuits are. That’s apparently not the case and a trial could start in March. Pegasus president Jack Berlin says he’s been trying to work out a settlement for the last 18 months. Allscripts isn’t commenting. Berlin believes Allscripts could owe him $60 million or more in license fees.

After budgeting  an initial $590 million to deploy an EMR, Catholic Healthcare West is adding another $419 million to its budget (holy cost overrun, Batman!) Of the initial funds, $240 million was spent implementing Cerner EMR at eight of the health system’s 41 hospitals. CIO Ben Williams says the cost per hospital will be much less going forward because the implementation team is now more experienced. My math says they need to be much more experienced.

Emergisoft releases Emergisoft EC Forms Digital Solution, an application that converts template-style documentation into a narrative language chart.

AT&T announces plans to expand its AT&T Healthcare Community Online (HCO) solution to include a portal with pre-integrated applications. HCO is AT&T’s cloud-based HIE and collaboration portal. Some of the new enhancements include real-time access to patient data at the point of care, single sign-on access, integration with e-prescribing, EMRs, and lab services.

Speaking of AT&T, I got a text yesterday saying there’s a brand new tower close to my neighborhood. Coincidentally I see PC World praises AT&T’s efforts to improve its 3G network performance, which is now 67% faster than the network speeds of Sprint, T-Mobile, and Verizon Wireless.

The HIT Standards Committee recommends that federal certification criteria for EMRs be flexible and not lock into specific requirements that could become outdated. Certifications should consist of a family of standards for certain criteria, rather than specific requirements, e.g., require HL7 version two, though not specify a specific release.

Phytel appoints Dr. Richard Hodach its chief medical officer.

NextGen says that for each person who follows them on Twitter and retweets “#NextGencares and I do too,” they’ll donate $1 to charity. At HIMSS you can vote on which charity you’d like see get the money, and for each vote, NextGen will donate more money. I’m all for corporations sharing their profits with the world, so starting Twittering and stop by booth #7433.

Keane’s Healthcare Solutions Division is awarded contract extensions with University Physicians Hospital (AZ) and Ernest Health. Both entities recently upgraded to Keane’s Optimum Patcom offering.

I have to ask: why do marketing types feel the need to mention ARRA in every single press release they issue? It’s not just the folks selling EMRs. New hire announcements, infrastructure upgrades, and earnings announcements are all deemed worthy platforms to mention ARRA stimulus money. Enough already.

I’m sure regular readers are aware that Mr. H has been especially prolific with the interviews the last couple of weeks (I only did one of two). A couple of trivial observations: where are all the intriguing female interviewees? Please send your suggestions. More trivial: HIT has its fair share of hunky guys. I’m definitely heading to the AirStrip booth in Atlanta.

As Mr. H mentioned, a few of our guest at Max Lager’s Monday night will be adorned with beauty queen-type sashes. Most of our sash-designees have been good sports in agreeing to participate, even though none of them yet know what their sashes will say. Note that we will be awarding the above sash to two lucky attendees at the party, so keep this in mind as you pack your bags.

If you are going to Atlanta – safe travels! If you are staying home, we will do our best to let you know all you’re missing.

E-mail Inga.

News 2/24/10

From The PACS Designer: “Re: HIPAA Survival Guide. Deborah Leyva of the Health & Technology Blog has posted the Second Edition of the HIPAA Survival Guide for download.”

Just published by The Huffington Post Investigative Fund: FDA is “moving closer” to regulating EMRs after receiving reports of six patient deaths and 44 injuries related to system malfunctions. Examples included an OR system whose lockups forced nurses to re-enter data from memory and another that didn’t display allergies correctly (hardly news if you’ve worked in HIT for any length of time, but apparently FDA was surprised). An FDA official admitted that the agency has steered clear of regulating HIT, but says, “In light of the safety issues that have been reported to us, we believe that a framework of federal oversight of HIT needs to assure patient safety.” Reaction from vendor executives at the recent hearings was interesting: Epic’s Carl Dvorak was quoted as saying regulation wouldn’t necessarily ensure safer products or encourage innovation, while Cerner says it supports making voluntary safety reports mandatory because it’s “the right thing to do.”

I have a couple of interviews yet to post, so once those are running, I promise you will see fewer HIStalk e-mail blasts. All of the interviews were fun to do and I’m pleased to bring them to you. I’m hoping to clear the decks before HIMSS since you know I’ll be writing every day from there.

This is new at HIMSS: the naming of the HITmen (and women) of 2010, the most powerful healthcare IT leaders. There’s an invitation-only reception at the conference and some PR, I’m sure, for the winners. Some familiar names are on the host committee: Jonathan Bush of athenahealth, John Halamka of BIDMC, Steve Lieber of HIMSS, and the one that sticks out like a sore thumb, Mr. HIStalk – CEO of HIStalk (and yes, I’ve taken considerable e-mail ribbing about that, but I swear the CEO thing wasn’t my idea and I have zero delusions of grandeur). More to come.

Secure access vendor Imprivata announces the formation of a healthcare division and the hiring of HIMSS chair Barry Chaiken, MD as chief medical officer.

Here’s a shout-out for Software Testing Solutions LLC, a new Platinum Sponsor of HIStalk. The Tucson company’s RATIO tools perform automated software testing, which I hope you hospitals and practices are doing before simply moving vendor code to production (both unexpected bugs and manual testing are expensive, as I can vouch from unfortunately personal experience). You set the application environment, the scope, and the transaction volume, then let the script take over to perform and document the tests (it even works with Citrix). If you have Epic inpatient or ambulatory, Eclipsys SCM, or Sunquest, you could be validating your orderables, generating test billing transactions, and validating new vendor releases and interface changes with minimal effort and with documented consistency. Thanks much to Software Testing Solutions for supporting HIStalk.

HealthStream’s Q4 numbers: revenue up 12%, EPS $0.47 vs. $0.07, although some one-time adjustments threw the numbers off a bit.

Weird News Andy expands his media sources to video, locating this story about a Kentucky psychiatrist who attacked a patient in his office with a sword, with his only statement after the fact being “four quarts low on the truck.” His patient, unfortunately, sustained life-threatening chest wounds. The uncharacteristically somber WNA also finds this story that he captions as “Patients or Guinea Pigs,” describing the FDA’s OK to dispense with informed consent guidelines for EDs involved in a resuscitation study.

Wellmont Health System (TN) names Kent Petty as VP/CIO.

I figure it’s the least I can do to wish Encore Health Resources a happy first birthday since they’ll be buying a few hundred of you drinks and food next Monday evening at the HIStalk reception, so here’s to them (and their reception co-sponsors Symantec and Evolvent).

Redwood MedNet and Thayer County Health Services connect their respective HIEs as a demonstration of the Health Internet using Mirth Corporation’s Mirth MUx (Meaningful Use Exchange), built on ONCHIT’s CONNECT software.

The fight is on for Amicas, with Merge Healthcare putting a $248 million offer on the table next to the earlier $217 million one from Thoma Bravo. Amicas already agreed to the Thoma Bravo offer, so the company is urging shareholders to vote that way, saying it doesn’t trust Merge’s financing.

My upcoming guest editorial for Inside Healthcare Computing: Dark Side on Line One: If Cash Really is King, Now’s the Time to Leave That Hospital Job. A sample of its caffeine-fueled prose: “If you have a loving, loyal hospital spouse who makes you happy and puts up with your idiosyncrasies, then think carefully before running off with the tarted up, drug-seeking vendor stripper who is whispering in your ear to throw it all away to run off to Las Vegas with her to gamble. It’s not nearly as fun as it looks.” It’s not Camus, but it’s what I do.

Porter Medical Center (VT) gets a mention in the local newspaper for its planned Meditech implementation, which awaits certificate of need approval. I like the CFO’s response to possible ARRA incentives: “There are all kinds of experts at the state and national level that swear that this will save money. I’d be the last person to try to guarantee savings.”

Also getting a nice newspaper story on its EMR implementation: Stormont-Vail HealthCare (KS).

More on the pharma-sponsored depression “test” that WebMD ran, pitching Lilly’s Cymbalta: no matter how you answered the 10 questions, the response was always “You may be at risk for major depression.”

Nevada banks are pre-qualifying doctors for EMR purchases just like they do for mortgages, expecting a jump in Q2 purchases. On the one hand, banks say nearly all doctors are contemplating an EMR purchase. On the other, falling home values mean banks aren’t as willing to take personal guarantees for the loans. A nice article by the Las Vegas Business Press.

TriZetto launches its PHR for health plan members. The press release was full of a lot of product names that I wasn’t really interested enough to follow, but it does interestingly distinguish EMRs from EHRs (as I do).

Genesis HealthCare (OH) seeks $25 million in taxpayer-backed loans to Epic, which it hopes will quality it for $12.5 million in stimulus money.

A Maryland fire department’s computer system loses over 10,000 ambulance transport records and fails to file required reports when its computer system has problems in its first year of use. The $275K HealthWares reporting system has been scrapped, with the head of the firefighter’s union saying, “”I thought there was no reason to purchase this when probably an overwhelming majority of fire departments in Maryland use EMAIS for free. There was no reason at all to reinvent the wheel. It was a complete waste of money.”

Robert Miller is promoted to North American president of iSoft.

The White House wants to create a government-wide Federal HIT Task Force, chaired by David Blumenthal, that would coordinate healthcare IT among federal agencies. Those could include the VA, DoD, Social Security, CDC, NIH, and FDA.

Indian Health Service will upgrade its RPMS EMR system to meet meaningful use requirements, including addition of a master person index, a patient flow dashoard, and an event tracking tool to ensure follow-up of abnormal lab results.

Odd hospital lawsuit: a city judge held in a mental health facility for court-ordered evaluation of suicidal behavior files suit against more than 30 employees of the health system, the district attorney, other county attorneys, and Aramark. When contacted about the suit, his only comment was, “Payback is a (expletive), and I get to reform mental healthcare in the process.”

E-mail me.

HERtalk by Inga

Clearly HIT vendors and their PR companies are working overtime to issue pre-HIMSS press releases. Some of the news is meaty, though a fair number are a bit more ho-hum. Save yourself some time and peruse these highlights.

LSU (LA) expands its HealthLink project to include clinical data exchange between the LSU health system and its regional physicians. LSU Healthlink will use CarefX’s Fusionfx product to facilitate data access.

South Jersey Healthcare Regional Medical Center selects Patient Care Technology Systems’ Amelior Tracker to manage physician location and communication.

WellStar Health System (GA) selects ICA’s CareAlign Solution as its connected health technology platform.

Emergin, a division of Philips Healthcare, announces a new interface between the Emergin alert management platform and Voalte’s communication server. The integration will facilitate alert message notifications from the Emergin system to Apple iPhones and iPod Touches and provide real-time communication between caregivers.

HealthPort says it has added electronic delivery functionality to its release of information process.

Somerset Hospital (PA) contracts with McKesson for its PROmanager-Rx system to automate medication dispensing. Somerset is also McKesson Paragon user.

Northern Michigan Regional Hospital picks Medicity’s Novo Grid technology to provide electronic health information exchange among its hospitals and physicians.

PatientKeeper partners with NextGate to offer NextGate’s enterprise MPI solution for its customers. NextGate’s MatchMetrix Suite will connect with the PatientKeeper platform to provide a single view of patient information.

maxIT Healthcare announces a number of leadership changes,  including the promotion of Mike Sweeney from divisional VP of strategic partnerships to EVP of strategy and corporate development. Mark Fangman is maxIT’s new EVP of sales and operations and David Leaman is a divisional VP of sales.

Childrens Hospital Los Angeles plans to deploy GetWellNetwork’s GetWell Town solution when it opens in spring 2011.

McLaren Health Care Corporation (MI) signs a $3 million EHR contract with Allscripts for its 150 employed physicians. Initiate Systems will build McLaren an enterprise MPI across its multiple systems and databases, which includes McKesson’s practice management system.

Associated Cardiovascular Consultants (NJ) selects Sage Intergy, Sage Intergy EHR, Practice Analytics, and Practice Portal for its 38-physician  practice. Sage Healthcare, by the way, has its own channel on YouTube, which includes a number of customer interviews, including one with Associated Cardiovascular’s executive administrator.

CliniComp wins another deal with the VA, its third in the last four months. The New York/New Jersey Veteran’s Healthcare Network will install CliniComp’s Essentris ED and Essentris Critical Care solutions.

Former IDX exec Wayne Koch is named VP of physician services for Apollo Health Street.

The Valley Hospital (NJ) adds Summit Healthcare’s Scripting Toolkit to integrate with Valley Hospital’s MEDITECH platform.

Wellsoft shares word that the ED docs at Memorial Hospital (PA) are successfully using Dragon Medical to navigate and dictate within the Wellsoft EDIS.

As mandated by the HITECH Act, HHS posts a list of 36 reported health information breaches from private medical practices, hospitals, health systems, and public agencies. Most of the breaches were the result of theft or loss of a computer/drive/backup or other storage media. The breach affecting the most people involved the theft of hard drives from BCBS of Tennessee. The potential number of individuals affected: 500,000.

Here’s your HIMSS tip of the day: I see that Medi-Span is giving away a couple of trips to the Indianapolis 500. It’s labeled a “luxury trip package” but that’s still not much of a draw for me. I will forego entering Medi-Span’s contest and thus improve the odds for real fans. Of course, I expect you race car fans to return the favor when it comes the drawings for a nook eBook Reader (Dialog Medical) or Amazon Kindle (Brocade).

E-mail Inga.

Monday Morning Update 2/22/10

From Luke O’Voron: “Re: Privacy and Security Standards Workgroup. Their meetings are now open to anyone by teleconference. This week, Judy Faulkner of Epic was in fine form, defending her 30-year-old product as the only way to go. Look for transcripts.” They haven’t been posted yet, but I’m watching for them.

From All Hat No Cattle: “Re: Looks like HIStalk is now a source of news! Congratulations.” Healthcare IT News has been openly scornful of HIStalk in the past (“a sorry commentary on journalism today”), so I’m not sure how I feel about having them cite HIStalk (I know it didn’t result in many incoming hits). I don’t claim to be a journalist, so I likewise assume nobody there claims to be a healthcare IT expert. I sometimes glance at it during the more boring educational sessions at HIMSS, especially since early print deadlines mean I can read what the keynoters will say before their sessions are even held, making me feel temporarily psychic and opening up the possibility of a “Dewey Defeats Truman” collector’s edition if the speaker would happen to cancel or go off script with an unplanned rant.

From Kiley: “Re: CEO. You should check out this guy’s past. Nobody seems to question his background when he’s speaking or writing.” We’re on journalistic thin ice here, even for a non-journalism major. I did some extensive Googling and it seems the individual named recently pled guilty to big-time federal income tax fraud. I got copies of the court records, but received no response when I sent details (twice) to the organization’s PR e-mail address and asked for confirmation. I can’t decide if that’s fair game or not, although I’m leaning toward no.

Long-range weather forecasts are notoriously inaccurate, but the Atlanta 10-day version predicts highs in the lower 50s for the start of HIMSS. If it’s not too cloudy, that should be pretty nice, especially compared to Chicago last year (or Chicago right now – snow and highs in the 30s).

Looks like Sully’s HIMSS audience will be about the same size as when he made that “we’re going down in the Hudson” PA announcement, with 88% of us planning to be long gone from Atlanta by the time he hits the podium on Thursday. New poll to your right: given the government’s track record in fulfilling its financial promises to providers, do you think ARRA money will be paid as stated?

Listening: Crucified Barbara. Sometimes you just need beautiful, non-English speaking Swedish women playing nasty biker metal hard rock.

Inga asked our BFF Tammi from AT&T a reader’s question about iPhone presentations at HIMSS, of which there are basically none on the education track since annual conference proposals are due nearly a full year before the conference (it’s ludicrous to be paying to sit through year-old presentations just because HIMSS can’t shorten its lead time, but that’s always been the case – this year’s sessions were finalized by May 29, 2009). Anyway, she mysteriously suggests dropping by the AT&T booth to check out “exciting developments.”

Thanks to MedVentive for supporting HIStalk as a Platinum Sponsor. The Waltham, MA-based company provides a wide range of solutions that include pay-for-performance systems, registries, evidence-based algorithms for quality management, point-of-care decision support for physicians that integrates information in its repository with claims data, managed care tools, and scorecards and provider profiling for payers. It was started by CareGroup and BIDMC in1997, expanded for a broader audience as MedVentive in 2005. If you want to connect with their folks at HIMSS, shoot them an e-mail. I appreciate their support.

Inga has been working her pretty fingers to the bone getting ready for HIMSS. Somehow she found time to prepare this guide to what our HIStalk sponsors will be doing at HIMSS, complete with booth and contact information, a description of their products and services, and their message to you about their HIMSS activities (including some giveaways, charitable projects, and the all-important snacking opportunities). You can download a PDF version to print and take to Atlanta if you like. If you enjoy HIStalk or benefit from it, please click their ads, check out their HIMSS activities, and drop by their booths and say thanks. We have some super-nice people and companies who are fans of HIStalk, which we as amateurs with day jobs sure do appreciate.

I don’t know about your hospital, but mine is packed to the gills. It’s a good thing flu activity was a lot less than expected or we would be having patients sleeping in the hall instead of just the ED holding area.

England’s Accountancy and Actuarial Discipline Board will conduct hearings this week on an accountant for iSoft Group, whose former executives are themselves are the subject of an investigation related to accounting irregularities alleged to have occurred from 2003 until 2006.

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

The Racine paper weighs in on the EMR implementation at Wheaton Franciscan-All Saints (IL), saying some doctors anonymously told reporters that its $67 million McKesson Horizon Clinicals implementation is “one of the cheapest, worst systems available.” The docs complain that Wheaton spent nearly as much as nearby Froedtert, which installed #1 KLAS-ranked Epic for $70 million. The hospital defends itself, saying its McKesson system (#7 ranked in KLAS, the paper says) is comparable to Epic and the #12 ranked Cerner system that another nearby hospital bought, neither of which had extensive problems (actually, that sounds to me like they defended their vendor pretty well, but themselves not so well). Since the hospital and its doctors were already fighting about unrelated issues, I’d take anything said there with a grain of salt. Other places run Horizon Clinicals just fine.

Strange: why is the non-profit Cleveland Clinic buying Google ads to brag on its technology and IT people on its own EMR site? This ad came up when I Googled “healthcare technology.” 

I’ve mostly quit reporting on government HIT handouts, you may have noticed. Truth be told, it makes me sick to my stomach to read, much less write, about all those undisciplined politicians bragging to the locals about how great it is they managed to snare taxpayer money to pay for local projects. Enjoy the economic party because it can’t last; the generations-long hangover is going to be brutal.

The Louis Stokes Cleveland VA Medical Center (OH), concerned about medical residents who clutter up the EMR with copied-and-pasted information, audits the notes of first-year residents and gives movie tickets to the best one. The newspaper article quotes a journal article: “The copy-and-paste function has led to a number of unexpected problems and concerns about electronic note writing and its impact on the culture of medicine, including reducing the credibility of the recorded findings, clouding clinical thinking, limiting proper coding and robbing the chart of its narrative flow and function.”

Facing a threatened libel countersuit, GE Healthcare drops its libel lawsuit against a Danish radiologist who had shared research findings unflattering to one of GE Healthcare’s contrast agents at a medical conference. The suit was featured Tuesday in The Globe and Mail in an article called London, sue capital of the world, describing “libel tourism” in which suits involving no English parties are tried there, mostly because unlike in the US, the burden of proof rests on the defendant and a libel defense costs 140 times anywhere else in Europe, leading to pocket-lining settlements for lawyers. At stake: self-imposed medical censorship, such as the Danish radiologist, who says, “I am not giving lectures any more in the U.K., where it seems you can be sued for telling the truth.” I liked this quote: “It’s acutely embarrassing for the government that various American states have passed laws to protect their citizens from English libel law.”

WebMD finds itself on the wrong side of Senator Chuck Grassley, who wants to know why the company’s TV ads pitch a pharma-sponsored depression screening test while it claims to provide objective medical information to consumers. WebMD claims editorial independence, but the Senator wants it to provide details on its drug company connections. Chuck’s all over the place, but I usually like his choice of targets.

Bizarre: the FBI gets involved in the case of a Pennsylvania school system that remotely activated the webcams of school-issued Apple laptops used by students. The school supposedly accused a student of selling drugs, providing as evidence a photo snapped by his school laptop from inside his house. The school claims the webcams were used only to recover laptops that had been stolen.

E-mail me.

News 2/19/10

From Pliny: “Re: Herb Smaltz, CIO of Ohio State University Medical Center. He is leaving the job on February 28 to run an OSU spinoff, Health Care DataWorks.” The company offers an off-the-shelf, pre-loaded data warehouse.

From Keanu: “Re: CCHIT. Has anyone heard of CCHIT events at HIMSS? Isn’t it a bit odd that they haven’t posted a town hall or something? With all the sessions on Meaningful Use, you would think they would have something to say.”

From The PACS Designer: “Re: disease outbreak alerting. The population of high quality healthcare apps for the iPhone keeps expanding. Outbreaks Near Me, an app introduced in 2006, recently created an iPhone version for mobile users. Software developer Clark Freifeld and epidemiologist John Brownstein started HealthMap in 2006 and designed Outbreaks Near Me for Childrens Hospital Boston."

From IKnowPlenty: “Re: AHA. Every day, more news comes out undermining Al Gore’s global warming hypothesis. For AHA’s upcoming Leadership Summit, they’ve added Newt Gingrich to share the stage with Gore. Now if we could just get someone who actually understands healthcare.” Newt makes good money from his Center for Health Transformation, so he must know something. In fact, he’s running an American People’s Online Health Summit as a counterpoint to President Obama’s meeting and most likely as an early step in a 2012 run for President (that’s my guess, anyway, now that his presumed opponent is obviously vulnerable).

Eclipsys announces Q4 results: revenue up 5%, EPS $0.07 vs. $0.06. Non-GAAP EPS of $0.17 beat expectations of $0.12.

Mary Horan, MD, chief of staff of Northwest Hospital (WA), will present “Med Rec: It Doesn’t Have to Hurt” at the AHA booth at HIMSS on Tuesday, March 2 at 3:30 p.m. She will talk about the use of MedsTracker from Design Clinicals, who will also offer private demos by request (at HIMSS or otherwise).

Picis announces a new version of ED PulseCheck and the launch of LYNX CareBridge, a documentation solution for medical necessity.

The Adoption/Certification Workgroup of HHS’s HIT Policy Committee will examine the safety of healthcare IT systems at an all-day meeting (warning: PDF) next Thursday from 9 until 3 Eastern. Executives from Cerner, Epic, and the VA will present, along with Ross Koppel, David Classen, and ePatient Dave (among others). You can participate remotely here without pre-registering. That should be interesting.

Thanks to Access, a new HIStalk Platinum Sponsor (actually Double Platinum, since they are also a Platinum Sponsor of HIStalk Mobile). The Sulphur Springs, TX company offers solutions that address patient flow, electronic forms, electronic signature, an e-Forms Repository, and portals that connect to media such as fax, e-mail, images, and universal documents such as EKG strips and other device output. We found out about each other when I did an HIT Moment with VP Chuck Demaree last week, which taught me stuff I didn’t know about electronic patient signatures and the capabilities of the Universal Document Portal for populating the EMR with data from biomedical equipment or even other applications. Being a barbeque connoisseur, I would find a reason to visit them at their place and then drop by Big Smith’s Bar-B-Q, but if that’s a stretch, they will be at Booth 4333 at HIMSS. Thanks to Access for its support of HIStalk and HIStalk Mobile.

Speaking of HIStalk Mobile, my colleague David Brooks is filling up his dance card to visit companies with mobile offerings (actually, he’s already got 20 appointments for Monday and Tuesday, so lay claim to Wednesday while you can). If you have the coolest mobile solution on the market, David says he will make time for you. I should also mention the fourth Founding Sponsor of HIStalk Mobile, 3M, which joins Vocera, Voalte, and another company not quite ready to be named. We really appreciate it.

I guessed wrong on the 2010 Grammy winner that MEDecision will bring to its HIMSS party. It’s Colbie Caillat, who has charted several times with some good pop tunes. Live video here. Their event is 6-9 Monday night at the Georgia Aquarium, It’s open to everybody, including those coming to the HIStalk reception who will need to leave early to hit Max Lager’s by 7:00. RSVP here to see Colbie.

And speaking of the HIStalk reception, thanks to sponsors Encore Health Resources, Evolvent, and Symantec. In fact, I notice that Ivo must have liked the looks of Max Lager’s since he’s hosting a Healthlink Alumni Pub Night there Sunday night.

Inga and I have done some good interviews that I’ll be posting each day for the next several. I want to get caught up before HIMSS and then feel free to collapse immediately afterward.

And Inga has obviously been a busy lady, putting together HIT Vendor Executives on HIMSS10, which features some fascinating executive predictions about the conference. How she got the top people at 42 companies to share their thoughts is beyond me (charm, I’ll assume).

Noteworthy Medical Systems is chosen by The Camden Coalition of Healthcare Providers (NJ) to power the Camden Health Information Exchange.

Strange: disgraced former Tour de France winner Floyd Landis, stripped of his title for doping, is the subject of a French arrest warrant for trying to hack into the anti-doping agency’s lab system to prove their results can’t be trusted.

General Dynamics wins a five-year contract worth up to $154 million to support the Army’s MC4 battlefield EMR.

Wacom launches a pen-on-screen display for healthcare professionals who need to annotate images.

An odd survey result: over 50% of Americans think other people’s health is going in the wrong direction, but only 17% said their own is. A third of respondents give themselves an A in the major health categories, while more than 90% of doctors grade them a C or lower. No amount of technology is going to fix that perception problem.

Jackson Memorial Hospital (FL) will lay off over 1,000 of its 12,000 employees, trying to avoid missing payroll by May.

You can tell HIMSS is upcoming. The fluff news is everywhere, but all the good stuff is being held to announce from Atlanta.

E-mail me.

HERtalk by Inga

Orion Health will use Merge’s Cedara WebAccess technology to bring images and information into its Orion Concerto Physician Portal.

The ONC selects Acumen Solutions to implement a cloud computing CRM and and project management from Salesforce.com. The solution will be used across all RECs nationally to help manage interactions with medical providers.

The ONC, by the way, names Joy Pritts, JD as its first chief privacy officer. Pritts will work with David Blumenthal to advise on privacy, security, and data stewardship issues. She was formerly on the faculty at Georgetown University.

athenahealth makes Fast Company Magazine’s “Fast 50” list of the world’s most innovative companies. I noticed that PatientsLikeMe and GE were also in the top 50, while Sermo, Kaiser Permanente, and Walgreens made the “also-ran” list.

Here’s something that sounds fun. Buzz Aldrin will be at the MMR Information Systems booth, taking commemorative photos with HIMSS attendees. Look for him March 1st, complete with a moon surface background in the Sea of Tranquility. If you participate, be sure to send us a copy.

EHR adoption in physician offices is up 3% over last year, according to a survey of 180,000 doctor offices. The numbers suggest a 36% adoption rate, with doctors using EHRs primarily for electronic notes. Not surprisingly, the larger the practice, the more likely the practice uses EHR. Hospital or healthcare system-owned practices are also more likely to EHRs that physician-owned groups.

A few sponsor updates:

• MED3OOO will incorporate data management and analysis tools into its MED3OOO Quality Management Suite. The application will be integrated  into MED3OOO’s InteGreat EHR to facilitate clinical data collection, help providers in determine HCC and PQRI scores, and meet other P4P reporting requirements.
• Sage Healthcare appoints Tony Ryzinski SVP of marketing. He previously worked for Misys in a similar role.
• MedAptus announces an expansion of its consulting services team to help providers and hospital to optimize financial and operational performance.
• e-MDs President and CEO Michaels Stearns, MD agrees to serve as board president of the newly formed Texas e-Health Alliance.
• Shore Sound Health System (NY) plans to undergo an accelerated activation of Eclipsys’ Sunrise Enterprise suite at two of its hospitals.
• Marietta Dermatology Associates (GA)  select the SRS hybrid EMR for its 13 providers.
• Sunquest completes a seven-hospital implementation at Cleveland Clinic.

I’d like to think that first there was Inga, then there was Barbie. Mattel introduces Computer Engineering Barbie, who carries a smartphone, a Bluetooth, and a laptop, plus wears stilettos. Any resemblance to me is pure coincidence.

E-mail Inga.

News 2/17/10

From Nurse: “Re: Community Hospital South (IN). The CEO has announced that the hospital’s problems with GE Centricity Enterprise going back to August will cause it go back to the old GE CIS inpatient system next month. Deployment of Centricity Enterprise is on an indefinite hold.” Unverified, but the e-mail snips included look genuine. Maybe this would have convinced them to stay on: GE Healthcare announces that Centricity Enterprise EMR is now in the ecoimagination portfolio, which the announcement claims was “rigorously tested in-house and by a third party in order to provide optimal satisfaction to GE clients.”

From Kate: “Re: B52s. Who’s having them? I need to crash.” It’s an invitation-only HIMSS event (which I know only because I was invited), so I blurred the vendor name. Cindy and Kate were warbling hotties back in the day, although they are now 52 and 61, respectively, so they may not hop around like they used to. If I were this vendor’s customer and not planning to attend the HIStalk event (whaaaat?) then I’d probably check them out since I can sing along badly with all of Cosmic Thing, especially Deadbeat Club and Dry County, with a few beers in me.

From Zippy: “Re: articles in Racine, WI paper about All Saints. Doctors are not happy with administration and a number may leave.” Doctors and administrators are feuding, with a third of the medical staff ready to bolt. The final straw, apparently, was the hospital’s contracting with a Florida anesthesia company, replacing a local group after failing to reach an agreement about pay, on-call policies, and the use of nurse anesthetists. Also noted as a key issue: the 2009 introduction of an EMR system, which the doctors complain wasn’t well supported.

From Wake Up: “Re: McKesson’s problems. All listed before: HERM cost $150 million and still isn’t ready for prime time, ambulatory and HAC are a shambles, the 10.xxx upgrade is needed for meaningful use, but is painful for customers,and the company likes to replace quality employees with green beans.” All unverified, although I’ve heard them all before, usually from disgruntled former employees. Others have speculated that Pam’s downfall involved ongoing Horizon Clinicals integration struggles, of which ER 10 was an early warning of the challenges ahead (not surprising since all of those apps were developed by different acquired companies, as I remember: Vanderbilt, CliniCom, HCS, and others I’m forgetting). On the other hand, I’ve talked to one HERM site so far and they had nothing at all bad to say, other than to observe that the requirement to upgrade to Horizon Clinicals ER 10 wasn’t clearly stated upfront. I’m trying to connect with a second site.

From Stealth: “Re: Oracle’s Sun Division. I heard an unconfirmed rumor that it’s about to announce that it’s not going to support its JCAPS for EGate interface engine. Has anyone heard this?”

From G-Dog: “Re: articles. I thought this article might be worth discussing on HIStalk.” It covers board certification in informatics for physicians, with the authors concluding that it’s not really like other subspecialties since it covers all other specialties to some degree. AMIA is hoping initial review by ABMS will happen next year or the year after.

From The PACS Designer: “Re: Pogo Stylus. iPhone apps and other new mobile phone accessories keep getting innovative and the Pogo Stylus from TenOneDesign is the latest innovation. You can use the stylus to be creative and design artful stuff. Perhaps, we can get postings from Inga using the Pogo Stylus on her iPhone to entertain us HIStalkers, while Mr. H. uses his BlackBerry to organize HIMSS 2010 entertainment!” It’s $14.95.

The lab division of Fresenius Medical Care North America goes live on McKesson Horizon Lab.

EHRScope releases its Spring 2010 issue (warning: PDF). I really like this publication since it’s a lot meatier than the fluff the rags usually run, with some thoughtful articles and editorials.

This article describes a study in which researchers used CDC’s diagnostic algorithms for acute hepatitis B to search 16 years’ of ambulatory EMR data. It found 112 of the known 113 positive patients, but also detected an additional eight cases, four of which had not been reported to the health department. The next step (obviously) would be to turn those algorithms into real-time alerts.

Duke University Hospital chooses Simplifi 797 IV compounding QA software.

Fallon Clinic (MA) cites several improvements in making Dragon Medical part of its EHR implementation.

Jobs: EHR Project Manager (CA), Systems Administrator (AZ), Senior Systems Analyst (GA).

Sleep well knowing that Weird News Andy is guarding the gate. He finds this article, with the key line being, “Each time the two had sex, documents say, the doctor would bill her Blue Cross Blue Shield Insurance for their ‘sessions’.” The psychologist involved, who called himself RHL (short for Red Hot Lover), is being sued by his former lover and investigated by the state. WNA also likes this story (he threw in a Subway $5 foot long pun at no extra charge) about surgeons in Czech Republic who left a foot-long medical tool in a patient’s abdomen after surgery, which stayed there until five months later.

Former Eclipsys VP Charles Tuchinda, MD is named chief innovation officer, healthcare of Hearst Business Media. He’ll also be a VP at properties Zynx Health and First DataBank.

iSoft will distribute iMDsoft’s MetaVision suite in Germany. It offers clinical decision support, CPOE, and reporting for critical care environments. Among its customers, iMDsoft has four of the top 10 US hospitals at 13 of the top 50 European hospitals, with a 100% retention rate in its 11 years. Coincidentally,  I’ve got an interview coming as soon as I have time to post it.

Orion Health gets some coverage of its recent large sales in the New Zealand business paper.

An ED doctor’s article in an Australian medical journal urges that hospital executives who fake quality data be prosecuted the same as corporate book-cookers. He claims that hospitals have submitted phony data ever since they started getting paid for performance, including discharging patients electronically and then re-admitting them to hit quality targets.

Odd lawsuit: a patient care tech brings a baby to the hospitalized mom of a newborn. The mom starts breast-feeding the baby, but a nurse walks in to tell her it’s the wrong baby. The mother is suing Evanston Hospital and its parent corporation, even though no harm was done and even though she herself didn’t notice (she says she couldn’t see in the dark). The tech apologized in tears, but the father said, “It’s not enough”.

E-mail me.

HERtalk by Inga

From Forest Green: “Re: Sage again. I just heard of another executive departure — Kat Henry, SVP of customer service. I hope the new president can turn things around for them!” Sage has confirmed.

From George Geef: “Re: patient survey. Obviously, we don’t quite agree with the ‘goofy’ categorization of the GfK Roper survey. Compared with the CDC and NEJM surveys, actual patients witnessing computers being used for charting seems to me more accurate gauge of the shift than doctors self-reporting on partial or full use of EMRs.” OK, goofy was not the most eloquent and descriptive word I could have used. Let’s just say I am suspect of the conclusions drawn. Just because a patient notices a PC does not mean the practice has an EMR. The study also noted that older and wealthier patients said their doctors have EMRs more often than younger and poorer patients, concluding that doctors treating older and wealthier patients are more likely to have EMRs. Perhaps, though I could come up with a few other equally plausible conclusions.

Yesterday I came across a mention of HIStalk on a one of our reader’s blogs. The writer’s note made Mr. H and me smile: “I am anxiously awaiting my annual trip to HIMSS. Should be interesting to see what companies are doing around ARRA. At least CCHIT finally released their test scripts today so that there can be a lot of buzz. I especially can’t wait to go to the HIStalk reception. It has been the highlight of the trip the last 2 years.” I have to admit it’s been a highlight for me as well.

After six years of no price increases, Surescripts drops the price of its e-prescribing services for pharmacies, pharmacy vendors, and pharmacy benefits managers. Surescripts says the move is part of its ongoing commitment to improve operational efficiencies and the result of economies of scale. And I bet Surescripts found a price adjustment was necessary in order to remain competitive since the market is a bit more crowded than it was six years ago.

Speaking of Surescripts, the company sets up an advisory committee to help with the development of a prescription history service for HIEs. Committee members include the heads of five HIEs.

Members of a federal HIT advisory group recommend relaxing the number of measures required for providers to demonstrate meaningful use of EHRs. The group wants to drop up to six MU measures for 2011, which still leaves about 80% of the measures originally proposed. The advisory group says the currently proposed 2011 measures set the bar too high, making it difficult for providers hoping to qualify for 2011 stimulus money.

Coming soon: a new post in our ongoing vendor executive series on HIStalk Practice. Several dozen industry CEOs provide answers to the following question: In addition to ARRA-related items, what will be some of the hot topics at HIMSS this year? The insights are diverse and include musings on interoperability, rapid deployment of EHR systems, data collection, mobility, and industry alliances and consolidations. If you’d like to receive a notification when the series is posted, make sure you are signed up as a HIStalk Practice subscriber.

I have to admit I found this press release a bit opportunistic — or at least cheesy. After four introductory paragraphs detailing the Olympic and professional accomplishments of speed skater Eric Heiden, it becomes obvious the piece is really an ad for the records management software used in Heiden’s orthopedic practice. To fully appreciate the message, I think you need to imagine Jim McKay saying these words:

Just as athletes benefit from high-tech gear, clothing and equipment that enables them to be faster, better, stronger, Heiden says Records Studio utilizes superior technology to help optimize the performance of all departments of his medical practice, not just patient care.

East Orange General Hospital (NJ) purchases GE Centricity Enterprise for its hospital-based EMR. GE’s data center will provide the hospital with remote application hosting.

Enovate releases its Enovate Lite Medical Cart services, which includes CompactLite, StandardLite, and UltraLite models. I see the Enovate guys will be showing off the new cart at HIMSS.

Kaiser Permanente reports 2009 net income of $2.1 billion, which is a vast improvement over 2008’s net loss of $794 million. Q4 net income was $214 million, which more than doubles 2008’s number. The turnaround was largely the result of improved financial markets. Meanwhile, membership numbers fell by 64,000 in 2009 after falling 30,000 the year before. Total membership is 8.58 million.

Nemours/Alfred I. duPont Hospital for Children (DE) goes live on GetWell Town, the pediatric version of GetWellNetwork’s Interactive Patient Care system.

The Camden Coalition of Healthcare Providers (NJ) selects Noteworthy Medical Systems to be the information hub for their multi-hospital HIE.

Mediware announces that Oregon Health Sciences University will implement its BloodSafe system.

MEDecision launches a new collaborative HIE service called InFrame that facilitates clinical data sharing, including diagnostic quality medical images.

E-mail Inga.

Monday Morning Update 2/15/10

From Conrad: “Re: Bassett Healthcare and their Stories of Success program. If it’s as good as the Go Red for Women/Put a Little Love In Your Heart video on their home page, they are doing all right. It’s clear they have employees who really like working there.” It’s kind of a Pink Glove Dance variant. Pretty good. I’m a sucker for this stuff.

From Talk of the Town: “Re: Allscripts. Two of the Allscripts sales veterans to leave were some of John’s boys from the original Medic lineup. The only thing surprising to me was that they have hung around this long. Combined with the exit of another of his sales guys from John’s golf company makes me wonder what John is up to these days.” He has five golf clubs now (the big real estate kind, not the sticks that badly dressed men hit balls with), although that may not be the best business in the world given the economy and lower property values. Not that he needs the money.

From Fact Finder: “Re: Sunquest. Take a look at the jobs posted to their Web site today. With that many sales jobs, it looks to me more than 30% left!” That’s quite a list — a clinical product specialist, two inside sales account managers, a regional VP, and six sales executives. Not the best timing with HIMSS booth duty coming up. From the “glass half full” side of the argument, they have jobs if you’re looking.

A physician’s Wall Street Journal editorial on EMRs ends with this:

If electronic records are only used to optimize billing and improve chart audits, patients will see little benefit. I doubt my patients received better care from the change.  Electronic records can only play a supporting role in a broader effort to change our troubled system. Until our health care system imagines patients as more than grist for billing, I will happily take my chances with a colleague’s inscrutable scrawl over a phone-book-sized stack of computer printouts.

HHS throws down another $1 billion for HIT, with $386 million in HIE grants (ranging from $600K to $38 million), $375 million for 32 Regional Extension Centers ($5.3 to $28.5 million), and $227 million for job training ($2 to $5 million). The jobs training one, in particular, has some odd recipients (Goodwill Industries and Spanish Speaking Unity Council, for example). I could write a bunch of stuff about this, but it’s kind of pointless until we see how those groups plan to spend our money. It better be good to be worth a billion dollars.

Cisco apparently fares much better than Microsoft and Google when it comes to healthcare, with nearly double their percentage of “positive” impressions. New poll to your right, for those going to HIMSS: what’s the last full day you’ll be there? I’m heading home Thursday, but the last I’ll see of the conference will be Wednesday (sorry, Sully).

Inga is putting together a list of HIStalk sponsors exhibiting at HIMSS. It occurred to us that Platinum sponsor O’Toole Law Group, aka Bill O’Toole who also writes HITlaw for us, would be a rather forlorn figure sitting alone in a booth looking wise and stern in a lawyerly way, surrounded by adjoining booths full of boisterous demo dollies and card trick magicians. So here’s the deal: Bill will be at the conference, but not in a booth, so you can read more on his Web site and make arrangements to connect with him at HIMSS to talk about HIT negotiations, non-compete agreements, and contracting (especially for Meditech shops). I told him I was going to mention (he probably thought I was kidding) that he will be at the HIStalk reception, so you can corral him there as well since that’s a good place to mix business with pleasure (if those terms aren’t synonymous, you’re doing it wrong). Bring your business cards.

One thing I like about having HIMSS in Atlanta: like Orlando and (formerly) Dallas, it’s cheap. Not just flights and hotels, but all-day convention center parking, gated and guarded, is only $10 or less. It snowed in Atlanta last week, but will be back up into the 50s by this weekend, which is the average daily high for March. The rooftop patio at Max Lager’s will be heated, so snow refugees can maybe get some outside air that won’t freeze their nose hairs. I also notice that some of the vendor bashes conflict with Sunday’s opening reception, which I think is a fantastic idea because I hate the opening reception.15,000 people elbowing each other to try to get a drink and an eggroll while a lame band plays isn’t fun for me, although I did like the San Diego one because the patio setting was so nice. Chicago was the worst ever, cramming a room with the charm and acoustics of an airplane hangar with bad music and a gazillion freezing people trying to get out of the ugly snowstorm outside. Can we admit, as HIMSS has tacitly done by vowing not to return to McCormick Place, that having the conference there in the first place was a really stupid idea like everybody kept trying to tell them? My almost-$300 hotel room was dumpy, everything from cabs to convention center coffee was overpriced, and there wasn’t anything to do except hang around the exhibit hall (which was the whole point of having it there instead of somewhere nice, of course).

Speaking of HIMSS events, soon-to-be announced Platinum sponsor MEDecision is having theirs on the same Monday night as the HIStalk one, but they are inviting HIStalk readers to drop over to their “HIStalk Pre-Party” from 6 until 7 Monday evening at the Georgia Aquarium. That event has the 2010 Grammy winner performing that I mentioned before, although I don’t know who it is (I would have guessed the Zac Brown Band since they’re from Atlanta and don’t start their tour until March 2, but really, I have no idea). The ever-diligent and protective Inga insisted on doing some research before giving me the OK to mention their event: “If you plan to go to both, you better drink fast and don’t go dunking in the shark tank. It looks like it is half a mile away, a 10-minute walk to Max Lager’s unless you are wearing your stilettos, in which case it is a two-minute cab ride.” Register here.

From the Weird News Andy vault: “at least he has a reason for not dancing.” A British hospital’s prosthetic limb specialist is fired after fitting an amputee’s right leg with an artificial left foot that was also one size too big. Paramedics noticed that the man was listing to one side, but he didn’t think much of it until taking off the fake foot’s protective sock five months later and saw a left foot on his right leg.

Last chance: please take my reader survey. Thank you. Speaking of which, a couple of readers had a good idea that I saw when I peeked at the results so far: a good time to read HIStalk (other than when it first comes out and you get the e-mail) is when you’re on a boring conference call or taking a lunch break at your desk. It’s like when I read the Howard Stern Show online recap at lunchtime: a guilty pleasure ideally suited for quiet time at work when you need a break (and this is even work-related, so you can read it guilt free).

Focus Informatics, Inc., a transcription provider that’s part of Nuance, has some job openings I said I would mention: a manager of US operations, account manager, team leader, and MTSO recruiter. Remote/virtual is OK.

Listening: reader-recommended Grace Potter and the Nocturnals, excellent Vermont-based throwback blues-rock with the female lead sometimes powering a vintage Hammond B3 organ or a big ole’ Flying V guitar. Video here. It’s cool that readers (some of them, like in this case, a top executive you would never expect) have figured out the music I like by my recommendations, then make their own back to me, generally with uncanny accuracy.

I am thankful that HIStalk’s sponsors nearly always stay with us. We lose one occasionally for one reason or another, but even then, they often find themselves missing the incessant good cheer of Inga the Sponsor Diva and end up returning to the fold. The InteGreat EHR folks have rekindled their Platinum flame after a short break and we welcome them back. As a refresher: the InteGreat EHR is modular, intuitive, browser-based, and CCHIT08 certified.

Speaking of sponsors for which we are grateful, here’s a new one: iSirona. The company specializes in capturing and delivering patient data: interfacing with stationary and mobile medical devices, providing  point-of-care charting screens, supporting positive patient ID, and streamlining charting and documentation workflow. Founder and CEO Dave Dyell said it better than I could in an HIT Moment With from May. Welcome and thanks to iSirona.

Nashville’s city government will spend money to buy clinical systems for Nashville General Hospital at Meharry, hoping to break even on the deal since the cost is $3.2 million and an even bigger government (the federal one) will pay it an estimated $4 million in return. Nobody’s mentioning any benefit to actual patients, but this is about stimulus.

Microsoft is opening some kind of health research center in Spain, interested in a location near a hospital that developed its “Florence” system using Microsoft technologies. This article says it includes smart phone access and SMS messaging. 

China’s $124 billion effort to move from socialized to US-like privatized health models is causing US-like problems: funding cuts, a dramatic polarity between services available to the rich and the poor, and rapid cost increases as doctors are financially motivated to order more drugs and tests. It’s so hard to get a hospital appointment that scalpers are openly selling appointment slots on hospital property (note to self – develop an eBay clone site to capitalize on this unauthorized secondary market).

Hospital-associated outpatient doctors can no longer qualify for ARRA meaningful use incentives after a Senate change to the HIRE Act. That may be addressed in other bills, however.

An odd situation caused by often-phony marijuana clinics: can an employee be fired for failing a drug test if he or she has a “marijuana card?” Marijuana is legal for medicinal purposes in 12 states, but only Rhode Island has a law preventing users from being fired for using it. Pot smokers are claiming they are being discriminated against, with theoretical legal claims under the Americans With Disabilities Act looming.

I’ve never heard of this: St. Vincent’s Hospital Manhattan, desperately trying to keep the doors open, lays off 32 medical residents as part of its 300 FTE headcount reduction. You know you’re in trouble when you can’t afford in-house physicians for 80 hours a week at $50K or so per year, or around $12 an hour.

Odd lawsuit: the family of a leukemia patient who died of Legionnaires’ Disease contracted from a water fountain gets a $1.2 million settlement from Ohio State University Medical Center. Nurses were told to give patients bottled water and to instruct them to avoid the fountains, but nobody put up signs. Strangely enough, the man’s daughter was nurse on the same floor and was with him at the time, but forgot to tell him not to use the fountain. Seems to me she’s responsible as well, but I doubt anyone is contemplating a lawsuit against her.

HIMSS posts its list of companies presenting at the all-day Health IT Venture Fair on Sunday, February 28. The list:

• Axial Exchange, an integration appliance vendor started by former Red Hat execs
• CareCloud, which offers Web-based practice management applications
• Clarity Health Journal, a PHR tool
• Dicom Systems, which offers a DICOM router and archive
• EDIMS, a vendor of emergency department information systems (and an HIStalk Platinum sponsor)
• Envisioner Medical Technologies, a personal medical imaging platform for endoscopic multimedia
• Heart Imaging Technologies, which offers a Web-based PACS, clinical trials system, and image sharing site
• Logical Images, vendor of a visual diagnostic system based on medical photographs
• Medical Diagnostic Associates, offering systems for electronic images and exam tracking for diagnostic imaging
• MedCPU, a clinical practice tool for high acuity hospital services including OB
• MedicExchange, a social networking and product review site for healthcare professionals
• MediViz Systems, a real-time decision support system for the OR
• Mensante, operator of FeelingBetterNow, a best practices site for Canadian mental health physicians and patients
• Polaris Health Directions, which offers behavioral health outcomes assessments and management systems
• Prodigo Solutions, a healthcare supply chain applications vendor
• Provider Advantage, EDI systems
• Sentient Health, supply chain systems
• Smart Association, smart cards
• Spring Medical, vendor of SpringCharts EHR
• TC Software, which sells an integration engine
• White Pine Systems, which offers a PHR
• Your Nurse Is On, an online tool that matches nurses to open shifts
• Zebec Data Systems, a IT infrastructure hosting and outsourcing vendor

The most common mistakes companies make pitching at the Venture Fair, from my limited experience in having crashed part of it once:

1. Not being able to summarize their offering in ten seconds.
2. Not being able to clearly explain right off the bat who their potential customer base is, what problem they intend to solve for them, and how they plan to efficiently reach those prospects with their message.
3. Saying “we don’t really have any competition” when inevitably asked.
4. Not knowing what it costs to get a customer (or worse, having no customers).
5. Pitching an unoriginal idea, an idea that’s interesting but not really much of a business to deserve outside investment, or an idea that requires competing against well-established competitors that could extinguish you in a corporate heartbeat.
6. Trying to hide modest numbers by not bringing any. Investors understand that early-stage companies aren’t often making a profit, but not having a handle on revenue and expenses is inexcusable.
7. Shooting for quantity instead of quality, spouting off an undisciplined array of ideas instead of focusing on one potential winner. Diversification comes later; focus reduces upfront risk.
8. Not really understanding the difference and expectations among funding options such as bank financing, friends and family, angel investors, private equity, and venture capital.
9. Taking up too much time with a product demo instead of talking numbers, management experience, and growth strategy.
10. Being an inexperienced, unpolished entrepreneur looking for a large investment (investors bet on the jockey, not the horse).
11. Trotting out wildly optimistic revenue projections that always start immediately after someone else puts their money in.
12. Asking for someone else’s money when they haven’t put in much of their own or when still running the business part time.
13. Having a management team made up of product people (i.e. geeks) and nobody with startup and management experience.
14. Not having an advisory board or mentor who has done it before.
15. Having only a vague story about how investors will get their money back and how the company will mitigate the risks that arise between the time they write you a check and the time when you return the favor.
16. Not having a detailed plan on what they plan to do with it (it better involve increasing revenue directly, not leasing an office or buying Aeron chairs for everyone).
17. Being too undisciplined or excited to stick to the venture fair’s limits on PowerPoint slides and session duration, or having glaring errors in the information sheet. This is speed dating, not courtship, so first impressions are the only kind.
18. Expecting to get someone else’s money without giving up some negotiable degree of control.
19. Expecting to walk out of the room with a deal or assuming that some degree of audience interest means you’ve scored. I don’t know what the hit rate is for the venture fair, but I bet it’s low.
20. Getting discouraged instead of vowing to learn from the experience, to make the business and the pitch better for next time, and to try again.

E-mail me.

News 2/12/10

From Spaghetti Eddie: “Re: VA and Cerner. I’m pretty sure the answer is that VA hasn’t decided yet, but it sure isn’t looking like a Cerner LIS decision. Still very very hung up on the issues associated with integration of EHR with DoD (AHLTA). Also, there’s a big study group of industry types (the Industry Advisory Council Vista Project) that was formed at VA’s CIO’s request to look at how to modernize VistA, clearly with an eye toward remaining open source. All in all, VA’s not there yet.” I’ve also read that the VA just opened up a program to solicit IT ideas from its employees instead of the contractors that are usually whispering in its ear.

From The PACS Designer: “Re: Google faster broadband. Google has announced that it is considering 1 gigabit per second broadband to the home as the next frontier it would like to conquer. Google said that speed would be fast enough to download a high-definition, full-length feature film in less than five minutes. Healthcare could also benefit from such a service as the medical image files can be  500MBs and larger.” I ran across this Extormity-like parody site that touts Google TiSP Beta, a free wireless broadband service that runs fiber optic cable in sewer lines. Incidentally, TPD is updating his list of iPhone apps for healthcare, so if you know of some cool ones, add a comment at the bottom of this posting and he will happily retrieve it.

From Ms. Curious: “Re: Sunquest. I hear they lost 30% of their sales force this week.” Unverified. I would be surprised if that were true.

From EHR Geek: “Re: Stanford Health Care. CEO Martha Marsh is retiring in August.” Unverified. I would be uninterested if that were true. Actually, only because I don’t know her and don’t know much about Stanford, but I assume I have readers who follow them.

From Joe: “Re: greenhorn manager. Reminds me of the old ‘three envelopes’ story that your younger readers may not have heard.” I thought everybody knew that one, but here goes (I’m using male pronouns only for convenience, not bias). A fired CIO’s replacement finds a note from his predecessor, saying he left three envelopes in the desk drawer to be opened only when things are going really badly. Six months later, the network goes down for most of a day, so the CIO opens up the first envelope and finds a note that says, “Blame the previous CIO.” Great idea! He makes up a convincing story about a historic lack of maintenance and capacity planning, saving his skin. Months later, the executive team complains about excessive IT operational and capital budgets, threatening to freeze expenses. Time to open another envelope. This one says, "Blame your coworkers." He does, arguing that the unchecked technology demands of his executive peers have made him the victim. Months later, doctors are pushing back against mandatory CPOE, saying that it’s typical CIO arrogance that makes him think he understands the challenges physicians face. He opens the third envelope, which says, “Prepare three envelopes.” I will also modestly add that several years ago, I won some local IT acclaim for embellishing the story with a fourth envelope that involved bringing in consultants, but I’ll stick with the non-customized version for the noobs.

From Lippy: “Re: greenhorn manager. It’s not just hospitals that like to stir things up. [vendor name omitted] just added an extra layer of management, making a chart that looked like the one from 4-5 years ago. The structure does not address sales-limiting problems inherent to most vendors — product limitations, support issues, and price. But, redoing an org chart makes upper management look like they are on top of things and justifies their existence.”

From Dulcinea: “Re: Wireless Life Sciences / Continua symposium in San Diego. Wish I had a recording of Patrick Soon-Shiang. He was all over the place from physics, biology, engineering, to healthcare integration based on the rail system network.” I can’t figure the guy out. He’s a drug company billionaire (some say a cutthroat businessman) claiming only benevolent intentions in getting involved financially (supposedly) with California’s interoperability project. What little I’ve heard him say publicly about it didn’t make a lot of sense to me either, but then again he’s at a level appropriate to a guy with a lot more zeroes in his net worth than me. I’d still like to interview him to see what he’s about.

Bassett Healthcare (NY) is recognized by the “Stories of Success” program sponsored by HIMSS and the American Society for Quality. Its submission involved quality and safety improvements using the SIS perioperative suite. 

Siemens renews its agreement with NextGen that allows it to sell that company’s physician practice systems to its customers. I hadn’t thought of it until now, but Siemens seems to be the only big hospital systems vendor that has done very little with regard to either acquiring or building practice systems. The market seems to be clearly indicating that those two previously separate demographics have quite a bit of overlap, so they seem to be at a disadvantage.

Medicity’s customer summit was last week, with half of its 700 customers in attendance and featuring presentations by David Kibbe and Marc Probst, among others. I had missed that, along with CEO Kipp Lassetter’s thoughts about California’s statewide HIE project and the transition of CalRHIO’s work to the state’s new governance organization.

Listening: good old anti-corporate, anti-government, Texas-based country from James McMurtry. I heard We Can’t Make It Here in a restaurant yesterday and was mesmerized enough to rush home and Google the lyrics to see who sang it. Turns out it was the son of Larry McMurtry, the guy behind the best Western ever made, Lonesome Dove. Makes me want a Lone Star, some brisket, and a pickup truck.

e-Val MD announces its H&P application for the iPhone and iPod Touch.

Confused by all the military HIT terms like CHCS, AHLTA, and VistA? Here’s a good overview and history, although not a very complimentary one when it comes to billions in costs and FCCs (fat cat contractors, for which I’ve decided to coin my own acronym) jostling each other at the taxpayer trough.

A gentle nudge: my reader survey awaits your electric touch, so titillate it, please. This is one of few times that your vote (and comments) make a difference.

Thanks very much to those several vendors who have invited Inga and me to their HIMSS shindigs. At least two of them are featuring some big-name entertainment that we’ve heard about (one has booked a 2010 Grammy winner, another will be rocking out with my favorite Athens beehive hairdo party band). I can’t speak for Inga, but I’m sure I won’t be able to go since HIMSS is really hard work for me with our own event and a ton of HIStalk writing that keeps me up late every night and eating McDonald’s (last year) and Subway (the year before), but it is delightful to be asked and I appreciate it.

Speaking the HIStalk event at HIMSS, I haven’t forgotten about readers who won’t be going to Atlanta. For the first time in HIMSS history (as far as I know), we will be streaming a party live over the Internet with full audio and video. We will have a little broadcast booth where our team will interview willing party-goers about whatever’s on their mind – meaningful use, who has the cutest shoes, or how many drinks they’ve had. The crew will have to swear not to let their cameras stray onto any scandalous behavior that may be taking place outside the broadcast booth since it may get a little bit rowdier this year with an open bar and a St. Patrick’s Day theme. More details to follow. For those who have asked, yes, there will be funny beauty queen sashes again this year (it’s an Inga thing that I gripe about since I have to assemble them, but it makes her happy).

I know I keep saying this, but if you’re waiting on something from me, hang in there — I am not ignoring you. My e-mail box is overflowing, I have HIMSS stuff to do, and of course I still have to make a living by day. I usually catch up over the weekend, but even that is threatened since I have interviews to do then.

Tony Cook joins GetWellNetwork as VP of marketing.

An interesting tidbit from the Cerner earnings conference call: the company had to reclassify some of its accounts receivable because it’s a subcontractor to Fujitsu, which is still duking it out with NHS in England. Cerner executives are clearly advanced when it comes to optimal buzzword deployment (they love words like footprint, space, and agile). Also casually mentioned: company president Trace Devanny is being relocated to London “to spearhead an increased focus on global markets and opportunity.” It seems curious that Cerner would allow its president to live and work overseas when only a tiny bit of its business comes from there, so I’m guessing there is more to that story.

Finally a healthcare jury verdict that makes sense: the Texas nurse who was fired and charged with “misuse of official information” for confidentially reporting concerns about a perpetually trouble-prone doctor to the state’s medical board is acquitted. The jury took less than an hour to dismiss the case, with the jury foreman saying, “We don’t feel that what she did was wrong because she had concern for the patients. Nurses are the eyes for the patient.” The nurse and a colleague who was fired over the same incident are now considering adding another claim to their lawsuit against the doctor, hospital, sheriff, and prosecutor: malicious prosecution. Reports are suggesting that the doctor not only peddled quack vitamins, but that perhaps also had previously hired as one of his salespeople the sheriff who went after the nurse.

Needless chemical nit-picking: this radio station’s headline trumpets that a family had “CO2 poisoning”. Those kids must drink a lot of soda.

As an IT guy, I’m fascinated by this article that talks about validation of embedded programming in medical devices. Pacemakers contain 80K lines of code and infusion pumps 170K, all prone to the same bugs as application code (memory leaks, improperly initialized variables, divide by zero errors, mishandling of variable type conversions). Those vendors, however, apparently have much more stringent testing methods than some of the hospital systems vendors I’ve worked with, where “compiled without errors” is synonymous with “passed a rigorous QA review.” (here’s an old RPG programmer’s joke I just remembered: hospital customer: “Are you sure this fix will work?” programmer: “Yes, I only had to set the gen level up once to get it to compile.”)

And speaking of that, I’m inspired to share my Five Answers You’d Rather Not Get from your Application Vendor When Reporting a Software Problem: (a) we already know about that and we’re working on it, so you wasted your time researching its cause on our behalf; (b) we don’t really want to look at it unless you can dedicate the resources to duplicate the problem and document it for us, even though we have a worthless QA department whose job you will be doing for free as a paying client; (c) we have a fix, but it’s going in a release you won’t be installing for at least a year since you wisely wait for all of our upgrade-related disasters to happen to other customers who don’t know any better; (d) that database error and file corruption problem is working as designed, so we will add your request to that list of enhancement ideas that we haven’t touched since 2001; and (e) you haven’t complained lately and we’re off doing enhancements for customers bigger, better, and newer than you, so can we just close your ticket so the suits won’t be all over us for bad metrics?

UVA chooses Sunquest Collection Manager for specimen collection.

Following disastrous financial performance, both the CFO and the VP of revenue cycle management of Jackson Health System (FL) quit. The board was not happy that the CFO’s numbers were off a smidge: he said the hospital lost $47 million in 2009, but the real number was $204 million. For 2010, the predicted loss is now pegged at $229 million.

Medicare fraud, Chapter Gazillion: a West Virginia coalfield clinic is raided and its non-physician owners charged for using a doctor’s DEA number to prescribe controlled drugs for four years, billing the government for physician services that were actually performed by extenders. Two doctors were also charged, one who admitted he knew Medicare bills were going out under his name even though he hadn’t seen a patient in 15 months. If you’ve ever been there, none of this will be at all surprising.

Microsoft may whine about all the attention Apple is getting for the iPad while nobody wants Windows-powered tablets, but their focus is apparently fickle: they shut down the Tablet PC Team blog, apparently dumping that group into the gulag that is the Windows organization. Or, maybe they’re just giving up without a whimper to Apple. I found this through OnTheRun.

HIMSS adds US CTO Aneesh Chopra to the conference keynote lineup. HIMSS always back-loads its keynoters hoping to get attendees to stick around, so he’s on Wednesday, meaning the audience will be somewhat diminished but still massive compared to the less-than-a-planeful that Sully Sullenberger will address Thursday at 12:30, long after most attendees are already back at work.

E-mail me (with only modest hopes for a quick reply).

HERtalk by Inga

From Tanya: “Re: Google Buzz. It’s like Facebook, only without any of my friends!” Buzz appeared in my Gmail account yesterday. So far, it looks like a me-too product without all the cool bells and whistles of Facebook and Twitter — and without the friends.

In light of NextGen’s announced acquisition of Opus Healthcare, I found it interesting that Siemens chose today to announce its renewed its strategic alliance with NextGen. Was Siemens wanting to ride the wave of NextGen’s five minutes of spotlight? Or did NextGen and Siemens want to reiterate that the Opus acquisition doesn’t have any affect on NextGen’s go-forward EHR strategy? In any case, it’s interesting to note that the Siemens / NextGen relationship (which goes back perhaps five years?) has resulted in 35 Siemens clients deploying NextGen software throughout their physician networks.

Continuum Health Partners (NY) selects Sunquest Information Systems for its LIS solution.

NuHealth, another New York health system, signs a $5 million contract with Allscripts to provide EHR, PM, and ED solutions across its hospitals and employed physician networks. The health system will also establish data exchange between the Allscripts solutions and the hospitals’ Eclipsys Sunrise, Sunquest lab, and Amicus radiology systems

Yuma Regional Medical Center (AZ) plans to spend $73 million implementing Epic EMR. The hospital says the five-year project will create 49 new jobs and includes creating connections with local providers.

This has to be one of the goofiest EMR surveys ever. A Practice Fusion-sponsor survey asks patients if their doctors stored their medical records digitally (48.4% said they did.) Now how exactly are patients making that determination when the “experts” can’t agree on what should be classified as an EMR? I mean, just because a doctor writes something on a piece of paper, does that mean the practice doesn’t have EMR? If the doctor types something into a computer, does that mean the practice has EMR (maybe he/she is simply checking up on e-mail). Does this survey tell us anything of value?

Henry Schein Medical says it will continue expanding sales of MicroMD, despite the recent death of founder Ajit Kumar. Kumar took medical leave in September, soon after being diagnosed with lung cancer, and died January 15th. VP/GM Keith Slater will continue to oversee operations at MicroMD, which is expecting 25%  sales growth this year.

Nuance rolls out a new bonus-incentive plan for employees that meet certain performance targets. Based on the current stock value, CEO Paul Ricci stands to earn an additional $7.25 million. To receive his full bonus, Ricci must also stay with the company through September 30, 2011. Nuance posted a 21% percent in revenue at the end of its fiscal first quarter.

Akron General Health System (OH) signs a strategic agreement with McKesson to provide Practice Partner EHR/PM to its PHO nd affiliated community physicians. McKesson reseller Complete Healthcare Solutions will provide implementation and support to a potential 500 community providers. The hospital McKesson’s Horizon Clinicals and is deploying the CPOE part of HEO.

Merge Healthcare releases  Q4 and 2009 numbers: $2.1 million loss for Q4, compared to last year’s $1.9 million gain; annual net income of $300,000 compared to 2008’s net loss of $23.7 million. Merge’s quarterly net sales grew to $19.3 million from $15.1 million a year earlier.

I see HIMSS has scheduled three separate “Meet the Bloggers Sessions” at the conference. They’re billed as roundtable discussion that give attendees a “behind the scenes” look at the responsibilities and dedication required to maintain a successful blog. Mr. H and I were invited to participate, but we opted to keep our low profiles. Now that I see the hunky John Halamka is on one of the panels, I am re-thinking that decision. (Gosh, what if I were able to sit right next to him???) Anyway, I might just sit in to learn what Mr. H and I should be doing since most of the time we’re just winging it.

HIIMSS also just posted the initial list of companies participating in the Health IT Venture Fair. HIStalk sponsor EDIMS is a presenter. I’ve sat in on a few of those sessions in the past and I must say that listening to all those financial projections mixed in with marketing hype requires me to keep the caffeine handy. Actually some of the new stuff is cool and it’s interesting to hear who companies view as their competition and why a CEO believes his company is well positioned to be the next industry superstar.

Potential good news for physicians who practice at hospital-owned ambulatory care facilities. The Senate is considering adding language to its current “Jobs Bill” that would allow some hospital-based physicians to receive ARRA subsidies. Current ARRA language excludes hospital-based physicians, much to the disappointment and anger of ER docs, pathologists, and physicians practicing in hospital-owned ambulatory facilities. However, the proposed bill would give physicians in this latter group a chance to qualify for ARRA funds (though pathologists and ER docs would still be exempt). For more details, see SEC. 620 under EHR CLARIFICATION.

The CEOs of four rural Texas hospitals claim their new rural RHIO is the first of its kind. The competing hospitals, which have a combined 104 beds, will share costs and clinical information using a single Web-based EMR from Prognosis Health Information Systems.

Halfpenny Technologies adds healthcare veterans Bob Cox and Mike Meyer to its leadership team.

Christiana Health Care System (DE) signs a three-year contract with Zix for the ZixCorp Email Encryption Service.

An Allegheny County judge okays a class-action lawsuit against UPMC on behalf of patients who said it overcharged them for copies.Pennsylvania state law allows “reasonable rates” to cover actual expenses for copies of medical records. The judge agrees that UPMC’s per-page fee of $1.50 may not be reasonable. OK, I’ll say it. Everyone knows UPMC has an EMR. So how time-consuming and costly is it to pull up a patient’s chart and hit Print? If it really costs them $1.50 a page, than UPMC has a much bigger problem on its hands.

E-mail Inga.

Quality Systems Acquires Opus Healthcare Solutions

Quality Systems, Inc., parent company of NextGen, announced this morning that it has entered into an agreement to acquire Opus Healthcare Solutions. Terms of the acquisition were not announced.

Austin, TX-based Opus offers the Web-based and ‘08 CCHIT inpatient EHR certified Opus Clinical Suite, an inpatient system that includes clinical documentation, order management, clinical data repository, and a laboratory information system. The company was founded in 1987.

Quality Systems will integrate the Opus product line with assets from its previous purchase of the assets of Sphere Health Systems, Inc., which included its Spirit Enterprise hospital information system. Both product lines will be operated as part of NextGen Healthcare Information Systems, Inc.

The acquisitions give NextGen an inpatient product line, which it says will sell primarily to hospitals with fewer than 100 beds.

Scott Decker, president of NextGen Healthcare, was quoted as saying, “We have seen demand grow in the rural and community marketplace due to the Stark relaxation, emergence of health information exchange initiatives and impending incentives resulting from the American Recovery and Reinvestment Act (ARRA). Through our many years of working with ambulatory providers closely associated with or owned by community hospitals, it became clear that we could meet this demand by broadening our offering to include both ambulatory and inpatient solutions. In addition, clients have expressed the need for a single, ‘cloud-based’ technology platform that can be leveraged across ambulatory and inpatient care settings. These new acquisitions afford us the necessary capabilities to address client needs and fill a void currently present within the rural and community hospital marketplace. When considered in conjunction with our complementary Siemens Strategic Partnership, this announcement completes a strategy for distributing NextGen solutions across the entire inpatient and outpatient continuum.”

We announced the acquisition last night on HIStalk Practice, thanks to a tip from Miss Lead.

News 2/10/10

From Snow Bunny: “Re: Pittsburgh snowstorm. The snow flake power outage was severe and crippling at Jefferson Regional Medical Center. It caused all computer screens to go blank with no EMR for 20 hours. Check with your Siemens IT friends to reconcile the facts. Retaliation will be swift for the staff that leak the truth. I have not yet been able to determine the impact of the outage at the Canonsburg Hospital (above) on its EMR, but hospitals do not close their ERs just because they cannot do CT scans.” Unverified. If they had a snowstorm and power outages, I’m not sure that’s a Siemens problem.

From Sally: “Re: Allscripts. They announced a sales re-org a few days ago. Several long-term folks decided it was a good time to make an exit.” Unverified. Allscripts doesn’t confirm rumors, so that’s all I can say except lots of companies seem to be reorganizing their sales teams lately, most likely to frantically shore up the front lines for HITECH spending.

From Othello: “Re: ARRA/HITECH resources. HIPAA Survival Guide is useful.” I notice that HIStalk did not make their list of “TOP healthcare blogs”, which includes some not-so-stellar ones, so I’m not exactly sure why I’m giving them a free link.

From LPJ: “Re: HIMSS. I have been in contact with many IDN CIOs across the eastern US this past week inviting them to a HIMSS event. It may just be a weird coincidence, but an unbelievable number of CIOs are not making it to HIMSS because they are so swamped with large projects in the hospital or with ambulatory implementations.”

From Paulie: “Re: editorial. Did you read this one from [publication name omitted]? Pretty lame with some basic facts wrong.” Newspaper people write editorials that involve issues that affect us all, like taxes and crime, which makes sense. What doesn’t is sideliners who have never worked a day in either healthcare or technology who crank out impassioned, overly confident editorials that industry experts are supposed to find insightful. But if they can get readers, more power to them.

From Joe: “Re: VA. Some months ago, the VA announced that some dozen or so projects were being placed on hold, some of them where VistA had shortcomings and off-the-shelf software could be integrated.” I knew that, but what I haven’t heard is whether they’re moving forward with Cerner LIS or sticking with internal / fat cat contractor development.

From Svetlana: “Re: Scott McNealy at HIMSS 2005. He was a no-show for the opening address. The loyal Sun health care partners slated to be a part of his presentation were given the bum’s rush by HIMSS folk and left to deal with the nasty PR aftermath in the exhibit hall.” I guess that’s why I didn’t remember him. I figured I must have slept in or something since the opening session is usually pretty lame (all the HIMSS speakers just read their speeches off the TelePrompter, usually stumbling frequently). The opening keynoter this time is the CEO of Sprint Nextel, whose inspiring five-year stock performance (blue) against the Nasdaq (red) gives me a good reason to plan for some extra rest before bussing over for the first educational session.

SDI Diagnostic Imaging, a nighthawking radiology company, acquires Stratus Healthcare, another Florida company doing similar work. “Stratus’ software platform allows radiologists to do final reads and use a voice recognition system to dictate their findings directly into the patient’s medical record at the hospital, which will grow in importance with the push for more electronic medical records. It also could mean more direct billing of managed care companies for SDI’s services instead of billing the hospital or radiology group that is SDI’s client, Younger said.”

Maybe you are snowed in, tired of short days, or just struggling with the winter blahs in general. Here’s your cure: complete my reader survey. OK, that was a blatant come-on, but I really do study your responses closely and agonize over what I could be doing better after I read your comments and re-evaluate my self-worth. I only do it once a year, so think of this as Pledge Week at your local PBS station, with aging, overweight doo-wop singers in bad toupees and Popsicle-colored tuxes standing at the ready to sing the only the achievable low notes of Goodnite Sweetheart, Goodnite after the break.

An argument for electronic patient records, witnessed by me first hand: doctors, nurses, and ancillary employees trying to figure out how they can all use the same patient’s MAR simultaneously following the invariable search party it takes to locate it in the first place.

From The PACS Designer: “Re: Receiver for iPhone. Most of us are familiar with Citrix and its servers sending applications to your home or other locations. Now, Citrix has released Receiver for iPhone to send applications to a mobile device so you can have your applications any place you might be with your iPhone.” I first mentioned it in May 2009, but I think this is a new version.

Rep. John Murtha, the big-time bringer of federal pork (some of it healthcare IT-related) to the coalfields of Pennsylvania, dies of what appears to be a medical error. Reports suggest that his surgeon at National Naval Medical Center nicked his intestine or a blood vessel during a routine laparascopic gall bladder removal, causing his death from complications three days later.

I ran across CareCloud, some kind of start up that is not very descriptive of its business, a couple of days ago. I also notice that they’ll be pitching to investors at the Health IT Venture Fair at HIMSS. From the minimal description on its site, it sounds as though CareCloud sells cloud-based physician office systems (“a Web-based healthcare IT ecosystem”)with some social networking thrown in. Pretty much everyone on the executive team came from RCM vendor Avisena.

Jobs: Senior IT Systems Analyst (GA), Clinical Informatics Specialist – Pharmacy (MO), Director – Clinical Informatics (CA), Information Services Manager (VA).

Cerner reports Q4 numbers: revenue up 0.1%, EPS $0.71 vs. $0.86. Some of that was because of a one-time benefit from a year ago, but I would still say it’s a pretty poor quarter given all the company’s bravado about HITECH-fueled growth. They beat earnings estimates, though, and nearly everyone admits now (finally) that stimulus dollars won’t be hitting vendor bottom lines for some time.

A Weird News Andy find: a Texas hospital nurse writes a confidential letter to the Texas Medical Board, asking them to check on a doctor whose medical practice she thought was substandard. The doctor, who has been reprimanded several times by the hospital and fined by the medical board for running a phentermine-dispensing weight loss mill, gets her and another nurse fired. He then reports the nurse to his happy patient the sheriff, who hits her with a felony charge of misusing clinical information. She faces up to 10 years in prison for doing what she thought she was obligated to do as a nurse. The medical board sympathizes, saying “It’s sort of an alarming idea that somebody reporting a doctor of concern has to be afraid of criminal charges.” The nurses are suing the county, hospital, sheriff, doctor, and prosecutor for vindictive prosecution and violating their First Amendment rights.

The greenhorn manager’s guide to fixing every organizational problem: (a) draw up a new org chart that looks exactly like the one from five years ago, which was changed back then to fix every organizational problem; (b) implement more systems in which to document work, record time, and report status; (c) move people around and expect significant synergies to result; (d) hold pathetically transparent motivational sessions and team-building sessions among co-workers who dislike each other intensely; and (e) dismiss all longstanding, serious problems as requiring nothing more than fresh perspective, additional meetings, and focused prioritization. This is a composite of all the hospitals in which I’ve worked. I felt the need to share.

PC World mentions Microsoft Research’s work in using consumer products like the Xbox and Windows Mobile phones for health-related functions. “Researchers are also looking at how to automate the data transfer from complex records and choose or filter displayed information according to conditions such as whether the doctor or family members are in the room, which could be detected by sensors, Tan said. Xbox units could be used for those purposes, to present other health information and to let patients play games or access certain Internet services, including through body gestures enabled by Microsoft’s upcoming Project Natal control system, he said.”

Sometimes it seems that as many spare bedroom programmers are writing iPhone apps as there are people using them. This Mayo cardiologist taught himself programming and spent 200 hours writing his 99-cent app that lets users screw around with photos, like adding balloon messages, devil horns, or giant pectoral muscles.

Nuance announces Q1 results: revenue up 21%, EPS -$0.02 vs. -$0.11.

Tasmania’s Department of Health and Human Services has issued a request for tender for a system to create a longitudinal patient with HIE and business intelligence capabilities from its legacy systems, just in case any of you vendors are interested.

E-mail me.

HERtalk by Inga

Picis announces its 2009 highlights, which include the addition of 30 new IDNs, 83 CareSuite selections, and a doubling of LYNX revenue cycle customers. Mr. H mentioned the other day that Picis was of HIStalk’s first sponsors and that he interviewed President Todd Cozzens in 2005 (back when he still had to beg people to talk with an unknown blogger). Here is what Cozzens said five years ago:

We’ve got plenty of room for growth. These care areas (ED, ICU, OR) make up over 50% of a hospital’s revenue and expense, and only 7% of ICUs are automated so far. We’ve proven that we have the technology and usability levels for users to spend money to make money in these areas. We’re past the early adoption phase. Most of our OR revenue comes from replacing antiquated scheduling systems, but only 7-10% have automated anesthesia and PACU, so that’s an add-on at the same price as the scheduling system. ED is only 10% automated and a hot area for investment. So, there’s plenty of growth for this company in the next five years, continuing to do what we do extremely well.

East Cooper Medical Center (SC) plans to install Patient-Aware OR in its new hospital opening later this quarter.

Mediware announces its Q2 numbers: net income of $783,00, which is a 158% increase over last year; revenues of $10.8M, 8% higher than last year.

Providence Health & Services Washington Region selects Compuware’s EHR Service Delivery Solution to proactively resolve performance issues.

Citrus Memorial Health System (FL) upgrades its HIS to McKesson’s Paragon community HIS. Citrus will use McKesson’s remote hosting services and plans to connect its outpatient clinics that are running McKesson’s Practice Partner ambulatory EHR.

The University of Colorado Hospital is seeking to fill 75 new jobs as it implements its $67 million Epic project over the next three years. Average salary is $74K for positions that include analysts, project managers, business systems analysts, and computer technicians.

I also noticed that MEDecision is soliciting potential employees to schedule an interview with them during HIMSS. If the interview goes well, perhaps you’ll be invited to attend the big party they’re hosting at the Georgia Aquarium. (Unfortunately it is the same time as the HIStalk party or I’d be making plans to be there.)

Phytel raises $14.2 million in funding from investors, including Polaris Venture Partners, Caris, and LAH Investments. Phytel plans to use a portion of the funds to advance product development.

Also raising new funds: PatientSafe Solutions (formerly known as IntelliDOT), which closed on $30 million in Series B-1 financing and will use the money to complete its next generation product.

Concord Hospital (NH) is replacing its Sun Microsystems eGate solution with Orion Health Rhapsody Integration Engine.

Garden City Hospital (MI) integrates Dragon Medical with EmergisoftED in its ED. The hospital says its now creating “transcription-free clinical documentation.” CareTech Solutions provided the implementation training and support for the EmergisoftED and Dragon Medical integration.

The CIO at Wayne Memorial Hospital says their Imprivata OneSign SSO application has eliminated password management challenges and is providing secure access to data from more than 40 applications. Connected applications include MEDITECH 6.0, McKesson PACS, Nuance ESW, Kronos, NetLearning, OWA, and RadNet.

Nash Health Care initiates a 15-month Cerner clinical implementation nicknamed “On Track for ePatient Safety.” The hospital anticipates saving $8 million a year over five years following its March 2011 go-live.

Cook Children’s Health Care System (TX) signs up for multiple enterprise software solutions from Lawson Software.

A new KLAS report looks at 22 HIE vendors and concludes that most have only one, two or three validated sites. Axolotl has the most live HIE clients in the acute-to-acute space (seven validated.) Epic also had seven validated acute-to-acute sites, though all are Epic software customers. Among acute-to-ambulatory HIEs, Medicity’s Novo Grid leads the pack with 22 live HIE organizations; RelayHealth has eight live sites.

A few sponsor updates:

• CareTech Solutions names Colleen M. Hanley as VP of marketing, communications, and government affairs.
• Quality IT Partners wins an IT infrastructure contract with a major health system in the West.
• Home health provider SunCrest Healthcare selects Philips as its provider of telehealth monitors for home care patients.
• Rob Kolodner headlines a Sunquest-hosted breakfast March 2nd during HIMSS.
• BridgeHead Software is surveying hospitals and healthcare organizations to gauge the industry’s readiness for and response to IT growth and the data it produces. If you’d like to participate — and earn a chance to win an Apple iPad – you’ll find the survey here.
• The Children’s Center (OK) purchases QuadraMed CPR, including the Smart Start solution, CPOE, Long-Term Care and Rehab, and AcuityPlus.

Google plans to introduce a Facebook-ish feature that will make it easier for Gmail users to view media and status updates shared online by friends. I see this as a potentially very bad thing. First and foremost, I am in Gmail all day and I can’t imagine how I will get any work done when I see friends post things like they’ve gotten a new haircut and need feedback, or ask questions like what kind of wine goes best with Mexican, or even that Nordstroms is having a major shoe sale. Second, I am already entrenched in Facebook and I can’t make a switch now (same excuse used by a lot of providers using EMRs). And third, do I really, really need another way to communicate with people? One reason I am really looking forward to HIMSS because I’ll have a chance to talk to people face-to-face versus virtual communication. Who is shocked to know that Mr. H and I have only talked on the phone once in the last year? Yet I know he is always lurking on my Facebook.

Talk virtually to Inga.

Monday Morning Update 2/8/10

From Nasty Parts: “Re: Sage. COO Lindy Benton resigned Thursday night.” Confirmed with Sage. Betty Otter-Nickerson starts as CEO this week.

From iSOFTen: “Re: UM Medical Centre in Kuala Lumpur, Malaysia. IBA/iSOFT have been invited to the exit door because of repeated product delivery failures. This casts long shadows over the future of their German-developed strategic lab product, planned for the still pending at Welsh procurement. And with regard to iSOFT’s alliance with Picis, it was because of IBA/iSOFTS’s product delivery failures.” Unverified.

Listening: Midlake, a Texas band that sounds like accessible, straightforward 60s pop meets the Flaming Lips.

I think it’s plainly obvious, but in case not: I use only phony names on the reader comments I post. Please do not pester your colleagues just because the phony name is similar to theirs since it most likely wasn’t their comment.

Tammi, our BFF from AT&T Mobility, said their “iPhone in Medicine” session was packed even after being moved to a larger room at the mHealth conference in Washington DC last week. mHealth Initiative is the group formed by former Medical Records Institute/TEPR people Peter Waegemann and Claudia Tessier when that group flamed out.

Weird News Andy ponders, “Where do babies come from? From iPhones, apparently.” After four years of trying to conceive, a couple hits pay dirt in just two months after using an iPhone menstrual calculator. Thank goodness humanity didn’t lapse into extinction before the iPhone came along to help it reproduce the species.

Yale New Haven Hospital chooses the document management solution of Perceptive Software for several departments.

The folks at Henry Schein Practice Solutions are offering a free, on-demand Webinar called 10 Questions to Ask your Electronic Dental Record Vendor. They’ve also hired Pete Cousins as national sales manager for Dentrix Enterprise. I’m sensing trouble because Pete is a big-time amateur golfer, which means if you want a customer’s game, he will probably thrash you despite his best intentions to keep it close.

Red Hat announces its February 10 Open Source Cloud Computing Forum, an all-day virtual forum hosted by its CTO that offers 12 half-hour technical presentations.

Sunquest will introduce its new BI solutions and physician portal at HIMSS.

We’ve mentioned some charity-related activities at HIMSS, so here’s one from Compuware and Covisint. The company will donate $10 to Habitat for Humanity for each attendee badge scan at their booth. It will also raffle off a $5,000 contribution to that same organization, which is the amount of money it takes to rehabilitate a home.

I guess Google can celebrate its big win over Microsoft in their respective HIStalk reader polls, with Google’s 65% negative rating in healthcare beating Microsoft’s 66%. New poll to your right, the last in the series: same question, this time about Cisco.

It’s that time of year again — please complete my HIStalk Reader Survey, won’t you? I read the response carefully and plan the whole next year based in what readers tell me, so your time won’t be wasted. Thanks.

This is the real payoff of EMRs, described in a well-written article in The Buffalo News. Buffalo Medical Group searches its database for patients at risk of abdominal aortic aneurysm. It identifies 2,000, of which 30 are found to have aneurysms that could burst at any time, which is nearly a certain death sentence. The article focuses on the benefits of the medical home concept, but also summarizes the concerns of its critics: “They also wonder if the concept is nothing more than a repackaging of managed care, bristle at the suggestion that doctors need financial incentives to do the right thing, and view the focus on efficiency as more appropriate for a factory.”

I don’t know about your hospital, but mine can’t give H1N1 vaccine away. I said early on that this latest scare might be as overblown as the Gerald Ford’s Great Swine Flu Epidemic of 1976, although I really doubted that. Other than putting some nice profits in the pockets of drug companies and McKesson, I’m struggling to decide if there was any benefit to getting everybody all worked up about it. It’s notoriously tough to predict pandemics, much less prevent them.

Kaiser Permanente is recognized with a security award from HITRUST, an organization that has a Kaiser security executive on its executive council. I Googled to see if HITRUST is a for-profit corporation as I expected; the only declaration I found saying it’s a non-profit came from Fierce Health IT, which I think is wrong. It looks to me like a regular business, despite a .net Web address and some noble mission statements. Its Web site says it is a “private, independent company” and its Texas incorporation records show its officers as a husband and wife. He’s founded a few other now-defunct corporately sponsored think tanks in the past.

An Epocrates survey finds that 20% of doctors say they’ll be buying an iPad within a year, good news for the company since it has already committed to creating an iPad version of its drug information software.

VirtualHealth Technologies completes the sale of its Secure eHealth secure messaging business and its VPS Holdings prescription drug monitoring business to Wound Management Technologies.That leaves the company with two primary business lines: EMRs and gold mines (insert joke here).

St. Joseph’s Hospital (WV) chooses eWebHIM from eWebHealth for scanning and HIM workflow.

Akron General jumps on the “show your ED wait times” bandwagon, putting them on its Web site and on billboards. The times reflect how long it takes for the doctor to see you, but most ED delays involve waiting for technicians, for labs or x-rays to come back, or for someone to get you signed out with prescriptions. Being called from the waiting area to the treatment room is only a small victory. Since they’re capturing the times from their EMR anyway, maybe they should measure arrival time to final disposition.

eClinical Works breaks the $100 million per year revenue barrier. I dug out my May 2006 interview with Girish Kumar Navani in which he boldly predicted $40 million in revenue for that year, a big jump from the previous year’s $25 million. And when I interviewed him in early 2008, they were at $60 million and he was predicting $500 million in annual revenue by 2018.

GE Healthcare names William Denman as chief medical officer. He’s coming over from Covidien, the Irish spinoff of Tyco Brands that sells healthcare products under the brands Kendall, Mallinckrodt, Puritan Bennett, and Syneture, among others.

Results look promising for the first-generation artificial pancreas for treatment of diabetes. It combines a blood glucose monitor with an insulin pump, creating a feedback loop that is managed by software.

The VA is budgeting $157 million next year to develop a Virtual Lifetime Electronic Record that will tie together data from the VA, DoD, and the private sector. DoD plans to spend $300 million to develop its part of the project. In more startling news, the VA will spend $347 million for HealtheVet, which it says is the “the future foundation of our electronic health record system” that will initially include a new clinical data repository, patient scheduling system, and pharmacy information system. On the VA’s VistA Web page, it calls HealtheVet “the VA’s next generation of VistA.” I never heard what happened with all those ambitious plans to replace VistA with commercial systems, so I don’t know where this money is going.

Sun’s big executives, including co-founder Scott McNealy, quit as the company is absorbed into Oracle. McNealy gave the opening address at HIMSS 2005 in Dallas. I don’t recall being impressed.

Odd lawsuit: a stripper gets drunk on the job and leaves the club despite its three attempts to stop her. She crashes her car, breaking her nose and back. Her injuries force her to stop stripping, so she sues the strip club for “wantonness.” The jury awards her $100,000, with her attorney declaring that “I think that it does speak to our community’s regard for safety”. The club’s lawyer disagrees: “Bottom line is she got herself drunk, had a terrible wreck, and wants someone else to pay for it.”

E-mail me.

News 2/5/10

From Farrell: “Re: Microsoft. Substitute Epic for Microsoft in this article and it holds true.” The article, written by a former Microsoft VP, observes that Microsoft is a “clumsy, uncompetitive innovator” whose products are “lampooned” and its marketing “inept” as it loses market share in nearly every important category, milking profits from Office and Windows but falling slowly into irrelevance otherwise. Company bureaucracy and infighting are blamed.

From Nell: “Re: McKesson. W-2 forms have always listed the employer as McKesson Corporation. The ones just sent out say McKesson Information Solutions LLC. I wonder if they are quietly preparing to spin off the HIT division?” I figured it was probably a Delaware corporation, so I check that state’s corporate database. That corporation was formed in 1974, so I don’t know why it’s suddenly showing up on W-2s. Could mean something, could mean nothing.

From Warren: “Re: QuadraMed layoffs. This is absolutely not true. There has been senior leadership change in sales, resulting in some realignment of the sales force, and two sales folks were let go. QuadraMed Sales is now better aligned to serve its clients. QuadraMed is absolutely committed to meeting Meaningful Use requirements for current and future QCPR customers. These types of rumors can be deal killers — please vet sources carefully before printing.” I held the first report I received suggesting layoffs and a change in the QCPR product just in case it was bogus. I then received two more saying the same thing. All three came from non-anonymous sources I’ve known for years who are also pro-QuadraMed. The official company contact told Inga last time we asked that they do not address rumors. We asked about this one anyway, but her e-mail bounced back as undeliverable. It’s tough to confirm when the company won’t talk. Still, I would be happy to hear that layoffs were minimal and that QCPR will live on. If it were me, I’d get an announcement out there.

From Doug Wallace: “Re: Dwight Schrute from The Office on EMRs. ‘I think one of the greatest things about modern America is the computerization of medical records. As a volunteer sheriff, I can look up anyone’s psychiatric records or surgical histories.’”

From FreddieMac: “Re: Cerner. In order to improve cash flow, the company is aggressively pursuing complete IT outsourcing deals (like MU) among its client hospitals through any any back door they can. Of course, they think RHO Millennium translates into knowing how to run all the other aspects of health IT. I believe they got Naples Community and are trying for some other academics. Beats the hell out of trying to compete with Epic for new sales.” It’s a good strategy, I think, and I expect it will open some doors to hospitals who don’t consider data center operations to be core. Not to mention that, as you noted, Epic is taking most of the pie anyway. (I just noticed that I said Cerner, Epic, and pie together … could that be a HISsies Freudian slip?)

From Mark: “Re: Dragon Naturally Speaking. I bought it on your first recommendation and absolutely love it. A product that lives up to its billing, just like HIStalk!" Another reader suggested that I note, probably unnecessarily, that I am using DNS for personal use, which is why it was cheap. For EMRs, you would need Dragon Medical, which comes with integration tools, a medical vocabulary, and a much larger price tag. My point is still valid: speech recognition absolutely works and is not just for geeks any more.

Mcesson announces Practice Partner Connect, an interoperability platform for users of its Practice Partner physician system.

Loma Linda University Medical Center chooses the MDaudit Hospital compliance and revenue risk mitigation system from Hayes Management Consulting.

eMix will launch its vendor-neutral medical imaging information exchange at HIMSS. The company is affiliated with DR Systems.

Janeen Cook says thanks for taking a look at her nursing video. She won the Vanderbilt School of Nursing student video contest with 560 views, saying, “One of my former team members said I was just like Susan Boyle. Wait a minute, I thought — is that a complement being thought of as frumpy and a bit odd? ”

Englewood Hospital and Medical Center (NJ) signs up for McKesson Horizon Clinicals and Horizon Enterprise Revenue Management.

I’m entering my second week or so of being ridiculously behind, so if you are expecting something from me, I’ll try to catch up over the weekend.

Arizona Regional Medical Center (AZ) chooses clinical and financial systems from HMS.

Mayo Clinic takes a minority position in Centerphase, a startup that will mine Mayo’s patient database to find patients who qualify for specific clinical drug trials.

eMids Technologies offers an “AGILE for ARRA” presentation at HIMSS that covers iterative product development. If you are involved in product development and delivery, you can sign up for the Tuesday morning breakfast at the “W” Hotel here.

This week’s e-mail from Kaiser Permanente CEO George Halvorson notes that of 16 organizations winning a Continuous Availability Award for computer uptime, Kaiser was the only healthcare winner. Two of its data centers that host clinical systems had 100% uptime for the full year, with overall availability of HealthConnect at over 99.9%.

Alert, the hospital information system vendor from Portugal that had fanboys swooning at HIMSS a few years ago and then promptly sank without a trace, signs its fourth hospital customer.  

Sentara CIO Bert Reese is interviewed on Cox Business TV, talking about EMRs and interoperability.

Please welcome Precyse Solutions, which has joined our merry band as a Platinum Sponsor of HIStalk. The Wayne, PA company offers a variety of HIM-related services: transcription, coding, consulting, outsourcing, oncology data management, audit, clinical documentation improvement, and its PrecyseAssist service to answer difficult coding and claims questions. You can download a variety of Webinars and presentations from their site for more information. Googling just to see what I’d said about them previously, I notice the company made my radar in mid-2008, when I said this: “I’d watch this company: HIM vendor Precyse Solutions puts Pam Arlotto and Carl Witonsky on its advisory board, giving them a lot of strategic horsepower.” Thanks to Precyse Solutions for their gracious support of HIStalk and those who read it.

A non-profit clinic run by an associate of a Louisiana Parish councilman overbilled West Jefferson Medical Center by $150,000 for its treatment of uninsured patients, an audit uncovers. Also discovered: the clinic had $100,000 in missing checks and undocumented purchases, spent $29,000 on parties, and gave $100,000 in interest-free loans to employees. The hospital has paid the clinic $4.2 million to keep patients out of its ED since 2004. The former clinic CEO says missing documentation for certain payments was caused by an accounting software virus.

We’re booming over at HIStalk Mobile, to the point that we could use some help. I’m interested in talking to a physician, resident, or med student who has good understanding of mobile health and would like to share their passion with our readers in some sort of paid arrangement. E-mail me. I also just remembered that I probably didn’t mention our latest HIStalk Mobile Founding Sponsor, Voalté, so thanks very much to the Men (and Women) in Pink for their support. 

College Park Family Care Center in Overland Park, KS wins a free radiology information system from Swearingen Software, chosen as the most deserving “hardship” radiology department.

Rich Helppie’s Santa Rosa Consulting announces (warning: PDF) its merger with CSA Consulting. Both companies are in Michigan.

Jobs: Information Services Manager (VA), Information Systems ERP Manager (WA), Clinical/EMR Project Manager (NC).

After-hours medical services come under fire in England after the recent death of a patient under the care of a sleep-deprived doctor brought over from Germany and put immediately to work with no rest. Computer problems are named as an issue since doctors can’t see each other’s records. The newspaper article cites a 2005 case in which a post-surgical patient spoke to six doctors by phone and saw two in person, only to die of undiagnosed septicemia.

The VA will freeze its $3.3 billion IT budget in FY11.

Canada reaches national consensus on using GS1 bar codes for drug products, led by the Institute for Safe Medication Practices and the Canadian Patient Safety Institute. The GS1 bar codes are smaller, hold more information, and can hold product-specific codes such as lot numbers and expiration dates that can be used to track products through the supply chain.

Meditech just released its annual report. Revenue was down 1%, the first drop in the five historical years listed. Product revenue dropped to $176 million from last year’s $186 million. Net income was way up at $81 million compared to a big investment-related drop in 2008, but still lagging compared to the past few years. Neil Pappalardo has 13.8 million shares worth $511 million at the internally set share price. I wouldn’t say the company is struggling, but the long string of growth numbers has clearly ended just as HIT spending increases. It will be interesting to see how well it competes for the small hospital business fueled by HITECH.

EnovateIT kicks off a dramatic expansion of its mobile and wall-mounted clinical workstation manufacturing facility, increasing its current space fivefold. The company also forecasts record 2010 sales and announced plans for further expansion later this year.

NHS Scotland will use TrakCare from InterSystems as its patient management system.

Informatics Corporation of America makes a white paper available called Health Care IT Investment Heightens Need For Effective Implementation.

A bizarre, only-in America lawsuit: Heart Attack Grill, a Arizona restaurant characterized as its attorney as “the originator of the medically-themed hamburger grill and restaurant” whose motto is “Taste Worth Dying For", files suit against Florida-based Heart Stoppers Sports Grill. The former has waitresses dressed as nurses serving Bypass Burgers and Jolt Cola, while the latter does the same for its Chili Chest Pain Fries. Another point requiring intellectual property interpretation: both restaurants offer free food to anybody weighing over 350 pounds.

E-mail me.

HERtalk by Inga

Picis and iSOFT form a strategic alliance that gives iSOFT the right to distribute, implement, and support selected Picis CareSuite solutions. iSOFT’s initial marketing focus will be on ICU and anesthesia in the UK, Ireland, Scandinavia, Australia, and New Zealand.

Design Clinicals’ MedsTracker medication reconciliation application is now fully integrated with Wellsoft’s Medication Verification & Exchange capabilities. CentraState Medical Center (NJ) was the first ED to employ the integrated solution.

Design Clinicals, by the way, gains an exclusive endorsement from the AHA for its MedsTracker program, having proved its ability to help health care organizations achieve organizational excellence.

I love the guys at Vitalize Consulting Solutions. Rather than spending thousands to throw a big party at HIMSS, the company has decided to donate funds to the Atlanta Community Food Bank. Of course I have nothing against big parties, but I like social consciousness as well. So, here is what VCS is doing. For every person who signs up to follow them on Twitter, joins their Facebook group, or leaves a comment on the “Help Us Help Atlanta” blog, they will donate $1 to the food bank. (do it now before you forget!) Or, you can pay them a visit at booth #5203 at HIMSS. Last year VCS had an equally cool program that allowed HIMSS attendees and VCS donate thousands of soup packets and money to the Chicago Food Bank.

Christiana Care Health System (DE) announces its go-live on CPOE at its Wilmington Hospital. The health system will soon  launch CPOE at its other facility, Christiana Hospital.

The US Patent and Trademark Office awards Medicity a patent for its agent-grid technology for health information exchange. The technology is the core of Medicity’s Novo Grid, which provides EHR integration and community-wide information exchange. We did a HIStech Report on Novo Innovations a couple of years ago,before it was purchased by Medicity. I remember at the time thinking that if it worked they way Robert Connely said it did, it was some hot technology. Guess the patent guys agreed.

The folks at EHR Scope blog did an awesome job summarizing our recent EHR executives series on the proposed meaningful use criteria. If you missed the series, the EHR Scope article succinctly outlines the bottom line opinion of each executive to each question. It’s interesting to see what vendors share similar philosophies on certain topics and who provided the more unique perspectives.

Edward Hospital in Naperville (IL) formally names Barbara Byrne, MD vice president of HIT. Byrne is former clinical director for CCHIT and was named a CCHIT commissioner just last month.

Would you pay $50 to text one question to one doctor? Truth On Call is hoping patients, or perhaps physicians in developing countries, will take advantage of the service. Patients text their questions on cell phones and the doctor texts back, receiving $10 for each question. The model sounds interesting, especially if you think about physicians in rural India needing a quick opinion from doctors in the US. But $50 per question per doctor? Seriously?

Here’s a more mainstream product that happens to be free. Text4Baby is a mHealth service designed for pregnant women and new moms through the baby’s first year. Expectant mothers can text “baby” to sign up for the service and receive three to four text messages a week that align with their due date. Federal CTO Aneesh Chopra is promoting its use to make sure moms-to-be and babies stay healthy. Voxiva created the system, mentioned by the company’s co-founder, chairman, and president Paul Meyer in our November interview.

I’m kind of glad that most of my plane rides are fairly boring. On the other hand, passengers on this flight had a bit more entertainment, when shortly after take-off, a man starts screaming, drops his pants, and attacks crew members. He later admits he overmedicated himself before take-off, downing a double dose of medical marijuana cookies.

E-mail Inga.

Spheris Files Bankruptcy, Plans CBay Asset Purchase

Clinical documentation and transcription vendor Spheris announced today that it has filed Chapter 11 bankruptcy in order to allow MedQuist and CBay, companies owned by CBaySystems Holdings LTD, to purchase its assets. Bids from other interested parties will be accepted, however. Spheris India is part of the transaction, but will not file bankruptcy.

Robert Butler, Chief Restructuring Officer of Spheris, stated, "Throughout the past year, Spheris has taken steps to strengthen its operations and customer service, and these initiatives are achieving solid results.  Spheris has also been engaged in constructive discussions with certain key constituents of the Company to identify ways to enhance financial flexibility for our operations.  We expect customers will continue to receive high-performing services through a company with a stronger capital structure."

Cracker predicted this action on December 9 on HIStalk:

From Cracker: “Re: Spheris. Warburg Pincus is looking to unload its albatross Spheris stake to CBay Systems, the largest medical transcription company in the US since their purchase of MedQuist in 2008. Spheris, second largest, recently ended a three-year run as a quasi-public company — public debt, not public stock. Uncompetitive technology and a heavy debt load handicap Spheris as medical transcription prices fall.”

We reported on December 17:

Daniel J. Kohl resigns as CEO of the struggling Spheris, a medical transcription service company. The company reported a 15% drop in revenue the first half of the year and ended its registration with the SEC in November. Likely adding fuel to the fire was the company’s poor showing in last week’s KLAS report on medical transcription service vendors. Amid customer complaints that Spheris was unable to resolve quality and technology issues, the company was ranked last in a field of 15.