News 12/22/10

From Vendor Prez: “Re: RFID tagging of HIMSS conference attendees. I think this is appalling. As an exhibitor, the last thing I want is for the attendees to feel more ‘targeted’ that they already do. Frankly, if exhibitors can’t get attendees in their booth on their own merit, they don’t deserve to capture key information from drive-bys. This is pitiful and my company will not be participating. We will however, proudly display the HIStalk Sponsor poster that you always drop by!” Above is the end result of tracking us attendees like stray cattle via the RFID chip tucked away in our badges. Vendors pay $3,000 for the basic package up to more than $20,000 for a turnkey tracking service. You can opt out on your conference registration like I did. And thanks to Vendor Prez for displaying our amateurishly made “We Power HIStalk” signs in their booth. I know it’s hokey, but we are really proud that many HIStalk sponsors participate because they want to support what we do. As you might imagine, I really appreciate that.

Speaking of which, you would think the stray cattle tracking company could at least spell the name of its excessively vendor-friendly partner correctly.

From Chatty Cathy: “Re: instant messaging. Do nurses typically use it in hospitals to communicate with each other and with doctors? Just curious.” In mine, the PCs are theoretically locked down and IM clients aren’t allowed, although I’m sure someone has figured out a way to bypass that (like using an online chat client like Meebo or the ones built into Yahoo or Google). I like the question, though, and would appreciate comments. It’s a pager-driven world in many hospitals, made kind of IM-ey with Amcom’s Web-based paging app that lets people chat primitively back and forth. Staff could also use SMS messages or specific VoIP apps. They could even use FaceTime video calling if they have iPhones or iPads.

From IT Begins: “Re: Ingenix. Appears to be the first steps of unveiling strategy around the recent acquisitions.” Inga covers it below, but Bethesda Healthcare System (FL) chooses Ingenix to manage the revenue cycle of both the hospital and its outpatient services. Ingenix will provide its Electronic Financial Record, coding solutions, patient financial counseling, an ED information system (since it bought Picis and can offer ED PulseCheck), and full-time employees in scheduling, registration, HIM, PFS, and decision support. It sounds like a great business move, although odd that a hospital would hire a company owned by an insurer to manage its revenue cycle, most of which involves dealing with insurance companies. Who better, right?

From Epic User: “Re: FDA oversight of EHRs. Epic’s ‘fear of stifling innovation’ doesn’t resonate with this long-time user of their applications. They routinely fail to prioritize making simple changes to their system (icons, language on screens, similar functions in different applications) that are consistent and would reduce user confusion / error. They also fail to prioritize making enhancements to their systems requested by customers year after year (apart from the annual voting, which is application-based and not focused on consistency across applications), and instead focus on new features that help sell the systems (e.g. focus on ‘what sells’ vs. ‘what’s useful’. If FDA oversight stifles their innovation and helps make their systems more consistent from application to application in terms of functionality, user experience, etc. then that’s a good thing.” Here’s who I blame for that: customers and prospects, since most vendors work pretty much the same as you describe, i.e. creating what the market demands. If customers don’t like their apps or feel they endanger patients, then it’s their fault for writing that check anyway. I’m growing weary of hearing how big, bad vendors prey on helpless health systems and their excessively paid C-level leadership who can’t be bothered to understand exactly what they are getting in return for their many, many millions of dollars or creating a vision of how it could be better. I’d like to see better applications, but those voting with their dollars are saying otherwise – guess whose vote counts? If there’s a demand for iffy software applications, unhealthy Big Macs, or illegal drugs, economics assures that someone will meet that demand.

This is sobering, but not surprising: Fitch Ratings downgrades the bonds of Lima Linda University Medical Center (CA) BBB with a negative outlook due to poor liquidity and inconsistent financial results (54 days days cash on hand). Once concern is the $1.4 billion it will need in capital over the next 10 years, mostly for seismic compliance requirements (which management has already said they can’t possibly meet) and implementation of electronic medical records.

The chief nursing officer of Capsule, Susan Niemeier, receives a slew of social media awards for her work under the pseudonym Nurse Sue.

KLAS releases a report covering single sign-on, concluding that high customer expectations aren’t always met, but that they are generally glad they implemented it. Imprivata edged out Microsoft (Sentillion) for the top ranking.

This sounds like something I’d come up with: UMass Memorial Health care allegedly hires hot models for $75 per hour to approach mall shoppers and football game attendees and ask them to give cheek swab DNA samples for its bone marrow registry. Those agreeing were told that their insurance would pay the $100 charge, only to find that their EOBs showed charges of $8,400, not to mention that many of them may not have been made aware that they were obligating themselves to donate marrow if they matched. A hospital worker supposedly told the models, for which the hospital paid up to $4 million, to wear short black skirts, heels, a white lab coat, and colorful wigs.

Good news: today is the shortest day of the year, meaning it can only get better when it comes to driving home from work in the dark.

The guy who robbed and shot Wheaton Franciscan Healthcare IT VP Tim Belec in WFH’s parking lot three year ago is finally sentenced to 12 years in prison after pleading guilty to a single charge of attempted intentional homicide. I never heard how Tim did after taking two bullets in the chest, but I Googled his name and articles I ran across indicate that he’s back on the job at WFH.

A Dean Health System (WI) doctor breaks hospital rules by storing patient information on her laptop, which was then stolen. The hospital sends the usual “so sorry, how about some free credit protection?” letters to 3,000 surgery patients. And in Virginia, Centra notifies 14,000 patients that their billing information was exposed when an employee atttending a Georgia conference has her laptop stolen from her rental car.

Cerner opens a Collaboration Center in its London offices. I’m not clear on what its point is, but the Cerner UK GM says it will help clients “identify their respective organisational imperatives, such as financial savings or patient safety initiatives, and align them with the capabilities of Cerner Millennium.” I guess it’s like a Vision Center for existing customers.

David Brailer’s Health Evolution Partners launches Halcyon Home Health, which he says will “redefine how home care is delivered” through clinical excellence and IT. Its Web site (above) isn’t quite ready.

The government of Hong Kong starts the next phase of its EHR project, soliciting proposals for pilot projects and interface work that involve patient-facing health applications and standard terminology. Proposals are due by January 31.

Healthland’s inpatient EHR earns CCHIT certification as a Complete EHR.

I happened to drive by one of those consumer lab store fronts the other day and noticed a somewhat fun sign in their window pitching their lab tests: “Sex, Drugs, and Cholesterol.”

iSoft finds a new source of revenue: offering another company’s technology that will extract information from its EMR and de-identify it for researchers (hopefully not selling it outright). The Cliniworks platform sounds kind of cool, actually.

The GAO says HHS missed the 2007 date set by Congress to develop a plan for an electronic system to support sharing of information in public health emergencies. I guess they aren’t Meaningful Users.

Clinical trials software vendor DrugLogic files suit against Oracle, claiming patent violations related to two life sciences software companies that Oracle acquired, Relsys and Phase Forward. In the mean time, Oracle turned in killer Q2 numbers, with revenues up 47% to $8.6 billion and profit up 28% to $1.9 billion.

The local Massachusetts paper runs an interview with eClinicalWorks CEO Girish Kumar Navani, focusing on the company’s local economic impact and impending move to bigger quarters. Tidbits: eCW will be hiring 100-200 people in 2011, it has more than 1,300 employees, its new building will cost $18 million, 2010 revenues are expected to be $130-$150 million, and its five-year goal is to have 100,000 providers and 100 million patients.

We’re having the usual semi-lame holiday events at work this week (you can’t say Christmas, of course, since somebody’s lawyer would show up before you finished the sentence). There are always a few really disturbing souls wearing Santa hats in an unwelcome public display of carefully orchestrated holiday exuberance (especially since they are usually the really obnoxious people or oddballs who haven’t said a peep since last Christmas). There’s the white elephant gift exchange, which everybody hates because it comes with pages of rules and the person who organizes it always seems to parlay their knowledge into ending up with the only good gift. There’s the door decorating contest, where hastily covering a door with old gift wrap and cut-out occupant pictures is considered extraordinary effort worthy of a noble prize, like a free frozen yogurt in the cafeteria. Leftover celebration food is dumped unceremoniously and anonymously on break room tables, fallen upon instantly and ravenously by beaming IT geeks who should be applying some of their vaunted analytical skills into questioning whether it’s a good idea to eat something that’s been standing at room temperature in a different conference room or office until everyone got tired of looking at it and decided to deposit it in the collective food trough rather than throw it out (hey look, everybody, there’s deviled eggs in the break room!) Guys wear hideous light-up Santa ties and ladies show up in Christmas sweaters smelling of mothballs from their once-yearly exposure to air (the sweaters, not the ladies). But the worst thing is that it will be over in a week, leaving a long stretch of no holidays as the serious work restarts. I’m going to study this holiday phenomenon once I finish my current observational research that questions why a large percentage of men puzzlingly spit in the urinal before or after using it for its intended purpose.

E-mail me.

HERtalk by Inga

A Puget Sound-based public radio station compiles a list of the 86 “top-earners” from area hospitals, including 15 executives who earned over $1 million in 2008. On top: former Swedish CEO Richard Peterson, whose total package exceeded $8 million.

The 600 physician member Morris-Somerset IPA (NJ) contracts with eCast Corporation for its ACO-Care HIE product.

Essent Healthcare (TN) selects ProVation Order Sets  from Wolters Kluwer Health as its electronic order set solution. Essent operates five hospitals across four states.

Billings Clinic (MT) signs a multi-year agreement with Craneware for five charge process applications and implementation services.

Child Health Corporation of American will offer LodgeNet Healthcare’s eSuite interactive television solutions to its owned hospitals.

More than a quarter of doctors in the Czech Republic have declared their intention to resign and emigrate to a better-paying country if their government can’t address pay concerns, long hours, and poor working conditions. The starting base salary for a Czech physician is about $11,000 year. In nearby Germany, pay is about $96,000 a year.  Government officials claim the current financial crisis prevents them from increasing doctor pay.

Vista Health System IPA and Central Jersey Physician Network IPA form a new accountable care organization, Optimus Healthcare Partners LLC. The organization will initially include 650 physician members.

HIT consulting firm PHNS realigns its management team following its acquisition by the ConJoin Group. PHNS founder Richard S. Garnick will remain as CEO.

The Texas Organization of Rural & Community Hospitals Foundation is offering QuadraMed’s ICD-10 Countdown Program and Readiness Assessment Services to its 150 member hospitals. Almost 70 hospitals have already contracted for the program.

mdi Consultants will be the anchor tenant for the Nashville Medical Trade Center, according to the center’s management company. Market Center Management Company also announced the creation of a Global Business Development Center to be located within the center. The 1.5 million square foot development is scheduled to open in 2013 and expected to attract 160,000 visitors a year.

Sponsor Updates

• Wishard Health Services (IN) expands its use of Surgical Information Systems (SIS) products to include SIS Anesthesia, SIS Analytics, and SIS Com.
• Ochsner Health System (LA) goes live on Orion Health HIE.
• CDW and Greenway Medical Technologies announce a partnership to offer a practice EMR package that includes PrimeSUITE 2011, technology, and services.
• BayCare Health System (FL) partners with MEDSEEK to develop and deploy an integrated eHealth solution for consumers, patients, clinicians, and employees.
• Bethesda Healthcare System (FL) picks Ingenix to manage RCM functions for its hospitals and outpatient facilities. Ingenix will deploy its Electronic Financial Record technology as well as provide full-time onsite staff to manage RCM functions.
• Momentum Billing LLC (CA) chooses Advanced MD’s medical management software for its medical practice operations and RCM business.
• McKesson says that Community Hospitals and Wellness Centers (OH) is the 100th hospital to go live on its Paragon HIS.
• Cumberland Consulting Group has been honored as a Patriotic Employer for supporting employees who serve in the National Guard and Reserve. The company was nominated by Major John Gobel, one of its consultants who served 20 years in the Guard, stayed on in the Reserves, and served in Iraq.

I stepped away from my HIStalk duties yesterday and met with The Jolly Guy. I shared with him my special request for fabulous boots. Santa said, “maybe.” True story: he asked me to leave out a glass of vino on Christmas Eve, in lieu of milk and cookies. My kind of Santa.

Send holiday greetings to Inga.

Monday Morning Update 12/20/10

From The PACS Designer: “Re: ResMD from Calgary Scientific. ResMD has been mentioned on HIStalk Mobile several times as an up-and-coming mobile solution for referrers only, since FDA approval is still pending for radiology use of the iPhone. Now that ResMD image viewing software has been adapted for the iPhone, referrers can get very good image quality and navigation when viewing images of their patients.”

From Digital Bean Counter: “Re: Alere Health. The EVP/CIO was finally let go. It was a longstanding belief held by many that he was single-handedly responsible for the demise of Alere’s poorly implemented Pega-based clinical health management system.” Unverified – he’s still on their Web page. I couldn’t place the company name, so I Googled to find that it offers online wellness programs, a PHR, and a health portal.

Listening: reader-recommended and Minneapolis-based catchy power pop from Sing It Loud. Sounds kind of Gin Blossomy or Weezerish to me in places, although I could have done without their note-for-note cover of Get Down Tonight. I’ve listened to stuff from the two albums on Rhapsody and I kind of like it – it would make nice driving music. They’re recently defunct, apparently parting ways just three months after releasing a new album. The reader’s family member produced the album and used his Hammond B3 organ on it, which is always a plus.

It’s been a great weekend so far as I write this Saturday evening. I worked ten hours at the hospital Friday, came home and worked another eight hours on HIStalk stuff, including doing a cool interview that I’ll run Monday (although I took a break to escort Mrs. HIStalk to our favorite sexy Asian bistro for some fine pad kee mao), worked on the HIT course I teach, got up way before dawn and worked another several hours on HIStalk, ran eight sweaty miles on the gym’s treadmill while blasting Metallica and REM into my skull and trying to impress the lithe young females running effortlessly just as fast as me while reading their Kindles and chatting on the phone, had some private time with Mrs. HIStalk sitting in front of the fireplace (which might have been triggered by my fighting off leg cramps from my just-finished run since she may have thought that I was performing a mating ritual with all my spastic leg-flexing and prancing around that threatened to topple the Christmas tree), planned our upcoming out-of-the-country beach break, and am now settled in for a few more hours of HIStalk work with college football on. It doesn’t take much to make me happy, which is probably why I rarely think it sucks to be me even when it might.

Athenahealth warns that FY2011 earnings won’t meet expectations, expecting $0.68-$0.78 vs. expectations of $0.85. Shares dropped around 10% on the news, but started a move back up Friday. As the graph above shows, the last trade was at $40.99, vs. a 52-week high of $47.82.

A Huffington Post Investigative Fund article covers the IOM’s just-begun study of the safety of electronic medical records systems. An interesting quote from Peter Pronovost, one of the most influential patient safety experts in the country: “There is a need for the basic science of safety of HIT. There is still a lot of basic knowledge we don’t have.” During the IOM’s two-day meeting last week, Epic’s representative repeated the mantra of boss Carl Dvorak, urging that any recommendations not stifle innovation. Human-computer interface expert Ben Shneiderman said, “Until we have a more public data collection, we will not have quality.” IOM hasn’t posted the minutes from Wednesday’s meeting that I can find. I think the writing is on the wall: FDA’s going to get involved in clinical systems oversight, in the form of a vendor registry and voluntary surveillance program if I had to bet.

HIMSS and RSNA incorporate IHE USA. HIMSS VP Joyce Sensmeier will be its president.

Weird News Andy knows how to repurpose an old joke. Q: How do you get from the pancreas to the uvula? A: Practice, practice, practice. He’s referring to Google’s just-announced Body Browser.

We missed mentioning another sponsor KLAS win. GetWellNetwork was the category leader in Interactive Patient Systems, with a 100% “would buy again” score. It’s amazing to me how many HIStalk sponsors lead their markets, although not as amazing as how many have been successfully acquired in the past couple of years (I’m resisting the urge to claim that as a sponsor benefit).

India is moving to what it calls Telemedicine 2.0, going beyond videoconferencing to live streaming of data and images to mobile phones. A pilot project involves detection of retinopathy in premature babies, offsetting a shortage of specialists.

Thanks to new HIStalk Platinum Sponsor Vocera, providers of instant voice communication systems that enhance staff efficiency and improve patient flow for more than 650 hospitals and 450,000 daily users. It runs on voice-powered communication badges and smart phones, connecting healthcare workers to each other and to alarm and alert systems, and is exclusively endorsed by the American Hospital Association. The company just made some nice acquisitions that bring in products for managing patient hand-offs. The San Jose, CA company announced Q3 numbers that include a 39% year-over-year growth rate, 22 new customers, and 31 new employees. They not only now support HIStalk, they were an original Founding Sponsor of HIStalk Mobile. Thanks to Vocera for their support.

Jack Janoso, originally hired by Sharon Regional Health System (PA) as CIO, is named acting CEO after the incumbent is fired.

My e-mailed copy of December’s Microsoft HUG Connection (which I can’t find online) says that HIMSS is canning its Users Group Alliance Program and turning the Microsoft Health Users Group over to Microsoft. I could never figure out how HIMSS could justify running vendor-specific user groups in the first place, so I can’t say I’m crushed that they’ve flip-flopped. I don’t know what happens to their Cisco group, Community for Connected Health, the only other one. The same, I’d guess.

HIMSS Analytics names Marc Holland as VP of market research. He previously ran System Research Services, an HIT market research and competitive intelligence firm.

About half of provider readers say would be less likely to participate in an HIE if its technology was owned by an insurance company, with most of the other half saying that wouldn’t matter to them. New poll to your right: if some level of FDA oversight of clinical HIT is required, which options do you like? You can choose multiple items and click the Comments link to elaborate.

Nine employees of St. Joseph’s/Candler Health System (GA) are disciplined for uploading a cell phone photo taken of an x-ray of “a male patient’s pelvic region” to Facebook. The hospital says the information wasn’t identifiable, so the employees broke hospital policies but didn’t violate HIPAA. An investigation found that a radiology employee left their workstation logged in while doing a procedure in another room, allowing someone to access the image twice in that time. The hospital fired three employees, disciplined three, and suspended three without pay.

More WikiLeaks stuff, this time an embassy report on Cuban healthcare. It claims hospitals are infecting patients with Hepatitis C, providers administer chemo and radiation treatments without meds to treat symptoms and side effects, the government jails homosexuals with HIV/AIDS, one doctor works 14-hour days and then hitchhikes home because low salaries preclude buying a car, providers aren’t allowed to access the Internet or attend conferences, rich foreigners get first crack at the best medical facilities, and government officials seek their care from other countries. Most interesting: the government supposedly banned Michael Moore’s movie Sicko, which criticized the US health system and lauded Cuba’s, for fear that Cubans would immediately recognize the movie as bogus since they have no such access to the excellent care the movie claims (Moore made a statement saying the US government made that up to discredit him).

I like to cruise the Web sites of sponsors every couple of months just to see what’s new. Here’s what I found:

• FormFast is offering a January 20 Webinar on lean healthcare strategies, featuring the well-known author of book on that topic.
• I’ve been following the Facebook posts of Cumberland Consulting Group, which instead of being dry and infrequent corporate drivel, are regular, cute profiles of its people and their goings-on.
• Lindsey Jarrell and Colin Konschak of DIVURGENT Healthcare Advisors have their book, Consumer Centric Healthcare: Opportunities and Challenges for Providers, published by ACHE. It’s available for $67.50.
• “Local” consulting form North Highland opened a new office in Jacksonville, FL.
• Orchestrate Healthcare and its partner Vangent won a $3.3 million contract to support a Meaningful Use HIE deployment for the Indian Health Service.
• IntraNexus ran a case study of Oswego Hospital, which uses its Sapphire browser-based hospital information system that includes CPOE, results reporting, a clinical repository, barcoding, documentation, and other applications.
• ZirMed released a free iPad app for its patient kiosk, which lets patients check in at doctors’ offices and send their information to its system. Future plans include real-time insurance verification and handling of co-pays.
• Informatics Corporation of America won the attendee-chosen Best in Show from a field of 38 vendors at a November payer and provider summit.
• Philips has started an Innovations in Radiology group on LinkedIn.
• Stockell Healthcare Systems offers a webcast on its InsightCS revenue cycle system.
• SCI Solutions has a good list of archived webinars, some created by hospitals, including How Can I Make My Customers LOVE Accessing My Hospital and Recipe for Success: How to Sweeten Physician and Patient Relationships.
• Orion Health had several announcements last week: its Rhapsody integration engine was chosen my Genesis Health System, the company was chosen as the primary technical provider for Alaska’s HIE, it announced an enhanced release of Orion Health EHR, and it just released GA of Version 4.1 of its Rhapsody integration engine.
• MedVentive’s founder and CMO Jonathan Niloff did a best practices Webinar called ACOs: Old Concept, New Name – Tales from the Field in late November. It’s available on their site through February.
• maxIT Healthcare has tagline I hadn’t seen, “Meaningful Use Requires Meaningful Assistance”, highlighting its 400 clients and their 350-consultant average experience of 19 years.
• Carefx will be at January’s eHealth Initiative Annual Conference in Washington and the 2011 Military Health System Conference the week after that.
• MyHealth DIRECT is growing and has openings for several client services positions.
• CynergisTek CEO Mac McMillan’s article (warning: PDF), Make Meaningful Sense of Meaningful Use: What to Do Right Now, is featured in the December issue of New Perspectives from the Association of Healthcare Internal Auditors.
• Cyndi Cahill of Vitalize Consulting Solutions was elected to the CHIME Foundation’s board of trustees. The company was just named #4 on KLAS’s list of professional services providers, landing in the top ten for clinical implementation, staff augmentation, and technical services.
• Mary Carr RN of iSirona just ran Part 3 of her series on steps to medical device integration success.
• Sentry Data Systems demonstrated its drug tracking, 340B, and business intelligence solutions at the ASHP Midyear a couple of weeks ago.
• MobileMD’s 4DX HIE scored (warning: PDF) 93.64 on its most recent KLAS report, with an all-green report card and all-green trending.
• AdvancedMD is offering white papers for practices that include Medical Practice Optimization and A Prescription for e-Prescribing: How to Make It Work for Your Practice.
• BridgeHead Software CEO Tony Cotterill was interviewed on the topic of protecting healthcare data, covering archiving, storage management, and data migration.
• Culbert Healthcare Solutions is offering consultant positions.
• Software Testing Solutions offers an analysis of how its solution can help Sunquest LIS users meet CAP requirements.
• Holon exhibited at the ASHP Midyear this month, with one of its offerings being Virtual Central Order Entry Pharmacy, its Web-based solution to distribute order entry workloads using custom rules to allow pharmacists to manage physician orders from any location.
• Virtelligence participated in the HIMSS Southern California meeting this month.
• Renaissance Resource Associates has a number of open consulting positions (Epic, GE, and all major vendor systems).
• EHRScope’s frequent blog postings cover industry news and product information.
• Salar has posted a demo of TeamNotes, its clinical documentation system recently selected by PinnacleHealth (along with its charge capture system).
• PatientKeeper offers a number of archived Webinars, including ones on physician adoption, CPOE, and physician portals.
• We ran an interview with MedAptus CMO David Delaney, MD on the subject of revenue cycle management tools a couple of weeks ago.
• NPC Creative Services highlights some of it public relations and press release work on its site. I believe Inga told me they were instrumental in steering a couple of new sponsors to HIStalk, which I appreciate.
• Keane Optimum has earned Complete EHR certification.
• An Intellect Resources blog entry covers how to choose your professional references.
• Enterprise Software Deployment posts its holiday card online, complete with staff pictures (who doesn’t like looking at people pictures?)
• Diligence Analytics offers its cost-effective, professionally conducted research and analysis services to HIT vendors.
• A2M posted a list of of some of its big-name consulting clients.
• MED3OOO just announced a strategic partnership with Emergency Reporting in which it integrated that company’s Web-based fire/EMS system with MED3OOO’s EMS billing and recovery services.
• Daniela Mahoney RN, president and CEO of Healthcare Innovative Solutions, will present Co-Pilots to your CPOE Success – Clinical and IT Collaboration and other CPOE-related sessions at the Ohio Hospital Association CPOE meeting in Dublin on January 18. She will also present several sessions at the South Carolina Hospital Association’s STEEEP Summit the following week.
• Anson Group posted its well-written review of last month’s mHealth Summit, comparing the rise in mHealth to that of Facebook.
• Capsule is running a “Wish I Had Time To … “ story contest for nurses. The entry deadline is March 31 and the submissions will be published as an interactive storybook on their site. Winners will be chosen by Facebook Likes.

I know many readers will be bugging out for the holidays this week. My wish for you is joy, peace, and unconditional love. Enjoy the break, then get right back here afterward because HIMSS will be just a few weeks away and it’s going to get crazy around here.

E-mail me.

News 12/17/10

From Wireless Observer: “Re: InnerWireless. They’ve raised at least $75M in VC cash. Their VCs are just flushing their investment — there is no way they will ever recover what they put in. A transaction amount will never be mentioned because it will be embarrassingly low. This company has been a bit of a financial horror show. Not only did they burn tons of cash, don’t forget that IW bought what was left of Pango Networks (billed as a ‘merger’)and killed that company. And if anyone remembers, they developed the SPOT RTLS solution to the tune of $6-8M and killed that one, too. Not a good track record, to say the least.”

From HIPAA Hound: “Re: Hans Rosling BBC video lecture on the statistics of national wealth and health in the last 200 years. Pretty interesting in a geeky way.” It is pretty cool, not just for the information it conveys about countries advancing in income and health, but in the graphical way the information was presented. It also supports something I find myself saying a lot: public and global health is not all that related to healthcare services delivery. Only in some countries are hospital and insurance considered synonymous with health.

From Orion’s Belt: “Re: JPS. Not only is their new CIO’s background light when it comes to hospitals, they’ve chosen a consulting partner, Accenture, with very limited EMR experience, especially with Epic. I’d keep an eye on them if I were in your business :).”

From Laddie: “Re: Texas Health Resources. Dealing with a severe outage of their Epic EMR caused by a Citrix upgrade that coincided with the 09 upgrade.” Verified. CIO Ed Marx says he’d love to blame a vendor, but the buck stops with him and it was a leadership failure in his mind. To Ed’s credit, I’ve heard CIOs say  lot of surprising things, but that’s the first time I’ve heard that. Many of those I’ve known would have been making excuses left and right and looking for an IT director to fire as a sacrificial lamb. I can say from first-hand experience that when you have Citrix problems, things get very exciting – lots of systems go dark since it’s a single point of failure for all the major apps of many hospitals (although it has to be a big failure since it’s not hard to work around a failed server in the Citrix farm).

From CYAO: “Re: University Health Care System (GA). Appointed an ED physician as CMIO to lead their EMR implementation.” Shannon Stinson, MD is named VP/CMIO. The announcement took a little shot at McKesson, which is egressing as Epic is ingressing. Said the CEO, “For many years, University and McKesson successfully partnered on clinical and financial information system projects. However, recent experience with McKesson has not been as successful.” You know the relationship had to have soured if it warranted a CEO dig in a press release.

From The PACS Designer: “Re: Opera 11 browser beta. TPD is experimenting with Opera 11 after being a Firefox advocate for a long time. Some recent Firefox changes result in numerous hiccups that make the Firefox browser less attractive for use.” I like Opera myself, although I rarely use it except when I’m testing some Web change I’ve made to make sure I didn’t screw it up. I use Chrome 90% of the time, with Firefox making up the rest (but it’s noticeably slower). Opera feels very lightweight and fast to me and it just seems smoother (and extra points for working a Spinal Tap reference into the page’s description, shown above from a Google search). I know I’d rather have a root canal than use IE.

I’ll be beaming these instructions to you telepathically when you least expect it, so do these things now and I’ll stop: (a) put your e-mail address in the spam-proof Subscribe to Updates box to your right, ensuring that 6,490 more ambitious souls aren’t the first to know that your company has been sold or your 1998 arrest record has been unsealed and printed verbatim here; (b) check out HIStalk Practice and HIStalk Mobile; (c) Friend (Inga or me) or Like (HIStalk) on Facebook to help that nice Zuckerberg boy dominate the world; (d) show some sponsor love by perusing their ads and clicking reflexively at the many interesting ones so those companies won’t crush my ego by abandoning me; (e) instantly find mentions about a company or person by dropping their name in the search box to your right, which digs through all three sites at your command; and (f) tell your friends and enemies to read HIStalk, but don’t get their hopes up by laying it on too thick. Thanks for reading, commenting, writing, rumor-reporting, and e-mailing. And be nice to Inga since she’s fragile.

The very nice Sunquest folks sent us a copy of a letter from President and CEO Richard Atkin that was e-mailed to customers Thursday afternoon, with the explanation that they know we’ve already written about their new investor (on December 3), but that they can comment now that the deal’s done (I really was touched a little that they remembered us, to be honest, but then again I’m easily won over with flattery). As we wrote earlier, an investor consortium led by Huntsman Gay Global Capital has taken a substantial equity position in Sunquest, but the company will remain independent and Vista Equity Partners, which bought the company from Misys, will continue as the largest single shareholder. The letter says the funds will be used to increase the field sales force, expand the regional consultant program, develop more products, create executive and strategic advisory boards, and possibly acquire other companies. My assessment is this: there’s not much of a safety net given the large amount of debt involved, but if management can use the money wisely and strategically to move to the next level, nobody’s going to worry about it. Like always, strategy and execution (in the form of management) will decide the outcome.

Listening: reader-recommended Dashboard Confessional, an emo band that I’m surprised I haven’t mentioned since I do listen to them occasionally.

KLAS just published its Top 20 Best in KLAS awards. I’ll probably dig deeper into it later, but here’s what has struck me so far:

• Epic was named as the highest scoring vendor overall, with Hayes Management Consulting taking the top spot among professional services firms.
• If you’re a single-vendor shop, the highest ranking software suite by far was Epic, but McKesson took two of the top four spots (Paragon and Horizon). Most surprisingly to me, Siemens Soarian came in #3.
• I always like to look at Worst in KLAS, the bottom-ranked products in the hospital application categories: GE Centricity (hospital EMR), CGI Sovera (document management and imaging), Emergisoft (ED), McKesson Pathways (scheduling), GE Centricity (lab), Cerner ProVision (PACS), McKesson STAR (patient accounting and patient management), Mediware WORx (pharmacy), Sunquest (radiology), and McKesson Horizon (surgery management).
• Some products did very well in one of KLAS’s subcategories, which means they can’t win an award, but some of them did earn a 100% “Would Buy Again” customer rating, which is to me the most useful measure of all.

RelayHealth’s RelayClinical EHR earns ambulatory EHR certification from Drummond Group, giving the company a trifecta of offerings (EHR, HIE, and PHRs).

Former Eclipsys CEO Andy Eckert is named CEO of CRC Health Corporation, which offers behavioral care services.

Xconomy Boston gives a status update of the integration of the former Sentillion into Microsoft. It’s still a work in progress and a lot of it is hush-hush, but former Sentillion CEO Rob Seliger has been promoted to GM of product management for all of the Healthcare Solutions Group, which includes HealthVault and Amalga, and references were made about new products yet to be announced.

I’ll take Things in Common for $200, Weird News Andy. And the Jeopardy answer is: blood pressure, surgeons’ egos, reimbursements, and meth users from the ceiling. The question: what are things that fall in the ED? A man shows up at a Louisville hospital’s emergency department with what he says are alcohol burns, but the woman who gave him a ride says his car-based meth lab had exploded. The police come, the man tries to climb into the ceiling to drop down into another room to escape, but he misjudges and crashes to the hallway floor. The police spokesperson’s assessment was cynically dry: “I would say it’s unusual for anybody that’s in the hospital to try and escape through the ceiling tiles.”

The VCs behind MedPage Today (which has an interest in the KevinMD site) sell out to Everyday Health, which runs ad-supported health and lifestyle sites that include that of Jillian Michaels.

Jobs on the sponsor-only Jobs Page: Application Consultant, West Coast (Nuance), Software/Implementation Engineer (MobileMD), Eclipsys Activation Consultant (Enterprise Software Deployment). On Healthcare IT Jobs: Client Manager, Soarian Clinicals Consultants, Dragon Trainer/Systems Analyst, McKesson Paragon Consultants.

Cerner founders Neal Patterson and Cliff Illig are sued for $3 million by their golf course partners, who claim the guys stiffed them on payments due.

I’ve said nice things about Nextgov, but this won’t be one of them. What were they thinking when they wrote the Wednesday story above? David Brailer quit as national coordinator nearly five years ago, in April 2006. David Blumenthal has been in that position since March 2009, but Rob Kolodner held the job between the Daves. Not to mention that its CMS, not ONC, that will “hand out” HITECH money (oh, if it were only that simple). When I saw the clumsily breezy headline, I thought that Health Evolution Partners was cutting Brailer’s pay and I wondered how (and why) Nextgov sleuthed that out.

A British hospital opens a communications room for hearing-impaired patients that offers assistive devices for hearing aid wearers and Webcam access to a sign language interpreter.

The board of 136-bed Rice Memorial Hospital (MN) approves $4.7 million to purchase a clinical information system. Its preferred vendor is Epic, which would make this one of the smallest Epic implementations ever, I would guess (assuming Judy goes for the deal). Now this is interesting since Epic contractually gags its customers from divulging what they paid, so you never see a price breakout: Epic was the cheapest of the five vendor proposals, with the cost detailed as $1.2 million for the license fee, $100K for hardware, $800K for implementation, and $2.6 million for five years’ of maintenance.

I was digging through the statement (warning: PDF) made this week by the FDA’s Jeffrey Shuren at the IOM’s Committee on Patient Safety and HIT meeting. Tidbits: (a) he implies that EHRs are medical devices for which FDA has elected not to enforce existing requirements, but FDA is interested in IOM’s opinion on whether it should start regulating them; (b) he suggests that clinical decision support will be a targeted area; (c) FDA believes interoperability should be standardized; (d) systems should be monitored with real-time surveillance. He points out that FDA oversight can take several forms: requiring manufacturers to register, running a voluntary post-market surveillance program, requiring manufacturers to follow ISO-like quality management programs, or require vendors to submit information before putting their products on the market.

Oracle announces Cloud Office 1.0, a Google-like suite of Microsoft Office-compatible word processing, spreadsheet, and presentation apps. That’s probably not the best news Microsoft has heard lately.

Former Allscripts EVP Mark Karch is named EVP of Apparture Inc., which offers Web-based marketing solutions for healthcare companies.

Strange: a woman in Australia reports to police that her iPhone has been stolen from her purse while she’s visiting a hospital. They track it down using its GPS-like application and call in a police helicopter to swoop down on the thief, a 16-year-old boy riding a stolen bike.

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HERtalk by Inga

From Eel Shoes: “Re: non-HIT matters. At this time of year, i don’t think we are hearing enough eel stories. I wondered if Inga had tried the soft but durable eel skin shoes?” I was quite amused by the reader that posted this comment, as well as the follow-up eel conversations. I am not an eel expert, though I once had a soft and durable pair of brown eel-skin pumps that have since been donated to Goodwill. As of late, my shoe fancy has been leaning towards new boots. Here is the pair I’d love to see under the Christmas tree (size 8, if anyone has Santa connections).

Cleveland Clinic will implement 3M’s Codefinder Computer-Assisted Edition software for inpatient and outpatient coding.

athenahealth expands its board with the appointment of its former COO, David E. Robinson. Before joining athenahealth, he was an EVP of SunGard Data Systems.

MedSynergies appoints former Dell/Perot exec James Dye as SVP of client management. MedSynergies also names Brid Kealey as SVP of human resources and Chris Walker VP of performance and change management.

Ephrata Community Hospital (PA) begins implementation of its Meditech EMR and expects to complete the first stage of the transition in early 2011.

Tool maker Stanley Black & Decker will pay $61.2 million cash for mobile workstation and asset tracking provider InfoLogix. InfoLogix will become part of Stanley’s Healthcare Solutions business, which Stanley is seeking to expand.

Hospital billing company and Tenet subsidiary Confer Health Solutions will close two of its seven offices as it tries to improve efficiencies. Conifer will close offices in Anaheim and Alhambra and consolidate its California work in its remaining Anaheim office. Closures will affect all 100 Modesto employees.

Colorado Regional Extension Center (CO-REC) announces its approved list of 14 EHR products.

Atlantic Health (NJ) forms an ACO that  encompasses a seven-county area. The health system has already aligned with more than 300 participating physicians.

The price tag for OSU Medical Center’s Epic EMR: $100 million over the next five years. Once implemented, Ohio State doctors and hospitals have the potential to earn $25 million in ARRA money.

Kaiser Permanente promotes CIO Philip Fasano to EVP and CIO. CEO George Halvorson says the promotion reflects the “magnitude of Phil’s impact and contribution to our organization.”

UC Davis concludes that EMRs impact physician specialties differently (duh). The initial implementation of EMRs decreased physician productivity 25 to 33%. Over time, internal medicine providers adjusted to the new technology and slightly increased their productivity, but pediatricians and family practice doctors did not recover to their original productivity levels. The conclusion: there is a  “mismatch between technology design and the work-flow requirements and health administration expectations” for different specialties.

Sponsor Updates

• API Healthcare introduces the Electronic Employee Record, designed for healthcare organizations to store and maintain employee information, track trends, and create forecasts.
• Wills Eye Health System (PA) contracts with NextGen for its EHR and PM products.
• Children’s Hospital Central California subscribes to CapSite to improve its capital expenditure process.
• Wellsoft signs a two-year extension contract with Premier, allowing Wellsoft to remain the sole contracted supplier of EDIS for Premier’s member hospitals.
• St. Tammany Parish Hospital (LA) selects RelayHealth as its partner to build its community-wide HIE.
• HIStalk sponsors placing in the KLAS top ten of all vendors are 3M, Philips, Picis, Sunquest, McKesson, and Merge Healthcare.
• Sponsors in the professional services top ten in KLAS are Hayes Management Consulting, Vitalize Consulting Solutions, Ingenix, and McKesson.
• Sponsor products earning a Best in KLAS title in their segment are eClinicalWorks EMR (ambulatory EMR 26-100 physicians), Greenway Medical PrimeSuite Chart (ambulatory EMR 6-25 physicians), e-MDs Chart (ambulatory EMR 2-5 physicians), McKesson Paragon (community HIS), Allscripts Sunrise EPSi Decision Support (business decision support), Wellsoft EDIS (ED), McKesson Pathways Financial Management, Materials, and HR Manager (financial/ERP), McKesson Horizon Practice Plus (practice management 26-100 physicians), Greenway Medical PrimeSuite Practice (practice management 6-25 physicians), e-MDs Bill (practice management 2-5 physicians), and Nuance eScription (speech recognition).
• Sponsors named Best in KLAS in the professional services category are Navicure (claims and clearinghouse services)and CareTech Solutions (IT outsourcing – extensive).
• Precyse Solutions ranked #2 in KLAS’s transcription provider category, but outscored everyone in report quality.
• UPDATE: we missed one! MedPlus’s ChartMaxx took Best in KLAS in the document imaging and management category, winning the #1 spot seven times since 2002. MedPlus has 140 implementations and 415,000 users.

E-mail Inga.

News 12/15/10

From Nasty Parts: “Re: InnerWireless. Their VC backers want their money. Look for it to be acquired soon.” Unverified. The Richardson, TX company offers wireless infrastructure. It struck me as odd that its board of directors has four members, all of them money guys from different VC companies.

From THRGuy: “Re: JPS Health Network, Fort Worth. The interim CIO, has been named CIO. So a complex hospital implementing a complex EMR hires a CIO who has never had that job before?” I thought maybe he’d been there a long time, but it’s just been a year. His LinkedIn profile indicates no college degree, either. But it’s the same argument that college football teams go through: do you pay huge dollars to bring in a big-name ringer who could fail or bail, or do you figure your chances are about as good going with a known quantity who seems capable? Especially when a successful EMR implementation shouldn’t be under the CIO’s control in the first place. I will say from the cheap seats it does seem like a puzzling choice, but I have to assume they have the knowledge and incentive to pick the best candidate. And like coaches, CIOs are replaceable if things don’t work out, even when it’s not their fault. UPDATE: Joe Venturelli e-mailed to say that he obtained a bachelor’s degree in design from School of Visual Arts, which I see he’s updated on his LinkedIn profile. He also notes that he was CIO for NewHope Bariatrics. Thanks for the update.

The IOM’s Committee on Patient Safety and Health Information Technology, which is conducting a year-long study on the safety of HIT, held its first meeting Tuesday, continuing through Wednesday. Tuesday’s presenters: Gail Warden (University of Michigan), David Blumenthal (ONCHIT, which is paying for the study), Peter Pronovost (Johns Hopkins), Lawrence Shulman (Dana-Farber), Rainu Kaushal (Cornell), Dean Sitting (University of Texas Health Science Center at Houston), Sumit Rana (Epic), Madhu Reddy (Penn State), Ben Schneiderman (University of Maryland), and folks from NQF, Geisinger, AHRQ, FDA, CMMS, and CCHIT. I’m not exactly sure why Epic had someone presenting (or CCHIT, for that matter – what about the other EHR certification bodies?) The key agenda item was the last one in Tuesday’s session – what is the government’s role in overseeing HIT safety?

David Blumenthal will deliver a keynote address at the eHealth Initiative’s annual conference in Washington, DC on January 19-20. He speaks at a lot of events, but I don’t ever see anything quotable, so I assume he sticks to the standard EMR stump speech.

Weird News Andy is intrigued that patients in England are raising huge amounts of money for US cancer treatments after being told by NHS that nothing can be done and being offered no financial help, only to find that the same treatment is actually being delivered in England as part of clinical trials. Some parents claim their kids were turned down for the trials because those running them didn’t want make their study look bad.

Cathy Bruno, CIO of Eastern Maine Healthcare, wins the CIO of the Year award from the New England HIMSS chapter.

Cerner opens an employee health and wellness center this week for Deffenbaugh Industries, a Kansas City trash company. I noticed that Liking Deffenbaugh on Facebook puts you in the running for a Stinky the Garbage Truck toy, just in case you haven’t chosen a Christmas gift yet for that special someone.

Federal CTO Aneesh Chopra, speaking at a Brookings Institute forum on Internet policy, talks up the healthcare data sharing platform Direct Project as an example of the government’s role as a convener to facilitate innovation.

The Tampa VA hospital launches a $3 million Smart Home project to rehabilitate veterans with traumatic brain injury. Apartments are set up to keep patients re-learn activities and to monitor their movement using a real-time location system.

Healthcare IT vendor Cegedim clarifies news reports suggesting that up to 4,000 French pharmacies rigged its software to underreport taxes due using a secret code, with authorities estimating revenue loss of up to $534 million over three years. The company says it highly doubts that the one known tax fraud case translates into 25% of all pharmacies in France, also pointing out that the change is traceable if they tried anything sneaky.

Massena Memorial Hospital (NY) gets a local newspaper mention for its use of Meditech’s bedside medication barcoding system.

A study published in Archives of Internal Medicine finds that patients who receive care from multiple hospitals and EDs have more medical errors, treatment delays, and duplicate testing, with the conclusion being that data-sharing technology might pay its way by improving that situation. At least what the (free) abstract says about the (not free) article. Sometimes I wonder why you still have to pay for medical journal articles in an age where publishing costs are close to nil, especially since much of the heavy lifting is done by unpaid peer reviewers anyway.

iSoft sells its financial management software group, trying to pay down debt and focus on its core clinical systems business.

The government of Ontario seizes Hôtel-Dieu Grace Hospital due to high executive turnover and a wrongful termination lawsuit. The hospital was under review for a series of pathology and surgery errors.

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HERtalk by Inga

CHRISTUS Health plans a seven-state rollout of Medicity’s ProAccess Community and MediTrust Cloud Services, plus ambulatory order initiation, physician referral, and CCD exchange. They were already using Medicity’s Novo Grid technology.

Now on iTunes: Dragon Medical Mobile Recorder from Nuance Communications. The app allows users to dictate at the point of care via iPhones, which is then delivered to the eScription and Dictaphone Enterprise Speech platforms or to Nuance’s outsourced transcription services.

Moses Cone Health System (NC) implements Proficient Health’s Proficient Orders to streamline communication with local physicians and facilitate future participation in the North Carolina HIE.

Discovery Health Records Solutions completes a $2 million equity offering with the backing of Silverhawk Capital Partners.

CCHIT names three new members to its board of trustees and 11 commissioners to start terms on January 1.

Elliot Health System (NH) implements EMC and VMware solutions to virtualize and consolidate its IT infrastructure. EHS says the VMware vSphere platform eliminated the need to purchase 130 physical servers and resulted in a 50% reduction in data center power usage. EHS, which runs Epic EMR and McKesson financials, next plans to deploy a private cloud to deliver EMR services to physician practices.

MedVirginia announces that it’s the first community HIE to connect with the VA’s and DoD’s Virtual Lifetime Electronic Record (VLER). MedVirginia is leveraging its existing open source CONNECT gateway to the NHIN to enable clinical information exchange based on the CCD C32 format.

Surprising: almost 90% of providers are actively planning or piloting a PHR solution, according to a new KLAS report. Providers are trying to decide whether to partner with their EHR or HIE vendors or choose a free-standing, no-cost solution. Many providers are interested in free options because they can brand them as their own. Microsoft is the most-considered PHR vendor, followed closely by Epic and Google.

Also new from KLAS: satisfaction scores for ambulatory clearinghouses. Navicure, ZirMed, EDI Gateway, and Capario earn the top scores while Emdeon’s indirect product was noted as “most improved.” KLAS also points out that providers are willing to pay higher fees for more functionality if it can make practices significantly more efficient and shorten A/R cycles.

Community Memorial Health System (CA) chooses Wolters Kluwer Health’s ProVation Order Sets as its electronic order set solution.

The executive director of the 10-county Rochester RHIO says all 15 hospitals in its region are connected, as well as labs, elder care agencies, and health insurance companies. In addition, over 360,000 patients have signed consent forms to allow their doctors’ offices see their records online.

Salinas Valley Memorial Hospital (CA) sends a company-wide memo announcing that between 100 and 120 employees will lose their jobs by the end of the year as the hospital tries to trim operating costs. Affected workers include 40 nurses, unit assistants, clerical workers, housekeepers, and nutrition workers. The hospital has already eliminated 205 employees since July. I am pondering the exact wording on that memo. Perhaps, “Merry Christmas! You are Fired!”

MMRGlobal names Sunil Singhil EVP and adds two new members to its board of advisors. Singhil is a co-founder of  Nihilent Technology and its former COO. Joining the board are Qualcomm VP Michael J. Finley and Spalding Surgical Center CEO John R. Seitz.

A Michigan pilot dupes the AMA, hospitals, and specialty colleges into believing that he is a physician. Apparently William Hamman attended medical school, but dropped out. At some point over the last 20 years he tweaked his resume to include a medical degree from the University of Wisconsin-Madison. He had spoken at meetings and universities since 1992 and for five years served as the co-director of Western Michigan University’s Center of Excellence for Simulation Research. He joined William Beaumont Hospital (MI) in 2009 as an educator and researcher. A routine background check by Beaumont eventually uncovered Hamman’s lack of credentials and he resigned. Nice job of vetting over the first 20 years.

Emergisoft partners with Crystal Cruises to implement EmergisoftMaritime, the first EHR designed specifically for cruise ship healthcare. I believe I must do a site visit in order to provide readers with a full product evaluation.

Sponsor Updates

• SCI Solutions wins an eHealthcare Leadership Gold Award recognizing its outstanding healthcare Web portals.
• CDW Healthcare signs up to be a channel partner for Greenway Medical Technologies, offering Greenway’s PrimeSUITE.
• Lower Bucks Hospital (PA) selects Wellsoft EDIS.
• Mindray signs a deal to become the sole distributor of iMDsoft’s MetaVision in China and will also make it available to customers in 10 other countries.
• Hopkins County Memorial Hospital (TX) chooses the Access Intelligent Forms Suite for printing barcoded and data-populated forms on demand.
• The Alaska eHealth Network picks Orion Health to provide its HIE solution in a hosted SaaS mode.
• Lisa McVey, VP and CIO for McKesson Provider Technology and RelayHealth’s provider and consumer business units, wins a Women in Technology award in the enterprise business category.

E-mail Inga, MD, PhD, FACP, CPA

Monday Morning Update 12/13/10

Half of readers from hospitals say their CIO reports directly to the CEO, with a fairly even split of the remainder reporting to the CFO and COO. New poll to your right, for providers: if an HIE’s technology platform is owned by an insurance company (as in Axolotl and Medicity), would your organization be less likely, more likely, or equally likely to participate in that HIE? Click the Comments link on the poll to add yours.

The president of the Australian Medical Association says the government’s EHR efforts should focus on making information available to doctors in real time: labs, rads, meds, and discharge summaries.

Trustees of Campbell County Memorial Hospital (WY) vote to buy themselves iPads and 3G accounts, claiming their $15,000 hospital cost will save time and copying expense. Otherwise, it’s an all-paper hospital, with CPOE and ED order entry “in the mill.” That jibes with my personal experience: electronic executive toys (and the IT support to keep them running) are always of highest priority, with no justification required except, “These are cool … we want them.”

A CDC survey finds that around half of physician practices uses EMRs, but only 25% of practices use a system that meets “basic system” functionality, with just 10% using a “fully functional” EMR that includes medical history, drug interaction checking, e-prescribing, electronic ordering of lab and radiology tests, and viewing electronic images. Still, the use “fully functional” EMRs has gone from 3.1% to 10% since 2006. Laggard states include Kentucky, Louisiana, and Florida, in which more than 60% of physicians in practice do not use any form of EMR. Leading the pack is Utah, with 51.5% of office-based doctors having access to a basic EMR.

ONC announces December 10 approval of two more certification bodies: ICSA Labs and SLI Global Solutions. They join CCHIT, Drummond Group, and InfoGard Laboratories.

Children’s Dayton chooses Medicity’s Novo Grid for exchanging information with its physicians and partners.

An EMT who took a crime scene photo of a dead woman and posted it on his Facebook avoids jail time, but is sentenced to 200 hours of community service and the permanent loss of his EMT license. His attorney blamed the man’s “raw sense of humor.” Social networking may also have been involved in the woman’s death: her parents say she was killed after an enemy spread false rumors on MySpace that she was romantically involved with the man who was eventually convicted of killing her over the incident.

The Army is testing the AHLTA EMR on mobile devices that include the iPad, iPod Touch, iPhone, Sprint HTC EVO, and Samsung Epic.

An ortho tech at Memorial Medical Center (CA) is arrested and charged with stealing 23 computers from the hospital.

An interesting WikiLeaks disclosure: drug company Pfizer hired investigators to check out Nigeria’s attorney general, hoping to uncover evidence of corruption that would force him to resign. A Nigerian state had sued the company for $2 billion, claiming its testing of meningitis drug Trovan there had killed 11 children (it was later heavily restricted in the US and banned in Europe). Pfizer settled for $75 million in July, but the AG had already been removed after corruption articles were run in local newspapers.

Above is a good interview with Stuart Rosenberg, MD of Beth Israel Deaconess Physician Organization, which just signed an “Alternative Quality Contract” with Blue Cross that pays the group a fixed amount for its HMO patients. He was paid over $700K in the organization’s most recent tax return, which despite being an ample income, doesn’t seem all that excessive considering what non-clinical hospital executives make.

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News 12/10/10

From Patella Poker: “Re: Joint Commission. Big news on medication reconciliation. They’ll start scoring again on July 1 with no phase-in period. I bet a lot of hospitals will have to rush to squeeze this in with all their other initiatives.” The “streamlined and focused” version of the National Patient Safety Goal for hospitals includes creating an admission medication list (and developing a policy for doing something similar in non-inpatient areas), comparing the home meds brought in against those ordered, providing written medication information at discharge, and instructing the patient to keep an up-to-date list and let providers know of changes.

From Kiosk Guy: “Re: VA. They have again selected Vecna. They originally won the award in July 2010, but it was protested by a competitor and the competition was done over last month.”

From Hirudo M: “Re: Aetna. What does its purchase of Medicity say about Aetna’s ongoing partnership with IBM? Aetna is using IBM’s HIE strategy and infrastructure for ActiveHealth.” Good question. That deal was just announced in August and there was a big press release about some Aetna-IBM HIE work in Puerto Rico just a couple of weeks ago, when Aetna was quietly well into its Medicity courtship.

From The PACS Designer: “Re: Pogoplug. We’ve been hearing more about different types of cloud apps lately and now there’s a personal cloud appliance called Pogoplug. Pogoplug turns your hard drive into an Internet accessible device so you can use any browser to call up your files with your iPhone and other mobile devices through a free online service.” The hardware component is $70 and the service is free. You can even stream music videos from your home PC anywhere on the Web, including your smart phone. The pitch is that in 60 seconds you’ll have your own personal cloud running your own content from an external hard drive.

Listening: reader-recommended Ned Evett, which I loved instantly. Well-produced killer guitar riffs, powerful drumming, excellent vocals, and good songwriting and big hooks. Forget the endless technical mention that he’s a “fretless” guitar player and focus instead on some really rhythmic blues, pop, or prog (it could pass well for all three). I’m really liking the Middle of the Middle album on Rhapsody (Shine Like a Diamond on Me is amazing, like the Beatles meet Pink Floyd). I’ve listened to all four albums and they’re excellent. This would be among the best stuff I’ve heard in a long time. I can’t get enough, other than my fingers are getting sore from drumming along on my desk. He’s opening for Joe Satriani on some tour dates.

The webcast of ONC’s day-long PHR Roundtable from last week is now online. They’ve also posted 16 new 90-second Beacon Community videos, one of which I’ve included above.

HealthCare Partners Medical Group goes live on Unity RIS/PACS from DR Systems.

Say hello to NCR, supporting HIStalk as a Platinum Sponsor. The Duluth, GA company is the #1 provider of patient self-service solutions, offering pre-registration, appointment scheduling, and bill pay online, which as they point out, can help preserve the patient experience as hospitals face being swamped with 32 million newly insured patients. Some of its healthcare self-service offerings a check-in kiosk, the eClipboard wireless unit for check-in and registration, mobile reminders and results, ED triage and check-in, revenue cycle management, patient portal, and a wayfinding kiosk. There’s a good video from Richmond Bone & Joint Clinic on their site, featuring the clinic’s CEO. Thanks very much to NCR for not just coming along for the HIStalk ride, but chipping in for gas.

Weird News Andy uses a deadpan delivery for this story, captioning it “You might be expecting twins, Mr. Plettell.” A British man receives a letter from a hospital inviting him to drop by for his ultrasound, urging him to bring along his maternity record. His mates (I’m picturing Andy Capp lookalikes) are encouraging him to show up in a dress and wig, which probably wouldn’t really be all that odd in England since they seem to find cross-dressing endlessly hilarious.

Greg from Citizens Memorial Hospital (MO), the super-progressive 74-bed hospital, tells me about work they’ve done there with Google Health.

We implemented Google Health in March of 2010. The initial response was large, mostly due to local TV news coverage. We send medications, labs, procedures, allergies, and conditions to Google Health. Our next step is working on sending radiology and other reports. We have the ability to import Google Health information as an external document in the EMR. It’s currently a manual process that has to be initiated outside of Meditech, but in the future, we’re planning to automate this process. As more patients and other providers start using the service, it will become a more valuable report. Since we are the only provider in our area sending data to Google Health (with the exception of a few national pharmacy chains), most of the reports we import have only the data we sent.We promote Google Health in conjunction with our Clinic Patient Portal. Users can sign up for both on our website. Information is verified by our HIM department and we contact the patients if necessary to verify their identity before linking their records.  We also have guest PCs in our rural family practice clinics so that patients can sign up at the clinic.

Ross Martin MD MHA, esteemed leader of The American College of Medical Informatimusicology, makes his Interoperetta available as an MP3, explaining that 85% of all humans should listen to it to provide herd immunity against dangerous subliminal messages that could be introduced by the questionably motivated fan who requested the MP3 version in the first place. I think Ross is simultaneously opening and closing the loop, in other words. I’m trying to cajole him into creating an HIStalk theme song in preparation for future HIStalkapaloozas.

On the Jobs Page, for sponsor postings only: Payer/Provider Connectivity Project Manager, Eclipsys Activation Consultant, Segment Marketing Manager. On Healthcare IT Jobs: Cerner ePrescribe Builder, Director EHR Systems Division, McKesson Paragon Consultants.

Orlando Portale, chief innovation officer for Palomar Pomerado Health (CA), tells me he’ll be demonstrating some prototype Android healthcare apps for tablets (EHR access and remote physiological monitoring) at Cisco’s Community for Connected Health Summit, which will be held Monday of the HIMSS conference. Jason Hwang, co-author of The Innovator’s Prescription: A Disruptive Solution for Healthcare will open the session.

Speaking of Cisco, I notice that they’ve released a personal version of their high-quality video telepresence system called umi (there’s supposed to be a bar over the non-upper cased U, but darned if I know how to type that character, which might have been one of those marketing-inspired gaffes since nobody can actually type out the name). Unlimited service is $24.99 a month, although the broadband specs are pretty beefy for non-FiOS residential customers (1.5 mbps upload). It works with your HDTV. I’m picturing a Webcam porn industry vertical sales, but there are probably other uses.

Cerner’s innovation subsidiary is assigned a newly awarded patent for a genetic banking system for securely storing genetic profiles.

I know it will seem odd since the Thanksgiving to New Year’s period is pretty slow for a lot of people, but Inga and I are super-buried at the moment. We’re working on lots of news items, several interviews, and a heavy load of new sponsor activity (thanks for that!), not to mention that we need to start planning for our HIMSS events and the HISsies nominations and voting. It’s the funnest job in the world, of course, but be patient or maybe even forgiving if you are waiting on something from us. I don’t expect our loads to lighten until after the conference. We may need to hire someone or something.

In the first Microsoft Amalga news I’ve heard in awhile, UW Medicine (WA) finally pulls the trigger after a two-year evaluation and licenses Amalga for translational research. That’s one slow sales cycle.

An Ohio doctor, angry that his uninsured patients can’t afford the lab tests they need, strikes a deal with LabCorp and an online lab test marketer to offer his patients discounted tests (example: a $148 lipid panel costs his patients $18). The patients simply order their tests from the county medical society’s site, pay by credit card, and go to LabCorp to get the tests. Everybody can use the service except residents of NY, NJ, and RI. Says the doc: “It’s like using Amazon.com to buy your lab tests.”

Drug and device companies are arming their sales reps with iPads for showing sales pitch presentations to doctors. Medtronic just bought 4,500 of them, Boston Scientific 2,000, Zimmer Holdings 1,000, and Abbott 1,000. It figures that the coolest, state-of-the-art technologies in a doctor’s office will be carried by a drug rep trying their best to keep healthcare costs high.

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HERtalk by Inga

From Camus: “Re: Drummond certification. Am I the only person finding it bizarre how fast the companies certified by Drummond have gone from relative obscurity to MU certified? What happens when practices pick these companies and the company goes out of business in nine months? It’s like wine — you just don’t go from planting vines to world-class cabernet in six months.” The issue is not unique to Drummond. I see plenty of “obscure” vendors on CCHIT’s list. I’ll also point out that Drummond’s certification clients include plenty of familiar names that are hardly fly-by-nights, including Allscripts, GE, and McKesson. I suppose your point is that certification does not guarantee a company is financially sound. Agreed. And I might point out that just because a company is financially viable and has a certified product, a buyer may still be left out in the cold if the vendor makes a business decision to sunset a certified product.

The HIE space continues to heat up as health systems and regional exchanges align with vendors. Recent announcements include:

• Beacon Community of the Inland Northwest (WA), a regional collaboration led by Inland Northwest Health Services, chooses the Orion Health HIE solution.
• Vantage HGT RHIO (PA) selects Verizon’s Health Information Exchange platform.
• The Children’s Medical Center of Dayton (OH) picks Medicity to provide bi-directional connectivity between the medical center and affiliated physicians and partners.

Tift Regional Medical Center (GA) implements the remote access management solution of Minicom Advanced Systems as part of its two-year process to consolidate two data centers.

Cymetrix aligns with Siemens Healthcare to provide conversion support for clients moving from legacy patient accounting systems to Siemens Soarian.

Maryland’s REC, CRISP, has signed up its 200th client.

Anvita Health, a provider of clinical analytics, hires Darren Schulte, MD, MPP as VP of Clinical Strategy. He was previously at Alere Health, where he served in executive positions related to clinical product strategy and development.

In Australia: 98% of GPs use computers for some clinical purpose and almost two-thirds are paperless. A mere 2% of the GPs use paper records only.

Rush-Copley Medical Center (IL) chooses Thomson Reuters Pharmacy Xpert, a clinical intelligence dashboard that helps pharmacists with medication management.

The VA awards Carefusion and technology integrator MicroTech a contract to supply Pyxis to 153 VA medical centers and 17 outpatient centers.

Providence Care of Kingston, Ontario, contracts with QuadraMed for QCPR, Enterprise Scheduling, and Electronic Document Management. Providence Care will also use QuadraMed technology to share clinical data with existing QuadraMed clients Kingston General Hospital and Hotel Dieu Hospital.

Wolters Kluwer Health acquires iCare, developer of an educational program that trains nursing students how to document care in an EMR.

Streamline Health Solutions posts Q3 revenues of $4.5 million, up 9% from a year ago. Earnings were $95,000 ($.01/share) compare to last year’s $296,000 loss ($.03/share.) The company says the improved results are a result of higher license system sales and increased recurring revenue from maintenance contracts.

This week I posted some new videos to HIStalkTV, including a few product demos, an interview, and a fun Lady Gaga spoof by Nuesoft. I must admit the posting task is time consuming, but only because once I get on YouTube I’m easily distracted by other fun videos that have nothing to do with HIT. For example, when I was looked at the Swype demo, I noticed a suggestion for the World’s Fastest Typist from a 1985 David Letterman episode. How can one not get sucked into watching a competition between shoulder pad-wearing women typing on IBM Selectrics with Letterman commentary?

Troubling: only 15% of CIOs think they’ll be ready to qualify for Meaningful Use incentives by April 1, 2011. That’s about half the number who said in April that they’d be ready. CIOs cite CPOE implementation as their biggest challenge, with more than half noting concerns with getting clinical staff to use the systems.

MED3OOO appoints John Wallace as a SVP on its business development team. He was previously SVP at mPay Gateway and served in leadership roles at Misys Healthcare.

Wemedx earns top marks in a KLAS report on outsourced transcription services. KLAS says overall the market “remains a high-performing, competitive segment.” Other top vendors include Precyse, Encompass, and TransTech.

This week’s must-read items on HIStalk Practice: GPs in the UK head to supermarkets. Hayes Management Consulting gets into the holiday spirit. Social media increase participation in online health programs. Building physician alliances in Northern California.

Sponsor Updates

• InSite One will offer its InDex image archive management and access solutions as a per-site license, independent of its hosted and on-site cloud services.
• Keane Optimum earns ONC-ATCB certification as a complete EHR from CCHIT.
• Berkshire Health Systems (MA) chooses Allscripts PM/EHR solutions for its employed physicians and will offer to host and support it for its 300 affiliated doctors.

E-mail Inga.

Healthcare IT From the Investor’s Chair 12/9/10

Ask the Chair

Apologies to all for the delay in posting the first question, but we still thought it might be relevant and/or interesting to some readers.

What was RSNA like? How does it differ from HIMSS?

RSNA is short for the annual meeting of the Radiological Society of North America. This year was its 96th Scientific Assembly and Annual Meeting.

A long-time attendee (the late CEO of Hologic) once told me that the reason it’s held Thanksgiving weekend in Chicago is because it was started as the Midwest society meeting. It allowed all the radiologists’ wives to do their holiday shopping on Michigan Avenue, the “Magnificent Mile”. I’m sure everyone loves flying in to one of the country’s busiest airports on one of the most-traveled days of the year, but there you have it. I, for one, am glad I can take the train!

RSNA is the largest medical conference/trade show in America (and if not the largest in the world, still one of the top two or three). Why? Radiologists use expensive toys and they’re here in force, along with everyone wanting to sell to them. How many? This year saw an astounding 60,000 medical and science professionals from all over the world (unlike HIMSS, RSNA is truly a multi-national show) and over 700 vendors … I mean technical exhibitors … selling them everything from lead aprons to coding software to MRIs and CT Scanners.

In contrast, I believe HIMSS 2010 attracted about 28,000 registered attendees, of which fewer than 14,000 were actual IT professionals. Yes, HIMSS has more vendors (over 900 last year), but some were virtually on card tables. The cost of admission and scale of RSNA keeps out more of the wannabes.

I’ve attended RSNA for over a dozen years. The scope and scale continues to amaze even this jaded HIMSS veteran. GE and Philips’ booths alone are the size of small city blocks, chock full of demo areas, gleaming machines, and conference rooms where the magic happens.

That’s another key difference: people actually bring their checkbooks to RSNA. Deals are done on everything from the big magnets (MRIs) to the mobile X-ray machines. Restaurants and hotels (not to mention the “helpful” McCormick Place staff) lick their chops at the prospect of separating exhibitors and their sales professionals from their T&E dollars.

The pure-play HCIT companies tend to be lost a bit in the noise of imaging systems, but the usual suspects that have a meaningful radiology offering (such as Cerner and McKesson) had a respectable booth presence that seemed well attended. I actually think I saw a tumbleweed or two blowing through the booth of NLP coding vendor A-Life Medical (recently purchased by Ingenix). Not sure if it’s a coincidence, but its competitor CodeRyte’s booth seemed pretty active.

Speech rec vendors Nuance and M*Model also seemed highly active each time I walked by. Merge Technologies seemed to have a hopping booth, some of which was likely due to the Tesla (see my new picture below) and the candy and video games they were providing, but also no doubt as a result of its re-emergence (no pun intended) from the purgatory of bad accounting and management with a new story and a new CEO. I’m looking forward to seeing what they do at HIMSS.

What’s your take on Medicity’s acquisition by Aetna?

Speaking from my usual perch in the peanut gallery (as I’ve done work for neither company), I’m fairly astounded by the price. Rumor has it that $500 million (twice what Ingenix paid for Axolotl) is approaching 8x revenues, a princely multiple that dwarfs, say, Allscripts’ purchase of Eclipsys for 2x revs or even Ingenix’s purchase of Picis for 3x revs.

Medicity appears to be the leader in its space, with over 750 hospitals and 125,000 physicians using its system. Still, it’s a huge bet on the HIE market that’s not quite emerged.

I believe a good part of the excitement (dare I say frenzy) around the HIE/clinical messaging space is that the emerging government regulations which mandate a minimum proportion of premium dollars that a payor spends on actually taking care of sick people (known as the medical loss ratios) appears to allow them to count this type of business towards the MLR (as opposed to say, marketing spend, corporate art, or even executive salaries). Therefore, I’d posit that United and Aetna see this as a way to improve their MLRs while actually improving patient care.

With health reform reducing the payors’ arsenal to maximize their profits (by prohibiting them from underwriting away sick people and mandating certain forms of community rating), they now have a greater incentive to reduce loss through what HIEs can, in theory, bring: reduced duplicative tests, better access to patient data, etc.

What I wonder most, however, is what will the fact that Axolotl and Medicity are now owned by payors do to their sales prospects, both near and long term? I’ve little doubt that a fair number of potential customers would rather douse their dollars in kerosene and torch them before giving them to the same insurance company that has tormented them (in their view) for years. The half-billion dollar question is: what percent of the market does this preclude them from selling to? I’d guess more than 15%, but less than 50%. I can only assume the buyers took that into account when developing their valuations.

Then again, maybe they didn’t need to, as discussed in a previous post. Lack of materiality can hide a multiple of sins, including overpayment or failure to integrate. I’m not suggesting either is the case, incidentally, just observing that we’ll likely never know. Meanwhile, I’m sure Sandlot, db Motion, CareFx, and the sales forces of other competing vendors are pretty excited.

Best wishes to all for a happy holiday and a joyous new year! I hope to connect with readers at HIMSS in Orlando, if not before. In the mean time, please keep those questions, cards and e-mails coming.

Ben Rooks is the founder of ST Advisors, a consultancy which has worked with dozens of HCIT companies and investors typically on issues around strategy, financing, and outcomes/exit planning. He has served time as both an equity research analyst and investment banker covering the sector. ST Advisors advised A-Life Medical in 2009, Sandlot in 2010, and really enjoyed sitting in Merge’s Tesla last week.

News 12/8/10

From Pecos Bill: “Re: physician-run ACOs. Why am I not surprised that MD bullies want to muscle their way to the head of the line to run ACOs? I’m certain they’d be just as ‘successful’ as they were running IPAs.” The AMA tells CMS that accountable care organizations can’t succeed unless doctors run them, so they want to remove any government bias that favors big health systems. If it’s like private practice, the first thing the male docs will do is put their wives in charge.

From One-Eyed Mike: “Re: Medicity acquisition by Aetna. Makes sense. This is a nice adjunct to the ActiveHealth Management business and Aetna wasn’t shy when they bought that. The even more interesting question is how the other big payers will react. You would think that Wellpoint, Cigna, and Humana have to start thinking through an HIT strategy given their competitors’ (Ingenix, Aetna, HCSC) actions.” As a refresher, Aetna acquired decision support and health analytics vendor ActiveHealth Management for $400 million in 2005. Co-founder Lonny Reisman, MD is still with the company, since promoted to CMO.

From No More Coffee: “Re: Medicity acquisition by Aetna. Am I the only one raising eyebrows? Does anyone think they will use the data to improve patient care?”

From Enrique Palazzo:”Re: plagiarists. I have proof by time and topic of some sites using your information and story finds without credit.” That’s OK. The HIT journalism business model is pretty much non-experts cleverly rewriting press releases without applying any kind of filter or analysis (thank goodness there are a couple of pros that I usually name by name for doing “real” journalism). Here’s my proof: I don’t think I miss important HIT stories or developments very often, yet you’ll notice that I never link to an HIT publication or site. I don’t have to — they rarely run anything useful that isn’t available from the original source (newspapers, press releases, etc.) If they trust my news judgment better than their own, then I’m flattered.

From Dandy Don: “Re: UCLA. With UCLA signing with Epic and announcing a wildly optimistic timeline, things will get ugly as they compete with Cedars-Sinai for the fairly small Epic talent pool in LA. Epic-certified staff already have a lot of market power there.”

From Ummagumma: “Re: UCLA. Just FYI. UCLA and LA County have virtually nothing to do with one another. UC is a state entity and LA is one of the five UC sites that have a healthcare campus. LA County has its own healthcare group (Dept of Health Services – LA DHS) that manages Olive View, Harbor, and I think parts of USC, as well as probably other locations, like clinics. The only official connection between UCLA and LA County is an academic one — Olive View and Harbor are both academically part of UCLA, which means that their physicians are professors at UCLA, and with King-Drew where their students are involved with the UCLA School of Medicine.  Otherwise all management, budget, decision-making, etc. with regard to HIT and budgets are totally separate. This is a common mistake, though, because both Olive View and Harbor have played up the UCLA part of their name. Also, in answer to one of the comments, we UCLA wasn’t on any one system – it’s very best-of-breed. Epic will be replacing at least 10 vendor systems and a half dozen homegrown ones.” The above Web shot is from the LA County Health Services site. Another reader clarified that what most people think of as LA County Hospital is actually part of USC’s teaching program, but it’s UCLA Center for Health Sciences (now Ronald Reagan Medical Center) on the UCLA campus that’s going Epic. What struck me most, though, is that of several people who e-mailed clarifications (most of them UCLA MD faculty) none seemed absolutely certain about how it all fit together and their explanations didn’t fully jibe, so it must be darned complicated. Anyway, a good source tells me that nearly 100 clinics are going up on Epic first, then revenue cycle, then inpatient. It’s supposedly a five-year, $250 million deal with a full expectation of blowing that budget.

From California Dreamin’: “Re: CareFusion. I’ve heard they may be in financial trouble. Is the CFO replacement the symptom or the cause?” The Cardinal spinoff (Pyxis, Alaris, MedMined, Jaeger, V. Mueller, etc.)  promotes James Hinrichs to CFO. The chairman and CEO is retiring in February, probably with a bundle. Shares have meandered since the spinoff, trading low in the 52-week range at the moment, with a market cap of $5.2 billion.

From Sleepless in Snowland: “Re: McKesson STAR. Support sent out an urgent e-mail around noon on Friday saying an emergency downtime would be required that day to fix a Y2K-like date problem. This despite the fact that the STAR HISNET listserv had been buzzing about this topic for over a week and McKesson apparently has known about the problem for MONTHS. And then…nothing. No further official word from McK until 2:30 a.m. the next morning, and oh, the fix has to be applied by 8:00 p.m. Saturday. Much wailing and gnashing of teeth by HISNET users who were the only source of information for the 14 hours between official notifications. Another blow for a vendor who’s having a hard time winning new business or keeping existing clients.” I found the above messages and others on the listserv.

Bellevue College (WA) and HIMSS get an NSF grant to develop some kind of national HIT certification and curriculum program for community colleges and high schools. HIMSS is setting the certification criteria, so I assume they’re planning to sell certification credentials.

Thanks to MobileMD, a new HIStalk Platinum Sponsor. There’s a lot of green in the KLAS scores (overall score over 93%) of the Warminster, PA HIE platform company. I always check out the management team of new sponsors to see if I know anyone and theirs is not only loaded with lots of HIT experience, they have several executives with military leadership backgrounds, which I see as a plus (CEO Todd Fisher was Special Forces and other company execs were officers in the Air Force, Navy, and Army, including grads of the Naval Academy and West Point, so thanks to those guys for their service). I guess I should finally get around to saying what they do. MobileMD offers a SaaS-based, turnkey HIE platform that can be brought live in 30-60 days. Its solution supports data exchange that include feeds to physician EMRs, transmission of CCR- and CCD-formatted documents, interoperability supported by a standards-based API and Direct Project (formerly NHIN Direct), a clinical portal, provider-to-provider messaging for referrals and consults, analytics, and iPhone/iPad access. Its technologies can qualify providers for Meaningful Use, of course. Some of its clients: Catholic Healthcare West, Pinnacle Health, and South Jersey Healthcare. Thanks to MobileMD for supporting HIStalk.

This is interesting: hospitals and doctors are using Facebook as a substitute PHR, looking up information on patients who can’t communicate. Case in point, in an article co-written by Newt Gingich and a neurosurgeon: hospital doctors checked the Facebook of a comatose stroke patient and found her detailed descriptions of her health in her own words (meds, symptoms, hospitalizations). They found that she had a history of blood clots, performed the indicated brain surgery, and she’s out of the coma and recovering. The article concludes, “Yet it also reminds us that at the heart of our 21st century health system is the individual patient. A personalized system that puts the individual at the center and helps us make decisions based on the needs of the individual will become even more accessible — and more important — as the digital world expands in ways that can save lives and save money.”

E-mail me.

HERtalk by Inga

The University of Colorado Hospital chooses InterSystems Ensemble for enterprise-wide integration as they migrate to Epic.

A new partnership between the VA and the Utah Health Information Network will facilitate bi-directional data exchange between the VA and rural providers. The Utah HIN uses Axolotl’s Elysium Exchange applications for its HIE.

eLINCx (OH) plans to implement GE Healthcare’s eHealth Information Exchange across Wooster Community Hospital, Dunlap Community Hospital, and area physician practices.

OnShift, a provider of shift scheduling software, closes $2.3 million in VC funding. The company says its customer base is growing 500% year over year. It will use the new funds to accelerate sales and marketing efforts.

Lutheran Medical Center (NY) achieves 93% CPOE adoption two weeks after implementing Medsphere’s OpenVista EHR.

Seventeen percent of healthcare CIOs are planning staff increases in the first quarter of 2011. Top positions in demand across IT in general are network administrators, Windows administrators, and help desk and desktop support professionals.

Lehigh Valley Health Network fires an internist for delivering personal patient information on 2,200 patients to MDVIP, a concierge medical network to which he was applying. MDVIP used the data to conduct a telephone survey. Lawsuits are being considered and possible HIPAA violations are being reviewed.

St. Clair Hospital Outpatient Surgery Center (PA) adds the Versus Advantages RTLS to provide automated nurse-to-patient assignment.

Citizens Memorial Healthcare (MO) selects Summit Healthcare as its integration vendor. That’s Denni McColm’s place.

Health reform will require collaboration and information sharing between hospitals and physicians, but one in five physicians don’t trust hospitals and six in 10 hospitals think it’s difficult to get health information from community physicians, according to a survey. Nearly 3/4 of doctors are already aligned with hospitals and most want even closer financial relationships to reduce their financial and administrative burdens.

CHIME elects George Hickman (Albany Medical Center – NY) and Gretchen Tegethoff (George Washington University Hospital – DC)to is board of trustees.

Health IT complications make the top five on ECRI Institute’s list of potential technology hazards for 2011. The federal safety organization ranked data loss, system incompatibilities, and other HIT complications as the fifth most hazardous technology issue warranting critical attention by hospitals. Suzy, RN, rejoices and says, “I told you so.”

I wanted to weigh in on the question from Cliff on how to break into HIT sales with no sales experience and the top 5-10 companies to work for. I must side with Grizzled Veteran and El Jefe: it’s going to be tough to get a sales gig with one of the top companies with no sales experience. The possible exception would be if you are already working for one of those companies and they offer some sort of junior sales rep program to groom new salespeople. I am sure some will disagree, but I think it is easier to teach an individual HIT than it is to teach great salesmanship. I’ll also add that sales isn’t for everyone and often isn’t nearly as glamorous it seems. It requires thick skin, hard work, and a decent offering to sell. All that being said, I would recommend you consider working for a smaller company where your can give sales a try and at the same time leverage your HIT background. After a couple of years, if you are successful, you will have a much better chance of getting the attention of bigger vendors.

Sponsor Updates

• Ingenix makes its ClaimsManager software available in a cloud-based version, targeting small and mid-sized physicians offices with fewer than 50 doctors.
• iMDsoft partners with Anesthesia Business Consultants (ABC) to offer the MetaVision solution to ABC clients. iMDsoft will also market ABC technology and create an interface between MetaVision and ABC’s billing technology F1RST Anesthesia.
• eClinicalWorks is named a silver winner in the Massachusetts Alliance for Economic Development Seventh Annual Team Massachusetts Economic Impact Awards, which recognize companies making outstanding contributions to the Massachusetts economy.

E-mail Inga.

Aetna To Acquire Medicity for $500 Million

 
Aetna announced this morning that it will acquire health information exchange vendor Medicity for $500 million. The Salt Lake City, UT company’s technologies serve over 760 hospitals, 125,000 physician users, and 250,000 end users.

“This acquisition will enable Aetna to offer a set of convenient, easy-to-access technology solutions for physicians, hospitals and other health care providers. That, in turn, can help improve the quality and efficiency of patient care,” said Mark T. Bertolini, Aetna CEO and president. “Strategically, we believe this acquisition will enhance Aetna’s capabilities and accelerate our growth in the health information technology and health information exchange space.”

“We are excited about joining Aetna, with the shared vision for improving the health care experience for all stakeholders,” said James K. ‘Kipp’ Lassetter, M.D., Medicity chairman and CEO. “The combination of Medicity’s connected health care platform for providers with the clinical decision support capabilities of Aetna’s ActiveHealth Management subsidiary can help physicians make better decisions in real-time as they collaborate and coordinate care.”

Medicity will operate as a separate Aetna business unit under the company’s current management.

Thanks to the anonymous HIStalk reader who tipped us off early – the same one who provided the earlier and equally accurate rumor that Ingenix would acquire Axolotl. I posted the teaser on Facebook last night after confirming the rumor, which I didn’t report in detail since it involves a publicly traded company.

Monday Morning Update 12/6/10

From Mighty: “Re: CMS. They’ve apparently again changed the MU denominator for the ED.” The FAQ is updated to say that providers must use the same denominator for all measures, either the Observation Services method (ED admissions plus those treated in observation units) or All ED Visits (all patients).

From Catatonia: “Re: UCLA going Epic. LA County is QuadraMed’s biggest client. Not sure if that includes UCLA, but if so, QuadraMed will lose a huge customer just as they are struggling with implementations. Rumor is that the company’s HIM and MPI business will go to Ingenix.” I tapped a key UCLA contact and HIStalk reader, who explained that only UCLA proper is going Epic. LA County is working on requirements for their EHR selection, with the obvious potential bidders being Cerner (already being used in the county’s 200-bed jail hospital), QuadraMed (they’re still running QuadraMed Affinity – not QCPR – in all DHS facilities), and Epic (if they would really want to take on a complex client like LA County). I appreciate that update. I hadn’t heard the Ingenix rumor.

From Wildcat Well: “Re: NJ. The NJ Physicians Group web site enrolls 1,500 docs and receives $350,000 for a EMR selection process while reviewing, in depth, about four out of 200 EMR systems. NJPG has stepped out quicker than the Colts left Baltimore. Now the NJ HIT REC has endorsed ITelagen as the EMR of choice. Will NJ back room deals never stop?”

From Cliff: “Re: sales. I’m working in HIT and would like to move into direct sales. What tips can you offer and who would you consider to be the top 5-10 companies to sell for?” I told Cliff that I have zero sales experience but would open the floor to readers, so feel free to add a comment to this post to help Cliff out, for which I’m sure he’d be grateful.

From RegularReader: “Re: MedAssets / Broadlane. Let the synergy begin! I don’t know if the acquisition has closed, but the layoffs have begun. Many people in the St. Louis office have been given their walking papers and in some cases a personal escort out the door. Happy Holidays! As you say, Mr. H, my condolences to those that have lost their jobs.” I hate to see employees have their jobs taken away, but I’m also aware that nobody wrings their hands for employers when key employees voluntarily walk for a better opportunity. That’s the hazard of employment at-will. Ed Marx said you have to “go to grow” and I believe that, even though for some people they don’t make the “go” decision but still benefit from it in the long run (most of the people I’ve known who were laid off ended up better off). Still, Christmas is always a lousy time to be shown the door.

Listening: reader-recommended Kristy Lee, an undiscovered folksy blues singer-songwriter from Mobile who sounds to me like a cross between Johnette Napolitano of Concrete Blonde and Tina Turner (meaning she has a BIG voice). She’s not a pretty, choreographed lip-syncher – it’s real music that she could play in your living room unprepared if you had a guitar in the corner, which is kind of what music is supposed to be.

The “who’s an informaticist” poll was close, but the winning answer is “clinicians who learned on the job and who have no formal credentials.” A commenter pointed out that the academic and certification programs are new enough that they aren’t common yet. It’s still a divisive topic: 23% of respondents think someone can be an informaticist without either education or clinical experience. New poll to your right, requested by a reader: if you work in a hospital, who does your CIO report to?

Joe Heins PharmD, former Eclipsys SVP and DocuSys COO, joins First DataBank as global product management and marketing VP. I remember him from his Cerner days, where he ran some of its pharmacy systems business. He gets extra points for being in the 1,229-member HIStalk Fan Club on LinkedIn (I’m sending every one of you a Christmas card, so if you don’t get yours, I’m calling that darned post office).

Inga got clarification from RTLS vendor Awarepoint: Jay Deady was named president and CEO last week, but Brad Weinert is still there as COO.

Ashe Memorial Hospital (NC) chooses PatientKeeper’s CPOE, physician portal, and mobile results solutions. Pretty slick stuff for a 25-bed hospital. I’ve been to Jefferson, NC several times and love it — canoeing the New River there up in the mountains is fun, not that that has anything to do with the hospital unless I fall out next time and crush my skull on a rock, in which case I’ll provide a first-hand PatientKeeper update.

Meditech Magic version 5.6.4 earns ONC-ATCB certification from Drummond Group. 

Want to earn your EHR (Esteemed HIStalk Reader) incentive? Here’s the roadmap: (a) put your e-mail in the Subscribe to Updates box to your right, since even if you’re a casual visitor, I guarantee you’ll miss something useful if you just wander over whenever you think about it; (b) Friend or Like Inga and me on Facebook since it’s a publicly visible barometer of our tortured, anonymous existence; (c) send me your news, rumors, pictures, or guest articles about anything HIT related; (d) show some sponsor love by reading and clicking the ads to your left, which will confirm to them that I wasn’t lying when I claimed I had readers; and (e) shake your right hand with your left, pretending it’s Inga and me thanking you for supporting HIStalk even though we may not meet face to face.

The Eye Care Institute (KY) implements the ophthalmology EHR from Medflow, which is an ONC-ATCB certified complete EHR. It’s pretty slick-looking, although some of the screens are unbelievably busy.

A hospital reader from Switzerland sent over a Huffington Post article called Don’t Repeat the UK’s Electronic Health Records Failure. It points out that the UK’s NPfIT, being dismantled after mixed results and colossal expense, is similar to what’s being done here. The reasons it failed, according to the article: it was too ambitious and it was overly dependent in several for-profit companies implementing proprietary systems while offering too little support to clinician users. Their conclusion: HITECH should be slowed down, penalties should be eliminated, and thorough studies should be conducted before mandating EHR use. “Simply following the lead of ‘IT Believers’ and salesmen without the requisite evidence will repeat the UK’s failures.” All valid criticisms, but the big problem is with out Bailout Central: ARRA is stimulus money, so the idea is to just throw the money out there and hope for the best. The real coup for vendors is that providers have to spend money quickly on EHRs to (possibly) earn money quickly via HITECH, which will goose sales a lot more than thoughtful studies.

Marty Mercer sent over the results of a little survey he did of 25 senior HIT sales types (this is for a class he’s teaching). Factoids from it:

• The #1 CXO strategic issue is MU/ARRA, closely followed by access to capital and ACOs.
• The worst things a salesperson can do is to not listen, show up unprepared, make assumptions, and bash competitors.
• The #1 information source was, by far, HIStalk and HIStalk Practice. (thanks!)
• Top pearls of wisdom: prepare before making contact, focus on care quality and not IT stuff, and be patient since HIT sales cycles are long.

Memorial Hospital (CA) uses Skype to conduct virtual visits between moms and their newborn babies that require ICN admission, hoping to reduce separation anxiety. They also use it to let far-flung family members check out the new addition.

A UK hospital says it will save $400K per year by using a privately developed dictation system that will send letters electronically between clinics and physicians. It uses WinVoicePro to create letters and other documents, including progress tracking and countersigning, that are then sent through the hospital’s data transfer service.

Patty Lavely, SVP/CIO of Memorial University Medical Center (GA) will serve as commencement speaker for Georgia Southern’s fall commencement ceremonies at 9:00 a.m. this Friday.

University of Chicago Medical Center chooses Sun SPARC servers and the Solaris OS (both now owned by Oracle) to run Epic.

I’m fascinated for some reason by pictures taken of abandoned amusement parks and formerly famous places, so this video someone took while prowling around the former Mansour Hospital in Jeanette, PA (just outside of Pittsburgh and home to the excellent DeLallo Foods) is both creepy and interesting. The hospital was shut down in 2006 and the bank is trying to sell the buildings.

The Street runs a really good overview of athenahealth and CEO Jonathan Bush. He comments specifically on the risk to his business as hospitals buy up practices that might have become athena customers: “Our job is to be an information infrastructure between various models. Certainly, hospitals have not been our historic wheelhouse, but if you think about it rationally, the cloud-based solution can lower business risk for the hospital CEO. The hospital CEO is taking a multi-$100 million business risk depending on standard health care information software applications … There’s no question that some of these marriages will work, but others, when rates do come down and hospitals can’t subsidize doctors at these levels, will fail. There’s a $100,000 subsidy to a primary care doctor for selling out to a hospital, and for a specialist it’s even higher. How many primary care physicians will bring in one million dollars in business each year for a business like a hospital, with an operating margin of 3%?”

Bizarre: a former hospital receiving clerk is indicted on charges that he stole $4 million from Memorial-Sloan Kettering Hospital by ordering $3.8 million in printer toner cartridges and reselling them. The $37K per year employee lived in Trump Tower (!), with neighbors wondering where he was getting his “his car, his jewelry, and his women.”  Imagine what he could have done with drug ordering.

So how do you work this into the healthcare cost equation? Partners HealthCare makes a $195 million profit for the fiscal year (much of that from your taxpayer dollars in the form of stimulus money for research) even as other Boston-area hospitals struggle to keep their doors open.

A high school basketball coach who saves his star center’s life by performing CPR on him after the boy collapses in practice credits a $1.99 iPhone app. The coach had purchased the app the night before and went through it as a refresher. It includes pictures, voice instructions, single-button 911 dialing, and other first aid advice.

E-mail me.

News 12/3/10

From EHR Geek: “Re: Sunquest. Gets bought again.” Several readers sent this link over. Huntsman Gay Global Capital LLC is leading an investor group that’s planning to pay $208 million for 51% of hospital ancillary systems vendor Sunquest Information Systems from Vista Equity Partners, which paid Misys $381 million for the company in 2007. There’s some tricky financing involved, with Sunquest apparently borrowing $655 million. The deal values Sunquest at a healthy $1.2 billion. I asked one of my Wall Street experts to explain. He said it’s “an odd transaction structure and a risky one” because of the amount of debt and the chance of changing conditions that could make it hard to repay. The big winner is Vista, who gets multiples of the cash they put in just three years ago and gets to keep 49% of the company. I asked Inga to contact Sunquest for a statement, but obviously they can’t really say anything, so she got the expected “we can’t comment.” Huntsman Gay, started by the guy who invented those environment-fouling Styrofoam Big Mac coffins and who also served in Nixon’s White House (but atoned somewhat for those sins by becoming a philanthropist), appears to have no other healthcare holdings is pretty much all over the place in its $1.1 billion fund (oilfield maintenance, bedding, business process outsourcing, and equipment for electrical utilities). Maybe BCBS will be somehow involved since a company subsidiary runs a venture fund for them.

From Epicdude: “Re: Epic. UCLA just signed an enterprise contract.” Unverified, but I found fresh UCLA job postings looking for Epic people.

From Wildcat Well: “Re: what are we missing here? The American College of Physicians, based in Philadelphia, birthplace of the US, presents AmericanEHR, developed with Cientis Tech of … Canada.” Maybe they left off the North part.

Weird News Andy first pointed out that bedbugs shut down a hospital floor, but he amended that statement that PEOPLE were the problem. NYU’s Hospital for Joint Diseases closes an entire floor because a patient claimed she saw a bedbug. Sick outpatients were told not to come in, leading one quoted in the newspaper to say she’s taking her business to Beth Israel. I don’t know that I blame her: does one unverified bedbug sighting really justify closing a hospital floor, especially given the far more dangerous bacterial types crawling all over? Maybe it was a ruse to get a less-affluent Saudi royal their own entire US hospital floor like the King got over at NYP.

WNA also weighed in with a “Say What?” on my story about patients in China having to pay cash for medical services because someone stole the cable carrying a hospital’s Internet connectivity. He summarizes thusly: “We moving towards a government-run health care system and people in China have to pay out of pocket? Weird news indeed.”

The Meditech 6.1 implementation at Kootenary Boundary Regional Hospital (BC) apparently went well, judging from the lead story in their December hospital newsletter. From the picture of their war room, you can almost smell the stale leftover “everything” bagels, human sweat from IT people working long shifts, and the oxygen-depleting fumes emitted from overheated laptops and whirring laser printers.

In England, the National Accounting Office will investigate the $850 million contract that BT got last year, with MP Richard Bacon suggesting that up to $695 million of that amount was excessive given the scope of work performed.

I got paged at home tonight by the hospital and dialed the number on the cordless phone. Nothing happened. Then I realized: it’s not like a cell phone where you dial and then press the button – you have to press the button, get a dial tone, and then dial. My brain knows this, of course, but my fingers sometimes forget because I don’t dial the land-line all that often. I bet I’m not the only one.

National eHealth Collaborative is looking for new board members. Your hat must be in the ring by December 22 (and yes, shockingly, it’s December already).

Omnicell announces a new version of the Pandora drug diversion detection system it bought in October. They’re at ASHP, of course, like most vendors of anything pharmacy-related.

Terri Steinberg MD MBA, CMIO of Christiana Care, sent over their patient safety submission that just won them a Cheers award from the Institute for Safe Medication Practices. She mentions some ways to influence doctors via CPOE that I had talked about the other day: when considering the choices to offer, put the best one first, make it the default, and standardize the list. They won the award for work with hydromorphone injection, with better success with CPOE than they’d had on paper. They defaulted lower doses, forced choosing a pain scale reason for high doses, required an indication for use, and added CPOE dosing alerts. They successfully reduced too-high initial doses and increased the number of doses within the recommended range. I’ll stick with what I’ve always said: CPOE will reduce some errors, but its greatest (but less flashy) benefit is helping doctors do the right thing, or as the paper says, “prescribers will not go out of their way to change predefined content unless warranted by unique patient characteristics.”

Cerner shares have been on a rocket lately, going from the mid-70s in September to Thursday’s close of $92.03. Market cap is $7.62 billion, pushing the value of the holdings of founders Neal and Cliff to nearly $400 million each. That’s a one-year chart above.

Jobs on the sponsor-only Jobs Page: Payor/Provider Connectivity Product Manager, RN Clinical Content Specialist, Segment Marketing Manager, VP Solutions Management ePharmacy. On Healthcare IT Jobs: Director EHR Systems Division, Horizon Physician Portal – Remote, Implementation Engineer – Integration, Epic Clarity Interfaces Security.

A former Deloitte Tax LLP partner and his wife are arrested for insider trading. The SEC says they gave tips to family members about impending transactions, including the buyout of Kronos by a private equity firm in 2007 and the McKesson acquisition of PerSe that same year.

RAPID Chiropractic Software is certified by CCHIT as an EHR module, giving its chiropractor users a shot at getting 44,000 taxpayer dollars for demonstration Meaningful Use.

Strange: the website for 988-bed Guam General Hospital has some interesting pictures, job postings, and contact info that includes a toll-free number. The problem is, there’s no such hospital – the pictures are of other hospitals and the telephone number has an Atlanta exchange. The local newspaper called the number and the guy who answered said it was indeed the hospital. They’re speculating that it might be a hiring scam that targets nurses from the Philippines. The FBI is looking into it.  

You just know that WikiLeaks is going to eventually expose something on a hospital or healthcare agency. While you wait for that, note that one of the confidential government documents it just released says that Venezuela’s hospitals are a mess – loaded with crime, unpaid suppliers, and doctors quitting medicine. Blamed: inefficient community clinics that provide free care, many of them staffed by Cuban doctors making $400 per month, that take funding away from the public hospitals that the public prefers.

E-mail me.

HERtalk by Inga

Former Eclipsys EVP Jay Deady joins Awarepoint as president and CEO. Before Eclipsys, he was a SVP and GM at McKesson Provider Technologies and a GM and VP with Cerner. Curiously, the press release doesn’t mention what happened to Bruce Weinert, who is still listed at president and COO on the Awarepoint website. The seven-year-old Awarepoint recently raised $9 million in a combination of equity and debt.

Evan Steele of SRSsoft says the company has listened to its customers and will seek ONC-ATCB certification for its EMR. Steele has been an outspoken critic of Meaningful Use criteria, suggesting the measures negatively impact physician productivity and are not relevant for specialists. However, Steele says participation has become more inviting since David Blumenthal recently clarified the exclusions that can be claimed by specialists.

Norton Healthcare (KY) will use Microsoft Amalga and HealthVault for its regional accountable care organization.

The US Army is testing EMR applications on the iPhone and Android devices to determine if they can be used in the field. Some of the hurdles include encryption requirements and signal certification from the DOD and local sources.

Health system value in the US is getting better in some critical areas and slowly gaining ground on its international competitors. According to the Business Roundtable’s Health System Value Comparability Study, the US is behind its G-5 peers, but is making substantial improvement as hospital errors are reduced and smoking rates decline. Rising obesity levels and per capita healthcare spending are two of the biggest factors keeping the US’s health system value behind Canada, France, Germany, Japan, and the United Kingdom.

Hillsdale Community Health Center (MI) goes live on CPSI’s electronic medical records.

The Senate unanimously approves legislation to exempt small businesses, including physician practices, from Identity Theft Red Flag Rules. The bill now goes to the House.

The Leapfrog Group names 65 hospitals to its 2010 Top Hospital list, based on a survey that measures hospitals’ performance in patient safety and quality. Kaiser and Northshore University did particularly well, taking 20 of the spots. It’s interesting to note who made the list, and, possibly more interesting to consider those who were not mentioned (Johns Hopkins, UPMC, MD Anderson, UCLA, Mayo Rochester, Mass General, etc.)

As part of a draft privacy report, the FTC proposes a “Do Not Track” list that would allow consumers to stop web sites and services from tracking online browsing. The report also recommends that businesses not store more information than necessary to meet specific business purposes, suggesting its use to build consumer profiles raises privacy concerns. For example, “the retention of location information about a consumer’s visits to a doctor’s office or hospital over time could reveal something about that consumer’s health that would otherwise be private."

New on HIStalk Practice this week: a new poll for practices, asking if they are currently running an ONC-ACTB complete EHR.  Also, medical liability insurance rates increase for providers adding EHRs. The non-traditional president of Physicians Computer Company. Dr. Gregg Alexander dishes on some recent EMR demos. Dr. Alexander, by the way, sent me this shot of the HIStalk Practice hit counter, which hit the 200,000 visitor mark today when a reader from Harvard dropped by.

Dick Hull joins Acuitec as VP of business development. He was previously with Premise and Surgical Information Systems before that.

The ONC sends the Office of Management and Budget a final rule to establish a permanent EHR certification program. The temporary certification program is expected to run through December 2011.

I am happy to report that my laptop is back home, safe and sound. For $65, my local computer nerd cleaned things up and removed several viruses (including a root virus), malware, and trojans. I am now running Symantec Endpoint Protection (for those of you that asked,) as well as the Mr. H-recommended Spybot Search and Destroy. I appreciate all the advice from readers, except the clever individual who suggested I stop downloading porn. Maybe next time I need a computer I will go the Mac route, but for now, I am feeling relatively safe from the unwanted PC infiltrators.

Sponsor Updates:

• Cumberland Consulting Group promotes Joe Mayberry to executive consultant. He joined Cumberland a year ago after three years with Accenture.
• Ashe Memorial Hospital (NC) purchases PatientKeeper CPOE, Physician Portal, Mobile Clinical Results, and NoteWrite.
• MEDecision is named as one of the 100 best places to work in Pennsylvania.
• Apple Valley Medical Clinic (MN) chooses e-MDs for its 13 family physicians.
• The VA awards Picis a contract to implement its perioperative solutions across the VA’s Stars & Stripes Healthcare Network. With this contract, a total of 42 VA hospitals have selected Picis solutions.

E-mail Inga.

News 12/1/10

From Specialty EHRland: “Re: ONC FAQ regarding Core and Menu Set items. I sent this question to ONC in September and they punted to CMS, which hasn’t answered. The rule is unclear as to whether vendors must require their clients to pay for and use all components of the certified complete EHR even if the client chooses not to qualify using those menu set measures. Why should a vendor of specialty systems where diagnostic lab results and growth charts are outside the scope of provider practice be forced to develop those features knowing that the providers will be given an exception by ONC and CMS anyway?” This was in response to a confusing ONC FAQ that I tried to interpret. I think the intended guidance, despite some misinterpretation by some publications, is that vendors must demonstrate capability for all Menu Set items to earn certification even if all of their customers plan to pass on those items in meeting their required five of 10 Menu Set items. The impact is on vendors, in other words, not customers (other than having to pay for features they know they won’t use).

From Frank Drebin: “Re: Black Book Rankings. Have you heard anything about the quality of their market research? I’m not wealthy enough to purchase the results of their recent HIT vendor surveys and I’m not an expert in statistical analysis, sadly, although it does not sound dissimilar to what KLAS already does. As a side note, I have three co-workers and a few nurses still quoting, ‘There is a fracture. I need to fix it.’ whenever we run into pedantic problems.” I don’t have a clue – the company seems to popped up out of nowhere with press releases blazing. It’s a recently acquired subsidiary of Datamonitor and one of the principals was Doug Brown, formerly of Avega and McKesson. Their site lists the vendors by category in order – alphabetical, that is (seeing them in score order costs from $799 to $4,995 per report). They sell the reports only through Amazon, oddly enough. Here’s the excellent “Orthopaedics vs. Anaesthesia” cartoon that won me over.

From Wildcat Well: “Re: Black Book Rankings. They rank top EMR vendors, which includes … everyone. Next they can rank the top 32 NFL teams. Morons.”

From Truth Seeker: “Re: news postings. A group says it’s posting stories on KevinMD and The Health Care Blog, saying they are the two most widely read healthcare blogs in the United States. What about HIStalk?” I don’t follow KevinMD, but HIStalk gets more readers than The Health Care Blog. October numbers: THCB, 67,534 visits, 110,191 page views; HIStalk, 95,366 visits, 134,141 page views. Maybe they’re talking only general healthcare sites.

From Mr. Excitement: “Re: Cerner. How ironic it is that they’re being snake-bitten after all those years of selling snake oil.” Cerner’s $400 million office building and soccer stadium project (of which $232 million is being paid by Kansas taxpayers) is jeopardized when two endangered snake species are found on the site.

From Charles De Mar: “Re: CEO salaries. Sturdy Memorial Hospital pales in comparison to its New England counterpart Lifespan, where the non-profit CEO took home a $9 million payday and employees had no raises that year.” I’d like to say that shocks me, but hospital executive salaries are so ridiculous that it doesn’t. Tiny hospitals paying million-dollar salaries is just absurd.

From RFIDebaser: “Re: HIMSS RFID technology. You wrote about HIMSS using RFID to track attendees on the exhibit floor and in educational sessions. You should ask them to talk about what exactly they are doing here and how they will use/sell the data. You can opt out at registration, which I will.” A few folks got worked up when I wrote that HIMSS will use attendee-tracking RFID chips embedded in the conference badges, but most didn’t seem to care. The idea is that your chip feeds leads to vendors in real time and allows them to deploy salespeople when someone of lofty provider rank enters their perimeter. The opt-out wording says that vendors won’t see your e-mail, phone, or address if you allow them to track you like a stray dog, but only the dimmest of vendors won’t figure out how to Google that since they’ll have your name, title, and employer. Needless to say, I’d recommend checking the opt-out box (or disabling the chip).

From The PACS Designer: “Re: Swype. Inga mentioned ShapeWriter this past June, which is now a division of Nuance Communications. ShapeWriter’s Swype application is now becoming a quite popular choice for replacing keyboard touching to speed up data entry in mobile apps and could help win over physicians who shun typing into medical records while treating patients.”

Weird News Andy concludes that “It’s good to to be the King,” at least if your kingdom sits on a lot of oil. King Abdullah, monarch of our supposed democracy-loving ally Saudi Arabia, has everybody else booted from the entire VIP wing of New York Presbyterian / Weill Cornell Medical Center so he can recover from back surgery in private. Relocated, lower-ranking VIP patients are whining that he’s getting special treatment, apparently missing the irony completely. I guess the hospital runs itself like any other business, taking the highest bidder’s cash in return for hanging out a “closed for private function” sign that keeps the tax-paying citizens away from its not-tax-paying doors.

Allscripts VP Rich Elmore, who the Communications Workgroup leader for ONC’s Direct Project (formerly NHIN Direct) offers this clarification of Direct vs. CONNECT:

The Direct Project (formerly NHIN Direct) is a project to create secure transport specifications for point to point messaging of protected health information using the Internet. While the Direct Project does make it easier for providers to communicate directly with one another, this is in comparison to the fax machine, not CONNECT. CONNECT is a software stack that implements health exchange specifications. The CONNECT roadmap includes support for the Direct Project specifications, which will allow any organization running the CONNECT stack to implement the Direct Project specifications.

I: Global Intelligence for the CIO will be running a version of Ed Marx’s July HIStalk post called The Authentic Leader (Death to the Cliche).

The Economist is running an Oxford-style debate and poll on privacy, pitting Microsoft’s Peter Neupert against Patient Privacy Rights’ Deborah Peel. Two-thirds of voters are siding with Peel so far.

Athenahealth CEO Jonathan Bush compares data-sharing among providers to friending someone on Facebook, describing an athena service that will allow providers to share and update patient information. That’s an alternative to “financial integration”, which he describes as the Kaiser-like model where hospitals buy other providers just to assemble their data into a single, proprietary repository.

Indian IT services vendor MphasiS, whose majority owner is HP, says it’s testing a new HIM product for small- to medium-sized hospitals in emerging markets as its entry into healthcare.

Internet image-sharing vendor lifeIMAGE integrates its product with Microsoft HealthVault, allowing physicians to send images to a patient’s account.

An iSoft press release touts the huge reduction in prescribing errors enabled by its medication management system. My critical review based on the abstract of the original work (since I don’t feel like paying for the article itself): (a) the study involved only 72 patients in four weeks as the “before” group and 58 patients in five weeks as the “after”, all of them patients in a psych unit where medication usage is about as different as it can be from the usual med-surg unit; (b) the rate of the most significant errors, such as wrong dose or wrong drug, didn’t change; (c) system-related errors averaged nearly one per patient. In other words, patients didn’t really benefit since the errors prevented were minor or almost certain to have been caught anyway. That’s usually the conclusion of studies involving CPOE, mostly because they focus on error reduction instead of improved ordering practices (putting the best choices first on the selection list, giving only reasonable choices, calling attention to duplicate orders, improving the timeliness and accuracy of order delivery and response, etc.)

Speaking of iSoft, acting CEO Andrea Fiumicelli is announced as CEO at the company’s annual meeting in Sydney. He was previously COO. The call transcript is here. Most of it involves reduced revenue because of the fall of NPfIT, cost-cutting measures, the hope of selling systems outside of the UK, and the usual streamlining efforts (reduced locations, discretionary spending freeze, sunsetted products). They’re still confident in Lorenzo given its relative youth and sales prospects outside of NPfIT, including in the UK itself as more NHS trusts get to make their own decisions.

Australia’s government says its $380 million (US) telehealth program may install service centers in drug stores and could be staffed by non-physicians for online consultations of low-acuity medical problems.

A hospital in China loses telephone service and Internet connectivity for the second time in a month when someone steals a section of telecom cable running through an apartment complex. Doctors wrote bills by hand and patients had to pay in cash.

University of Iowa Hospitals and Clinics says the MyChart part of its $60 million Epic system is a hit with patients, with 35% of them activating their account, 48% of those checking lab results online, 12% looking up appointments, and 11% sending an electronic message to a provider.

Piper Jaffray is holding its healthcare conference in New York right now (November 30 – December 1).

The odd campaign promise by an incumbent Australian politician to buy every doctor an iPad with government money is apparently history after he loses the election.

In England, NHS lists a few abuses of its emergency services: a woman who wanted her toenails clipped, a drunk man brought by ambulance because his wife locked him out of the house, and a child brought in because she had stepped in dog droppings and her mother was too squeamish to clean her up herself.

E-mail me.

HERtalk by Inga

From Hercules: “Re: Cerner fun fact. There’s a full gym right on the Cerner campus with trainers. Most associates don’t use it unless they are trying to get promoted quicker, but this does eliminate the need for them to leave the parking lot.” I figured that Neal Patterson was a pro-fitness kind of guy, given his strong support for soccer. Funny that fitness helps those on the fast track.

KLAS recognizes DR Systems as the leading PACS vendor for large hospitals with Infinitt ranking first for community PACS. In the same report, 92% of KLAS respondents say they don’t plan to replace their PACS in the next few years.

MedLink completes an aggregate of $2.25 million in financing, including $1 million in private placement. It will use the money to increase sales and marketing efforts, for working capital needs, and for the acquisition of MedAppz.

Hill-Rom hires Brian Lawrence as SVP and CTO. He was CTO of Life Support Solutions for GE Healthcare.

M*Modal and Virtual Radiologic announce a strategic partnership to integrate M*Modal’s Speech Understanding technology into the vRad Enterprise Connect 3.0 Technology Suite.

Genesis HealthCare System (OH) deploys BIO-key’s biometric identification solution, enabling clinicians to establish their identity when ordering or administering meds in Genesis’s Epic system. In its next phase, Genesis will implement fingerprint biometric user logon with the Sentillion Vergence SSO product.

Bill Sterling, the former director of healthcare systems for Vocera, joins clinical workflows company EXTENSION as VP of channel and business development. Maybe he can convince them to ditch the all-caps name.

The CFO for Cincinnati Children’s Hospital Medical Center says the health system plans to add 500 new employees over the next year, in addition to the 480 who were hired over the last year.

Advocate Good Samaritan Hospital (IL) wins the 2010 Malcolm Baldridge National Quality Award in healthcare, which honors performance excellence through innovation, improvement, and visionary leadership. Other healthcare-related winners included MEDRAD(medical devices) and Studer Group (healthcare coaching and consulting). 

A subsidiary of Wolters Kluwers Health enters into an agreement to acquire Pharmacy OneSource, a provider of clinical decision support tools for the hospital pharmacy market.

The Leapfrog Group names the University of Maryland Medical Center and Virginia Mason Medical Center (WA) as its Top Hospitals of the Decade. The recognition was based on their public commitment and patient safety and quality innovations.

I don’t recall if I had mentioned this before, but Mr. H generously bought me a new laptop over the summer. The 30-day trial version of antivirus software ran out a few months ago and I have been “too busy” to load new antivirus. I am now realizing that was a pretty stupid excuse since I have now picked up a nasty virus which is preventing me from getting on the Internet. After spending an hour cursing and trying to fix it myself, I took it to a local computer nerd for repair. Now I’m working on the old laptop, which is missing four keys and runs slowly. I only mention this as a reminder, just in case you are also one of those really busy people that has failed to keep your antivirus current. It’s best to take care of these matters as soon as possible in order to reduce the number of expletives you utter.

The CIO of Northern Hospital of Surry County (NC) says the hospital’s implementation of EMC and VMware virtualization solutions has allowed them to eliminate 20 physical servers, decrease power usage, and reduce network congestion. Northern Hospital claims it has saved hundreds of thousands of dollars despite a 30-40% growth in data and the addition of a couple thousand medical devices.

Tensions appeared high at a recent Regional Medical Center (SC) trustee meeting. Trustees were informed that for a one-month period, charges from the pharmacy system were not passing to the billing system. The hospital is working with their HIT vendor (Cerner) to resolve the problem , but had to reissue 3,600 bills. The situation did not please trustees, who had just approved  an additional $2 million for the hospital’s Cerner project, including $628,000 for Meaningful Use upgrades. Now here is where things get a bit testy. One trustee, Danny Covington, says that if the hospital had used Meditech, it could have met the Meaningful Use objectives for less money. Here is the play-by-play in the local paper:

"That is not so," trustee Milton Dufford said.

"I know you want to believe …" Covington said.

"Don’t tell me what I am going to believe now," Dufford said.

"You wanted to believe that we had everything for ‘meaningful use,’" Covington said. "What you think and what you believe are contrary to the end result here."

Why can’t we all just get along?

The 70-provider Riverside Radiology and Interventional Associates (OH) adds ZixGateway Inbound to scan incoming e-mail for unsecured PHI.

CHRISTUS Health and United Regional Health (TX) are some of the dozens of healthcare customers who recently signed up with Catapult Systems for Microsoft IT consulting services.

A study published in the Archives of Internal Medicine concludes that lower-income families with out-of-pocket medical expenditures are more likely than higher-income families to delay or forego medical care. They are also more likely to question services requiring out-of-pocket expenditures.

Sponsor Updates

• ICA wins Best of Show honors in the provider and insurance categories at the recent Everything Channel’s 2010 healthcare IT summit.
• Wellsoft ties for first place in the best of breed category in KLAS’s recent EDIS report.
• The 13-physician Apple Valley Medical Clinic (MN) selects e-MDs for its EHR and PM system.
• Indiana Hand to Shoulder Center (IN) will implement SRS Unified Desktop (PM, EMR, PACS) for its 35 providers.
• Springs Memorial Hospital (SC) chooses the check printing solution of the Access Enterprise Forms Management suite.
• Orion Health announces that its HIE solution has been enhanced to include a modular suite of components to match specific needs of individual healthcare organizations and allow them to scale out projects over time.
• Nuance Communications introduces PowerScribe 360, a radiology and communications platform that combines capabilities of PowerScribe and RadWhere. The solution also works with Dragon Medical to provide core radiology reporting.

E-mail Inga.

Monday Morning Update 11/29/10

From Bit Byter: “Re: Samsung Galaxy Tab. I’m interested in it.” The new $600 iPad tablet competitor (discounted by carriers selling data plans) runs on Android, has a 7-inch touchscreen (the iPad is 9.7”), two cameras, integrated GPS, Flash support, the cool Swype typing system, Wireless-N, Bluetooth, and seven-hour batteries. It’s too early to say (or buy, probably), but it looks like a reasonable alternative to the iPad for anyone who wants one (just like there are many smart phones better than the iPhone in some ways, but that most people don’t want because they aren’t iPhones).

From Train Wreck in Progress: “Re: CONNECT. ONC can shuffle paper, but they are screwing up real software and progress in treating the CONNECT team like unloved stepchildren despite multiple awards and demonstrated progress in connecting VA, DoD, and Kaiser. It’s a sad day when initiatives like CONNECT are not celebrated, embraced, and supported. Doug Fridsma’s framework was attacked at the HIT standards meetings as not practical, yet he marches on.” The top two CONNECT consultant managers quit as the program stalls while GAO investigates a complaint from Harris, the incumbent contractor, over a new contract awarded to CGI. The open source CONNECT platform, which won WSJ’s technology innovation award for HIT this year, was developed by a group of more than 20 federal agencies to support secure healthcare information exchange among providers, insurers, government, and consumers. ONC standards director Doug Fridsma says ONC wants to make it easier for providers to exchange information directly through NHIN Direct.

From Capiche: “Re: ONC clarification. Any thoughts on hospitals and practices being required to implement all Core and Menu items?” It’s a ONC FAQ that seems to mix vendor and provider requirements in a confusing way, but I’m interpreting it as being applicable only to providers with self-certified, homegrown EHRs. To do that requires implementing all of the Menu set items even though as providers, they could qualify for MU by using a vendor-certified EHR to meet only five of the 10 menu set items. But another interpretation is that all providers must meet all 10 Menu items even though CMS requires reporting only five. Click the above image to enlarge and let me know what you think it means. Or maybe someone from ONC can clarify their clarification since it’s a pretty big deal if that latter interpretation is correct.

Hospitals may lock down their internal e-mail systems with malware protection and tools to prevent PHI transmission, but docs can just go to their Web-based e-mail on those same PCs and do whatever they want, so say 80% of respondents to my poll. New poll to your right, rekindling an old argument — who should be calling themselves “informaticists”? As usual, click the Comments link in the poll to support your position.

Listening: reader-recommended Ry Cooder’s I, Flathead. I haven’t warmed up to all the music yet, but I like that he’s a non-conformist roots music songwriter who doesn’t really care what the masses think. This one’s a third of a three-part concept album series dealing with the Southern California culture in the first half of the 20th century. The alternative to auto-tuned, air-headed, ad-packaged Barbies and Kens singing about lust. And Watching – one more thing I hadn’t thought of that you can do on an iPod Touch: stream your Netflix movies over WiFi, which I did this morning in watching MST3K while brushing my teeth in the bathroom, just because I could.

A five-year study using trigger tools (instead of unreliable self-reported errors) finds that hospitals have made no progress in reducing incidents that cause patient harm. Nearly one in five hospitalized patients were harmed by the care they were given; nearly two-thirds of their injuries should have been prevented; and those injuries contributed to their deaths in 2.4% of the cases. The article concludes that preventing mistakes isn’t rocket science since every hospital knows that they should be doing. The problem is that they aren’t doing those things consistently: handwashing, medication reconciliation, decubitus prevention, etc.

A good article with the great title of The Doctor-Patient-Laptop Relationship looks at how doctors typing into computers changes the doctor-patient dynamic. A past president of the Connecticut State Medical Society says medical schools in her day taught doctors not to see patients from behind a desk since it served as a barrier, but they aren’t teaching today’s medical students ways to keep computers from becoming an equally disruptive barrier. It makes an excellent point: writing makes no sound and people can do it while they’re talking, while keyboarding makes noise and requires most people to look at the keyboard and monitor. I was thinking about that and I agree: when someone’s typing, I usually stop talking because they won’t hear what I say anyway.

Politicians get involved in the plans by two Canadian hospitals outsource IT to Cerner. They don’t like losing local jobs and they also don’t like the fact that Cerner sells de-identified patient data from this side of the border. Meanwhile, the IT department’s “whistleblower” who heard rumors of the discussions and quit in protest says the hospitals are making a mistake in turning over system knowledge to contractors who will have the hospital over a barrel. Anything related to HIT is a touchy subject in Ontario after audits last year found that eHealth Ontario was wildly overpaying no-bid consultants who were filing padded expense accounts, kicking off a political scandal in which heads rolled. The papers are making a big deal about the fact that IT staffers weren’t consulted in advance of the outsourcing discussions, which is ludicrous – in what world does management seek the input of those who would be negatively impacted by one of the two potential courses of action?

Inga interviewed David Delaney MD, CMO of MedAptus, about revenue cycle management tools.

NEJM runs the case study of the Mass General surgeon who performed the wrong surgical procedure on a patient and went public afterward to help prevent errors elsewhere. The Swiss Cheese Effect was in full force, with several potentially minor problems adding up to one big one in which the surgeon performed a carpal tunnel release instead of a trigger-finger release. Contributing factors: (a) the patient did not speak English and the hospital had no interpreter available; (b) the surgeon did several hand cases the same day; (c) the nurse had not marked the planned incision site; (d) the OR suite was changed because other cases were behind; (e) the change in room also involved a changed in staff, including the nurse who did the pre-op assessment; (f) the change in rooms delayed the surgery, so the surgeon saw another patient while waiting; (g) the circulating nurse fell behind in her documentation to go find a missing supply item; (h) the patient’s site marking was washed off when the area was cleaned; (i) the surgeon spoke to the patient in her native Spanish, so the circulating nurse assumed that was the mandatory time-out and didn’t call for one; (j) the nursing team changed mid-procedure; (k) computer monitor placement in the OR forced the nurses to look away from the patient. The best takeaway came from another physician in the case review:

Surgeons need to take ownership of these policies. When the airline industry evaluates a crash, the pilot is not considered responsible except in two circumstances: the pilot was under the influence of drugs or alcohol, or the pilot did not follow protocol. All hospitals need to have a culture in which surgeons feel responsible for making sure the protocol is followed.

Another HIMMS sighting, as even trade show supply companies can’t spell it right.

Funny: Steve Wozniak, the goofball half of the founding team of Apple Steves, mistakenly says in an interview that Apple has acquired speech recognition vendor Nuance, sending that company’s stock on a tear. The Woz says he must have read something wrong.

A court rules that the Iranian government owes McKesson $44 million for illegally seizing its dairy there in the 1979 revolution. The company was Foremost-McKesson back then.

Here’s why you probably don’t want to buy penny stocks of companies more competent at selling shares than product. Shares in would-be HIT vendor Healthmed Services, which I mentioned last week along with pictures of its “headquarters”, go down just as quickly as they’d gone up when pumped earlier in the week. Share price was less than four cents on Monday, up to over 12 cents on Tuesday, now back to under four cents and dropping. Considering the company has zero revenue and prospects for earning any, even the current $7 million valuation is ridiculous. Penny stocks aren’t usually worth even a penny.

IT application coordinators and analysts working for Kaiser Foundation Hospitals get a $2.91 million settlement from Kaiser for being misclassified as salaried instead of hourly. The employees were part of the HealthConnect go-live team, which required uncompensated travel, overtime, and on-call support responsibilities.

In the UK, a hacker gets 18 months in prison for send spam-infected e-mails that allowed him to take control of the PCs of anyone who clicked a link. He bragged on being able to turn on the webcams of infected PCs and to browse their files without the knowledge of their owners. One of his targets was a hospital. About one in 250 of the spam recipients clicked the link. The man is a father of five, runs a computer security firm and did his hacking from his mother’s living room.

The founder of India-based Apollo Hospital Group judges healthcare ideas for a reality TV show about entrepreneurship, choosing Medsynaptic. The Pune company offers imaging solutions, including PACS, low-bandwidth teleradiology, and image workstations.

The South Asia president and CEO of GE Healthcare says the company’s “de-featured” (up to 40% less expensive) medical devices will improve healthcare efficiency, adding that “India will teach the world healthcare innovation.” GE’s healthcare business there is growing 25% a year and they’re planning to hit annual revenue of a billion dollars within five years.

Strange: a UK nurse who accidentally killed a premature baby by giving 50 ml of sodium chloride injection instead of the ordered 5 ml gets in more trouble when the dead baby’s parents find that she posted a Facebook picture of herself asleep beside the baby’s bed a week before the mistake. Afterward, she posted messages asking for friends to “wish her luck” in the inquiry, and when allowed to return to work after her suspension, posted a message saying, “Has had a fantastic day! Is goin 2 treat herself 2 bottle wine!” The hospitals says they knew about the posts.

The Australian government issues $55 million in grants for interoperability projects, or at least that’s what I assume the article is referring to with the term “personal e-health records.” The government is looking for vendor bidders, just in case you’re interested.

A patient sues Halifax Health (FL), claiming his ex-wife, a former hospital employee, provided information from his electronic records to a hearing officer in their divorce and child custody trial. The hospital had already fired her for accessing the records of another plaintiff, which one might assume is hubby’s new love interest.

Nuance will collaborate with Montage Healthcare Solutions to offer radiology users the ability to search their Powerscribe 360 reporting database using voice commands or keystrokes. They’re demoing at RSNA if you want to drop by for a peek.

Surely we can agree this is excessive: the CEO of 128-bed Sturdy Memorial Hospital (MA) is paid $1.18 million per year. You know the excuses: they have to dig deep to prevent her from leaving, the not-for-profit hit its performance targets that enabled it to bank a big surplus, etc.

E-mail me.

The Obligatory but Heartfelt “What I’m Thankful For” Thanksgiving Post

This will be one of those really rare times where I get all reflective and maudlin, it being a holiday and all. I was moved by Inga’s Thanksgiving post. I might have sniffled a little, but I did cook Indian food for dinner, so it could be that the oils from the chili peppers I was chopping for the aloo matar found their way from my fingers to my nose. That’s my story, anyway.

What I’m most thankful for is that I don’t have to think hard to come up with a “what I’m thankful for” list every day of the year. That’s the great thing about having low expectations and a cynical outlook. Any day above ground is a good day.

I love my day job and the hospital that pays me OK for doing it. It’s the best place I’ve ever worked. I’m just as happy when the alarm goes off Monday morning as when it doesn’t on Saturday.

I am thankful for my family and that I found a woman early who not only tolerates my eccentricities and insecurities, but appreciates them. We ought to be sick of each other after all these years, but the first thing Mrs. HIStalk said when she came home tonight, instead of complaining about the paint-peeling stench of my simmering chana masala that she detests, was that I looked sexy. That’s doubtful (especially since I had just sneezed violently from accidentally inhaling sinus-searing masala vapors) but characteristically commendable of her to say. She’s as cute to me as the day we met in college.

I’m happy that I’m healthy, protected by those in military service, and still moved by good music. I’m glad I don’t care much about money, power, and fame since I’d be worrying all the time about losing them even if I managed to get them in the first place.

I’m glad I started writing HIStalk way, way back in the dark ages of 2003. Nobody was reading and I didn’t care, but somehow it has improbably allowed me to meet some pretty amazing people who are trying to make a difference. Sure, and a few douchebags too, but that’s a small minority. We have our differences and our debates in healthcare, but we always end up on good terms.

I’m thankful for everybody who spends their valuable time reading what I write (even the music recommendations, especially the weird ones). I’m grateful that companies support HIStalk just because they appreciate my work and knowing that I’m still going to rag on them when they deserve it.

I appreciate everyone who takes the time to e-mail me, write guest articles, submit thoughtful comments, be interviewed, and tip me off to news and rumors. You make me look smart and your efforts benefit many.

I’m really thankful for whatever cosmic forces sent Inga my way. She keeps me sane and amused, balancing my negativity with cheery optimism and funny e-mails. The insecurity oozed from her early writing as she struggled to keep inside her tiny industry comfort zone. Now she’s confident, insightful, and eagerly read by her many fans (and just as insecure). You’d like her even more if you knew her in person.

I’m thankful that Mrs. HIStalk knows her culinary limits without me having to remind her, so I’ll be doing the cooking Thursday (after popping Zantac all night because the chutney for the samosas was a little too hot). She does make a mean pumpkin pie, though. I’ll just need to crank up the iPod while she’s watching those idiotic televised parades she likes so much.

Have a fabulous Thanksgiving, Black Friday, and the long weekend. And, in my final “what I’m grateful for” item, thanks for reading.

News 11/24/10

ONC invites the public to weigh in on personal health records as long as they do it by December 10.

A just-in report from Canada says that two hospitals there are talking to Cerner about outsourcing IT.

Central DuPage Hospital (IL), a long-time Lawson customer, says it has implemented Lawson Contract Management in less than four months.

Listening: new from My Chemical Romance, high-energy, defiant punk/pop with some nice hooks that provide a needed break from auto-tune singers and phony country warblers. Driving music.

St. Joseph Medical Center (TX) develops a 10-physician hospitalist program with Intercede Health, which includes the use of the company’s Order Optimizer software. It provides SaaS-based diagnosis-specific order sets and order set management tools, medication alerts, physician favorites, and a nine-week implementation time. That product is also available separately from a subsidiary.

In Ontario, Sunnybrook Health Sciences Centre partners with Telus Health Solutions to roll out a consumer health portal / PHR that will allow Telus employees to upload and enter medical information that providers can review. Its underlying technology is Microsoft HealthVault.

Happy birthday to Ed Marx, whose special day was Tuesday. You can post belated best wishes on Facebook.

Jobs on the HIStalk sponsor-only job page: Implementation Consultants and Project Managers, Director of Technical Readiness, Implementation Consultant. On Healthcare IT Jobs: Health Information Technology Support Manager, IS Senior Project Manager, Ambulatory EMR Implementation Specialist.

I received a nice response from AMIA President and CEO Ted Shortliffe about a reader’s question as to whether the organization will decline financial support from vendors who won’t go on record as not using “hold harmless” clauses in their customer contracts. He says AMIA’s vendor contracting task force received redacted contract copies and have no knowledge of how specific vendors are writing contracts. He mentioned that Senator Chuck Grassley had sent letters to vendors asking that very question, but he has not made whatever responses he received public. Ted says AMIA’s role is as an educator, not an enforcer, so it made strong recommendations. I can see that point of view: other than Epic, most vendors aren’t going to walk away from business if the prospect insists on removing clause like that one. Nobody makes customers sign on the line which is dotted.

Speaking of that, I’m amazed that hospitals allow vendors to provide the first draft of a contract, loading it with vendor-friendly boilerplate and making sure to look astonished and hurt at any suggestion from their “partner” that it be changed before they hand over their large check. Job #1 is to create your own contract draft and give it to the vendor as the starting point for negotiation. I’m thinking of starting a telenegotiating service where I whisper electronically in the ear of hospital and practice IT people, telling them what to say and how to use classic negotiating techniques to their advantage. Customers are always complaining about the bad deals they got without accepting blame for taking what was offered without a whimper. In negotiation, 80% of the money on the table is going to be split equally between the two parties. When you’re negotiating, you’re fighting for a bigger share of the remaining 20%.

Investment bank TripleTree will host a Webcast about cloud computing in healthcare on December 1. The panel includes top executives from Castlight Health, SCI Solutions, MedVentive, and Connextions. Two of those four are HIStalk sponsors (SCI and MedVentive), so tune in and support them if you’re so inclined.

Nuance announces Q4 numbers: revenue up 17.7% to $310 million, EPS $0.01 vs. $0.02 after some accounting adjustments. 

British company Cambridge Consultants announces the Minder smart device, which transmits medical data in real time to EMRs. It can also receive checklist information from providers to instruct patients. Technologies used: Bluetooth, Wearable Mobile device hardware, accelerometer, the Continua-compliant Vena platform, and input devices that include a blood pressure cuff and scale.

iSoft’s former auditors face misconduct charges over – what else – allowing questionable recognition practices.

Odd: Healthmed Services, which has staked its fortune on some kind of iPad-to-desktop communication tool for healthcare use, floats a bunch of press releases touting its vaguely described agreements with Facebook and Google. Its also-vague Web site features a video of President Obama and a lot of generic information about the vast healthcare IT market it plans to conquer. The company today announced a development agreement with Veritas Software Systems, which might sound like the big backup system vendor unless you recall that Veritas was acquired by Symantec in 2005 (and its name was actually Veritas Software Corp. – this particular company has no Web presence that I could find). It also announced this week a new Web-based practice management system called HealthTrac, with no details whatsoever. What’s really newsworthy about the company: (a) it just filed an 8-K disclosure that it paid a company $600K to develop its flagship product, armed only with an oral agreement, but that company is holding them up for more money; (b) the company’s stock was being pumped and dumped by cocaine-smuggling New York longshoremen (note this “monster pick” that ran up the price 93% on Monday, with 42 million shares changing hands); and (c) its SEC filings from August indicates that the company had zero revenue, had no expectations of any revenue, and was down to its last $52 in the bank. I Googled its listed address and came up with the Las Vegas building above from Google Maps, which I assume is a mail drop. The address it uses for its SEC filings is a one-person virtual office in California that’s currently for rent for a minimum period of one night (that photo is above, too). The CEO quit in August and the CFO was replaced. Shares are at $0.08, with a market cap of $14 million. Maybe I’ve finally found that HIT vendor who’ll have me on their board, enjoying the corporate headquarters any time I can come up with the daily rent.

Odd: Spirit Airlines refuses to give a surgeon’s pregnant wife water while their overheated plane is sitting on the tarmac, offering instead drinks for sale. He makes a scene and makes vague references to terrorism, his son kicks a flight attendant in the groin, the flight crew kicks the family off, the surgeon is suing for $11 million.

Attachmate acquires Novell for $2.2 billion, if there’s anyone left who cares. A Microsoft subsidiary chips in $450 million to get a bunch of Novell patents, leading to speculation that their interest is either in suing other companies or perhaps porting .NET to Linux.

I think we probably won’t have enough news to be worth posting new issues of HIStalk, HIStalk Practice, and HIStalk Mobile through the holiday, but I’ll have the usual Monday Morning Update. Inga has written a sweet Thanksgiving piece that I’ll run on HIStalk Practice and I may write one myself for HIStalk since we are both sentimental, dreamy-eyed romantics anxious to give our BFF readers a clingy holiday hug, just like the watch-those-hands Uncle Bill on the porch after a little too much spiked eggnog and cheap Thanksgiving wine. We’ve been ultra-busy with new sponsors, interviews, and party planning, so we will enjoy the short break. if you’re headed off to RSNA this weekend, travel safely and make sure to crack up your fellow airline passengers in the security line by loudly delivering a few carefully rehearsed jokes about TSA’s full-body scanners. Have a wonderful Thanksgiving.

E-mail me.

HERtalk by Inga

Fun fact: at Cerner’s on-site cafeteria in  Kansas City, color-coded serving tools prompt employees to notice good food choices. Green handles indicate a great choice (think broccoli), yellow handles suggest you might want to limit your portion (pimento-stuffed olives), and red handles (burgers and fries) mean you might want to make time for a workout after work (that is, if you can sneak out of the parking lot without Neal noticing).

Austin Regional Clinic (TX) implements Webmedx’s Enterprise5 platform for its outsourced transcription and speech recognition services.

CMS will give providers online tracking capabilities to check the status of their Meaningful Use incentive payments. The payment information will be available online once a provider is notified that they have met Meaningful Use requirements.

In an article profiling Epic, the story’s author notes that the company rarely advertises and doesn’t encourage media articles. Apparently the reporter had difficulty getting answers to some basic questions. After several phone and e-mail attempts, she was basically told no one was available to assist. Finally an Epic spokesperson told her that the company’s “managers and leaders were too busy to speak with newspaper reporters, even if the reporter in question was writing a major feature story about them.” I bet lots of companies wish they were that busy.

Meanwhile, another local publication points out that Epic makes financial contributions to over 100 nonprofits. The company also donates older computers to local school districts, supports the local public library, and hosts area high school graduations in its auditorium.

The US Bid Committee announces  that Cerner is now an official partner in efforts to bring the FIFA World Cup to the US in the 2022. The committee chair says that Cerner has “clearly demonstrated” its commitment to the sport “in their innovative web-based health surveillance system for professional soccer players in the United States.” I was aware of the Cerner / Kansas City Wizards connection but didn’t realize Cerner also has an “athlete-focused” solution that was launched earlier this year and is now used by all 16 Major League Soccer teams.

Microsoft’s Peter Neupert says the company is abandoning efforts to make HealthVault profitable because of the complexity of the country’s health system. Neuport told  the Financial Times that HealthValult’s benefit to Microsoft was simply to increase the brand relationship” by raising Microsoft’s image with customers as “important, critical and trusted.” Compare those thoughts to what Neupert had to say at HealthVault’s unveiling three years ago:

The way we make money is by encouraging online activity, and through our search application.We know that search is a big business, it’s an important tool, it’s where consumers are today. And by growing the overall search market and delivering more value to consumers, and delivering a better end-to-end search experience, that’s where we can make our money to support this effort.

Florida doctor Arturo Carvajal sues a restaurant after injuring himself while consuming an artichoke. The doctor claims the restaurant failed to “explain the proper method of consuming an artichoke.” Carvajal, a brain surgeon, ending up eating the entire outside of the vegetable, which caused him "severe abdominal pain and discomfort," ultimately resulting in "disability, disfigurement, mental anguish," and "loss of capacity for the enjoyment of life".  OK, Carvajal really isn’t a brain surgeon, but I thought that sounded funnier than family practice, which is his real specialty. Regardless, I hope he has better luck eating his turkey and that someone advises him not to eat the wishbone.

Sponsor updates:

• NextGen Healthcare partners with Scimage to release a jointly develop the NextGen Medical Image Integration Module. The new module will give NextGen EHR ambulatory users the ability to view images produced by any imaging modality or PACS from within the NextGen EHR.
• Eight MEDSEEK healthcare clients win a total of 14 awards at the Strategic Communications eHealthcare Leadership competition. The program recognizes outstanding health web sites.
• Consulting firm North Highland hires Rebecca Whitehead Munn and Brent Holman as account managers. Munn was formerly the SVP of sales and marketing for Consensus Point. Holman comes from a large for-profit healthcare system (which I assume is HCA since both Munn and Holman are based in Nashville).
• North Sunflower Medical Center (MS) will deploy a suite of McKesson products, including Paragon HIS, Practice Partner EHR, and RelayHealth claims and eligibility  processing solutions.
• Surgical Information Systems says its SIS Version 5 is the first perioperative system to be certified as a modular EHR.

E-mail Inga.

Monday Morning Update 11/22/10

From SpaghettiCode: “Re: GE. The recent reorganization confirms that they made a huge mistake with the $1 billion IDX acquisition. After many attempts to defibrillate the CareCast business, they finally orged the legacy business under the EMR side and key execs were moved out.” Here are snips of what I had to say about the acquisition in September 2005. I mentioned collaboration with Intermountain Healthcare as a positive (that’s gone nowhere that I’ve seen), although I was focused mostly on the inpatient apps:

If you’re an optimist, you might assume that a mega-conglomerate like GE will pump R&D into the old warhorse IDX products, make them wonderful in a way that a small player like IDX never could … Pessimists would ask for even one example where that has ever happened, including with prior GE acquisitions … Much of CareCast was written 20 years ago by that little band of Phamis employees in Seattle. Does it contain enough intellectual property or technical excellence such that a quick spit-and-polish treatment will make it a world-beater? I don’t think so, but maybe GE does … Conglomerates have a way of screwing up products (McKesson, Siemens, and maybe even Misys.)… IDX needed a white knight. It was devaluing itself day by day, with an embarrassing UK performance and no CareCast sales. The acquisition announcement mentioned that IDX needed a partner with global reach, but it had already created its own opportunity in the UK and blew it. Cerner and Epic were threatening to run the table on them … Somehow HIT companies seem to lose their passion when swallowed up by multinational firms selling everything from light bulbs to Jay Leno. That’s kind of sad, don’t you think?

From Boston Patient Advocate: “Backlash is building by patient advocates against self-appointed ePatients who make a living selling a modified version of their story. They often fail to mention that they misunderstood information they found online, weren’t really as sick as they thought, or that it was their doctors that found the correct treatment or gave them an RX for online communities. Then again, we love myths of the little guy in America.” I ignore news stories in which reporters try to mask their opinionated reporting with phrases such as "debate rages”, “some are questioning”, or “pressure is building”. In other words, I don’t doubt your sincerity, but I’d like to know specifics behind your “backlash is building” assertion. As we say in the medical world, “In God we trust … others bring your data.”

From The PACS Designer: “Re: Continuity of Care. TPD is happy to see that HHS has embraced the concept of Continuity of Care as it is laid out in the ASTM Continuity of Care Record (CCR) and requires providers to include it in their EHR certification submission request. Healthcare organizations will have to include the ASTM CCR in their discharge process to get their EHR certified, and at the same time, we’ll have a chance to transfer information between providers to help eliminate duplication of procedures and reduce medical errors.”

Eastern Maine Medical Center (ME), preparing for a three-day lockout of striking RNs by bringing in replacements, will shut down all of its clinical systems except the eMAR and go back to paper. Here’s a hint for those living near Bangor: go somewhere else if you’re sick this weekend. Or, if you’re one of those “EMRs are evil” naysayers, this is your rare chance to do some Maine-based medical tourism to receive critical, elective medical care at a paper-based hospital.

The usual list of stuff you can and should do here: (a) subscribe to the updates so you aren’t embarrassed by the idiot three offices down who learns breaking news before you and rubs your nose in it; (b) use the search function to amplify your HIT intelligence in real time; (c) Friend or Like us on Facebook or connect with us on LinkedIn so that we may both pretend to be more popular than we probably are in real life; (d) click some of the sponsor ads to your left to see what they’re up to; (e) visit HIStalk Practice and HIStalk Mobile to get mostly different news particular to physician practices and mobile health, respectively (and sign up for those updates, too, if you want to stay on top of stuff).

Listening: the remastered 1978 debut solo album of former Pink Floyd leader David Gilmour, recommended by a reader. I appreciate that: I really like his music and respect him for his charity work, but I never think to recommend his solo stuff, which at that early stage of his career was kind of Pink Floyd Lite (not necessarily a bad thing). He’s supposed to be reuniting with former bandmate Roger Waters at one live performance of The Wall, which is on tour now.

Forbes runs maybe the weirdest, worst HIT article I’ve seen, apparently intended to be a cheerleading piece for Allscripts. It claims that open source is about to make its healthcare debut, courtesy of Allscripts (meaning Allscripts Helios, previously Eclipsys ObjectsPlus, which has been around since the 1990s). It claims that many tech vendors have gone out of business because they “chose to cling to closed, proprietary software or hardware” (care to share names and proof of the cause of their demise?) It mumbles something about the need to interface a “computerized drug order system” to an EHR (huh?) It says Judy Faulkner’s statement that you can’t mix and match vendors is an Allscripts advantage, failing to notice that Judy’s company (whose industry-leading product is closed and proprietary) had pretty much killed Allscripts (nee Eclipsys) Sunrise single-handedly since to install Sunrise, unlike Epic, required mixing and matching vendors to cover the many hospital areas it doesn’t address. To top it off, the article uses the old Allscripts logo pulled from Wikipedia instead of actually checking their site directly to get the current one. All of this was a lame attempt to create an interesting, insightful article around an October press release in which Allscripts announced that it would create an apps store for the former Eclipsys Sunrise, which has nothing to do with open source in the first place since nobody’s seeing and contributing to anybody else’s source code (extensibility isn’t the same as open source). It’s just amazing to me how many people write authoritatively but wildly inaccurately about healthcare IT (usually spinning entire articles around press releases and a couple of Google searches) who have never worked a day in either healthcare or IT except as a cheap-seats spectator. Caveat lector.

A little more than half of respondents to my poll say they’ve seen “hold harmless” contract clauses, although I liked the excellent comment by NotQuite, who pointed out that a “hold harmless” clause is not the same as a “limit of liability” clause. I’m no lawyer, but that sounds legally insightful. Gotham City CIO requested the new poll to your right, for hospital people: does your organization block access to outside e-mail services by physicians using hospital PCs? They block access to Gmail, Hotmail, etc. at his place to prevent the possible transmission of PHI via untrackable e-mail services, which is apparently common in other industries. The new CEO is getting heat from the docs even though they can still use a dedicated PC in the doctors’ lounge or their own PDAs to get to those services. Feel free to add any comments to the poll that would help our CIO colleague.

Thanks to new HIStalk Platinum Sponsor Orion Health. The international company, based in Auckland, NZ and with US offices in Santa Monica and Boston, offers solutions that include an HIE platform, the Concerto Physician Portal with single sign-on to provide a single patient view across multiple clinical systems, the Rhapsody Integration Engine for inter-system messaging and integration, the Rhapsody Connect solution for connecting to public health agencies, and the Symphonia developers’ messaging system for rapid system integration. The company just reported an 80% increase in revenue for the first half of the year and has 22 HIE sites in 12 countries. In the US, Orion’s HIE solution was recently chosen by the Wayne State University Physician Group and Maine’s state HIE. Rhapsody 4 just came out with new support for SOA integration and Web services, with Philips choosing it as its integration tool. The company offers a much broader product line than I knew about (EHRs, registries, whiteboards, bed management, chart deficiency, etc.) so feel free to cruise over to their site to learn more. Thanks to Orion Health for supporting HIStalk.

McKesson’s Horizon Clinicals earns ONC-ATCB certification through Drummond Group.

Marty Mercer is putting together a HIT sales training class for newbies and is looking for input from industry long-timers. You can help out by completing his short survey like I did. He’ll send me the results afterward since I think they might be fun to review here.

Inga emulates Weird News Andy with this link: doctors warn of the psychological dangers of social networking after an 18-year-old boy’s asthma attacks are found to be triggered by looking at the Facebook profile of his former girlfriend. His mom measured his peak expiratory flow before and after.

The Rural Nebraska Healthcare Network starts construction of its Nebraska panhandle fiber optic network that will connect nine rural hospitals and their clinics.

Vendors beware: patent troll Acacia Research buys 11 patents for wireless physiologic monitoring. Let the nuisance lawsuits begin.

A company that has developed an electronic parking space finder wins at the IBM SmartCamp World Finals in Dublin, but a couple of HIT-related companies were in the hunt: CareCloud (Web-based practice management and revenue cycle tools for practices) and Sproxil (checks the authenticity of drug products via SMS messaging, primarily in developing countries).

Speaking of “cloud”, everybody’s hopping on that bandwagon with as much self-serving enthusiasm as they did previous sloppily defined fad terms (ASP, EHR, clinical transformation). Since HIStalk runs from a Web host, I think I should start referring to myself as a “the leading cloud-based business intelligence and collaboration platform for the healthcare technology and life sciences sectors.” I’m thinking investors will line up at my door dripping saliva at the chance to throw money at me. 

St. Paul Heart Clinic (MN) closes its doors, with its 36 cardiologists going to work for either Allina or HealthEast. A key reason, as explained to patients, was the ability to share a common EMR.

Orlando Health (FL) offers local medical practices a discount on GE Centricity.

Weird News Andy likes this story: the call center for TennCare is a women’s prison, as discovered and reported by the overly dramatic and pot-stirring local TV station anxious to use that “breaking exclusive” graphic typically rolled out when someone’s flat tire backs up traffic almost a quarter mile. WNA likes the eloquently expressed consternation of one Leon Rippy, apparently goaded randomly by the TV station to weigh in on the issue of the potential but entirely theoretical impact on patient privacy: “That ain’t good.”

Coliseum Hospital (GA) investigates a former employee who dropped by to attend a nurse’s birthday party, then logged into the hospital’s computer system with her still-active password and looked at patient information. She’s caught by hospital security, which was apparently more effective than IT security considering the terminated employee’s credentials had not been inactivated. Assuming HR let them IT, of course (and trusting the competency of any hospital’s HR department is indeed foolhardy).

A blog entry in The Economist says HITECH could be as big a bust as NPfIT in the UK, suggesting that France provides a better model:

Maybe the Americans (and the British) should swallow what the French would term their “Anglo-Saxon” arrogance, and look at France. A French citizen presents his credit-card sized Carte Vitale to the doctor or the pharmacist or the hospital and everything—for example, the date and dosage of a prescription—is recorded by a national computer system (which also usually deals with payments). Visit another pharmacy or doctor in another town, and the patient’s details are automatically available. Perhaps this helps to explain why the World Health Organisation in 2000 (the last time it did the exercise) put France at the top of its rankings for health care. By contrast, Britain came 18th and America 37th. Mind you, it may also explain why the French pop more pills than anyone other than the Japanese.

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Being John Glaser 11/10/10

Meaningfully Using Industry Buzzwords at Home

With the HITECH and ACA legislation and rules. many new phrases and words have been introduced and old ones have gained additional prominence. I have found that these phrases and words also have use in several situations at home. See some examples below.

Death Panel. Your sixteen-year-old son returns home drunk at 2 a.m. after a long Saturday night. He parks the car sideways on the lawn. You and your wife are sitting on the couch in the living room waiting for him. As far as he is concerned, you and your wife are a death panel.

Stimulus funds. Your spouse shows you the new clothes that she bought. You like the clothes, but are mystified by the apparent need for new clothes when the old clothes aren’t that old and you liked those too. Moreover, the clip-on tie you had in third grade is still good and forty years later you still wear it from time to time. You don’t realize that the household income is really a stimulus fund to keep retailers employed.

Data exchange and interoperability. Your daughter (a senior in high school) wants to spend the weekend with her new boyfriend, who is a freshman at a local college. You, recalling quite well what’s always on the minds of young males, say “No.” Your daughter protests, “But Dad, it’s not what you think. I will be staying at his cousin’s (who is a girl) dorm room. Nothing will happen!” You think – I don’t believe that for a second – and again say “No.” You and your daughter are engaged in data exchange, but there is no interoperability going on.

Certification process. The first time you met him, you instantly liked your daughter’s new boyfriend. The second time you met him, you engaged him a lengthier conversation and discovered that he is a moron. The third time you met him, he had been invited for dinner and was clearly stumped by the role of the napkin. You decide that you and your daughter need a new boyfriend certification process.

Meaningful Use. You notice a dead tree in the yard. You find your chain saw and install a new chain. You assure your wife that you know how to fell this tree so that it won’t hit the house even though the tree is close to the house. You miscalculate and tree branches take out the kitchen window. Your spouse is less than impressed. You are clearly not a Meaningful User of advanced technology.

Bundled Payment. You are arm-wrestling with a new car salesman over the price of a car. He mentions all of the features that come with the base price – seats, steering wheel, front window, headlights, and an engine. He informs you of all of the extras – roof, glove compartment, and radio. You want the extras for free. Plus you want a sun roof, Jacuzzi, and toaster. You and he are negotiating a bundled payment.

The great thing about words and phrases is that they have so many uses and meanings.

John Glaser, PhD, FCHIME is CEO, Health Services of Siemens Healthcare. He describes himself as an "irregular regular contributor" to HIStalk.