Monday Morning Update 10/26/09

From Croc Dundee: “Re: academic censorship! The Australian Ministry of Health has forced the withdrawal of Dr. Patrick’s essay on EHR problems in the ED in NSW. See his page now – the download is disabled. Was Cerner involved?” Beats me, but Scot Silverstein archived a copy. It’s anecdotal, opinionated, and more of an editorial than a research study, but interesting. The fact that someone doesn’t want me reading it sent me looking for a copy. Jon Patrick tells me the university took it offline late Friday afternoon and he’s meeting with them Monday to find out why. Rumor has it that complaints were made.

From Fil_Peed: “Re: Eclipsys User Conference. Mr. Pead’s ‘joke’ went over like a lead balloon. Here was the opportunity for him to make a mark on the client base, many of whom he was meeting for the first time, and instead he makes an off-color analogy to what one should do in bad economic times and customers started walking out.” I’ll withhold judgment until someone tells me what he said.

From HITGhost: “Re: lost data. CalOptima reports that its claims imaging vendor, ImageNet, accidentally sent out unencrypted DVDs that contained claims from 68,000 of its members. The DVDs were sent to CalOptima via certified mail, but never reached CalOptima. CalOptima actually posted this information and identified ImageNet on its home page.”

From Avon Calling: “Re: a paperless and telephone-less, state-of-the-art hospital. Babies turn blue, but are always OK. Did Han write the classic CPOE-caused mortality paper from this hospital? And with all of those computers, there are gaps in the record?” UPMC’s Children’s Hospital of Pittsburgh is criticized by the state health department for not responding to a report in which a baby’s mother claimed her baby turned blue but nurses didn’t respond to the emergency alarms. The mother says the nurse’s emergency alert phone wasn’t working, but the hospital disputes that. According to the investigation report, the alarm phones that were claimed not to work were from Emergin (Philips). Children’s was indeed the subject of a 2005 journal article that showed that the use of Cerner Millennium for CPOE was the second-best predictor of patient death, behind shock but ahead of coma (I criticized that conclusion right after and I’ll stand by that – the hospital made some spectacularly bad implementation decisions).

From Ex-Cerner Guy: “Re: Methodist-Gary. They have lost $220 million over the past five years. The consultant was suggesting Meditech, a system they might be able to afford and still be able to pay the consultant.” It’s hard to believe that one hospital would, over just a few years, sign with Epic, drop it for Meditech, and then contemplate going back to Epic.

Speaking of Cerner, St. Bartholomew’s Hospital in London faces fines of $650,000 per month for lengthy patient backlogs that it blames on the “dreadful” Cerner Millennium. I doubt it’s that simple, but blaming the computer is always convenient.

Listening: Muse. I mentioned them before, but I cannot get enough of this band, maybe the best music I’ve heard in a few years. The live album, Haarp, shows they aren’t just studio overdubbers. My highest recommendation.

Welcome and thanks to Dentrix Enterprise, now a Platinum Sponsor of HIStalk. The company is featuring its Dentrix Enterprise Electronic Dental Record, the industry-leading paperless, centralized record system for community health centers. You can read a product review by the National Network for Oral Health Access here (warning: PDF – it’s on page 29). Dentrix Enterprise is a wholly owned subsidiary of Henry Schein, Inc. a Fortune 500 company with annual sales of over $6 billion. Thanks much to Dentrix Enterprise for supporting HIStalk.

GE says the rumor about its Centricity Cardiology layoff is not true and that the system continues to be sold, installed, and developed. Instead, my contact says, “We’re just migrating the business from local to global over the next few years and have shifted some resources for future project development to avoid redundancies.” Sounds like the product is fine but the people working on it aren’t.

A fun practice EMR comment from Gartner’s Wesh Rishel: there are hundreds of systems, not including those developed by “nephews of doctors.” On ARRA: “If they put up $44,000, they don’t want the doctor to buy (Microsoft) Office and open a spreadsheet.” He also predicts that those hundreds of EMRs will shake out to 10. The same article (which is excellent and objective, by the way, since it was written by a local paper’s reporter) quotes Cleveland Clinic CEO Toby Cosgrove on EMRs: “Whether it will drive down quality, I don’t know. It doesn’t increase efficiency or lower costs.” Cosgrove says he told the President that the biggest savings will come from e-prescribing.

A Mass High Tech article covers Lawrence General Hospital’s IT systems, including its Picis ED PulseCheck system that an ED doctor says reduced wait times by more than 30 minutes and reduced ED walkouts from 6% to 1%. It also notes that transcription costs were reduced by $600K per year and revenue was increased by $5 million for IV charges alone through accurate documentation. The hospital will replace most apps (not the EDIS, though) with McKesson Paragon.

The e-mail update subscriber list just passed 4,800 people, some of whom are your archest of enemies and competitors who will read (and possibly act on) time-sensitive news before you if you haven’t entered your e-mail address in the Subscribe to Updates box to your upper right.

CPSI announces Q3 numbers: revenue up 8.7%, EPS $0.37 vs. $0.38.

Two universities get ARRA grants for EMR projects related to genomics. University of Virginia will collect $1.9 million to create a genome-enabled EMR that will be part of Epicare. Vanderbilt is given $415K for its Vanderbilt Genome-Electronic Records project, which will look for a link between blood values and arrhythmia and also develop natural language processing tools to mine EMR data.

Bloomberg profiles rookie private equity manager David Brailer, whose Health Evolution Partners has invested $120 million of California pension money from Calpers so far. He says he will invest $150 to $200 million each year starting next year. A pension consultant comments, “No matter how you look at it, $1 billion is a lot to allocate to someone with no track record.” Some of the biggest investments so far involve radiology. One investment that sounds interesting is in Triveris Inc., which offers an add-on insurance plan just for diabetics that emphasizes preventive care using software to identify diabetes risk. It’s part of Health Network America.

TriZetto issues a press release to notify an impatient world anxious for yet another PHR that “additional features and functions” of its own version will be ready by year end. The opening sentence of the breathy press release is possibly the most awkwardly structured and confusing sentence I’ve read lately.

Not Yet sent a copy of an October 16 letter sent by Senator Chuck Grassley to Cerner and nine other big HIT vendors (I posted the full letter here). The Senator said, as the ranking member of the Senate Committee on Finance, that he is collecting information about healthcare software defects. He cites “learned intermediaries”, “hold harmless”, and “gag orders” clauses that let software vendors shift responsibility to users and prohibit them from disclosing defects. The Senator asks whether the vendor’s contracts include those provisions, asks for copies of all user correspondence involving software complaints or concerns, requests documentation of any lawsuit settlements, asks whether the vendor has offered financial incentives to facilities or providers to get them to choose its products, and wants to know how the vendor tracks reported defects.

My most recent poll asked about your plans for Windows 7. The voting was pretty evenly divided, but reading between the lines is interesting. Around 37% of reader employers plan to use Windows 7 compared to 61% of those readers themselves. New poll to your right, suggested by a reader: what would your reaction be to seeing the CPHIMS credential on the resume of a job candidate?

Perot (soon to be Dell) announces that it has been contracted to develop a plan for a city-wide RHIO in Changsha, China.

NIH awards the University of Florida a $12.2 million stimulus grant to develop a Facebook-like social network that will allow scientists to find research opportunities.

The creator of the MySQL database says Oracle should sell it to a third party to soothe antitrust concerns about its Sun Microsystems acquisition. Suggested buyers were Red Hat or Novell.

E-mail me.

News 10/23/09

From Bill Costanza: “Re: HIMSS keynote speakers. I’ve ranted to HIMSS about the lame speakers who have no bearing on either IT or healthcare. They would rather have vapid celebrities to entertain the troops. I can just see Bob Hope and his golf club on stage.” I quickly came up with 10 I’d like to see: (a) Bill or Melinda Gates (to talk about global health and atone for Ballmer); (b) Larry Ellison (an entertaining wacko); (c) Richard Grainger (to describe the folly of massive civil works healthcare IT projects); (d) Barack Obama (he hasn’t done much, but he’s maybe the funnest and nicest President so far); (e) Suzanne Somers (cute and fun for a 63-year-old and full of all kinds of bizarre medical theories); (f) Senator Chuck Grassley (hates government and healthcare waste and suggested that AIG executives who got huge bonuses from taxpayer bailouts should quit); (g) Judy Faulkner or Neil Pappalardo (pioneering industry recluses); (h) any health bigwig from Chinese government; (i) Ben Carson (Hopkins neurosurgeon); and (j) Hans Rosling (Swedish global health expert and inventor of free healthcare statistical display software). I could also be convinced to back Artie Lange, Bill Murray, or Kate Winslet as the token celebrity.

From Doug N. Nuts: “Re: patient safety. Thought you might be interested in Bob Wachter’s commentary on the media and safety. This is an excellent site for safety in general and has great monthly CME.” The editorial postulates that hospitals in the Northeast and those known to house celebrity patients get disproportionate coverage for making medical errors, and even though hospitals shy away from the publicity, they generally emerge better after the public scrutiny (Hopkins, Dana-Farber, and Duke are given as examples). I agree completely. It’s a shame that greedy conglomerates bought local newspapers, loaded them with debt, and mismanaged them into near irrelevance — we need real reporters as public watchdogs. Since the trade rags do little original reporting of real news, especially if it makes any healthcare stakeholder look bad, almost all the big patient safety stories come from the local newspapers or peer-reviewed journals.

From Lady Pharmacist: “Re: hi. Could you put in a kind word? This week is National Pharmacy Week. There are a number of pharmacists and pharmacy technicians (both in hospitals and the vendor side of the world) involved with informatics and are trying to make software / products / systems safer as it relates to the use of medications and ultimately patient safety.” We love pharmacists and techs at HIStalk, so here’s that shout-out, especially for those who serve patients in an IT or patient safety capacity. I always give lab people credit for being excellent developers, adopters, and users of IT, but the unquestionably most complex set of functions and workflows to automate in healthcare involve the ordering, dispensing, and administering of hospital medications. As the photo above proves, lady pharmacists like yourself have been providing pharmaceutical care for at least 50 years.

From Lee Samosa: “Re: GE. GE has pulled the plug on development of the Centricity Cardiology DMS program. All of the developers and most of the support staff in the Sioux Falls office were laid off this week, leaving behind a small team of sustaining engineering and a single Level 4 support person to support the installed base.” My GE Healthcare contact is checking on this. That’s the cardiology data management systems group.

From Certifiable: “Re: Epic. Gary (IN) Methodist de-installed Epic, at the recommendation of consultants who deemed Meditech more appropriate. I have heard they are considering an Epic return.” Any hospital considering those systems as interchangeable alternatives, much less swapping them back and forth, is clearly in need of some soul-searching.

From EndoIndiana: “Re: Mr. Richard Johnson, CIO of Clarian Health. He died in the last few days of metastatic renal cancer.” Richard Frederick Johnson, 50, died Tuesday. Online condolences can be left here.

I messed up the Moment With featuring Jon Phillips last night (I was tired). I posted it to HIStalk Practice by mistake and sent out the e-mail blast without noticing. Inga caught it right away, so I then posted to HIStalk like I originally intended and sent out the corrected link (no spam intended). So, Jon is up on both sites, which I told Inga is like when the president’s speech is on every TV channel.

Dr. Gregg Alexander thanks the folks who stopped by the Pediatric Office of the Future exhibit (under the white roof during setup above) or his get-together after. He was sick as a dog, so I think he was in a daze, but he was a trouper throughout.

Omnicell’s Q3 numbers: revenue down 16.1%, EPS $0.03 vs. $0.09. The CEO says he’s happy with that and shares are up a little, so expectations must have been low.

I was talking to a colleague about today’s Windows 7 launch. Both of us longed for the good old days when desktop software was so important that people slept outside computer stores (remember those?) to be early in line when the store opened at midnight. Actually, I should correct that: there are still massive lines when products launch, but only at the Apple Store.

The nice folks at MedVentive e-mailed to let me know that they’re hosting a Webinar next Thursday, October 29 at 1:00 Eastern entitled “Measuring the Business Value of Business and Clinical Intelligence (BCI)”. The company offers intervention, registry, dashboard, and P4P solutions for providers, along with quality, scorecard, registry, HEDIS, and Medicare Advantage programs for health plans.

AHIMA will publish a new book next month called H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations.

Allen Tien, MD, MHS of mdlogix checked in to say that Johns Hopkins is using the Subject and Protocol Registry of the company’s Clinical Research Management System for all of its new studies. It’s being used for 790 studies, 15,000 subjects, and more than 1,000 users in all departments.

Florence Community Hospital (AZ) brings in a new management team, among them CIO Stephen Franken, formerly CIO of San Juan Regional Medical Center (NM).

Jobs: Clinical Application Educators, IT Manager, Laboratory Systems Application Analyst.

Document management and revenue cycle management vendor HealthPort announces the terms of its upcoming IPO, with a market value of $338 million at the midpoint of the proposed range. The Alpharetta, GA company has annual revenue of $285 million.

International Medical Solutions announces availability of smart forms and Web-based mobile applications to manage informed consent processes digitally.

Fletcher Allen Health Care chooses Netezza and Business Objects for its Cerner-fed data warehouse.

Ranjan Das, the 42-year-old CEO of SAP India, dies of a heart attack. He worked for InterSystems and Oracle previously.

In London, Kingston Hospital NHS Trust goes live with Soliton’s radiologist and pathologist workflow system, powered by Nuance Healthcare and integrated with iSoft RIS, Sectra PACS, and Clinisys LIS.

Cal Berkeley researchers dream up CellScope for the developing world, a microscope attached to a cell phone that allows sending highly magnified sample images to medical experts anywhere.

A writer decries companies that jumped all over Second Life, only to leave it littered with virtual ghost towns after they abandoned them to chase equally trendy but newer technologies like Twitter. Called out: Cisco’s Virtual Palomar West, intended to promote “The Hospital of the Future” and Cisco’s medical-grade network, but now “totally deserted and mostly broken.” I’m not sure I believe that even though I always thought Second Life was an over-hyped bust.

The Quantum Group gets a delisting notice from Amex and voluntarily decides to trade its shares on the OTC BB. Amex didn’t like the fact that it “sustained losses that were so substantial …that it appeared questionable, in the opinion of Amex, whether the Company would be able to continue operations …” The company offers “a 21st Century EMR Solution” (not surprising since that’s the century we’ve been in for quite a few years now), an MSO, and provider services. Shares are trading at 55 cents, for a market cap of just over $6 million.

A hospital rabbi is fired for violating HIPAA privacy laws after writing an essay about comforting the family of a security guard killed at the U.S. Holocaust Memorial Museum. She says she didn’t say anything that wasn’t public knowledge. She thinks the hospital fired her for complaining that it pays male rabbis more, so she’s thinking about suing.

Researchers in Japan develop software that predicts with 80% accuracy the chance that a 911 caller will die. It may have application in routing ambulances to the most critically ill callers. I say license it to Hollywood to make another sequel to The Ring.

United Health posts Q3 earnings that beat Wall Street expectations, with one of its fastest growing segments being its Ingenix healthcare IT business.

CareTech Solutions is named one of the best places to work in the Detroit area.

Odd lawsuit: a psychiatric hospital patient sues the facility for $7,500, claiming it should have prevented a female employee from having sex with his roommate. She already admitted it and quit.

E-mail me.

HERtalk by Inga

GE launches a $250 million equity fund to invest in small healthcare technology. The GE Healthymagination Fund will focus on HIT, life sciences, and diagnostic companies developing unique and innovation business models and services. The fund is part of GE’s $6 billion Healthymagination initiative. GE’s total revenues in 2008 were $187 billion, by the way, making the $250 million equity fund look smaller than a rounding error.

System integrator Emtec expands its healthcare offering with the signing of partnership agreements with FairWarning and BridgeHead Software.

Federal authorities admit that the lack of electronic interfaces between labs and provider EHRs continues to be a challenge to the industry. Technological and financial challenges force many labs and providers to rely heavily on paper and fax options. The HIT Policy Committee heard testimony on the topic this week as it prepares its meaningful use recommendations for HHS and the ONC.

Former PracticeOne and Picis CFO Scott Lentz takes over CFO responsibilities at Aprima Medical Software. Interestingly, Lentz started at PracticeOne just this last January.

The American Academy of Professional Coders introduces an online ICD-10-CM code conversion tool that converts ICD-9-CM codes to ICD-10-CM codes (and vice versa). The tool is free and looks pretty easy to use, even for someone who knows nothing about coding (like me). Note that the site doesn’t provide any sort of data conversion of your existing files, but advises you which ICD-10 codes will take the place of the current ICD-9 scheme.

You got to know this was a painful discovery. A Canadian medical office realizes it permanently lost two years worth of electronic patient records, presumably during an EMR conversion.

Across the pond, Basildonand Thurrock University Hospitals NHS Foundation Trust awards a contract to Sentillion to deploy expreSSO single sign-on.

Integrated Medical Services (AZ) selects Allscripts’ EHR, PM, and RCM solutions for the members of its physician services organization.

The White Stone Group installs the latest version of its TRACE software at San Antonio Community Hospital (CA.) The implementation is the first for this newest release, which tracks communication across the healthcare revenue cycle. I interviewed the company founder Guile Cruz a couple of years ago and was impressed with the number of prominent clients and its highly functional product.

Presbyterian Intercommunity Hospital plays host to physicians and technicians from Singapore who were checking out the hospital’s EMR (Eclipsys, I believe). The Singapore group wanted to see an EMR in action before implementing their own at their 1,600-bed Singapore General Hospital.

Hoag Memorial Hospital Presbyterian (CA) implements Amelior EDTracker solution by Patient Care Technology Systems. The hospital will use the system to track patients in its 66,000-census ED.

Here’s a prediction that’s sure to appeal to many readers: up to 50,000 new HIT positions will be created over the next several years as a result of the federal stimulus package. A recent Robert Half survey of healthcare CIOs found that 76% were looking to hire network administrators in Q4 and 72% were positioned to add desktop support. If you need a lower-tech job, be assured that demand for medical records clerks is also on the rise, making Robert Half’s list of 10 Promising Jobs for 2010.

VeriChip continues to try to re-establish itself in the market, announcing a strategic partnership with the Diabetes Research Institute(DRI). VeriChip and DRI are developing a glucose-sensing RFID microchip. VeriChip also hopes to incorporate findings into its Health Link PRH.

I think this may be the best name ever for a business: Snoring Isn’t Sexy, LLC, which offers an online directory service to facilitate communication between patients and providers. The company just announced that it can handle the secure transmission and storage of all electronic communication. Curious logo, don’t you think? Is the suggestion that you get to sleep with beautiful women if you don’t snore, or that perhaps some beautiful women actually snore? (unlikely)

E-mail Inga.

News 10/21/09

From Winston Zeddemore: “Re: SNOWMED. Almost as bad as ‘HIPPA’ eruptions are ‘SNOWMED’ eruptions, where the terminologically naive misspell the name of SNOMED-CT. Here is a link to the latest, courtesy of Government Health IT.” Revisionist history does not work well with Google caches (see previous and current images above). While they were doctoring it up, they should have corrected physician’s to physicians’ unless they are being extra-pessimistic in assuming that only one doctor will be using an EMR by 2015 (not likely since they’re owned by HIMSS now). The same reporter misspelled it the same way in Government Computer News, so it’s time to fire up that spell check dictionary. Googling turns up several other examples by people who should know (or is that KNO?) better.

From Will Weider: “Re: de-identification. Wired finally picked up a story you highlighted months ago.” They sure chose odd sources in trying to flesh out a New York Times article about patient privacy: CCHIT’s marketing director, investment guy George Hill, and a 2007 quote from PAMF’s Paul Tang from Modern Healthcare (which they spelled wrong). They did, however, spell HIPAA correctly and put up a nice graphic from Patient Privacy Rights (although it was too small to read).

From ITRN: “Re: Epic. Did KLAS report they had a de-install in 2008?” I don’t have access to KLAS (I have no KLAS, in other words) so I’ll ask readers to chime in.

From DDD: “Re: Windows 7. I upgraded a month ago and have found it to be more and more intuitive every day. There’s no ‘killer app’ per se, but management of multiple apps, windows, files, etc. are amazingly different. Learn how to use it, and I’ll bet you become a fan.” They said that about Office 2007. At work, I de-installed Access 2007 and went back to 2003, every minute in front of Word is torture, and the only reason I don’t dislike Excel and PowerPoint is that I don’t use them much. Like they say, change is welcome only when the status quo is untenable, which it wasn’t. Maybe I should install Win7 on a spare PC (I love that PCs are so cheap that everyone has spares) and report.

From Secret Squirrel: “Re: McKesson. Horizon Clinical Infrastructure (HCI) appears to use hard-coded database passwords. A security organization has run the entire password list online.” I thought everyone knew that, but maybe not (I reconsidered adding fuel to the technical fire, so I’m not including the link). The poster was amused that e-mailing security@mckesson.com bounced back as undeliverable. I would imagine that many vendors have services that log on as “users” that may or may not use encrypted passwords, some of which give full read/write/update database privileges. I would also imagine that vendors ship default passwords (some intended as their own “back door” in case clients screw up) that unlock every system they’ve ever sold. The clients I’ve known never seem to worry much about that.

From Just Curious: “Re: EMR. I’m sure you got this question by the thousands already, but I’m curious as to what vendor your PCP uses for his/her EMR? Thanks and keep up the great work!” It’s McKesson, he told me last time, although he didn’t seem too certain.

From Enrico Brizzi: “Re: CPHIMS. I was wondering what the industry’s current view of the CPHIMS designation is, specifically in Canada since CPHIMS-CA is fairly recent.” I have my own opinions, but I will leave others to express theirs for a change.

From Sore Arm: “Re: flu vaccine. The Atlantic is running a major article questioning the received wisdom about flu vaccines and antivirals, for both seasonal flu and H1-N1.” The article speculates that the benefit of flu vaccine has been wildly overestimated due to the inherent variability in a self-selecting patient cohort (i.e., it’s healthier people who get the shot even though unhealthy ones are the target audience, so naturally they live longer). Also, that a lot of “who the hell knows” deaths get incorrectly coded as influenza. The conclusion from a noted investigator: getting the flu shot doesn’t reduce mortality rates at all. The high-powered naysayers say, studies aside, they still believe in it and don’t like all the frowny talk. The article also questions why the US government has stockpiled millions of doses of Tamiflu and Relenza despite lack of evidence that they are effective.

From Bernie Tupperman: “Re: Archimedes. Kaiser licenses it to corporations to screen employees, but you can use it free since it was licensed to the American Diabetes Association. You put in your numbers and it takes about 10 minutes to crunch your data to show your 30-year risk of diabetes, stroke, heart attack, and complications. You can then play with the numbers – what if you lose 20 pounds or start taking aspirin? This is a great patient motivational tool and I am busy telling EVERYONE.” That is just cool (access it here). I didn’t realize that it was Kaiser’s but it is definitely an eye-opener. Brilliant.

The VA engages the Industry Advisory Council to identify the issues involved with keeping and modernizing VistA. This sounds ominous: “… opportunities and impact of modernizing and deploying VistA upon private industry …” Surely they aren’t considering dumping VistA just to protect for-profit vendors.

Weird News Andy sniffs out this story about a high-tech scalpel that detects the presence of malignant cells from cauterization smoke, helping surgeons remove all parts of a tumor.

Gila Regional Medical Center (NM) chooses the Cboss patient payment portal.

Cleveland vendor Lakeshore Health System announces Urgicode, which notifies the pharmacy via a cellular network when a code cart is used, then allows restocking by bar code. They probably should have held off on the press release until they improved their Web site a bit, like maybe adding the company’s address, phone number, or that same press release.

Healthcare Growth Partners releases its Q3 2009 Healthcare IT Transaction Summary (warning: PDF). Not to give away the conclusion, but merger and acquisition activity is on the upswing.

TPD forwarded a link to the Kaiser Family Foundation’s tool for comparing health care reform proposals.

I enjoy reading comments left for articles, but I need to disclose that I have the obligation to edit or remove those with advertising, personal attacks, or questionable claims. That almost never happens, but just so you know.

GE Healthcare announces that something has finally come to market from their Intermountain relationship: a new real-time decision support product. Details were skimpy and buzzwords were ample, but it might be interesting given Intermountain’s original HELP system and the work of Brent James. It will be “unveiled” at HIMSS.

Speaking of HIMSS, I keep forgetting to mention the keynote lineup for the March conference: Sprint Nextel CEO Dan Hesse (I’ve never heard of him and Sprint’s shares have dropped from $25 to $3 in four years, so I’ll pass); celebrity doctor Sanjay Gupta (you can see him free everywhere); Harry Markopolos (him I’d see – he’s the former Army officer and securities executive who tipped off the SEC boneheads about Bernie Madoff); and pilot Sully Sullenberger (who has started a safety consulting firm and might be interesting). Given the propensity of HIMSS to grab whomever is popular at the moment, I expected Balloon Boy (like Dana Carvey and that guy who sawed his own arm off in previous conferences). I should run a poll on who they should get since I haven’t been happy with the choices for several years.

Vangent, Inc. says ONCHIT has chosen its HIEOS HIE system as a component of NHIN CONNECT Gateway Version 2.2, which includes XDS.b and XCA profiles (its open source Wiki is here).

Sequel Systems announces GA of its SequelMed Patient Portal for practices, priced at $75 per provider per month according to its site.

San Francisco IPA Brown & Toland Physicians says one reason for its spat with UCSF is that the hospital didn’t want to participate in its EMR program. From Googling, it appears that the practice uses GE for practice management and Allscripts for the EMR. UCSF, you may recall, just halted its own GE Centricity Enterprise project. According to a rumor posted here last year, the IPA was threatening to cut off referrals to doctors who wanted to stop using its EMR and billing services.

More e-health fraud accusations in Canada, this time in British Columbia. Allegations have been made that health ministry officials paid falsified invoices and improperly chose vendors for an $108 million project.

And more: Canada Health Infoway is under government scrutiny for heavy use of consultants, missed deadlines, and having spent $1.6 billion so far with another $500 million on the way. The newspaper article points out that Infoway fell far short of its goal of covering 50% of Canadians with an EMR by March 2010, currently stuck at 17%. The federal auditor’s report will be out next month.

Geisinger Health System (PA) partners with Navigant Consulting to offer consulting services, including those related to EMRs and process improvement. I’m not sure how I feel about that or any other hospital business that has nothing to do with caring for their own patients, but it’s all the rage.

The managing partner of consulting firm Courtyard Group, stung hard by the reports of auditors investigating eHealth Ontario, says his firm was deeply entrenched in the project, but only because the agency’s people were clueless and without goals. He claims the company billed only $7 million of an authorized $10.6 million. His quote about the predecessor agency Smart Systems, which spent $800 million to build a non-Internet based network that went mostly unused: “I remember a conversation with the previous CEO of Smart Systems and he was very proud of the fact Ontario was the only jurisdiction in the world building a private health network. My reaction was, maybe the fact we are the only ones doing it might be an indication this is a bad idea.”

Epocrates announces that its drug reference will run on BlackBerrys.

Virtual Radiologic upgrades its vRad Enterprise Connect product work with new mobile device and speech recognition support.

Cedars-Sinai and GE Healthcare get their first lawsuit (of many, no doubt, and this one seeks class action status) over the CT radiation overdoses caused by unnoticed equipment settings.

Odd: the IT guy at an animal hospital changes the computer system to record a Valium tablet dispense when artificial tears were ordered, allowing him to pocket 18 of the tablets worth $3. The animal hospital let him slide after he quit over it, but then filed a report after the admitted addict tried to claim unemployment.

MIT’s Technology Review interviews ONCHIT head David Blumenthal. I like his terse answers: the writer asked why insurance companies don’t push EMRs, and he said, “The insurance companies have been able to pass along the costs of waste in our health-care system to their clients.” When asked about why progressive hospitals like Blumenthal’s own Mass General don’t share data, he said, “There has never been a business case for health-information exchange. As a matter of fact, there has been a negative case: if you give away your information, you may lose it. You may lose the patient.”

E-mail me.

HERtalk by Inga

California-based St. Joseph Health System cancels its Perot IT outsourcing contract and establishes a new system-wide service center in Lubbock, TX, expecting to add 60 jobs and $3.1 million in salaries the first year.

Healthcare deals represented nearly 30% of all US mergers so far this year, based on dollar value. Typically, healthcare represents only 10%.

Swedish company Anoto Group announces that the EDs at Western Maryland Health System have transitioned to MEDITECH’s EMR and are using Anoto’s digital pen and paper technology. In case you missed it, I mentioned a similar product called Shareable Ink that I saw at last week’s MGMA meeting. As long as the data capture will fully integrates with the EHR and the price point is reasonable, I think the digital pen technology has a lot of potential.

I’m thinking about trading out my Snuggie for one of these. Arizant Healthcare introduces a fully covered hospital gown that features a built-in warming system that blows warm air through tiny holes in the garment. The “Bair Paws Flex” gown sounds like the perfect Christmas gift for that hard-to-buy-for relative.

Cerner teams up with CDW to promote Cerner’s PowerWorks, the first time Cerner has offered its ambulatory suite through a national partner. Clearly Cerner wants to make sure it receives its share of the ambulatory EHR money that vendors expect to flood the market.

Picis announces that 25 hospitals have selected its Anesthesia Manager software this year. Among the new contracts are two with the VA for Picis Anesthesia Manager, PACU Manager, and Critical Care Manager.

University Children’s Eye Center (NJ) selects SRS’s hybrid EMR product. The Eye Center’s physicians are on faculty at RWJU and St. Peter’s University Hospital.

Axolotl Corp. realigns its management team, naming a new president, COO, and two VPs.

Wolters Kluwer Health announces new sales, including SwedishAmerican Health System’s (IL) and Signature Healthcare Brockton Hospital’s (MA) purchase of ProVation Order Sets to automate authoring and maintenance of evidence-based order sets. Sadler Clinic (TX) is also adding ProVation MD for procedure documentation and coding.

Oregon Health & Science University says it has received $51.5 million in ARRA funding, which has helped create 116 full- and part-time jobs. That’s about $444,000 a job, though the university does expect to add more. So far, the grants have funded over 100 research projects which require additional lab employees.

Eclipsys names six winners in its 2009 Circle of Excellence Awards. Winners had to demonstrate innovation and achievements in  process improvement, adoption, or collaboration, or actively participate in the Eclipsys ClientConnect program. Recipients were given $2,000 to be donated to a charity of their choice.

Rutland Regional Medical Center (VT) agrees to serve as a national host site for visiting community hospitals. Rutland will demonstrate to visiting clinicians and administrators how they utilize various GE solutions.

The MEDSEEK folks informed us of their ranking in Deloitte’s Technology Fast 500 program, based on the company’s 346% fiscal year revenue growth over the past five years. There was no healthcare-specific grouping. but I identified several in the “software” group. Congrats to GetWellNetwork, CAREfx, Red Hat, CodeRyte, athenahealth, and other HIT companies making the list.

BryanLGH Medical Center (NE) contracts for Salar’s electronic forms tool.

NorthBay Healthcare (CA) retains PHNS to assess its readiness for obtaining ARRA funding, an example of stimulating the economy without the government spending a dime.

Physicians are using Kryptiq’s escriptMessenger software to send 310% more electronic prescriptions than last year. Its 10,000 users send about 1 million electronic prescriptions per month. I think it is safe to say that e-prescribing is finally catching on, in the same way everyone has long been predicting EMR will.  Hard to believe it has been 5-1/2 years since George W. Bush made mention of computerized health records in his 2004 State of the Union address.

Social media update: I now have 25 friends on Facebook (and frankly pretty amused by the amount of time some of our readers spend doing goofy quizzes). Also, 216 connections in LinkedIn (which is about 100 less than Mr. H, but who is counting?) Also, 574 followers on Twitter (200 less than Mr. H, not that I noticed.) Forever the undercard.

E-mail Inga.

Healthcare IT from the Investor’s Chair 10/19/09

Initial Public Offerings, Part 2

The IPO market for HCIT continues to show some signs of life, or at least hoped-for life, as Accretive Health filed its IPO Prospectus (known as Form S1) with the SEC for a $200 million capital raise in late September, with part of the use of proceeds to pay back its private equity investors. Those who notice, track, or even care about such things observed that the company filed with four of Wall Street’s largest firms (known as Bulge Bracket banks) as lead managers — Goldman Sachs, Credit Suisse, JP Morgan, and Morgan Stanley.

These four Goliaths will take about 90% of the offering fees (known as economics), leaving the crumbs for one or two smaller firms that actually focus on HCIT to take or divide. An interesting choice to motivate those smaller banks and their analysts who will actually be paying long-term attention, but, clearly their prerogative. By the way, if this paragraph is meaningless to you, you probably missed my last post and might want to read it before proceeding (here).

Loyal readers will recall that when last we tuned in, our intrepid management team of HISTalkCo had just decided to go public and, after completing the ordeal of selecting underwriters (and, almost as bad, the economics negotiation) was getting ready to start the next phase of the process. After the dust settles on economics and cover order discussions, it’s time to begin the process in earnest. This starts with an “org meeting,” short for organizational.

The org meeting ritual sets the stage for the fun to follow. They generally start first thing in the morning in a location at or near the company issuing the stock (known as “the issuer”, or “the client”). Org books are handed out by the lead underwriters’ junior bankers and the meeting is called to order by the senior banker from the lead firm. The first 30-40 minutes are what I always refer to as “Mousketeer Roll Call”, aka introductions. This is where everyone in the room introduces themselves. Why so long? It’s a big crowd. For an org meeting, you’ll almost always see a few members of the management team (3-10, in my experience), three or four bankers from each firm (except for the lead, who brings a small army of bankers and capital market folks), two sets of lawyers (one set for the company, one set for the underwriters), and often some accountants. Before Elliot Spitzer changed the rules, you’d always have the equity analyst and usually their associate at the shindig as well, but those days are gone. It’s a big group, and usually a costly one.

Then the managing director of the lead firm re-takes control, reiterates their pleasure in being there, and then starts going through the rest of the agenda for the day and the subsequent weeks of the process. It always seems to be “a great story” that he or she “expects to have minimal issues with the SEC” and there’s always an “aggressive, but achievable” timeline. All agree to that, and it’s on to D&D — no multi-sided dice though, it’s time for diligence and drafting. The CEO, usually aided by the CFO and a few others, begins telling the story of the company in, of course, as glowing terms as possible, all with the goal of creating a prospectus that, in addition to having the required disclosure of risks and history, is as much of a marketing document as possible. This prospectus and the roadshow presentation delivered are the tools management and their bankers have to market the stock to potential investors.

Oftentimes these meetings start with a draft that’s been developed between company, lead underwriters and lawyers, making the process easier, but it’s primarily committee-driven, with all the fun and efficiency that suggests. From this point, there are multiple steps required to create the prospectus that will ultimately be submitted to the SEC for review.

First, the underwriters have a fiduciary responsibility to exercise “due diligence” to ensure that what’s being claimed is, in fact, the case. That means over the next few weeks, representatives of each bank will share conference calls with their clients’ clients, suppliers, and others who can verify that the system or product does what the prospectus and marketing materials claim. At the org meeting or subsequent drafting session, each member of the executive team will stand before the underwriting group (and lawyers) and discuss how they manage their department and discharge their other responsibilities. Sales pipelines and how they’re tracked will be discussed; product plans reviewed, and financial controls and forecasts are analyzed and “diligenced”.

It’s an important part of the process, and, in my experience, taken quite seriously. In addition, risk factors have to be discussed (and blessed by lawyers from both sides), though they are quite often cribbed from competitors’ SEC filings. Cover art is shown and discussed over and over again and the first few pages (known as the summary, or “the box” for the box it appears in) are virtually, and not inappropriately, obsessed over (“should the logo be that big?”).

Drafting a prospectus can generally take months and it can be painful. After the first diligence session, the herd of attendees is thinned dramatically, however. Senior bankers who aren’t at the lead firm rarely if ever show up after the first meeting. In many instances, I’ve been the most senior non-book-running banker in attendance, in part because my “pitch” to get my firm on the cover was that I’ll bring the research perspective to the process. Hopefully I always managed to.

While the diligence aspects of the meetings are often interesting (at least to me), it’s the drafting sessions that really drag and drag and drag. These are where the document actually gets written and rewritten and each mid-level banker (generally associates, but occasionally VPs, who should know better) tries to put a few fingerprints on the prospectus and show that their firm really and truly cares. There’s nothing quite like being in a room of 15 or more people, some of whom are paid by the hour (remember the lawyers present) arguing over whether something is a ‘strategy’ or a ‘tactic’, which SIC code to use, or how to punctuate a sentence to really get your blood running!

Possibly my favorite drafting session moment was underwriting a company that made blood glucose meters. The prospectus had a table that showed various parameters of each meter the company made, one of which was atmospheric tolerance (how many feet above sea level it could function). An associate from a co-managing firm asked (in her only speaking role of the day, I might add) if that meant they couldn’t be used on airplanes. The CEO took a breath, and patiently explained that no, it didn’t, because airplanes tend to be pressurized. I’m guessing said associate earned over $250,000 that year. The number of drafting sessions vary depending on the complexity of the story, whether any are done via conference call (where senior bankers are often on for the beginning and ends and have junior folk listen and throw in occasional comments for the vast middle) and how much the story needs prettying up for the investors.

Are these as bad as they sound? Yes, except for a few aspects, top of which can be the food! I had one Minnesota-based IPO client that had its meetings at its New York law firm, and, with apologies to Mr. HIStalk’s meeting comments, the spread they brought in was better than some weddings I’d been to. I remember commenting to my junior colleague that only in New York could you see sushi, corned beef sandwiches, and buffalo wraps (plus much, much more) at the same buffet. All that was missing was a bar.

How else could you pass the time? Like other corporate types, there was the ubiquitous BlackBerry usage. Recall that the BlackBerry was first popularized by bankers and you’ll have an idea of just how much your thumbs could hurt after a marathon drafting session. Clients, bosses, even friends and loved ones could be contacted during these meetings. Once in a while a banker would get caught, but for the most part, it was more or less ignored — though the CEO of Visicu imposed a strict no-BlackBerry rule in his sessions — at least for the ones he attended. Aiming for subtlety, I sometimes worked on other things, but on paper. My best use of time during an endless tangent was writing a poem for my wife, so it wasn’t a total waste.

Many, many circulated drafts later, hopefully close to the scheduled date, it’s time to “go to the printer”. Now, I’ve never been to the printer, as I became a banker at a senior level and my old firm never lead-managed a deal in HCIT, so much of this relies on colleagues’ stories. The printer, not surprisingly, prints the prospectus and oversees its transmittal to the SEC. Back before computerization, this relied on typesetting and other complex processes, but in the days of WYSIWYG (you young folks look up that term), it seems needlessly complex.

While at the printer, auditors sign off on the financial statements, the lawyers do their final bit of obsessive wordsmithing and editing — helped by junior bankers (analysts and associates) who’ve been instructed to find times to chime in to ensure the smaller firms are perceived by the management as “adding value”, final battles are fought over cover order (believe it or not) and the i’s are dotted and the t’s are crossed before the lead manager “pushes the button” and it’s off to the SEC. Printer sessions can last well into the wee hours and there’s a fair amount of idle time while these things happen, so I’m led to believe the place is stocked with an array of goodies (from snacks to beers) and toys (from pool tables to massage therapists) to occupy the oft-abused junior folk, where they’re finally treated the way many of them believe they should be. Sadly, the advent of WiFi and laptops makes the printer less fun than it used to be as they’re expected to keep working through the night on other projects. But, all good things come to an end and now the S1 is on file with the SEC.

I apologize if this is starting to sound like Schoolhouse Rock (I’m an S1, I am just an S1 and I’m telling you that drafting’s not fun…), but Bismarck must have forgotten this task when he said Laws are like sausages: it’s better not to see them being made.

Once the SEC has the first draft of the prospectus (and it’s simultaneously posted to www.edgar.sec.gov), a few things occur. First, HISTalkCo’s clients and competitors can all rush to read how profitable the business is (if at all), how it describes its business and, for the nosy friends, how much senior officers earn (“wow, I knew Inga had nice shoes, but always wondered how she could afford them”), and how much stock they have and what it will be worth at the time of the offering (“hmm, guess she’ll start shopping at Ferragamo”). Competitors can have a field day sharing the bad parts (like boilerplate risk factors or accounting details) with potential clients: “It says here if an asteroid hits their facility, they may experience service-related issues. Are you sure you want them as your vendor?”

Meanwhile, the issuer is assigned an SEC examiner who carefully reads the whole document and has approximately 30 days to send the company and its lawyers and underwriters a “comment letter.” These letters vary in length, but are usually at least a dozen pages and require the company to substantiate virtually every claim made, or at least tone them down. While at times these comments can get a bit silly, by and large, I think they do protect the investing public, which is, after all, the agency’s primary goal, we’re told. While the SEC doesn’t rule or opine on the veracity of prospectus statements, they do, in general, ensure that risks are disclosed and the worst hyperbole is eliminated. The company (and its underwriters and lawyers) amend and resubmit the draft and the process iterates until all the comments are “cleared” and the document ruled acceptable — kind of like a software QA process.

HISTalkCo now has an acceptable prospectus, it’s time for the Roadshow!

While the review process has been taking place, the lead (and occasionally the co-) managers have been working with the client on the presentation that the CEO and CFO (say, Mr. HIStalk and Inga) will give to institutional investors on the roadshow. With the help of the underwriters (and occasionally consultants or colleagues), Mr. HIStalk and Inga have rehearsed their presentation over and over again and also been prepared for any potential question that might be thrown at them. New suits (and perhaps shoes for Inga) are bought, hair is cut, and it’s time (cue the music).

Most firms have set itineraries that they like to use for roadshows and have it down to pretty much a science to ensure that the parts of the country that matter (to them) get covered as efficiently as possible. At the very least, this tour will include New York, Connecticut, Boston, Denver, San Francisco, San Diego, and Kansas City. Minneapolis, Chicago, Los Angeles, and even Europe, depending on the type of company and how much demand is forecast, are often added to the itinerary. The two fun-filled weeks go like this:

First, the management team delivers the 30 minute or so presentation to each of the underwriters’ sales forces (the people who call on the mutual funds, pension funds, and hedge funds that will buy the stock and pay all the underwriters’ commissions), then they hit the road along a pre-planned itinerary where they’ll repeat the presentation 50-100 times. Then it’s almost one of those scavenger hunts where management (accompanied by bankers of varying ranks) go from fund to fund in city to city in limos and often private planes (as schedules are tight).

The itinerary is constantly evolving as the sales people (perhaps mindful of the higher commissions inherent in an IPO) call their institutional clients and suggest they take a meeting with HISTalk Co (“as it seems to be a great play on the growth of HCIT in America”). Large funds get private meetings, smaller or less-active funds are relegated to group lunches or breakfasts where they hear the same story. When I was an underpaid associate research analyst, I’d sometimes go to these lunches, partly because hearing lots of stories was a good way to get trained (and hone my BS detector) and partly because the food was often better than I could afford for dinner, let alone lunch.

The quality of the meetings varies greatly and range from buy-side analysts who have no intention of recommending their firm buy, but are doing a favor to the sales person who took them to a game last month (it’s good to be at a big fund), to portfolio managers who’ve not even looked at the S1, but liked the sales pitch, to analysts who will grill the management team on even minute items and likely read the document more carefully than some of the bankers or even the company did. So, the meetings vary, as do the accommodations (but generally we’re talking Four Seasons level) and the amount of annoyance generated for both sides.

Management’s goal here is to convince the investor that HISTalkCo is a stock worth owning for the long haul. Simultaneously, the firms’ research analyst is fielding calls from potential investors, answering questions, sharing his or her estimates (which, incidentally, are never provided in writing), and trying to help sell the deal as well. They’ll have done separate diligence from their bankers to build their own models and (in theory) form their own opinions (thank you, Mr. Spitzer).

After the management meetings, the investors decide whether they want to own the stock and, if so, how much and at what price. As I mentioned last month, while the underwriters suggest a target price, it’s the investors who actually determine it, and it works as follows. Readers will recall from the last post that the underwriters (now, primarily the lead), have established the likely price of the stock as it relates to comparable companies and applying a 15% “IPO discount” to offset the risk inherent in buying a stock with no trading history. This range of values is what’s put on the cover of the prospectus a week or so before the road show so that investors will have an idea of what the company is worth, at least in theoretical terms.

Economics teaches us that prices are set by the intersection of supply and demand. The supply of stock is generally limited, so price depends on demand. Each fund that wants the stock will decide how much (up to a ten percent order) they want, and at times will say, we want none at $x/share, 5% at $y/share, but would take 10% if it’s priced at $z/share. Others and smaller funds will just say no, or how much they’d like to buy. Meanwhile, the lead underwriter’s capital markets department is keeping track of all this in a “book”, hence the term “book-runner”. The goal (and, in fact, some of their art) is to build a book that is over-subscribed (more demand than supply), so the stock will be priced within the hoped for range and, ideally, jump up after it opens on the market as funds buy more to build the amount of stock they want to hold (a position).

In some cases, demand within the range exceeds supply to an extent that the underwriters will “raise the range” and target a higher price, and/or the company will sell more stock. In less happy situations, issues price “below the range” and the price is lowered. Because companies want long-term shareholders, not funds that will sell the stock immediately to gain the 15% (or higher, in the case of a hot issue), the book runner primarily focuses on those funds that indicate they like the story or have a history of being loyal shareholders. I say primarily because, if an IPO is dramatically oversubscribed, the stock will rise immediately, and some funds will sell into that demand (a practice known as spinning) and make a very quick and easy profit. This can be a way for underwriters to reward loyal clients (saying, in effect, “sorry the last IPO you bought didn’t work, we’ll make it up to you with this one” or, “thanks for all that other commission business you’ve given us lately”.) Back in the dotcom days, banks did the same thing for CEOs of hoped-for clients as a way of currying favor (see “Friends of Frank” for details, or ask me in a follow-up post to discuss that phenomenon).

Once the calendar says the road show’s over (and hopefully it’s even close to the same date as we predicted at the org meeting), it’s time for “bring down diligence” and the pricing call. Bring down is simply checking in that nothing material has changed. In my experience, it rarely has. Then the lead banker and capital markets guys have a chat with Mr. HIStalk and his board or other advisors. The state of capital markets over the past few days is rehashed, the team congratulated on what a great road show they put on, the orders summarized, and the lead underwriter recommends a price of $x/share.

Assuming that’s acceptable to the company, the orders are then filled based on an amalgam of size, price, importance of fund to the investment bank, promises made by the funds to buy more the next day (known as the aftermarket), favors owed, and the best judgment of the capital markets group. The orders are thus filled in the morning, the Registration Statement is declared “Effective” by the SEC and HISTalkCo is now a public company (maybe Mr. HIStalk even gets to ring the opening Nasdaq bell). Depending on the state of the broader market that day or week, how strong the book is, and how good the allocations were, the stock than starts to move. Part of the art is to allocate and price it so that there are more buyers than sellers and the stock goes up and everyone is happy. That said, if it goes up too high, the company (and bankers) just left money on the table as they could have sold the stock at a higher price, but a big first day pop gives some bragging rights, so issuers don’t tend to complain too much when that happens.

From this point, all that management has to do is manage their business as before, but pay attention to investors, analysts, and the SEC, while ensuring they always hit the quarterly targets that investors are expecting. Miss a quarter, you can see your net worth plummet. Hit them consistently and it can skyrocket. It’s all just part of the fun that being a public company entails (well, that and Sarbanes-Oxley). I’m stunned, simply stunned that Ms. Faulkner continues to pass it up.

This was a long post, and I appreciate your patience in reading it. Please keep the questions coming, I’ll devote more of the next post to answering them.

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

Monday Morning Update 10/19/09

From eHealthDC: “Re: the Senate’s plan for making EHR incentives permanent. I had staff follow up on the story. According to a source, there was some misquoting – while there are a few areas of interest in Senate Finance, it does nothing aggressive on HIT. The key areas it touches on are the following: (a) the Secretary will conduct a study on methods to encourage meaningful use by entities offering insurance plans through a state-based exchange; (b) organizations participating in the CO-OP program will be permitted to enter collective purchasing arrangements for HIT-related materials; (c) the bill requires CMS to develop a plan to integrate the PQRI program with the standards for meaningful use; (d) no less than triennially, the Secretary will identify quality measure gaps and may appropriate grants to entities with expertise in developing such measures. These measures specifically include, among others, meaningful use of HIT. To this end, HHS will appropriate $75 million for fiscal years 2010 – 2014; (e) free clinics will be eligible for meaningful use Medicare and Medicaid HIT incentives; (f) the Secretary will incorporate reporting requirements and incentive payments and penalties related to electronic prescribing and EHRs into accountable care organization requirements; (f) the bill creates a bonus payment structure for care coordination and management activities conducted by Medicare Advantage plans. HIT programs are included as eligible activities. Nothing earth-shattering.” Thanks.

From MEDITECH Customer: “Re: Kronos. I guess it isn’t really a rumor since I heard it first from my Kronos sales guy, then verified it in about half a dozen places. Kronos bought Stromberg from Paychex Inc. Stromberg had been beating out Kronos in some of the small hospitals in my area lately.” Paychex sells its time and attendance business to Kronos for an undisclosed sum. Kronos gains 1,400 customers that it describes as primarily mid-market (250 to 1,500 employees). Stromberg was an independent vendor in Lake Mary, FL that Paychex acquired in 2004 after first buying its Time in a Box product for small businesses the year before. It continued to operate under the Stromberg name as a Paychex subsidiary, offering free version upgrades, fixed price implementation, and a 99.7% customer retention rate.

From HITgeek: “Re: Siemens reorg. You can assume that Siemens reorg rumors around this time of year — right at the start of its fiscal year — are based on reality. Siemens’ most dependable product release timing is new org charts every year.”

From Simon Kirke: “Re: Meditech 6.0. I hear Meditech is forcing customers to buy a scanning and archive product with Meditech 6.0, even if they have a current document imaging solution. Can you verify this?” The floor is open.

From VA HIMSS: “Re: HIMSS. Friday night at the VA HIMSS Fall Conference, John Hoyt, VP HIMSS Analytics, said that HIMSS sees itself as matchmakers between providers and vendors. Huh? I thought HIMSS was a professional organization!” I’ve said all along that HIMSS is a highly profitable bar with a business model in which ladies (providers) drink free provided they don’t mind being groped by men (vendors) who pay dearly for the privilege. As evidence, I usually link to the HIMSS Exhibitor Priority Point Opportunities list (warning: XLS) that enumerates what vendors have to buy to earn the right to spend massive dollars on their annual conference exhibit (the cover charge?) 

I’m fascinated by the unintentional insight provided by responses to the poll I did on whether your primary care doctor uses an EMR. The PCPs of 63% of respondents use an EMR, which is astoundingly high and, frankly, hard to believe as representative. However, only 23% feel so strongly about EMR use that they would choose only EMR-using doctors, so those of us in the HIT industry aren’t eating our own dog food.

My doctor uses an EMR and I’m finally buying the concept after longstanding skepticism. I can confirm my appointment online and pay my co-pay online with a credit card (which lets me skip the check-in at the office), I can see my labs online from anywhere with his notes about what they mean, he can pull up my records from anywhere I’ve been seen within the health system, he uses e-prescribing, and he has done a great job in integrating the EMR as part of his patient teaching right in the exam room. Nobody has asked me even once for repetitive information. And most importantly, he says he finds it useful and clinically beneficial. Like most of the respondents, I’d stick with him even without the EMR, but it makes my encounters more convenient, adds clinical value, and gives me the peace of mind that if I show up at another health system facility I won’t be just an empty clipboard to them. I get it, I like it, and I’m looking forward to having more electronic and online services. I figure it’s no different than when I get my $13 haircut from the local cheap chain place since they look up my records by telephone number, their version of an EHR (electronic haircut record).

New poll to your right: are you and/or your employer planning to upgrade to Windows 7? It ships Thursday. I’m riding the fence myself. Microsoft panicked that it would lose impressionable students for good when Apple priced its Snow Leopard upgrade low, so I’ve got a $29.99 upgrade coupon for Windows 7 Home Premium since I have an EDU e-mail address for reasons too complicated to explain. Even then, I’m finding it hard to get excited about displacing XP since the Vista wounds are still fresh and I’d have to install from scratch this time since there’s no XP upgrade. Everything I do is on the Web, so I don’t know that a prettier and allegedly better Windows would change my life since Firefox would still look the same.

I see some folks have added their Webinars and conferences to my events calendar. Just a suggestion: put them up well in advance so those interested folks can lock in. You won’t get many new registrants for an onsite conference if the posting is made the week before.

A reader forwarded an e-mail from Kaiser CEO George Halvorson touting the Archimedes healthcare modeling system. Interesting: it’s an artificial intelligence system that uses computer models of the human body to analyze treatment approaches, rather like a virtual clinical trial. Kaiser did a stroke and heart attack prevention study with it to determine optimal combinations of drugs in a large population. It predicted that a combination of aspirin, lisinopril, and lipid-lowering agents would reduce risk by 71%, darned close to how it turned out in Kaiser’s real-world result of 60%. It has rolled out the protocol to 250,000 patients. Kaiser is the ideal environment for that kind of project since it fully manages its HMO patients and is incented to improve their health.

This isn’t news to us industry types, but an investigative report says EMR stimulus could cost twice the $19.5 billion figure that everybody remembers. Now we all know the real numbers – the incentives are pegged at $46 billion but will supposedly be offset by non-specific savings, giving a net cost of $19.5 billion as a best case. The report quotes a taxpayer group that compares HITECH to irresponsible overeating with a plan of going to the gym later to work off the calories. There’s not much point in debating whether the numbers are right or wrong, however. Once you’ve hitched your wagon to idealistic taxpayer bailouts as a national program despite crushing national debt, you shouldn’t expect the SWAG numbers to be anything more than irrationally exuberant.

UMass Memorial chooses Accenx Exchange for interoperability.

Iowa Health System and Allscripts launch ePrescribe Iowa, in which physicians will be offered a free Web-based e-prescribing tool.

Eclipsys Sunrise Pharmacy customers are on the rise, although exact numbers aren’t given in the press release. It says 80% of them do CPOE on Sunrise (a more interesting stat would be the number of its CPOE customers using their pharmacy system, of course, since Sunrise Pharmacy probably isn’t bought as a standalone system very often). It has some big-name users like El Camino, RWJ, SUNY Downstate, University of Kentucky, and HUP.

University of Iowa Health Care creates a half-time CMIO position and hires otolaryngologist Douglas Van Daele, MD for it. He’ll oversee its new $61 million implementation of — you guessed it — Epic. Their state representative gripes that UI gave the doc a $46K salary boost to $291K, saying, “I can’t think of any justification for adding any position while these cuts are being made that can’t draw down more (grant) dollars or doesn’t save lives. I can’t believe they’ve gone this long and they are adding it into a half-time position — and that couldn’t wait?" Apparently there’s friction over the university’s recent layoffs and some other recently added executive positions.

If you’re a fan of Dr. Gregg Alexander on HIStalk Practice and are attending the American Academy of Pediatrics conference this week, Gregg invites you to stop by the Pediatric Office of the Future exhibit and then join him at the Official Unofficial HIStalk Practice Happy Hour Reception at the President’s Sports Bar in the Renaissance Washington from 5:00 to 7:00 p.m. on Monday, 10/19. It’s a block and a half from the conference center.

Indiana cancels its 10-year, $1.34 billion welfare services contract with IBM and ACS, saying “the system wasn’t working, and it wasn’t getting better, despite best efforts.” The failed effort to privatize the systems was the largest contract in state history. It was supposed to save the state $500 million. ACS call center workers said they were told to lie to welfare recipients whose benefits were delayed, always telling them they’d get them within 48 hours just to get them off the phone. House Speaker Pat Bauer wants IBM to “go away and pay us something.”

Speaking of Indiana, its HIEs band together under a new governance organization called Indiana Health Information Technology to apply for stimulus money.

GE announces ugly Q2 numbers: revenue down 17%, EPS $0.26 vs. $0.54. GE Healthcare’s earnings were down 20%.

Just who you want advocating for EMRs: South Carolina Governor Mark Sanford, who is best known for disappearing for a week to cavort with his Argentine mistress and then lying about it with a lack of skill that is surprising for a politician.

Vanderbilt University Medical Center gets $6.4 million in stimulus money to look for a link between drug performance and genetic factors, matching 67,000 DNA samples in its database to de-identified patient medical records.

E-mail me.

News 10/16/09

From Nash Rasty: “Re: HIT Regional Extension Centers. Is there a list of sites that are on the preliminary approval list? Is it your understanding that for-profit vendors can provide technical expertise? I’m foggy on how companies can get involved.” I haven’t seen a list. I believe the original announcement indicated that the non-profit organization that is awarded an Extension Center contract (up to 70 of them will be created using stimulus money) can farm some of the work out to a for-profit company. In fact, Perot has already thrown in with AMGA and MGMA to offer services to them. I assume but don’t know for sure that each Extension Center is free to choose its own partners. That’s an interesting point: there’s going to be a ton of spending by these organizations, so if my assumptions are correct, consulting and other firms should be watching developments there carefully.

From Midwest CIO: “Re: Siemens. Siemens IT is reorganizing. Hospitals here say experienced associates are no longer with the company.” Unverified.

From The PACS Designer: “Re: Microsoft Tag. Using your iPhone to navigate the web will be easier if you use Microsoft Tag. The application is designed to read a color-coded 2D pattern called a High Capacity Color Barcode (HCCB) that is similar to the black and white checkerboard ones your find on packages which are called Portable Data File 417 (DF417). The PDF417 is a stacked linear bar code symbol used in a variety of applications, primarily transport, identification cards, and inventory management.”

I’m looking for a really good writer, preferably with a clinical background, who is on top of the mobile computing market, especially smart phones and caregiver apps that run on them. Let me know if you know of someone.

Patent troll Acacia Research Corporation extracts cash from Sage in return for dropping its nuisance suit against Sage over PACS, which Acacia claims to have invented. Despite having “research” in its name, even the company itself admits that its business is pretty much suing companies who quickly realize that it’s cheaper to buy ridiculous licenses than mount a legal defense. “The subsidiaries of Acacia Research buy patents as well as represent patent owners on contingency basis to generate revenue from licensing and enforcement.”

More hospital IT employees get the axe courtesy of a Cerner outsourcing deal, this time at Naples Community Hospital (FL). Thirty of the IT department’s 75 employees are turfed off to Cerner, nine stay on as NCH employees, and 36 are screwed.

Former ONCHIT head Rob Kolodner joins Open Health Tools, a North Carolina-based non-profit trade association of open source developers working on interoperable health records, as CIO.

A couple of readers e-mailed to say that former Baylor CIO and Cleveland Clinic IT executive Bob Pickton has been named CIO of SEHA, the health authority of Abu Dhabi. I know Cleveland Clinic has a management contract for one of its hospitals (Johns Hopkins has a couple, too), so maybe there’s a connection. Bob starts work Sunday. The high there today: 96 degrees.

A New York Times article says that time pressures, mandatory multitasking, and real-time attention demands (including EMRs) are burning out doctors who no longer have any contemplative time.

Surescripts will adopt the NCPDP SCRIPT 10.6 standard to connect EMRs to pharmacies for prescription information. 

Coastal Communities Hospital is the first site to go live on CalRHIO’s statewide HIE.

Now I won’t be able to enjoy my pork barbeque, thanks to a YouTube-prowling reader: pigs whose foodd is automatically dispensed in controlled portions by their RFID collars are smart enough to look for discarded collars on the ground and carry them in their mouths back to the feeding station, earning a second meal for the effort. I’ll refrain from making witty comparisons to healthcare scanning.

In the UK, the CEO of the Colchester Hospital trust blames poor service numbers on “data issues”, implying that the CIO was fired as a result. According to the article, “a new chief information officer had been appointed to address this.”

Stock publications have a terrible track record of being able to predict the future, so take this for what it’s worth: someone lists the five companies Dell should take over, all of them in healthcare IT. They are Allscripts, Quality Systems (NextGen), CSC, Cognizant, and Citrix Systems. Citrix isn’t technically a healthcare IT vendor, but it’s probably their biggest vertical since the industry is dominated by 1970s time capsule applications that won’t run efficiently and securely without it (my war horse Citrix joke: Citrix is like a Denny’s restaurant – chosen often, but only out of desperation). Actually I use Citrix a fair amount at work and it’s pretty cool – poorly architected fat client apps run a heck of a lot better over wireless or VPN when you’re only painting screens and not slinging massive data packets back and forth.

Michael Dell hints that the services business he’d like to get into is practice EMR hosting. I’d say that boosts the credibility of the Allscripts part of the rumor above. I bet he would love to get his hands on eClinicalWorks if the founders would sell.

Speaking of Quality Systems, it gets the #3 spot on the Top 10 Small Companies list by Forbes.

Senator Mike Enzi (WY) wins the HIMSS Federal Leadership Award. He’s HIT-friendly, of course.

Caritas Christi Health Care will use the Azyxxi part of Amalga and HealthVault, both from Microsoft.

Virginia Governer Timothy M. Kaine creates the Health Information Technology Advisory Commission, charged with spending a lot of federal taxpayer ARRA money. I don’t think I know anyone on the long list of commission members.

Five hospitals and health systems go live on MEDSEEK’s consumer portal: Advocate Healthcare (IL), Connecticut Children’s, EMN Regional (OH), Forrest General (MS), and St. Joseph (WI).

Cardinal Health signs a deal to distribute Orchard Software’s LIS and anatomic pathology systems.

Recombinant Data Corp. and Sun Microsystems sign a $4 million deal to create a translational research and quality improvement data warehouse for Health Sciences South Carolina, made up of the state’s big hospitals.

I don’t know why this popped into my head, but you aren’t a newbie if you know which popular software once had competitors named Quattro, Symphony, and Lucid.

Informatics Corporation of America wins the Best New Technology award at the HealthIT Insight Conference.

Centegra Health (IL) chooses GE Centricity Enterprise.

Everybody wants to get their snout into the ARRA trough. Medical equipment and monitoring manufacturer Welch Allyn launches an EHR preparation and selection consulting program.

Health plan software vendor HealthTrio spins off an independent company, Monument Systems LLC. The same guy owns both companies, so I’m not sure this is really big news, especially since the only thing I know about HealthTrio is that HIT industry pioneer Ralph Korpman used to work there.

The LA Times covers the Cedars-Sinai radiation overdoses, citing “the blind trust of medical machinery” as a key cause since the incorrect dose came up on the screen every time and nobody noticed for 18 months. I’m sure Cedars is doubly thrilled that the Times reminded its readers that the hospital also nearly killed the Quaid twins with massive heparin overdoses.

Interesting: 80% of Taiwan’s citizens are happy with the country’s national health insurance, they have lower infant mortality than we do, and the country spends 6% of GDP on healthcare compared to 15.3% here. Technology is credited, including a nearly universal smart card containing medical data that uploads to central systems (not separate insurance company databases) to provide a real-time view of healthcare. As a result, administrative costs there are 1.5% of the total vs. over 30% here.

Hoboken University Medical Center will implement Medsphere’s OpenVista.

New England Baptist Hospital bans social networking sites, fearing that employees could be posting confidential patient information.

Bizarre: the Minnesota Board of Nursing revokes the LPN license of a man who allegedly encouraged people in suicide chat rooms to hang themselves while he watched via webcam. At least two people did, the board said; the person who alerted police claims there were actually at least eight victims.

ACS gets a $4.5 million, three-year contact to develop the Kentucky HIE. All of us are paying for it: CMS covered the initial amount and the state wants ARRA money to take it statewide.

The Senate’s healthcare reform bill would create Internet-based health insurance exchanges with standard enrollment and make EHR incentives from the stimulus bill and make them permanent. That second item is interesting.

Pitt County Memorial Hospital (NC) says a missing Flash drive contains information on 1,700 former patients. And in Florida, a laptop stolen from the car of an employee of Halifax Health contains billing information for 33,000 patients.

The Health IT Standards Committee will assemble a panel later this month to share best information management practices, bringing in experts from other industries.

Hospital systems vendor Healthcare Management Systems will start selling an ambulatory EMR this month.

This sounds like a good job for you MD or PhD types: University of Missouri-Kansas City’s school of medicine is recruiting to fill a new position to lead a newly created department — Chair, Department of Informatic Medicine and Personalized Health.

E-mail me.

HITlaw 10/14/09

When is “perpetual” not perpetual?

Recent encounters in my practice have required me to carefully explain the intricacies of perpetual software licenses, so I decided to share some thoughts with the HIStalk readership. Perhaps due in part to the economy and in part to the anticipated availability of EHR funding, healthcare executives are asking some very specific and important questions in the HIT acquisition process, such as; “What exactly do I get for my money? How long until I must reinvest? How do I avoid or predict additional fees?”

Unless you are using a Software as a Service (SaaS) model, then you probably have acquired use of your software applications under one of many varieties of software licenses that ultimately grant to the license holder a perpetual right to use the software, subject to certain limitations. These limitations vary widely and would make a good topic for another writing. The purpose of this HITlaw article focuses on the single word PERPETUAL.

Perpetual license grants are never 100% perpetual. There is always a proviso. In most cases, this is fine and good and protects the vendor.

Here is a simple boiled down example: “Provided that the customer licensee abides by the terms of the license agreement, use of the software in perpetuity is permitted.”

Perpetual use is conditioned on abiding by the terms of the entire agreement, so read carefully and understand the license agreement offered by your vendor. Find the conditions under which the vendor can suspend or terminate the “perpetual” license.

And before I start another firestorm (like the non-disclosure clause HITlaw submission in August), let me be clear that there are some very valid and proper conditions for a vendor to suspend or terminate the right to use its software.

My point is to understand the terms of the license grant itself. First, the terms by which the license is granted (typically payment in full of all license fees) and then the events or conditions that could suspend or revoke that license. Make sure you identify the triggers and weigh the consequences as you make your vendor selection. Hard work up front can alleviate heartburn later.

Finally, keep in mind that the perpetual license is granted subject to certain limits, such as number of users, number of acute care sites, or net patient revenues. In that vein, perpetual also means “assuming status quo”. An increase in users, sites, or revenues above the stated maximum, while not a trigger for termination, could trigger payment of additional license fees, which is acceptable as long as the condition is clearly stated and understood up front.

Think of a standard cell phone bill. The customer pays a certain amount per month for up to X minutes of use. If the limit is exceeded, there is an additional fee. This is a simple example, which obviously leads to whole different discussion about being able to accurately predict the additional fees that could potentially arise should the stated limit(s) be exceeded (never leave this term open).

My advice and my mantra are consistent. Recognize and fully understand the terms of use for the license for which you are paying.

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

News 10/14/09

From Lizzie Borden: “Re: University of Rochester. I hear they just signed with Epic systems for their EMR solution. What are they installing and are they hiring? Interestingly, I also know that Buffalo Medical Group has acted proactively and offered their Epic analysts a $$ incentive to stay with them instead of fleeing to U of R.” URMC’s Web site says Epic says contract negotiations “were finalized in September 2009.” It also says that they’ve had to scale the $49 million project back, but still hope to nab $8 million of taxpayer ARRA money. It’s the full-blown inpatient system, apparently, expected to go live in the fall of 2011. Details here.

From Topper Harley: “Re: trial. Not too nice of the doctor!” An HIT company executive goes on trial this week, facing multiple felony charges for an alleged road rage incident. I initially did a detailed write-up complete with links and accident scene photos, but I reconsidered for several reasons: (a) he’s been charged, but not found guilty, which means he’s innocent; (b) he is an HIStalk reader and I’ve swapped e-mails with him in the past, so it would be needlessly painful for him to read the story here and know that his peers are doing the same; (c) I could easily wreck his career unintentionally just by giving the unproven details a spotlight. If and when he’s found guilty of something major, I’ll provide details. Until then, I’ll express non-specific sympathy for all involved and my hope that justice prevails.

From Luke O’Scyte: “Re: Ontario. It is called a learning opportunity, or perhaps a teachable moment, how not to spend one billion dollars. The Ontario government, through arrogance and folly, decided that they new best how to pick the market winners, run their own networks, decide on which technologies to approve and which to ignore. So how did that work out for them? See the auditor’s report (warning: PDF).” It’s full of juicy details, like that eHealth Ontario’s CEO paid a recruiter $1 million upfront to fill 15 management positions; one successful contractor’s bid was five times more than a comparable one and more than quadruple the budgeted amount; and $800 million of the $1 billion spent to date was for a private network that “remains significantly underutilized because as yet there is insufficient health-related information on it.” in other words, they jumped all over their equivalent of NHIN without first getting provider EMRs up and running to populate it. 

UCSF finally confirms what I reported in August as a rumor (supported by a reader-forwarded copy of an internal department e-mail): UCSF has halted (temporarily, at least) its $50 million GE Centricity project. You’d never know there was trouble in paradise if you Google UCSF+Centricity: the rags and press releases were making it sound like a match made in heaven. Thanks to SF Business Times Chris Rauber for giving HIStalk and rumor reporter UCSFWatch credit.

Here’s the next gossipy tidbit provided to me by one of those UCSF rumor reporters: as soon as UCSF’s lawyers get them out of their GE contract, they’re going with Epic. Unverified.

Cisco takes its Vision Van (or whatever you call a demo trailer) to Auburn Memorial Hospital (NY), showing off technologies such as videoconferencing and mobile caregiver communication.

Eclipsys announces scheduled events for its EUN conference in Dallas next week. ARRA’s on the list, not too shockingly, along with the customer knowledge sharing tool Eclipsys Outcomes Toolkits and physician sessions on its PeakPractice ambulatory EHR.

Welcome back to HIStalk Gold Sponsor MedMatica Consulting Associates of Chester Springs, PA, a software and technology implementation firm (Epic, Eclipsys, Siemens, Meditech, Cerner, etc.) The company provides HISAssist support plans (live, telephone-based, or Web-based) for those vendor products as well. I’m blessed with amazing sponsor retention, so having MedMatica come back soothes my overwhelming feelings of inadequacy at least temporarily.

McKesson announces that all of its physician EMRs can now use Bright Note Technology. I didn’t really understand from the press release what it does, exactly, but it’s some kind of multiple input/single search capability for patient data. I found this demo on YouTube, showing a doctor using speech recognition to dictate a single SOAP note that parses out the information into specific chart data elements.

Inga’s update from MGMA today is on HIStalk Practice.

GetWellNetwork announces GetWell Town, an interactive patient care system designed for pediatric patients, and its first customer, Walt Disney Pavilion at Florida Hospital for Children. It includes care content, child life programming, entertainment options, parental controls, pediatric education, and pediatric pathways.

A summer intern (Harvard-graduated lawyer, Stanford PhD candidate) at IBM Research comes up with an encryption breakthrough that may have great potential for protecting health information, especially with cloud computing. Homomorphic encryption, formerly viewed as impossible by cryptographers because it takes a lot of computing horsepower, allows running calculations on encrypted data without actually decrypting it. IBM hired him, of course.

Listening: My Dying Bride, an old favorite doom metal band that I’d forgotten about.

Weird News Andy characterizes this story as both weird and sad. An 31-year-old English veteran of the war in Iraq dies after receiving cancerous lungs transplanted from a donor who had been a heavy smoker. The tumor wasn’t discovered until months after the transplant, during which time its growth accelerated, fueled by the routine post-transplant immunosuppressive drugs the patient was taking. The delay in noticing the tumor was blamed on poor communication among the radiologists and doctors involved. The cancerous lung made him ineligible for a second transplant since, under hospital rules, he had become a cancer patient.

NIH gives Kaiser $54 million of ARRA/taxpayer money to conduct biomedical and personalized health research using HealthConnect.

RelayHealth announces that 50 health systems and hospitals have contracted to join its RelayHealth Network, which connects 20,000 doctors, 90% of retail pharmacies, and 52 reference labs, all of which automatically update 7.6 million shareable personal health records for HIE connectivity and care coordination. We may need to talk to a participating site since that sounds pretty interesting.

Allscripts announces that it’s the first EMR vendor to integrate its systems with Intuit’s Quicken Health Bill Pay, which gives patients an easily understood statement and the ability to pay online. Doctors get paid 18 days faster on average. Everybody seems to like the Quicken app, which I first wrote about in early 2006 and talked up as potentially a big deal, although it seemed to take a long time to see the light of day.

Also announced: Allscripts will offer its practice customers point-of-care patient payments via mPay Gateway, which calculates patient responsibility and obtains payment authorization before the patient leaves the office. Inga interviewed mPay Gateway CEO Brian Beutner just last week on HIStalk Practice. We asked him the obvious question – are patients really willing to pay before leaving the office? He says 90% of them will. “They like the fact that there are no more unpleasant surprises and the simplicity of taking care of the payment up front, rather than having to wade through numerous statements from the doctor and comparing them to the multiple EOBs and other confusing insurance documents.”

Check out TPD’s list of iPhone applications for healthcare. If you know of others, leave a comment on that article and he will expand his list. Thanks to TPD for putting the list together and for his ongoing contributions to HIStalk.

Dave Roberts, the VP of government relations for HIMSS and former mayor of Solana Beach, CA is running for Congress.

A reader e-mailed to ask if I’d heard of QlikView, with which she was impressed in using it on a consulting project. I hadn’t, so I Googled. It’s a very cool BI tool (check the online demos) and supposedly the fastest growing BI company in the world (which probably means Oracle, IBM, or Microsoft will be buying them next week, unfortunately). I noticed that Bassett Healthcare was listed as one of its healthcare customers, so I Googled yet again to find that apparently Surgical information Systems uses it for its SIS Analytics offering (PDF case study here).

Two Johns Hopkins pediatricians and informatics faculty members launch Applied Clinical Informatics, an official online publication of the International Medical Informatics Association and AMDIS that hopes to “bridge the gap between visionary design and successful and pragmatic deployment.”

The VA awards a claims processing contract worth up to $60 million to VistA integrator Document Storage Systems.

Cedars-Sinai admits that it overdosed 206 CT scan patients with eight times the intended dose of radiation because of  “a misunderstanding about an embedded default setting applied by the machine.”

Dell, fresh off its Perot buy, will be looking for more healthcare acquisitions, says Michael Dell.

UVA Medical Center confirms that it will implement Epic, which I speculated in February (I’m not psychic – if a hospital has more than 400 beds, I always guess Epic and I’m usually right). UVA was the hospital that got a lot of press (some of it snarky) recently when it said it would hire scribes instead of repurposing busy doctors, so now we know which EMR they’ll be typing into.

University of Central Florida gets preliminary HHS approval to start a health technology regional extension center and apply for $8 million in stimulus money.

An Oklahoma hospice owner fears that reimbursement cuts and government-encouraged EMRs will drive him out of business. “One of the things they talk about is electronic medical records, which has great applications for medical doctors’ offices, but for hospices, that doesn’t help us at all.”

Philips posts surprisingly good Q3 numbers, with an expected loss of $66 million actually turning into a $258 million profit. Healthcare margins dropped to 9.6% and sales were down 4%, however.

You would think PHR vendor MyMedicalRecords is a huge enterprise given endless press releases and PR efforts. Not so: the quarterly revenue of its money-losing parent company was $221K.

Virginia Tech gets a $28 million NIH grant for infectious disease research at its Virginia Bioinformatics Institute.

E-mail me.

TPD’s List of iPhone Applications

TPD’s List of iPhone Apps – Update #4
By The PACS Designer

Input from HIStalkers and some further research helped expand the number of iPhone applications for this updated list. Newly added applications are marked with an (N).

Hopefully the expanded list provided with this update will get more users of iPhones the education needed to do better in their daily job performances.

Monday Morning Update 10/12/09

From Defiant One: “Re: University of Missouri. Don’t know if you had heard, but the CIO position there was also outsourced to Cerner. That’s a really bonehead move considering the amazing progress they have made since a Hunter turnaround in 2003. They won the CHIME collaboration award and now give away the position to Cerner.” Inga is trying to connect with MU, which is what they call themselves for some reason (odd: UM calls itself MU just like University of Kansas Medical Center calls itself KU Medical Center – are dyslexics running the Midwest?)

From Lou Mannheim: “Re: athenahealth. Maybe it got lost this week with their buy of Anodyne, but did anyone else find it interesting that athenahealth is now working with IBM for their BPO? Vague filing and no press release. Anyone know what they are doing together? Interesting given the Dell/Perot deal.” SEC filings indicate that athenahealth signed a five-year deal on October 2 to have IBM provide business services from India and the Philippines. Some of athena’s claims work was being done offshore, so I suspect this is routine.

From Ex-Cerner Guy: “Re: Bellevue lawsuit award. Ellis Hospital was more or less forced by NY State to take Bellevue over, so it should be interesting to see if NY State has written some sort of indemnification or protection into the merger agreement.” This relates to the $43 million jury award I mentioned last time in which the since-acquired 40-bed Bellevue Hospital was sued for mishandling the resuscitation during a baby’s birth in 1984. The 24-year-old woman, who has since graduated from college but uses a wheelchair, was awarded $20 million to pay home health aides, $15 million for future pain and suffering, $6 million for past pain and suffering, and $2 million for medical expenses and loss of earnings. So in a single judgment, a 40-bed hospital is on the hook for $43 million for a patient who didn’t even die (it would have been far cheaper if she had, apparently). How do you manage healthcare costs and not address cases like this? If the patient had the same injuries but wasn’t awarded the money, where would she have come up with the supposedly needed $20 million? This is another form of cost-shifting: hospitals insure themselves at great expense against awards like these, thus sticking everyone with the tab and giving insurance companies nice profits.

From Lou DiPisquale: “Re: EMRs. I have a friend looking for some suggestions for a home health/parish nursing EMR that is fairly inexpensive (her work is grant funded). Do you know of any basic EMRs that would be a good fit?” I’m calling in a lifeline since I’m a hospital guy and the home health EMRs we used were not inexpensive. Anyone have suggestions?

Cerner shares continue their tear, closing Friday at $84.41. The three-month graph above compares CERN (blue) to the Dow (red). If shares hit $89.70, Neal Patterson’s holdings will be worth a cool half a billion dollars.

HIMSS is looking for a Director of Government Services whose responsibilities will include “managing the Government Relations growing book of business for government services contracts” and “Develop programs and initiatives related to recruitment and retention of commercial organizations involved in the Payer and/or Life Sciences aspects of healthcare.” Wonder what that’s all about?

I was hoping for better news from my poll that asked how the employers of readers are doing economically compared to six months ago. Their situation is better, say 49%, while 31% say it’s worse and 20% say things haven’t changed. I suppose that’s not terrible, given that only a third are worse off now than before. Now here’s a fun new poll to your right: does your primary care doctor use an EMR and is that important to you?

This tech-savvy doctor, entrepreneur, and IT investor in Mumbai seems fun. He likes his job because “I get women pregnant – and get paid for it!” (he’s a fertility specialist). He’s got cool technology on his practice’s site and some creative informational cartoons and courses. The VP of one of his angel investments lists the Top 10 reasons that doctors in India don’t use software in their practices, observing that “Most doctors are very poorly organised, and don’t even bother to keep records of their patients. They often do not remember anything about the patient ; and forget even his name ( as many patients have learned the hard way).” India’s Top 10 is not much different than the US Top 10.

Peter Witonsky, president of iSirona, e-mailed to say that University Hospitals Geneva Medical Center is live with his company’s DeviceConX , which is sending GE critical care monitoring data to Eclipsys Sunrise.

Inga’s off to MGMA this weekend, so keep an eye out for a perky, curious female furtively taking notes for her daily recap on HIStalk Practice. Inga and Dr. Gregg Alexander have conspired to produce some fun HIStalk/HIStalk Practice magnets that some of the sponsors will be giving away in their booths (the booth list is here). 

Speaking of conferences, the American Academy of Pediatrics one starts Saturday in DC, where I’m one sponsor of the Pediatric Office of the Future exhibit (divided into sections: Patient Access, Enhancing Workflow, Advanced Communications, and Care Management and Quality). I made a primitive and snarky PowerPoint to run on my little display that hopefully Dr. Gregg Alexander can turn into something presentable that won’t embarrass him as a Pediatric Office of the Future team member. I had an unworkably last-minute brainstorm that we have a little meet-and-greet with Dr. Gregg, but our day jobs don’t leave much time for event planning. At least give him a little nod if you see him around.

Jonathan Bush red shorts at Health 2.0 mystery solved, courtesy of Matthew Holt. Jonathan heard that Glen Tullman of Allscripts would be appearing remotely on huge video monitors, so he re-enacted Apple’s brilliant 1984 commercial where the runner shocked the mindless drones to life by hurling a hammer into the video image of a thinly disguised IBM overlord. Now that’s funny.

Speaking of Glen Tullman, Forbes chats him up. He predicts Allscripts will double its count of doctor users next year, observing that “We are watching what will be the fastest transformation of a major U.S. industry in history”. He observes that it took ATMs 10 years to proliferate while EMRs till take only three, but he didn’t mention that banks paid for their own ATMs as their own rational business decision and that EMRs have been around for decades with minimal user interest until taxpayers were volunteered as their underwriters.

I like to Google HIStalk occasionally to see who’s talking about me. I ran across this nice mention on The Huntzinger Management Group’s site. “The Huntzinger Management Group is a Platinum Sponsor of the HIStalk Web Blog and supportive of the interactive communication among healthcare organizations. HIStalk is a fantastic place to read the most up-to date healthcare IT news.” I appreciate the sponsorship, but the kudos are even better and I appreciate them. I know it’s hokey, but when I write HIStalk the picture in my mind is of a bunch of us (providers, vendors, consultants, etc.) standing around swapping stories with beers in hand. That quote gets the “interactive communication” part right since I’m even happier sharing the ideas of others than I am my own.

An article covers the cash flow improvement at Kentucky Medical Services Foundation in its use of the Professional Intelligent Charge Capture application of MedAptus.

Apelon releases the latest version of its open source Distributed Terminology System on SourceForge.

Korea IT Times is running a series on what it calls u-Health, which means ubiquitous technologies that improve health and well-being of the general population. I like the term. This is another international example where you could read the whole article without realizing it’s not talking about the US. “Information system analysts and Web developers may also feel threatened when u-healthcare consumers and u-healthcare providers dictate specific information management functions and requirements instead of relying on the experts. Poor and inadequate ubiquitous technologies and interfaces will not be tolerated and will fall by the wayside.”

Speaking of EMR problems that are international, Finland is behind on its legal mandate to roll out EMRs and e-prescribing by 2011 because expanding it to a national level exposed problems with incompatible software. They’ve decided it’s easier to change the law.

Another doctor who’s not afraid of using a computer: this cardiologist made $40 million day-trading his way through the late 1990s, but gave only the losing trade information to his accountant. When the market collapsed, he had to underreport IRS losses to avoid triggering an audit for the gains. He’s looking at big fines and jail time for $16 million worth of tax evasion, not to mention the $476K he already paid for Medicare fraud.

University researchers in Canada say their open source OSCAR EMR, used by 600 doctors so far, could be rolled out a heck of a lot cheaper than the widely panned $1 billion eHealth Ontario project. One reason, its physician developer says with a straight face, is that “we don’t have very many high-priced executives and consultants”. I found the user group page here and also this video demo.

Mediware’s CFO quits to become CFO of an IT security firm.

The good times just keep rolling for eHealth Ontario. CTV News finds that $2.1 million of severance was paid to seven executives fired from its predecessor, Smart Systems for Health, when the new political administration took over.

eClinicalWorks will include Healthwise patient instructions and online health information library with its EMR and patient portal, respectively.

E-mail me.

News 10/9/09

From Bush vs. Tullman: “Re: Health 2.0. Was at Health 2.0 for the Jonathan Bush and Glen Tullman panel. Bush came out in red boxing shorts and a blazer! I will say Bush and Kibbe made some good points. Was disappointed that Tullman didn’t even show and came via teleconference.” Maybe Glen shares my belief that if it’s really 2.0, it shouldn’t require hauling in a ton of carbon-burning attendees to sit in a room together to watch oddly named startups hoping to find buyers for their no-revenue companies —  err, helping empower patients via the Internet. Still, it sounds like fun. I’d rather have the noobs pitch their businesses to a panel of money guys, like my semi-favorite show Shark Tank (“You’re dead to me now.”) Maybe I can get rich guys like JB and Glen to be on an HIStalk shark panel at HIMSS and they could actually invest in some HIT bootstrapper’s venture.

The response to a USA Today article on medical scribes is getting me riled up, with smug know-it-alls weighing in with uninformed comments like these: “I guess the older doctors who aren’t computer literate need scribes.” I’m trying hard to censor the profanities that I’m itching to write. Do you think less of your “younger” CPA if he or she isn’t typing into your 1040 form while you’re talking? Would you be happier if your lawyer stared at a PC screen instead of the jury? Does the President tickle the ivories on a laptop sitting in front of him while meeting with heads of state? Do even Steve Jobs and Steve Ballmer type their own meeting minutes while running Apple and Microsoft? Sure, the information needs to be entered into the EMR, but who says the doctor has do their own typing to get it there? Kiss your EMRs-for-everybody plans goodbye if the best method you can come up with is having doctors do all the data entry, the only highly paid professionals shamed into using tools whose benefit they question just because someone else thinks it’s a good idea (why not make patients enter their own information into a PHR? or schedule their appointments and ED visits on the Web? Or, for that matter, eliminate their own financial “scribes” and pay doctors by credit card before leaving the office?)

Law firms chosen to represent the state of New York in class action suits are heavy donors to state controllers. Among the “pay to play” firms is the one that made $80 million in engineering McKesson HBOC’s $1 billion settlement. 

Medical City (TX) goes live with the On-Cue patient itinerary system, a NASA-developed, AI-driven resource optimization system that servers as the “air traffic controller” for getting inpatients and outpatients where they need to be as orders and department backlogs change. I’m impressed with the credentials of the execs (former NASA and Philips people, with even the sales VP holding two master’s degrees from excellent schools).

The VA and DOD have finished the first of three phases of the military’s lifetime record program, the VA CIO says, making their systems interoperable. Phase II is making the records available on NHIN and Phase III involves making all information available during care delivered anywhere and at any time.

A reporter from one of the biggest national newspapers e-mailed to ask if I have examples of vendor non-disclosure contract language as mentioned in Ross Koppel’s interview. I’ll be the anonymous middleman if you can e-mail me examples (or use the Rumor Report form to your right, which accepts attachments like a contract scan).

Cerner keeps getting press for its H1N1 reporting project, which some lazy newspapers are reporting as some kind of exclusive arrangement initiated by Uncle Sam. I had mentioned that the Feds won’t get much data from big academic medical centers unless Epic jumps on board, to which Sunquest e-mailed me to mention that 60% of Epic’s customers and over 70 academic medical centers run LISs from Sunquest, which has been reporting infectious disease data to CDC and states since 2005.

A new HIMSS Analytics report (warning: PDF) says hospitals will struggle to meet ARRA funding requirements, with less than 25% of them live on nursing clinical decision support needed to track measurements such as A1c diabetics under control, smokers offered cessation counseling, and patients receiving VTE prophylaxis. This is an excellent, meaty report that crosswalks system capabilities to ARRA requirements and shows where the industry stands in having the necessary systems implemented. If you are a CIO whose hospital plans to collect stimulus money (or a hospital systems vendor), you should study the expected criteria and how your hospital compares nationally. Some hospital bed ranges have only single-digit penetration of systems that will probably be needed, meaning they had better get on the stick if they want handouts.

Lots of events have been posted to the HIStalk Events Calendar, which also lists events on the main page of HIStalk. You can add yours (free).

Like today’s posting? Add your e-mail address to the Subscribe to Updates box to your upper right and you’ll be the first to know whatever’s important. You might be surprised by the number of e-mails I get from people who thank me for (a) giving them an intense introduction to how the healthcare IT industry really works; (b) reporting some piece of information that made or saved them millions; or (c) making them feel more connected to the industry while traveling. You would spend hours a day to get the information you get here in minutes (and some of what’s here isn’t available anywhere else). The downside is that you may find me annoying, but hopefully that’s a trade worth making (and there’s always Inga as the sweet, sexy one in any case).

Speaking of handouts, they’ve driven us to this kind of headline: Kidney patients, job creation are focus of e-records initiative. University of Buffalo’s practice plan and Computer Task Group embark on a $29 million project ($7 million coming from the state), that “should improve health care.” It sounds like a separate project from the HIE announced there a few weeks ago, but I’m not sure since the practice plan is involved with both.

A hospital in Wales selects a Web-based diabetes care management tool from Hicom Technology.

The Y-12 National Security Complex in Oak Ridge, TN licenses EMBOS, an EMR developed for its 4,500 employees, to Healthcare Technology Partners LLC. The system was developed for Y-12 to help the Department of Energy meet the government’s EMR push. I found nothing on the company, other than it was started by former Y-12 executives. 

The mysterious HisserVideo e-mailed to say that he (or she) posted two more funny HIT cartoon videos. CIO: “Didn’t you just send me a press release about a 30-hospital group implementing Super-2000? How could it work for them?” Sales Guy Steve: “Those hospitals are in El Salvador and we sort of just gave it away to get a tax break to offset profits on our Salvadoran coffee business.” He worked my Vision Center observations into the third video, with Sales Guy Steve explaining its expansion: “We are taking over the space where we used to have the QA team.” Sales Guy Steve responds to the product expert’s observation that he knows little about his client except their bed count: “Because I was once having dinner with Bob [the CIO] and the bottle of wine was $414 and Bob said that was funny because they have 414 beds. Pretty neat that I remembered that, huh?” You can add comments to the YouTube page suggesting future installments.

Sentillion is placed in the “visionaries” quadrant of Gartner’s Magic Quadrant for User Provisioning, even more impressive considering that Sentillion was the only healthcare-specific vendor evaluated. That jogged my memory to go back and re-read my interview with Sentillion co-founder and CEO Rob Seliger from two years ago. “People often say that healthcare is slow to adopt technology, yet you can look at the amazing equipment from imaging systems to robotic surgery that is used. I don’t see a fear of technology in healthcare, just an avoidance of technology that’s an impediment to healthcare delivery. Vendors often miss that. We work really hard to get that right.”

It’s a good time to be an HIT vendor shareholder, at least if you bought at the right time. Above is a chart comparing Cerner (blue), Eclipsys (red), Allscripts (green), and the S&P 500 (gold) for the past 12 months. If you had the foresight to buy at the lowest price in the previous year and sold today, your money would have more than doubled with Cerner, nearly tripled with Eclipsys, and quadrupled with Allscripts.

The Toronto Star dissects the ambitious Smart Systems for Health initiative, which started out with grand ideas that turned into a money pit. By 2005, the agency had spent $260 million but accomplished little, triggering an operational review that characterized it as poorly regarded, short on strategic direction, and subject to inadequate oversight. By then the tab had run up to $458 million and the agency had over 300 employees. A year ago, it was dissolved and replaced by eHealth Ontario, now the subject of its own accusations of bloat, wasteful spending, and underachievement. The total now stands at over $1 billion. On Wednesday, Health Minister David Caplan resigned the day before an auditor’s “scathing” report criticizing the project was released. The auditors also uncovered government executive pay problems, where salaries were funneled through local hospitals to bypass government salary limits. Former CEO Sarah Kramer provides a statement that says, basically, that she was on the hook for quick results, the board knew exactly what she was doing, and, while people think a lot of money was wasted under her watch, it was a fraction compared to the amount that was blown before she took the job.

It didn’t take long for the lawyers to jump on the Broward General “reused IV” newspaper article. A personal injury law firm is “taking a proactive stance” to “educate and protect”. Translation: they opened 24-hour-a-day call center offering “free legal advice” from a “legal intake professional” (which I would guess means an offshore call center rep). Apparently the firm is a fixture on daytime TV in South Florida, or as one local puts it, “They are most ubiquitous during Unemployment TV (AKA, the morning talk shows, soap operas, and early afternoon game shows).”

The Wall Street Journal sees opportunity for vendors like Apple and RIM as hospitals replace pagers with smart phones. The article mentions a Stanford trial of accessing Epic on the iPhone, UPMC’s giving doctors and nurses BlackBerrys, and THR Presbyterian’s use of AirStrip OB.

Another Missouri hospital outsources application hosting to Cerner, this time Heartland Health. Eight hospital employees are being canned as a result, apparently.

Forbes profiles Epic. “But the hottest company in the electronic medical records industry is a secretive Wisconsin outfit called Epic Systems. It does little marketing or advertising, shuns acquisitions, never issues press releases and tries to stay out of the headlines. The privately owned company admits it once put up a billboard that said ‘Marketing Sucks … Epic Systems.’” It quotes KLAS as saying Epic is winning 40% of big-hospital sales, which seems low to me since I almost never hear of anyone else selling a big site.

E-mail me.

HERtalk by Inga

From Maathai: “Re: MGMA must-have trinkets. We will be handing out cards for people to ‘Plant a Tree’. They take the card, log on to a Web site, and select one of 16 countries where Seed the Future has a reforestation project going. We are hoping to have 1,000 trees planted before the end of the year. We also have recycled cardboard pens, but I don’t think they are as exciting as planting trees.” I’ll definitely be popping over to The Origins Healthcare Solutions booth (1006) to help make the world a greener place. Maathai also noted they are handing out stickers and will randomly hand out $50 bills to people wearing the stickers. That’s the kind of green I’m talking about.

From Ernestine: “Re: Health 2.0 conference. Lots of payer and consumer market here. So far it is a disappointment. Sitting in a session now and half are gone, even with cocktails to follow, and it is the first full day.”

From Dr. Love: “Re: Health 2.0 and Jonathan Bush. I don’t think we fully understand what he is wearing.  He’s a strange dude.” athenahealth’s Jonathan Bush and Allscripts’ Glen Tullman participated in a “Cats and Dogs” panel, which was suppose to pit “major IT vendors” and Web-based “clinical groupware” vendors. The athena folks tell me that JB was having a little fun with the whole show-down theme and was wearing his boxing shorts. I’m looking forward to seeing the video.

While at the Health 2.0 conference, MDLiveCare announces it will be the first telehealth company to partner with Google Health. The partnership includes the exchange of medical data between MDLiveCare and the Google Health PHR.

Just days after announcing its purchase of Perot Systems, Dell says it’s closing a desktop computing plan in Winston-Salem, NC. Six hundred people will lose their jobs next month, and another 300 by the end of January.

In a more positive announcement, Dell reveals plans for a new smart phone using Google software and running on the AT&T cellular network. The phone will use Google’s Android operating system.

Voalte, our favorite pink pants-wearing vendor, announces the results of its pilot installation with Sarasota Memorial Hospital. Using Voalte’s iPhone-based voice, alarm, and texting product, Sarasota’s nurses were able to provide faster response times for patients and reduce overhead paging by 78%.

CCHIT announces that vendors and developers can start applying for modular certification programs focused on meeting meaningful use requirements. The Preliminary ARRA 2011 program is limited to meaningful use standards spelled out in the ARRA legislation and will provide a certification label identifying which objectives the EHR technology supports. CCHIT is also launching its 2011 Certification program.

MedicAlert Foundation teams with SNOMED Terminology Solutions to provide SNOMED CT controlled medical vocabulary as part of its MedicAlert EMIR service.

David Blumenthal tells an AHIMA audience that the growth of EHR will create at least 50,000 new positions in HIT. 

E-mail Inga.

News 10/7/09

From Alborg: “Re: Herb Conaway’s bill. Good news! I researched the status of the 5/2009 Assemblyman Herb Conaway’s bill (first reported at HIStalk) to make non-CCHIT certified EHR systems illegal in the state of NJ, and it seems that they shelved it without action. Two things helped kill the bill: the fact that the HHS finally threw the Sherman Antitrust Act-busting CCHIT "under the bus" on 7/16/2009, leaving CCHIT’s future murky in 2010 and beyond as EMR vendors will flock to the new ONC certification, and the bad press that started all over the ‘net with nothing but the bad facts about this bill and its main sponsor, Assemblyman Conaway, who had HIMSS associations and had received corporate lobbying money.” I’m a political illiterate, but I wonder if he just introduced the bill to return a favor incurred somewhere along the way but never really thought it could or should pass. I can’t imagine that a politician (even a doctor like him) suddenly decided this was his hill to die on unless someone was prodding him.

From S. Silverstein: “Re: HIT vendors selling ‘de-identified’ clinical data to pharmas (with the latter’s increasingly public record of ghostwriting of scientific articles favorable to their products, salesmanship of drugs for non-approved uses in violations of FDA guidelines, suppression of adverse clinical trials results, etc.). The vendors are perhaps opening up unnecessary cans of worms that will bite them when civil libertarians start taking notice. See: Ohm, Paul, Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization (August 13, 2009). University of Colorado Law Legal Studies Research Paper No. 09-12. Available at SSRN. Perhaps vendors should stick to their core business of HIT production, which — as regulation of HIT increases — will require even more focus.” I think a lot of the work being done hides conveniently behind the concept of “anonymization” as an absolute; a simple technique of magically rendering highly sensitive personal data untraceable. Sounds good to a lay person, right? It even sounds technically reasonable as long as you’re thinking of someone having only one data element (just your birth date) instead of multiples (your birth date and ZIP code) and one database (a prescription file) instead of multiples containing joinable fields (prescriptions plus driver’s license records plus a grocery store loyalty card database). It’s like security in general: rarely absolute, secure only if there’s not enough incentive for someone to go to the trouble to crack the code.

An associate professor of pathology at University of Missouri criticizes his employer’s decision to outsource to Cerner, pointing out that the political appointees that make up the university’s Board of Curators have led the university to a 102nd place ranking among 110 national colleges (in their defense, it’s right up there with a lot of other big, football-obsessed easy admission state schools like Oklahoma, Nebraska, and Tennessee). Some snips, obviously fueled by a few rounds of tenure: “It appears he [University president Gary Forsee] is prone to make the same top-down decisions that were unsuccessful when he directed a large communications network … The medical school’s administrative residency program is on probation and is undergoing critical review; a major factor is that the Cerner system is so cumbersome that resident training is compromised … Three years ago, the radiology department dropped a Cerner software program because it was seriously flawed.”  

Sarah Kramer, the former eHealth Ontario CIO who was fired for handing out no-bid contracts, is accused in a CBC article of doing something similar at her previous job as CIO of Cancer Care Ontario. Accenture was told it didn’t make the final vendor cut for a $5 million surgery wait time application, but an Accenture senior partner friendly with the CIO was allowed to make an oral presentation criticizing the two short-listed vendors, resulting in Accenture’s being awarded the contract three days later. And in the least shocking news of all, the $5 million system turned out to be a $20 million system. That’s one side of the story, anyway. I’m guessing there are two.

Former Google Health bigwig Adam Bosworth launches Keas, a Web site that provides individualized care plans. It sounds like a rather pedestrian idea, but he’s got a big executive team, an army of stock art models, and grand plans to let providers create plans (not medical advice, the terms of service make clear) to which patients can subscribe as easily as buying an iPhone app. My money would be on the usual revenue sources, i.e. drug company advertising and trying to get deep-pockets insurance companies to buy bulk subscriptions for their patients. Apparently all the good domain names were taken, leaving the company to link its futures to an obscure New Zealand parrot (the kea) shown in its logo.

Speaking of Google Health, it proudly announces that two more insurance companies have signed on, rocketing the total to three (with just a few hundred to go) after 20 months, which is decades in Internet time.

Weird News Andy approves this message: “Impending lawsuits? Nah!” An anonymous caller to the compliance hotline of Broward General Medical Center (FL) reports that a nurse is using the same IV fluid bag and set on multiple cardiac stress test patients. True, the hospital found. They’re warning 1,800 patients to get hepatitis and HIV tests. The nurse quit and left the country.

Ingenix announces that its CareTracker EMR has new Surescripts-certified e-prescribing capabilities.

Kathleen Sebelius tells Cerner and its customers that President Obama thanks them for being “a health partner in this ongoing battle.” This refers to Cerner’s H1N1 network, to which 200 hospitals are contributing data. It sounds like they’re flagging ED admissions with elevated temperatures, which doesn’t seem all that specific (I seem to remember that some county or state health departments already track that). I’m also not sure what the government would do faced with an obvious local flareup (drop ship Purell? redirect Tamiflu supplies?) but at least they’ll know (except in communities served by large academic medical centers that are more likely to be running Epic than Cerner).

Speaking of Cerner, the local paper covers its prospects, citing a William Blair estimate that HITECH will goose Cerner sales by as much as $8 billion. They have a great picture of the three founders beaming. Another article describes Neal Patterson’s emotional recounting of the healthcare experience of his wife Jeanne, who has breast cancer.

Cerner announces its uCern social networking site, the uDevelop development platform, and the uCern Store for buying applications. I don’t know anything more about those offerings since only Cerner customers can access them. It sounds interesting, anyway, although the all the hospitals I’ve worked at would not have contributed apps because (a) it’s not our core business; (b) we don’t want some rube hospital calling us up demanding support for something we wrote for our own use; (c) we don’t want to help our competitors who might buy our stuff; and (d) we have irrational fears of being sued if something goes wrong. My experience is that hospitals are mildly willing to help out a vendor’s customer peer provided they feel technically or medically superior and hopefully geographically distant to them, but nobody’s going out of their way to make it happen.

Tressa Springmann, VP/CIO of Greater Baltimore Medical Center (MD), is named to the advisory board of Maryland’s HIE, CRISP (Chesapeake Regional Information Systems for our Patients). I made fun of the tortured acronym a few weeks back and got a nice note (and a music recommendation) from Johns Hopkins CIO and CRISP board member Stephanie Reel, who explained that they just tried to pick a name that reflected their intentions. Always quick to jump at the chance to provide unrequested and likely unwanted advice, I suggested Chesapeake RHIO, to be acronymized into CHERHIO (the jaunty English greeting, not the oaty breakfast cereal).

Open source BI vendor Pentaho acquires the assets of SaaS BI vendor LucidEra. The companies have raised nearly $50 million of capital between them.

I had planned to attend Mayo Clinic’s symposium on healthcare last month since they were kind enough to invite me (as did Dr. Natalie Hodge, the “iPhone Doctor” and co-founder of Personal Medicine International), but day job logistics got in the way. They have session videos up, though, so I will need to check those out. I’m watching Natalie right now, in fact.

QuadraMed launches its ICD-10 Countdown Program, which includes the Quantim ICD-10 Coding Simulator, educational tools, and services to help providers convert to ICD-10.

The press seems shocked that Bellevue Hospital (NY) got a tip that Joint Commission was on its way and sent a staff e-mail urging the discharge of “patients that do not need hospitalization” and having supervisors check to make sure patient documentation was complete. Surely they don’t think that hospitals just conduct business as usual without regard to an impending survey, even now that they are unannounced? Or that Joint Commission isn’t aware of its multiple roles of accreditor and vendor? You used to be able to pay them (and maybe still can) to do a mock survey to make sure you were ready for the real thing, kind of like cramming for the SAT to get a score you couldn’t have obtained without help.

Was this really how stimulus money was supposed to work? General Hospital in Nashville says it will get more than enough stimulus money to cover the remaining $3 million cost of its EMR project, but wants to borrow city money to finish it since that chicken has to come before the financial egg.

E-mail me.

HERtalk by Inga

Routine use of electronic health records can improve the quality of preventive care and help manage chronic disease in primary care practices, according to a primary care study.

athenahealth signs an $30 million agreement to purchase AnodyneHealth Partners, a SaaS business intelligence provider. Anodyne will continue to market its BI solution as a standalone product. In addition, athenahealth plans to integrate the service into the athenaCollector platform. The deal includes a cash payment of $22.3 million with the potential for additional consideration of $7.7 million, based on the achievement of certain business and financial milestones. Neither Mr. H nor I had heard of Anodyne before, but understand they traditionally serve large and enterprise-size medical groups. Jonathan Bush says the Anadyne purchase should help them get their foot in the door at some of the larger institutions.

Blue Shield of California makes $29.6 million available for pay-for-performance bonuses. Medical groups and IPAs can qualify by demonstrating the performance of quality care using such measures as diabetes care, patient experience, managing ER visits, and deployment of IT.

The Wyoming Department of Health grants a $4 million, three-year contract to ACS to provide an EHR and HIE for the state of Wyoming.

Baptist Healthcare System (KY) becomes the first health system to simultaneously implement both the access and business management modules of McKesson’s Horizon Enterprise Revenue Management solution. Baptist Hospital Northeast went live August 15th.

In a $54 million stock deal, Nuance Communications acquires eCopy, a provider of document scanning solutions. Nuance plans to combine eCopy’s touch screen technology with its existing multifunction printer desktop solutions.

3M Health Information Systems, McKesson, and Executive Health Resources sign a strategic agreement to offer RAC Advanced Services. The joint solution will combine 3M’s coding and billing solutions, McKesson’s InerQual medical necessity criteria, and EHR’s physician advisors to conduct second-level reviews.

The use of smartphones by physicians is expected to increase from 64% today to 81% by 2012. A more “mature” and proficient physician audience will emerge and the Internet will become physicians’ primary professional resource. Look for physicians to use their smartphones for everything from administrative tasks to patient monitoring.

The Bronx RHIO selects Axolotl’s Elysium Exchange to power its HIE. Participating providers will be able to electronically exchange via existing EHRs, or, with Axolotl’s Elysium EMR Lite product.

Summa Health System (OH) selects Wolters Kluwer Health to provide its ProVation MD software for cardiology procedure coding. Summa plans to use the software at its three cardiac cath labs at Summa Akron City Hospital.

People keep asking when we are going to get on Facebook. Yesterday, I decided to forego all my much more important tasks to set up a site for myself (Inga Histalk) and an HIStalk Fan Club. Now, in addition to reading HIStalk, HIStalk Practice, and Twitter, you have one more way to stay in the know/surf the Web and pretend you are working.

I’m Denver-bound this weekend, headed to the national MGMA conference. We’ll be posting a Must-See Vendors guide later this week, plus I’ll be sending in daily updates. If you are attending, feel free to pass on any tips for sessions to attend or booths with must-have trinkets. Be sure to visit our great sponsors, who will be handing out a limited supply of HIStalk magnets (I’d bet everyone would think you were really cool if you brought one back to put on the lunchroom fridge). Special thanks to the multi-talented Dr. Gregg Alexander who created the magnets and who regularly writes on HIStalk Practice and still finds time to practice full-time.

E-mail Inga.

Monday Morning Update 10/5/09

From Cernerfan: “Re: Barts 18-week backlog in thousands.” In England, Cerner Millennium is blamed for the jump from 1,700 to 23,000 patients whose referrals don’t meet the 18-week target from referral to treatment at Barts and the London NHS trust. They’ve been live since April 2008, so the “things are shaking out” excuse is getting a bit long in the tooth.

From The PACS Designer: “Re: Google Sidewiki. Google has a new feature called Sidewiki that permits useful information to be added to any web page. The Cleveland Clinic is using Sidewiki to add heart disease information to enhance details about the disease and its prevention.” I have to admit that I hate this idea with a passion. Users can now take control of Web sites, splattering unvetted comments onto any site without the owner’s permission or involvement (they call it “contribute to any web page”, in other words, even those to which you weren’t invited to contribute). Who’s to say that the nasty comments on Cerner.com didn’t come from a competitor? It’s a step backward for sites like this one that already allow nearly unrestricted comments, but exercise some control to keep the conversation civil, the facts accurate and relevant, and the personal attacks limited. Using some third-party tool also splits off what should be a threaded conversation, with Sidewiki hijacking for Google’s benefit conversations that could have been better served with existing technology. Sidewiki is a really bad idea, but I’ll predict that Google will kill it anyway after it gets wrapped up in a few slander suits over malicious postings. In fact, I seem to remember that a similar technology met a timely death for exactly that reason not too long ago, although I don’t remember its name.

From EHR Geek: “Re: FierceHealthcare. Rumor is that Mr. HIStalk was named one of FierceHealthcare’s Nine Healthcare Bloggers worth a click. We love us some Mr. HIStalk!!” Thanks to the folks there for the mention.

From Electric Slide: “Re: vendor evaluation. Are hospitals that are evaluating vendors still using Gartner’s Magic Quadrant, KLAS, or HIMSS Analytics? Given ARRA, it would seem like the value has diminished and both charge a lot of money from the vendor side.” I’ve always thought that, for major purchases like clinical systems, hospitals mostly went with less logical criteria: (a) how enamored the hospital executives are with the vendor’s vision, executive charm, and marketing fervor (all of which usually are negative signs rather than positive, but are widely accepted); (b) whether they just want to dump an incumbent and try their biggest competitor as something new; or (c) CIOs choosing the option that looks like the least work and risk for IT (i.e., just buy more stuff from current vendors). I can only speak to the selections I’ve been involved with personally, but those (oddly, for science-based organizations), usually ended up being influenced by intangible BS like the Vision Center, personal relationships that really should have required the hospital executive to recuse themselves from the selection, or either buying the same system as a competitor (to show them up with better utilization) or what they didn’t (to avoid being labeled as imitative). Any resemblance to an orderly process driven by the needs of clinicians and their patients was purely coincidental.

From J-Lo: “Re: HIMSS. Enjoyed your reception, but it was hard to hear and kind of frustrating that people stayed in their typical cliques rather than a whole bunch of mingling. I did meet several new folks cuz I made the effort, but maybe, just maybe you and Ms Inga could come up with a way to integrate your guests a bit more.” I agree completely. We need some gregarious event ambassadors to get people talking (I had high hopes for the strippers from year before last, but as I should have known, spirited conversation wasn’t their long suit). Former A-V club geek Dr. Gregg Alexander has promised to help out with improved presentation logistics now that we won’t be constrained by the limited capabilities of a hotel ballroom, so I’m looking forward to fog machine effects and maybe Inga flying in on a wire.

From NHIN-a-new: “Re: NHIN. This exclusive confab last week may be worth analysis – did we just hear the sound a door opening? Looks like ONC is exploring a really interesting way to apply the NHIN to the reality of consumer environments. Think linking the ATM network to your cell phone – now that would be a ‘cool technology of the week.’ As long as there is enterprise aggregation of data we need the structure the NHIN provides in standards and specifications (the work going on inside the NHIN project on details specs and governance issues is absolutely amazing!)  And this session shows a way to coordinate these two innovations.” John at Chilmark Research reports that the government’s intentions for the Nationwide Health Information Network maybe be changing from a data exchange platform for provider data to a “Health Internet” that is more driven by and beneficial to consumers. That makes sense based on some of the buzz around new federal CTO Aneesh Chopra and his interest in “government as a platform”. I’ve been saying all along that “meaningful use” ought to be based on the data providers contribute electronically rather than paying them for simply replacing paper with EMRs, so perhaps this is a step in that direction. Everybody (except the government and its Medicare payment rules) knows you ought to be paying for the result you want.

From Lips Kudlow: “Re: EMRs as medical devices. This is truly frightening. It would result in the decimation of an already beleaguered Canadian EMR software industry, not to mention smaller added-value healthcare software vendors. It wouldn’t surprise me if the large vendors (Cerner, Meditech, et al) have lobbied Health Canada to issue just such a ruling, since large companies typically have a vested interest in stifling innovation and competition from upstarts.” Health Canada releases a notice stating that software “use only for archiving or viewing information or images” is a Class I medical device and systems that manipulate, analyze, edit, measure, or graph information are Class II medical devices. That means vendors must be ISO certified to sell those products in Canada. The definition of “patient management software” is a bit vague and sounds as though it was intended to cover physiologic monitors (note the reference to “active diagnostic devices” and “monitoring a physiological condition”), but I’ve e-mailed for clarification.

I’m back on the job, so thanks to Inga for keeping things under control while I was away. She did great, if you ask me. I’ve got a lot of catching up to do and will unavoidably mention items she already covered, but it’s all new to me.

Regional Medical Center (SC) is always doing something newsworthy when it comes to Cerner, whether it involves board members fighting over parliamentary procedure in approving its Cerner contract or having its employees crying racism over including a banana-wielding gorilla in its post-project celebration. Now its board argues bitterly over its proposed $1.3 million purchase of medication dispensing cabinets from Cerner, specifically debating whether Cerner is a sole-source supplier in that marketplace (uhh, ever heard of Pyxis or AcuDose?) The CFO says they decided that only Cerner could provide the cabinets since theirs are “integrated”. Board members argued, shouted, and insulted each other to the point of having to be gaveled down by the chair. Cerner still gets the business, or at least I think it did based on the somewhat confusing recap.

A-Life will connect its Actus computer-assisted coding system to the Ingenix Web.Strat encoder.

Plains Regional Medical Center (NM) learns that its mammography information was hacked two years ago in a breach at the University of North Carolina at Chapel Hill, which provided its previous system for generating mammography follow-up letters.

A reader asked if GE is still selling Centricity Lab in the UK. Inga asked GE and we appreciate their response: “The business has decided to shift its strategy away from forward production on the Centricity Lab product. The demand for it is, perhaps, as strong as ever yet currently concentrated in smaller, community-based EMR settings. We really need to focus on maximizing the personalized service we can deliver to the existing install base and will continue to service and support all current installs (as well as honoring all current orders).”

In Ontario, the hospital CIO who was involved in issuing $3 million in no-bid consulting contracts to a former co-worker steps down. Diane Beattie and her employer, London Health Sciences Centre, have agreed to part ways, but now the politicians are arguing over the $451,000 in severance pay she will receive for her 21 months on the job. Her contract called for severance of a full year’s salary plus a month of pay per year of service. Maybe someone ought to investigate who approved that kind of a deal, which is somewhere between remarkable and nuts (her employer says it’s a “standard contract for senior staff in teaching hospitals”).

Oracle’s Larry Ellison on cloud computing: “I remember I was reading W and I read that ‘orange is the new pink’ and ‘cloud is the new SaaS’ or ‘cloud is the new virtualization’ … maybe I’m an idiot, but I have no idea what anyone’s talking about. It’s just complete gibberish … I’m going to access data on a server on the Internet and that’s cloud computing? … These people who are writing that crap are out there. They’re insane.”

HHS secretary Kathleen Sebelius will address the 6,000 attendees of the Cerner Health Conference on Tuesday, talking about healthcare reform. Any irony is unintentional.

Beaumont Hospital (MI) CIO Paul Peabody will retire after 35 years there, part of an executive restructuring. 

My poll on who readers would like to work for given comparable jobs offer drew 527 responses, which I’m guessing indicates some level of either fraudulent voting or vendors encouraging employees to vote for the home team. Anyway, take it for what it’s worth: Epic won with 30%, followed by McKesson (17%), Meditech (13%), Cerner (12%), Eclipsys (11%), GE (11%), and Siemens (6%). New poll to your right, raising a moistened finger into the air to detect a shift in the winds of economic change: over the past six months, how has your employer’s economic situation changed?

The layoffs just keep on coming at Texas Health Resources.

Cerner digs deeper into the life sciences, licensing its Discovere system to clinical trials vendor Quintiles. Part of Discovere is the former First Genetic Trust technology that Cerner bought somewhere along the way. Quintiles signed an agreement with that company back in 2001 and took an equity position in it. The Discovere modules include biobanking, research registries, public health investigator workflow, clinical trials management, and adverse event reporting.

I ran across an overview (warning: PDF) of Cerner’s LifeSciences, which apparently involves selling patient data from the EMRs it hosts. “Through our data mining of our vast warehouse  of electronic health records (EHRs), you can accelerate development processes and reduce business risks. This is when Cerner LifeSciences makes it possible to analyze anonymous, HIPAA-compliant, EHR-derived data for efficacy and safety.” That’s an interesting business. Long-time readers will remember that I’ve cautioned previously about providers selling off their data rights since they have more value than you might suspect. Cerner is pretty smart to include contract language that allows them to sell anonymized customer data to drug companies, getting it free, in essence, from its IT customers.

Several hospital nurse executives provide testimonials about the contribution of the Kronos employee scheduling solution to their Magnet designation.

West Tennessee Healthcare CIO Jeff Frieling gains additional responsibilities as VP of hospital services.

Another big hospital CEO retirement payout: Valley Medical Center (WA) gives its CEO a $1.73 million retirement bonus even though he’s not retiring. The hospital put the money aside in 2003, payable if the CEO retires after his 60th birthday or if he is fired or demoted (!). He’s still working at $900K per year and still has a separate pension plan for whenever he really does retire, courtesy of the local property owners whose taxes support the hospital. The hospital issues the boilerplate lame excuse that every other over-paying hospital uses: “It’s a highly competitive market, and our board feels that in order to keep someone of Rich’s caliber, he needs to be compensated as such.” Are they admitting that it’s such a dump that nobody would sign on for the pittance of, say, $500K? $250K? Like Wall Street, nonprofit hospitals are clearly out of control in their executive pay practices.

This is interesting: the orthopedics chair at Bronx-Lebanon Hospital Center (NY) e-mails an unsolicited testimonial to the vendor of an iPhone aviation pre-flight checklist app. The doctor had modified the templates to create pre-surgical checklists for total hip, total knee, and arthroscopy, one of which reminded him to check a particular patient’s lab result. The outcome, in his words, was “a life was saved.”

TeleTracking Technologies acquires small RTLS vendor RadarFind.

Odd hospital lawsuit: the family of a man who died of a heart attack in the ED sues the hospital, claiming the ED doctor let him die so he could steal the patient’s $16,000 Rolex.

SUNY Stony Brook will expand its use of PatientKeeper, adding its ePrescription and Pay for Performance modules. ePresciption will be live by the end of the year in time to qualify for the 2010 Medicare incentive payment. PQRI will also be running in time to get that incentive.

UK stock analysts postulate that the three divisions of Misys (healthcare, banking, and treasury and capital markets) could be split off into their own companies to increase shareholder value, also guessing that Allscripts will be the first since it’s about the only bright spot the company has. Meanwhile, some nuggets from the Allscripts-Misys earnings call: (a) “Some of our competitors are talking about a pause; we’re surely not seeing it.”; (b) Allscripts is working with Henry Schein in implementing the big North Shore-LIJ deal recently announced; (c) a new factory-type Enterprise rollout has cut deployment time and hours by 50%.

A reader sent in a flyer for a series of invitation-only Apple executive briefings covering the iPhone in medicine. The ones in Chicago, Reston, and New York are over, but sessions in Boston and Cupertino will be held later this month (we geeky programmers are amused at the address of Apple’s executive briefing center: 4 Infinite Loop). I’m certain it was oversight that Inga and I haven’t received our invitations yet.

GE Healthcare’s joint venture with Bangalore’s Wipro is enhanced to become GE Healthcare’s sole vehicle in India. GE CEO Jeff Immelt predicts that healthcare products and services developed cheaply in India will be exported to the US, helping manage healthcare costs here.

Former FCG president Steve Heck joins Impact Advisors as VP after a couple of years at Navigant.

This doctor doesn’t mind using a computer: a former pediatrician is ordered to appear before North Carolina’s medical board, charged with failing to report his DWI arrest and for using the PC of a practice for which he was working to write pornographic stories.

A Children’s Boston research article says EMR data can be used to help doctors identify domestic abuse. The most positive correlation for females was for injury, poisoning, and alcoholism. For men, it was mental health conditions.

E-mail me.

News 10/2/09

HERtalk by Inga

From: Coding Guy “Re: ER Documentation System. I can tell you from compliance training I have received from HBMA and networking with other compliance officers, that providing prompting for higher services is a no-no. It’s similar to having superbills where there are no checkboxes for non-billable services – if you’re not providing a mechanism for recording non-billable services it could get attention. I’m not a lawyer but I do have access to very good counsel and providing provider feedback that hints of guiding upwards for bills is definitely to be avoided.  Most OIG investigations are triggered by disgruntled employee tips, so any bad messaging and training around a system like this could lead to unwelcome attention.”

More than three-quarters of healthcare executives surveyed by PricewaterhouseCoopers LLP agree that the secondary use of EMR data will be their organization’s greatest asset over the next five years. Essentially, it is all about data mining, and how it can be used to improve patient care, predict public health, and reduce healthcare costs. However, PWC finds that the lack of standards, privacy concerns and technology limitations are holding back progress.  PWC just published  “Transforming Healthcare through Secondary Use of Health Data,” which calls for public-private collaboration and government incentives to collect, share and use health data; to establish standards; and to redefine technical architecture to allow interoperability.

Here’s a keynote address I would have loved to hear. Ron Galloway spoke at the Healthcare Facilities Symposium & Expo this week and said that the Wal-Mart’s distribution of eClinicalWorks “is the biggest thing going on in healthcare right now.” Galloway also predicts that between the company’s plan to get its 1.4 million employees’ health record formatted electronically and the projected 22 million patients visiting its EHR-equipped clinics by 2014, Wal-Mart is positioned to be a major force in HIT.

Surgical Information Systems (SIS) names St. Anthony’s Medical Center (MO) an SIS Center of Excellence, based on its “best practices” use of the SIS Solution. Within a year of installing SIS, St. Anthony increased efficiencies in several areas, was able to increase OR caseloads 5%, and decreased late case starts by 4%.

Jewett Orthopaedic Clinic, a 32-provider, seven-office clinic in Florida, selects the SRS hybrid EMR. Speaking of SRS, I noticed that Evan Steele was recently interviewed on the EMR and HIPAA blog. His take on ARRA and stimulus money: “The cost associated with reduced productivity that a high-volume, high-performance physician would incur by entering the data to meet the meaningful use requirements dwarfs the incentives being offered and the relatively small penalties which start six years from now (in 2015).”

Allscripts announces its first quarter numbers, which include non-GAAP revenue of $167.5 million compared to $164.7 million last year. The non-GAAP revenue numbers take into account the 2008 and 2009 revenue numbers of both Allscripts and Misys Healthcare. GAAP revenue was $164.9 million versus $92.8 last year and earnings were $.15/share. The company exceeded Wall Street estimates of $.14 cents/share earnings. During Allscripts’ investor call, the company indicated its recent deal with North Shore-Long Island Jewish was worth just over $10 million, but had a potential value of more than $75 million, depending on how many physicians signed on. Investors seemed pleased, with shares on Wednesday hitting their highest point in nearly two years ($20.61.)

Southeastern Regional Medical Center (NC) plans to implement Allscripts suite of care management solutions, by the way. The hospital will use the web-based SaaS  product to enhance continuity of care across the organization and prepare for Medicare’s RAC program.

CVS pharmacy customers now have the ability to download their prescription histories into HealthVault.

Ingenix expands the e-prescribing capabilities of its CareTracker EMR solution and is now SureScripts-certified.

Emergisoft releases its iPhone Simulator, which will allow physicians to customize the iPhone for use with Emergisoft’s physician documentation in the ER.

HHS Secretary Kathleen Sebelius releases a report detailing how The Columbia Basin Health Association (WA) was able to improve health care using HIT. After implementing an EHR, the community health center initiated automated tools to increase the monitoring of diabetic patients. Within six months, the facility documented dramatic increases in overall care for its diabetics, including a 55% jump in the number who received foot exams and a 34% increase in eye exams.

Virginia Blood Services purchases Mediware’s LifeTrak software to manage its blood donor records throughout central Virginia.

iMedicor successfully completes a pilot project involving 225 pharmacy outlets using iMedicor’s information exchange portal. All the outlets successful implemented iMedicor’s direct-to-pharmacy electronic prescription refill technology, which is available at no charge to physicians and pharmacies.

eMED-ID introduces a wearable device that uses GPS technology to track a person. Their target market includes people prone to wander, such as Alzheimer’s patients and those with autism. No mention if it is appropriate for straying boyfriends.

Broadlane, a cost-management company for healthcare providers, names Greg Ericson CIO. Most recently Ericson worked for a medical device company, but I’d love to hear more about his stint at the Home Shopping Network.

API Healthcare announces the general availability of its Acuality Patient Classification System. The software helps hospital to assess patient care requirements to make appropriate staffing assignments.

A mere week or so after its official launch, Humedica says it’s entered a long-term partnership with Anceta, the healthcare informatics subsidiary of AMGA. The association selected Humedica as its exclusive partner to develop a nationwide data warehouse and clinical analytics platform.

Doylestown Hospital (PA) selects MedQuist to provide RAC consulting services and software.

Mr. H finally found an Internet connection and checked in long enough to say he doesn’t miss any of us. (Well, that isn’t really what he said. That was just my interpretation. His exact words: “Life sucks 90% of the time. This is that other 10%.”)

Maybe he will smile just a bit upon learning that Fierce Healthcare named HIStalk to a list of  Nine Healthcare Bloggers Worth a Click. Editor Anne Zieger says that “if you’re in health IT, there’s no excuse to miss HIStalk.” And, Dodge Communication put HIStalk on their list of Top 10 Twitterers for healthcare marketing and PR Professionals, saying HIStalk is “a great way to hear the perspective of those professionals working in the trenches.”  Many thanks!

E-mail Inga.

News 9/30/09

HERtalk by Inga

From: Overworked “Re: UCSF cancels GE Centricity project & lays off 33 IT analysts & support staff. Was this reported already somewhere? I work with a pharmacist who was formally laid off from UCSF last week and given 2 months severance pay. Apparently UCSFMC cancelled their GE Centricity project three weeks ago and he said he knows of 33 IT analysts and IT support folks that were laid off. He says the GE project budget was blown out of the water within 1 year and it had been going on for over 3 years – he had been on board for 3+1/2 years. He says it wasn’t even close to being implemented. I thought it was interesting that I couldn’t find anything in the press – but forgive me if I’m telling you old news.” Unverified. Dang. Mr. H always accuses me of not reading what he writes but I don’t think we have any official word that UCSF ha terminated its relationship with GE. However, UCSFWatch did send over a note last month suggesting things were not going well. The medical center management had hired Kurt Salmon Associates to figure things out and at that time GE-related activity was on hold.

The North Shore-LIF Health System (NY) announces it is subsidizing up to 85% of the EMR implementation and operating costs for over 7,000 of its affiliated physician. Participating doctors can received subsidies of up to $40,000 each over five years to implement Allscripts EHR. The initial agreement with Allscripts includes licenses for 1,200 doctors and one analyst suggests the deal is worth $20 million. In any case, it’s definitely one of Allscripts’ largest sales ever. North Shore’s subsidy program includes a unique twist: physicians will be subsidized at a rate of  either 85% or 50%, depending on whether or not they are willing to allow North Shore to use the EHR to report and share their performance data and allow them to compare it against a set of nationally care and outcome metrics.

Allscripts also announces that Baptist Memorial Health Care (TN) has selected Allscripts EHR/PM to automate its 65 employed and 3,100 affiliated physicians.

Meanwhile, a Jeffries’ analyst upgrades Misys to a buy and predicts the company will sell off each of its three divisions. Speculation is that the first division to go would be the Allscripts segment, which would appeal to buyers like “GE Healthcare and similar major players.” Analyst Milan Radia says, “”Our upgraded price target reflects our view that we are now approaching an end game in the transformation of Misys.”

A reader forwarded the attached copy of an email sent to all the ER docs at his hospital. He explained to me the ER recently adopted a new documentation system and is now paperless. However, authorities are now questioning if the system is in compliance with billing regulations because it prompts users to add certain items in earn a higher level service. If the “experts” determine that the system is out of compliance, the hospital will likely need some sort of fix from the vendor. In the worst case, the hospital (and presumably others in its chain) will have to revert to paper for some amount of time. I asked a reader his opinion, and he believed that technically the system was “legal” because the doctor still has to approve the code. However, he suggests it is a tricky game that can invite “serious auditing.” Any other opinions?

If you are a careful reader, you will have noticed that Mr. H left me to my own devices this week while he is out gallivanting the world. We always joke about how I would handle things if some major IT story broke while he was out of pocket, like someone buying Cerner or Judy Faulkner resigning from Epic. I’m thinking that Xerox’s acquisition of ACS was just a warm-up for some really big, breaking story during Mr. H’s next vacation. Investors, by the way, appeared lukewarm on the merger, and Xerox’s stock price fell 15% on Monday. The $5.7 billion cash and stock deal allows Xerox to expand its footprint into the services business, not unlike HP’s EDS purchase last year and Dell’s recently announced bid to buy Perot.

Cerner and the University of Missouri announce a $100 million partnership that reassigns about 100 workers from the UM Health System to Cerner. The plan calls for the creation of the Tiger Institute of Health Innovation, which will be tasked with designing innovations to improve patient care and population health. University and Cerner officials say the collaboration could improve patient safety and save the state $1 billion (sounds optimistic.) As part of the 10-year agreement, the university and Cerner would split profits from any new developments based on the amount of money each invests in the institute. A portion of the proceeds would be used to continue funding the institute. Former Ascension Health CIO Sherry Browne will lead the institute.

Accretive Health, a provider of RCM services, files for  a $200 IPO.

HHS Secretary Kathleen Sebelius announces $27.8 million in ARRA awards, including 18 grants totaling $22.6 million for EHR implementations. The balance will support various HIT projects, including HIEs and helping existing health centers use existing EHRs to improve patient health outcomes. Think how fun it must be to be Sebelius, handing out millions of dollars to grateful recipients every couple of weeks. Almost as good a gig as Santa Claus

The Hannaford Charitable Foundation presents Health Quest (NY) a $50,000 donation to help fund its CPOE project. This is the second such gift from the foundation that was created by the Hannaford supermarket chain. Health Quest is investing about $60 million to overhaul its IT infrastructure, including implementation of a Cerner system.

Freshmen at Indiana University are embracing the school-supplied PHR, with 40% already using the program just weeks after the start of school. NoMoreClipboard.com is the PHR vendor.

The State University of New York at Stony Brook expands its deployment of PatientKeeper products, adding the ePrescription and Pay for Performance applications.

Nuance Communications announces the availability of version 9 of its eScription application. Among other changes, version 9 offers advancements in document quality review and administrator efficiency.

The Lake Erie Regional Health System/TLC Health Network is awarded a $4 million grant towards a $5.6 million IT integration project between the Brooks Memorial Hospital and TLC Health Network facilities. The grant is part of $436 million in funds being distributed through the Health Care Efficiency and Affordability Law of New York State.

RelayHealth says that both Hill Physicians Medical Group (CA) and Montefiore Medical Center (NY) have improved care collaboration, patient satisfaction, and specialty treatment prioritization using RelayHealth’s referral management service. The product, which was co-developed with Hill Physicians, facilitates secure health information exchange between primary care providers and specialists.

West Georgia Health System signs a seven year deal with Perot Systems for revenue cycle services to the hospital organization. Perot just recently provided the health system support services to implement MEDITECH 6.0.

Speaking of Perot, I was sad to hear that the individual charged with insider trading ahead of Dell’s proposed purchase of Perot was one of the heroes in the 1979 Iranian hostage rescue. If you aren’t familiar with the story, Ross Perot spearheaded a mission to rescue two of his employees held hostage in an Iranian jail. Reza Saleh was an EDS employee at the time and led the mob that broke into the prison and ultimately rescued the hostages. The SEC has now charged Saleh of making $8.6 million in illicit profits from the Perot/Dell deal.

Hudson Headwaters Health Network, a network of 16 community health centers in upstate New York, receives a $7 million grant to finance HIT and a medical centered home initiative.

A new report from the Information Technology and Innovation Foundation finds that Finland, Sweden, and Denmark are the clear global leaders in terms of EHR adoption in hospitals. Those countries also ranked far better in their use of electronic prescribing and CPOE. At least we beat the Brits and New Zealand.

University Hospitals (OH) makes plans to rent a closed school to train more than 4,000 employees on its new Eclipsys Sunrise EMR system. The health system wants 6-day-a-week, 24-hours-a-day access to the school from January to June.

Cumberland Consulting Group is named one of 2009 Best Small Firms to Work for by Consulting Magazine.

The CDC issues $4.37 million in grants to fund four new Centers of Excellence in Public Health Informatics. The recipients will use the funds to enhance HIT and improve the detection of and response to emerging public health interests. Winners are Harvard Pilgrim Health Care, Indiana University, the University of Pittsburgh, and the University of Utah.

Warning: if you are an HIT purist, feel free to mosey along and not read this last note. For the rest of you, here is an amazing statistic: more than 2 billion applications have been downloaded from Apple’s App store since July, 2008. More than 85,000 apps are currently available, and only about 18% of the downloaded apps are paid for. However, the average cost of paid applications is growing and US revenues for applications will grow 10 times between 2009 and 2013, reaching $4.2 billion. I downloaded my first paid application recently: Scrabble ($4.99) and I am totally addicted.

E-mail Inga.

Xerox to acquire Affiliated Computer Services

Xerox announces plans to buy ACS for in a $6.4 billion cash-and-stock deal. The deal is worth $63.11 per share, which is a 34% premium over Friday’s closing price.

Monday Morning Update 9/28/09

From Evan Marcos: “Re: conference invitations. Amen. After a lifetime in healthcare marketing, this is how the VIP scam works. Target a slice of C-level pigeons (CEO, CFO, CIO, CNO, etc) who need a few days off to relax. Next, choose a speaker panel of political hacks, policy wonks, executive has-beens, and think tank blowhards. Throw an innocuous agenda that yaks about the obvious in a fabulous, expensive resort. Now, the hook. Market the VIP ‘Summit’, ‘Roundtable’, or ‘Executive Leadership Council’ to healthcare C-levels and tell them they can attend for next to nothing but airfare in exchange for 20-30 minutes of their time talking to a vendor. Second hook, market the ‘executive lead opportunity’ to vendors wanting badly to make their quarterly numbers and find low-hanging fruit in exchange for a mere $30,000 – $50,000 (which pays for the conference and salaries for the organizers). Now, market the everloving stew out of it with aggressive, relentless, pit bull sale folks in a boiler room. I’ve been on both sides of the invitee list and I assure you there’s rarely anything truly positive to come from it except for the salaries and commissions to the organizing company. And I think you know who the top two or three offenders are.”

From Larry Leotard: “Re: new company. I saw an analysis that said new SaaS companies need to assume negative cash flow for 3-4 years because when you get paid monthly, the cash comes in slowly compared to selling licenses. Sales expectations in start-up biz plans are always too optimistic. Anyone can sell 10 hospitals, but getting to 40 is hard.”

I’m taking a little break, so Miss Inga will be presiding for a few days. Please treat her with the appropriate deference and civility as she is a delicate flower.

The newly opened Jane Pauley Community Health Center (IN), a collaboration between Community Health Network and the local school system, is using the GE Centricity EMR, merging physical and behavioral data. Its namesake, the former news anchor and Mrs. Garry “Doonesbury” Trudeau, was on hand.

Salem Hospital (OR) signs for PureSafety’s Occupational Health Manager.

The PACS Designer is putting together a list of iPhone apps designed for healthcare people to use on the job. Send me the names of those you like and I will forward to TPD for a future Readers Write article.

In Australia, the Royal Flying Doctor Service is rolling out a new EMR for its remote patients.

Some employees of Regional Medical Center (SC) are crying “institutional racism” after a hospital ceremony recognizing the IT people involved in its Cerner project kicked off with someone in a gorilla suit handing out bananas while “Hail to the Chief” played in the background. The committee who planned the program always starts off with that music to introduce the CEO and the theme of the program was, “We’re Bananas Over You”, but that explanation didn’t appease those who were offended. The trustees get into the act, claiming the hospital tried to “sweep things under the rug,” so the hospital is sending everybody off for diversity training.

I’m happy to announce that we’ll be having another blockbuster HIStalk event at the Atlanta HIMSS conference in March. Sponsors have stepped forward, a topnotch venue has been secured, and liquor trucks are being diverted from all over the Southeast to stock it up. More details to follow, but mark down Monday, March 1 in your planner. Your event ideas are welcome.

Former ONCHIT head Rob Kolodner retired on September 22 after 31 years of public service. A job darned well done, I say. In his e-mail announcement, he said, “I am delighted to not only to have had the honor to serve our nation’s veterans for almost three decades, and be able to help them in their time of need after so many of them put themselves in harm’s way on our behalf, but also to have had the privilege of participating in VA-wide and nationwide activities to improve the quality, safety, and efficiency of patient-centered health care. Hopefully, this time we will finally succeed in achieving sufficient health reform to trigger the transformations in health and care that we so desperately need in the US.” 

Bayer announces Contour USB, a plug & play glucometer that launches diabetes management software on a PC.

West Georgia Health System chooses Perot for revenue cycle services in a seven-year agreement.

An insurance company executive recommends three areas of focus for HIT startups: electronic connections for families, caregiver coordination, and population health.

Boston Medical Center, which just gave former CEO a one-time $3.5 million parting gift at her retirement, will close an ICU and lay off its 40 workers. The selectively generous facility will lose $170 million this year. Maybe it has board members from Merrill Lynch.

Newly announced Davies winner Urban Health Plan (NY) was able to create alerts and clinical decision support rules on its eClinicalWorks EMR the same day that CDC issued its H1N1 guidelines.

Odd lawsuit: an ambulance chaser and a Florida hospital are suing each other after the malpractice lawyer demanded records of all the hospital’s adverse events going back to its opening in 1934. The lawyer claims he’s thinking about getting a colonoscopy and wants to know how many perforated colons have occurred there. So why not just ask for those specific records? “"I could have a family member contemplating another procedure,” he said evasively. Or a client — he’s suing the hospital over a client’s perforated colon.

E-mail me.