News 8/25/10

From Teaberry: “Re: Verizon vs. Comcast. To provide the secure backbone for HIEs.” I keep hearing that Comcast will make some big healthcare moves soon, so we’ll see if that’s one of them.

From Eclipsys Observer: “Re: Allscripts and Eclipsys leaders. Under fire and intense scrutiny as the merger unfolds. The Newco has not identified a single product management leader, with John Gomez and Jon Zimmerman vying for power. Rumor is that Gomez is in the lead.” Unverified.

From DigiGuy: “Re: Roche/Ventana purchases BioImagene. You probably knew about it before it happened.” The Swiss drug maker will pay $100 million in cash to acquire the privately held California-based BioImagene, which sells a digital pathology system (slide scanner, biomarker analysis software, workflow, etc.) for tissue-based cancer diagnostics. The drug makers are struggling for some reason (prescription prices make that hard to believe) and are all over personalized medicine.

From WhatDoYa Know: “Re: Yale CIO job. [name omitted] is in line for it.” I left out the name while I wait to hear back from that person. Lack of response usually means confirmation. I’m waiting on that rumored Siemens surgery system vendor acquisition since John Glaser didn’t reply when I e-mailed.

From Toomer: “Re: Ingenix. I bet their next acquisition will be iSoft.” That wouldn’t surprise me, although I don’t know how interested they’d be in a company with minimal US presence.

From Wildcat Well: “Re: NJ’s HIE program. They held a conference call Friday for fielding questions from EMR vendors. The good Garden State showed themselves to be sometimes unyielding, under-informed, and at times down right combative with EMR vendor participants.” Unverified. I can’t decide if that’s necessarily a bad thing.

From Oregon Lab Guy: “Re: Portland weekly tabloid article about open source and HIT’s ‘gold rush.’ It suggests that we have ‘thousands’ of EHR experts roaming the streets of the Rose City – OHSU must have a big lecture hall!” The article says that Portland is the country’s open source capital even though the big companies took ideas and people from there and moved elsewhere. It bemoans the lack of follow-through with good ideas born there, mentioning that Portland’s techies have a reputation for wanting to head out at 5:00 each day (kudos to them). It’s a pretty good article, using the cynical mandatory EMR analogy that I thought I made up — requiring restaurants to use electronic order-taking and processing to improve their efficiency and reduce mistakes. Above is a July OSCON lecture on open source in HIT from Deborah Bryant of the OSU Open Source Lab.

Cumberland Consulting Group is named to Inc. magazine’s Top 5000 Fastest-Growing Private Companies for the second straight year, a nod to its 34% growth and its increase from 53 to 91 consultants in the past year.

Former Allscripts COO Ben Bulkley is named president and CEO of Fluidnet, an Amesbury, MA maker of what looks like a pretty sweet IV pump.

PerfectServe announces its Clinician iPhone application, which works with its system to allow doctors to make calls using the internal directory and manage their on-call schedules and notification preferences.

Ingenix completes its acquisition of Picis. That didn’t take long.

Industry longtimer Rich Goldberg, formerly of Misys and Confluence Medical Systems, joins TeleTracking as SVP of strategy and business development.

HITECH and MyEMRChoice.com are written up in the Philadelphia paper.

McKesson CEO John Hammergren is chairing the search committee of HP’s board that will choose a successor for ousted CEO Mark Hurd.

Dana-Farber Cancer Institute implements Informatica for data integration.

NIST’s approved testing procedures for temporary certification of EHRs are here.

Clairvia announces GA of mobile open shift alerts and scheduling for its physician scheduling system. The Durham, NC-based company, which sells resource management and scheduling systems, has executives from Atwork and Per-Se. It changed its name from AtStaff this past spring.

Northern Virginia RHIO will use GE Healthcare’s Global eHIE system to bring patient medication histories into Inova Alexandria Hospital’s Picis EDIS.

A PHI-containing and apparently encryption-free laptop is stolen from the University of Kentucky Medical Center.

E-mail me.

HERtalk by Inga

From KISS: “Re: (Company X). Is it me or do these guys have the worst elevator pitch ever?” I left out the vendor’s name, but I agree that it’s a pretty bad pitch when you can’t figure out what the company sells. It’s a shame that so many companies get caught up with using all these non-descriptive but trendy buzz words in an attempt to pitch their products. As Mr. H says, “they get too highfalutin’”. Note to marketing types: Keep It Simple Stupid for those of us who don’t want to read/hear your pitch more than once just to understand what you’re offering.

Community Hospital of the Monterey Peninsula (CA) selects RelayHealth’s HIE solution to connect and exchange clinical data with physician practices. RelayHealth, by the way, just achieved full EHNAC accreditation for its e-prescribing services.

Sage North America adds its healthcare division products to Sage’s Partner Advantage program, meaning its EHR/PM/EDI are now available through resellers.

McKesson names Eisenhower Medical Center (CA) and HealthFirst Care Systems (MN) the winners of its 2010 Distinguished Achievement Award competition for outstanding use of McKesson’s HIT products.

Intermountain Healthcare (UT) contracts with The Advisory Board Company for its OptiLink patient acuity solution.

BayCare Health System (FL) confirms news we reported over a month ago: Tim Thompson, most recently CIO at the Methodist Hospital System, is BaycCare’s new CIO.

Children’s National in Washington DC successfully implements the AuditACE compliance solution from Streamline Health Solutions.

CHRISTUS Health premiers a MEDSEEK-developed enterprise website that consolidates its 16 sites.

Mahaska County Hospital (IA) fires two employees for snooping in patient medical records for purely personal reasons. The violated patients included the ex-wife of a current boyfriend, an ex-husband, a husband, the mother of an adopted child, and a hospital volunteer. Ah…it is so tempting to ignore the law and common sense and just be nosy.

Epic moves into Heaven and the local papers have photos to prove it. The Madison and Verona papers provide updates on Epic System’s newest building (Heaven), which includes a curving, stainless steel slide that lets employees shoot from the first floor down to underground parking. With Campus 2 scheduled for completion next year, Epic is now contemplating a third campus. Judy — send me an invite because I really want to try out the slide.

Lenox Hill Radiology (NY) contracts with Professional Data Systems to manage Lenox Hill’s IT department.

The University of North Carolina Health Care System signs a contract to implement the Lawson Health Resource Management suite.

The North Texas REC selects WaveTwo, LLC as an official agent, tasked with helping physicians to implement EHRs and qualify for economic incentives.

I’m guessing that someone at Methodist Le Bonheur Healthcare (TN) has not signed the Oprah No Phone Zone pledge. The hospital says it will post updates on ER wait times every two minutes. The information can be accessed via Methodist’s Web site or by texting ERwait on a mobile phone. OK, I know they are not the only hospital offering this type service and I don’t mean to pick on them, but for some reason when I read their announcement, I envision a driver speeding down a highway while texting for wait times while looking in the rear view mirror to the back seat at a child holding his arm and screaming in agony. But really, I am sure it is a great service. So great that I see that MetroWest Medical Center (MA) is launching a similar program.

Canton-Potsdam Hospital (NY) names Jorge C. Grillo its new CIO. One of his priorities will be the implementation of a $2 million EHR system (Meditech, I believe.) He’s the former CIO of the Island of Bermuda’s Hospital System (sounds like a nice gig),

KLAS takes a look at RIS, awarding the top satisfaction rating to Epic Radiant in the 200+ bed hospital market. Avero interWorks and NovaRad tie for the number one spot in the community hospital market segment and FUJIFILM Synapse IS is the leader in the ambulatory market. The top four functionality items on providers’ wish lists include management reporting tools, flexible scheduling, rollout of mammography tools, and critical test results management functionality.

Modern Healthcare readers vote President Obama the most powerful person in healthcare. Lots of politicians and policy wonks fill out spots 2 through 100 on the magazine’s annual ranking of the 100 Most Powerful People in Healthcare. Rumor has it that Mr. H came in at #101.

E-mail Inga.

Healthcare IT from the Investor’s Chair 8/23/10

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First, let me offer my apologies to all, especially Mr. H. and Inga, for the heinous length of time between posts. It won’t happen again.

It’s been an interesting time with multiple industry-shifting M&A transactions (but not much in the way of public equity activity). The big question on everyone’s minds these days is not “Who is Salt?” but rather, “What is Ingenix?” (a) a drunken sailor? (b) a whale at the HCIT casino? (c) just too darned wealthy? (d) a genius assembling parts in a way that has yet to become clear? I would submit it’s actually (e), all of the above.

Let’s take each in turn. Ingenix, as all likely know by now, is the wholly-owned IT subsidiary of UnitedHealth Group, one of the largest publicly traded managed care companies. Mr. HIStalk himself recently posted a list of its recent buys.

The first thing that’s noteworthy to me is its dramatic movement from only managed care-focused companies — such as Symmetry, Claredi, or AIM — towards first the hospital business office (CareMedic, Executive Health Resources) and then towards the clinical side of the healthcare system (Picis and, most recently, Axolotl).

When Ingenix tried to buy managed care claims system vendor TriZetto a few years ago, it was going to make the questionable bet that its competitors would purchase their core systems from them. A stretch, but one with precedent. Now it’s betting that hospitals and physicians will not only pay real money to the Great Satan of Managed Care, but that they’ll entrust their clinical data to it as well.

(A provider-focused HIE vendor I know was recently licking their virtual chops over the prospect of selling against a managed care company. Even consumers will likely start to wonder if they want UnitedHealthcare to have the moment-by-moment deep clinical data inherent in some of the recent purchases).

Let’s talk valuation for a moment. As a buyer, Ingenix is, in many ways, ideal for a number of reasons. First, recall that by SEC regulation, public companies have to disclose any material information to their shareholders. The definition of material, however, is open to some debate.

When you’re owned by a company with a $35.5 billion market capitalization that expects to generate $5 billion of cash this year, materiality is a blessedly high bar (by way of comparison, Cerner’s total market cap is $5.7 billion). What this means is that outside shareholders can’t second guess the prices paid. It is, in effect, like a transaction between private companies.

Let’s imagine for a moment that Eclipsys was a private company. Because of their relative sizes, Allscripts still would have had to disclose the purchase price. It would also have been held, at some level, accountable to its shareholders for what it paid, imposing an additional layer of market discipline. Ingenix/United, in contrast, doesn’t view any of its acquisitions in the space as financially material, which no doubt helps loosen the purse strings.

An even better attribute in a buyer than ability to remain silent is ability to pay. At the time of its last earnings release (Q2), Ingenix’s parent United raised its guidance for cash from operations by $200-600 million (or almost as much as CPSI’s enterprise value). I’m sure Bill Gates’ kids would concur — when your parent generates that kind of money, you can pretty much buy what you want if they’ll let you! So when your business generates cash of almost $14 million per day, money is just not a problem.

Now I wonder is this a casino whale or a drunken sailor? One smart HCIT company president opined to me that this characterization was offensive to drunken sailors everywhere, but perhaps he’d just been outbid. Personally, I’m leaning towards whale. Unlike Misys in the 90s, United clearly understands healthcare and Ingenix clearly understands HCIT. Even some of the prices paid, if scuttlebutt is to be believed, aren’t totally irrational (though they are unquestionably aggressive).

Let’s consider Picis as an example. The company was widely rumored to have sold for about 3x 2009 revenue or about 12x 2010 EBITDA. By way of comparison, Eclipsys is selling to Allscripts for 2.1x trailing revenues and 10.5x forward EBITDA. Who’s getting the better deal? Eclipsys has a much broader product offering, but Picis’ products have great depth in the few areas of the hospital in which it plays. Both companies are coming off difficult years with fairly robust growth forecasts. Both have a great ARRA/Meaningful Use story to tell, which pushes their multiples upward.

Bottom line, to me, it appears to be a very aggressive, but not totally absurd price. Now, on the pricier side, Executive Health Resources was purchased for over $1 billion, and I’ve heard Axolotl went for as much as 9x trailing 12-month revenues, which seems a different story.

Finally, there’s the matter of motivation, which I expect is multi-fold. I have no doubt that there’s a grand strategy at play here that will be likely be revealed by the company once the pieces are assembled. But in addition to that, each year the operational dollars that are deployed towards these IT solutions are almost certainly to be counted towards patient care (as opposed to other business purposes). This will have the effect of making the optics of its medical loss ratio appear more attractive to government regulators. Further, I believe there will ultimately be some actual patient care improvements in many cases.

Ordinarily I’d say time will tell if the prices paid are fair, appropriate, or even reasonable; but in this case absent a total implosion, lack of materiality will likely make it difficult ever to learn. I’m aware of a few assets that Ingenix is on the hunt for. I’m sure, to their current shareholders, that the price paid will quite material indeed.

Ben Rooks is the founder of ST Advisors, LLC, a consultancy which works with HCIT companies and their sponsors typically on issues around strategy, financing and outcomes/exit planning . He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, was a leading healthcare IT equity research analyst and then worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

Monday Morning Update 8/23/10

From The PACS Designer: “Re: Yale’s Epic cost. $250 million!” TPD, who tells me he works for Yale in some capacity, sent over a copy of the Certificate of Need response for Yale New Haven Hospital’s Epic implementation. No wonder it took them awhile to find the money.

From Anon: “Re: VA and DoD. I’m not sure Epic is the frontrunner, but I think you are close. InterSystems is the likely winner with their TrakCare product. Take a poke around and see the massive size of their new implementation workforce and the sizable country-based contracts. It’s worth noting the rumor that InterSystems is allowed to sell Trakcare in only two ways to avoid waking the sleeping Wisconsin cash cow: outside the US and to the US government.” Interesting … InterSystems is strong at integration and of course has endless expertise in Cache’ and MUMPS, not to mention that as a big and very profitable company can probably make believable promises to the military. I notice they’ve also been steadily increasing their annual lobbying expense, over $200K in 2009 and much of that going to VA database issues. InterSystems acquired the Australia-based TrakHealth in 2007, rolling the Web-based enterprise system into their integration and HIE offerings. You may be on to something. Even if not, I like your thought process.

From Soliloquist: “Re: Epic and the DoD. I just can’t see a scenario for this working. This would be the ultimate culture clash, as you state. I also am having trouble envisioning how the government could take the heat for forking over billions for such a system. It wouldn’t fly when the media got wind of the deal and Epic would be unwilling to cut a deal. They don’t need the business.” See new poll to follow.

From Book ‘em Danno: “Re: HIMSS and Forbes HIT magazine insert. A full-page ad costs $37,000. The lowest price option is a 1/6 page ad for $7,000.” Verified – BED forwarded pricing information.

From Traveler: “Re: Siemens. I heard they are buying [surgery software vendor’s name omitted]. Have you heard anything?” I e-mailed John Glaser now that he’s in charge at Siemens, but I haven’t heard back so far. I’ll leave out the vendor’s name for now since it annoys me that unscrupulous competitors immediately start flashing the rumor to prospects to create FUD, but I’ll update when/if I hear.

From CTCIO: “Re: two Connecticut academics lose data. Our attorney general is on it!” A UConn laptop containing information on 10,000 undergraduate applicants is stolen from an IT department cabinet. Then came another stolen laptop at Yale School of Medicine, that one with information on 1,000 patients. Encryption was not mentioned in either case.

From Irene: “Re: LTC. I am the VP of IS for a small non-profit that serves adults the ages of 20-60 with severe physical disabilities. Although the organization falls under the Long Term Care regulations and is almost solely Medicaid reimbursed, the consumers are not typical of a LTC skilled nursing facility (frail elderly). Average length of stay is 10 years. We are entering work for EHR readiness and I am looking for any/all vendors that implement solutions outside of the Acute Hospital space, that have flexibility in their design and integration between clinical and financials, and ability to data warehouse long term health data. Any information would be appreciated.” If you have advice for Irene, please leave a comment.

From BackToOurRoots: “Re: EncounterPro EMR. Going open source. Wondering what this means for their current customers …” I don’t get the strategy even after reading their reasons the product went open source, only a couple of which seem to be relevant.

From WNA Wannabe: “Re: paperless at the VA.” What a strange story … a VFW claims representative makes “a unilateral decision to go paperless” and shreds all the files he has without making electronic copies. Or at least that’s the claim – the story gave me headache as everybody involved in handling the paperwork of veterans seems to blame everyone else for missing documents that are shuffled from one group to another. I didn’t realize that VFW helps veterans with that kind of paperwork, either. Paperless, done right, would be an apparent improvement.

From HITGeek: “Re: NHIN. See Twitter #newNHINnames.” Some pundits make up witty NIHN replacement names. My acronyms are always sophomoric semi-profanities, so I’ll keep quiet even though mine are funnier.

It seems that we can never reach consensus on the CIO education issue, still divided equally among “it doesn’t matter", a BS, or an MS. New poll to your right: would Epic be a good replacement for the DoD’s AHLTA?

A reader sent over the paper evaluating hospital EMR usage in California, which concluded that EMR usage was associated with higher costs and lower nurse productivity. The methodology was as I expected and have seen in other studies conducted by people outside of healthcare (the authors are business school professors): take some conveniently available but questionably useful databases, match them up, and try to find generalizable conclusions. It just didn’t work for me. The analysis started with the HIMSS Analytics database (which I wouldn’t trust too far since it’s a self-reported sampling), assumed that EMR implementation started a year after contract signing since that date wasn’t known, and then matched that information with cost and nurse staffing databases. It covered nine years and ignored all other relevant events that occurred during that time (mandatory nurse staffing laws, changing reimbursement, individual hospital quality improvement projects, shift of patient load from inpatient to outpatient, etc.) Some of the conclusions make the data relationships questionable: EMRs were associated with reduced nurse overtime, sophisticated EMR usage was associated with higher costs and longer stays (ignoring the fact that certain kinds of hospitals are more likely to be sophisticated EMR users), and high-level EMR usage increased complications but decreased mortality. EMRs are categorized only by usage level, not how well they were implemented, what level of integration they have, and which vendor’s product was involved. And of course, the biggest problem: “associated with” is a long way from “caused by.” I just can’t get excited about the article, but if you can, feel free to send in your analysis.

The same primary author, by the way, used similar survey data noodling to conclude that EDs with sophisticated EMRs have a lower length of stay for eventually admitted patients by nearly 25%, but admitted another finding that seems to invalidate the entire premise: basic EMRs didn’t really help. I’m not buying that, either. I’d be more convinced by a short-term, one-hospital case study that measured LOS before and after an EDIS implementation. I’d also be highly wary of assuming that inpatient admission times reflect ED efficiency (instead of inpatient efficiency in having available beds, for example).

Cerner adds nearly 400 employees so far this year, bringing their total to 5,185. 

CEOs of the five largest health insurance companies made $200 million in 2009. Cigna’s outgoing CEO got $111 million in retirement benefits, while the not-retiring CEO of UnitedHealth Group received salary and options worth $108 million. Apparently those of us actually working in non-profit hospitals made the wrong career choice in choosing to deliver care rather than administer it, although wildly overpaid CEOs are hardly unique to healthcare.

Maybe the folks at Zacks Investment Research need to update their spell check dictionary.

Another stolen laptop containing patient information, this time from Cook County Health and Hospitals System. They vow to review encryption practices. Honestly, can’t someone come up with an encryption method that’s easy to implement and invisible to the end user? Organizations clearly understand the value of encryption but aren’t doing it, so that tells me it’s too much of a pain.

E-mail me.

News 8/20/10

From Scatman Crothers: “Re: Stanford Hospital and Clinics. Replacing Dell Perot, which has just a few months to transition and leave. Accenture is taking over the whole thing.” Unverified. Perot got that seven-year deal in 2004, so maybe Accenture won the next round.

From No Surprise Here: “Re: EMRs. A study of California hospitals shows minimal positive effects of EMRs.” I hesitate to comment because the article is not up in full text yet, but it concludes: “EMR implementation was associated with 6-10 percent higher cost per discharge in medical-surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15-26 percent and reduced licensed vocational nurse cost per hour by 2-4 percent. EMR stage 3 was associated with 3-4 percent lower rates of in-hospital mortality for conditions.” I’ll be interested to see whether the authors attempted to quantify before and after results from individual hospitals, and if so, how they handled the other variables that surely changed in the study’s nine-year timeframe. My experience with these database-driven analyses, usually conducted by publish-or-perish academics, is that they use public information that’s conveniently available but not terribly relevant, leaving logic holes you could drive a truck through. I’ll review the article once it’s out.

From Jennifer: “Re: CPOE and meaningful use. My hospital uses protocol orders for meds that are triggered by specific criteria. For example, a lady comes in with a troponin of 1.0, which orders a contraindication screening for the nurse to complete. If no contraindications exist, then aspirin and Toprol are automatically ordered. These orders go to the queue for the attending physician to sign and are driven by evidence-based practice, but aren’t considered written, verbal, or direct. How would these be defined under Meaningful Use?” I’ll say upfront that I have no idea and I doubt HHS does either, but it seems reasonable to count them as physician-entered (feel free to correct me if you know for sure). The physician has agreed to use of the protocol and is the first signer of the order, so that sounds like a CPOE order to me and it’s certainly not a paper order. I’ll also add that one of the seldom-discussed aspects of MU is that it resembles Most Wired in that you turn in your own numbers with minimal chance of being audited, so in the absence of definitive guidance, I’d count those orders. Not to mention that evidence-based order sets like this are exactly what the government should be encouraging.

From HIT Insider: “Re: Eclipsys. Another sales leader departs – Jay Colfer, SVP who managed the biggest revenue producing team in the company. Big loss.” Unverified, but not surprising if true. If you’re a sales stud, you can work anywhere without the uncertainty of an impending acquisition on prospects and your own career possibilities. I wouldn’t say it’s a negative development for either the company or the individual.

Listening: new Iron Maiden, slower and more complex than their frenetic 80s stuff, lapsing more into non-wimpy progressive (think Ritchie Blackmore’s Rainbow or Rush with some AC/DC admixed in). I never liked them much, but this is really good. It’s a long album, but I’m on my third listen and liking it better each time.  Based on this live video, I’d definitely go see them.

Weird News Andy warns ahead of time that this story might offend some sensibilities, so I shall word it carefully. A newly delivered mother in China claims that her midwife, unhappy with the insufficient tip given to her by the father, sutures shut a nearby but unrelated opening. Also from WNA: a quality analysis concludes that church-owned hospitals deliver better quality care than for-profit ones, with Catholic hospitals also outperforming community hospitals.

HIMSS is involved, for some reason, with a November advertising insert in Forbes called Transforming Healthcare Through IT. The pitch: “Produced in partnership with the Healthcare Information and Management Systems Society (HIMSS), Forbes’ special Health IT report offers participating advertisers the opportunity to share how your organization will contribute to healthcare transformation through IT.” Whatever happened to just doing it instead of preening in front of a business reader audience? I’d bet that the only companies that sign up are those that are publicly traded or those that yearn to be.

Thanks to AdvancedMD for supporting both HIStalk and HIStalk Practice at the Platinum level. The Draper, UT-based company offers a Web-based practice EHR, practice management, medical billing, scheduling, and e-prescribing. The company also offers its AdvancedBiller program, which connects billing service partners with practices. As often happens, our first contact with the company was when Inga interviewed CEO Eric Morgan a couple of weeks ago, apparently triggering the company’s interest in supporting what we do. It’s a good interview — Eric and Inga covered the pros and cons of being a privately held company, EHR market consolidation, how AdvancedBiller competes with companies like athenahealth, and the influence of hospitals on practice EHR adoption. Thanks to AdvancedMD for supporting HIStalk and its readers.

University of Chicago Medical Center partners with a technology company to produce an epilepsy monitoring system that uses Bluetooth and a smart phone to continuously stream EEG information to a monitoring center. Interesting: it won’t work in iPhones because Apple hasn’t opened up the APIs it needs. Also interesting: the company has patented a technology that uses text messages to trigger smart phone events, which I assume means that monitoring centers could “order” additional diagnostics remotely by cell phone.

Industry longtimer J. R. Hughes, most recently at McKesson, joins the nine-employee healthcare consulting firm The Winkenwerder Company, which has some impressive clients.

Patient Privacy Rights releases its Health Privacy Risk Calculator, which is really kind of pointless since just about every American will score in the High Risk red zone (it only takes three positive answers to questions such as do you have insurance, do you take prescription meds, and do you pay for any health-related products using checks or credit cards). Actually, I guess that was the point.

Holzer Consolidated Health System (OH) chooses help desk and performance monitoring services from CareTech Solutions.

I’ve joked that the VA and DoD should get rid of their expensive, contractor-managed systems and just buy Epic even though I’m not sure it could cleanly replace VistA or AHLTA. I recently mentioned the NextGov-generated nugget that the DoD is soliciting proposals for an AHLTA replacement. If that happens, there’s no way it will be any vendor except Epic, even though Cerner got its foot in the VA’s door by selling them Millennium lab (or nearly so — I’m not clear on whether a deal was ever signed). Epic’s the only company with experience with decentralized organizations of that size (Kaiser), not to mention that Epic’s nearly clean-sweeping the big hospital market. Benefits to DoD: it’s ready to implement instead of taking years of expensive AHLTA rewrites, it won’t choke like some of the bad software that the trough-lappers have written for the government, it will be a heck of a lot cheaper, and lots of clinicians will already know how to use it. Disadvantages: Epic’s “our way only” model won’t fly too well with the military brass, it will be missing quite a few key pieces that are unique to DoD, and there would be quite a culture clash between the Woodstock-like bunch from Wisconsin and the inside-the-beltway crew cuts.

Sponsor jobs: Web Developer, Regional VP, Project Manager/Web. On Healthcare IT Jobs: Sales Client Executive (New England), Health IT Sales, Director of Ancillary Systems, Senior Director, Applied Clinical Informatics.

I mentioned the Emendo CapPlan capacity planning software back in May. The New Zealand company wins a six-hospital deal in Canada and says it’s still planning to go after the US market.

Philips invests in a $250 million medical technology venture capital fund that will focus on home health, sleep improvement, image-guided therapies, and clinical decision support.

Rhode Island Congressman Jim Langevin visits fast-growing EHR vendor Amazing Charts, with the company’s presentation including such items as forced EHR adoption, overpriced EHRs, and the need for transparency of Regional Extension Centers (the company’s obviously got a bit of a ‘tude, which I like).

McKesson CEO John Hammergren was one of the HP board members who forced Mark Hurd out. Wonder if he’s a candidate to replace him?

Former TeleTracking sales VP Joseph Gentile joins another Pittsburgh company, healthcare robot vendor Aethon, in the same role.

MidSouth eHealth Alliance signs for the CareAlign HIE solution from Informatics Corporation of America (still my favorite company name).

Testing the North Carolina Healthcare Exchange: WakeMed and Moses Cone Health System.

Israel-based satellite services vendor Gilat Satellite, which wrote off its $4.5 million investment in Axolotl almost immediately after it made it 10 years ago, will get $24 million in cash from the proceeds of Axolotol’s sale to Ingenix, with the possibility of getting another $3 million per the contract terms.

I’m trying to strike at least a sham of work-life balance lately, so naturally I’ve fallen a bit behind as a result. I promise you’ll like me better if you indulge me by patiently awaiting any delayed e-mail replies.

E-mail me.

HERtalk by Inga

athenaHealth announces a standalone option for its athenaClinicals product. Clients had been required to use it with athenaCollector. Removing the billing and PM service requirement will likely help athenahealth get into more opportunities, especially those involving hospitals and their affiliated physicians. Pricing is expected to be a flat fee per provider per month, based on patient volume.

The Homeland Security Department plans to acquire an EHR to manage illegal aliens detained by immigration officials. DHS says the EHR could be a commercial, government-developed, or hosted service.

Over half a million Mississippi Medicaid beneficiaries can now use Shared Health’s HIE, whose contract with Mississippi Medicaid includes the implementation of an EHR and e-prescribing system for state Medicaid providers.

Now this could be fun. Jonathan Bush from athenahealth Girish Navani of eClinical Works square off to discuss their views on the future of HIT and how each is dealing with their larger rivals. It’s September 29th in Boston.

CMS names Ingenious Med an official 2010 PQRI Registry.

St. Edward Mercy Medical Center (AR) is scheduled to go live September 26th on Epic. The local paper shares some of the detail on training requirements for users: physicians 12-16 hours, nurses and LPNs 24 to 27 hours, CNAs 6 hours, and schedulers 4-28 hours. Physicians with the hospital’s cross-town rivals are also preparing for an EHR live. By the end of the month, Sparks Health System should have several practices operational on NextGen’s EHR.

From the latest HIStalk Practice: Good Neighbor Community Health Center (NE) selects Sage Intergy CHC; the AAFP’s Center for Health raises some concerns about Meaningful Use; and, compensation for doctors in hospital-owned groups now exceeds pay for those in other type practices.

St. Charles Health System (OR) selects Velocity Technology Solutions to host and manage its Lawson ERP and Kronos time and labor management applications.

Cumberland Consulting Group promotes Amanda Hage to principal.

Members of West Virginia’s Governor’s Office of Health Enhancement and Lifestyle Planning discuss the hurdles of adopting HIT and agree that EHR utilization is a problem. Stephen Sebert, MD, the council chair for the West Virginia Medical Association, provided this comment: “I have an electronic system already, but the thing is it’s not being used.”  Don’t you know his EHR vendor is cringing a bit.

Rebranding: the 20-year-old Medical Transcription Industry Association changes its name to Clinical Documentation Industry Association.

The interim administrator of Coshocton County Community Hospital (OH) says the hospital will begin a six-month installation of a new Meditech system in April. Financing for the $4 million project may be an issue: as of July, the hospital had a $3.5 million operating loss. The administrator says funds for the $246K software down payment are available from reserve funds and financing options for the rest of the project “will be researched” between now and April. The hospital hopes the system will eventually qualify them for $4.5 million worth of stimulus dollars. I wonder how many dozens (hundreds) of community hospitals around the country share similarly dismal financial pictures? Meditech, by the way, was chosen over two other vendors for “functionality, cost, and meeting government mandates.”

GetWellNetwork introduces a new interactive care solution designed for senior patients.

Orlando Health (FL) and Advocate Good Shepherd (IL) contract with PerfectServe for its clinical communications system. In addition, Hoag Hospital (CA) signs an agreement to expand its PerfectServe services to its new Irvine facility, scheduled to open later this year.

E-mail Inga.

News 8/18/10

From The PACS Designer: “Re: Box.net. With the Google Wave application headed to Google’s archives, another collaboration tool called Box.net may offer an alternative for developers. The path to Meaningful Use is being studied by many, and the Box.net collaboration tool can work with Google Apps to satisfy the need to work together to improve healthcare processes.”

From Jim: “Re: Ed Marx. Although I read HIStalk regularly, I haven’t paid enough attention to him. The recent mention of his strategic plan got me to go back a read many of his postings. I don’t know how I’ve missed him, but what a find. He is one of the more refreshing and inspirational voices in HIT. Very belated congratulations on spotting his talent and sharing it with us. Thanks.” I’ll accept those compliments on behalf of Ed and add my own since I agree completely. I should mention, though, that you didn’t actually miss Ed’s earlier postings here — he’s been posting only for a few months. He had been writing for one of the rags and decided to make a change, part of which involved my back-loading all of his earlier posts to HIStalk. I think he’s found a wider and apparently more appreciative audience. Inga gets some credit, too, since she was his main contact (everybody likes Inga, of course).

From Defiant: “Re: Tiger Institute for Health Innovation at the University of Missouri. Next month will be its anniversary. Would you be interested in interviewing leadership there about the progress made to date and what their vision is all about?” Sure.

Thomas Jefferson University Hospitals contracts with 3M for document management and abstracting solutions.

Sacramento Maternal-Fetal Medicine (CA) chooses the SRS hybrid EMR.

We reported a reader’s rumor awhile back that suggested the Department of Defense might be thinking about mothballing its multi-billion dollar AHLTA EMR system. That may be correct, according to some sleuthing by NextGov, which found this solicitation buried in TRICARE procurement documents. It suggests that the military is considering commercial alternatives. The scope (warning: .DOCX) includes inpatient, outpatient, intensive care, ED, expeditionary, and ambulatory surgery, with “integrated support” of lab, pharmacy, radiology, and PACS. The EHR piece must cover telehealth, referral tracking, decision support, identity management, secure messaging, NHIN integration, cost accounting, personal health records, and a patient portal.

Thanks to the readers who tipped me off early about the Ingenix acquisition of Axolotl. Actually, Ingenix itself was prompt in sending over the announcement. Much appreciated. I think many people had failed to notice the company’s impressive string of acquisitions until I listed some of them yesterday.

Pittsburgh paramedics are upset with the county’s $10 million dispatching system upgrade, which they say is incorrectly prioritizing calls.

QuadraMed will offer clinical practice guidelines from CPMRC to its QCPR customers.

HIMSS, WEDI, EHNAC, and NACHA (that’s a bunch of acronyms, but they’re spelled out in the press release) release a white paper covering HITECH and HIPAA compliance for financial institutions.

Australia’s prime minister funds $225 million for telehealth sessions, plus more money for provider hardware and a videoconferencing-based triage service.

An Australian doctor accused of defrauding Medicare in 90% of her hormone testing patients says the government is wrong in saying she maintained incomplete medical records that did not include complaints, procedures, and histories. She says she’s just one of the 90% of doctors with bad handwriting, but has since computerized and “now I write a big story and I don’t abbreviate anything.”

An odd medication error: a mother who had just delivered triplets by C-section is ordered morphine. She was holding one of the babies when the nurse pushed the morphine into the baby’s IV line instead of hers. The baby’s fine, but the mom is suing anyway. The hospital has since created a policy that prohibits giving meds to moms in the NICU.

E-mail me.

HERtalk by Inga

Former Siemens Healthcare CEO Jim Reid-Anderson  is the new president and CEO of Six Flags Entertainment. I’m sorry, but that statement is just a bad joke waiting to happen (chime in, if you are so inclined.)

Moses Cone Health Systems (NC) and WakeMed Health & Hospitals (NC) are working with their state’s hospital and medical associations, as well as Thomas Reuters and CareEvolution to develop and launch the North Carolina HIE. The HIE will initially connect seven hospitals, three EDs, and 57 physician practices.

Over 40 health systems join Premier healthcare alliance’s ACO Readiness Collaborative and work together on building the critical components of accountable care organizations. Those 40 health systems represent a lot of hospitals and doctors who are betting ACOs are going to have a big impact.

If ACOs aren’t enough to give you a bit of anxiety, perhaps consider the pending v5010 deadline. Robyn O’Connell  of Hayes Management Consulting shares information and advice for migrating to v5010 here.

The Methodist Hospitals (IN) intend to fully implement Epic’s EMR within the next 30 days.

The local business journal chronicles the leadership of API Healthcare CEO J.P. Fingado, who left Cerner two years ago to head up API. Francisco Partners bought API  shortly after his arrival. Since 2008, the 28-year old company has gone from serving 600 hospitals to 700, increased sales from $40 to $50 million, and grown its employee base from 250 to 330. Sounds like Fingado is doing something right.

Here’s a recap of some good stuff from HIStalk Practice, just in case you missed it:

• An interview with AdvancedMD Inc. CEO Eric Morgan, who shares some insights on industry consolidation, on the advantages of being a private versus a public company, and on some of his company’s recent successes.
• Dr. Joel Diamond rants a bit about statistics. Try not to grin.
• If you need some inspiration, read about the work of Kenyan pediatrician Dr. Sidney Nesbitt, who Dr. Gregg Alexander calls an “amazing pioneer.”
• I rally for the co-founder of DoseSpot, who may have been an entrepreneur longer than he’s been shaving.

MidSouth eHealth Alliance (TN) signs a multi-year contract with ICA to provide its CareAlign HIE solution.

Orlando Health partners with Isabel Healthcare to implement its diagnosis decision support checklist tool.

Patient Access Solutions intends to integrate the iMedicor portal into its offerings, plus provide users access to iMedicor’s ClearLobby platform.

Persuading influential medical centers to adopt EMRs helps speed adoption by neighboring hospitals. That’s the conclusion of a study published in Management Science, which looked at what mechanisms influence the rapid spread of technology in hospitals. Apparently hospitals seem to follow a “social contagion” model. Note the parallel with fashion: celebrities first, then the rest of us. Draw your own conclusions.

Governor Schwarzenegger and a bunch of dignitaries launch the $30 million California Telehealth Network initiative, which aims to connect over 800 healthcare facilities to a statewide medical-grade network of healthcare and emergency services.

Odd: the police are called to a Burger King, tasked with removing a woman taking blood and urine samples in the bathroom. The woman claimed to be an RN working for a mobile medical exam company and collecting samples for insurance screenings. At least she wasn’t working the drive-through.

Chinese hospitals are apparently not the safest placed to work. During the month a June, a doctor was stabbed to death by the son of a patient who died, three doctors were severely burned when a patient set fire to the hospital office, and a pediatrician was injured after he jumped out a fifth floor window to escape the angry relatives of a newborn that died under his care. Such violence is apparently standard fare for Chinese physicians. Now if I were a Chinese doctor, I might be asking Steven Slater some advice on how to resign.

E-mail Inga.

Ingenix Announces Axolotl Acquisition

 
Ingenix announced after the market close today that it will acquire health information exchange technology vendor Axolotl of San Jose, CA. Terms were not disclosed.

”HIEs are bringing us closer to the point where all the health care professionals patients select to oversee their care can connect to share information and optimize outcomes," said Andy Slavitt, chief executive officer of Ingenix. "We will work with Axolotl to continue to meet the needs of multiple HIE stakeholders and to expand its technologies that serve health care communities."

We reported on July 23 that Axolotl was seeking a buyer that would be named soon, although the early rumors suggesting RelayHealth as that buyer were incorrect. We reported the Ingenix rumor earlier this afternoon.

Ingenix, a subsidiary of the Fortune 100 UnitedHealth Group, has acquired several healthcare IT companies this year: QualityMetric (outcomes measurement), Executive Health Resources (compliance), and Picis (high acuity systems). Other recent healthcare IT acquisitions by Ingenix include AIM Healthcare Services (payment solutions), Healthia Consulting, Lewin Group (consulting), CareMedic (revenue cycle), Global Works Systems (software), Integris (IT management), Claredi (e-commerce), HealthWatch (payment systems), Innovus Research (pharma software), Advana (claims management), Distance Learning Network (continuing education), and Symmetry Health Data Systems (analytics).

Monday Morning Update 8/16/10

From Delgado: “Re: contracts. I thought you might want to check out a contract between an HIE and its EMR vendor participants. Some doozies: the price is fixed for all EMR vendors with no deviation and the vendor can’t charge for support for the first five years.” I was amused that this particular HIE requires that any communication to it be sent by both snail mail and fax. Maybe HIEs don’t really buy into the whole idea of electronic communication of important information.

From Nuther1BitesDaDust: “Re: MedeAnalytics. If Ralph Keiser is in as SVP, then Sandy Cugliotta must be out. When will they stop shooting the sales leader messengers? The stuff is losing in the market.” Unverified. Both still list the company as their current employer.

Listening: Sister 7, reader-recommended, female-led funk or rock or something (whatever it is, I like it). I can’t figure out if the Austin band is still active.

The magazines try to convince everybody that Most Wired matters. It doesn’t, according to the 82% of industry expert readers who said on my poll that it’s irrelevant to their choice of hospital (if HIT experts don’t care about a hospital’s HIT, who should?). New poll to your right, because I’ve run a similar one before and I know people get stirred up about it: what educational level should a hospital CIO have achieved? The poll accepts comments, so feel free to argue your position while expressing it.

I interviewed Debby Madeira, a nurse manager at Huntington Memorial Hospital (CA) about mobile devices on HIStalk Mobile. I don’t get the chance to interview front-line people all that often, so I would welcome more opportunities.

Verified: Ben Clark, SVP of client support for Allscripts, is leaving. He’ll be replaced by his Eclipsys counterpart, Cos Battinelli.

The Milwaukee paper does a nice piece on API Healthcare’s success following its acquisition by Francisco Partners and its appointment of J.P. Fingado as CEO.

Response to Ed Marx’s post on multitasking was overwhelming, with over 100 folks requesting a copy of his personal strategic plan. Inga and I e-mailed out a bunch of copies until Ed offered to let me make it available for anyone to download here (he felt sorry for us having to send individual copies). Note: browser quirks sometimes cause it to download as a .zip file (at least on my PC), so just rename it back to .docx so Word can open it.

Weird News Andy won’t refuse this story: paper medical records from four Massachusetts hospitals, including pathology reports, are found in a public dump. The hospitals said the former owner of a billing service used by their pathologists told them he dumped the records when he sold the company in June. I think he’ll probably regret that decision.

Shareholders of Eclipsys and Allscripts approve the acquisition of the former by the latter.

A reader sent over a copy of the McKinsey article that says hospitals will need to spend $80-100K per bed to meet HITECH requirements (with HITECH money offsetting only a small percentage of that), but will save $25-44K per bed per year as a result. Unfortunately, the article was light on detail, making any kind of critique impossible.

UK hospitals are using a not-for-profit social networking site for patients to post updates about the condition of patients. Patients can post messages or use instant messaging. NHS says the service doesn’t cost them anything to use, plus it saves nurses time since family members don’t have to call them for updates. Brilliant. I’d be selling ads, though.

Big contractor CSC says it will sue if NHS cancels NPfIT as it’s threatening to do.

E-mail me.

Epic Staffing Guide

A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project.

Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say.

The guide suggests hiring recent college graduates for analyst roles. Ability is more important than experience, it says. That includes reviewing a candidate’s college GPA and standardized test scores.

I bet many readers were taught by their HR departments to do behavioral interviewing, i.e. “Tell me about a time when you …” Epic says that’s crap, suggesting instead that candidates be given scenarios and asked how they would respond. They also say that interviews are not predictive of work quality since some people just interview well.

Don’t just hire the agreeable candidate, the guide says, since it may take someone annoying to push a project along or to ask the hard but important questions that all the suck-ups will avoid.

Epic likes giving candidates tests, particularly those of the logic variety.

Given my dismal experience with clueless hospital HR departments (was that redundant?), I love this guide.

Editorial Critique

Chris Lehmann, editor in chief of the online-only Applied Clinical Informatics, asked me to discuss this editorial from the current issue. It’s called Electronic Health Records – Beyond Meaningful Use, written by Asif Ahmad, soon-to-be outgoing CIO at Duke University Health System (he’s leaving for US Oncology next month). Some of its points:

• HIT adoption in academic medical centers has experienced two key events since 2000: (a) publication of an IT chapter in IOM’s 2001 Crossing the quality chasm, and (b) the HITECH act.
• HITECH makes it too easy for hospitals to look at EHRs as just having a checklist of features that lead to a buying decision.
• Hospitals should use analytics to continuously improve their EHR systems.
• Duke believes that the natural extension of Meaningful Use includes (a) support translational research; (b) support patient empowerment; (c) streamline care delivery; (d) reduce costs; (e) enable knowledge extraction and application.

It conclusion, as I inferred it, is that instead of rushing to buy and implement new EHR products simply to qualify for HITECH payments, hospitals should use and improve what they have to meet their local needs.

My first reaction was that the editorial states the obvious. However, I’m reconsidering since cooler heads need to prevail during the EHR gold rush that’s consuming the energies and budgets of many hospitals, many or most of which are likely to be disappointed by the result.

Contrary to popular perception, HITECH does not require providers to buy new systems. They’ll get paid for results, not rebated for newly incurred IT capital expense. As long as their existing system is certified, the rest is based on how they use it. It’s not a vendor problem.

For some providers, their HITECH checks will be pure gravy. They’ll just use their existing systems better and earn a check without spending any new capital dollars.

For other providers, disappointment lurks. Just buying a new system doesn’t get you anything. Writing a big vendor check won’t automatically trigger even bigger government checks. HITECH money must be earned the hard way — by creating change.

I’ve been involved in a few hospital EHR selections and implementations. It takes quite a while to do them wrong and even longer to do them right. I would bet most of the Johnny-come-latelys won’t be ready by 2012 even if their vendors are. And I can only hope they don’t harm patients in their frenzied attempts to take the HITECH checkered flag.

Asif’s third point is easy to gloss over. Everybody talks about analytics, so it’s easy to miss his point: EHRs are massively complex living and breathing packages of processes that coalesce around business and clinical rules that are almost always poorly defined and documented. EHR customers cause many more EHR failures than EHR vendors. These aren’t set-it-and-forget-it systems that can be checked off as completed once the switch is thrown and the IT people are sent away to work on other stuff.

Asif doesn’t offer examples of analytics, but here are some I came up with. How has CPOE changed ordering and utilization patterns? How quickly can be be used to correct clinical problems, such as inappropriate drug utilization or lack of documentation needed for research or reimbursement? How quickly can CPOE and decision support changed clinical practice based on new findings, such as new dosing algorithms or promising adjustments in how diabetic patients are managed? How often do providers heed guidance offered in order entry and documentation? How have clinical system changes impacted length of stay, cost per DRG, and outcomes? What information is available to analyze outcomes by provider, by treatment, or by predisposing factors? What can be done to standardize practice by the use of order sets and predefined pathways? How can clinical systems support applied research, such as the effect of rotating antibiotics on a given service or the use of new medical devices in selected patient populations?

One of the most disgraceful aspects of US healthcare is also one of the least noticed: it takes decades before doctors actually use in practice the mountains of available (and expensive) research that could improve lives. Unless someone or something pushes them forcefully, doctors keep practicing like they did straight out of residency (that’s not opinion, that’s fact). The best way to get their attention is to pay them to do it a certain way. The second best way is to push them electronically by making it convenient for them to do the right thing.

Asif’s last point is also easy to gloss over as fluff, but it’s not. Let me paraphrase to make his point more clear: hospitals are lazy, incompetent, or both if they can’t think of anything better to do with their expensive new EHRs than punch an MU checklist and bank their stimulus check. I believe that’s Asif’s challenge to hospitals: do something with your EHR that benefits patients and not just your CFO.

Those with hospital experience know how big IT projects progress: (a) internal interest turns into impatience after the fun parts of the project, like site visits and system selection, are over; (b) once the hard work begins, the vendor and product chosen are almost always maligned as deceitful, undesirable, and unresponsive; (c) going live is such a drawn-out process that the project team is disbanded immediately afterward to catch up on deferred work; and (d) nobody goes back to measure before-and-after performance and push the organization to keep using, improving, and learning (often because that wasn’t budgeted upfront).

The five points he lists as the role of the EHR are nearly universally applicable. Even if they aren’t, every hospital should make their own list: what exactly do you hope to accomplish with this software other than to make people use it in some unspecified way? What are your success criteria and how will you measure them in a way that’s specific to patients? Is the organization capable of mandating change?

Practice makes perfect in almost everything, including EHR usage. Nobody get it right at go-live. Docs scream, nurses roll their eyes, and the IT people cast downward glances at their shoes even more often than usual. When the first batter doesn’t knock one out of the park, the crowd streams for the exits.

None of that makes any sense whatsoever. Quality improvement is, by definition, continuous. Usually it happens without anyone even noticing until some obscure quality geek armed with Excel e-mails out a graph that startles everyone: holy crap, we actually changed something for the better. The overriding question should always be: are we delivering better patient care today than we were yesterday?

Uncle Sam, Asif, and your vendor can tell you how to Meaningfully Use your EHR. They can’t tell you how to use it meaningfully. There’s a difference. Each hospital must choose its own goals and the methods by which it will achieve them. MU is the least common denominator, the gentleman’s C that causes no shame, but earns little respect. What hospitals do beyond being minimally compliant with the MU checklist is meaningful. That’s the part that will make all those taxpayer billions worth it.

News 8/13/10

From Buck S. Pearl: “Re: West Virginia Health Information Network. It’s tough to explain paying a $200,000 salary for overseeing five temporary workers. The HIE’s director resigned abruptly a few months ago before the RFP was complete. They need to finish the RFP, pick a vendor, and start building the HIE or there’s going to be political hell to pay.” The biggest atrocity is that they’re try to convince people that their WVHIN acronym should be cutely pronounced “Win”, which surely nobody’s buying. Being an HIE, they’re burning through state and federal grant money like the party will never end.

From Luria: “Re: Catholic University’s MSIT-HIT. I figure this is the result of HITECH, but what do you do with a MS in IT with a concentration in HIT? Do CIOs really favor a newly-minted Master’s over a clinical background or work experience?” I would see it as an add-on to both that might help land some jobs that aren’t too specific (i.e., not project management, implementation, software analysis, etc.) I doubt it would get you a job on its own, but it could get someone into management. You’re probably right that it’s riding the HITECH coattails since it even mentions Meaningful Use. Let’s hear what readers think.

From DeAnne: “Re: Microsoft. They’re working with a vendor to create a mobile physician workflow solution for Azyxxi-Amalga.” Unverified.

Listening: Razorlight, catchy indie rock by guys from England and Sweden. I’ve listened to three of their albums today, one of them twice. A reader asked what music I listen to in the gym, so here’s the current heavy rotation: Hole, Beatnik Termites, Nine Black Alps, After Forever, and Luscious Jackson. It changes since I play stuff to death and then move on, but these have stood the test of time and and are fast enough to keep me from establishing a too-slow running pace that will propel me off the back of the treadmill.

Ed Marx’s post on multitasking was a hit, obviously. He has updated it with responses to those questions he was asked. Ed is, I think you’ll agree, The Man.

Some stuff you can (and should) do here: (a) stick your e-mail address in the Subscribe to Updates box to get instant notices when something new goes up; (b) justify my expense in buying a search engine application by using the Search All HIStalk Sites box, which digs though everything in HIStalk Practice, HIStalk Mobile, and seven-plus years of HIStalk without you having to lift a finger other than the one with which you click the little magnifying glass; (c) Friend or Like us on Facebook on the widget to your right to stroke the emotionally needy Mr. H and Inga; (d) report a rumor using the ugly green but securely anonymous Rumor Report box; (e) check out the ads of my sponsors, consider them when doling out your business, and thank them publicly or otherwise for keeping the HIStalk fires burning.

Sponsor jobs: Web Developer, HL7 Analyst, Regional VP of Sales, Clinical Product Specialist.

Weird News Andy sprouts this story, in which a man’s suspected tumor turned out to be a pea plant growing in his windpipe. He was fine once de-legumed.

This fascinates me: pictures taken by GPS-equipped smart phones and cameras contain invisible geotags that identify the exact location at which the picture was taken. It’s possible but complicated to disable that function in iPhones, but if you don’t, pics taken outside your home tell anyone who cares precisely where you live. Check out this site, which runs a stream of posted tweet pictures and the addresses from which they were taken, of which the site’s creator described the typical reactions: “’I’m going to punch you out,’ or ‘No duh, like I didn’t already know that’ or ‘Oh my God, I had no idea.’”

Thanks to the folks at ZirMed, a new Gold Sponsor of HIStalk. The Louisville, KY company offers services that include eligibility verification, payments, claims management, ERAs, collections, and analytics. Their latest offering is Patient Notebook, a green way to manage statements by sending them electronically and allowing patients to view, manage, and pay them online, saving providers 40% on mailing costs in the process. The provider can view delivery information and print a paper statement if needed. It also sends an electronic reminder and then a paper statement to patients slow to respond. Thanks very much to ZirMed for supporting HIStalk.

An LA Times blog suggests that HP CEO Mark Hurd got a raw deal by being ousted over falsifying $20K on expense accounts to hide his alleged philandering, citing the case of HP director and McKesson CEO John Hammergren. It argues that Hammergren joined his fellow HP board members in holding Hurd accountable for the same standards as other HP employees, yet McKesson admitted it fudged the formulas used to calculate Hammergren’s nest egg to raise it from $74 million to $85 million. I mentioned his “golden coffin” bennies last year, saying

Those provisions pay a lump sump to heirs when a senior executive dies, $25 to $39 million when John Hammergren meets his maker (in addition to the $80 million his family would get from his retirement plan) … You would think he founded the company instead of just coming on board eight years ago. Maybe Senator Grassley should look there if he wonders why healthcare is so expensive. But, if MCK shareholders would rather he get the money than them, so be it.

The VA starts posting a monthly list of data breaches that include lost BlackBerrys, unencrypted e-mails, mis-mailed prescriptions, and missing laptops (to their credit, all six laptops reported missing or stolen in July were encrypted). A fun non-breach item reported: a VA employee was caught using someone else’s SSN on her employment documents. “Per the OIG, the employee is definitely using the wrong SSN. The question is why.”

A tech article describes the SafeBaby Breast Milk Tracking (SBMT) system, which bar code matches babies against mothers and also checks expiration dates.

WakeMed (NC) rolls out Axial Alerts, an open source platform that allows pediatricians to review real-time clinical information from the ED of WakeMed’s new children’s hospital. I mentioned the Raleigh-based Axial Exchange in February when I listed the participants on the Health IT Venture Fair at HIMSS. Some of its execs are from Red Hat.

Jobs: Senior Project Manager, Epic Inpatient EMR Manager, NextGen Consultants, Marketing RFP Consultant.

A McKinsey Quarterly article (or at least the teaser part I can see as a non-subscriber) says HITECH-encouraged EMR adoption could save $40 billion per year.

Massachusetts regulators approve creation of a doctor shopper database to curtail prescription drug abuse.

Transition of control of Marin General Hospital (CA) from Sutter to the local healthcare district has gone well, except that “some of the imperfections have been in the IT area.” They had problems between their McKesson systems and their printers, causing delays in the outpatient lab. The CMO said the integrated system should be an improvement, but the nurse’s union rep said she’d heard the software was hard to use.

Dell is pitching its Android-powered Streak tablet to schools and will go after the healthcare market starting in the next few weeks.

E-mail me.

HERtalk by Inga

From Get Off of My Cloud: “Re: Ben Clark. He’s left Allscripts.” Unverified. Clark is/was the SVP of support for Allscripts and had been with Misys for a decade before that. True or not, I suspect we’ll see plenty of changes at Allscripts and Eclipsys over the coming months as talent is “synergized.”

Nuance introduces Dragon Medical Mobile Search, a free iPhone app that allows physicians to search for medical information using voice technology. A physician can use voice commands to search a variety of sources, such as Medline, Medscape, and Google. Definitely sounds cool. Anyone tried it?

NYC REACH, the REC for New York City, selects Business Technology Partners as a preferred vendor to help physicians implement EHR solutions.

CareFusion says it will cut about 700 management and support jobs following a big decline in net income. The company posted Q4 net income of $52 million compared to $96 million a year ago and expects the cuts will save as much as $120 million per year.

Microsoft names FormFast as a Certified Partner.

Southwest Medical Center (KS) selects Summit Healthcare and the Summit Express Connect interface engine to manage its Meditech connections.

Rhode Island’s medical board reprimands a neurosurgeon when a patient complains her medical record documented services she did not receive. The doctor blames his EMR, saying he erroneously clicked on items using the software’s drop-down menu tools. The insurance company was also billed. The board was skeptical of the doctor’s claim based on the number of items selected. He’ll have to attend a medical record-keeping class and pay $500 in administrative costs.

CliniComp announces that seven US Air Force, Army, and Navy military treatment facilities implemented its Essentris EMR in the second quarter.

IBM is working with the VA to test a new paperless claim process. The VA hopes the electronic process will reduce its backlog of 497,000 pending disability claims. Am I the only one shocked that this process is just now going paperless?

Another step in the right direction: the VA’s CIO says that for the last month and a half, the VA has been successfully using the DOD’s personal ID system for each of its service members. Meanwhile, the VA expects to announce its plans for modernizing VistA by the end of the year

DR Systems announces six new contracts for its Unity RIS/PACS, each worth between $225,000 and $1 million.

Pinnacle Health System (PA) will deploy MobileMD’s eShare module, which allows providers to exchange messages and share clinical documentation electronically.

A new reseller alliance between Crossroads Systems and Dell Services gives Meditech customers new options for virtual tape backup and encryption. The Crossroad solutions TapeSentry and SPHiNX are certified by Dell for Meditech and will be the first two products offered.

Cardinal Health Foundation awards over $1 million in grants to help 40 organizations improve healthcare efficiency and quality. Some of the selected projects include implementation of CPOE and/or bedside medication administration, medication reconciliation, and e-prescribing.

What you may have missed in yesterday’s HIStalk Practice: a good read from HemOnc Today that examines the good and the bad of EHR implementations; an iPhone app for identifying adverse side effects; and AirStrip Technologies scores some VC money. Oh, and show me you care by signing up for the e-mail updates when you pop over to the other site.

Hospital execs as a whole are underwhelmed with existing enterprise resource planning (ERP) tools, according to a new KLAS survey. The report’s author says, “Providers say they can expect either robust functionality or service and attention — not both.”  McKesson was the highest-rated vendor with a score of 74.5 out 100. Oracle was a relatively close second; Lawson was ranked a distant third.

Global IT and engineering provider Smartronix expands into HIT with the purchase of HIE vendor Cogon Systems. We interviewed the CEO three years ago.

In odd but non-HIT related news, a Seattle police officer tickets the parked vehicle of a 36-year-old man who appeared to be sleeping in the driver’s seat. The officer attempted to wake him by tapping on the window. When he failed to respond, she assumed he was a sound sleeper. Less than an hour, later the man’s girlfriend tracked him down with a GPS. Medics believe he had been dead in the car for several hours before he was found (and ticketed). The deceased man won’t be required to pay the $42.

E-mail Inga.

News 8/11/10

From Staff Infection: “Re: HealthPort. I overheard that the Germany-based CompuGROUP is looking to expand beyond its Noteworthy acquisition. They want to have 30,000 US physician customers by the end of 2010 and have been peeking inside the kimono of HealthPort. Not a pretty sight, but I bet the brain trust at the Thurston Group (manages HealthPort) would unload it on the cheap. Reminds me of the old Steve Martin line of how to make a million dollars and not pay taxes — spend $30M on Companion Technologies and drive it into the ground and sell it for $1M.”

From Misys_Ex: “Re: from the QuadraMed user group. Michael Simpson, SVP of product strategy, has resigned after six months on the job.” Unverified.

From Alanya: “Re: your Las Vegas rant. That’s why I LOVE reading your blog. You make me laugh out loud on a Monday morning. It’s nice to get your perspective for those of us who are office-bound. Keep it up!” Thanks, sweetie. You may regret encouraging me.

From Irene O. Tican: “Re: McKesson. Lee Fowinkle, VP of engineering at McKesson Ambulatory, has left. He was leading the single database project and his departure will have a significant impact on MCK’s ability to deliver an ambulatory MU product.” Verified, at least the part about his MCK departure. I’m cackling to myself at the fake name I made up for this reader’s post, by the way (oncologists will get it).

From The PACS Designer: “Re: Google Wave. TPD has posted about the collaborative aspects the Google Wave platform. Google has announced that it’s ending all development on Google Wave. Some EHR experimenters are unhappy with this news, as they wanted to incorporate the Continuity of Care Record (CCR) and the Continuity of Care Document (CCD) using Google Wave to provide a complete record of a patient’s treatment history across institutions.” I can’t say I’m too surprised at this rare Google misstep. I got an early invitation to Wave, watched the endlessly long video that tried to explain it, tried it for a few minutes, and walked away for good because I couldn’t see the point. If you can’t explain it in less than an hour of edited video, nobody’s going to bite.

From Cassie: “Re: Mercer. Mercer has apparently lost another piece of IT equipment and thus lost employee data for City of Boise employees. I doubt Mercer is going to be signing deals in the State of Idaho anytime soon.”

From Amy: “Re: Aprima Medical Software User Group in Dallas. This is one of the best events I have attended. I am very happy with the path Aprima is taking. This is not an advertisement, but a shout-out for a job well done. An industry colleague turned me on to HIStalk – love it!” President/CEO Michael Nissenbaum invited me to attend the next one after reading my ACE recap. I interviewed him two years ago when the company was called iMedica and had recently licensed its product to Misys (now Allscripts) to sell under the MyWay name. He’s a pretty funny guy.

From Joe: “Re: pagers. Although it would seem this technology should have disappeared, some facilities do not have call penetration. They are also cheaper for workers who just need to receive brief messages.”

Watching: Pushing Daisies, an outstanding and highly awarded comedy-drama with some surprisingly effective poignant and romantic moments (I might have sniffled a couple of times — I’m sentimental). The narration and art direction is outstanding, as is the snappy dialog, the acting, the music, and the always endearing Kristin Chenoweth (instantly recognizable as Bebe’s chirpy assistant Portia from Frasier) and Swoosie Kurtz. Like most shows that require a reasonably cognitive audience, this one died fast, but has arisen from the dead (no pun intended) on Netflix. My highest recommendation.

Kern Medical Center (CA) recovers from a malware attack that took down most of its systems.

The Center for Biomedical Informatics at The Children’s Hospital of Philadelphia creates a free iPhone app that classifies adverse events in clinical trials.

My last post asking for keynote speaker suggestions generate several comments at the end of the article. Check it out.

Former QuadraMed VP Larry Visk joins PerfectServe as EVP of sales.

Santa Clara Independent Physician Association signs up for the Excelicare system (HIE, clinical apps, disease management) from AxSys Technology.

Omnicell will co-market Sentinel RCM (medication functions for 340B billing, drug diversion, inventory, drug cost, and J-code management) from Sentry Data Systems.

Ralph Keiser, formerly of Eclipsys, joins MedeAnalytics as SVP of provider sales.

MedNetworks raises $5 million in Series A funding. Its technology, licensed from Harvard, maps the social networks of doctors to empower its clients to “leverage existing data to disseminate information and focus interventions,” which suggests equal potential for good and evil.

Weird News Andy notes “a Hefty piece of lifesaving equipment” as a paramedic fashions a makeshift incubator from a trash bag and towels to save a preemie weighing less than two pounds.

This is exciting: Microsoft will start a beta of Visual Studio LightSwitch this month. It’s an business application builder (desktop and cloud) for non-programmers that can tie into information from SQL Server, SharePoint, and other data sources. I’m all over it once it’s up.

I was annoyed by the sluggish performance and uncomfortable bulk of my ancient laptop at ACE, so I bought an HP Pavilion DM3-2010us when I got home. I love the 13.3” display, 4.2 pound weight, long battery life, a fast boot option to get to the Web, and built-in webcam and N-capable wireless. It’s like a super-powered, stylish, reasonably sized Netbook. $499.95 at Office Depot after rebate. I didn’t realize how much I hated Windows Vista until I got this one with Windows 7, which is excellent. Now I don’t have to be jealous of those Mac users and their 13.3” lightweights. All it doesn’t have is a DVD drive: $37 for a USB-powered external at Newegg. I’ll be getting some looks at Panera, I hope.

HIMSS VP Pat Wise does a Q&A on What Meaningful Use Means to Nurses.

Actuaries estimate that medical errors cause the US economy almost $20 billion per year.

Speaking of actuaries, even the Medicare Chief Actuary says CMS’s optimistic estimates of Medicare cutbacks are a load of crap, at least unless voters are OK with providers going broke and refusing them service.

SaaS productivity application vendor Zoho and NetSuite form MedicalMine, a consumer tool for managing children with autism. Phase II involves a physician version and an EMR. Zoho has cool, easy-to-use apps, so this could be interesting.

Vangent will pay $65 million to acquire 450-employee Buccaneer Computer Systems, which provides healthcare IT services to the government. I found this interesting: Buccaneer, which previously processed Cash for Clunkers vouchers, wants to ride the wave of federal HIT spending, which is what caught Vangent’s interest.

One of the cooler things I’ve seen on a company’s home page: check out Kronos and the cute Australian who strolls out chatting from behind the application screen shot.

Oracle’s Larry Ellison criticizes HP’s board members for forcing CEO Mark Hurd to quit despite finding that he did not violate the company’s sexual harassment policy. “The HP board just made the worst personnel decision since the idiots on the Apple board fired Steve Jobs many years ago.”

I’m a bit behind in my e-mails, interviews, etc. as I get reacquainted with Mrs. HIStalk after my little Lost Wages junket, so bear with me. I have 15,000 sent e-mails in Yahoo Mail, if that gives you an idea of the volume of interaction I have with readers, sponsors, etc. Happily, I might add, so don’t let that stop you from giving me a holler.

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HERtalk by Inga

Meditech restructures its client services operations with the promotion of Joanne Wood to SVP of client services, Leah Farina to VP of client services, and Helen Walters to VP of clients. The three execs have a combined 68 years tenure with the company, which says a lot about these women and the company (all good). We reported this on July 30, but the official announcement just came out.

Lowell General Physician-Hospital Organization (MA) implements MedVentive’s business and clinical intelligence platform to manage risk contracts.

Another HIT acquisition: EHR/PM solution provider MedLink purchases Health Informatics, supplier of the Health Informatics Digital Pen and MD Form Manager. MedLink, by the way, partners with Patient Access Solutions to participate in the SunCoast RHIO program. MedLink’s president predicts 500 participating practices will generate over $11 million in EHR sales over the next four years.

Madison Center (IN/MI) reports a $25,000 reduction in transcription costs within two months of moving to Webmedx’s web-based medical transcription service.

Press Ganey Associates acquires the Quality Indicator Project division from the Maryland Hospital Association. The QI solutions provide tools for quality reporting, collection, and reporting.

Orion Healthcare Ventures completes its acquisition of Aspyra.

The CEO of Cooper University Hospital (NJ) reports the facility is now live on Epic’s physician documentation with 100% CPOE usage.

Former Eclipsys SVP Ralph Keiser joins MedeAnalytics as SVP of provider sales. Prior to Eclipsys, Keiser had senior leadership positions with EPSi, Cerner, and @OUTCOME.

In the first half of the year, MEDSEEK increased its total gross sales bookings 40% over the same period last year. YTD revenue grew 18%.

Merge Healthcare reports a $30.9 million Q2 loss, in part due to costs associated with its Amicas acquisition. Total sales, which include figures from Amicas, grew 89% to $29 million.

Nuance Communications also posts a loss amid higher revenue for its second quarter. The company lost $1.53 million, compared to last year’s $2.82 million loss. Revenue grew 13% to $273.2 million. Investors expected more revenue, leading the stock price to slip 16% on Tuesday.

Over on HIStalk Practice, Dr. Gregg Alexander comments on the industry’s newest bedfellows: insurance companies and EMR companies. Dr. Alexander calls it a move, “that would surprise most of us about as much as hearing that Coke and Diet Coke are actually made by the same company.”

At St. Mary Medical Center (CA), four staff members are fired and three disciplined for posting photos of a dying patient onto Facebook. The patient had multiple stab wounds and was nearly decapitated from a throat slashing. If you like blood and guts, I guess that might be pretty thrilling stuff and actually get you a few thumbs up. But seriously, how can people be so stupid?

Methodist Healthcare System (TX) selects TeleTracking Technologies’ RadarFind RTLS for five of its hospitals.

Highmark partners with A.D.A.M to provide a new iPhone application that includes medical reference content for members.

I forgot to mention last week that I finally got my new iPhone4. I hate the reception, which is not nearly as good as what I had on the 3G, and definitely not as good as a regular old cell phone. I’m looking for suggestions on bumpers or cases. I had the Otter before and I liked it because it was quite heavy duty and was survived being thrown between my purse and the console of my car. Now I’m open to anything that might enhance reception, if that is possible.

Memorial Hospital of Union County (OH) selects DigitalPersona Pro to provide secure EHR access and biometric authentication.

NextGen is awarded two-year accreditation as a provider of continuing medical education for physicians by the Accreditation Council for Continuing Medical Education.

Here’s a story that I am sure warms Dr. Deborah Peel’s heart. A US appeals court upholds the constitutionality of a Maine law that allows doctors to withhold their individual prescription-writing information from data mining companies.

UC Health University Hospital (OH) contracts with MRO Corporation to incorporate MRO’s ROI processing services with its EMR.

Wellpoint plans to align its P4P incentives with Meaningful Use criteria and implement a financing program to support HIT in rural and underserved communities.

From Weird News Andy, here are details on study by an Iowa State University student who obviously does not understand fashion. For her thesis, the student looked at the whether or not wearing high heels increased the risk of developing osteoarthritis. Big surprise here: the higher the heel, the greater the risk of joint degeneration and knee osteoarthritis. And (duh) heel heights change walking characteristics (slower speeds and shorter  strides). Any woman who has sacrificed her feet for fashion for any length of time could have saved this researcher lots of time and money and told her the same thing. Heels are about looking hot, not being sensible.

E-mail Inga.

Monday Morning Update 8/9/10

From Your Name Here: “Re: Community Health Systems. Medicity wins VOC, beating out RelayHealth.” Unverified.

From Scotty B: “Re: ACE. I guess you scared the cardboard Mr. HIStalk into hiding today.” The vendor who misappropriated my Smoking Doc logo at the Allscripts user meeting demonstrated at least a little bit of creativity in acknowledging their transgression. Two readers with what I assume are tongues in cheeks are urging me to sue them.

From Lem Hewitt: “Re: ACE. I wish you would go to Epic’s UGM and do a similar report.” Now that would be interesting — I’m kind of embarrassed that I’ve never thought of doing that. Lem generously offered to cover the hotel costs using his Marriott points. I’d have to swing some time off from the hospital and probably find a customer willing to let me pose as their fake employee. Something to think about although there’s not much time left.

From Dirk Squarejaw: “Re: speakers. Do you know of any dynamite speakers for a CIO-type crowd?” I get asked this question a lot, so I’m appealing to readers to suggest outstanding speakers they’ve heard. The criteria: (a) inspiring; (b) unbiased; (c) not the HIMSS semi-celebrity types who charge thousands of dollars, like the guy who sawed his own arm off or Dana Carvey; (d) not just canned speech-readers riding the rubber chicken circuit. Ideas? I should disclose that I’ve been asked a couple of times to do keynotes, but I always decline – I have nothing insightful left to say that I don’t say right here, so I’m leaving it all on the field, as the jocks say.

From Ollie: “Re: mobile healthcare. I was getting blood drawn at Emory Midtown and saw an infectious disease MD tapping away on an iPad in the Starbucks line. I asked how he liked it using his Cerner PowerChart EMR that way. He said it loves it, it runs great, he places orders, does documentation, etc. He was happy to share and smiling when he said it. An MD reviewing an EMR, maybe even placing orders, while in line to get coffee … what is the world coming to?” That’s pretty cool. As much as we debate software usability, mobile device capabilities are right up there when it comes to physician satisfaction — just like it is in the consumer world, where the same old e-mail app takes on another dimension when you can use it untethered.

From Geri: “Re: objectivity. How do we know that an anonymous Mr. HIStalk doesn’t have interest that conflict with those of his readers? I’m not accusing, just asking.” Here’s how I would judge anyone running a site like HIStalk: (a) do they have a hidden agenda, like owning stock in a particular company or profiting in some undisclosed way? I have no way of proving it, but I don’t. (b) are they pitching their own profitable endeavors such as consulting, speaking, or landing a board gig? (c) do they shill out every possible revenue source, such as spamming readers with sponsored e-mail blasts? (d) have they ever actually worked in the field, particularly on the non-profit side, or did they just cruise in and hang out a shingle proclaiming to be an expert? and (e) does the author try to use his or her readership to make themselves more famous and influential? Feel free to judge me on any of the above — you have seven years’ worth of evidence to review. Staying anonymous keeps me honest — there’s no way to cash in even if I was tempted, i.e. there’s no such thing as an anonymous celebrity. It’s a fair question, though, and there’s more information on my About HIStalk page.

Listening: new from the highly regarded Arcade Fire.

It appears that we remain collectively unconvinced that HIEs can figure out how to support themselves financially, like trust fund babies who struggle when daddy’s money (or Uncle’s in this case) is gone. New poll to your right: if you were seeking hospital care, would you care whether a hospital is on the Most Wired list or not?

Tucson Medical Center’s CEO talks a lot about its Epic implementation in her blog entry about upcoming layoffs that were triggered by a 10% drop in inpatient volumes. One the one hand, “While costly, the investment was worth it because, as we were told by Epic last week, we are far ahead of other hospitals in terms of system optimization,” but reading between the lines, she seems to say that the labor needed to implement it caused the hospital to miss its productivity goals.

Kaiser reports Q2 numbers: $11 billion in revenue and $313 million in operating income. They, too, talk a lot about Epic / HealthConnect, saying that members exchanged 5.3 million messages with their providers in the first six months of the year.

Looks like the Sunny Sanyal rumor was on the money. He’s at T-System now. Thanks to You’ll Know Who for the original rumor and Mark for telling me about Sunny’s updated LinkedIn profile (done since my original report, apparently, since I checked it originally and it was unchanged).

Somebody breaks into a Texas allergy clinic and steals four PCs containing PHI, although as one of the docs said, “We’re an allergy clinic, so I don’t think there was anything embarrassing taken.” The clinic complains that it cost them $15,000 to send the mandatory breach notification letters to its 25,000 patients, more than the cost of replacing the computers.

A reader sent over a note about the death of Christopher Heller, MD, FACS, a co-founder of hospital software vendor MIDAS+. Condolences can be sent to his family via this e-mail address or left on the obituary page.

Encore Health Resources announces its EHRight solution, which helps map EHR technology to the MU requirements, match clinical data elements to quality measures, and assess EHRs.

Medicare’s fraud contractors, which cost taxpayers more than $100 million per year, come under the gun of Senator Chuck Grassley, whose investigation finds that they take six months to send their cases to law enforcement and only seven percent of the suspicious billing they identify is recovered. Also noted: the Program Safeguard Contractors are poor at identifying new fraud trends. The Obama administration, of course, says it will fix everything, with the only announced change so far being to give the groups a new name.

The travel habits of athenahealth CEO Jonathan Bush are profiled in the Watertown section of the Boston paper. “I literally rent [an] airplane every Tuesday morning, and I hit five cities by Thursday night, every week. I’m cold calling . . . That’s my life now. It’s like any government fiscal stimulus thing — it’s a gold rush.”

Sharp Community Medical Group signs up for the just-announced Collaborative Care Solution jointly sold by IBM and Aetna. I’m not entirely clear on exactly what it is, but it sounds like analytics. I’m always skeptical about IBM’s healthcare intentions even when insurance companies aren’t involved, so I’ll assume it’s a repackaging of a hodgepodge of its existing technologies that will tap into insurance company billing data for clinical purposes (always questionable), with a key motivator being getting stimulus money. Reference is made to HIE-type services as well. They say it will cost less than $1,000 per doctor.

The Milwaukee paper writes up AskHermes, software developed by University of Wisconsin-Milwaukee researchers that uses natural language processing and artificial intelligence to review medical case descriptions to recommend treatments.

A study looks at telepsychiatry, in which patients are interviewed on camera with the resulting video analyzed later by psychiatrists. I found that of minimal interest, but that announcement (and a couple of unrelated ones that talked about video recordings of patient encounters, including remote ICU monitoring) suggest that the multimedia EMR is finally at hand.

Oracle’s punishment if found guilty of defrauding the government by overcharging it for software could reach $1 billion. Imagine being the former Oracle employee who is the sole whistleblower in the case.

Ingenix releases a version of its CareTracker PM/EHR with specific functionality for Federally Qualified Health Centers.

Incoming medical students at the UC Irvine School of Medicine will receive an iPad preloaded with mandatory course materials and hundreds of medical applications. Interesting: they’re ditching the sage-on-the-stage lecture model in favor of student-controlled learning. That’s the big announcement if you ask me.

MedAptus announces GA of the new version of its Intelligent Charge Capture system, which runs in the iPhone and iPad.

MEDecision releases Alineo 3.0, the new version of its case, disease, and utilization management system.

eHealth Insider reports that NPfIT is about to be scuttled as part of its decentralization, even losing the Connecting for Health name in a program to cut its massive costs. The government is putting CSC on the hook to reduce its costs dramatically and the Microsoft enterprise licensing deal has already been cancelled.

Odd lawsuit: the widow of comedian Bernie Mac sues his dermatologist for not recognizing his symptoms of respiratory failure. The doctor says he told him to get to a hospital and he did.

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Final Thoughts – Allscripts Client Experience 2010

I have to say that I enjoyed ACE a lot, although I can’t pinpoint what I liked about it specifically. I think it may have been that, unlike HIMSS, the attendees had modest egos. I saw no one pontificating, traveling with a sycophantic entourage, or working their pectorals with a foot-long string of “I Love Me” badge ribbons. These are mostly frontline people from practices and hospitals, i.e. my kind of folks. I liked the Allscripts people, too. The logistics were manageable, the lunches and opening reception held in the Hub with vendors was a smart idea, and there were plenty of essentials at hand (restrooms, break-time snacks, and entertainment).

One more full disclosure item: I take my “everyman” role seriously, so I turned down an e-mailed company invitation to meet personally with Glen Tullman. I appreciated the offer, but it wouldn’t be right to claim to be objectively reporting “from the ground” and while meeting personally with the CEO. I came and went anonymously.

Friday’s sessions may have appeased the person I talked to who felt the conference wasn’t detailed enough. In looking back, Thursday’s meetings were heavy focused (intentionally, I’m sure, to accommodate one-day attendees) on Meaningful Use and product roadmaps. Friday moved into deeper topics at a product level. My favorite was one from ColumbiaDoctors on their Enterprise implementation — it was candid and informative about the challenges of changing the culture of a huge organization that is quite set in its ways (one of the more interesting presentations I’ve ever attended, actually). They used the classic commercial above, which even though I’d seen it before, made me inadvertently laugh disturbingly loudly a couple of times, probably jolting the adjoining attendees into thinking a psycho had crashed the session. I think I was overly caffeinated from the readily available soda from the break.

Most impressive to me, however, was that Glen made good on his promise to fix the breakfast line problem. It was gone Friday morning. I had a feeling he was serious when he announced in the opening session that he had designated a team to make it happen. Now if only he had a similar chance to re-do the Friday night bash, which involved moving from a huge line to get into the House of Blues to multiple huge lines to get food and more huge lines to get drinks (guaranteeing that either your drink was warm or your food cold in your unsuccessful quest to enjoy them simultaneously as they raced from opposite directions toward room temperature). The house band was OK if you like Top 40 covers (I abhor them, but these guys were adequate) and they had karaoke (I’m not a fan, but that Chris dude who knocked out a deadpan but flawless “Baby Got Back” with beer in hand might have changed my attitude). It was fun, just a little too packed.

I checked out a demo of the patient portal (Allscripts / Medfusion / Intuit). Well, sort of — they were running screen shots instead of a live demo, which I hate with a passion (I always assume that either the demo people or the product are untrustworthy when they aren’t willing to risk showing it live). It looked good in the screen shots, anyway, showing functions for patient communication, scheduling and charging for online consultations, pulling EMR data into notes for patients, scheduling appointments, and placing incoming patient communication into the chart. I’m a little surprised that Allscripts is trusting another company to provide such an important part of its offerings. I’m just guessing, but I bet Allscripts had a strong interest in acquiring Medfusion before deep-pocketed Intuit came along to push the price into the stratosphere so they could latch onto the financial transaction possibilities it creates.

I saw Enterprise running on an iPad in the Innovation booth. It was really cool — clearly the iPad is just the right size to balance portability with screen real estate. I still can’t figure out how I’d comfortably hold the thing for extended periods, though.

A complaint I heard more than once from both Enterprise and Professional users: Allscripts has experience in implementing all kinds of specialties, yet each implementation starts over from scratch. The plea was to use the content and knowledge from one implementation to expedite future implementations. I’ve complained to vendors about that before — as long as a new client is willing to take the risk of using someone else’s ideas and the old client doesn’t mind, it sure would be nice to start with a non-blank slate and piggyback on their experience.

I talked to an Enterprise customer who was not only happy with the product, but very satisfied with Allscripts support. She said the case backlog was ridiculous at one point, but the company brought in some new leadership and added resources to the point where she’s getting quick callbacks from people who know what they’re doing.

Funny, but even though the presentations talked a lot about Meaningful Use, I didn’t hear it mentioned much by the attendees. Either there’s just no collective experience to make it worth discussing or practices aren’t all that interested in it. I’m almost concluding that it’s (b). Those of us in the industry who talk about it knowledgably and constantly may be overestimating the HITECH knowledge and interest level that’s out there in the real world. And these are the practices astute enough to send people to a national user meeting, not the average small-practice customer.

I wandered into the area where sessions for users of Allscripts hospital products were meeting. I had to wonder if they felt like orphans since so much of the emphasis was on practice-based PM/EMR. I didn’t connect with any of them to ask. I don’t know if the Eclipsys users will be rolled into the next meeting, assuming the acquisition goes through.

Las Vegas is my least-favorite city. It’s sleazy, tacky, and not even cheap any more. Fake beaches in the middle of dull desert moonscape, fake cleavage, fake celebrity chef restaurants (think your local mall’s food court at 10 times the price), and shows that (as Mrs. HIStalk points out) mostly involve aged celebrity tweeners too passe’ for Hollywood and a only a small step above Branson. I caught the 5 a.m. shuttle and even then the casino had plenty of people (families with small children, two-fisted drinkers, and groups of scantily clad women whose motivations were not clear, making for an interesting but depressing mix). The airport was a madhouse, although kudos for having free WiFi good enough for me to stream Better Off Ted while waiting for my flight. I’ve been to meetings there maybe 4-5 times and am always happy to leave. It was a good setting for ACE, though, since the deals were good and the logistics were outstanding.

When it comes to Allscripts, it came across as a bigger and more polished company than I anticipated. It’s growing fast, maybe a little too fast to stay connected with its customers in the same ways, but scaling well in general and trying to add technology to replace some of the “just call me directly” type of contact that’s no longer feasible. I don’t know how a salesperson would figure out which of the many overlapping EMR products to push at a prospect, a situation that will be more confusing when those from Eclipsys are brought into the fold.

Customers seem to be adapting to the idea that their vendor has changed since they signed up, which is always a challenge (it’s like getting married, only to have your new spouse gain weight, join a cult, and start sleeping around). Unless someone like Oracle buys the company, Allscripts seems early in a lofty trajectory given its ambitions and footprint and it appears to be executing pretty well, with the Eclipsys acquisition being a crucial test. Thanks to the folks there for inviting me to attend without even asking to influence what I might say.

News 8/6/10

From Astonished: “Re: University Medical Center of Southern Nevada in Las Vegas. They have selected McKesson over Epic as VOC.” Oh, my. They should print up a lot of signs now that say, “Remember, this one was cheaper.”

From Patty: “Re: your logo’s head. I spy your cartoon likeness at the MBA HealthGroup booth at ACE. Your head is smaller than I imagined it would be.” I checked it out during the opening reception and you are right — they apparently lifted my logo’s image, which cost me a pretty penny to have custom drawn. They need to do something clever to placate me, so I’ll go by their booth again Friday to see if they’re creative enough to have come up with something. Stop by and ask them. I take enough heat from literalists who don’t get the intended irony of the pipe-smoking doc.

From RumorReporter: “Re: Eclipsys and Allscripts. Word on the street is that once the merger is completed, all finance functions will be relocated to India. So who is coming out on top here?” Unverified. It’s probably not a big deal (if it’s true) as long as it’s the grunt stuff that makes up a lot of what finance does.

From You’ll Know Who: “Re: Sunny Sanyal. The former McKesson Provider Technologies president now the CEO of T-System.” Unverified.

From PrettyKitty: “Re: Epic Beaker LIS. After a four-year project rolling out Epic to 10 of their hospitals and replacing existing systems in an effort to standardize, Sisters of Mercy Health System is developing Epic’s Beaker lab application for their next two hospitals to be implemented in the second quarter of 2011. They had been retaining and integrating the previous lab systems — Cerner and Meditech — but have been told that Beaker is ready. They are in the selection process for a Blood Bank system since Epic will not offer that.”

From Dino: “Re: Kaiser. They say they have 99.96% availability. At least now we know that $5 billion doesn’t even get you five nines of uptime. They have come a long way from aiming for 99.7%, though! Remember that Oakland forced Pleasanton to come up with a ‘revised systems availability formula’ a few years ago — a formula that would have made Arthur Andersen blush. It basically only counts the power being off in the data center as downtime. Still, if you’ve got $5 billion and some change, you can get a nice, fully (and somewhat frequently) functioning EMR than can help improve and save lives. We just need to get the cost down and the reliability up, and then we’re good to go.”

From Allscripts Client Experience 2010

I’m in Las Vegas, checking out ACE 2010 as an attendee. Full disclosure: Allscripts invited me and comped the registration and hotel, but I’m paying otherwise. I’m still anonymous to them and I told them I was going to report what I saw and heard objectively. I don’t usually go to user meetings, but I knew the timing would be perfect to hear what people think about Meaningful Use and PM/EMR systems.

Note: the questions I asked were opened ended, such as, “What products do you have and how do you like them?”, so I was not asking leading questions that were positive or negative. Still, I can’t say for sure that the comments I got were representative of the Allscripts customer base. And keep in mind that I have no hands-on experience with any Allscripts product, so I’m just a wide-eyed noob at this conference.

They say 3,500 people are attending, which I believe since at least 3,000 of them were in the Starbucks line at 7 a.m. due to logistical challenges that I don’t need to explain since we attendees heard the gracious Allscripts apologies all day, from Glen Tullman on down. But no kidding, that was the longest line of people I’ve ever seen, at least 2-3 hours’ worth snaking back hundreds of yards (you people are seriously hooked on caffeine), and the buffet lines weren’t much shorter. It didn’t bother me since they had fruit and drinks in the meeting area anyway, so I was just as happy with a protein bar and a Diet Pepsi.

Some observational bits:

• Half the attendees were first-timers, the registration person told me.
• The lunch buffet was the best I’ve ever had at a conference. In fact, the overall meeting logistics were outstanding, from the handouts to the music to the friendly Allscripts people always willing to guide folks to their meeting room or connect them with an Allscripts contact.
• On the other hand, I don’t want to see another orange shirt for a year or two.
• A couple of users told me their Patient Portal (which I was told is the former Medfusion, but I don’t know that for sure) attempted implementations were disappointingly unsuccessful. They liked the promise of the portal, but said it was not ready for prime time. That’s a problem since it’s basically required to meet MU requirements. It’s obviously a key part of the Allscripts strategy (and an expensive recent acquisition for Intuit), so getting those problems fixed is key. There were demoing some pretty cool online payment functions.
• Related to that, several users said their main gripe with Allscripts was releasing and pitching products that aren’t ready (not uncommon for vendors in general).
• One user said the QA of Allscripts is much better than before.
• I saw a couple of iPads in use.
• Glen is an excellent speaker. Most of those I heard were good, except one who inserted the dreaded conversational crutch “sort of” every 2-3 sentences. Nuance was in the Hub and I wanted to ask them to use their speech recognition capabilities to set off a siren each time she did that, which should provide operant conditioning to help her stop. This is a near-epidemic – when I edit my interview transcriptions, I have to exterminate dozens of “sort ofs” in probably half of them.
• The biggest news to me was the announcement of the Allscripts Referral Network, a service that lets users of Allscripts products communicate with each other. People seemed to be pretty happy about that announcement, including a practice manager and a consultant I talked to. Glen said they’ll open it up to users of other vendors’ EMR products by the end of the year.
• Odd products that had surprisingly fanatically supportive users that I talked to: Homecare and Tiger.
• I wanted to look at Payerpath, but I forgot to stop by. Maybe tomorrow.
• A couple of people said they felt the meeting felt more like a heavily orchestrated cheerleading session and sales opportunity than something geared for their benefit. Hopefully they’ll get more out of it in the remaining sessions. I saw some very meaty sessions on the agenda, especially in the more specific technical and product tracks, so I’m pretty sure there are nuggets to be mined through careful session choices.
• I went to the Professional roadmap meeting. A show of hands made it clear that even though MU awareness is nearly universal, very few attendees are really ready for Meaningful Use. Based on the graph shown of client release levels, a great percentage of Professsional’s 2,000 sites will need some serious upgrading. Most are on Version 8.3 and down.
• I saw one person wearing a badge that said “No Hybrid EMR”.
• I got no indication that MyWay is on the outs. They showed its MU deliverables and I spoke to several users who love that product, including some surprisingly large ones (one Enterprise EHR customer said semi-seriously that they were considering replacing it with MyWay). I think it’s a keeper for the company.
• I asked one somewhat unhappy Enterprise user what they would be using otherwise. They hated Epic and said the product to beat was Greenway. Another liked Sage Intergy, saying it was truly integrated between PM/EHR instead of the “two screens” method of visual integration.
• I talked to a handful of Enterprise users. That group seems to be the least happy with Allscripts, with gripes that include unresponsive support, lack of proactive contact from reps, the cost of buying the Stimulus Pack vs. Analytics (Allscripts was a bit evasive on pricing, turfing users off to their reps, but promised to make it right for customers who have purchased previous products), database bloat caused by the technical method of updating physician notes, and some obvious residual bad feelings from the premature TouchWorks Version 11 upgrades that caused significant practice disruptions. It’s always hard to keep the bigger customers happy, I guess, but Allscripts needs to do some work to delight that constituency again from what I heard.
• I got the sense that all of the Allscripts growth has strained communication capabilities (reps not calling back, no direct access to support people, etc.), which may explain some of the new customer tools that Glen introduced.
• One person bragged on how great their remotely performed upgrades are, with everything done overnight or over a weekend by Allscripts.
• Glen showed an “upgrade wizard” thingie called the Upgrade Enablement Center that was explained further in the Enterprise MU session. It was created for migrating Misys users to Professional, with parts of it used by the customer and parts by Allscripts, but they said there’s work remaining for it to be finished. They said they had cut migration downtime from 4-6 days to 4-6 hours with the tool. One user said they had experience with it and thought it was great.
• One Enterprise customer said they have no worries about meeting MU requirements since their doctors happily enter their own orders.
• Glen also announced a new Web service that allows customers to one-stop-shop a lot of Allscripts services and communicate with each other.
• Allscripts announced a new Web-based project management tool, where a client chooses their desired date for a the Stimulus Set upgrade and the application backs them into a schedule that Allscripts can work from.
• Eclipsys was barely mentioned, probably since it’s not a completed transaction yet.

As someone with no skin in the game but a lot of conference experience, ACE is fun and well run. The company has obviously grown hugely and has a pretty big vision, although with a few inevitable rough spots in execution that are probably inconsequential in the big picture. I’d like to hear from my fellow attendees who are real customers, though, so please leave a comment if you’re at ACE. You know how conferences are – you can ask a bunch of people and all will report different conclusions.

News 8/4/10

From HIStalk Junkie: “Re: Alert Medical. The company has hired and fired several chronically underfunded US ‘consultants’ / salespeople, preferring to pay straight commission. Some have said they won’t pay for even basic tools for understanding the US market. I have run into them in several countries. They hired a very smart fellow who was at HIMSS looking for a US partner to ‘invest’ in the chance to represent ALERT. Sounds to me like they want to sell their US marketing rights. They have no revenue cycle product, but a very pretty clinical product” Unverified, although I do remember that someone told me that before.

From J.G. Giant: “Re: odd but true. In keeping with the season, I thought you would appreciate this. Keep up the excellent work!!!” I wonder if these providers use EMRs?

From Hitchens: “Re: Meditech. I work for a Meditech partner and I hear they are looking at offering Allscripts for certain interfaces. Also, this may be Step 1 in a buyout of Meditech by Allscripts, as Meditech’s founders have been looking for a few years to exit and the $$ now is so high.” Unverified. Seems unlikely, but it’s a crazy industry right now.

From LISales: “Re: Epic Beaker LIS. Word on the street is that they have one SMALL site using the system within the Wisconsin area, but nothing major yet. I’ve also heard that they are beefing up the development team while including the licensing right to the module within ALL of their enterprise licensing agreements. Also heard is that the functionality is being somewhat oversold compared to actual capability with no desire to develop certain aspects of a full-scale laboratory’s needs, Blood Bank to name but one.” Unverified.

From UKnowMe: “Re: business associates. What training are consulting firms using to ensure their employees take appropriate measures with regard to PHI?”

From Kermit: “Re: NHS. Britain is proposing a shake-up. Here’s one article.” The new government changes its mind about its pre-election promise to leave healthcare alone, planning a reorganization of NHS. The goals are to move central control back to doctors, cut out administrative layers, and give patients more say-so. Here’s an interesting (condescending) quote from a research group about giving doctors control of the equivalent of a $3.4 million annual budget each to pay other providers:

It’s like getting your waiter to manage a restaurant. The government is saying that GPs know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.

From The PACS Designer: “Re: OneNote on WP7. As we learn more about Windows Phone 7 (WP7), it appears Microsoft will be pushing the use of MS Office OneNote for mobile users with its scheduling, meeting notes, and To Do List features, among others in the application.”

From Cassie: “Re: Mercer does it again! Apparently Mercer lost another piece of IT equipment in the great state of Idaho, this time for St. Al’s hospital ,therefore losing numerous employee data. Supposedly it’s been missing for months (and is still missing) and Mercer is just now telling St. Al’s staff.” Verified. Mercer lost a backup tape in March containing information on 1,000 employees of St. Alphonsus.

Watching (instead of Listening this time): Better Off Ted, a just-cancelled, brainy comedy from my streaming Netflix recommendations (rightly so — I love it). What’s not to like about a soulless, thoroughly evil and Dilbert-esque conglomerate (its motto: Money before People, and check out the amazing phony commercials) and the ever-luscious Portia de Rossi? It rounds out my personal TV triumvirate that includes Arrested Development (there’s Portia again) and 30 Rock. All are on Netflix, so I can watch whenever I have time (which is rarely).

Surescripts will announce tomorrow that Microsoft HealthVault users will be able to download their pharmacy prescription history into their PHR.

mHealth Summit books Bill Gates as a keynote speaker. I’m thinking about attending since I need to get out from behind a desk more often.

RIM announces the BlackBerry Torch 9800 and BlackBerry 6 OS, offering a slide-out keyboard, a touch screen, and a 5-megapixel camera. I think it’s safe to say that iPhone and Droid users won’t be interested, but it might keep some non-corporate BlackBerry users in the fold for awhile longer and placate the business user suffering from iPhone envy. The Torch will cost $200 with a two-year AT&T contract.

Weird News Andy packages this story with a pun: “He asked the nurse if he could use her needle and thread and thought she said ‘suture self’.” A man with a leg cut waits an hour to be seen in an ED in Sweden. He becomes impatient, notices the “needle and thread” in the room, and sews the cut up himself. Unappreciative hospital employees reported him for using hospital equipment without authorization.

Thanks to Neil Versel at FierceHealthIT for saying nice things about Inga and me in mentioning our little link exchange project. I like that he envies “the Cult of Mr. HIStalk,” which I’m pretty sure is apocryphal, but it still makes a good fantasy for my next dull hospital meeting. He does seem to harbor some doubt that I work in a hospital, but I assuredly do, full-time and mostly happily. My self-selected theme song is Rush’s Working Man.

A hospital in Australia says its upgraded Philips Intellivue Clinical Information Portfolio has reduced ICU costs by 20-25%. If provides clinical decision support, a patient summary, clinical guidelines called “care bundles”, order management, ICU scores, digital picture documentation, analysis and reporting, and wireless access.

Keane Optimum 3.1 earns CCHIT Preliminary IFR Stage 1 certification as an inpatient EHR.

July’s HIStalk stats for those scoring at home (you know who you are): 97,368 visits, 138,957 page views, 5,941 e-mail subscribers. As always, thanks to my readers and sponsors. Back in the old days, I wrote HIStalk without either and would do it again, but it’s a blast knowing someone’s actually reading.

VMware will co-market Imprivata’s authentication and single sign-on products with its VMware View virtual desktop.

Boston-based SV Life Sciences, which has invested in six HIT companies, plans to fund more healthcare IT startups, with a primary interest data mining solutions. Its investments include Vitalize Consulting Solutions, Phase Forward, and eMed Technologies.

GE and Intel form a 50-50 joint venture to start a technology company that will target telehealth and independent living, extending their alliance from last year. That squares them off solidly with Philips, it would seem.

Orion Health announces GA of Rhapsody 4, a new version of its integration engine. Features: secure Web services, support for lookup tables, a monitoring API, Web-based monitoring tools, and a drag-and-drop user interface for analysts.

The Singapore Ministry of Health awards Accenture a contract to implement its national electronic health record system, scheduled for initial release next year. 

A New York Times investigation finds that at least 400 patients in eight hospitals have been overdosed on radiation during CT brain perfusion scans. The FDA was unaware of the problem and doctors and hospitals missed symptoms such as hair loss in the irradiated areas. GE’s equipment wasn’t the problem, but two hospitals said technicians confused a feature that raised radiation levels and thought it lowered them, saying the feature was “counterintuitive.” Interesting: Cedars-Sinai, one of the hospitals named, overdosed a member of its board of governors, who left the board when she found out. The best comment came from a plaintiff’s lawyer: “What is amazing and seems painfully obvious is if someone walks in with a band of hair missing around the entire circumference of their head, you would ask the question: Have you had a CT scan? Not ‘What did you eat for breakfast yesterday that would cause your hair to fall out today?’”

E-mail me.

HERtalk by Inga

A bi-partisan group of legislators introduces the EHR Incentives for Multi-Campus Hospitals Act, designed to ensure that multi-campus hospitals receive their fair share of economic recovery dollars. The way the law is written, multi-campus hospitals receive the same dollars as a single hospital despite higher implementation costs.

Advocate Health Care (IL) is deploying Fusionfx physician portal from Carefx Corporation at its recently acquired Condell Medical Center facility. Condell is also in the process of migrating from McKesson Horizon to Cerner.

The 100-physician Manhattan’s Physician Group selects ITalagen to host, support, and manage its EHR.

Corner Children’s Hospital (IL) plans to integrate its EpicCare inpatient clinicals with GetWell Town, a pediatric interactive patient care solution. The connection will support the bi-directional flow of patient information so that nurses can order educational material specific to a child’s diagnosis, then document progress in the patient’s record.

The local paper highlights the transition of Doctors Hospital (TX) to Cerner EHR and its desire to automate 300 community physicians.

Fremont Area Medical Center (NE) advances its HIE plans, signing a contract to implement Lawson Enterprise Exchange.

I don’t love Las Vegas, though I usually find a one-or two-day visit  is pretty fun. I had hoped to trek to Sin City this week to attend ACE with Mr. H, but alas, “real” life is getting in the way. In exchange for keeping the home fires burning, I’m thinking Mr. H should waste at least $20 in quarters playing the slots on my behalf. If you are one the 3,000 attending, feel free to send me some pics.

OA Centers for Orthopaedics (ME) chooses the SRS hybrid EMR for its 41-specialist practice.

Greater Baltimore Medical Center (MD) picks eClinicalWorks to provide EMR and PM to its 100 employed physicians.

Scott Bagwell takes over as SVP of sales and marketing for Passport Health Communications. Bagwell held a similar position with McKesson Pharmacy Systems and RelayHealth Pharmacy Solutions.

Q2 results for Henry Schein: earnings up 14%, though North American medical sales fell 0.4%. Total revenues of $1.85 billion exceeded analyst expectations.

Marion General Hospital (OH) implements GE Centricity Enterprise via a remote hosted delivery option.

A new eHealth Initiative survey on HIEs finds that the number of exchanges is growing, with at least 73 of 234 total HIEs now operational and transmitting stakeholder data. This is up from 57 last year. Sustainability continues to be a challenge, although 107 report they aren’t dependent on federal funds. Another challenge: addressing government policy. Participants also say the HIEs are helping reduce staff time and redundant testing.

Speaking of HIEs, the Electronic Healthcare Network Accreditation Commission (EHNAC) names the Utah HIE the first entity accredited through the HIE Accreditation Program.

From another local paper: the soon-to-open Mills Peninsula Medical Center (CA) will have no paper records. The new Sutter Health facility is replacing Peninsula Medical Center, which runs Epic.

Finally, Nielsen Co. says Americans spend 23% of their online time checking out Facebook, Twitter, and other social media sites. Which reminds me: Mr. H and I would love to suck more time out of your day, so feel free to friend us on Facebook and become a HIStalk fan.

E-mail Inga.

Monday Morning Update 8/2/10

From Capillary: “Re: Allscripts. The CEO announced last week on the earnings call that the company was chosen by the Indiana REC, but the selections have been announced and Allscripts was left off. Anyone know what happened?” Allscripts confirms that you are correct. They have apologized to the REC for the unintentional miscommunication. The vendors chosen by the Indiana HITEC as appropriate for small and rural providers are athenahealth, iSALUS, and MDLand.

From UK Watcher: “Re: Aspira. Aspira is/was the UK feeder to IntelleHealth/iCapital, the consulting entity working some of the Cerner projects in the Middle East. Many of the recruits that they had secured in the UK were from Cerner UK and had been moved to the ME anyway. Will be interesting to see what happens to their tax-free and prior negotiated packages with the ‘new’ boss.”

From Privacy NOT: “Re: security breach. The Achilles right heel of HIT is failed privacy. The Achilles left heel of HIT is failed safety and efficacy. The rotator cuff tear of HIT is failed usability.” I don’t know about all of that, but it was in response to news of a stolen laptop from Thomas Jefferson University Hospital in June. The laptop was password-protected, but was not encrypted (I swear the hospital laptop encryption rate must be even lower than CPOE adoption, but in this case, it the employee’s personal laptop and storing PHI on it violated hospital policy). Laptops apparently aren’t encrypted at Texas Children’s Hospital either, as the hospital admits after the theft of a doctor’s laptop containing patient information.

From Smart Room Needed Here: “Re: UPMC. Hospitals should get their employees to watch the monitors.” A patient’s family sues UPMC Mercy Hospital, claiming he suffered permanent brain damage after choking on a clogged tracheotomy tube for 40 minutes before ICU nurses answered the cardiac monitor alarm. And in other UPMC news, it creates a VP of community relations position for a state senator who’s quitting. The closed UPMC Braddock Hospital is in his district, leading an official with Save Our Community Hospitals to state, “… Sen. Logan worked to ensure UPMC’s objective of closing and demolishing the hospital. Now we know why. Mr. Logan has received his ’30 pieces of silver’ as payoff for his work on UPMC’s behalf.”

A reader asked me to put together a list of some of the music I’ve recommended over the years, so I compiled and posted a list here. And in digging back through those archives, I dug up an old favorite to revisit: Nine Black Alps, hard rocking Brits.  

As hospitals issue press releases congratulating themselves on being Most Wired, most HIStalk readers think awards of that type mean nothing, while the majority of the remainder think they’re just self-promotion for magazines and CIOs. New poll to your right: will state HIEs be viable once their stimulus money has been spent?

Speaking of Most Wired, AHA says the criteria have been toughened up, requiring hospitals to at least claim (on the self-reporting survey) that they are actually using technology. So, if you are among the Most Wired skeptics who think it means nothing, imagine what it was like before (those old and now-suspect awards still pepper CIO resumes, I’m certain). If this were an art contest, it has gone from (a) who owns the most paintbrushes, to (b) who uses the most paintbrushes, but is still far short of actually evaluating (c) whose painting is the best and whether having the most paintbrushes made any difference. I was in charge of completing the survey for a Most Wired hospital for several years (I have a Most Wired Winner shirt somewhere) and even my hospital made fun of it given our hopelessly outdated and seldom-used clinical systems back then. I suspect that we and our fellow award-seekers were as optimistic as a vendor’s RFP department in our responses.

Are patients better off in a Most Wired hospital and can it be proved that the technology is responsible? No on both counts.  As I always say, if you are a good hospital, judiciously deployed IT can make you a little bit better. If you’re a bad hospital, all the technology in the world probably won’t help you improve (and may well increase your level of suckitude). If you are marginal, you might see improvement, but I wouldn’t count on it.

The folks at FierceHealthIT and I are swapping links for a few weeks, so you’ll see their headlines to your right and mine on their site. It’s a trial to see if we send each other readers. If not, we call the experiment quits.

Scott Storrer is ousted as CEO of MEDecision, replaced after just eight months by un-retiring founder David St. Clair (above) until a permanent replacement is named in six months or so. David’s blog entry on the subject is here.

Q1 numbers from NextGen parent Quality Systems: revenue up 24%, EPS $0.42 vs. $0.36, missing on consensus earnings.

A reader sent over workshop documents from a July 27-28 invitation-only meeting involving the Institute of Medicine and ONC, addressing the role of technology in continuous healthcare improvement. Some of the issues discussed: what can IT do to improve health and healthcare by 2020, what are the rate-limiting issues, how can data be used, how can innovation be fostered, how can healthcare cost be reduced by technology, how can disease management be improved by technology, how can consumers be engaged, and how can a global public network be created? Some familiar names were on the participant list: Molly Coye, Bill Bria, Mark Frisse, John Halamka, Rob Kolodner, Marc Probst, Stephanie Reel, and Paul Tang (familiar names not on the list were yours and mine).

UMass Memorial Health Care will announce Monday that it has chosen the Symedical terminology management and interoperability tool from Clinical Architecture to create a central data repository with a single terminology set.

HIStalk sponsor jobs: Interface Analyst, Epic Clarity Analyst, RVP Sales – Southeast, New England/NY, and Mid-Atlantic Territories.

McKesson’s Q1 numbers: revenue up 3%, EPS $1.10 vs. $1.06. My interpretation of nuggets from the call transcript: (a) Health Solutions and RelayHealth did fine; (b) Provider Technologies (the hospital technology part) underperformed, with revenue growth slowing to just 2% and profit down 7%; (c) they’re spending a lot of money on Horizon Clinicals and Horizon Enterprise Revenue Management, taking an $8 million accounting hit on HERM amortization during the most recent quarter alone; (d) John Hammergren says the company is interested in global acquisitions, but is often named just to increase the price that someone else eventually pays; (e) MCK isn’t seeing an increase in technology purchases by physician practices, but Hammergren says it’s because those practices aren’t yet paying attention to HITECH; (f) the company is confident that its products can get providers to Meaningful Use. My cheap seats analysis: Horizon Clinicals and HERM are struggling, which is hardly news other than it’s McKesson saying so (indirectly).

HHS withdraws HITECH’s breach notification final rule after reviewing the public comments. Organizations involved in a privacy breach would have been allowed to decide on their own whether to notify patients or just keep them secret. That’s significant given that the rule had already gone to OMB. A replacement rule will be issued “in the coming months.”

DrLyle weighs in on Meaningful Use on HIStalk Practice. A snip: “To correctly measure many of these details (e.g. give clinical summary to 50% of those who ask) we would need to figure out a way to keep track of who ‘asks’. That seems like a strange request for structured data and certainly should not be what a doctor is spending his time doing.”

Dossia Consortium names Jim Hansen, former CEO of the Kansas City-based CareEntrust HIE, as VP and executive director.

TriHealth and University of Cincinnati will spend up to $100 million each on clinical systems, with Epic being a candidate in both (I’d say shoo-in given that TriHealth already uses Epic in its physician practices). Also named as local hospitals bringing up Epic and spending more than $50 million each to do so: Mercy Health Partners, Cincinnati Children’s, Christ Hospital, and St. Elizabeth.

A senior at University of Maryland who created the DoseSpot electronic prescribing system is named a finalist for an entrepreneur award.

Doctors and nurses in Thailand wear black lab coats to protest a draft law that would allow patients to be immediately compensated for medical malpractice from a special fund. A medical union representative says, “It means our staff would have to be extra careful during work, which would decrease efficiency.”

An Alaska clinic becomes the first US site to use ALERT Clinic software, which I assume is from the Portugal-based ALERT that made a mini-splash a couple of years ago at HIMSS (I think I recall cute booth staff in red-striped white jumpsuits, but I could be wrong), then seemed to disappear without a trace. Everybody (me included) was impressed by what we saw, so I don’t know what happened. I pegged them as a hot new entrant.

A hospital employee is fired for posting a Facebook comment about the suspected killer of a police officer that she treated, saying she hoped he rotted in hell. The hospital said she violated HIPAA even though she didn’t mention the name of the suspect or her hospital.

A Stanford Medical School professor and novel writer worries about letting technology interfere with patient-physician relationships:

Rituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation. The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault, you know, tell me that that’s not a ritual of great significance. And if we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is a transformation? It’s the sealing of the patient-physician bond.

Hospitals in Victoria, Australia will arm 500 doctors and nurses with iPads in a pilot program.

Boy Scouts at this year’s Jamboree at Fort A.P. Hill, Virginia have access to AT&T WiFi and a wireless EMR system used by its 20 medical centers and team of EMTs. Next thing you know they’ll be using a GPS to track snipe.

Standard Register’s healthcare revenue fell short of expectations in Q2, mostly because of cheaper document management solutions.

The former CEO of Baltimore-based insurance company CareFirst BCBS, recipient of a contested $18 million severance package, joins Healthcare Interactive as an advisor. The company offers healthcare performance management systems of several types.

E-mail me.

News 7/30/10

From SnagMonkey: “Re: confirmation of Providence Oregon’s transition to Epic.” He (or she) sent over the July 19 internal announcement. GE Flowcast, GE Centricity, McKesson Horizon Clinicals, McKesson Star, and pretty much all the unnamed ancillary systems will be shown the door. Implementation starts in January, the first go-live will be in 2012, and the project will be finished 30 months after it starts. Thanks for the scoop.

From Girls Just Wanna Have Fun: “Re: acquisitions. Hold on to your hat the next six weeks. Lots about to start shaking loose. Can’t say more, but August and early September will be the most active HIT M&A announcement months in a very long time.”

From TooLate: “Re: iSoft. Massive cuts continue and positions will be eliminated. Major shifts, consolidation of leadership, off-site London meetings are more frequent, and more stock will be issued. Sound like everything is being done right except fixing the actual problems — product and leadership. Can’t wait to see this annual report.” Shares are at less than 14 cents US.

From ThinGreenLine: “Re: management changes at Meditech. It was previously announced that Steve Koretz would assume all installation and support responsibility for 6.0 product line. Now Joanne Wood will assume same for all Magic and Client/Server products. Joanne being promoted to Senior VP. Two new VPs promoted under her, Leah Farina and Helen Waters. Leah has her roots in the HCA group, while Helen came from sales. This is the change Howard Messing hinted at in his interview with you.” Verified by Howard. That’s Joanne above.

From MaxPayneUK: “Re: Apira. Closes operations and gives all employees to IntelleHealth, which insists that new employment contracts be signed. Not sure how that happened without violating labour laws, but there you go.”

From Jenny Penny: “Re: Jay Deady. Cheers Across Atlanta may be thrilled that he’s leaving Eclipsys, but as much as an ass as he can be, I challenge anyone who has ever worked for him to debate that he challenged them to do their best. He is super duper intense about work – certainly no dumb slacker like many HIT sales guys.” Ouch!

From Buck S. Pearl: “Re: West Virginia Health Information Network. Five vendors still in the running to run the state’s HIE: Thomson Reuters, CSC, Deloitte, Medicity, and HealthBridge. The selection deadline was June 30, but they are re-evaluating functionality (which probably means they don’t have enough money to buy what they want). They are also negotiating with NaviMed and Quadax for a separate claims and eligibility portal, with one or both offering it to the state at no cost to open up the chance to sell other services to providers (clever buggers).” Board meeting minutes are here (warning: PDF). I knew Thomson Reuters jumped into the HIE game in December, but it still seems odd to see their name among those others.

From Laboratorian: “Re: Epic’s Beaker laboratory information system. Anyone know much about it? Are its big new clients implementing it?” Beats me. Anyone know?

From Jimmy DeLorean: “Re: posting the Monday Morning Update on Sunday. It’s always great feeling like I’m getting Monday’s news a day or two early.  ;)  But, you certainly have earned more than a few Saturdays off, and I’m sure Mrs. H appreciated having your undivided attention for the weekend. How you’ve managed to hold down two full-time+ jobs all this time and still have a personal life (and sleep) is a remarkable feat, though. Someday you’ll have to write a book on time management and life balance, even if pseudonymously.” Thanks – that made my day. I like having a few readers who get antsy when I don’t post until Sunday afternoon since it makes me feel needed. Mrs. HIStalk did indeed appreciate my attentions (and vice versa).

From Loyal Reader Kathy: “Re: Meaningful Use. Since you put together such a great spreadsheet over New Year’s, I thought someone ought to do it for you for the final and give you a little time for Mrs. HIStalk.” Kathy did a great job putting together the final rule information, including both the requirements and the quality measures (download it as Excel since it won’t look right otherwise — it has two tabs). Very cool, thanks! UPDATE: Scribd has some Facebook auto-login crap that isn’t obvious, so if you’re not on Facebook, download from here or here instead.

Listening: new from Asia, back with the original members (Palmer, Howe, Downes, and Wetton). I’ve got tickets to see them live soon.

Q1 numbers from The Advisory Board Company, the new home for much of the former HIMSS Analytics management team: revenue up 18%, EPS $0.29 vs $0.27. Market cap is $682 million.

pMDsoft announces its native iPad charge capture application.

Weird News Andy goes non-weird in finding this: Americans are consuming fewer healthcare services, according to financial results of publicly traded healthcare-related companies. Evidence: fewer elective procedures performed, increased numbers of high-deductible insurance plans, fewer new prescriptions for maintenance drugs, and (of course) increased insurance company profits. Athenahealth was quoted for its observation that the number of claims per physician and the average value per visit dropped over last year. The WSJ article seems optimistic that consumers are getting smarter, but I’d bet they’re just holding off until they get those shiny new insurance cards courtesy of healthcare reform.

St. Vincent’s HealthCare (FL) signs a deal with CVS Caremark’s MinuteClinic to provide medical staffing and to work together on disease management. The organizations are integrating their respective EMRs to share histories and visit summaries.

Cerner’s Q2 numbers: revenue up 13%, EPS $0.65 vs. $0.52, guidance raised. Shares jumped a little (one-year CERN against the Nasdaq above, with Cerner in blue). I’ll repeat what I said earlier this week: it’s one thing for Epic to take some business away from Cerner, but Neal’s always going to book great numbers, keep shareholders happy, and let everyone who wants to ride the Ferris wheel with him do so by purchasing shares. Millennium may have fierce competitors, but the company is doing just fine.

Speaking of Cerner, the earnings call transcript is here. It’s mostly the usual hack phrases used by executives and analysts (traction, footprints, give some color around), but there were a few interesting points. They’ll open a Vision Center in Europe. They don’t sound like they’re doing too well (my read, anyway) in the small hospital and physician practice markets. They expect 75% of their clients to earn full HITECH payouts. They’re going after revenue cycle services with RevWorks. One analyst asked directly about Cerner repeatedly losing against Epic in academic medical center sales, which COO Mike Valentine deflected by bragging on CERN’s success with for-profit hospital chains because of Cerner’s predictability and ability to scale (he also referenced HIStalk indirectly, saying “So we added 15 new footprints this quarter. In more than half of those we competed against the firm that you mentioned that gets mentioned a lot on the HIT blogs, and that’s good. We’re like the strong silent type. We’re going to continue to compete with them.” I snorted Diet Pepsi with Lime out my nose when I read the part about the “strong silent type” given Cerner’s notorious (over) marketing machine (i.e, the Vision Center), but that probably resonated with the stock guys as being humble. Neal dropped by for his usual one quick comment at the end, obliquely mentioning the acquisition of Picis by Ingenix (United HealthCare) and implying that they see opportunity in the platform that digitization enables.

CPSI’s Q2 numbers: revenue up 22%, EPS $0.39 vs. $0.32, beating consensus estimates of $0.36 and providing in-line guidance. In the 8-K, they mention that fired former CFO Darrell West not only charged $55,000 to a company credit card to pay his taxes, he cashed in almost 5 million membership reward points for personal benefit.

IBM will sell and implement the “smart room” developed by UPMC, which involves staff-worn ultrasound tags that trigger the display of role-based clinical information on the monitor when they enter the patient’s room.

Paris-based Cegedim acquires Pulse Systems, vendor of the CCHIT 2011-certified Pulse Patient Relationship Management ambulatory EHR, along with solutions for e-prescribing, practice management, revenue cycle management, and patient self-service. Cegedim sells life sciences technology and is a pretty big deal with 8,600 employees and annual revenue of $1.2 billion (a little smaller than Cerner). They make it clear in the announcement that their interest is ARRA money. It also says that Pulse is profitable on annual revenue of $16 million, that Cegedim will pump another $13.5 million into the company, and that the value of the acquisition won’t exceed $58 million.

The former chair of the British Medical Association’s IT group urges doctors not to upload patient records to the Summary Care Record, saying it’s unsafe and should require patients to opt in instead of opt out. He’s setting up his EMR to prevent uploading unless patient consent has been checked off and is telling his peers to contact their EMR vendors to make the same arrangements.

This interesting article describes the advanced status of EMRs in Finland (91.1% penetration and a national health network), but calls out the pitfalls: it’s still hard for individual systems to communicate with each other, each local jurisdiction has different privacy rules, and the only way to transfer information when a patient moves to an area that uses a different EMR is to print everything out. I may need a site visit to Helsinki since I’ve not been for a few years and I like it there.

EyeHealth Northwest chooses NextGen’s PM/EMR for its 30 providers.

Free EMR vendor PracticeFusion launches its Research Division, which will publish lists of top-prescribed meds by specialty (which was in the announcement) and sell de-identified patient data (not announced, but that’s been the company’s stated plan, along with advertising to doctors, from the beginning — how else can they give away an EMR?) Some of their arguments on the Research Division page for providing patient data are a bit lame: (a) it’s a public health service; (b) it’s a research service; (c) Kaiser and the VA do it, so why shouldn’t we? (d) and lamest of all, under the category of Social Responsibility, “To keep this information from medical researchers would be a disservice to the safety and advancement of medicine in this country.” If you’re going to sell patient data, just say so — don’t try to make it sound noble.

Guess who’s an HIT demo dolly? Todd Park gets the thrill of having the leader of the free world pitch the site he built. Pretty cool. The President isn’t a Mac man, apparently.

United Health Group is rumored to be buying Executive Health Resources for $1.5 billion, making it part of Ingenix. The Newton Square, PA company staffs hospitals with Physician Advisors to maximize reimbursement, improve efficiency, and improve quality of care.

Mediware renews its agreement with William Blair, which includes exploring “a variety of strategic alternatives to enhance shareholder value.”

Odd lawsuit: a former nurse manager sues Halifax Health (FL) for discrimination after a failed romance with a radiology manager. She provided evidence that included a receipt for a romantic couples massage, but she dumped her beau after discovering she wasn’t the only co-worker with whom he was consensualizing. She says she was harassed after the breakup, including being asked by HR to dress as a go-go dancer during the employee banquet and having one of her patients delayed in radiology for no reason.

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News 7/28/10

From Gregarious: “Re: HCA. They are doing competitive pilots of Meditech 6.0 vs. Cerner, possibly as a move toward displacing the long-term HCA / Meditech relationship.” Verified. HCA will run a Cerner pilot in at least one hospital sometime next year. Meditech 6.0 is a big step from HCA’s Magic (pretty much starting over), so it makes sense to test the waters. The wild card could be how the hosting models compare. Several HCA hospitals have reached EMRAM Stage 6 on Magic, which ironically makes it harder for HCA to switch since you’d need heavy clinical usage from Day One to avoid moving backward. Any change (even to 6.0) will be painful.

From BeCarefulWhatYouWishFor: “Re: Epic. They are about to pick up another large academic facility in Nebraska. You can only imagine who is going to have the LastWord now.” Unverified, but thanks for the excellent punmanship in any case. As a couple of readers pointed out, it will be interesting to see if Epic can scale its model up to cover all these big implementations going on at once. A CIO reader who knows both systems says Cerner requires clients to take ownership of the design and use outside consultants, while Epic offers a more turnkey implementation at a higher price. It’s also interesting that Epic doesn’t offer hosting and Cerner is runnin hard with that offering, so that’s a key differentiator to some prospects.

From SnagMonkey: “Re: Epic. Not officially announced, but all Providence hospitals and hospitals in Oregon will convert to Epic.” Unverified.

From You’ll Know Who: “Re: Epic. Not only is Epic replacing Eclipsys and Cerner at sites, they are likely removing 30+ year old financial systems from McKesson, such as HealthQuest or the old Ibax product. That again highlights the lack of success with the ‘new’ Horizon ERM. It would be interesting to hear which products the CIOs looked at.” My ears are open if anyone wants to share.

From Ragnar Danneskjold: “Re: your comments about Cerner and corporate bureaucracy. Man, can you turn a phrase! I’m going to have that framed and put on my office wall (and then wonder why my career is not going anywhere :-)). Been loving your work for many years now. I don’t know how you do it, but keep on doing it.” Thanks.

From Cheers Across Atlanta: “Re: Eclipsys. Jay Deady announced today at the Eclipsys sales meeting that he will be leaving concurrent with the Allscripts acquisition.” Unverified.

From Reddy Kilowatt: “Re: PM/EMR in Asia. I’m looking for information (Web sites, articles, databases, etc.) on penetration in the smaller private practice market.” I have readers there, so if you know some sources, let me know.

From Anonymous: “Re: Merge Healthcare’s ortho imaging products. I’m surprised you didn’t catch wind of this.” I did, earlier this month when a reader tipped me off that Stryker was selling its imaging division (i.e., ortho products) to Merge.

From Lori S: “Re: AirStrip Technologies. They will announce that their cardio and critical care apps have received FDA approval, setting the bar high for other vendors.” Verified. The news just came across the wire Tuesday evening. AirStrip users can monitor patients in real time from their iPhone, iPad, and other mobile devices. That sound you heard was change jingling in the deep pockets of GE, Philips, etc. as they suddenly think AirStrip Technologies looks like something they’d like to get their hands on. I interviewed co-founder Cameron Powell, MD in February.

SRS will offer customers its hybrid EMR bundled with practice management and scheduling systems from Ingenix, calling it SRS CareTracker PM powered by Ingenix. SRS will also offer its EMR customers a migration path to the Ingenix CareTracker EHR. That’s interesting — Ingenix has been promoting CareTracker much more heavily recently, plus rumors suggest that the company won’t stop its HIT-related acquisitions with Picis.

I’m a sucker for hospital music videos, so here’s one from Lake Pointe Medical Center in Rowlett, TX, a top-rated Tenet facility celebrating its 5-Star Patient Satisfaction Rating for the full year of 2009.

Marshfield Clinical lists its CIO job. An advanced degree is not required.

Monday Morning Update 7/26/10

From Gamara: “Re: Epic. Random stuff found in Googling Epic.” Good sleuthing, although some have turned up previously The following organizations appear to be going Epic: Stormont-Vail HealthCare (KS – above), University of Colorado Hospital (CO), The Mount Sinai Medical Center (NY), Maricopa Integrated Health System (AZ – old), University of Miami Health System, South Broward Hospital District.

From LookingForAnswers: “Re: Epic. They’re winning deals like Cerner did 15 years ago when they were small. Cerner seems to be a revenue-churning machine that the public can participate in by buying stock. The only people who benefit from Epic are the owners and/or Judy. Which company has made more millionaires? Which company will change the face of HIT for the long run?” Here’s the real question: why can’t Cerner, with all its billions in market capitalization and name recognition, compete with Epic for new sales? As has been asked of other Goliaths (Microsoft, GM, Dell, GE, etc.) how could Cerner, given its ample lead time and resources, let the once-tiny David called Epic beat them year after year? My theory is threefold: (a) even entrepreneurial big companies naturally evolve into highly ineffective corporate bureaucracies that are motivated by fear and executive entitlement, the antithesis of innovation; (b) publicly traded companies let their numbers drive their business instead of vice versa, and (c) corporate Darwinism would have Cerner just buying Epic outright, but Judy throws a wrench into that evolution by refusing to sell the company.

But all is not lost: we don’t know Epic’s profitability, so Cerner may be beating them where it counts. And we know that Cerner has built a business that could weather Neal’s transition or sale to another organization, but we don’t know that with Epic. What I care about most is why Epic beats Cerner for every important deal, which would seem to indicate that Millennium isn’t up to the task. In other words, a $6 billion market cap company with a single, fairly low-rated product line that’s getting hammered by a smaller and much higher-rated competitor should think about developing a better product. Here’s another way to look at the value of ongoing R&D: the only company that beats Cerner consistently in new sales is also the only one with a newer product.

From JA: “Re: Epic. More details on the Yale and Epic adventure.” Yale Medical Group describes their plans for Epic, also mentioning that a CMIO will be hired who will share time with the School of Medicine and Yale-New Haven Hospital. The specific Epic features that seemed to seal the deal were the obvious ones: ambulatory-inpatient integration and MyChart, areas in which Millennium is clearly inferior.

From Dave U. Random: “Re: Epic. Google RGHS+Epic.” Rochester General Health System has chosen Epic.

From SEC Fan: “Re: University of Michigan. CareWeb does many things well (less than they claim), but they have installed Eclipsys Sunrise over the last five years for inpatient. Interesting that after 3+ fails at EMR, they get one right and now replace it.” Thanks for reminding me. That’s another big Eclipsys loss to Epic, six years after the contract was signed and less than two years after Sunrise went live at UM.

From The PACS Designer: “Re: Windows Phone 7. The mobile phone marketplace will have more competition soon, as Microsoft has announced the beta for Windows Phone 7.” It had better be good if it’s going to displace the iPhone, Android, and BlackBerry this late in the game. I don’t see Microsoft as being good at come-from-behind victories; it’s better at running a prevent defense to protect the leads it generated a couple of decades ago. On the other hand, Windows 7 was a hit, so maybe they’re finally getting it.

From Vendor CEO: “Re: HIStalk. I have really enjoyed watching your progression. It’s kind of like watching the New York Times and Murdoch sites (HIT rags) try to get customers to pay for their sites while hordes of readers are rushing to all the free specialty news sites (HIStalk). Fascinating!” Thanks. Maybe I’m the open source alternative, a marginally skilled but enthusiastic spare bedroom pseudo-journalist trudging home to a PC after a long day at the hospital.

Listening: new from Grand Mal, which sounds like the Rolling Stones playing a smoky New York club in 1973.

Tom Ogg is named CIO of Akron Children’s Hospital, coming from Oakwood Healthcare Systems (MI).

Stuff you can do here: (a) put your e-mail in the Subscribe to Updates box to your right and be the first to know; (b) use the Search All HIStalk Sites box to dig through all HIStalk-related sites, including the 7+ years since HIStalk has been around; (c) send me your secret information and rumors via an anonymous Rumor Report, the lifeblood of HIStalk; (d) Friend or Like us on Facebook; (e) support my sponsors by giving their ads an occasional look and click; and (f) send in a pitch-free Readers Write article.

Not many readers think the final Meaningful Use requirements are too hard for providers to meet, but beyond that, it’s pretty much even as to whether they’re too easy or about right. New poll to your right: who benefits most from Most Wired-type awards?

A reader mentioned a JAMIA article last week, eliciting only a general reply from me since I didn’t have access to the full text version. Thanks to the folks at AMIA, who read my comment and hooked me up with anonymous access to their site so I can give a better answer next time around.

This from Weird News Inga: a medical practice sues its landlord over rights to a meteorite that crashed through the roof and into their examination room. The landlord claim it belongs to them, but the doctors say the landlord plans to renege on their promise to sell it to the Smithsonian for $5,000. The doctors say they’ll honor that deal and send the money to Doctors Without Borders for Haitian relief.

These rumors come up all the time, but once again Oracle comes up as a potential acquirer of Cerner. An Oracle VP supposedly claimed the company will spend $70 billion on acquisitions over the next five years, which always leads to talk about vertical markets such as healthcare, which means Cerner.

Duke University researchers develop software to predict MRSA drug resistance, offering it free to researchers.

Interesting: All Children’s Hospital (FL) will become part of Johns Hopkins Medicine (MD). In related news, the governor of Maryland wants to position the state as a health IT leader, citing a statewide HIE, EHR implementations, and recruitment of HIT professionals.

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News 7/23/10

From Erin: “Re: Medicity and Axolotl. I heard a rumor that both were on the sale block with active participants. That sure would give a new stimulus to the HIE market.” Unverified. The rumors I’ve heard say that Raymond James is shopping Axolotl, with a possibility that RelayHealth will be announced as the buyer soon. Medicity is getting feelers, supposedly, but it’s going to take some serious cash to get their keys and I’d expect the company to do some acquisitions of its own to raise the stakes. It’s a pretty great time to be in the HIE business since everybody wants government money, connectivity, and control of massive amounts of data. The proposed Ingenix acquisition of Picis may be the first signal that insurance companies (like Ingenix parent UnitedHealth Group, market cap $35 billion) are putting their smartest guys in the room on the problem of how to position themselves for healthcare reform.

From Dan Mann: “Re: Epic. Signed LSU’s 10 hospitals.” Unverified, but this is getting ridiculous. Does any vendor other than Epic ever sell a full system to a 400-plus bed hospital these days?

From Flynn: “Re: Most Wired. Why haven’t you mentioned the winners?” Because I don’t care. Hospital IT is not a competitive sport, other than for magazines hoping to sell ads, their vendor advertisers hoping to sell systems, and their participating CIOs seeking a career-enhancing resume credential. Filling out a survey of what you’re doing with computers doesn’t impress me nearly as much as proving your technology-driven superior patient outcomes and lower costs. Unfortunately, the winners can’t usually do that (and in fact, the relationship often seems to be inverse).

From Kelly: “Re: Mike Cottle. The IT director at the former Sumter Regional Hospital has taken an IT director job at Newton Medical Center (KS).” I interviewed Mike after a tornado destroyed his hospital in 2007.

From Laura V: “Re: Picis. What’s up with your sponsors getting bought?” Inga and I were just talking about that. I’m not claiming a relationship, but companies that sponsor HIStalk seem to have a great track record in being acquired under favorable terms. We like to take a small amount of credit for their success even though we usually lose a paying sponsor, so our celebration is short lived. I did get some nice e-mails this week from some investment banker types who appreciate what I do, so thanks to them.

From Ted Nugent: “Re: Ingenix. The Picis acquisition implies they’ll be doing other acute care deals soon. Healthland or SIS, perhaps? Both have a book out.” Unverified. It’s funny how you’ve never heard a phrase, then suddenly you hear it from a bunch of different people. “Have a book out” means a company is seeking a buyer, as I now smugly know.

From Briana: “Re: CPHIT, CPEHR, and CPHIE certifications. Are they worth pursuing? Do hiring managers care? I have 25 years in healthcare IT.” You’ll get different opinions, mostly depending on whether the person you ask holds certifications, but I consider these (and any other certifications, whether it be CPHIMS, certified healthcare CIO, etc.) mostly a waste of time and money unless you have no other credential and are desperate to hide a lack of experience or formal education. I’m not trying to be harsh, just realistic: non-technical certifications don’t mean anything except as an income source to those who offer them, some of which are purely for-profit companies exploiting career insecurity (lack of a degree, lack of work history, lack of US experience, etc.) If in doubt, read a bunch of healthcare IT job listings and count those that require or favor certification (the military is a possible exception since they do in some cases). Nobody’s going to hire you just because you wave some credential they’ve never heard of. We’ll know the industry has lost its mind if it requires a 25-year HIT veteran to prove they didn’t snooze through it by passing a multiple choice test. But certification can’t hurt, so if you don’t mind spending the time or money, do it with appropriately modest ROI expectations.

From Safety Not: “Re: JAMIA article on unintended consequences of e-prescribing. It is not known whether there are advantages over paper in the real world of medical care.” I didn’t see a full text link, but the abstract says the problem is allowing prescribers to enter free text instructions, basically turning e-prescribing into a clipboard with the same inherent risks. I wouldn’t take that as being indicative of a problem with those systems, but rather how they are deployed.

Listening: Scarlet Storm, “female-fronted symphonic gothic metal.” Found them accidentally, like them.

Inga did her usual bang-up job in collecting the thoughts of over 20 vendor executives on the final Meaningful Use rules (and in doing so, earned herself the night off from HIStalk). Some of them are really insightful, offering a fresh take that providers should notice. You can’t ask executives a question without expecting a little sales pitch and she got some of those, but I think every person she interviewed gave some good perspective or advice. Definitely worth a read. You’ll make Inga happy if you add your e-mail address to the Get Instant Updates box while you’re over there since she’s passionate about tracking her stats (she’s insecure in the cutest possible way).

Q2 numbers from athenahealth: revenue up 28%, EPS $0.04 vs. $0.06, beating expectations. Shares are up 7% in after hours trading as I write this.

Microsoft’s Q4 results: revenue up 22%, EPS $0.51 vs. $0.34, beating expectations. Good numbers, helped by Windows 7 and Office 2010.

Weird News Andy goes all culinary in his observational humor, asking of Terra Haute Regional Hospital, “Does their cafeteria serve Haute cuisine?”

Doctors in Australia complain about the new EMR installed in two hospitals, saying that it’s “unfriendly and wastes a lot of time” and “is an awkward electronic and written hybrid.” I can’t swear to it, but I think it’s Cerner, although the doctors say it’s an old version of whatever it is. “It is a US developed system, but in the US they are using version 11 while we are using version three.”

Confirmed: University of Michigan signs with Epic, ditching its homegrown CareWeb. The price was quoted at $20 million, but I would be shocked if that’s all it will cost (although that’s probably software only). The article also said that UM will be eligible for only $2 million in HITECH money, which also sounds way too low for a 930-bed hospital system.

Jobs: QA Engineer, Clinical Product Analyst, Project Manager – Physician Liaison, Web Application Developer.

Tim Thompson’s former CIO job at Methodist Houston is posted. Like many or most CIO jobs, this one requires only a bachelor’s degree and experience.

North Shore-LIJ chooses Skire Unifier for managing its capital projects. I’ll be honest: I hadn’t heard of it, but several big hospitals apparently have.

Harvard Medical School toughens up its conflict of interest rule for faculty, prohibiting them from shilling drugs and accepting free meals and trips. Their consulting and board income is also limited and payments of $5,000 or more must be reported on the school’s Web site. My hero, Senator Chuck Grassley, is largely responsible since he investigated some Harvard docs for taking Pfizer’s money (an excerpt to his letter to Pfizer’s CEO above).

GE Healthcare and Boeing are fighting over a section of the communications spectrum. Boeing uses it to test planes; GE wants it for patient monitoring.

WNA competitor Guy ran across this story. A woman who had just delivered a baby is visited by a group of women who enter her hospital room, shut the door, and start beating her up over comments she made on Facebook. People who’ve never worked in a hospital would be amazed at how often human drama unfolds right in the rooms. I’ve taken guns away from patients, watched a newly delivered 12-year-old mother hitting on a hospital security guard, and declined the offer of patients to share their recreational drugs. There’s a reason they put metal detectors and police officers at the ED door — hospitals are one place other than the driver’s license office where community demographics are proportionately represented.

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