Being John Glaser 8/31/09

If you had to answer the question below in one sentence, what would you say?

What is the fundamental contribution of information technology?

My answer — information technology enables complexity.

Our personal financial assets are much more complex that those of our grandparents; savings accounts have been replaced by retirement plans and mutual funds that can automatically shift assets based on a person’s risk tolerance. Handwritten flight manifests have been replaced by the ability of an individual to book air travel involving multiple stops and carriers. Weather forecasting based on seasonal expectations and reports from adjacent states has been replaced by sophisticated models. Complex activities such as sending a satellite to Jupiter, non-invasively observing metabolism in the brain, and simulating the interactions between proteins would not be possible without information technology.

These problems of healthcare cost, safety and quality are based in and exacerbated by the complexity of healthcare. The knowledge domain of medicine is vast and evolves rapidly. Patients with complex acute problems and multiple chronic diseases will be seen by many providers within a short period of time and undergo several parallel treatments. The delivery system is highly fragmented and dominated by small physician groups and hospitals. Standardized care processes have multiple varieties. Managed care contract provisions can fill volumes.

Information technology can be applied to enable the complexity in healthcare. Clinical decision support and clinical documentation applications can assist the provider in keeping up with medical evidence. Results management systems can highlight the patient data that deserves the most attention. Interoperable electronic health records can support the coordination of multiple providers taking care of an elderly patient. Telemedicine can assist patients and providers in joint management of chronic disease.

Maybe that’s the fundamental contribution of information technology in healthcare. It might enable the current complexity to actually work.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 8/31/09

VA plans emerging technology research center
iSoft lays off in England
Children’s Pittsburgh leads peds hospitals in HIT

From Scott: “Re: Joint Commission and nondisclosure. Yesterday’s Sentinel Event Alert provides further support for providers’ rejection of vendor nondisclosure clauses that could limit the sharing of information on software problems that have patient safety implications. The Joint Commission’s previous Sentinel Alert, Safely implementing health information and converging technologies, is also worthwhile reading for providers who might rush to deploy EHR systems in response to federal incentives.” Joint Commission should be all over healthcare IT in the context of patient care. It would give customers a way to collectively pressure their vendors (with regard to design and disclosure, for example). For vendors, it’s still better than having the FDA in your shop. For patients, Joint Commission is the one group that looks out for their best interests as a package, not just how technology is deployed and managed in a vacuum. And unlike HIMSS and its spawn, they have no vested vendor interest.

From Billy Roentgen: “Re: Stanford. Stanford is going live on Epic September 1, replacing Siemens Invision. Palo Alto Medical Group is going live on Epic at about the same time, replacing IDX. Epic is EVERYWHERE, starting in the physician’s office and carrying through to the hospital.” It’s easy to see with 20-20-hindsight why Epic owns the markets they choose to play in: (a) they built new products that reflected that inpatient-outpatient continuum while their competitors kept bolting on marginally useful features and acquisitions onto old platforms that were clearly unsuited for them; (b) they created MyChart before anyone cared about sharing data and PHRs; (c) they didn’t get bogged down in a Viet Nam of unsuitable customers by selling indiscriminately to just anyone; and (d) they ran their implementations firmly and protected customers from their own success-sapping indecision. Nobody else is even close, handing over the entire upper-end market to Epic without much resistance. Cerner had a shot but doesn’t seem to be selling much new business, while the reps from GE, Siemens, and McKesson might as well carry a white flag when they visit hospitals of more than 400 beds. Eclipsys is strong in the traditional inpatient core of CPOE, pharmacy, and nursing, but won’t get a foothold with customers who want a broad application line that covers outpatient in a single database. Epic owes its success to weak competition as much as anything else. In a perfect world, someone would step up to offer an Cadillac alternative, but for now, Epic is running its own Cash for Clunkers program (they get the cash).

From Joce: “Re: Logi-D. Heard a rumor that Stanley InnerSpace might have entered into an agreement to acquire Logi-D. Any truth to this?” I’m probably the wrong guy to ask since I don’t follow either company. Stanley makes carts and cabinets, Logi-D is a Canadian logistics consulting company specializing in the OR.

From The Nuge: “Re: claims. The reader’s comment hit the nail on the head, but that’s only a small part. Look at what happened with Emdeon and Aetna a few years back when they went exclusive (how can that even be legal?) Misys couldn’t send electronic claims to them for months! And what when PCN bought Versyss, declared bankrupty (iirc), was picked up by Medical Manager for pennies, and sold zillions of ambulatory claim events to WebMD? Very well orchestrated.”

From Kwame Mojito: “Re: GE. The nurse call group (formerly Dukane) has been sold internally from GE Security to GE Healthcare under the clinical systems division. It will be interesting to see if they can tie this into their Centricity product in a useful manner. To my knowledge, this will make GE the only EMR vendor who also owns a nurse call system.” And a theme park.

From Curious George: “Re: OSHA. I hear that hospitals are definitely on their toes in case an OSHA inspector drops in for a chat. Do you have any information on how many physician clinics are being targeted by OSHA? Have you heard of anyone who has and what their top five non-compliant issues were?” I’ll take a lifeline. Anyone?

From Ditka: “Re: sales. Greenway, according to a sales rep, is having the best year of their lives. Office Practicum is a small peds EMR with rabid fans and their pendulum is swinging mightily up. I keep seeing eCW everywhere. I’ve run into a bunch of e-MDs sales.” I had not heard of Office Practicum – looks cool (although I’d get those old TEPR awards off the front page). None of the others you listed are surprises.

From Norberg: “Re: sales. What can I say? It’s slow. The problem is that most organizations are almost singularly focused on ARRA. And because of the ambiguity around meaningful use, they’re doing nothing. I would hazard a guess that imaging and all other ancillary (read: non-EMR) solutions are not being given any attention / considerations by providers these days. If it’s not related to ARRA, it’s not getting done. If you’re the incumbent vendor at a facility, it’s probably high cotton for you there. But you can’t even get a meeting at a facility where you’re not the incumbent HIS/CIS vendor. I have some friends in the indy EMR space and they say they’re doing pretty well. I guess there are enough independent practices who are buying that the top 3-5 vendors are making out OK. But the large , monolithic vendors are struggling.”

A funny phony magazine cover from The Onion. Some good headlines: Researchers Quietly Chuckling At Placebo Group, Congress Deadlocked Over How To Not Provide Health Care, U.S. Government Stages Fake Coup To Wipe Out National Debt.

Children’s Hospital of Pittsburgh, says KLAS, is the pediatric hospital IT leader, coming in at #1 of the top five. Of course, it’s only the pre-season poll.

HealthPartners (IN) saved $430K in one year with its implementation of Epic and Merge Healthcare, which the local business paper concludes “is providing some proof for health reform advocates who say that electronic medical records can save providers money.” With a payback period that spans generations, I’d say that particular proof isn’t compelling.

A reader tells me his hospital’s Epic contract has no nondisclosure terms. That’s hard to believe given Epic’s legal lock on everything from employment to implementations, but that led me to a sobering thought: what if Cerner is the only company demanding that language in its contracts? Could this medico-legal brouhaha be over just one overzealous vendor’s contracting practices? A Fan was right in the last issue, though — being legally allowed to talk about known patient-endangering software defects is not worth much if (a) the vendor doesn’t tell you about them until you find them, and (b) the customers who are aware of the problem have no incentive or platform to get the word out to other customers (assuming the vendor isn’t doing it). In fact, some of the IT departments I’ve worked in kept the lid on known errors in a manner little different than the vendor themselves and for the same reasons – vanity, lack of resources to address the issue, and condescension toward end users who shouldn’t bother their pretty little heads with computer topics (which is actually sort of true – if you e-mail any of the big clinical departments about a computer problem, they drive you nuts with repeated uninformed questions and a flood of wildly unrelated problem reports that they suddenly observe and decide are related to the one you mentioned).  

Intellect Resources is doing a three-question HIT hiring survey of recruiters and hiring managers if you are one of those and want to chime in .

Institute for Safe Medication Practices weighs in with ample expertise on the Ohio pharmacist’s error that killed a child. If you’ve done FMEA or other root cause analysis, it won’t surprise you that the Swiss cheese holes aligned once again. Contributing issues: (a) the pharmacy computer system was down, causing the pharmacist to be swamped; (b) pharmacy staffing was short that day; (c) they were too busy to take breaks or even eat; (d) the technician who made the IV was distracted; and (e) a nurse called to get the IV early even though she didn’t really need it, causing everyone to rush it out without following the usual cautious procedure. ISMP likens sending the pharmacist to jail to Whack-a-Mole: “Marx notes that this child’s game is a telling depiction of how we set unrealistic expectations of perfection for each other and then unjustly respond to our fellow human beings who inevitably make mistakes. We play the game at work by writing disciplinary policies that literally outlaw human error.” The bottom line: nobody’s child is any safer now than that two-year-old was then.

The board of Phelps County Regional Hospital (MO) approves a measure that mandates physician CPOE usage.

An excellent Wired Magazine article makes a point that companies that can turn out “cheap but good enough” alternatives to expensive products can thrive, giving fresh-thinking startups a big advantage over their Goliath competitors who “believe the myth of quality” and fail to see "the rubric of accessibility”.  One example is a Kaiser experiment to put high-tech offices in strip malls. “In 2007, Flanagin and her colleagues wondered what would happen if, instead of building a hospital in a new area, Kaiser just leased space in a strip mall, set up a high tech office, and hired two doctors to staff it. Thanks to the digitization of records, patients could go to this ‘microclinic’ for most of their needs and seamlessly transition to a hospital farther away when necessary. So Flanagin and her team began a series of trials to see what such an office could do. They cut everything they could out of the clinics: no pharmacy, no radiology. They even explored cutting the receptionist in favor of an ATM-like kiosk where patients would check in with their Kaiser card. What they found is that the system performed very well. Two doctors working out of a microclinic could meet 80 percent of a typical patient’s needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist.” Makes perfect sense to me. Wouldn’t electronic triage be a lot more efficient and convenient to all involved?

University of Central Florida launches its 20-month master’s in healthcare informatics degree.

This can’t be entirely good news: iSoft will lay off up to 100 technical employees in England, but brags it will offset that by hiring up to 50 salespeople.

Odd: PACS vendor UltraRAD gets an FDA warning for “failure to validate computer software for its intended use.” The software that drew the warning: Microsoft’s SharePoint portal and the HEAT help desk system.

The VP of human resources at St. Joseph’s Medical Center (CA) is indicted for paying no income taxes in the past 12 years, also charged with altering the hospital’s computer records to reduce her withholding.

My last poll found that the employer of 18% of respondents is using Skype for some business purpose. Pretty interesting, although now the obvious question is “for what?” New poll to your right for providers: how good are your vendors of clinical systems at notifying you of patient-endangering problems and getting them fixed fast?

The VA is soliciting proposals to build a San Diego-based Emerging Health Technologies Advancement Center. Projects to be conducted there involve identity verification, interoperability, and developing an interface for patient consent directives.

Raj Dharampuriya, one of the founders of eClinicalWorks, is interviewed by India Knowledge @ Wharton. He mentions that the company has opened a Mumbai support center to handle US customers that run 24 hours a day, such as a prison. The company will hire 500 people in the next two years, most of them in implementation and support, and will open an office next month in San Francisco. He credits the Indian culture of the founders in helping them focus on their goal of building a business and changing the delivery of healthcare. He still practices medicine part time and says he’s in the top 10% of performers according to BCBS.

E-mail me.

News 8/28/09

CEO donates $1 billion to create “Bell Labs of healthcare”
Investors seek HIT companies that improve provider cash flow
Organizations partner to create next-generation LIS

From Roger Murdock: “Can you figure out a way to shake the truth out of HIT vendors and consultants? It seems to me that sales and acquisitions of anything HIT have really stalled since the beginning of the year. What do you think? I know vendors are reluctant to say anything other than ‘Sales are through the roof!’, but I don’t think so.” I don’t think so either, in most cases. Some companies, especially those with big market share and some diversification, are doing OK. Most, I’m guessing, are limping along as meaningful use uncertainty and capital constraints keep customers on the sidelines, at least for now. I think you’ll see the rich and the best get richer, while those with mediocre leadership, uninspiring products, and a shrinking war chest will find it hard to keep the vampires away until daylight finally comes. Vendors, please leave a comment (anonymous is OK) about your experience – is it boom times, so-so, or bust?

From Vilma Banky: “Re: MUSC. Funny, but I can remember community hospitals and vendor executives saying that they didn’t need anything that one of those big tertiary care or academic hospitals might need. MUSC provides care across a wide spectrum of patients in the Charleston area. I just can’t imagine them not needing everything for clinical documentation or medication administration. There are relatively standard charting requirement or needs (as well as medication administration needs).” I think Frank was saying that he doesn’t necessarily want it all from a single vendor. I’ve interviewed him twice and I really like him, by the way. I can never tell how someone comes across in the written interview transcript, but I can tell you that he impresses me as honest, sincere, and respectful.

From The PACS Designer: “Re: another WebOS. WebOS platforms are gaining more popularity, and this month SourceForge has named eyeOS as project of the month. The eyeOS  application was created in Spain and is an open source Web desktop that would be good for testing potential cloud applications.”

From Seeking Truth: “Re: Cigna’s decision to stop receiving electronic claims via the Emdeon clearinghouse. The battle is presumably over the fees Emdeon charges payers to receive electronic claims. Cigna doesn’t want to pay and Emdeon doesn’t want to offer a lower price. Emdeon and Cigna may resolve this price battle, or alternatively, Emdeon may ‘reclassify’ the payer as ‘non-participating’ payer (similar to Medicare and Medicaid, which are prevented from paying clearinghouse fees). This reclassification may allow Emdeon to charge providers a higher per claim charge per their contract terms with the provider. The Cigna e-mail indicates other options available to providers, but those options require a vendor change, which may involve other costs to the provider community. Obviously, the healthcare industry is being hammered to ‘reduce costs’ and this may be a payer response to that pressure. As a publically traded company, Emdeon will try to preserve their revenue, though clearinghouse charges may be difficult to justify. Since the advent of HIPAA Title II – Transactions and Code Sets (TCS), clearinghouses have had growing difficulty justifying transaction charges incurred by both providers and payers (consider how many ownership changes for Emdeon, NDC Health, Per Se’ and other clearinghouse vendors since 2002). The upcoming ANSI 5010 conversion may also influence how payers and providers exchange transactions. Dare I say, ‘never a dull moment in healthcare EDI.’” 

From Ex-Cerner Guy: “Re: Waterbury to Meditech. Waterbury hosts site visits and reference calls for Cerner and WH Clinicians are happy. Could be for Patient Financials / Rev Cycle, but even then, I doubt it.” Me too. A reader’s got a line on a source there who may give us the real scoop, which I’m betting is no scoop since I doubt they’re switching.

From A Fan: “Re: vendor disclosure. We’re coming at it from the wrong angle. The real issue here is not what your vendor is preventing you from disclosing, but rather what your vendor discloses to you (whether or not it came from another client). The other thing I wonder is, of the issues that are reported to someone like Dr. Koppel, how many make it to the vendor? There’s no question vendors gear development towards sales, but as we all know, health care has arguably as much bureaucracy as government and the feedback loop from real users to vendors is not great.” I know my vendor doesn’t seem to care much about issues we report, even those with patient safety implications. Their excuse always is: (a) it’s working like we designed it, as suckily as that might well be; (b) nobody else has reported it, so it can’t be much of a problem; (c) you’re doing weird stuff, so stop it; (d) we begrudgingly acknowledge that it’s a problem, but we plan to give you an unrealistic workaround and mark it as a future development project until you simply wear down; and (e) it will take at least a year to get a quick fix into your hands, so that automatically makes it unimportant since you’re stuck with it until then. I’ll also say that none of my vendors have ever been very good at proactively letting customers know about issues reported by others, meaning you go through a ton of testing and documentation to place the neatly tied package into their laps only to be told they already knew about the problem. If your vendor is better than mine, tell me.

All Children’s Hospital (FL)will open its new building in December (a very cool set of daily construction pictures is here – check out the Time Lapse option) and will use the Pediatric Edition of the Patient Life System by GetWellNetwork.

SNOMED Terminology Solutions is offering a free course by teleconference, SNOMED Clinical Terms Basics. New courses offered: Introduction to Terminology and Classifications and Introduction to Mapping.

I’m guesting (is that a word?) at Inside Healthcare Computing with an editorial called Lessons from Shark Tank — Beware of Vendors Borrowing Money or Going Public, where I drew my inspiration from (what else?) a TV show. Here’s a snip: “It also makes me wonder how many dull, average companies got that way because they took someone’s cash, put the founders out to pasture, and set all the fun, smart ideas aside and turned themselves into a bad mutual fund run by second-tier MBA school graduates.” I also worked in a fun reference to, as I call him, Dead Billy Mays.

I guess a wheezing economy has led us to this TV news headline, which refers to temporary jobs at a McKesson H1N1 vaccine center: Swine Flu Brings Jobs to West Sacramento.

Sunquest, Mass General, and Partners will jointly develop a new generation of LIS that focuses on anatomic and clinical pathology. I’ve said for years that if you want to see inarguable success in getting benefits from IT, find yourself some lab people. It’s no accident that the first really useful and clinically-focused hospital systems were LISs, back in the day when “nursing systems” meant online requisitions (aka, “order communication”). The most advanced automation of its kind is in the big reference labs, where you see a lot of computers and not so many people handling pipettes and swabbing agar plates. Instead of complaining about automation, laboratorians embraced it, designed it, extended it (rules capability, standard interfaces, repositories, barcoding, digital imaging, FDA-regulated instrument interfaces, portable data collection, RFID), and are now on the cutting edge of genomics, clinical alerting, and data warehousing. Among all providers and ancillary departments in hospitals, labs are about the only ones that we don’t have to be embarrassed by when talking to people from other sectors that are decades ahead of healthcare. The MGH pathology informatics doc said that tomorrow’s labs will “utilize advanced diagnostic and information management technologies, such as digital pathology, molecular studies, business intelligence and service-oriented architectures to simplify and strengthen the informatics infrastructure.” That ball you saw going over the Green Monster was Sunquest smacking one out of the park in a blockbuster boost to the company.

You know when a press release says somebody “applauds” some government action, they’re smelling cash. The HIMSS Electronic Health Record Association “responded with enthusiasm” (salivation) to Uncle Sam’s decision to donate $1.2 billion in freshly printed and rapidly devaluing currency to pay for the software its members sell. According to the “About” section, membership is open only to HIMSS Corporate Members. Should a non-profit, advocacy-heavy member organization like HIMSS really be running a vendor trade group while claiming to be impartial and patient-centered? As a provider, should I be paying dues to an organization that sells my information to vendors (mailing lists, HIMSS Analytics survey results, conference information), organizes those vendors to influence government policy, and runs Webinars and sales pitches on their behalf that are aimed at getting us poor provider members to buy stuff from its far more lucrative vendor members? It’s Ladies’ Night – I’m getting cheap drinks, but only if I can stand being constantly groped by those paying full price for that privilege.

Peace Health expects to get $30 million from HITECH.

This is one of those times where I say that I’m a bit behind despite working absurd hours, so if you’ve e-mailed me about something lately, be patient – I read every e-mail and respond appropriately, but it might be a bit slow in coming (working two full-time jobs is sometimes challenging).

Another vendor heard from who does not put non-disclosure language in its contracts: Eclipsys. They join Meditech and Medsphere. So. what say you, Cerner, Epic, and McKesson? 

Inga connected with one of our old pals at Noteworthy Medical Systems (they used to be a sponsor pre-CompuGroup) since a reader asked about the Cleveland office. She says it’s alive and well and nobody has moved to Phoenix, although all locations have had some restructuring.

If you don’t read HIStalk Practice, you missed this excellent piece, DrLyle’s Meaningful Discussion about Meaningful Use. Put your e-mail address on that page if you want updates when we write something new on HIStalk Practice – it has its own e-mail list separate from the HIStalk one. We have some fine sponsors, guest writers, and interviews there – like HIStalk, but more oriented toward physician practices.

Sparrow Hospital (MI) kicks off its EMR project.

A sweet deal for Misys PLC CEO Mike Lawrie: his contract requires him to be paid in dollars, so the significant drop in pound against the dollar didn’t cost him loss of several hundred thousand dollars of buying power. With a projected US 10-year deficit now up to $9 trillion, I don’t think he’ll have that problem for long.

In India, Apollo Group of Hospitals has started on its IBM-led “Health Superhighway” connectivity project. It’s also working on a unique ID number project. I’m pretty sure I’ve mentioned both before, but it’s still pretty cool.

A WSJ blog on venture capital says investors are looking for opportunity at the intersection of healthcare and IT (that’s us). It credits athenahealth and its $1.3 billion market cap for increasing investor interest, also juiced by HITECH headlines. As we’ve said here before, though, investors want companies that can improve the cash flow of providers, not those trying to sell a nice-to-have product.

Dayton Children’s (OH) goes live with its $27 million Epic project.

So why isn’t this making headlines? A drug company billionaire CEO/MD is donating $1 billion of the $3 billion he made from the sale of his company “to create the Bell Labs of healthcare”. Some quotes from him: “The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid … The idea is to actually go across the country and bring scientists, mathematicians, computer scientists, engineers, biologists, clinicians, surgeons, oncologists, pathologists, all together. And really integrate, truly integrate, information from the basic science to the bench to the clinic … So I’ve started funding and bringing together computer scientist to implement the grid, in an open architecture for the country … We have now the opportunity to jump-start health care, straight into molecular world. Or having the integrated, open-source software system that allows access to the 200-300 Legacy systems of software. So my great concern is, if we go ahead and implement a plan that just says, ‘OK, everybody just has an electronic medical record, with 200 proprietary systems, that don’t talk to each other by its nature.’” This is truly amazing, fascinating, and inspiring all at once. If anyone has a connection, I’d like to interview this guy (maybe sucking up a little in a quest to become Official Blogger of the Bell Labs of Healthcare at a significant salary).

Everyone thinks Cache’ is a healthcare-only MUMPS thing, but here’s proof that they’re wrong: a private bank for rich people selects it to run its Web-based banking system.

E-mail me.

HERtalk by Inga

Christiana Care Health System (DE) selects Patient Care Technology Systems’ Amelior Tracker system to automate the management and tracking of its hospital assets.

Five hundred doctors with Jefferson University Physicians  (PA) will soon be live on Allscripts EHR.

The newly public Emdeon signs a 15-lease for a new data center in Nashville. Emdeon, whose IPO raised $367 million, will rent  34,200 square feet for $39,500 a month, making the lease value more than $8 million.

Thanks to Mike and those crazy guys at Compuware for sending over their latest Youtube creation. This Rockstar CIO interview is definitely worth a 41-second diversion. And since I was amused enough to watch it over and over, I’ll give the company a little pitch for a survey of hospital clinical system users they’re doing that should take about 60 seconds or less of your time.

Covenant Medical Center (IA) agrees to pay $4.5 million to settle alleged violations to the Stark Law and submitting false Medicare claims. The federal lawsuit claimed the hospital paid the five specialists “above fair market value” for their services at rates that were “commercially unreasonable.”  The government claims the physicians, who referred patients to the hospital,  were among the highest paid hospital-employed physicians in the entire country. Records show the doctors were each paid between $633,000 and $2.1 million.

A couple of traditional ambulatory vendors announce they are now offering HIE functionality. Greenway Medical introduces PrimeEnterprise, which enables a community of Greenway customers to share select clinical and financial data. Also, Rabbit Healthcare Systems implements the first phase of its HIE solution, going live with data exchange between McKesson’s Lynx Mobile Inventory Management System, GenPath Reference Lab, and Docuda’s ERCard patient product (it doesn’t sound like an HIE, but that’s what they say).

The Stevens Institute of Technology (NJ) plans to use a $2.8 million grant from HHS to create an electronic system to boost the care of women of color with HIV/AIDS.

The Northwest Pennsylvania AIDS Alliance was also a recipient of grant money to support their IT projects. The HRSA awarded the alliance $45,188, which will allow it to create a new computer network and permit real time access to the Lab Tracker database.

More consolidation in the medical transcription world: Transcend Services will pay $16.2 million in cash and stock to acquire Medical Dictation Services.

The National Quality Forum endorses 18 standards for measuring quality and safety metrics for over-the-counter and prescription medications.

A friend was diagnosed with the H1N1 swine flu, which got me surfing a bit, just to assess the likelihood that I, too, might end up being bedridden. Fortunately my friend is now fine and I seemingly dodged the bullet. Anyway, I found this cool flu-tracker map that allows you to see the the number of suspected and confirmed cases in your community. Or, perhaps to figure out what vacation spots to avoid.

Another ex-hospital worker is arrested for allegedly stealing personal information from patients. The former Our Lady of the Lake Regional Medical Center (LA) employee opened 46 debit cards and filed fraudulent income tax returns. He also received $20,000 from fraudulent claims.

Researchers now believe that women with stronger thighs might be better protected from knee pain. Surely my thigh abundance is related to strength. Thus, I’m no longer going to obsess about the size of my thighs; rather, I’ll now be thankful that they are helping to preserve my articulatio genu.

E-mail Inga.

News 8/26/09

From Limber Lob: “Re: VistA. The key thing about VistA is not that it’s open source, but that the VA developers and users were joined at the hip during VistA’s three-decade long evolution. I worry about today’s vendors who have ‘architects’ in California or Florida and developers in Poland, India or elsewhere who know little about the users of the software they develop. The VA’s process from the outset in the late 1970s was to have front-line users work closely with the system developers to tweak and tune the applications to meet the needs of the caregivers caring for the patients.” Excellent point. I’m not too interested in the definition of open source (beyond that it’s free), but VistA doesn’t seem to fit the model as I understand it. It was built by VA employees at a cost of billions in salaries and other costs and is free only because it’s in the public domain, not because a multi-national bunch of spare bedroom programmers decided to donate their time to a cool project. For that reason, it’s probably a mistake to tout VistA as a shining example of how open source development works. It’s also no coincidence that arguably the two best and most widely used clinical systems ever (VistaA and TDS) were created in exactly the same environment – techies on the ground working with clinicians for years at a time. Vendors don’t do that any more, shipping specs overseas and giving clinicians only limited involvement at the beginning and again at the end. Or, putting a bunch of coding kids together with a Foosball table and letting them talk to the salespeople about what will move on the market. Too bad.

From CrazyRumorMan: “Re: Waterbury. Waterbury Hospital is rumored close to signing with Meditech to replace Cerner. This despite the successful rollout of the majority of the Cerner Millennium suite in just the last 2 years. I would say the IT decision makers at WH may have a screw loose.” Unverified. That’s a lot of wasted money and effort if it’s true, so I’ll presume it isn’t (and if it is, I’d like to interview someone there and find out what led them to that decision).

From Scot Silverstein: “Re: NPfIT. A question I’d like to ask the new head of ONC, Dr. Blumenthal. With all the funds being steered to HIT. how will the US national program avoid the problems that occurred in the UK’s national IT program?” The ONCHIT head (see how I inadvertently mock its regrettably late realization of the phonetic implications of its acronym?) is welcome to respond here. It’s a good question since NPfIT seemingly did everything right (rigorous planning, aggressive bid terms that nearly bankrupted its ‘”successful” bidders, and supercharged project management). The federal government’s track record of big IT projects is pretty bad, especially since it keeps hiring the same underperforming big contractors whose core competency is working the good old boy system.

Kathleen Sebelius visits Ohio State to check out its Epic system. Her father, John J. Gilligan, was governor of Ohio from 1971-75, making them the first father-daughter pair of governors (she from Kansas, of course).

From Weird News Andy: a UK man’s appendix ruptures three weeks after NHS surgeons claimed they removed it. WNA likes this quote: “A spokesman for Great Western Hospital . . . was unable to confirm what, if anything, was removed in the first operation.” The patient must have a black cloud over his head: not only did the rupture leave him with a serious infection, it also got him fired when his employer refused to believe that he needed time off to have his appendix removed a second time. Also from WNA: NHS is so desperate for off-hours doctors that it’s flying them in from all over Europe at hourly rates of up to $165. One of them, a Nigerian working on three hours of sleep, had two patients die on his very first shift – one after he gave the patient a tenfold overdose of morphine, the other who died of a heart attack after he declined to admit her.

Geisinger will implement the eICU program of Philips VISICU.

A Discovery Channel article mentions OpenMRS, an EMR for the developing world, and includes a couple of podcasts. I’ve mentioned it several times, such as the program in Rwanda to train developers for it and a college intern project to develop a touch screen interface for it.

Saint Vincent Hospital (MA) begins using the RFID-based surgical sponge detection system from RF Surgical Systems, which they say costs about $15 per case.

In what must be pretty big news for a vendor of software for chiropractors, Future Health issues a press release to announce that it has hired a former Eclipsys programmer.

New York hospitals line up in a “mad dash for digital cash”, as the headline says. Interesting factoids: (a) Montefiore has spent $200 million on its EMR; (b) the 180-bed New York Downtown Hospital can earn up to $8 million in federal incentive payments, as an example; (c) a Columbia doctor says he had to reduce his patient load by 60% when he first starting using an EMR and even now is only back up to 80% of what he could do on paper; and (d) experts say some doctors see EMRs as “a ploy to find out how much money doctors are making.”

The usual housekeeping reminders: your lifeline to breaking news and smirky humor is your e-mail address in the Subscribe to Updates box at the top right of the page (I don’t send anything except update notices to that list of 4,578 confirmed subscribers, even though companies ask me all the time). Please take a moment to peruse and possibly click the adverts (isn’t that very Continental-sounding?) of those brave sponsors who convince their financial guardians to send checks to an anonymous blogger’s PO box that could be forwarded to Lithuania for all they know. You will find a Search HIStalk box to your right that will invoke the power of Google to effortlessly search the 6.5 years and millions of words of HIStalk. Inga and I love rumors, news, guest articles, new sponsors, and shameless fawning , so you can click the hideous green Rumor Report box just below the search box or just e-mail me. And here’s the magic secret I keep forgetting to share on how to get a list of previous postings: just click the Archives link at the top of the page (I bet there are readers who think I purge all but the five most recent postings that make up the front page, so I’ll take the blame for that). Most importantly, thanks to the real stars: our commenters, guest writers, sponsors, and readers (that’s you). You have no idea how important you are.

Blessing Hospital (IL) signs with CareTech Solutions for its Web content management system and BoardNet board of trustees communications portal.

A Seattle public radio station’s investigation finds that 15 non-profit executives in the area made at least $1 million in 2007, seven of them from Swedish Medical Center.

Paging Dr. Halamka: VeriChip, smelling stimulus money, will try again to sell medical records-containing implantable RFID chips readable by an ED hand-held scanner. I see nothing to make me think that turkey will fly the second time around, especially given that they proudly state that only 500 people have signed up so far. Not that it’s a bad idea (pet chips are big business), but they didn’t market it well (or to the right audience). As an indication of just how committed to healthcare the company is, it also wants to invest in green energy.

Creighton University files a patent for “a novel, electronic program to coordinate patient health care.” It’s some kind of daily diary that’s monitored electronically by caregivers. They even made up a word for the people who meet with the patient monthly – an “ambulatist”.

An English teaching hospital is reviewing its ED system after discovering that someone altered patient records to make it appear that they were seen within government’s standard of four hours.

Odd malpractice award: a “rogue dentist” treating a 28-year-old woman’s cracked tooth removes all 16 of her upper dentia for some unstated reason. The jury awards her $2 million.

E-mail me.

HERtalk by Inga

A coding error leads the VA to mistakenly notify 1,200 veterans they have Lou Gehrig’s disease. Whoops. The panicked veterans were later informed of the error and assured they were not suffering from the generally fatal disease.

PatientKeeper announces that its user community has grown more than 60% in the last year. In addition, the company has increased staff 23% and is planning to add another 20-30% over the next six months.

Phoenix Children’s Hospital achieves 99% CPOE adoption with its Eclipsys Sunrise Acute Care system. The hospital’s CEO says that during their go-live, they reached a 95% adoption rate and are now placing an average of 3,250 orders electronically each day.

Another pediatric hospital is just getting started on its EHR project. Children’s Medical Center of Dallas is embarking on a $60 million project will eventually allow them to connect their Epic EHR to three other hospital systems in the Dallas area.

Next time you are depressed, you might consider sending an instant message to your therapist. Researchers conclude that “online cognitive behavioral therapy” (which sounds like a fancy way of saying you are IM’ing with your therapist) is an effective means of treating depression.

This might make you depressed: the cost of health insurance is skyrocketing. Between 2000 and 2009, the cost of a family premium provided by an employer increased 95.2%. And, plans today have higher deductibles and co-pays. Unfortunately, our incomes have only grown an average of 17.5% over the same period.

No less depressing: the White House and CBO project a $1.5 trillion budget deficit for 2009. That figure is 11.2% of the country’s GDP, making it the highest deficit since WWII. OMB director Peter Orszag says fixing health care costs is critical because “the federal government simply cannot be put on a fiscally sustainable path without slowing the rate of health care cost growth in the long run.”

Not feeling sorry for him if he’s depressed — Neal Patterson. The Cerner CEO cashes in on $320,600 worth of company stock. That’s on top of his $65,000 sale earlier this month. Stock is trading about $10/share higher than a year ago and closed at $64 on Tuesday.

St. Cloud Surgical Center selects Wolters Kluwer’s ProVation EHR for perioperative documentation and patient charting.

Ulrich Medical Concepts becomes the first Certified Integration Partner for ICA.

NaviNet offers its HIE solution at no charge to all state governments and US territories. More than 770,000 providers use NaviNet (formerly NaviMedix) for claims processing.

A Princeton junior and his recently graduated brother are awarded a $100,000 grant to expand an iPhone application to monitor diabetes. Their iAbetes Web 2.0 Diabetes Management System allows patients to record food intake, blood sugar readings, and insulin injections. The application interacts with a Web site that can be accessed by patients and their providers. The only award I won as a college junior was runner-up in a fraternity’s Miss Toga contest.

The state of Ohio seems to think its healthcare workers are bigger bigots than the rest of the population. The state senate is considering legislation requiring nurses, doctors, and other healthcare professions to take cultural competency training. Other states apparently have similar laws on the book. Why target just health professionals?

The FTC finalizes its rules for reporting data breeches for personal health records. Beginning September 24th, PRH vendors and entities that offer third-party EHRs must notify consumers when the security of their PHR data is breached.

Advocate Health Care System (IL) implements CPM Marketing Group’s physician relationship management system. The application will help Advocate manage its physician relationships and provide analytics and reporting. 

Tuality Healthcare (OR) celebrates its first complete year live on Cerner’s EMR. The 167-bed hospital says the system has strengthened patient safety and improved the quality of interactions between patients and providers.

iMedX, a transcription provider and developer of TurboRecord and TurboScribe, purchases competitor Worldtech. The combined entity serves several thousand physicians in hospitals and medical clinics nationwide.

EMR vendor Noteworthy Medical Systems internally raises $4 million to smooth the transition after its partial acquisition by CompuGROUP. The company also moved its headquarters from Cleveland to Phoenix, which is apparently closer to the bulk of its clients.

Sparrow Health System (MI) officially announces the launch of its multi-million dollar EHR project. Last year JohnnyReb tipped us off that Epic was the vendor of choice over McKesson. Sparrow says its $10 million phase one will start with physician offices by early next year.

Physician adoption and achieving meaningful use requirements now dominate purchasing decisions for community hospitals, according to a new KLAS report. In the under-200 bed market, cost and infrastructure requirements are no longer the top priorities. Instead, executives are now considering more complex and expensive options. Though Meditech and McKesson dominate this market, community hospitals are now considering Cerner, Eclipsys, Epic and Siemens — all vendors that traditionally paid them little attention.

Email Inga.

HITlaw 8/24/09

Non-Disclosure Agreements

I am weighing in on the recent flurry of activity on HIStalk regarding non-disclosure clauses in software agreements that preclude a customer from discussing or revealing problems with a vendor’s software.

Any worthwhile attorney reviewing agreements for a provider client should flag such an inclusion and require its deletion. Something like that should scream for attention to the savvy IT person, be it the CIO, the consultant, or the attorney.

Executives — when negotiating a contract, really think through the obligations. Where a clause requires education of your entire staff (such as telling them that they cannot disclose a serious software problem), just imagine giving that talk to your chief medical officer. If you find yourself not being able to defend or justify the offending term, you know what to do — get rid of it.

I cannot think of a more self-serving “requirement” in the paperwork that establishes the vendor-client relationship (some would say partnership). Imagine a high profile hospital negotiating with any vendor. The vendor is salivating, not just for the potential sale, but for the huge publicity it hopes to gain at some point by announcing that the high-profile hospital is running its software.

Certainly that vendor does not offer to keep secret the fact that the hospital runs its software in exchange for the hospital keeping errors or defects quiet. I personally find this offensive. I am not speaking for Meditech, but in speaking for myself, in the 20 years I spent negotiating tens of thousands of agreements for Meditech, I never once included such language in any agreement with any customer.

Imagine an ER physician who comes across a dangerous software malfunction. That physician may moonlight across town at another ER. Suppose that hospital has the same software vendor. Assuming the physician knows about the disclosure restriction (which is unlikely), you have placed the physician in a horrible situation. Should he or she abide by a software contract’s egregious terms and risk the health and safety of patients? Or, do what it is right (and required under the Hippocratic oath, I would say) and let the staff at the second hospital know about the software malfunction? In the more likely scenario, if the physician has no idea the restriction exists and divulges the existence of the problem, then the hospital is in breach of its agreement with the vendor.

Also consider the CIO, who you hopefully want collaborating with other CIOs on all things HIT related. You’re putting pressure on them as they sit at a table with other CIOs with the same software system, knowing this problem exists, but not being able (contractually) to divulge the information.

For a little perspective, let’s remember that the errors or malfunctions we are most concerned about are the ones directly involving patient care. A misaligned billing form does not rise to the level of concern as a bad dose amount. However, the non-disclosure terms do not differentiate, I am sure, in permitting disclosure of severe problems and restricting disclosure of minor ones. That makes no sense, which tends to enforce the assumption that the vendors using such restrictions wish to keep critical issues from the public because they fear the negative exposure that may result.

I say boo hoo. The vendor selected the market and designed the software. The vendor takes the profits. The vendor should stand behind its products, bad or good. The profit/loss reports do not differentiate. Neither should disclosures about software performance.

Just as a vendor should be proud of a good endorsement by any customer, so should the vendor permit free disclosure of serious problems. Not in a headline-grabbing, gossipy manner, but in a manner befitting this industry for the care of patients and avoidance of harm to those patients.

Providers should dust off their agreements and check to see if any such language is included. If so, call the vendor and demand an amendment deleting the provision. Better yet, vendors should be able to identify customers with such terms and do the right thing — provide the amendment without being asked.

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

Monday Morning Update 8/24/09

Former VA CIO’s assistant named by OIG for paying unapproved bonuses
Cleveland Clinic wants a new technology-enabled revenue stream
Government’s “Connect” tool to be modified to allow Medicaid data exchange

From Brian Wagner: “Re: Mount Sinai Biden visit. They actually did hold a conference call for reporters and other interested members of the public just minutes after the meeting in Chicago wrapped up. Unfortunately, all the reporters wanted to ask about meaningful use and certification, not about the $1.2 billion in extraordinarily essential infrastructure funding that will be going to regional extension centers and state grants. Read the application materials for the government. The documents are actually really interesting in laying out their vision.” Good information – there’s a lot of detail there. I’m smelling opportunity – the average Regional Center grant will be $8.5 million, with a range of $1 to $30 million. You have to be a nonprofit, but that’s easy to set up (think HIMSS will get involved somehow?) If you’re a shaky vendor or struggling consulting firm, you could fill out the paperwork and see if you win the lottery. I might want to throw in with you. Brian’s with eHealth Initative, by the way.

From @hightechattorney: “Re: Lance Armstrong is getting on the health IT bandwagon. ‘While everyone’s trying to fix the healthcare system in the USA, let’s make all medical records electronic. It is nearly 2010 after all.’ Posted on Twitter today by Lance after finishing a stage at the tour of Ireland.” Did you ever notice that Twitter postings sound eerily like those SNL sketches in which Larry King blurts out stream-of-consciousness non-sequiturs? And since Lance is shining his considerable expertise on healthcare IT, I’ll reciprocate by providing my expert opinion on his field: let’s replace bicycles and people who are paid astronomical sums to ride them with modern technology like motorcycles or cars. It is nearly 2010, after all. See how easy it is to opine confidently about something you don’t understand?

From Mr. RIS: “Re: Sunquest radiology information system. It seems they’ve sunsetted it. They let go all the development, support, and the one final domain expert on Friday. Clock is on to see who picks up this business.” Unverified, but we’ll ask. I can see it both ways: I liked the product as a long-ago customer, but it’s a little outside their core business. UPDATE: Not true, according to Sunquest. “The Radiology Information System is, and will continue to be, an important part of Sunquest’s diagnostic information solution portfolio. No one was let go Friday, in fact, we are actively recruiting to fill open positions.”

Listening: Radio Paradise, live, human-hosted streaming radio recommended by a reader. Lots of bands I’ve recommended are on the playlist: Silversun Pickups, Tori Amos, Peter Gabriel, Heather Nova, Leonard Cohen, and The Pixies. Like college radio, it’s a bizarre segue of music that sounds like it was randomly chosen by a wasted DJ: just now, it was Henry Mancini’s Pink Panther Theme followed by Pink Floyd’s Time from Dark Side of the Moon (maybe the next song will be Get the Party Started by Pink, continuing the color theme).

Consulting firm and HIStalk Platinum Sponsor Virtelligence is in the ten-company hunt to be named National Minority Small Business Person of the Year by the Small Business Administration. It’s on the Healthcare Informatics Top 100 list as well.

Inga connected with the CEO of the HIE vendor that people are gossiping about. He said he’s anxious to be interviewed, so we sent some questions Monday, some of them probing (why do we keep getting an answering machine on the 24-hour support line, what’s up with the company’s credit reports, etc.) Nothing heard so far.

The nonprofit Digital Pathology Association announces its formation and its first meeting, September 13-15 in San Diego. I got the notice from Sunquest, a DPA founding sponsor. Personally, I’m sorry that HIMSS outgrew San Diego since it’s a great conference town.

UCSD signs an agreement with a technical school in India to build a 300-bed hospital there.

WTAE in Pittsburgh covers the Health Buddy home monitoring system, which comes as a small appliance that sends information to a Web application. It has a long list of health management programs: CHF with various complications, anticoagulation, CHF, diabetes, etc. It has a USB and infrared connection to medical devices. A simulated demo is here. It’s by Bosch, the spark plug people.

Observations from the video of the Sebelius “paperless hospital” Omaha visit: (a) the nurse educator showing her the tablet PC gets in a couple of unintentional plugs for the C5 computer and Pyxis (b) Sebelius looks kind of snotty to me, never smiling except when she uncorks a tiny one when talking directly to the camera at the end, even looking distinctly uncomfortable while pretending to comfort a patient during the photo op; and (c) I have to decide whether I’m annoyed that the guy talking about industrial engineers referred to “processEEZ” instead of “processESS”, which always makes me think that somebody’s “puttin’ on airs”, as Southerners say. I Googled to see what they are using at the hospital’s parent, Alegent, and it looks like Soarian and NextGen on the inpatient and ambulatory side, respectively. If Siemens wasn’t so darned cold and stodgy, they would be all over this. They should hire me to be their obnoxious yet anxious to please online presence since theirs is about as inviting as a Berlin winter.

The VA’s IT department is the weekend’s top story, and not in a good way: the OIG says the former executive assistant of former VA CIO Bob Howard “acted as if she was given a blank checkbook” in paying “unusual and often absurd” bonuses totalling $24 million over two years (including $60K to herself plus $140K in tuition benefits to family members and friends). The VA also paid $37,000 in travel costs for a woman that Howard admits having screwed around with. Howard, you may recall, was the Bush political appointee and former government contractor executive who demanded complete control over all of the VA’s $2 billion IT program and decided it should dump its acclaimed VistA software in favor of buying commercial applications. His two-year VA legacy will apparently be as uninspiring as most of the people Bush appointed, consisting of disastrous security breaches, floundering IT projects, ill-advised attempts to dump the most successful EMR in history, and cheating on his wife. That’s a shame for a two-tour Vietnam vet and retired major general who should have known and done better for the veterans he was hired to serve.

Philippine hospitals lag in EMR adoption because of the cost of software, but one medical center bucks the trend by using an open source system.

The State of Virginia finally names a CIO to replace the one it fired after he suggested not paying Northrop Grumman’s big privatization contract because it was doing a crappy job even while asking for more money than was agreed on. In what is surely a bad sign, Northrop Grumman praises the new guy.

Best Buy looks interested in getting into the wireless health device business with Microsoft (I missed the announcement, but this guy didn’t).

My most recent survey results: 90% of you think more EMR vendors will increase their promises of future EMR certification and/or Meaningful Use compliance. New poll to your right: is your employer using the Skype VoIP service for any official purpose?

I see the AHA’s for-profit shill AHA Solutions is still out there “endorsing” products and selling services to vendors. There ought to be a law: nonprofits should not be allowed to affiliate with for-profit organizations (hello, AMA?)

Speaking of for-profit nonprofits, UPMC is the frontrunner to get a taxpayer-and-GE funded $830 million vaccine factory. UPMC’s CEO, who made $4.5 million last year, has already gotten face time with Joe Biden, Kathleen Sebelius, and the free-spending Homeland Security people to make his case.

Like Microsoft’s Bing, Yahoo’s search engine is accused of violating federal and state laws by accepting advertising by illegal drug vendors posing as legitimate online pharmacies. Seems silly to me; they can’t possibly check the good character of everybody who wants to run a text ad. If that’s the expectation, say goodbye to Craigslist, which in the few times I’ve tried to use it, seems to be about 90% shady. In the mean time, I see that the DEA is taking out its own Google ads tied to drug keywords.

I’ve tried to use Facebook lately and it was mildly interesting to connect with people I went to high school with (most of whom I don’t even remember, to be honest), but it’s getting as annoying as Twitter. Reason: people keep wasting time with online crap like FarmVille, pointless online tests, and “Which WKRP Personality are You?” results that clutter up the page. Americans seem uniquely suited to taking potentially useful technology (TV, cell phones, the Internet) and dumbing it down to the lowest possible level of triteness. Most of the Twitter followers I’ve gotten lately are porn sites and companies urged by their marketing people to attempt hipness. I thought lame blogs (is that redundant?) were as low as we could go, but Twitter makes the typical cheese sandwich blog look like War and Peace.

I’m not a big David Brailer fan (I can’t put my finger on it, but he just seems kind of arrogant), but he’s good for sound bites that I agree with: “I’m still shocked that there is a business argument for electronic medical records because it kills the very thing that makes hospitals money. The way we pay for health care penalizes efficiency.” OK, I’m warming up to him.

Parkland Hospital starts eliminating 200 jobs, giving its EMR a bad name by crediting it for the cutbacks, “As we have rolled out more components of electronic medical records, more of those [clerical] functions have been replaced.”

The HIT Standards Committee recommends using either ICD-9 or SNOMED to meet 2011 EMR standards, but wants to incent providers to move to SNOMED by 2015.

An Epocrates survey of medical students has some interesting findings from tomorrow’s doctors. They like mobile devices, with 45% of them using an iPhone or Touch and 60% of the non-users saying they’ll buy one of those Apple products within a year. They give medical schools an A- (up from a B) exposing them to technology, with 84% saying they’ve had EMR exposure and 90% saying use of an EMR will influence their practice choice. Over 70% of them said the US healthcare system sucks and 90% say drug salespeople are scumbag liars (I’m paraphrasing, but accurately).

A former network administrator for a hospital in Australia pleads guilty to voyeurism, choosing the geek’s method of planting a video camera in hospital restroom.

We had a big go-live at my hospital recently, giving me a chance to ruminate (no pun intended) on the most important assignment: what’s on the war room food menu? My tips: (a) if you bring bagels, skip the stinky “everything” ones loaded with garlic since the room and the breath of the participants reek of it for hours; (b) don’t cheap out and make people buy their own drinks from the nearest soda machine and also buy about 10 to 1 diet since it always runs out fast; (c) nobody likes pasta salad because it’s oily and full of olives, so get potato salad or, even better, kettle chips; (d) pizza is the cheap and easy option because they deliver, but you don’t want a roomful of IT people stuffed with greasy cheese, pepperoni, and hot peppers to be stuck in an airless room for hours; and (e) you can never have too many kinds of cookies and candy, at least until the analysts freak out on a sugar high and then crash just as you need their full attention to fix some IT disaster. It’s an IT low point to be covering the night shift and subsisting on hardening bagels and weird sandwiches (vegetarian, bloody rare roast beef) that everybody has passed on throughout the day. Other war room disasters: setting up in an office building where the air conditioning shuts off automatically for the weekend, forgetting to bring a hub so everybody can plug their laptops in, and quickly running out of toilet tissue in the nearest restroom that usually goes unused over the weekend.

Cleveland Clinic’s “Chief Emerging Business Officer” says they’ll develop a new revenue stream by selling eICU services and possibly home health telemedicine. As another of those nonprofits that seem anxious to make money, they had a $246 million profit on their latest federal forms, run a bunch of for-profit subsidiaries, and paid several multi-million dollar salaries.

ONCHIT (I know they keep trying to call themselves ONC because they don’t like the sounded-out version of the acronym they chose, but I don’t care) will modify its Connect software to allow states to share their Medicaid information over the Nationwide Health Information Network.

Sloppy physician handwriting is blamed in a Florida hospital lawsuit in which a pregnant inpatient was mistakenly given the abortion-inducing drug alprostadil instead of the labor-slowing drug that was intended, causing her to deliver her two-months-premature baby in her bedpan.

HIMSS tries to drum up member support for having people run around Washington to bug the aides of politicians about using taxpayer money for healthcare IT (haven’t they done enough?). Its Policy Summit kicks off with a “PREP Rally” with a reception “to discuss your future Hill strategy”, which I’m pretty sure the average dues-paying HIMSS member doesn’t have. I notice the HIMSS recap of recent news carefully omits those involving CCHIT’s ongoing marginalization.

E-mail me.

News 8/21/09

Obama people bring healthcare PR show to Chicago bearing taxpayer gifts
Research article: eICUs may or may not work, but we didn’t really have time to check that out
Medsphere gets a sale

From I.T. Guy: “Re: Cape Cod Hospital. Apparently they made the decision to pull the plug on Meditech after a long relationship and install McKesson.” Unverified.

From Jules Verne: “Re: Check out these earnings.” Ancillary systems vendor Aspyra (warning: their site has loud and gratuitous Yanni-type music to accompany an otherwise stark site) files a horrendous 10-Q: a loss of $1.6 million on revenue of $2.1 million. The company says it will have losses and negative cash flows for the foreseeable future, meaning it needs financing or to sell shares (not likely: 12 million shares are already out and trading at 19 cents, 66% off the year-ago price, valuing the whole shebang at just over $2 million). I might have to ask our new financial expert Ben Rooks to lay out what options the company has (beyond the obvious – sending everyone home).

From Dr. T: “Re: hospital in Taiwan using the PBX-to-Skype gateway. I had been to this hospital and seen this working. It is very effective and the carts are battery operated with standing space for the nurse to actually ride it. The cart accommodates a fixed touch screen along with MAR drugs.” I’m getting a brainstorm … nurse golf carts with a built-in Pyxis machine, a Skype headset, and maybe a drink holder and MP3 player. They can be like those golf course ladies who sell snacks to the people pretending to exercise by riding around on carts of their own and swinging a club occasionally between beers. Patients pop their “give me drugs” bedside button, the nurse gets a Skype message, the eMAR pops open the onboard Pyxis and pops out the med, and the nurse careens off to dispatch it to the patient. Actually, the Taiwan hospital does have a pretty good idea, although Segways would be cooler.

From Sylvester Stallione: “Re: boards. Are you an advisor or board member of any companies that you haven’t disclosed? I don’t see it mentioned on your About page.” I’m not. Nobody really is interested in me as me, only as Mr. HIStalk, and that’s not happening. Sometimes companies ask for advice, but in the rare cases where I have the time and interest to do it, it’s free (and of corresponding value).

Vice President Joe Biden, HHS Secretary Kathleen Sebelius, and ONCHIT head David Blumenthal visit Mount Sinai Hospital in Chicago to talk up the administration’s healthcare reform programs and to announce $1.2 billion in ARRA grants for Health Information Technology Regional Extension Centers and state-level information sharing projects. The public wasn’t invited and the dignitaries wouldn’t take questions from reporters. Maybe I’m cynical (OK, I’m cynical for sure), but it mostly seemed like a PR visit to put some positive spin on the administration’s floundering healthcare reform program, sending the politicians with some Uncle Sam financial lollipops to hand out. The best quote came from an ED nurse at the financially dying hospital, which recently had less than two days’ cash in the bank: “We’re spit at. We’re swung at. We’re kicked. We have urinals thrown at us. We have bedpans thrown at us." That’s always the bad side of some of us paying for the care of others like we do for welfare and other entitlement programs: sometimes the recipients are nasty ingrates that make us wish we’d spent the money on someone who appreciates it.

Hospitals using electronic ICU systems like those sold by VISICU/Philips think they are improving safety and outcomes, but a 100-hospital study of those facilities shows no improvement, according to a Robert Wood Johnson Foundation study. But here’s the kicker: it appears that the methodology used was to just do a bunch of interviews about why hospitals bought the technology and ask their opinions about the benefits received. I didn’t see anything in the article suggesting that the authors actually looked at outcomes data of any sort. So, the conclusion isn not that eICUs don’t work, it’s that hospitals that use them think they do; therefore, they don’t see the need to do outcomes studies of their own (notice also that the article appears in Health Affairs, which is a health policy journal, not a clinical journal). Here are the takeaways: (a) nobody knows if widespread adoption of eICUs would save money, improve outcomes, or increase intensivist coverage (even after reading this article, which you might think would try to answer that question); (b) hospitals use eICUs to improve outcomes and utilization of specialists; (c) eICUs would work better if they were more interoperable with other clinical systems (gee, I wonder why clinical systems vendors aren’t more cooperative about interfacing to the product of a competitor like Philips?); (d) hospitals that don’t use them don’t believe they are worth the effort and cost (duh, and why even bother surveying those who don’t have them?); (e) here’s the money shot: “All ten respondents from eICU hospitals were enthusiastic about the technology’s impact on ICU performance, particularly on quality and safety. They all emphasized the benefits of redundant processes in the care of critically ill patients, whose clinical conditions can worsen rapidly.” So why in the world would the opinions of the non-adopters be relevant in any way? If you were considering buying a particular car, which would influence your decision: (a) asking 100 owners of that model if they like it and having every one of them say yes, or (b) asking 100 people who don’t even own a car at all why they haven’t bought one? The article doesn’t even answer the question that serves as its title: “Does telemonitoring of patients – the eICU – improve intensive care?” It seems like a pitch to have further eICU studies funded by government grants. The organizations with which the authors are affiliated get most of their income from grants. I suspect correlation, if not causality.

Informatics Corporation of America will add XML-based quality reporting capabilities from Mark Logic to its clinical portal.

NextGen gets several community health centers as new customers. ARRA will help a lot of them pay for new IT systems, so it’s a market that could be pretty hot.

HP, which bought EDS for almost $14 billion less than a year ago, is whacking the top-heavy salaries of the former EDS employees to be in line with what other HPers make, which is also a lot less since they cut salaries on the HP side in February. Some employees will take a hit of more than 30%.

Adena Health System (OH) extends its contract with MEDSEEK to automate physician referrals and to let patients view estimated out-of-pocket expenses before tests or procedures are performed.

The just-finished and sold out e-MDs user conference in Austin provided CME credits to physician attendees, which was apparently well received.

Scot Silverstein had a great idea to follow up on my “should I disclose vendor non-disclosure terms”. His thoughts: I shouldn’t have to do that because vendors should, as he says eloquently, “in an atmosphere of transparency and in deference to patients safety and to hospital governance, should gladly and transparently do so if such language exists in their contracts.” Great idea. OK, here’s what I know: Medsphere says it does not put nondisclosure language in its contracts. A reliable Meditech source says they don’t either. So here’s the challenge to Cerner, Epic, Eclipsys, McKesson, and other vendors of clinical systems: tell me that your standard contracts don’t prohibit customers from freely talking about software defects that could have patient safety implications and I’ll proudly announce that on your behalf right here. Or if your contracts do include such language, tell me why. I still feel creepy that when I worked for a vendor long ago, we were instructed to lie to customers who were anxiously reporting patient-endangering bugs, resulting in some wildly over-the-top telephone histrionics by thespianically challenged support reps. A typical overheard conversation: “Oh, you’re kidding – you don’t get a warning when entering that order?” (meanwhile, the rep is giving adjoining cube mates a laughing nod and making an overtly suggestive up-and-down fist movement that indicates a serious lack of concern that somebody’s loved one may be at risk because we as the scumbag vendor didn’t want to admit defects that would get us sued or replaced).

Medsphere gets a sale to 60-bed Beauregard Memorial Hospital (LA).

Weird News Andy found this article, which describes the previously illegal practice of hospitals paying doctors a cut of whatever cost savings their treatments generate. CMS is testing the practice in, as you might expect, graft and corruption rich New Jersey, where the concept of healthcare vig is well established in a less reputable way.

”Experts” in Australia say that too-rapid implementation of e-prescribing could compromise patient safety, citing a government study that found one hospital’s system doubled the rate of medication errors because it defaulted to the maximum dose and auto-refilled.

CMS is shopping for claims auto-denial software that will cut the $10 billion in improper payments it paid in 2007. These are the folks urging adoption of patient-critical computer systems, right?

OhioHealth goes live on a remotely hosted version of the EMPI of Initiate Systems, running on the interoperability platform of Accenx.

Garden City Hospital (MI) contracts with CareTech Solutions to support new AMICAS radiology workflow modules.

The backup generator fails at Fletcher Allen Health Care, taking its Epic system offline.

Capital Health CIO Gene Grochala is intereviewed about its implementation of Keane’s clinical system, which he called “a diamond in the rough … a sleeper” that the hospital’s clinicians scored 93 on a 100-point scale.

Cardinal Health’s Q4 numbers: revenue up 10%, EPS $0.86 vs. $0.96, but meeting expectations. The sexy part of its business will be spun off on August 31 as Carefusion, leaving Cardinal as basically a warehouse and truck delivery operation for drugs.

Sometimes I wonder if doctors pay attention to pre-med economics: this one is proud to do his own network wiring and PC maintenance, thus turning his own valuable time into that of a $30 an hour technician. You can’t accumulate wealth if your time is spent doing low-value chores like computer programming or screwing around with PCs, which is really more of an expensive hobby than a frugal handyman gesture when the only thing you have to sell is your time.

Odd lawsuit: a patient given what appears to be a single dose of the very common sedative Ambien during a hospital sleep study sues the hospital, claiming the drug blinded and paralyzed him. Ambien is not known to cause either problem.

E-mail me.

Biden, Sebelius, Blumenthal to Announce HIT Grants in Chicago Today

Vice President Joe Biden, HHS Secretary Kathleen Sebelius, and national coordinator David Blumenthal will meet today with doctors, nurses, and administrators at Chicago’s Mount Sinai Hospital, according to an announcement from the vice president’s office.

Grants of $1.2 billion will be announced, including $598 million to fund 70 Health Information Technology Regional Extension Centers and $564 million for states to develop practices on sharing information with the Nationwide Health Information Network. The grants will be funded under ARRA, with money available in 2010.

The panel discussion will include Peter Ingram, CIO of Sinai Health System, as well as clinicians from Mt. Sinai and Northwestern Memorial Hospital. The discussion is not open to the public. A second event will take place Friday in Ohio.

HHS also says it will e-mail everyone who has signed up for the administration’s healthcare updates with the benefits of using healthcare technology. Jeanne Lambrew, director of HHS’s Office of Health Reform, was quoted as saying “All that paperwork is more than just annoying. It wastes time, prevents quick and accurate diagnoses and makes our health care system less efficient. And it simply doesn’t make sense in today’s digital age.”

The government also released a video of Secretary Sebelius touring “first paperless hospital” 83-bed Lakeside Hospital in Omaha, NE in June.

News 8/19/09

From Just wondering: “Re: Eclipsys. More Professional Services leadership cuts at Eclipsys, VP Linda Lockwood and RVP Gaye Fright.” Unverified.

From Lucky13: “Re: Healthland. A letter from our account rep today – we are a Healthland (formerly Dairyland). Thanks! Love the blog … I have learned so much about our industry through it.” Healthland (the former Dairyland) announces that it has acquired small hospital HIS vendor American Healthnet. A snip from the letter: “Not only are we staying the course with Healthland solutions and our product roadmap, we expect to continue improvements across the board in how we support and service your hospital and staff. This includes launching new modules and enhancements you’ve been waiting for — like Emergency Department, Long-Term Care, Home Health, and others.” Thanks for sending it over.

From Kyle: “Re: conference. I’ve been a reader for a little bit now and found out about an event through my school. Loma Linda’s School of Public Health is hosting the Southern California Health Care Summit on October 29 at the Ontario Convention Center. The conference will be a chance to earn FACHE credits and learn about some the latest trends in HIT. They are billing it as the West Coast’s version of the World Health Care Congress.” Thanks.

Listening: Tindersticks, British and obscure, a lush mix of dark vocals, lounge music, and jazz. Kind of like Leonard Cohen or Nick Cave, rainy night music.

She’s not a doctor, but she plays one on TV: an Obama campaign volunteer admits that she claimed to be a doctor in praising Obama’s health reform plan at the town hall meeting of Congresswoman Sheila Jackson Lee of Texas.

A Congressional Budget Office report (warning: PDF) gives the VA’s VistA good marks (above), although it cites conclusions from elsewhere that EHR adoption incentives should specifically require quality improvements.

Picis announces an enhanced ED PulseCheck: more clinical rules, alpha paging, and standard integration with bed management systems.

Former A4/Allscripts executive David Bond gets out of healthcare to develop a social networking site for teen athletes, earning kudos from former boss John McConnell (who did the same, now running his string of high-end golf courses).

El Camino Hospital goes live on the first phase of its Medicity-powered HIE. The Medicity Novo Grid is delivering real-time information to physicians, depositing ADT, insurance information, lab results, and transcribed reports into their EHR systems.

Mercy Medical Center (IA) will implement PatientKeeper’s Physician Practice Connector to give doctors a view of inpatient data, connecting the PatientKeeper Physician Information System with Sage Intergy EHR.

A couple of readers wisely suggested that I not consider running nondisclosure language from vendor contracts. Reasons: (a) it might identify the client since terms are often customized; (b) it might violate vendor privacy requirements and get a client or me in trouble; (c) clients might not want to share anyway since they may like the idea of being prohibited from sharing patient safety information. A couple of vendors e-mailed to say they don’t include such terms. I’d  be very surprised if Cerner and Epic don’t based on my limited history with them.

Jobs: QA Engineers, GE Centricity CPOE Project Manager, Strategic IT Consultant, Eclipsys SCM Systems Engineer.

A hospital in Taiwan implements a PBX-to-Skype gateway that allows free calling between nursing stations and its computers-on-wheels. Each COW has a USB handset tied into the hospital PBX so that employees can make and take Skype calls on regular phones. I Googled around and the four simultaneous calls version of the VoSKY appliance costs $1,500.

API Healthcare announces availability of its Business Analytics solution, which covers Staffing Solutions (staffing ratios and schedules) and Overtime Cost Control. MemorialCare (CA) is running it now.

The federal government rolls out a very Web 2.0-ish IT Dashboard that gives a quick green-yellow-red report like that of the VA above.

Chicago hospitals spent $32.4 million on advertising in 2008.

German HIT vendor CompuGROUP’s Q2 numbers (warning PDF): revenue up 61%, earnings up 19%.

In Australia, iSoft reports a 50% increase in revenue and 143% increase in profit, also predicting 10% sales growth for 2010.

Oracle’s Larry Ellison made $557 million in compensation in 2008, but was still #2 to the CEO of Blackstone Groups, who took home $702 million.

E-mail me.

Healthcare IT from the Investor’s Chair 8/17/09

“Tap-tap-tap, is this thing on?”

I’d like to thank the Academy, Mr. HIStalk, and Inga for allowing me the chance to post on a regular basis. Starting today, I’ll be writing a column sharing the Wall Street/investor perspective on HCIT, so I first thought I’d briefly share my background to give an idea of why Mr.HIStalk thought I’d be a good regular contributor.

I began my Street career on a crisp autumn day as a sell-side stock analyst (well, I was an associate analyst first) covering healthcare IT companies, most of which seem to have been acquired by HBO & Co. (now, of course, known as McKesson). Spending about a decade as a research analyst, I covered the stocks of around 25 companies such as Cerner, HBO, Sunquest, Eclipsys, etc. As the dotcom/e-health era arose, I covered those stocks as well, helping to take companies like Allscripts, Healthstream and others public.

After ten years, it was time for a change, so I went to what many called “the dark side” and became an investment banker. I spent six years doing both M&A and public offerings, primarily in the healthcare IT sector that we all know and love.

Wall Street has a few things to recommend it as a career, but the ability to speak truth isn’t always one of them. So, in March, I left the Street to become an independent strategic advisor to healthcare IT and other companies. So far, so good …

Yes, but just what does an analyst do and what’s the sell-side and how is it different from banking? For my first few posts, Mr. HIStalk and I thought a brief tutorial on the industry might be interesting to you, gentle readers. Let’s start with equity research.

There are two sides of Wall Street, the “buy-side” and the “sell-side”. Buy-side means the entities that actually purchase stocks (mutual funds, hedge funds, pensions, etc.). These institutional investors are what typically drive stock prices and through their commission dollars, sell-side behavior.

Sell-side analysts work for brokerage firms, aka investment banks. The other key difference is where buy-side analysts might cover hundreds of stocks or even the entire healthcare sector (from Merck to Mediumune and from McKesson to Medtronic), sell-side analysts typically focus on much smaller swaths of the economy such as biotech, big pharma, or healthcare IT and distribution, covering 15-25 stocks.

It’s the sell-side analysts’ job to know how the companies in their sector perform, what’s driving their growth, and to predict what their income statements will look like each quarter for the next few years. Why? Because it is viewed as axiomatic that earnings drive stock prices and so an analyst will model what they expect the company to earn and then try to determine if its stock price is appropriate. If it’s not, the analyst puts a coveted “buy” rating on it and proceeds to pitch the idea to the buy-side. If a buy-side client likes your idea, there’s the usually unspoken assumption that their fund will try to buy the stock through your firm and you get some credit for the commission dollar.

Earnings might drive stock prices, but I think John Maynard Keynes had a better assessment. He said, in effect, that picking stocks is like judging a beauty contest, but you are trying to figure out who the other judges would find the most attractive. This is why companies that care about their stock prices (and given that CEOs tend to own a lot of stock, most seem to care about this), care about the care and feeding of their sell-side analysts, trying always to paint the rosiest picture possible without (hopefully) crossing the line into fabrication or outright dishonesty.

I say “hopefully” because in my research days, I had countless CEOs telling me how their company was kicking competitive butt, taking market share, etc. All too often (especially early in my tenure), I’d then stand in front of my sales force and call clients to say, “we’re feeling very confident in HIStalkCo’s upcoming quarter”. Usually other analysts were saying the same thing (conformity is typically rewarded) and a “whisper number” began to circulate, meaning analysts are in print saying earnings will be $0.12 this quarter, but they’re all really expecting $0.15. This is why stocks would sometimes drop after hitting analysts’ consensus. This rosy feeling would often last until the company in question reported its quarter and, instead of the $0.12 – 0.15 expected, they reported $0.05 and the stock (of both the company and the analysts) fell.

I should note that it wasn’t always outright dishonesty. CEOs, by their nature, tend to be optimists and salespeople at heart, and the best salespeople, in my experience, believe their own stories.

A few questions might arise.

What does share price mean to me, the customer? In my view, often more than it should. Assuming your vendor has a decent amount of cash on their balance sheet and has a market capitalization high enough to remain somewhat relevant to investors (say, over a few hundred million), let investors and vendors obsess over share price and you can obsess over implementation and support issues.

Why the focus on quarterly results? When I was on the banking side, I had a client who was private and had just missed their internal quarterly budget numbers. The CFO, however, felt “great” about the year. Wanting to go public in the worst way, he asked me why they couldn’t just give annual guidance (like some companies were starting to). The answer is analysts are required by both their firms and their clients to develop quarterly estimates, which are then published. That means an expectation has been set, regardless of whether the company has endorsed it.

The company then achieves, exceeds, or disappoints on those expectations and, in my experience, its stock price reacts accordingly. Discussing what it would be like if this weren’t so is like discussing how pro baseball would be like if they switched to softballs. It might make an interesting conversation over a glass of cabernet or two, but it’s not terribly relevant to the real world. The fact is that quarterly results matter to stock prices here in America, at least in the short term. (incidentally, the company than proceeded to go public in the worst way, missing their forecasts within a few weeks of its IPO. The stock never again saw the IPO price and the management team didn’t get half the kicking around they deserved).

Should I chose a vendor that’s public or private? I’ve never selected a vendor, but IMO, you should choose the one that offers the best product for the best price (sorry to state the obvious). Recognize that there are certain incentives that drive public companies and this quarterly earnings game can impact the amount they spend on R&D, customer service, or other areas you care about. Recognize also, however, that this access to capital and currency allows them to invest in ways private companies often can’t and also is often a recruitment and retention tool (assuming the stock price goes up).

What else matters when dealing with public companies? There was an interesting Readers Write posting a few months ago where a customer complained that they were being ignored by a vendor for reasons having to do with their need to make quarterly numbers. Now as I mentioned, companies really care about their stock price and what investors are saying about them, perhaps more than they should.

Further, analysts (at least good ones) love to have any kind of proprietary morsel about the companies they cover. It’s always great to go to the buy-side and share special information — a key form of currency on Wall Street, and customer insights are always some of the best. It shows the analysts are doing some research away from the companies they follow.

Were I the ill-used client in question, I’d draft a lengthy e-mail detailing all these issues and send it to the vendor’s CFO saying, I’ll be forwarding this and similar views to one or two analysts that follow the company. I’ve not tried it, but it might improve your care and feeding as no company should want to have anything but a good reputation for customer service. Recall how the stock of Cerner fell after CEO Neal Patterson wrote his scathing “parking lot” e-mail and it surfaced on Yahoo! a few days later.

Thanks for your attention, I very much appreciate it. If interest warrants, we’re hoping to make this a regular column. Please let me know what topics you’d like to see discussed or just e-mail or leave a comment. Other areas Mr. HIStalk and I thought might be well received are:

A similar view of investment banking
How does an IPO work?
What exactly is private equity and what is it doing in healthcare IT?
An M&A watch – who’s buying whom, why, and does it make even a modicum of sense?

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

NAHIT Shuts Down

The National Alliance for Health Information Technology announced this morning that it will cease operation on September 30. COO Jane Horowitz says NAHIT has accomplished its mission of moving HIT “front and center” to reinvent the US healthcare system.

The NAHIT announcement says the challenge of implementing and using technology can be better met by other organizations. It named those as the American Hospital Association and the College of Health Information Management Executives, both of which were NAHIT founding members.

NAHIT was founded in 2002 as a technical standards organization. CEO Scott Wallace resigned in early 2008 as the group explored “new strategies and tactics and a different operating structure.” According to federal records, NAHIT took in $3.5 million in 2007, but had net liabilities of over $600,000. Scott Wallace was paid $679,000 that year.

NAHIT, along with HIMSS and AHIMA, found CCHIT in 2004. It also funded a controversial project to define five common healthcare technology acronyms, paying BearingPoint $500,000 for the job. The organization had begun calling itself “The Alliance” in 2005.

The HIMSS Web site refers to NAHIT as one of its sister associations, along with AHIMA, AMIA, CHIME, and eHI.

Monday Morning Update 8/17/09

From Don Money: “Re: West Michigan HIE article.” Here’s the link, but you have to be a subscriber (the reader sent me a PDF). The Grand Rapids Business Journal covers an HIE created by three hospitals, all of which are using technology from the former Novo Innovations (now Medicity). Medicity’s Robert Connely: “It’s not designed to create the next generation of applications. It’s designed mostly to solve work and save tons of money, and that’s the reason they’re willing to pay for it.” The hospitals’ HIE is replacing the community-based model advocated by Alliance for Health, which found providers unwilling to pay third-party usage fees. Trinity Health will use the Medicity approach for all 45 of its hospitals, according to the article. Medicity says its technology and business models can be adapted to any connectivity scenario: a hospital-owned HIE servicing its doctors, a RHIO/HIE with third-party governance, and (as in this case) a RHIO/HIE without third-party governance.

From Stan Pacifica: “Re: PROMIS pain scale. This is an adaptive testing methodology that contains 120 items in the item bank, but far fewer than 120 are used to assess pain.” That makes sense, although the reporter specifically said “asks patients 120 pain-specific questions, as well as hundreds more that probe the physical and mental effects of pain.”  

Here’s the layoff letter from Philips Healthcare, citing lower profitability and “risk of further deterioration in several of our markets.” The usual “simpler, leaner, more flexible organization” mantra is recited, oddly enough by the same CEO who originally oversaw its regrettable transformation to more complex, fatter, and more rigid organization in the first place. He’s making $2.5 million a year for 20-20 business vision, which would value it at $5 million if it worked in foresight and not just in hindsight.

It’s clear from Friday’s excellent recommendations to HHS by the Certification and Adoption Workgroup of the HIT Policy Committee that they want major changes made to EHR certification. Some of the high points:

• HHS certification (notice they didn’t call it CCHIT certification) is not intended to be a seal of approval.
• A new certification process should be developed that focuses on Meaningful Use rather than specific functionality points (that change will let specialty EMR vendors certify their products).
• Certification should include all privacy and security policies that are in ARRA and HIPAA.
• New highly detailed interoperability and data exchange specs should be created.
• “Test harnesses” should be created so that providers can test their own software.
• Multiple certification organizations should be allowed, with NIST accrediting them.
• ONC should define certification criteria, not the organizations performing the certification testing.
• Certification criteria will be updated no more frequently than once every two years and certification should be good for four years.
• “Lock down” requirements should be eliminated to level the playing field for open source systems.
• Since Meaningful Use definition is imminent, HHS should create a preliminary certification that would be valid through 2011.
• Interesting quotes: “There has been criticism that CCHIT is too closely aligned with HIMSS or with vendors. While we did not see any evidence that vendors were exerting undue influence on CCHIT, we also understand that the appearance of a conflict is important to address … Most vendors advocated for a minimal approach to certification, complaining that CCHIT has ‘hijacked their development effort’ and that they are developing features/functions that nobody will use.”

The takeaway: if the recommendations are accepted, CCHIT’s role will be diminished and shared with other certification bodies, none of which will be allowed to create certification criteria; certification will move away from a detailed product design to focus instead of how EHR products are used; and CCHIT cannot shake its reputation for being controlled by a few big vendors and HIMSS. It’s pretty clear that CCHIT may well have an ongoing role in the government’s HIT policies, but not at the level of influence it has enjoyed until now. Finally, someone says no to HIMSS.

The Colorado Hospital Association and the Colorado Behavioral Healthcare Council select Qwest Communications to provide broadband services to create one of the largest health information networks in the country, connecting 400 providers and supporting telemedicine initiatives. The Colorado Telehealth Network will focus on rural areas, giving them 100-megabit connectivity via Qwest’s fiber-optic network.

Ross Koppel pointed out that hospitals probably can’t sign software vendor contracts containing non-disclosure language without running afoul of the Joint Commission’s accreditation requirements, which require hospitals and providers to share information about known patient safety risks. Here’s my challenge to you providers: send me a copy (scanned or copied and pasted) of the non-disclosure language in your contracts and the vendor involved. I’d like to run some of them here anonymously (nothing but the wording and the vendor) so new customers will recognize those terms and insist they be removed.

Recondo Technology announces EligibilityPlus, a SaaS insurance eligibility application. I mentioned the defunct (well, acquired by Sybase, which is pretty much the same thing) New Era of Networks the other day and, what do you know, founder Rick Adam is now chairman and CEO of Recondo. It’s a small world, this healthcare IT stuff.

A Florida medical magazine covers the history of EMR vendor DoctorsPartner, which says its PM offering was Best in KLAS 2007 and its EMR #2.

A London Times article compares US healthcare to the NHS, quoting a patient who moved from Britain to the US. “Every time you go for any treatment here, they want to see your insurance card and check every detail they have about you and that is wearisome. But I’ve had some terrific treatment. There are all sorts of things you have to be aware of: some treatments you part-pay for and you have to choose a doctor who is approved by your insurer. But it’s not all about money here. The doctors are doctors – they really want to help you.” Another insightful comment from a UK cancer patient who sought treatment here: “Most doctors in Britain, if they’ve worked overseas, will admit that somewhere like America has the best of the best. What it doesn’t have is the breadth of coverage. Ours is an equitable, morally cogent way of doing things. But looking at the amount and quality of research into my cancer, there was a clear difference between Britain and the United States.”

A pharmacist who didn’t catch a technician’s IV mixing mistake that killed a child at Rainbow Babies & Children’s Hospital (OH) is sentenced to six months in jail for involuntary manslaughter, to be followed by six months of house arrest, three years of probation, a $5,000 fine, and 400 hours of community service. His pharmacy license was also revoked. It appears from the newspaper’s description that the technician mixing the chemo IV used sodium chloride concentrate 23.4% instead of sodium chloride 0.9%, related to the fact that the hospital’s computer system had been down for some time. The tech was charged, but not indicted. I don’t know that putting healthcare providers in jail for making an honest mistake is a good idea, especially if you want to keep enough providers providing.

E-mail me.

News 8/14/09

iSoft Enters US Integration Market
Social Security Administration Says New Certification Bodies Coming
HIPAA Violations: Nobody Has Ever Been Fined

From UCSFWatch: “Re: UCSF CIO’s e-mail. The GE Centricity Enterprise project is in full stop mode.” The attached and unverified e-mail from CIO Larry Lotenero says this: “The medical center’s Senior Management Group has engaged Kurt Salmon Associates (KSA) to assist us with a review of our IT clinical strategy. We are doing the review because we are dissatisfied with our progress to implement clinical applications to support the care of our patients. KSA will arrange interviews with many of you to capture your insights for the strategy planning. They will be on-site to begin their interviews on August 18. If KSA contacts you, I ask that you be as flexible as possible with your schedule to accommodate this process. We expect to receive a final report before November. For now, all activities associated with developing the GE clinical system should immediately be put on hold. Despite this action, we remain fully focused on our goal to complement our excellent clinical care providers with equally excellent clinical applications as soon as possible.”

From Jeannie with the Light Brown Hair: “Re: Allscripts. What? No mention of the Allscripts class action? Thought we’d hear some anti-lawsuit rhetoric at least.  :)” Jeannie, I’m concerned about you. I mentioned the securities lawsuits prominently on 8/5 and again on 8/7, appropriately loaded with anti-lawsuit rhetoric (all the lawsuits since then are just copycat litigation filed by the same old me-too corporate heel-nippers who must love America’s legal system since they make a nice living wasting everybody’s time and money with BS lawsuits just because a company’s stock price drops). My concern: I bet a third of the e-mails I get regularly say, “Wow, you have to check out this story” and send a link to something I’ve mentioned days, weeks, or even months before. So here’s the warning: I write concisely and I don’t follow the lazy “Generalissimo Francisco Franco is still dead tonight” trick of repeating a story endlessly. I figure HIStalk readers are smart enough to get it the first time around. So, the takeaway is this: (a) read carefully, even the short paragraphs; (b) if you miss reading a posting, don’t just skip it since I will probably not repeat any of the same stories out of respect for your time; and (c) I still appreciate having stuff sent my way even if I’ve already mentioned it.

From Weird News Andy: “This is neither weird nor news; I have instinctively known it for years.” Heart attack survivors improve their survival odds by eating chocolate at least twice a week.

WNA also called attention to the above photo, which shows a Lahey Clinic doctor consulting with a patient in a hospital 20 miles away. That led Andy to ponder, “Is the point of service the hospital room or the clinic where the doc is?”

I’ve been citing strong hints for months that iSoft had eyes on the US market, so that has finally turned into news. The big Australian HIT vendor acquires Boston-based integration vendor BridgeForward, which sells the Viaduct integration design studio, the Physician Integrator for connecting EMRs to practice management systems, and integration servers. They paid up to $15 million depending on performance. BridgeForward’s founder was John Moriarty, who founded integration vendor MicroScript before it was swallowed in the bottomless pit that was New Era of Networks. All of the company’s executives were from MicroScript as well.

A former Kaiser executive files a whistleblower lawsuit against the organization, saying it ignored his concerns and instead assigned an HR “grim reaper” to make him quit. He claims that Kaiser refused to track patient deductibles and instead made them bring in receipts; exposed medical information on all of its dementia patients by putting a registry on an unsecured network; and dumped intact patient records into unlocked Dumpsters. This site reports that the complaint says KPIT’s compliance officer responded to his complaint as follows: “That officer told Plaintiff that Kaiser leadership did not care and that there was widespread violations of HIPAA throughout the Kaiser network and throughout the organization. He told Plaintiff that the only way he could get the company’s attention would be to send the information anonymously on a disk to George Halverson, Kaiser Foundation Health Plan’s then CEO, at his home with a note telling him that unless this was corrected by a certain date, the next time he would see the information would be in the New York Times.”

A company I’ve never heard of is bringing 40 jobs “to Henderson”, with no mention anywhere on the site of the Evansville Courier & Press as to what state the company, Henderson, or Evansville are in (I’d guess Indiana except I don’t care enough to waste the energy since the ace journalists can’t be bothered to actually say). The company, Innovative Workforce Technologies (wow, killer name there) doesn’t even have a Web site that comes up on Google. The story says they have an odd lot of apps like interactive patient entertainment, bed management, and some other stuff I can’t decipher from the reporter’s description.

TPD says he likes Google’s Caffeine search engine, the heir apparent to Google search and a Bing-killer, the company hopes. It’s fast for sure (and free of Adsense ads for now). I tried “HIStalk” on both and Caffeine got 91,000 hits vs. 90,000 for plain old Google. I did find one killer Bing feature a couple of weeks back: if you Bing a location and click Maps, you can shoot the location with one click directly to your MSN Direct-powered GPS right over the satellite connection without even plugging the GPS into the USB jack. I’m find that highly useful – any time I’ve looked up an address or location by name, I just click Send and it loads as a Web favorite on my Nuvi 780 the next time I turn it on. That’s just plain brilliant.

maxIT Healthcare of Westfield, IN is a new HIStalk Gold Sponsor. The company’s 300 healthcare-only consultants offer a long list of services, with their long suit being EMR and clinical systems (Cerner, Epic, Meditech, Allscripts, and all the big names). In fact, a recent KLAS report, 2009 Maximizing Your Consulting Investment: A Report on Healthcare IT Consulting Services, survey found that where only four companies had enough engagements for clinical applications consultants to be rated and found that ‘maxIT Healthcare scored the highest, receiving especially high marks for the quality of their consultants’ in Staff Augmentation. Thanks to the folks there for supporting HIStalk.

I don’t have enough interest to want to absorb the details and I suspect you don’t either, but it appears JMJ and its EncounterPRO EMR may or may not be wrapped up in some kind of lawsuit and bankruptcy actions, depending on how you define some confusing holding and parent companies. There’s supposedly a family feud involved (or so this message purports), a 1:250 reverse stock split, a management attempt to authorize 500 million shares of stock, the resignation of the CEO from the board of the holding company, and all kinds of questionable but entertaining gossipy tidbits. Shares are at 6/10 of a penny. If you think your life is hard, imagine being a salesperson for them.

Health plans are responding in inconsistent ways to the drug price drop that will happen in September as a result of the McKesson, First DataBank, and Medispan AWP lawsuits that were settled awhile back. Payors expect a windfall, while PBMs are adjusting prices upward to protect their now-lower margins.

Cardinal Health launches the Pharmacy Health Network, a closed-circuit video channel for retail pharmacies that will will carry what sounds like endless paid advertisements for drug companies aimed at people waiting the inevitable 20 minutes for their prescriptions.

Researchers at Northwestern University create a 120-question pain scale software application. Sounds good, except if I was in pain I sure wouldn’t want to sit there and answer 120 questions about it instead of just pointing to a smiley/frowny face or grimacing theatrically to make sure the narcotic analgesics keep coming.

Here’s another argument for placing exam room computer monitors so docs don’t have to turn their backs on patients. A family medicine doctor turned away from a drug-seeking patient to enter information on the computer. The patient attacked him, biting his finger off.

A consulting firm says half of the $2.2 trillion the US spends on healthcare is wasted.

Siemens posts some ARRA-related online tools (I can’t imagine they’ll be a player, but they have to try), but what caught my eye is the “all your base are belong to us” odd grammar and phrasing, like someone with English as a second or maybe a third language labored to sound like a native English speaker.

The Social Security Administration will pay $500 million to settle a class action lawsuit claiming that it illegally withheld benefits. The agency’s computer matched beneficiary names to arrest warrant databases in an attempt to cut off payments to criminals on the run, but instead shut off benefits to people with false allegations and old warrants. I bet there was a fat cat contractor company doing the programming.

CMS, until recently the HIPAA security rule enforcer for over four years, didn’t levy a penny in fines to violators. Likewise, new enforcer Civil Rights Office, which received 44,000 privacy complaints over six years, didn’t issue even one fine. Joe Conn did what journalists are supposed to do (but rarely do in HIT-land) when covering an otherwise mundane story – he dug for the facts that nobody else even thought to ask about.

While I’m kudoing journalists, I’ll laud nextgov, which I’ve found to be an excellent resource. This article about the Social Security Administration’s $24 million contract to automate its disability program, but only for certified products, has some fascinating facts buried in it. An SSA spokesperson said that while CCHIT is the only certifying agency now, “other programs are planned for the near future”. US CTO Aneesh Chopra was reported as acknowledging that CCHIT’s specs have a worthy competitor in the Continuity of Care Record and finds the discussion important. GE was somehow involved in commenting on certification, and being a multi-national conglomerate that hasn’t innovated anything interesting that I can recall in HIT and that sells CCHIT-certified products, took the obvious position: “Officials at GE, which manufactures CCHIT-compliant technologies, said not only are certification criteria not a barrier to innovation, they actually enable it by focusing product development on value-added areas, while facilitating the exchange of data among different health organizations and products.”

A US district judge issues a permanent injunction prohibiting Microsoft from selling copies of Word after a ruling found that it violates the XML patent of a Canadian company. If the injunction is upheld when appealed in the next 60 days, Microsoft won’t be able to sell Word 2003 or 2007.

E-mail me

HERtalk by Inga

From Michelle Duggar: “Re: Tweeting during childbirth. Obviously this lady had issues.” Michelle Duggar sent this story about the wife of Twitter CEO Evan Williams. Ms. Williams tweeted her 14-hour childbirth experience to 15,000 followers, starting from the time her water broke. Narcissistic? Twitter hype? Or perhaps just more effective than Lamaze breathing?

KLAS confirms what vendors have been saying for months: sales of acute care EHRs have been slow. KLAS, which has been collecting similar sales data for the last seven years, reports that 2008 sales were the lowest they’ve ever recorded. However, Epic grew its market share, selling 40% of the new systems sold to 200+ bed hospitals. McKesson and Siemens also saw market gains, though Cerner saw no new net growth for the first time.

CSC is named a preferred vendor for the Georgia Hospital Association. CSC hopes to help Georgia hospitals comply with ARRA’s yet-to-be-finalized Meaningful Use provisions for EHR.

maxIT Healthcare announces that its client, Gila Regional Medical Center (NM), has achieved Stage 6 designation on the HIMSS Analytics EMR Adoption Model. Phoenix Health Systems also assisted Gila Regional advance its Meditech utilization.

Ochsner Health Systems will take advantage of a three-year grant from the CDC to create a telemedicine stroke network. Ochsner will connect physicians at five of its community hospitals to on-call neurologists using REACH’s telestroke and telehealth service.

AHRQ plans to extend $48 million in grant opportunities for developing national patient registries that can be used for comparative effectiveness research. This amount is in addition to the $300 million funded by the economic stimulus to fund similar research. Look for more details this fall.

Meridian Health (NJ) selects Language Access Network to provide real-time video language interpretation services.

Virtua, an IDN in New Jersey, picks the Picis CareSuite perioperative and anesthesia solution for its nine facilities. The Picis software will connect to Virtua’s Siemens applications.

Healthcare Managements Systems secures an order with Madison County Memorial Hospital (IA) to supply an integrated clinical and financial solution for Madison’s 25-bed hospital and two rural health clinics.

MGMA members say their top concerns and struggles are dealing with operating costs rising faster than revenue, maintaining physician compensation despite reimbursement declines, and selecting and implementing an EHR. Interestingly, medical practice managers ranked these same three issues at the top of last year’s survey. Other big concerns centered around patient collections, uncertain Medicare reimbursement rates, recruiting physicians, and negotiating payer contracts.

Telehealth Services signs up two new customers for its TIGR on-demand patient education system. Both Peace River Regional medical Center (FL) and SSM St. Clare Health Center (MO) will install Philips LCD televisions and the TIGR interactive patient education and entertainment systems.

Presbyterian Intercommunity Hospital (CA) reports a 99% CPOE adoption rate since going live on Eclipsys Acute Care last year. The director of pharmacy also notes a 60% decrease in medication delivery times, down from 60 minutes to 24. The hospital recently activated Eclipsys’ Sunrise Pharmacy solution.

At least 10 HIStalk sponsors made the 2009 Inc. 5000 list, which recognizes the country’s fastest growing private companies in terms of revenue. One of the highest ranking HIT companies was eClinicalWorks, which has grown revenues 460% between 2005 and 2008. SRSsoft has grown 330% over the same time period. In case you were wondering, the overachieving Northern Capital Insurance topped the list with a 19,812% growth rate.

Global Med Technologies saw a 79% jump in its Q2 net income. Net income was $272,00 and quarterly revenues increased 66% to $8.1 million. Global Med provides blood and laboratory systems and services.

Perhaps a lawyer can explain how one can even file a lawsuit this vague. A man files suit against an unknown person for an alleged and unnamed medical condition. The unnamed medical condition created unspecified disabling injuries, so the man is asking for Mr. Unknown for $75,000 in damages.

E-mail Inga.

News 8/12/09

McKesson Will Distribute CytoCare Chemotherapy Compounding System
Nuance Trims Losses, Beats Expectations
England’s Conservative Party Pushes Non-Centralized Electronic Medical Records

From Baron de Cobray: “Re: blaming vendors. Hospital administrators seem to be using clinical systems as an excuse for poor outcomes instead of their own poor management and operational workflows. I have seen hospitals bleed money because they refuse to fix workflow while demanding to replace a current IT system. The attitude that a system should fix these problems is absurd. Why do people believe they no longer have to think?” Ever since systems were first sold. In my experience:

• Hospitals like the idea of solving a problem by buying something — a piece of equipment, the services of a consultant, or a software application. It seems so much more decisive than the unglamorous chore of fixing poor organizational habits or culture.
• Hospital project management is usually iffy and IT portfolio management and governance even worse. IT should not own or run any IT project except infrastructure, yet you see IT departments claim they are going to lead clinical transformation. Not likely.
• Once the switch is flipped, everybody walks away instead of starting the long-term work of wringing value out of the technology.
• Hospital buy applications to avoid confronting employees for subpar job performance and managers for poor job definition. Hospitals almost never fire salaried employees, so nobody feels much pressure to change.
• Every area within a hospital thinks they are too different to allow conformance (especially pediatrics and surgery). Every hospital with an IDN (especially the flagship one) is convinced that nobody has a better idea.
• All that said, it’s easier to blame your vendor and then dump them than to look in the mirror to see who’s really responsible. I rag on vendors because I know they could do better, but when you paint an ugly picture, it’s ludicrous to blame the paintbrush you willingly chose. Every vendor’s product is wildly successful in at least one site, so that pretty much validates that it works when implemented and used correctly.

From The PACS Designer: “Re: file backups. TPD wants to inform HIStalkers of a backup system that can provide automatic continuous backup of your files through a USB attachment. The product is called OneTouch 4 Plus and is manufactured by Seagate/Maxtor. The OneTouch comes in several capacities. TPD installed a one-terabyte system for a family member and was impressed by how easy it was to copy all aspects of the system to a USB backup system. The one-terabyte system can be bought for about $125.00 from various sources.” I got the same device in a 500 gig USB hard drive configuration a couple of months ago, with the OneTouch software doing daily backups and prompting for regular full-system backups. What impressed me the most (other than the price, now $70) was that the drive turns itself off when the PC is turned off, apparently reacting to the loss of USB connection, so I don’t have to unplug it or turn it off.

Kaiser Permanente is cutting 1,200 more jobs, or 2% of its workforce, due to economic and enrollment issues. IT took the big hit back in the spring, with Kaiser confirming 850 IT-related jobs eliminated then. It’s also eliminating merit increases and delaying capital spending. A reader reports that one Kaiser region is offering voluntary retirement in hopes of reducing layoffs and, for those affected, offering generous severance benefits.

Health Alliance (OH) promotes Jay Brown to CIO.

Web-based transcription vendor iMedX gets a $13 million equity investment.

The eHealth Ontario news just keeps getting juicier. Former CEO Sarah Kramer got the job only after Ontario Premier Dalton McGuinty overrode the objections of his staff who questioned her lack of experience. Sealing the deal was the hiring of Alan Hudson as eHealth’s chairman of the board, who said he wouldn’t take the job unless Kramer, who worked under him as CIO when he was president of Cancer Care Ontario, was chosen as CEO. Both recently resigned in a scandal over excessive expense reimbursement and no-bid consulting contracts. Critics say eHealth Ontario has spent hundreds of millions of dollars without accomplishing much of anything.

Medsphere’s strategy is interesting, as published (warning: PDF) on the WorldVistA site: they’re targeting hospitals of 100-500 beds, for whom they say competing systems are unaffordable and low in customer satisfaction (I’m not sure that’s true of all competitors, but certainly some). They’re looking to hit the customer bang-for-the-buck plateau of the HIMSS Analytics EMRAM Stage 3, meaning no CPOE, clinical decision support, closed loop meds administration, physician documentation, PACS, and interoperability. Reason: Stage 3 costs only 40% of the tab required to get to Stage 7 and that bed range doesn’t necessarily have the money or the interest to shoot for the EMR moon. All of that sound good, but it’s really not all that insightful since most vendors in those bed ranges aren’t pushing CPOE or physician documentation either. Still, it’s a solid plan. Click the graphic above to see the cost-per-bed of several vendor clients.

Healthways, the disease management and health management company (market cap: $470 million) contracts for health services for its employees from Marathon Health. Employees get an on-site clinic, health coaching, and an EMR/PHR. Just about everyone on the Marathon executive team came from IDX.

McKesson announces an exclusive five-year partnership with Italian oncology IV robotics vendor Health Robotics, whose CytoCare compounding system will be sold along with McKesson’s ROBOT-Rx cart filler and MedCarousel drug picking system. A good move by them. Health Robotics also sells systems for non-hazardous IV compounding and is developing a similar system for TPN compounding in the pharmacy. I mentioned the company in March, also pointing out that former Eclipsyser Gaspar DeViedma is on the company’s management team and board.

England’s Conservative Party, calling NPfIT “shambolic,” wants to dump plans for a single national medical record per patient and instead share records kept individually within each hospital and practice (in other words, they propose to do it more like we’re trying to do here). Their plan to renegotiation contracts with BT and CSC doesn’t make sense to one analyst, who said, “It sounds a nonsensical approach with all the compensation payments that would be due. They could not make the contracts any cheaper – when they were struck years ago they managed to screw the lowest possible price and that led to the suppliers not being able to make any money.”

Weird News Andy checks in with a story from England involving a gang who held down a 14-year-old boy and forced a python to bite him. Paramedics on the scene identified the snake by Googling “snakes” on a cell phone, showing the boy pictures until he recognized it. It was found to be non-venomous, so he’s fine.

HITGhost followed up on my “female bass player” observation, pointing out Jeff Beck’s outstanding, jazzy bassist Tal Wilkenfeld (excellent live video here). She’s 23; Beck is a doesn’t-look-it 65.

Kaiser Health News runs an interesting story on EMR projects in Seattle’s hospitals, pointing out that three of the best hospitals in Washington are in the same neighborhood and use fancy EMRs, none of which can share information with each other. Fine comments from Swedish Medical Center CIO Janice Newell, who says that the Feds should encourage use of existing systems to avoid having the money “go down a rathole.” Even Steve Lieber of HIMSS gets in a rational, non-cheerleading quote that advocates reform along with automation: “As long as you will pay every time I do that test, the incentive is to do that test as many times as I can.” And kudos to David Brailer, whose viewpoint I share in pushing the network, not the devices that connect to it: “Imagine if companies tried to sell cell phones connected to some networks, but not others or that would call only certain area codes. The equivalent is trying to get doctors to switch to electronic medical records when they have, at best, a patchwork network to connect to.” That’s not the kind of story the trade press runs between the Most Wired beauty contests and vendor-written fluff pieces.

Tidewell Hospice (FL) names David Lafferty as EVP/CIO.

A group of Connecticut providers and insurers plans to launch an HIE next year, hoping to get stimulus money.

Allscripts is named one of North Carolina’s 10 Best Employers for 2009.

Hospital PR people will get hammered for information after a Hearst investigation concludes that 200,000 Americans will die from preventable medical errors and hospital infections this year. The report noted that federal and state governments have done next to nothing since “To Err is Human” came out in 1999, although assuming that government reporting and regulation will improve the admittedly ludicrous situation is a stretch.

An unemployed math instructor who claims his “energy medicine” machine can cure disease has sold 17,000 of them at $20,000 each (that’s $34 million worth) despite a lie-filled resume and a shady network of dealers and practitioners. He got two of the devices into St. John’s Hospital in Springfield, MO and touted that as mainstream acceptance, but it turns out that an RN in that department is also a regional sales manager for the company and her VP boss conducts training on its use. Googling the product’s name (EPFX) yields 26,000 hits.

Mayo Clinic hires an online ad network to place consumer ads on MayoClinic.com. Seems like a really bad idea for Mayo to pimp itself out that way. There are lame excuses at how the ads will help consumers, but it looks to me like Mayo just wanted to cash in like a mini-WebMD.

India will issue an RFP for a 20-hospital Health Management Information System, which sounds like a patient portal for getting information, making payments, and reviewing lab results.

iSoft says that a National Broadband Network in Australia would save $8-10 billion per year in healthcare alone, paving the way for healthcare reform and cost reductions and paying for itself twice over. It could be used for a health records network, patient management, and telemedicine.

The family of a patient who died of what they say is a Stanford University Medical Center medical error claim that, after the mistake, the hospital deleted entries from the patient’s medical record. The Department of Public Health seems to agree, finding that entries were indeed deleted and post-mortem entries were made by a nurse as instructed by her supervisor. Stanford says the deleted information was intended to be temporary, not part of the medical record.

A study conducted by a children’s hospital in Israel finds that the adoption of CPOE in the pediatric intensive care unit reduced error rates a little, but clinical decision support made a big difference. Medication prescribing errors dropped from 5.5% to 0.7%, although one might quibble at the definition of “error” vs. “error likely to not be intercepted and to therefore cause patient harm.”

Odd lawsuit: the widow of New York City’s first H1N1 flu victim says the city didn’t do enough to control the outbreak and didn’t tell her husband that he had come in contact with people who had tested positive for H1N1. She’s filing a $40 million lawsuit.

E-mail me.

HERtalk by Inga

The Social Security Administration plans to spend $24 million to link with healthcare organizations and hospitals. The goal is to seek health data on patients seeking Social Security disability benefits.

Healthvision boasts 13 new customers and two new partner engagements for the second quarter. The company also announced its upcoming user conference October 5-7 in Irving, TX.

INTEGRIS Health (OK) signs a three-year agreement with CareTech Solutions to provide Web services. INTEGRIS will implement the CareWorks CMS content management system to support its 13 hospitals.

James E. Peebles is named the new Chairman of QuadraMed, replacing Robert L. Pevenstein. Pevenstein will continue to serve as chair of the audit committee. Meanwhile, Julian A. L. Allen resigned from the QuadraMed board after a year and a half of service.

Springhill Medical Center and Eclipsys announce that their outsourcing agreement won a 2009 Outsourcing Excellence Award for Best Impact. The award is presented by the Everest Group and Forbes and winners can be nominated for a mere $1,500 fee. In addition to industry recognition, winners have the opportunity to spend a “winners night” on the Forbes Highlander yacht. I like the $1,500 per nomination idea. In fact, I’m now motivated to work on a business plan for Mr. H that includes charging similar fees for next year’s HISsie Awards. I’m hoping to leverage Jonathan Bush’s boat show connections for a cruise down the Chattahoochee River.

Patients needing to visit an HCA hospitals in South Carolina can send the hospital a text message and and their zip code; a reply will come back with the average ER wait time. If that method doesn’t work for you, you can either view the wait times online (www.grandstrandmed.com) or check out one of the digital billboards along the highway.

McKesson Specialty Care Solutions is adding up to 200 full-time positions at its call center in Scottsdale. New jobs are so much nicer to talk about than job layoffs.

Speaking of jobs, healthcare employment grew by 20,000 in July. The total unemployment rate, by the way, is a dismal 9.4%. Healthcare employment has grown from 13.3 million to 13.6 million over the last past year.

Elsevier announces that CHRISTUS Health (TX) will install five of Elsevier’s online clinical decision support solutions.

LRGHealthcare (NH) purchases IntraNexus SAPPHIRE clinical software suite, including IntraNexus’ Web-based EHR.

Diagnostic imaging provider Foundation Radiology Group will use software from Vital Images in its 20-hospital customer base.

Pendulum Healthcare Development Corporation selects DocSite as its preferred PQRI vendor.

Individual and family health savings account balances increased in the first quarter of 2009, which is the first time since Q2 2008. Employer and employee contributions to HSAs nearly doubled quarter-over-quarter. Individual and family account holders age 51+ hold the highest average account values.

Boston Medical Center claims referral volume has grown 10% since adding Carefx’s Referral Management Solution. Since May, the hospital has measured a a net 20% improvement in scheduled referrals and a net 5% reduction in no-shows. Administrators estimate they’ll generate an additional $7 million annually, based on preliminary ROI analysis.

Nuance Communications beats analysts’ expectations for its fiscal third quarter. The company posted a quarterly net loss of $1 million, compared to a loss of $9.9 million during the same time period last year. Total revenue grew 11% over last year, led by a 27% increase in Nuance’s healthcare and dictation revenues.

The folks at SCI Solutions are sponsoring a webinar next week and asked us to extend an invite to readers “following the healthcare reform issues/challenges on Capitol Hill.” After one of last week’s posts, I am positive there are a large number of folks following the situation closely. The webinar is entitled, “Healthcare Reform Update from Capitol Hill: The Latest News from the Senate Finance Committee.”

Virginia Hospital Center is deploying a wireless network across 1.1 million square feet in three separate buildings. The hospital is installing Horizon Converged Wireless solution by InnerWireless  to provide mobile access to a variety of applications, including the soon-to-be installed Siemens Soarian HIS.

A grandmother becomes the first American to receive a wireless pacemaker that allows her doctor to monitor her health over the Internet. The monitor communicates with a server at least once a day. If anything is abnormal, the system immediately calls the doctor.

Canadian researchers announce some important results of a social networking study: the more time people spend on Facebook, the more jealous they get about about the other relationships of their partners. Having been de-friended by someone recently (the nerve, huh?) I found the results very comforting. Clearly I was de-friended because of some jealous, psycho girlfriend and the action had nothing to do with me. Whew!

E-mail Inga.

Monday Morning Update 8/10/09

Merge Healthcare will acquire MRI software developer Confirma
Continua certifies new personal health devices
Google, Microsoft execs disagree with government’s EMR plans

From Ruppert Breedlove: “Re: Meditech’s latest results. They are trending from high margin (product sales) to low margin (services) revenue that is bringing down profits. Maybe it’s a short struggle while they try to get 6.0 going, or maybe it’s the start of a slow, chronic decline. They are losing a few customers at both ends (Paragon and Epic) and the larger Magic hospitals see a long and winding road that leads to the 6.0 door. Service revenues lag product revenue, so if those flatten and then decline, that would be significant.”

From Cathy Halloran: “Re: Eclipsys Knowledge-Based Charting (KBC). The latest go-live of KBC occurred at North Shore Long Island Jewish Health System in the last three months. It incorporates CPMRC/Elsevier’s evidence-based content within Sunrise Clinical Manager to support the clinical workflow of the  interdisciplinary (nursing and allied health) patient care team. This content and design was endorsed by enterprise-wide  NSLIJ interdisciplinary teams including physicians with the goal to use KBC to advance practice at the point of care. NSLIJ teamed with the CPMRC for Transformational Services and with Eclipsys for implementation services. There are two hospitals live right now, the  children’s hospital and a large academic/tertiary hospital. As we continue to  implement KBC across NSLIJH, the tools and content will support evidence-based  care and practice.” Cathy is VP of clinical systems at NSLIJ.

From Bulbs: “Re: GE. GE has a warranty on Meaningful Use and, unlike NextGen’s, it doesn’t specify ‘to use our BEST EFFORTS to keep a general released version of the Software in compliance’. It actually says it WILL meet compliance with certifying bodies, although they have carved out Enterprise stating they will use ‘diligent efforts’.” GE’s warranty text is here. The penalty, though, is only a credit (not refund) of six months’ of support fees, which isn’t much consolation if you’ve bought licenses, hardware, and implementation services (all from GE, the warranty specifies). My advice would be to forget the boilerplate and insist on your own contract language, backed up by more significant penalties. And, while customers are semi-guaranteed that GE’s product will be certified, most of the Meaningful Use obligations will fall on them, not their vendor (e-prescribing, getting quality results, keeping data in electronic form, etc.) I’ve got a UL-approved electric saw, but I’m still not prepared to build a house.

From Fed up with Zynx pricing: “Re: evidence-based nursing. With the recent acquisition of Provation, WoltersKluwer is now a reasonably priced alternative to Zynx for evidenced-based order sets and the recently released care plans. We were able to negotiate a substantial savings compared to Zynx when we bundled in the UpToDate product that Wolters also offers.”

Here’s what you thought about NPfIT in my previous poll: big success (3%); big failure (51%); somewhere in between (27%); don’t know and don’t care (19%). New poll to your right: will more EMR vendors promise their prospects future CCHIT certification or Meaningful Use compliance?

Allscripts will add 125 new jobs in Raleigh.

I couldn’t resist looking up Ken Kizer’s 11 acronyms: MD (medical doctor), MPH (master of public health), FACEP (Fellow of the American College of Emergency Physicians), FACPM (Fellow of the American College of Preventive Medicine), FACOEM (Fellow of the American College of Occupational and Environmental Medicine), FAMT (Fellow of the American College of Medical Toxicology), FAACT (Fellow of the American Academy of Clinical Toxicology), FAAMA (Fellow Academy of Medical Administrators), FACPE (Fellow of the American College of Physician Executives), FRPH (Fellow of the Royal Society for Promotion of Health), and FRSM (Fellow of the Royal Society of Medicine). He’s one busy “fellow”, apparently, since he’s also board certified in six medical specialties.

Listening: reader-suggested Silversun Pickups, LA indie with an all-too-rare female bass player. 

The Seton Law people say that HITECH improves requirements for breach handling, holds business associates directly accountable to the government, increases enforcement of violations, strengthens “minimum necessary” restrictions, improves accounting of disclosures, and prohibits sale of PHI. On the other hand, personal health record vendors like Google and Microsoft are not specifically included, so they can still use, disclose, and possibly sell the health information of patients, leaving consumers no choice but to accept their privacy promises. 

Speaking of Microsoft, it’s taking heat after a report found that 90% of the ads displayed when searching for prescription drug information on its Bing search engine led to unlicensed pharmacies, many of them providing illegal offshore counterfeit drugs.

Girish Kumar Navani, president of eClinicalWorks, is interviewed in The Journal of New England Technology and is asked excellent questions. He predicts the stimulus impact to eCW will be only 20-25% and will take 5-6 years to evidence itself. Asked if he wants to take the company public: “No. There is no question about it. There’s no way I would kill my freedom to be shackled by reporting to Wall Street every quarter … I think going public is like the hangover after a night out. You really feel good about it the day you go public, and then after that it feels like a hangover — and it never stops.”

A North Carolina business paper covers local companies that have added HITECH-inspired services (EMR hosting, order management, patient communication) to their physician product list.

The C. difficile bacterium killed 248 people in Scotland last year and was involved in the deaths of another 517, leading a public health official to urge use of an electronic bed management and infection tracking systems to combat the problem.

A new RFP tender from NHS: an order communications system.

Continua Health Alliance certifies three new personal health devices for connectivity and interoperability: a blood pressure cuff, scale, and glucometer.

Cleveland Clinic CEO Toby Cosgrove says healthcare reform “may end up making the problem substantially worse” if all it does is make insurance more widely available, adding that “the conversation has morphed from health-care reform to insurance reform.” Unfortunately, we’ve let those terms become synonymous.

Interesting results from the President’s Council of Advisors on Science and Technology this past Thursday and Friday in Washington. Attending were CTO Aneesh Chopra, ONCHIT head David Blumenthal, and our own John Glaser. According to the excellent recap by nextgov, Google CEO Eric Schmidt told them that the administration’s health IT system will keep hospitals using outdated databases in a Web-centric world, stifling innovation. He, of course, humbly suggested using Google Health and then snipped when Blumenthal told him the national system will share some information with PHRs. “Giving me a summary … is not the same thing as giving me the record." Microsoft’s Craig Mundie advised the administration to worry more about metadata and information lookup instead of specific EHR applications, but Blumenthal told him that’s not possible because stimulus funding was tied to EHR adoption (which seems more and more to have been a big mistake – you pay for a house, not for a pile of boards and a promise, to continue my construction analogy from above). He also admitted that we’re way behind Scandinavian countries in EMR usage (not to mention overall health and healthcare value). 

South Florida HIE and Community Health Alliance, two dormant and broke RHIOs that never got much of anywhere, regroup to chase stimulus money. They’re arguing that it makes sense to give them the cash instead of using it to “reinvent the wheel”, which I almost buy given today’s prevalent bail-out mentality (crappy car makers, criminally greedy financial institutions, and market-failed EMR vendors and RHIOs … hey, it’s only taxpayer money).

GE paid $50 million in fines and $200 million in legal fees to make SEC book-cooking charges go away, but it was a corporate embarrassment nonetheless, “like a professional baseball player revealed to have been dabbling in steroids”, Forbes says (while also pointing out that the SEC is mighty blustery about going after GE considering they missed major scandals like Bernie Madoff’s). Other articles I’ve read said that Jeff Immelt panicked because he was about to break a long string of profits under Jack Welch as the new CEO and maybe created a culture of fudging the numbers. A former GE executive says he was told, when he advised another executive that results were coming in light, he was told he was “taking those accounting courses way too seriously” and to “just reverse a few journal entries.” 

St. Vincent Indianapolis Hospital is experimenting with letting UPMC’s neuropathologists perform live biopsy readings via TeleNeuropathology, in which the Indianapolis neurosurgeons follow along as UPMC’s pathologists control a robotic microscope in the OR and inspect its images over an Internet connection.

Merge Healthcare will acquire Confirma, a Seattle-based MRI software developer, for $22 million in stock. I thought those Merrick people were obnoxious when they took Merge over a year ago, but they are doing everything right, including the eTrials acquisition last month and a stock price run-up of 16 times its 52-week low.

Kaiser Foundation Health Plan and Hospitals had a fair Q2: revenue was up a little, but net income was way up on lower non-operating losses (investments, I’d guess). It lost 36,000 members, but surely that’s related to higher unemployment. HealthConnect got a big mention in the announcement.

Winner of the Highest Potential Startup Idea at IPhoneDevCamp: Nurse Brain, a patient dashboard that nurses use to log their activities and then hand off to the oncoming nurse at shift change. Brilliant.

An HUC at St. Francis Hospital (WI) gets her job back after an arbitrator finds that termination was too severe a penalty for violating HIPAA laws in using the hospital’s medical records to locate her estranged son. The son filed a hospital complaint when he received a birthday card from her, claiming the only way she could have gotten his address was from hospital records.

The former director of interoperability and standards at HHS says the Nationwide Health Information Network needs to be scrapped because it’s obsolete, but there’s time because “I have not seen in the stimulus where the NHIN is being advanced.” David Blumenthal responded that HNIN is important and a work in progress.

HIMSS keynoter Dennis Quaid is on the big screen in GI Joe: The Rise of Cobra as General Hawk. How does a movie about a generations-old doll translate to the big screen? “Big, brainless action and bad acting,” said one critic. Others:  “Whoever said Dennis Quaid was set dressing in this film was absolutely right … every line he delivers sounds as if he’s reading it right off the page” and “Dennis Quaid has apparently been assigned to look gruff and bark orders.” Roger Ebert gives it 1.5 stars and, in the biggest Dennis insult of all, doesn’t even find him worthy of mentioning. Despite the pans, it’s pulling in big box office, at least until word gets around.

E-mail me.

News 8/7/09

From Wade Welles: “Re: evidence-based nursing. Do you know of any product in the market similar to Zynx Care, Milliman Guidelines, or McKesson InterQual?” I’ve heard of MCAP, which might be worth a look. Sunrise Knowledge-Based Charting from Eclipsys looked pretty good last time I checked quite some time ago. The floor is now open for suggestions.

From Sally Apizza: “Re: Todd Park. Todd’s appointment as CTO for HHS makes perfect sense. He is one of the most sincere, honorable people in the industry and, while the money he made building athena is nice, he is clearly focused on fixing the healthcare system. Besides, he has way too much energy to stay retired at 35.”

From Wes Jeeter: “Re: magazines. They are doing blogs and interviews. Like yours, only way not good.” I’m flattered in that imitation sort of way, especially since I’m a toiling-after-work amateur competing against companies and full-timers.

From The PACS Designer: “Re: cloud basics. Smaller institutions can benefit from good content on the Web. InformationWeek has a Plug into the Cloud blog that continually posts the latest in trends when it comes to cloud computing concepts.”

From The Queen: “Re: TPD. Would it be possible for TPD to please, please stop referring to himself in the third person?” It’s possible, but of unknown likelihood. Mr. HIStalk will leave that up to him since it’s his brand.

QuadraMed announces Q2 numbers: revenue down a little, EPS -$0.04 vs. $0.05. Severance payouts for two departed executives were largely responsible for the loss.

Eclipsys also moved into the red in Q2: revenue was down slightly, EPS -$0.07 vs. $0.15, missing revenue estimates by a large margin and guiding lower for the fiscal year. CEO severance was part of that loss, too.

Listening: reader-suggested Muse, pop-progressive that sounds kind of like the best parts of Queen. They’re doing a big stadium tour starting next month as the opening act for U2.

Streamline Health Solutions names board member Jonathan Phillips as board chair, replacing Brian Patsy, who will continue in his CEO role. Jon is founder of Healthcare Growth Partners and has supported HIStalk as a sponsor nearly from the beginning, also sharing his expertise in some interviews that turned out to be eerily accurate about the HIT vendor marketplace.

Merge Healthcare, seemingly back on the right track after some long and ugly struggles, announces that its PACS product has been integrated with Epic at HealthPartners. Shares have nearly tripled in three months, with market cap back to a respectable $235 million.

Speaking of Merge, it says it will “unlock the vault” on its internal imaging software tools, making them available to the commercial market as toolkits.

Salesforce.com takes a minority equity position in free EMR vendor Practice Fusion, also announcing the use of Salesforce.com’s cloud infrastructure for Practice Fusion’s new PHR, due out in November.

The military releases an independent report (warning: PDF) reviewing the design plans for the “world-class medical facility” that will replace Walter Reed. On the IT side, it worries about infrastructure planning (fiber and wireless) and EHR issues such as interoperability and usability. Most interesting is the highly practical definition of “world-class medical facility” in Appendix B, which calls for Stage 6 of the HIMSS Analytics EMRAM and state-of-the-art technology for knowledge management and unified communication. A fine job, but no surprise given those involved, including Ken Kizer of Medsphere (with a record-breaking 11 credential acronyms after his name) and Orlando Portale of Palomar Pomerado Health.

A reader is looking for technical experts who have experience with the Touchworks data model. E-mail me if you are interested.

AHRQ will provide a Web site generating application that allows organizations to publish hospital quality and utilization data.

Mississippi Medicaid will offer beneficiaries an EHR and e-prescribing system from HIE provider Shared Health.

EHRtv filmed last week at the Orlando Allscripts ACE09 meeting.

Speaking of Allscripts, several more uncreative law firms have filed suits against the company that are identical to the ones already filed by their legal competitors, i.e. the same “material misrepresentation” charges that don’t stand a chance at lining legal pockets unless certified as class action. The stock went down and is climbing back nicely, but naturally anyone who lost money must have been a victim of something other than market conditions or their own bad decisions. At least we still lead the world in something: resource-wasting lawsuits.

Epocrates gets a nice plug from US CTO Aneesh Chopra: “There is not a doctor I know who hasn’t downloaded a copy of Epocrates. It’s accessible and they use it on their Treos and iPhones."

China’s Ministry of Health is getting expert opinions on EMR standards, hoping to use electronic records to save money.

Jobs: Account Executive, Practice Partner Consultant, Lead Pharmacy Informaticist, Project Office Manager, CFO/VP Finance, Director of Marketing. Lots of winners here. I might apply.

Memphis startup Provider Health Services, which puts doctors and nurse practitioners in nursing homes, is using EMRs as a core strategy to manage costs and reduce provider paperwork.

Local police are mad at Rhode Island Hospital for refusing to give them details about a suspected homicide victim’s injuries, citing state privacy laws. Disclosure to police is allowed only in cases involving gunshots and abuse of children and the elderly, the hospital says. Police called out an exception that allows it if the information could help law enforcement.

Massachusetts, which has most expensive health care in the country, wants to replace the fee-for-service model for all providers with a capitated payment (although they avoid calling it that to prevent memories of bad HMOs).

Children’s Hospital of Philadelphia gets recognition for its Pediatric Knowledgebase, which provides dosing guidance, therapeutic drug monitoring, and medication usage research. It can be customized to work with EMRs.

IT solutions vendor PC Mall announces the formation of a dedicated healthcare division. 

This gripes me too: a husband and wife get their annual physicals, taking care to get blood work at an in-network hospital. They got a bill for $1,700 after the fact — the in-network hospital had sent their blood off to an out-of-network lab. The hospital told them it was their job to figure out which lab the hospital uses, later sending collectors after them. I had the same problem with my own hospital’s ED doc – the hospital’s insurance didn’t cover their own ED doctor services because they contracted ED coverage out to another company. How the heck are hospital patients supposed to figure that out in an emergency? And what alternative do they have anyway?

AMICAS reports Q2 numbers: revenue up 73%, EPS -$0.19 vs. $0.00, and guides revenue up. The stock jumped 15%, now having nearly tripled since December.

Somehow hearing Fannie Mae say this while asking for another $10.7 billion in taxpayer bailout money because of their bad mortgage investments makes me nauseous: “We are dependent on the continued support of Treasury in order to continue operating our business.”

UnitedHealthcare will make Quicken’s health expense tracking tool available to 700,000 of its enrollees, with plans to roll it out to 20 million people by the end of the year. Or, you could just download it here.

E-mail me.

HERtalk by Inga

From Worried: “Re: healthcare reform. Consider this: over the next three months, more than 700 post offices will be reviewed for possible closure. Don’t know about you, but the last time I had to go to the post office, I stood in line forever. Rates continue to rise and the quality of service doesn’t come close to Fedex. Hmm … does anyone seriously want this same government to run our healthcare system?”

From Robe 411: “Re: ARRA vendor guarantees. With all the talk about how IT vendors can get hospitals to Meaningful Use, is anyone aware of any guarantees vendors are stating should they be selected? For instance, are they promising in writing to be CCHIT certified by a particular date or promising to have a capability gap filled by a certain date?” Robe 411 posted this now on the HIStalk Discussion Forum, in case you missed it. I’d be interested in hearing what companies are doing. I do know that NextGen has a money-back guarantee program that includes a promise that the “solution that will always evolve to meet the standards and certifications for federal stimulus reimbursement programs of interest to physicians using NextGen Healthcare products.”

Eclipsys names former Trinity Health CEO Judith C. Pelham to its board of directors.

Cardinal Health elects current executive George Barrett chair and CEO, just in time for its August 31st spinoff of CareFusion. The company also announced a $500 million stock buyback plan and appointed Glenn Britt, chairman and CEO of Time Warner Cable, to its board.

Twitter suffers a denial of service attack Thursday, making the service unavailable and leaving users like me confused about alternate ways to waste time. Meanwhile, Facebook was suffering its own performance issues, possibly also due to an attack or maybe because of extra traffic from all those Twitter-deprived folks.

SRS announces that the 12-provider Chestnut Hill Cardiology (PA) has selected the SRS hybrid EMR for its practice. We mentioned this on HIStalkPractice and included a photo of the office. EMR_guy sent us this note: “I saw the building and immediately recognized it even though I haven’t lived in Chestnut Hill in 12 years. When I was a kid (a long long time ago) the building was originally a fast food burger place (fitting that it is now a cardiology practice). The place was call Gino’s and they had great burgers and shakes.” We are happy to inspire trips down memory lane. Mr. H, being a sucker for nostalgia and reader happiness, tracked down the photo above that should really take you back.

Maryland state officials agree to fund up to $10 million over the next five years to build a statewide HIE, getting the money by adjusting hospital reimbursement.

Picis enhances its ED PulseCheck solution with the embedding of First DataBank Drug Data File Plus. Picis has long supported access to Cerner Multum Vantage Rx Database, but with the addition of FDB, now covers 95% of what hospitals use.

Perot reports a 3% increase in profit for the second quarter despite an 11% decline in revenues. Perot says tighter cost controls helped earnings to rise to $31 million, compared to $30 million last year. New contract signings decreased 48% to $135 million, but have totaled $1 billion over the last year.

PeaceHealth (OR) selects ProVation MD software for procedure documentation and coding. Meanwhile Provation vendor Wolters Kluwer Health introduces its ProVation Care Plans solution, which allows interdisciplinary care teams to customize care plans and create education programs and guidelines.

AT&T agrees to extend special pricing to VHA member hospitals and non-acute care organizations. The contract allows VHA members to obtain “competitive” rates on AT&T wire line services, including local, long-distance, and toll-free services, plus audio and video conferencing.

Consumer Reports, the granddaddy of rating services, offers patient satisfaction ratings on more than 3,400 hospitals. The Consumer Reports Health Ratings Center rates the overall patient experience, including doctor and nurse communication, room cleanliness, and hospital staff attentiveness.

Healthcare Management Systems launches a new online bill pay service, providing hospitals the alternative to send electronic bills and receive payments online.

athenahealth reports its second quarter results, which included a 9% increase in profit compared to a year ago. The company reported $3 million in profit ($.03/share) and revenue of $46.7 million (a 42% increase.) athenahealth attributes the positive results to better sales, including an increase in athenaClinicals EMR users from 498 to 1,034 providers. Results were in line with analyst expectations, yet the stock price has fallen the last two days. Go figure.

A British GP receives a formal warning for downloading pornography at his surgery computer. The General Medical Council said the actions don’t meet the standards required of a doctor, but “are not so serious as to require any restriction on his registration.” Got to love those Brits and their sense of humor. I know people who have been fired for far more frivolous dalliances.

AMICAS second quarter results: revenue of $23.5 million compared to $13.6 million last year; net loss of $6.6 million compared to last year’s $97,000 loss.

Darn. Why didn’t I think of this?

E-mail Inga.

News 8/5/09

From Sweet Duck: “Re: Philips. Starting RIF this week. Some will be notified this week, most next week.”

From Former Misys: “Re: interesting lawsuit.” It’s the usual securities fraud lawsuit that inevitably results when share price drops even temporarily, one of many filed by “corporate wrongoing” attorneys Izard Nobel LLP, this time against Allscripts. Another was filed against Allscripts by fellow corporate heel-nippers CSGRR, which has filed hundreds of similar suits (I’m not kidding – I broke out of their Web page navigation structure to get this folder of suits filed, of which company names starting with A alone take up three pages). I get several of the class action notices every month for one company or another since my IRA is in a “wrap fund” that trades a lot, but I thrown them straight to the trash unopened because I’ve long since learned that (as in life in general) the only benefit invariably accrues to the lawyers on both sides.

From The PACS Designer: “Re: Scribd. Another collaboration Web site you might want to checkout is Scribd. It’s a place to form a group to discuss a specific subject or event. TPD came across this site when viewing a cloud computing use cases white paper, and the open cloud manifesto (OCM) website, which also may be of interest to HIStalkers.”

From Bob in Accounting: “Re: Huron Consulting Group. Wow.” Shares of Chicago-based Huron Consulting Group dropped 75% on Monday after an audit uncovered what looks like suspicious accounting, the company announced it will restate three years’ of results, and most of the company’s executive team resigned (Holy HBOC, Batman!). They did a bunch of healthcare acquisitions over the years: Spelz & Weis, Wellspring Partners, Aegis Advisers, and Stockamp. Huron was founded by a bunch of former consultants from Arthur Andersen, the scumbag, fee-obsessed company that let Enron and HBOC happen as their see-no-evil auditors. I know there are at least a couple of folks who work there who read HIStalk, so hang in there. The sins of the suits usually hit the peons hardest.

Speaking of Huron, here’s an ironic story lead from a 2004 WSJ: “Down the road and across the river from Arthur Andersen LLP’s old 28-story headquarters in Chicago, a firm set up by some of its former employees is hoping to become a beneficiary of the spate of accounting scandals that helped cause the collapse of the once-venerable audit firm. Huron Consulting Group Inc., a financial and legal advisory firm founded by former Andersen partners during the company’s death spiral in 2002, is set to go public with a $115 million stock offering by the end of the year. Its specialties include "forensic" examinations of companies with accounting blowups. That is, its consultants drill deep into particular accounting areas to figure out what went wrong, often working with audit committees and their law firms.” If they were Andersen, they would hire themselves as external auditors.

From Kit Kittredge: “Re: Todd Park as HHS CTO. What do you think about that?” Brilliant, although I’m shocked that they could get him since he doesn’t need the paycheck and seemed to be enjoying semi-retirement and starting up Maria Health (apparently now Ventana). I’m surprised HHS went outside the usually bureaucrat farm system to get someone so notable from private industry, especially since athenahealth is about as opposite as you can get from the COBOL-loving civil servants unimaginatively carrying out tedious political decrees involving the most arcane and mind-numbing financial transactions. You have to admire him for giving up cushy family time to get into a government grind with little to gain in money or reputation, knowing that entrepreneurs don’t easily morph into DC lifers. I e-mailed him today and he promises to interview here again once he’s settled in.

Speaking of Todd Park, ABC News e-mailed after finding his interview here, asking to use the picture I had run (which came from athenahealth, who gave their OK to them, which I now see has been picked up by Modern Healthcare). I see they are running it now in a story quoting a watchdog group’s spokesperson as saying TP “played the campaign finance system well” in donating to Obama’s campaign and expressing concern that his recusal on issues germane to athenahealth would hinder his effectiveness. I’d strongly disagree on the former: you’d have to be an incredibly idealistic multi-millionaire to want a wonky beltway CTO job, so I’m pretty sure he’d otherwise have rather have kept his ATHN shares. On the latter issue, I suppose it’s a theoretical risk, but since he has to sell his shares and give up his board position, he wouldn’t have much motivation. I’d rather have this situation than the ever-present ones where influential public servants quit to sell their influence to the private companies they formerly regulated.

Fred e-mailed the Allscripts internal e-mail announcing that field engineering services will be outsourced to DecisionOne in October. “DecisionOne is the right partner because they are expert at hardware installation and repair and have been in this business for the past 50 years. They have high standards and their employees will be trained and certified to the same standards as our employees. More importantly, they are committed to retaining the majority of our employees.” Sounds like a win all around, although hiring on with a new outsourcer is always traumatic for the affected employees (hopefully Allscripts put in the contract that nobody gets let go for some period of time). Outsourcing non-core business under carefully defined terms often works well.

A reader sent over the Boston Business Journal article featuring eClinicalWorks President Girish Kumar Navani, who founded the company with his brother-in-law and cousin, all three of whom live in houses next door to each other. Doing EMRs was their third idea after a golf course tee time app and a hotel reservation system. I like it that he’s cheap like me: the article mentions that he didn’t like the $90 walk-up rate he was quoted at a rental car counter, so he whipped out his laptop and made an online reservation for a $19.95 rate.

And I swear this is coincidental because I forgot to mention it Saturday until Inga reminded me: eClinicalWorks has signed on as  Gold Sponsor of both HIStalk Practice and HIStalk, which I appreciate even more now that I know how much Girish hates wasting money. I was super impressed when I interviewed him in 2006 and 2008 because he seems like an absolute straight shooter whose physician practice systems were forcing dramatic changes in the EMR marketplace. He said the company was doing $60 million in revenue in the 2008 chat, but that BBJ article pegs it at $100 million now. He had this to say about the much-watched New York project: “New York is not just about implementing an EHR, it’s about demonstrating that you can improve quality of care. Then, it’s all about expanding that to connect into the local RHIOs. There’s another level and degree of integration that’s big in the city – connecting with their school health program, with their immunization registries. You’re now talking about a truly digital healthcare system.” I’m really honored that he always takes my calls and e-mails, like when he hastily arranged a telephone interview on his way to the airport the day news of the eCW-Sam’s Club distribution deal broke, allowing me to get the details to you just a couple of hours later and before anyone else. Thanks to eClinicalWorks.

Listening: Keane, sweeping pop-rock, mostly piano and soaring harmonies. If you’ve seen the gazillion ads for the final season of Monk, that’s their song Time to Go playing. Excellent all around.

We’re working on an interview with the CEO of the unnamed HIE vendor that has been the subject of reader speculation. If you have information or questions we can use, send them my way.

The RN Pocket Guide is offered as a $19.99 iPhone version. Nice.

Brigham and Women’s gets an $8 million research grant to strengthen Rwanda’s health centers, including expanding its EMR to cover all patients instead of just those with HIV/AIDS and TB.

I’m sure Kathleen Sebelius is relieved that HIMSS issued a press release supporting her HIPAA security enforcement responsibility change to the Office of Civil Rights, then pitching HIMSS products and its self-nominated involvement in CMS’s work just two paragraphs later.

NHIN vendor MEDNETWorld.com announces that it will offer the Voluntary Universal Healthcare Identifier from Global Patient Identifiers, Inc. (that’s former Gartner guy Barry Hieb and former HIMSS VP Liddy West).

eHealth Ontario makes headlines for financial excess again, although support or criticism seems to follow party lines. One SVP consultant was paid $58,000 plus another $10,000 in expenses for just 21 days of work, later upping the average to $76K per month and billing for his nightly glass of wine. The CEO and board chair stepped down in June over no-bid contracts, of which $16 million were issued. Courtyard Group got $10.5 million of those, billing several of its executives (some of them believed to have political connections) at $393 per hour.

This Information Week article says CIOs should embrace Twitter because it’s “driving significant business value” and not “solely the province of professional goofballs and teenagers.” Case in point: Mayo Clinic, which announced a disease study on Twitter, checked to see who re-Tweeted it, and then e-mailed some of those people copies of the embargoed study so they could blog about it.

RealMed is named the exclusive practice clearinghouse for Adventist Health System.

E-mail me.

HERtalk by Inga

eHealth Ontario names its third new CEO in three months. Rob Devitt is stepping in until the end of the year as the board searches for a permanent CEO.

MedMatica Consulting Associates announces the availability of its HISAssist service line, which offers EMR implementation assistance such as go-live support, on-demand service desk support, and remote analyst and report writing assistance.

TrialX will release an iPhone application that gives doctors and patients the ability to search for various clinical trials. Could be cool to play with next time I’ve self-diagnosed myself with some life-threatening condition.

Durham, NC internist Esther E. Poza, MD joins TSI Healthcare as the company’s chief medical officer, tasked with leading the company’s efforts help physicians adopt EHRs.

The Hospital of Central Connecticut signs an agreement with AMICAS for its PACS, Reach, and RadStream solutions.

Merge Healthcare announces net income of $400,000 for the quarter ending June 30th. This compares to a $18.2 million loss during the same period last year. Second quarter 2009 revenues rose more than 15% to $15.4 million. Merge also announced a new contract with the Center for Diagnostic Imaging, a 51-center network based in Minneapolis. And, Allscripts selects Merge Healthcare’s Cedara WebAccess software application to “image enhance” Allscripts EHR solutions. The Cedara WebAccess portal will provide users a zero-footprint method of distributing medical images and reports.

MedAssets releases its second quarter 2009 earnings report, which included a 37.5% increase in net revenue over 2008. Total revenue was $84.2 million; net income was $2.2 million vs. last year’s $1.6 million loss.

Sac-Osage Hospital (MO) is likely not alone in its financial struggles or its desperate hope to win federal monies. The 47-bed facility, which bagged an 0.065 on the seven-point HIMSS Analytics EMRAM scale, is borrowing $1 million to purchase an EHR, apparently solely to hope to qualify for $3 million in ARRA funding. Says the CEO: “We wouldn’t have gone to an electronic health record at this point and time, because we just don’t have the cash to do it. We’re taking a risk that we’re going to be able to meet the criteria and get some of this stimulus money to help offset the cost … If that doesn’t happen, we’re shutting it down.”

A new KLAS report reiterates the struggles of small critical access hospitals wanting to adopt healthcare technology. Challenges include the limited number of vendors serving that market segment, inadequate functionality, and low CPOE adoption. Cost is also noted as a barrier.

Meanwhile, Randolph Medical Center (AL) completes an 18-month transition to Healthland EMR. To fund the project, the 25-bed hospital received a $1.2 million Critical Access Hospital Health Information Grant from HHS.

DOD introduces an online mental health system for its service members and their families. The TRICARE Assistance Program allows members and families speak via webcam with a licensed counselor at any time.

JPS Health Network (TX) anticipates a net loss in its new fiscal year, yet its proposed budget includes $152 million for an upgrade to existing computer technology. Adding a system-wide EHR accounts for $44 million of the budgeted funds.

An ultrasound tech from Jackson Memorial Healthcare (FL) pleads guilty to selling confidential medical information. The tech was paid $1,000 a month to capture details on patients involved in accidents, gunshot wounds, and stabbings. A third party then sold the information to a lawyer suspected of soliciting patients to file personal-injury claims. Details on at least 26 patients were compromised over a two-year period.

Despite of a weak economy (or because of it?) women continue to spend money on plastic surgery, particularly to enhance their professional marketability in a tight job market. In fact, the American Society of Plastic Surgeons finds that about 3% of working women have already undergone a cosmetic surgery they considered a career investment. Botox use was up 8% in 2008 and the use of hyaluronic acid was up 6%. The volume of tummy tucks and breast implants fell 9%, however. Draw your own conclusions.

I’m lobbying Mr. H to send me on assignment to do some investigative reporting. The Mexican government is offering free health insurance for tourists staying in city hotels. The plan will pay for medical care for any disease or accident, including ambulance service, hospital accommodations, prescriptions drugs, and emergency dental care. Sounds like a perfect time to visit if one needs emergency mammoplasty or the like. The offer comes on the heels of a 50% decline in tourism since the first outbreak of swine flu.

E-mail Inga.