News 5/19/10

From Epic Watcher: “Re: USF. Heard that GE did not go well, Epic has been chosen, and the docs are signed. Just what I heard and I am looking to triangulate. Kinda what you do sometimes, Mr. H, if that IS your real name!” Unverified on both counts, but I’ll always answer to Mr. H since Inga started calling me that way back when and I’ve warmed up to it.

From MaxPayneUK: “Re: value probe. Is iSoft/CSC the prime target after missing ‘must meet’ delivery targets? Or BT/Cerner CCN3 because of value?” The British government will review all spending commitments made since January 1, with IT contracts a key focus of cost-saving initiatives.

From The PACS Designer: “Re: Office Live Workspace. Since Windows Office 2010 is now released for businesses, the next step is the release next month for consumers. TPD has been testing Office Live Workspace for use with Windows Office 2010 to compare it to Google Documents. Also, Microsoft just announced that Office Live Workspace is becoming Windows Live SkyDrive soon.” Sounds a lot like Google Docs except you need a licensed copy of Office on your desktop (Microsoft will imitate Google in nearly every way except when it comes to giving stuff away).

Government healthcare IT contractor Quality Software Services will hire up to 70 people for its new South Carolina office.

Physician Michael Westcott, CMIO of Alegent Health, and pharmacist Jeannell Mansur, medication safety practice leader for Joint Commission Resources, will present a Webinar on medication reconciliation next Thursday, May 27 at 2:00 p.m. Eastern. Design Clinicals is sponsoring.

Strange: up to 55 people getting free blood glucose screenings offered by physician assistant students are exposed to blood-borne diseases when the students fail to change out the glucometer’s lancets between patients.

Indiana appoints Andrew VanZee, a former Logansport Memorial Hospital VP, as the state’s healthcare IT coordinator.

Cleveland Clinic grants Carefx an exclusive license to sell its business intelligence dashboard, developed by the clinic’s startup subsidiary IntellisEPM.

Listening: I’m still enjoying old and new stuff from Hole, but a reader recommended Neon Trees, a Provo, Utah pop/rock band that sounds to me like Muse meets The Cure. I like it.

Weird News Andy notices a blog’s rant against a MEDSEEK ad campaign in which a Facebook page was created for a mythical patient named Sara Baker who updates her wall with chatty descriptions of her healthcare interactions that often involve electronic services like those offered by MEDSEEK. Perhaps the page has been changed, but from what’s there now, it’s hard to believe someone would mistake Sara for a real patient, although obviously the folks leaving heartfelt congratulations for Sara’s new twins must have been gullible (or maybe they were enlisted to help add realism). My opinion: it’s brilliant! The only thing worse than bad publicity is no publicity. Whoever wrote Sara’s postings (probably a young marketing intern somewhere) did a nice job in making it realistic. It’s giving me all kinds of ideas for various stunts a la Fake Steve Jobs (check out the Ballmer Reviews iPad video – “No Flash, no Farmville, no porn, no sports – now I know why Steve calls it Safari – ‘cause it’s a hunt to find a Web site that works on this thing.”)

The Care Collaborative (Ascension Health, Adventist Health System, and Catholic Healthcare West) licenses its collective order sets to Zynx Health. HCA has already signed up.

Doctor Dalai describes big PACS problems in all hospitals in Western Australia, where a new version of Agfa IMPAX is apparently behaving so erratically that one hospital called a Code Yellow (a disaster that prevents accepting new patients). Dalai also says that previous versions were so flaky that radiologists were bringing in their own non-Agfa image reading software on USB sticks so they could continue to provide patient care, only to have the IT department delete the software and threaten them with disciplinary action. Another article confirms the problems with a hospital source, adding a fun tidbit in which the Department of Health apparently has blocked internet Web access to Dalai’s site.

A Texas hospital runs Doc Shop, a speed dating type event that connects doctors looking for patients with patients looking for doctors.

United Arab Emirates hospitals are using government-issued ID cards to check patients in faster.

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HERtalk by Inga

PEPID announces the availability of its medical and drug content tools for Google Android devices.

Demand for skilled consultants is high, according to a new KLAS survey of healthcare providers. Thirteen firms enjoy significant mindshare, up from just five in 2007. CSC tops the list, followed by Vitalize, Dell, and maxIT Healthcare. Providers striving to achieve Meaningful Use guidelines are leading the demand for skilled consultants, though another key driver is the migration of Meditech clients to the 6.0 platform.

Health Management Associates (FL) will add enterprise-wide CPOE functionality to its PatientKeeper solution.

The federal government won back or negotiated approximately $1.63 billion of your money last year and sent 77 people to prison for Medicare fraud.

Lest the government hold onto your money too long, the HHS says it will conduct two surveys to learn more about patient perceptions and preferences related to HIT. ONC will collect data on patients’ opinions of EHRs, while the HHS Office’s Assistant Secretary for Planning and Evaluation will determine user satisfaction with personal health record programs.

Thirty-six hospitals conducted mass layoffs in the first three months of 2010, just one fewer than the same period last year. The number of affected employees, however, dropped from 3,003 to 2,516. The figures do not include a couple of key layoffs in April, including 1,000 from St. Vincent Catholic Medical Centers (NY) and 511 from Jackson Health System (FL).

CMS selects Northrop Grumman to develop a National Level Repository to process HITECH payments to providers meeting Meaningful Use objectives. The order is valued at $34 million over one year with five and one–half year option periods.

Providence Equity Partners pays $17.25 per share to buy Virtual Radiologic Corp. That’s about $294 million, which represents a 42% premium of the three-month average stock price.

A widow sues her husband’s doctors after he dies of uterine cancer. No, he never had a uterus, but he did receive a transplanted kidney from a woman who died of uterine cancer. His NYU doctors said that even though the transplanted kidney was covered in tumors, they felt he had a less than 1% chance of contracting uterine cancer. Sadly, the 37-year-old died just seven months after the transplant.

I finally made it to the Apple store this weekend and checked out the iPad. It was love at first touch. Must. Have. One. Don’t exactly know why, but I’m sure that I can’t live without one.

Centegra Health System (IL) is partnering with Dell to launch Centegra Physician Network, a newly created HIE. The HIE will be built on Axolotl’s Elysium Exchange platform.

The 471-bed Jefferson Regional Medical Center (AR) becomes the first hospital to activate Eclipsys Sunrise Enterprise 5.5.

Kudos to United Health Foundation for extending a three-year, $3.3 million grant to Daughters of Charity Services of New Orleans. The funds will be used to support and expand the new Daughters of Charity Health Center-St. Cecilia in the city’s 9th Ward.

Universal Health Services (PA) will purchase behavioral health provider Psychiatric Solutions in a $3.1 billion deal. Together the companies will have 196 behavioral health facilities and over 19,000 licensed beds, plus 25 acute care facilities with 5,500 beds. UHS expects to realize $35-$45 million in annual cost synergies; 35-40% of those synergies will come from the elimination of PSI’s senior management.

Mount Auburn Cambridge IPA (MA) extends its 10-year relationship with MedVentive.

The Dallas Morning News takes a look at the region’s larger health systems and how they (and their EHR vendors) may be putting patient privacy at risk. Cerner, used by Tenet Healthcare, is mentioned for its practice of sharing patient data with drug companies. athenahealth, which provides Cook Children’s Health Care System its physician EHR, is cited for its plan to offer discounts to providers willing to share patient data. The announcement by three other large health systems that they will share patient information between their separate Epic systems also raises privacy concerns. Patient privacy advocate Dr. Deborah Peel is quoted in the piece, using an analogy that Paris Hilton surely appreciates and that likely makes Mr. H chuckle:

“Once your information is released, it’s like a sex tape that lives in perpetuity in cyberspace. You can never get it back.”

E-mail Inga.

Monday Morning Update 5/17/10

From Skyline Pollution: “Re: non-profit UPMC. They may be paperless, but can’t do without their $1.7 million skyscraper signs, according to the spokesperson for the multi-million dollar CEO. More help desk support and nurses could be had for that chump change.” CEO Jeffrey Romoff, who took a 25% pay cut this year to $3.6 million, admits that UPMC is being sued by a local sign company for an unpaid balance, but says the company’s work was substandard because high winds delayed hanging the 20-foot-tall “M” in “UPMC” atop the 64-story US Steel Tower.

From Larry’s Pizza Guy: “Re: Oracle. With the buyout of Sun completed, Oracle is reworking the contracts for EGATE/JCAPS Integration Engine clients to be based on the number of cores of a system instead of the actual number of interfaces being used. The clients’ only option is to invest time and money to replace the engine(1+ year process) or paying the outrageous increased fees (200,000+ more) to continue using the EGATE/JCAPS.” I hadn’t heard that, but I’m not a bit surprised since a lot of CEO Larry Ellison’s $30 billion in net worth came from charging licensees for theoretical usage capability rather than usage itself. Or, perish the thought, just selling the product for a fixed price. Imagine how much more money Bill Gates would have been worth if Word was licensed by CPU power or by the number of words typed. I’m still a market forces guy, so if Oracle is taking advantage of customers, those customers should bolt for a better option.

From Better Late: “Who do I call when my Monday Morning Update isn’t delivered on time?” Funny. I usually publish Saturday evening, but a pretty wonderful getaway with Mrs. HIStalk took me offline until Sunday afternoon. If it’s any consolation, you’ll get that late-breaking Sunday morning HIT news that you would have missed otherwise (irony meets irony). Thanks to those who expressed concern, best wishes, or consternation – it’s nice to be noticed.

A Wall Street Journal article called Smart Money: Is Your Favorite Charity Spying on You? highlights Sharp HealthCare, which uses data mining software to identify patients who might be financially capable of becoming hospital donors. The article points out that hospitals are even training doctors to identify prospects, and once a VIP has been tagged, hospitals may give them perks such as free visitor parking passes, direct access to staff, and priority appointments with specialists. The president of a philanthropy group admits that such targeting is kept quiet by nonprofits because it “creeps a lot of people out.”

I’ve been involved in a couple of CPOE implementations and they went well, so I’m a little surprised that 33% of respondents to my poll believe that CPOE makes outcomes worse. Maybe theirs didn’t go so well, or maybe CPOE sounds more dangerous theoretically than it really is to those without first-hand experience. Anyway, in the new poll to your right: is a best-of-breed application strategy a good or a bad idea? The poll accepts comments, so feel free to add yours along with your vote. Ed Marx stirred up a lot of commentary from his post that touched on that topic, so let’s see the consensus.

Speaking of Ed, thanks to him again for his inaugural HIStalk post, which drew a lot of thoughtful discussion. I posted his response at the end of the original article, so it’s worth a re-read.

The 150-bed Robinson Memorial Hospital (OH) recently chose Eclipsys Sunrise. The local paper discloses the overall cost of its EMR project: $39 million, or what seems to be $260K per bed.

A rare Weird News Andy weekend factoid, which he calls “Oh, the irony”. Financial organizations consider bailing out Greece’s debt-ridden economy want it to privatize its expensive government-run healthcare system, a leftover from the country’s previous Socialist Party rule.

A group of Baltimore hospitals, including Johns Hopkins, donates technology to the city’s fire department that allows EKGs to be transmitted from ambulances to hospitals, allowing faster diagnosis and treatment of heart attacks in progress.

In Ireland, a hospital requests an urgent review of its 20-year-old IT system because it poses “consequential risks to patient safety.”

Ohio State University Medical Center will operate retail clinics inside Giant Eagle grocery stores.

A local newspaper article covers the use of AirStrip OB monitoring software at Somerset Hospital (PA), paid for by us federal taxpayers.

Alpharetta-based healthcare data solutions vendor MDdatacor raises $2.6 million in funding.

Meditech says it will add 300 employees this year to its current 3,000 to keep up with customer demand.

A night shift security guard at a Texas clinic who spent his last scheduled night on the job hacking into 14 of his employer’s computer systems pleads guilty to two charges of “transmitting a malicious code” and faces 10 years in prison for each count. He hacked the clinic’s HVAC system (apparently feeling a need to mess up the air conditioning) and another that contained patient data. He’s not the brightest bulb in the circuit: the self-styled “GhostExodus” posted a dry run of his adventure on YouTube (above – some language is PG13) which led to his arrest. This isn’t an entirely original observation on my part, but the line between known criminals and security guards (especially those of the rent-a-cop variety, which GhostExodus was) is often blurry.

Vidyo introduces its telepresence system for healthcare that uses a standard broadband connection instead of a dedicated network. The system, which the company says costs around $1,000 per user or 85% less than competitive offerings, is being used by North Region Health Alliance in Minnesota and North Dakota.

A Delaware state congressman, chair of an “obscure” committee that recommends which government programs to end, subpoenas a state auditor for information on the Delaware Health Information Network. He says he wants to know where DHIN has spent $20 million in taxpayer money. The auditor calls the subpoena “a joke”, adding that “All you need to know is they sent out the subpoena and a press release at the same” and that the audit would have been completed earlier without having to deal with the surprise subpoena.

Anyone who likes to make fun of healthcare’s reliance on MUMPS and the Cache’ database: the European Space Agency chooses Cache’ to support the Gaia space mission that will map the Milky Way. Now who’s the rocket scientist?

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News 5/14/10

From The PACS Designer: “Re: an iPad challenger arrives. While the iPad gets all the press briefings, there’s a similar device called the Notion Ink Adam, brought to TPD’s attention courtesy of a posting by Michelle W. on HIStalk. It looks pretty cool, operates using the Tegra-Android platform, and best of all, it only weighs 1.35 pounds.” The company says they won’t release it until Flash works, which is probably a big mistake since the iPad doesn’t support Flash either and they’re letting Apple saturate the market in the meantime. It’s supposedly coming out in June for around $300, which would be an attractive price point if it works as advertised.

From Ex-Cerner Guy: “Re: Millennium and FDA’s MAUDE database. Not a huge surprise. Orders in Clinicals and FirstNet were designed and written by non-clinicians, with implementation done by non-clinicians. Try to find a Cerner Physician Executive in the field with more than two years under his or her belt. The referenced problem was evident at the Children’s Boston roll-out of FirstNet. From a sales standpoint, we used WYSIWYG-YBLI: what you see is what you get, you better like it.” Unverified.

From NorwichSammy: “Re: William Backus Hospital. Their attempt at digital cardiac access using GE’s Muse has been a big flop. It seems that paper trails are more effective for the clinicians.” Unverified.

From NoSleep: “Re: Hackensack University Medical Center (NJ). They successfully went live with Epic on May 1. It was a big bang cutover of all inpatient units, ED, radiology and several outpatient departments including nursing documentation, mandated CPOE, and medical device integration. Epic Ambulatory EMR and Practice Management will go live starting July 1, including both hospital and private practices in the rollout schedule. Rather than hire additional FTEs or engage consultants to implement Epic, HUMC recruited clinical and operational staff from within the organization, consolidated them within IT, and sent them to be trained and certified by Epic. As a result, the project was implemented on schedule and under budget. HUMC will retain its own in-house staff with expertise to support Epic.”

 

From the desk of Weird News Andy: a guy in Austria missing both arms passes his driving test by using a mind-controlled robotic arm. In England, a transsexual challenges NHS’s decision not to pay for her breast enlargement operation, claiming her female social life isn’t that great and that local street kids are calling her names because she doesn’t look like a woman. WNA editorializes a bit: “So, how many cancer patients won’t get the drugs they need to live so she can feel good about her appearance? How about, oh, I don’t know, paying for it yourself?” Lastly, WNA notices that NHS is using fear to convince patients to opt in to its Summary Care Record, warning them that its propensity to lose paperwork may expose them to NHS errors if they don’t sign up. 

SAP will buy Sybase for $5.8 billion. I hadn’t thought about Sybase for years since its healthcare dabblings have been infrequent and uninspired, but maybe I missed something.

Inga and I are a little behind, as evidenced by folks who are re-sending us e-mails when we don’t respond immediately (connected world expectations are sometimes unreasonable, I’ve noticed). We will catch up, I promise, but it may take a couple of days. Darned day jobs.

Abu Dhabi Health Services Company extends its Cerner deal to cover all applications for all of its areas, including its Lighthouse quality improvement solution.

Housekeeping: check out the Jobs Page. Drop your e-mail address in the Subscribe to Updates box to your upper right to get immediate notification when I write something new. The search box to your right now uses the new search engine I installed, so it covers all HIStalk sites (HIStalk, HIStalk Practice, and HIStalk Mobile.) The “Find us on Facebook” box to your right has adorable pictures of HIStalk readers, but also a link to our Facebook page (which Inga and I are using more often) and the thumb-up icon that gives us a Like when you click (thus temporarily soothing our raging insecurities). And as always, please support our sponsors by perusing and clicking their ads to your left, since they in turn will be motivated to continue supporting HIStalk. Thank you.

McKesson signs a big deal to implement PACS in Ireland.

How to tell you’re a hospital fanboy: when on vacation, you can’t resist following the blue signs to check out hospitals you’ve not seen. I knew a hospital executive who carried an AHA guide in his car and would choose routes that would let him check out all the hospitals along the way. He’s probably still doing it, only now with a GPS.

McKesson shares hit a 52-week high after analyst upgrades, although still below their 1998 (pre-HBOC scandal) prices. Thursday’s closing price was $68.99.

Jobs: Oacis – Clinical data Business Analyst, McKesson HED Consultant, Advanced Programmer Analyst – Interface, Meditech LSS Consultants.

Amcom’s messaging platform now supports Android smartphones.

Genesis HealthCare System (OH) will spend $40 million on an unnamed EMR (it’s Epic, of course, which should be obvious given the price and the fact that nearly every major sale is theirs these days).

Long term care operator Advocat names its IT consultant David Houghton as permanent CIO.

I see that Ed Marx’s first column here generated many comments about HIT vendor relationships. I thought both those who agreed and those who didn’t made their points quite well. Inga is sending out Ed’s PowerPoint as promised to all who commented and provided an e-mail address.

Integrated Document Solutions says it has implemented a cloud-based, RIS-less teleradiology system driven entirely by speech recognition and templates, all within 30 days.

A now-fired hospital employee of Perry Hospital (TX) is being investigated by police after allegedly using a doctor’s password to sign off on mammograms. The hospital has contacted 900 patients to have theirs redone.

A Forbes editorial by PatientKeeper CEO Paul Brient notes that all three technologies covered by Meaningful Use have been around for two decades, failed to hit double-digit adoption, and were avoided because they couldn’t pay their own way.

Odd: several dozen New Mexico residents are surprised to find themselves named as plaintiffs in a lawsuit against the local hospital. Most of them signed what they thought was a petition because a local guy asked them to.

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HERtalk by Inga

Henry Schein promotes Keith Slater to VP and GM of Henry Schein Medical Systems.

Northeast Georgia Health System says QuadraMed’s AcuityPlus nurse staffing management system generated $901,000 in first-year benefits. A 60% improvement in nursing productivity goals saved $659,000 in overtime and contract work and another $241,000 in incentive pay.

Diagnostic imaging provider InSight Services Holdings selects MobileMD’s HIE solution to provide electronic orders and results exchange for physicians.

A CIO involved in an HIS search shared with me his observation that the vendors that spent more time in due diligence gave better demos that met the hospital’s needs. A good reminder that cutting corners in the sales process can cut you right out of a deal.

St. Vincent Health (IN) deploys ZynxOrder to standardize evidence-based order sets. The 19-facility health system built over 350 order sets.

Grinnell Regional Medical Center (IA), Providence Kodiak Island Medical Center (AK), and Union Hospital (IN) are implementing eICU tele-health services from Philips Visicu.

Faith Regional Health Services (NE) anticipates a June 20th go-live on Siemens Soarian.

Medical transcription provider MedQuist releases its Q1 financials, which included a 6.3% decline in revenues to $74 million. Net income, however, grew from last year’s $6.8 million to $7.3 million. The company blames the revenue decline on poor February weather, which it says negatively impacted its transcription volume.

South Nassau Community Hospital (NY) selects the Capacity Management Suite from TeleTracking Technologies to manage its patient flow.

University Physicians Hospital (AZ) will use EmergisoftED for ED patient tracking and nursing and physician documentation.

Richmond Memorial Hospital (NC) is live on Wellsoft’s EDIS.

Here’s an interesting project to watch. SunCoast Health Partners is a joint venture between the SunCoast RHIO (FL) and for-profit partners. Using MedLink’s RHIO Financial Stability Model, SunCoast plans to offer products and services to over 500 practices in the RHIO, betting that providers will need clinical data to support their EHR investment. They expect to generate sales of over $4 million year in the first year and more than $7 million in the next four years.

And from a few of our much-appreciated sponsors, here are some quick updates:

• IntrinsiQ and eClinicalWork partner to integrate IntelliDose with eCW’s EMR/PM solution. eCW will offer the IntelliDose chemotherapy management solution to its oncology practice customers.
• ICA aggregates data from all core clinical systems within the HIE of Montana, which includes seven hospitals and more than a dozen clinics.
• Community & Dental Care, an FQHC in Monsey, NY, selects Allscripts Health Center Solution for its 30 multispecialty physicians.
• maxIT Healthcare announces plans to become an Eclipsys Certified Consulting Partner with Eclipsys, providing installation services for Sunrise Enterprise release 5.5.
• EDIMS and Medit Corporation form a strategic relationship to combine the EDIMS ED system with Medit’s MiRapidAccess registration tools.
• IntraNexus appoints Tom S. Visotsky VP of sales and marketing.
• Medicity announces that its iNexx platform will be generally available August, 2010. It will be free for physicians, allowing them to automate referrals to providers on the platform.
• EHRScope releases the beta version of EHRScope Reviews. End users and consultants can add information to their (free) database, so offer your opinions here.  

E-mail Inga.

News 5/12/10

From Snoop John B: “Re: Cattails MD. Heard its implementation at Ministry Health has been suspended because of poor upgrade quality.” I asked Ministry CIO Will Weider, who says the implementation has not stopped. Three clinics are live and planning is underway for the remainder. They are reviewing their plans and figuring out how to incorporate Meaningful Use. Will was nice enough to provide a summary:

There have been the usual surprises and unanticipated occurrences. So, this won’t be my first flawless large clinical project. In March the system (it is hosted by Marshfield Clinic) had some stability problems. That may be the source of frustration from your source. It was frustrating for us too, but Marshfield Clinic, led by their CIO, has taken ownership of their problems. We at Ministry are also working through our issues. The situation has improved and Marshfield Clinic has bent over backwards to provide us reports to monitor stability. They are also quickly updating their systems to prevent recurrence of the problems. They have been very transparent in their efforts. I have lots of different clinical system vendors, so I can put Marshfield Clinic’s support in perspective. They are better than most, but admittedly, the bar is not as high as I would like. As you can see, I am not afraid to share the good and the bad (hence the blog name candidcio.com). Our contract doesn’t contain a gag clause like many vendors. So, I will email you directly if our plans change.

From 153 Anecdotes: “Re: FDA’s MAUDE database. Updated with additional anecdotes.” MAUDE is FDA’s database of voluntary reports of adverse events caused by medical devices. There are quite a few reports related to Cerner Millennium, although there’s no way to tell if they were filed by one disgruntled practitioner or several concerned facilities. Some (most?) of the reports involve design complaints rather than actual examples of patient harm, such as: “This cpoe product allows doses to be ordered that are not a multiple-s- of the pill size.”

From Nolo Contendere: “Re: does anyone do background checks? [Name omitted] was recently hired as VP of sales for [vendor name omitted]. Here are links to public records. People are sending this all around, making the vendor a laughingstock.” I’m omitting the names and the links since I don’t want to get threatened, sued, or notified that the guy killed himself or something because I mentioned his crimes (theft, drug possession, driving violations, etc. with some jail time and house arrest). Or for that matter, notified that it’s someone with his name but not the same guy. If it is, he’s bounced around quite a few EMR vendors and has also been accused of stealing leads from competitors a la Glengarry Glen Ross.

From The PACS Designer: “Re: Google search enhancements. Google has made over 500 changes to its search capabilities over the last year. TPD likes one of the new search options that now appears on the left when you first begin your search effort.” I noticed the 3D logo, the left column that allows subsetting the results by source, and some minor redesign. I like it.

Listening: She and Him, musically marginal, but I’m crazy enough about about Zooey Deschanel in movies that I’ll listen to her sing.

Weird News Andy runs across PriceDoc, which he calls “Priceline for doctors” where prospective patients can name their own cash price for specific dental, medical, and vision procedures.

I got a really nice handwritten card from Brittanie Good, marketing director of Enterprise Software Deployment, who thanked Inga and me on behalf of Team ESD for mentioning their new sponsor ad. “We are very excited about our growth and refreshed changes, and we are proud to be a sponsor of HIStalk. We love what you do – keep up the great work!” I’m always amazed and moved that I have such supportive sponsors. I’ve stood the card proudly right beside my monitor.

A New York Times article titled The Agenda Behind Electronic Health Records pits athenahealth’s Jonathan Bush against ONCHIT’s David Blumenthal over the issue of whether HITECH is a cash-for-clunkers program for old-line vendors at the expense of upstarts or the logical way to goose EMR usage among reluctant providers. According to Bush, “Established technology is being given a federally funded new lease on life … Traditional health software now is on Medicare, being kept alive like grandma.” Blumenthal’s comment was that the government had to intervene to correct a market failure, saying, “The market doesn’t reward performance.”

Speaking of athenahealth, the company responds to Dr. Deborah Peel’s HIStalk editorial on athenaCommunity and patient privacy.

Jeff Surges, sales president for Allscripts, is appointed to the board of Merge Healthcare.

Voalté releases a white paper covering the use of smartphones at the point of care.

A medical group that provides services to correctional facilities in 25 California counties chooses eClinicalWorks.

Mac McMillan, CEO of IT security consulting firm CynergisTek, is serving (warning: PDF) as a panelist at a HIPAA conference sponsored by the Office of Civil Rights and National Institute of Standards and Technology that started Tuesday. His session involves OCR’s enforcement of privacy regulations.

Evidence-based protocol platform vendor Order Optimizer forms a strategic alliance with EHR vendor Prognosis Health Information Systems. Prognosis will make Order Optimizer’s protocols and orders available to its customers, along with its SaaS-powered merging engine.

Intuit will buy (warning: PDF) Cary, NC-based patient portal vendor Medfusion for $91 million in cash. Intuit (QuickBooks, Quicken, TurboTax, and Quicken Health) says it will use the Medfusion’s technology to enable patients to communicate with providers, review their health information, and track their healthcare expenses. They also mention the Meaningful Use requirement to give patients access to their records. Medfusion founder and CEO Stephen Malik will become an Intuit SVP and general manager. Allscripts announced a deal to distribute its patient portal a year or so ago.

Vanderbilt chooses Allscripts Care Management for discharge planning.

Nuance announces Q2 results: revenue up 19.2%, EPS –$0.05 vs. $0.02 due to the cost of its acquisition of SpinVox, which converts voice mails into text and e-mail messages.

Cottage Health System (CA) expands its use of Eclipsys applications by choosing the PeakPractice PM/EMR and Eclipsys HealthXchange to link community physicians with its inpatient Sunrise Enterprise system. The HIE product is powered by Medicity.

Northwestern Lake Forest Hospital (IL) says it saved $3.4 million in nurse labor costs through its use of the Kronos workforce management system to reduce overtime and agency use.

Hunterdon Healthcare (NJ) uses InterSystems Ensemble to connect its QuadraMed Affinity HIS to the NextGen PM/EMR of its physician groups.

Twelve hospitals in Australia sign contracts for the Emendo CapPlan capacity planning software. The company plans to enter the US market next year.

Apollo Hospitals, a private hospital operator in India, signs a deal with Cisco to deploy desktop-based telemedicine applications to rural parts of the country.

All Children’s Hospital (FL) will expand its use of GetWellNetwork’s education and entertainment system, courtesy of a donation from a local entrepreneur.

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Monday Morning Update 5/10/10

From MeHere: “Re: Millennium Medical. I used to work for them. I hope there’s a full-scale investigation into their unsavory activities. The IS guy would write up employees for forgetting to encrypt inter-office e-mail.” An unencrypted portable hard drive is stolen from the Chicago offices of the medical billing company in February, exposing the information of 180,000 people. Patients are complaining that they weren’t notified promptly and that the company is not offering the usual free credit monitoring.

From Nothing More: “Re: UPMC. DOH and CMS found ‘easily resolved differences over paperwork.’ I thought that hospital was paperless.” Inspectors find that UPMC did indeed match transplant donor and recipient blood types, but didn’t document properly because the paper form has only one signature line. Doh! And in other UPMC news, it’s on pace to hit $8 billion in annual revenue this year.

From MaxPayneUK: “Re: HC2010 conference. McKesson and Eclipsys were noticed there. Both will focus on the customer base of legacy supplier iSOFT and NPfIT programme player BT/Cerner.”

The Texas Board of Pharmacy hits Parkland Hospital with one of its largest-ever fines ($20,000) for allowing five outpatient pharmacy technicians to steal 370,000 oral doses of drugs in a one-year period. Cases against three supervising pharmacists are pending. The lesson learned is that Parkland did what most hospital pharmacies do — they took drug inventory only occasionally, estimated counts, and didn’t reconcile purchasing records to dispensing records. Parkland says it’s running a perpetual inventory now, always tough to do in pharmacies and ORs.

Meditech’s Q1 results: revenue up 10%, EPS $0.60 vs. $0.48. Very good numbers. I’ve confirmed that Howard Messing will be given both the president and CEO titles, subject to routine shareholder approval in the next few weeks. The company also announces that students at Northeastern University’s health sciences school will use Meditech’s clinical systems as part of their training.

You would expect clinical systems to be a top priority for providers, but I wouldn’t have guessed that portals would score so high. New poll to your right: based on experience, what impact do you think CPOE has on patient outcomes?

Congratulations to the Georgia Tech Flatliners, a team of graduate students that finished first, second, and third at the NHIN CONNECT Code-a-Thon Challenge held last week at Florida International University. The challenge was to create an online format for a Continuity of Care Document that a primary care doctor could use to take calls after hours. Medicity sponsored the team, which as a condition of its participation was required to donate the resulting style sheets to the CONNECT Open Source Community.

An MIT medical engineering student creates print management software and lands his own university as a paying customer for his new startup. The software is Web-based, does not require installation on print servers or desktops, and encourages “community engagement” by matching user groups as rivals to reduce their printing costs.

I appreciate the several companies that have asked about sponsoring the HIStalk reception at HIMSS in Orlando next year. It’s cool to have people thinking about it this early! Anyway, I’ve chosen the sponsor and we’ve already got the venue, entertainment, and menu locked down, just in case you want to mark your calendar now for February 21, 2011 for what will be a memorable blowout. I truly appreciate the companies who support what I do, not to mention the readers who make it worth doing.

Inga and I are writing up the results of the HIStalk Practice reader survey, which I’ll probably run this weekend. My favorite reader comment: “I just absolutely adore Inga.” Who doesn’t? She is entirely adorable.

I forgot to mention that with the rumored but unannounced demise of ADVANCE for Health Information Executives, Texas Health Resources CIO Ed Marx temporarily became a blogger without a home for his CIO Unplugged writings. He’ll be moving to HIStalk this month and I’ve posted all of his previous writings. I’ve tagged them all in their own category, viewable here.

Thanks to everybody who has clicked “like”on the HIStalk Facebook widget in the right column. I’m posting to the Facebook page that Inga created each time there’s a new posting and I’m seeing inbound clicks from it, so I think readers are finding it handy. Click the HIStalk logo or link to go to the FB page.

On the job board: Eclipsys SCM Consultant, Market Research Analyst, Epic Practice Manager. HIStalk sponsors post their jobs for free and can contact me to sign up.

The VA’s VistA Modernization Working Group recommends modernizing the VistA system by moving it to open source and dumping MUMPS as its programming language. The group’s chair says VistA is “outdated and difficult to maintain” and that “we don’t think MUMPS is the answer.” That’s an interesting conclusion given that Epic, Meditech, and other systems are written in MUMPS, a programming language that is almost certainly involved in more US healthcare encounters than any other.

And as I like to do occasionally, allow me to acknowledge Meditech’s Neil Pappalardo, who with colleagues created the MUMPS language and thus the HIT industry in 1966. He’s still my #1 choice of someone to interview, although Judy Faulkner runs a close second (both are MUMPS-made centimillionaires, I should note).

The non-profit Kaiser Permanente’s net income for Q1 was $706 million on operating revenue of $11 billion.

Here’s the danger of announcing one of those sketchy correlation-causation EMR studies: an overambitious headline writer summarizes as, “Doctors: Boot Up a Computer to Save a Life.” 

E-mail me.

News 5/7/10

From Sea Pea Oui Couvert: “Re: say it’s not true. This is not supposed to happen when the entire hospital is wired. Millions spent on EMRs, yet they forget informed consent and then cover up the adverse events.” UPMC’s transplant program is cited by state health department inspectors for violating federal regulations, including failing to document organ and blood matches before transplant procedures were started. The state got suspicious when UPMC reported only one adverse even in a year.

From A Tax’ing Employee: “Re: our CEO at Sunquest. He just moved to Tennessee for what I heard were ‘tax reasons’.’ He has never lived in Tucson for the same reason. Is that fair that he is allowed to live anywhere to dodge taxes and we are not?” Unverified. If it’s my money as a customer or shareholder, I’m cynical about work-from-home CEOs unwilling to relocate to the home office. It’s their call, though, and I’m probably more old school in that regard given today’s virtual organizations.

From The PACS Designer: “Re: iPad’s booming sales. Apple has sold one million iPad’s since the recent launch, the fastest sales results ever for Apple. As we head toward the middle of this year, it will be interesting to see if there will be any waning in the monthly sales figures for the iPad Wi-Fi version now that the iPad 3G version is available for sale.”

Several dozen provider organizations, including AHA and AMA, offer HHS their comments (warning: PDF) on Meaningful Use. They and I agree on the parts we don’t like:

1. The all-or-nothing approach, where you either meet all the criteria or get nothing (actually, I’m OK with that part as a taxpayer footing the bill).
2. The aggressive timetable for complex applications such as CPOE and medication reconciliation that aren’t usually front-loaded in implementation projects.
3. The overall short timeline.
4. The underrepresentation of small practices on the HIT Policy Advisory Committee.
5. The two EDI-related non-clinical requirements for eligibility and claims.
6. The definition of a hospital using Medicare provider numbers.
7. The parts I immediately pounced on when the proposed criteria were published  — manual chart pulls are required to arrive at a denominator for electronic performance metrics, such as the percentage of orders placed via CPOE.

Weird News Andy uncovers a gem: two employees of Olive View-UCLA Medical Center are placed on leave after complaints to Joint Commission that they are running a beauty salon out of the hospital’s NICU. They were giving manicures and eyebrow waxes to co-workers, with one complaint alleging that a doctor “had a French manicure right on the high-frequency ventilator.” WNA also likes this research finding: dark chocolate can protect the brain in stroke patients, which means I’m set in an emergency because I like to keep some of the good stuff (more than 50% cacao) around.

Listening: the new CD from just-reunited Hole. Courtney Love doesn’t do it for me and I was hoping to hate the new music, but the band kicks it even though they’re all suing each other and membership changes hourly. I’ll be playing this quite a few times, I suspect.

McKesson signs an exclusive deal to eventually manufacture, implement, and support the i.v.STATION Robot and i.v.SOFT Workflow Engine from Italy-based Health Robotics. It’s pretty hot stuff.

If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here’s a shout-out to the one group of professionals (both male and female) that hospitals can’t run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time:

The only critical people involved in patient care are nurses … My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center … Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn’t that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren’t really all that much worse when it came to living and dying. If I’m sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.

Business Week frowns at hospitals that use technology to determine whether patients can afford to pay their bills. Apparently the business publication does not like the idea that customers may actually be expected to pay for the services they consume. I clicked its Subscribe Now link and, given that philosophy, was shocked to find that their subscriptions are neither free nor payable at the reader’s discretion.

Jobs: Epic Inpatient EMR Manager, Eclipsys Physician Consultant, Senior Applications Analyst – CPOE, Epic Clarity Report Writers.

ONCHIT announces $220 million in grants to establish 15 Beacon Communities that will prove the value of HIT. I don’t exactly get that since the message is that they wouldn’t have bothered without the $15 million taxpayer gift (which doesn’t make a strong case for proving value at all), but I gave up long ago trying to dissect the particular pallets on which taxpayer money is being parachuted down over the countryside into greedily outstretched provider and vendor arms. Even the City of Tulsa gets $12 million in federal money to screw around with electronic medical records and see if anything good happens.

I see that Google now has the Google Apps Marketplace that offers third-party add-ins to Google Docs and relate apps. One I noticed contains administrator tools for rolling out Google Apps to the enterprise.

Maybe the doc-in-the-box trend died and I never noticed: Florida Hospital’s Centra Care walk-in clinics now take online appointments, saying it will significantly cut down on wait times. Meaning that if you just show up, which was the whole point, you’ll sit around like you would in the ED except instead of a seriously injured trauma patient holding you up, it’s somebody healthy enough to have made an advance appointment. That and posting ED wait times to troll for non-urgent patients makes me wonder what the heck providers are thinking out there.

Inspectors from the VA find lots of problems with the brachytherapy program at the Philadelphia VA Medical Center, among them a VariSeed radiation treatment planning PC that was unplugged for over a year despite regular clinician reports that it wasn’t working. It also wasn’t running on the hospital’s secure network and was used by employees to get on the Internet. 

Merge Healthcare’s Q1 numbers: revenue up up slightly, EPS -$0.04 vs. $0.05. Now they’ve got a couple of hundred million dollars worth of AMICAS acquisition debt to service on top of that. 

E-mail me.
 

HERtalk by Inga

From Celtic Fan: “Re: athenahealth. Don’t know if you saw this article about athena wanting to increase its profile to compete better with the HIT Big Boys. Buried in the end of the article is some information on a new product called ‘athenaCommunity.’ Bet the privacy rights folks won’t think much of it.” athenaCommunity is slated to launch later this year, with discounts for providers willing to share patient data with other providers. Hospitals will pay athena a small fee to access patient insurance and medical information. I asked privacy guru Dr. Deborah Peel what she thinks about the idea. Celtic Fan predicted correctly:

This is an ABSOLUTE nightmare—it TOTALLY violates medical ethics and the patients’ rights to privacy — not to speak of Americans’ well-known constitutional rights to privacy. Physicians who go along with that could well violate state licensing laws which often require adherence to the AMA’s principles of Medical Ethics, as well as violate many state laws that REQUIRE informed consent for disclosures of many kinds of information, from genetic tests, to mental health information, to STDs, to addiction treatment information. athena and all the many vendors who coerce doctors to disclose patient health information without consent will have NO liability. Who do you think the patients will sue for violating their privacy? Their doctor, of course, who chose to use an illegal, unethical EHR system. athena will not pay for this massive privacy disaster —their doctor/users will.

British Columbia’s Interior Health Authority begins its Meditech 6.1 migration with technical assistance from Summit Healthcare.

IBM’s Integrated Health Services division launches a multi-year research project to determine how different actions may affect health. Big Blue will combine and analyze data from a wide variety of sources, looking for cause-and-effect relationships. The project will initially focus on childhood obesity.

Kronos reports second quarter revenues of $177.9 million, a 10% increase over last year. EBITA increased 28% to $41.3 million.

Data storage company Iron Mountain urges CMS to consider expanding Meaningful Use guidelines to include subsidies for digitizing paper records. Iron Mountain’s efforts remind me of similar pleas from the transcriptionist organizations, who think digitized transcription records should be recognized in the final Meaningful Use equation.

I’ve yet to venture to the Apple store to actually touch an iPad, though a field trip does seem to be in order. This HIT writer observed a in-store demo, of sorts, where a Genius was educating a group of healthcare providers on a variety of healthcare-specific applications. Sounds like Apple wants to assure a  piece of the healthcare pie.

Clarian Health is changing its name to Indiana University Health next spring, in part to reinforce its partnership with Indiana University and the IU School of Medicine. Clarian owns or is affiliated with more than 20 hospitals and health centers in Indiana.

PatientKeeper presents Oakwood Healthcare System (MI) with its customer innovation award, recognizing the more than 1,000 users (600 of them physicians) who are using the company’s patient portal since its December introduction.

Hospital CIOs rank EMRs and CPOE as their top IT priorities for the next two years. Other high priorities include database initiatives, bar-coded eMARs, and hospital expansion. Among hospital IT managers and directors, EMR was ranked a mere 7th, far below PC refreshing, security initiatives, and CPOE. Another interest data point: the majority of hospitals were either developing telemedicine programs or already had something in place.

Albert Santalo, founder and CEO of the Web-based practice management company CareCloud, is named the Best Up and Coming Technology Innovator by the Great Miami Chamber of Commerce.

York Memorial Hospital (PA) selects Recondo Technology’s SurePayHealth solution for revenue cycle management.

The Texas Health Services Authority hires CTG to help plan the implementation of statewide HIEs.

Here’s a fun fact to share at your next cocktail hour. By 2020, the amount of digital information created within a year will reach 35 zettabytes. If you put that amount of data onto DVDs, they could be stacked halfway to Mars, making them quite inconvenient to access from your couch.

Gartner reports that Dell has gained the largest market share in HIT, making it the world’s largest provider of HIT services in the world. The ranking is based on 2009 revenues generated by both Dell and Perot Systems.

The 130-provider Jackson Clinic (TN) plans to move from its Misys EMR to Allscripts EHR, integrating it with its Allscripts Vision PM.

Siemens Healthcare appoints former Quest Diagnostics VP John Nosenzo to the newly created role of VP of Zone Customer Relations. Nosenzo will manage the company’s national accounts team and all zone general managers.

Odd: a GE Healthcare employee, having dinner with co-workers, is hit by a stray bullet. The 17-weeks-pregnant woman was sitting outdoors when she felt something hit her in the side. When she stood up, a bullet fell out. It came from a handgun fired from a shooting range that was about a quarter of a mile away. Fortunately, she was only bruised and scratched on her abdomen and both she and the baby are fine. An attorney for the shooting club says a member was at fault for shooting at an unapproved target (clearly).

Researchers at Brigham and Women’s Hospital find that using bar-code technology with an eMAR substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events. The hospital documented a 41% reduction in non-timing admin errors and a 51% decrease in potential drug-related adverse events. Naysayers, feel free to send in your comments pointing out that just because A and B happened together, it in no way implies that A caused B or B caused A — as Mr. H always cautions. I’m just glad someone is taking the time and energy to try to figure out if all this technology really does save lives.

E-mail Inga.

News 5/5/10

From Newsies: “Re: Radianse. The RTLS vendor has filed for Chapter 11 bankruptcy as of April 20.”

From Take the Time: “Re: Neal Patterson. The latest kudos.” Neal makes the Forbes list of best-performing bosses and rightly so: quibbles aside, there aren’t many executives who have transitioned successfully from scrappy startup founder to big-company CEO and kept investors financially happy most of that time. He’s a HISsies pie-in-the-face regular, but if I was investing my money in healthcare IT, he’s the guy I’d trust it with. That’s CERN (blue) vs. the Nasdaq (green) above, just in case you’re a hater.

Eclipsys announces Q1 numbers after Tuesday’s market close: revenue down slightly, EPS $0.09 vs. -$0.02. Shares are up a little in after-hours trading. In other Eclipsys news, E-Health insider reports that the company will take Sunrise Clinical Manager to the UK, offering it to trusts looking for an alternative to NPfIT’s systems.

Dr. Dalai and anonymous contributors document what they say is the end of AMICAS as Merge Healthcare does its best to screw it up after buying it. I’m linking to his main page since he’s running new pieces, so read back a couple of articles for the whole story. It’s big business as usual: layoffs of all the people that made the acquired company successful, forced relocations resulting in resignations, and apparent mothballing of previously sound products. He summarizes with a plea to Merge executives:

Bottom line is this: your actions are destroying AMICAS. If you don’t reverse what you are doing, you have just flushed $250 million down the toilet. Don’t do it to yourselves, don’t do it to the AMICAS people, and don’t do it to me and the other AMICAS customers.

I see that some new jobs have been posted on the HIStalk Job Board, so feel free to cruise over and see if any of them look interesting. Each job lists the number of times it has been viewed at the bottom of the page, so you can see which ones are hottest. I should mention, since a couple of folks have asked, that while everybody can view available jobs, only sponsors can post them.

Small-practice SaaS EMR vendor ClearPractice names pharmacist and former NotifyMD CEO Gary Ferguson as CEO. The company offers its entire suite for $425 per month, including revenue cycle management, help with stimulus funding paperwork, and CMS approval as a preferred provider for patient registry. I don’t know much about the company, so that’s just me reading the press release to you in an authoritative, yet know-nothing voice like a clueless TV news anchor.

A couple of readers e-mailed me noting quotes from both Steve Lieber of HIMSS and David Blumenthal of ONCHIT in which they discounted EHR safety issue reports. Blumenthal called such reports “fragmented” and “anecdotal”, not surprising given the lack of a central, well-publicized reporting mechanism for such problems. One reader also noted that problem reporters are often seen as troublemaking whistleblowers rather than staunch patient advocates, not to mention that some vendors prohibit such disclosure in their contractual language. My response to one e-mail was that we need this industry’s equivalent of the Institute for Safe Medication Practices to take up the banner of centralizing problem reporting and disseminating those reports out for everyone’s benefit. After all, the FDA’s medication safety track record wasn’t very impressive until ISMP got involved. Plus, you would think vendors would prefer that to FDA oversight.

Thanks to new Platinum Sponsor FormFast of St. Louis, MO. The company’s healthcare solutions include forms automation, document management, and workflow automation that help eliminate the paper chase. Specific solution examples include RAC tracking and response, admissions, bar coding, positive patient ID, cancer staging, patient self-service portals, e-signature, on-demand document printing, and importing documents into the EMR and saving the cost of preprinted forms, imprinters, embossers, and labels on the way to becoming paperless. The company is offering a free Webinar on May 25 at 11 a.m. Central, a Forrester Research update on Microsoft’s healthcare strategy called SharePoint 2010: What Value Does It Bring to Hospitals? Three attendees will win an iPad, just in case you’re interested. Thanks for FormFast for supporting HIStalk.

Revenue cycle services vendor Accretive Health sets its IPO price at between $14-16 per share for 13.33 million common shares for a market cap of $1.44 billion. The company had $510 million in revenue last year, which you’d never guess given its crude Web site and the fact that you’ve probably never heard of it except maybe when I mentioned their IPO plans back in the fall.

McKesson’s Q4 numbers: revenue up 2%, EPS $1.26 vs. $1.01, but falling short of analysts’ expectations on both revenue and earnings.

athenahealth CEO Jonathan Bush has told me that he started his internal company blog using HIStalk as a model, so now he’s got a customer-facing version as well. Unlike most CEO blogs, it’s actually interesting and sounds like someone other than a marketing department committee talking.

Smartphone application developer Voalté announces seven new hires.

I’m streaming Netflix like a madman using my new Roku box as a defensive move to Mrs. HIStalk’s usual BBC and dancing shows, so a couple of old movies inspired this week’s guest editorial in Inside Healthcare Computing, an opus I called Healthcare IT Leadership Lessons Learned from R. Lee Ermey. Spoiler: I make a convincing argument that Neal Patterson’s famous “tick, tock” e-mail was cribbed from one of R. Lee’s profanity-laden monologues in Full Metal Jacket. I don’t think a Pulitzer is in my future, but at least I snickered while I was writing it.

All the big hospitals in Madison, WI run systems from next door neighbor Epic, so now they’ve decided to share ED records in a pilot project that runs through July.

Brigid O’Gorman, a Connecticut College pre-med junior and captain of the women’s hockey team, wins a $10,000 grant from Davis Projects for Peace to implement electronic medical records in Uganda. The money will go towards four computers, solar panels to run them, two printers, software, a laminating machine, and an external hard drive. The college will contribute $3,000 to allow her to spend eight weeks there to set it up and help transfer information from the paper notebooks carried by patients into the computers. I like her spirit: “I’m not a wiz at the computer, but I figured I could get a system and teach myself how to input the data before I go.”

Mississippi Baptist Health Systems says it has saved more than $4 million by switching to Symantec for storage, backup, and archiving of its 130 terabytes of data.

This was probably embarrassing: Canadian EMR vendor Medworxx issues a corrected press release about year-end earnings when it notices that the date was given as December 31, 2010 instead of 2009.

A couple of recent journal articles try to peg CPOE and EMRs to mortality and cost, at least in the minds of the headline writers. As I always caution, just because A and B happened together in no way implies that A caused B or B caused A, even though folks looking for someone to agree with their anecdotal beliefs will always drag those articles out as evidence.

Surgeons at Children’s Hospital of Pittsburgh are using a video-over-IP system to monitor progress of cardiac transplant procedures from any VPN-connected PC using a zero-footprint software video player. The Haivision Furnace system lets surgeons know when it’s time for them to jump in to do their part.

E-mail me.

HERtalk by Inga

From Sean Fitzpatrick: “Re: Paul Levy’s lapses of judgment. I’m with you on your observation. It’s too easy to write off the little lapses, which typically reveal underlying bigger ones.” I was glad to see a number of readers agreed with me. Apparently the BIDMC board did as well, fining Levy $50,000 for his “poor judgment” and saying it will also consider his “serious lapse” when determining his next pay package (which is over $1 million now). Board member Patrick Ryan is apparently not pleased with the outcome (not harsh, enough I suppose?) and announces his resignation.

From Madrigal: “Re: Meditech. Thought you’d like to know that Howard Messing has been promoted to CEO (his new title is president and CEO). His previous title was president and COO. Neil Pappalardo’s title is now chairman (it was chairman and CEO)” Unverified, though we heard this report from a couple of readers. The company’s Web site still lists Pappalardo as chair and CEO and Messing as president. One in-the-know person suggests the change means little in the short term and is more of a symbolic shift of official responsibilities.

Lucile Packard Children’s Hospital (CA) reports a 20% drop in mortality rates since introducing CPOE, giving it the lowest rate ever observed in a children’s hospital. Until Packard published its findings, no hospital has been able to show reductions in medical errors and mortality from using CPOE. The hospital, which spent $50 million on its EHR project, attributes its success to a careful and well-planned implementation.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Pantain Holdings Berhad, a 1,500-bed, 10-hospital network in Malaysia, selects Eclipsys Sunrise Enterprise. John T. Mather Memorial Hospital (NY) also plans to add multiple Eclipsys Sunrise products to create a single EHR across multiple venues of care.

Washington County Hospital (MD) replaces 40 interfaces with Corepoint Integration Engine. The hospital runs Meditech and connects to referring physician offices.

Doctors from Catholic Healthcare West will serve as medical directors for 10 CVS Caremark MinuteClinics in the Phoenix area. The new CVS/Catholic Healthcare West alliance includes plans to eventually integrate EMRs.

The 54 providers at Syracuse Orthopedics Specialists (NY) and New York Spine & Wellness Center choose Allscripts to provide EHR and PM across their 11 locations.

Chatham County Safety Net Planning Council (GA) goes live on its HIE, leveraging technology from Orion Health and Initiate Catalyst Patient Registry.

Mark R. Briggs, the former COO of Carefx, takes over as CEO of HIE vendor VisionShare. He was previously with NaviNet, QuadraMed, and LinkSoft Technologies.

Fort Healthcare (WI) will partner with Cerner to create a connected health community through the use of Cerner Millennium solutions. The hospital, ambulatory surgery center, and specialty clinics will implement more than 20 Millennium products and use Cerner for IT management services.

Senior Lifestyle Corporation selects the selection and hiring solution of Kronos to manage the end-to-end hiring process.

MedLink partners with iMedicor to integrate iMedicor’s information exchange portal with the MedLink TotalOffice program. The combined solution will facilitate secure messaging and clinical data exchange. TotalOffice users will also have access to iMedicor’s ClearLobby drug and medical device information platform.

Healthcare analytics vendor Outcomes Health Information Solutions appoints Gary Velasquez CEO. Former Ingenix CIO Jim Egan is also hired to serve as the company’s CIO.

Ingenix and Health Language, Inc. launch Ingenix Global Code Manager to translate between ICD-9 and ICD-10 coding systems.

Mediware releases Q3 numbers: revenue of $12.8 million compared to $10.2 million last year, net income $891,000 vs. $483,000.

E-mail Inga.

Monday Morning Update 5/3/10

From BestofBreed: “Re: Merge Healthcare. Laid off 80+ people Friday.” I heard that from more than one reader. The Amicas acquisition closed Wednesday, so they obviously didn’t waste any time addressing redundant positions. Steamin’ Pyle says rumor has is it that no years-based severance was offered to the expungees, meaning nobody is supposed to get it in the future.

HIStalk sponsors have posted quite a few jobs on the new Job Board, so you might want to check it out. Healthcare IT hiring is definitely picking up.

Sam Patton is named chief quality and regulatory officer of medical device integrator iSirona.

Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm. New poll to your right for those working in a provider setting: which systems will your organization buy within the next two years?

CHIME sends comments to ONCHIT on EHR certification, expressing concern that certification capacity needs to be adequate to handle the rush of vendors that will be trying to get their products certified at the first opportunity. It also says any program that monitors real-world EHR performance (presumably including any new FDA oversight) should not not be “overly prescriptive”. You’d think CHIME was supporting its 70 big vendor members instead of its 1,400 CIO members with those comments, but that’s the HIMSS model at work.

David Blumenthal, speaking at a Boston conference, says that reports of EMRs causing patient harm have been “anecdotal and fragmented” and should not affect their aggressive rollout.

Sentry Data Systems has an upcoming Webinar on decreasing data center costs by using cloud computing.

Columbia HCA and Solantic founder Rick Scott announces his candidacy to become governor of Florida. His campaign site says things were great at Columbia/HCA when left, but fails to mention that he was fired after the FBI raided its hospitals and the company was charged with the biggest healthcare fraud scandal in US history, eventually costing Columbia/HCA $1.7 billion in fines. His FAQ makes that travesty sound like a valuable lesson learned under fire that makes him a better candidate for public office:

Since I’m not a career politician or a political insider, I’m going to lay it out for you as simply as I can without spin or fancy words. Let me start by being crystal clear about this… I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader. Lessons I will bring to the Governorship with your support and vote.

An audit finds that University of Iowa Heart and Vascular Center failed to bill patients for $11 million worth of charges in November. Officials claim it wasn’t their new Epic system that was at fault, but declined to speculate further until an investigation is complete.

The usual housekeeping facts: put your e-mail address in the signup box on each site (HIStalk, HIStalk Practice, and HIStalk Mobile) to receive instant updates when we run something new. The “Search All HIStalk Sites” box to your right lets you search all those sites at once. Check out the industry event calendar, where you can also post your event for free. The hideous green  “Report a Rumor to Mr. HIStalk” button lets you send me anonymous, secure information, including any attachments that you might want to include. Please support HIStalk’s sponsors by checking out their ads to your left and clicking on those of interest – Inga and I appreciate their support. And lastly, I thank you for reading, writing guest articles and comments, and making those 3 million HIStalk visits possible by spreading the word. The incredible support I get from sponsors and readers keeps me going through all those after-work nights and weekends when I’m lashed to the keyboard.

The VA says it has figured out the problem responsible for incorrect data displaying when its employees accessed the DoD’s AHLTA system: an interface server change from a single to multiple processors. The description sounds as though it was a transaction timing issue, but that’s just my guess. VA and DoD are back to fax and e-mail for patient information inquiries until a fix is installed.

Carolinas HealthCare (NC) announces several changes in top management, including bringing on Brent Lambert from Carilion Clinic as VP/CMIO.

An ED nurse at Tomah Memorial Hospital (WI) is arrested for using patient information to divert narcotics logged out for 600 patients. The hospital has notified the patients that their information was breached but probably not exposed, other than they were charged for drugs they didn’t receive and will be credited (not that patients usually care since they aren’t paying with their own money anyway, so they probably won’t get a refund).

Shares in athenahealth dropped 18% Friday and bounced off a 52-week low after announcing a surprise Q1 earnings shortfall after the market close on Thursday. One analyst said the company missed expectations in nearly all areas, while another termed its Q1 performance as “disastrous”. Market cap is now under $1 billion.

Odd lawsuit: a woman trying to kick her husband as they walk along a Chicago street loses her balance and crashes through the window of a beauty salon. She admits to have been drinking beforehand, but is suing, claiming the business and building owners knew that drunk pedestrians on their way to or from Cubs baseball games could fall through the window. She’s also suing the hospital that treated her, insisting that a radiology tech stole her BlackBerry and $6,000 worth of jewelry while preparing her for an MRI.

E-mail me.

News 4/30/10

From The PACS Designer: “Re: cloud printing from Chrome. Google has in development a new application that will give Chrome users the ability to send documents to the cloud for printing by a wireless network or cloud-aware printer.”  

From SantaBarbaraLocal: “Re: Santa Barbara Cottage going with Epic. It’s actually Sansum Clinic, which is adjacent to the hospital, that has signed with Epic.” A couple of readers confirmed. That makes more sense than the hospital replacing Eclipsys.

From Brit: “Re: NHS projects in the South. They are being delayed even further because the government bureaucrats are getting cold feet about using Cerner’s Upgrade Center in KC. They have asked BT to build an equivalent center in London, which will push projects out by months and cost the taxpayer tens of millions of dollars more.” Unverified.

Nashville Medical Trade Center gets its first anchor tenant — HIMSS, which will make the facility the year-round home for its Interoperability Showcase. The company developing the $250 million facility says it will try to entice vendors who are HIMSS members to lease space by offering them discounts. HIMSS will now literally be even closer to its high-paying constituents.

Q1 numbers for MedAssets: revenue up 18%, EPS $0.09 vs. $0.03, beating estimates.

Weird News Andy felt bad that I missed the 3 millionth HIStalk visitor, so he “went into my time machine” (which probably means he Photoshopped the above since the next-to-last zero looks a bit clipped) to commemorate the moment.

The National Association of Healthcare Access Management conference starts in Orlando’s Marriott World Center this weekend. The folks from SCI Solutions will offer a Stress Free Zone on Saturday afternoon at 4:30 before the exhibits open, with free drinks and massages.

If you clicked the Like button on the HIStalk Facebook widget to your right, thanks! Inga and I don’t get to know who’s reading all that often, so that’s pretty cool.

Also announced after the market close: athenahealth’s Q1 results: revenue up 33%, EPS $0.01 vs. $0.04. News that spending was up 72% without immediate growth wasn’t taken well by investors, with shares dropping 15% in after-hours trading.

Cerner’s Q2 results, announced Wednesday: revenue up 10%, EPS $0.59 vs. $0.49. Bookings were at an all-time high. Pretty good considering that their hosting services cut into the hardware revenue. New services are mentioned, including running IT departments and revenue cycle services. ProFit finally gets a mention, although not by name, with “great progress” claimed. Oddly, Cerner will resell Pyxis while selling its on RxStation medication dispensing cabinet, also planning to tie into Alaris smart pumps with its medical device hub.

Jobs: Eclipsys Physician Consultant, Soarian Clinicals Consultants, Chief Information Officer.

A flash drive containing information on 25,000 patients turns up missing from Our Lady of Peace, a Kentucky psychiatric hospital. Like everyone else who gets burned, they vow to start encrypting.

The folks from CattailsMD responded to the rumor Alphonso’s rumor from Monday that the project is in trouble and executives have moved on. The leadership changes did occur, with Bob Carlson taking a different role and Paul Olinski retiring, but they say the EMR is now used by more people outside of Marshfield Clinic than within, they just released a dental module for it, and an external customer will implement it using an accelerated go-live process to reach Meaningful Use.

DPS Health, UCLA, and a South African women’s organization announce a study to look at the effectiveness of using text messaging for peer support of people with Type 2 diabetes.

Nuance deploys its eScription computer-aided transcription solution to four NHS trusts in the UK as a pay-per-use SaaS offering.

RTLS vendor Awarepoint announces management changes: the CEO has been replaced, former McKesson executive Ben Sperling is brought in as VP of business development, and former UCSD Medical Center associate administrator and Awarepoint client Thomas Hamelin is hired as SVP of business process improvement.

The CEO of Telus, interviewed on Bloomberg TV, explains the importance of healthcare to the company’s business and why it may pursue telecommunications acquisitions to support it.

Vish Sankaran, manager of the Connect gateway to NHIN for ONCHIT and former Brailer guy at CareScience, resigns. He was program director of the Federal Health Architecture program. His LinkedIn profile says he’s interested in job inquiries, so I’m betting he got one from one of the usual government contractors.

A group offering free clinics staffed by volunteers was founded by Stan Brock, a guy who wrestled animals on TV in Mutual of Omaha’s Wild Kingdom in the 1960s, just in case you were parked in front of the three-channel black and white back then. I like this guy: he decided to leave TV in 1985 “to make people better”. Here’s a snip from a newspaper profile:

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

The British University in Dubai will host that country’s first national meeting on health informatics on May 5. The one-day program is free.

A Maryland startup will commercialize the Blink lab monitoring software for critical care developed at University of Maryland, Baltimore.

Park Nicollet Health Services will pilot diagnostic software from Zipnosis, a Minneapolis startup run by a co-founder of MinuteClinic. Patients pay $25 online by credit card, take a five-minute automated interview online, a clinician interprets the results, the patient gets an answer back (diagnosis, treatment options, and prescriptions), all within an hour. Park Nicollet will get a cut of the revenue.

E-mail me.

HERtalk by Inga

From NoPollyanna: “Re: mobile healthcare apps. I was searching for information on healthcare systems using mobile marketing — find a doc, directions to office, ED info and wait times. Didn’t come up with much outside of appointment reminders by phone. Is this still just a ‘nice to have’ or is there more happening here?” NoPollyanna is looking for apps that help healthcare systems extend their brands. Suggestions? As for advertised ED wait times, do they have an effect on patients choosing an ED vs. their primary care provider?

From George Stephanopoulos: “Re: EHR implementation blogs. Another to add to your list of ‘EMR journey’ blogs. From the URL, it appears CCMH is implementing the hosted Cerner application suite.” The blog’s author is the CFO at Carroll County Memorial Hospital (MO) and says the hospital is going live in about six months. I had to register on what appears to be on a Cerner-hosted site to request access. I’ve got to hand it to Cerner for figuring out a clever way to get some new leads.

I have been pondering Mr. H’s “so what?" comment in regard to Paul Levy’s "lapses of judgment in a personal relationship.” So, perhaps it does not affect his ability to lead the health system. Then again, what other lapses in judgment might he have had? What future lapses, either his or others, might be brushed under the rug?  Rightly or wrongly, we want our leaders to be role models, at least professionally. An inappropriate work relationship bleeds into the professional world and creates potential for an imbalance (or abuse) of power. I’m not suggesting anyone be fired, but some official reprimand by the board might be appropriate.

Sinai Medical Group (IL) is implementing NextGen’s EHR and PM products and expects to go live in August. Sinai’s faculty group practice includes almost 200 physicians.

HP announces plans to purchase Palm for approximately $1. 2 billion cash. I read the opinions of a couple of pundits who suggest HP was interested in getting its hands on the Palm webOS to run future tablet products.

Billing service provider Healthcare Billing Consultants (PA) selects Sage’s Intergy practice management and analytic tools for their 80 providers.

Medical & Surgical Clinic (TX) commits to Allscripts’ EHR for its 31 physicians.

CareFusion and Cerner announce they will integrate the CareFusion Pyxis systems and Cerner’s CareAware solution. Cerner will also resell the CareFusion Pyxis dispensing technologies to its existing EHR clients,which seems odd since Cerner was offering a competitive product at one time.

Health reform legislation will increase the IT needs for a number of government agencies, including HHS, the IRS, and state and local governments. Job security if you are in IT, I suppose.

GE Healthcare teams up with Ascom Wireless Solutions to launch a wireless, hospital-wide message system that allows clinicians to receive clinical text-messages and alerts throughout their facilities.

Earlier this week I mentioned that we’d like to find a hospital and/or physician office willing to share their EMR selection and implementation journey. I should have explained that a bit better. As opposed to connecting with a entity that has already implemented an EMR, we’d like to find someone just starting the process who would be willing to provide periodic updates. If you have a candidate, let me know.

Ten of the 13 most-considered enterprise business intelligence solutions in healthcare come from industry-agnostic vendors, according to a new KLAS report. Healthcare provider executives ranked Dimensional Insight the top vendor, followed by Information Builders, and McKesson.

St. Joseph’s Regional Medical Center (NJ) deploys Infinitt North America’s Enterprise PACS. Infinitt migrated over 30 terabytes of image and patient data in less than five months.

UNC Health Care (NC) engages MEDSEEK to establish a patient portal that will combine EMR and administrative data from UNC’s Siemens system and its other HIS products.

A NYC grand jury indicts two former executives from New York-Presbyterian Hospital and two contractors for participating in a mail and wire fraud scheme. The hospital officials allegedly received payments and gifts in exchange for awarding contracts to certain companies. The questionable contracts totaled more than $42 million.

A former researcher at the UCLA School of Medicine is sentenced to four months in federal prison for snooping in medical records. The research assistant, a licensed cardiothoracic surgeon in China and a US immigrant, claims he did not know it was illegal to look at the confidential medical files of his co-workers or celebrity patients. He’s now sort of a celebrity, too, since he’s the first person to be sentenced to prison for violating HIPAA’s privacy provision.

Chesapeake Regional Information System for Our Patients (CRISP) selects Axolotl to provide the core infrastructure for its statewide HIE.

Thanks to the Brits, we now have a better idea of the risk factors that predict future professional misconduct by physicians. Doctors who are male, from lower socioeconomic groups, or had academic difficulties in medical school are more likely to be misbehaving doctors.  I think someone needs to do a follow-up study to determine the risk factors that predict misbehaving boyfriends or husbands.

And, thank you Weird News Andy, for referring me to the www.ifshoescouldkill.com website. OMG.

E-mail Inga.

News 4/28/10

From Harpo: "Re: Halamka’s CEO. Accused of hanky panky with a staff member, but he apologizes and will stay on. Being the most visible and transparent hospital CEO is great, but I didn’t see this on his blog yet." Beth Israel Deaconess CEO Paul Levy admits to "lapses of judgment in a personal relationship" that were first reported to the hospital’s board by anonymous letter. My reaction: so what? He’s human. People sure love to throw those stones.

From Epic Watcher: "Re: Santa Barbara Cottage. Heard from two folks they’re going Epic, although I’m not sure whether inpatient or ambulatory." Maybe someone will report back. I know they’re Eclipsys on the inpatient side and I doubt that’s changing, but you never know. 

From Don Diego: "Re: ADVANCE for Health Information Professionals. Dead." According to the company, they’re shutting it down "due to unfortunate conditions in the market."

From Ex-Cerner Guy: "Re: quick login. Several of my clients experimented with HID Proximity Cards for speed, security, ease of use, and then cost. Speed was instantaneous, security was 100% (they added a fingerprint pad), and ease of use was great. Everyone remembered to bring their ID card and right thumb with them. As soon as the user was more than 10 feet from the workstation, they were logged off. Re-login would bring them to the screen they left. The item that was rated #4 in importance quickly became #1, as the support time and costs became insane due to each non-hospitalist needing a level of customization the facilities were not prepared for. I loved the solution, as did the CIOs and CMOs. CFOs killed it, and probably correctly. Time-and-motion study for typing vs. swiping and pressing did not support the cost model in 2006."

From RedDog: "Re: Northeast Georgia Health System. New CIO and hear the consulting company is leaving as well. A totally fouled up RIS/PACS install in December is the catalyst. Epic is being talked about in the admin suite." Unverified.

From Partial Eclipse: “Re: West Penn-Allegheny. Delaying its go-live of Eclipsys Sunrise because of excessive costs and the shrinkage in CMS payments.” Unverified.

Listening: In This Moment, alt-metal with an angry-sounding female lead who looks like an angelic supermodel.

Texas Health Resources and Children’s Medical Center Dallas will exchange patient information via their common Epic systems. THR also plans to do the same with UT Southwestern and Parkland. 

Macquarie University Hospital in Sydney, Australia and the Australian School of Advanced Medicine will implement iMDsoft’s MetaVision (OR, PACU, and ICU) when the new hospital opens in June.

A new Medicity brief called Key Components of a Successful HIE Strategy covers best practices in deploying a "future-proof" HIE.

McKesson says it will adopt its Paragon HIS for the British market, hoping to offer an alternative to its long-in-the-tooth TotalCare and Star systems for hospitals opting out of NHS-offered systems due to implementation delays.

Speaking of McKesson, it announces availability of 12 new templates for chiropractors for its Practice Partner, Medisoft, and Lytec MD physician systems. Back-crackers get a rebate and the templates for free.

I put a "Find us on Facebook" widget to your right that offers the new "Like" button. Click it and Inga and I will have a tiny bit of our insecurity relieved at least temporarily. You are all so cute in your FB pictures that it makes us proud to have you as readers.

Mike DeSimone joins MedVentive as VP of business development.

The Platinum sponsor-only jobs page is in full swing with 34 jobs posted, so you might want to check those out. Inga will be her usually cheery self in hooking up sponsors to use it as a free benefit of supporting HIStalk.

Neither Inga nor I were home Sunday afternoon to take a screen shot when the HIStalk visit counter rolled over to 3,000,000, darn it. A visitor from Epic was the 3 millionth visitor since June 2003.

GE Healthcare and Ascom Wireless announce plans to tie GE’s patient monitors into Ascom’s VoIP, pager, and DECT handset communication systems.

E-mail me.

From BowerSocks: “Re: giving back. Just wanted to say I didn’t know about the Cerner Diabetes Initiative. We are always looking for great places to donate and I think both the Diabetes Initiative and the First Hand foundation sound awesome.”

Picis implements 53 new US healthcare facilities using its LYNX E/Point revenue management solution for the ED.

Catholic Healthcare East (PA) selects Zynx Health’s evidence-based order sets and plans of care solutions for 18 of its hospitals.

SCI Solutions releases an EMR-enabled version (v6) of its Order Facilitator order management tool. The new version includes the ability to capture H7 order transactions sent from a physician’s EMR to a hospital’s Order Facilitator database.

Oroville Hospital (CA) claims to be the first hospital to implement VistA without the help of outside consultants. The hospital is halfway through the implementation process and is relying on its internal IT group for all customization.

The executive director of the Rochester RHIO says the organization is “no longer an experimental pilot service.” The four year old RHIO now includes participation from 15 hospitals, 866 physicians, and 225,000 patients.

San Juan Regional Medical Center (NM) contracts with Perceptive Software to use the ImageNow document management and workflow system. San Juan will integrate the ImageNow application into its existing Meditech system.

The GetWellNetwork folks tell us they are hosting their  Third Annual User Conference later this week in National Harbor, Maryland. Keynote speakers include The Studer Group’s Brian Robinson and Gerard van Grinsven of  Henry Ford West Bloomfield Hospital.

The Electronic Healthcare Network Accreditation Commission appoints four new commissioners to serve through 2012.

The Alaska EHR Alliance selects e-MDs and Greenway Medical as the “best choices” for the state’s healthcare providers. ACS Healthcare Solutions was the managing consultant for the selection process, which lasted eight months and started from a pool of over 250 EHR vendors.

Thomson Reuters will integrate its Micromedex clinical decision support and CareNotes patient education content within the M2 HCIS.

Beacon Partners is named to the Boston Business Journal’s 2010 Pacesetter list, which recognizes the 50 fastest growing private companies in Massachusetts.

The first of three Thomas Jefferson University Hospitals (PA) goes live on Wellsoft’s EDIS.

Mercy Hospital of Portland (ME) selects Allscripts EHR for its 58 employed providers. The physicians already use Allscripts PM product.

I came across this blog today, written by the CIO of a hospital that’s in the midst of selecting an EMR. So far they have eliminated Cerner and now they are giving Meditech Magic a good look. The post brought to mind something Mr. H and I have discussed a number of times: finding a hospital and/or physician practice that’s willing to share their EMR selection and implementation journey over a period of time. If you’d care to volunteer your insights on behalf of your organization (fame could be yours!), or if you’d like to share any recommendations, please let us know.

Newly posted on HIStalk Practice: the latest question in our HIT Executive series. Check out what several EMR vendors and consultants had to say about the HITECH Act’s short and long-term effects on innovation. Spoiler alert: the answers range from yes to no to maybe.

Thanks to folks at Vitalize Consulting Solutions (VCS) who shared the the news that HIMSS and Modern Healthcare named recipients of their 2010 CEO IT Achievement Awards. The two winners are Peter Fine, president and CEO of Banner Health (AZ), and, David Bernd, CEO of Sentara Healthcare (VA) — and a VCS board member.

E-mail Inga.

Monday Morning Update 4/26/10

From Alphonso: “Re: CattailsMD. The Marshfield Clinic’s CattailsMD project is in serious trouble and may be dead. Senior leadership for the project has been let go or moved to ‘new opportunities’ inside the organization (Bob Carlson and Paul Olinski). Project has gone nowhere for the past few years.” Unverified. I’m not sure why they had a booth at HIMSS or why they would try to commercialize their own product in the first place since that hardly seems core to their mission. Their own use of CattailsMD seemed imperative to them, so I’d be surprised if it’s being allowed to fade.

From Wade Wells: “Re: log on. What’s the fastest, most secure way to log on to PCs in health institutions? We key in our usernames and passwords, but with the rollout of clinical systems and speed being an issue, I’m interested to hear of others’ experiences. Some are suggesting card readers, biometric, etc.” Thoughts?

From Mad Max: “Re: WellPoint cancelling insurance for newly diagnosed breast cancer patients. This ought to be criminal activity. Please keep this story in the public eye and drive those insurance actuary slugs back under the rocks where they belong.” It’s the age-old debate of whether healthcare should be a noble calling or a cutthroat business. It’s in the same vein as to whether Cerner should use its legislative clout to squash competitors – who decides where good business yields to compassionate care? Meanwhile, HHS secretary Kathleen Sebelius asks WellPoint’s $13 million-a-year CEO to voluntarily stop the cancellations, noting that the practice will “soon be illegal” (which obviously reinforces the concept that it’s legal now). The company’s response claims that computer algorithms aren’t used for that purpose, that one patient who complained isn’t a WellPoint member, and that they’ll divulge specifics about her case that proves their side of the argument if she’ll sign a HIPAA waiver.

From The PACS Designer: “Re: iPad review. Another more complete test review of the iPad as a business tool comes to us from InformationWeek’s Fritz Nelson.”

The sponsors-only job board seems to be working fine, so I’ll consider it open for business. It has quite a few job listings already, thanks to volunteers who helped out by testing. This is a lightweight replacement for the job listing topic in the discussion forum. It’s not as fully featured as Healthcare IT Jobs and, unlike that site, it’s open only to HIStalk Platinum and Founding Sponsors (and is free to them).

I gave the iPad a quick grope yesterday. As you’d expect from Apple, it’s very sleek and has great graphics, with a display size that seems perfect for Web browsing or running apps. On the other hand, I’d worry about dropping it since there’s nothing to grab onto. I wouldn’t pay $499 for it since I could buy a full-feature Wintel laptop for less (with a real keyboard and everything). Travelers with computer needs mostly involving entertainment would probably like it, although they’d need to add on a data plan and even then I’d probably stick with an iPhone. Apple is selling a bunch of them even though they don’t really replace anything, though, so I will defer to public opinion.

Thanks to those who responded to my little survey about what hospitals readers are from. I’ve posted the list of organizations (without the job titles). 

Half or fewer doctor will get the HITECH money they expect, said 78% of readers. Only 9% think most of the doctors will get the full payoff. New poll to your right: are you personally aware of a situation in which a healthcare computer system directly caused patient harm?

EHRtv posts over 40 video interviews from the HIMSS conference.

The FDA will step up its oversight of IV infusion pumps, citing 10,000 complaints, 79 recalls, and at least 710 known patient deaths.

McAfee apologizes for its antivirus fiasco that took down computers all over the world, blaming its poor testing. A hospital reader’s comment you may have missed suggests VIPRE Antivirus from Sunbelt Software as a superior alternative.

Brigham and Women’s will freeze hiring and cut its operating budget by 3%, but says those actions are unrelated to the decision by Harvard Vanguard Medical Associates to shift its referrals to Beth Israel Deaconess Medical Center instead. BIDMC implies that its shared EMR access was a key factor in that decision.

An MIT mobile health group says open source mobile platforms are important for affordability and accessibility, making its first choice Google Android and eventually Symbian.

MedQuist completes its acquisition of Spheris.

A problem with the patient verification software used by Australia’s Medicare service causes several hundred errors, the significance of which is disputed. The software vendor had urged the agency to notify the 2,700 affected medical practices in February and March when the problem was found, but the agency declined.

This sounds like something Oracle would do: a formerly free Sun plug-in for Microsoft Office that allows saving documents in OpenDocument Format will now cost $9,000 for 100 users plus annual support, now that Oracle owns Sun.

Odd lawsuit: a Connecticut woman is charged with impersonating a nurse and forging prescriptions for narcotics while employed in a physician’s practice as an RN. Prosecutors say she spent $2,000 to make up a “Nurse of the Year” dinner in her honor from the Connecticut Nursing Association, an organization that she also made up. She sent her boss an invitation on fake letterhead to be a guest speaker at the dinner, which he did.

E-mail me.

News 4/23/10

From Reader: “Re: McAfee bug. Multiple hospitals (U of Michigan, Rhode Island Hospital System, Upstate University Hospital in Syracuse) report being affected by buggy McAfee security release. 1000s of computers down, emergency patients diverted and surgeries being postponed.” I know first-hand since it nailed our place, too, with all kinds of disruptions and “everybody get off the network NOW” emergency messages. McAfee wasn’t much help, being slow to post the problem and a tricky solution. It’s a great time to be a competing antivirus vendor.

From LeapFrog: “Re: Allscripts. I am hearing rumors of a joint GE and Allscripts user conference in June. What does that mean?” Inga tried to tracked this rumor down, reaching the conclusion that a joint meeting is unlikely given the short time frame. However: (a) the Allscripts sales meeting is in June; (b) Allscripts might like getting its hands on an inpatient product like the old IDX one that GE has botched, despite lofty Intermountain partnership announcements; (c) a new Allscripts sales director came from the old IDX group; and (d) GE’s IDX failure might make it happy to get rid of that product. All speculation, but not too far out there as rumors go.

From Dr. M: “Re: Meditech. The iPad runs Meditech using the Citrix connector.” Dr. M supplied the photo above. Another reader cautions that just because apps run in Citrix Receiver shouldn’t be construed to mean that vendors have released specific iPad clients or, until they do, that the Citrix versions are fully usable. The reader says some apps look good and navigation is OK, but typing is slow on the on-screen keyboard.

I’ve confirmed a couple of reader-reported rumors. You’ll Know Who reported yesterday that McKesson Provider Technologies had replaced Sunny Sunyal as president with McKesson Automation’s Dave Souerwine, which was confirmed today on the MPT site. In the Cheap Seats told you on March 29 that Merge Healthcare had acquired anesthesia EMR vendor Docusys, which I’ve finally confirmed through independent sources. Thanks for those reports!

Greenville Hospital System goes live with SabalRx, which routes medication orders to the proper dispensing location and technology based on location. I’ve never heard of Sabal Medical, the press release isn’t very good, and the “About Us” on the company’s Web page doesn’t say who “us” is, so that’s all I know.

Listening: Material Issue, long-defunct Chicago-based power pop.

This sounds like a bad idea: Medical College of Georgia will consolidate management with its hospital and physician group, with the just-hired college president (a doctor and scientist) also serving as CEO of MCG Health. The college’s CFO and CIO may also serve dual roles.

A New York Times article lists the downside of electronic medical records: odd computer placement in the exam room, the need to type instead of listen, an overwhelming amount of information for the doctor to review (like “having a 2-year-old in the exam room”), difficult to use systems that were designed for charging and not treating patients, and the failure of those systems to convey complicated information in an easily understood “story” form.

Another blow to iSoft and NPfIT: northern trusts scheduled to implement iSoft Lorenzo can now opt out and instead run McKesson’s Totalcare instead, courtesy of a new $55 million contract signed last week. Three of the trusts will stick with McKesson Star for some time. Reader UKMaxPaying thinks Cerner may be well positioned to take advantage of the mess and also calls attention to another Lorenzo go-live delay at Morecambe Bay, rumored to have been rescheduled from early May to the end of May.

Sage Healthcare is sponsoring the Texas Health Information Technology Summit, which started Thursday in Dallas. Everything you need to know about the agenda is contained in the prominent explosion-shaped graphic that says, “Learn how to get your $44,000”. I know a handful of the speakers, but not most.

CPSI announces Q1 numbers: revenue up 4.7%, EPS $0.27 vs. $0.37, missing analysts’ expectations and its own estimates.

The Huffington Post Investigative Fund continues its coverage of electronic medical records. In an article on patient harm, it cites 18 voluntary reports to the FDA involving Cerner software, one of which involved a patient death after “an unplanned hospital wide CPOE and electronic record breakdown.” A second article calls attention to a lack of FDA oversight, with its example being a GE Healthcare imaging system that reversed the patient’s image, causing the surgeon to operate on the wrong side. It concludes that a new oversight group might be formed by ONCHIT, with providers held accountable for reporting problems as a condition of receiving stimulus money.

Italian vendor Health Robotics says it’s now the largest American IV robotics vendor after signing 15 new contracts for i.v.STATION, i.v.SOFT, CytoCare, and i.v.Room of the Future as well as some beta contracts with big-name hospitals like Brigham and Women’s, Cleveland Clinic, Duke, and MD Anderson.  

Jobs: Allscripts Consultant, Integration Engineer, Senior Product Marketing Manager, NextGen Consultants.

The Birmingham paper profiles MedManagement, a 110-employee local company that offers advisory services and software, now offering Medicare admission help to hospitals. I like the poster in the background of the CEO photo, titled “Between a RAC and a Hard Place.”

Harvard-affiliated Massachusetts Eye and Ear Infirmary alerts several thousand patients that a laptop containing their information was stolen from one of its doctors who was lecturing in South Korea. They were able to detect it through its LoJack “phone home” feature and determined that someone installed a new OS without the software needed to read the information. They then sent a LoJack command over the Internet to trash the laptop’s hard drive. That’s pretty cool, although they still should have used encryption.

Strange: a British doctor labeled as a “Jekyll and Hyde” drives 800 patients away from his practice in four years by being rude to them during surgeries and focusing on his computer instead of them during consultations. And in this hardly shocking development: his wife, also his practice manager, was equally rude to his employees.

Reuters reports that WellPoint, the country’s largest health insurance company, uses software to target newly diagnosed breast cancer patients for the purpose of finding excuses to cancel their medical insurance.

Ideal Life, a Toronto company, says its wireless home monitoring devices (blood pressure, scales, blood sugar) are the first that are easy and affordable for remotely managing chronic disease, establishing two-way communication between patients and providers that can include motivational messages or tips. That along might not have earned the company an HIStalk mention, but this did: the CEO’s prior job involved the company that sells Teddy Ruxpin and Funoodles.

The outgoing CEO of Sage will get a $32 million parting gift.

E-mail me.

HERtalk by Inga

From NoPie: “Re: Cerner. I am a Cerner employee. I would like to point out that the McKesson Diabetes Initiative posted on the website yesterday is somewhat old news when compared to what Cerner has been providing for free for many years. There is no place I would rather be able to call home for my career. While others may read this e-mail and consider me just another person drinking from the ‘Cerner Kool-Aid’, we really are devoted to promoting a change in what Neal likes to call ‘the middle’ of healthcare.’ How refreshing to find someone from the vendor world who is willing to stand up and say they are passionate about their employer. I happen to like Kool-Aid every once in awhile, as long as it’s made with real sugar. I see on the Cerner Web site details of their Cerner Diabetes Initiative, which pledges to invest $25 million over 10 years for an online diabetes management tool for diabetic children. And, the Cerner-founded First Hand Foundation is a 15-year-old program that provides assistance to children with health-related needs. To date, the foundation has given $12 million in funds to children across 70 countries. Big kudos.

Allina Hospitals and Clinics (MN) selects Language Access Network to provide video language interpretation services to 11 of its hospitals.

University Hospitals (OH) launches Siemens Soarian Financials at Case Medical Center, completing University’s enterprise-wide deployment.

Edwin Miller, formerly with Artromick and athenahealth, joins Curaspan Health Group as VP of product management, along with three new sales executives.

Quality Systems, the parent company of NextGen, shuffles the roles of several executive leaders. Tim Eggena moves from executive VP of NextGen Practice Solutions to the newly created role of executive VP of R&D for NextGen’s ambulatory products. Monte Sandler takes over as EVP of Practice Solutions after serving as NextGen’s VP of account management. Finally, Donn Neufeld is now EVP of EDI for NextGen and QSI, in addition to SVP and GM of QSI’s Dental unit.

Kentucky Governor Steve Beshear announces the official launch of the Kentucky Health Information Exchange (KHIE), which currently connects six hospitals and one clinic. The Kentucky Department for Medicaid Services will also begin data exchange with the facilities.

Robinson Memorial Hospital (OH) selects Eclipsys Sunrise Enterprise as its integrated EMR solution.

Cullman Regional Medical Center (AL) will deploy MedAssets’ revenue cycle solutions for its 145-bed facility.

EDIMS will incorporate Callibra Inc’s Discharge 1-2-3 solution into its ED EHR product.

Harris Corp wins a $72 million contract to update the VA’s billing and collection operations.

University Health System (TX) implements InfoLogix’s HealthTrax mobility solution for its hospital and 20 clinics.

Brandeis University starts an online master’s degree program in health/medical informatics.

McLaren Health Care Corporation (MI) contracts for McKesson Paragon. PHNS will implement six more of McLaren’s hospitals, adding to the two already running Paragon.

Researchers from Henry Ford Hospital release details on their use of electronic medical records during last year’s Detroit Free Press Marathon. Using laptops and a Web sites, medical team members were able to coordinate patient care in real time, as well as help family members locate injured runners. Researchers say the solution also provides data to identify injury patterns and thus improve preparations for other large sporting events. There’s got a be a clever pun to tie the Ford/EMR/road race thing together, but it’s just not coming to me.

Franciso Partners expands its HIT holdings, making a significant capital investment in T-Systems. Founders Woodrow “Woody” Gandy, M.D. and Robert Langdon, M.D will remain on the board, with FP operating advisor John Trzeciak taking over as president and CEO. The company also owns QuadraMed, Healthland, AdvancedMD, and API Healthcare.

EMH Regional Healthcare System(OH) selects Allscripts EDIS for its three emergency rooms.

E-mail Inga.

News 4/21/10

From You’ll Know Who: “Re: McKesson. Pat Blake (Pam Pure’s replacement) just announced that he has moved Sunny Sunyal to the dreaded position of ‘strategic initiatives’ and will move Dave Souerwine into the MPT President role. Dave is moving from Pittsburgh, where he ran Automation (home of the cabinets and AdminRx).” Unverified. No changes on the Web site yet. Obviously this would be huge news if it’s true. Update 4/21 1:00 PM Eastern: McKesson’s Web site has been updated, verifying the rumor as reported and giving Dave Souerwine’s start date as MPT president as April 10.

From Dmitri: “Re: Advisory Board. Dave Garets and Mike Davis, the band formerly known as Gartner Group’s non-physician Thought Leaders and HIMSS Analytics, are duplicating the Gartner model of research reports, access to analysts, targeted benchmarking services, and targeted consulting services. Interesting move in that they will bring a wider than just IT view to provider-side IT.” ABCO stock has recovered nicely from its March 2009 dip to less than $15, climbing back to $34.30 today for a cap of $530 million.

From amMUSEd: “Re: MUSE. It looks like only 100 or so customers are attending out of Meditech’s 1200ish installed, less than a dismal 10% attending their premiere conference. I wonder if all the confusion around the migration to Focus 6.0 has scared them away or whether the economy is just killing the event? Thoughts?”

From Gary Playa: “Re: recall. Did you see this?” I’m not familiar with the process or the site, but it appears that Picis has recalled its Caresuite version 5.1 modules for anesthesia, PACU, and critical care in Canada (which if I remember correctly, regulates medical software much like the US FDA regulates drugs). I found a long list of health-related recalls of many types on Health Canada’s site, so I’d take this more as an interesting observation of how Canadian medical software regulations work than anything specific to one vendor. I don’t see why we don’t have something like that in the US.

From Certifiable: “Re: Cerner. A rare big-hospital win of Cerner over Epic: Northwestern Memorial in Chicago.” I should mention that well-placed sources suggest that Cerner is not, in fact, at the Yale-New Haven table as a reader reported earlier. The hospital will either find the money for Epic or stick with Eclipsys.

From HIS Junkie: “Re: CMS. Stop the implementations  … just of the presses: ‘Medicare payments to acute-care hospitals for inpatient services will decline by 0.1% or $142 million in fiscal 2011 under a proposed rule issued by the CMS.’ Since the MU penalty is tied to the Medicare adjustment, that means if I don’t meet MU criteria, they will reduce my adjustment by 33%. So as a math major I know 33% * -0.1 = +3.3% increase! Really though, with CMS wanting to cut doc payments by 21% and now hospitals 0.1%, do we really expect there to be MU bonuses at the end of the EMR rainbow?”

A Calgary radiology professor’s company gets Health Canada approval for its iPhone medical image viewing application, now being tested at some American sites.

Speaking of Apple, its stock is flying after announcing a 90% increase in net income for Q2 with an amazing 8.7 million iPhones sold in the quarter. The three-year-old iPhone revenue contributed 40% of Apple’s total. Apple’s market cap is at $222 billion, not far behind Microsoft’s $275 billion.

Weird News Andy has competition from Bizarro Jim, who notes this story from Ireland in which a surgeon who mistakenly cut off a patient’s testicle instead of just the cyst growing on it was also charged with injecting himself with meds intended for a patient. Not to be outdone, WNA parries and thrusts with this story about a British woman with Foreign Accent Syndrome – following a severe migraine attack, she suddenly starts speaking with a Chinese accent, about which the inquisitive and insensitive WNA queries, “How does she ask for an Advil now?” And this, about which WNA  expresses hope that it isn’t near the food court: a mall celebrates Colorectal Cancer Awareness Month by erecting a 40-foot-long Coco the Colossal Colon that visitors can crawl through.

Apparently everyone wants to be WNA: EHR Geek finds this story about a 10-year-old boy who is nearly struck by a laptop that fell from a medical helicopter leaving the local hospital. EHR Geek wonders if there are HIPAA implications.

Kaweah Delta Health Care District (CA) will roll out 100 iPads within the next few weeks, loading them with e-mail, medical image viewers, and EKG viewers, all running under the Citrix virtual desktop. The hospital also says that 20 docs have already bought their own.

The National Cancer Institute will release a lightweight oncology EHR based on HL7 CDA, giving oncologists a way to push oncology encounter information through a Web interface that could send it to PHRs, to other providers, or directly to consumers. SAIC and Microsoft are providing assistance. NCI says it will meet Meaningful Use requirements, but whether it does or not, it sounds like a fantastic idea to me. Onc records are complex and vital from one visit to the next.

Indiana-based cardiology EHR vendor GEMMS will expand its headcount of 40 to more than 100 within the next five years, with hiring starting immediately.

The Securities and Exchange Commission launches an investigation into Jackson Health System (FL) to determine whether purchasers of $83 million worth of its A+ rated bonds were defrauded since the hospital announced a surprise $244 million loss right after the sale.

The Leapfrog Group selects Quantros to administer its online Leapfrog Hospital Survey, replacing Thomson Reuters.

A Canadian Medical Association article says lack of national standards is hurting EMR adoption:

Several physicians and academic experts say the political will to implement national standards appears non-existent. EHR vendors are fuming. Health Canada stepped into the fray by introducing new certification and licensing requirements, some of which are fuzzy. Canada Health Infoway, meanwhile, has thrown its hands into the air and says it has no authority to compel provinces to comply with national standards. And federal Auditor General Sheila Fraser will again wade into the murky EHR waters on Tuesday by updating a November 2009 report that concluded Infoway has had little success in removing interprovincial barriers and, therefore, little “assurance that EHR systems will be correctly implemented.”

The CEO of Westchester Medical Center (NY) is fined $3,000 for letting Cardinal Health, which runs the hospital’s pharmacy department, pay for his hotel and limo at a conference.

E-mail me.

HERtalk by Inga

From ImageThis: “Re: voice recognition. Love to awaken every day to read the HIStalk news, very useful and insightful. As a vendor, I was intrigued by the recently mentioned study on PACS and was wondering what sort of voice recognition tools hospitals will be buying for imaging. Appreciate any feedback.” I’m sure that we have readers who can discuss this more authoritatively than me, so I will defer to the voice/imaging gurus.

Lourdes Hospital (KY) says that 100 affiliated physicians (80%) have adopted the hospital’s Web-based clinical portal. Two years ago, the hospital contracted with ICA to aggregate electronic healthcare information for physician online access.

Emdeon reports that the electronic medical claims adoption rate is now 85%. Electronic remittance adoption stands at 46%.

Clinics of North Texas select Allscripts EHR and PM for its 35-physician group.

Like this: McKesson employees from 130 different locations will create 32,000 Stop Diabetes care packages to distribute to fourth- and fifth-grade students. The initiative, which is intended to encourage healthier eating and more active lifestyles, is part of McKesson’s annual Community Days corporate citizenship program.

GE Healthcare says it added 12 new Centricity Perinatal clients in Q1, on top of  its installed base of 1,500 hospitals and health systems. GE also just announced its overall Q1 numbers, which included flat sales for its US Healthcare division. Healthcare as a whole had a “strong quarter” with $3.8 billion in orders, up 5% from the previous year. Overall EPS was $.16 with revenue of $36.6 billion.

eClinicalWorks makes the annual Boston Business Journal Pacesetters list of the 50 fastest growing private companies in Massachusetts. eCW ranked number nine, based on revenue growth.

Radiology services provider Optimal IMX implements MobileMD’s HIE technology to provide HIT connectivity between its client facilities and the physician community.

MediConnect announces 20% growth in first quarter revenues, compared to Q1 2009. The company also recently completed its acquisition of the PassportMD PHI portal.

Physicians working in hospital-owned outpatient facilities will be eligible for stimulus incentive payments, assuming they demonstrate meaningful use of EHRs. Congress passed a new bill which gives more physicians the ability to quality for funds, including an additional 13-17% of family physicians. Physicians working primarily in the ER and in inpatient settings are still excluded. Meanwhile, Congressmen Patrick Kennedy and Tim Murphy introduce legislation allowing behavioral, mental health, and substance abuse treatment provides to qualify for meaningful use of EHRs.

Health Care Systems Inc. (HCS) intends to join the Helios by Eclipsys application development program and integrate HCS’s Medication Reconciliation software.

Texas Health Presbyterian Hospital-WJN hires PHNS to provide IT services.

Happy anniversary to HIStalk sponsor Stratus Technologies, which celebrates 30 years in business on May 5th. To mark the milestone, they found the client that has been running its high-availability Stratus server the longest with no unscheduled outages. The winner was a Michigan manufacturing firm that’s had the same server since 1993. In case you don’t recall what you were doing in 1993, note that Clinton was president, Intel shipped its first Pentium chips, and Whitney Houston topped the charts with “I Will Always Love You” (I am sure someone finds this last fact significant). Highmark has also been running a Stratus server for quite a while: the company installed its EDI server 2001 and hasn’t rebooted in four (!) years.

Michael Ball, PhD, joins BridgeHead Software’s executive team as SVP, North America. Before Bridgehead, Ball oversaw marketing, product management, and professional services for InfoMedics; he also spent time with Ardais Corporation as VP of sales and marketing.

Royal Philips Electronics releases its Q1 numbers, which included $270.8 million in net income, compared to last year’s $79.5 million loss. The Healthcare division grew equipment orders 20% over last year, though US orders rose only 7%. Most of the growth was driven by sales of clinical and imaging systems.

E-mail Inga.

Monday Morning Update 4/19/10

From MisterEd: “Re: Yale-New Haven. The bulk of Cerner management is on site with CIO Mark Anderson. Epic’s not a sure thing yet.” Given Cerner’s ongoing dismal sales performance against Epic, plus the fact that YNHH has already been talking up Epic, I’d say Cerner’s chances are minimal, even though they offer the software for free to try for a rare big-hospital win. If I were YNHH, I’d consider Cerner only if I couldn’t find the money for Epic.

From The PACS Designer: “Re: iPad productivity apps. The iPad may not be on your list of must-haves, but you might change your mind if you saw some of the productivity apps for the iPad. TPD thinks that IT personnel may like a feature such as server management that Rackspace has designed for the iPad.”

From Dr. M: “Re: iPad. We found out that the iPad runs Epic! I am going to have to get one! Blanked out the patient and physician names.” Looks good on there, I have to say.

From Gotta Love Neal: “Re: Cerner. Is Cerner planning to manipulate HIT regulation to block small companies and upstarts from entering the market? This Duke distance MBA paper by a Cerner strategist provides a clue.” The PDF has been pulled down, apparently (the paper’s a year old) so the link is to a cached image of it I found. I wouldn’t put too much stock in an MBA paper that isn’t part of company policy, but here’s the part Gotta Love Neal called out, which doesn’t seem far from how it actually played out:

In the current environment, much of the strategy concerning the ARRA stimulus package depends on the details of government regulation. Specifically, the outcome of the definition of “meaningful use of EHR” will greatly impact the strategy that Cerner should adopt. The higher the regulatory burden placed on vendors the greater the advantage is to incumbent vendors. Therefore, it is a critical time to influence the direction of regulatory decision regarding “meaningful use”. In the coming months as Congress and Health and Human Services decide the details of the regulations, Cerner should invest resources to understand the direction of proposed regulations and partner with other incumbent firms to lobby the government to raise the regulatory hurdles as high as possible. Using the Healthcare Information and Management Systems Society (HIMSS) classification scheme for EHR adoption, Cerner should influence policy makers to set the meaningful use bar around stage 4 of 7 stages. This level would encourage even large academic hospitals, which currently average stage 2.5 adoption, to adopt new technologies to qualify for government incentives. It would also erect significant barriers to entry for new firms and encourage small, less technically capable and financially limited firms to exit the market. The message to government officials must not appear to be for the purposes of establishing barriers to entry, rather, it must suggest that meaningful cost savings and quality improvements cannot be achieved without a high standard of “meaningful use.”

Listening: Phoenix, indie pop from France. They’ll be at Bonnaroo and Lollapalooza. I’m not a big pop fan, but I like this OK.

VA renews its agreement to use McKesson’s InterQual evidence-based clinical content application.

I’m looking for a couple of HIStalk sponsors to test a sponsor-only job board that I had built. If you are interested, let me know.

An article in the just-published issue of Lancet looks at diabetes screening criteria using the Archimedes large-scale modeling tool that reviews EMR data such as physiology, disease, and interventions. The authors claim that a randomized clinical trial to generate the same information would have required following one million people for 45 years. It’s the first Lancet article based on a mathematical model rather than a clinical trial.

Thanks to the 191 hospital readers who have completed my three-question survey so far. If you haven’t, would you mind doing a quick, anonymous response for me? All it asks is your job description, employer, and employer’s location. It helps me understand who is reading. Thank you.

Forget my last poll in innovate HIT vendors since unknown pro-Eclipsys parties spammed it. New poll to your right: how many docs who buy EMRs will get all the HITECH money they’re expecting? Note that you can also leave comments on the poll itself, just in case you’re trying to sway someone.

Off topic: I’ve seen the future of TV and it’s not TV. Netflix now offers free, unlimited streaming of a pretty large library of movies and TV shows with any level of its traditional DVD-by-mail subscription. $8.99 per month gets you a free DVD that you swap out by mail as often as you like, but the streaming is the real draw. All you need is an WiFi capable DVD player, a videogame system (Wii, PS3, or XBox 360), or a $100 Roku HD streaming video player and you can watch a ton of video on demand 24×7. It’s fast, reliable, has some nice features like creating your instant queue on the Web, and is pretty high quality. I’m thinking about getting the Roku box since I played around with it this weekend and was instantly hooked. You don’t need cable or dish, you don’t need to buy channels you don’t watch, and you don’t have to watch commercials.

Nashville-based onFocus, which offers performance tracking systems for healthcare management, raises $3 million in Series C funding.

Oracle buys pharma drug development software vendor Phase Forward for $685 million, expanding its health business unit and possibly signaling its interest in other healthcare-related acquisitions.

Interesting: how hacker-resistant are implanted patient technologies such as insulin pumps? In a laboratory experiment, researchers used a computer and radio to access a cardiac defibrillator, killing the simulated patient. Some devices have a 15-foot wireless range with unencrypted signals. They’re talking about tattooing the embedded passwords onto the skin of patients so that caregivers could take control if needed.

We’ve got fresh news and interviews over on HIStalk Mobile for those who care about smart phones, mobile healthcare computing, and similar topics. It has its own e-mail list, so drop your e-mail address in the Subscribe to Updates box at the upper right of that page to jump on.

Doctors in Queensland, Australia are threatening to strike over underpayment caused by implementation of a new payroll system, specifically the Infor WorkBrain workforce management application. Experts from IBM, which managed the implementation, are being brought in from Canada to try to fix the problem.

Debra Medina, a libertarian activities, former medical billing company owner, former nurse, and former candidate for the Texas governor’s seat, shows up at a state committee meeting on health information exchange with a camcorder, apparently to call attention to privacy concerns.

Australia’s plan to issue a national healthcare identifier to all citizens starting July 1 is criticized by a senator, who notes that just 10 weeks out, the legislation hasn’t been introduced and vendors haven’t been chosen.

HHS’s open source Connect project that facilitates connecting IT systems to the Nationwide Health Information Network is named a finalist for an award recognizing innovative technologies that improve citizen services.

eClinicalWorks, in need of space for expansion of its headquarters, tentatively plans to stay in Westborough, MA with a move to another in-town site.

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Responses to Reader Question – Will Hospitals Offer Practice-Based Physicians A La Carte Systems or a Standard Enterprise Model of Software and Devices?

Response 1

I believe most will select a "standard" set of systems they feel they can support with their staff and if they have enough influence/control over their staff physicians, they’ll get majority buy-in; especially if they are leasing it at a "reasonable" price. I also think many physicians who admit the majority of their patients at a facility that offers that option will be very tempted because the research is already done and they can blame the facility and it’s system(s) if anything goes wrong and expect the facility’s support staff to resolve the problem without having to beef up their office staff substantially (or sufficiently). That could be a double-edged sword for the facility if they bite off more than they can chew and don’t set proper expectations or possibly don’t write a good contract and SLA. Otherwise, they have standardization and can brag about it. Obviously all this assumes the hospital/facility has done proper due diligence in selecting their vendors and already has good contracts and SLAs. I’ve heard and read of many multi-facility environments that have tried to support multiple systems and almost always talk about trying to migrate to a single set of favored solutions. Right or wrong, most view supporting multiple systems as more costly in the long run and it tends to spread the staff expertise too thinly. Moreover, they want to consolidate their IT operations and usually think they can reduce the headcount through "operational efficiency". It sells well to management but usually doesn’t work out as well as stated.

Response 2

think that the hospitals will offer a standard physician office rollout package, not an a-la-carte selection. After all, if the hospital has to support the physician users, they will want to keep things standardized. Trying to figure out which office uses which applications/features is too difficult.  The hospital’s support staff is probably already stretched too thin to take variability into account. Another consideration is pricing for the services offered. I think hospitals will want to keep this simple as well, so a standard package fits better for the pricing side.

How to Not Suck in an Interview
By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make this editorial available from its newsletter.

I do a lot of interviews for HIStalk. Like a mother who loves all her children equally, I like to think that they’re all good, but let’s be realistic: I know that some of them have been spectacular duds.

Those clunkers sounded good on paper as I planned them, a no-holds-barred discussion with some vendor executive sporting a big title and enviable credentials. The end result, however, was about as exciting as uncomfortable first date conversation involving the weather. I swear I could hear the crickets chirping while I yawned through yet another boring, pedantic answer to a question that I hadn’t actually asked.

It’s especially hard with HIStalk because I run the transcripts of my interviews verbatim. I don’t edit out endless pontification, question-dodging, or rambling answers that tumble off the page like a jackknifed truck full of bricks. If someone says “sort of” every other sentence (and it seems that’s about half the people I interview these days), those warts are going to be out there for the whole world to see unless I’m so annoyed by the result that I break my own “no editing” rule.

It’s not like I don’t warn my interview subjects. I tell them to keep their answers short but animated, illustrate concepts with stories, fight the urge to constantly brag about the company and its products and instead let their answers do the talking, and to speak like a human and not a brochure.

They don’t always listen. They nearly always regret it afterward. And even if they don’t, I do, because readers usually complain.

My Rule #1 is this: when talking to vendor people, I will almost never interview anyone other than the CEO. Some of the worst interviews I’ve done were with VPs, usually because they were (a) clueless; (b) responsible for only a limited part of the business and therefore not really conversant about the big picture; or (c) so scared of being corporately backstabbed that they wouldn’t say anything that deviated from the marketing-approved talking points.

I don’t like interview subjects who over-prepare, which is why I won’t let them see my questions in advance. I want spontaneous answers and the chance to make up questions on the fly based on previous answers. I know I’m in trouble when I hear papers shuffling on the other end since that always means my subject is frantically digging through a stack of carefully scripted notes to find an answer that absolutely nobody will want to read because it’s … carefully scripted.

Executives also sometimes don’t prep, just getting on the phone at the time the marketing person told them to. Since they don’t have a clue about my audience or my own level of understanding, they sometimes dumb down their answers like I was from the local hippie weekly paper. No, I do not need to see your stick figure drawing of what CPOE is, thanks.

I learned the hard way to never allow a second person to sit in on the interview, even if the company is run by two inseparable and equal partners who can’t bear the thought of not speaking as one. It drives the transcriptionist crazy, they end up constantly enhancing each other’s comments pointlessly in an effort to wrest equal air time, and readers have no clue who’s talking and why it took two people to have so few original thoughts.

I’ve also learned by bad experience to never let the interview subject see the transcription draft before it runs. It’s tempting because they might catch a glaring transcription mistake caused by poor audio (usually because they insist on being interviewed on their cell phones), but their insecurity always moves them to convene an impromptu review panel, always led by a marketing person who insists on sticking trademark symbols on everything and making irrelevant punctuation changes (I always put a comma after the second item in a three-item series and no, I don’t care what reference says otherwise since I can find at least one that says it’s OK).

The answer to the first question sets the tone. I tell the subject that I’m going for about 20 minutes and will ask maybe 6-8 questions. The message is clear – don’t prattle on. Several years ago, in one of the worst interviews I’ve done, the guy hadn’t come up for air 10 minutes after I’d asked my usual “tell me about yourself” icebreaker question, still blabbing endlessly about his wondrous experiences at a bunch of companies. I’m pretty sure readers would rather draw their own conclusions about his abilities instead of listening to him recite them.

So my interview advice is succinct: develop a rapport with the interviewer, talk just enough, and always be fascinating. Heck, if you can do that, you’d make a great first date for someone, too.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

News 4/16/10

From The PACS Designer: “Re: Google Documents. In a challenge to Microsoft Office, Google has expanded its online document offerings. TPD has been using the Google spreadsheet application for some time and now will be testing the new features as well as the usability of Google Presentations and Google Drawings.”

From Rysanwss: “Re: Yale-New Haven. An EVP made a formal announcement to the IT staff that Epic is in their future. No signed contract yet, but they are close.”

From Jobs: “Re: Apple iPad unpacking video. A staple of Star Trek movies is a long, slow tour around the exterior of the ship, showing the exquisite detail of nacelles, the phaser emitters, the gentle curves of the saucer section, etc. This scene is ‘trekkie foreplay’. The iPad video is the Apple version.”

O’Connor Hospital (CA), Orlando Health (FL), St. Vincent’s East (AL), Huntsville Hospital (AL), and UC-Irvine (CA) are recognized for excellence at the annual conference of Surgical Information Systems.

Sad news: Steve Tanaka, CIO of Palomar Pomerado Health (CA), drowned last week while on vacation on Costa Rica. He was 50. The hospital has created the Steve Tanaka Award for Excellence to honor his work and memory.

This story doesn’t inspire much confidence in healthcare IT security. Auditors reviewing the security of electronic patient records of Vancouver Coastal Health Authority found so many vulnerabilities in every area that they buried the report for six months, fearful that anyone reading it could start digging through its systems. “No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time. Almost all users have some access to confidential information about all clients in the database. Many clients’ full health information is accessible to a large number of users.”

Software developed at Brigham and Women’s Hospital to optimize the schedules of astronauts based on their sleep rhythms may have a role in healthcare, with potential use in creating employee schedules, predicting low-performing times to avoid errors, and using light therapy to  change natural sleep cycles. I found a free beta download here.

From Weird News Andy, who comments on his find as <predictable>The thought of an implantable chip just gets under my skin.</predictable>. PositiveID (formerly VeriChip) strikes a deal with the International Maritime Medical Association to offer its PHR to seafarers. WNA also found this story about the theft of 57 hard drives from BCBS Tennessee, now estimated to include records of 1 million patients.

Jobs: Cerner Build Specialist, Senior Product Marketing Manager, Regional VP Sales – HIT Consulting, Anesthesia Product Specialist.

Epic CEO Judy Faulkner will receive an honorary Doctor of Science degree on May 14 from her alma mater, the University of Wisconsin-Madison.

Sheehan Medical Cork Medical Centre, the first new private hospital to open in Cork, Ireland in 30 years, awards its IT contract to Meditech. The company has several other Irish clients.

Dennis Quaid has produced and narrated a documentary called “Chasing Zero: Winning the War on Healthcare Harm” that will air on the Discovery Channel next Saturday, April 24. It was inspired by the near-fatal heparin overdose given to his infant twins at Cedars-Sinai.

An Army doctor faces court martial after refusing deployment orders to Afghanistan, stating his belief that the orders are illegal because President Obama was not born in the US and therefore cannot serve as his commander-in-chief.

University of South Florida will hire 100 “e-ambassadors” for its stimulus-funded PaperFree Florida electronic medical records initiative.

Christoph Lehmann, MD, a Johns Hopkins neonatologist, is chosen as founding medical director of the Child Health Informatics Center, an American Academy of Pediatrics informatics group created in October 2009. That group will design a prototype model electronic pediatric health record.

A former medical records clerk of St. Peter’s Hospital (NY) is arrested for stealing patient information and shopping online using their credit card numbers. He was caught after ordering merchandise and forgetting to change the default shipping address, sending a package to the house of one of his victims, who realized someone else had ordered it using his credit card.

Oppenheimer upgrades shares of open source vendor Red Hat to outperform, while UBS flags the company as a compelling takeover target.

Odd lawsuit: the sister of a man accused of beating his parents to death sues the hospital for negligence in the death of their mother, claiming “wrongful death”.

E-mail me.

HERtalk by Inga

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Enterprise Software Development changes its name to Enterprise Software Deployment to better reflect the company’s evolved breadth of EHR implementation services. You can check out their good-looking new logo and ad to your left.

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

I don’t think I’d be starting a career in PACS sales any time soon, assuming the results of this CapSite Consulting study are accurate. Currently 96% of hospitals have already own PACS solutions and only 17% of the surveyed hospitals have plans to buy a new or replacement system. The biggest imaging IT spend in coming years will be for image archiving and storage, plus voice recognition tools. Almost half of hospitals with PACS cited functionality as the biggest weakness of their PACS.

CareTech Solutions doubles its number of Web Products and Services clients in fiscal year 2010, now serving over 150 hospitals.

Cardiology Associates (AL) picks Allscripts’ EHR for its 38 providers.The practice will tie the EHR into its existing Allscripts PM and document management systems.

Complete Women’s Imaging (NY) selects Merge Healthcare to provide a diagnostic imaging workflow solution, including Merge’s Fusion RIS/PACS MX.

Desert Orthopedics (OR) plans to implement SRS hybrid EMR for its 10 physicians.

The Heart Hospital of New Mexico chooses TeleHealth Services for interactive patient education services.

IDC Health Insights takes a peek at 14 HIE vendors and provides assessments on their offerings (for $4,500, you can get a copy of the report and fill us in on the details). For the most part, the 14 vendors were the ones I would have expected (Axolotl, dbMotion, Medicity, etc.) One surprise vendor was eClinicalWorks. I knew they had an HIE product, though it’s not heavily promoted. On the other hand, I know other ambulatory vendors like NextGen and Allscripts are trying to establish an HIE presence, yet were not included. A quote:

Typical of nascent markets, the HIE vendor market is volatile with new entrants and market consolidation. We can expect dramatic changes in the next 12 to 18 months as HIE technologies become a commodity and dominant players acquire their way into a crowded market currently made up of many small, privately held vendors.

The California Telehealth Network awards AT&T a $27 million contract to build a telecommunications network to connect hundreds of providers throughout the state.

Spheris wins court approval to sell its assets to fellow medical transcription vendor CBaySystems Holding for $116.3 million, which includes $98 million cash.

Here’s a good tax day story for you. The president of a San Diego medical billing company pleads guilty for failing to pay $2.5 million in employment taxes, even though the taxes had been withheld from employees pay checks. Anthony Vacchi, Jr faces up to five years prison.

E-mail Inga.

News 4/14/10

From Dr. Know: “Re: California Nurses Association. We have been rolling out an electronic health record system and have been confronted with growing resistance from the nursing staff, which is heavily unionized. They continue to refer to this document (warning: PDF) published by the California Nurses Association, which says, ‘Don’t Automate.’” The union’s flyer says that healthcare IT is driven by the desire of employers to control workers, that EMRs are used to spy on employees, and that technology is intended to homogenize health professionals and patients like interchangeable machine parts. I don’t disagree with all of it, but it’s pretty over-the-top.

From Minute Man: “Re: Leagcy Health. Dick Gibson MD, senior VP and CIO of Legacy Health System in Portland, OR who spearheaded the purchase of Epic, has been let go. In addition, Carol Edwards, VP of information systems with 20+ years at Legacy Health, was let go at the same time. They both left at the end of March. The Epic implementation has encountered significant costs overruns and delays. The project manager is a consultant who has no prior Epic implementation experience. Interestingly, the same consultant managed the Cerner implementation at Legacy, which is being replaced with Epic.” Unverified.

From The PACS Designer: “Re: iPad first look. If you haven’t purchased and received your iPad yet, you may enjoy the arrival experience by viewing Fritz Nelson’s iPad delivery and first use out of the packaging in his review for InformationWeek. Also, the Apple Insider has a full review of all the features available on the iPad.”

The Methodist Hospital (TX) enhances its online patient experience by launching distributed authorship of content for Web visitors from MEDSEEK.

A hospital in Thailand says it will be among the world’s best after an IT investment of $1.5 million. It will run PeopleSoft financials and HR.

Vanderbilt researchers present a paper describing the privacy method they developed that generalizes genomic data in EMRs to prevent linking patients to their genetic profiles.

I closed out the poll to your right because it was getting spammed hard by respondents (or automated scripts) choosing Eclipsys as the most innovative vendor. The polls usually get around 200 votes and this one was up to 688, with Eclipsys getting 528 of those. You can decide whether you believe that result.

Healthcare Growth Partners releases its HIT market report for Q1 (warning: PDF).

The Wall Street Journal writes up HIEs, profiling the data sharing of Children’s Denver, Kaiser’s Colorado physician group, and Exempla, all of which use Epic and share information.

A doctor and EMR consulting company vendor criticizes Canada Health Infoway’s multi-billion dollar EHR project, citing low physician adoption. Among his criticisms: the “unconscious patient in the ED” is rare and hard to justify as a necessity; investments have been focused on hospitals instead of doctors’ offices where most care is provided; EMRs don’t help with referrals or consultations, which still require paper; and privacy issues and local legislation prohibits the free flow of information that the system was built around.

Speaking of Infoway, the specially created pension plan of its CEO has accumulated $1 million in benefits after six years on the job, not bad for running an organization with only 200 employees.

It’s not just medical doctors who suffer through EMR implementations – veterinarians have similar concerns. “They really pushed big at the conferences. They knew that they were going to be bought and had to make their numbers look good. I just don’t think they were ready to take on a practice like ours.”

The mother of a nationally known activist who died at UPMC Shadyside blames the hospital’s “unreliable and insufficiently tested” computer system, saying its faulty records resulted in his being given soup too soon after surgery, leading to his asphyxiation. She also claims the hospital released his information to a congressman without permission.

If you work for a hospital or health system, please complete my three-question anonymous survey: your job title, the name of your employer, and the location. It’s nice to know who’s reading.

A primary healthcare center and ED launch what they say is the first HIE in Georgia, with the organizations sharing medical records of uninsured patients to streamline delivery and reduce duplication of services.

E-mail me.

HERtalk by Inga

From CowCHIT: “Re: Karen Bell. She was just named Mark Leavitt’s replacement at CCHIT. Don’t know her myself, but … she can’t be any slimier than Leavitt seems.” Sounds like a glowing endorsement. She was most recently SVP of HIT services for Masspro, and before that was director of the Office of HIT Adoption and acting director of ONC. Because of her previous association with ONC, she’ll be unable to lobby for CCHIT in front of federal officials until November 2010.

e-MDs announces it has increased its employee count by 36% over the last year and experienced a 36.5% increase in organic sales since the start of 2010.

CliniComp says that three more US Army and Navy facilities deployed the Essentris EMR during the first quarter of this year.

CynergisTek launches its HIPAA/HITECH Security Compliance review solution for hospitals that qualify for SHIP grants from the Office of Rural Health Policy.

Eclipsys announces the release of Sunrise Enterprise 5.5, which the company says includes significant EHR updates. The new release includes Helios, the new Eclipsys open platform strategy that allows third parties to natively integrate their applications.

The Children’s Hospital at Montefiore (NY) will implement GetWellNetwork’s GetWellTown, the pediatric version of its Interactive Patient Care program.

Foundation Radiology Group appoints Tom Skelton CEO. Last month a reader tipped us off that Skelton was leaving MED3000, where he served as president of technology services.

HIE Health Advancement Collaborative of Central New York signs a multi-year agreement with Axolotl for its Elysium Exchange suite.

Thomas Jefferson University and Jefferson University Physicians select Allscripts and dbMotion to provide an integrated and interoperable EHR and population management solution.

Eight thousand Vancouver Coastal Health (BC) employees are now live on workforce management solutions from Kronos, including time and attendance and employee scheduling.

Catholic Health Initiatives chooses RelayHealth RevRunner for patient eligibility verification.

David Blumenthal wins his second big award in just over a month. In early March, Blumenthal won top HISsie honors as HIStalk’s Healthcare IT Industry Figure of the Year. He has now been named the Most Powerful Physician Executive in America by Modern Physician and Modern Healthcare readers. I’m sure the latter award, while not as prestigious as a HISsie, will still be coveted.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. I’m assuming I am just too old / uneducated and/or poor since I don’t have one. Mostly I am PHR-less because it seems like far too much work to maintain. However, just today I was thinking that it would be kind of cool if I had a PHR. I’m trying to buy health insurance and am needing to provide the evil insurance company TEN years’ worth of medical history. As in, every antibiotic for every strep throat or bronchitis attack, every outcome to every dermatologic encounter, and every little medical incident that I have either forgotten about or don’t care to share. Seriously? I have a new theory about why so many Americans are uninsured but that’s all a can of worms I don’t care to open. Suffice it to say that maybe – maybe — I’ll start looking into using a PHR.

A man sues medical device maker Stryker, claiming its artificial hip destroyed his sex life. He alleges that while having an intimate moment with his wife, the act was interrupted because the squeaking made her start laughing (how insensitive). About 750 individuals have also filed lawsuits, including a fellow who put a video of his squeaky hip on YouTube. If you check out the video, let me know if you think this guy is wearing Superman pajamas.

E-mail Inga.

Being John Glaser 4/12/10

Working with ONC on HITECH: Some Observations

I have spent a large portion of the last eleven months working with the Office of the National Coordinator for Healthcare Information Technology (ONC) to develop the regulations and grant programs that resulted from the HITECH legislation. This time and this work have led to four major observations.

The Power of Meaningful Use

For decades, the healthcare information technology industry has tracked adoption. How many hospitals have adopted CPOE? What is the adoption rate of personal health records?

While adoption is a measure of industry uptake of a technology, it has an obvious flaw. Adoption does not mean that providers are using the technology or that care is being improved. Adoption does not, per se, lead to complete problem lists or providers doing a good job of managing the health of their patients.

Meaningful Use is a very potent idea. It says that if our goal is care improvement, adoption is only relevant if the technology is used well.

Meaningful Use also stops short of initially basing incentives on changes in care outcomes. While providers must report quality data, early stages of Meaningful Use do not require that specific improvements in care occur. It was understood that broad care improvement will take more time than is likely to be achievable under the initial HITECH timetables. And it was understood that while EHRs are an essential foundation for care improvement, additional factors must also be present.

Most importantly, payment reform must happen — reimbursement that explicitly rewards providers for improvements in care quality, safety, and efficiency. The recently passed Health Reform legislation begins the process of the implementation of payment reform for federal programs.

Meaningful Use moves the industry away from a focus on adoption, but does not overstep that movement by leaping all the way to outcomes.

The Joint ONC/CMS Approach to Regulation/Rule Development

After HITECH passed. there was a need to develop the regulations (also known as rules) that translated the legislation into specifics, e.g., what are the specific things a provider would have to do to be considered a Meaningful User?

As it writes rules, the government must follow a core protocol. Those who are drafting the rule cannot talk, outside of government, about the draft language. The draft rule must be reviewed and approved by several government departments such as the Office of General Counsel. And the government must ask for comments, on a draft of the rule, from the public and it must read those comments.

While it followed that protocol, ONC (and CMS for Meaningful Use) made a critical strategic addition. They leveraged the Policy and Standards Committees (which were open to the public) to develop recommendations of the rule content. The Meaningful Use Work Group defined an approach to the 2011 (Stage 1) objectives and measures. The Certification and Adoption Workgroup developed recommendations for a new EHR certification process. The Workgroups of the Standard Committee developed recommended data, transaction, quality measures, and security standards.

Most of the time, government does not do this. Generally government staffs do not precede rule writing with external committee (and public) input.

Why did ONC do this?

First, the rule content is likely to be better if it is based on the contributions of individuals who represent the broad spectrum of stakeholders in healthcare. These individuals “live” the delivery, financing, supplying, and management of care every day. And their experiences and knowledge cannot help but make the rule better. Moreover, the discussion of rule specifics from different perspectives helps to ensure that the rule balances, as well as it can, the variety of stakeholder interests.

Second, it is good government. Good government is transparent. Government is put in place by the people and it exists to serve the people. The people should be able to “drop in” on regulation deliberations and government should minimize the times it closes the doors.

Third, it is a terrific example of risk mitigation. It is very difficult to develop, for example, the specifics of Meaningful Use in a way that understands the complexity of healthcare; its current reality and its aspirations. By seeking the advice of experts through Committees and Committee testimony and inviting the comments of all, the Government is asking about areas where the proposed rule may have unintended consequences or could lead to sub-optimal outcomes.

Fourth, it helped the industry know, as early as possible, the direction that the rules were likely to take. The recommendations of the Committees were presented in the summer of 2009. The draft rules were unveiled in the winter of 2010. Through its use of the Committees, ONC was trying to give the industry as much of a lead time as it could.

The Complexity and Scope of the Challenge

HITECH has resulted in two classes of ONC efforts: definition and implementation.

HITECH required that specifics (and hence rules) be defined for

• Meaningful Use
• The data, transactions, and measures standards needed for health information exchange and quality reporting
• Certification standards and the certification process, and
• Privacy and security.

While essential, rules are not enough. Other actions are needed if we are to have the broad achievement of Meaningful Use by providers across the country.

Most of the care in this country is delivered by small physician groups and hospitals; they do not have an IT staff. Regional Extension Centers have been established to provide necessary support to those providers.

A health information exchange infrastructure needs to be in place to support the secure movement of data necessary for the care of an individual patient and the management of populations by public health organizations. Funds have been given to the states to establish this infrastructure and a plan to establish an over-arching National Health Information Network (NHIN) is being developed.

The country will need to increase the size of the work force available to support the broad achievement of Meaningful Use. Funds are being awarded to educators to provide necessary training and curricula.

Beacon communities will help us understand how best to leverage the technology to improve the health of a community and will teach us how to address important issues of governance, data use, and coordination of care.

Advanced health information technology research centers (SHARP) will provide ground breaking research into the critical areas of security, new architectural models, decision support, and secondary uses of data.

These implementation activities are breathtaking in their scope and sophistication. And the activities are the result of a very astute assessment of the range of “levers” that should be applied to achieve Meaningful Use.

However, initiating that many diverse initiatives that individually and collectively have a significant impact on multiple parts of the industry comes with some risk.

It is not possible to launch this much activity of this scope with this many actors and have great certainty about the outcome. This uncertainty will be magnified by the actions of the private sector — hospitals, health plans, suppliers, and others that are engaging in a diverse array of often very imaginative implementation activities.

The ONC implementation plans are very good plans. But they bring complex and substantial change to the industry. Change of this magnitude will bring very real progress, but it will also bring a period of time that is likely to be bumpy.

When significant change is introduced, one plans as well as one can, ensures that one has a realistic appreciation of the uncertainty, and preserves the agility to change course as needed. And, most importantly, one makes sure that there is ongoing dialogue with all stakeholders about issues, answers, and progress.

The Caliber of Federal Government Employees

Perhaps like many of you, I might have had this mental image of a typical government employee — a person with a rubber stamp in their hand and a scowl on their face. That mental image is wrong.

The people I worked with at ONC, CMS, NLM, NIH, FDA, DoD, VA, and a host of other government agencies and departments are exceptional. They are very smart and skilled. They work incredibly hard. They feel a sense of urgency. And they care deeply about making the country better. They listen thoughtfully to the comments, testimony, feedback, and articles from those who care about healthcare because they want to get it right.

They made me proud of my government because my government (and yours) is them.

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