Monday Morning Update 2/1/10

From You’ll Know Who: “Re: Horizon Enterprise Revenue Management. Some observations from MCK’s January 26 conference call. It was said that HERM was designed ‘with an architecture similar to our clinical systems,’ which means it isn’t the same and not likely to be very integrated. Still scratching my head on the HERM amortization costs. Software revenue had to be deferred for ANY contract that mentioned HERM before it became GA. Now that it’s GA (supposedly), why is profit still declining and why did it trigger so much incremental amortization? McKesson tried to develop HERM quick and cheap in India, and when it didn’t work, executives were fired and the rumor now is that development is moving to Mexico. What happened to the original pilots, Gwinnett in Atlanta and Peninsula in Maryland?” All unverified. I still haven’t heard back from the Baptist CIO. I’ll say this: revenue cycle has been the Vietnam War of some big vendor superpowers. I was also thinking – is this the first product McKesson has actually built from scratch rather than bolted on from an acquisition? Maybe not, but I just can’t think of others.

From Lady IT: “Re: Sisters of Saint Francis. The rumor is true. I work for the vendor who is being displaced.” Hoosier is working there and agrees, saying Epic was chosen over McKesson.

From Bobby Orr: “Re: Rutland. They actually went Cerner for the EMR, not GE. Also, the vendor relationship movie was excellent. I think I’ve met some of those people in real life.” I thought that parody of bargain-seeking customers was funny, with excellent acting. Like my hero from the video says, we can do this!

From PeaPicker: “Re: CCHIT. Their committees haven’t met in a month and have done nearly nothing since early fall. CCHIT is completely focused on ARRA and has no interest in anything else.” Like the rest of the industry, unfortunately.

From Arnell: “Re: Riyadh Military Hospital. Is this a loss for QuadraMed? Saudi Arabian National Guard went live with then-Misys CPR in Fall 2004. Those implementations were also military hospitals. As a side note, it is interesting that when issues were created for that project, severity levels were determined by whether there was a member of the Royal Family involved as a patient or user.” Not much different than the small community hospitals I’ve worked in, where the entire facility went on red alert when a relative (even a distant one) of the hospital administrators or key doctors showed up. I’m not making this up: at one small hospital that was owned by a national for-profit chain, we management team members were convened in emergency session because the mother of our obnoxious eye surgeon had been admitted. Apparently the care those administrators oversaw for everybody else wasn’t good enough for people with connections. I wouldn’t exercise that privilege, though: I think you increase your chance for medical misadventure by breaking out of the routine.

From PBnJ: “Re: industry newbie. Which HIT publications should I subscribe to to learn, preferably free or low-cost ones?” You’re asking the wrong guy since I don’t read a single one of them, either hard copy or online, except for Inside Healthcare Computing. Try this test: go to the online site or current issue of any of them. Ask yourself, “Which stories gave me timely information that I can truly use in an informed manner?” Read the bios of the people involved – have they ever worked in healthcare? How quickly did the publication report on real news? Is the reporting balanced, or just typical fluff? If articles covered hospitals or people you know, were they accurately portrayed?

In honor of my intentionally politically incorrect logo, a reader sent links to smoking doctor posters from the 40s. I think I’ve run a couple of them before (Link 1, Link 2, Link 3). The guy above must be really good if the comparative size of his reflector is any indication. Using doctors to pitch cigarettes reminds me of the early days of the White Castle hamburger chain, which fed doctors and nurses workers free if they showed up in uniform, which inspired confidence in their product (kind of like the HIMSS conference). In those minimally regulated days before In-N-Out and Five Guys, people were wary of eating hamburgers in restaurants, probably for good reason. 

I ran across Audit Integrity, a free online tool that claims to be able to identify shareholder risk measured by “corporate integrity”, mostly related to accounting practices. The higher its AGR number (up to 99 since it’s a percentile), the better. I checked a few healthcare-related ones: Cerner (42), McKesson (5), Eclipsys (7), Quality Systems (54), athenahealth (99), Dell (2), and GE (1). I’m sure there is disagreement as to its criteria and usefulness, especially among the low-numbered companies.

Wales NHS will introduce a new clinical portal that allow clinicians to view patient data and perform limited order entry. It will eventually allow clinicians to see a patient’s health record that includes information from physician practices once they work out information governance issues. The guy in charge makes subtle fun of NPfIT and it’s big bang, big bucks strategy. Wales kept it simple and its price tag was under $5 million. The portal has an interesting privacy approach: patients have to give their consent every time someone tries to look at their record.

CPSI’s Q4 numbers: revenue up 5.3%, EPS $0.33 vs. $0.44. The company blames hospital uncertainty about meaningful use, among other factors, as the reason it missed estimates. CEO Boyd Douglas from the conference call: “I think there’s obviously there’s hesitation on the part of new system sales. Some of that is coming from waiting on again while we have got the interim final rule, we still don’t have the final rule. And I think frankly, there’s some degree of skepticism out there amongst some of these hospitals about whether the money is really available, whether they really think they can meet meaningful use, things like that. And I think that will certainly turn once you start seeing some money flow. But hopefully, it will turn sooner than that.”

Quarterly results for Quality Systems/NextGen: revenue up 14%, EPS $0.46 vs. $0.46. Investors didn’t like the absence of an ARRA-fueled jump, punishing the stock as shares dropped from over $60 to close Friday at $51.54.

Albert Einstein Healthcare gets a mention in the local business journal for its $100 million EMR project. It’s happy about the prospect of ARRA payments, but concerned that only 50 of its 350 owned physicians will be eligible for stimulus money. They say that doesn’t make sense because they use different tools in their practices than they do in the hospital. A Pennsylvania Medical Society spokesperson also expressed concerns about the 80% CPOE requirement for practices, saying that as an example, radiology centers are not covered by the rules and therefore have little incentive to receive electronic orders.

McKesson announces GA of Horizon Practice Plus 12.0.

Expensive politically correct action at Regional Medical Center (SC) results from its well-intentioned celebration of IT accomplishments, at which an employee in a gorilla suit handed out bananas at the “We’re Bananas For You” event. They always introduce their main speaker at those events with the sounds of “Hail to the Chief,” the timing of which offended someone whose outrage trigger meter must be set at 11. That’s good for an out-of-town diversity consultant, who gets a $78,000 contract to deliver a 2.5 hour mandatory employee in-service. Their Cerner implementation that was cause for celebration is going fairly well after some initial bumps.

The $28 million Epic implementation of Altru Health (ND) gets a mention in the local paper. A selling point: patients will get a single monthly bill that covers both clinic and hospital charges.

Omnicell’s Q4 results: revenue down 11.9%, EPS $0.02 vs. $0.10. They’ve had some big Pyxis replacement wins, but those haven’t helped the bottom line so far.

Patrick Soon-Shiong, the drug billionaire with a big interest in interoperability, announces the spinoff of Abraxis Health from Abraxis BioScience. The new company will deal in personalized healthcare and molecular profiling. According to the press release, “Abraxis Health plans to develop a proprietary model for the delivery of healthcare, requiring a unique global computer software and hardware infrastructure that integrates patient data management, bioinformatics, discovery, molecular medicine and clinical development. Abraxis Health currently is designing and acquiring the necessary infrastructure and plans to acquire and internally develop the hardware and software modules to organize and integrate the data streams that form the foundation of this interactive database.” I’ve heard rumors that his foundation provided financial support to CAeHC, which recently benefitted from the unseating of CalRHIO as California’s statewide interoperability organization. Whatever group controls that project will be the conduit for billions of federal stimulus dollars in addition to sitting on a potentially lucrative database of patient information.

Iatric Systems brings in Aprima as its PM/EMR partner for physician practices connecting to Meditech. Aprima, as I have to remind myself every time I read the name, is the former iMedica. I interviewed CEO Michael Nissenbaum in the summer of 2008. He’s a straight shooter, even when I asked him some very direct questions (some of the best I’ve come up with on the fly, if I may humbly and impartially suggest).

News from President Obama: stung by low approval numbers and voter backlash, healthcare is apparently no longer his administration’s showcase issue (since he didn’t mention it in his weekly address), replaced now by a new windmill at which to joust: reducing the crushing deficit that, according to him, is not his administration’s fault. I’m still anxious to be proved wrong about my Jimmy Carter reference from Inauguration Day.

A cardiologist is sentenced to four years in prison for underreporting taxes he owed on the estimated $40 million he made from day-trading in the late 1990s. He also has to cough up $16 million in back taxes, which must be extra painful since his portfolio went down in flames in 2000 along with the dot-bomb companies in which he was investing.

Billboards sprout up in South Florida as hospitals put up real-time ED wait times along busy highways, elbowing each other for market share of business that they always claim is a money-loser. Fast food restaurants and other businesses that rely on fast service don’t do this, of course, since McDonald’s would be out of business if they couldn’t promise fast service except when the sign says.

Inga did a really good interview with hand surgeon Neil Zimmerman, MD on HIStalk Practice:

But I’m very, very mobile now. I never know when I’m done with surgery. Some days it’s 1:00 p.m., some days it’s 4:00 p.m., but I just said, “Okay, I’m out of here,” because I can take my laptop, or I can even use my home computer and just VPN into our system and I’ve got every piece of paper that I can if I’m sitting in the office. For me, it got me out of the office today — I was done at 1:00 p.m. — it got me out about three hours earlier because I wasn’t sitting doing all my stuff there, which I normally would be, or taking home all those charts.

A preliminary report by the Massachusetts attorney general finds that insurance companies pay some hospitals and doctors twice the rate as others, with the main driver being the clout of the individual providers. “Everybody knows that there is dysfunction in the system, and nobody is happy with it. These rising costs are unsustainable. If we don’t do something about it, the only thing we’ll be able to afford is health care. No one will have money for food or housing.”

Michael Jackson’s father wants UCLA’s medical records pertaining to his son’s death so he can figure out how much to sue someone for. He claims there’s no doctor-patient privilege because MJ was long dead by the time he was taken to the hospital.

A British doctor living in Texas is in trouble for claiming a link between MMR vaccine and autism, which led to a resurgence of measles in England as moms passed on having their kids vaccinated. Lancet published his study that involved only 12 patients, including research in which he paid attendees at his son’s birthday party to give him blood samples. Reviewers say he was dishonest and irresponsible, noting that he was getting lawyer kickbacks from patients suing vaccine manufacturers. On the other hand, there’s a lot of money in traditional medicine that doesn’t want the apple cart upset, so who knows?

E-mail me.

News 1/29/10

From Ex-Cerner Guy: “Re: Yale New Haven. You’re not wrong, just early. Epic will unite all three facilities on a single enterprise-wide platform. Details are being worked out.” I have lots of moles feeding me information, some of them very well connected, so here’s the real story. YNHH recently hosted Epic demos and is actively discussing a system-wide implementation with them, but they are still working out the details and trying to figure out the money issues (back to rumor, someone told me over $150 million). They are reportedly not considering alternatives, possibly due to a strong desire to share data between the hospitals and their practices, which is an obvious Epic strong suit.

From Certifiable: “Re: Sisters of St. Francis. The chain of 10-12 hospitals in the northwest Indiana area has signed with Epic for virtually all applications.” Unverified.

From GoogleWave: “Re: HIMSS10. A Google Wave has been set up. You must have a GW account to access. Search for HIMSS10 and join.” HIMSS is always dabbling with Facebook or Twitter or whatever tech fad du jour their marketing people convince them is cool. I’ll bet money right now that, like its one-time experiment with live-blogging the conference, its Wave won’t be around for the next one.

From Jedi Knight: “Re: HITSP’s ‘wake’. I was there and it didn’t feel particularly sad to me. Everyone is wondering what the successor will be; HITSP2 or some other acronym. Somebody has to turn vague federal mandates into specific implementation guides, after all. My personal feeling is that whatever is next will be a lot more paid employees and fewer volunteers. There is a giant pile of money being dumped in here after all for the beltway bandits and lobbyists to jump into. It’s a shame for the volunteers, but also interesting to think that there is a core group of seemingly salaried standards people from federal agencies and large companies doing all this work. It was also interesting to watch the attendance over the years; a small group swelling to a large group as newcomers were sent in to figure out how to get some ARRA pie. Then, to dwindle back down to the diehards who did all the work.” The government has extended HITSP’s contract until April 30 (without further payment) so it can participate in HIMSS and the Interoperability Showcase. They are trying to convince the board members to stick around until the newly extended end of the line.

From Anthony: “Re: Boxtee. There is also a neat iPhone app for Boxee that allows you to use your phone as a remote for your laptop.”

From The PACS Designer: “Re: Microsoft Office 2010 Beta. If you are contemplating the purchase of Microsoft Office for a new PC, you might want to wait a bit. Microsoft has posted their new Microsoft Office 2010 Beta for everyone to view and also try some new added applications such as Microsoft Office Home and Business 2010.” That’s advice that I will use since I’m on a trial version of Student and Home or whatever the cheap version is called. I don’t have much choice but to either buy or re-install since, in typical Microsoft fashion, its installer assured me that my existing Office XP installation would not be affected, but now I can’t open any of the old versions without getting the dreaded “Preparing to Install” error that means it really did. Be cautious if you try the Beta. Since I don’t often say nice things about Microsoft, here’s one: OneNote is darned cool, although they don’t really seem to understand how to market it since it’s rarely mentioned.

From Mallory Keaton: “Re: showcase. Whatever happened to your idea of having a (not) HIMSS event to showcase selected new healthcare-related technologies? One or two days in a non-expensive setting. It was, and still is, a great idea.” I’m going to reply personally to Mallory, but here’s my problem: I was really stoked about the “unconference” idea, but I have no time between my hospital job and HIStalk. I’m long on ideas, short on time, unless I go part time at work or learn to Halamka-nap instead of sleeping for six hours. I guess I could contract with someone to do the heavy lifting, but that’s another management headache right there.

From JN: “Re: logo. Am I the only person who thinks that your graphic of a presumed doctor smoking a pipe is a little over the top? Do you have any plans to change it?” (a) yes; (b) no. Actually some other folks obsess over the logo (“he’s SMOKING and it’s 2010, for God’s sake”) without seeing the anachronistic 1950s irony that I strongly signaled with the Ben Casey head reflector thingie. On the other hand, I like hearing that criticism because I know I’m getting new readers — the old ones have heard me explain it many times in the past (use the search box to your right to find “reflector” and you will see). My HIStalk Mobile logo guy is not smoking, so at least I’m showing progress.

From David: “Re: Meaningful Use. Do you know where the technical specifications for the quality measures are located?” Some information is in the incentive program document, but maybe someone knows a better source.

From Sinead: “Re: HIT worker shortage. How does the situation bode for us with new undergraduate degrees in healthcare informatics? Is there a place for us without healthcare experience, or are those degrees suited only for currently employed nurses or clinical workers?” I’ve been asked that question a couple of times in the last few days. First of all, you are always better off with more credentials and yours is a timely degree. However, as you noted, when employers look for “informatics” employees, that often means nurses with no formal informatics education (maybe an ANCC certification or 10×100 at best) or perhaps a dabbling doctor, but with hands-on implementation experience and peer credibility. The health systems in which I’ve worked (big ones) did not have formally educated informatics employees that I can recall. Perhaps you have technical experience such as programming or project management? Reader input, please.

The RSVP page for the HIStalk reception at HIMSS is now open. We’ve maxed out signups pretty fast in years past only to have a mountain of leftover name badges of people who RSVP’ed but didn’t come, so please don’t take up a spot if you aren’t sure you can come. Your hosts are Encore Health Resources, Symantec, and Evolvent, so thanks very much to them. I’m not exactly sure what’s on the agenda beyond lots of food and drinks, but it doesn’t matter anyway because the attendees are scintillating on their own.

Hamilton Healthcare System (TX) signs up for applications from Healthcare Management Systems.

eHealth Initiative announces new board members, including Robert Marotta, Esq. of WebMD (chair) and William Jessee, MD of MGMA (vice chair).

The American Occupational Therapy Association is working with Cedaron Medical to develop and EMR and documentation system for OTs.

I’m not a fan of unions, but congratulations to the Teamsters, who get McKesson’s shareholders to agree that the company can’t pay John Hammergren’s family big money when he dies without first calling a shareholder vote. He’s already got $80 million in retirement money socked away on top of his $29 million annual income last year, but his family would have received another $3.5 million at his demise, not to mention another $30+ million in posthumous benefits that aren’t impacted by this new policy. MCK shares are up 139% since he took over in 2001, which isn’t terrible (about the same as competitor Amerisourcebergen) but still behind HIT competitors such as Cerner (up 366%) or Quality Systems/NextGen (up over 2300%).

I am honored to report that Vocera has joined HIStalk Mobile as a Founding Sponsor. David Brooks and I appreciate their support. We have other Founding Sponsors on board to announce shortly. In the mean time, e-mail me your thoughts about the iPad in healthcare, although I’m taking into account that in my January 2007 poll, 84% of you said the iPhone would have little to no impact on healthcare (doh!)

AT&T reports Q4 numbers: revenue down 0.7%, earnings of $3 billion, up 26%. Also announced: the company will spend an additional $2 billion in wireless network improvements this year, it added 2.7 million new customers in Q4, it activated 3.1 million new iPhones, and it’s offering an unlimited iPad data plan for $30 per month.

A couple of readers e-mailed me about the McKesson earnings announcement, wondering if the company is having problems with Horizon Enterprise Revenue Management since they wrote off some of their investment. I’ve e-mailed the CIO at Baptist Health System (KY) to see how well they’re doing as the first go-live, but haven’t heard back. As one reader wants to know, “is HERM following ProFit and Soarian?”

Riyadh Military Hospital in Saudi Arabia will implement Web-based clinical systems from ICT Health.

An interesting Q&A with Dan Rosen, assistant vice chancellor for personalized medicine at Vanderbilt, about its DNA sample database called BioVu and the Vanderbilt Electronic Systems for Pharmacogenomic Assessment:

The second thing we want is for BioVu to act like a giant clinical laboratory. The idea is that we all see the increasing robust science of genetic or genomic variation as ultimately coming to the bedside … It’s a pretty commonly held vision that at some point in the future a doctor will write a prescription and the electronic health system will say, ‘That’s the wrong drug,’ or ‘That’s the wrong dose of the drug for that patient,’ or ‘This particular patient doesn’t have the disease that you think they have because of genetic variations of some type.’ While people talk about that kind of vision, actually executing it presents a lot of practical problems, such as which genetic variants would you actually want to act on? What would be the strength of evidence? How expensive is it to do this? What information technology challenges are there? How do you store huge amounts of genetic data on huge numbers of patients, and access it rapidly?

Also going Epic: Genesis Healthcare System (OH), although the article isn’t clear on whether it’s inpatient, practice, or both.

E-mail me.

HERtalk by Inga

From YellowPad: “Re:iPad. I am interested to hear what HIStalk and its readers have to say about the iPad. I’m not sure why the market needs yet another device in addition to laptops, Kindles, and smartphones. On the other hand, Steve Jobs hasn’t made too many mistakes. My nine-year-old daughter wants one — that speaks volumes.” Like your daughter, I think it looks really cool and I’d love to have one to play with. However, it remains to be seen whether it can achieve widespread HIT adoption given its unique size, its price, and its lack of features compared to a notebook. I told Mr. H that I couldn’t see myself slipping the iPad into my purse on the way to a cocktail party, like I do my iPhone. And I wouldn’t want to use it all day, given the on-screen keyboard. However, if I traveled more, I’d like having one to take on the plane because it would make me look really hip.

From Weird Andy: “Re: $7 million to track down stolen hard drives. Well, yes, I bet there are some other people who think that it is a stimulus. However, instead of having a choice of where the $7M would be used, whether to buy equipment, reduce layoffs, improve facilities, or other options.”  All true, although in this case it was an (evil) insurance company that had the disk drives stolen and is now spending money for damage control. I bet those 700 temp employees aren’t complaining.

Rutland Regional Medical Center (VT) kicks off its $15 million EHR initiative and announces the project’s code name: SNOW (Simple Navigation to Online Wisdom). The project is scheduled to take 19 months to complete. I’m assuming GE is the vendor, since last fall Rutland agreed to serve as a national host site for hospitals considering GE products.

A Dell-sponsored survey by HIMSS Analytics concludes that data center demands for small and medium hospitals will increase 20-50% over the next two years. I’m sure Dell and its investors liked those results.

Valley Medical Center (WA) licenses Sunquest Collection Manager to automate specimen collection. Sunquest also recently installed its LIS and ICE Desktop solutions at employee clinics for the global airline Emirates.

Officials with University Medical Center (NV) say that personal information on traffic accident victims has probably been leaked from its trauma center. For more than three months last year, someone allegedly was selling patient information to personal injury attorneys. The FBI is involved.

McKesson and HP announce they are collaborating to accelerate EHR adoption among independent physician practices. The companies are bundling McKesson clinical and PM applications with HP solutions and including training, implementation, and local support. The program will be executed through HP distributor Tech Data. Good move, I’d say. McKesson seems to recognize that most practices, unlike hospitals, lack the internal resources required to coordinate the technical aspects of an EHR installation. And, despite how popular SaaS is becoming, there are plenty of providers who still insist on an in-house server. Offering a turnkey solution is going to appeal to a large constituency. HP is also a winner here because it’ll have a chance to increase its footprint in the small physician office space, a market where they’ve not been much of a player.

A reader forwarded me this link to a blog compiled by Texas Orthopedics. Several of their physicians and other Texas clinicians are currently in Haiti helping earthquake victims. A few excerpts from real life heroes in action:

• Our team performed around 14 surgeries today with 16-17 in-house patients remaining. The RNs and doctors will be taking turns over night to stay with these patients and take care of them.
• The ORs at the Haitian hospital are like open out houses. Enclosed spaces with slits in the top of the walls to the outside. Our team converted a room into a two-bed OR with AC and an autoclave.
• Today two women were getting their amputations revised, which involves cutting more of the leg off. They had spinals and were in no pain. Both of the women started singing a Haitian hymn while the saw blades were going.
• Dr. Scott Smith from Texas Ortho group is hilarious. He is using his iPhone to entertain the kids in the village. He’s becoming a superstar!

McKesson announces the general availability of its Horizon Practice Plus 12.0 practice management system.

CareTech Solutions is providing healthcare help desk services to Mercy Memorial Hospital System (MI) and just implemented a Service Request Catalog to automate service requests.

Epocrates claims that over 350 medical centers and universities now use its mobile clinical and decision support software.

Odd lawsuit: A woman sues her oral surgeon for leaving an inch-long piece of steel in a mouth wound during a tooth extraction. Despite ongoing complaints of pain, nosebleeds, and sinus infections, she was told her reactions were normal and she needed to stop complaining. Eleven months later, after experiencing numbness and dizziness, she went to the ER and doctors found the metal piece. The steel has since been surgically removed.

E-mail Inga.

News 1/27/10

From Joe: “Re: NIST certification award. As I understand it, this is a contract extension of work that Booz is already delivering, modifying the simulation model for HIEs to test their connection to NHIN. That is the tenuous connection to certification since HIEs are expected to be an information source for CMS and a transfer point for regional hubs.”

From JJ: “Re: shortage of HIT workers. Do you have any information on the workforce situation?” Quite a few studies and SWAGs have been done, all claiming that the industry will grind to a halt due to a lack of experienced informatics people (especially the good ones). I hesitate to name any particular prediction since there are several and they vary widely. ONCHIT has even weighed in with similar conclusions. So while I think predictions on magnitude may differ, pretty much everybody says there will definitely be a shortage as lots of people try to implement systems simultaneously due the HITECH window.

From The PACS Designer: “Re: Boxee. Another cool application has appeared that may be of use to HIStalkers. It is called Boxee and makes linking applications simple. With Boxee and a cable that sells for under $20, you can link your PC to your TV. Even MR. H can link his music on Pandora to his TV!” The folks who designed the Xbox 360 are designing the Boxee Box, which will go on sale shortly at under $200 with support for media of most every kind and some Web pages (Facebook, Twitter, etc.) Until then or as a free alternative, you can hook up your laptop directly to the TV and run the free download (Windows, Mac, Linux).

I ran a anonymous reader’s rumor claiming that Yale New Haven is replacing Eclipsys with Epic (no details were provided). Eclipsys e-mailed to say that is not true. I was at work at the time, so I removed that item pending further research (hard to do since Epic doesn’t issue press releases when they win and Eclipsys doesn’t issue them when they lose, which is why I ran it in the first place because I thought maybe it was commonly known even though Google turned up nothing). I asked Eclipsys for a statement from the hospital and haven’t heard back, but another reader ( not anonymous) said YNH has three hospitals, multiple systems, and outpatient facilities, so Epic could be in play somewhere or maybe nowhere. Anyway, I originally said the rumor was unverified and it remains so, but further information is welcome.

A couple of readers have reported crashing IE8 when opening the HIStalk page. The culprit appears to be the poll to your right, hopefully something to do with JavaScript and not the fact that it is reporting that 2/3 of respondents take a dim view of Microsoft’s involvement in healthcare. Nothing has changed on my end. I only use Chrome and occasionally Firefox, so I had no idea. It’s actually a known issue with IE8 and possibly Win7.

McKesson reports Q3 numbers: revenue up 4%, EPS $1.19 vs. -$1.12 (although most of that prior year’s loss was because of their AWP settlement). That beats Wall Street estimates. Technology Solutions didn’t do so great, with profits down 11%, although some of that was due to amortization of its revenue management product that went GA during Q2.

Q4 numbers for Philips: flat revenue, EPS $0.27 vs. -$1.99, beating expectations. And at Siemens, revenue was down 12%, operating profit up 11% after major cost-cutting.

I am happy to welcome Anson Group of Carmel, IN as a Platinum sponsor of HIStalk. Their Connected Health Practice has a multidisciplinary team of experts ready to help clients commercialize their healthcare products while meeting regulatory requirements. They work with device manufacturers that provide networked devices to hospitals, tech companies submitting FDA 510(k) forms, consumers, and traditional HIT vendors interested in connecting their EMR, PACS, and other clinical systems to drug and device products. The company covers the gamut from FDA, HIPAA, reimbursement, coding requirements, and post-market support for participants in Connected Health. I was interested in their case study describing their work with a university to commercialize internally developed CT imaging technology. Thanks to Anson Group for keeping the keyboards clicking here at HIStalk.

Wednesday is Apple Tablet day, supposedly. Is it an e-book reader? A supercharged netbook that runs iPhone apps? An overpriced version of a form factor that keeps failing? Yet another category killer that demonstrates how well Apple develops products, or perhaps how poorly their competitors do? We will know soon. Speculative rendering above by Wired/CNN.

Huffington Post has an interesting story reminding that when you open up electronic records to patients, somebody’s going to have to explain to them what the heck they are reading. Something as simple as displaying a routine lab result as “abnormal” will freak out some of them (generating anxious, no-reimbursement calls). Hopefully it will work as well as the system my doctor uses, where he adds a comment at the top of each results page to tell me what’s important. That probably takes us full circle back to paper charts, which providers were reluctant to let patients read not because they were secret, but because patients might do something irrational due to their lack of understanding. It’s not much different than trying to decipher that cryptic work order that your mechanic uses when aligning your car’s front end – invaluable to the mechanic, worthless to you.

It’s the end of HITSP, at least for now. The organization’s contract with ONCHIT has run out, although it or its participants will probably resurface in some form. I heard its final lunch this week was billed by ANSI as a celebration, but felt more like a wake because it was the end of the line.

Jobs: Clinical/EMR Project Manager, Misys (Allscripts) Practice Management Expert, Soarian Clinicals – Plan of Care, Application Analyst.

Listening: White Witch, the hardest rocking, most-imitated 70s band you’ve never heard of. The Tampa-based Southern glam/rock band released two albums including a killer debut, opened for big names like Grand Funk Railroad, then broke up. Two of the five former members have died of cancer since 2000, unfortunately making a reunion impossible.

Former BayCare SVP/CIO Lindsey Jarrell joins consulting firm DIVURGENT as a partner. He just won the CHIME-AHA Transformational Leadership Award.

Inga and I keep getting e-mails asking about the HIMSS reception, so here’s a minor change in plans: the RSVP Web page will be activated on Thursday. Don’t worry, sign-ups haven’t started.

On the brand new HIStalk Mobile, we have an editorial on the impact of HIEs on mobility and a fun physician report on How I Use My Mobile Device. If you are a doctor or nurse, why not tell us how you use your mobile gadgets? And while you’re on the site, subscribe to the e-mail updates to stay in touch.

A couple of readers e-mailed that they liked my Marry in Haste, Repent at Leisure: Choose your EMR Soul Mate Carefully editorial, which I appreciate. Since they went and encouraged me, I wrote my next one for Inside Healthcare Computing about the most visible employee of any EMR vendor, called Notice of Proposed Rulemaking: Everybody Must Watch Jay Leno at 11:35 Eastern, a riff on Meaningful Use.

HIMSS Analytics names three new Stage 7 EMRAM hospitals: Citizens Memorial Hospital (MO), Stanford Hospitals & Clinics (CA), and University of Wisconsin Hospital & Clinics. Denni McColm and 74-bed Citizens stand tall between the giants.

Weird News Andy digs up a French-language video showing an inflatable hospital like the ones Doctors Without Borders will set up in Haiti. “No wonder healthcare costs are inflated,” he shamelessly quips.

Brighton Hospital (MI) is discussing a potential contract to manage a 250-bed addiction treatment hospital in Saudi Arabia. Part of the Saudi hospital’s interest is Brighton’s chemical dependency EMR, which Brighton developed with MCS.

Hackers hijack the e-mail accounts of several high-profile doctors in India, sending out e-mails asking friends and patients to send money by Western Union. Several did. At least one of the doctors wasn’t so bright: he got an e-mail claiming to be from Gmail telling him to e-mail back his user name and password or his account would be terminated, so he did.

At a primary care summit in Canada, a Kaiser Permanente presenter says EMRs can improve quality and outcomes, but a Canadian researcher says there’s no evidence to prove it and that Canada’s EMR investments are being driven by vendor profit motives rather than evidence. Interestingly, the Kaiser presenter also said that “none of the things we’ve achieved can be achieved within a fee-for-service healthcare system,” meaning as I read it that even Kaiser questions their value for most providers.

Kudos to Inga, who was prowling around this weekend and found that the online comments about the proposed Meaningful Use rules were visible on HHS’s site. I ran that information with the link Saturday afternoon. At least one publication ran it as “breaking news” Monday, although it was not mentioned how they obtained that bit of intelligence.

Two former owners of City of Angels Medical Center (CA) will pay $10 million to settle a lawsuit for paying recruiters for bringing in homeless people for unnecessary medical treatment that was billed to Medicare and Medi-Cal.

E-mail me.

HERtalk by Inga

BCBS Tennessee says it has spent over $7 million in response to the October theft of 57 old computer hard drives, including hiring more than 700 contractors to determine what data they contained. The drives, which were taken from an abandoned office and scheduled for permanent disposal, contained personal financial and clinical detail on as many as 500,000 individuals. I realize that identity theft is serious business, but am I the only who appreciates the “economic stimulus” that has resulted from this theft?

RelayHealth and Craneware team up, with Craneware adding RelayHealth’s eligibility verification functionality into Craneware’ Patient Charge Estimator.

Day Kimball Healthcare (CT) selects athenaClinicals and athenaCollectorM for its network of 200 physicians.

Mountain States Health Alliance signs an agreement to implement Schedule Maximizer and Order Facilitator from SCI Solutions. Mountain States will use the SCI products to support centralized scheduling across nine of its Tennessee facilities.

Virtual Radiologic releases its 2009 financial results, highlighted by a 13% jump in revenue to $121 million. Adjusted EBITDA grew 34% to $27.6 million.

HealthGrades releases its annual Hospital Quality and Clinical Excellence study and concludes the top 5% of hospital have a 29% lower risk-adjusted mortality rate. The top hospitals also had a 9% lower risk-adjusted complication rate. HealthGrades claims that more than 150,000 Medicare patient deaths and 13,000 in-hospital complications could be avoided each year if all hospitals performed as well as the top 5%. The complete list is here.

Healthland appoints Julie Weber-Kramer to the role of VP of client experience, meaning she’s responsible from the Healthland client relationship from initial contact to ongoing support. Most recently she served as a professor of management at the G. R. Herberger College of Business at St. Cloud State University.

Emdeon acquires FutureVision Technologies, a provider of electronic data conversion and information management solutions. Using FutureVision’s document conversion technology, Emdeon will be able to electronically process all patient and third-party healthcare agreements regardless of the format. Emdeon paid $20 million in cash at closing and may pay as much as $40 million more, depending on FutureVision’s financial performance over the next three years.

Continuum Health Partners (NY) plans to expand its partnership with Duane Reade drugstores. Over the last two years, Continuum has placed physicians in Manhattan walk-in medical clinics located within Duane Reade pharmacies. Both companies say the arrangement has gone better than hoped and another 20 clinics will be added over the next year. No money exchanges hands between the two companies. Instead, Duane Reade benefits from increased retail sales, and the hospital system offers follow-up appointments at its own facilities. The companies believe that having clinics staffed with physicians, rather than PAs or nurse practitioners, is one reason for the arrangement’s success.

SRS names David Thomas to its Board of Directors. Thomas is the former chairman and CEO of IMS Health and a 28-year IBM veteran.

As Mr. H mentioned, I touched base with a few sponsors last week. Here are a few more updates:

• Greenway Medical says that over the last year, more than 30 healthcare systems, PHOs, and IPAs have selected its PrimeSuite for their employed or affiliated physicians. New clients are  include the 1,400-member IPA Genesis Physicians Group (IP), Detroit Medical Center, and Bloomberg Health System (PA).
• Huntzinger Management Group just released its first-ever newsletter. If you have yet to memorize all the ins and outs of Meaningful Use and ARRA, I found this article quite comprehensive. The Huntzinger folks included timelines, calculators, and clarification on what performance measures are required for which years.
• maxIT is offering a MEDITECH Meaningful Use / Stage 6 Success Story webinar on Thursday, February 4th at 2:00 EST. More details here on how maxIT has helped organizations successfully complete a Meaningful Use implementation.
• ICA has just revamped its Web site and it looks very Web 2.0ish (2.0 is still hip, right? If not, then replace “2.0” with “user-friendly and sleek.”) While you are admiring the site, you might also want to peek at their new white papers that highlight what ICA is all about and how they are helping organizations roll out EHR. ICA will have a booth at HIMSS and will be demonstrating the interoperability between ICA’s CareAlign system and Sevocity.
• The Intellect Resource folks are putting together a number of Blog Radio Productions called IRBeat. The latest recording includes a conversation with Treff LaPlante, the president and CEO of WorkXpress, and discusses cloud computing and its impact on the HCIT industry. Coming soon is a chat with Lisa Disselkamp, one of the industry’s leading workforce management technology consultants and president of Athena Enterprises.

When an article has headline like this, how can one not be compelled to read the details? Seems as if the San Diego-based company Histogen has discovered “the cure” for baldness, but operations are a bit stalled due to a lawsuit. Apparently another company thinks Histogen and its execs stole proprietary hair growth secrets. Meanwhile, millions of men are left suffering. Personally, I hope the cure is never found. When it comes to sexiness, I think a shiny bald head may even beat out a pair of Christian Louboutin high-heeled pumps.

E-mail Inga.

Monday Morning Update 1/25/10

From Cannondale Guy: “Re: ACS. Xerox buys ACS. Xerox headquarters are in Connecticut. Hospital of Central Connecticut dumps ACS. Not a good way to start, I’d say.”

I’ve closed the HISsies, so if you voted, thanks. Winners will be announced at the HIStalk reception at HIMSS. I’ve invited some of the winners to speak, but history has prepared me for rejection.

Thanks to CynergisTek for joining our happy little band as an HIStalk Platinum Sponsor. The Austin, TX company offers general and healthcare-specific security services that include audit, compliance, information security, and infrastructure services. Some of their specific offerings that would make a good first step include vulnerability and penetration testing, Web security assessments, security tool selection, independent risk assessment, disaster recovery testing, and business continuity planning. Check out the experience of the executive team (I think I may have run across COO/CTO Mike Mathews, PhD at some point when he was CSO of Parkland). Thanks to CynergisTek for supporting HIStalk and its readers.

I guess this is one of those “kissing your sister” results that satisfies nobody. New poll to your right, triggered by Steve Ballmer’s visit to Nashville: when you think of Microsoft’s involvement in healthcare, is your overall impression positive or negative?

An Oregon psychiatric hospital will spend $25 million on a new computer system from Netsmart Technologies.

You vendor types will like this reader-recommended video on the consumer equivalent of contract negotiation. My favorite line: “We can do this!” The follow-up video on marketing people designing a stop sign is also funny, especially the perky but clueless blonde.

Albany area hospitals weigh in on ARRA in the local business paper. Their concerns: penalties are just five years away, implementation takes time, insurance companies are not ready for electronic eligibility checking, and the requirements are all or none.

Inga figured out how to view the comments that have been left so far about the proposed Meaningful Use criteria on HHS’s site. Only a couple of dozen have been posted, although that’s just one method of sending feedback to HHS. One I liked came from Christine Sinsky, MD, who previously wrote an AAFP opinion letter advocating technology, but not necessarily the current generation of EMRs:

I am concerned that the current emphasis, promoting adoption of existing EHRs, with little focus on the need to make EHRs better, will ultimately slow innovation. Subsidization of the EHR industry and allowing vendors to lock up the EHR marketplace with existing products will set us back in the long run. With six years experience using an EHR in both the inpatient and outpatient settings as a primary care physician I have trouble reconciling the high expectations for improved patient care and physician efficiency with my own experience. Usability is the Achilles heel of current EHRs. An EHR may meet all of the functionality requirements and yet be so burdensome to use that patient care is made more difficult. At this point we don’t need more EHRs, we need better EHRs.

Janeen Cook, our pen pal HIT marketing VP turned nursing student, is in a class contest for getting YouTube hits. You can help the “old lady in the class” (as she calls herself) “look cool to all the 20-some-year-olds” by watching her video on “Why Nursing is the Career for You”. 

Syed Tirmizi, MD, a VA physician and informatics expert, joins Quantros as VP of international business development and government relations.

IP5280 Communications acquires Denver-based CEWest Consulting, Inc., a vendor of data and voice over IP services to healthcare organizations using hosted EMRs, telemedicine, and videoconferencing.

GE Healthcare announces Q4 results: revenue down 2%, earnings down 3%, but Jeff Immelt says it was the strongest quarter since Q3 2008. GE itself had a 19% drop in Q4 earnings, but gave an upbeat forecast.

Sen. Charles Grassley, interviewed by an Iowa radio station, is asked about his letter to hospitals regarding technology:

There’s two reasons for doing it. One is, $19 billion is a lot of money, and that’s probably not all we’re going to spend on it. Some hospitals have had some experience in information technology on their own initiative without federal law and without federal money. And we want to know how it’s going, learn from any mistakes that are being made, so when we continue to spend more money and expand this program, we know that — that we can learn from the mistakes of the past. The other one is to check to see on the wise use of money, and then I suppose I’d better add a third one, and probably a third one is as important as the first two, because we’ve had some questions about interoperability of various software and systems set up. So if you’re going to have a medical technology information system, so when you’re in Algona in the — in the summer and you need a doctor, but you’re in, let’s say, Arizona in the winter, and you have a different doctor down in Arizona, but you want full access by both doctors to whatever’s done to you in the respective places, that that information is — is available. So it ought to be available wherever you are with whatever doctor or hospital you’re involved in and that you give them permission to use this information to know more about you, how you’ve been treated elsewhere. So if it’s not interoperable, that’s a problem. So we’re just generally trying to be ahead of the curve as we get further into more medical information gathering and computerization of it.

VC firms invested $7.73 billion in healthcare companies in 2009, including a jump in healthcare IT investments from $363 million in 2008 to $498 million.

Expect more of this as HITECH money pushes doctors into buying software for which they are not prepared. Several Florida physicians, lured by a reseller’s promise of ARRA-funded billing software, complain of unauthorized charges and a training session that lasted only one day. The reseller says the doctors “are all in a clique together” and sends cease-and-desist letters to prevent them from going public with their gripes. His trainer says the doctors didn’t know how to use computers and seemed scared to use a mouse. Even one doctor whose got everything free because she’s a former TV reporter was so unimpressed that her promised product endorsement wasn’t enthusiastic enough for the reseller, so he denied her access to her patient records on his server and sent her a software bill. Maybe Chuck Grassley should talk to them.

A hospital in Scotland suspends a nurse after colleagues spot Facebook pictures of patients undergoing surgery.

David Blumenthal is interviewed by InformationWeek. What he said: (a) he wants to see lots of comments on the proposed Meaningful Use criteria; (b) ONCHIT will be considering recommendations to simplify NHIN so that less tech-savvy providers can use it; (c) ONCHIT’s focus now is on creating a certification process, setting up NHIN governance, and finishing the Meaningful Use criteria; (d) on CCHIT, he said, “We’ll have to see what the regulation actually is and see where CCHIT fits in. CCHIT is clearly going to have the option to participate in certification going forward, but I can’t tell you what role exactly it will play.”;  (e) he suggests that reported shortages of healthcare-trained IT people can be mitigated by bringing in technical people with no healthcare exposure.

Strange: the former mistress of a high-ranking Oracle executive goes public in a big way, buying a three-story sign in Times Square and two other cities featuring a photo of the pair and the inscription, “You are my soul mate forever.” The potential successor to Larry Ellison, who made $20 million in 2009 and owns $80 million in Oracle stock, admits his indiscretion with the “writer and actress”.

United Health Group’s Q4 numbers: revenue up 6.5%, EPS $0.81 vs. $0.60.

I write regular editorials for Inside Healthcare Computing’s electronic news update, visible to subscribers only. The publisher really liked this latest one and suggest running it on HIStalk.

Marry in Haste, Repent at Leisure: Choose your EMR Soul Mate Carefully 
By Mr. HIStalk

Too much Meaningful Use has led me to Meaningless Musing. Here’s where it took me: the same handful of wrong reasons that convince people to marry unwisely also convince them to buy EMRs that will make them unhappy. 

Let’s start with lust. A good-looking partner often leads to hasty and ill-advised EMR marriages. Providers swoon over the slick, sexy sales demo of an EMR that seems cool and popular. They can’t wait to get legally hitched and embark on a lifetime of what they expect to be never-ending passion and soul-mating, flinging themselves at each other several times a day.

Once the vows are said and the papers signed, the romantically foggy lens they’ve been looking through clears shockingly. In the unforgiving harsh light of day, the sultry enigma turns into an endlessly argumentative pest, or maybe a hot mess looking for company in their downward slide. Your new EMR is Bobby Brown to your Whitney Houston.

The most in-vogue reason to marry an EMR is cold, hard cash. Certified EMRs come with a taxpayer-funded dowry. Golddiggers rationalize that it’s just as easy to marry someone rich as it is someone poor. You are Anna Nicole-Smith, trying to work up lustful yearnings for a billionaire who is 63 years your senior. And like Anna, EMR users may not live long enough to enjoy the fruits of their connubial labors. Once your $44,000 has been spent, you still have to enter orders and pay larcenous tech support rates for hardware maintenance.

There’s also the shotgun wedding, although that’s a hopelessly dated concept now that society’s moral linkage between parenthood and marriage has been fully disengaged. Still, HITECH-seeking hospitals and practices are sure to push doctors and EMRs together despite their inherent incompatibilities, unwilling to take no for an answer when ARRA money is on the line.

My college roommate’s mom had wise advice, triggered by his ill-disguised lust for all things female and fearing he would sully the family home by marrying the pregnant, drug-using dropout that he found endlessly fascinating (she even had a tattoo, unheard of back then). His mom told him to picture a person who is horribly disfigured and wheelchair-bound after being burned in a fire, requiring his constant care and attention. Would he still be happy to spend the rest of his days with that person? If not, she isn’t the one. She wasn’t, apparently.

If the sweet young thing of an EMR that’s catching your eye becomes old, cranky, or unreliable, would it still be attractive once the money is gone?

Doctors should not be shamed into EMR marriage because of societal pressure (all the other doctors are getting hitched), age (being an EMR spinster isn’t all that shameful), or lust (you can get free milk without buying the cow by messing around with computers as a hobby instead of actually using them in practice, i.e., like informatics doctors do).  

Ditto getting EMR betrothed because you want a big wedding (the vendor’s celebratory dinner) or to rebound from a bad previous marriage (the EMR you de-installed because the vendor was unresponsive).

Breakups are ugly. They involve a lot of ill will, money, and wasted time and energy. Like they say, marry in haste, repent at leisure.

The right reasons to get EMR nuptialized is that you’ve finally found that special lifetime companion with whom you want to spend every waking minute, the one you admire, that special person with whom you will grow together, and that soul mate with whom you will share intimate thoughts through good times and bad. For better or for worse, for rich or for poor, till death (or vendor insolvency) do you part.

I bet my roommate’s ever-practical mom would add one last item: just on the off-chance that you’ve chosen unwisely, get an ironclad pre-nup.

E-mail me.

News 1/22/10

From All Hat No Cattle: “Re: Senator Grassley. He’s at it again, asking hospitals about their experiences with EHR vendors.” Huffington Post Investigative Fund reports that 31 hospitals and health systems were sent a letter this week that asks about software problems and vendor responsiveness to them. It’s vague, open-ended stuff that will be hard to interpret. He also asks about any vendor-provided incentives for product purchases, citing two unremarkable examples: discounts based on contract size and shared royalties for co-development. Recipients are asked to respond by February 16.

From The PACS Designer: “Re: new iPhone features. As the iPhone gets more widely used by all segments of our economy, new features could make the iPhone a universal access device for healthcare. InformationWeek is reporting on a comment made by GoldmanSachs that the next feature to be announced later this year is a new touch feature involving motion using hand movements on the iPhone case to create commands similar to using a touchpad on laptops.”

From Capo DiTutti: “Re: HIStalk reception at HIMSS. Tell Encore that the Georgia Dome may be a more appropriate venue for the hoards of like-minded, sardonic skeptics that are drawn to your straight-up commentary. LOL.” I used to be ashamed of my cynical side, but then I realized that while it’s those glass-half-full go-getters that get stuff done, they need a real-world foil to their obnoxious, exuberant optimism and I’m just the person to provide it. The reception, since I keep getting e-mails from folks wondering if they’ve missed the announcement, is Monday, March 1. The RSVP page will go up early next week.

From Rumeister: “Re: a Washington hospital. They get poor grades on a vendor’s audit.” He or she sent over the full client assessment document from the Eclipsys Assessment Team. I have to say that the Eclipsys people did a great job, avoiding the consulto-babble and laying it out nicely without resorting to PowerPoint slides. They got into the details: charge on dispense vs. charge on administration, nursing use of the Sunrise messaging function, security groups, flowsheet setup, handling removal of Q72H patches, and ED setup. The hospital has work to do, but I am impressed with the logical, calm manner in which the ECLP people laid it out.

From Joe DiNardo: “Re: Connectathon. It was great seeing bright system engineers from very competitive companies sitting arm to arm for days working together as a team to solve health care’s ills.”  They are my kind of people, revved up by piles of conference-sized non-decaffeinated soda in the picture. I’ve said it before, but I’ve seen few problems techies couldn’t solve if the suits were locked out of the room. The nerds are naive enough to solve problems, while their bosses fret and posture about why improving healthcare might be bad for their personal or corporate bottom line.

From HISWatcher: “Re: Eclipsys. It let go of VP of marketing and sales readiness, with more changes on the way as sales once again plans to reorganize.” Unverified, so I left the name out.

From Billy Bathgate: “Re: HL7. Like Tide’s ‘New and Improved’, HL7 changes its name and nothing else. It was a lost chance to come up with something catchy, like InfoStandards International.” In a wild and crazy moment, Health Level Seven radically changes its name to Health Level Seven International. I had to look up where the original name came from – according to Wikipedia, it was the seventh application layer of the OSI reference model, which smug network types recite reverently at every social opportunity (generally few in number in their case). Both the old and new name are constantly misspelled, forgettable, and meaningless to non-geeks, so I agree they could have done better, like opening it up to an HIStalk reader contest.

From Pedro Fumar: “Re: KLAS. Adding the KLASroom, an online community for discussions and the latest blogs from KLAS researchers.” Sounds swell, although I can say from painful experience that getting and keeping readers is hard. Getting them to interact just because you put up a forum to do so is even harder. Everybody and his brother is starting up sites, some of them using the sincerest form of HIStalk flattery, so readers have lots of choices of varying usefulness.

From Lemmy: “Re: Harvard Vanguard. Not a rumor, the official announcement of the new CIO, the fifth in three years.” The internal e-mail says Harvard University CIO Dan Moriarty has taken the CIO job at Atrius Health and Harvard Vanguard.

From North of the 49th: “Re: air travel like healthcare video. The concept works but the video is too long … kind of like the wait time to see a specialist.”

  

Betty Otter-Nickerson, former COO of the Lance Armstrong Foundation, is named president of Sage Healthcare Division. That news just came out, so I don’t have a link yet. Nasty Parts said in mid-November that the company was interviewing for the spot.

Inga conducted her Operation Reach and Touch Our Sponsors, checking with some of those we don’t often hear from to see what’s new:

• SCI Solutions has several Webinars available for folks interested in access management. Also, Marta Kosarchyn, former product development director at Intuit, just joined the company as director of engineering.
• CAP STS has posted its 2010 education schedule, including its free SNOMET CT Basics Webinar.
• BridgeHead Software will exhibit at the HIMSS Europe’s World of Health IT in Barcelona, which I believe is in March. They will also exhibit at the HIMSS conference with a partner, so we will get specifics later.
• Intellect Resources is on Twitter, offers daily news, and has job openings online.
• Greenway is offering a January 27 Webinar, EHR “Meaningful Use” ~ How to Optimize the EHR Opportunity in your Practice.
• Vitalize Consulting Solutions, Inc. has been named a PMI Registered Education Provider, allow it to provide project management training.
• Wellsoft just issued its winter newsletter (warning: PDF) that includes news of its Best in KLAS ranking, a new medication verification module, an upcoming e-prescribing module, and several new and add-on customers.

   

Here’s an unusual way to wreck your day. A Virginia doctor working in his office hears what sounds like an explosion in his exam room 10 feet away. He checks it out and finds that a meteorite has crashed through the ceiling.

GetWellNetwork announces availability of new version of its patient care system. New features: a nursing dashboard, medication teaching, integration of the pain management interface with bar code verification and paging systems, and a patient orientation function that comes up when the TV is first turned on.

Science has a nice piece on informatics careers in translational and clinical research. It’s a good overview without being fluffy. Bill Hersh of OHSU is quoted and linked.

PeaceHealth will lay off 38 transcriptionists, shifting their work to domestic transcription companies. Said the CFO: “When I opened the meeting, I just wanted to thank them. When I closed the meeting, I just wanted them to go away.” OK, I may have made up that second sentence. I’ve been watching old Mystery Science Theater 3000 episodes, so I can’t resist riffing.

Interesting sleuthing: did the chair of the Kansas Republican Party (who is also a Cerner employee) donate $5,000 to the campaign of a Democrat at Cerner’s behest? That reminds me of my previous hospital employer, which strong-armed executives to make political donations (we had to write the checks out to the candidates, but give them to a hospital person to mail in a single envelope to make sure the candidate knew whose back to mutually scratch).

Microsoft CEO Steve Ballmer, speaking to HIT executives in Nashville, seems positively radiant about the healthcare technology market. “I’m optimistic. The money is coming. The national debate has been engaged.” I guess it’s too late to stop the money, but the national debate isn’t exactly going as planned as the approval rating of the budget-busting President heads steadily south, especially disappointing if you don’t like Newt Gingrich since I bet he’s itching to take him on after seeing Ted Kennedy’s seat won by a Republican. Anyway, Ballmer was asked about why healthcare is technologically behind and gave every answer except the right one: technology benefits everybody except the person who has to pay for it. Also announced was $1.25 million in grants (not federal ones, shockingly) to Tennessee nonprofits, with Microsoft donating $1 million in software (theirs) and HCA chipping in $250K in cash (theirs).

CCHIT’s Mark Leavitt cranks up some commentary about NIST’s award of a $400K contract to Booz Allen Hamilton. I didn’t exactly understand his conclusion, but I think he’s saying that the nature of the contract involves certification policies and procedures, not actually getting involved with certification.

Healthcare Growth Partners has released its latest Transaction Report, which you can download here.

Listening: nothing lately since I’ve been too busy, but I am watching Arrested Development DVR’ed from IFC and liking it a lot.

Weird News Andy notes this article, in which a man’s iPhone was literally a lifesaver. He was buried in the rubble of a collapsed Haiti hotel, used the iPhone’s light to check out his injuries, and then punched up a medical app for instructions on how to stop his bleeding. He was pulled out 65 hours later.

Strange: a Massachusetts school nurse giving employees what was supposed to be H1N1 vaccine instead mistakenly injects them with insulin.

QuadraMed announces that its identity management and HIM solutions earned #1 and #2 rankings, respectively, in the 2009 Top 20 Best in KLAS.

Sunquest announces that its Integrated Clinical Environment physician portal will be available this year.

All I could think of when reading about ultra-clueless NBC executives bungling their way through their self-inflicted Jay-Conan tribulations: this is the same GE that sells critical medical equipment and software.

E-mail me.

HERtalka by Inga

From MarlboroMan “Re: no smokin’ at Memorial Hospital. Just a reflection that you’re probably too young to recall. When I was working in respiratory therapy in the early 70s in Atlanta, the Seventh Day Adventists built a beautiful circular, state-of-the-art hospital. They started staffing, but had a rule that no one, neither patients nor staff, could smoke on premises and no coffee to tea would be served. If memory serves, they were unable to find enough staff (especially on the 3-11 and 11-7 shifts) to open the hospital. It was eventually sold. How times have changed (for the good).” No way I could have worked there, Starbucks fan that I am. MarlboroMan also reminded me that way back then (way before my time) Maxwell House ruled the coffee pots and most coffee was served from vending machines. Oh my.

Northeast Alabama Regional Medical Center selects Allscripts EDIS for its emergency department.

Boston Business Journal names athenahealth one 10 Boston-area Businesses of the Decade, recognizing its solid growth and innovation.

CCHIT updates its 2011 certification requirements to reflect the latest changes in the interim final rules. For vendors who have already qualified for 2011 CCHIT certification, CCHIT will offer incremental testing at no charge.

FirstDataBank licenses its drug information and associated development software to Surgical Information Systems. The arrangement will allow SIS to integrate drug screening, dosing, and documentation into its perioperative software.

Siemens Health veteran Mark Lusser is appointed SVP of global sales and services for Carestream Health. Carestream also announces it received accreditation to be a wholesale distributor from the National Association of Boards of Pharmacy.

Hyland Software develops a new version of its OnBase document imaging and management system for hospitals running Meditech systems. These are the guys that always have the baseball theme booth at HIMSS, right? If so, they’ve always struck me as a fun bunch.

Since I’ve never plastic surgery (really!), I’m wondering if I’d be more inclined to get nipped and tucked if my first consult was via the Web. The docs with Surgeonhousecall.com are hoping that the anonymity of the Internet might encourage some patients to seek a virtual conversation with a plastic surgeon and discuss surgery options. Potential patients can chat via Web cam with three different surgeons who will recommend a course of action, complete with price.

Mr. H had me on special assignment today, so my post is a bit short. My virtual conversations will resume next week.

E-mail Inga.

News 1/19/10

From Garnut: “Re: Michael Blackman. The former Berskshire CMIO moved to Charlotte to become CMO of McKesson Paragon, which got 42% of the small hospital market last year. He started today.” Unverified.

From Dr. Know: “Re: unfortunate rumor. [name omitted], CIO has come clean about an affair with one of the VPs he hired, [name omitted]. The buzz is all over the vendor community. She may be leaving, but I’m not sure if he gets the hook. Too bad, because he has some good accomplishments under his belt (no pun intended).” Obviously I can’t name names in the absence of real news (like if he quits), but maybe there’s a lesson in there somewhere.

From Anonymous: “Re: Epic Haiku. Complaints submitted / About the Haiku app should / Be in proper form.” Nicely done – 17 syllables exactly.

Weird News Andy contributes some non-weird research on charities with a presence in Haiti. He turned up Food for the Poor, which gets high marks from Charity Navigator, Ministry Watch, and Forbes with only 1.7% fundraising overhead. My charity of choice is always Salvation Army, so that’s another option.

An Indiana angel investor group invests in PolicyStat, an Indianapolis-based vendor of a policy and procedure management system.

Just a reminder: if you are on the HIStalk e-mail list, I’ve sent you two e-mails with a link to the HISsies 2010 survey. A couple of readers who didn’t see the e-mail asked for one final reminder, so I’ve sent that Tuesday evening. Thanks for voting! To prevent ballot box stuffing, only those on the e-mail list get a ballot and they get only one vote. I’ve peeked at the results so far and, as always, they are pretty interesting. Hopefully we can get a winner or two to join us in Atlanta for the HIStalk reception. The RSVP page for that will open up next week, by the way.

It was a short stay at IBM for Janet Marchibroda, who joined the company this past April as chief healthcare officer after a long stint as the founder of eHealth Initiative. Sources tell me she has taken a job with the Office of the National Coordinator, i.e. David Blumenthal, at what must have been a gigundous pay cut.

Coincidentally (as far as I know), Janet’s former employer eHI announces its new CEO, Jennifer Covich Bordenick. She has worked there since 2001, most of it under Janet as COO.

Inga’s series of questions and answers with several executives of EMR vendors about Meaningful Use continues in HIStalk Practice. In the series:

Were the criteria a surprise and will they require product changes?
Which criteria will physicians find hardest to achieve?
What kinds of practices will hit the 80% CPOE threshold?
Is clinical decision support and interoperability emphasized enough in the proposed criteria?
How will providers give patients electronic copies of their visit information?

This video would have been more effective if edited down by about 70%, but what do you think?

Complaints about Epic are not too common, so several readers sent over the link to a newspaper article describing staff gripes about the $61 million Epic implementation at University of Iowa Hospitals. On the list: the system takes too long to use, support is spotty, information is missing, and lots of useless information is generated. They went live big bang in May, migrating off a homegrown app (always hard since those systems could be made to do whatever harebrained task users demanded), so I don’t think I’d put too much stock in the early complaints of a few users.

A couple of Massachusetts hospitals offer the Dossia PHR to a subset of their employees.

Several people have e-mailed me about more coverage of enterprise mobile technology in healthcare. I’m no expert in that topic, but I found someone who is: David Brooks, a co-founder of MercuryMD and the creator of a very cool and professional Mobile Resource Guide that has been downloaded something like 60,000 times strictly by word of mouth The result is HIStalk Mobile, which we’re just bringing up in soft opening mode. David will follow the tried and true HIStalk formula of news, rumors, opinion, and maybe the occasional cynical snark. We will also be cranking up a supercharged, online version of the Mobile Resource Guide shortly. Sign up on the site for e-mail updates if you are so inclined, and if you are an end user of mobile technology (especially the clinical kind), we might want to interview you about what you’re doing.

With the holidays behind us, I see quite a few new submissions to the HIStalk events calendar, to which you can add yours free.

Microsoft CEO Steve Ballmer will lead an HIT panel discussion in Nashville on Wednesday. A connected HIStalk reader invited me to attend, but I can’t get off work.

The Valley Hospital (NJ) promotes Eric Carey to VP/CIO.

Simon Samaha, MD is appointed to the New Jersey Health Care Facilities Financing Authority.

Former Aultman Health CIO Martin Tursky is named VO/COO of Memorial Hospital of Rhode Island.

In what could be the first CCHIT domino to fall, NIST awards Booze Allen Hamilton a $400K contract to help it create testing and certification tools for EMRs.

Stanford Hospital and Clinics is involved with the Personalized Medicine World Conference, running now in Mountain View, CA. Attendees were “investment bankers, investors, attorneys, accountants and entrepreneurs,” so that pretty much says all you need to know about the business aspects of US healthcare.

Former VA head Sumner Whittier, who installed the agency’s first computer in 1959 (all 6,200 square feet of it) dies at 98.

Sad lawsuit: the family of a patient who died in a New Orleans hospital when Hurricane Katrina knocked out power to her respirator is suing the hospital for $11.7 million, claiming employees were negligent in not preparing for the disaster.

E-mail me.

HERtalk by Inga

From Intelligence-R-Us: “Re: reporting and IT stimulus package. Based on the new proposed guidelines, it’s clear that there are many reporting requirements that hospitals will be compelled to adhere to in order to qualify for funding. Each data source will exist in the form of certified systems, but hospitals will still lack the holistic reporting engine that can bring them all together to meet the requirements for the stimulus funds. Do you think that CIOs share this understanding?” In the last week or so I’ve talked to several CIOs, all of whom have understood the need for more advanced reporting. In fact, a couple admitted that their current systems lacked the required functionality and stated that they will need business information tools to capture the data. So, yes, at least some CIOs understand their reporting gaps and will be seeking new BI tools. However, I would also add that many facilities are probably even more concerned with getting the basic infrastructure in place and are not yet ready to address the reporting aspects. After all, you can’t do much reporting if you don’t have the data.

From Pink Panted Trey: "Re: Huntington Hospital. FYI … this is a direct result of HIStalk. I asked the CIO how he found out about us and it was HIStalk! We are currently installed at three sites and all three CIOs follow your Web site. Amazing!” Trey forwarded the latest press release from Voalte, announcing that the nurses at Huntington Hospital (CA) are now live on its application.

Memorial Healthcare System (FL) selects Axolotl’s Elysium Exchange to network their hospitals’ IT systems with the EMR in community physician offices.

Congrats to HIE provider Medicity, which announced a 91% increase in bookings in 2009 versus 2008. Medicity’s five-year revenue backlog also grew 35%.

I particularly enjoyed yesterday’s Readers Write, which included Tiffany Crenshaw’s Lessons Learned From Our Top 10 Infamous Interviewees. Some of those people sounded familiar. I’d add a Number 11 — the Limp Handshaker. I recall several years ago interviewing a gentleman who was 10 or 15 years older than me. When we first shook hands, I shuddered because he gave me one of those limp-wristed handshakes. You ladies in particular know what I mean –  it’s that handshake where the guy barely squeezes your three middle fingers, as if the he’s scared he will crush your delicate hand. I learned later than when he shook the hand of my male co-worker, he gave him a regular “guy” handshake. I gave him two more chances to shake my hand as I booted him out the door and his follow-up attempts were no better. Perhaps it was a cultural thing or an age thing, but I sure wasn’t going to hire a guy who even unconsciously saw me as the weaker sex.

Starting next month, Memorial Hospital (TN) will no longer hire people who use tobacco products. Potential employees will be tested for nicotine during a required drug test. The hospital, which is part of Catholic Health Initiatives, claims its move is not about saving money but about the hospital’s commitment to health. The rule does not apply to existing employees. It’s a slippery slope to ban employees for personal habits, but I applaud the move nonetheless.

IB-Salut regional health services in the Spanish Balearic Islands implements Picis Critical Care Manager and PACU Manager at Hospital Can Misses in Ibiza. Sure looks like a nice place to visit. Anyone know what famous person was born in Ibiza?

Molina Healthcare agrees to acquire the health information outsourcing business of Unisys for $135 million in cash. This segment of Unisys provides outsourcing for several Medicaid systems.

eClinicalWorks signs a big order with Summa Physicians (OH) to provide EMR for its 223 physicians. Summa Health Systems is already an eCW client, having contracted with eCW in 2006 to provide EMR and PM solutions for its community physicians.

The Bureau of Labor Statistics says that mass layoffs of hospital staff will hit an all-time peak when the final 2009 number are tallied. Prior to December, there were a reported 145 mass layoffs (which is defined as a layoff of more than 50 people from a single employer). Unfortunately, economists are not ready to predict that the mass layoffs are over.

Meditech is integrating Micromedex CareNotes Systems from Thomas Reuters into four of its applications.

Microsoft announces a collaboration with Premera Blue Cross to integrate HealthVault with paid claims data. Premera provides coverage for Microsoft employees, so the partnership makes good sense. Now I am curious what percentage of Microsoft employees use Healthvault themselves.

Kronos announces the general availability of its Workforce Mobile Scheduler. This actually sounds pretty handy. Managers can broadcast a text message to the mobile devices of employees qualified to fill an open shift. Once an employee accepts the shift, it is automatically assigned and another message informs employees the spot is taken.

MRO Corp adds DeKalb Medical (GA) and St. Luke’s Hospital and Health Network (PA) to its customer base. Both have contracted to implement Audit Tracker Online.

Misys Open Source Software (MOSS) successfully tests its Connect Exchange application at the Chicago IHE Connectathon. MOSS representatives say it is the first time all the software needed to exchange electronic files in a healthcare community will be made freely available in open source.

Here’s a cool idea. At the American Association of Neurological Surgeons meeting, doctors will be given iPod touches pre-loaded with all session information, summaries of research presented at the meeting, and vendor information. Doctors will also be able to use the iPods to message and interact with presenters during meetings. The Association says the perk increased registration fees by $100. But they’re neurosurgeons, so I’m sure they can afford it.

E-mail Inga.

Monday Morning Update 1/18/10

From LargePop: “Re: David Brailer comments on HITECH. He says he thinks Congress will back down on penalties. He also says we’re approaching the peak of the hype cycle and will slide back to reality once we see how slow the money comes from CMS.” Also interesting: he thinks it was wrong to dump healthcare IT into ARRA, saying it puts too much risk into adoption (I assume he means the accelerated timeline).

From Haiku: “Re: Epic’s Haiku iPhone app. It’s piece of junk, hiccupping and having connection issues. Epic needs to go back to the drawing board.”

From ChrisF: “Re: Extormity. Any chance you could get an interview with CEO Brantley Whittington?” I don’t know how I’d arrange an interview with the fictitious CEO of a fictitious company put up as satirical Web page by unknown individuals, but if I can figure it out, I will do so. Or, perhaps its equally fictitious CMO: “I may have graduated last in my class at the Medical School at Universidad de Guatemala, but the parchment still says MD” whose value is described as “Bartram’s recollections of practicing medicine bring a real world perspective to Extormity products and services.”

From KayBee: “Re: Picis. I’m shocked by how often Todd Cozzens and Picis is mentioned in only the positive questions in the HISsies again this year.” Every year I urge people to nominate, stating in advance that the nominees with the highest number of votes will be the finalists for the actual voting. Every year, someone who didn’t nominate anyone complains about the choices of the people who did. I don’t know what else to say except that democracy rules when it comes to the HISsies nominations and voting. 

From Kasabian: “Re: Michael Blackman of Berkshire Health Systems. Any idea where he went? You did a a great interview with him a while back.” E-mail to him bounces back saying he left BHS on December 11, but his LinkedIn profile has not been updated. I’ll let you know if he provides an update.

From Atlanta Observer: “Re: McKesson. The comment re: Dr. Bill O’Connor jumping ship from McKesson to Eclipsys to join Jay Deady has more than made MCK ‘not happy’. They are going to aggressively make an example of his non-compete agreement breach. Decided at the highest levels.” Unverified.

From Jessica: “Re: Haiti. I was searching for ways to help with the recent earthquake in Haiti and came across Partners in Health (PIH). They are doing medical work in a number of poor countries and even more interesting, have a number of volunteer opportunities for healthcare IT types – some in the Boston area, others remotely. Thought this would be a nice way for your audience to have the opportunity to make a difference with an organization making a really big
difference.” I checked the organization in Charity Navigator and it looks solid: a four-star rating, low CEO salary, and low overhead (95% of income goes to programs).

From EMRDude: “Re: Ivo Nelson of Encore Health Resources. Heard that his house burned to the ground.” True, sadly, as Ivo confirmed to me by e-mail. Thank goodness nobody was hurt. Here’s an eloquent quote from Ivo’s e-mail: “I don’t think memories sit on shelves or hang on walls. Memories are what you did to procure those treasures. The real treasures are in our minds. Everything else is just ‘stuff’.” Here’s my one and only Ivo story since I met him only one time (and that was as me, not as Mr. HIStalk). I was talking to someone at the IBM booth at HIMSS shortly after they bought Healthlink and asked some “just being polite” question about something or other that didn’t really interest me all that much. The guy said, hey, come with me and I can get you an answer. I was sitting waiting and some guy walked in and started shooting the breeze, running off to get me a soda and talking about the good old days of being a consultant on the road. We swapped stories like old pals. He didn’t have a name tag and I wasn’t even sure he worked for IBM, so I said, “What company did you work for?” He said Healthlink. I said, what was your name again? He said Ivo Nelson. Dragging my memory, the light came on. I stammered out something like, “But … but … you are the guy!” He was really casual about it. Good guy. I’m really sorry to hear about the fire, but he’s taking it philosophically.

I’m traveling to a land where hotel wireless performance is awful (which narrows it down to everywhere, in my experience), so I’ll need to be uncharacteristically abbreviated this time around. I promise to resume posting massive tomes once I’m home. Thanks to Inga for handling Thursday’s post for me.  

I think the above poll results speak for themselves, at least if uncertainty is a valid conclusion. New poll to your right: David Brailer said it was a mistake to include healthcare IT in ARRA, saying it adds risk to adoption. Do you agree?

Chris Rauber, the excellent San Francisco Business Times reporter, covers the stunning breakup of CalRHIO, which was until recently the lead contender to run all interoperability projects in that state and serve as a conduit for millions of stimulus dollars. He says CalRHIO and its competitor CAeHC were told by the state to settle their differences and figure out who should develop a statewide HIE by mid-January. They didn’t, so the state will create a new entity to replace them both. Chris says CAeHC seems to be working with the state, but CalRHIO has laid off all its staff and CEO Molly Coye (who had just started on July 1) has gone into consulting. Board members from both organizations (and possibly some employees) will be involved in laying out next steps. Molly Coye sent this statement to me:

HIStalk readers may have heard that CalRHIO and CAeHC, the two finalists in California for ARRA funding governance entity, were unable to negotiate an agreement and form a new organization as the state requested. As a result the state has taken the lead in forming a new governance entity, with input from board members of the two organizations. For the past six months, I served as CEO of CalRHIO, and I’d like to take this opportunity to clear up possible confusion about the basis for the state’s decision. The decision was in no way a rejection of CalRHIO’s technology, as some media reports have implied. In fact, the state did not review CalRHIO’s technology in the RFI process, and specifically welcomed our technology partner, Medicity, to participate in the open procurement process that the state and the new governing entity will initiate some time this spring.

Medicity has been an excellent partner, from planning through the early stages of implementation. CalRHIO is grateful to Medicity for its innovative thinking in developing with us a sustainable business model based on shared savings. We hope other states and local health information organizations will consider this model as they develop their long-term financial plans. Medicity also helped us develop the concept of statewide shared services, a framework that California seems likely to adopt. In collaboration with the Orange County Partnership RHIO, CalRHIO and Medicity teamed to launch HIE services in one of the largest counties in the state, an initiative that will continue to bring critical patient data to emergency rooms throughout the county.

For more information please see the statement from CalRHIO’s board at www.calrhio.org.

Hundreds of California health care leaders and stakeholders worked together to create and build CalRHIO over the past five years, and we want to thank them again for their pioneering efforts. We hope that the new governance entity will be convened promptly and that providers and consumers will be well served as HIE is deployed over the coming years in California.

Jackson Health System in Miami is tanking big-time, with its reported $56 million fiscal year loss possibly actually being as much as $150 million. One excuse for its $438 million in AR is its billing system change.

Back to normal soon, so e-mail me but don’t expect an immediate response until I dig out of the backlog in two or three days. Taking time off is really hard.

News 1/15/10

HERtak by Inga

From: TV Critic “Re: ‘Biggest Loser’ Loses Paper with help of GE’s EMR. Did you see this – actually pretty good marketing! Reminds me of 30Rock and all their corporate synergies.  Hmmm… maybe they could do a Mercy showing the nurses getting mad at the docs for not using CPOE, or a Law and Order on people who violate HIPAA, or a new Hero who has the ‘ability’ to actually use an EMR efficiently :)” It’s a curious world we live in. Perhaps they could do an American Idol and the “winner” would be the provider that documents the most complete chart at the point of care. Also curious: the only link I could find to this article was in the Ethiopian Review. I would have never guessed that Ethiopians were fans of Biggest Loser.

From: Trouble Brewing “Re: Ambulatory physician eligibility for ARRA. Thanks for providing the additional explanation about how a  hospital-based EP is defined. Lots of physicians and hospital administrators are not happy with the likelihood that a big segment of the physician population will be left out in the cold.” I’ve heard similar feedback. The committee reasoned that if the physician was using hospital owned clinics or facilities, they would most likely be paying for their own EHR. Maybe true, maybe not. If the hospital is paying for the physicians’ EHR and no one is eligible for stimulus funds, wouldn’t a hospital be inclined to make ambulatory EHR a lower priority and instead follow the money? I suspect we’ll hear more on this topic.

I’m flying solo today while Mr. H is out and about. I’m actually not sure what he is doing but I hope it is something fun.

Siemens names Eric Spiegel CEO and president, taking over for the retiring George Nolen.The official press release hails Spiegel a top influential international management consultant and energy expert who previously served as SVP and senior partner at Booz & Co. I didn’t note anything in his background related to healthcare, by the way.

The NIST awards Booz Allen Hamilton Inc. a $400,000 contract to help develop a testing method and processes for certifying electronic health record systems.

eClinicalWorks joins several competitors in offering a guarantee that its software will meet meaningful use criteria. The company is also offering free meaningful use webinars, and, onsite and online readiness assessments. eCW says that 2009 was a great year for them, with revenues exceeding $100 million for the first time.

Congrats to Bill Spooner of Sharp Healthcare (CA) who was named CIO of the year by CHIME and HIMSS. In addition to his lifetime achievements in HIT, Sooner was recognized for spearheading his organization’s EMR transition.

Hum ho. Yet another insurance company reports the loss of confidential patient information. BCBS TN announces 500,000 patients records may have been compromised after 57 computer hard drives were stolen from a closet. The company believes at least 220,000 records included social security numbers.

Apparently the state of Connecticut was not happy about Health Net’s privacy breach last year. The state attorney general is filing suit against the company, charging it with violations of HIPAA privacy and security rules, based on the disappearance of a hard drive. The company believes the missing drive contained PHI on 1.5 million members, including 446,000 from Connecticut.

The news out of Haiti is mind-numbing. This article highlights the work of Doctors Without Borders, who have already set up four tented facilities to treat the injured. Some are working in undamaged hospitals in Port-au-Prince, while others try to identify medical structures that are still intact.The organization is also waiting on the arrival of an inflatable field hospital, which sounds like a incredible piece of technology that includes two operating theaters and 100 beds. Lots of worthy organizations like Doctors Without Borders and The Red Cross are, of course, accepting donations. If you’d like a quick option, you can text “HAITI” to 90999 on your cell phone to donate $10 to Red Cross.

Cerner promotes Michael Valentine to COO, filling a vacancy that’s been open since 2007. Valentine previously served as Cerner’s US general manager.

Saint Peter’s University Hospital (NJ) plans to deploy Horizon Clinicals, including CPOE and enterprise care visibility. Saint Peter’s already utilizing McKesson’s revenue management products.

I was recently asked how I got this great opportunity to work with Mr. H and HIStalk. Almost three years ago, Mr. H made this small comment about needing an extra hand: “I need some help doing HIStalk (writing, chasing down information, etc.) If you know someone who’s interested and who might work remotely for a less than extortionate pay rate, let me know. I was thinking about hiring a grad student who might work a few hours a week to handle routine stuff. I’m just completely tapped out on time.” Since I was a big fan and at a point in my career where I had a bit of extra time, I begged him to hire me. One phone call later I was on board. When I arrived in April 2007, HIStalk had about 42,000 views for the month; today, between HIStalk and HIStalkPractice, we average nearly 100,000 hits a month. Mr. H is still tapped out and HIStalk now takes me more than just the original “few hours a week.” And it’s probably the most fun job I have ever had.

Eric Zimmerman, RelayHealth’s former SVP of marketing joins RedBrick Health Corp. as chief marketing officer.

Here’s something to contemplate: by 2020, the newest doctors will have been born after Amazon.com and will have never known a world without email or cell phones. MEDSEEK will discuss the impact of technology on patient care in its upcoming webinar “2020 Vision: The ePatient Evolution Over the Next Ten Years.” Register here for the January 27th event.

Ridgeview Medical Center (MN) expands its use of Wellsoft’s EDIS program, upgrading to v11 and adding electronic OE, charge capture and an HL7 interface to McKesson’s Paragon HIS.

Coming to HIStalkPractice tonight: ten execs answer the question, “What kinds of practices will be able to reach the 80% CPOE level?” I was personally a little shocked that a couple CEOs thought it was going to be so easy. Sign up for e-mail updates while you’re there.

Good news. Americans are not getting any fatter than we’ve been over the past 10 years. Of course a “hefty” number of adults (73 million or 34% of the adults) are still obese. A greater percentage of women are obese than men, but the guys are catching up pretty fast. Unfortunately, so are the kids. Perhaps too many folks are just sitting on their couches watching shows like the Biggest Loser.

E-mail Inga.

News 1/13/10

From rx4change: “Re: dialog. This is a very interesting dialog at the President’s Council of Advisors on Science and Technology two days ago. Atul Gawande and Google CEO Eric Schmidt talk health technology and policy.” Schmidt should have kept his mouth shut, but instead expounded his unoriginal thought that practicing medicine should be a simple as having a doctor type in symptoms and then review the resulting computer list of best practices. Gawande gently sets him straight, mentioning the doctors have 15 minutes to manage six problems instead of plowing through reams of computer-generated junk. The problem with computer people is that when all you have is a hammer, everything looks like a nail. As nice as it would be if patients simply got better because of computer algorithms that matched Symptom A to Government-Approved Treatment B, that doesn’t work. I say let Schmidt find a doctor who practices that way and commit to seeing him or her for the next five years and then report back.

From Computer Historian: “Re: first real microcomputer. This article says the first real microcomputer, three years before the Altair, was built to handle medical records.” That’s pretty cool. The article says the computer was built at Sacramento State University in 1972 specifically to manage medical records. Of course, Meditech had been in business for several years by then, but this refers to an actual PC built expressly for healthcare use. The only surprise is that some hospital isn’t still running it.

From The PACS Designer: “Re: Google Wave.TPD has alerted HIStalkers about the beta called Google Wave. Now, InformationWeek has some interesting comments on what Google Wave is trying to convey to users.” Its major problem seems to be that no one can explain what it is or what problems it solves. I guess it has passed the Peak of Inflated Expectations and moved on to the Trough of Disillusionment.

From Cryovac: “Re: Bill O’Connor. The former McKesson doc who was in charge of clinical sales support is now SVP of marketing at Eclipsys. He was connected with Jay Deady at McKesson, so I am sure McKesson is not happy about his move.”

From Sylvester: “Re: wikibook. Here’s a compendium of wikipedia articles on informatics. The standard textbook is Shortliffe’s Biomedical Informatics. I don’t know how they compare, although this one is favorable on price!”

An insider says that the allegedly upcoming Apple tablet will be aimed at healthcare, not the consumer market. He makes the good point that the Intel C5, the hottest thing at HIMSS a few years back, has been pretty much a dud, now wildly overweight and overpriced. Of course, tablets haven’t exactly lit up the night skies of healthcare either, but Apple wasn’t involved.

I like to report on my personal technology experiments every now and then for you fellow geeks out there. Here are two winners: Dragon Naturally Speaking and SugarSync. I bought DNS Standard for $55 and it is truly amazing, deadly accurate straight out of the box and a very polite application on my modestly powered PC. I’m using it to reply to e-mails since my fingers tend to get tired after the third or fourth hour of typing after a full day doing exactly the same thing at work. SugarSync is an online backup application, of which I had tried Mozy and Carbonite without much satisfaction. SugarSync is fast, easy, and free with up to 2 GB of storage. It’s a real-time backup and has a Web interface that allows you to use or view your files from any PC or mobile device. I recommend both from my limited experience so far.

Allscripts announces Q2 numbers: revenue up 32%, EPS $0.10 vs. -$0.05. Showing how little I know about stock-picking, some analysts were disappointed despite what looked like gangbuster numbers to me. Market cap is at $2.8 billion. The company also announces its EHR certification guarantee, an EHR financing program requiring no payments for the first six months, and a faster implementation program. I also noticed that Glen Tullman mentioned HIStalk in the investor conference call.

Vince Kuraitis has a useful resource list for the proposed Meaningful Use rules.

Speaking of Meaningful Use, I like to think HIStalk is nimble in getting information to you faster. For that reason, I’m proud of Inga’s series on HIStalk Practice in which she connected with several industry executives to get their thoughts on the proposed regulations. She asked our 10 executive collaborators whether the proposed criteria were a surprise and whether they will have problems meeting them in Part 1. In Part 2, we find out what difficulties they expect physicians to have in meeting the proposed requirements. Thanks to our participants.

Our pen pal Janeen Cook, a former RelayHealth marketing VP now at graduate nursing school at Vanderbilt, says she’s torn between using her student discount or her AARP discount to attend HIMSS (funny). She’s doing a little marketing on the side, so that’s her Killer Marketing Collaborators text ad to your right. She’s trying to convince me to let people bid to sponsor her schooling in return for clinician and marketing services afterward. Sounds fun to me.

An internal Kaiser memo says that starting next week, patients will be able to securely e-mail images to their Kaiser doctors, giving patients an alternative to follow-up visits. Suggested uses are for post-operative wounds, lesions, acne, and rash. Their pilot project showed that 90% of received images were useful in making clinical decisions. Smart.

Gerard Livaudais MD, MPH, formerly of Kaiser-Hawaii, is named EVP of product management for Quantros.

Tim Adams, chief investment officer at Constitution Medical Investors, is named SVP and CFO of athenahealth, replacing the recently retired Carl Byers.

Athens Regional Medical Center (GA), chooses Eclipsys PeakPractice PM/EMR.

Cerner’s CareAware iBus receives FDA pre-marketing clearance, making it generally available. It provides data exchange between EMR systems and medical devices.

It’s a Weird News Andy field day. A new blood test finds that 80% of people previously thought to be allergic to peanuts really aren’t. Expectant but absent fathers can see live videos of their unborn child on their iPhone. A British TV show seeks a terminally ill volunteer to be mummified Egyptian style. And a professional singer who hiccupped 20 million times over three years is cured by brain surgery.

The judge in Charlie McCall’s HBOC securities fraud trial freezes his assets and raises his bond to $4 million, uncomfortable with the ease that Charlie could hightail it in his yacht. He also denies the defense a new trial and soothes the concerns of his attorney that Charlie can’t pay him if his assets are frozen. Charlie got off on a solicitation charge in 2006 when the undercover officer’s tape recording was of poor quality. According to statements, he asked the female vice officer about “various options” and offered her $100 to accompany him back to his hotel.

ONCHIT is advertising for a vendor to attempt to re-identify a de-identified database, linking the data elements to individual patients.

Flagstaff Bone and Joint chooses the SRS hybrid EMR.

The National eHealth Collaborative posts its preliminary slate of board candidates for public comment.

The Houston business paper does a writeup on Encore Health Resources, highlighting its growth from 10 employees a year ago to 41 currently with 10 new folks coming on board each month. The company is sponsoring the HIStalk event at HIMSS, which I appreciate. For all the experience Ivo and Dana have in consulting, they have obvious deep domain expertise in the bartender-to-guest metric, as evidenced by their wildly popular reception at the last HIMSS conference. I’m pretty sure a good time will be had by all.

The entire 26-member EMR team at Royal Berkshire Hospital is canned as part of its UPMC implementation partnership. Also in the UK, Charles Gutteridge is appointed as the first national clinical director for informatics.

A New York Times article mentions an upcoming study that concludes that the Danish HIT system is the most efficient in the world, saving doctors 50 minutes per day and the country $120 million per year. They have advantages for that kind of adoption, however: high taxes, free medical care, and different attitudes toward privacy. Not mentioned is the prevailing Scandinavian model of not having healthcare be a rampant playground for greedy capitalist enterprises. You get the feeling that their healthcare isn’t run by MBAs and multimillion dollar CEOs.

MediConnect Global acquires PHR vendor PassportMD.

The state of California establishes the use of open source software as an acceptable practice. The CEO of Red Hat notes that economic conditions are pushing companies to consider open source to offset budget shortfalls.

E-mail me.

HERtalk by Inga

From UB40: “Re: ambulatory physician eligibility for ARRA. I know there has been some fuzziness about MDs who work for hospitals, like pathologists, radiologists, anesthesiologists, ED docs, etc. Obviously, the object of the ruling was that if the EMR was bought and paid for by the hospital and the MD was working exclusively in a hospital setting, then he shouldn’t reap the benefit of the work the hospital did.” UB40 is referring to an upcoming conference call hosted by The Health Management Academy, to discuss the exclusion of “thousands of physicians practicing in hospital-owned ambulatory clinics or facilities, whether or not the physicians are employed by the hospital or health system.” Reading over the latest documents, the wording does indicate that hospital-based EPs are not eligible for the Medicare or Medicaid incentive payments. A hospital-based EP is defined as one who furnishes substantially all (90% or more) of his or her Medicare-covered professional services in a hospital setting  (inpatient and/or outpatient) through the use of the hospital’s facilities and equipment, including the hospital’s qualified EHR. In other words, if a provider performs 90% or more of his/her services under place of service codes 21, 22, or 23, regardless of the provider’s employer, he/she would not be eligible for stimulus funds. The assumption is that a provider providing 90% or more of his/her services in the hospital are not likely to expend significant resources related to EHRs in other, non-hospital settings. OHCHIT is looking for feedback on whether or not this assumption is correct. I admit their assumptions sound reasonable to me.

Rome Memorial Hospital (NY) selects McKesson to provide the software for its $7 million EHR investment. Last month Mr. H mentioned that a Congressman helped the hospital obtain $250,000 to help fund the effort.

Meditech and Zynx Health partner to provide Meditech Magic and C/S customers the Zynx Health portfolio of evidence-based order sets.

The results of this new EMR usage survey indicate that 43.9% of physicians use an EMR, at least partially. However, only 6.4% utilize the full functionality of their systems. The survey used a self-reporting methodology, so the results may not be the most statistically valid. Regardless, adoption is clearly on the rise.

Thomson Reuters names Raymond Fabius, MD, FAAP, FACPE as chief medical officer of its Healthcare & Science business.

Frimley Park Hospital NHS Foundation Trust goes live with Picis in surgery and critical care.

Bronx Lebanon Hospital Center is now live on Sunrise Emergency Care in it ER and Ambulatory Care at a 40-doctor practice. The hospital plans to deploy the the Ambulatory Care solution to all it 27 outpatient clinics in 2010. Eclipsys also announces that New York Downtown Hospital (NY) is adding Sunrise Acute Care, Pharmacy, and Emergency Care applications.

University Medical Center at Princeton, a 10-year client of QuadraMed’s, plans to offer e-MDs to its affiliated physician practices. I was curious what would happen with the QuadraMed/e-MDs partnership now that QuadraMed is owned by Francisco Partners. Looks like the alliance is not dead yet.

Michael Martens takes over as Mediware’s new CFO. Martens replaces Mark Williams, who announced his retirement last fall. Martens’ previous employers include Euronet Worldwide and Cerner.

Geisinger Health System is implementing RelayHealth’s RevRunner solution for eligibility and benefits verification.

Southeast Alabama Medical Center selects Wolters Kluwer Health to deploy Provation Order Sets, powered by UpToDate Decision Support. Fort Worth Endoscopy Center also contracts with Wolters Kluwer Health for ProVation MD for procedure documentation and coding and ProVation EHR for patient charting.

CliniComp says four military treatment facilities went live with Essentris inpatient documentation solution during Q4.

Florida Hospital, an eight-location system with 2,188 beds, deploys HealthPort’s release of information technology, alongside Cerner Millennium.

VirtualHealth Technologies announces plans to sell its Secure eHealth messaging division to Wound Management Technologies.

Now that the holiday season is behind us, I’m beginning to feel that pre-HIMSS excitement. I love opening my mailbox each day to discover all the informative junk mail from vendors. Mr. H and I have been so busy lately that we have yet to talk much about details. I am sure he’d like to hire a dozen fake Ingas in low-cut blouses to sashay about the exhibit floor. And for the last three years I’ve asked him to hire a Mr. H look-a-like — that would be someone looking a lot like George Clooney — to provide foot massages. If you have any suggestions on how we can make HIMSS more fun and/or informative, let us know.

E-mail Inga.

Monday Morning Update 1/11/10

From Situation: “Re: little Epic app. Haiku available now. Get it from iTunes.” I like that it even has tallman lettering on the drug names. The one mention I found says users need a Haiku license and Epic Summer 2009. It works on the iPhone and iPod Touch.

From Colleen: “Re: Meaningful Use. Looks like the comment period has opened.” It sure does, even though ONCHIT just told be it would be Wednesday. You can submit comments electronically on the Meaningful Use criteria. The link to the larger reimbursement document isn’t working yet.

From SniffSniff: “Re: RHIOs. I’m working with RHIOs in various locations. A large vendor is not playing nice — won’t share data, won’t participate, and is pushing its hospitals to not be part of the health exchange. It’s apparently coming from the top. Yep, you guessed it — Epic. I’m going to the client in two weeks to explain this and advise them against the EHR, solely based on this reason.”

From Proust: “Re: HIMSS Analytics Stage 7. University of Wisconsin Hospital and Clinics got its designation on January 7, another Epic facility.” Do you suppose its outcomes and costs showed improvement and are superior to its lesser-staged competitors? My guess: no.

Ingenix will announce that it will offer interest-free loans to practices who buy its CareTracker PM/EMR. In addition to guaranteeing that CareTracker will meet meaningful use technical requirements, Ingenix says it will also help providers qualify for CMS incentive payments. Here’s their best pitch, though: the Web-based CareTracker EHR costs only $23,500 over five years, less than the ARRA reimbursement of $44,000 over five years.

Revenue cycle management vendor Origin Healthcare Solutions of Windsor, CT announces that Technology Crossover Ventures has made a “significant growth equity investment” in the company.

US CTO Aneesh Chopra, speaking at the CES show in Las Vegas, emphasizes healthcare IT:

“We don’t have a lot of innovation yet about how consumers can communicate with our electronic health record systems and smart meters and frankly education technology. We need more innovation. If you ask how many people receive an electronic record of their health information after they visit a physician or a hospital… I would be shocked if it was more than five percent. It’s probably more like two percent. That’s one of the provisions we’re calling for — the ability of patients to get records within 48 hours of their request. We should have a fairly open standard that will allow entrepreneurs to make that a low-cost product that physicians and hospitals could acquire.”

I’m not sure anything about HITECH encourages innovation, low-cost products, or entrepreneurs, but that’s what he said.

Listening: reader-recommend Hey Marseilles, an unsigned Seattle indie folk/pop band with orchestral backing. They’re good, reminding me a little of R.E.M.

Myrtue Medical Center (IA) chooses MedsTracker Enterprise Medication Reconciliation from Design Clinicals, which the hospital’s CEO says will increase patient safety while qualifying it for ARRA funding.

Above are your responses to my last poll on the proposed Meaningful Use criteria. New poll to your right: if providers meet the Meaningful Use criteria, will the average patient benefit?

Ninety-four of the 100 University of Missouri Health Center IT employees who were offered a chance to transition to the Tiger Institute the hospital created with Cerner take the offer, with six passing. Those 94 are now Cerner employees, bringing their seniority along and keeping their current salaries plus $1,000. Some of them think that’s unfair given that they are now Cerner employees working for state employee wages. “We have a ton of experience, so we don’t want young whippersnappers coming in making $10,000 or $15,000 more than we are.” Did he really say “whippersnappers?” I’d bet the number left in a year is a good deal less than 94.

Elsevier acquires NurseSquared, which offers an EHR simulation product for nurse training.

Christopher Thompson MD, chief medical officer of ED documentation system vendor Touch Medix, is sentenced to five years in prison for his role in a road rage incident involving bicyclists.

An Arkansas county jail will make prisoners responsible for paying a co-pay for medical treatments and prescriptions. The ordinance was approved by justices of the peace, who also passed a “pay for stay” ordinance that bills convicted prisoners for their room, board, and transportation to and from jail.

Royal Victoria Hospital in Barrie, ON launches its TELUS Sourcing Solutions HR systems as it begins recruitment for over 1,000 new employees to staff its expansion.

SAIC gets up to $14 million over five years to support the VA’s blood bank software.

Wales announces The Welsh Clinical Portal.

Odd lawsuit: a man trying to determine if his surgeon made mistakes sues University Community Hospital (FL) when the hospital tells him the search through decades of paper information will cost him more than $1 million. The hospital explained that its employees would have to manually search patient charts and redact privacy-related information. The lawsuit demands that the hospital prove its actual cost of producing the records.

E-mail me.

Healthcare IT from the Investor’s Chair 1/8/10

Ask the Chair

All these HCIT companies have been issuing press releases lately informing us that they are going to present at the 28th annual J.P. Morgan Healthcare Conference. What is that and should I even care?

The J.P. Morgan Healthcare Conference is the biggest healthcare-focused investor conference of the year.

Now, almost all the large and middle market banks have conferences for their institutional investing clients to meet with public companies, hear their pitches, chat with management, and hobnob in general. While most of them are sector-specific (be it healthcare, gambling — which is probably a fun conference, energy, consumer goods, etc). J.P. Morgan is truly the mother of all healthcare investing conferences.

Formerly known as the H&Q Conference until JPM acquired Hambrecht and Quist, the conference is held every January in San Francisco (home of H&Q), by tradition at the Westin St. Francis in Union Square. All next week, CEOs and other officers of healthcare companies and their hangers-on will converge on the City by the Bay.

It’s important to know that HCIT is just a small part of the fun and often lost in the excitement of pharma, biotech, managed care, medical device, and healthcare service companies all showing up to tell their stories. I’ve often thought that if the next big San Francisco Earthquake occurs during this week, healthcare costs would drop by a meaningful percentage!

But why the flurry of press releases? Under SEC Rule FD (for Fair Disclosure), because the companies participating might say something material to their stock price, the fact that they’re presenting needs to be disclosed in advance, and presentations are usually Web-cast, too. Note that back before this rule was adopted, companies would often disclose information only in this type of setting (i.e., only for institutional investors to act on).

Making the conference even more interesting (and widely attended), in addition to the public company presentations, banks invite up and coming private companies to present in a separate track. This allows both private (i.e., venture or PE) investors to look for investment opportunities for their portfolios and public investors to have access to private companies that might not be on their radar yet – giving them a chance to check out what’s coming down the IPO path someday, likely to compete with a public company they hold in their portfolio, or increase their knowledge of the industry as a whole. More importantly, it allows the bankers to show some love to prospective clients by giving them a forum and an audience.

What’s particularly interesting about the JPM conference (and H&Q before it) is the size of the crowd it draws. Because so many companies and investors are in one place, others follow (Metcalf’s Law in action, perhaps). Not only are J.P. Morgan bankers on hand, healthcare investment bankers from its competitors can be found in the vicinity of Union Square as well, in addition to a bevy of others who service the industry (including me), a practice commonly known as “poaching”. The city fills up with not only the companies and investors invited, but companies, investors, and assorted others who weren’t invited and won’t be attending anything official.

As a result, the week becomes a mammoth series of meetings, receptions, and the like hosted by PE and venture funds and even competing banks. It’s like the joke about why the atheist goes to temple: “Meltzer goes to talk to God, I go to talk to Meltzer”. To me, the H&Q Conference (as many still call it) is second only to HIMSS as a time to have 3+ days worth of consecutive meetings with clients, prospects, and old friends. Just like at HIMSS, you can be at a coffee shop or street corner waiting for a meeting to start and run into people you’ve known for years.

Does the non-investing HIStalk reader need to care? Well, unless you’re wondering where everyone went, but truly, not a whit. However, since the question was asked, and Mr. HIStalk has asked for the “insider view”, I thought this might provide some interesting color on explaining the recent press release action.

My next post (coming soon), will discuss the hows and whys of QuadraMed and Amicas’ announcements last month that they were escaping the slings and arrows of the public equity markets into the waiting and eager arms of private investors. In the meantime, please keep those interesting questions coming.

Ben Rooks
The Chair

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

News 1/8/10

From Nurse Carol: “Re:  meaningful use. Will you provide links and document numbers for commenting on the proposed rules?” I e-mailed ONCHIT just to make sure I understood the process and they kindly verified: the 60-day comment period starts with the date the rules are published in the Federal Register, which is scheduled for next Wednesday, 1/13. Comments can be left on regulations.gov. I’ll run the exact link once it’s available.

From Nosy me: “Re: GE. GE has put their Centricity EMR implementation on hold at UMDNJ School of Osteopathic Medicine due to lack of payment. UMDNJ, the health university of New Jersey, contends that they have gotten nothing for their investment so far except extended timelines and escalating bills.” Unverified.

From The PACS Designer: “Re: Thoma Bravo LLC. PACS vendor AMICAS has decided to accept an offer from Thoma Bravo LLC to buy their shares at $5.35/share. TPD is very familiar with AMICAS and their acquisition of Emageon. While the AMICAS PACS is a great product, the Emageon PACS is just the opposite and the reason AMICAS may want to go private is to keep their shareholders from finding how bad things really are with the Emageon product line. Having Thoma Bravo LLC is just what the patient (AMICAS) needs to get better!”

From IKnowPlenty: “Re: things that make you go ‘hmmm’. The keynote address for AHA’s annual leadership meeting is disgraced climatologist Al Gore. I fail to understand what he has to do with healthcare or hospitals, other than wanting to sell them carbon credits.” He finally got his big house LEED certified once word got out on the Internet he invented that his electricity usage was more than a dozen times the average. He’s about as relevant as the other speakers, though: Freakonomics guy Steven Levitt, former White House secretary and Vanity Fair editor Dee Dee Myers, and film maker Ken Burns. You know it’s a stretch when the guy with the most relevant healthcare credentials is talking head Sanjay Gupta. These folks don’t speak free, so your hospitals (meaning patients and taxpayers) are footing their bill. According to tax records, AHA took in $120 million last year, of which $22 million was pure profit (in a non-profit way). Three of its executives made more than $1 million, the CEO made $2 million, and all are appalled that anyone would suggest that healthcare reform is needed.

From FinSoft: “Re: QuadraMed. Steven Russell gets 86’d as collateral damage from the Dunn hiring.” The 8K also gives Tom Dunn’s hiring details.

From Nasty Parts: “Re: Sage. I hear they will announce a new president shortly and Lindy Benton will stay on as SVP of sales.” Unverified, although Nasty Parts has a pretty good track record.

From CongestiveITFailure: “Re: CCIM. Community Care Information Management, another Ontario Ministry of Health and Long Term Care eHealth agency, is currently being run by the partners from Blue Pebble, a consulting firm. There is a serious conflict of interest, as Blue Pebble hires their own eHealth subcontractor consultants and places them (on a contract basis) within CCIM. They take a percentage of their subcontractors’ daily rate and pay them via a third-party vendor so as to skirt current provincial salary disclosure rules. The partners from Blue Pebble consulting were put together by the current Ontario MOHLTC Associate Deputy Minister John McKinlay. Another scandal is imminent with such a conflict of interest.” Unverified, but I found this October article that says the same thing. Three of the project’s senior managers set up Blue Pebble and then got 30% of the project’s consulting business. CBC says Blue Pebble also did work for the disgraced eHealth Ontario and its predecessor, Smart Systems for Health Agency. An anonymous informant said Blue Pebble was using the government’s people and technology and charging them for it.

From MalaysiaHITFan: “Re: HIT vendors. Surprised no announcement out of HIT vendors on what are presumably sizeable contracts. Focus on openness must be why Epic missed the cut.” I saw the article, but couldn’t decide whether I was interested in it. Malaysia awards contracts to Microsoft, Eclipsys, Cerner, and IBA Health for new systems, although the date of those contracts isn’t mentioned, so I’m thinking its old news. Still, the projects are interesting: teleconsultations, personalized education, CME, smart cards, and a Lifetime Health Plan for every citizen (which the article candidly says “became the biggest failure of the Ministry” when the business model turned out to be shaky and the managing company went bust). Now they’re doing an HIE instead.

Cardinal Health announces a bar code-powered inventory and ordering system called Connect System (catchy name) for laboratories.

Wait … what’s that sound? Someone crying out for help? Why, it’s my HISsies nominations, pining for some Web-based intimacy with all those knowledgeable HIStalk readers who would be the first people I would ask to name the Industry Figure of the Year, the Best and Worst Vendors, the CIO of the Year, and of course the happy winner of The Pie. The upcoming voting won’t be all that interesting if the only nominations I get are from vendors nominating themselves for the good awards and their most hated competitor for the bad ones. I’ll close the nominations out this weekend, so vote now or forever hold your peace.

Twin County Regional Hospital (VA) expands its McKesson Paragon implementation to include Practice Partner. It’s in Galax, a town I like although I’ve been only a couple of times (the Rex Theater for live bluegrass, Aunt Bea’s for barbeque, and a bounty of fiddle players).

The College of American Pathologists releases its updated XML version of the CAP Cancer Checklists, used for cancer description and reporting.

Many thanks to Wellsoft, new on board as a Platinum Sponsor of HIStalk. What you should know about the company: (a) it offers a highly awarded emergency department information system; (b) Version 11 has some cutting edge new features (anatomical diagrams, clinical decision support, medication reconciliation, and a patient entry kiosk), and (c) the Wellsoft EDIS has some powerful technology behind it, such as Oracle, interfaces to all hospital information systems, remote updating, guaranteed 15-minute support response time, and custom reporting. Get on their mailing list here and check out the video. They will be in Booth 7005 at HIMSS, FYI, which reminds me that a couple of years ago at HIMSS, I went to some super-geeky, small-room session on clinical decision support architecture or something like that and I noticed a casually dressed, deeply immersed guy sitting a couple of seats over. I checked his badge and it was John Santmann, MD, founder of Wellsoft. I don’t think I’ve ever seen a CEO in a real HIMSS session and a hardcore one at that, so I admired him immediately. End of pointless anecdote.

Hocking Valley Community Hospital (OH) will implement Keane Optimum iMed and migrate to Optimum Patcom.

I’m all for free speech, but the same people posting the same comments about EMR safety and FDA regulation under multiple phony names (yes, I can tell) is wearing a bit thin. I sometimes agree with the argument, but I don’t need it jammed down my throat several times a day. Would I be wrong to delete those comments?

Listening: a recommendation from Tom in Verona, WI (gee, wonder where he works?): Nothington, polished and pop-tinged punk that immediately motivated me to attempt a frowning-faced, intense desk drum solo that nearly slung the watch off my arm. An excellent choice. I was going to listen to part of just one song to be nice to Tom, but I keep playing them over and over.

Vanderbilt opens BioVU for internal research projects with IRB approval. It’s a DNA data bank with 75,000 samples linked to the de-identified EMR records of their owners. One of the first studies will look for a relationship between DNA and drug response.

I got some info on the contract between Universal Health Services and Cerner. It’s a pretty big rollout: ED, clin doc, orders, CDR, meds, biomedical device integration, LIS, pharmacy, and OR. Not ADT or accounting, which are notoriously weak links of Cerner (heard much about ProFit lately? Exactly.)

Practice management vendor AdvancedMD acquires EHR vendor PracticeOne, hoping to roll the products together into a SaaS solution.

This might make a good remote hosted EMR commercial: thieves break into a medical practice and steal its Fujitsu Lifebooks, but as the CEO tells the reporter, “None of the electronic medical records reside on the computers or on our property” since they use a hosted service.

Capital Regional Medical Center (FL) publishes its ED wait time to the iPhone via iTriage.

Several former executives of iSoft, including the former chairman and CEO, face criminal charges in Britain for making false and misleading statements.

AT&T will launch five Android-powered mobile phones in the next few months, one made by Dell and another rumored to be a version of Google’s just-announced Nexus One.

At the International Consumer Electronics Show, Cisco demonstrates a home version of its TelePresence videoconferencing system, showing how it could be linked to medical devices to pass voice, video, and data from patient to physician. At the same show, Skype announced that its application is now capable of making high definition video calls and will be incorporated into HDTVs (as a newfound Skype Video user not even using HD, video calls via Skype are still one of the coolest things ever, just like being in the room with the person on the other end of your free call).

Two Regenstrief informatics fellows win AMIA student awards, one for a graphical tool to examine drug interactions, the other for a system that proposes drug and lab suggestions based on physician ordering habits. I’m thinking I should cover more of this research-based informatics stuff since it interests me and it’s innovative.

eClinicalWorks will offer patient education from Krames, including 1,300 aftercare instructions in several languages that are suggested to physicians based on EMR information as well as for direct patient access through eCW’s patient portal.

Odd lawsuit: an MRI clinic’s car injury claim is fully paid by its insurance company, receiving the state-allowed maximum $10,000 in PIP benefits. Their attorney sues the insurer for $2.59. For once, an insurance company gets to accuse someone else of being a scumbag. “Who has the greater motivation to sue in this case, the MRI clinic that’s seeking $2.59 or an attorney who charges about $375 an hour for his services?”

E-mail me.

HERtalk by Inga

From Father Time: “Re: meaningful use timeline. It is my belief that the MU clock will start ticking 10/1/2010 as that is the start of the government’s 2011 fiscal year. I am certainly no authority on the subject, but it would seem the government would use their year vs. calendar or any other for the time period used  to verify meaningful use of hospitals and providers.  If you consider that time period and use the HMS/CMS 90-day model, a hospital would have to begin to prove meaningful use BEFORE July 1, 2011. In hospital years, that is REALLY soon!” I agree with Father Time that the MU clock could start as early a 10/1/2010 for hospitals (in fact my graphic indicated that). HIMSS also said 10/1/2010 in their webinar this week. However, the committee’s “recommendation” is that the Secretary choose the calendar year (starting 1/1/2011) for meeting the definition, which would give both hospitals and vendors more time to ramp up.

From CPOE Guy: “Re: EMR and girl talk. Maybe I don’t understand girl talk, but those of us providers using Epic (Kaiser for example) are doing at least 99% order entry; in my case it’s 100%. The only exceptions in our organization is for super emergency verbal orders during codes where the doc can’t get to a computer, and even there it is frowned upon. Our prescribing is 100% electronic for normal Kaiser patient prescriptions not requiring written (the former ‘triplicates’  such as morphine, Ritalin). I write handwritten prescriptions only for non-Kaiser patients who wish to fill their meds elsewhere and even then, I enter these electronically into the EMR to keep our record complete.”

From Outta Touch: “Re: Latest meaningful use guidelines. In the last few days, I’ve asked a few doctor acquaintances about their impressions on the latest proposed meaningful use definitions and certification guidelines. Most have simply given me a blank stare, asking what I was talking about. Am I running with the wrong crowd or is the average doctor just not interested?” My guess is both. Who wants to hang out with doctors that can’t talk techie? Give me a Dr. Alexander or Dr. Diamond any day. And, I suspect that most doctors are more concerned with practicing medicine and getting paid then they are with dealing with the minutiae. Most practices have at least one doctor or an administrator who is more interested in following the specifics. Plenty of doctors are happy to defer to the “experts” until they are handed a tablet and told to enter a prescription.

From Jabez William Clay: “Re: draft rules on the EHR incentive plan. Have you guys seen this?” The CSC study that indicates US hospitals are only halfway ready to qualifying ARRA payments. In fact, only two-third of hospitals have identified gaps in their current systems. A quarter of the 58 hospitals think they meet at least 70% of the readiness criteria.  

From Felice Fontanta” “Re: ARRA questions. Thanks for your analysis! Very helpful. A few questions I haven’t seen answers to yet: How and when are the funds going to be disbursed? Say you demonstrate MU in the 1/1/2011 – 3/31/2011 time period, when and how will you be paid your $18k? And,  In terms of qualifying docs, is the Medicare program restricted to Medicare providers? So a pediatrician would not be eligible for any funds unless they have a significant Medicaid panel?” The legislation says that incentive payments be disbursed in a single consolidated payment or in periodic installments, as the Secretary may specify. However, the recommendation is for a single lump payment “as soon as we ascertain” meaningful use for the applicable reporting period. Regarding participation in the Medicare incentive program, it is restricted to Medicare providers. Pediatricians can participate in the Medicaid program if at least 20% of their patient volume is Medicaid.

Mr. H and I have had multiple questions posed to us regarding the latest certification and meaningful use recommendations. We don’t claim to be experts, but we are happy to try to get clarification on certain points if we can. Here are a few FAQs that we have gathered from readers, this week’s HIMSS webinar, and the CMS website:

Q: To count as CPOE, must the provider personally (hands on keyboard) enter the order, or may physical entry of the order, under the provider’s direction, be done by other staff?

A:  The reg states “directly”.

Q: Our pathologists are employed by a clinic and physically work in a clinic. Do they qualify as eligible Medicare outpatient providers?

A: Depends on whether the clinic or the hospital provides the facilities or the equipment.

Q: Is an eligible hospital is only an acute care facility or does it include other types of facilities, such as rehabilitation facilities?

A: CMS uses the "CCN" – the CMS certification number assigned to each hospital – to assess whether or not a hospital is eligible.

Q: If a hospital ER is using CPOE for all orders, does it qualify for the 10% of CPOE for a hospital?

A: The ER is counted as outpatient, so no, it will not fulfill the 10% CPOE requirement for an inpatient facility. (HIMSS waffled a bit on this during their webinar but finally came to this conclusion.)

Q: On the hospital side, must the physician enter the CPOE order directly? Or may they have their MA do the entry under their authority?

A: The reg states "directly".

Q: If only 10% of the hospital’s staff is using the certified system, and the rest are still paper-based, would this satisfy the CPOE requirement?

A: The requirement is that 10% of all orders be entered by CPOE.

Q: Do State Mental Health Hospitals qualify for incentive payment? What about long term care providers such as nursing homes?

A:  No. The following types of institutional providers are eligible for incentive payments under Medicare and/or Medicaid provided they meet the applicable criteria. Under Medicare, institutional providers eligible for the EHR incentive payments include “hospitals" as defined under section 1886(d) of the Social Security Act and critical access hospitals. Under Medicaid, these institutional providers are acute care hospitals and children’s hospitals.

Q: If you are a provider or hospital and not a meaningful EHR user, when do the penalties kick in?

A: Starting in calendar year 2015 for physicians and FY2015 for hospitals. At that time, CMS will begin to reduce Medicare Market Basket adjustments. There are no payment adjustments associated with the Medicaid provisions.

Q: How will the public know who has received incentive payments under the Recovery Act?

A: CMS will post the names of those receiving Medicare incentives online. The list will include the elements identified in the Recovery Act: name, business addresses, and business phone number of all Medicare eligible professionals and hospitals who received incentive payments under the Recovery Act. There is no such requirement for CMS to publish the names of those receiving Medicaid incentive payments,though States may opt do so.

That last fun fact was Mr. H’s favorite, by the way. Surely it will be a boon to telemarketers who will have all the information required to pounce on the nouveau riche doctors.

SCI Solutions launches Schedule Maximizer (v32) which includes e-mail appointment reminders, expanded portal functionality, and several new revenue cycle reports.

An Arkansas doctor is indicted for planting a bomb that critically injured the chairman of the Arkansas Medical Board last February. Dr. Randeep Singh Mann, who had been previously penalized by the Arkansas Medical Board for overprescribing medication, was charged with planting a car bomb that left the board chairman with blindness on one eye, damaged hearing, and several broken bones. Mann was already facing federal weapons charges for possessing unregistered machine guns and explosives that are permitted only for military use.

Wake Forest University Baptist Medical Center (NC) selects QuadraMed’s Enterprise Scheduling for scheduling hospital ancillary procedures.

Allscripts strikes a deal with CVS Caremark to migrate thousands of users from the proprietary CVS iScribe e-prescribing tool to Allscripts e-prescribing.

Surgical Information Systems picks up an endorsement from the American Hospital Association for its surgery scheduling system.

Our favorite pink pants-wearing friends at Voalte say their Voalte One iPhone application is now generally available, following a successful pilot program at Sarasota Memorial Hospital (FL).

CHIME raises some concerns about the newly released meaningful use regulations, particularly with the short timeline for hospitals to implement EHRs. They believe that the 2014 deadline for hospitals and EPs to meet Stage 3 criteria is too soon. CHIME also says the extensive reporting requirements will be burdensome for hospitals. And, CHIME points out that since hospital-based physicians aren’t eligible to receive stimulus funds, it may create a disincentive for health systems to invest in ambulatory EMRs. To that last point, I don’t quite agree, since hospitals will need the physicians to have EMRs to meet interoperability requirements.

E-mail Inga.

Lawson Software To Acquire Healthvision for $160 Million

Lawson Software announced this afternoon that it will acquire integration vendor Healthvision and its parent company, Quovadx Holdings, Inc. for $160 million. The all-cash transaction is expected to close later this month.

Lawson said it expects to use Healthvision’s Cloverleaf technology, used in 33% of North American hospitals, to connect multiple source systems and help providers comply with interoperability requirements. Healthvision also offers a Health Information Exchange platform and MediSuite, a clinical applications suite marketed in Canada.

HIStalk contact Thomas Servo reported on December 11 that Healthvision’s owner, Battery Ventures, would announce a sale of the company around New Year’s.

News 1/6/10

From HIPPAcrates: “Re: notice of proposed rule-making. The summary spreadsheet is very useful, thanks. I just found this error in the government document and hope it’s not an omen.” Even the feds can’t spell HIPAA with the full wording right in front of them. Surely I’m not the only one who knows how to modify Word’s dictionary to catch gaffes like this.

From Dean: “Re: MU. Was just reviewing your summary of the meaningful use doc. Very nice work, even better than Halamka’s at geekdoctor, of course you probably don’t have a Kevlar suit or a handy folding bike! I think a great reader poll would be to ask whether people with CPOE installed have implemented drug-drug or drug-allergy interactions. My bet is that most people who have tried this have turned it off. I think this is a terrible requirement. Current drug-drug interaction checkers are way too sensitive and generate way too many false positives. I’ve reviewed some papers that reported over 25% of medication orders generated alerts. That is unacceptable in my book.” Maybe he needs the Kevlar suit because of bike-induced thigh chafing. The problems with clinical warnings are:

• Practitioners universally believe they don’t personally need them, but they think they should be turned on for their less-capable peers.
• Duplicate drug checking throws out a ton of false alarms and is useless 99% of the time.
• Allergies are often entered without the type, severity, and onset of the reaction, meaning that everybody’s “makes my stomach hurt” allergies trigger the Cry Wolf syndrome and allergy warnings are overridden 95% of the time.
• Users aren’t always given the tools to modify the warnings to suit their needs, such as expanding the by-the-book dose ranges and setting their own ranges based on experience.
• The few vendors of clinical data rigidly adhere to conservative manufacturer data and the advice of their overly cautious lawyers in overweighting accuracy at the expense of usefulness.
• Systems don’t allow personalizing the alerts, so while the family doc might benefit from a renal warning for a particular drug, it’s a sure bet that the nephrologist who gets the exact same warning surely won’t.
• Of all these, the last one could be easily implemented, other than the fact that data vendors, hospitals, and IT people don’t trust their docs to turn off warnings that they don’t value (a rather condescending “computer knows best” outlook).

From Crumbgirl: “Re: GE Centricity Enterprise. You will hear big news out of Indiana if you have not already!” I haven’t heard anything so far.

From Infodoc: “Re: your MU summary. Thought you’d like to know that the Advisory Board referenced your Meaningful Use summary in their Meaningful Use briefing published Monday. HIStalk is becoming a good example of a disruptive technology.” Honestly, all it took was a couple of hours of skimming the documents to pick out the relevant parts. I think the trick is that, as a nerd, I was the only pseudo-journalist sitting home with nothing better to do right before New Year’s. I do appreciate the nice comments about it, though. And I do like to disrupt whenever possible.

From Bob in Accounting: “Re: Epic’s newsletter list for customers to prepare for meaningful use.” My 99% condensed summary of what it said: (a) upgrade; (b) finish rollouts; (c) implement e-prescribing; (d) install MyChart; and (e) install Care Everywhere for data sharing.

From Chris: “Re: EHR. First off, I really appreciate your ongoing coverage of all things health IT related. As I’ve been reading your site and others, I’m failing to identify a distinction between EMR and EHR in terms of the ARRA/HITECH legislation, ‘meaningful use’ and certification criteria. Is there a true distinction between the two? I feel as though I see them used almost interchangeably. Thank you for your insights and clarification!” Theoretically, HITECH applies only to EHRs since the products must be certified and, by definition, all certified EMRs are actually EHRs since they are interoperable. I have a philosophical disagreement with that loose terminology, however, probably because vendors have latched onto it for marketing purposes for the same old products that pre-dated the EHR term. EMRs are used to treat patients. EHRs are used to manage health and community wellness, including collecting data from a much wider net than just doctors and hospitals. I’ll stand by my crotchety proclamation: I don’t care what vendors say, none of them have an EHR. That’s why I always call them EMRs unless I’m quoting someone else.

From Lacey Underall: “Re: Humana. A dermatologist takes them to small claims court. Way to go!” I love this. A dermatologist, tired of Humana not paying his claims for years ($120K total) but unwilling to pay a lawyer 40% to go after them, takes the insurer to small claims court by bundling the claims into packages that fall within the $5,000 limit. Humana’s lawyer is surprised, given that he has never been to small claims court. The doctor tells him, “This is the first of 25 claims we’ll be submitting … Humana could save those $350 filing fees times 25 and his time and fees times 25 if they would just process our claims." Even though the tactic hasn’t worked for other doctors because Humana got their case moved to federal court, it did this time: Humana coughed up $80K and the doctor is hoping to collect the rest of what they owe him before their next court date.

I’ll be charitable in characterizing the post-holiday response to my HISsies nominations plea as modest. The voting that will follow next week or so is going to be pretty dull if nobody nominates their best and worst vendor, industry figure of the year, etc. It takes just a minute or two and validates my pathetic existence, so humor me.

Former Cerner sales VP Mike Supple joins recruiting firm B.E. Smith as SVP of business development.

Ten-provider Orthopaedic Center of Southern Illinois chooses the SRSsoft EMR after its free trial, saying the docs are saving 30-60 minutes each per day.

Madrigal sent me an e-mail announcing Meditech’s merging of PtCT into its regular organization, which I reported last week. The company has posted the announcement and a company Q&A.

Universal Health Services chooses Cerner and its Remote Hosting Option for its 24 hospitals. The modules weren’t stated (red flag – did they commit to all of Millennium or just a few modules?), but per FlimFlam Man, they will replace Opus Healthcare, Siemens pharmacy and ADT, RMS, and others.

Cerner also announces a deal in which Tenet will increase its Millennium use from 14 hospitals to 47. Shares were up 6% today, hitting a 52-week high and raising the market cap to $7.29 billion and nearly making Neal Patterson a hemi-billionaire (he’s got $496 million worth).

Revenue cycle vendor Passport Health Communications names David Whitt CFO.

Jobs: Eclipsys Systems Engineers/DBAs, Anesthesia Product Specialist, Clinical Implementation Specialist.

Former Eclipsys SVP Tom Dunn joins QuadraMed as SVP of sales and marketing.

Tennessee gets $2.7 million in stimulus money for a project that CMS says will improve patient outcomes. Reading further: the money will be spent on “planning activities”, like doing a study to figure out why doctors won’t use EMRs.

Three Montana provider organizations go live on the beta version of EMix, a vendor-neutral cloud computing platform from DR Systems for sharing radiology images and reports. They claim it’s as easy to use as e-mail. The company pitches charging patients to manage their images online, for which it takes a cut of the revenue.

Newham University Hospital NHS Trust says its Cerner system is saving it money and reduced patient wait times. Patients in the same area are using Philips home monitoring diagnostic equipment in a test for NHS.

The owners of paging and communications systems vendor Amcom Software sell controlling interest to a partnership of a private equity firm and a venture capital firm. The private equity firm says they’ll probably sell it at some point.

I think I missed this when it was announced: Epocrates names Geoffrey Rutledge MD PhD, formerly of Wellsphere, as CMO/EVP of product development.

Google announces its Nexus One Android-powered cell phone. It seems anti-climactic, hardly an iPhone-killer. Too bad it didn’t involve cheap cell service, although maybe the master plan is to serve up phone ads that offer a lower cost all around.

Odd lawsuit: a woman sues Walgreens, claiming that a store employee leaving the bathroom knocked her down with the door. She wants medical costs, damages and “other sums to compensate her for her injuries,” claiming that Walgreens should have instructed employees to look before opening the door, for failing to tell her to move, and for failing to equip the door with a warning device.

E-mail me.

HERtalk by Inga

In yesterday’s HIStalk Practice, I touched on a few nuggets of information about the latest EHR meaningful use recommendations. I might add it is worth a read because there are some points Mr. H and I haven’t seen covered elsewhere (and while you are there, sign up for the e-mail updates.) One particularly confusing item relates to the timeline for proving meaningful EHR use in order to earn incentive dollars. I tried to summarize a bit on the timeline for getting money, but because it is particularly confusing, I decided a graphic might help (click it to enlarge).

For those that want to follow along at home, this information is found around pages 23 to 31 in the larger, 557-page document. As I interpret things, to qualify for stimulus money during 2011, a hospital or eligible professional (EP) must demonstrate meaningful use of EHR for “any 90-day period within the first payment year.” The earliest possible start date for that 90-day reporting reporting will likely be January 1, 2011. The latest day to start a 90-day reporting period and still qualify for 2011 money is October 1, 2011. After earning incentive money in the first year, entities will be required to prove meaningful EHR use for a full year, starting on January 1, in order to qualify for second-year funds. Thus, if an entity qualified any time during 2011, it would have to continue to prove that it used its EHR meaningfully from January 1, 2012 to December 31, 2012 in order to qualify for the 2012 incentive funds. And, if the entity doesn’t try to qualify for the first time until sometime in 2012, then it must prove meaningful use for the full year beginning January 1, 2013, to get the second-year funds. And so forth. If someone interpreted things differently (or can explain this better), please advise.

athenahealth signs a deal with Caritas Christi Health Care to offer athenaclinicals to 500 employed providers and 1,200 affiliates. CIO Todd Rothenhaus, MD, the Caritas SVP/CIO, confirmed to me that Caritas will offer athena and eClinicalWorks, which was announced previously.

I was talking EMRs with a girlfriend at lunch today (isn’t that what most gal pals do?) and we agreed that we can’t think of any providers that currently enter 80% of their orders themselves. We thought we might come up with a doctor who uses e-prescribing 75% of the time (but we thought of lots of reasons why a patient and provider might prefer the paper prescription). We couldn’t come up with a single small office group that is currently capable of sending patient data electronically to other providers (often times because the receiver can’t accept the data). The one bright spot is that the recommendations clearly state that “documenting a progress note for each encounter” is not a requirement for proving meaningful use. Otherwise, the mountain is high.

Ridiculously sad, any way you look at it. An unemployed, unmarried 35-year-old mother of nine sues three doctors and two nurses after being sterilized against her will. The mom was delivering baby number nine via a planned C-section and and asked for an IUD to be implanted immediately after delivery. Instead, the doctors performed a tubal ligation.

Trinity Health (MI) buys 1,200 bundled EHR/EPM software licenses from NextGen, increasing its rollout to all employed providers in its network.

Happy 2010, by the way. The ever-generous Mr. H gave me a bit of time off during the holidays, but now I am back at it. Mr. H and I have each waded through pieces of the latest meaningful use documents in hopes of becoming industry experts. Unfortunately, at least in my case, more wading is required. I was hoping there might be some clarification about what exactly a “certified EHR technology” is. Of course “CCHIT” is never mentioned anywhere, even though it seems a given that CCHIT will be a requirement since they are the only certifying body out there. Why can’t the Secretary or the ONC come right out and say it’s CCHIT 200x for now? That way buyers know what is required and vendors know what they need to do if they want to participate.

Send Inga meaningful words.

Monday Morning Update 1/4/10

From Ned Flanders: “Re: remote ICU monitoring. Publication bias apparently runs both ways. JAMA rejected a study evaluating the clinical and financial impact of remote ICU monitoring last year because although the results were extremely impressive, they claimed the study had a weak design (before and after) and did not shed light on the actual reasons why remote ICU monitoring helped (since it had already been shown to help). Curious considering the recently published study had the same design and flaws, with the only difference being outcome.” This highlights a little-appreciated reason for not believing everything you read: the most powerful influence wielded by publishers isn’t how they spin a particular story, it’s their choice of which stories to include in the first place. That process has zero transparency to readers, so it’s the most dangerous. The second most powerful is where the piece appears if it is published. The third is how the headline (or abstract) is worded since many people will base their conclusion, consciously or subconsciously, on that alone.

From FinSoft: “Re: QuadraMed. Jim Klein is out – read the 8K from December 30.” This was actually reported by Misys_ex to me in early December, but I always hesitate to run rumors about named individuals unless it’s public knowledge since I’d hate to see my own name in “he’s been fired” speculation (no need to give the boss ideas). Jim was SVP of product management and CTO until his “involuntary termination”. Some degree of executive change is all but mandatory when a company is acquired. Companies don’t generally buy other companies because they don’t want to change a thing.

From Anne Onymous: “Re: HHS rules. For years, vendors charged a fortune for simple interfaces to the systems of other systems. Now, in order to get certified, they have to offer this interoperability. In addition, they may not be able to charge for it! There are no provisions for them to charge for receiving patient data, although there is no mention about sending patient data (I could have overlooked it). I predict that in the final rules, certified vendors will have to receive select patient data and respond to inquiries for it from other certified systems at little or no cost. This is reasonable and necessary for patient care. The impact of these rules will be very positive for vendors that provide niche applications.”

From Downtown: “Re: meaningful use. Awesome summary. Will anyone other than attorneys read the whole thing? With an unusual lack of fanfare, ONCHIT seems to have published a new Web site, StateHIEResources.org. It was registered on the 13th by some Canadians. Now I’m really confused!” I signed up for the listserv and it’s apparently a follow-up to (and the same domain registrant as) the State Health Information Exchange Leadership Forum, run by AHIMA “through a cooperative agreement with the Office of the National Coordinator for Health IT.” The new site has no AHIMA reference. ONCHIT apparently offshored its Web development to Canada.

From ChiSalesChick: “Re: a big EMR vendor I won’t name. They are ‘restructuring’ a lot of their sales people right out of a job.”

From Cleveland Brown: “Re: HIStalk. I was scrolling down the sponsor list yesterday and thinking about how far your little blog site has come in the years that I have been reading. All of your hard work and your integrity surely has brought you well-deserved respect and fame (if not fortune). Thank you so much for producing the one blog that I turn to daily! I do admit, however, that I do not share your site with many of my peers. It is important for my ego to always know more than anyone else and reading HIStalk makes it so.” Lots of readers have confidentially told me they keep their HIStalk reading habits secret for the same reason, which is flattering and amusing. I guess that does slow the word-of-mouth effect, although I note that December’s HIStalk visits were up nearly 40% year-over-year, which is closer to shocking than merely surprising since I keep figuring that anyone who cares has already found it.

Speaking of the remote ICU article, thanks to the reader who sent over the JAMA full text article. The article by a University of Texas Medical School associate professor looked at mortality, complications, and length of stay before and after implementation of Philips VISICU in six ICUs in five hospitals (in a single health system) from 2003 to 2006, using around 2,000 randomly selected patients (about half the total). Hospital mortality dropped a little, but that was not statistically significant after adjusting for severity. There was minimal effect on complications and length of stay. The big gotcha: two-thirds of the patients studied had doctors who allowed the intensivists to intervene only in life-threatening situations, i.e. they were not really letting the remote intensivists manage those patients. Also: the hospitals did not integrate their CPOE and progress notes into VISICU, so all the intensivists had to work from was a daily fax (note the irony that, among all that expensive technology, the only “interface” was a daily fax from one user to another). My conclusions (crediting Smalltown CIO for some thoughtful comments left on my original post about this article): (a) as is often the case, implementation decisions had more impact on outcomes than did the technology itself; (b) you could flip the conclusion around and say that, since tele-ICU had no negative impact, it provides opportunities to maximize use of scarce resources; (c) rural sites could use tele-ICU and keep the patient closer to family members without negatively impacting outcomes (and helping support those rural facilities instead of big academic medical centers); and (d) hospitals buying remote ICU monitoring technology should first see if local docs will support it by letting those remote intensivists do something more than just provide off-hours fire watch coverage.

Speaking of tele-ICUs, Advanced ICU Care, a St. Louis ICU monitoring service whose 60 intensivists and ICU nurses use VISICU, raises another $2 million of investor money, bringing its total to $12 million.

It’s a new year – time for parades, bowl games, and HISsies nominations. Tell me your thoughts about 2009’s best and worst vendors, the smartest and stupidest vendor moves, and of course the granddaddy of all HIT industry awards: your choice for “HIT industry figure in whose face you’d most like to throw a pie.”

Another New Year’s tradition: newspaper profiles of the local hospital’s first baby of the year, which as I annually note, seldom involves married parents.

Listening: Boston-based Lyres, which sounds like the Animals or Seeds time warped from a 1960s garage into the 1990s with their Farfisa organ in tow.

HHS didn’t make its proposed Meaningful Use standards easy to work with, scattering them over two verbose PDF files (they didn’t exactly lead by example when it comes to discrete data and interoperability). I pored over the documents again in my usual nerdy New Year’s Eve (while watching some guy doing an Evel Knievel-style car jump on TV and all three hours of Rush in Rio) and put the actual criteria and thresholds into a handy-dandy Excel worksheet (note: it looks crappy in the preview, but perfect once you download). It spells out the provider parts of the MU requirements in concise detail. Certification and payment specifics means nothing if you can’t look down this list and nod your head that, hey, we can do all this stuff on the computer. Let me know of any additions or changes. I numbered the criteria just for reference, but it’s a made-up number.

Some thoughts on the proposed Meaningful Use criteria:

• I’m trying to figure out who the big winners will be if these criteria are approved. Consultants for sure. Companies like RelayHealth that provide eligibility, claims, and information exchange services. Companies that can perform a security analysis. Vendors that offer a usable medication reconciliation function. Vendors with patient portals. Companies that can help put vital signs information directly into the EMR.
• Losers: EMR vendors already strapped to pay for CCHIT certification who now have to cough up another million or two to meet the additional requirements. That’s another blow to small and innovative vendors who aren’t raking in the cash, meaning the market tilts even more in favor of the older, bigger ones whose sales were so limited that the government decided to intervene in the free market in the first place. Market consolidation is probably good, but I expect the development agenda will now be even more driven by Uncle Sam, not users (especially since the HITECH sales window is small, so even sales-driven innovation may dry up once everybody has chosen their dance partner).
• Lots of folks, me included, expected the criteria to be a slam dunk for moderately tech-savvy hospitals and practices. Not so: considering the small percentages of them using CPOE and e-prescribing, the minority that can provide electronic copies of information to patients, and the small number of practices that can provide patients with fast access their online health information, the these are stretch goals. I bet those requirements will be dialed back in the final version for that reason.
• Good luck with providing the denominator number for the reimbursement measures. You will need to know the total number of prescriptions generated, the number of orders issued, and the number of episodes in which medication reconciliation should have been performed. The document indicates an estimated time to generate the denominator at one hour using the EMR’s capabilities, which is surely a mistake since the EMR doesn’t help you count paper orders.
• The CPOE requirement is generous to hospitals, which have been screwing around since the 1980s trying to get doctors to use CPOE with dismal results. They are required to hit only 10% CPOE usage since “CPOE is traditionally one of the last capabilities implemented at hospitals.” (like, decades after buying it?) Practices, most of them considering their first EMR in a quick ramp-up to earn HITECH money, need 80% usage right out of the gate. I expect changes here, too, with the hospital target raised and the practice one lowered.
• With the minimal CPOE usage required for hospitals, the five required (and undefined) clinical decision support rules won’t have much impact on patient outcomes.
• The report cites a pseudo-fact that, “Some vendors have estimated that EHRs could result in cost savings of between $100 and $200 per patient per year.” Vendors say a lot of things, but I believe only those that are enumerated in a contract, preferably with rewards or penalties to encourage backing up self-serving statements with risk. I’m not sure I would have included that stat.
• The report used the high estimate of EHR cost from a range of $25,000 to $54,000 per provider, stating that “we believe the cost of such technology will be increasing.” Why should software costs increase when user bases are increasing, which should allow vendors to spread their fixed software development costs over more users? The only one factor that would raise the price is the vendor cost of complying with certification requirements (government meddling in free markets never comes free).
• That higher upfront EMR cost makes the elusive $44K jackpot even less enticing. Doctors were already avoiding EMRs because of cost and negative workflow impact. Providers are questioning whether they can qualify for the incentives and whether they trust the government to pay them.
• Conclusion: if you like the idea of having the government use taxpayer money to encourage the use of specific products in the pursuit of lofty and possibly unrelated goals, this at least pushes some theoretical behavior change in the users who choose to participate. If you’re a provider trying to decide whether the government money has too many strings attached, this might convince you that it does. And if you asked me how the odds of high EMR utilization changed with the release of these proposed requirements, I’d say they got worse.

Apparently we are not collectively certain that Epic is a proven solution for acute treatment of seriously ill patients, at least based on the results of my last poll. A new one to your right (or lower left if your screen resolution is set low): are the initial Meaningful Use criteria too easy for providers to meet, too hard, or about right?

I love this newspaper article because it reminds me how shocked I was the first time I saw what it describes first hand: the person in scrubs assisting a surgeon performing an OR procedure is sometimes an unlicensed salesperson of the medical device being used. In addition to the skilled medical personnel in the OR, “at the foot of the operating table, there’s Chuck Bates, a guy who studied biology in college and always wanted to go to medical school but never did. Instead, he began his career selling hot dogs to grocery stores. As the surgeon prepares to make an incision, Bates stares at the X-ray monitor. Come up one centimeter and make your incision there, Bates tells the surgeon.”

This is what the lure of taxpayer-funded EMR Welfare has done. An Indiana group holds its first planning meeting about applying for $15 million in federal HIT money (the Beacon Community Program) even though the representative of the only hospital involved (and the main beneficiary of the grant) skips the meeting because he’s on vacation. Their application is due January 8, so they met without him. The county health department director figured the financial windfall would be nice, but low EMR provider usage makes the group a pretty poor EMR beacon for the country to follow: “It’s been a real struggle. The hospital’s computer system has been crap. I’m not sure it is even 15 percent, let alone 25 percent.”

E-mail me.

ONCHIT Releases Preliminary Definition of Meaningful Use

The federal government announced regulations this evening that define “meaningful use” of EHRs and the CMS incentive program associated with it, barely meeting the December 31 required date for issuing an initial set of standards.

The rules will go into effect 30 days after publication following a public comment period. The meaningful use rule is here (warning: PDF).

The incentive rule (all 556 pages of it) is here (warning: PDF). It contains specifics about percentages of orders, payment schedules, specific numerators and denominators for measures, etc. I gave it a quick skim and got most of the information about use measures, but if someone wants to summarize the payment portion early Thursday, I will post it (since I’ll be at work).

These specifications apply to Stage 1, which take effect in 2011. They fall into four categories of standards: vocabulary, content exchange, transport, and privacy and security.

Stage 2 requirements start in 2013 and Stage 3 requirements in 2015. Those will be defined later by HHS.

This is a summary of the most important information.

CPOE
Practices: Use CPOE for orders involving medications, laboratory, radiology, and referrals.
Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer.
Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.)
Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Clinical Checking of Orders
Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Problem List
Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT.
80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).

E-Prescribing
Practices only.
Must send 75% of non-controlled substance prescriptions electronically.

Active Medication List
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Medication Allergy List
Longitudinal with allergy history.
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Demographics
Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth.
Hospitals: all of the above plus date and cause of death if applicable.
80% of patients must have demographics recorded as structured data

Vital Signs
Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse.
80% of patients aged 2 and over must have blood pressure and BMI entered.
Children 2-20 must have a growth chart.

Smoking Status
Record if current smoker, former smoker, or never smoked.
Must be recorded for 80% of patients.

Structured lab results
Display results, translate LOINC codes, allow maintenance based on new results.
Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Patient Lists
Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Report Quality Measures to CMS and States
Calculate, display, and submit quality measure results

Patient Reminders
Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Five Clinical Decision Support Rules
Beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.

Eligibility
Allow user to record and display based on eligibility response from insurer.
Must cover 80% of unique patients.

Submit Claims
Must submit 80% of all claims filed electronically.

Electronic Copy of Health Information to Patients
Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary but not procedures.
Must provide an electronic copy of health information to requesting patients within 48 hours.

Electronic Copy of Discharge Instructions
Hospitals only.
Must provide electronically to 80% of discharged patients who request them.

Timely Patient Access to Health Information
Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability.
Must provide to 10% of unique patients.

Clinical Summary of Each Office Visit
Practices only: diagnostic results, medication list, procedures, problem list, immunizations.
Must provide for 80% of office visits.

Information Exchange
Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary.
Must conduct at least one test of exchanging information.

Medication Reconciliation
Compare and merge two or more medication lists into a single list that can be displayed in real time.
Must be performed in 80% of encounters and care transitions.

Submit Data to Immunization Registries
Must conduct at least one test of submitting information.

Submit Lab Results to Public Health Agencies
Hospitals only.
Must conduct at least one test of submitting information.

Submit Syndrome Surveillance Data to Public Health Agencies
Must conduct at least one test of submitting information.

Protect Electronic Patient Information
Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures.
Must conduct a security risk analysis and implement security updates.

Transport Standards
SOAP and REST
HL7 CDA R2 Level 2 CCD or ASTM CCR
ICD-9-CM or SNOMED CT for problem lists
ICD-9-CM or CPT-4 for procedures, moving to ICD-10-PCS or CPT-4 for Stage 2
RXNorm for medication lists
UNII for Stage 2 allergy lists (no standard now)
CDA template for Stage 2 vital signs (no standard now)
UCUM for Stage 2 units of measure (no standard now)
LOINC for lab results
NCPDP Formulary & Benefits Standard 1.0 for drug formulary checks
NCPDP SCRIPT 8.1 or 10.6 for prescription information
ASC X12N and NCPDP for transactions
CMS PQRI 2008 Registry XML for quality measures
HL7 2.5.1 for submitting lab results to public health agencies, with UCUM and SNOMED CT encouraged
HL7 2.3.1 or 2.5.1 for submitted surveillance information to public health agencies and for immunization information
Encryption only if organization sets it as a standard

Median Estimated One-Time Costs for CCHIT-Certified EHRS to Be Certified as Complete EHRs
CCHIT Ambulatory 2008: $1 million
CCHIT 2007/2008 Inpatient: $1.38 million

Median Estimated One-Time Costs for Pre-2008 or Uncertified EHRS to Be Certified as Complete EHRs
Practice EHR: $2.4 million
Hospital EHR: $3.3 million

Estimated Median Industry Costs for EHR Preparation
2010: $61.35 million
2011: $54.53 million
2012: $20.45 million

News 12/30/09

From C’mon Man: “Re: would you buy an EHR from this man? Or a demonstration of how easy it is to smile at the patient, hold the computer, and enter data all at the same time. I do not get it, why is anyone fussing? This ad has sold me, outdated CCHIT and all.” Hey, have some holiday compassion: it’s tough making a living trying to get doctors to use EMRs they don’t really want. My first thought reading the “gift that keeps on giving” part of the ad: the old joke about syphilis.

Note to Mississippi Governor Haley Barbour: don’t ask a question if you don’t want to know the answer. The Gov, getting his tweet on, sends out a blurb pitching cost cutting. An administrative assistant in University Medical Center’s nursing school tweets back, suggesting that maybe he should get his medical exams during normal working hours like everybody else instead of requiring employees to come in after hours on overtime. The Governor’s Office is not appreciative, tracking her down and demanding that the hospital’s compliance officer deal with her. They did, citing HIPAA laws in telling her to quit or be fired even though she didn’t know anything about his health first-hand. The Governor’s Office claims they didn’t contact anyone.

I just noticed that the verified e-mail subscriber count has passed 5,000. Thanks to everybody who reads HIStalk. I can’t express how satisfying and humbling that is, especially when I’ve had a sucky day at work (not today, though – it’s great with everyone taking time off, although the long winter grind starts in earnest next week).

From Thanks: “Re: KLAS. Thank you for publishing the article on KLAS. I was really upset that you never said much lately about this. KLAS is a big scam.” The Readers Write article by Swearingen Software CEO Randall Swearingen drew quite a few diverse comments. Some believe KLAS is an evil money factory, while others say their approach is reasonable. Not that you care, but here are my observations about KLAS.

• I have contributed to KLAS surveys (although not recently) and never detected any suggestion of impropriety. I found their information useful and referred to it fairly often, although not to the exclusion of doing my own homework. I wouldn’t have paid for the subscription and reports.
• I would like to see more statistical transparency in their methods, preferably by external and impartial oversight. Adam Gale said he welcomed this in my 2007 interview with him, but I haven’t seen any changes.
• I don’t believe it when KLAS insists that wild result swings (the “first-to-worst” phenomenon) is a reflection of vendor changes. I think it highlights the problem of trying to extrapolate hard statistics from squishy interview data, no matter how many mumbo-jumbo graphs you include.
• KLAS doesn’t claim to be the Consumer Reports of the industry (see Adam’s comments in my interview). They are a survey company, not a software testing company. At best, they accurately summarize information that vendor customers have given them.
• KLAS has always taken specific data of limited usefulness and wildly extended it into all kinds of repurposed reports that mean very little but that provide extra sales revenue. I have always ignored those anyway, so I can’t say that bothered me.
• The KLAS business model is the same as that of HIMSS: providers pay little to nothing, but their participation motivates vendors to pay to play. Whatever they are selling, vendors keep buying of their own free will.
• Like every other survey-based award, vendors who score well plaster their results everywhere. Those who don’t complain that the process was rigged.
• For me, I paid the most attention to the user comments rather than the fancy graphs and stoplights. For we provider-siders, I bet I could provide an equally valuable service by just contacting a lot of verified system users, asking them a handful of questions, and publishing the results.
• My overall conclusion: the evils of KLAS are really a reflection of the evils of its provider and vendor members. Vendors try to game the system without getting caught, while providers unwisely overweight the value of KLAS in making their IT decisions. All of that is highly profitable to KLAS, but more power to them for creating a niche that still has minimal competition and strong business after all these years.

Back in 2005, I wrote an editorial pitching the idea of a standard healthcare database schema. I’ve seen other folks pick up that idea lately. Given the push for interoperability, I still like the idea. Here’s a snip of what I said then:

This is where my noodling got out of hand. Why can’t every vendor voluntarily or mandatorily use the same database layout for core information? How many ways can you express and repose standard elements such as date of birth, gender, address, etc.? Vendors can, when under duress, feed their data to a standard interface. Why can’t all systems just use an approved core set of tables, updated by the same core set of business rules, and then add their value through additional related tables, GUIs, business rules, etc.? Everyone’s patient database could look and work the same. Seen one, seen ’em all. Customers would be as thrilled by this idea as vendors would be appalled by it. Standard reports would work for every hospital, not just those of a particular vendor. Data translation for third-party reporting would be a no-brainer. Conversion of one system to another would be a piece of cake. Hospitals could easily merge and un-merge with each other to their heart’s content, with data conversion and extraction being assured. You might even have your choice of database software, given an Internet-like abstraction layer that supports everything from Oracle to Cache’. Talk about your interoperability!

An unconvincing article a couple of months ago concluded that remote monitoring of ICU patients by intensivists had little impact on outcomes. I can’t see the full text of this new JAMA article, but it seems much more conclusive, even though its conclusion is the same: “Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.” It’s the CPOE problem, however – many of the institutions had it, but weren’t really using it (although that in itself might, as for CPOE, give an organization reason to question its own capabilities before whipping out the checkbook).

LifeBot announces GA of its VoIP-based workstation for EMS telemedicine, offering full compatibility with digital radio systems.

Inga’s got a couple of great interviews running on HIStalk Practice: Scott Decker (new president of NextGen) and William Zurhellen, MD (a pediatrician and CCHIT expert panel member who has some shockingly frank things to say about the state of EMRs, CCHIT, and standardization).

Listening: Ben’s Brother, slightly whiny Britpop that still sounds good, although I eventually needed some nasty chick music to offset it and headed over to desk-drum to L7 for the zillionth time.

OHCHIT has an upcoming conference call to talk about the $6 million it will spend to get universities to develop a health IT competency exam (warning: PDF) for degree-less HIT people, a little chunk of its $120 million Health IT Workforce Development Program.

Greenway Medical rolls out its PrimeSuite EHR, PM, and interoperability product to Bethesda Healthcare System (FL).

Northwestern Medical Center (VT) gets CON approval to implement Meditech for $5 million, also expecting $577K in stimulus money as a result.

Odd lawsuit: a man sues Barnes Jewish Hospital after he claims he slipped on a Q-tip while visiting a patient, causing extensive injury, disability, and suffering.

E-mail me.