News 3/10/10

HERtalk by Inga

From: Sioux Supporter “Re: Janet Dillione. I can confirm that Janet Dillione has resigned from Siemens. No announcement of new role or firm, but the announcement was made Friday.” Still unconfirmed, though a few readers have sent note with similar messages.

From: Big Mouth “Re: iSOFT. iSoft loses another senior executive from it’s flagship business unit. Just confirmed from internal source that Keith Kirtland, UK&I Commercial and Sales Director resigned earlier this month. This is the 4th sales director in as many years and is expected to have a destabilising effect on both the Wales Lab deal and overall sales in the UK for this troubled NPfIT supplier. In February,  iSOFT reported significant drops in both revenue and profit.  This resignation will certainly impact 2nd half results.”

From: Beauty “Re: Press Releases. To Beastly – I see you are putting the spin on the negative. Any which way you slice it – too many press releases = too little bang…leaving out ‘for the buck’ cuz we know you are still pulling down the bucks. Too much noise at HIMSS…and those who would be interested are too busy ‘doing’ HIMSS. As for me – I deliberately launched product before HIMSS…with press release…specifically to avoid the noise and being one of the 100 needles lost in the haystack. Hmmm – opinion of the those who are in the business of press releases…or those of us targeted by the press releases?  Listen to your audience. Let’s have a HIStalk vote on this one!” Personally I am just happy that it took less than a week for me to finally weed through all those releases.

From: William Tell “DoD and VA disconnect. Nice to know CPOE and electronic records are going to solve everything . . . as if.”

From: Curious “Re: Promise Healthcare. I am curious about your opinion of them.” Alas, I have no opinion since I know nothing about them. In the absence of the ever-wise Mr. H, perhaps readers can weigh in.

From: Emily Dickinson “Re: Medical Manager execs guilty. Two former executives of Medical Manager Health Systems Inc. have been convicted of federal securities fraud after a two-month trial in U.S. District Court in Charleston, SC.” The company’s former VP and COO John P. Sessions and former president John H. Kang were found guilty of conspiracy to commit mail, wire and securities fraud for their part in a scheme to inflate Medical Manager’s earnings by more than $16.8 million between 1997 and 2003. Sentencing will occur at a later date.

From: Mr. H “Re: Charles McCall heading to prison.That news made my day.” Really? I get one email from Mr. H in four days, and this is all he has to say. What’s up with that?

Quest Diagnostics and Surescripts team up to form an integrated service that combines lab and prescription information available to connected physicians. I suppose that means that if my grandmother in Washington goes to a doctor in Florida, the Florida doctor might be able to access Grannie’s lab and prescription data. Now we are getting somewhere.

Surescripts, by the way, reports that e-prescribing rates tripled from 2007 to 2009, with an estimated 18% of all eligible prescriptions now being sent electronically. The number of prescribers routing prescriptions doubled from 2008 to 2009, and now includes 25% of all office-based physicians.

Huntington Memorial Hospital (CA) plans to offer HuntingtonRx, a branded version of Allscripts stand-alone e-prescribing solution, to its 1,000 affiliated physicians.

Five hospitals select Summit Healthcare as their sole integration partner to assist with migrations from current Meditech platforms to Meditech 6.0.

Annapolis Pediatrics selects Sage Intergy suite to automate its clinical and financial operations. Annapolis Pediatrics is a four-location, 21 provider group.

Trinity Health (MI) deploys Medicity’s Novo Grid solution, establishing an HIE between almost 1,000 affiliated physicians. The headline of the press release claims this first stage took “9-1/2 weeks,” which happens to be the same amount of time it took Kim Basinger’s Elizabeth to walk away from Mickey Rourke’s John.

Sisters of St. Francis Health Services (IN) select Epic for its 13-hospital system.

Northwest Hospital & Medical Center (WA) contracts with dbMotion to create an interoperable patient record for both in-hospital and ambulatory care providers.

UPMC introduces an EHR application that runs on a BlackBerry smartphone. The program leverages the interoperability platform created by dbMotion and provides a single view of key patient data from multiple information systems.

Henry Schein launches ConnectHealth, which partners companies in the EHR, medical device and computer services sectors. Specifically it sounds as if the new program leverages Henry Schein’s partnerships with several vendors to implement EMR in physician offices. Partner vendors include Allscripts, Midmark, Welch Allyn, Siemens, Dell, and Medline.

The nice folks at Bridgehead Software have invited me to visit their booth at the World of Health IT event in Barcelona, March 15-18. Bummer that I have a manicure scheduled during that time so I will have to miss the event. If you are attending, visit the Bridgehead team at Stand #841 and sign up to win an iPad.

Speaking of Spain, Gestion Sanitaria de Mallorca in Palma selects Orion Health technology to serve as the backbone for its EHR. The EHR solution will be the first for community care in Spain.

We have a new interview on HIStalk Practice with Dr. Joel Feinman of Valley Medical Group in Massachusetts. He’s an EMR proponent on many levels, but especially in terms of providing patient care: “I don’t see how you can do that anymore without some kind of electronic system that actually works.” Check it out and sign up for e-mail updates while you are there.

Today I joined a conference call with the wonderful sponsors of last weeks HIStalk reception. After accounting for walk-ins and a few no shows, total attendance was about 430, making it our biggest bash ever. Thanks again to Encore, Evolvent, and Symantec for making it such a great event.

General Dynamics Information Technology hires Raymond Sullivan to serve as VP of HIT Solutions, tasked with business development for the federal government and commercial health organizations. Sullivan was previously executive director of the VA’s Office of Information and Technology.

Hospital nurses estimate they spend a quarter of their 12-hour shift on indirect patient care. Wow. While not providing direct patient care, nurses are working on regulatory requirements, handling lots of paperwork, and securing needed equipment and supplies. Solutions recommended by surveyed nurses include more ancillary staff support, better hospital-wide communications technology, and reductions in redundant regulatory requirements.

Anne Arundel Medical Center (MD) implements Corepoint Integration Engine to facilitate a migration to Epic’s HIS and improve clinical data exchange with community physicians and patients.

In what could be the greatest news of the decade, a report in the Archives of Internal Medicine finds that normal-weight women who drink a light to moderate amount of alcohol appear to gain less weight and have a lower risk of becoming overweight and obese than non-drinkers. On that note, I’m off to find a cocktail.

E-mail Inga.

HITlaw 3/9/10

Non-Compete Agreements

Non-compete agreements (NCAs) are designed to prevent individuals from leaving a company with valuable information and then using that information in a new job with a competitor of the company to the detriment of that original company/employer.

Sounds reasonable on its face. On the other side, what if you are the employee that with no malicious intent whatsoever, elects to change jobs and move on to bigger and better things? You should be free to do so, right? If on exiting your current job you are presented with the NCA that you signed when starting (and may have forgotten or misplaced) and you are a valuable developer, your soon-to-be former employer may be dropping more than a subtle hint in your lap.

So what is fair and reasonable in light of the two justifiable yet opposing positions?

This is the essence of the determination that courts must make in cases involving NCAs. In general terms, in order for an NCA to be “reasonable” it must protect an employer’s legitimate business interests while not unduly restricting the employee’s ability to work elsewhere. Other key considerations are length of time and geographical area (historically). The first part, protecting legitimate business interests, is satisfied if the employee involved had access to trade secrets of the former employer. Further, if the employer uses NCAs for only certain employees that have access to confidential material or trade secrets, they strengthen greatly their likelihood of support from the courts. As for length of time, six months to two years depending on the situation, is usually found to be acceptable. Anything longer than that would require a stiffer business reason for the restriction. Finally, geographic scope is considered. In the technology industry however, geographical area could include the entire US market. There has been some relaxing of the geographical scope restriction, which is why I used the parenthetical “historically” above.

Note that the NCA is a contract. All contracts must have “consideration”, or something of value, offered by each party and consequently accepted by the other party in order for the contract to be valid. If the NCA was a condition of employment at the point of hiring, then the promise of a job fills the consideration requirement. Introducing the NCA in an existing employer/employee relationship is different. Some courts have held that continued employment is sufficient consideration. In other cases, the execution of the NCA in conjunction with a raise or promotion has served to establish that sufficient consideration is present to enforce the NCA. An employee faced with the new (post-hiring) NCA requirement may not have any reasonable opportunity of negotiation. Some may however. If the employee is a valued software scientist, then ideally that individual could seek a severance package, providing an amount of money sufficient to offset the period of time in which they are prevented (by the NCA) from working in the same field for a competitor. As a general statement, the employee should always review the NCA carefully, even seek legal advice, in order to determine the restrictions imposed and the reasonableness of those restrictions.

The employer should make sure it is seeking to protect a legitimate business interest, and NOT just that it does not want competition. Lack of a justifiable business reason could be argued in the case of an employer having all employees sign an NCA, regardless of position, from receptionist to software engineer. Limited duration and geographical area are also helpful. An NCA of unlimited duration, where the employee can never work for a competitor, would work against the employer. In short, if the employer is careful to make the NCA as tight in scope as possible, in order to make the burden on the employee as little as possible, then they are in much better shape if the NCA is contested. If an NCA is too broad and lacks a sound business reason, its enforceability is strongly suspect.

Where a valid NCA exists, the new employer may also be susceptible to legal action by the former employer. Employers that lose key personnel to competitors often bring action against both the former employee (for violation of the NCA) and the new employer (for tortious interference with the prior relationship evidenced by the NCA). It is not unheard of for a new employer (that lures the key employee away) to belly up and take care of the employee’s anticipated defense, legal bills, and settlements with the former employer. I am not trying to scare people, but it should be understood that if an NCA is valid and you breach it, you are potentially liable for damages to your former employer. In addition, the former employer could seek an injunction preventing you from working for the new employer while the case is decided. Finally, if everything goes the former employer’s way, you could still be prevented from working for the competitor into the future. If you are the employee considering a job change and you asked directly if you signed and NCA, then obviously you must reveal the fact. If not asked and you do not volunteer the information, and the former employer sues the new employer, then the easiest way for the new employer to reduce its exposure is to terminate you. Not a welcome thought.

An interesting twist to consider is the situation where the employer terminates the employment relationship. Assuming that the NCA is valid and reasonable (see above), and would probably be upheld if the employee were the one terminating the relationship, then the issue really comes down to a restriction on the employee’s ability to make a living when the employer terminates employment other than for cause. Keeping in mind that we started with the assumption of a valid NCA, then strictly speaking, the employee is not free to ignore the NCA and the former employer could sue the employee, but then the court would have to look at the fact that the employee did not leave voluntarily and determine the reasonableness of limiting that individuals livelihood. My point is that being “let go” does not nullify the NCA, but enforcement by the former employer will be more difficult than if the employee left on their own.

Note that NCAs should not be feared, but they must be understood. In the HIT industry companies invent things and they try to sell more of these things to the industry than their competitors. They have a right to protect their inventions, know-how, trade secrets and customer bases. Anyone seeking to join such a company really should understand this going in. That said, it is not reasonable to expect a person to work for only one company in a given industry for their entire career. Some do, most do not. There is also the consideration of the type of work that the employee performs. The software scientist should have far more expectation of restriction on the ability to switch to a competitor than an administrative staff member.

Final Comments:

NCAs are not bad. If a company has something worth protecting, something essential to its business that if shared with a competitor would be damaging to its business, then they should be able to protect it. I don’t know how an employee would consider it “OK” to take that information elsewhere. I know it happens, but that does not make it right. Separately, we are all free to work wherever we choose. Absent the malicious factor, people should not be restricted from working for a competitor.

The problem is that you cannot unlock the brain of a software scientist, extract all they have learned at your company, then let them go on their way. Knowledge is retained and there is nothing we can do about that. I once saw it referred to by a BIG hardware/consulting company as “intellectual capital” (and I knew it was time to put that file down for the day). So even if nothing is physically removed, the secrets go right out the door in the scientist’s gray matter. Keeping them from using that knowledge to a competitor’s advantage is fair. Keeping them from earning a living doing what they like is unfair. It is a balancing act, a weighing of the consequences to each side, and a determination of fairness that the courts must perform when ruling on NCAs.

Please understand that even though I expound on valid or enforceable NCAs above, you must note that certain states basically do not permit NCAs (like California), others do but only in limited circumstances (New York and Virginia), while in others enforceability depends on the circumstances. This article has focused mainly on the individuals involved in the technology aspect of healthcare. Many states (like Massachusetts) clearly prohibit by law NCAs for physicians and nurses due to the fact that such agreements restrict a medical professional’s right to practice and also limit the patients’ right to choose their caregivers.

The NCA issue is heating up. Legislation has been proposed here in Massachusetts that would dramatically restrict NCAs by instituting strict guidelines, brightline determinations (clear “black & white” language) as well as safe harbor provisions. One very interesting aspect of the proposed legislation is that it would protect the employee residing in Massachusetts, even if the employer is not located in Massachusetts. I am watching closely as the bill winds its way through the legislature.

Finally, if you are faced with a situation involving an NCA and have serious concerns, please consult with an attorney or your local US Department of Labor office.

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

Monday Morning Update 3/8/10

HERtalk by Inga

From: HIS user “Re: Rumor. (The CEO for the HIT business unit) of a (large, international technology company) has resigned. Heard from multiple direct sources at the company. Was announced there Friday.” The CEO was at HIMSS and had a press conference as recently as Monday. I sent a note over the weekend to the company but not heard back. If it’s true, I suspect the company will share the news Monday.

From: Bean Town Gal Re: Highlights. “We attended the HIStalk party and it was a highlight of HIMSS. Nice to be in the fishbowl; surrounded by friends and competitors — and truly enjoying it. Great vibe — thank you to the sponsors — the spinach & artichoke dip was yummy, GREAT to sit down and rest the paws after a very long day …. but most of all, the intrigue and credibility that you & Mr. HIStalk create, will keep us coming back again.  Truly appreciate what you both do. Kudos and …. Love the shoes.”

From: Beastly “Re: Press Releases. As PR professionals we are compelled to issue press releases when our companies bring new products to the market that are worthy of acknowledgment. A true PR professional knows the difference between newsworthy and wasting a journalist’s time. We also have an ethical responsibility to advise our clients if and when their perception of news doesn’t merit coverage. Issuing press releases about non-news compares to the ‘boy who cried wolf,’ syndrome. For many within the healthcare industry, HIMSS is our Super Bowl. The opportunity to showcase the products we developed, believe in and are proud of. The media and most importantly our customers expect to see us with our best game. Companies don’t indiscriminately issue press releases – they plan product releases so that they coincide with HIMSS. If a product is ready two months before HIMSS, the HIMSS exhibitor companies traditionally wait for HIMSS to show and announce it.  And if the product won’t be consumer ready until a few months after HIMSS, the exhibitor will often develop a mock-up or engineering sample so it can be shown to the audience at HIMSS. The majority of us aren’t trying to waste your time; we’re inviting you to share our exuberance.”

From: Pat Avatar “Re: HITmen event. I was unimpressed with the “boys club” HITmen event. I think it was very unimaginative. Same people named over and over. A while back, Colin Powell was quoted along the lines of if any area was in need of imagination, it was healthcare. If we keep trotting out the same handful of people – we are truly in trouble. Enough of Tullman, Bush, the government appointees who are elevated only by title and not by progress, Halamka, and the usual short list. Why not have someone meet the challenge of recognizing the worker-bees – the ones really getting the job done – while the same people are the headliners. Besides, Inga and I are going to take over the world of healthcare and get something done.”

Note sure that I am going to take over the world of healthcare (or that I want to) but I am taking over HIStalk for the week. An exhausted Mr. H is taking took some well-deserved time off and hopefully cleansing his mind of the HIT world. If you have any news to share, be sure to send it my way since Mr. H is avoiding e-mail this week.

Last week MS HUG and Microsoft announced four winners of its annual Innovation Awards. SingHealth earned honors for the best use of inpatient clinical records use for levering its implementation of  Eclipsys Sunrise Patient Flow and CADI Scientific. Other winners included Brigham and Women’s Hospital, Doylestown Hospital, and Premera Blue Cross/Get Real Consulting.

Former McKesson Charles McCall is sentenced to 10 years prison and ordered to pay a $1 million fine for his part in a $8.6 billion fraud scheme.

Medicity and Emdeon collaborate to create the first “converged national HIE, leveraging Emdeon’s network of payers, providers, and pharmacies and Medicity’s iNexx Health 4.0 platform.

The Advisory Board Company enters an agreement to acquire Concuity, the healthcare-focused RCM software and services division of Trintech Group. Price: $34.5 million.

The Wall Street Journal reports that shares of Nuance Communications rose 5.7% Friday on rumors that Google is interested in buying Nuance Communications. There are lots of reasons why such a marriage would not make sense, but an acquisition of Nuance would certainly help Google increase its presence in the healthcare space.

McKesson is named the “World’s Most Admired” company in healthcare wholesalers sector in a survey by FORTUNE magazine and the Hay Group.  McKesson also made Corporate Responsibility Magazine’s list of 100 Best Corporate Citizens.

Start queuing up at your local Apple store: the Wi-Fi-enabled iPad goes on sale April 3, with pre-ordering starting March 12th. Suggested retail prices will range from $499 for the 16B model to $699 for the 64GB. The 3G equipped models will hit the market in late April, though you can also pre-order starting March 12th.

Lumetra PSO agrees to provide iSOFT’s AIMS incident management software to US healthcare organizations.

Bridgehead software unveils preliminary results of its Data Management Healthcheck 2010, reporting that only 6.5% of respondents use cloud storage as the destination media for their organization’s data. Only 33% say they are planning to adopt a cloud storage strategy for any data over the next 12-24 months. The biggest concern is security and availability of data using a cloud strategy.

A couple HIMSS education sessions I missed: “A Big, Hairy Audacious” CPOE Goal, and, It’s More than Pizza! Improving House Staff Adoption of CPOE. I wonder if the presenter for the second one got any snack tips from Mr. H.

Former RelayHealth COO Jeff Bairstow joins Journal Register Company as CFO.

RWJF awards over $2.4 million to five research teams studying how patient-recorded observations of daily living can be captured and integrated into clinical care.

Wellmont Health System (TN) names Kent Perry CIO and VP and Dr. Troy Sybert chief medical information.

Verizon Business launches The Verizon Medical Data Exchange, a platform that gives transcriptionists an interoperable tool for sharing digitized patient notes.

A fan files suit against the Kansas City Royals after being hit in the eye – by a hot dog. The team’s mascot (Sluggerrr) regularly fires hot dogs into the crowd, but one last year hit John Coomer in the eye, resulting in a detached retina and cataracts.So far his medical costs have exceeded $25,000. It’s unclear whether Cooner actually ate the errant hot dog.

E-mail Inga.

Merge Healthcare To Acquire AMICAS

AMICAS has agreed to terminate its previously announced agreement with Thoma Bravo and instead has entered into a merger agreement with Merge Healthcare, the company announced this morning. Merge will acquire all outstanding shares of AMICAS in an all-cash deal valued at $6.05 per share, a 35% premium to Thoma Bravo’s offer and a 39% premium to the average monthly share price.

"We are very pleased with this significant positive step toward successfully combining these two great companies," said Justin Dearborn, Merge CEO.  "Merge and AMICAS have strong histories of innovation in medical imaging software, experienced employees and engaged customers.  As a combined company, our suite of health IT solutions will encompass a broad range of medical and biopharmaceutical imaging solutions to meet the needs of today’s medical imaging providers.  In addition, Merge’s OEM and CAD technologies, international and eCommerce distribution channels, and additional market segments such as clinical trials provide new opportunities for AMICAS products and customers. On behalf of everyone at Merge, I look forward to welcoming and working closely with the AMICAS team."

News 3/5/10

From JT: “Re: speech recognition. I know of patient populations that might be able to use it because of disabilities. Any information you can share is greatly appreciated!” Dragon Naturally Speaking is the standard and the one I bought. It not only does an amazing job of hitting 99% accuracy right out of the box, but also allows controlling Windows functions by voice (like using Word’s menu bar, navigating files, etc.) I know the military puts it on laptops for recovering soldiers who can’t use their hands, giving them a way to use the PC, use e-mail, etc.

From The PACS Designer: “Re: Microsoft Windows Phone 7. InformationWeek has posted a video gallery for the new Windows Phone 7 application. It should give us a good comparison to Apple’s iPhone.”

From Anon: “Re: Epic. Last Monday, Luke O’Voron reported that Judy Faulkner used the HIS Policy Committee Privacy and Security Workgroup call that week to shill for Epic. The transcript is posted (warning: PDF) and I can’t find anything in it remotely like what Luke said. Do you read it the same way?” I don’t see anything that looks like shilling, so I’m not clear on the original reference either.

Listening: Band Marino, possibly defunct indie pop from the Orlando area. They sounded good on the Clemson radio station I was playing in the car this morning, so I checked them out. My favorite tune is here (video).

The strange courtship of Amicas continues. The Amicas board now decides that Merge’s offer of $6.05 is better than the $5.35 one from Thoma Bravo it previously supported (duh). So now it’s back to Thoma Bravo to make a new offer by Monday, which of course they should have done immediately instead of sitting around waiting to have their hand called. Amicas has pushed its shareholder meeting back from March 4 to March 16. PACSMan weighs in on Dalai’s PACS Blog, using one of my favorite movies (Wall Street) as a backdrop. He even quotes the Greed is Good speech that I could recite nearly verbatim like the guys in another great movie, Boiler Room.

Here’s Dr. HITECH, Ross Martin, MD, doing the world premiere of his excellent Meaningful Yoose Rap at the reception.

The VA and DoD disconnect their shared EMR connectivity after after data errors are discovered, first noticed by a doctor who wondered why a female patient had been prescribed an erectile dysfunction drug. As a risk manager pointed out, it’s a good thing at least one error was obvious enough to raise a flag.

Prompt Medical Systems, a “vendor” whose only asset is a CPT entry patent and whose only business is suing other vendors (it doesn’t even have a Web site that I could find), files suit against nearly everybody selling an EMR, extending a string of lawsuits going back to 2005. A Virginia investment banker apparently funds the lawsuits, filed in friendly Texas courts.

Lakeland Regional Medical Center (FL) selects API Healthcare’s time and attendance and remote hosting solutions. API also announces go-lives at seven provider organizations.

A Microsoft VP makes an odd suggestion: treat PC security as a public safety issue and collect taxes to fund “hospitals” that will remove viruses and reduce their spread. Seems like that’s their job, especially since Apple users aren’t having problems.

A survey says 58% of doctors not using EMRs now plan to buy within two years, but would prefer a hospital help cover the cost. Federal incentives and penalties were cited as the main adoption drivers.

Eclipsys announces Helios, its open architecture platform that exposes Sunrise Enterprise 5.5 to third-party developers. Already building add-ons: Microsoft, Capsule Tech, and Hill-Rom. A reader asked why I hadn’t mentioned it, with the main reason that John Gomez already talked about it here when I interviewed him right before Christmas. ECLP calls developers out in the Helios site: “An open invitation to innovate. Competitors welcome.”

Merge Healthcare and Mass General will partner to build a testing environment for mobile healthcare applications.

Odd lawsuit: an IHOP cook accidentally cuts off his fingertip, which nobody can find. It turns up in the fried chicken salad of a woman eating after-church brunch. She suing for $20.5 million.

E-mail me.

HERtalk by Inga

From Midwest Doc: “Re: roundtable with Blumenthal. I was one of about 40 physicians who somehow earned an invite to a roundtable with Dr. Blumenthal. I was impressed that he cared enough to ask our opinions. He had a politically correct answer for every question we posed of him, so maybe he is well suited for his job.”

From Day Tripper: “Re: ambulatory EMR vendors. I asked several EMR vendors if they have seen a big increase in buyers, especially now that we at least have the interim final use definitions. The general consensus is that many physicians are still dragging their feet.” I’ve heard that comment as well. Either because of fear or because it sounds like a good excuse, many physicians are waiting until the MU guidelines are truly final and the certifying entities are identified. Perhaps a minority of physicians are savvy to understand that the RECs will offer some free implementation services so they are waiting for those to ramp up. And, likely others are waiting to see what opportunities their hospitals may offer to affiliated physicians. In other words, if you are looking for an excuse to not move forward, there are plenty to choose from.

From Samantha Brown: “Re: shoe patrol. Inga, please tell me. Was Judy wearing Birkenstocks?” Gosh, I was so excited that she was there I failed to notice the shoes!!

From Justen Deal: “Re: HIStalk party. Overheard: ‘Judy and Jonathan in the same room? Isn’t that like matter and antimatter?’? One observation: The fact that Jonathan Bush was able to charm a crowd made up mostly of his competitors says a lot about his comedic timing. Secretly, nearly everybody in the room is terrified of him,since his business model scares the scheiße out of them. I think the atmosphere (read: the lager) helped reduce their fears, at least for the evening.”

From BFF in Footwear: “Re: Inga Loves My Shoes! I must say that last night’s party was incredible — two of my dreams came true. First, I got to meet and chat with a very gracious Judy Faulkner, a woman who has been my inspiration and a role model for building and growing my software company. And second, I received the industry award that I have coveted for years — the Inga Loves My Shoes. I will wear my sash proudly and strive to always be worthy of this honor.”

From Inga BFF: “Re: great reception. The venue was wonderful and good beer was involved, to boot! It was a high-powered crowd, and yet everyone was friendly and cordial. Please let your reception sponsors know that we truly appreciate what they did.”

Before HIMSS, I was sent a notification that I might want to attend the “CCHIT EHR Certification Town Hall.” I was quite frustrated Monday because I could not find the session either on the navigation kiosk or the paper schedule. I eventually found it, but learned the session had been renamed “EHR Certification Town Hall.” The CCHIT folks were still leading the session, but it was interesting that either CCHIT or HIMSS decided to drop CCHIT from the title. One of the more troubling points made was that the ONC is not expected to designate CCHIT or any other entity until late 2010, or even into 2011. Everyone assumes CCHIT will be one of the certifying bodies but until it is etched in stone, plenty of conservative buyers are going to wait for the final, final declarations.

I wonder if Mr. H and I were the only ones who noticed the HIStalk signs displayed at many of our sponsors’ booths? Thanks for the promotion.

I’m still wading through the endless number of e-mails and need some PR person to answer me this: why does every single vendor feel the need to issue press releases during HIMSS? Don’t companies realize their news is more likely to be overlooked because of the sheer volume being churned out by companies, PR people, and media outlets?  But what do I know? I’m just a blogger. If you haven’t had a chance to see some of the news highlights, hang on for these brief updates:

• CynergisTek announces a new data loss prevention solution that leverages its partnership with Code Green Networks.
• Gartner places Compuware in the “leaders” quadrant of its “Magic Quadrant for Application Performance Monitoring” report.
• The AMA and Ingenix form a partnership to offer the web-based Ingenix CareTrack through the AMA web site.The AMA says that they will be offering additional new technologies to help enhance physician practices. The AMA also announced a collaboration with Dell, which sounds as if it is part of this same physician-automation initiative.
• UPMC announces the development of new PHR technology created in collaboration with Google Health, Carnegie Mellon University, and dbMotion.
• Precyse Solutions introduces Catalyst, a front-end automated speech recognition product.
• NextGen introduces a special offer to provide rural and community hospitals free financials with a qualifying purchase of inpatient clinicals. The NextGen Clinicals, by the way, is the former OpusClinicalSuite. NextGen was also named a winner of an MS-HUG 2010 Innovation Award in the category of Interoperability/HIE for its work with Doylestown Hospital (PA) and the Doylestown Clinical Network.
• MGMA President and CIO William F. Jessee announces he will retire in the fall of 2011.
• Enterprise content management vendor Hyland Software acquires eWebHealth, a provider of hosted medical records workflow solutions.
• MED3OOO and Acryness announce a strategic partnership to provide the MED3OOO QuikBill patient billing solutions, powered by Acryness, to MED3OOO’s RCM and ASP practice management clients.
• CHIME awards fellowships to Pamela McNutt of Methodist Health System (TX) and Rick Schooler of Orlando Health (FL.)
• 4medica launches its Integrated Health Record designed to tie patient data from diverse care settings to create a single picture of an individual’s patient record.
• Fifty eldercare agencies join the Rochester RHIO, which is powered by Axolotl’s Elysium Exchange.
• Nuance introduces a suite of voice-enabled mobile solutions for smartphones including Dragon Medical Mobile Dictation, Search, Recorder, and SDK.
• Healthland releases an EDIMS for small community hospitals, as well as an Analytics solution.
• Covenant Health and Sharp Healthcare select Allscripts Care Management and Post Acute solutions for their hospitals and post-acute care facilities.

Posting from the HIMSS Facebook page on Tuesday, the day of the big snowstorm: “HIMSS 5K Fun Run has been moved Indoors. Please come to Hall A, A1 to register. Run starts at 4 p.m.” I wish I had seen the run.

Speaking of Facebook, if you have any great HIMSS pics you’d like to share, our HIStalk Fan page is waiting for you. I have uploaded a few that readers have forwarded, but haven’t had time to load all of them yet. Feel free to friend me since you can never have too many friends, right?

E-mail Your Friend Inga.

From HIMSS 3/3/10

From The PACS Designer: “Re: Panasonic C1 Toughbook. At HIMSS 2010, Panasonic announced an exciting new Toughbook called the C1. It has many features that on-the-go healthcare professionals will see as being attractive.”

From Joe: “Re: McKesson. Hunting season came early this year. Firings in the Physician Practice Solutions group.” Unverified.

We have a lot of HIMSS-related observations on HIStalk Mobile.

I’m still tired, but here are my impressions of HIMSS10:

• The emphasis was on money and business rather than patients for the most part (my low point: a session that rattled off dozens of government grant programs from ARRA right on down, which reminded me of that seedy guy with the Free Government Grants infomercial).
• For that reason, it was a rather passionless conference. It’s hard to get charged up by filling a room full of people who want to lap from the federal trough.
• The KLAS/HIMSS Analytics presentation was good, with the primary message being that adoption of EMR, CPOE, etc. is going well, but there’s a long way to go. Also, that several vendors and products, despite slick glossy materials, basically aren’t getting any traction at all and don’t enjoy much support from their customers. It was refreshing to sit in a HIMSS conference room and have some of the vendors with big booth spreads being called out as dragging down the market with their incompetence (the usual big conglomerates).
• Atlanta is a pretty good convention town and GWCC has nicer public areas (seats) than most convention centers, but the split exhibit hall should have been a showstopper. If you were a vendor on the C side, you missed a lot of traffic. Maybe HIMSS should have limited the space per vendor so they could all be squeezed in on the A/B side.
• Many vendors were so vague on what they were selling that it was hard to tell on a quick glance, which is about all they’ll get from most attendees. Broad, catchy statements may work in an ad, but on the show floor, there are 200 vendors claiming to sell an EMR and little way to figure out how they are different.
• As happens every year, vendor people in the hall seemed to have trouble focusing. It’s inevitable to get tired and maybe jaded, so the to-do I would give vendors is to bring more people and rotate them. I went to several large (expensive) booths and couldn’t get anybody’s attention, and in at least a couple, the person made me feel genuinely unwelcome, like maybe they were anxious to get back to their personal phone chats.
• A fun scavenger hunt would have been to try to find a presentation that didn’t have any of the above words in the slide deck: ARRA, HITECH, or Meaningful Use.
• Everybody got excited over certification announcements, but I found myself caring not at all. I overheard someone providing a good summary of certification: it sets the bar extremely low for real vendors with real customers, but keeps doctors from selling crappy EMRs written by their brothers-in-law.
• There was a lot of activity on the show floor, but I can’t really say I picked out any theme that didn’t involve stimulus money.
• Education presentations ranged from pretty good to pretty bad, which is par for the course.
• HIMSS ran the conference smoothly as usual.
• Despite frantic reporting from the exhibit hall(s), there really wasn’t all that much big news, which is why I didn’t mention much of it.
• I got to see a lot of familiar faces and that’s always nice.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Most effective CIO in a healthcare provider organization
John Glaser, Partners

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal

HERtalk by Inga

I am in the Atlanta airport, headed home, so this will be another quick post.

Overall impression of HIMSS10: fun, huge, and a lot of excitement in the industry. More on that in a second, but I will first throw out a few things that I found less than perfect:

• Someone made a comment to me that Atlanta must not have had big convention like this for some time because they seemed overwhelmed at times at the convention center. Long lines for food (except at the Asian place, which apparently ran out of noodles early in the day) and untidy restrooms were the biggest evidence of this.
• The two-exhibit hall thing needs some tweaking. All the vendors in "C" felt like the stepchildren. Why not split the bigger vendors evenly between the two halls so that one does not look so much like an afterthought? And, having the two halls so far apart was pretty inconvenient. More than one person told me they didn’t realize there was a second hall until they failed to find a particular vendor.
• Is there such thing as a convention center that doesn’t involve miles of walking to get from one area to the next?
• I found too many vendors unable to give you a 15-second elevator pitch about their company or offering. Maybe it would be too much to ask for vendors to also tell you in 15 seconds what is unique about your offering.

Other than that…good stuff. I have to admit the educational sessions are tough for me to sit through (I failed to last the whole time for any session I attended).  Perhaps I picked the wrong sessions.

The last three days have flown by. I spent a good amount in the exhibit hall, but didn’t see all I wanted to see. I did check out a few software products and I will share more on that later. Thanks to all the kind invites to stop by booths — I didn’t get a chance to look deeply at every one, unfortunately.

And I popped in to a few parties, including Eclipsys, Allscripts, and HITmen awards. The HITmen awards had some great sushi and a lot of A-listers in the industry. I thought Mr. H was winning some award, but apparently not. Someone will have to explain to me why his name was on the promotional material but he didn’t win one of the cool plaques.

The MEDecision folks told me there were expecting 2,000 to their party, which they said was to be the largest HIMSS party. If you went, tell us about it.

Tuesday night I got back to my hotel after a VERY long day and popped up HIStalk to read the latest post. I literally fell asleep with iPhone in hand. Good thing HIMSS only comes once a year.

E-mail Inga.

From HIMSS 3/2/10 (Part 2)

From Clingy: “Re: your party. You do realize that, last night, your party became the party that everybody will have — and want — to attend? I’m sure it already was that, but now everybody else will know that, too. I think you may have to resort to a lottery for invites in Orlando…  Or you may have to rent a stadium.” I really appreciate the nice comments about the party, but I’m passing the kudos along to Amy Glass and Inga since I was too busy to jump in during those final weeks to set it up. Actually, I’ll thank a third group: those who booed and cheered during the HISsies, who enjoyed each other’s company even though many of them are on-field competitors, and who made up a darned impressive group. It’s the only time I get to see who’s reading and it recharges me for another year. If Jonathan Bush doesn’t win something next time, I may have to stuff the ballot box just so he can chew the scenery again. He was supposed to be on for like five minutes, but turned it into its own extravaganza (recall that this was the first business day after ATHN shares gapped down, but you would never have known it from his hilarious performance surrounded by the stock analysts in the room).

From Jim: “Re: your party. The HIStalk party rocks! This was the best party I have been to in the 15 years I have been going to HIMSS events. People were having a genuine great time and mingling nicely – something that would happen at a party you want to go to, not you feel you have to go to. Can’t wait to come again next year!”

Above are a couple of pictures taken by Dr. Gregg Alexander of the bagpiper and Max Lager’s. I thought it was a very cool place – lots of brick and wood character, beer tanks, and genuinely attentive staff (I could barely set my beer down before someone wanted to bring me a new one, which was just fine with me). The DJ kept the music going without being obtrusive. I asked Inga to take the large poster that you can barely make out on the very left, which had a giant beer glass with the HIStalk logo. It looked like a great souvenir.

From Gregg Alexander: “Re: HIStalk reception. All those who attended can attest, all proper propers belong to Ivo, Inga, and Mr. H for organizing an exceptionally fun evening. Great job, guys, a truly fun time…thank you!” We had some recognition for direct caregivers during the reception and it’s guys like Dr. Gregg who ought to be honored. People forget how hard pediatricians work for a relative modest paycheck while the procedure guys need a wheelbarrow to get the cash to the bank.

I’m so proud of this picture by DrLyle and I’m moving Judy Faulkner of Epic way up on the cool-o-meter. I had e-mailed her ahead of time and told her Epic had won in several categories and she also in the category of “Industry Figure with Whom You Would Most Like to Drink a Few Beers.” She e-mailed back and said the strongest thing she drinks is milkshakes, but she might drop by (riiiight). On the 1% chance she actually would, Inga had her a “No Pie for Me” sash made to celebrate her “loss” to Cerner’s Neal Patterson for the “Industry Figure in Whose Face You Would Most Like to Throw a Pie.” I am totally shocked and honored that she and Carl Dvorak dropped by because I know she doesn’t really like that kind of stuff and there really wasn’t anything in it for her or Epic. She even joked around with Jonathan Bush. Judy, I had you figured for a pretty cool lady, but now I’m certain. Epic won all the “good” HISsies categories, so it was kind of like a KLAS report.

I think we’ve discovered a natural female attractant in those sashes. Someone sent in a pic of one of our male sash-wearers who wore it back to his own hotel and he was getting lots of female attention. I bet we get more volunteers next year.

From GG: “Re: Charlie Munger. How long until you and Inga get a $20,000 check?” Warren Buffet’s homespun partner reads Atul Gawande’s New Yorker article on healthcare costs, and then writes him a $20,000 check and sends it to the magazine, telling them to give it to Gawande, who then donated it to Brigham and Women’s. I had a nice chat today with some smart vendor people who observed how broken the HIT journalism model is (they refused to even call it journalism) and how hard it is for up-and-coming vendors to afford the megabuck ad spreads that seem to help get companies featured. I like scrappy newcomers, so they will always have a spot here if what they offer helps patients.

From KZ: “Re: have you checked out the race car simulator in the 3M HIS booth?” How did I miss that, especially when I’m running a text ad for it? Somehow I didn’t see it.

From HITMAN: “Re: David Blumenthal. Interesting – a large number of CIOs received an invitation last night at about 7:30 to attend a meeting with David Blumenthal this morning at 8:30. Apparently the response was large – they turned away many by e-mail and may have a second session set up for later Tuesday.  David opened the session with about three minutes of welcome and thanks then said he was there to listen to us. Of about 75 in the room, about 20 made comments about the need for federal leadership on master patient index, about the challenge of all-or-nothing meaningful use, about the need to include ED CPOE in meaningful use criteria, and about the compressed timeline we are working under. All were polite and he had two minutes of thanks at the end. He said he is not allow to comment about ongoing work and regulations, and was happy for the pointed feedback. Good that he asked for the feedback but it was all over the place and I am not sure how much he could have gotten from the session.” I heard some CMS people talking about it on the escalator.

Check out David Brooks’ HIMSS coverage on HIStalk Mobile.

Henry Schein announces its ConnectHealth initiative that packages products and services from a number of vendors for physician practices: Allscripts, Midmark, Siemens, Welch Allyn, Dell, and Medline.

Content management vendor Hyland (the OnBase people) acquires hosted medical workflow solutions vendor eWebHealth.

SIS introduces Anesthesia View, a new module in SIS Analytics. I asked someone in the booth today about the Inga-tinis and they said they were flying out the door yesterday evening.

Former QuadraMed CEO Keith Hagen is named COO of digital pathology solutions vendor Aperio.

The latest radio show from Intellect Resources interviews a number of HIT experts, including Texas Health CIO Ed Marx, on security.

Keane will offer EmpowerED as an ED module for its Optimum solution.

In the UK, NPfIT is trying to quickly sign billions in extension contracts with CSC and BT before the elections, hoping to keep the struggling program financially alive.

I forgot to mention it yesterday, but I attended the best HIMSS session I have ever seen, which few saw since it was on the military systems track. It was given by Rear Admiral Matthew L. Nathan MD, Commander, Navy Medicine National Capital Area, National Naval Medical Center on their pilot project for an integrated medical home. I can only say it was brilliant, covering the need for preventive care and EMR outreach programs as well as the practicalities of delivering medical services remotely (such as to a ship in the South China Sea, but with the same challenges as to a rural town). Given the military’s experience with the healthcare models we’ll probably need everywhere and considering his obvious capabilities, he ought to be leading the charge. While everybody else was slobbering over meaningful use, he was covering the real healthcare issues that stimulus money can’t fix.

HIMSS attendee count so far: 25,989, but fewer vendor people. I should also say, that despite my occasional disagreements with what HIMSS does, they are superb at managing conference logistics. I noticed no proceedings CD in the tote this year, but I assume they’re free online since I always review them later.

I have lots pictures and stuff that folks have sent, but I’m beat. Here’s a final little show floor wrap-up.

• I had a great visit with the people from enterprise forms management vendor Access, who not only have a great product, they also have a championship barbeque team that can cook hundreds of pounds of pork butt or brisket at a time. I naturally begged them to load up the 40-foot smoker at the next HIMSS and watch people pack the booth for a taste.
• MEDecision had nice umbrellas out to take, which was nice since it poured cold rain all morning and then snowed for most of the rest of the day.
• The Eclipsys booth was packed.
• I wanted to caress all the stuff in Enovate’s booth as usual since their carts have the sexiest curves you can imagine. They also had a cool green pony saddle seat that I spun around in a road test and it was sweet.
• Big crowd at Allscripts.
• For some reason, I found myself wanting coffee and a shoeshine a lot (back me up, guys).
• ICA had their HIStalk sign out and had a demo of their HIE solution running with Sevocity.
• iMDsoft’s telemedicine app was one of the coolest ones I saw.
• Keane had our sign out too – thanks!
• athenahealth’s booth was packed.
• The guy doing electronic caricatures at the Televox booth was fascinating to watch.
• Sunquest had our sign out, too, and I still like their green color and their bags.
• Picis had a crowd and also our sign out.

From HIMSS 3/2/10

HERtalk by Inga

From: Soda Pop Man “Re: HIStalk reception. All those who attended can attest, all proper propers belong to Ivo, Inga, and Mr. H for organizing an exceptionally fun evening. Great job, guys, a truly fun time…thank you!”

From: Evan Steele “Re: Sashes, strangers, and shoes. Thank you for a GREAT evening at Max Lager’s!  The sash was perfect (“HIStalk Certified” made for a great conversation piece)! Although I am not the type who easily mingles with strangers in a room, I found the HIStalk readers very approachable and I had some great conversations.

This will be a quick post as I have an 8:15 meeting (what was I thinking?) HIMSS has been predictably fast and furious with big crowds and lots of walking. Here are a few random impressions from Monday:

• Overheard in the ladies’ room: “Where the heck is the coat check?” I, too, had problems finding one. I am sure there’s at least one but the place is so huge that I wasn’t going to walk from one Hall C to Hall A just to dump my coat.
• I was a little bit disappointed with my interoperability booth tour. My presenter had some microphone problems so I couldn’t hear very well. And, too much time was spent with the overview of the whole interoperability concept, rather than demonstrating how it all worked. Still, it’s impressive that something like 70 vendors participated.
• The Blue Cat booth is offering a roller coaster-type experience, if you like that sort of thing. If you like eye-candy, they offer that as well.
• Hexaware had a unique booth concept with lots of plants on the ground, making the booth look a bit like a garden. They were promoting their green theme.
• Actuate is handing out $5 Starbucks gift cards, if you spend a few minutes chatting with them, like I did.
• I sat in on a Sage presentation in hopes of winning an iPod shuffle. I lost but the presentation was good (short and to the point.)
• I’ve noticed that the booths with the most activity are the HIE vendors. I rested my weary feet a bit and listened to an Ingenix presentation. When I stood up to leave I noticed there was a crowd three deep standing behind me. I saw similar crowds at Medicity, Axolotl, and dbMotion.
• PatientKeeper, Nuance and RelayHealth seem to have much bigger booths than in previous years.
• Chair massages can be found at DCS, which was near the McKesson booth
• As I walked by Bottomline Tech at about 3:45, folks were queuing up for cocktails. I waited until 4:00 and got an “Inga’tini from SIS. Highly recommended.
• Mr. H mentioned that the Google booth appeared slow. Not when I went by. Although I can’t figure out what they are offering that makes the crowd so curious.
• Chetu has a couple of gorillas in their booth. One of the guys working the booth told me they had wanted the gorillas to walk the floor wearing a Chetu sign. HIMSS nixed that idea. Apparently HIMSS thought some company might conclude that if one vendor could have gorillas walking around, then it would be acceptable to send forth girls in bikinis.

And, of course, the HIStalk reception was incredible. Thanks to all who attended and definitely to our hosts. Amy Glass with Encore rocks! Jonathan Bush was an incredibly funny announcer, which I believe our EHR-TV folks caught on tape. Yes, the very down-to-earth and friendly Judith Faulkner did stop by and even wore her sash that said, “No Pie for Me.” We awarded a couple of bonus sashes for great shoes. I checked out the shoes of both recipients and agree they were worthy of recognition. I’m hoping someone snapped a photo of the winning shoes.

I have lots of photos to post and will get to those in the next couple of days. More later!

E-mail Inga.

From HIMSS 3/1/10

From Kermit Randa: “Re: today. Long day of goodness sharing the critical importance of the OR in the current healthcare economic and IT landscape. The reception is a welcome end to a long day. Nicely done! Who can argue with beer, great apps, and a little John Cougar?! Thanks for all you an Inga do! Hope she stopped by the SIS booth for an Inga-tini!” I totally forgot that she told me that SIS has created a specialty drink for her, apparently available in their booth. She is enthralled with the concept of alcohol on the show floor, so I’m sure she has tried it already with a report forthcoming.

From Jack: “Re: camera cable. You should get an Eye-Fi.  It’s an SD Card that has built in WiFi capability and will upload images automatically.”

From Festus: “Re: partners. Seen on booths in the exhibit hall, ‘your partner in meaningful use’. A lie on two accounts. As discussed before on HIStalk, rarely is a vendor ever your partner and does anyone really believe they will help them use technology in a truly meaningful way?”

It was so cool to see everyone at the HIStalk reception this evening, so thank you so much if you attended, including our insiders who work on the sites who had a chance to be recognized. Thanks to Jonathan Bush for handling the HISsies announcements, to John Glaser for his video acceptance as CIO of the Year (I’ll post the HISsies winners when I get time), to Ross Martin, MD for his excellent world premiere of Meaningful Yoose Rap (you would not believe the government approvals he had to get to do it), to our sash wearers, and for Encore, Evolvent, and Symantec for putting it together (especially Amy Glass on the Encore side). I’m sure I’m forgetting people, but like you, I’ve had a beer or two too many (if you didn’t try the Max Lager’s Red, it went down pretty smooth). And how about that bagpiper! Thanks to Deborah Peel, MD from Patient Privacy Rights for staying over an extra night just to hang out with us, to Inga for all the work she did to prepare for the reception, and to those many people in the audience who work for companies that sponsor HIStalk, HIStalk Practice, and HIStalk Mobile and who chose to spend their evening with us. It’s just 364 days or thereabouts until the next one in Orlando!

I need to get the scoop on this since I left the party early. It appears from a reader’s cell phone pic just sent that Epic’s Judy Faulkner showed up and is pictured with Jonathan Bush from athenahealth. Big props for her if she did since I know she basically never does that sort of thing even though I asked her and she said she might. More to come.

And Dr. Gregg Alexander snapped this one of the B52s at the Eclipsys party. Love ‘em.

Speaking of Symantec, the company announces a cloud-based storing and data sharing environment for healthcare.

Dell announces that it will offer EMR hardware and consulting services in affiliation with the AMA.

Microsoft announces HealthVault Community Connect, which allows hospitals to make EMR data available to patients or to share the information with other providers.

I didn’t go to the opening keynote because I didn’t really want to get up so early, but it apparently talked up 4G quite a bit. Sprint CEO Dan Hesse says it can take health care out of the 70s, which could be argued.

I think we reported this as a rumor back in November or something, but Sisters of St. Francis chooses Epic.

Bassett Healthcare (NY) chooses PatientKeeper.

Voalte asked me to pass along that you iPhone users can stop by their booth to charge up.

I’ll add a few booth reviews and that’s all the time I have tonight since I have to get up early. And I’m exhausted since I remember now why hate the GWCC exhibit hall (Hall C is way separate from A/B and I never did find the secret passage that connects them, even though I’ve used it in years past and I even asked a security guard to point it out). As a result, I didn’t see much in Hall C.

• Several sponsors had their autographed We Power HIStalk signs in their booths, so thanks for that.
• Virtelligence had theirs front and center.
• Cattails MD from Marshfield Clinic had a pretty substantial booth.
• OnBase had the sports bar and that amazing card trick guy again.
• Not much changed with Epic’s booth,including the fact that Judy was in it most of the time.
• EDIMS had a video game.
• Eclipsys had a nice, open booth.
• Kronos staffed theirs very well, making it easy to get someone.
• Allscripts had lots of orange and looked good.
• Microsoft’s had a decent crowd, but not as much as last year from what I could tell.
• API’s was kind of skyscrapery, which I liked.
• GE’s was sprawling and divided up into sections.
• I’ll award NextGen the best booth award with its bold, purple cylinders and arches.
• McKesson had the usual blue and orange, but a whole separate sub-booth for Paragon.
• The Alert people from Europe had females some pretty impressive pants that I can’t really describe.
• Sentillion’s was labeled as “A Microsoft Company”
• RelayHealth’s was nicely done in McKesson colors, very open.
• Google’s was tiny and kind of dead.
• iMDsoft had a giant John Glaser photo.
• MEDSEEK made the best use of a reasonable space with some good design and an upstairs area. They attached their HIStalk sign directly to the podium, which was cool to see (Inga fretted that she told Kinko’s to go one size bigger than 8×10 and the next jump was apparently pretty big).
• Rel Ware had what was apparently a full sized Back to the Future DeLorean. Pretty cool.
• Chipsoft had the yellow wooden shoes again, still my favorite giveaway.
• eClinical Works had their sign out – thanks. So did Greenway.

HERtalk by Inga

Greetings from Atlanta!

I arrived at the convention center mid-day Sunday lurked around a few meetings and looked for famous CIOs. I realize how nerdy this is, but I was thrilled to catch a glimpse of a few CIO superstars like Bill Spooner, John Bosco, and Ed Marx as well as vendor big-wigs like Glenn Tullman, Sunny Sanyal, Judy Faukner.  We are definitely in the land of HIT rock stars.

If you are not a rock star but want people to think you are, HIMSS has made available a plethora of extra ribbons to adorn your name badge. I gave Mr. H one that says "PMP" and told him it could be a good conversation starter since from afar the mind automatically wants to insert an "I".

Mr. H and I had an HIStalk executive board meeting Sunday afternoon and voted to continue the blog. Since he was designated CEO of HIStalk for the HITmen event, he graciously awarded me the title of President. My mother would be proud.

When the meeting was adjourned, we joined a relatively small crowd at the opening reception. I suppose it is difficult to create an ambiance with a warehouse-like room that has concrete floors and open rafters. There was a live band, but the acoustics were so bad I couldn’t tell you what they played or if they were any good. Mr. H reminded me how crowded the reception was last year as people tried to avoid walking in the Chicago snow storm. I’ll take the sunshine of Atlanta.

Today’s agenda includes CCHIT town hall meeting and checking out the exhibits, including the interoperability booth. Then a bit of primping and on to Max Lager’s. I promise to keep good notes and share details of the day, especially for those of you keeping the lights on at home.

E-mail Inga.

From HIMSS 2/28/10

From Zale: “Re: Eclipsys. I wonder if anyone at either Microsoft or Eclipsys knows that Bill Gates demoed an early version of Sunrise Clinical Manager at HIMSS in 1995?”

From Sheri: “Re: clinicians and IT people. But if you combine the best of both worlds – the experienced Clinical Analyst — you get a great opinion. Clinicians don’t know what they don’t know about IT. Experienced clinical analysts have one foot in both worlds and can make really good decisions about the solutions that will work for the clinicians. You just have to hire the right people and get out of the way.” Sometimes, as long as the analyst remembers that as soon as they cross the dark side to IT, they need to consult the still-practicing clinicians before making decisions. Most of the ones I know are excellent, but a few think their decades-ago practice makes them even more expert than those still working. But I agree in general and at least the CAs always put the best interests of patients first. 

From Diamond Jim: “Re: drink beer, get CME.” Strange — attendance at the HIMSS opening reception earns CME/CNE credits. Somehow I don’t think patients would be comforted to know that. I really did get some good education from some of the HIStalk pals Inga and I hung out with there, though.

It was strangely quiet and low-key at the convention center today, but you could smell the money. New exhibitors, new attendees, and lots of expensive advertising stuff were obvious. It looked nice outside, but with temps in the low 50s and lots of wind, it wasn’t really all that comfortable. I had forgotten until someone mentioned it about the weird layout of the exhibit hall, with the two unconnected halves that mean some vendors paid big dollars for Siberian real estate.

Speaking of that real estate, I was explaining to someone that it’s not enough to be willing to pay big bucks for booth space – you have to earn the right to spend that money by first accumulating HIMSS points. I’m not sure they believed me, so here’s the proof.

Like I always say, it looked like the Marines laying in supplies for the siege at Khe Sanh. Trucks, cartloads of food and drinks, and vendor shipments were everywhere. Everybody was dressed casually, which will be in contrast to the dolled up crowds tomorrow.

The opening reception was surprisingly uncrowded, with no drink lines at all (I only drank, but the food lines didn’t look much longer). The atmosphere, of course, was like taking an aircraft hangar, putting a small band at one end of it and leaving them to compete with their own echoes, and sticking up a few palm trees with Christmas lights on them. I’ll stick with my prediction of 30,000 attendees, but 90% of them weren’t at the opening reception for some reason.

Strangest line overheard, this from a supposed HIT journalist: “What does CIO stand for?”

Two acquisitions will be announced tomorrow morning, sources tell me (although one may be delayed until later in the week). One involves an imaging vendor, the other a document company.

My cheap hotel has slow wireless and I forgot my camera cord, so I”m working without much technology support. Luckily Inga is handy with her iPhone. She also brought me barbeque sauce, so anything she does is fine with me.

GE makes some announcements early: a clinical knowledge platform, eHealth solutions, and HIE improvements.

A reader snapped this candid photo (looks like a phone one) of Epic’s Judy Faulkner behind a coffee urn that looks like a 1950s sci fi robot or spaceship. I swear the woman never ages. I tried to get her to come to the reception tomorrow night and she says she “might drop by”, but I’m not holding my breath. If she does, we have a sash for her.

I’m counting on my fellow attendees to keep me abreast of rumors and news. Photos would be nice since my camera is useless without the cord. Send me anything interesting.

Monday Morning Update 3/1/10

From Skippy: “Re: Nuance. It will announce acquisition of Language & Computing either today or Monday.” Unverified, but interesting timing considering both the typically Monday-heavy announcements at the HIMSS conference and this announcement: the Justice Department drops its antitrust investigation into Nuance’s 2008 acquisition of Philips Speech Recognition Systems.

From Delta Dawn: “Re: KLAS. You’ve laid out the issues regarding the benefits and limitations of KLAS information before. With their new vendor rating coming out at HIMSS, it seems like a good time to dig a little deeper. IF KLAS is really an unbiased source and is providing an unbiased scorecard, then they should have no problem revealing how much each vendor pays them. To spare them the trouble, I’m attaching the table here. Also, any vendor who uses KLAS data should be required to publish how much they are currently paying KLAS.” According to the table, KLAS scales pricing to annual organizational revenue, ranging up to $175K per year. My only reaction to that is that I wished I had thought of the business model myself. Everybody gripes about KLAS for one thing or another, but everybody continues to participate, so they are simply meeting a demand and pricing their supply at what is apparently an acceptable point. I like the listed add-on service of meeting with vendor executives for a brain dump, which sounds more like the business model I would have created. My variation would be to have the engaging organization’s executive write me a frighteningly large check and then take me to a long lunch somewhere that serves beer and hopefully barbeque and after a couple of rounds of each and with no advance preparation whatsoever, I would spill everything I know, including some of the more scandalous stuff readers have sent me that I can’t run on HIStalk for reasons that mostly involve libel and possibly stock market manipulation. I’m pretty sure KLAS doesn’t do it that way, though.

From Skeptic Shock: “Re: SIIM. Funny how they send out an e-mail about their one and only HIMSS presentation after the Readers Write article by Mike Cannavo. Looks like SIIM and HIMSS both read HIStalk. My hopes is that more IT folks will come forward and express their opinion that enterprise multi-modality, multi-disciplinary imaging is a major component of the EMR and can bring down a hospital’s efforts if not handled well.” Future collaboration is mentioned between the groups. I believe we need more PACSMan in the HIStalk future since IT people need more knowledge about imaging and related applications. Plus, as one reader pointed out, he’s just as cynical and abrasively outspoken as me in his PACS circles (in a heated moment, one executive screamed that he was the Antichrist, apparently, which is the coolest thing I’ve ever heard). That’s the guy you want telling you about imaging.

Want to see Sen. Chuck Grassley’s letter to Kathleen Sebelius urging FDA oversight of healthcare IT? Sure you do. A snip: “… I have been surprised by the lack of discussion about patient safety concerns … they [clinicians] tried raising their concerns to hospital administrators and/or to the HIT vendors, but told me their concerns were often ignored or dismissed.” He cites a 1997 JAMIA article that observed the lack of FDA oversight and the 1996 counterproposal from a group of vendors who presumably were trying to avoid it. He asks HHS directly whether FDA oversight should be revisited, and if not, how does HHS plan to oversee the safety of HIT and ensure that vendors follow quality process. Also included is a letter to Steve Lieber of HIMSS, asking him to clarify the HIMSS position on FDA oversight, recommendations going back to the CHIM days of a “code of good business practices” for vendors, and the HIMSS position on vendors reporting safety issues and notifying users of potentially safety issues. The Senator wants an answer by March 10, with interesting timing in sending HIMSS the letter right before the annual bacchanal begins. A reader comment suggested that the Feds will have folks observing the conference to see exactly how taxpayer money will be spent, but that’s unverified.

Here is my modest proposal to improve HIT patient safety in hospitals: let clinicians appoint a committee of nurses, doctors, and pharmacists (and any other caregivers you like) to independently make decisions about user IT communication, vendor priorities, and training needs, all with no IT people in the room and no IT veto power. I’ve been in those conference rooms a zillion times on both sides of the table and, as much as the IT people have the organization’s best strategic interests in mind, they are the de facto partners of the vendor in getting the system implemented, running, and hopefully accepted. They do not have the knowledge or the objectivity to decide whether a particular problem is OK to work around or whether the users need to know about it even though it’s embarrassing (any more than having drug company reps participate in a formulary committee meeting). IT people will dominate those meetings if they attend, so the decisions need to be made without them present unless the clinicians need them, like a jury left alone to deliberate until they send out for information. Just my opinion as an IT person.

AMA will offer Ingenix CareTracker EHR through a new AHA solutions platform being beta tested in Michigan. The announcement will come sometime Monday.

Salar (pronounced SAY-lar) is a new Platinum Sponsor of HIStalk, so thanks to those folks in Fell’s Point in Baltimore (a great area for eating and drinking when they aren’t getting blizzards) for supporting us. I interviewed company president Todd Johnson this week so that’s a good overview, but here’s the summary: Salar’s clinical documentation system TeamNotes works with core clinical systems, providing tools for documentation, physician charge capture, patient handoffs, quality reporting, and team collaboration. Customers include places like Johns Hopkins, UPMC, GWU, etc. I have to say I enjoyed reading their recent “Dear Physicians” blog entry that says it so well I can’t even excerpt it and do it justice (rare for me since I enjoy excerpting). I would seriously drop by Booth 2644 at HIMSS and check them out since they sound kind of dangerously disruptive in a good way. Thanks to Salar for the support.

CCHIT is rearranging some of its work groups, according to an internal communication a reader sent over. Oncology and Women’s Health are new specialty EHR certifications and CCHIT is looking for volunteers. Under way for later this year are long term and post acute care, dermatology, clinical research, and behavioral. Most of the main groups are on hold until meaningful use standards are finalized, which CCHIT says will happen by summer.

Cumberland Pediatric IPA (TN) chooses Informatics Corporation of America’s CareAlign data analysis and reporting tool.

Obviously we have some HITECH skeptics in the ranks. New poll to your right: with all the sudden interest in patient safety oversight of healthcare IT, do you think the government will mandate some degree of FDA involvement?

The Encore folks have been working incredibly hard to finish up details for our reception Monday evening. I’m sure nobody’s naive enough to think that you just book a facility and show up, but the amount of detail that requires attention is surprising even to me. Of course, if it all goes perfectly, everybody will just enjoy themselves without noticing those details specifically. I’ll say this: I certainly never expected to have an HIStalk specialty drink designed and named, but I’m looking right at it. Inga and I got the guest list and, as we digested the Who’s Who list of attendees (no kidding – lots of star power), she e-mailed me her one-word reaction: “Surreal”. To which I replied back with a line from That Thing You Do: “How did we get here?” It’s an early St. Patrick’s Day theme, so feel free to wear green if you like, although I don’t think they bought my idea of green beer.

Speaking of events, a couple of readers are looking for fun events for Tuesday and Wednesday evenings, so I told them I would deputize them as HIStalk roving reporters if anyone knows of cool stuff. Inga and I got a lot of invitations, but I didn’t save mine.

Shares in athenahealth dropped over 15% Friday on the announcement that its Q4 report will be delayed pending completion of an audit and a review of service revenue accounting procedures. If the company decides to implement an accounting change based on the assumption of ongoing customer renewals, it will have to restate earnings. You may recall my recent mention of an independent organization that gave ATHN a 99 rating for accounting and governance (meaning very conservative), so this is one manifestation of that, but one with a negative shareholder interpretation: they are considering a change to even more conservative accounting practices, but that might mean lower paper profits. I would think that’s good news if I were buying the product or the stock, but both markets have minds of their own.

Ohio State University Medical Center will bring its 617-doctor affiliated private practice into the university, with the stated primary incentive being the ability to implement a complete electronic medical record.

This is probably an important case to watch: the federal government files a fraudulent billing lawsuit against a Florida cancer clinic because its physicians billed for services delivered while they were out of the country. Regardless of what the clinic was up to, it brings up the question of exactly what constitutes supervision in an ever-connected age. Is value added by having the doctor physically standing there, and it insurance paying for that standing around or the oversight that can be equally well provided from anywhere?

I’m receiving powerful psychic emanations that Microsoft will make an interesting product announcement Monday morning. 

I’ve been overwhelmed lately, so I forgot to mention this like I promised. The Fierce people are having an executive breakfast Tuesday morning at 7:00 at the Sheraton Atlanta and are offering HIStalk readers a discounted rate of $50 if you enter the code TALK on the online registration form.

Former Cerner COO Glenn Tobin joins coding solutions vendor CodeRyte in a newly created COO position.

Sage announces its meaningful use guarantee.

Greenway donates several of its applications to Northern Kentucky University to be used in training students in the university’s health informatics programs.

A Florida health network reports the results of its year-long study of the Patient-Centered Medical Home model: hospital days dropped 4.6%, admissions were down 3%, costs swung around 20% to the positive compared to the market in general, and quality metrics improved.

I will be posting daily from HIMSS, of course, perhaps with some of Inga’s usual entertaining insights (like where to get margaritas in the exhibit hall). If you aren’t going, I will try to give you the on-site flavor. If you are, safe travels.

E-mail me.

HCIT from the Investor’s Chair 2/26/10

The end of 2009 brought a few company announcements that were particularly relevant to the investment community. Noteworthy among them were the sales of enterprise vendor QuadraMed and radiology systems vendor Amicas to private equity (aka PE, buy-out or leveraged buy-out – LBO – investors). When a public company is sold to an investment firm rather than another company in the same or adjacent sector (such as Sentillion’s sale to Microsoft or CareMedic’s sale to Ingenix), it’s known as a “take-private” transaction.

When this happens, private equity investors, usually acting with the existing management team, are making the assumption that they can purchase the company at a premium to its current stock market value, make some changes over the course of a few years, and then sell it to another buyer at a premium to what they paid. Sometimes this is likely “Greater Fool Theory”, but in many cases, it’s quite logical. Readers who’ve not had the sometimes dubious pleasure of being involved in a process like this might wonder how it happens and what’s the thinking behind it.

In my decade as a research analyst, I rarely heard a CEO say they thought their stock was fairly valued, and never heard one say it was overvalued — at least where anyone could hear them. This is because (a) they typically own a fair amount of said stock (or options); (b) they’re inherently optimistic by nature (if not outright promotional); and (c) the same reason that my mom thinks all her children are both bright and attractive (well, perhaps she really is right). In many cases, the company has lost much of its sell-side analyst coverage, perhaps missed a few quarters’ earnings estimates and has become a “single digit midget”. All the while, its CEO and the board are thinking their stock is worth more than that silly stock market is willing to pay for it, and time passes. And more time passes. And still, the stock is worth less than they think it is.

Clearly, it’s time for Action! At some point, they start to realize that if the stock market isn’t according them their “fair” value, perhaps another entity will. It’s time to call the bankers (or start returning their calls). Much like with an IPO (discussed in previous posts), the bankers show up and, using a dazzling array of PowerPoint and spreadsheets, confirm that, why golly, yes, your stock is undervalued! Clearly a transaction is called for: it’s time to find a buyer for the entire company. In some cases, incidentally, the bid comes unsolicited, as PE firms have people whose primary job is to call companies to convince them to go private, but even then, some form of sale process is usually required to ensure a fair and appropriate price is paid.

Rather than enumerate yet another type of banking process for a posting (but readers can request it for a subsequent post if interested), let’s skip that process for now and assume that no strategic buyers have opted to participate (at least at as high a value). What motivates a private equity investor to outbid a strategic buyer? A few key elements typically underlie their analysis.

• Being public is expensive, often costing smaller companies over $1 million to cover their SEC requirements, insurance policies and Sarbanes-Oxley compliance costs, etc. Once private, all these costs fall straight to the bottom line.
• Public markets are notoriously short-term focused. Many believe (I among them) that, freed of the requirement to manage on the instant gratification of a quarterly basis, company performance is likely to improve.
• Sometimes it is best to take a hiatus from the public markets for other reasons. Emdeon used its “private time” to make substantial improvements to its operations, management, and other areas. TriZetto Group is moving to more of a subscription model. Netsmart Technologies did something or other. Etc.

A few questions leap to mind, however:

• If there are changes that should be made, why hasn’t management already made them to benefit current shareholders rather than the new private investors?
• Did the fact that typical senior management parachutes (inherent in change of control transactions) would inflate — plus their stock would now be worth more, plus they’re likely to be re-loaded with new equity — impact their decisions?
• What drives the new investors’ confidence that they’ll be able to sell later to a strategic buyer, when they presumably just outbid all of them?

All good questions, but, at the end of the day, two groups of smart PE investors looked at both QuadraMed and Amicas and decided that they could make a good return on their money by purchasing these companies, so clearly their spreadsheets, extensive diligence and planning supported them. I’ll note that, besides the suppositions made above, their math was definitely helped by the fact that their fund likely only put up around 20-25% of the money; the rest was borrowed, substantially magnifying their returns (hence the term leveraged buy-out) and, further helping their math, significant transaction and management fees are often imposed on the newly acquired companies for the privilege of taking the money — often these fees run in the millions.

What about all the lawsuits that have been flying though? It seems that each company has been hit with about a dozen lawsuits (or threats), from apparently the same firms. It appears inevitable that, despite the fact that an auction was conducted, a bevy of class action lawyers will invariably announce investigations “on behalf of shareholders” alleging the unfairness of both the amount being paid and the process that was run. In my view, while the threat of these might be important to preserve the integrity of a process, the reality is 90% or so are merely opportunistic behavior on the part of the law firms. As a review of the proxy statements for either Amicas (also available in a nifty PowerPoint summary) or QuadraMed show, efforts were taken to ensure a fair price was paid.

In the case of QuadraMed, a fairly broad auction was conducted, which included a sizable number of PE firms and four unnamed strategic buyers. While Amicas responded to in-bound, apparently unsolicited interest, the agreement with the buyer allowed them to actively “shop” the bid to see if a higher bidder would emerge. Presumably, none did. By the way, as a student of the sector, I think these documents make for an interesting read, but that could just be me. For example, QuadraMed has apparently tried to sell a number of times over the past few years to no avail. It would also be interesting to contrast Amicas’ slightly gloomy assessment of risks on its slide deck with its no doubt more bullish one that was likely given to potential investors a few weeks earlier.

Also, every time a public company is sold, its board is required to seek a Fairness Opinion to ensure a “fair” price is paid. A Fairness Opinion is provided by the seller’s investment banker (typically the one who ran the sale process — and who stands to get a very sizable fee upon its success — but I’m sure there’s zero conflict of interest there). In a Fairness Opinion, the bankers assess and determine that the amount being paid is “fair”. How? By looking at how similar companies are currently valued in the public markets, what price (and what multiple of sales and profits) similar companies have sold for, and by using a discounted cash flow analysis (DCF) as an additional check on value, as well as what kind of premiums to current share price have been paid for similar public company sales.

It’s actually a fairly rigorous analysis, and each firm has a special committee that vets it prior to issuance, as the issuing firm has some potential liability (which is part of why the fee for the Opinion is determined by the size of the transaction). Then again, the AOL-TimeWarner merger was considered “Fair” as well so, as the programmers can attest, Garbage In, Garbage Out. For more detail, please check the proxy links above, or just drop or post me a note.

And so, the public markets bid au revoir to these two players, wondering only if they’ll resurface as strategic sales (like Healthvision, nee Quovadx — generating an outstanding return for Battery Ventures) or IPOs (like Emdeon). The final question, of course, is what does this mean to users or customers? It could well be a positive. As suggested, assuming responsible behavior on the part of the new PE firms, freed of the pressure and scrutiny of public investors, they’ll both be able to focus more on running their business, supporting customers and developing new products — just like companies are supposed to do.

Post script: the action continues on Amicas. Readers of “the tape” will note a minor battle underway between Amicas and its competitor, Merge Technologies. After I submitted this to Mr. H, Merge has announced that it was bidding 13% more than the PE firm Thoma Bravo to buy Amicas. “Not so fast”, Amicas responded later that day.  “Do you really have the dough?” The plot has thickened with accusations flying both ways and a Massachusetts Supreme Court enjoinder on having the shareholder meeting.

Theoretically, regardless of management’s preferences on the outcome, the board has a fiduciary responsibility to accept the highest quality bid. With the stock trading today between the Thoma Bravo bid and the one from Merge, the outcome appears uncertain, and will be likely continue to be played out on the tape and in the courts. In the meantime, I can only observe that this minor drama seems to support that the market is setting the prices here somewhat efficiently, notwithstanding the complaints of the class action bar “representing” QuadraMed’s shareholders. Clearly when someone else wants to buy a company, they can emerge and do so.

Ask the Chair

What do investors do at HIMSS?

Aside from walk around looking for cool trinkets?

HIMSS is always great for the investor community. Most of the larger public companies in attendance have analyst meetings, or at least booth tours. It’s a chance to talk to current and potential clients of the firms one covers. There are parties to attend and for both investment bankers and private investors (VC and PE) and a virtual feeding frenzy of business trolling opportunities.

Speaking of which, Mr. HIStalk’s discussion of the HIMSS Venture Fair beat anything I could have done, but I will be attending and sharing a write up a week or so after, so watch this space for post-HIMSS thoughts.

See you at the HISTalk party, please come up and say hi.

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 2/26/10

From Wrangler: “Re: is Inga a man?” An online article suggests that perhaps Inga is a man writing as a woman. I couldn’t wait to tease her about that, but she had already seen it and responded back that a couple of readers have e-mailed her with the same suspicion. Let me forcefully allay that speculation: Inga is most definitely female, and a quite striking example if I may say (not only at least as cute and charming as her avatar suggests, but darned smart and caustically funny in our offline e-mails). So let’s treat the lady with some respect, OK? She’s the queen around here.

From Olivia: “Re: karma. With hard times and cutbacks around him [vendor exec name omitted] goes out and buys a $450,000 Maserati, parking on the corporate lot (and taking several spaces) for viewing by the layoff-ees exiting the building. Need I say there was a small round of applause that swept the building when news traveled that he’d hit the back of another vehicle and smashed its pretty little face. He has to be the most hated exec in the EHR industry – I’ve never met anyone about whom 100% of people say he is truly insufferable.” I hope he closes the Maserati’s gas cap tightly because the sparks from keys repeatedly meeting paint could present a fire hazard.  

From Lee Minors: “Re: first step of Microsoft purchasing Eclipsys?” Microsoft will integrate parts of Eclipsys Sunrise Enterprise with its Amalga UIS. The press releases talks about an open platform and the pretty cool MLMs and ObjectsPlus components that are exposed for customer self-development (not all inpatient EMR vendors offer something like this, but I’d find it hard to justify buying one that doesn’t). I don’t see any clear-cut evidence of further Microsoft interest at the moment, but its recent Sentillion acquisition started out this way and I’m hearing the rumors, of course. Thanks to Eclipsys for offering me personal, pre-announcement access to its very tippy-top management to discuss the strategy behind the move, which I had to unfortunately decline because I was occupied with stuff at the hospital. As I e-mailed Inga afterward, “One of these days, it will hit me how strange that is — telling a billion-dollar company that I unfortunately don’t have time to talk to their top executives.” Darned day job. Even without the briefing, though, I like the move.

From Connie: “Re: HITMEN. You didn’t mention the TV series behind the theme. It’s Mad Men on AMC, based on early 1960s Madison Avenue advertising men. There have been two seasons and it’s wonderful!” I knew that but forgot to mention it. I haven’t seen the show — I guess my DirecTV package doesn’t have AMC because I keep scanning the DVR list to record it and it never comes up.

From Byter: “Re: Quality Systems acquires Opus Healthcare Solutions. From the SEC 8-K, they paid $12 million in common stock plus up to $14 million in future shares subject to performance.”

From PACS All Mighty: “Re: Merge. Given the odd but always entertaining history of Merge, Amicas, Emageon, Cedara, eFilm, etc. and their oft-crossed swords of mutual conquest, an Auntminnie.com forum writer SlingshotPM  calls this “Efilmergemedeageonicas – a seamless and fully integrated solution that capitalizes on the synergy of integrating a best of breed technologies solution to the radiology workflow paradigm.’ Clearly the GE, Philips, McKesson, and Siemens big dogs would love to see all these yapping Chihuahuas go away.” Speaking of Merge, the company is suing its former CEO and CFO for the $880K it spent defending them on accounting fraud charges, plus the $3 million it shelled out to settle the class action suit that resulted. Also speaking of Merge: the company gets $200 million in bridge financing to support its $248 million offer for Amicas.

First time I’ve seen this: advertising for Epic people for “a massive healthcare project” on Craigslist.

I interviewed the folks from DIVURGENT for HIStech Report, including former BayCare CIO Lindsey Jarrell, who just joined the company.

Listening: Tarja, the operatic former lead singer of Finnish symphonic metal bad Nightwish, which just may teleport you to a winter’s evening in Finland spent on a bear skin rug in front of a fireplace (hopefully not alone).

I interviewed iMDsoft CEO Phyllis Gotlib a couple of weeks ago, so it’s fun to have the company back, this time as an HIStalk Platinum Sponsor. iMDsoft has big plans for expanding its US market, which should be made a lot easier by already having a Who’s Who of top US hospitals as customers (BIDMC, Lehigh Valley, Mass General, Henry Ford, Barnes-Jewish, Johns Hopkins, etc.) Its flagship product is the Metavision continuous patient record for ICU, anesthesia, and acute care, along with solutions for electronic dashboards, remote intensivist monitoring, and mobile clinician access. Drop by Booth 8633 at HIMSS and tell them you read about them in HIStalk. Welcome and thanks to iMDsoft.

Several HIStalk sponsors have swapped out their ads on the left with HIMSS-specific ones, so give them a look and click on any that move you.

Thanks to the one and only PACSMan Mike Cannavo for his guest article this week. Mike doesn’t know who I am, but we hired him at our hospital to help with a PACS selection years ago. He’s one of those guys who knows more people in his first hour on site than you do after years of working there, and seems to be reverentially quoted by all of them constantly. The best I could do to compete was to remind everyone that I signed off on the contract to bring him in.

Medical University of South Carolina will deploy the care continuity module of the Oacis data aggregation solution of TELUS Health Solutions. It creates a portable care record that can be printed, faxed, e-mailed, or sent to an EMR as an HL7 message. I think I got an early copy of the announcement because I don’t see it on the Web yet. I respect and like Frank Clark of MUSC as much as any CIO anywhere. We chat occasionally, so I asked him about Oacis a couple of weeks back (they use it because McKesson’s Horizon portal isn’t so great for academic medical centers). Oacis is still a big piece of their strategy, providing viewer capability as a front end for Horizon Clinicals. He was remarkably frank (no pun intended) and modest when I interviewed him a couple of years ago, including giving me a nice overview of Oacis.

3M Health Information Systems releases its Mobile Dictation Software for the iPhone. It was already available for BlackBerry and Windows Mobile.

ONCHIT is Tweeting. Or at least has the capability.

Here’s an amazing video of a new Enovate computer wallstation. I wasn’t paying too much attention until the guy started moving it up and down the wall electronically with one finger; then, it turned itself off and closed its own keyboard tray and shut down when the user walked away.

We’ve got an interview with Paul Brient, PatientKeeper president and CEO, on HIStalk Mobile. We will have daily updates there from HIMSS, so if you are interested in mobile healthcare computing, signed up for the e-mail updates and get the scoops (we will get first crack at a few of those, I think).

Order Optimizer is a brand new HIStalk Platinum Sponsor, so thanks very much to those folks. It’s the first inpatient system certified by CCHIT as meeting preliminary ARRA 2011 standards for CPOE and decision support. The SaaS sytem was developed by the hospitalists of Intercede Health and provides comprehensive support for evidence-based admission orders. It contains over 180 evidence-based order sets and a merging engine that helps doctors create evidence-based treatment plans. Admission orders can represent up to 70% of the total during a patient visit and the product focuses on those, so the company says hospitals can get Order Optimizer up and running within weeks with no capital expense, giving much of the benefit of CPOE without requiring 100% physician adoption, reducing time, risk, and cost. It was a finalist for the 2009 Microsoft Healthcare Innovation Award. Thanks to Order Optimizer for supporting HIStalk.

Charge master applications vendor Craneware announces six-month results: revenue up 25%, earnings up 36%.

PatientKeeper and and EMPI vendor NextGate announce a partnership to integrate their technologies to enhance PatientKeeper’s HIE capabilities.

Mayo Clinic will conduct a one-year study to determine if home monitoring technology from GE and Intel can reduce hospitalization and ED visits of patients with chronic disease.

HIMSS says it expects 28,000 at the conference next week and all the hotels are full. Atlanta weather for Sunday: lows in the low 30s, highs in the low 50s, sunny. Getting cold by Tuesday, in the upper 40s with a chance of snow (can’t HIMSS go anywhere without the snow following?)

I’ll be writing as usual Saturday and then daily from Atlanta. You are my eyes and ears, so let me know if you learn something that others would like to know.

E-mail me.

HERtalk by Inga

Healthcare execs say their biggest hurdle in EHR adoption is lack of internal resources, according to a Beacon Partners’ survey. I was surprised that only 25% of the execs believe their organization won’t fulfill the first meaningful use deadline with most feeling comfortable with their progress. Even more surprising to me was that a whopping two-thirds of the 168 surveyed were not familiar or had little knowledge of Stark.

In yesterday’s HIStalk Practice I mentioned that HIMSS has a new HIT Buyers Guide just for HIMSS. It’s free to providers, though not vendors nor consultants and I assume not bloggers. When I am told I can’t have something (unless I pay a bunch of money), why do I feel I must have it? Anyhow, a kind reader shared these reflections:

A good number of vendors aren’t going to like this guide because no one wants to see anything less than an A by their name. A few categories have no vendors earning an A and most categories are littered with Bs and Cs. I even noticed one F. Even industry darling Epic made a B+ in one of its categories. If I were a buyer, I would be seriously depressed by the lack of low-risk choices.

Sunquest Information Systems extends its relationship with two customers who are expanding their use of Sunquest’s anatomic pathology solution. Massachusetts General Hospital is installing Sunquest CoPathPlus and Bon Secours Health System (MD) is adding Sunquest CoPathPlus at three facilities.

Praxis EMR selects MedUnity as its exclusive provide of HIE and fax services.

MD Anderson Cancer Center (TX) deploys LodgeNetRX Interactive Television System throughout its 11-building campus.

The Voalte One solution is now offered on Blackberry smart phones, in addition to the iPhone. The pink pants guys say they will be showing off both versions at HIMSS, booth 2407.

OakBend Medical Center (TX) successfully implements McKesson’s Paragon HIS, along with AcuDose-Rx medication dispensing cabinets. The hospital CEO says 100% of the nurses were using the system the first day of go-live and 100% of the physicians were using it within three months.

Beth Israel Deaconess Healthcare selects MedAptus’s Professional Intelligent Charge Capture technology for its 170-physician hospitalist group.

Five years after first implementing Allscripts’ practice management system, the 70-provider Mid-Michigan Physicians decides to add Allscripts EHR.

The Oregon Department of Human Services contracts with Netsmart Technology to implement Netsmart’s Avatar EHR and PM software at Oregon State Hospital and other state behavioral health facilities.

athenahealth announces it will postpone the release of its Q4 and 2009 year end financials in order to allow additional time to complete a year-end audit and conduct an internal accounting policy review. The delay is in connection with an internally-initiated review of its accounting policy for the amortization period for deferred implementation revenue.

Medsphere Systems appoints Michael Previti as VP of national sales. He was previously VP of provider sales for Initiate Systems and also did stints at both Cerner and McKesson. I see that former Picis exec Doug Schumann also just joined Medsphere to head up implementation and training, and, Health Data Sciences alum Carol Somer is the new director of marketing.

In September 2008 Mr. H mentioned that Pegasus Imaging Corporation filed a lawsuit against Allscripts, claiming  intellectual property infringement over licensing fees for a Pegasus development toolkit. I don’t recall ever hearing more about the lawsuit so I assumed that it was settled privately, as most lawsuits are. That’s apparently not the case and a trial could start in March. Pegasus president Jack Berlin says he’s been trying to work out a settlement for the last 18 months. Allscripts isn’t commenting. Berlin believes Allscripts could owe him $60 million or more in license fees.

After budgeting  an initial $590 million to deploy an EMR, Catholic Healthcare West is adding another $419 million to its budget (holy cost overrun, Batman!) Of the initial funds, $240 million was spent implementing Cerner EMR at eight of the health system’s 41 hospitals. CIO Ben Williams says the cost per hospital will be much less going forward because the implementation team is now more experienced. My math says they need to be much more experienced.

Emergisoft releases Emergisoft EC Forms Digital Solution, an application that converts template-style documentation into a narrative language chart.

AT&T announces plans to expand its AT&T Healthcare Community Online (HCO) solution to include a portal with pre-integrated applications. HCO is AT&T’s cloud-based HIE and collaboration portal. Some of the new enhancements include real-time access to patient data at the point of care, single sign-on access, integration with e-prescribing, EMRs, and lab services.

Speaking of AT&T, I got a text yesterday saying there’s a brand new tower close to my neighborhood. Coincidentally I see PC World praises AT&T’s efforts to improve its 3G network performance, which is now 67% faster than the network speeds of Sprint, T-Mobile, and Verizon Wireless.

The HIT Standards Committee recommends that federal certification criteria for EMRs be flexible and not lock into specific requirements that could become outdated. Certifications should consist of a family of standards for certain criteria, rather than specific requirements, e.g., require HL7 version two, though not specify a specific release.

Phytel appoints Dr. Richard Hodach its chief medical officer.

NextGen says that for each person who follows them on Twitter and retweets “#NextGencares and I do too,” they’ll donate $1 to charity. At HIMSS you can vote on which charity you’d like see get the money, and for each vote, NextGen will donate more money. I’m all for corporations sharing their profits with the world, so starting Twittering and stop by booth #7433.

Keane’s Healthcare Solutions Division is awarded contract extensions with University Physicians Hospital (AZ) and Ernest Health. Both entities recently upgraded to Keane’s Optimum Patcom offering.

I have to ask: why do marketing types feel the need to mention ARRA in every single press release they issue? It’s not just the folks selling EMRs. New hire announcements, infrastructure upgrades, and earnings announcements are all deemed worthy platforms to mention ARRA stimulus money. Enough already.

I’m sure regular readers are aware that Mr. H has been especially prolific with the interviews the last couple of weeks (I only did one of two). A couple of trivial observations: where are all the intriguing female interviewees? Please send your suggestions. More trivial: HIT has its fair share of hunky guys. I’m definitely heading to the AirStrip booth in Atlanta.

As Mr. H mentioned, a few of our guest at Max Lager’s Monday night will be adorned with beauty queen-type sashes. Most of our sash-designees have been good sports in agreeing to participate, even though none of them yet know what their sashes will say. Note that we will be awarding the above sash to two lucky attendees at the party, so keep this in mind as you pack your bags.

If you are going to Atlanta – safe travels! If you are staying home, we will do our best to let you know all you’re missing.

E-mail Inga.

News 2/24/10

From The PACS Designer: “Re: HIPAA Survival Guide. Deborah Leyva of the Health & Technology Blog has posted the Second Edition of the HIPAA Survival Guide for download.”

Just published by The Huffington Post Investigative Fund: FDA is “moving closer” to regulating EMRs after receiving reports of six patient deaths and 44 injuries related to system malfunctions. Examples included an OR system whose lockups forced nurses to re-enter data from memory and another that didn’t display allergies correctly (hardly news if you’ve worked in HIT for any length of time, but apparently FDA was surprised). An FDA official admitted that the agency has steered clear of regulating HIT, but says, “In light of the safety issues that have been reported to us, we believe that a framework of federal oversight of HIT needs to assure patient safety.” Reaction from vendor executives at the recent hearings was interesting: Epic’s Carl Dvorak was quoted as saying regulation wouldn’t necessarily ensure safer products or encourage innovation, while Cerner says it supports making voluntary safety reports mandatory because it’s “the right thing to do.”

I have a couple of interviews yet to post, so once those are running, I promise you will see fewer HIStalk e-mail blasts. All of the interviews were fun to do and I’m pleased to bring them to you. I’m hoping to clear the decks before HIMSS since you know I’ll be writing every day from there.

This is new at HIMSS: the naming of the HITmen (and women) of 2010, the most powerful healthcare IT leaders. There’s an invitation-only reception at the conference and some PR, I’m sure, for the winners. Some familiar names are on the host committee: Jonathan Bush of athenahealth, John Halamka of BIDMC, Steve Lieber of HIMSS, and the one that sticks out like a sore thumb, Mr. HIStalk – CEO of HIStalk (and yes, I’ve taken considerable e-mail ribbing about that, but I swear the CEO thing wasn’t my idea and I have zero delusions of grandeur). More to come.

Secure access vendor Imprivata announces the formation of a healthcare division and the hiring of HIMSS chair Barry Chaiken, MD as chief medical officer.

Here’s a shout-out for Software Testing Solutions LLC, a new Platinum Sponsor of HIStalk. The Tucson company’s RATIO tools perform automated software testing, which I hope you hospitals and practices are doing before simply moving vendor code to production (both unexpected bugs and manual testing are expensive, as I can vouch from unfortunately personal experience). You set the application environment, the scope, and the transaction volume, then let the script take over to perform and document the tests (it even works with Citrix). If you have Epic inpatient or ambulatory, Eclipsys SCM, or Sunquest, you could be validating your orderables, generating test billing transactions, and validating new vendor releases and interface changes with minimal effort and with documented consistency. Thanks much to Software Testing Solutions for supporting HIStalk.

HealthStream’s Q4 numbers: revenue up 12%, EPS $0.47 vs. $0.07, although some one-time adjustments threw the numbers off a bit.

Weird News Andy expands his media sources to video, locating this story about a Kentucky psychiatrist who attacked a patient in his office with a sword, with his only statement after the fact being “four quarts low on the truck.” His patient, unfortunately, sustained life-threatening chest wounds. The uncharacteristically somber WNA also finds this story that he captions as “Patients or Guinea Pigs,” describing the FDA’s OK to dispense with informed consent guidelines for EDs involved in a resuscitation study.

Wellmont Health System (TN) names Kent Petty as VP/CIO.

I figure it’s the least I can do to wish Encore Health Resources a happy first birthday since they’ll be buying a few hundred of you drinks and food next Monday evening at the HIStalk reception, so here’s to them (and their reception co-sponsors Symantec and Evolvent).

Redwood MedNet and Thayer County Health Services connect their respective HIEs as a demonstration of the Health Internet using Mirth Corporation’s Mirth MUx (Meaningful Use Exchange), built on ONCHIT’s CONNECT software.

The fight is on for Amicas, with Merge Healthcare putting a $248 million offer on the table next to the earlier $217 million one from Thoma Bravo. Amicas already agreed to the Thoma Bravo offer, so the company is urging shareholders to vote that way, saying it doesn’t trust Merge’s financing.

My upcoming guest editorial for Inside Healthcare Computing: Dark Side on Line One: If Cash Really is King, Now’s the Time to Leave That Hospital Job. A sample of its caffeine-fueled prose: “If you have a loving, loyal hospital spouse who makes you happy and puts up with your idiosyncrasies, then think carefully before running off with the tarted up, drug-seeking vendor stripper who is whispering in your ear to throw it all away to run off to Las Vegas with her to gamble. It’s not nearly as fun as it looks.” It’s not Camus, but it’s what I do.

Porter Medical Center (VT) gets a mention in the local newspaper for its planned Meditech implementation, which awaits certificate of need approval. I like the CFO’s response to possible ARRA incentives: “There are all kinds of experts at the state and national level that swear that this will save money. I’d be the last person to try to guarantee savings.”

Also getting a nice newspaper story on its EMR implementation: Stormont-Vail HealthCare (KS).

More on the pharma-sponsored depression “test” that WebMD ran, pitching Lilly’s Cymbalta: no matter how you answered the 10 questions, the response was always “You may be at risk for major depression.”

Nevada banks are pre-qualifying doctors for EMR purchases just like they do for mortgages, expecting a jump in Q2 purchases. On the one hand, banks say nearly all doctors are contemplating an EMR purchase. On the other, falling home values mean banks aren’t as willing to take personal guarantees for the loans. A nice article by the Las Vegas Business Press.

TriZetto launches its PHR for health plan members. The press release was full of a lot of product names that I wasn’t really interested enough to follow, but it does interestingly distinguish EMRs from EHRs (as I do).

Genesis HealthCare (OH) seeks $25 million in taxpayer-backed loans to Epic, which it hopes will quality it for $12.5 million in stimulus money.

A Maryland fire department’s computer system loses over 10,000 ambulance transport records and fails to file required reports when its computer system has problems in its first year of use. The $275K HealthWares reporting system has been scrapped, with the head of the firefighter’s union saying, “”I thought there was no reason to purchase this when probably an overwhelming majority of fire departments in Maryland use EMAIS for free. There was no reason at all to reinvent the wheel. It was a complete waste of money.”

Robert Miller is promoted to North American president of iSoft.

The White House wants to create a government-wide Federal HIT Task Force, chaired by David Blumenthal, that would coordinate healthcare IT among federal agencies. Those could include the VA, DoD, Social Security, CDC, NIH, and FDA.

Indian Health Service will upgrade its RPMS EMR system to meet meaningful use requirements, including addition of a master person index, a patient flow dashoard, and an event tracking tool to ensure follow-up of abnormal lab results.

Odd hospital lawsuit: a city judge held in a mental health facility for court-ordered evaluation of suicidal behavior files suit against more than 30 employees of the health system, the district attorney, other county attorneys, and Aramark. When contacted about the suit, his only comment was, “Payback is a (expletive), and I get to reform mental healthcare in the process.”

E-mail me.

HERtalk by Inga

Clearly HIT vendors and their PR companies are working overtime to issue pre-HIMSS press releases. Some of the news is meaty, though a fair number are a bit more ho-hum. Save yourself some time and peruse these highlights.

LSU (LA) expands its HealthLink project to include clinical data exchange between the LSU health system and its regional physicians. LSU Healthlink will use CarefX’s Fusionfx product to facilitate data access.

South Jersey Healthcare Regional Medical Center selects Patient Care Technology Systems’ Amelior Tracker to manage physician location and communication.

WellStar Health System (GA) selects ICA’s CareAlign Solution as its connected health technology platform.

Emergin, a division of Philips Healthcare, announces a new interface between the Emergin alert management platform and Voalte’s communication server. The integration will facilitate alert message notifications from the Emergin system to Apple iPhones and iPod Touches and provide real-time communication between caregivers.

HealthPort says it has added electronic delivery functionality to its release of information process.

Somerset Hospital (PA) contracts with McKesson for its PROmanager-Rx system to automate medication dispensing. Somerset is also McKesson Paragon user.

Northern Michigan Regional Hospital picks Medicity’s Novo Grid technology to provide electronic health information exchange among its hospitals and physicians.

PatientKeeper partners with NextGate to offer NextGate’s enterprise MPI solution for its customers. NextGate’s MatchMetrix Suite will connect with the PatientKeeper platform to provide a single view of patient information.

maxIT Healthcare announces a number of leadership changes,  including the promotion of Mike Sweeney from divisional VP of strategic partnerships to EVP of strategy and corporate development. Mark Fangman is maxIT’s new EVP of sales and operations and David Leaman is a divisional VP of sales.

Childrens Hospital Los Angeles plans to deploy GetWellNetwork’s GetWell Town solution when it opens in spring 2011.

McLaren Health Care Corporation (MI) signs a $3 million EHR contract with Allscripts for its 150 employed physicians. Initiate Systems will build McLaren an enterprise MPI across its multiple systems and databases, which includes McKesson’s practice management system.

Associated Cardiovascular Consultants (NJ) selects Sage Intergy, Sage Intergy EHR, Practice Analytics, and Practice Portal for its 38-physician  practice. Sage Healthcare, by the way, has its own channel on YouTube, which includes a number of customer interviews, including one with Associated Cardiovascular’s executive administrator.

CliniComp wins another deal with the VA, its third in the last four months. The New York/New Jersey Veteran’s Healthcare Network will install CliniComp’s Essentris ED and Essentris Critical Care solutions.

Former IDX exec Wayne Koch is named VP of physician services for Apollo Health Street.

The Valley Hospital (NJ) adds Summit Healthcare’s Scripting Toolkit to integrate with Valley Hospital’s MEDITECH platform.

Wellsoft shares word that the ED docs at Memorial Hospital (PA) are successfully using Dragon Medical to navigate and dictate within the Wellsoft EDIS.

As mandated by the HITECH Act, HHS posts a list of 36 reported health information breaches from private medical practices, hospitals, health systems, and public agencies. Most of the breaches were the result of theft or loss of a computer/drive/backup or other storage media. The breach affecting the most people involved the theft of hard drives from BCBS of Tennessee. The potential number of individuals affected: 500,000.

Here’s your HIMSS tip of the day: I see that Medi-Span is giving away a couple of trips to the Indianapolis 500. It’s labeled a “luxury trip package” but that’s still not much of a draw for me. I will forego entering Medi-Span’s contest and thus improve the odds for real fans. Of course, I expect you race car fans to return the favor when it comes the drawings for a nook eBook Reader (Dialog Medical) or Amazon Kindle (Brocade).

E-mail Inga.

Monday Morning Update 2/22/10

From Luke O’Voron: “Re: Privacy and Security Standards Workgroup. Their meetings are now open to anyone by teleconference. This week, Judy Faulkner of Epic was in fine form, defending her 30-year-old product as the only way to go. Look for transcripts.” They haven’t been posted yet, but I’m watching for them.

From All Hat No Cattle: “Re: Looks like HIStalk is now a source of news! Congratulations.” Healthcare IT News has been openly scornful of HIStalk in the past (“a sorry commentary on journalism today”), so I’m not sure how I feel about having them cite HIStalk (I know it didn’t result in many incoming hits). I don’t claim to be a journalist, so I likewise assume nobody there claims to be a healthcare IT expert. I sometimes glance at it during the more boring educational sessions at HIMSS, especially since early print deadlines mean I can read what the keynoters will say before their sessions are even held, making me feel temporarily psychic and opening up the possibility of a “Dewey Defeats Truman” collector’s edition if the speaker would happen to cancel or go off script with an unplanned rant.

From Kiley: “Re: CEO. You should check out this guy’s past. Nobody seems to question his background when he’s speaking or writing.” We’re on journalistic thin ice here, even for a non-journalism major. I did some extensive Googling and it seems the individual named recently pled guilty to big-time federal income tax fraud. I got copies of the court records, but received no response when I sent details (twice) to the organization’s PR e-mail address and asked for confirmation. I can’t decide if that’s fair game or not, although I’m leaning toward no.

Long-range weather forecasts are notoriously inaccurate, but the Atlanta 10-day version predicts highs in the lower 50s for the start of HIMSS. If it’s not too cloudy, that should be pretty nice, especially compared to Chicago last year (or Chicago right now – snow and highs in the 30s).

Looks like Sully’s HIMSS audience will be about the same size as when he made that “we’re going down in the Hudson” PA announcement, with 88% of us planning to be long gone from Atlanta by the time he hits the podium on Thursday. New poll to your right: given the government’s track record in fulfilling its financial promises to providers, do you think ARRA money will be paid as stated?

Listening: Crucified Barbara. Sometimes you just need beautiful, non-English speaking Swedish women playing nasty biker metal hard rock.

Inga asked our BFF Tammi from AT&T a reader’s question about iPhone presentations at HIMSS, of which there are basically none on the education track since annual conference proposals are due nearly a full year before the conference (it’s ludicrous to be paying to sit through year-old presentations just because HIMSS can’t shorten its lead time, but that’s always been the case – this year’s sessions were finalized by May 29, 2009). Anyway, she mysteriously suggests dropping by the AT&T booth to check out “exciting developments.”

Thanks to MedVentive for supporting HIStalk as a Platinum Sponsor. The Waltham, MA-based company provides a wide range of solutions that include pay-for-performance systems, registries, evidence-based algorithms for quality management, point-of-care decision support for physicians that integrates information in its repository with claims data, managed care tools, and scorecards and provider profiling for payers. It was started by CareGroup and BIDMC in1997, expanded for a broader audience as MedVentive in 2005. If you want to connect with their folks at HIMSS, shoot them an e-mail. I appreciate their support.

Inga has been working her pretty fingers to the bone getting ready for HIMSS. Somehow she found time to prepare this guide to what our HIStalk sponsors will be doing at HIMSS, complete with booth and contact information, a description of their products and services, and their message to you about their HIMSS activities (including some giveaways, charitable projects, and the all-important snacking opportunities). You can download a PDF version to print and take to Atlanta if you like. If you enjoy HIStalk or benefit from it, please click their ads, check out their HIMSS activities, and drop by their booths and say thanks. We have some super-nice people and companies who are fans of HIStalk, which we as amateurs with day jobs sure do appreciate.

I don’t know about your hospital, but mine is packed to the gills. It’s a good thing flu activity was a lot less than expected or we would be having patients sleeping in the hall instead of just the ED holding area.

England’s Accountancy and Actuarial Discipline Board will conduct hearings this week on an accountant for iSoft Group, whose former executives are themselves are the subject of an investigation related to accounting irregularities alleged to have occurred from 2003 until 2006.

Former RelayHealth VP Bob Katter joins First DataBank as VP of sales and marketing.

The Racine paper weighs in on the EMR implementation at Wheaton Franciscan-All Saints (IL), saying some doctors anonymously told reporters that its $67 million McKesson Horizon Clinicals implementation is “one of the cheapest, worst systems available.” The docs complain that Wheaton spent nearly as much as nearby Froedtert, which installed #1 KLAS-ranked Epic for $70 million. The hospital defends itself, saying its McKesson system (#7 ranked in KLAS, the paper says) is comparable to Epic and the #12 ranked Cerner system that another nearby hospital bought, neither of which had extensive problems (actually, that sounds to me like they defended their vendor pretty well, but themselves not so well). Since the hospital and its doctors were already fighting about unrelated issues, I’d take anything said there with a grain of salt. Other places run Horizon Clinicals just fine.

Strange: why is the non-profit Cleveland Clinic buying Google ads to brag on its technology and IT people on its own EMR site? This ad came up when I Googled “healthcare technology.” 

I’ve mostly quit reporting on government HIT handouts, you may have noticed. Truth be told, it makes me sick to my stomach to read, much less write, about all those undisciplined politicians bragging to the locals about how great it is they managed to snare taxpayer money to pay for local projects. Enjoy the economic party because it can’t last; the generations-long hangover is going to be brutal.

The Louis Stokes Cleveland VA Medical Center (OH), concerned about medical residents who clutter up the EMR with copied-and-pasted information, audits the notes of first-year residents and gives movie tickets to the best one. The newspaper article quotes a journal article: “The copy-and-paste function has led to a number of unexpected problems and concerns about electronic note writing and its impact on the culture of medicine, including reducing the credibility of the recorded findings, clouding clinical thinking, limiting proper coding and robbing the chart of its narrative flow and function.”

Facing a threatened libel countersuit, GE Healthcare drops its libel lawsuit against a Danish radiologist who had shared research findings unflattering to one of GE Healthcare’s contrast agents at a medical conference. The suit was featured Tuesday in The Globe and Mail in an article called London, sue capital of the world, describing “libel tourism” in which suits involving no English parties are tried there, mostly because unlike in the US, the burden of proof rests on the defendant and a libel defense costs 140 times anywhere else in Europe, leading to pocket-lining settlements for lawyers. At stake: self-imposed medical censorship, such as the Danish radiologist, who says, “I am not giving lectures any more in the U.K., where it seems you can be sued for telling the truth.” I liked this quote: “It’s acutely embarrassing for the government that various American states have passed laws to protect their citizens from English libel law.”

WebMD finds itself on the wrong side of Senator Chuck Grassley, who wants to know why the company’s TV ads pitch a pharma-sponsored depression screening test while it claims to provide objective medical information to consumers. WebMD claims editorial independence, but the Senator wants it to provide details on its drug company connections. Chuck’s all over the place, but I usually like his choice of targets.

Bizarre: the FBI gets involved in the case of a Pennsylvania school system that remotely activated the webcams of school-issued Apple laptops used by students. The school supposedly accused a student of selling drugs, providing as evidence a photo snapped by his school laptop from inside his house. The school claims the webcams were used only to recover laptops that had been stolen.

E-mail me.

News 2/19/10

From Pliny: “Re: Herb Smaltz, CIO of Ohio State University Medical Center. He is leaving the job on February 28 to run an OSU spinoff, Health Care DataWorks.” The company offers an off-the-shelf, pre-loaded data warehouse.

From Keanu: “Re: CCHIT. Has anyone heard of CCHIT events at HIMSS? Isn’t it a bit odd that they haven’t posted a town hall or something? With all the sessions on Meaningful Use, you would think they would have something to say.”

From The PACS Designer: “Re: disease outbreak alerting. The population of high quality healthcare apps for the iPhone keeps expanding. Outbreaks Near Me, an app introduced in 2006, recently created an iPhone version for mobile users. Software developer Clark Freifeld and epidemiologist John Brownstein started HealthMap in 2006 and designed Outbreaks Near Me for Childrens Hospital Boston."

From IKnowPlenty: “Re: AHA. Every day, more news comes out undermining Al Gore’s global warming hypothesis. For AHA’s upcoming Leadership Summit, they’ve added Newt Gingrich to share the stage with Gore. Now if we could just get someone who actually understands healthcare.” Newt makes good money from his Center for Health Transformation, so he must know something. In fact, he’s running an American People’s Online Health Summit as a counterpoint to President Obama’s meeting and most likely as an early step in a 2012 run for President (that’s my guess, anyway, now that his presumed opponent is obviously vulnerable).

Eclipsys announces Q4 results: revenue up 5%, EPS $0.07 vs. $0.06. Non-GAAP EPS of $0.17 beat expectations of $0.12.

Mary Horan, MD, chief of staff of Northwest Hospital (WA), will present “Med Rec: It Doesn’t Have to Hurt” at the AHA booth at HIMSS on Tuesday, March 2 at 3:30 p.m. She will talk about the use of MedsTracker from Design Clinicals, who will also offer private demos by request (at HIMSS or otherwise).

Picis announces a new version of ED PulseCheck and the launch of LYNX CareBridge, a documentation solution for medical necessity.

The Adoption/Certification Workgroup of HHS’s HIT Policy Committee will examine the safety of healthcare IT systems at an all-day meeting (warning: PDF) next Thursday from 9 until 3 Eastern. Executives from Cerner, Epic, and the VA will present, along with Ross Koppel, David Classen, and ePatient Dave (among others). You can participate remotely here without pre-registering. That should be interesting.

Thanks to Access, a new HIStalk Platinum Sponsor (actually Double Platinum, since they are also a Platinum Sponsor of HIStalk Mobile). The Sulphur Springs, TX company offers solutions that address patient flow, electronic forms, electronic signature, an e-Forms Repository, and portals that connect to media such as fax, e-mail, images, and universal documents such as EKG strips and other device output. We found out about each other when I did an HIT Moment with VP Chuck Demaree last week, which taught me stuff I didn’t know about electronic patient signatures and the capabilities of the Universal Document Portal for populating the EMR with data from biomedical equipment or even other applications. Being a barbeque connoisseur, I would find a reason to visit them at their place and then drop by Big Smith’s Bar-B-Q, but if that’s a stretch, they will be at Booth 4333 at HIMSS. Thanks to Access for its support of HIStalk and HIStalk Mobile.

Speaking of HIStalk Mobile, my colleague David Brooks is filling up his dance card to visit companies with mobile offerings (actually, he’s already got 20 appointments for Monday and Tuesday, so lay claim to Wednesday while you can). If you have the coolest mobile solution on the market, David says he will make time for you. I should also mention the fourth Founding Sponsor of HIStalk Mobile, 3M, which joins Vocera, Voalte, and another company not quite ready to be named. We really appreciate it.

I guessed wrong on the 2010 Grammy winner that MEDecision will bring to its HIMSS party. It’s Colbie Caillat, who has charted several times with some good pop tunes. Live video here. Their event is 6-9 Monday night at the Georgia Aquarium, It’s open to everybody, including those coming to the HIStalk reception who will need to leave early to hit Max Lager’s by 7:00. RSVP here to see Colbie.

And speaking of the HIStalk reception, thanks to sponsors Encore Health Resources, Evolvent, and Symantec. In fact, I notice that Ivo must have liked the looks of Max Lager’s since he’s hosting a Healthlink Alumni Pub Night there Sunday night.

Inga and I have done some good interviews that I’ll be posting each day for the next several. I want to get caught up before HIMSS and then feel free to collapse immediately afterward.

And Inga has obviously been a busy lady, putting together HIT Vendor Executives on HIMSS10, which features some fascinating executive predictions about the conference. How she got the top people at 42 companies to share their thoughts is beyond me (charm, I’ll assume).

Noteworthy Medical Systems is chosen by The Camden Coalition of Healthcare Providers (NJ) to power the Camden Health Information Exchange.

Strange: disgraced former Tour de France winner Floyd Landis, stripped of his title for doping, is the subject of a French arrest warrant for trying to hack into the anti-doping agency’s lab system to prove their results can’t be trusted.

General Dynamics wins a five-year contract worth up to $154 million to support the Army’s MC4 battlefield EMR.

Wacom launches a pen-on-screen display for healthcare professionals who need to annotate images.

An odd survey result: over 50% of Americans think other people’s health is going in the wrong direction, but only 17% said their own is. A third of respondents give themselves an A in the major health categories, while more than 90% of doctors grade them a C or lower. No amount of technology is going to fix that perception problem.

Jackson Memorial Hospital (FL) will lay off over 1,000 of its 12,000 employees, trying to avoid missing payroll by May.

You can tell HIMSS is upcoming. The fluff news is everywhere, but all the good stuff is being held to announce from Atlanta.

E-mail me.

HERtalk by Inga

Orion Health will use Merge’s Cedara WebAccess technology to bring images and information into its Orion Concerto Physician Portal.

The ONC selects Acumen Solutions to implement a cloud computing CRM and and project management from Salesforce.com. The solution will be used across all RECs nationally to help manage interactions with medical providers.

The ONC, by the way, names Joy Pritts, JD as its first chief privacy officer. Pritts will work with David Blumenthal to advise on privacy, security, and data stewardship issues. She was formerly on the faculty at Georgetown University.

athenahealth makes Fast Company Magazine’s “Fast 50” list of the world’s most innovative companies. I noticed that PatientsLikeMe and GE were also in the top 50, while Sermo, Kaiser Permanente, and Walgreens made the “also-ran” list.

Here’s something that sounds fun. Buzz Aldrin will be at the MMR Information Systems booth, taking commemorative photos with HIMSS attendees. Look for him March 1st, complete with a moon surface background in the Sea of Tranquility. If you participate, be sure to send us a copy.

EHR adoption in physician offices is up 3% over last year, according to a survey of 180,000 doctor offices. The numbers suggest a 36% adoption rate, with doctors using EHRs primarily for electronic notes. Not surprisingly, the larger the practice, the more likely the practice uses EHR. Hospital or healthcare system-owned practices are also more likely to EHRs that physician-owned groups.

A few sponsor updates:

• MED3OOO will incorporate data management and analysis tools into its MED3OOO Quality Management Suite. The application will be integrated  into MED3OOO’s InteGreat EHR to facilitate clinical data collection, help providers in determine HCC and PQRI scores, and meet other P4P reporting requirements.
• Sage Healthcare appoints Tony Ryzinski SVP of marketing. He previously worked for Misys in a similar role.
• MedAptus announces an expansion of its consulting services team to help providers and hospital to optimize financial and operational performance.
• e-MDs President and CEO Michaels Stearns, MD agrees to serve as board president of the newly formed Texas e-Health Alliance.
• Shore Sound Health System (NY) plans to undergo an accelerated activation of Eclipsys’ Sunrise Enterprise suite at two of its hospitals.
• Marietta Dermatology Associates (GA)  select the SRS hybrid EMR for its 13 providers.
• Sunquest completes a seven-hospital implementation at Cleveland Clinic.

I’d like to think that first there was Inga, then there was Barbie. Mattel introduces Computer Engineering Barbie, who carries a smartphone, a Bluetooth, and a laptop, plus wears stilettos. Any resemblance to me is pure coincidence.

E-mail Inga.

News 2/17/10

From Nurse: “Re: Community Hospital South (IN). The CEO has announced that the hospital’s problems with GE Centricity Enterprise going back to August will cause it go back to the old GE CIS inpatient system next month. Deployment of Centricity Enterprise is on an indefinite hold.” Unverified, but the e-mail snips included look genuine. Maybe this would have convinced them to stay on: GE Healthcare announces that Centricity Enterprise EMR is now in the ecoimagination portfolio, which the announcement claims was “rigorously tested in-house and by a third party in order to provide optimal satisfaction to GE clients.”

From Kate: “Re: B52s. Who’s having them? I need to crash.” It’s an invitation-only HIMSS event (which I know only because I was invited), so I blurred the vendor name. Cindy and Kate were warbling hotties back in the day, although they are now 52 and 61, respectively, so they may not hop around like they used to. If I were this vendor’s customer and not planning to attend the HIStalk event (whaaaat?) then I’d probably check them out since I can sing along badly with all of Cosmic Thing, especially Deadbeat Club and Dry County, with a few beers in me.

From Zippy: “Re: articles in Racine, WI paper about All Saints. Doctors are not happy with administration and a number may leave.” Doctors and administrators are feuding, with a third of the medical staff ready to bolt. The final straw, apparently, was the hospital’s contracting with a Florida anesthesia company, replacing a local group after failing to reach an agreement about pay, on-call policies, and the use of nurse anesthetists. Also noted as a key issue: the 2009 introduction of an EMR system, which the doctors complain wasn’t well supported.

From Wake Up: “Re: McKesson’s problems. All listed before: HERM cost $150 million and still isn’t ready for prime time, ambulatory and HAC are a shambles, the 10.xxx upgrade is needed for meaningful use, but is painful for customers,and the company likes to replace quality employees with green beans.” All unverified, although I’ve heard them all before, usually from disgruntled former employees. Others have speculated that Pam’s downfall involved ongoing Horizon Clinicals integration struggles, of which ER 10 was an early warning of the challenges ahead (not surprising since all of those apps were developed by different acquired companies, as I remember: Vanderbilt, CliniCom, HCS, and others I’m forgetting). On the other hand, I’ve talked to one HERM site so far and they had nothing at all bad to say, other than to observe that the requirement to upgrade to Horizon Clinicals ER 10 wasn’t clearly stated upfront. I’m trying to connect with a second site.

From Stealth: “Re: Oracle’s Sun Division. I heard an unconfirmed rumor that it’s about to announce that it’s not going to support its JCAPS for EGate interface engine. Has anyone heard this?”

From G-Dog: “Re: articles. I thought this article might be worth discussing on HIStalk.” It covers board certification in informatics for physicians, with the authors concluding that it’s not really like other subspecialties since it covers all other specialties to some degree. AMIA is hoping initial review by ABMS will happen next year or the year after.

From The PACS Designer: “Re: Pogo Stylus. iPhone apps and other new mobile phone accessories keep getting innovative and the Pogo Stylus from TenOneDesign is the latest innovation. You can use the stylus to be creative and design artful stuff. Perhaps, we can get postings from Inga using the Pogo Stylus on her iPhone to entertain us HIStalkers, while Mr. H. uses his BlackBerry to organize HIMSS 2010 entertainment!” It’s $14.95.

The lab division of Fresenius Medical Care North America goes live on McKesson Horizon Lab.

EHRScope releases its Spring 2010 issue (warning: PDF). I really like this publication since it’s a lot meatier than the fluff the rags usually run, with some thoughtful articles and editorials.

This article describes a study in which researchers used CDC’s diagnostic algorithms for acute hepatitis B to search 16 years’ of ambulatory EMR data. It found 112 of the known 113 positive patients, but also detected an additional eight cases, four of which had not been reported to the health department. The next step (obviously) would be to turn those algorithms into real-time alerts.

Duke University Hospital chooses Simplifi 797 IV compounding QA software.

Fallon Clinic (MA) cites several improvements in making Dragon Medical part of its EHR implementation.

Jobs: EHR Project Manager (CA), Systems Administrator (AZ), Senior Systems Analyst (GA).

Sleep well knowing that Weird News Andy is guarding the gate. He finds this article, with the key line being, “Each time the two had sex, documents say, the doctor would bill her Blue Cross Blue Shield Insurance for their ‘sessions’.” The psychologist involved, who called himself RHL (short for Red Hot Lover), is being sued by his former lover and investigated by the state. WNA also likes this story (he threw in a Subway $5 foot long pun at no extra charge) about surgeons in Czech Republic who left a foot-long medical tool in a patient’s abdomen after surgery, which stayed there until five months later.

Former Eclipsys VP Charles Tuchinda, MD is named chief innovation officer, healthcare of Hearst Business Media. He’ll also be a VP at properties Zynx Health and First DataBank.

iSoft will distribute iMDsoft’s MetaVision suite in Germany. It offers clinical decision support, CPOE, and reporting for critical care environments. Among its customers, iMDsoft has four of the top 10 US hospitals at 13 of the top 50 European hospitals, with a 100% retention rate in its 11 years. Coincidentally,  I’ve got an interview coming as soon as I have time to post it.

Orion Health gets some coverage of its recent large sales in the New Zealand business paper.

An ED doctor’s article in an Australian medical journal urges that hospital executives who fake quality data be prosecuted the same as corporate book-cookers. He claims that hospitals have submitted phony data ever since they started getting paid for performance, including discharging patients electronically and then re-admitting them to hit quality targets.

Odd lawsuit: a patient care tech brings a baby to the hospitalized mom of a newborn. The mom starts breast-feeding the baby, but a nurse walks in to tell her it’s the wrong baby. The mother is suing Evanston Hospital and its parent corporation, even though no harm was done and even though she herself didn’t notice (she says she couldn’t see in the dark). The tech apologized in tears, but the father said, “It’s not enough”.

E-mail me.

HERtalk by Inga

From Forest Green: “Re: Sage again. I just heard of another executive departure — Kat Henry, SVP of customer service. I hope the new president can turn things around for them!” Sage has confirmed.

From George Geef: “Re: patient survey. Obviously, we don’t quite agree with the ‘goofy’ categorization of the GfK Roper survey. Compared with the CDC and NEJM surveys, actual patients witnessing computers being used for charting seems to me more accurate gauge of the shift than doctors self-reporting on partial or full use of EMRs.” OK, goofy was not the most eloquent and descriptive word I could have used. Let’s just say I am suspect of the conclusions drawn. Just because a patient notices a PC does not mean the practice has an EMR. The study also noted that older and wealthier patients said their doctors have EMRs more often than younger and poorer patients, concluding that doctors treating older and wealthier patients are more likely to have EMRs. Perhaps, though I could come up with a few other equally plausible conclusions.

Yesterday I came across a mention of HIStalk on a one of our reader’s blogs. The writer’s note made Mr. H and me smile: “I am anxiously awaiting my annual trip to HIMSS. Should be interesting to see what companies are doing around ARRA. At least CCHIT finally released their test scripts today so that there can be a lot of buzz. I especially can’t wait to go to the HIStalk reception. It has been the highlight of the trip the last 2 years.” I have to admit it’s been a highlight for me as well.

After six years of no price increases, Surescripts drops the price of its e-prescribing services for pharmacies, pharmacy vendors, and pharmacy benefits managers. Surescripts says the move is part of its ongoing commitment to improve operational efficiencies and the result of economies of scale. And I bet Surescripts found a price adjustment was necessary in order to remain competitive since the market is a bit more crowded than it was six years ago.

Speaking of Surescripts, the company sets up an advisory committee to help with the development of a prescription history service for HIEs. Committee members include the heads of five HIEs.

Members of a federal HIT advisory group recommend relaxing the number of measures required for providers to demonstrate meaningful use of EHRs. The group wants to drop up to six MU measures for 2011, which still leaves about 80% of the measures originally proposed. The advisory group says the currently proposed 2011 measures set the bar too high, making it difficult for providers hoping to qualify for 2011 stimulus money.

Coming soon: a new post in our ongoing vendor executive series on HIStalk Practice. Several dozen industry CEOs provide answers to the following question: In addition to ARRA-related items, what will be some of the hot topics at HIMSS this year? The insights are diverse and include musings on interoperability, rapid deployment of EHR systems, data collection, mobility, and industry alliances and consolidations. If you’d like to receive a notification when the series is posted, make sure you are signed up as a HIStalk Practice subscriber.

I have to admit I found this press release a bit opportunistic — or at least cheesy. After four introductory paragraphs detailing the Olympic and professional accomplishments of speed skater Eric Heiden, it becomes obvious the piece is really an ad for the records management software used in Heiden’s orthopedic practice. To fully appreciate the message, I think you need to imagine Jim McKay saying these words:

Just as athletes benefit from high-tech gear, clothing and equipment that enables them to be faster, better, stronger, Heiden says Records Studio utilizes superior technology to help optimize the performance of all departments of his medical practice, not just patient care.

East Orange General Hospital (NJ) purchases GE Centricity Enterprise for its hospital-based EMR. GE’s data center will provide the hospital with remote application hosting.

Enovate releases its Enovate Lite Medical Cart services, which includes CompactLite, StandardLite, and UltraLite models. I see the Enovate guys will be showing off the new cart at HIMSS.

Kaiser Permanente reports 2009 net income of $2.1 billion, which is a vast improvement over 2008’s net loss of $794 million. Q4 net income was $214 million, which more than doubles 2008’s number. The turnaround was largely the result of improved financial markets. Meanwhile, membership numbers fell by 64,000 in 2009 after falling 30,000 the year before. Total membership is 8.58 million.

Nemours/Alfred I. duPont Hospital for Children (DE) goes live on GetWell Town, the pediatric version of GetWellNetwork’s Interactive Patient Care system.

The Camden Coalition of Healthcare Providers (NJ) selects Noteworthy Medical Systems to be the information hub for their multi-hospital HIE.

Mediware announces that Oregon Health Sciences University will implement its BloodSafe system.

MEDecision launches a new collaborative HIE service called InFrame that facilitates clinical data sharing, including diagnostic quality medical images.

E-mail Inga.