ONCHIT Releases Preliminary Definition of Meaningful Use

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

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

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

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

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

This is a summary of the most important information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

News 12/30/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

AMICAS To Go Private in $217 Million Buyout

Medical imaging vendor AMICAS announced this morning that it will be bought by private equity firm Thoma Bravo LLC for $5.35 per share, a 21% premium to Thursday’s closing price.

Stephen Kahane, AMICAS president, CEO, and chairman, was quoted as saying, “With the additional capital and operational expertise available to AMICAS through Thoma Bravo, we will be able to grow as the needs of our customers evolve and will be enabled to better serve our market.”

Monday Morning Update 12/28/09

From Madrigal: “Re: letter sent to Meditech customers on December 21.” Unverified, but here’s what the reader sent:

I am happy to announce that effective January 1, 2010, the products, functions, and staff of Patient Care Technologies, Inc. (PtCT) will be fully merged into MEDITECH. PtCT will no longer exist as a separate entity, and all divisions within PtCT will report through MEDITECH’s organizational structure. PtCT’s products will become part of MEDITECH’s HCIS, and will include three offerings: Home Health, Hospice, and well@home Telehealth.

From Lee Morningwood: “Re: Wellogic. Did you decide not to expose them?” I hadn’t named the Cambridge, MA HIE vendor by name, but I received several e-mails purporting to be from former employees back in August. They made a number of claims about the company. I exchanged a couple of e-mails with the CEO and sent him a list of questions, but didn’t hear back. So, all I know now is what I knew then: JobVent said in November 2006 that Wellogic asked it to remove negative postings about the company and Wellogic’s 24-hour support line rang to voice mail (and still did when I tried it today, despite the CEO’s assurance in August that it was a temporary problem due to a telephone system switchover). Meanwhile, I see that JobVent has several recent postings of unknown veracity about the company that repeat some of the same claims that I got by e-mail.

From RocketRobo: “Re: Cerner. The Vancouver Island Health Authority gets local media mention for their $67M Cerner implementation. Five years to bring up the first four hospitals, another three years to bring the rest up. A lot of remote communities will benefit from this model.”

From Ed: “Re: update. Is an update available on the rumor that a major health system will cancel its outsourcing agreement?” I mentioned previously that I had received a couple of anonymous e-mails claiming a big outsourcing contract will be cancelled in early January. The client was supposedly Ascension Health and the vendor CSC, with which Ascension signed a ten-year, $1.4 billion agreement in 2004. Ascension CIO Mark Barner did not return my e-mail of December 8. Therefore, it’s just a rumor – for now.

Construction begins on the future Kansas home of the Kansas City Wizards soccer team and 4,000 Cerner employees, encouraged by $230 million in incentives offered by an apparently desperate Kansas. This architectural rendering is apparently from Neal’s perspective as he can happily note that the parking lot is substantially full and all the Wizards are hard at work, although the pizza delivery vehicle is difficult to discern.

The DoD-VA IT integration project will be delayed for up to two years after a Pentagon review discovers an “inappropriate and potentially unethical relationship” between a DoD manager and the CEO of network performance technology vendor Adara Networks. The tiny company was reported to be under a DoD investigation in July after paying $240,000 in lobbying fees and then getting earmarked funds from Sen. Thad Cochran of Mississippi.

ONCHIT announced $80 million in grants for HIT training last month. Now comes another $38 million for universities for competency assessment and certificate programs. I’m picturing David Blumenthal wielding one of those tee shirt shooter guns like you see at sporting events, launching $5 million packets of taxpayer currency to crowds of handout-hungry universities. HIT Geek sends this assessment: “Why not a program to re-employ the many skilled workers who have been laid off from healthcare IT vendors due to the economic downturn? No need to train them, and they are available immediately.”

Speaking of David Blumenthal, he declares that ONCHIT’s advisory work group meetings will be open to the public starting January 1. Modern Healthcare reporter Joe Conn had called them on it, questioning whether “it was appropriate to close the meetings even if they had legal authority to do so” considering the President’s recent open government order. Suddenly, Blumenthal’s blog cheers the “no closed meetings” idea like he had just thought it up, declaring that “we want to do more to bring you into the conversation” without referencing the earlier resistance to open meetings (and a somewhat haughty-sounding defense of the practice). It’s a good move, but a simple “we were wrong” would have been nice, especially since I bet the closed door meetings were inconsequential anyway.

The HIStalk party at HIMSS will be Monday, March 1 at 7:00 at Max Lager’s, a short walk from the Georgia World Congress Center. Thanks to primary sponsor Encore Health Resources. Ivo Nelson and Dana Sellers know how to throw a bash, as several of you mentioned by e-mail after the last conference in Chicago. More to come, including the usual online RSVP.

Two unnamed Mayo Clinic employees, one of them a doctor, are fired for violating privacy policies.

I was in the Apple store today (Saturday, the day after Christmas). Recession or not, it was packed with buyers, not returners. A big announcement is supposedly coming in January, which I’d speculate is its rumored tablet offering. I was feeling up the Mac Mini, which is a cool little $599 computer for PC’ers like me who don’t need to re-buy a monitor and keyboard.

Recent articles aside, EMR adopters shouldn’t put too much stock in the results realized by users who preceded them, according to my last poll. New poll to your right: when I asked John Gomez from Eclipsys about Epic’s dominance, he said, “But when you get into the real serious acute care, when you get into the real treatment of very, very sick patients; to the best of my knowledge, I don’t know if they’ve proven themselves yet.” Do you think Epic has proved itself in that regard?

Creepy: a Canadian inventor creates a robotic dream girl that speaks 13,000 sentences in two languages, recognizes faces, plays games, and slaps anyone who paws her. Her “husband” says she’s the perfect woman because she “is always helpful and never complains.” He hopes his robot can serve as a home health companion, which I’m guessing could be funded by selling it for seedier purposes.

Finnish doctors have the same EMR gripes as US ones, according to this Helsinki newspaper article: work slowdowns, lack of an easily understood abstract of immense amounts of information, and decreased time with patients due to increased time entering data. “Software companies have started to become interested in listening to users only in recent years,” a board member of the Finnish Medical Association said.

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News 12/23/09

From BlackBerry Bramble: “Re: BlackBerry. Tonight, for hours, a widespread BlackBerry service outage has occurred and spread to Messenger. Does anyone depend on it for patient care and can I sign up for a backup system?” Sounds like a Messenger upgrade cause the problem like it did last week.

From HC Biker: “Re: Cerner’s IMC acquisition. I know IMC pretty well. They recently decided to use eClinical Works for the primary care side of their business and had some custom software written to link eCW with the occupational medicine software that they were using. Not sure what Cerner plans on doing with this business, but they had a couple of failed bids to provide employer-based primary care and perhaps this is their way to finally get some success in the business. On the surface, it does not appear to be a good fit.”

From RaleighObserver: “Re: my 2010 prediction. Dell acquires Allscripts for their footprint. Tullman pockets a ton of money before Dell realizes the house of cards that it inherited and he runs for public office.”

From The PACS Designer: “Re: Microsoft live@edu. Microsoft is trying to attract new students to its e-mail application called live@edu. So, if you are a student reading HIStalk, let your school administration know about their service. One of the key features is each user is granted 25GB of storage space for their e-mail address, plus they also have some other nice features at low cost to the institution.” It doesn’t work with Chrome, I see.

From Weird News Andy: “Re: no longer a member of the 3-H club.” Harlem Hospital gives a 54-year-old woman an advertised $15 mammogram, throwing in a blood test for free. She claims the hospital told her the blood test revealed that she had terminal HIV, hepatitis, and herpes. She suffers for weeks, then gets a call from the hospital saying it was a mistake and she’s fine after all. No apology, though. She thanked God for her new lease on life, then got herself a malpractice lawyer because “we don’t want anyone else to go through what we’ve been through.” People always say that when suing, but they always just keep the money.

From Marvin Gartner: “Re: Why nothing on the AM J Med article by Himmelstein et al entitled ‘Hospital Computing and the Costs and Quality of Care: A National Study?’ No savings – limited outcomes improvement in only one of four measures. This article needs to be discussed.” OK, allow me to rant: I get e-mails fairly often from someone who indignantly claims I missed or intentionally ignored some big story, when in fact it was prominently featured and mentioned more than once. I pretty much never miss a story, but casual readers much less rarely skim blissfully right by them. I mentioned that article twice in November, one writeup coming in uncharacteristically long at four paragraphs, 555 words, and even a picture of one of the authors (that was exactly one month ago today). So, it has been discussed amply right here, with my conclusion being that the article is not surprising, but not definitive, either. I bought a guitar once, but I’m not blaming the manufacturer for my inability to play the guitar parts of Rush’s The Trees since I’m pretty sure Alex Lifeson could pick up my old six-string and knock it out flawlessly, so mileage most definitely varies with both guitars and EMRs, mostly because of who’s playing. This article matched up a few databases and then blamed the guitar, written by folks who have a definite political agenda and who profess that “idiot hospital administrators” buy EMRs “to extract more money” and “jack up the charges.” I don’t disagree with the concept that providers haven’t historically shown impressive IT results (I preach that myself all the time), but I question the takeaway that nobody should be implementing software systems because they universally don’t work. The problem isn’t that 80% of providers are too weak in change management and reproducible processes to implement software successfully — it’s that they think they are in the 20%.

From Big Wayne: “Re: Flower. You might want to take a look at a sorta grassroots movement to get patients informed about interoperability issues and asking their providers to ‘talk’ to each other.” Flower is some kind of interoperability manifesto. I have a short attention span, so I couldn’t really figure out if it’s a movement, a technology, or a business.

I made a couple of tweaks to speed up page loads: I cut the number of front-page stories from five to three (click the Archives link at the top of the page to see the last 200) and I took pictures out of the View/Print Text Only page. In case you were wondering.

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‘Twas the Night Before Christmas
By Inga

‘Twas the night before Christmas, when all through IT
Not a creature was stirring – not a single PC.
The charges were updated by users with care,
In hopes that more money would make its way there.

The doctors were finished, all smug in their heads,
While nurses were checking on every last bed.
And the CIO in his office, and I in my cube
He cleaned out his email while I watched YouTube.

When out from Windows 7 there ‘rose an odd clatter,
I switched off The Who to check on the matter.
Then away across the ‘Net I flew – launching Flash,
I opened up HIStalk, hoping nothing would crash.

My tunes on Pandora were silenced at once
Yet my laptop moved slowly – it seemed to take months.
When, what to my wondering eyes should appear
But a miniature Mr. H and Inga, that dear.

As my GeForce driver became lively and quick
I knew in a moment it must not be a trick.
More rapid than eagles, his rumors quickly came,
And he whistled, and grumbled, and called them by name.

“Now Neal! Now Glenn! Now Girish and JB!
Now Philip! Now Judy! Now Pappalardo and Sunny!
To the top of web page! To the top of the crawl!
I know all your secrets! Yes I do know them all!”

With news and some gossip, the wild rumors fly
The leaders read closely, hoping they will not win pie.
Daily to HIStalk – those the top dogs do click
To read Mr. H and his Inga, with all of their shtick.

And then, in a twinkling, I heard a new sound
My disk drive was churning and chugging around!
As I drew down my head to refresh the screen
Out popped Mr. H – an amazing sight to be seen!

He was dressed in polyester, from his head to his foot,
He had quite the old-fashioned programmer look.
A bundle of gadgets he had flung on his back,
As well as a Blackberry, still new from its pack.

His eyes – how they twinkled! His dimples how merry!
He looked ready to scribe a new fun commentary!
His droll little humor was clear from the start
This was the man who made blogging an art!

The stump of a pipe he held tight in his teeth
And a light was encircled on his head like a wreath.
He had a kind face and pooch at his belly
So this the man who turned vendors to jelly?

He was quiet and quick – the picture of stealth
As he checked out the tech things in our office of health.
A wink of his eye and a twist of his head
He noted our software and computers by beds.

He spoke not a thing as he took a keyboard,
I recalled how his words were stronger than swords.
Then touching his finger upon the word “send”
Today’s posting had clearly come to an end.

He sprang to my laptop and gave a short whistle
Then into cyberspace he left – as fast as a missile.
But I heard him exclaim as he slipped out of sight
“Happy Christmas to all, and to all a good-night!”

E-mail Inga.

Monday Morning Update 12/21/09

From Pete Pistol: “Re: Dell/Perot. Looking at additional details on the conference call, ‘Chief Executive Michael Dell has suggested that the company may purchase another software company to beef up its offerings’. Care to speculate who that might be or what type of software they are likely to buy? I’m thinking an EMR vendor (based on another mention on that call), but not sure. They also mentioned becoming a Primary Source Vendor for the federal government and expanding services to outside of the US, which I thought was interesting.” It always makes me nervous when a company with one fading core competency, even one like Dell that was a hotbed of manufacturing and logistics innovation years ago, runs out of runway and suddenly decides to jump into something it knows nothing about without any apparent conviction, especially when patients are involved. I’m hoping it’s not an EMR vendor since the last thing we need is another big company like GE or Siemens dipping a corporate toe into healthcare just because it makes diversification sense. But, if it’s a healthcare software vendor they want, I’d suspect their partners might get a look just like Perot did (Allscripts, eClinicalWorks, AMICAS, etc.). So let’s help Michael Dell out … who should Dell buy? Tell me.

Another of those jumps into a non-core competency … Cerner’s announced acquisition of IMC HealthCare. I’m not sure I’d want a software company providing my healthcare services, any more than I’d want a healthcare provider selling software. I’d have to guess that Cerner picked it up cheap since it had only 23 health centers and was announced as having no impact on Cerner’s 2010 financials. The company says it has custom-developed software, so maybe that’s what Cerner wants. I’ve heard no rousing employee endorsements of Cerner’s health clinic, so maybe having Mr. Tick Tock managing your healthcare matters isn’t the height of employee compassion.

From Avid Reader: “Re: a summary of healthcare overhaul on a napkin.”

David Blumenthal sends an e-mail announcing availability of $60 million more of taxpayer money to “fund research focused on identifying technology solutions to address well-documented problems impeding broad adoption of health information technology,” whatever that means. He calls the program Strategic Health IT Advanced Research Projects, preferring the cute acronym of SHARP rather than the correct one of SHITARP (hey, they picked the name and decided to turn it into an acronym, not me). 

Rodney Schutt resigns as CEO of troubled vendor Aspyra. COO Ademola Lawal will replace him. I don’t have a link, but someone sent over the 8K form. Going down in flames.

I’ve said more than once that click-and-dropdown EMR forms don’t provide the richness of information as an old-fashioned narrative, despite their appeal due to supposed ease of use and the capture of discrete data. A Nuance survey proves it. When presented with an HPI note for the same patient, one dictated in Dragon Medical and the other from a completed EMR point-and-click template, 97% of doctors said the former would be more useful in their treatment of the patient. All the press people must be taking Christmas off early since I got all these announcements that aren’t on the Web yet.

National eHealth Collaborative announces Laura Adams of the Rhode Island Quality Institute as board chair; Simon Cohn, MD of Kaiser as vice chair; and Thomas Fritz of Inland Northwest Health Services as treasurer. I haven’t seen the press release posted yet. The organization is still looking for board members, with nominations due by Christmas day.

I think the above results say all that needs to be said about my last poll. A new one to your right (or to your lower left if your screen resolution is set low): should a provider implementing an EMR care about general studies that attempt to generalize success rates?

It’s a Weird News Andy twofer: he notices that Intermountain Healthcare has resumed its employee 401K contributions, but then also finds that it’s facing a class action lawsuit for claimed overcharging of patients.

Astronaut, LLC announces the beta of VistA Shuttle, a Amazon cloud-based version of either WorldVistA or OpenVista.

Southwest General Health Center (OH) finishes the first phase of its ambitious $26 million IT plan that includes clinical systems, wireless technology, tablet PCs, biometric security, mobile carts, periop documentation, speech recognition, enterprise scheduling, and an HIE. That’s a lot for a hospital of around 300 beds.

Practice EMR vendor DoctorsPartner offers the Sushoo (bless you) independent HIE, free for DoctorsPartner customers or $2,500 upfront and $80 per month otherwise.

Saskatchewan’s electronic health record could be finished for all residents within four years for an additional $365 million beyond the $235 million already spent with another $60 million a year in operating costs. The problem is they may not have the money due to “nose-diving potash prices.”

I plan to write HIStalk at least some of the time over the holidays, if for no other reason than because almost nobody else does that (pros and amateurs alike). It’s a good time to write a guest article or tell me something interesting since hard news may be in short supply (but you never know).

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News 12/18/09

From Lucius Q.C. Lamar: “Re: Cerner. I hear they are working with Cisco to develop a payer product.” Unverified, although the companies have worked together on Cisco’s health center and Cerner’s pilot of Cisco’s TelePresence, so maybe they are BFFs.

From Broadway Joe: “Re: Best holiday wishes to Mr. H and Inga! I really enjoy your blog and appreciate all the hard work you both do to provide us with timely and witting industry information.” Thanks and back atcha. We wouldn’t do it if it wasn’t fun for us, too.

From Hellboy: “Re: EMR articles. Why do you deny conclusions that EMRs don’t provide the expected benefits?” Because I also deny conclusions that they do. Healthcare people are already lemming-like enough without obsessing over whether a 1982 Invision implementation disappointment should mean anything to them. On the other hand, fretting doubters are probably justified in holding back since that kind of hand-wringing usually predisposes to project failure. All these articles carry the subtle message that the semi-study of a few wildly different implementations will yield a universal predictor of software-correlated outcomes. I don’t buy that for a minute. As I’ve said ad nauseam, if software was a magic bullet, every hospital spending their $50 million on Epic or Cerner would simply drive all their competitors out of business with lower costs and better outcomes. They aren’t. Your mileage will most assuredly vary no matter how many articles you read.

From Skip Tracer: “Re: GE. As the owner of a EMR reseller and a competitor to GE, it’s offensive that they received government bailout money and then have turned around and offered free financing to their prospective clients. Now, I know, we’re all feeding at the Obama trough, so I wouldn’t be as ticked if GE used the money to improve their product or services. Instead, they’re floating free money to overcome the fact their product is having problems and their successful installs are few and far between. And, in a roundabout way, I’m helping them do it. Only in America.” GE got $140 billion of taxpayer money to save the GE Capital garbage heap, but only after elbowing its way to the front of the federal bailout bread line by convincing panicking bureaucrats to broaden the definition to “affiliates” of an FDIC-insured institution.

In New Zealand, Waikato District Health Board is recovering from a Conficker computer worm attack that disrupted services to the point that non-emergent patients were asked to stay away. I read somewhere that over seven million PCs are infected with it, meaning those computers will accept remote commands from hackers.

Also in New Zealand, the former health district CIO who was accused of taking $755K worth of kickbacks from a service provider pleads guilty. He had struck a deal to approve a help desk services contract for $95 per hour, of which he received $25. When they board found out, they simply hired the same three people who were already working the help desk, saving $500K per year.

This is juicy: federal prosecutors say former McKesson chair Charlie McCall should be jailed immediately because he violated terms of his 2003 release with his 2006 arrest for soliciting a prostitute. I have a couple of boffo lines, but I like to keep it family-friendly (but I bet you are thinking the exact same ones). He’s been out on $1 million bail since 2003 with a condition that he not commit any crimes. He’s already been found guilty of the $8.6 billion HBOC stock fraud and will be sentenced in March. The US attorney says Charlie needs locked up since he might skip town before then.

RIM just announced Q3 numbers: smoking BlackBerry sales pumped up revenue by 41% and moved earnings to $1.10 vs. $0.69, with most of the good numbers coming from consumers rather than business customers.

University of Alberta professors design software that helps senior citizens identify and organize their tablets and capsules (which are not the same as “pills” no matter what the article says), hoping to port it to a smartphones.

I usually read Bruce Friedman’s Lab Soft News, which has interesting conjecture about the Abbott acquisition of Starlims:

Putting all this all together, I think that it’s possible that Abbot has the following scenario in mind as a long-term goal: sell to clinical labs, as an integrated package, analytic instruments, reagents, and test result management supported by a cloud-based LIS/LIMS. Pricing would be on a per-click or taxi-meter basis. This would be the first PaaS offering for the clinical lab industry

David Whiles, IT director at Midland Memorial Hospital (TX), is recognized by the hospital district’s board of directors for its implementation of OpenVista. He expresses surprise: “It’s a hospital project, not an IT project.” Seems like they should give him a CIO title.

Dell says its acquisition of Perot Systems will allow it to expand its healthcare services, which one might hope given that it just paid $3.9 billion for the company.

Quantros announces creation of a healthcare IT consulting division to be led by Michael Tulloch.

Cerner will offer HealthDock from Certify Data Systems, which it says will help hospitals using its Cerner Hub connectivity services exchange data with any practice EMR system.

MDI Healthcare Solutions gets a mention in the Jacksonville, FL business paper. The company uses claims data to predict the future cost of caring for a given individual. The article’s timing isn’t so great since the company’s Web site is “undergoing renovations” at the moment, consisting of just a picture of what it might look like if it actually worked.

Former Senate Majority Leader Tom Daschle, whose tax woes killed his nomination as HHS secretary, is profiting from HITECH, according to a Huffington Post article. It says he set up a law firm division to cash in on stimulus money, implying that he’s had face-to-face meetings with David Blumenthal “in trying to position our clients for meaningful use.” He’s also on the advisory board of GE Healthcare’s “healthyimagination” project, joining Bill Frist, Newt Gingrich, and “former chiefs of Medicare and the Food and Drug Administration”, although the company implies it’s not paying them much (by their standards, anyway). From the law firm’s Web site: “Our life sciences team members include former U.S. Senate majority leaders Senator Bob Dole and Senator Tom Daschle, a former CMS administrator, a former associate FDA commissioner and a former associate chief counsel for Enforcement at FDA.”

Another hospital thanks their fairy godmother Congressman for EMR money instead of the taxpayers who have to pay it: Rome Memorial Hospital (NY), which will get $250K in Congressional pork funds (aka the $410 billion “Omnibus appropriations act”).

I could write a novel from this: an Indiana otolaryngologist whose sinus clinic was raking in $3 million a year, some of it apparently via insurance company fraud, disappears from vacation in Greece owing $5.7 million. Italian authorities arrest him in the tent he’s living in on a glacier at the foot of Mont Blanc, suspecting he’s fleeing to Switzerland after stops in Monaco, China, and France (and making America’s Most Wanted in the process). He smuggles a box cutter into jail in his rectum and slashes his throat in a suicide attempt, but ends up with only minor neck injuries despite his expertise as a throat surgeon.

E-mail me.

HERtalk by Inga

From Easy Money: “Re: Lourdes whistle-blower. The whistle-blower that alerted federal officials of the potential fraud activity at Our Lady of Lourdes Medical Center earned a nice $356,000 bonus. He was supposedly a ‘consultant’. Do you think the hospital paid him a consulting fee?” Easy Money is referring to the $8 million settlement between Lourdes and the Justice Department. The hospital was charged with fraudulently inflating charges to Medicare patients. I did a quick Google search of Anthony Kite and determined he must moonlight as a whistleblower, having been awarded several hundred thousand dollars in similar lawsuits over the last few years.

Here’s some good and bad news for HIEs. The good news is most physicians believe that HIEs would improve quality of care, reduce costs, and save time. However, don’t count on the doctors to help keep the lights on. This survey of 1,000 physicians didn’t find a single doctor willing to pay a proposed $150 a month fee to connect to an HIE. In fact, half of the doctors said access should be free.

Someone might want to share the news with Thomson Reuters, who just announced plans to launch a new HIE platform.

The CIO of the 300-physician Springfield Clinic (IL) claims their Allscripts EMR plus a patient kiosk system netted a $4.5 million ROI in the first year, thanks to staff reductions and reduced transcription costs.

Stratus Technologies announces its Zero Downtime $50K Guarantee. The company says the server line has surpassed 99.999% uptime reliability since introduced in 2001.

Congrats to Cumberland Consulting Group for its #10 ranking in Consulting Magazine’s Best Small Firms to Work For, 2009.

Special alert for all you road warriors: McDonald’s, in partnership with AT&T, will provide free Wi-Fi in over 11,000 restaurants by January. Personally, I’ll remain partial to Panera when it comes to eating and surfing. But, there are definitely more McDonald’s and they have the best fries.

QuadraMed announces GA of Quantim Workflow.

WellStar Health System (GA) selects Kronos to provide workforce management solutions to manage its 11,000 employees in five hospitals.

Every time I see the name Kronos, by the way, I think about Zeus’s father, who ate his children. The Greeks also had a Kronos, the father of time. I am pretty sure that the latter Kronos is the company’s namesake.

Baylor Health Care System (TX) signs a multi-year agreement to license TeleTracking patient flow solutions across 14 hospitals.

Picis says that 67 healthcare facilities have gone live on its LYNX E/Point solution over the last six months.

Healthland wins back a hospital client that left its fold several years ago. The 15-bed Webster County Memorial Hospital (WV) re-signs with Healthland for its patient accounting system, which they claim is its first step towards moving to an EMR system.

Vangent wins a $20 million contract with the DoD to implement a an integrated SSO and context management solution throughout the Military Health System.

Cincinnati Children’s Hospital Medical Center completes a self-service check-in pilot program and now plans to deploy D2’s My Patient Passport Express kiosk throughout its facilities.

Southcoast Health System (MA) selects Wolters Kluwer’s ProVation Orders Sets for its three hospitals.

St. Joseph Health System chooses Accenx to help integrate its hospitals with affiliated physicians.

A faculty physician at UC San Francisco falls for an e-mail phishing scam and ends up exposing personal information on about 600 patients. The doctor gave out his user name and password when replying to what he thought was an internal e-mail.

And in Detroit, health department officials say that clinical and demographic information on 10,000 patients has been compromised following two separate thefts. A flash drive containing patient data was stolen from an employee’s car in October and a desktop computer was taken from a health department facility over Thanksgiving.

Cape Cod Healthcare (MA) signs a seven-year agreement with Siemens to implement Soarian, including Clinicals and Financials. The hospital expects the project to be completed by mid-2011.

Former Ottawa Hospital chair Ray Hession takes over as chairman at the troubled eHealth Ontario.

I’m betting this Congressman gets re-elected. Madison Memorial Hospital (ID), having collaborated with Congressman Mike Simpson for three years, learns it is “likely” to receive a $350,000 EMR grant from the federal government.

Collaborate here.

News 12/16/09

From Edison Carter: “Re: another one bites the dust. Arizona Medical Information Exchange shuts down.” AMIE runs out of Medicaid Transformation Grant money and will set its sights on grabbing some ARRA cash by reinventing itself as a statewide HIE.

From Bob in Accounting: “Re: contest. If you can’t make people buy it, then give it away?” Inga mentioned this on HIStalk Practice: CDW and Cerner pair up to give one lucky (?) physician practice a Cerner EMR. The fine print is interesting: entrants must sign over the rights to use their image and biographies, agree to hold the sponsors harmless for everything in the world, and sign a liability release. Only Cerner would create a multi-page legal agreement requiring a team of lawyers to interpret just to enter a contest giving away an EMR that few want anyway. What are the odds that the winner’s implementation will never happen or will be so unimpressive that you’ll never hear anything more about them? My two-word analogy: free kittens.

From Bridget: “Re: Vigilance iPhone app. Is it FDA approved? It looks like a patient monitor to me. I looked at Acuitec’s Web site and couldn’t find any info on the FDA certification. As a clinical engineer, if it has waveforms and physiological info on it, it better be accurate, and as for alarms, you can’t call it an alarm unless it ‘alarms’ within 10 seconds of detection of physiological condition contributing to alarm status. Thanks for the excellent Web site — I work in the CE/IT interface arena.” Above is shot of Vigilance running on a different device, which I’m including because I think it’s cool. I e-mailed Acuitec and received a nice reply from Lionel Tehini, president and CEO:

Those products of ours for anesthesia charting that require FDA approval have this. In the case of Vigilance, it does not require FDA approval, provided the systems it is aggregating data from and the information being represented in the application have FDA approval. So for example displaying of the wave forms — if we render those ourselves, then it requires the FDA approval (and has it). If those use the rendering services of the vitals sign vendor (Philips, GE, etc.) then it does not, since those are already FDA approved. Yes, I know a complicated answer for such a simple question. But when it comes to the FDA, nothing is simple. My advice is always err on the side of caution and submit the for approval and let them make the judgment call.

From The PACS Designer: “Re: Windows 7 screens. InformationWeek has given use some useful information about what Windows 7 screens look like for us new users. TPD will be testing a Dell Wi-Fi netbook with Windows 7 Home Premium and will post a user perspective of the pluses and minuses for HIStalkers in the near future.”

From Lester Bangs: “Re: ARRA certification. Companies like this one (and they aren’t alone) get checked off on SOME of the ARRA criteria (which are changing) and get labeled as Pre-ARRA Certified by CCHIT. Amazing. And we wonder how folks are confused.” I found CCHIT’s disclaimer more interesting (click the above screen shot to enlarge) since it clarifies that the certification is preliminary, possibly irrelevant depending on the standards that are eventually approved, and possibly worthless since CCHIT may not even be a recognized certification body by them.

From Toadie: “Re: interviews. Some of the interviews read like a press release, while others are interesting. How do you choose who to interview?” Readers suggest some of the interviewees, PR firms sometimes e-mail to say they read HIStalk and can connect us to a CEO, and sometimes I just read about someone interesting and e-mail them. I get turned down sometimes (most recently by Atul Gawande, who was at least polite about it). Each interview is done by either Inga or me and we do our best to ask the right questions and steer the conversation away from self-promotion. It’s worked well, I think, since nearly every interview has redeeming aspects that makes it worth reading. No matter how an interview turns out, I’m always thankful that a busy person will take time to be interviewed by some idiot blogger who warns upfront that (a) the conversation will be published as transcribed; (b) I will not provide my questions beforehand for prep; and (c) I don’t allow proofing or changes afterward. What you read, good or bad, is a real conversation.

Now’s the time to add your event for free to the HIStalk Calendar (Webinars, conferences, etc.) I noticed that five items were listed for today alone, so everybody must be wrapping up before the holidays. Other housekeeping items: if you aren’t getting the e-mail blast when a new HIStalk article is posted, you really should take a few seconds to put your e-mail address in the Subscribe to Updates box to your upper right (you don’t want your competitors and co-workers to scoop you, after all). And, the best secret weapon there is for looking smart isn’t just Google, it’s the Google HIStalk search box to your right. Even industry noobs can sound like battle-weary HIT veterans when talking on the phone by quickly searching for HIStalk mentions of companies, products, and people, then uttering their newfound pearl at just the right moment to an unsuspecting colleague who doesn’t need to know that you used a lifeline.

KLAS announces the best healthcare IT software vendors, with Epic pulling even further away from the pack (I don’t have access to KLAS, so I’m going by the press release). I did learn from the announcement that Epic renamed some of its products, with its pharmacy system now called Willow and RIS renamed Radiant. Several sponsors of HIStalk and HIStalk Practice made the list: eClinical Works, Greenway, McKesson, Eclipsys, Wellsoft (coming soon), Nuance, CareTech Solutions, and Hayes Management Consulting, so congratulations to them.

Listening: The Oohlahs, reader-recommended, female-led punky pop. Reminds me a little of of Throwing Muses. I like it. Mrs. HIStalk is listening to (and watching) So You Think You Can Dance in the living room, which is obvious because I leap a foot out of my chair each time judge Mary Murphy elicits one of her incessant blood-curdling screams for no apparent reason.

My Health Direct, which sells a Web-based referral management system for EDs to send non-emergent patients to other providers, raises $4 million in Series A funding.

Regional Medical Center (SC) says they are happy with their $15 million Cerner go-live, despite significant clinical delays. “Patients have been quite patient,” a board member said without apparent irony.

Abbott Laboratories will acquire Starlims Technologies, an Israel-based lab systems company, for $123 million. It sells systems to hospitals, HMOs, reference labs, and pharma labs. All Web-based, zero client, and high tech, running the presentation code in a .NET control in the browser. Abbott mentions wanting to get into healthcare informatics, so perhaps this has more than the obvious significance.

Barnes-Jewish Hospital (MO) goes live with SIS surgical scheduling, charging, and the SIS Trax tissue management system BJH co-developed with SIS.

I’m on the EHR Scope e-mail list, so I see they’ve made some improvements to their site, fine-tuned their EMR matching system, and are now offering weekly Dragon Medical Webinars. Article submissions for the January issue are being accepted through December 30. I still think their EHRtv is brilliant and darned professional (check out the set in the interview with Evan Steele of SRS above).

The Senate’s health bill will likely not ban the use of prescription data for marketing purposes.

Pfizer’s sales reps will be required to use company-issued tablet PCs when requesting drug samples for doctors, choosing the doctor on the screen to then display a list of appropriate products for sampling. Pfizer has a mighty big meaningful use incentive: the company paid a $2.3 billion fine for illegally marketing its drugs to doctors, so Uncle Sam wants to keep an electronic eye on them.

Is it just me, or does this article about a Serbian EMR vendor have a distinctly AYBABTU quality? “Antamediamedical.com created an amazing software, which helps doctors in different ways. All the software are unique and has amazing results. Medical software is one of the most efficient and workable software, which has sorted a large number of tensions and problems of those people, who are working in medical centers and hospitals. With its installation, the doctors and other medical staff have taken a sigh of relief, for most of other issues have been resolved by it.”

Free (in some configurations) EMR vendor SynaMed announces its free HIPAA-compliant patient-doctor messaging application (the screenshot’s spelling of “Tylonal” suggests that a spell checker might prove useful). The app does look kind of cool, sort of an Instant Messenger tied into the application’s modules.

Hawaii Pacific Health launches its MyHealthAdvantage patient portal. Gee, I wonder who their unnamed vendor is?

The VA posts the raw data behind its 2008 Hospital Report Card on Data.gov, downloadable as .CSV files.

E-mail me.

HERtalk by Inga

From Professor Higgins: “Re: you must talk funny. I love that new iPhone Dragon app and have been astounded by its accuracy. The main limitation is that one needs a good, high speed connection for anything more than a sentence. But for a quick response while driving — perfect! Maybe your voice is just so charming it got distracted? Also, they explained on their app site that while they do collect names only from your contact list, it is to improve accuracy, so when I say ‘John Vinkelgardenhorse,’ they know what I mean!”

With the release of the KLAS end-of-year reports, it’s time to start the  annual discourse on whether or not the KLAS ratings are fair / objective / rigged / irrelevant, etc. I’m sure plenty of vendors lean on their happiest customers, asking them to (favorably) complete the KLAS surveys. Some likely extend honoraria for their clients’ time. That extra tweaking of the process may help move a vendor’s rankings a place or two, but, I think it’s safe to assume that if a vendor was not serving its client base, it would not have enough happy clients willing to provide a favorable report.

MED3OOO appoints Hillary Harlan, an attorney and RN, as its chief compliance and ethics officer.

PatientKeeper closes a $13 million round of funding comprised of equity and debt. The company says it will use the money to accelerate development of physician documentation and CPOE applications and extend its support operations. As part of the financing, Chip Hazard of Flybridge Capital Partners is joining PatientKeeper’s board of directors. Back in August 2008, I mentioned that PatientKeeper secured $7.5 million in Series F funding, which increased its total VC dollars to $75 million. Those funds were designated for R&D and to grow the company’s infrastructure.

3M Health Information Systems releases 3M Mobile Dictation software, a new option for its 3M Mobile Documentation System. The product is available Blackberry and Windows Mobile platforms and allows physicians to review patient detail on their smartphones.

Amcom Software also announces its new smartphone application, Amcom Mobile Connect. The app allows clinicians and staff to use a Blackberry device for messages and critical codes.

Halfpenny Technologies is also jumping on the smartphone bandwagon, introducing its ITF-Mobile application, which allows physicians to securely access test results.

Healthcare Information Xchange of New York selects InterSystems HealthShare software as its core HIE platform.

The Healthcare Authority for Baptist Health (AL) purchases McKesson Practice Complete to handle physician billing and claims management for its employed physicians. Physicians will also use the McKesson-hosted Horizon Practice Plus PM system.

Sounds like Ohio is seeing an economic turnaround, at least for healthcare workers. Cleveland Clinic says it’s planning to add 1,800 new jobs in 2010, a year after posting a $62 million loss. New positions include jobs for both staff and physicians. Meanwhile, University Hospitals (OH) plans to add 550 workers and MetroHealth (OH) has 270 full and part-time openings.

A new study concludes that EHRs often fail to achieve expected gains in healthcare efficiency. They often improve auditing and billing efficiencies, but decrease clinical efficiency.

ONC accelerates its timetable for rolling out health IT regional extension centers (HITRECs), planning to announce 30 grants on January 21 and another 40 or so in March. Sounds like a good move, given the amount of work that needs to be done in short order.

athenahealth names Dr. William Winkenwerder to its board of directors. He’s chairman of The Winkenwerder Company, a healthcare consulting company, and a former Assistant Secretary of Defense for Health Affairs.

The New York Post obtains 2008 tax records for several of the city’s biggest non-profit health systems and finds that at least a dozen CEOs received $1 million or more in compensation. Dr. Herbert Pardes of New York-Presbyterian took home a $1.67 million salary plus a $1 million bonus.

Anne Arundel Medical Center (MD) goes live on its $35 million Epic system, to which it gave the obligatory cute nickname (Alec), but at least based it on something more cerebral than a strained acronym (it means “protector of mankind” in several cultures, they claim). They even make pegged their super users as Smart Alecs, making the whole naming thing worth it.

Last year I wrote a little holiday poem for HIStalk, which I must say was very clever. I plan to update my prose this week and ask Mr. H to publish it a bit earlier, before the masses turn off their e-mail for the holidays. Stay tuned.

Holiday poems here.

Monday Morning Update 12/14/09

Indiana Regional Medical Center thanks Congressman Bill Shuster (R-PA) for getting it $350,000 in federal money to buy an EMR. Question: shouldn’t they be thanking the people like you and me who are actually paying for the porkfest? Given the federal spending spree, It’s not shocking any more that at least a half-dozen other hospitals were named in news stories this week for getting federal grant money for EMRs.

Proloquo2Go makes Apple’s list of the top iPhone apps for 2009, surprising many who didn’t expect to see a medical app on the list. The $189 software helps people with speech problems by converting text to speech.

Quotes from this week’s e-mail from Kaiser CEO George Halvorson (forwarded by a couple of insiders):

Putting medical information in the computer and then leaving it in electronic silos is just as non-functional as putting medical information on pieces of paper and leaving the pieces of paper in file drawer silos. Medical information needs to flow to the caregiver at the point of care. It needs to be available when the patient needs care … We looked to the other biggest and most successful electronic medical record system in the United States — the Veterans Administration (VA) — and we decided to see if we could figure out ways for patients from our system to visit their system — or patients from their system to visit our system — with the medical information following the patient electronically. Our information can follow our patients now, to some degree. KP patients can remotely access their own medical record.We also often give our patient copies of their medical records. Our patients who travel sometimes carry their medical record with them on a thumb drive. That particular experiment has been a success. So we have done some data transfers for some individual Kaiser Permanente patients. But that data did not flow directly to another caregiver, or to another care team. The goal of our VA project was to see if we could design a secure way to transfer that data purely electronically. We managed to do that.

Inga found this news story, which she calls “something Weird News Andy might like.” A man is arrested after speeding down a country road and running over two people, wearing only pajamas and flip flips. He bolts from police in the five degree weather, heading for his wife’s office. But what’s really bizarre is his lawyer’s defense: “caffeine-induced psychosis”. Next think you know, Folgers will be in a class action suit.

Listening: Biffy Clyro, Scottish rock.

Jobs: Account Executive/Sales Rep, Manager Clinical Application Services, EHR Project Manager, Soarian Clinicals Consultants.

Scumbag lawyers: Google QuadraMed and you’ll get three ads with the same headline, all trying to convince QDHC shareholders to jump on a class lawsuit claiming breach of fiduciary duties by QuadraMed management. Google the names of any of the three law firms and the phrase “breach of fiduciary duties” and you’ll get thousands of hits from their previous legal efforts.
 

From my last poll, it appears that enough new folks will go to HIMSS to offset those who are dropping out. If it’s a representative sample, you might therefore expect attendance to increase a little. New poll to your right: did EMR vendors and trade associations influence the Obama administration’s decision to spend billions on EMR usage?

A WSJ editorial called Health Care’s ‘Radical Improver’ covers athenahealth. One quote from the editor:

The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can’t link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks … Mr. Bush is less sanguine about the White House cost-control approach of better living through technocracy … he singles out the idea of dispensing bonus payments to hospitals that find ways to reduce Medicare spending. If the bonus is higher than what the hospital would have been paid under the status quo, then Medicare is worse off—but if the bonus is less than what the hospital would have earned otherwise, in what sense is it an incentive to change?

And a fun quote from Jonathan Bush:

It’s probably terrible that all this new bureaucracy is being created. But there’s going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them.

In Canada, Campbellford Memorial Hospital joins several others in abandoning an $80 million project to use a common hospital information system (Meditech). As is happening in the UK, nobody has the money to chase a grand interoperability plan at the moment. Another hospital in Canada just started its Meditech project last week. 

Ten EDs of Orlando Health and Florida Hospital will start sharing data in January in a Central Florida RHIO project.

UPMC’s health plan will offer the $690 Insight Brain Fitness Program software to its Medicare members at no cost.

University Medical Center (NV) notifies 71 trauma patients who were seen on Halloween and the day after that their personal information appears to have been sold to personal injury lawyers. They are now requiring employees to enter PINs on copy machines and may add electronic door controls.

Red Hat will host an online forum on cloud computing on February 10.

Congratulations to the hospital IT people named as Computerworld’s Premier 100 IT Leaders:

• Avery Cloud, SVP/CIO, New Hanover Regional Medical Center
• Philip Fasano, SVP/CIO, Kaiser Permanente
• Stanley Huff, CMIO, Intermountain Health Care
• Edward Marx, CIO, Texas Health Resources
• Bill McQuaid, CIO/AVP, Parkview Adventist Medical Center
• Susan Schade, VP/CIO, Brigham and Women’s Hospital

E-mail me.

News 12/11/09

From Mogall: “Re: Sentillion. Word on the street is $200 million for the purchase of Sentillion. It will be interesting to see if anyone hears the Sentillion name again.” If I were guessing, I’d say the name will fade away from widespread use since Microsoft likes its own brand, but the technology and the people will do fine under the Microsoft banner, perhaps jump-starting a concept in which Amalga UIS is the “control panel” that launches various applications and databases and tie them together with CCOW (sort of like making iGoogle or MSN your home page). It’s a good strategy — it’s time for the best-of-breed pendulum to swing back, and visual/virtual integration provides customers with a lot of options, including interoperability. Microsoft has been working with Sentillion since at least early summer, so that peek up their skirt must have stirred up some ideas.

Speaking of which, thanks to Peter Neupert and Rob Seliger for inviting me to chat with them about the acquisition the day before it was announced. A reader had tipped me off, so when Jenn from Sentillion e-mailed to see if I was available, I probably startled her a little by speculating that it must be Microsoft announcement time. I was surprised to see quite a few folks on and reading HIStalk on so early when I posted the article (since I was bound to an after-midnight embargo), so I jotted down some of their locations: UK, Ontario, India, Dubai, Austria, Sri Lanka, Australia, and what must have been a bunch of night shifters or insomniacs right here in the US.

From Fashionista: “Re: Dr. Halamka’s blog. If there was ever a day to read it, today is it. He itemizes each piece of the $1,500 outfit he wore to meetings today … serenity now.” He always says he rarely sleeps, but I think he might need a nap or a jet lag cure judging from his obsessive ensemble: a Gortex suit, a Kevlar shirt, and vegan boots (who knew?), all donned before riding a folding bike to work in sub-freezing Boston blizzard. Maybe the Kevlar is for protection the next time the BIDMC network goes down.

From Tim: “Re: Christmas ornament. Or is that YOUR name?” Inga and I use names sometimes. They aren’t necessarily the ones on our birth certificates, not that it matters.

From TV’s Frank: “Re: AHIP. Surely Karen Ignagni’s hugely oversized income has nothing to do with the health insurance industry and its cost to the system.” She’s the president and CEO of AHIP, a trade group and lobbying organization for insurance companies. According to a Modern Healthcare article, she was paid $1.9 million last year. AHIP lost  $4.6 million after spending $1 million on lobbyists, $2.5 million on lawyers, and $10 million on consultants. AHIP got snippy with a Mother Jones reporter a few weeks back when she asked the company what Ignagni’s coverage and copay is. I’m sure she’s like members of Congress — convinced she is qualified to decide what insurance dozens of millions of us can have, but secure in the knowledge that she’ll never have to stoop so low anyway (that’s Point #16 by Dan Fields – everybody in government should be required to use whatever health system they cobble together for the rest of us).

From Thomas Servo: “Re: Healthvision. A good source says Battery Ventures will close the sale of the company around New Year’s.” Unverified.

From RoadWarrior: “Re: Allina. Heard through the grapevine that they are out for RFP on a new LIS. Rumor is that ‘integration’ has been touted as a high priority, but McKesson and SCC have been engaged.” Unverified.

I mentioned that I like reader pictures related to HIT, so here are a couple from Joe of Clarian Arnett Hospital in Lafayette, IN.

Cerner wins its five-year-old patent dispute with Visicu (now Philips). I enlisted an attorney to give a legal overview of it way back in December 2004.

Keane will implement RCM for Atlantic General Hospital (MD).

Listening: The Volebeats, who must be really obscure since they’re barely on the Web at all. Sounding good, with finely crafted, brooding jangle indie pop like R.E.M. at their best. I’m also anxiously watching the mail for delivery of some DVDs that I didn’t know existed, but now crave: homebrew recordings of Mystery Science Theater 3000, one of my favorite TV shows ever.

Hayes Management Consulting has developed a hospital version of its RAC auditing tool called MDaudit Hospital. Webinar signup is here.

SCI Solutions announces that it signed 51 new contracts with 76 hospitals this year for its Order Facilitator, Schedule Maximizer, and Revenue Accelerator.

CCHIT announces three new board members and five new commissioners: On the board are Lori Evans (ActiveHealth), William Jesse (MGMA), and Stephen Klasko (University of South Florida). New commissioners are Patricia Becker (University HealthSystem Consortium), Barbara Byrne (Edward Hospital), Timothy Elwell (Misys Open Source Solutions), Jay Srini (UPMC), and Grace Terrell (Cornerstone Health Care). That’s a pretty strong lineup considering the heat that CCHIT has been taking. It must have been a quick turnaround for Bobbie Byrne since she just quit her CCHIT job this month, but is now a commissioner.

Vanderbilt joint venture partner Acuitec releases an iPhone version of its Vigilance messaging system for high-acuity providers.

John McInally, formerly of biotech company CollabRX, joins MetroHealth (OH), replacing the retired Vince Miller. He was also CIO of Lucile Packard Children’s Hospital at one time.

A Weird News Andy find, although not a happy one: a woman drinks herself into a stupor while celebrating her 20th birthday and is taken to the ED of Uniontown Hospital (PA). The doctor leaves her passed out on the floor with her legs tucked under her for 12 hours, she claims, with the lack of circulation eventually requiring her legs to be amputated at the knee. She’s suing the hospital and the doctor.

A reader in his early 20s asked me for some education and career advice, also suggesting that a good interview question would be to ask industry veterans what they would do if they were starting fresh in HIT. Feel free to comment or Readers Write me on his behalf.

Kansas, following the federal government’s lead of trying to buy its way out of a recession, throws more money at Cerner and Neal’s soccer team, freeing up an immediate $47 million in cash of its $230 million incentive to start construction on the $414 million project.

Maybe lawyers could be our main export, at least to Singapore. A woman who was overdosed on chemo by a hospital receives a cordial visit of apology from the country’s health minister. She said she was touched. Her husband is philosophical, telling the two pharmacists who made the error, “You will have much more to achieve. Do not allow a single mistake to be a permanent psychological barrier. Just focus on helping more patients and serving them well.” He also urged the hospital not to fire them. I can’t even imagine that here. The injuries from the lawyers trying to leap over each other to get to the bedside would be widespread.

The Georgia inspector general gets involved after Business Computer Applications of Atlanta wins a big contract to develop a prison EMR despite a bid that is double that of eClinicalWorks, the second-ranked vendor. Someone from the Atlanta company hinted to an evaluation team member that he might be hired if BCA got the bid. In fact, it played out exactly that way, with the employee going to work for the vendor less than a month after the company was chosen on the basis of subjective evaluation to which that employee contributed.

Interesting conjecture in Charlie McCall’s case: did his high-powered legal team intentionally allow an attorney to be seated on the jury, knowing they might be able to find something to challenge later just in case he lost? Charlie’s team is demanding a new trial, claiming the jury foreperson, an attorney, improperly defined a term for her fellow jurors. The judge doesn’t seem impressed. “Please, Mr. Wells, you knew when you left her on the jury she was a lawyer … This is such a mess you’re inviting.”

iSoft sells its first PACS system to a customer in Germany. The company also said it may hire up to 500 new employees in Australia. The managing director, in complaining that innovative businesses often are acquired or sold to an overseas company, also admitted that half of iSoft’s 4,700 employees are in India.

The FBI launches a privacy investigation at University Medical Center (NV) after a Las Vegas Sun investigative reporter’s source produces copies of patient face sheets, saying they are regularly being sold to ambulance-chasing lawyers.

ONCHIT chooses members of the Health IT Policy Committee’s privacy and security workgroup.

CMA Consulting Services fires its CEO and former New York state Senate Majority Leader Joseph L. Bruno within hours of his conviction on two felony fraud counts. Competing bidders Thomson Reuters and Ingenix protested, the newspaper article says, when CMA was awarded a $159 million contract to build a Medicaid data warehouse despite his indictment earlier this year.

E-mail me.

HERtalk by Inga

The VA awards QuadraMed a $24 million contract for its Encoder Product Suite and training services.

MedAssets confirms its 2009 forecast, predicting revenues of $341 to $345 million. The company also forecasts 2010 revenues of $390 to $400 million.

The Georgia Department of Community Health will use recently awarded grant money to create a State Medicaid Health Information Plan, designed to manage incentive programs for EMR adoption. The $3.2 million in federal funds will promote the state’s to give all Medicaid providers access to an EMR and the ability to participate in health information exchange.

Community Memorial Health Systems (CA) selects Allscripts’ EHR, PM, and RCM products. Community Memorial Health System will host applications for 70 contracted physicians and a pilot group of 12 community physicians. The health system will also use technology from dbMotion to allow physicians access to a virtual patient record that includes aggregated clinical information from all the heath system’s computers.

Speaking of dbMotion, the company was chosen to provide an interoperable EHR for the Canadian province of Manitoba. IBM Canada is also participating in the project.

St. Vincent’s Medical Center (CT) picks Streamline Health’s Contractor Management Solution for workflow management to ensure OSHA compliance. Streamline Health released its third quarter numbers this week: a net loss of $296,000, compared to net income of $15,000 a year ago. Total revenues were $4.1 million, down from $4.4 million.

Streamline Health also negotiated a 45% tax credit from the state of Ohio, valued at about $214,000. The credit will help the company undertake a $2.75 million expansion project expected to create 25 jobs.

A UK study concludes that one in 10 handwritten hospital prescriptions contains a mistake. Poor handwriting, transcribing errors, and ambiguous prescriptions create most of the problems. Most mistakes are minor and few lead to serious patient harm. Not sure if that last part is suppose to make us all feel better.

Hospitalist management company PrimeDoc Management Services signs a three-year contract renewal with Ingenious Medical to provide automated charge capture, practice management, and reporting.

Nuance introduces a Dragon Dictation app for the iPhone that help users create e-mail, text messages, and notes. Despite the warnings that it downloads and stores all your contact, I added it to my phone. While it’s cool, so far it’s been less than 50% accurate for me. Does it mean I talk funny?

Deck Inga’s e-mail.

Microsoft to Acquire Sentillion

Microsoft will announce later today that it will acquire Sentillion, Inc. of Andover, MA. Terms of the acquisition were not announced. The transaction is expected to close in early 2010.

Privately held Sentillion, founded in 1998, sells patented solutions for single sign-on, context management, and identity management. It has over 1,000 hospital customers and over 500,000 users. It was named by KLAS as the #1 healthcare SSO vendor in its December 2008 report.

I interviewed Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group, and Robert Seliger, CEO and co-founder of Sentillion, about the acquisition on Wednesday.

Neupert says clinician users of Microsoft’s Amalga Unified Intelligence System, live in 115 hospitals, will benefit from Sentillion’s SSO and context management technologies. “Our goal is not to be an EMR,” Neupert said. “When we provide data and they want to take action on it, we want to make it easy for them.”

The companies signed an agreement this past June to incorporate Sentillion’s SSO and context management in Amalga UIS. The announcement quoted a Microsoft spokesperson as saying, “… for clinicians and others to readily adopt and get the maximum value out of a new platform like Amalga UIS, it needs to become an inherent part of the clinical workflows that drive the patient care delivery process. Our collaboration with Sentillion is designed to achieve that level of integration.”

I asked Neupert why Microsoft wants to acquire Sentillion rather than just continue the licensing arrangement. He said Microsoft can use Sentillion’s domain expertise in context sharing to create more solutions, particularly those that allow customers to continue with their best-of-breed strategies. “We want people to understand that best-of-breed is a reasonable path for them to pursue,” Neupert said.

“Our goal is not to just sell Microsoft products,” he said. “Our goal is to help create new innovation in the health ecosystem. What we are trying to enable is workflows that cross organizational boundaries.”

I asked him if there are important aspects of the announcement that might go unnoticed. “This shows that Microsoft is continuing to invest, the Health Solutions Group in particular, to make health an important vertical inside the company, making a series of thoughtful steps in acquiring domain knowledge and technology and people to make that investment practical,” Neupert replied.

I asked Seliger why he’s selling Sentillion now. “We are a healthy company, profitable, and growing … the next step is a perfect outcome. You take our business legacy and commitments to customers and preserve that, but also take it to new levels, new countries, new venues that we wouldn’t get to as quickly on our own … To build an entire organization with P&L behind it that says Microsoft is unprecedented. It’s a fabulous home for Sentillion.”

Seliger says the Sentillion management team will stay on. The company will be operated as a wholly owned Microsoft subsidiary from its Andover office, with Seliger reporting to Neupert.

News 12/9/09

From The PACS Designer: “Re: Google Chromium OS. Courtesy of InformationWeek, we can get an idea of what Google’s Chromium OS is all about, even though it won’t be released for another year.”

From Joe Bologna Sandwich: “Re: [health system name omitted]. I heard second hand that they will cancel their contract with [vendor name omitted] in January.” I’ve e-mailed the CIO. Sorry for the redacting, but this is a publicly traded vendor and a humongous contract, so I’d like to confirm the rumor if possible.

From Nancy: “Re: Bobbie Byrne. The pediatrician, Eclipsys alum, and former clinical director of CCHIT is leaving CCHIT to become CIO of a hospital.” According to her LinkedIn page, she is now VP of informatics at Edward Hospital (IL), having left CCHIT sometime this month after only seven months or so.

From Cracker: “Re: Spheris. Warburg Pincus is looking to unload its albatross Spheris stake to CBay Systems, the largest medical transcription company in the US since their purchase of MedQuist in 2008. Spheris, second largest, recently ended a three-year run as a quasi-public company — public debt, not public stock. Uncompetitive technology and a heavy debt load handicap Spheris as medical transcription prices fall.” Unverified. Spheris doesn’t file SEC reports any more, but management had said margins and revenue were down. I also noticed that Spheris is no longer listed on the portfolio page of Warburg Pincus even though it’s still showing in the Google cache of the page, so I’d say something is up.

From Anonymous Coward: “Re: NHS cutting back on IT project. Enjoy your writings a lot. I work for one of the Big Vendors that I wish you talked about more — we are doing some good stuff (finally….).” Budget deficits take their toll in Britain, with a proposed large scale-back or maybe outright scrapping of the $20 billion and overdue NPfIT project. The arguments are the same as here: do those big systems really pay their way in terms of outcomes or cost reductions? The Conservative Party has proposed moratorium on all government computer projects, claiming the Labour government has spent $162 billion on IT in the past 12 years and another $115 billion will come due in the next two years. Lots of interesting comments on NPfIT are here.

Thanks to our HIMSS contact for chasing down our inquiry (on behalf of a reader’s question) about how government employees are compensated for speaking at the annual conference.She says HIMSS works within federal guidelines and does not offer honoraria or expense reimbursement to government employees (as I assumed). David Blumenthal asked for nothing and was offered nothing.

I like the move by Francisco Partners to buy QuadraMed. QuadraMed has had more than its share of struggles, all of them conducted in the spotlight since it was a publicly traded company (albeit with little benefit since market cap was low and share price stagnant). It had some old preferred shares that were so favorable that those shareholders were getting much of the cash. It has good products (HIM, Affinity, and QCPR) that ought to be selling well, especially if the QCPR migration to Cache’ is indeed complete. Francisco Partners has been a good steward of the companies it has bought, getting their houses in order, distancing them from previous baggage, and clarifying their identities and strategies. I think it’s the best possible outcome for customers and employees. A reader tipped me off with perfect accuracy last night, so I watched the news ticker this morning to jump on the announcement as soon as it went out.

The Chicago inspector general will review the 13 bids the health department received for a mental health system, determining whether anything suspicious was involved in choosing Cerner over 13 other bidders. The system had disastrous financial repercussions, it’s claimed, when billing problems prevented collection of money from the state for services rendered.

I was a bit loosey-goosey in my description of the products of new sponsor BridgeHead Software, so their VP contact provided clarification. Just so I don’t do it again, here’s the verbatim quote, better than I could have done anyway:

BridgeHead provides healthcare data management solutions that combine backup and archive into a single platform that it easy for IT to manage.  While you mentioned it’s cool that we can “do business intelligence on a backup”, it’s actually the archive that provides that value. Our archive is able to capture data from a variety of sources (including DICOM data from various PACS), transform that data (dedupe, compress, encrypt, containerize), index the content and make it all searchable. This truly enables the EHR by providing a foundation for managing all the data sources that comprise the electronic health record, regardless of whether that data is actually “owned” by your primary EHR application. Backup complements the solution by providing point-in-time recoverability, and this is just one aspect of our larger disaster recovery/business continuance functionality.

The HIT Policy Committee’s NHIN Workgroup will meet next Wednesday. On the agenda: a review of objectives and NHIN Meaningful Use. The Webcast runs from 10 a.m. to 1 p.m. Eastern.

Wirral University Teaching Hospitals is the first UK client to go live on Cerner PowerTrials, which connects physicians and researchers to support clinical trial participation by patients.

Lancaster General Hospital (PA) releases data about its use of auto-programmed smart IV pumps, linking them to the Cerner Bridge Medical eMAR/bedside barcode checking system. Their results: nurse IV pump programming time was reduced by 25%, infusion pump programming steps were cut from 17 to seven, and reprogramming was cut by 90%.

In New Zealand, Auckland Hospital’s clinical systems go down hard for four hours when a UPS circuit board fries. Related: the health board spends $1 million for software to track requests for follow-up X-rays after doctors missed a request; 10 patients were overdosed on meds because the automated dispensing cabinets don’t check doses; patient systems at another hospital failed when a roof leak dripped water into a computer; and information entered on the wrong patient caused another patient to be given an unnecessary colonoscopy. For IT noobs, I know this is a splash of cold reality, like that first time you saw your objet d’amour in the dawn’s early without benefit of makeup.

Steve Stanic, formerly the National Director of the McKesson solution center for Perot Systems and CIO of Memorial Savannah, is named CIO of Mississippi Baptist Health System.

Charlie McCall’s lawyers want a new trial after finding out that the jury foreperson, a Stanford Law graduate, gave fellow jury members a definition of “reckless disregard”.

Dennis Quaid, livin’ large on the healthcare conference circuit, announces at his keynote at the ASHP Midyear the National Alert Network for Serious Medication Errors. What caught my eye, however, was the picture below Dennis’s of three hot blondes with violins, apparently holding as much pharmaceutical expertise as Dennis, pre-keynoting fresh from America’s Got Talent … ladies and gentlemen, blond Polish triplets with graduate degrees in fiddlin’!

Someone wanted to hear ideas that would save healthcare $1 billion a year, so here’s mine: stop paying healthcare people to screw around at conferences. If the knowledge is all that important, someone will cover it in a Webinar or journal article (or let everybody pay their own way to go to conferences like I do). I’m pretty sure the salaries, travel costs, and registrations add up to way more than a billion since it seems like half the hospital is junketing somewhere at any given moment and nothing useful ever seems to come of it except the attendees brag to everyone let behind at how enriched their professional lives are since having dinner at Bouchon or cutting up after too many flirtinis at the Donnie & Marie show. Patients, check your drug doses extra carefully this week.

Australia’s industry groups agree on certification criteria for medical software. The National E-Health Transition Authority also announced that the SNOMED CT-AU terminology database is available to Australian license holders (note to vigilant seekers of SNOMED misspelling sightings – Computerworld spelled it SNOWED).

CareFusion announces new Pyxis products at ASHP: drug-lab alerts on MedStation, a PDA-based pre-selection tool for nurses, a maintenance console for all MedStation and SupplyStation systems, and a new version of CII Safe.

E-mail me.

HERtalk by Inga

From Sandy Claws: “Re: Pam Pure. Do you know where she is and what she is doing? I would look and see if she is doing any work with Francisco Partners or Blueline Partners. My guess she is at least consulting with one of them.” Interesting question, especially in light of the QuadraMed/Francisco deal and the recent hire of two former McKesson bigwigs. Blueline owned, at least at one time, a large number of shares of QuadraMed.

Medicity announces the opening of its platform to third-party application development. Partners developing to Medicity’s iNexx API can leverage Medicity’s customer base of 700 hospitals, 25,000 physician practices, and 250,000 providers.

At its Executive Summit in Las Vegas, Allcripts announces its Professional EHR 9.0 release, as well as Allscripts Remote for BlackBerrys. The 9.0 release includes an enhanced user-interface and expanded disease management capabilities.

CliniComp names Phillip LaJoie, the former CIO of the Naval Medical Center and CTO of the Military Health System’s infrastructure arm, as VP of deployment.

On my Christmas list: smart slippers, like these designed by AT&T scientists that include electronic insoles with four pressure sensors and an accelerometer to measure how well you are walking. I’m not sure exactly what I’d do with them. Perhaps make my departing party guests try them in order to evaluate if they are walking well enough to drive home. AT&T is making major investments in telehealth products. Seems they want to establish a “foothold” in the growing telehealth industry.

Moses Cone Health System (NC) selects Streamline Health Solutions’ enterprise document workflow solution.

Gannett Health Services at Cornell University is now live on Point and Click EHR, which is designed for college health. A staff member calls the transition “incredibly challenging, but invigorating.”

St. Vincent’s Hospital Manhattan lays off 180 of its 3,800 employees to cut costs. The hospital cites “severe financial shortfalls” as a result of the recession and funding cuts. Those affected include managerial and patient care positions. Condolences. There’s never a great time to be laid off, but I’m sure this doesn’t make for a merry holiday season.

Duke University approves a new one-year Masters of Management in Clinical Informatics degree program to be offered by the Fuqua School of Business and the Duke Center for Health Informatics.

The personalized medical care segment of the personalized health and wellness market market could grow to $100 billion by 2015, assuming telehealth takes off. This segment includes telemedicine, HIT, and disease management services offered by traditional health and wellness companies.

No sooner than Charles McCall gets his due then another story of greed in healthcare emerges. The latest scandal comes courtesy of Canopy Financial and co-founder Jeremy Blackburn. Canopy filed for bankruptcy protection after the FBI began looking into alleged fraudulent financial statements that were created as part of a $75 million investment scheme. Blackburn has since resigned as president and his assets have been frozen. KPMG discovered the potential fraud after learning that Canopy was presenting financial reports to prospective investors that were supposedly audited by KPMG. In fact, KPMG had never been retained by Canopy to audit its financials.

If you work in the patient safety, quality of care, or regulatory compliance fields, check out a new social Web site just for you and your peers. Quantros launched the new site called Clinical Cafe.

Two health systems are among five recipients of the 2009 Malcolm Baldrige National Quality Award. AtlantiCare (NJ) and Healthland Health (MO) were both winners in the healthcare category.

The California Nurses Association, the MA Nurses Association, and some members of the United American Nurses combine to form National Nurses United. The new entity represents over 100,000 nurses.

Actuaries calculate that West Virginia could save over $1.1 billion by going digital and centralizing patient care. Savings would be seen by the government as well as private insurers and policy holders. The low-hanging fruit includes e-prescribing (estimated savings of $164 million), EMR ($317 million savings), and the creation of medical homes.

Thanks for the very sweet reader who sent Mr. H and me our own personalized Christmas ornament. I’m glad Mrs. H never reads HIStalk, just in case she happens to be the jealous type.

First, Congress considered taxing cosmetic surgeries. Now they are looking at tanning services. Seriously, what do those folks in Washington have against a little beauty enhancement? Will makeup be next? Or, heaven forbid(!), pumps?

E-mail Inga.

QuadraMed To Be Acquired by Francisco Partners

QuadraMed announced this morning that it has agreed to be acquired by Francisco Partners, a private equity firm, in an all-cash deal valued at $126 million. Shareholder approval is expected in the first quarter of 2010.

”Francisco Partners brings to QuadraMed extensive resources, expertise and a proven track record of helping healthcare technology companies sharpen their strategy and operational execution. Operating as a private company will also allow us to place more emphasis on generating long-term value for our clients with less distraction on short-term results for the public markets,” said Duncan James, QuadraMed president and CEO.

Francisco Partners partner Ezra Perlman was quoted as saying, “We are excited to become part of QuadraMed’s future success with this acquisition. We understand the critical role technology plays to drive quality care and to make healthcare more efficient. QuadraMed has a quality set of products, an extensive customer base, and a solid market position. We look forward to supporting Duncan and the Company’s management team as we go forward together to create long-term value for the Company’s customers, employees, and stakeholders.”

Other healthcare IT investments of Francisco Partners include API Healthcare, AdvancedMD, and Healthland.

The $8.50 acquisition price represents a 32% premium to yesterday’s $6.41 market close price of common shares.

Monday Morning Update 12/7/09

From Interesting: “Re: Courtyard Group. Encore Health Resources (Dana Sellers and Ivo Nelson’s latest company) is in detailed talks and due diligence to merge with or acquire Courtyard Group. Courtyard Group recently had a large layoff because of decreased sales due to the ‘trouble’ they got into in Canada.” All unverified. I e-mailed Ivo, but haven’t heard back.

From Scritti Politti: “Re: Cerner in the UK. The editor of E-Health Insider likes their recent go-lives and UPMC’s involvement.” It’s hard to tell whether early problems really were Millennium or the terms under which NHS decided to implement it. As in Australia, a lot of the issues seemed to be related to localization, local support, and how the government wrote the contract and the implementation plan. I’m thinking it’s the Gartner Hype Cycle – NHS promised a lot, struggled early, and looked like a disaster, but the individual trusts doing their own thing with either Cerner or iSoft seem to slowly be coming up the curve and making good progress. Big government IT projects (including here) usually flop, which is why the VA’s VistA is even more remarkable (although the fat cat contractors weren’t involved early enough to mess it up – that came later).

From Todd Johnson: “Re: Stephen Hau interview and Shareable Ink. Stephen is absolutely correct. 100% physician adoption is the keystone to successful implementations, and you can only achieve that by enabling the physician’s natural workflow. Since the next wave on the path to Stage 6 EMR adoption is electronic physician documentation, vendors are turning their attentions toward how to efficiently capture notes. In my view, there are three critical success factors. (1) Systems must provide the speed of dictation or paper with the value of exchanging and analyzing structured information. (2) Physicians must have the freedom and flexibility to enter information in a way that is convenient for them as individuals. In the ED, a tablet PC might be most effective, while in a surgical setting, dictation is more logical.  Residents, the next generation, demand typing. (3) Revenue capture must be a byproduct to provide strong financial incentive for both the hospital and physician practice. Ultimately, you risk achieving 100% physician adoption if any one of these areas fail.” Todd is the president and co-founder of Salar, Inc.

From Former Bruin: “Re: UCLA Medical Center. Please confirm the rumor that UCLA Medical Center is looking to replace ClinicComp Essentris. I heard they are going through a selection process.” I e-mailed CIO Virginia McFerran, but she hasn’t responded. I’ll let you know if she does.

From Timber Roller: “Re: Epic. Are they changing their technology? They have a job posted for server systems that asks for experience with Linux, Oracle, or Microsoft SQL.” I hadn’t heard that, although maybe that’s for MyChart or portal stuff. It doesn’t sound specific enough to make me think they are abandoning Cache and MUMPS, but I’ll allow others to chime in.

From Maxwell Hammer: “Re: TIPAAA conference. I read this review of the lead speaker. That last line got to me.” Here’s the quote, source unknown and excerpted somewhat:

I was most troubled by the first part of the TIPAAA conference, which was a presentation by a VP from [vendor name omitted]. His job right now is to meet with hospitals, IPAs, HMOs, etc. … His basic pitch is that the money is there and you should help your physicians take advantage of it. The easiest way to do this is to buy them an EHR (using the Stark Law exemption), and then have them sign their ARRA money over to the hospital …Whenever someone questioned any of ideas, he would respond that they were just afraid of using an EHR and that they needed to embrace the changes and move forward … What drove me crazy was that the veneer was rather thin and that the entire pitch was about money; not about health care, improving quality, or doing a better job.

From Bernie Tupperman: “Re: Kaiser. This week’s e-mail from CEO George Halvorson outlines making chlamydia detection a priority.” Here’s an e-mail snip. I’ll say this — he’s the best, most easily understood writer/teacher I’ve seen in a CEO chair (I joked with Bernie once that surely the marketing people ghost-write his stuff and he says George really writes like this).

Early detection requires a care system that cares enough about women patients to make chlamydia testing and detection both a priority and an active agenda. That would be us … We know how well we are doing relative to the rest of America. We have the best scores … Our electronic medical record gives us an incredibly useful tool so we know who has and who has not had their tests. Combining our commitment to helping women detect and cure the disease with our systematic support of women’s care put us in a position where we do a better job then almost anyone on chlamydia detection … Smart people need to do smart things in a consistent way to get our care teams to those levels of success. Congratulations to our caregivers who care enough to make a difference in so many women’s lives.

You may have noticed a theme that several of the people we contacted to confirm rumors this time around didn’t respond. That happens pretty often, so even when we don’t mention that we tried and failed, it happens. Inga is good at chasing down stories, but sometimes our contacts are out of the office or don’t get back to us. As an example, she e-mailed someone at HIMSS to ask about expense reimbursement and/or honoraria for annual conference keynote speakers (since a reader wanted to know whether David Blumenthal’s expenses will be paid by taxpayers or HIMSS) but hasn’t heard back yet.

IT has improved patient safety nationally, 61% of reader respondents said. New poll to your right: what are your plans for the HIMSS annual conference in March?

Students in a University of Saskatchewan iPhone developer program design a physician diagnosis reference, although they are hamstrung a bit because of copyright issues with the AMA data that powers it.

Listening: the Hairspray soundtrack. I might be the only straight guy who likes the remake, singing along badly to Good Morning, Baltimore and I Can Hear the Bells. I’m also desk-drumming to Southern Culture on the Skids, reader-recommended surfabilly from Chapel Hill, NC, and more to my usual tastes, Brit rockers Travis.

Quantros and Allscripts integrate their respective products to create a Web-based care management solution.

An interesting problem: if 40 million people suddenly get health insurance, rural areas don’t have nearly enough primary care doctors to see them. The reason is obvious: the doctors go into specialties and geographic areas where the pay is better.

The economic planning committee of Taiwan, whose EMR usage is at 95% in hospitals and 56% in clinics, says it hopes to hit 100% within five years.

ONCHIT reorganizes, with five offices reporting to David Blumenthal: Economic Modeling and Analysis, Chief Scientist, Deputy National Coordinator for Programs and Policy, Deputy National Coordinator for Operations, and Chief Privacy Officer. The CPO will be appointed by HHS Secretary  Sebelius. 

Welcome and thanks to Philips, a new HIStalk Gold Sponsor. Talk to them about their fee-per-study iSite PACS replacement program, which lets you affordably move off your outdated, clunker PACS to a shiny new one. You can also check out what’s new, fresh off their RSNA announcements. Thanks to Philips for helping power HIStalk.

Michael Simpson’s deal as SVP of QuadraMed: $330K base, up to 50% bonus, 90,000 stock options, $50K relocation, expense account, $3,000 per month temporary housing, guaranteed 12 months’ severance plus regular bonus unless terminated for cause, and a year’s health coverage.

Shares in athenahealth hit a two-year high Friday afternoon after the company stated expectations of annual revenue growth (30%) and profits (40%) through 2014.

Bizarre: a UK student, unable to contact a female acquaintance on whom he has a crush, leaps to the conclusion that she has died. He buys an axe, breaks into the morgue of the local hospital, and spends 90 minutes inspecting documents, computer records, and bodies, all on Valentine’s Day this year. The judge orders him to get medical help.

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News 12/4/09

From Not Yet: “Re: contract gag clauses. Showcase Cerner site Homerton University Hospital NHS Foundation Trust rejects FOI requests.” The hospital declines to provide information to a journalist, claiming that “our contract with Cerner includes a confidentiality clause and as such disclosure of the information could give rise to an actionable breach of confidence.” Cerner wouldn’t sue if the hospital wanted to gush superlatives, so I’d guess that’s not what the records show.

From HITGradStudent: “Re: Health IT Facts. Is it any surprise that someone has hopped on the Chuck Norris bandwagon with HIT? Both a blog and a Twitter feed. Could use some HIStalk-style snark, though.” I’ll give it credit for being terse. The most recent post is pretty funny: “There is no we in Health IT. There is an I.”

National eHealth Collaborative (aka “AHIC Successor”, which advises HHS) is accepting nominations for its four board vacancies.

HHS will issue $235 million worth of HIT grants in early 2010 through the Beacon Community Program, which David Blumenthal calls a “proving ground for meaningful use of EHRs and health information exchange.” It seems like the decision has already been made to dump billions of taxpayer dollars at the feet of EMR vendors regardless of past history, so it’s a bit late to figure out how to make them work by plowing more money into areas with high EMR use. That’s just my opinion as one of a tiny minority of taxpayers who don’t believe that wild government overspending is the right way to encourage a “healthy” economy (since we’ve been doing that for years and it failed). Do you get the feeling that HHS and the rest of the ‘crats just can’t shovel the money out the door fast enough to keep the economic bear dancing? Anyway, you can leave a comment on DB’s blog if you like.

William Young, formerly CIO at Ellis Hospital (NY), is named CIO at Berkshire Health Systems (MA).

Patient Privacy Rights publishes its PHR Report Card. It’s not obvious, but if you click the vendor name on that page, there’s a lot of detail behind each. No More Clipboard gets an A, while everybody else sucks.

HIStalk readership always slows down in November and December since people are off for the holidays, but this past month was good: 70,680 visits and 93,300 page views, up 28.5% compared to last November.

A reader said to check this page for Siemens jobs since they aren’t listed on the Siemens site. He got a response from a Siemens recruiter from applying there.

Ireland stops its test of cell phone-blocking technology to prevent the smuggling of contraband into its prisons. The technology worked too well, knocking out cell phones at the hospital across the street.

Please join me in welcoming BridgeHead Software to HIStalk as a new Platinum Sponsor. Their tagline is “Enabling the EHR” and they offer enterprise data backup solutions used by over 450 customers. It provides a fully indexed, searchable information store (pretty darned cool that you can do business intelligence on a backup). They also offer a vendor-neutral PACS archiving solution, which could be crucial if all the folks in that recent survey really will be replacing their PACS and will need to migrate images. If you’re a Meditech user, their BH FileStore for scanning and archiving might catch your eye. White papers are here. Many thanks to BridgeHead Software for supporting HIStalk.

CHIME and AHA give their Transformational Leadership Award to BayCare Health System (FL) and CIO Lindsey Jarrell for their Cerner implementation.

A nice sale for Medsphere: 222-bed Kern Medical Center (CA) will implement OpenVista.

Carolinas HealthCare System chooses Omnicell’s automated dispensing cabinets.

Someone must be reading HIStalk for the Kindle. I got paid $12.30 for five months’ of subscription sales. I’m pretty sure the groupies will be along any day now.

New Hanover Regional Medical Center (NC) CIO Avery Cloud gets a nice picture in a local newspaper’s article about the group exercise program of the hospital’s senior management team.

Strong Hospital (NY) announces its EMR project, with HITECH covering $8 million of its $49 million cost. You will never guess what they bought — Epic! (irony intended — sometimes it seems a though Epic is getting every sale in hospitals of over 400 beds).

Sheikh Khalifa Medical City (United Arab Emirates) is starting the second phase of its Cerner implementation. ADT, HIM, pharmacy, and radiology are live, with CPOE, clindoc, lab, surgery, and ED coming up next.

What a brilliant video by Providence St. Vincent Medical Center (OR) — the Pink Glove Dance for Breast Cancer Awareness. Nurses, techs, doctors — everybody got in there and did a phenomenal job. Did I say it’s brilliant? I’m a crass cynic, but I admit I misted up a little. Everything I love about working in hospitals is right there. It’s not just me — it has nearly 3 million YouTube views and nearly 5,000 comments. A portion of the sales of the Medline gloves that are pictured will go toward providing mammograms for uninsured women. Thanks to Ann Farrell for sending the link.

Sounds like a pretty good job: Allscripts is looking for a Director, Education Development and Technology in Raleigh.

Speaking of jobs: Lead Business Intelligence Developer, Electronic Health Record Project Manager, Epic Project Managers.

A reader sent over a link to a treasure trove of online SMS memorabilia. Yes, industry sprouts, there was HIT before Epic and Cerner.

UAB says it has saved 93,000 nursing hours by using Cerner’s CareAware medical device bus to connect devices to the EMR. Retroactive vital signs charting time was reduced by 97% and patient-to-device association logging time was cut by 89%.

A Toronto doctor and professor creates a physician shift calendar application, allowing docs to trade off coverage with “the eBay of physician scheduling.” DocRoster is used by 2,000 physicians and Rosterware just got new capital sources and a board of advisors.

Driscoll Children’s (TX) chooses the CAREt System bedside medication administration system from PatientSafe Solutions. Never heard of it, but I think it’s some kind of successor to IntelliDOT. The CEO was chairman and CEO of Bridge Medical and founded Caremark before hooking up with this company in April. 

Massachusetts HIT companies are hiring in anticipation of ARRA: InterSystems (200 employees), Sentillion (25-30), and Picis (80 this year).

The head of GE Healthcare’s imaging division says the US market has bottomed out and he expects 2010 to be flat at worst.

Siemens, on the other hand, just reported a Q4 loss and says 2010 will be “challenging”. But, that’s for the whole German conglomerate, not just healthcare.

In Australia, iSoft acquires Patient Safety International, which sells an adverse event management system for hospitals.

Strange: Health Sciences, which publishes a health and wellness magazine, retires 2 billion shares of stock (current price: $0.0010, or a tenth of a penny). It’s latest health endeavor: growing marijuana for California’s phony medical use dispensaries, choosing as its research partner Greenway University, “formed to provide the highest quality training and education for the  medical marijuana/ cannabis industry.”

The good news for the hospital in which a patient’s watch was stolen while he sat unattended in the empty ED waiting room: video suggests that he had been dead 39 minutes before he was robbed. The bad news: ED staff didn’t notice he was dead until 50 minutes after that. It was the hospital’s second ED waiting room death, the first being a 33-year-old woman who died without being seen two years ago.

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HERtalk by Inga

From George Emerson” “Re: Meditech building. Here’s a picture of the view from the inside (taken during construction). Not bad, huh?” I’ll say. The view has got to be one heck of recruiting tool.

From Jimmy Chew: “Re: female healthcare bloggers. You should have been on this list!” Thank you Jimmy (and of course my mom) for suggesting I should have made the “Five Fierce Female Healthcare Bloggers to Watch” list. I was disappointed that Barbara Duck of The Medical Quack wasn’t named because I like her stuff. In any case, as long as I remain Mr. H’s favorite blogger, then life is good.

Butler Health System (PA) picks the PatientKeeper Platform and Physician Portal to improve physician documentation and workflow.

Washington Radiology Associates (VA) selects AMICAS PACS. The 26-physician group already uses several AMICAS products, including RIS and Financials.

TelaDoc Medical Services, a provider of telehealth medical consults, secures $9 million in funding to expand its operations.

The folks at Intellect Resources sent us this link to their new IRBeat podcast, a 40-minute overview of the HITECH act. For someone needing to learn the basics — particularly if you are involved in the ambulatory world — the content is very good: logically discussed, knowledgeable speakers, and good questions (“Eileen” is the moderator and she has an Irish accent, which of course makes the whole thing sound classier).

CIOs are concerned about their ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines. That’s the conclusion from CHIME, following a recent survey of its members. Two-thirds of the 176 CIOs participating in the survey said they were at least somewhat worried about their ability to implement standards-based applications. Respondents fear that IT application vendors won’t be ready to offer products in time and are worried by the need to implement upgraded or new systems. Other concerns include lack of funds and insufficient staff.

Hospira acquires hospital surveillance software developer TheraDoc for an undisclosed sum. In 2006, UPMC was TheraDoc’s biggest institutional investor, but UPMC’s ownership stake at the sale of the deal was not known.

GetWellNetwork announces a number of new hospitals clients and contract expansions, including with Loma Linda University Heart and Surgical Hospital and Thomas Jefferson University Hospitals.

Scott & White Healthcare (TX) engages Beacon Partners to assist in its $12 million, 15-month GE Centricity revenue cycle implementation.

The 250-bed Liberty Hospital (MO) successfully implements Eclipsys Sunrise Enterprise, including CPOE activation.

Alan Dowling, PhD, is named CEO for AHIMA, taking over for the retiring Linda Kloss. Dowling is an adjunct professor of information systems at Case Western Reserve University and earned a PhD in healthcare management and management information systems from MIT.

QuadraMed hires Michael J. Simpson as its senior VP for product strategy and development. Simpson comes from McKesson, where he served as senior VP and CTO for McKesson Provider Technologies. Last year a reader tipped us off after Simpson was removed as GM over Horizon Clinicals and moved to the UK to serve as CTO of the International Operations Group. Simpson is the second executive to come over from McKesson in the last month; QuadraMed recently announced the hiring of Michael Jarrett as VP of client services.

Hayes Management Consulting announces that more than 50,000 providers are now using its MDaudit Professional compliance audit software.

EDIMS names A. J. Sultan director of technology.

Send holiday jingles.

News 12/2/09

From Ex-Cerner Guy: “Re: FirstNet. I am loath to come to the defense of my ex-employer, but ED/ER applications feeding an EMR are notoriously difficult to successfully rollout. It’s the nature of the ED physician. He does not care about generating a record for the floor or medical records — he cares about triage / diagnosis / treatment / discharge-or-admit-floor, with those words quickly strung together. It’s about treatment and discharge. And cost does not enter the picture. Ever. We NEVER won a deal with FirstNet as the ‘entry’ product — it was an add-on or check-the-box application. Did they not look at any of the other vendors? There are so many good small shops making great product. $1M for a report writer for about 200 facilities seems like a pretty good deal, so that number might be off a bit.  If they really received Report Writer for all users and facilities for $1M, they need to ease up.”

From Clint Gristwood: “Re: HIPAA firings. What do you think the over/under is on HIPAA-related firings or reprimands at Health Central Hospital in Ocoee for unauthorized access to Tiger Woods’ medical records?” I think the odds that employees have already peeked are 100%. The odds they will be caught and/or disciplined is 20%, even though the hospital will be watching. It’s a 141-bed facility and I have slight familiarity with IT there, so I don’t know how sophisticated their systems are with regard to role-based security and access monitoring. The tabloids would pay big bucks for copies. The Florida Highway Patrol was considering asking Health Central for the records, but it sounds like they’ll just write Woods a $164 reckless driving ticket and be done with it (I’m pretty sure he can afford it). Imagine the eBay price for the golf club his wife was supposedly beating him and his car with.

From LE: “Re: Siemens. I applied for a job there six weeks ago and there were many US jobs listed, over 100 I’m sure. Now, mysteriously, there are only nine internships listed.”

From The PACS Designer: “Re: Windows Live Mail. With the release of Windows 7 comes a new way to access multiple e-mail accounts. Microsoft has announced the availability of Windows Live Mail, which can make you more productive while online.”

From Inside Outsider: “Re: two doors. I agree, but only because this is radiology we’re talking about. Now, if this practice ever gets pushed through to more emergency healthcare — the extreme example being the ER — then I might begin to disagree. Those that come in the common man’s door are not sacrificing their healthcare; they are sacrificing time and amenities. Let’s hope it doesn’t get to the point where Mr. Bigbucks gets priority in the ER and Mr. Littlepennies suffers grave consequences because of it.”

From Certifiable: “Re: stolen identity. Patient at St. Anthony Hospital (IN) had identity stolen. Got bills in the mail for phones shipped overseas, ordered via Sprint. Patient suspected hospital system, hospital would not talk to her until Sprint got involved.”

Thanks to Barbara, a former Sarasota Memorial Hospital employee who set me straight on the Eclipsys announcement that the 50 millionth order had been entered in Sunrise there. It’s true: SMH was not a TDS user and all 50 million orders were entered into Sunrise, which is pretty darned amazing (that’s around 12,500 orders per day for 11 years). I don’t know what made me agree with the reader’s TDS comment since I remember when SMH signed on originally.

HHS Secretary Sebelius and National Coordinator Blumenthal will announce some kind of new grant program (Beacon Community Cooperative Agreement Program) on Wednesday.

Weird News Andy likes this picture, the result of burned out light bulbs at a New York hospital’s ED. He also noticed this sad ED story, in which a school counselor waiting in a hospital ED’s waiting room was robbed by three homeless addicts there, dying of a heart attack immediately afterward without ever getting to see the triage nurse despite having waited for 80 minutes. Aria Health had no comment, but the whole event was captured on surveillance video. It seems like every horrifically negligent patient care issue in EDs and nursing homes is recorded on security cameras, making you wonder if maybe they shouldn’t pay someone to watch the monitor in real time.

How could this happen? A toddler in South Africa being treated for hand burns has her legs amputated by surgeons in the 1,100-bed academic medical center.

Andrew Watt, MD is named VP at Southern New Hampshire Medical Center. He was already CMIO, CIO, and an ED doctor and formerly worked on ED systems for Meditech.

Reminders: the HIStalk events calendar is here and you can add yours for free. Put your e-mail address in the Subscribe to Updates box at your right to join 4,924 people who have already done so and maybe become the five thousandth subscriber (signing up makes you eligible to vote in the HISsies awards, which I’m doing differently this year). Click the crude Rumor Report box in the right column to send me juicy news anonymously (it even takes attachments). Use the Search HIStalk box to the right to dig through 6.5 years worth of HIStalk (maybe I’ve mentioned you or your employer). That is all.

Wisconsin will spend federal stimulus money to create the an HIE, to be dragged from the womb sporting the obligatory painfully contrived acronym WIRED (Wisconsin Relay of Electronic Data) for Health. The governor is looking for nominations (warning: DOC) for its board and committees.

OntoMed, an Ann Arbor, MI startup, is talking to University of Michigan Health System about helping it validate its COSMOS PC-based bedside monitoring and alerting system for the ICU. Their conveniently cutesy product acronym is even lamer than WIRED – COmplexity-based Stability MOnitoring System.

It was fun running pictures of the SMS reunion. In fact, I really like using any pictures that people (rarely) send me: department pictures, data center shots, IT people in their natural habitat, doctors using computers (those are hard to get), and anything related to healthcare IT. Send them my way, please.

Newsweek runs an article extolling Cleveland Clinic’s methods, declaring it “The Hospital That Could Cure Health Care”. Epic is prominently mentioned, although not by name (except for MyChart). CEO Toby Cosgrove is lauded for not hiring smokers to work there and declaring he’d do the same for overweight candidates if federal discrimination laws allowed it. He doesn’t think healthcare reform will do much to reign in costs. Technologies mentioned: clinical decision support, a smart IV system being developed there, MyChart, home monitoring, and powerful data capabilities.

Welcome to Sage, a new Platinum Sponsor of both HIStalk Practice and HIStalk. The Tampa, FL company offers a variety of physician systems, including the Sage Intergy EHR, practice management solutions, Sage Intergy RIS and PACS, community health applications, analytics tools, and EDI services. The Sage Intergy EHR Kit includes ARRA information, access to an online demo of Sage Intergy EHR and Sage Intergy, a presentation covering EHR benefits, and a practice case study. Thanks to Sage for their much-appreciated support of HIStalk Practice and HIStalk.

AMI is looking for a CIO for a 200-bed hospital in Kuwait.

Nuance announces Version 4.0 of its Veriphy critical result management system.

An e-mail about H1N1 claiming to be from the CDC is actually the carrier for a different kind of virus, a PC Trojan. The e-mail urges the recipient to create a profile on the CDC’s Web site, which is actually a phishing site that downloads the Kryptik Trojan.

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HERtalk by Inga

CCHIT certifies four new products under the newest programs announced in October. ABELMed EHR-EMR/PM, Version 11 received certification under the CCHIT 2011 Comprehensive program, while eHealth Made EASY, KIS Track, and Medios earned Preliminary ARRA 2011 certification.

Here’s the difference between the two certifications: the Comprehensive certification program “provides a more rigorous inspection of integrated EHR functionality, interoperability, and security in addition to full compliance with Federal standards.” CCHIT also includes an inspection process in the Comprehensive program that considers successful use at live sites and good usability. Additional certification announcements are pending, per CCHIT. And OK, I admit it — I’ve never heard of any practices using any of these products.

Driscoll Children’s Hospital (TX) selects CAREt System by PatientSafe Solutions (IntelliDOT) for beside medication administration.

KLAS reports there is a “huge gap” in provider satisfaction scores for PACS software. In acute care, GE Centricity PACS-IW scored 23 points higher than the lowest performer, Cerner. Infinitt was the best-performing community PACS vendor and Intelerad led the ambulatory PACS vendors. At the top end of the market, almost nine percent of large hospitals plan to replace their PACS. KLAS predicts the vendors most likely to be replaced include Merge, Siemens, eRAD, and Emageon.

eClinical Works adds a couple of healthcare systems to its client list. Portage Health (MI) is providing the eCW software to its 31 employed physicians and will interface the application with the hospital’s Meditech system. Also, Johnson Memorial Hospital (IN) will offer eCW to its employed physicians and use eCW’s Electronic Health eXchange to allow access for other physicians and hospitals.

In yesterday’s HIStalkPractice, a reader shared that eCW was the “clear-cut winner” in Health Industry Insights’ recent review of the ambulatory EMR market.

MedQuist signs an agreement to license Nuance’s SpeechMagic speech recognition engine and processing software. MedQuist will use SpeechMagic in its SpeechQ for General Medicine, a front-end speech application for all medical specialties. MedQuist, which seems to be churning out press releases in conjunction with the RSNA meeting, also introduces SpeechQ VTB for Radiology, which integrates speech recognition, automated coding technology, and Web-based billing services. MedQuist has also integrated a radiology search tool from Primordial Design into its SpeechQ for Radiology application.

The architects that designed Meditech’s Fall River facilities win an award for their work. The New England chapter of the American Institute of Architects and the Boston Society of Architects said the building shows “excellent site organization” that capitalizes on “great views”. Now I am curious what exactly the “great views” are from all those windows.

The Chatham County Safety Net Planning Council (GA) picks Orion Health to build the Chatham County HIE pilot, which will serve over 250,000 people.

Meanwhile, the Pennsylvania HIE (PHIX) issues a draft strategic plan for a 30-day public comment period. The plan is the same as everybody else’s – get stimulus money.

Continuum Health Partners is replacing multiple imaging systems with Horizon Medical Imaging.

General Leonard Wood Army Community Hospital implements ClinicComp Essentris inpatient clinical documentation, part of a 36-facility contract with the DoD.

The 18-physician Naugatuck Valley Radiology Associates (CT) claims its use of MedInformatix RIS, along with DR Systems PACS and Nuance PowerScribe voice recognition, has allowed the practice to achieve a 100% paperless environment.

Picis announces that several medical centers have selected Picis ED PulseCheck, including Scottsdale Healthcare, Antelope Valley Hospital, and Bayonne Hospital Center.

The CareTech Solutions folks informed us of their revamped corporate Web site, built with its CareWorks CMS content management tool. I can’t say I fully understand what makes a particular CMS tool robust or weak, but I can say the new site is easy to navigate, has a clean look with nice graphics, and contains a nice mix of written and multi-media content. I also see they are hiring in Ohio and Michigan, in case you are looking.

e-Prescribing in Delaware is up 150% one year after the state began funding e-rx start-up costs for the top 50 Medicaid providers.

The Champaign-Urbana Public Health District (IL) sets up a drive-through H1N1 vaccine clinic that allows patients to stay in their cars. Wait times averaged 45 minutes and 2,000 people received shots at the first clinic. Not as much fun as a drive-through Starbucks, but pretty handy nonetheless.

Despite Mr. H’s prediction that Twitter is a passing fad, Global Language Monitor proclaims “Twitter” the top word in the English language for 2009. In fact, it beat out Obama, H1N1, stimulus, vampire, and 2.0. Healthcare was ranked ninth.

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Monday Morning Update 11/30/09

From DemoChic: “Re: NextGen. Pat Cline, President of NextGen, has been promoted to president of Quality Systems. His replacement will be Scott Decker, formerly of Healthvision, but in place at NextGen since 2007.” Rumor reporter Boba Fett said in June 2008 that these changes would happen. The announcement is here (warning: PDF). I was impressed with Scott (but not so much Healthvision) when I interviewed him in 2007. Maybe he said the right thing in the interview in naming Pat Cline as the person he who admired in the industry (he was hired by NextGen as SVP nine months later). It’s a strong team there.

From Cousin Carl: “Re: reader contest. Let’s hear ideas to reduce healthcare costs and improve quality with a minimum benefit of $1 billion in 500 words or less. The simpler and easier to implement, the better.” Sounds like fun. Anyone want in?

From Junior Mints: “Re: Eclipsys. Eclipsys failed to disclose that the 50 million orders entered at Sarasota Memorial actually go back to the days of the TDS 4000 system, which was later upgraded to TDS 7000, which was replaced with Sunrise. The company has never been forthright on this.” I knew the history, but in their defense, they didn’t specifically say Sunrise and it is true that Sarasota’s 50 millionth order was entered in Sunrise even though the first 30 or 40 million went into TDS. It also didn’t specifically say Eclipsys systems since TDS sifted through a variety of corporate hands before winding up as Eclipsys and Eclipsys bought Sunrise from HealthVISION (the Canadian EMR vendor, not Scott Decker’s previous employer). I think it’s a fair announcement that pays de-identified tribute to TDS, arguably the best system before or since when it comes to innovation, pro-clinician design, and patient impact. If a company wants to compete with the decades-old clinical systems that dominate the market, they need to do it the TDS way — put the development teams on the ground in a forward-thinking hospital to work with clinicians and target a specific customer demographic instead of a one-size-fits-all approach (TDS was aimed at big community hospitals and some academic medical centers with big iron hardware and internal technical expertise).

I hope your Thanksgiving was happy. Now begins the official season of not getting much work done in hospitals, so here’s to a month of fewer meetings, fewer project startups, and days with fewer annoying co-workers around.

Thanks to Steve Meyer for pictures from the recent SMS reunion. That’s Harvey Wilson and Jim Macaleer in the first picture. The second has Steve, Harvey, Vince Ciotti, and Jim Carter. If you work in the healthcare IT industry, you might give pioneers like these some mental thanks for creating it several decades ago. Steve was telling me how long some of them have been retired, so they must have made some nice money back in the day (or maybe hung onto their SMED shares until Siemens came knocking). I also said I hoped they raised a glass to those who aren’t with us any more, to which he replied that they did, using a phrase that I’m sure I’ll co-opt as my own: “Any day I’m still on the green side of the grass is a good one.”

Give Mediware credit for ambition, albeit unfocused. It acquires Healthcare Automation Inc. (home care software) and Advantage Reimbursement (home infusion reimbursement) from their single owner group for up to $8 million in cash. The company cites the 20% annual growth in home care, but the markets they’re already in (blood banking, medication management, BI) should be growing pretty well, too.

The Johns Hopkins Hospital is recruiting a chief nursing information officer, co-reporting to the CIO and nursing VP.

I mentioned the radiology practice that had two doors and different levels of service for insurance vs. cash-paying patients. I didn’t mention my opinion: I think it’s great. Patients get precisely the same medical care using the same personnel and equipment. Those willing to pay extra for shorter waits, a nicer waiting room, and a more personal experience have that option, no different than those folks willing to pony up for first class airline tickets even though everybody still lands together. Why not let providers make their profit from cash-paying nicety-seekers and let those profits subsidize the medical care of those who can’t or won’t pay the difference?

Christian Scientists are pressuring Congress to include a provision in healthcare reform legislation that would require insurance companies to pay church members who pray for patients from home.

The local paper has fixed their headline’s spelling error (is a rouge employee one of those mall cosmetics people?), but the story stands: two pathologists say Wentworth-Douglass Hospital (NH) is ending their contract of 28 years because they that discovered a rogue hospital employee got into the IMPAC PowerPath anatomic pathology system and inappropriately changed the names of doctors on the reports. The employee was fired and the doctors say they were, too. I’m going to hazard a guess that other unmentioned issues are in play.

The folks at Mikogo saw my post about the questionable marketing company award given to LogMeIn and pitched their own product as a free alternative. It looks cool: screen sharing over the Web, remote keyboard/mouse control, file transfer, a whiteboard, and session recording and playback. It’s good for Web conferencing, online demos or meetings, or remote support. They even have a native Mac client and free voice conferencing. Best of all, it’s free for both commercial and non-commercial use for up to 10 session participants with unlimited use (there’s no catch other than they offer a paid version for running larger meetings). I love this stuff and have tried several apps, so if this one works as advertised, a bunch of HIT people might find it highly useful. 

Welcome aboard to DIVURGENT Healthcare Advisors, a Platinum Sponsor of HIStalk. The company, which was started by healthcare veterans (I noticed that a pharmacist, PMP, revenue cycle expert, and physician are on the team) who strictly follow standard project management and project quality methodologies. Services offered include strategy, project management, vendor selection, clinician adoption, CDM, benefits realization, training, optimization, medication management, and interim leadership. You can also check out their white papers and blog. Job seekers might want to shoot them a resume since I see they are hiring. Thanks to the folks at DIVURGENT for their support of HIStalk.

Harris County Hospital District (TX) fires 16 employees for inappropriately accessing patient information and violating HIPPA (sic – see their internal form above), some of them doctors and nurses. Some of the employees got into the records of a first-year female resident who was shot in an attempted robbery in a Kroger’s parking lot. She’s expected to recover.

The controversial report on the Cerner FirstNet rollout in New South Wales by Professor Jon Patrick of the University of Sydney (Australia) is back online (warning: PDF) after would-be censors demanded it be removed. The new version takes a more academic tone and has more details, most of which are not flattering to Cerner’s product and, to a lesser extent, the people involved in choosing and implementing it. Some major points it contains: Cerner paid little attention to its Australian clients because the product is primarily driven by the US market, Cerner left a vital report writer application out of the contract that cost NSW an extra $1 million, and physicians hated nearly everything about FirstNet and its impact on their workflow. Who asked the university to pull the article down? Apparently the CIO of NSW Health, the FirstNet customer, at least as I read between the lines of this story. He claims he contacted the university, but didn’t ask to have it removed, but I’m having trouble believing that (I’d also be somewhere between surprised and shocked if somebody from Cerner wasn’t prodding him, but that’s wild speculation on my part).

Speaking of Jon’s article, a couple of readers said I shouldn’t have criticized the recent report by the Harvard people that found EMRs have had little cost or quality impact. I disagree. That article and Jon Patrick’s above are not rigorous clinical studies backed up by specifically required measurements and analyses, so readers need to look carefully at their data and methods. Both sets of authors are open source advocates and proprietary system critics, so when they rip commercial systems while lauding open source ones, you have to think about the subject they chose to write about, whether their data are optimal or simply conveniently available, and whether their conclusions are supported by their facts. In my opinion (and it’s only that), neither article is bias-free — no different than when readers complain that a vendor VP’s HIStalk guest article is “an advertisement” even when it’s fairly objective. And there’s reader bias, too – those who defended the Harvard article are themselves outspoken EMR critics. Both articles are useful and thought-provoking, but more open to challenge than if their authors had no known strong feelings one way or another. 

Providers are the main reason that EMRs haven’t met expectations, readers said (although not overwhelmingly). New poll to your right: have information systems improved patient safety nationally?

Ms. Adventure was telling you back in February that Dubai’s economy was in a free-fall, affecting its ambitious healthcare construction projects (“In one short year things have changed so much, from a thriving and booming town to a town that may not have a tomorrow.”) She had e-mailed me that she probably wouldn’t write more, giving me the feeling that she felt she was in some kind of professional or personal danger. In any case, she was right: Dubai is $60 billion in debt and that news is dragging down world markets (which seems quaint considering the free-spending US government is something like $12 trillion in the red and digging the hole deeper every time the bailout-happy Congress meets).

Marin Healthcare District (CA), awaiting the June turnover of Marin General Hospital by Sutter Health, says it will have to spend $1.1 million to convert PACS images because Sutter wouldn’t give them up without first going through court-ordered arbitration. The newly created district also has to replace Sutter’s systems and will pay ACS $55 million to install McKesson Paragon and support it for seven years.

It’s RSNA time, which I always forget until someone sends me announcement. lifeIMAGE will demonstrate its diagnostic imaging sharing platform, in use by Continuum Health Partners (NY) and Montefiore.

An attorney whose accusations of patient abuse in a New York for-profit mental hospital led to $110,000 in fines is suing the hospital, claiming the hospital retaliated by intentionally revealing mental health information about a relative and threatened to do the same to any patients who joined a 2007 class action lawsuit against it.

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