News 2/20/09

From The Watchman: “Re: rumblings from Verona. I’m hearing that there’s a 10% Epic downsizing going on. Can this be validated?” That doesn’t sound likely, but someone will probably chime in one way or another.

From Lemmy: “Re: announcement from Harvard Vanguard Medical Associates, Boston. ‘I regret to inform you that Kash Basavappa, Chief Information Officer, has resigned from Atrius Health effective March 18 to pursue other career opportunities.'”

Ardent Health Services announces that it has saved $2 million (TN) using the eScription computer-aided medical transcription system.

World Health Organization designates Regenstrief Institute as the first WHO Collaborating Center for Medical Informatics. Paul Biondich, MD from Indiana University School of Medicine has been named director; he co-founded the OpenMRS EMR for resource-constrained environments (aren’t they all these days?) 

Albert Einstein (PA) signs up for Cerner Millennium.

McKesson announces its Achieve IT Web site and telephone center for doctors interested in HITECH.

Here’s what piles of stimulus money does: the non-profit Massachusetts eHealth Collaborative creates a for-profit subsidiary to bid on commercial EMR work. As far as I’m concerned, they should now be treated like any other for-profit vendor, with justified suspicion about credibility and lack of bias when they start trotting out educational programs and studies. Too bad. Even HIMSS couldn’t pull that off with HIMSS Analytics.

E-mail me.

HERtalk by Inga From Famous Johnny: “Re: HIMSS. Just wanted mention how sorry I am we shall again not meet at HIMSS, you being undercover and all. However, I, being the public kind of guy I apparently am, will be the one nursing an obvious hangover. Folks I know in this world have recently postulated that with HIMSS budgets being skinny, a few notable no-shows, and these governmental (we hope) tailwinds combined with economic headwinds, this year may be more substantive than most. I guess we’ll see.” That is actually a great point. If you are a real buyer, you are going to find it in the budget to attend HIMSS. If you are a vendor, perhaps you will see fewer tire kickers and those (like me) just stopping by for free trinkets.

 From Oakie: “Re: HIMSS Webinar. Just wondering if the word from the Webinar today was focused only on EMR/EHRs? Or is some of this $$$$ able to be used for other HIT like eRx, registries, portals, document management, etc. We deal with a LOT of small practices who aren’t always so gung ho about EMR, even eRx for that matter. Just wondering what help they can expect, if any.” I sat through most of the HIMSS Webinar Wednesday that gave an overview of the economic stimulus act and its HIT components. No specific mention (that I recall) about funding for eRX, etc. One requirement for receiving government reimbursement is that a provider use the EHR in a “meaningful” way, which includes eRX, information exchange, and reporting on quality measures. My guess is that a purchase of document management only, for example, would not qualify. However, if someone interprets this differently, please share your thoughts. Here is a link to the HIMSS presentation, if you are interested.

This may very well be the year that I come home from HIMSS with a new Vespa scooter. Despite the recession, tight budgets, and HIStalk criticism of the ludicrous and crass commercialism of such a move, Health Data Management and three co-sponsors are giving away four of these cool rides for dropping by booths. One sponsor is athenahealth, surprising given its anti-boat show stance.

Speaking of HIMSS, we hear that consulting firm Quammen Group is the latest vendor to cancel.

Mercy Medical Center (IA) implements a hiring freeze, as well as a salary freeze for its managers, directors, and senior managers. In addition to the general economic decline, Mercy is still recovering from the floods last June, which forced the hospital to be evacuated and created $66.3 million in property damage.

Another troubled hospital is River West Hospital (LA), which cuts its FTE count in half to around 100. The cuts couldn’t have been too much of a surprise given that the paychecks of 60 employees bounced last month. It’s another hurricane-related problem.

German eHealth service provider CompuGroup, spurned in 2007 for iSoft but looking for acquisitions since, completes a “substantial” equity investment into Noteworthy Medical Systems.

A transcription company lapse is blamed when patient records from Northeast Orthopaedics (NY), including full dictations and patient data, are found to be openly accessible on the Internet.

I’m always amazed by the number of niche solutions in HIT. Case in point: a company named ACEOS announces that the Johns Hopkins Bayview Medical Center has successfully implemented a wound documentation system called WoundMatrix. Who knew such programs existed?

Pee Dee Cardiology, a 16-provider group in SC, selects Allscripts’ EHR and PM to replace its Misys system originally purchased in 1987.

Sentillion signs 30 new customers in 2008, representing over 500,000 new licenses for its SSO product.

The 25-bed Marcus Daly Memorial Hospital (MT) installs HospitalPortal.NET’s Intranet solution.

Allen Technologies, an interactive patient communication systems provider, adopts the Avance high-availability software from Stratus Technologies.

Frimley Park Hospital NHS Foundation Trust selects Picis CareSuite integrated software.

DR Systems announces $1.53 million in sales for four new Unity RIS/PACS solutions.

Satilla Regional Medical Center (GA) enters into an agreement with Perceptive Software to deploy ImageNow enterprise document management, imaging, and workflow software.

E-mail Inga.

Being John Glaser 2/18/09

The Stimulus Bill has been signed. The $19B healthcare IT portion is now official.

There will be Webinars, briefings, conference sessions, and blog postings galore as the industry tries to get its hands around the legislation and the challenges and opportunities that it presents. And it is appropriate that a whole lot of learning go on over the next several weeks.

As we all head up the steep part of the learning curve and enter a period of hype, anxiety, salivation, and confusion, we should be collectively thoughtful about several things.

First, it will take weeks and months before several important sections of the legislation are clear. It is not clear how states can apply for grants. The specific meaning of "meaningful use" is not clear. It will take the government some time to develop the regulations, policies, and procedures needed to fully answer the question, “What do I need to do?” Even after you’ve listed to ten Webinars, there will be holes in your understanding.

Should you wait for all to be made clear? No – you could lose valuable time. Some things are clear, e.g., e-prescribing is important and outpatient EHR implementations could be accelerated. Should you plow ahead full speed? No – some things are not clear enough, e.g., if I didn’t have a regional HIE, I wouldn’t try to start one tomorrow.

It will take some thought to figure out initiatives that should be pursued now and initiatives that would benefit from waiting a little bit.

Second, despite the near-term availability of funds, the factors critical to the success of an electronic health record implementation have not changed. Processes must be thoughtfully re-engineered. Clinicians must be meaningfully engaged. Giving these factors short shrift in a stampede to get money is not smart and could leave the organization with an EHR that has been funded by the government but has fundamentally failed since care improvement has not happened and the clinicians are angry.

Third, these funds, while large, are not infinite. At some point, monies for initiatives such as health information exchanges and research will probably go away. The country cannot afford a never-ending stimulus. Pursuing stimulus funds will require that those pursuing think through how they might sustain the activity once the stimulus bolus runs dry. Cheap/free capital can become an expensive operating budget.

The stimulus funds were meant to be spent. It is smart to pursue the funds. However it is not smart to be seduced by the prospect of buckets of money to the point that we forget that we have to balance moving forward with waiting. The fundamentals of care improvement through EHRs have not changed and capital investments bring operating budget hangovers.

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

News 2/18/09

From Smells Like Teen CCHIT: "Re: did you get wind of this already? I don’t remember hearing about it on HIStalk yet but I could be wrong! It gets less juicier as you read, but leaves at least one major issue open for interpretation." Link. Don’t get too excited – nearly every point in the "very troubling post" is wrong, starting with the first paragraph (HBOC is indeed the former HBO & Company). CCHIT was dissolved, but only to change its organization type. CCHIT is still a private, non-profit organization and it’s entirely irrelevant as to which state it’s incorporated in since you don’t have to incorporate in the state in which you operate (surely everyone’s heard of the huge number of Delaware and Nevada corporations out there). Conflicts of interest with HIMSS? Obviously – HIMSS, AHIMA, and NAHIT founded it in 2004, so clearly they share an agenda and aren’t exactly secretive about that fact. Mark Leavitt of CCHIT used to work for HIMSS, but left to take the CCHIT job. CCHIT has paid staff, but most of the work is done by volunteer commissioners. CCHIT’s criteria are publicly vetted and open for anyone to see, so it’s not like they’re doing some kind of beauty pageant judging with no oversight. I could go on, but clearly it’s a waste of time — someone with an axe to grind decided to air their prolific ignorance or denial of the facts publicly. The legitimate gripes about CCHIT are its fees (but it is a self-supporting nonprofit), its existence (but Brailer sold the world on CCHIT-certified EHRs for interoperability reasons even though most of the CCHIT criteria have nothing to do with interoperability), and its failure to get its stated job done (reducing EMR purchase risk of doctors to move the adoption needle).

I’m not going to dwell on this, but suffice it to say the folks at MEDHOST dealt professionally with the issue I mentioned previously involving comments sent to me regarding a competitor. I appreciate their support.

The stimulus bill is signed, so right or wrong, it’s happening. I have to commend Allscripts for being on the ball – they had a new ad (to your left) to me almost immediately that links to a resource page for providers. We’ll stay in touch with our EMR vendor contacts since it will be interesting to see how the stimulus actually gets operationalized and what providers do.

And now that we’re getting stimulated, may I offer a brief criticism of Saint Obama on the day he signed the stimulus bill and yet the Dow dropped another 300? Enough of the gloom and doom predictions of just how bad the economy is and how long it will take to recover. We’ve got the pessimism angle covered, thanks. You’re supposed to inspire us with your energetic optimism, which is why people vote for big-picture vision-painters and not analytical realists. Take it from Ronald Reagan: the economy will recover when people believe it can. It’s your job to convince them. Thank you.

Jobs: Client Services Director, SCM Clinical Consultants, Epic Resolute Professional Billing Consultant. Sign up for weekly job blasts.

Least-shocking news of the day: the Electronic Health Records Association and HIMSS support spending taxpayer billions on their wares, reminding everyone that broad, noble-sounding causes always mean someone makes bunches of money.

Hong Kong’s hospital authority will spend $130 million over 10 years on a national e-health project, linking to the free physician EMR being developed by the Hong Kong Medical Association at government expense.

Picis signed several EDIS deals in Q4: Alegent, Palisades, Inova, and others listed in the press release.

Modern Healthcare gives its latest round of awards to big-salary hospital CEOs who have spent a lot on healthcare IT. Other than making the healthcare IT vendor advertisers happy and encouraging consumption of their products, I don’t understand why buying IT merits an award. First, their IT projects were presumably for their own organization’s benefit, not to get an award from an ad-supported magazine. Second, there were only 48 nominees for three awards, so obviously hospitals aren’t all that interested. Third, why give an award for "leadership and commitment" (tools) instead of outcomes of their use (results)? No offense to the winners, but we ought to be a little more mature than treating IT like its own little Most Wired science fair with winners and losers. Other than Concord Hospital this year, every past winner seems to be the huge, massively budgeted and staffed health system that represents about 0.1% of the hospitals out there purring happily along with non-award winning technology. All the hospitals I knew of (including my own) who won Most Wired made fun of it offline, so I don’t think anyone really thinks these magazine contests mean much (at least the HISsies recognize bad achievements, like stupidest strategic move and the much-discussed Pie in the Face award). Modern Healthcare is usually more rational than the cheerleading HIT magazines, so I’m disappointed. Next think you know they’ll be giving away a car at HIMSS to bribe people to visit advertiser booths.

Eclipsys names former Per-Se CEO Philip Pead to its board. Says he’s a managing partner of Beacon Point Partners that’s supposedly a healthcare consulting organization, but I’m guessing it’s just his own shingle since the only connection I could find had an address in a building full of multi-million dollar condos in Coconut Grove, FL.

Microsoft will be selling Amalga in the UK, at least if customers want it.

Ronald Tomo is named CIO of Nassau Healthcare Corp. (NY), coming over from Episcopal Health.

This is interesting, but confusing. An Illinois clinic CIO who used to work for Allscripts is rolling out a registration kiosk for his clinic, which he developed under his separate company, and which Allscripts will resell.

South Dakota pharmacist and physician groups want the state to join those that have rolled out a doctor shopping prescription database.

Vint Cerf, who beat Al Gore in creating the Internet, makes the case that online privacy is relative. His example: if you’re in the ED, you don’t care about privacy at that moment because you want staff to see your medical records so they can help you. But, that proxy should be limited by time, so that the ED has a few hours to check out your information, but your doctor has longer. That’s an interesting concept: time limits can be a privacy enforcer (after you’re discharged or transferred, for example).

A Texas company wants a judge to let it tap into the accounts receivable of shuttered Brownsville Tri-County Hospital (PA) to collect the money owed to it, blaming inept hospital staff for its failure. "The audit revealed that (the hospital) and its personnel do not fully understand the components and functions of the (computer billing system) due to the fact that expertise in neither hospital billing nor financial reporting exists within the hospital."

Check out this amazing photo and story from the UK, showing "the world’s highest intensive care ward" in a C-17 Globemaster transport jet in which British troops critically injured in Afghanistan are brought back for treatment.

Sad lawsuit result: a baby born in 1988 with brain damage is awarded a $2.4 million medical negligence award in 1999 from a Boston hospital. She lived with her father, who was just sentenced to five years in federal prison for spending more than half her money on race cars, drugs, and his own attorney fees in trying unsuccessfully to beat an attempted murder charge in 2004.

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HERtalk by Inga

SouthEast Alaska Regional Health Consortium (SEARHC) launches the ALERT EDIS from ALERT Life Science Computing. SEARHC is in the middle of a two-year, $5.4-million transition to EHR, one of first and largest of its kind for tribal health systems.

Mount Sinai Medical Center (NY) signs a multi-year contract with GE Healthcare for management consulting and IT services.

The VA discovers that a contractor providing medical transcription services violated department rules by allowing employees to use computers that did not adhere to the government’s security policy. The contractor has been suspended, even though there is no evidence that patient information was disclosed.

A Utah study finds that 98% of stroke patients evaluated using telestroke consulting technology received appropriate treatment, compared to 82% of those evaluated by telephone alone.

Conifer Revenue Cycle Solutions files a warning letter with the Texas Workforce Commission that confirms 57 employees will be laid off by April 13th. The 2,300 employee Conifer is a division of Tenet Healthcare. The affected employees are employed with within Conifer’s Center for Patient Access Service.

As everyone scrambles trying to figure out how to get their piece of the economic stimulus package, I am wondering how things will shake out with vendors. For example, what if your product is not CCHIT certified? Are you going to lobby against any policy that formally requires providers to have CCHIT–certified products in order to receive subsidies? Or are you going to rush to get your product certified? Do vendors need to start ramping up their implementation staff (if they haven’t already?) I also wonder if providers will attempt to hold vendors liable should a provider fail to be using EHR “meaningfully” in time to qualify for the various adoption deadlines.

Informatics Corporation of America (ICA) announces that its solution is live and aggregating data from all core clinical systems at Northwest Healthcare (MT).

Former McKesson VP of Customer Operations Tom Pianko joins Occupational HealthLink as executive VP of business development and marketing.

Two former Healthlink executives launch a new HIT consulting firm named Encore Health Resources. Ivo Nelson is chairman and Dana Sellers is president and CEO.

Fairfield Medical Center (OH) deploys Imprivata’s SSO technology.

IntelliDOT appoints Margaret Laub to its board of directors. She is CEO of the HIT outsourcing company Policy Studies, Inc. and a former president for McKesson Health Solutions.

Cardinal Health chooses CareFusion as the new moniker for its $4 billion clinical and medical product business spinoff. You may recall that they acquired CareFusion awhile back, so they are getting good use of the name.

I’ve received a number of e-mails recently asking if any fake Ingas will be floating around HIMSS. Truthfully, I have no idea. I wonder if fake Ingas are too “last year?” Perhaps too frivolous in these days of tight budgets? On the other hand, who could resist a wise (and sexy) fake Mr. H, with sort of a George Clooney-ish look? Wouldn’t we all feel a little more reassured that our HIT world is safe if we had a few Mr. Hs bopping around?

PatientKeeper and St. Vincent’s Hospital Manhattan will host an eSeminar focusing on the hospital’s use of PatientKeeper’s charge capture and clinical portal. The event features CMIO Dr. Richard Roistacher and takes place February 26th from 2-3:00 EST.

Mediware introduces a new product designed to manage the storage, preparation, and administration of mother’s milk used in hospitals. All Children’s Hospital (FL) has already adopted Mediware’s LacTrack SafeLx software.

HIMSS is hosting a series of Webinars highlighting the new economic stimulus package and its effect on healthcare. In additional, HIMSS has added 10 new sessions on the topic for the April convention.

Advocate Good Samaritan Hospital (IL) selects Patient Care Technology Systems’ Amelior ORTracker system.

A KLAS study concludes that healthcare providers are largely unaware of the RTLS solutions on the market and their capabilities. Only 29% of those surveyed could list an RTLS by name and 59% were unable to identify which RTLS offerings they would consider using.

E-mail Inga.

SEC Moves on HSS Primary Shareholder Stanford International Bank

Federal regulators filed a complaint in Dallas federal court today against billionaire R. Allen Stanford and three of his companies, including Antigua-based Stanford International Bank, alleging "massive fraud" in promising unreasonably high rates of return on $8 billion worth of CDs sold by the bank. The judge has entered a temporary restraining order and has frozen Stanford’s assets.

"We are alleging a fraud of shocking magnitude that has spread its tentacles throughout the world," said the SEC’s director in Fort Worth, TX. Most of the subpoenaed company witnesses, including Stanford, either failed to appear or could not account for the $8 billion in assets claimed to be housed in the bank.

Earlier reports suggested that the bank had laid off significant numbers of employees, weeks after Stanford paid $20 million in prize money to the winners of a single cricket match at which he arrived in a gold-plated helicopter.

Stanford International Bank is the primary shareholder of Health Systems Solutions Inc, which last week backed out of its plans to acquire imaging vendor Emageon for $62 million after Stanford International declined to provide financing. HSS paid $9 million in escrowed money to Emageon for failing to complete the transaction.

Monday Morning Update 2/16/09

From Barney Rubble: "Re: AtStaff. AtStaff, Inc. of Durham, NC laid off some 15% of its workers, including sales and marketing along with some other belt tightening (people)." Unverified.

From A-Fraud: "Re: Picis interview. Why not challenge Cozzens with [laundry list of company criticisms] … as a potential customer, we need to know this and Picis would not share this information with us!" The sender attempted to camouflage his or her information, but a little sleuthing revealed that it came not from a hospital or prospect, but from someone at Picis EDIS competitor MEDHOST (hopefully not encouraged by the company). Picis must be a formidable competitor if it’s come to that.

Mary Pettys, a software director for TriZetto, was one of the passengers who died in the Buffalo plane crash. Condolences.

Kaiser had a terrible 2008, swinging from 2007 net income of $2.2 billion to 2008 net loss of $794 million. Reading between the lines, investment losses were to blame, "marked down to current market values for financial reporting purposes." Interestingly, most of the press release brags on IT and HealthConnect, which is obviously a key strategy (as you would expect given the cost). Like everyone else, Kaiser will defer capital projects. An ominous sign: Kaiser’s total membership declined by 30,000 last year, the first drop in five years (maybe due to unemployment?)

I see that 113 people who attended HIMSS last year have completed the poll to your right. Results: only about half of them are going to HIMSS this year and 75% of respondents say their organizations will send fewer people this year. HIMSS may be getting a lot of early registrants, but it sure looks unlikely that attendance will match that of last year’s conference.

The CEO of Royal Free Hospital in England complains that its early adopter implementation of NPfIT’s Cerner Millennium costs it dozens of millions because of extra costs, lack of billing data, and reduced patient throughout. NHS says early adopters always have to spend and suffer more and that hospitals often fail to set adequate training budgets (all true in my experience). 

Listening: Flo Rida. If you already have a stripper pole and strippers in your house, this is all you need – they will instantly start gyrating since it’s a club staple, so I hear (I haven’t been in a strip club since they were dancing to Toto).

Jonathan Bush of athenahealth and John Glaser of Partners HealthCare will speak at the Transforming Healthcare conference in Boston the evening of Thursday, February 26. HIStalk readers get a discount – see the text ad to your right.

Cleveland Clinic strikes a deal with MinuteClinic to provide clinical consultations as backup to nurse practitioners in nine CVS store MinuteClinics, with integration of their respective electronic medical records, with patient-approved access to the clinic’s Epic MyChart information.

We did an "HIT Moment" with Vatsal Thakkar MD of NYU, who’s an actual user of the free Practice Fusion EMR. He has some quite interesting thoughts that are worth a read.

The drug industry got its hands into the stimulus bill’s earlier versions, creating a new lobbying group to make sure big pharma controls medical information and keeps provisions that require cost effectiveness out of any outcomes research. The drug makers don’t like the $1.1 billion earmarked for comparing medical treatments and want it removed, claiming it will lead to government rationing (the drug industry loves the "it’s expensive, but worth it" argument that it often makes directly to patients spending someone else’s money). An interesting quote in the article: "When the government’s Agency for Health Research Quality suggested in 1995 that there were too many unnecessary back surgeries, doctors and industry groups attacked the conclusion. Mr. Cannon noted that Congress at the time slashed the agency’s budget and stripped its authority to make medicare-payment recommendations. ‘They almost killed AHRQ,’ said Dr. Avorn. "The memory of their near-death experience hasn’t been forgotten."

Early reports are that privacy groups like the final stimulus bill, with ACLU giving its stamp of approval. No comment yet from Patient Privacy Rights.

BT’s earnings took a big hit after writing down the value of most of its big IT contracts, including its NPfIT ones.

Indian IT vendors are expecting to get contracts from HITECH. iSoft was named, which is strange since neither it nor parent company IBA Health sell into the US as far as I know, but maybe plan to do so.

Emageon gets the $9 million of escrowed money from Health Systems Solution for the latter’s failure to consummate the merger transaction with the former. In the meantime, the SEC, FBI, and IRS are investigating HSS’s parent company, Antigua-based Stanford International Bank, wary of missing another Madoff-type situation in which investors received abnormally high rates of return in what turned out to be a Ponzi scheme.

Merge Healthcare announces Q4 numbers: revenue down slightly, EPS $0.03 vs. -$0.28. With annual revenue tracking at $60 million, nobody’s probably paying much attention, but it’s at least a start toward some kind of recovery from three years or so ago when shares were in the high 20s vs. $1.65 now.

HITECH Provisions of the Stimulus Package
By Dr. Herzenstube

After reading through the entirety of the HIT language of the bill (title XIII, which covers all but the Medicare and Medicaid incentives), here are the bits I find most noteworthy.

1. The bill seems to stipulate a role for a certification organization a la CCHIT. "The National coordinator, in consultation with the Director of NIST, shall keep or recognize a program or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle." (3001.c.5).
2. However, that certifying body will not be the one to decide on the certification criteria. That will be the role of the HIT Standards Committee, with final say — at the individual criterion level — lying with the Secretary of HHS: "The National Coordinator shall review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee." (3001.c.1).

   …and the HIT Standards Committee will take its marching orders about what to focus on from the HIT Policy Committee. "The HIT Policy Committee shall recommend the areas in which standards, implementation specifications, and certification criteria are needed … and shall recommend an order of priority for the development, harmonization, and recognition of such standards, specifiations, and certification criteria." (3002.b.2.A)

   "…the HIT Standards Committee [shall] recommend to the National Coordinator standards, implementation specifications, and certification criteria…consistent with the latest recommendations made by the HIT Policy Committee.." (3003.b.1.A) (The bill also stipulates some areas that the HIT Policy Committee must address in some manner, e.g. segmentation of data to facilitate limited disclosures of PHI).

3. 3008.b Implies that the AHIC Successor, aka NeHC, might serve as the HITPC or HITSC (although HITSP has developed many of the interoperability implementation specifications used by CCHIT, most CCHIT criteria relate to innate functionality of EHR systems, NOT interoperability features, and were developed by the CCHIT workgroups themselves. It will be a major shift to have CCHIT relegated to basically just a testing organization, with criteria developed by another entity).
4. HIPAA will now apply to business associates of covered entities just as it applies to covered entities (13401.a)
5. "Pay for privacy". Upon written request of the patient, disclosures to health plans for payment or health care operations must exclude any PHI pertaining "solely to a health care item or service for which the health care provider involved has been paid out of pocket in full." (13405.a)
6. Accounting for all disclosures including for PTO. "An individual shall have a right to receive an accounting of disclosures … The Secretary shall promulgate regulations on what information shall be collected about each disclosure." (13405.c.1.B)

E-mail me.

Being John Glaser 2/14/09

The convergence of the Information Technology and Clinical Engineering functions is likely to accelerate in the years ahead. This convergence centers on six shared areas:

• Goals. Both functions have goals of improving the safety of care, enhancing clinician decision making, and improving clinical operation efficiency.
• Infrastructure. Both functions need to leverage the enterprise wired and wireless networks, workstations, and server farms.
• Knowledge management. Clinical information systems and medical devices increasingly have computer-based decision support logic; logic that must be kept current, checked for inconsistencies, and assessed for impact.
• Applications. Applications such as acute care documentation and cardiology systems are integrations of applications and devices.
• Regulations. For example, the FDA is examining IEC 80001, which would place enterprise IT networks, which are linked to biomedical devices, under FDA oversight.
• Support. Both functions may need to work together when devices and/or applications and/or infrastructure encounter problems.

Despite the acceleration of convergence, crafting effective working relationships between the functions remains a significant problem.

Most Clinical Engineering departments do not have formal reporting relationships to the Information Technology department. The two groups have differences in culture, vendors, support requirements, regulation, and domain knowledge that often cripple working relationships. The vendors that serve the respective departments don’t often understand the needs of the other departments, e.g., the need to co-exist with other vendors on a wireless infrastructure.

While convergence is challenging, it is essential that it happen — technically, managerially, and strategically. This convergence will require efforts on the part of provider organizations, vendors, regulators, and professional societies. The convergence starts with the two groups sitting down and talking to each other.

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

News 2/13/09

From Squirmy: "Re: Compuware. Compuware’s Covisint subsidiary hires convicted former Detroit Mayor Kwame Kilpatrick for their Dallas office." Kilpatrick, on five years’ of probation and disbarred after serving 99 days in jail for obstruction of justice and assault following his sex-and-text trysts (and his administration is still under a federal corruption investigation), bags a job as a Detroit-based Compuware account executive. Hopefully he’ll be well paid since he owes $1 million in restitution.

From Mark: "Re: stimulus. I was looking for comment or perspective on a disturbing article published in the WSJ. As a healthcare IT professional who works with EMRs, this scares me." The article, A Health-Tech Monopoly, is actually an editorial that claims the bill will make ONCHIT all-powerful, concluding it will "be deciding which platforms are up to code and shutting down competitors" and will hamstring IT users with "faux privacy provisions," leading to government healthcare price controls and micromanaging providers. The author isn’t named, but if it’s not Betsy McCaughey, it’s someone who thinks like her. ONCHIT is not new and has been entirely benign, although I’d double check once their bank account gets all those extra zeroes. They won’t (can’t) shut down software vendors, at least those able to pay a not-huge sum to earn CCHIT certification (maybe that would have been a nice use of the stimulus money – fund CCHIT and make its EMR certification free). Also, the stimulus bill isn’t a never-ending blank check for imposing socialism or running roughshod over privacy — voters will still have some say. Right-wingers like me hate the bill because it’s probably going to be one giant wasteful failure that will eventually leave the country worse off once the big spending party is over and they bring the bill to our children. Democrats love it because it tries to do something, at least, and might help average people now that the fat cats have gotten their handouts. Like always, zealots on both sides preach loudly to the choir and breathe each other’s air, convincing nobody who wasn’t already in their camp (here’s a liberal counterpoint, for example). Right or wrong, the stimulus bill is pretty much a done deal at this point, so editorializing is pointless. You saw the effect of grassroots opposition to the bank bailout – zip (about the same as its results).

From HawkI: "Re: University of Iowa Hospitals and Clinics. They had a successful go-live of Epic’s Inpatient Pharmacy, Critical Care, and eMAR products this week. May 2, they go live house-wide with documentation and CPOE." Nice. Congratulations to them. How’s Epic Pharmacy and the connection to CPOE? I haven’t heard anyone say.

From Inside Outsider: "Re: Sunquest. More layoffs yesterday, including the remainder of the Service Exec team, which coordinated support for clients."

From Art Vandelay: "Re: HIMSS conference. Never thought of it before, but another alternative could be some podcasts, video podcasts, and use of SlideShare for an ‘open source’ conference. Mr. HIStalk, you could take the next step with this one. Allowing attendees to make requests would be pretty cool and then use the normal discussion board to have a time-bound Q&A. The authors could distribute free with HIStalk as the coordination point pointing to their URLS." A brilliant idea. An HIStalk education center, which could also screen presentations imposing publication-like standards (disclosure of interests, author affiliations, etc.) and no commercial pitches (or at least clearly labeling them since those can be educational, too). And, letting readers vote on each using a star system (like Amazon’s) and with a mini-discussion board for each presentation like Art said. All free, of course. Art and I just ran the idea up the flagpole — are you saluting or not? Let me know.

Listening: Sunny Day Real Estate, defunct emo since 2001 for obvious reasons: they declined publicity, refused to play in California, lost their lead singer when he converted to Christianity, used gibberish for lyrics to get the songs out faster, and released an all-pink album with no writing. I admire that, although I’m not sure why.

Harris Corp. gets a 10-year outsourcing contract from nearby Health First (FL) to provide support, training, and network security.

Cerner gets a two-year extension of its UK contract with Atos for Choose and Book. And, BT will resume its Millennium rollouts in London after fixing earlier problems.

Students in Rwanda can take an 11-month software development program that encourages them to further develop the OpenMRS system, a project led by Regenstrief Institute and Partners in Health. Students are trained in Java programming, web development, and informatics.

The Army buys 10,000 more Dragon Medical licenses for its physicians as part of a provider satisfaction project with the AHLTA EMR. "Being able to speak notes into an e-health record at the patient’s beside — rather than staring at a computer screen typing — also helps improve doctors’ bedside manner and allows them to narrate more comprehensive notes while the patients are there, or right after a visit. That cuts down on mistakes caused by memory lapses and boosts the level of details that are included in a patient record.”

Former Summit Healthcare CTO Charles Williams starts his own company, Infinity Healthcare, which I ran across in this news item.

Odd: a visitor reaching into his pocket to pay for lunch in a Colorado hospital’s cafeteria hits the trigger of the gun in his pocket, shooting himself in the leg (he’s been Burressed!)

I swear those Hollywood types need to start writing spec scripts about the Emageon saga. It’s off-again for the umpteenth time, as HSS’s parent company, Antigua-based Stanford International Bank, won’t provide the money for it to acquire Emageon. Meanwhile, these blogs (Link 1, Link 2, Link 3 – thanks to the reader who sent them) paint an interesting picture of the bank, which the first one claims has one shareholder, a single board member who is an 85-year-old used car dealership owner, is audited by a tiny Antigua company run by a 72-year-old local, and somehow manages to pay abnormally high interest rates on CDs despite big losses. That last linked article makes some rather strong statements, claiming the bank is a scam and "going down very soon." All unverified by me, of course.

Strange lawsuit: A Florida woman is arrested and charged with practicing medicine without a license after two women suffered injuries from the "buttocks enhancement" injections she administered.

Canada is running its own EMR stimulus: $500 million more to Canada Health Infoway, bringing the total to $2.1 billion ($1.7 billion US).

Want to see the real-time ED load of several Western Australia hospitals? Sure you do.

Open source software companies (seems like an oxymoron, doesn’t it?) urge President Obama to consider open source EMR applications. "Open-source software brings transparency to software development. There are no ‘black boxes’ in open-source software and therefore no need to guess what is going on ‘behind the scenes.’ Ultimately, this means a better product for everyone, because there is visibility at every level of the application, from the user interface to the data implementation. Furthermore, open-source software provides for platform independence, which makes quick deployments that benefit our citizens much easier and realistic."

Another Vendor You Won’t See at the HIMSS Conference

A reader had asked us to confirm that Picis will not attend the HIMSS conference (along with several other companies that we already told you about). Inga jumped to action and e-mailed some questions to CEO Todd Cozzens. Since I’m a neurotic rule-follower, I’ll run his answers here instead of as a "Moment With" since she asked only three questions, not my standard five.

How’s business?

We’re holding up pretty well. We just finished a very strong year in 2008, with new bookings up well over 40% over 2007 and solid improvements across all business lines in a quarterly customer satisfaction survey. Our SaaS business is driving a lot of that, but we were pleasantly surprised to contract with many net new ED and OR customers in the back half of the year. In all we picked up over 20 new hospital systems – not many companies doing that these days. And of course these contracts also help drive better margins and cash flow. 

We also released a slew of new products in 2008 – most notably our integrated EDIS and facility coding system and some very well received BI tools and decision support capability in our OR product line. Our focus in recent years of integrating point of care revenue management seamlessly into our high acuity clinical automation products is helping us maintain good traction throughout the slowdown in hospital capex spending.

Has Picis pulled out of HIMSS?

We’re being very conscious and prudent about controlling costs and hunkering down on our business. Don’t let anyone tell you there isn’t a completely different environment out there now — if they do, they’re either lying to you or have their head in the sand. For example, we’re balancing our portfolio with our marketing spend — we’ve increased our attendance at domain-focused trade shows (ACEP, ASA, ENA, HFMA, etc.) and decreased our presence at more general shows such as HIMSS. 

We surveyed our prospects and customer base and found that over half had imposed a travel ban or would not be attending. We figure that spend is about the equivalent of an investment in a small R&D team that could work on a new product. We want to maintain our focus on innovation and R&D in this downturn to come out even stronger on the other side. We still will do a lot of HIMSS-sponsored events, such as HIMSS virtual tradeshow presentation. Our Webinars on driving profitability through clinical business intelligence had record attendance for HIMSS last year.

What’s your take on the HITECH part of the economic stimulus package?

When I ask the same to CEOs and CFOs of providers, they say, "Make my hospital solvent and viable and I’ll have the right capital to invest in IT." So, the $80 billion to prop up Medicare for the states will surely help there.

Another little-known provision is expanded tax credits for municipal bonds. That’s a major source of hospital financing that’s been completely shut down, and getting that market churning again will have a big affect. The average hospitals only has about 50-75 days of what they call uncommitted cash on hand to bridge the gaps between operating expense obligations and revenue from payors. It’s sad to see hospitals laying off people, not because their numbers are particularly bad, but because they need to bridge their working capital shortfalls

As to the grant money, we still haven’t seen wording in the final bill that obligates hospitals to spend the grant money on healthcare IT. I’m also curious to see how the incentive money is applied and what the criteria are — that still has not been worked out, to my knowledge. The increased funding for the national HIT office and interoperability could be very useful if spent wisely. Re-inventing the wheel is not the answer — there are already many interoperability standards available. 

The key is obligating the vendors to be interoperable. Don’t let them talk out of both sides of their mouth by saying they’ll comply with all standards, then propose proprietary data lockout products to health systems. I like Peter Neupert of Microsoft’s term of "data liquidity." We need to increase data liquidity in healthcare as much as we need to increase monetary liquidity!

E-mail me.

HERtalk by Inga

From Gary: “Re: NCR brings Patient Self-service Downunder. Love your work. Mr. H is lucky to have someone as dedicated and talented (and beautiful) as you on his team. Now that the obligatory ‘sucking up’ is done, we are doing a rather ‘soft launch’ of our entrance into the South Pacific region.” Since Gary appears to know how to work the system at HIStalk, I agreed to give him a plug. Plus I was excited to know we have readers in Australia, especially since he has agreed to take me shoe shopping in Melbourne any time. Gary is heading up sales in the South Pacific for NCR’s healthcare self-service group.

Marisco Capital Management acquires a 5.7% stake in athenahealth. The 1.88 million shares of stock are estimated to be valued at $630 million.

athenahealth also names David E. Robinson as executive VP and COO. His most recent role was executive VP at SunGard Data Systems.

Cancer Treatment Centers of America opens the nation’s first all-digital cancer hospital at Western Regional Medical Center in Goodyear, AZ, which would make it the first Stage 7 hospital in the HIMSS Analytics EMR Adoption Model. It’s using Eclipsys Sunrise.

Speaking of Eclipsys, it picks up an endorsement from Genesis Physicians Group, a 1,450-member IPA in Dallas. IPA members purchasing the PeakPractice product will be eligible for discounted pricing.

USC agrees to pay Tenet Healthcare $275 million to acquire USC University Hospital and USC Kenneth Norris Jr. Cancer Hospital. The deal ends a three-year fight over the control of the facilities. Employees will stay on.

A 57 year-old woman who questions a $143 pregnancy test charge on her detailed hospital surgery bill is told it’s standard procedure even at her age. She’s pushing for a policy change. I am still hung up on the fact that the test is $143 when the at-home version is about ten bucks.

Emory University Orthopaedics & Spine Hospital (GA) opens this week and will feature a Cerner CareAware my Station system in each of the 45 patient rooms. I also noticed the hospital offers four private luxury suites with two separate living quarters. Amenities include fine linens, plush towels, two fax machines, a conference/dining table, in-room newspaper delivery, and gourmet room service.

HCA seeks to raise $300 million in a bond offering to repay bank debt and to amend terms of some of its loans. Earlier this month, HCA announced its 2008 net income was $673 million, down 23% from 2007.

The son of an 89-year old woman who died at a UPMC hospital charges that the facility’s new and untested Cerner EMR system was a major factor in her death. The woman, who was undergoing treatment for strokes and dementia, left her unit and ended up freezing to death on the hospital’s roof. The suit claims that the staff caring for the woman was struggling with a system that “they were not properly trained on,” placing patients “at a severely increased risk of harm and death.” The family’s attorney charges that UPMC ignored warnings that the records system could put patients at risk because UPMC had an ownership interest in Cerner Corporation.

In an attempt to expose medical students and doctors to its new surgical procedures, surgeons at Henry Ford Hospital (MI) use Twitter to provide real-time time surgery updates. During a surgery on a kidney cancer patient, doctors used a laptop in the operating room to give a play-by-play of the action, plus answer online questions. Is it really 1.0 of me to hope my surgeon doesn’t Twitter during my next surgery?

A new KLAS research report claims that more hospitals are looking for aggregation solutions that provide a more complete view of medical records and documentation. Such solutions would help clinicians improve patient safety. The report names six vendors that account for 85% of contracted deployments, with MEDSEEK owning the largest installed base. KLAS concludes the solutions from Microsoft and dbMotion are the most functional. The other top vendors include Medicity, PatientKeeper and CareFx.

Greenway Medical Technologies and Navicure partner to offer more integrated solutions and services. Both are “Best of KLAS” winners in their respective areas.

Perot Systems announces its Q4 financial results, which included a profit of $29 million, compared to $44 million in the same period last year. Perot blames the bulk of the 34% drop in profit on a client termination.

iMedica names Mark L. Richards its new VP of Sales. Prior to iMedica, he was the divisional VP of group practice sales at McKesson’s Physician Practice Solutions business unit.

Data Dimensions, a provider of business process outsourcing services for healthcare, promotes Jon Boumstein to CEO.

SCI Solutions wins three eHealthcare Leadership Awards for its Consumer Portal self-scheduling application. The awards included Best Business Suite, Best Overall Internet Site, and eHealth Organizational Commitment.

Healthvision closes the fourth quarter with 22 new client engagements.

Infinity Healthcare Solutions partners with Stratus Technology to resell Stratus hardware, software, and service products.

NextGen announces that AltaMed Health Services (CA) and Valley-Wide Health Systems (CO) have selected its enterprise software solutions. Both are community healthcare facilities.

E-mail Inga.

News 2/11/09

From Brailer’s Revenge: "Re: another non-profit seeking hospital and vendor members. Most hospitals would have to ante up $8-20K for a seat at the table. Not clear what you get in return." Link. The National eHealth Collaborative’s initiatives include prioritizing standards initiatives and NHIN (it’s the AHIC successor, as it was known for awhile). It was just launched last month and John Glaser (who’s on its board) described it right here on HIStalk right after that. It’s a pretty big deal, especially with stimulus money coming and some structure needed around it, and entirely above board. I don’t know why hospitals would join either, but if they’re spending big money on EHRs, they at least get some voice in long-term direction. And, coincidentally, right after I wrote this, I got an e-mail from NeHC communications director Meryt, who sent over a newly released white paper developed with HITSP and CCHIT (fulltext on John Halamka’s blog, which saves me having to post it) that lays out their vision.

From Ex IBM’er: "Re: Healthcare and Life Sciences. Several folks RIF’ed out today."

From The PACS Designer: "Re: Alfresco. Enterprise Content Management is becoming more in demand by healthcare professionals and one free software solution addressing ECM is called Alfresco. HIStalk sponsor Red Hat has some experience with being an Alfresco installer and can help those who are interested in this software solution." Link.

From Cloud Jumper: "Re: alternative to HIMSS. Maybe you could do something like the TED talks, where the coolest people could give their talks to cool savvy people in the audience and it’s all on video so we can watch it later if we were uncool enough not to be invited. You could get the vendors to do tasteful little ads in front of each video, as TED does, to pay for it." That would be fun, although healthcare is so profit-oriented and fiercely protective of turf even on the non-profit side that the cool factor is turned down several notches (kind of like being the heppest cat at HFMA). Still, it would definitely be different than the mainstream conferences, where the same old faces exaggerate their successes with the same old ideas prettied up to seem more daring and contemporary. But, the one article commenter was spot on: HIMSS can only put people on stage who volunteer to be there, so those who have never been a speaker or committee member have no excuse to gripe about the result (I have, so I can). That’s one of my HIStalk goals, though — to showcase the good ideas of people who don’t have the time, money, or ego needed to ride the PowerPoint Podium.

The Senate passes the economic stimulus package and Kaiser Family Foundation has a summary of it (the current version, until a compromise is reached with the House). The Senate’s bill calls for $19 billion for HIT vs. $20 billion in the House bill. Both sides want to give Rob Kolodner’s previously shoestring-funded office incomprehensible amounts of "discretionary" funds, $3 billion vs. $2 billion (is anyone a little scared of that?) Surely up for heated debate: the Senate’s bill punts on privacy, while the House calls for strict privacy protections. Wall Street wasn’t exactly overjoyed with the grim reality of this financial Hail Mary or the worse-by-the-day bank bailout; the major indices all dropped nearly 5% on Tuesday.

Speaking of that, the former lieutenant governor of New York weighs in with Ruin Your Health With The Obama Stimulus Plan. She says senators should vote against what she calls "the handiwork of Tom Daschle": ONCHIT as a big new bureaucracy, government interference with physician decisions, and intentionally slowed development of new drugs and technologies because they’re expensive. Daschle, she says, thought seniors should deal with conditions that come with old age instead of being treated for them, moving dollars to younger people (as cold as that sounds, I’d have to agree at least in general). Here’s the big finish: "The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy."

Add Rush Limbaugh to the list of HITECH haters. From his Monday show: "Your medical treatments will be tracked electronically by a federal system. Now there are arguments back and forth about whether or not this is a good thing. The opportunity for the loss of privacy is huge here … by digitizing and making everybody’s healthcare records computerized … especially having a major federal database where everybody’s health records are." I’m conservative and even I can’t stand that pompous gasbag, so I can’t imagine who’s still listening to him.

The New York Times just published a piece on HITECH, citing a letter that urges not just throwing EHR money at doctors, but also distributing lessons learned via "Regional Health IT Extension Centers" to help out with projects in small medical practices, which sounds like a great idea. You will note that the letter (warning: PDF) has few vendor signatories, unsurprisingly.

Cerner’s Q4 numbers, announced after the market close: revenue up 18%, EPS $0.86 vs. $0.49, thrashing expectations of $0.59. Say what you want about good old Republican boot-strapper and plain-speaking Neal, but the man knows how to run a company better than those big, fancy foreign conglomerates choking on healthcare IT and everything else they toe-dip into. Thank goodness for MEDITECH, Cerner, and Epic, run by the founders instead of hired gun Wall Streeters and sticking to their healthcare IT knitting instead of selling nuclear weapons, theme parks, and jet engines (not to mention toxic assets to taxpayers in one huGE example).

I got a couple of e-mails suggesting that Medical Records Institute, the folks who run TEPR, have laid everyone off and closed down. I’m sure that’s somehow tied in with their new focus and conference, but perhaps the change was more severe than was hinted. I’m sure updates will follow.

Listening: Seether, South African metallish grunge.

IBA/iSoft gets two contract extensions with Netherlands hospitals.

A surgeon in Australia develops a USB emergency button that, when pressed, sends a message to all PCs on the network along with the location of the sender. He created it after noting that several doctors had been killed by patients.

Allscripts announces that it will sell its Medication Services business (I asked Glen Tullman about it almost three years ago). The company also approved a $150 million stock repurchase plan.

Hospital layoffs: Columbia St. Mary’s (WI), 54; Cascade Healthcare Community (OR), 74.

Jobs: FCP-MS4 Patient Accounting Expert, McKesson Horizon Lab Consultant, IT Director.

Healthcare Growth Partners publishes its Q4 2008 Healthcare IT Transaction Summary & 2008 Year in Review (warning: PDF).

IBM and UnitedHealth test the medical home model, in which a primary care physician (not a gatekeeper) coordinates care among other medical professionals, often by using information technology. I’ll defer to Scott Shreeve, who provides a better synopsis than I can.

Interesting: hospitals that hire doctors often write employment contracts that don’t allow the doctor to contact patients if he or she leaves and also prohibits them from opening a practice within a specified radius. Patient are also charged large amounts to have their paper records copied so they can seek care elsewhere. Noncompetes are standard in business, in case nobody noticed that even non-profit healthcare is one.

A third of Australian healthcare and IT professionals say they’ve experienced compromised patient safety due to IT downtime.

Idiotic lawsuit: an admitted alcoholic on a two-day bender (more like a "breaker" in this case) in a Marriott falls more than 100 feet off a stairway while drunk, causing what he says is permanent brain damage. He’s suing the hotel for serving alcohol to an addict (him) and thereby causing his injury. He’s claiming injury, pain and suffering, anguish, disfigurement, medical expenses, loss of earnings, loss of the enjoyment of life, and aggravation of a previous condition.

A laptop stolen from Parkland Hospital (TX) last week may contain information on over 9,000 employees.

Availity announces the availability of real-time Florida Medicaid eligibility and claims status at no charge.

E-mail me.

HERtalk by Inga

From Ronald Miller: ”Re: Henry Schein. Former MED3OOO VP Keith Slater is now the GM at Henry Schein Medical Systems. Good move for Henry Schein. It was only a matter of time until they figured out they had NO CLUE how to deal with a PM/EMR product after spending all that money on it. Maybe now the button ups at Schein will do a better job than Pfizer did with Amicore.”

From Jerry McGuire: “Re: Great piece today with Allscripts CEO on stimulus. From your piece, it seems the curious angle is identifying when IT does and doesn’t serve as a stimulate function. Maybe a virtual roundtable?” We’d love to hear readers’ opinions on what IT functions could stimulate the economy.

The Washington Post posts a graphic that breaks down the $819 billion stimulus package. It doesn’t say where the $20.2 billion for HIT is going, much less what part of IT is stimulating, but it is a pretty impressive graphic.

Caritas Healthcare (NY) files for Chapter 11 bankruptcy protection and its two hospitals are projected to close this month. Caritas had a net loss of $64 million for 2008, prompting the board to vote to close Mary Immaculate and St. John’s Queens hospitals.

QuadraMed announces that revenue for FY08 will be slightly ahead of the $146-149 million guidance previously provided. The company also expects EBITDA to significantly exceed the previous $15.8 million target. Reading between the lines in the press release, Keith Hagen sounds a bit cautious when discussing 2009 and the company’s potential for new business: “Approximately two-thirds of our revenues are produced by recurring maintenance and term license contracts, and a large percentage of our 2009 revenue is expected to be generated by this recurring base, our project backlog, and our broad set of products and services."

The 25-bed Hiawatha Community Hospital (KS) becomes the 55th hospital to go live on IntelliDOT’s BMA system.

Catholic Health Initiatives names Michael O’Rourke its permanent CIO and senior VP. He’s been interim CIO since August 2008 for the 77-hospital organization.

Capsule announces that 10 new healthcare organizations selected its device connectivity solution during the last quarter of 2008.

Marshfield Clinic (WI) adopts a new BI solution to make better use of its vast amount of patient data. Marshfield will utilize SAP’s Business Objects XI intelligence system to improve patient care and analyze internal business operations.

Eclipsys announces that Greenwood Pediatrics (CO) has selected Eclipsys PeakPractice (the former Medinotes PM/EHR solution). The 10-physician group apparently chose Eclipsys over Epic, which their hospital offered to subsidize.

A former Queen’s Medical Center (HI) administrator pleads guilty in federal court for defrauding her former employer out of $594,000. Patricia Syling is accused of creating bogus contracts between a company she owned and Queen’s, and charging the hospital for services that were not performed. Syling was hired by Queen’s in September 2001 as the corporate compliance administrator and director of revenue cycle. In an unrelated charge, Syling is also accused of defrauding another former employer, Citrus Health Care of Florida, of more than $1 million and using $320,000 of the proceeds to buy a luxury sky box at Tampa Bay Buccaneer football games.

The McKesson Foundation awards $60,000 in grants to nine Minneapolis-St. Paul-area non-profits. The funds will be used to support health and wellness programs benefiting children and families.

A Texas Medical Association survey finds that doctors worry their financial hardships threaten quality of care and access. Declining payments, claim denials, incorrect or late payments, and administrative burdens are taking time away from patients.

The University of Chicago Medical Center (the First Lady’s old haunt) plans to cut 450 jobs in order to cut 7% off its annual budget. This is in addition to the elimination of 15 senior executive posts, including the one vacated by Michelle Obama (we’ll try not to be cynical about the huge raise UC gave her just before Obama won using the rationale that she was essential and therefore worth every penny).

MRO expands its services to include remote release-of-information processing and remote and staffed services.

HIMSS Analytics releases a list of the top vendors of acute care EHR systems based on total number of installations. For 2008, MEDITECH topped the list at 26.6%, followed by McKesson (14.1%) and Cerner (12.6%). I wonder how the rankings would end up if the list were based on number of total beds?

The octuplet story just gets crazier and crazier. Apparently the mom’s fertility doctor is not as successful as most doctors around the country, with his patients having much lower than average rates of pregnancies and births. Also, at least two former employees have sued him, including an office administrator who accused Kamrava of tax and insurance fraud. The office manager claims the office kept two sets of books, one for cash and the other for insurance, and some cash was never entered into the computer or deposited in the bank. Meanwhile the Kaiser Permanente hospital where the children are receiving medical care is requesting Medi-Cal funding to help pay for the octuplets’ medical care since Mom is unemployed, living on food stamps, and mostly letting her mother raise her first six children.

Compuware’s Covisint subsidiary collaborates with the VIP Health Initiative to provide a secure single point of access to share clinical data. The VIP Health Initiative was formed by Scripps Mercy Physician Partners, SMPP Services and Physician Partners Management Services.

Despite massive financial losses as a result of Hurricane Ike, UTMB Galveston intended to pay $3 million in bonuses until a faculty group discovered the plan. According to the Texas Faculty Association, once the bonus plan was uncovered, UTMB canceled the payments. The largest bonus recipient would have been the school’s executive VP, provost, and dean of medicine, who was scheduled to receive over $122,000 – on top of his $700,000 annual salary. The school claims it was planning to cancel the bonuses anyway.

E-mail Inga.

MD Leader 2/10/09

The Stimulus Bill Will Change How IT Data is Used in Healthcare

At this writing, the Stimulus Bill has not been passed, but it will change how we use IT. The funding and implementation incentives will get all the press, but it is the fine print that has the potential to change how IT healthcare information is used.

The Stimulus Bill will restrict use of healthcare data. To date, the biggest areas of concern have been:

• The use of patient consent for internal healthcare operations;
• Revised definitions of healthcare operations limiting use of patient information (potentially including use of patient information for quality reporting);
• Accounting for of all disclosures, even for treatment;
• Patient consent for information use by a healthcare exchange;
• Extending privacy and security rules to business associates.

None of these issues may appear in the final bill and additional elements can be added at the last minute. The legislation is moving fast and there will be unintended consequences. How government chooses to enforce the provisions and how our own organizations choose to interpret will determine the impact on our operations.

When the final bill is signed, evaluate the direct economic impact. Also be sure to look for additional provisions that will change how healthcare uses data.

Peter Sanderson, MD, MBA is a family physician and Director of Medical Informatics and Operations and Executive Sponsor, EHR Program, at Ministry Health Care. He can be reached at pete.sanderson@ministryhealth.org. He also blogs at MD Leader.

CNN: Compromise Stimulus Bill Eliminates All $2 Billion of HIT Grants

CNN reports that the slimmed-down economic stimulus bill being debated by Congress has had the $2 billion line item earmarked for healthcare IT grants removed as part of a cost-cutting compromise.

The original House plan called for $2 billion in HIT grants plus another $18 billion to be managed by CMS in the form of pay-for-performance incentives. Details of the current plan being debated have not been released.

UPDATE: a reader sent over a worksheet provided by his Senator. The House had originally proposed $2 billion for ONCHIT, while the Senate had proposed $5 billion. The proposed compromise calls for a $2 billion reduction from the Senate’s proposal, leaving $3 billion, which is still $1 billion more than the House had suggested. Those aren’t final numbers.

UPDATE 2: Here’s a link to the current version of the bill as of Monday morning (warning: PDF). The HIT grant part is on page 139, but here is the full text:

OFFICE OF THE SECRETARY
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH
INFORMATION TECHNOLOGY (INCLUDING TRANSFER OF FUNDS)

For an additional amount for ‘‘Office of the National Coordinator for Health Information Technology’’,  $3,000,000,000, to carry out title XIII of this Act which shall be available until expended: Provided, That of this amount, the Secretary of Health and Human Services shall transfer $20,000,000 to the Director of the National Institute of Standards and Technology in the Department of Commerce for continued work on advancing health care information enterprise integration through activities such as technical standards analysis and establishment of conformance testing infrastructure so long as such activities are coordinated with the Office of the National Coordinator for Health Information Technology: Provided further, That funds available under this heading shall become available for obligation only upon submission of an annual operating plan by the Secretary to the Committees on Appropriations of the House of Representatives and the Senate: Provided further, That the Secretary shall provide to the Committees on Appropriations of the House of Representatives and the Senate a report on the actual obligations, expenditures, and unobligated balances for each major set of activities not later than November 1, 2009 and every 6 months thereafter as long as funding under this heading is available for obligation or expenditure.

Monday Morning Update 2/9/09

From Doug DeCinces: "Re: E&Y. E&Y is shutting down its Health Sciences Advisory Services practice. At least 100 employees at all levels (partners and down) are losing their jobs." Unverified.

From Skeptic: "Re: TEPR. They’re claiming 800 registrants, which is pathetic even if the number is accurate. They’re also claiming that a common comment was ‘best program in 25 years.’" The only positive comment I’ve heard is that the weather was good. Now that HIMSS is eating the universe, it’s like the NIT basketball tournament once the NCAA expanded to 64 teams. If someone really wanted to offer a HIMSS alternative, it would need to be a lot cooler and a lot brasher. I’m thinking I’ll start a BIL conference or an unconference whose whole agenda is like the interesting, less commercial hallway meetings that are usually the best part of any conference. Those could be held at cooler, smaller, cheaper locations than the tired old Orlando-Las Vegas-Chicago circuit of mile-long convention centers and $15 room service burgers, like an HIT Chautauqua that leaves you educated, rejuvenated, and not embarrassed that your employer’s time and money were wasted.

From Kate: "Re: medDispense. Emerson (NYSE: EMR) bought them last month for an undisclosed amount." I confess that I didn’t even know that automated drug dispensing vendor medDispense was still around. Trivia: they started as a division of HCS, the Montgomery, AL software vendor who sold McKesson what is now Horizon Meds Manager. Emerson makes heavy duty commercial stuff like power plants and air conditioners. Not too successfully of late, apparently, since the company announced late Friday that it will axe 14,000 employees, more than 10% of its workforce, by October. The sale went through on January 15.

From Tarhill: "Re: HHS secretary. Has anyone heard if Newt Gingrich might be a candidate?" Well, like Daschle, he’s written books and held high political office. The similarities end there. Maybe he would be a good choice, but he brings a lot of baggage, is on the wrong ideological side, and would never fully trusted at the level Daschle would have been. The problem is that all the plans were built around Daschle, so he’ll be tough to replace even if the job is split into two (advisor and HHS leader). I hesitate to say this, but I’m not convinced he wasn’t the best choice despite questionable industry ties. Sure, it’s iffy that he was paid millions as a non-lawyer working for a law firm in ways that sure seem to indicate off-the-books lobbying, but if Obama wants political experience, every closet has a surplus of skeletons.

From Vendor Guy: "Re: QuadraMed. Heard a rumor that QuadraMed is getting to pull the plug on the old Compucare/Affinity product." Half accurate, as I suspected and Inga confirmed with a company spokesperson. QuadraMed recently notified existing Affinity Clinical customers that Affinity Clinicals will not be supported after 1/1/12. This is hardly a surprise: they were very clear with the QCPR acquisition that Affinity Clinicals weren’t up to snuff and that QCPR was a far better solution that would be the go-forward offering. However, the far, far more widely installed and much better Affinity Registration/Access and Revenue Cycle products aren’t going anywhere. See also the interview I did with CTO Jim Klein in HIStech Report: "We had to be frank with ourselves. The Affinity clinical system, unlike the patient accounting system, had not kept up with functionality. Both ‘build’ and “buy” options were viable, but people’s expectations about how the team could turn things around just screamed ‘buy.’" They’re offering deals and extended Affinity Clinicals support to customers who move to QCPR.

HIMSS just won’t seem the same without MEDITECH and Cerner there, will it? Maybe that’s a good thing. Past excesses at all levels (individual, business, and government) make it appropriate to tone down the boat show (and that MEDITECH, as the always-frugal but huge vendor, lead the way after Cerner). Non-conspicuous consumption is "in" again, thank goodness. The big question: will other companies follow their lead? My pledge: I will not criticize or allow criticism here of any company that decides to refocus their resources on something other than the HIMSS conference. Each vendor has to decide for themselves whether it’s worth it. Even if there’s little money to be saved by pulling out at this late date, I think both providers and vendors are cautious about appearing extravagant. I’ll be there, but I’ve always been a complete cheapskate, like subsisting at last year’s HIMSS on Subway sandwiches and going for the cheapest hotel on the bus route. I did buy a can of soda one day, but griped constantly about the cost to anyone who would listen.

Sisters of Charity of Leavenworth Health System (KS) sues Lawson Software for retiring "critical" applications it bought in 2001 for $1.4 million. Lawson says it will end support in May 2010 for employee time off tracking and medical supply inventory management. Their contract says they can exchange their applications for other similar ones for a nominal fee, but Lawson wants another $155K in licensing fees plus increased maintenance because their only other similar applications have additional capabilities.

A Sacramento publication (I’m guessing it’s one of those free counterculture weeklies that features wildly liberal articles, ads for sex chat lines, and good restaurant and concert reviews) takes on EMRs, managing to make Britney Spears the focus. Here’s a fun snip: "It [Kaiser] developed two versions before settling on its current HealthConnect project using Epic Systems software (which is quickly becoming the national standard for EMRs)." Popular, but a national standard? It may be an obscure publication, but Deborah Peel of Patient Privacy Rights found the article and left the only comment it has received, calling EMRs "dinosaur technologies" and urging readers to contact Congress to vote no on HITECH unless privacy provisions are added.

Clarian Health (IN) shuts down a $475 million construction project as part of an urgent cost reduction project that includes 10% pay cuts for VPs and efforts to renegotiate vendor contracts. More than 400 construction workers were immediately put out of work, some of them finding out only when they arrived at the job site Friday morning.

The University of Virginia Health System gets approval for a new $59 million EMR project. The vendor isn’t named, but I’d have to guess Epic given (a) the price; (b) the line about access to records anywhere on Earth; and (c) the fact that nobody’s selling any big deals these days except Epic (the hippie weekly may be right). I believe UVa was IDX/CareCast, so I assume GE Healthcare will be losing another customer.

Kaiser Permanente announces that a recently arrested non-employee had a computer file containing KP employee information, source unknown. They offered the usual free year of credit monitoring.

I’ve closed the two polls on economic conditions. Results: EMR vendor people say they’ve seen slowdowns because of the economy (68%) and because prospects are waiting to see if the government will help them purchase (11%). Only 21% say it’s business as usual with no slowdowns (it would be interesting to know which companies those are!) On the provider side, 54% of those considering an EMR purchase say they’re moving forward without planned delays, 38% say they’ve delayed their project because of the economy, and 8% say they’re waiting on possible government help. Respondent counts were 47 vendors, 26 providers. It appears that the possibility of government handouts isn’t holding many prospects back, but the economy definitely is.

New poll: if you went to HIMSS last year, what are your plans this year and what’s your employer doing? It’s awkward to phrase the question in a poll, but I did it this way: indicate whether you’re going or not, and then whether your organization is sending fewer people or not. People keep asking me how I think attendance will be; I can’t imagine it won’t be down, but conventions are like sporting events: fan-flation uses the most flattering number — turnstiles or ticket sales. I care less about announced attendance than what vendors tell me they’re seeing in the exhibit hall since, let’s face it, that’s the metric that drives conferences.

The Virtual Practice Project at Mass General is working on a medical kiosk that walks patients through touch screen-answered questions and checks blood pressure. The doctor in charge explains: "The way we deliver traditional health care is a bit antiquated. It’s based on face-to-face interaction between the doctors and the patient." I found this report (warning: PDF) which mentions that RelayHealth is providing some of the online visit technology.

The unSummit for Bedside Barcoding will be in Tampa May 6-8. Good agenda, good hotel, and CEUs for nurses, pharmacist, and lab techs. You save money by signing up by February 28.

Here’s a TV show that I hope has met its much-deserved demise: "Flip This House." When Joe Sixpack starts thinking he’s an expert in day trading, commodities speculation, and real estate investing, it’s time to run for the hills.

I think it’s obvious, but for any newcomers, you will want to read the article comments because some thoughtful conversations are to be found there. If you’ve clicked the e-mail link, you’ll see them automatically, but readers will post comments after you’ve read it. To see those, click the Home link at the top of the page, then click the "show comments" link at the bottom of the article. I’m pleased that folks comment quickly, knowledgeably, and respectfully, offering a nice mix of opinions (I don’t claim to be right all of the time and readers sometimes change my mind).

Also for newbies: add your e-mail address in the Subscribe to Updates box at the upper right of the page and you’ll get instant e-mail updates when I write something new (surely you want to be among the first to know — you should see the server drag when hundreds or thousands of people all hit the site at once when an e-mail update has gone out). The Search box does a Google custom search on HIStalk and HIStalkPractice combined, all 5.5 years worth (I may have mentioned your company, your boss, or you in those millions of words). Also, click that "Email this to a friend" graphic to alert some e-mail pals about an HIStalk article or click the horrid green Rumor Report box to tell me a secret.

One more update: someone asked for the "Print This Post" option that used to be here, so I’ve re-installed that function that I didn’t realize had gone astray. The link is at the bottom of each article.

Inga did a couple of cool interviews on HIStech Report. Our old friend John Holton of SCI Solutions provided his usual honest, experienced assessment of the industry ("PHRs are being developed by Microsoft and Google and others. It’s the way information will be stored and sent because no one really cares about your medical history except you.") She also talked to Bruce Cerullo of Vitalize Consulting Solutions, another friend of HIStalk who I had fun with at last year’s HIStalk HIMSS event ("Having really good people wanting to come under our umbrella is a win for them, a win for us, and a resulting win for our clients. I also think there will be a lot less job-hopping in general over the next 12 months. I believe we will see more stability among the consultant firms.")

Bizarre: Wuesthoff Health System (FL) is offering patients from competing hospitals $100 gas cards for a copy of their EOB. They want to see how they stack up on charges. Maybe they got the idea from Scott Shreeve’s Million EOB March.

Like it needed more bad news: Grady Hospital (GA) may be the source of four patients’ Legionnaires’ disease, which allows Legionella and attornii scumbaggia to thrive at the expense of normal species.

Four employees of Somerset Medical Center (NJ), one of them the hospital’s credit manager, are charged with altering patient bills to trigger $35,000 worth of refund checks made out to the four and sent to the same address. That doesn’t seem like a very smart plan coming from someone in management.

Idiotic lawsuit: a couple attacked and beaten in their home are treated at Stephens Memorial Hospital (ME). A security guard hears them talking about being attacked and calls police, who check out their house and find 95 pounds of marijuana, for which the couple pleads guilty. They’re suing the security guard and the hospital, claiming violations of HIPAA and state confidentiality laws, violation of privacy, and emotional distress.

E-mail me.

Report from the Field
Nick van Terheyden on TEPR

For those coming from the fully winterized East Coast and Midwest in February, any location that has a temperatures rising above 35° is going to be attractive, but Palm Springs would be hard to beat. Set in the shadow of the San Bernardino Mountains and weather that sat in the mid 70s and provided clear blue skies every day was a delight. The conference itself has clearly seen better days and estimates ranged from the “official” ~7-800, to my unofficial count at opening keynote of 4-500 to overheard “only 320 rooms sold." Whatever the number, it was small and often felt overrun with presenters and vendors.

AHIMA felt similar this year, with a distinct feeling that there were fewer attendees and several anecdotal stories of cancellations to save money. Even the RSNAathon was lighter than previous years, but with such large numbers to start with, the decrease has less impact. Fascinated to see how significant the effect will be on HIMSS.

The opening sessions were great, and like or not Adam Bosworth’s views on where to spend the $50 billion stimulus, he had a compelling story that was not about technology investment (surprising for an acknowledged pioneer of XML) but centered on incenting behavioral change in the US population to stop the epidemic increase in American waists. But it was the Illness in the Age of “e” hosted by Danny Sands from Cisco and his patient Dave deBronkart that stole the show.

In an emotional and graphic account, the pair detailed Dave’s experiences from the first incidental finding of an aggressive form of renal cell carcinoma through intense and “often severe and rarely fatal” side effects to the closest thing you can hope, for next to cured: No Evidence of Disease, or NED. Insisting on patient participation to help guide the process, even check for errors (he cited a recent case of wrong side surgery for someone with the same renal carcinoma where they removed the wrong kidney!) that would have easily been prevented with patient involvement. Nothing to bring home the relevance of what we all work for than hearing right from the patient’s mouth. Dave (@epatientdave) stayed the duration, shook up several other presentations, and joined the impromptu TweetUp by the side of the pool on Monday night with @alphabest @HealthITGirl and yours truly @DrNic1.

But no social networking presence from the Medical Record Institute, and as I pointed out in my Tweet, “It’s so Web 1.0…. no blog, no tweet, one month before presentations will be online." There was some activity as @Megan_maguire weighed in, but a little late. (unlike HIStalk and HIStalk Practice that have wrapped their arms around these media, use it effectively, and participate jacked in just like Neo from The Matrix – which is how I feel a lot of the time!)

The panel discussion with Google and Microsoft and MedCommons was a bust – and an education in panel techniques. Hearing three replies, all similar, to each question was uninformative and boring … sigh. The case is made — we need disruptive attacks to the current status quo and that needs to come from innovators who shake up the system and incumbents. PHI will play a role and the individual will become a key player. The recurring focus on the big cash supposedly heading for our industry was in many instances distracting and in some cases potentially detrimental since the likelihood that the cash will end up steered towards those with the best advocacy and influence in Washington places additional strain on the small upstart that is trying to disrupt the status quo.

The final panel discussions on Thursday were like many conferences — poorly attended, and at one point the panelists outnumbered the attendees. However — a gem from one of the discussions: "CCHIT certified EMR = unusable" … but you can *upgrade* to a non-CCHIT certified alternative.”

There was little traffic in the vendor area, which was located at the end of a long walk past all the educational sessions and had limited opening hours. The main topic of conversation was the likelihood of anyone returning to the show or if there would be a show to return to.

Sadly for this long time attendee, this year’s TEPR felt too much like an Irish wake without the alcohol. Much of the oxygen has been sucked out of the conference circuit by HIMSS, which is unfortunate since smaller conferences offer more opportunity to really meet colleagues and vendors and gather information in a practical learning environment.

MEDITECH Pulls Out of HIMSS 2009

MEDITECH announced today that it will not attend the HIMSS conference in April, citing the expenses involved for both the company and attendees.

The statement of President and COO Howard Messing is as follows:

Participating in the annual HIMSS conference has proven to be beneficial to MEDITECH and LSS through the years, as we have been able to renew acquaintances, attract new customers, and showcase new product offerings there. Nonetheless, the current economic climate mandates we pay particular attention to spending resources wisely this year. Just as we encourage customers to make HCIS selections based on value, we too must carefully evaluate our expenses and focus on priorities. For this reason, MEDITECH and LSS will not attend the HIMSS conference this year. Instead we will use communication channels such as our extensive program of regional events, annual workshops, Webex demonstrations, and meditech.com to share information. Using this approach, we will be able to continue sharing information on key topics, control our expenses, and minimize everyone’s costs.

News 2/6/09

From The Watchman: "Re: Epic. I hear that Judy Faulkner is telling newly signed clients to not use consultants, sending her own instead. Word is she was out at Dartmouth and at NYU saying the same thing."

From Carpluv: "Re: HITECH. If my practice is on a Stark-sponsored hospital ASP, will we still get the stimulus that totals $41,000?"

Inga worked hard to interview Glen Tullman of Allscripts in the pre-dawn hours this morning, so look for that to follow. I’ve given her the night off as her Employee of the Month award, so I’m solo-posting this time.

TEPR non-attendance and this should be scaring the bejeebers out of HIMSS: GE Healthcare cancels its August User Summit, citing customer travel cutbacks.

Community Medical Center (PA) signs for SIS.

TPD mentioned IPv6, the solution to running out of IP addresses worldwide. Here’s an article about it, co-authored by a VP from Stratus Technologies, an HIStalk sponsor.

This is odd but probably a good idea: Cincinnati Children’s Hospital offers employees a class in minimizing their foreign accents to sound more American. A bit steep at $2,300 considering the hospital benefits as well as the employee, but it’s still cool.

Listening: brand new The Red Jumpsuit Apparatus, melodic hard rock. Failure to air-drum is not an option. Also: A Cursive Memory.

Jobs: Epic Resolute Professional Billing Consultant; PMO Eclipsys, Cerner, or Epic; Team Lead, Load and Performance.

Rotherham NHS bails out of NPfIT to bid its own EMR contract, unwilling to wait for Lorenzo to be ready. They will issue their award shortly in a deal expected to exceed $50 million.

IBM announces software that will transfer medical device data into a PHR. IBM says it built the product following Continua’s guidelines. That’s kind of interesting, assuming doctors will find it convenient to get the information from the PHR. Since most of them wouldn’t have access to home monitoring data otherwise, maybe they’ll use it.

Terry Ragon, founder of InterSystems and co-founder of the former IDX, donates $100 million to Mass General with the goal of developing an AIDS vaccine within ten years. He’s also convinced several scientists to join up with the new institute bearing his name instead of working in their individual silos. All the money spent on Cache’ licenses and maintenance fees by users of MEDITECH, Epic, and a bunch more HIT vendors will at least go back to a worthy healthcare cause. That’s an amazing gift.

Inside Healthcare Computing has opened up its new Electronic Library, an archive of articles from that newsletter and its HIS Insider acquisition that’s available to everyone. Full articles are available from 2007 back, with more being added regularly. And while other publications and sites are awash in self-important policy analyses and spouting ivory tower eggheads, my guest contribution to the newsletter this week is My Lifelong Clock-Puncher’s Entrepreneurial Brainstorm: How the HIStalk Home Shopping Channel Will Make Me Rich. Don’t say I didn’t at least try to squelch the gloom and doom.

Sad: an elderly man injured in a traffic accident in Japan dies after being turned down by 14 EDs called by paramedics, reflecting lack of capacity in Japan’s hospital system. That’s not the record, though: one woman got shut out 49 times in Tokyo.

A UCLA photonics research group modifies a cheap cell phone with around $50 worth of parts to create a mobile lab for certain tests, such as CD4 or hematology. The device counts microparticles using a UCLA algorithm that’s 90% accurate. A biochemistry professor says, "What makes it quite valuable is that it is small and inexpensive. It’s also the scientific proof of a principle in its very early stages. Once the group puts more and more work into it there are going to be a huge number of applications that are going to come out."

Heart Imaging Technologies of Durham, NC, which makes the "100% client-free PACS" WebPAX system, announces a free Web site for patients to upload and share diagnostic-quality DICOM images. It allows anonymizing the images, has some PACS-like viewing tools, and provides discussion tools for each image in a kind of social networking wraparound to medical images. I’m not exactly sure how patients will use it, but it’s available for research and educational use as well.

Hospital layoffs: St. Clare (WI), 25; Santa Rosa Memorial Hospital (CA), 152; Petaluma Valley Hospital (CA), 30; Swedish Medical Center (WA), 200; Niagara Health System (ON), 90.

Speaking of St. Clare, notice the ironic juxtaposition of the layoff story right by their paid recruiting ad. 

A former employee of Bon Secours DePaul Medical Center (VA) is sentenced to a year in jail for using patient information from the hospital’s computer system to apply for loans in their names, then stealing the loan checks from the mail.

Red Hat announces a call for papers for its Red Hat Summit in Chicago, September 1-4. Papers are due March 9.

Idiotic lawsuit: a golfer’s ball ricochets off a yardage marker on the course, hitting his eye hard enough to cause a permanent loss of sight. He’s suing the golf course, saying the owners should have warned him about the markers. "It’s not a frivolous, run-it-up-the-flagpole-and-see-who-salutes kind of thing," his lawyer assures.

E-mail me.

News 2/4/09

From At TEPR: "Re: I’m at TEPR. Attendance is way,way down. I feel sorry for the MRI, and that’s bad to feel sorry for a good organization. Might be best to pull the plug and go out with dignity, or else morph into something else."

From oneHITwonder: "Re: TEPR. Opening session — 3 hours and 15 minutes straight, four different speakers. Nothing earth-shattering in the first three, couldn’t sit there for the fourth speaker. Breakouts are organized strangely, with multiple speakers on a related topic grouped together, some talking for 20 minutes, some 25 minutes, some 30 minutes. Makes it very hard to session-hop. First two speakers in breakout were like an advertisement for particular vendors. Interesting to learn about new products, but geez. The best part of the day was the conference center fire alarm that got me out of one session that was a bit dull. Oh, and no refreshments other than water. Lunch was a brown bag with a chicken wrap and a cookie … the cookie was 631 calories…OMG! But for those of you buried under snow, it was 82 degrees here yesterday!"

From The PACS Designer: "Re: IPv6. The Internet is running out of available IP addresses and it is forecast that the 4 billion address maximum will be reached by 2011. To alleviate this problem, some of the countries outside the U.S. have already upgraded to the new Internet Protocol version 6 or IPv6. The IPv6 can handle 340 billion or more addresses, so upgrading your systems to be able to handle IPv4 and/or IPv6 will be necessary in the near future." Link. 

From RIS Guy: "Re: Agfa. As a follow-up to the report a few weeks ago about Agfa cutting sales positions, they laid off 80 people in their service and support groups. They were already threadbare."

From Tom DaschedHopes: "Re: printing HIStalk. Is it possible to have a printer-friendly button for articles?" That was apparently lost in the recent upgrade, which I hadn’t noticed. I will try re-installing it. I liked it myself.

Another Obama nanny tax washout: chief performance officer candidate Nancy Killefer, who withdrew her candidacy Tuesday for the same "distraction" reason that Daschle gave. The former Treasury Department CFO led the modernization of the IRS, but once she left office, had a tax lien placed on her home for $298 in unpaid taxes. Treasury Secretary Geithner somehow slipped by despite far more significant transgressions. 

Guess which regional healthcare therapeutic product business grosses $100 million a year, pays its CEO $500K, employs 1,000 people, and has people questioning why its board members are also its vendors? The non-profit Florida’s Blood Centers of Orlando. I suppose its tough not to make a fortune when your product cost is zero (courtesy of donors) yet sells for $300 a unit to other non-profits.

Philips creates the iPill programmable pill (technically, iCapsule) that can be directed to travel to specific parts of the body and to release its payload in specific ways. Mentioned here before, but apparently closer to reality.

An Allscripts survey finds that physician groups are overwhelmingly happy to take federal stimulus money to use toward EHR adoption. Less consensus was found in what form the payments should take — being paid to buy EHRs or being paid to use them. Two-third of doctors said they would participate in a pay-for-purchase program, and not surprisingly, practices that already have EHRs think Uncle Sam should reimburse them retroactively. Survey flaws: only 15% of the respondents were actual providers; the rest were administrative staff. EHR users made up 60% of those surveyed, far outpacing overall adoption. And, the response rate was less than four percent. That’s not a criticism of the survey, just the usual cautions about drawing conclusions from it.

London Health Sciences Centre gets a magazine mention for its Censitrac software system that tracks medical instruments in sterile processing right down to the tray and follows them through the cycle of use and preparation for re-use.

Epocrates enhances its iPhone drug reference application with a premium version that includes disease content and medical calculators.

SafeMed, the real-time analysis vendor that Google Health uses, changes its name to Anvita Health. It claims the new name (from some Sanskrit word that nobody’s ever heard of) is more reflective of the company’s expanding decision support capabilities beyond the original drug interaction checking. I’m suspecting an infringement lawsuit, but I’m reliably cynical.

Apple and Adobe are collaborating to create an acceptable version of Flash for the iPhone.

I did an HIStalk Practice interview with Garrison Bliss, MD of Qliance, a concierge-type medical practice in Seattle. I really like the concept: patients pay from $49 to $129 per month, depending on their age, whether they want family medicine vs. internal medicine coverage, and whether they prefer after-hours access to general coverage vs. a specific physician. There’s no contract required and no exclusions by health or insurance status. They use technology, although I see all the sign-up documents are PDFs that have to be mailed or faxed back. This blogger wrote a great piece summary of the model.

E-mail me.

HERtalk by Inga

From Tempid: “TEPR. Official attendance is supposedly over 700 people, but the opening session looked to have only about 200 people. A few years ago, this show drew about 2,500. But the weather is great.”

I’m feeling pretty 2.0-ish, using Twitter to follow the TEPR show. Nick van Terheyden provided some great impressions, including: “Interesting view shared @TEPR. It’s so Web 1.0…. no blog, no tweet, 1 month before presentations will be online; Google thinks PHR penetration is 2-3%; The panel format is difficult since we get 3 similar answers to each question.” Nick said he would try to give HIStalk readers a more expanded write-up. (Nick is my latest BFF because he took the time to check out my LinkedIn photo and tell me he loves it).

Speaking of Tweetering, is it appropriate to send Tweets while your wife is delivering your child? Or, while you are in the middle of getting a vasectomy? (Note to self: ask these questions before getting serious with next boyfriend).

UMass Memorial Health Care (MA) selects dbMotion to create a single, interoperable electronic patient record across various IT environments and care areas.

Yet again, Nuance Communications extends its cash offer to acquire Zi Corp. Nuance is giving the shareholders two more weeks to consider the merits of its $.40/share offer. I wonder if I’d like having a boyfriend as persistent as this?

The National Qualify Forum (NQF) names Memorial Hermann Healthcare Systems (TX) the 2009 NQF National Quality Healthcare Award winner.

Medical Records Institute announces the 2009 TEPR Award winners. The VA won first place with its MyHealtheVet PRH and the Private Access suite won in the “Hot Products" category.

HIMSS announces that registration for its annual conference is ahead of 2008 trends. Non-exhibitor attendance is up almost three percent from the same period last year.

Police take a prisoner to United Medical Center (DC) for unspecified medical treatment. The patient/prisoner is allowed to go the men’s room alone, wearing only a white shirt and boxers. Before anyone has time to miss him, he climbs through the restroom ceiling, reaches another hospital room, and escapes. The prisoner has not yet been found. The paper indicates that the police didn’t provide a description of the boxers.

Researchers develop a new application for RFID that evaluates walking patterns to detect early signs of dementia.

Quality Systems, the parent company of NextGen Healthcare, reports a 17% jump in net income in its fiscal third quarter, to $13.2 million. Revenue grew 36% to $65.5 million. The bulk of the earnings came from the NextGen division, which posted $61.5 million in revenue (up 40%) and operating income of $22.8 million (up 28%). About $7.5 million of NextGen’s revenues came from two separate practice management companies acquired last year.

Mediware Information Systems reports a Q2 profit of $303,000 ($.04/share) compared to a $337,000 loss the same period last year. Revenue was up from $8.7 million a year earlier to $10 million.

Aspen Valley Hospital (CO) signs a five-year extension to its business process outsource agreement with CSC. The original outsource agreement was with First Consulting Group in December 2005. CSC also announces a new subscription tool called HealthSpace Advisor, which enables hospitals to analyze how effectively they’re using space in key revenue-generating areas.

Logical Images names Andrea Pennington chief medical office. The company provides decision-support technology for diagnostic-imaging providers.

E-mail Inga.

Daschle Withdraws from Consideration for HHS Secretary

Tom Daschle has withdrawn from being considered as HHS secretary, citing his desire to avoid distractions over his failure to pay taxes previously owed. President Obama said, "I accept his decision with sadness and regret."

Daschle was quoted as telling a journalist this morning, "I read the New York Times this morning, and I realize that I can’t pass health care if I’m too much of a distraction."

Being John Glaser 2/3/09

An Alternative Plan for $20B

The congressional discussion around the $20B HIT investment is rapidly drawing to a close. However, there may still be time to discuss an alternative investment approach.

Rather than financial incentives for physicians and hospitals, education of HIT professionals, and other current ideas, I came up with the following.

For Healthcare Providers

There are something like 4,000,000 physicians, nurses, and other allied health professionals. For each of them, we would get:

• 3-D goggles. These goggles will improve EHR usability and hence we’re more like to see high levels of e-prescribing and other important EHR uses. I would suggest that we get high quality goggles; not the Super Bowl cheap kind. 4,000,000 providers x $30/quality goggle = $120,000,000.
• iPhone. Again, to improve ease of use and also provide some cool software (including a GPS so they know where they are in the hospital) I would get all providers an iPhone. 4,000,000 providers x $200/iPhone = $800,000,000.
• EHR baseball caps. So their patients know that they are all on the EHR team, we would get all providers an EHR baseball cap with a fancy EHR logo. 4,000,000 providers x $12/cap = $48,000,000.

For HIT Professionals

I think (without facts) that there are something like 200,000 professionals who will be involved in EHR implementation and support. For each of them, we would get:

• Oscilloscope. This will help troubleshoot EHR problems and configure the software. 200,000 professionals x $1,200/oscilloscope = $240,000,000.
• Soldering gun. They will also need a soldering gun to fix any problems they find. 200,000 professionals x $200/soldering gun = $40,000,000.
• Trinkets. All of these professionals will go to HIMSS to hear talks and see what’s what in the exhibit hall. Since we want them all to get high quality exhibit hall trinkets, I am proposing that each attendee get $1,000 worth of trinkets. 200,000 professionals x $1,000 worth of trinkets = $200,000,000.
• Infrastructure. To connect all of these EHRs, we will need an EHR satellite. 1 satellite x $1,000,000,000/satellite = $1,000,000,000.

Patients

We should do something for patients since this really is about them. I had initially thought that we’d get everyone in this country an electronic stethoscope that could be connected to the satellite, but with only $20B, we can’t afford it. 300,000,000 people in the US x $300/stethoscope = $90,000,000,000.

We have $17,552,000 left to spend. This is approximately $60/person.

Since it will take some time to launch the satellite and manufacture and distribute goggles, caps, trinkets, etc. and since we want everyone to take better care of themselves soon, I would get each person in this country:

• The AMA Family Medical Guide at $30 each
• A Deluxe Pilates Exercise CD at $30 each

And that’s the alternative plan. Some of the estimates of healthcare professionals and EHR staff may be low, but I am also sure that we could get a bulk deal on the items above and still stay within budget. We may not be able to get a deal on the satellite.

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

What Usability Is and How to Recognize It

By Jim Bradford, Ph.D.
The Bradford Report

From time to time when I use a new application, I seem to develop a kind of Tourette’s Syndrome characterized by teeth grinding, fist clenching, and dark mutterings. As I struggle through yet another badly designed, user-unfriendly system, I find myself wishing fervently that Bill Gates had finished college.

Technically, the user friendliness of a system is known as “usability.” There is an entire academic discipline (variously called “Human Factors” or “Ergonomics”) that is devoted to the study of usability. But if you don’t happen to have a Ph.D. in Ergonomics, how do you recognize a well designed, highly usable system?

Mental Models and the Psychology of Geeks

The human brain constantly monitors the environment and creates models about it. This allows us to think about our environment and make predictions about what will happen next. We carry over this natural tendency to model things into our interaction with computers.

Not all models are created equal, however. I have a friend who believes that if you set a thermostat as high as it will go, it will warm up the house faster. It is not an unreasonable model — it just doesn’t happen to be right.

The best system designers work hard to give you many clues about how a system works. This allows your brain to make a good model that produces accurate predictions about system behavior. When you encounter such a system, you begin to feel that the system is natural, intuitive, and easy to use.

Unfortunately, geek psychology doesn’t often lead to this kind of design process. In 1971, Gerald Weinberg published his (now classic) book, The Psychology of Computer Programming. To boil a long tome down to its essence, the kind of person attracted to computer programming is frequently the type of person the media would characterize as a “troubled loner.” Unfortunately, the design of usable systems requires a well-developed ability to understand how people think, feel, and react when confronted with a complex system. As a rule, troubled loners are not good at this.

As a consequence, human factors experts are often drawn from the “touchy feely” disciplines (i.e., anything other than engineering or computer science). They are often brought in to fix computer systems that are so horribly hard to use that almost no one can make them work. This strategy is akin to bringing in a doctor only after the patient has died. The usability specialist does what he or she can, but the result is usually a system that has evolved from being impossible to use to the point where it is merely frustrating to use.

The traditional approach to developing computer software (design-code-fix) is pretty well entrenched. Thirty years of preaching from academia has not noticeably improved the usability of computer systems. The key to usability, I believe, is an informed and demanding consumer. This is rooted in a fundamental property of a free market economy — if people stop buying poorly designed products, companies will eventually stop making them.

The Informed Consumer—How to Recognize Usability

Affordance

This design principle dictates that the appearance of things should provide a strong hint about how they are used. A hammer looks like it would be good for driving nails. A screwdriver suggests how screws should be managed. An espresso machine … well, not so much. Hammers and screwdrivers have good affordance and espresso machines have poor affordance. When you look at the user interface of a new piece of software, do the commands, buttons, menus, and other gizmos give you a good idea of how to use the system? If they don’t, it’s Strike One against the designer.

Prescriptive Feedback

When using complex systems, people will make mistakes. This provides the acid test for usability. Have you ever encountered an error message that says something like, “Illegal command or filename”? Good grief! Which is it, the command I just used or the file I just named? What law did I break? What makes a command illegal? Why can’t I call a file anything I want?

Can you imagine if other products were designed like software? Can you imagine a dashboard trouble indicator saying, “Illegal battery voltage or engine temperature”? If software doesn’t help you fix mistakes, then it is Strike Two against the designer.

Task Fit

Software is a tool. Some software is a tool for creating documents, other software helps manage your finances and still other software exists purely to entertain you. Well designed software should focus on doing a small number of distinct tasks (a half dozen at most) and it should be obvious how the controls of the user interface help you do each task.

Unfortunately many software companies prefer a “one size fits all” approach to development and end up creating a “one size fits nobody” product. If it’s not obvious how a software application’s capabilities relate to the task you have in mind, then it is Strike Three against the designer.

The Bottom Line

In recent years, the nature of our daily lives has changed to such an extent that many of us spend the majority of our working and private lives sitting at a keyboard. Usability has become an important determiner of the quality of life for citizens of the twenty-first century. If the software you use is not intuitive, if it is not helpful, and if it doesn’t fit the tasks you want to do, then walk away … just walk away.

Jim Bradford is a scientist, professor, and consultant dedicated to the art of making technology easier to use. He wrote this article specifically for the readers of HIStalk after we exchanged e-mails about the problem of usability in healthcare applications.