Monday Morning Update 11/30/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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News 11/25/09

From Dolphins Fan: “Re: Accretive Health. I finally had a chance to read the Accretive SEC filings. Ascension Health is their largest client as well as a major (11% stake) investor. I wonder how Wall Street reacts to a situation where the client supplying the largest share of company revenues is also someone who stands to gain big from the IPO? Take that major investor/client out of the revenue mix and this is really a pretty small company.”

From Chanice Kobolowski: “Re: Epic registry. Hospitals that need Patient Registry functionality should look into Phytel. Epic has a great deal of this functionality embedded in their integrated applications, but the true registry functionality is not present, in my opinion. Several Epic clients use Phytel for this need.”

From Kid Rockette: “Re: vendor installations. Is there a free source that says which hospitals are running which clinical information systems?” None that I know of, but I will defer in case anyone has a source. CHIME used to have something, I think, but I don’t know how current or pervasive it was.

From Goin’ Mobile: “Re: blog format. I often read your blog on my iPhone. Have you ever thought of running a WordPress plug-in like WPtouch iPhone Theme? It nicely formats the blog for mobile devices.” I have WordPress Mobile Edition running, although I need to upgrade it. I looked at the iPhone theme but it scared me since it seems to want to take over the master theme, which would displease the 99% of readers who are reading from a PC screen. Maybe I’ll get some expert to figure it out for me since I like the idea.

From Carol Queen: “Re: Flash ads. We are a sponsor and I vote against the flash ads. Let them use a link to tell their story. Flash is annoying and I actually ignore ANY Flash ads, anywhere.” A reader sent over an recent article whose finds were that most Flash ads are ignored, but text-based ads surprisingly aren’t (since they seem to offer solutions to whatever the reader is looking for). The bottom line was that simple ads work best on Web sites. Some sites ban animated ads, but I’m uncomfortable telling marketing pros which ads will probably work best even though I probably know pretty well from experience and personal preference.

From IT_Nurse: “Re: unions. In the September issue of Registered Nurse (a California nurse’s union magazine), there’s a 20-page tirade about the evils of HIT, including CDSS, CPOE, EBM, EHR, HIE, HIT, RCM, RFID, RTLW among others. Their conclusion: the whole industry is just a management ploy designed to replace RNs and should be resisted at every opportunity.” It’s really hard to take a professional group’s union seriously when they are so quick to lash out at everything that’s employer-related, all while using what they claim are the best interests of patients as a hammer to beat management over the head. They probably have a good point every now and then, but as a former manager in a violently unionized hospital, everything I saw first-hand was highly negative. You haven’t lived until you’ve seen striking union lab techs and nurses destroying hospital lab equipment, blocking ambulances and doctors from getting to the ED, and cursing and taunting the family members of patients trying to check on their loved ones. And, the union’s blocking of my attempt to upgrade some of my para-professional staff so I could pay them more  because it “would cause resentment” — meaning my people were paying mandatory dues to an organization who refused to let me increase their wages. Or, like this current example, where the Steelworkers Union (which represents non-professional hospital workers!) is suing a hospital for banning smoking on campus.

Analytics vendor Quantros licenses University of Michigan-developed technology that creates Patient Safety Indicators from discharge diagnosis codes for follow-up.

What’s driving me up the wall lately: crappy online slide shows that magazines put together for some reason. I get a teaser e-mail for “Top 16 Declining Tech Salaries for 2010” (you know who you are, eWEEK), click the link, and only then find out it’s the cheesiest, slowest, dumbest slide show in the world. Not only do I not need to see stupid clip art with what little story is there, I don’t need to click and click and click (of course, they love that since they are probably selling ads based on clicks). I will not waste 10 minutes watching a slideshow that contains content I could have read in literally 20 seconds had they not been so cutesy about it.

The Army creates the Joint Telemedicine Network for a relatively cheap $10 million, allowing X-rays to be transmitted among its far-flung facilities into the AHLTA EHR. Before it was implemented, soldiers being evacuated from the field often beat their X-rays to Landstuhl AFB, making trauma treatment within the Golden Hour impossible. Kudos to those named in the excellent Nextgov article as key players: now-retired LTC Alfred Hamilton, CMIO; LTC Nanette Patton, deputy CIO; Salvatore Granata, project manager; and MAJ Dan Bridon, director of command, control, and communications for the 30th Theater Medical Command at Bagram AFB, Afghanistan.

I’ve mentioned before that HIStalk’s sponsors, in most cases, aren’t just running ads — they are fans of what we do who read it and want to support it. Submitted for your approval: Quality IT Partners, a new sponsor who did a reverse sponsorship in putting the HIStalk intentionally ironic smokin’ doc on their page along with some nice words.

Thailand-based Hospital OS, an award-winning open source hospital systems vendor, is giving hospitals analyzed information back from their data: best practices, clinical guidelines, alerts, and an epidemic alarm system to track disease outbreaks back to their source.

Listening: Supergrass, British alternative that’s been around since the early 1990s. Reader recommended as something I’d like, which it is.

This brilliant MSNBC article speaks volumes: New York medical practices are using separate entrances and providing different levels of service for patients with and without insurance. Example: Lenox Hill Radiology takes insurance, requires 15 days to get an appointment, takes more than a week to give results by mail, and always has 20-30 patients crammed into its waiting room. New York Private Medical Imaging has a four-chair waiting room for its cash-only patients, gives appointments in two days, hands out plush robes instead of flimsy gowns, and doctors read the images immediately and visit personally with the patient immediately after. The separate entrances lead to the same techs, rooms, and equipment because it’s the same company with the same radiologists reading the images. Most interesting is that patients on the boutique side are warned not to tell the insurance patients about “their door” and employees sign a written policy agreeing to do the same.

The EHR of Mater Health Services in Australia holds the records of 1.4 million patients, connects 95 separate clinical systems, and handles 100,000 messages per day, integrated using InterSystems Ensemble.

Michael Nauman is named VP/CIO of Children’s Hospital and Health System (WI). Old news that I missed until now.

I’ve been really busy lately, so I’ve got a backlog of interviews and reader articles ready to go. Soon it will be time for the HISsies voting, additional ideas for the HIMSS event (shaping up nicely, I should add), and maybe some new stuff. It’s been a really good and fun year, even though I occasionally wish I’d done something more than work all the time. The thanks I’m giving, in no particular order: Mrs. HIStalk for putting up with me, Inga for making what we do fun, those in the military for the sacrifices they make, and the people who are in healthcare and healthcare IT for patients and not a bloated paycheck. And of course, every HIStalk reader, sponsor, guest author, and interviewee who makes me anxious to run to the computer as soon as I get home from work every day and stay there for way too long.

The plastics convention people aren’t just taking their show to Orlando after decades in Chicago, they’re running a Crain’s Chicago Business investigative piece on the authority that runs McCormick Place: (a) the CEO got the job after raising money for Rod Blagojevich and lots of its bigwigs are connected to the Daley political machine, including a former bartender given a $130K HR job because of connections; (b) despite extortionate charges, it loses a ton of money; (c) it taxes citizens directly, collecting over $100 million a year and borrowing $2.5 billion using the state’s credit line;  (d) McCormick Place West was a 2007 boondoggle that will fall short of paying itself by $500 million; (e) they’re laying off 500 people despite having added more senior managers; and (f) companies that contributed to political campaigns got contracts to service the facilities despite their markedly higher bids. If you are shocked by any of this, you obviously don’t know much about Chicago (I like to think President Obama is clean, but the fact that he worked his way up there makes me wonder since honest Chicago politicians are unheard of).

GE gets into the Web-based teleradiology business in India, planning to provide software and hosting to emerging markets.

LogMeIn’s remote support solution wins a healthcare IT award from a company that helps vendor sell stuff (“innovative sales and marketing solutions”). I’m sure there is no connection, especially since “hundreds of IT executives” voted for the winners “after previewing and learning about new technologies and services in private boardroom appointments”.

Nuance announces Q4 results: revenue up 3.9%, EPS $0.02 vs. $0.09, beating expectations. 

Strange: Apple says users void their warranty if they smoke around their Macs since the second-hand smoke is a biohazard for its techs. And, the Turkey Genome Sequencing Project gets a $900K grant to find ways to improve the immune system of turkeys, with the timing of the announcement being fortuitous since I assumed the purpose isn’t to enhance the quality of life for Thanksgiving-doomed turkeys, but rather to keep the cost low and the profit high in selling their carcasses.

What the authors of a Christian Science Monitor editorial hate about the Senate’s healthcare bill: mandatory insurance, HIEs, EDI, analysis of data for effectiveness research, and unprotected PHI.

Odd lawsuit: a woman has surgery without fentanyl when a drug-addicted nurse steals it, replacing it with water. She’s suing the nurse and the hospital.

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HERtalk by Inga

Sarasota Memorial Health Systems recently entered its 50 millionth order into Eclipsys Sunrise. I was having trouble grasping how many 50 million is, so I did some simple math. If you input 27,397 orders a day, it would take five years to enter 50 million orders.

Cascade Healthcare Community (OR) leverages Accenx ExchangeT to integrate its clinical information system to distribute lab results to community clinics and regional hospitals.

The Rochester RHIO says that over 100,000 patients have opted to share their health information with their participating doctors. About 500 physicians are participating in the RHIO, which uses Axolotl’s Elysium Patient Index to manage the patient data.

Iowa’s Medicaid program is the first recipient of a federal matching funds program for EHR. The $1.6 million grant from the CMS will allow Iowa to begin planning the activities necessary to implement EHRs.

The prolific folks at KLAS release a new report examining revenue cycle consultants and whether the returns are worth the investment. Perot Systems was the top performer in the extended business office category.

Meanwhile, KLAS says it’s making its performance evaluations shorter, based on feedback from providers and vendors. KLAS will also begin grouping questions on software into four main categories. The goal of the changes is to eliminate redundancy and focus on questions that best differentiate vendors.

The current poll to the right points out that EMRs have not been shown to improve quality or cost and asks who’s to blame. I think the ever-brilliant Mr. H left out at least one blame category (it’s probably due to all those long hours he has been working). I don’t think the issue is necessarily software nor providers needing to use the software better. Instead, perhaps we should look at implementers (who may be vendors, consultants, or internal staff) who fail to diagnose flaws in work processes and thus promote inefficient workflows. Of course, someone could still say the software doesn’t lend itself to efficient workflow (so blame the vendor) or that providers won’t change (blame hospital management).

Mr. H and I are facing some new competition in the blogosphere with the launch of HHS’s Health IT Buzz. David Blumenthal says he will use the forum to report on the progress of healthcare technology, health information exchange,  and the meaningful use of EHR, plus “create an open dialogue among members of the health IT community.” Kind of like what we do here but probably without Mr. H’s the good / the bad / and the ugly approach. Likely no music or shoe recommendations either.

Speaking of shoes, a special thank you to all our wonderful sponsors who support HIStalk and HIStalk Practice. Without your support, I would be resigned to last season’s shoe fashions, which would certainly make Clinton Kelly cringe.

Zynx Healthcare partners with the Healthcare Solutions division of Keane to integrate Zynx decision support solutions with Keane’s OptimumTM EHR.

The House passes a $10 billion loan program to help doctors and small medical practices purchase EMR and other HIT systems. The bill would allow loans of up to $350,000 per physician and $2.5 million for group practices. The bill has now moved on to the Senate.

Dr. Blumenthal took some time out from blogging to announce HHS’s plans to make $80 million in grants available to help develop and strengthen the HIT workforce. Seventy million dollars will be available for community college training programs and $10 million will used to develop educational materials to support the programs.

The nation’s most stressful job: surgeon. Also making the Top Eight list are general practice physician, physician assistant, and newspaper reporter (no mention of bloggers, though). The least stressful jobs include computer systems analyst and software engineer (i guess when you are creating software you can’t get too stressed about missing release dates or producing buggy software).

In yet another new report, KLAS looks at the anesthesia information (AIS) market, which is deemed “small and immature.”  Of the 100 organizations interviewed, almost all claimed holes in functionality for reporting and integration. However, all products had generally high marks for ease of use. The highest rated products were GE Centricity Perioperative Anesthesia,  Philips CompuRecord, Picis Anesthesia Manager, and Draeger Medical Innovian Anesthesia.

Health Industry Insights releases two separate reports, each assessing the offerings in the ambulatory EMR space. The reports looks at the one-to-20 provider market, as well as the 20+ provider space. Mr. H wasn’t willing to pony up the few thousand bucks required to look at the report details, so we are hoping readers will fill us in. Sage Healthcare reports they did “great, landing firmly in the upper right quadrant on both reports.” eClinicalWorks also says they did “quite well.”

The MGMA sends a letter to David Blumenthal, noting concerns that an inappropriate definition of meaningful use and an ineffective administration of ARRA stimulus funds could result in a failed implementation of ARRA, needless squandering of resources, and significant disruption of the health system. MGMA offered several specific recommendations, including instituting a pilot test prior to the start of the program to ensure that the process of demonstrating meaningful use is achievable and practical. The letter also encourages the National Coordinator’s office to monitor the EHR marketplace for cost-effective and efficient products and to ensure fair business practices. To William Jessee and staff: well-done. MGMA is voicing valid concerns that highlight the many gaps in ARRA legislation, and offers logical recommendations. We absolutely need the meaningful use requirements to be achievable and applicable. And, why not do some testing in advance to make sure that HHS, vendors and providers all agree what meaningful use looks like. I am not sure how necessary it is to have the government provide vendor oversight; I mean, if a vendor doesn’t have a product that works, won’t market forces address that?  Still, MGMA did a good job addressing what are likely major concerns of its members.

I am truly thankful for many things. Near the top of the list are HIStalk/HIStalk Practice and of course Mr. H and our readers. Some days I have to pinch myself to make sure it’s all real, that I really do get to spend my days reading and writing about the fun world of HIT, that people send me notes saying they like my stuff, and that I even make a little bit of money doing it. I’m also thankful for yummy food, good wine, college football, and days off. Happy Thanksgiving!

Holiday greetings or football bets here.

Monday Morning Update 11/23/09

From The PACS Designer: “Re: Google’s Chromium OS. Google has just announced the Chromium OS, an open source project. Since it is a completely Web-based open source development application, it brings with it some interesting possibilities for developers and eventually users. The Chrome OS browser will still be used to access all of the Chromium OS applications that evolve from development efforts, and some of the new features will eliminate the need for a hard drive since solid state memory will take its place. Chromium OS Security is a new approach to address security flaws.” Video overview here. I’m buying the concept because the Chrome browser is shockingly faster than FireFox (and less surprisingly, IE) when it comes to running complex Web apps. I’ve moved to it almost completely, even though it has some annoying deficiencies (no Google toolbar and no drop-down history).

From Dr. Pepper: “Re: Flash animation in ads. It’s causing me difficulties in scrolling and appreciating the content of your Web site. Can you limit this or allow us to turn it off?” There are many ways, but here’s the easiest one: click the View/Print Text Only link at the bottom of a posting to bring up a nicely formatted, paper-sized Web page with a Print option. Even then, it would be great if you take an occasional look and/or click on the sponsor ads since they make the wheels go ‘round and often have interesting information to share (nearly all the sponsors are big fans of HIStalk beyond just running ads).

From Bernie Tupperman: “Re: Kaiser. US News & World Report named KP Medicare Advantage in Colorado as the best in the country for Medicare, with all the rest of the KP plans except one near the top of their markets.” I don’t have any first-hand experience with Kaiser, but the pitch from George Halvorsen’s  internal e-mail that Bernie forwarded is certainly compelling, not to mention big on IT:

When you are a KP Medicare Advantage member and have coordinated care, fully linked caregivers, prescriptions and tests done onsite in convenient proximity to the rest of our care team and then leave our coverage and have to go out into the wilderness of solo, unconnected, unlinked, uncoordinated doctors — and when your new doctors don’t even know what prescriptions other doctors have written or what tests your other doctors have taken — and when you can’t schedule an appointment electronically or order your refill prescriptions electronically or even send e-mails to your doctor — those patients feel like they have fallen into a time warp into a very primitive world.

From Cam Winston: “Re: Pennsylvania HIE. I’ve heard Medicity has been chosen as the vendor in a $10 million deal.” I’ve seen that mentioned, but not officially. I’m sure Medicity won’t issue a press release until the contract is signed. Obviously that’s a big win for them if so. That led me to think how long it’s been since they started sponsoring HIStalk and I think it was in 2003, the year I started writing it. I don’t know where the time has gone. Including this year — can it really be just three months or so until HIMSS?

I’ve been slightly involved in some software usability projects over the years, so I enjoyed these clips (above) of real-life user frustration with healthcare software. They’re from Healthcare Human Factors, based in University Health Network, Canada’s largest teaching hospital. Thanks to JustAThought for sending over the link.

The Harvard people who published the study (warning: PDF) saying EMRs don’t improve quality or save money don’t exactly come across as impartial academics in an interview with HealthLeaders Media. Some quotes: “The idea from this administration that we’re going to pay for health reform out of savings from electronic medical records is baseless propaganda … What kind of an idiot hospital administrator would buy a system that will actually decrease what you can bill to payers? These systems help them extract more money.”

Speaking of those Harvard authors, nobody seems to have noticed that they wrote Bleeding the Patient: The Consequences of Corporate Healthcare and seem to have a socialist bent (“only when the U.S. has a party of labor will we have a national health program … it’s going to take a broad strengthening of the left.”). They also founded Physicians for a National Health Program, which advocates single-payer national health insurance, so they have an agenda that goes beyond IT. They also advocate open source over vendor systems: “We should really think about whether we want to continue to use our public funds to promote private, entrepreneurial HIT systems that have a business orientation, or if we should use those funds for further development of less expensive, open-source HIT systems designed specifically to enhance the quality of patient care, just as the VA health system has done.” Not to quibble, but the VA didn’t get VistA for free — it spent what must have been millions if not billions to develop it, and unlike vendor system development, taxpayers footed the bill. Even though the authors seem to have strong opinions that bled over into what was supposed to be a research article, I can’t say I disagree with most of what they say.

Meanwhile, here’s how the authors did the research for their article. They matched up self-reported levels of hospital automation from HIMSS Analytics with Medicare Cost Reports and Dartmouth Health Atlas data over a four-year period, looking for a correlation between degree of computer use (calculated from the authors’ own formula), cost, and quality. They not only didn’t find any, but even the Most Wired hospitals showed no clear advantage. There are lots of limitations in their method (using Medicare cost data, using the limited quality measures in Dartmouth to extrapolate overall quality, and having incomplete data for some of the years). Do their conclusions hold water? Maybe in aggregate.

Here’s the same observation I always make when the Most Wired people use similar number-crunching to try to convince you that IT improves costs and outcomes — correlation is not causation. Also, the conclusion isn’t that IT isn’t worth it, only that they could not prove that it was from their approach. Still, I’ll go with their general conclusion since I’ve been saying it for years — if there was one rock-solid case study of a hospital that reduced cost or improving quality solely because of IT, that hospital’s competitors would be out of business, their IT vendors would own the market, and we wouldn’t be stuck with the unsatisfying conclusion that it’s not what you buy, but how you use it (actually, Kaiser may be that one rock-solid case study now that I think about it). Still, prospects who think they’ll be a notably positive exception keep the HIMSS exhibit hall full.

HIMSS paying people to watch EMR demos is a bad idea, 79% of you said. New poll to your right: studies are showing that EMRs haven’t done much to improve quality or reduce costs, so who’s to blame for that?

A Mayo Clinical family medicine clinic in Arizona notifies patients that it’s dropping Medicare because it doesn’t pay enough to cover the clinic’s costs. Patients will be fully responsible for a $250 annual administrative fee, office visit fees ranging from $175 to $400 each, and a physical, with the grand total estimated at $1,500 per year.

Some interesting quotes from jurors on Charlie McCall’s trial. Referring to Al Bergonzi: “We just thought he was a thug in a suit”. Of Charlie’s legal dream team: “They were a little more theatrical … It goes to show spending millions of dollars on your defense is not necessarily effective.”

Three Denver area provider groups (Children’s Kaiser, and Exempla) go live on their HIE.

Listening: 30 Seconds to Mars, a reader recommendation. Sounds good – hard progressive with a little grunge DNA in there.

Shaun Priest, a vendor VP (I’m not sure if I’m supposed to mention the company’s name), has a novel available on Amazon called Decisions that involves an HIT sales guy fighting his demons.

HIMSS isn’t the only big trade show bailing on Chicago because of cost. The CEO of the huge plastic industry trade show, which is leaving Chicago for Orlando after 40 years, blames the work habits of union workers rather their reputation for being nasty. “We heard over and over again that the electricians were nice, but they dragged their tails. Jobs that should take two hours, they dragged out to five or six.” The president of the Chicago Federation of Labor said it was a wake-up call, but the electrician’s union boss wasn’t so humble: “I think HIMSS would have left anyway. They took a parting shot when they pointed at electricians.”

Odd, but possibly effective: a British dancer with epilepsy plans to induce an on-stage epileptic seizure to raise awareness of the condition.

MedAptus announces that its system for capturing professional charges is available for BlackBerry smartphones and coming next year for the iPhone.

Tampa General Hospital, like everybody else, signs with Epic in a $90 million project. It was just announced, but rumor reporter Jerry Seinfeld told you about it here on November 6.

The CSI Companies, the Jacksonville, FL-based staffing company that Grady Hospital (GA) chose for its Epic implementation, says business is up 40% over the past four years to $21 million, mostly because of healthcare IT. It says EMR implementations typically require 20-40 employees for 2-4 years.

Odd lawsuit: a man whose ear was torn off by his son’s dog is transported to the hospital by New York City paramedics who brought the ear along on ice. The hospital said the ear was contaminated, so the paramedics tossed it in the trash. He’s suing the city for being deprived of treatment, so the city is suing the hospital for telling the paramedics to throw it away. And in Florida, a woman who claims her emphysema was caused by smoking is awarded $300 million in her lawsuit against Philip Morrris, claiming the company is responsible for her addiction.

Mr. HIStalk’s 10 Ways to Get Off on the Wrong Foot as a New Hospital IT Executive

1. Convene endless department meetings under the naive assumption that all problems, from understaffing to poor system architecture, are due to insufficient employee communication.
2. Insist on extensive cross-training and information-sharing, thereby alienating the experts who deliver most of the results, but who don’t like working in teams.
3. Mandate the use of overlapping software applications that require employees to record time and write status reports in multiple locations.
4. Fill leadership positions with people from your previous employer, communicating a clear message of distrust for the department that just hired you.
5. Spend time behind closed doors working on org charts, having meetings with high-level peers, and plotting strategy, all without ever getting to know the employees who have to actually do the work being planned.
6. Repeatedly state that you wouldn’t have been brought in from outside if things were going all that well, so obviously past accomplishments were bogus and everything must be immediately changed to the exact structure, policies, and practices of wherever you came from.
7. Compare the software applications in use with those great ones where you came from, implying that you’ll displace the existing ones at the first opportunity even though you know nothing about them.
8. Consider group consensus to be equal at best to your own anecdotal experience.
9. Convince the executives to increase IT funding as part of the job offer, then take personal credit for the resulting technology improvements even though they could have been achieved at any time had the money been freed up.
10. Repeatedly remind low-level employees that, unlike them, you get a reserved parking spot, a sweet office, and bonuses.

E-mail me.

News 11/20/09

From Sam Shem: “Re: mammograms. An independent body, after review and analysis of eight clinical trials, comes out with EVIDENCE that mammogram screening in under-40-year-olds has little or no value. What happens? The radiologists are up in arms and the Obama administration, in the person of DHHS Secretary Kathleen Sebelius, tells patients to just keep doing what you did last year. And they want to cut costs by a billion dollars over the next decade to pay for national health insurance? If anyone really believes this country will ever control the costs of health care, they are living in a dream land!” Interesting, too, that nobody’s paying much attention to the study that showed that electronic medical records haven’t improved outcomes or cost so far, even as the government is spending lots of money on those, too. At least EHRs have potential. In an economy where jobs are dying out, politicians don’t have the guts to make serious change since the people unhappy with healthcare don’t have the clout of those who like it just fine. I cited statistics here years ago saying that healthcare was making a staggering economy look robust because of rising costs, profits, and high employment, all unsustainable in a global economy.

From Fred: “Re: Lattice. Lattice has been threatening to sue KLAS for the past few months. I guess Lattice didn’t like their ratings.” Unverified. I hadn’t really heard of the Wheaton, IL company, which sells point-of-care systems to hospitals. Far more interesting to me is its company history. I’d heard the name in seemingly wildly different contexts, but it’s the same company: they wrote the first C compiler for the IBM PC in 1982, sold the company to SAS in 1987, developed programming systems for the System/36 and AS/400 in the 80s and 90s, then went private again in 1993 and started selling application software. I haven’t seen their scores.

From Interoperator: “Re: SNOMED-CT and ICD-9-CM crosswalk. Here’s a guided tour.”

From J. Lo: “Re: Epic. Do they have or will they soon have patient registry functionality? If so, will it meet NCQA standards for Patient-Centered Medical Home designation? Some say it’s coming in February, others say never.” If you know, please post a comment.

From Nasty Parts: “Re: another Sage resignation. Maureen Peszko, SVP of strategy and business development, resigned last week.” Unverified since I didn’t have time to ask Sage.

Charlie McCall is finally found guilty. I’m flabbergasted that his ultra-expensive legal team couldn’t get him off since that’s usually how it works (although they may wangle a light sentence). To paraphrase the otherwise ineloquent Gerald Ford, our long industry nightmare is over. And now that he’s as officially guilty as everybody unofficially knew he was, I hope he will be as uncomfortable in prison as McKesson’s shareholders were watching the stock drop due to his actions (with the help of inept McKesson management who paid premium dollars for what was obviously a house of cards).

A hospital in India is piloting software that will send retinal images to the iPhones of specialists, allowing quick diagnosis and treatment of retinopathy in newborns. The software was developed by i2iTeleSolutions, a Singapore-based telemedicine software vendor. As the company says, the iPhone is now an EyePhone.

Ministry Health Care (WI) starts its implementation of Marshfield Clinic’s CattailsMD EHR, a $40 million project.

Ben Rooks didn’t sound too keen on Healthport’s business model, saying it was trying “to convince portfolio managers and buy-side analysts that even though over 85% of revenues are related to release-of-information services, it really is a revenue cycle management company and should be valued as such.” Those efforts apparently failed, as Healthport withdraws its IPO citing poor market conditions, but almost admitting that having never made a profit might have diminished some of the market’s enthusiasm. The always-vigilant Ben, however, floated the possibility that maybe a bidder emerged to buy the company outright, which he called the “dual path” in filing the IPO as “stalking horse.” I love that Gordon Gekko talk. Blue Horseshoe loves HIStalk.

The MyMedicalRecords people announce their partnership with a Chinese technology company to build PHR and document imaging applications for that country. That might make more sense there than here since I’ve read that in China, it’s the responsibility of patients to bring their paper medical records with them when seeking medical services. I don’t know if that’s necessarily worse than our way of having each provider keep their little chunk of a given patient’s medical record, never to be combined.

The UK division of UnitedHealth acquires ScriptSwitch, a prescribing decision support vendor.

Greenway Medical Technologies starts up a series of Webinars covering HIT Regional Extension Centers.

Odd lawsuit: a hospital surgery tech is suing her former employer after she was fired for complaining about unsanitary OR conditions that included bugs, holes in the walls, rusty surgical instruments, mold, and biological fluids splatter in the rooms. She took pictures. What will become fodder for lame morning zoo radio shows is her claim that a scrub nurse “actually defecated inside her clothes during a surgery and continued to work with fecal matter pouring down her legs and onto the floor.” She didn’t get pictures of that, I guess.

E-mail me.

HERtalk by Inga

University Hospitals Geneva Medical Center and University Hospitals Geauga Medical Center (OH) go live on ISirona DeviceConX. The technology delivers patient medical device data to Eclipsys Sunrise EMR.

API Healthcare announces that Version 9.0 of its Navigator payroll and HR system is now in GA. Enhancements include a new user interface designed to facilitate integration with other API Healthcare applications.

HHS awards CSC an IDIQ contract, which has a three-year base period and four, one-year options. CSC will have the opportunity to compete with one other vendor for specific IT tasks defined in the IDIQ.

ACL Laboratories selects Accenx Exchange to provide EMR integration between ACL Labs and its customers. Accenx is a wholly owned subsidiary of Initiate Systems.

The OMB says about 5% of federal spending was paid improperly in 2009, including $54.2 billion for Medicare and Medicaid programs. Those programs actually had improper payment rates of 15.4% and 9.6%. I believe OMB Director Peter Orszag wants Americans to feel encouraged because better detection methods have uncovered more improper payments than in previous years. Orszag cites the example of an invalid doctor signature, which was much more likely to trigger an improper payment in 2009 than 2008. I wonder how much sooner I could retire if Mr. H improperly overpaid me 15% every month.

Yet another health insurer loses financial, health and personal information on patients. Health Net says an unencrypted portable drive went missing and contain data on 1.5 million patients. The company took more than six months to report the breach, leading Connecticut state attorney to chastise it for “incomprehensible foot-dragging.”

Informatics Corporation of America captures "Best of Show" honors across both Provider and Insurance categories at Everything Channel’s 2009 Healthcare IT Summit.

Florida’s online medical records system for the state’s 2.6 million Medicaid recipients is now live. The site, developed with Availity, allows patients and their doctors to access 18 months of Medicaid claims data.

Trinitas Regional Medical Center (NJ) settles with the federal government, agreeing to pay $3 million in a Medicare fraud lawsuit. The hospital admits no wrongdoing. Meanwhile the whistleblower who originally alleged Trinitas illegally inflated charges gets a nice paycheck from taxpayers.

Image Movement of Montana,  a grassroots organization that includes 30 Montana healthcare facilities, plans to implement DR Systems’ eMix, a cloud-based technology for the secure sharing of radiology images and reports.

E-mail Inga.

Former McKesson Chair Charles McCall Found Guilty of Securities Fraud

A San Francisco jury has found former McKesson chairman Charles McCall guilty of five of six counts of securities fraud. He was acquitted on a single charge of falsifying records.

Federal prosecutors said the former chairman, president, and CEO of HBO & Company covered up that company’s fraudulent activities, allowing it to be acquired by McKesson for $14.5 billion in January 1999. The fraud was discovered three months later, sending McKesson shares into a nosedive.

Former McKesson general counsel Jay Lapine was acquitted on all three charges he faced.

McCall was originally tried on the charges in 2006, but a mistrial was declared. He will be sentenced in March.

News 11/18/09

From Xper: “Re: Cedars Sinai. The ED is live, including the docs — yes, CPOE at Cedars! — seems like anything really is possible. Nurses are live on the system now and so is registration and billing. They appear to have more food and PR junk than support calls, probably a good thing. Many Epic folks are on site to make sure this goes well, but it’s kind of cool to see all the leaders here during the 40 hour go-live and sitting in the actual command center. One of the better projects I’ve seen as a consultant.”

From Kate Spayed: “Re: Windows 7. Anyone know which EHRs are compatible?”

From Dick Scrushy: “Re: Mark Leavitt of CCHIT. You should interview him.” I asked this week. He said no.

From Industry Watcher: “Re: Cerner. More bad news for Cerner in the US. Saint Peter’s University Hospital in NJ has decided to replace all Cerner Millenium clinicals for two primary reasons: (a) Cerner continually presented work orders for work outside scope and, (b) physicians were starting to admit elsewhere because of issues with Cerner CPOE. McKesson’s Horizon was selected as the vendor to replace Cerner. By my count, that means Cerner has been replace seven times in the last 18 months.” Unverified.

From The PACS Designer: “Re: FDA and iPhone apps. Back in February of this year, there was some discussion about the FDA’s role when it comes to using an iPhone for a clinical procedure. Now that the interest in iPhone apps for healthcare is gaining momentum, it would be a good time for comments to be sent to the FDA on if or how the iPhone apps issue should be handled. It’s hoped that the FDA won’t slow iPhone innovation and only regulate iPhone apps that are part of a system design submission seeking FDA approval.”

From Former Colleague: “Re: death of Frank Canestrari. He passed away suddenly on Sunday, November 15th at his home. He was the president of Newbold/Addressograph Corporation. Frank led the organization for the past two decades.” The online guest book is here and services will be at noon Thursday in Roanoke. 

David Brailer’s Health Evolution Partners takes an equity position in CambridgeSoft, which offers a long list of life sciences desktop software and scientific databases.

Keane announces that 13-facility Ernest Health has extended its agreement and will be installing Optimum Patcom at all sites current and planned. University Physician Healthcare (AZ) will also install several Optimum modules, including Patcom, HIM, scheduling, and document management.

The National Library of Medicine releases a draft of a crosswalk between SNOMED CT and ICD-9-CM, inviting users to give it a try and let them know how it goes. The intention is to automate much of the work required to turn clinical terminology into billing information. It was developed by SNOMED Terminology Solutions.

Intellect Resources is running a series of interviews it’s doing called IR Beat, kind of a radio show for HIT. The latest one’s on cloud computing and the one before is about Epic certification.

Dee Cantrell, CIO of Emory Healthcare (GA), is named CIO of the Year by the Georgia CIO Leadership Association.

A hematologist and his programmer son, both from New Zealand, are named finalists in a healthcare software contest for their warfarin monitoring system for patients at home. Their blood thinner system works like a glucometer, with patients testing a drop of blood in an INR electronic reader and then receiving electronic advice (along with their doctor) of dosing changes needed. I think there are already warfarin point-of-care test kits for home use, but the software is darned cool.

The London newspaper says Summary Care Records will be uploaded to the NHS spine by the end of next year, also warning that everybody’s records will be available except those who specifically opt out. The timing of that announcement wasn’t so great since NHS Hull announced a data breach by a former employee the same day.

UPMC will manage 30,000 PCs with Verdiem Surveyor, a centralized system that enforces and monitors PC power policies without disrupting users. UPMC says it will reduce PC power consumption by half and save $1 million per year.

Medversant may be crass in using the Fort Hood shootings in its PR pitch, but it still has an interesting idea — continuous credentialing, where provider licenses are constantly checked against OIG and DEA records, but also against general Web information such as social networking sites, articles, and blogs. Also interesting: its recent study found that 1.9% of practicing medical professionals did not have a license and 18.7% had expired or falsified credentials or malpractice judgments.

E-mail me.

HERtalk by Inga

A new study by the Harvard School of Public Health finds that the use of EMRs has not had any effect on healthcare cost or quality. I’m sure some HIT critics will point to the study as proof that we should stop spending billions on EMRs. I personally side with Masspro’s Dr. Karen Bell, who believes the findings highlight the need to focus on helping physicians, hospitals, and the public health system use technology more effectively.

NYU Langone Medical Center launches the first phase of its EHR implementation, taking live its Trinity Center faculty group in Manhattan. Patients can also now access the practice’s SmartChart portal.

The National Institutes of Health’s Fogarty International Center grants Indiana University and the Regenstrief Institute a $1.3 million award to establish the East African Center of Excellence in Health Informatics. The center will focus on increasing the capacity of EHRs in the region and teaching East Africans to use electronic tools to solve healthcare problems. The center’s director claims that Kenyan clinics using EMRs are able to serve two to four times more patients than those using paper records.

GetWellNetwork appoints Michele Perry COO, tasked with helping to “lead the company to a new level of growth.” She was previously involved in three IPOs, so perhaps that’s the “next level” the company has in mind.

A new KLAS report takes a look at Allscripts a year after its merger with Misys. KLAS surveyed 200 Allscripts clients and found declining customer satisfaction in several key areas. However, Allscripts remains the “most-considered” vendor in outpatient EMR purchases (which sounds about one step better than always being the bridesmaid, never the bride). The release of v.11 created challenges, though clients on versions 11.1.5 or higher are seeing positive results. About 85% of Misys EMR users who plan to replace their EMR say they’’ll go with Allscripts Professional EHR, which is being offered at a relatively low migration price.

Meanwhile, Forbes has a nice write-up on Allscripts iPhone app, Allscripts Remote, which gives physicians real-time access to patient data, fast communication with ERs and the ability to e-prescribe (the article says “e-mail prescriptions,” but I am assuming the author meant e-rx.) Allscripts Remote also made New York Times columnist David Pogue’s listof the top health-related iPhone apps. Right up there with PeriodTracker. Really.

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Singapore General Hospital actives Eclipsys’ Sunrise Patient Flow solution at its 1,500 bed facility.

Using reporting tools from EDIMS, 22 New York and New Jersey area hospitals are providing their state health departments daily H1N1 influenza data. Details include the number of patients by county with flu-like symptoms and a breakdown of those with respiratory and/or GI symptoms.

Over half a million users are now live on Sentillion’s single sign-on and context management solutions.

Community health organization Neighborhood Healthcare (CA) selects eClinicalWorks’ PM/EMR and Enterprise Business for its 115 providers across 11 locations.

Computerworld releases its annual salary survey of IT professionals. Not surprisingly, the economy has had an impact. Salaries were flat and bonuses and benefits were reduced or eliminated. Nonetheless, IT folks remain satisfied with their career choice, though they may be feeling stress over job security. If you are a CIO, you’ll likely find the best-paying jobs in the mid-Atlantic, with compensation averaging $172,000 a year.

CliniComp contracts with Multi-Services Group to provide training services at military treatment facilities using CliniComp’s inpatient documentation solution.

Cost management company Broadlane acquires Healthcare Performance Partners, which provides Lean Healthcare and Six Sigma consulting services.

Harris Corporation also makes an acquisition, buying Patriot Technologies, a provider of integrated and interoperable HIT solutions for the federal government.

Business associates are largely unprepared to meet HITECH’s data breach-related obligations. One-third of surveyed business associates (billing, accounting and legal services, claim processors, pharmacy chains, and offshore transcription companies) were not aware that HIPAA’s privacy and security regulations applied to them. Comforting.

DigitalPersona says its biometric fingerprint reader, which is incorporated into the Picis ED PulseCheck product, is being used by 150 hospitals.

E-mail Inga.

Healthcare IT from the Investor’s Chair 11/17/09

Update – The IPO Market Return

Or in the words of Santayana, "Those who cannot remember the past are condemned to repeat it."

As I write this post, the IPO market continues to rock and roll. As some confidence returns, investors look for new places to put money, and perhaps dress their year-end performance results with some nice IPO bounces. Wall Street is, of course, happy to oblige, especially in our own little corner of the economy, healthcare information technology.

Accretive Health’s IPO prospectus continues to wend its way through the bowels of the SEC. Management has no doubt endured the begging of numerous middle market firms trying to catch a few crumbs left after the four big banks received 95% of the available dollars. Given the size of the offering ($200 million), 5% economics is still over $800 thousand in fees left up for grabs, so you can’t blame folks for wanting a piece of it.

First of all, it’s an impressive transaction to be on, and nobody wants to blink. Second, there are a few small bragging rights: “They could have picked anyone, but they chose us”, I’m sure managing directors or partners will tell other prospects. But finally, as I said, even if they put two more banks on for $400K each, it’s high margin and extraordinarily easy business.

Recall our earlier discussion on IPOs with organizational meetings, drafting, etc.? That’s all been done before the new bank shows up. All that remains for the lucky new co-manager(s) to do is hold a few basic diligence calls, draft a memo to their firm’s commitment committee (the inter-departmental group that approves participation in equity transactions), and then take some slapping around by said committee as they ask the bankers the ritual hard question in this situation: “Doesn’t this set a bad precedent, to put our name on the cover for only (or perhaps less than) 5% economics?”

In the end, however, I’m confident Accretive will have its pick of underwriters. A fee’s a fee, especially in this market, and in my experience, the average managing director level banker will spend less than half an hour working once hired, farming it out to VPs, associates, and analysts. (readers who would like a Who’s Who of roles in a bank, please feel free to submit a question).

Meanwhile, HealthPort is concluding its road show this coming week as it works to convince portfolio managers and buy-side analysts that even though over 85% of revenues are related to release-of-information services, it really is a revenue cycle management company and should be valued as such.

Ask the Chair

I really appreciate the comments and questions I’ve received, both posted and e-mailed, so please keep them coming as I aim to inform and educate, not just ruminate. Let’s take a few:

Who coaches the management of publicly traded companies on what they can and can’t say?

It’s actually a combination of people, but last word is given to the lawyers. Part of the role of the board, I believe, is to help mentor first time public company CEOs, helping them strike the right line between promoting their stock (which is, after all, part of their job) and telling only truth. There are also investor relations professionals who do this for a living, though I’ve found their quality varies dramatically. Further, it will come as no surprise that, in both my prior lives as research analyst and investment banker, I’ve always tried to share my views on good Street communication, and I’m sure other bankers and analysts do as well.

At the end of the day, however, given the myriad SEC rules and regulations on stock promotion and our litigious society (and class action lawyers who don’t wait for the phosphors to fade on a negative press release to file a claim), it’s corporate counsel who often has the last word. This has been even truer since the adoption of SEC Regulation FD in 2000. Reg FD (for Fair Disclosure) was adopted to eliminate (really minimize) the phenomenon of selective disclosure that was rife on Wall Street. Companies would often tell their favorite analyst (who usually seemed to have a buy rating on the stock) a material fact before others, allowing him or her to share it with their best clients. Clearly that puts the investing public at a disadvantage, so the SEC adopted FD and lawyers suddenly had a lot more press releases to vet.

Let’s say I’ve been burned by the stock market and would like to invest some money, say $50,000, in a healthcare IT startup. Is that a good idea and how would I go about doing it?

Individuals investing in private, early stage companies are known as “angel investors”. There are pros and cons to making investments like this.

In theory, the readers of this blog, as well as being charming and perceptive, should know more than most anyone about the prospects of a healthcare IT startup. Recall that legendary investor Peter Lynch advised us to invest in what we know. A few things to think about beyond the obvious questions of “is this a good business?” are: “Do I trust and respect the judgment and integrity of the entrepreneur?” “Does this seem like a fair price for the company?” and dozens of other questions.

I think the first question to ask before an individual invests in a private company is, “How much do I care about that $50,000?” If you need it for Junior’s college tuition or your retirement in the next five or ten years, don’t even think it. Venture investing (which is what this is) is extremely high risk, that’s part of why venture investors demand high returns. Further, most startups fail (and HCIT is a tough area for success). VCs protect themselves there by investing in a portfolio of companies to diversify away some of their risk (typically, they expect multiple failures or break-evens for each success).

Also, ask yourself how you’ll get your money back: will the company be sold or go public? How much more money will they need? Angel rounds are usually early in a company’s life cycle, and subsequent money raised could well dilute your investment (lower the percent of the company you own). If you think you have the opportunity to invest in the next Epic Systems or athenahealth and are willing to take a flyer, more power to you, but caveat emptor (and good luck).

And finally, Matthew Holt wrote:

Ben I think you should take Ms. Faulkner on a fake road show, and then write that up.

Judy, if you (or one of your staff) are reading this and you would like the opportunity to hit the road and meet with the high and mighty of Wall Street to share your views of the sector and the publicly traded companies that make it up, I’d be thrilled to accompany you. I am pretty darned confident we could have the trip sponsored by a brokerage firm who’d also make a hefty donation to your favorite charity.

And if you agree, I’ll also go buy five lottery tickets and take a trip to Vegas, because it’s clearly my lucky day 😉

Thanks for reading, have a great Thanksgiving, and keep those posts and e-mails coming.

Ben Rooks
The Chair

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

Monday Morning Update 11/16/09

From HITMarqueen: “Re: OR cameras. I’m curious if you have any thoughts on the recent ruling by Rhode Island’s Dept. of Health that requires video cameras be installed in all Rhode Island Hospital operating rooms to monitor patient safety during surgical procedures? This is in addition to a $150K fine for the most recent wrong-site surgery at the hospital.” The state had to do something. Rhode Island Hospital has done five wrong-site surgeries since 2007, most of them really stupid (three wrong-side brain surgeries and the most recent gaffe, operating on the same finger twice instead instead of the two intended fingers — how can you make excuses for that?) Surgeons weren’t marking their sites and time-outs weren’t being done, which sounds like a great reason to revoke their privileges. The state ordered the hospital to assign someone to watch the camera for at least a year, observing every surgery to make sure the marking and time-outing are done (sort of like a football replay official, I guess). They’re darned lucky to be allowed to keep their OR open. Want to bet it’s not just the OR that has problems?

From H. Boc: “Re: Pano Logic devices. HBOC had one of these years ago. Whenever money was nearby, a little hand would come out of the box and snatch it. Then a voice in the box would tell you that the software was going through an upgrade and would be delayed for install.” That must have been a Pathways box. Maybe it handed back a side letter.

From Connie Ripley: “Re: content management. I’m curious to get an idea of how many healthcare or HIT companies are taking Content Management seriously? I see this as an area in dire need of improvement and I can tell you straight from the trenches that it’s not for the faint of heart.”

From Mercy, Mercy Me: “Re: parking garage advertisement. This is what attracts doctors to use CPOE.” UPMC Mercy has the right idea since you only have a few areas in which you can get the attention of doctors: the parking lot, the doctor dining room or lounge, and the chart completion area. Once they get them on CPOE, they can add nag screens for subtle messages of propaganda. Or, send them off to re-education camp

From Peter Gunn: “Re: HIMSS. Dang! I was dying to go to HIMSS last year in Chicago, but I live in Atlanta, and now that HIMSS is here in Atlanta, it sounds like it’s not worth going!” I’ll go out on a limb and say that it’s been years since it was worth going if you consider just the official offerings — the self-congratulatory opening session, lame keynotes, mediocre educational programs carefully limited to ensure vendor access to providers in between, having HIMSS-sponsored and ad-filled publications thrust into your face at every turn, and being herded to the exhibit hall like cattle in a slaughterhouse. The best thing about HIMSS is all the non-HIMSS people and events. They haven’t figured out a way to screw that up yet (although the uber-commercial tone threatens to keep providers home, which would then make the conference pointless). You could get most of the value of the conference by not registering at all, just hanging around the public areas of the convention center and attending non-HIMSS events. That would save you only $640 of the total cost, though. There are many things I don’t like about the conference, but I still go.

From Michelle Flaherty: “Re: EHR vendors. QHR will acquire Clinicare, a KLAS winner (Chartcare). Both companies are in Canada. Also, Noteworthy Medical Systems, acquired early this year by CompuGROUP Holding AG of Germany, is sunsetting its non-ASP product.”

From Just Checkin’: “Re: HIMSS shindig. So admittedly we’re not even to Thanksgiving, but given the need to schedule time off way in advance, I gotta get organized. Will the annual shindig take place at HIMSS? If so, is there a date?” I theorize that the beginning of winter gets people thinking about HIMSS, even though it’s a while away (I’ve booked an ultra-cheap hotel already myself and need to pay my $640 registration fee before it jumps to $740 on December 15). I’m still working on details of the reception with the sponsoring company. It is horrifically expensive to put these on — you could have a swanky evening in the best restaurant in Atlanta and still spend a lot less than it costs per person to offer just  a couple of drink and snacks in a private reception. When we first did it in Orlando, I was naive enough to think that we could just buy out some big restaurant and spend $75 per head for an open bar and dinner, but that brings other challenges: which places are available during HIMSS, how many can they hold, how do people get to and from, is it suitable for mingling and having a speaker or two, and how many slots does the sponsoring company want for their own use. It’s also a tough sell to vendors since many of the attendees will be HIStalk readers who work for other vendors. I’m hoping for the usual Monday night, but it’s still up in the air.

Speaking of which, it will be HISsies voting time soon. To prevent the usual ballot box stuffing, only those on the e-mail blast list will be able to vote this year. If you want in, put your e-mail address in the Subscribe to Updates box.

HIE service provider MobileMD gets $4.75 million in a VC funding round led by Health Enterprise Partners.

Athenahealth is awarded a patent for its athenaNet billing rules engine. Shares rose almost 5% Friday after the announcement, closing near their 52-week high.

An MIT research assistant creates SixthSense, a combined camera and projector worn around the neck that turns any surface into a screen and input device for smartphones, which he says will allow low literacy citizens of India to use software applications as their gestures are translated into commands. The TEDIndia demo video is amazing. If you’ve seen Minority Report, it will look familiar. Manufacturing costs are estimated at $350. The audience went bonkers, especially when he used his hand as a screen in the picture above.

Here’s my response to the announcement that HIMSS won’t be going back to Chicago because it’s too expensive: duh. Everybody who has every been involved in conference planning is well aware that strong unions, expensive hotels, and rife corruption have made Chicago a terrible place to hold a conference (not to mention that it snows in April, as we now know, although that was a plus to HIMSS because it kept people in the exhibit hall instead of doing something fun). If HIMSS was shocked (no pun intended) by the electrical costs of the most recent conference, then it didn’t do its due diligence and the vendors who had to pay those ridiculous costs ought to be mad. I’ll predict now that exhibitors will be griping after the Lost Wages conference that everybody bailed on the exhibits to go to the casinos and shows.

September’s Harvard Meeting on an HIT Platform (the “HIT should work like an iPhone” meeting) was invitation-only, but they’ve posted videos and an executive summary (warning: PDF). It includes Aneesh Chopra and Todd Park talking about turning NHIN into the “Health Internet”, hoping to make a lot of patient data available around which new applications could be built.

A non-profit hospital paying its CIO over $500K is not clearly excessive, say 64% of survey respondents. New poll to your right: is it OK that HIMSS offers cash payment to conference attendees who attend vendor demos?

The Madison paper covers the construction of Epic’s second campus, with the four buildings now halfway finished and one occupied. It says the company will add another 200 employees this year for a total of 3,400, including a Netherlands office with 35.

Speaking of Epic, this comment from a David Blumenthal e-mail (that I get, for some reason) seems to be a shot at MyChart and Epic’s other data sharing programs that work only for Epic-using hospitals: “… we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries.” Glen Tullman was also talking apparently talking about Epic (since he’s made similar comments elsewhere that named them specifically) in my interview with him this week:

“We need an interoperable system no different than the ATM networks that we use, no different than cellular networks. We have many different competitors, but they’re all using — they’re all connected to a network exchanging information; and of course, no different than the Internet. That’s the model that everyone ought to be forced to play in. We have some holdouts who are really not supporting this idea of full interoperability. So if I could change one thing, I would say we’ve got to much more aggressively push on interoperability.”

I had a question I would have asked had we not been running short on time: “Wouldn’t Allscripts do the same thing if it had the same chance as Epic?” Not for unsavory reasons, but because having big market share in an area provides some fast, cheap interoperability opportunities that are great for patients in those areas, even if they don’t tie into whatever regional or national networks that are being considered.

Exempla Lutheran Medical Center (CO) goes live with its Epic EMR. The three-hospital cost: $85 million, plus another $4 million for its physician practice.

Tampa-based Tech Data forms a healthcare business. Stimulus dollars may not be doing much good for unemployment, but they’re bringing a lot of companies into healthcare that weren’t interested until the taxpayer money chummed the waters. All I’ll say to the prospects they’ll try to convince of their newfound interest: lots of companies got out of healthcare just as fast as they got into it when the expected profits didn’t materialize. It’s not like we’re a new industry.

The ACG Boston 2009 Fall Conference & Private Company Showcase is this week in Boston. Speakers: John Halamka (of course), Todd Cozzens of Picis, and Carl Byers of athenahealth. Cost to attend the 3.5 hour conference – $330.

A doctor in China loses his job and his license after investigators checked computer records and verified that he was playing online computer games at work while a five-month-old baby he was supposed to be monitoring died.

Apple files a patent for its long-rumored tablet PC.

University of Maryland Medical System will float a $250 million bond sale, with a portion of the proceeds to be spent on clinical systems.

Merge Healthcare will sell $27 million worth of new shares to pay off debt. Shares are worth eight times what they were a year ago, but still barely more than 10% of what they sold for three years ago. It also has expanded its offerings in China.

E-mail me.

CCHIT Chair Mark Leavitt Announces Retirement

The Certification Commission for Health Information Technology announced today that its chair, Mark Leavitt, MD, PhD, will retire from the organization in March. A search firm has been engaged to recruit his replacement.

Steve Lieber, HIMSS president and CEO and chair of the CCHIT Board of Trustees, said the board “accepts Mark’s decision with reluctance” and says the search for his successor will be “open and transparent.”

News 11/13/09

From Vendor Bribes: “Re: Amazing bribery to EMR buyers via HIMSS.” The HIMSS Takin’ HIT To the Streets campaign (gag, even for Doobie Brothers fans) leaps that last boundary of member organization common sense —  they’re paying people to attend the sales presentations of their vendor members. I’ve been watching the remake of the old miniseries V and I think maybe vendor visitors have taken over Steve Lieber’s body since the previously furtive and tentative vendor-HIMSS gropefest has advanced to a full-on public consummation.

From Dr. Know: “Re: HIMSS. I think that HIMSS needs a shock to the system. We all recognize their priority is to serve the interests of the vendors and not hospital end users. Therefore, I wonder whether an organized boycott of this year’s conference is in order?” I’m not a fan of boycotts. If members and attendees don’t like how they are being represented, they know their options. Without providers as attendees and members, the vendors would bail quickly.

From Ryan: “Re: HIMSS. Not sure why Siemens would pull out of HIMSS 2010 in Atlanta, as they have an office in Alpharetta.” They still would have to buy horrendously expensive exhibit space, pay people to work the show, pay union carpet sweepers and power strip deliverers, and bring in people from places a lot further away than Alpharetta. All to reach the mostly non-decision makers (competitors, consultants, and people who don’t influence hospital IT purchases) who pad out the otherwise impressive attendance numbers. Siemens did it before (as SMS) and this time around, Cerner can’t shame them to prospects since they’re not coming either.

From Hockey Dad: “Re: EMR ratings. 2,556 primary care physicians (family doctors) rate their EMRs. Results published in Family Practice Management from AAFP.” You have to subscribe to read, but Hockey Dad sent a PDF. The article admitted some unavoidable bias (self-selected respondents, too many vendors to ensure adequate sample sizes for all, and different levels of expectation based on practice size) and accordingly warned about taking the results as anything significant. They didn’t really name overall winners, but the closest thing to it placed the top 10 as (1) e-MDs, (2) MEDENT, (3) Praxis, (4) Amazing Charts, (5) eClinical Works, (6) Epic, (7) Practice Partner, (8) Allscripts Professional, (9) Centricity, and (10) Aprima.

From Demetri Noh: “Re: survey. Got this survey, which appears to be from a rival group of HIMSS.” Or “HIMMS”, if you like their version. It’s not clear who funded the research firm’s survey. It’s a great time to be starting up a HIMSS alternative, if you ask me, although I don’t know if that’s the point of the survey.

From Billy Bong: “Re: radiologist. This can’t be good for the industry.” An Atlanta doctor who runs a radiologist coverage service faces 20 years in jail, charged with letting unlicensed employees write up his interpretation reports for images he didn’t bother to look at.

From Craig Powerplay: “Re: AHA Solutions. They understand their endorsed products only to the extent that they need to believe people will buy it. They only make money if the endorsed product/ service sells. When we negotiated with them, we didn’t see much understanding in what our product was, but they did understand this:  press hard for a high yearly endorsement fee and a high percentage of each sale. We passed — our margin would have been near zero.”

From The PACS Designer: “Re: RSNA iPhone review. With the popularity of the iPhone in healthcare increasing, you may want to check in at the RSNA for a presentation by Presenter Dr. Krishna Juluru, an assistant professor of radiology at Weill Cornell Medical College. Along with others, he will be discussing the use of the various healthcare apps in radiology, and how they can improve the care process.”

Listening: Amorphis, another of those Finnish progressive metal bands that I like.

I interviewed Allscripts CEO Glen Tullman on HIStalk Practice. If you decide to check it out, drop your e-mail address in the Get Instant Updates box on that page and you’ll be the first to know when we run something new there (it’s a separate e-mail list since not everybody who reads HIStalk follows physician practice software).

Cris Assif is named managing partner of consulting firm Entrust Healthcare.

A reader forwarded an e-mail from Duncan James, president and CEO of QuadraMed, welcoming Michael Jarrett as the new VP of client services, coming over from McKesson but also sporting QCPR experience from its previous owners Per-Se and Misys. Linda Baum and Linda Benson were wished well in future endeavors required to take place elsewhere.

I can’t find any updates on Charlie McCall’s trial. If you’re in San Francisco, you could wait outside the court house and snap a picture for me, and maybe thrust a recorder in his direction while asking accusatory questions that might startle him enough to answer.

EDIMS, the Livingston, NJ based vendor of emergency department systems, is supporting HIStalk as a Platinum Sponsor, so thanks to the folks there. Its EDIMS flagship product is live at 39 sites, has documented over 12 million encounters, and is used by EDs that document 100% of their patients compared to a national average of 40%. It offers a quick registration kiosk, nursing documentation, graphical patient tracking, an alert-driven nursing dashboard, CPOE, order sets, charge capture, prescription writer, medication reconciliation, and lots of other features. I appreciate their support.

McKesson announces Horizon Connect, an interoperability product. For home buzzword-counters, the press release included these: solution suite, seamlessly, discrete, actionable, workflow, collaboration, continuity, aligned, continuum, and ubiquity.

Epic Systems is among the financial backers of Porchlight, a Madison prevention and treatment agency for homeless veterans.

Iowa State University researchers develop software that converts CT and MRI scans into 3-D representations that can be navigated by joystick, making them useful for doctors for planning surgeries and for teaching. As one said, “2-D is guessing and 3-D is knowing.” The product has been commercialized as a $4,995 PC package that uses Xbox controllers. The above image is a converted cardiac CT.

St. Vincent’s Catholic Medical Center (NY) replaces its PC desktops with a virtual desktop infrastructure, speeding up their network since the zero client cubes do screen scrapes of VMware server-hosted applications. The 3x3x2 inch Pano Logic devices have USB plugs that connect to a virtualized Windows desktop server in the data center — no moving parts, minimal energy consumption, and minimal footprint.

Medical Mutual of Ohio will roll out Intuit’s Quicken Health Care Expense tracker to its 1.6 million members. A consumer advocate says easy-to-read bills are good, but reminds, “Even if you are armed with this information, it’s not as if you shop for health care directly. You go with your insurance company. It’s unclear that the information really translates into any new buying power.”

Sam Heard, the doctor who runs Ocean Informatics in Australia, is profiled in a newspaper article. His company developed openEHR, a “shareable EHR” chosen by Sweden as the basis of its national eHealth infrastructure. Its template designer is pictured above.

The nursing school at Case Western Reserve University gets a $1.3 million grant to develop avatar-based software that teaches patients to communicate with their doctors. They envision it running on a kiosk outside the doctor’s office to coach patients on what to ask.

A critical results related lawsuit verdict: the doctor of a hospitalized 18-year-old woman who had just given birth orders blood tests, which showed a serious infection. The hospital lab didn’t get the results to the doctor in time to avoid a complete abdominal hysterectomy. The jury returns a $2.3 million verdict against the hospital.

E-mail me.

HERtalk by Inga

Design Clinicals reports that it’s on track to double its revenue and product sites for FY09. Its MedsTracker medication reconciliation product is now live or in implementation mode at 18 sites. Mr. H interviewed founder Dewey Howell a couple years back when the company was in the midst of its first installation.

Hewlett-Packard agrees to pay $2.7 billion to acquire 3Com. The acquisition strengthens HP’s position as a one-stop shop for corporate customers.

Trinity Health plans to install seven of Elsevier’s online clinical decision support solutions across several of its facilities.

Picis recognizes winners of the Picis 2009 Customer Recognition Awards, selected based on their use of Picis solutions to improve their financial and clinical operations in the ED, OR, or ICU.

Allscripts contracts with DecisionOne to provide hardware infrastructure support to its clients. Allscripts internal hardware service personnel will integrate with DecisionOne’s field service organization. Sounds like a good move as it allows Allscripts to focus on the software side of the business. Having an internal field service team is less critical in today’s server/PC world than it was in the good old days of proprietary hardware.

HIMSS announces it will head to Sin City for the 2012 Conference and Exhibition. According to the Chicago paper, HIMSS chose Las Vegas over the Windy City because of the high cost of labor at McCormick Center, with electrical service at this year’s conference costing 4-10 times as much as it did in Orlando the year before. I love Chicago, but like the Vegas choice simply because the average February temperature is about sixteen degrees higher.

Iowa Health System deploys McKesson’s Horizon Medical PACS solution at 34 locations throughout Iowa.

Healthvision calls its third quarter “healthy” based on its closing of 97 transactions, including 13 new customer engagements.

Intel’s Digital Health Group introduces a mobile handheld device designed to assist people with dyslexia or vision problems. The Intel Reader uses a camera to capture text and converts it to digital text. The device then reads the text aloud. List price: $1,499.

API Healthcare signs an agreement with Logicalis to offer remote hosting services to API clients.

Premier Purchasing Partners awards Meta Health Technology a 36-month contract to provide Premier members special pricing and terms for Meta’s patient chart abstracting and Electronic Physician query software products.

Scott A. Storrer takes over as president and CEO at MEDecision. The transition has been in the works since Storrer joined the company in 2008. Founder and current CEO David St. Clair will retire December 31, but stay on the board for one more year.

First Citizens Bank agrees to market mPay Gateway’s patient payment system to its physician practice clients.

Indian police arrest the head of an outsourcing company for allegedly selling the medical records data of patients treated in a British hospital. An undercover investigation revealed Vikas Dhairyashil Bansode had thousands of records that included confidential clinical and financial information. Bansode and his accomplices obtained the records from IT companies contracted to convert the paper records to digital. The group then sold individual records to middlemen for as little as $6 each via Internet chat rooms.

Senator John Kerry introduces legislation to help small medical practices become eligible for SBA loans to cover EMRs and e-prescribing costs. Funds could be used for both hardware and software.

A whopping 94% of healthcare organizations don’t think they are ready to comply with the privacy and security provisions included in the HITECH Act. The new regulations, which go into effect in February, extend existing HIPAA rules including increased enforcement, penalties, and audits. Funding is the biggest barrier.

The University of Colorado Hospital signs a contract for multiple Lawson enterprise applications to enhance HR and overall business operations.

Healthwise, a non-profit provider of consumer health information content, lays off over 10% of it 222 employees. It has traditionally provided printed materials, but the market is shifting to electronic sources. Healthwise is now focused on providing content via EMRs.

E-mail Inga.

News 11/11/09

From Downwit-IT: “Re: HIMSS. Following Cerner and Meditech, Siemens has made the decision to pull out of the upcoming HIMSS conference. No booth, no representatives traveling to Atlanta. Siemens will reach out to its customers and prospects via virtual, Internet-based means.” Unverified, although I don’t see their name on the exhibitor list. Anybody else not going?

From Keenen I. Wayans: “Re: AHA Solutions. Would you look favorably on a product that earned their endorsement?” It wouldn’t influence my opinion, but I’d like to hear what everyone else thinks. It’s a pay-to-play award, but that alone doesn’t make it worthless, I guess.

From Larry Fink: “Re: stock. If you compare the ten year-stock performance of Cerner and Eclipsys, the difference is mind-blowing. Cerner is up 948% over ten years (including 106% this year); Eclipsys is up just 18% over ten years.”

From Nasty Parts: “Re: Sage. Jason Dvorak, most recent VP of sales, resigned last week. Multiple sales execs have also resigned recently. Rumor is that Sage Healthcare is interviewing to hire a new company president.” I invited Sage to respond directly. “2009 was a very positive year for Sage Healthcare. With the opportunities that exist in this marketplace today, Sage plans to expand the leadership team with the hiring of a Division President in the near future.”

From Anon: “Re: Being John Glaser. The title sends a message that the subject is a narcissist.” I made that title up because Being John Malkovich popped into my head, knowing that John is anything but a narcissist. I didn’t see the movie, by the way, but Ebert’s review made me think it was appropriate: “Malkovich himself is part of the magic. He is not playing himself here, but a version of his public image — distant, quiet, droll, as if musing about things that happened long ago and were only mildly interesting at the time.”

From Wounded in Plano: “Re: Dell. The Dell-Perot merger has already started to see the loss of healthcare talent that Dell sees as dead weight. Dell is sending projects overseas (including clinical EMR support), laying off ‘expensive’ talent and focusing on a manufacturing mentality in a consulting world.” Unverified.

From The PACS Designer: “Re: Sectra’s loss. TPD is deeply saddened upon hearing of the accidental death of Sectra’s president, Dr. John Goble, in a helicopter crash. The selection of Thomas Giordano as acting president is a move in the right direction to continue Sectra’s strong presence in this country.  My deepest condolences go to his family, co-workers, and friends.” Goble, 58, had led US operations for the company since 1997.

From Funny: “Re: SEEDIE. Very. And it could be funnier if it wasn’t so true.” I’ve mentioned SEEDIE and the Extormity EHR before, pretty funny parodies (although also ironic in its criticism of technology — the site is down at the moment with a MySQL error). I didn’t notice until now that they’ve been putting out phony news items, also funny:

After a raucous 3 minute debate, the SEEDIE board of directors voted against PHR standards that would force certified EHR vendors to interoperate with personal health record systems using a common set of data standards.

“Our members advocate a walled garden approach, with a distinct preference for proprietary PHR applications that treat interoperable vendors as untouchable members of a caste system,” said SEEDIE executive director Sal Obfuscato. “Like Farmer Brown in the tale of Peter Rabbit, we want to keep all those rapidly multiplying PHR companies from nibbling our electronic health record cabbage.”

Today is Veterans’s Day. If you served, thank you. If you didn’t, thank them.

Firefox has been inexplicably bogging down constantly for me, requiring me to three-finger salute it, so I switched back to Chrome. Darned annoying, though: you can’t get Google Toolbar for Google Chrome. Sounds like they have some healthcare IT DNA in there somewhere.

Ingenix will acquire CareMedic, a Florida-based vendor of revenue cycle solutions for hospitals, in an all-cash deal whose terms were not announced.

Welcome and thanks to Quality IT Partners, new to HIStalk as a Gold Sponsor. The Mt. Airy, MD company, which will be nine years old next month, offers its consulting clients (hospitals, health systems, long term care, payers, pharma, etc.) first rate services at a value-based cost structure. The company almost never advertises, so I was pleased to hear this from Director of Business Development Bruce Werner: “The President of our company (Mark Debnam) and I have been following HIStalk for quite some time and we recently got our leadership team hooked on it as well.  The leadership team unanimously voted to invest in HIStalk. You and your team have done a great job with the site and we are proud to be a sponsor!” Inga and I appreciate that.

John Piano, the founder and CEO of tissue and organ EMR vendor Transplant Connect, is named Better Man for 2009 by GQ Magazine, which recognizes “charitable work, volunteerism, and/or community involvement.” He received the award at the Gentlemen’s Ball (really). I don’t know if physical appearance was judged (it’s GQ, after all, not that I have any idea whether he’s attractive or not) but his company helpfully included lots of flattering photos.

The Carolina eHealth Alliance will use Oacis HIE from TELUS to power its health information exchange, starting with 12 EDs in South Carolina’s Lowcountry. The product includes an EMPI and the Oacis Clinical Viewer.

Weird News Andy hacks this story up: researchers funded by a Gates Foundation grant say their cough-analyzing software, which will run on cell phones or MP3 players, can diagnose disease by measuring coughs.

Kronos announces several new Q4 sales, along with financial results that include $672 million in FY revenue and $143 million EBITA.

Being a non-profit wage slave, I don’t pretend to understand the “variable prepaid forward contracts” that Cerner founders Neal Patterson and Cliff Illig just exercised ($64 million worth). Somehow they get money now for shares to be sold in the future (three more years in their case). All I know is it’s one of those fancy hedging strategies that sometimes gets people in big trouble with the IRS.

Mayo Clinic and Steelcase study the influence on the latter company’s computer furniture, which was designed for Mayo to help doctor and patient view a computer monitor together for teaching.

Idiotic lawsuit: a man goes into a deli and claims he was bitten by the owner’s cat. He’s suing for $5 million.

HERtalk by Inga

The VA Heart of Texas Health Care Network expands its collaboration with CliniComp, adding the company’s Esentris Critical Care solution.

Jordan Hospital (MA) selects ClaimTrust InSight Denials for claims denial management.

eClinicalWorks adds another IPA to its client list with the signing of Catholic Independent Practice Association (NY). The IPA purchased 150 PM/EMR licenses to connect community physicians and will work with eCW to tie into the HEALTHeLINK RHIO.

Former Allscripts-Misys and Emdeon exec Ray DeArmitt takes over as the executive VP of sales for NotifyMD.

Hoag Memorial Hospital Presbyterian (CA) expands its partnership with Surgical Information Systems with its purchase of the SIS’s anesthesia, BI, and tissue management products.

NextGen Healthcare just completed its user group meeting in Washington DC, reporting attendance of over 2,700 and featuring keynote speakers Newt Gingrich and Howard Dean. The hot topics: ARRA, healthcare reform, interoperability, and patient-centered medical homes.

iSirona appoints John Cooper chairman of the board, replacing iSirona founder Dave Dyell, who will continue to serve as CEO. Cooper’s previous gigs executive roles at Sungard, Eclipsys, and SMS. Totally off subject, but am I the only person who thinks of that song by the Knack every time I see the iSirona name?

The healthcare sector added 28,500 new jobs in October, 10,000 of them in hospitals.

OhioHealth selects ProVation Order Sets to automate its creation and management of evidence-based order sets.

If you are a regular HIStalk reader, the details in this report will not surprise you. Scientia Advisors expects the global HIT market to grow 11% over the next four years, with the US setting the pace. Most new investment will go towards EHRs. Lower-cost remote hosting will increase in popularity for smaller hospitals and clinical decision support systems will continue to impact the clinical diagnostics area. SaaS and open-source models will drive down pricing, they say.

HealthBridge selects Mirth Meaningful Use Exchange for its interoperability infrastructure. Once implemented, HealthBridge will become one of the first HIE’s to enable physician access to the NHIN.

CSI Tech wins the implementation contract for Grady Health System’s (GA) $40 million Epic installation. The inpatient and ambulatory installations will take 18-24 months. CSI Tech already handles Grady’s ongoing internal IT needs.

Here’s an iPhone application I don’t need but wouldn’t mind seeing one day. Lit: A Game Intervention for Nicotine Smokers is in development at Columbia University’s Teacher College and will be released within two years. The application is designed to emulate the physiological responses smokers get from smoking and would involve blowing into the device’s microphone. The RWJF is funding $150,000 for the project. With cigarettes costing an average of $5 or more a pack, it will be interesting to see how the application is priced.

Hayes Management Consulting announces it will be offering services for ARRA-funded Regional Extension Centers, including EHR readiness assessments and planning, clinical workflow redesign, EHR selection, and HIE development.

MEDSEEK honors seven clients who earned a total of 15 eHealthcare Leadership Awards at the company’s 13th Annual Healthcare Internet Conference. They were selected from over 1,100 applicants.

Kaiser Q3 numbers: operating income $336 million; net income $569 million. These numbers are significantly higher than last year’s when the company suffered major investment losses. Meanwhile, enrollment dipped about 63,000 to about 8.58 million.

E-mail Inga.

Being John Glaser 11/10/09

While waiting for my annual physical, I enrolled in a research study. (About every other year, I participate in a research study. Two years ago, a sleep apnea study involved me spending the night in an iron lung with electrodes in my mouth and all over my head and chest. Not conducive to a good night’s sleep).

My current study centers on healthy behaviors. The study is intended to improve the health behaviors of people who are fundamentally healthy (my blood pressure, cholesterol, weight, etc. are fine) through a set of pretty modest interventions. Armed with a pedometer, a Web site for recording progress, and an every-other-week call from Maria (my “health coach”), I am supposed to:

Have one multi-vitamin each day. Duck soup.

Eat three or fewer servings of red meat each week. This takes some thought and planning, but is not that hard.

Eat five to seven servings of fruit or vegetables each day. Since I usually eat one meal a day, this has proven to be a real challenge. I tried to persuade Maria that onion rings were a vegetable. As was a cup of coffee (coffee beans come from plants) and vanilla ice cream (vanilla beans also come from plants). She wasn’t buying it. But I have been able to drink some fruit juice during the day and toss down a banana and apple, allowing me to meet this goal.

Walk 10,000 steps a day. During a normal day “at the office”, I will walk 3,000 steps. This means I have had to find an hour each day to walk to get the other 7,000 steps. Finding that hour takes some planning — for example, getting up early to walk before work. (This has turned out to be an enjoyable experience — it’s quite cool to watch the sun come up over the Capitol Building and the Washington Monument).

So far, three months into this six-month study, I have been pretty good at meeting my goals. Maria has not scolded me.

This experience has reminded me that maintaining health, restoring health, or ensuring that a disease does not progress requires that patients engage in “health behaviors.” And it has reminded me that instilling such behaviors is a multi-faceted undertaking. I am not as well versed as those that have deep experience in this area, but this study experience seems to indicate that four factors must be present.

Focus. You have to know which behaviors are the ones that must change or be performed. This can be different — lose weight, take medications, take it easy after surgery, or stop smoking — across patients and situations.

Information. The patient needs information. This information is diverse — the linkage between the behavior and health, specific data about the behavior (e.g., coffee is not a vegetable), and behavior alternatives (how many steps is a game of racquetball?)

Tools. For example, my pedometer and the Web site to daily record whether I met my goals. Depending on the behavior, there can be other tools. Some do not involve IT, like nicotine patches. Some do involve IT, such as measurement and transmission of blood pressure.

Motivation. The desire to alter one’s daily routine to adopt a more healthy routine is probably the most important factor. It is also the most complex and difficult factor. Why would I get up an hour earlier to walk when I can use that valuable time to sleep? Motivation requires motivators (desire to please, guilt, basic type A behavior to achieve a goal, interest in living long enough to play with grandkids). It requires the removal of barriers that could discourage a motivated person, such as limited access to providers. It requires feedback on progress. It requires a social structure of family or friends that are supportive. And it requires the other three factors.

We will never have a reformed or transformed health care system unless we are broadly able to engage patients in managing their health. Cost reductions and outcomes improvements in treating chronic diseases require a motivated patient. Reducing unnecessary treatments is greatly facilitated by an informed patient. Improvements in the quality of care are helped by patients who make good decisions about which providers and health plans to choose.

We can help engage patients. Clearly we can provide tools and support access to information. While recognizing its complexity, we can also help with motivation.

Motivation opportunities range from making whatever IT is involved easy to use (reducing a barriers for a motivated person) to offering graphs of progress and corny but effective “attaboy” generated phrases to avatars that exhibit motivating emotions such as disapproval to online communities of others who can offer support.

While the opportunities can be listed, we have limited understanding of how to apply IT to motivate.

I need to go eat an apple. Otherwise Maria will yell at me.

 

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System and is also on temporary assignment as Advisor to the Office of the National Coordinator. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 11/9/09

I decided it was time to update the About page, which answers questions I’m sometimes asked (why did I start HIStalk, why am I anonymous, how I decide what to write about, etc.)

Respondents to my most recent poll have a slight preference for not having the FDA regulate clinical software. That’s pretty close considering that vendors usually have the strongest feeling about that and are likely to click No. New poll to your right: what do you think about a hospital with over $1 billion in revenue paying its CIO over $500K? That’s not a loaded question – I’m just curious. Note: if you’re still seeing the old poll, clear your browser cache. 

HIStalk interviews are highly educational, depending on who I’m interviewing, anyway. If you have someone in mind (and, better yet, if you can hook me up), let me know. The ideal subject: someone who works for a non-profit organization on the front lines of something HIT-related, is doing creative work that the industry could learn from, and comes across as interesting on the telephone since that’s how I do them.

Meditech held its Physician/CIO workshop recently (I assume it was recently, anyway, since the write-up doesn’t say when or where it was held). Paul Egerman was one of the speakers, meaning I would have enjoyed it.

Meditech also just filed its 10-Q. For the quarter, revenue was down 4%, but net income swung from a $27 million loss to a $20 million gain (EPS $0.57 vs. -$0.76), mostly due to investment write-offs last year. Product revenue was down a slightly alarming 16%.

The Chicago Department of Public Health (CDPH) still can’t bill for mental health services because of Cerner problems (the article is in some kind of union publication, but it seems solid). They are using a different system for billing since fixing Cerner remains “an active process.” This conversion says it all. [Alderman]: "You’re saying that after 18 months you’re unable to work out technical glitches that prevent us from billing the state?” [CDPH commissioner]: “That is correct.”

Some nuggets from the just-published 2009 HIMSS Security Survey (thinking ahead to ARRA, since stimulus dollars are tied to privacy and security, not just Meaningful Use): 

• 61% said information security gets less than 3% of the IT budget, nearly unchanged from 2008.
• Fewer than half of the organizations have a C-level security officer.
• 74% have conducted a formal risk analysis, of which 52% found patient data to be at risk. Those problems took longer than six months to correct, said 40%.
• Most of them collect audit logs (firewall, application, server, intrusion detection, etc.) and review them manually.
• Electronic data sharing is already big (91%) and about to get bigger (HIEs, other hospitals, PHR vendors, and NHIN led the list), with 41% adding new security controls for that reason.
• Most used wireless security and electronic signature, with 67% encrypting transmitted data, 60% encrypting e-mail, 44% encrypting stored data, and 39% encrypting mobile device data. Only 29% had single sign-on.
• A third said their organization had experienced medical identify theft, although most reported no consequences.

From the Eclipsys earnings call: Sunrise 5.5, due out in the first quarter, will have a “more intuitive user interface”; the company is banking on heavy CPOE use by its customers to influence new ARRA-related sales; margin improvement efforts, much of them related to internal procurement costs, will consume $1 million in outside consulting fees each quarter but will pay for itself starting in the second quarter; they will target 600 hospitals of greater than 150 beds that do not have a recent-vintage clinical system; MediNotes / PeakPractice underperformed because it was run as separate businesses; demand for Premise / Patient Flow has slowed; 60% of their sales were to existing customers.

Cardinal spinoff CareFusion sells MediQual Systems (the Atlas clinical database vendor) to quality database vendor Quantros.

Speaking of Cardinal, neither it or CareFusion is doing all that great after the spinoff. Cardinal lost money (EPS -$0.11 vs. $0.69) and CareFusion’s Q1 profit was down 28%. Optimism was expressed.

Wound Management Technologies will buy the healthcare assets of VirtualHealth Technologies for $1 million in cash, 4 million shares, and royalty payments. I’ve written about the latter company before, surely one of the most bizarre business combos around: medical office software and gold mines (insert your own joke here). 

Interesting: Microsoft Research develops the $800 SenseCam, a low-res, wearable camera that takes two pictures per minute. It’s designed to help Alzheimer’s patients by letting them review pictures of their day, which seems to help them remember events long term since Alzheimer’s patients may store memories normally but can’t access them.

Henry Schein CEO Stanley Bergman on EHRs: “Electronic medical records will reduce the cost of health care, errors will be reduced, the quality of health care will go up. We don’t know exactly how long it will take, but it’s going to happen in the next few years. And we are the exclusive distributor for the number one player in this field, Allscripts.”

A Commonwealth Fund survey of primary care doctors finds that the US is way behind in several healthcare categories: access to care, providing financial incentives for healthcare quality, and using IT. Only 29% of practices provide after-hours care (other than the hospital ED). Less than half use electronic medical records, well behind the 90+ percent of several other countries. That’s despite spending twice as much per person as other countries.

Cleveland Clinic launches a site to teach student nurses how to use EMRs.

Some AMA members are upset that the organization’s trustees endorsed the House’s health reform bill without asking its members first (doesn’t HIMSS do that all the time?) Delegates will vote Monday on whether the endorsement should be withdrawn.

TELUS announces availability of its new mobile solution, TELUS MobileCare, for homecare providers.

HCA International wins the 2009 Innovation Award for its use of PatientKeeper Physician Portal.

HHS will award contracts to build out the Nationwide Health Information Network by the end of the year.

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News 11/6/09

From Ryan Nichols: “Re: CIO salaries. In 2004, you posted salary data for a number of CIOs, including some fairly high ones like Shands. How accurate was that data? Was there some other reason for some salaries to be off the scale, >$500K?” The salaries came directly from IRS reports, so they show exactly what a CIO was paid in one year, skewed only if that person quit and got lump sum benefits. Not true in most cases, including Shands — 2008 tax records show they paid Joan Hovhanesian $708K, more than everybody except the CFO (who made barely more) and the CEO, who got $1.26 million. Sweet, although not up there with what they pay Urban Meyer to coach football ($24 million over six years).

From Jerry Seinfeld: “Re: Tampa General. Heard a rumor that they will move to Epic from Siemens. Going to the board for final approval.” Unverified.

Listening: Travis, alternative rock from Scotland that sounds like an upbeat, pop-tinged Radiohead.

Eclipsys announces Q3 results: revenue down 5%, EPS $0.07 vs. $1.58, although most of the Q3 2008 earnings came from a one-time tax treatment. Without that, earnings were down 47%. The company also announced that North Mississippi Medical Center has chosen Sunrise.

QuadraMed announces its Q3 numbers: revenue down 7%, EPS $0.02 vs. $0.12.

Cleveland’s MetroHealth has had Epic for ten years, so Judy was there Thursday for the celebration.

An undercover journalist in England buys detailed medical records of British patients from two chat room “salesmen”, apparently provided by India-based transcription center employees. One said, “We can do really good business with these leads. These leads will give you diagnose, entire diagnose of all the customers, what the customer is facing … The floor managers, they are working as freelancers for me.” The records came from London Clinic, which doesn’t outsource transcription, but some of its doctors hired a local firm and may not have been aware that their information was being sent to India. In a quick marketing reaction, Atlanta-based Webmedx assures customers that all of its employees are US-based and therefore aren’t out of the reach of US laws.

HuffPo covers EMR stimulus money and the vendor marketing techniques being employed to go after it: “cash for clunker” rebates, interest-free loans, Walmart sales, and the Stimulus Tour. John Glaser is quoted as saying that ONCHIT will start tracking EMR prices and marketing claims, looking for any stimulus-related misstatements like the ones Siemens claimed Cerner user to steal its customers (and sued them over it, although it has settled, which I’m not sure I know until I read it in this story). HIMSS was invited to comment but, not surprisingly declined, knowing it might step on some diamond toes. I was amused that John Halamka was identifed as “John D. Halambra” in the article.

USA Mobility announces GA of I-LAND, a two-way emergency messaging system for hospital and government campuses that gets through in emergencies because it doesn’t use public networks.

Over 97% of healthcare organizations say they have behavior problems with doctors and nurses, according to an ACPE survey. Examples: yelling, cursing, insulting, refusing to work with each other, throwing objects, trying to get someone fired or disciplined unjustly, and harassing sexually. Many of the problems happen in public or in front of patients. Here’s an interesting one from the respondent comments: male surgeon says to female nurse, “You must be deliberately screwing up. No one could be so stupid as to be this incompetent.” Nurse replies, “If you don’t stop insulting me, I am going to drag you out into the parking lot and kick your ass.” Surgeon reports nurse to administration, nurse gets fired. Only 22% of respondents said doctors had been terminated over incidents, while 61% said nurses had.

Maybe this is related: a couple of readers Googling for the doctor road rage story may have uncovered an important trend — there are a lot of those stories in the news. Doctors have beaten motorists with Thermos bottles, punched women drivers in the face, and pinned a pregnant woman against a wall with an SUV. Do they teach anger management in medical school?

Dann from RelWare says the Fall Technology Conference of Midwest HIMSS in Grand Rapids this week drew over 400 registrants. He took a picture of someone reading HIStalk during the sessions, which creeps me out the couple of times I’ve seen that at HIMSS (I write it entirely alone with only e-mail contact, so seeing someone read it in person makes me feel exposed).

I missed a couple of graphics from Mark Moffitt’s Web services article (you code geeks will love it because it shows a little bit of programming and some XML). I also ran across this video in which doctors talk about it and give a quick glimpse or two.

NHS is threatening its suppliers CSC and BT with termination if they don’t hit the November dates that were set earlier this year for bringing patient systems live. Sounds great, other than the previous suppliers it tried to hardball walked away. I tried to suppress the sophomoric cackling as I read the name of the hospital that went live this morning on Lorenzo, but I couldn’t — NHS Bury. 

My UCSF sources told me in August that it was stopping its Centricity project (finally verified by UCSF in mid-October). They also said that Epic would be brought in as soon as the lawyers killed the GE contract. Right again, apparently, as negotiations with Epic are underway and, if all goes well, implementation will start in the first quarter. I snooped around and found a copy of the e-mail online (warning: PDF). The GE experience must have been ugly: “I understand the frustration in our prior efforts over the past several years, and the concern that we are facing another two years of this work. However, because we are going with an established, proven system, we can have much greater confidence that in two years we will have the tools that our clinicians need to improve the quality and safety of the care they provide.” Wonder what that Strike 1 cost them?

Speaking of Epic, I got a nice note from Dr. Lucy, aka #1 Dinosaur, who was surprised to find that people assumed her EPIC FAIL line in her anti-EMR blog post that I mentioned referred to that Epic (she’s a fan of FailBlog and was riffing on that about EMRs in general). She does, however, stick to her guns in not buying an EMR for her practice, with her reasons listed in this post:

A man in the back spoke of the new EMR he had just purchased for $30,000. Once all the numbers were crunched, though, it turned out he was only going to see about $3,000 in P4P bonuses. The response, delivered somewhat more softly than the stentorian tones of the main presentation, was that his return was more likely to be in the areas of quality and lifestyle. I imagined presenting a proposal to an insurance company — actually to any kind of business — and saying, "Now, you’ll only make back about 10% of your initial investment, but you’re likely to see improvement the areas of quality and lifestyle."

And speaking of EMRs, cost is a big concern for doctors, but 58% of them know nothing about ARRA. 

Philips and the biggest insurance company in the Netherlands start a pilot project to develop home monitoring programs there.

This strikes me as bizarre: the MyMedicalRecords people engage a clinical trials company to help bring its monoclonal antibodies assets to market. An earlier announcement says it acquired the technology when it did a reverse merger with Favrille, Inc. in January 2009, although all the Phase III trials results I could find indicated that all of Favrille’s products were flops. The news didn’t seem to help the parent company’s share price, now down to less than eight cents, about a quarter of what it was worth in May.

Pharmacy OneSource acquires the MedBoard in-hospital drug delivery tracking system from MedKeeper.

Strange: a Phoenix doctor’s office gets 1,000 hang-up calls a day from a man angry at a former practice employee with whom he had a relationship. He’s done it for months and says he will keep it up for 25 years. They can’t block the calls because he’s in Jordan.

eHealth Ontario’s $236 million contract, signed quietly a few weeks after its CEO and board chair quit after a bidding scandal, will give 5,700 doctors a connected EMR – less than a fourth of those practicing in the province. The backlash over Ontario’s problems has stalled approval of a request from Canada Health Infoway for $500 million of what is basically stimulus money, although its audit was clean. That non-profit has spent $1.5 billion so far.

State government in India, annoyed that private hospitals obligated to treat poor patients are turning them away, directs them to post a count of empty beds daily on the Web page of the Director of Health Services. The newspaper article concludes that “If this works as planned, it will mean that patients will no longer have to share beds, limiting cases of infections.”

David Grant USAF Medical Center (CA) goes live in six weeks on ClinicComp Essentris CPOE, repository, and alerts.

Seton Family of Hospitals (TX) says its Sychron desktop virtualization saves caregivers 30 minutes each per day since the “roam button” allows them to save a session, leave, and then pick up where they left off on another PC without logging in again.

IMS, the big seller of patient and prescription data, sells itself for $5.2 billion, the largest buyout of the year. Thank them if you believe drugs are too expensive since they specialize in telling drug companies how to wring the most profit out of their products.

The SEC settles with imaging vendor Merge Healthcare and its former CEO and CFO for improper revenue recognition that overstated net income by 230% for three years, resulting in a $500 million hit in market cap when it was discovered. The former suits will pay a combined $870K. I read the original complaint and it said Merge did what an insider told me that HBOC did in the 90s — shipped empty boxes to customers when products weren’t ready so the revenue could be recognized anyway.

The whistleblower who turned in a Texas hospital group for paying doctors kickbacks for referrals gets a 20% share of the settlement amount — $5.5 million. Anybody know a really crooked hospital that’s hiring?

Q3 results for AMICAS: revenue up 121%, EPS $0.05 vs. -$0.02, handily beating estimates of $0.01 and guiding up. The one-year share price graph is above (they’ve nearly tripled).

Odd lawsuit you’ve already seen: the woman mauled by another woman’s pet chimpanzee has already sued its owner for $50 million, but now her family wants to sue the state of Connecticut for another $150 million because it didn’t prevent the attack.

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News 11/4/09

From The PACS Designer: “Re: Windows 7. Microsoft has released a 90-day trial copy of Windows 7 for IT professionals to use in testing Windows 7.”

From Charles Chips: “Re: road rage story. The doctor was found guilty on all counts.” Thanks for the link. After some soul-searching, I’m going to pass on running specifics even though I said I would once the jury had reached a verdict. The person’s in enough trouble already (looking at up to 10 years in jail) without having the details trumpeted to the industry just because their employer is an HIT vendor and just because I happen to know that. I’m a Golden Rule kind of guy, so I’ll sleep better knowing that, right or wrong, I didn’t go against my conscience. You can probably Google it.

This moment brought to you by Weird News Andy: “Snoring less improves your golf game. Yes, a bit late except for those in Florida, but remember it for the spring.” Another reason to seek treatment for sleep apnea — the handicap of golfers studied improved by three strokes. I like that the UK newspaper, obviously scratching their heads at not having a photo of a CPAP-wearing golfer on the links, stuck in an unrelated picture of Barack Obama holding a golf club.

Ingenix Consulting names John Nackel as CEO, replacing Ted Chien.

Thanks to the reader who sent over the six best practices for medication administration from CALNOC, which dramatically reduced errors in several large hospitals. They are simple: (a) check the medical record against the med; (b) don’t get distracted; (c) leave the label on the med until it’s given; (d) use to methods of patient identification and explain the med to the patient; (e) chart the med immediately after giving it; and (f) check the Five Rights. Bedside bar code verification isn’t on the list. I supposed you have to assume that if these steps reduced errors, they weren’t doing them before, but it’s not much of a magic bullet for those looking for one.

eHealthOntario issued another $236 million in contacts after CEO Sarah Kramer resigned in July over excessive consulting expenses. A political opponent is outraged that the government made no announcement about the new agreements, saying “It’s very ominous that at the height of the controversy around the billion-dollar boondoggle at eHealth, the government slipped another $236 million out the door.”

MD Buyline jumps on the ARRA EHR bandwagon, offering an odd lot of services (a glossary, a list of Web links, customer survey results, etc.) Maybe their services have improved since I was pressured to subscribe to them years ago.

The Advisory Board Company reports Q2 results: revenue up 1.2%, EPS -$0.14 vs. $0.32, but a lot of that loss was one-time write-offs. Shares that were in the high 60s three years ago are at $25.45 now, dropping the market cap to around $400 million. None of the executives are big holders, with even the president holding only around $350K worth.

A guest editorial in a Toronto newspaper says the Canadian government’s H1N1 vaccination rollout “looks like rush hour at a Mexican bus terminal” (I’m a bit uncomfortable with that choice of words). It lauds, however, a clinic that used its scheduling system to book vaccinations and its EMR to verify that recipients were high risk, resulting in no patient waiting. It summarizes, “If there were a Group Health Centre in every Canadian community, the H1N1 vaccination campaign wouldn’t make us look like a Third World country. We need more effective primary health care in Canada and we need to seamlessly link primary health care to public health.” Don’t we all.

London hospitals are testing a “digital patch” that allows wireless patient monitoring, with information being downloadable into a smart phone or integrated directly into EMRs. Toumaz Technology, which makes the Toumaz Sensium, says its on-board chip extracts critical information and not just raw data, working over low-power radio.

Here’s a fun blog post complaining about EMRs from the perspective of a family practice doc who can’t get information about his or her ED patients. What’s notable: the gripes (“The Emergency Department EMR from Hell”) apparently involve Epic (it’s too detailed to summarize). I really liked this comment from an anonymous reader of that site, though:

“Medicine is often compared unfavorably to the airline industry in its failure to use checklists to avoid mistakes. Well, I’m pretty sure there’s no checklist that requires a pilot during take-off to go into the cabin and ask who ordered the fruit plate. But the forces that run modern medicine (including our professional societies) feel that there is no administrative task too trivial that it should not be allowed to interfere with the doctor’s interaction with his patients. This trend is only exacerbated by making an EMR the focus of the physician’s concentration. Basic point: anything that reduces the time and mental energy a physician has to bring to direct, one-on-one patient contact is BAD.”

From accidental Googling, I see that Sharon Howard, formerly of Sage, is now VP of marketing at RelayHealth.

I editorialize on PR-fueled H1N1 data reporting in my guest editorial at Inside Healthcare Computing this week. I must have had too much soda since I sound manic: “Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah (‘headaches’ become ‘migraines’, ‘a cold’ becomes ‘the flu’, and ‘getting sick from too much Super Bowl beer, wings, and guacamole’ becomes ‘food poisoning’).”

I see HHS got a few EMR comments on its site, some of which are good. Here’s a snip of one I agreed with as a contrarian: “The fictional scenario of showing up unconscious at some distant medical center, alone and without ID and contact information, and needing instant treatment that solely depends on an EHR (not on physician judgment) is so rare as to be nil.” Most medical care is delivered near the homes of patients, so it would be a stretch to justify spending a lot of interoperability money to avoid the oft-told “unconscious in a Florida ED on vacation alone and avoided a penicillin allergic reaction” fable that happens, but rarely.

In England, three thumb drives are lost that contained information on 76 cancer patients, stored in unsecured Word documents.

Odd lawsuit: a woman sues her former lover, the married head of the OB-GYN department of Greenwich Hospital, claiming the doctor used the OR for their trysts, told her to get Hepatitis C vaccine afterward, and illegally injected her with Botox. He says she’s out to get him after he dumped her at his wife’s insistence, saying the former mistress posted Internet comments under his wife’s name that called him “a pervert”.

John Fontanetta MD, CMO of ED systems vendor EDIMS and a practicing ED physician, is named a Top Emergency Doc in a survey by New Jersey Monthly Magazine.

A psychiatry magazine says stimulus dollars won’t encourage psychiatrists to buy EMRs because the Meaningful Use criteria will be aimed at generalists controlling chronic physical disease. A New York state mental health official says quality indicators exist for psychiatry if HHS really wanted to use them to define Meaningful Use for that specialty. He also pointed out that hospitals look harder for physical conditions whose treatment generates revenue, which has encouraged vendors to focus on the broader market.

Fletcher-Flora announces GA of its lab outreach portal. 

Jeff Arnold, a founder of WebMD, launches Sharecare.com, which features expert advice from “celebrity physicians”, big-name hospitals, and “Knowledge Partners”, advertisers who provide answers marked as sponsored comments. Oprah is a backer.

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HERtalk by Inga

From DragonGuy: “Re: conversations meeting. Had a great Dragon conference in Vegas last week. Dragon 10.5 will (we all hope) partially solve the ‘Citrix issue’. The room was mostly filled with Epic-based hospital IT people wanting to improve the experience for their docs:  Kaiser, Cleveland Clinic, and similar.”

Drummond Group, which provides interoperability/performance testing and certification, announces that it will apply to become an EHR certifying body once ONC releases its requirements. I think mixing things up a bit and giving CCHIT some competition isn’t a bad thing. Of course the introduction of choice is bound to lead to strife, with certifying bodies and their constituents each claiming superiority. Perhaps competition will reduce certification fees, which would be especially appealing to smaller vendors. Now that Drummond has announced its intentions, will other entities step forward as well? Could be fun to see what unfolds.

Perot Systems is now Dell Services Global Business Unit, following Dell’s purchase of 90% of Perot’s outstanding shares. Perot CEO Peter Altabef was named president of the division.

Hospital have had a total of 126 mass layoffs (50 or more employees) through the end of September, which exceeds the 112 layoffs for all of 2008.

dbMotion opens a regional office in Singapore to address the growing demand for EHR solutions in Asia-Pacific.

Mediware reports a 184% increase in earnings over last year, and a 9% jump in revenue. Shares climbed 15%  based on its better-than-expected numbers.

West Penn Allegheny Health (PA) makes plans for a new medical school, as well as an overhaul of its 700 member physician practice group. Despite a $34.6 million loss for the nine-month period ending March 31, West Penn is investing big money in EMRs for its physician offices.

McAllen, Texas once again makes healthcare headlines. The area’s largest hospital system agrees to pay the federal government $27.5 million to settle allegations that it paid doctors illegal kickbacks to refer patients to its facilities. The government claims that South Texas Health Systems disguised payments to doctors in a series of sham contracts that included medical directorships and lease agreements.

St. Rose Hospital (CA) deploys Horizon Cardiology CVIS from McKesson. Meanwhile, Crittenton Hospital (MI) selects McKesson’s Horizon Enterprise Revenue Management solution.

The seven-physician Toledo Orthopaedic Surgeons group selects SRS EMR.

HHS says it’s taking HIPAA violations seriously, imposing significantly stiffer penalties for HIPAA breaches. The maximum penalty for a civil violation jumps from a mere $100 to a hefty $25,000 fine. The penalty cap was also raised from $25,000 to a whopping $1.5 million.

Following what seems to be low-tech techniques, VHA helps 28 hospitals in Oklahoma and Arkansas improve ER traffic. Most of the EDs made significant reductions in wait times and LWBS rates, despite increases in patient volumes. I was surprised that VHA did not attribute the improvements to some new HIT tool. Instead, old-fashioned internal competition and communication were the main forces at work. One VHA official says, “The real driver for improvement for these hospitals is not comparing themselves to national standards, but with each other. Once a hospital administrator sees that another hospital has achieved success, he or she picks up the phone and asks how.” Now that’s innovative.

Bermuda’s primary hospital and urgent care center are getting rid of paper processes and installing MEDHOST’s EDIS.

CareTech Solutions reaches an agreement to acquire IGCN, which helps hospitals build and manage Web sites.

Moses Taylor Hospital selects ClaimTrust’s InSight Denials to track and analyze claims.

Cortland Regional Medical Center (NY) contracts for ProVation Order Sets to automate evidence-based order sets.

E-mail Inga.

Monday Morning Update 11/2/09

From HISJunkie: “Re: InfoLogix. Looks like they are on their last breath. Never did think this outfit would make it. They always seemed kind of shifty to me — did the Wall Street dance, pumped it up, took it public, made a killing on stock sales … then puff!” The company, which sells an odd lot of healthcare systems ranging from RFID to ERP, defaults on loan covenants requiring it to keep $1.5 million of cash. They were supposed to either raise $12 million or sell themselves by July 31, but missed the deadline. Share price has dropped steadily over the last couple of years, from over $5 to the current $0.18 and a market cap of less than $5 million.

From CK: “Re: Lindsey Jarrell, CIO of BayCare. He was awarded the CHIME-AHA Transformational Leadership Award on Thursday at CHIME’s Fall Conference.”

Jonathan Bush in the athenahealth earnings call, acknowledging that the company is at capacity in its EMR implementations: “.. our Clinicals implementation process still has some vestiges of the early EMR thought that went into building it. EMR is a shitty way to get a practice online. It’s just garbage, and we still have that stock inside of some of our thinking. It’s almost gone … we are getting much more of our thinking oriented towards, ‘This is a clinical information network.’” He answered a question about enterprise deals with a little jab at the big HIT vendors: “We don’t have massive professional golfers on the ground ready to be buddies with these people the way some of our giant competitors do. The athena jet doesn’t fly people into the experience center to have a day of visualizing the software of the future.”

Interpreters at UNC Hospitals (NC) replace their pagers and cell phones with the iPod Touch at half the cost, also rolling out a customized version of their ServiceHub dispatching software to work over WiFi.

British parliament member Richard Bacon gets his answer on how many people actually use NHS’s Lorenzo system in the five early adopter trusts: 174 total, with a peak concurrent user count of 19, according to NPfIT. Bacon’s cost estimate of up to a million pounds per user may not be far off.

Data analysis vendor Initiate Systems (I challenge you to concisely describe what they sell after a quick glance at their Web site, but they’ll always be an EMPI vendor to me) acquires interoperability vendor Accenx. You may recall that Initiate was initially an investment and also a vendor of the CIA (identity intelligence stuff, which was big during the previous administration) and also pulled its $75 million IPO last year.

Weird News Andy, straying from his core competency of weird news, recommends this healthcare series by noted thinker Dr. Thomas Sowell. I like it that Sowell is not only brilliant, but actually writes so you can understand it (unlike the 99% of academics who lapse into obfuscatory journo-babble). “In reality, an injured, deformed, or brain-damaged baby and an eloquent lawyer can lead to jury awards in the millions of dollars, even when it is by no means clear that the doctor who delivered that baby was in any way at fault … It costs a jury nothing to ‘send a message’ warning doctors to be more careful, and the particular doctor in the case at hand probably has insurance from a company that can pay a few million dollars easily out of its billions of dollars in assets.”

The HIT Standards Committee wants to hear about your EHR experiences, good or bad. You can also vote on the submissions of others. “Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might ‘pull forward’ the benefits of healthcare information technology (IT). Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards.” Your comments are welcome by November 19, the date on which they will be presented to the committee. 

Results of my CPHIMS poll are above. Apparently, the credential doesn’t hurt but also doesn’t usually help, which is what I would have said. New poll to your right: should clinical software be treated as a medical device under FDA guidelines?

Border unrest escalates between Missouri and Kansas, bitter combatants fighting for the right to pay Cerner hundreds of millions of dollars in incentives to lure its office complex and the pro soccer team that Neal and Cliff own chunks of to their apparently economically desperate states. Right as Cerner was choosing its new BFF state, Missouri hires the commerce secretary of Kansas who was instrumental in putting the Kansas package together. Kansas officials, sustaining mortal wounds in the civic pride area, said that’s was like a baseball player switching teams during the World Series, with one adding, “We thought (Kerr’s) Number 1 goal was to bring jobs to Kansas, but find out now he was working to take his own job to Missouri.”

Doctor complaints about patient safety and an increasing backlog of delinquent charts lead Jefferson Regional Medical Center (PA) to go back to paper for some reports. They’re using Siemens, as evidenced by this cheery article about how swell it was going in 2007. You wouldn’t think chart completion would be such a big deal.

TPD has updated his list of iPhone applications.

A quiz question for you non-newbies, spawned from some random Googling: in what year did these companies first make the Healthcare Informatics Top 100: Per-Se, Applied Healthcare Informatics, Object Products, and Triple G? (hint: it was the same year that these companies were acquired and therefore fell off the list: Phamis, Amisys, Medicode, Medicus, HPR, Bukstel & Halfpenny, SDK, Rothenberg, and HCI).

The Teamsters put out an angry press release against McKesson, which sided with the minority of shareholders in continuing to allow “golden coffin” provisions to be offered without shareholder approval. Those provisions pay a lump sump to heirs when a senior executive dies, $25 to $39 million when John Hammergren meets his maker (in addition to the $80 million his family would get from his retirement plan). “Mr. Hammergren took home $29 million in total realized pay last year alone and has ample opportunities to provide for his estate. We believe shareholders should have a say in whether they’re saddled with payments made without receiving any services in return, and clearly our fellow McKesson shareholders agree.” For the first time ever, I agree with the Teamsters. Hammergren is always in the top ten lists of executives salaries, benefits, and security costs. You would think he founded the company instead of just coming on board eight years ago. Maybe Senator Grassley should look there if he wonders why healthcare is so expensive. But, if MCK shareholders would rather he get the money than them, so be it.

A hospital in Ireland reduces appointment no-shows by 44% by sending patients text message reminders.

Speaking of text messaging, StaffKnex, a nurse scheduling vendor whose product sends text messages about open shifts and schedule changes, raises $1.3 million in funding. The product originally sent only text messages, but it now converts them into voice messages for recipients who don’t like texting. Interesting: recipients can respond to the message (“I’ll work that shift”), the scheduler is alerted to the overtime cost involved, and the request is routed to the supervisor for approval.

A group of California hospitals that includes Stanford, San Francisco General, and two Kaiser facilities says it reduced medication administration errors by 88% by following best practices from the California Nursing Outcomes Coalition. I was hoping to find a list of those practices but struck out.

Patrick Soon-Shiong, the billionaire drug company founder with a keen interest in healthcare technology, offers to back $100 million in loans to reopen MLK-Harbor in LA. He’s on the board of Dossia. I tried to line up an interview awhile back, but he passed.

Charlie McCall’s attorney says he’ll call former HBOC president and CFO Al Bergonzi to the stand. He says Bergonzi, convicted years ago, will back Charlie’s story that all the phony accounting happened without Charlie’s knowledge.

Merge Healthcare’s Q3 numbers: revenue up 16%, EPS -$0.02 vs. $0.01. 

Confidential records of House ethics investigators are made public when a junior staff member working on documents from home accidentally makes them available to his peer-to-peer file sharing application.

Quality Systems’ Q2 numbers: revenue up 22%, EPS $0.41 vs. $0.37, meeting expectations on earnings and exceeding on revenue. ARRA is accelerating PM/EMR sales, the company says. Market cap for the company, including its QSI and NextGen divisions, is at $1.74 billion, of which founder and chairman Sheldon Razin holds over $300 million worth.

Odd lawsuit: drug company Amgen is sued by 14 states for offering doctors kickbacks for using the anemia drug Aranesp. The suit claims that Amgen intentionally added extra overfill to the drug vial as a “free sample” that could be billed to insurers.

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News 10/30/09

From HITGhost: “Re: Aspyra. It voluntarily delists itself from NYSE Amex.” The market cap of the LIS/PACS vendor is down to $1.4 million, so obviously it’s not worth the administrative cost to stay publicly traded.

From UKnowMe: “Re: Accenture. I hear that Accenture is eliminating its healthcare practice over the next 2-3 months and will be releasing 300-400 people. Can anyone confirm?” I haven’t heard that, but Accenture just launched the Center for Health. I never know what a company or university means when it announces a “center” that doesn’t seem to involve new people, new facilities, or anything more than a new marketing campaign and maybe a new suit or two, but it happens all the time. Here’s another one: IBM is opening a Health Analytics Solution Center in Dallas, which one of its people says is related to Dell’s Perot acquisition.

From Weird News Andy: “Re: brain surgery. Being in Britain, the patients did not have to pay through the nose for this procedure.” Surgeons are removing skull base tumors through the nose, with one patient leaving the hospital just to days later. Just in case this doesn’t impress, the newspaper article gives a graphic description of the alternative: “Previously, neurosurgeons would have had to split the facial skeleton or peel back the scalp and remove the skull on the forehead to complete the same operation.”

Athenahealth reports Q3 numbers: revenue up 37% to $49 million, EPS $0.14 vs. $0.14, missing expectations of $0.16.

In Britain, a member of Parliament wants to know the cost of iSoft Lorenzo at early adopter sites, saying the number could run anywhere from hundreds of thousands to even millions of pounds per concurrent user. Richard Bacon says Lorenzo isn’t providing value and Cerner Millennium “has caused absolute havoc.” On the other hand, the arguments seems largely political.

HIMSS continues its acquisition of other member groups, this time taking over the Medical Banking Project (HIMSS always calls it “unification with” the group it takes over). Its membership is a bit company-heavy with 163 individuals and 42 corporate members. The only employee mentioned is its founder, from whose home in Franklin, TN it is apparently run. I could find only one reference that called it a non-profit, with its own materials describing it as “a self-funded policy research firm.”

CHIME awards Ivo Nelson, chairman of Encore Health Resources, its Lifetime Achievement Award. I couldn’t find a link for the press release that someone sent me.

A radiation oncologist says Varian’s linear accelerator sales should increase in an economic recovery, but its clunky ARIA oncology EMR is a dog that might hold it back. In his words, “ARIA is far too complex and does none of the simple everyday tasks well. Obviously written by an engineer with little clinical input from the end users, ARIA is a major physician dissatisfier, as they find daily tasks much more time consuming.” Just what you want your doctor to be struggling with as they’re treating you for cancer. If you agree with his opinion, that is.

In all the Charlie McCall talk, I shamefully neglected to observe the October 18 11-year anniversary of the announcement that McKesson was buying HBOC. I editorialized about his first trial back in 2006, with this shout-out to the neglected McKesson shareholders who got burned the worst: “Among those involved were certainly some crooks and some fools, but let’s not forget those who suffered most, those McKesson lifers who had stashed away years’ worth of shares of their unexciting company’s stock instead of risking it on flaky enterprises like Microsoft and Dell. When lonely old conservative widower Dad McKesson brought home a sexy young step-mom named HBOC, she stole the kids’ piggybank.”

Cerner announces Q3 numbers: revenue down 3%, EPS $0.57 vs. $0.54, falling short of revenue estimates. System sales were down 14% and global revenue was down 23%. CERN also guided down on Q4 revenue. Neal actually chimed in at the end of the conference call.

A little recognition for HIStalk’s Founding Sponsors: Medicity and Nuance. Medicity has started a rather cool HIE Blog, I notice, that unlike the usually crappy corporate “blogs” that have “posts” written by chipper marketing types that don’t even claim to be written by executives, Medicity’s is the real deal. Included are posts from one of the smartest people I know in the biz, Robert Connely. Both companies (eScription, in the case of Nuance) were among the sponsors of HIStalk back when I was writing it with a chisel on stone, so I ought to thank them a little more often.

Allscripts used to own the domain escripts.com but let it lapse, so it went up for auction this week. There were no takers at the expected range of $10-25K. On the other hand, medicalpractice.com went for $9,000, conciergedoctor.com fetched $1,250, and h1n1fluvaccines.com was bought for $1,000.

I e-mailed the Canadian medical device licensing people about classifying EMRs as regulated devices. I appreciate this response:

In general, but not necessarily inclusive, patient management software is any software that is intended to be used to diagnose, treat, mitigate or prevent a disease, disorder or abnormal physical state, or its symptoms, in a human being. Please be advised that the classification of patient management software as a medical device and the requirement for licensing is not a new approach taken by Health Canada. Manufacturers have always been responsible to undertake their own due diligence to determine regulatory requirements. Health Canada has considered software of this nature a medical device for several years. Health Canada did not create the notice regarding patient management software with specific ‘information systems’ in mind. It has always been Health Canada’s role to review medical devices to assess their safety, effectiveness and quality before being authorized for sale in Canada.

According to the US FDA’s interpretation, a medical device is “intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals.” It almost sounds like software vendors in Canada recognized their own products as medical devices and had them evaluated as such, but US vendors have staunchly argued that their products aren’t covered. Software that displays or manipulates lab results, provides diagnostic suggestions, or manages drug therapy seems to fall into the broad category as laid out by FDA.

Ten software developers in Rwanda who work on the OpenMRS EMR graduate from an 11-month course called e-Health Software Development and Implementation, part of the country’s effort to transform itself into an IT hub.

The Center for Connected Health and Mass General buy a Tandberg telepresence videoconferencing system for telemedicine. I thought they dealt more with home medical sensors and monitoring, but maybe the mission has changed.

A med student and his programming partner (isn’t that who always creates medical apps?) develop iMurmur, an iPhone-based learning tool for heart murmur. It has sold 15,000 copies to users in 35 countries, pushing its price from 99 cents to $2.99 and leading to its acquisition by a digital stethoscope company.

The King of Jordan hosts hosts a public demo of its VistA system, implemented by Perot and the non-profit Electronic Health Solutions. Jordan is creating a VistA educational program to make itself self-sustainable.

Jobs: Director of Business Development, Clinical Application Educators, Cerner Remote PathNet Support.

Half of the doctors responding to a British survey say they are too busy typing into the computer to look patients in the eye. One doctor said, “The demands of the patient’s agenda, the Government’s agenda and the requirement that everything I hear, say and do must be meticulously recorded make for an extremely crowded consultation.”

John at Chilmark Research finds interesting facts about the Dossia PHR. After they parted ways with Omnimedix and hooked up with the Indivo platform from Children’s Boston, they found that Indivo wouldn’t scale, so they had to rewrite it. John outlines other problems they’re having. One I’ll add is that PHRs aren’t exactly lighting up the skies and Google and Microsoft are formidable competitors for what little interest there is.

Odd lawsuit: welfare recipients in Michigan file a class action lawsuit against the state for not paying for adult dental benefits. The state is broke, of course.

Also going broke: California, which paid $2.1 billion in overtime to state employees last year. One state hospital nurse made $733K in overtime in a five-year period, while two other nurses at the same hospital made $132K each per year, twice their annual salary.

E-mail me.

HERtalk by Inga

The US Postal Service finds CalOptima’s missing CDs that contained unencrypted personal data on 68,000 members. The package landed in a secure postal facility in Atlanta and the disks appear to be intact.

GE Healthcare’s Medical Quality Improvement Consortium (MQIC) is submitting anonymous clinical data to the CDC to provide H1N1 tracking information. MQIC is a repository of de-identified clinical data captured from GE’s Centricity EMR users. Every 24 hours, MQIC is forwarding updated data that’s been collected from 14 million record patient records. Great use of EMR data, though I wonder if the patients (and/or providers) are aware their de-identified clinical data is being used for this purpose. Or if they need to know.

Would you be more willing to travel to Thailand for surgery if you knew the hospital was using Microsoft HealthVault to document your treatment? Me neither. Hospital officials at the Bumrungrad International Hospital in Bangkok seem to think it will add to their appeal. I believe the $5,000 knee replacement that would cost $50,000 at home is still the bigger draw.

St. Paul Eye Clinic (MN) selects SRS EMR for its 15-provider group.

API Healthcare announces that seven new hospitals have signed on for its human capital management solutions.

El Camino Hospital (CA) deploys Web performance monitoring solutions from Gomez, Inc. The performance and availability monitoring applications will concentrate on El Camino’s recently launched public Web site and its physician application site.

Ingenious Med reports that nine new organizations have added its inpatient practice management system over the last three months.

I love my iPhone, so I was not surprised to learn that 99% of all iPhone users are happy with their smart phones. In fact, we are two times more likely than BlackBerry users to say we are very satisfied. I’m not sure I can think of any other consumer product with a 99% satisfaction rating.

Speaking of iPhones, Harvard Medical School launches an application to update consumers with the latest H1N1 flu virus news, including tips for shaking hands or other body parts to avoid the spread of virus. (Do people seriously do this?)

One last iPhone comment: here’s a nice list of healthcare applications, complete with product summaries and pricing.

GE expands its healthymagination campaign, launching a new e-health business unit that is focused on connectivity among providers, hospitals, and patients. While the announcement suggests that GE is jumping into a brand new world, the core products sound familiar: LifeSensor PHR, Centricity HIE, a clinical portal, and master patient index technology. I guess GE wasn’t too concerned over the use of “eHealth”, even though the folks in Ontario sort of sleazed up the name.

Allina Hospitals collaborates with CVS’s MinuteClinics to align clinical care operations and medical oversight. Allina and MinuteClinic will also develop interfaces between their two EMR systems.

Regional Medical Center Anniston (AL) selects ProVation MD software for cardiology procedure documentation and coding.

A Florida man opens his mailbox and finds an envelope containing medical records of over 70 people. The full chain of events is unclear, though a postal employee or two seem partly at fault. Just a reminder that while we might one day have fully secure EMRs, we’ll never rid the world of stupid (lazy?) people.

Send Inga a scary note