Dell To Acquire Perot Systems

Dell announced this morning that it will acquire Perot Systems Corporation for $3.9 billion. The all-cash transaction is expected to close in the November to January time frame.

The $30 per share offer for Perot represents a 68% price premium to Friday’s close.

Perot will become a services unit within Dell as it attempts to diversify beyond hardware sales. Perot President and CEO Peter Altabef will say on, Dell says.

Monday Morning Update 9/21/09

From Carpluv: “Re: CCR. It has been reported that a group in Wisconsin has actually tested and exchanged CCR record from a different ambulatory EHR system. This is big news since hospitals tell doctors they have no interoperability unless they work through them. CCR and CCD are part of CCHIT certification and are certainly a component of future HIEs, but nobody really did it until this week. This reduces the drama and cost of interfaces on both sides and plays well in the small physician market.”

From Clint Gristwood: “Re: Epic. I consulted a friend and Epic employee when considering a job there. According to him, turnover is extremely high. In his trainee class of 20, only five or six were left standing after a few months. Responsibility and workload constantly accrue, and those who are struggling will only get buried. Most of the people who fail try moving into consulting or return to school for graduate studies. As far as the employment contracts, Epic cannot legally enforce them, but will try other tactics. One trick they pull is threatening to not work clients who poach Epic’s human capital. This puts a steep price on employers picking up talent out of contract.”

From Eli Cummings: “Re: Emdeon. I believe the stock analyst’s sour note on Emdeon should be taken with a grain of salt. Emdeon has a solid core transactions processing business that is unlikely to see an erosion of its recurring revenue anytime soon. This analyst previously worked at Leerink Swann, where he gained notoriety for making outlandishly bearish calls on healthcare IT companies. eResearch’s stock was devastated by a report of his, even though the thesis has yet to play out in fundamentals. Perhaps the fact that this analyst was one of only two analysts covering that company had to do with its precipitous decline. He launched a similar assault on Computer Programs & Systems (CPSI) with an Underperform rating, albeit less successful. After leaving Leerink, Bret Jones resurfaced at Brean Murray, completely turning around his opinion by launching with an Outperform on CPSI. Some stock analysts will go out of their way to craft outrageous statements if it gets them the limelight.”

From Rex Wife: “Re: smart phone software. Do you have a good list of healthcare software for the iPhone? It’s too hard to find the good stuff in the apps store.” No, but I could start one. Good idea or not?

I asked in my previous poll how much influence Dell will have now that it’s jumping into the practice EMR fray. Not much, according to readers: 62% said none and 31% said a little. New poll to your right: we keep talking about vendors as employers, so if you had an equivalent job offer from the ones listed, which would you choose?

Those computer programs that crunch through long lists of kidney donors and would-be recipients to find compatible pairs are very cool, making it possible for family members to get a transplant for a loved one even when their blood types are incompatible. University of Michigan announces that it has developed its own organ matching software. Profiled are two husbands whose tissue incompatibilities precluded donating a kidney to their respective wives, but the program matched them so they could donate to each other’s wives. Confusing, which is why it takes major software to sort it out when dealing with thousands of people and infinite possibilities.

Speaking of transplants, here’s a sad tale of family bickering: a man accepts $37,500 from his leukemic brother to donate bone marrow to him, but then backs out and says he’s too sick, claiming the money was a loan. In a statement to the newspaper, he said, “I did not make David ill, and I am not to blame for his illness” and suggested his brother find a donor registry or hit up their other brother. His brother responds, “If he knew he had this Wizard of Oz disease, this magical disease that he won’t disclose to anybody, then why did he take the money? And to say I loaned him the money, then, gee, it’s a coincidence that he needed money and I needed a transplant".”

Welcome aboard to new HIStalk Platinum Sponsor Apelon of Ridgefield, CT. The international clinical informatics company focuses on data standardization and interoperability. Its computer scientists, informaticians, and clinicians are involved with projects involving Mayo, CDC, NLM, Stanford, and many others. The company is heavily involved with deploying and maintaining terminology and vocabulary such as SNOMED CT, UMLS, RxNorm, ICD-9 and ICD-10, also working with US Cancer Institute, VA, FDA, NIST, ONC, the Social Security Administration, and Canada Health Infoway. All the work involving EMR deployment, interoperability, and data mining will require stringent deployment of expertly designed terminologies, so I’m sure their phone is ringing a lot these days. All that plus it’s their tenth birthday this month. Thanks to Apelon for supporting HIStalk and the people who read it.

The CIO of two hospitals in London is named in a whistleblower’s complaint for hiring a former colleague to do $3 million worth of no-bid consulting over six years. An internal auditor concluded, “The arrangement — and in particular, the dollars involved — begs the question as to whether LHSC should just be hiring TV (Tom Vlasic) as an employee, and stop paying the exorbitant per diem rates of a consultant. An in-house solution would most likely be more economical.” Nobody’s claiming the work was subpar, so at least the money wasn’t wasted. Also in question is whether the hospital should be working on regional integration projects (observations from the audit are above).

An LA Times article covering California’s 12.2% unemployment rate mentions a hospital IT guy who lost his job eight months ago. Shown are union members picketing Toyota for daring shut down their plant, which is full of all kinds of irony. Maybe we’ll all learn lessons about not getting too complacent about being someone else’s employee since it’s a voluntary arrangement both ways. Personally, I wish more people would hang out their own shingles instead of just looking for someone else to pay them since the idea of working for yourself is just as foreign (no pun intended) as paying your own medical bills. Small business is usually what keeps the economy moving, not multi-national corporations.

A VA inspector’s report finds that the Hampton VA Medical Center misdiagnosed a man’s stroke that left him permanently disabled. The former paramedic told the ED clerk that he was having a stroke and presented with classic symptoms, but was sent home. Also noted was that another patient’s lab result had been posted to his EMR, leading to the incorrect assessment that his labs were OK. The doctor, whose contract was not renewed, had copied and pasted results from another patient.

I interviewed Justin Barnes and Mark Segal, the chairman and vice chairman of the HIMSS Electronic Health Record Association, on HIStalk Practice.

I don’t think I’ve heard of Accretive Health, but a reader says their primitive and information-devoid Web site hides a powerhouse revenue cycle company. I found this Crain’s Chicago Business article (warning: PDF) on CEO Mary Tolan, who sounds like a fireball (the “happy, confident capitalist” fires the bottom 10% of company employees, or as she says, “invites them to their next career chapter that is not us”). It’s a $250 million company with former Secretary of State George Shultz on the board. Gearing up for an IPO, so I’ve heard.

Weird News Andy loves this, proclaiming “I’ve heard of inhaling your food, but your utensils, too?” A man puzzled by months of coughing spells and lack of energy sees several doctors who eventually figure out there’s something stuck in his lung. One offers to remove the lung, but he fortunately he seeks more opinions. Turns out he had a one-inch chunk of a Wendy’s spoon stuck there, apparently inhaled as he gulped down a drink. The doctor summarizes: “We’re looking at it and realizing that there are letters on it … We started reading out loud, ‘A-M-B-U-R-G-E-R,’ and realized it spelled, ‘hamburgers.’ Everybody was shocked. We had no clue why something that said, ‘hamburgers’ would be in someone’s lung." The patient is doing great, saying he can get around and breathe again.

Andy also noticed that two Central Florida hospitals have put up electronic billboards showing their ED wait times, updated every half hour.

Former Healthlink/IBM VP Stacey Empson joins Courtyard Group (or Couryard Group, if you believe the misspelled headline) as partner.

Two Johns Hopkins cardiologists write a Washington Post editorial extolling VistA as a cheaper, more effective practice solution that is “much more user-friendly than its counterparts.”

Boston Medical Center, a safety net hospital on such shaky financial ground that it could be closed, pays its retiring CEO $3.5 million on top of her $1.3 million salary.

Speaking of Hopkins, JHMI, MedStar, UMMS, and Erickson Retirement Communities are mentioned as the organizations behind Chesapeake Regional Information System for our Patients (CRISP), which is hopefully better at creating an HIE than it is at brute-forcing a cute and irrelevant acronym out of the uncooperative name it also chose. It’s getting $10 million in Maryland money to get going. Also mentioned is Baltimore vendor Salar Inc., which sells documentation and charge capture applications.

Former Cardinal Health marketing director Laura Bellon is named VP of healthcare solutions and strategy of Perceptive Software, makers of the ImageNow document management system.

Anesthesia systems vendor DocuSys raises $9 million in financing. It also says business has slowed and its plans to add 300 Atlanta-based employees to its current 55 have been postponed.

Allscripts shares hit a 52-week high on rumors it has signed a $20 million contract with North Shore Long Island Jewish Hospital. Market cap is at $2.69 billion, more than double that of Eclipsys and nearly half that of Cerner. Share price has nearly quadrupled in a near, so like all other investments you didn’t make, it was a natural.

Perot Systems gets its first international outsourcing deal, winning a 10-year contract with India’s Max Healthcare hospital chain worth $18 million. Perot will also deploy VistA there.

Someone goofs at Great Ormond Street Hospital in London, e-mailing detailed patient care complaints from the family of a teenager who died there to the local newspaper by mistake. It’s the usual story – the employee was trying to send an e-mail to someone by name, but instead got someone else with a similar name, in this case a newspaper reporter. The paper, showing restraint that would be surprising here, alerted the hospital and declined to disclose details about the information.

E-mail me.

News 9/18/09

From Doofus: “Re: Allscripts. Word on the street that Allscripts is sending a letter to Misys EMR clients stating that they will not make MISYS EMR compliant with ARRA guidelines and that these clients will need to move to the Allscripts family of products. Fees are in the area of $2,500 per provider and a fee per practice. Training and data conversion are not included but are discounted.” A contact there says word on the street is wrong. Since meaningful use hasn’t been defined, Allscripts hasn’t made any statement about the likelihood of MEMR being compliant or what they’ll do (or offer) if it isn’t. Maybe there was some confusion over an ongoing offer to those MEMR customers who would like to upgrade to one of the company’s better products at their convenience.

From Pat Patterson: “Re: HIStalk Practice. The last e-mail blast link takes you to the eClinicalWorks home page. PS – Tell Inga she is my ‘secret girlfriend’. I just love women who can talk tech and shoes all in one column!” Inga was scurrying to the airport and pasted the wrong link into the e-mail, leading Pat to joke that we must have sold the mailing list to eCW. She can definitely talk the girl stuff, to which I agree there’s nothing more attractive than a really smart woman who’s still fun. My secret girlfriend is Tina Fey since I’ve become a big 30 Rock fan. Love the glasses.

From The PACS Designer: “Re: InformationWeek Top 250. The latest rankings from InformationWeek’s Top 250 Innovators has been released with the following healthcare providers being amongst the top 25:  #2 Cincinnati Children’s Hospital M. C., Marianne F. James, Sr. VP & CIO; #9 University of Pittsburgh M.C. (UPMC), Daniel S. Drawbaugh, Sr. VP & CIO; #18 Beth Israel Deaconess M.C., John D. Halamka,CIO; #21 Sentara Healthcare, Bertram S. Reese, Sr. VP & CIO; #22 Christus Health, George Conklin, Sr. VP & CIO;  #23 University of Arkansas for Medical Sciences, Kari Cassel, CIO. TPD salutes these institutions for being tops in IT innovation!”

From Dr. Curious: “Re: Eclipsys. After reading the post about Eclipsys letting their consultants go and giving their implementation work to consulting partner, a huge red flag went off. In this year, they have replaced their CEO, CFO, and dismantled their professional services division. It makes me wonder if there is more to this than meets the eye. For example, could it be that they are preparing for a buyout, or are they struggling through financial difficulties? Everything I have seen and heard about Eclipsys points to a near-term end for them. What are your thoughts?” I suppose it was time to replace the CEO and CFO. Outsourcing the professional services organization is puzzling since theirs was pretty good, but it never seemed to make the money they expected it to, possibly because they don’t sell Sunrise all that often and that probably caused bench time (how else can you lose money billing out $50 an hour employees as $250 an hour consultants?) You may not have noticed that share price has made a steep climb up in the last six months, going from $8 to $20, which is highly positive given the company’s erratic financials in years past. Despite some impressive successes in clinical systems, they’re always going to be banging heads (usually unsuccessfully) with the Epic juggernaut since they have the same sweet spot, but Epic’s got everything else and not just the core doctor-nurse-pharmacist stuff. Positives: the former Premise, EPSi, and MediNotes, all good (but not cheap) acquisitions. Andy Eckert knew zip about healthcare, so I’d consider that a minus, as was the long roster of lackluster and revolving door VPs that served time there. OK, so now that I’ve brain-dumped, here’s what I think: excellent products, hopefully improved management, but sorely in need of a strategy that keeps them out of Epic’s way while earning the confidence of stock analysts. They need a Neal Patterson.

The rumored Eclipsys contractors, by the way, are Vitalize, ACS, and MaxIT. All fine companies, but as one reader said, it all rides on how Eclipsys manages them.

From Anomymously Happy to be Done with Epic: “Re: Epic. I find it really hard to believe that an office is such a perk, given that the employees actually working hard for Epic don’t spend more than three days a month in the office! And as you nicely put it, people become ‘untouchable’ when they leave Epic. They don’t truly try to LEGALLY enforce the non-compete, because they can’t! I was a team lead at Epic and you are ‘encouraged’ to set mutual end dates with your team members rather than fire them. These people are too naive to know that if they do set a mutual end date that they won’t be eligible for unemployment, etc. Mr. HIStalk, please don’t ‘Like their model as a capitalist!’ I feel really bad for new young people who think that Epic is a place to start their career!” I’ll have to disagree a little. Lots of those folks aren’t all that employable, so it’s a darned good job in comparison to their likely alternatives (and pays a lot more than Meditech without the Boston expense besides). The former employees who complain about the company are self-selecting, i.e. they left, so naturally they aren’t going to brag. The ultimate measure is employee turnover, a stat I don’t have.

From Dan: “Re: your doctor’s EMR. You are an experienced observer and your comments are welcome, but we could all use the context of the make to put it all into some perspective.” I hinted around to my doc, but he never came out and said whose product it was and, surprisingly, I didn’t see its name on the screen. I was thinking GE, but that might have been another doc that I’m recalling. He mentioned McKesson, but he was tying into some hospital information, too, so I don’t know which system he was talking about. I don’t know that there was anything all that special about the EMR anyway, but I was impressed with how he integrated it into his practice.

From RIS Reporter: “Re: Kindred. The Radiology Information System unexpectedly went down at more than half of all Kindred LTAC hospitals in the US. Current radiographs were unavailable for interpretation or view for hours. That would not be so bad, except that Kindred harbors hundreds of train wreck patients.” Unverified.

An Ohio hospital employee opens a personal e-mail from a former boyfriend using Yahoo Mail on a hospital PC, surely violating a number of IT security policies. The e-mail had been intentionally infected with a $115 commercially available program that sends all keystrokes and a regular series of screen images to a designated party (the former boyfriend in this case). He not only got 1,000 screen captures loaded with patient and employee information, he also was the recipient of up to five years in jail and a bill for the hospital’s trouble in the amount of $33,000. A quoted security expert was mildly sympathetic to the hospital, but questioned how they allowed it to happen.

Weird News Andy finds this odd but not humorous story: a patient dies six days after she is somehow set on fire during surgery in an Illinois hospital.

Alliance Health Network, which runs disease-specific patient social networks used by vendors of related products and services to try to sell them stuff, raises $3.3 million in Series C funding, raising its total to $6.6 million.

University of Missouri big wheels meet behind closed doors with “several unidentified men”, leading to speculation by 100 IT employees that their jobs are about to be outsourced to Cerner. One was quoted as saying, “The workplace is miserable. We come in every day not knowing if we’re going to have a job in five months,” which means nothing much would change if CERN takes over. The suits got careless, apparently, with the CIO letting slip the never-heard term Tiger Partnership in referring to the Cerner relationship and another executive denying a newspaper’s open records requests with the excuse that pending contract discussions are exempt, then saying “we’re done here” when he realized that he had just let the cat out of the bag by acknowledging that the Cerner correspondence involved a contract.

Edgefield Hospital (SC) signs for Swearingen Software’s RISynergy RIS. I didn’t know Randall was still selling, to be honest. Great product, but the “what if he gets hit by a bus” question always came up when we considered it at places I’ve worked, even though we all liked it. I like their Web site, in which the first menu item to the left of the standard About Us is one called About You, which is fun.

UC Irvine acknowledges that CMS nailed it with an “immediate jeopardy” warning earlier this summer, the result of a California Nurses Association complaint that faulty PCA pumps were overdosing patients. Ironically, the CMS found that the pumps were fine and it was nurse errors that caused the overdoses, one of which happened while the inspectors were on site. I’m guessing the rather radical and pro-union CNA quieted down the mad-dog rhetoric a bit on hearing the nurses were at fault like the hospital said all along.

Revenue cycle management vendor Passport Health Communication hires former Cerner VP Seth Rupp as CTO.

Medicity is offering a Webinar next Friday called On the Leading Edge of Meaningful Use: HIE in the State of Delaware.

Listening: new from Muse, dramatic and theatrical orchestral progressive. They even sound kickin’ live — a little Uriah Heep, a little Queen, a little U2 (by my untrained ear). I’m surprised that they’re #6 on Amazon and they have 63 million MySpace plays. Like it lots, although I wish they were more obscure so I could feel smug about finding them by accident.

Our sponsor friends at Culbert Healthcare Solutions redesigned their Web site with a lot of highlights listed for some of their practice areas (Allscripts, Epic, GE/IDX, revenue cycle, etc.) I have to admit that I didn’t know they did as much as they do – workflow, EHR, RCM, interim management, and systems integration. Business must be good because they’re looking for consultants, I noticed.

National coordinator David Blumenthal tells an AHRQ audience that nobody’s done enough research to really know how to implement EMRs, saying “one thing we haven’t done is apply the scientific method in the practice of healthcare and medicine.” So in other words, if EMRs were drugs, FDA wouldn’t allow them to be sold, especially $19 billion worth of taxpayer expense. I’m feeling really good about HITECH right about now. I’m being facetious, but the problem with studying technology implementation is that, unlike drugs and devices, the technology is just a reliable extender of unreliable human variation. Hospitals are run like mom-and-pop shops when it comes to repeatable processes, with a massive variation between what administration decrees and what the front-liners actually do in the uncarpeted areas of the hospital. It would be unenlightening, as well as unfair, to hold the technology accountable for any change in outcomes (good or bad). This makes probably the thousandth time I’ve said this, but here I go again: if you are really good (personally or organizationally), healthcare IT has the potential make you a little bit better. If you aren’t very good, your level of suckitude will be unchanged or very likely will increase when you throw technology into the mix.

Rwanda will implement the Jeeva system in all hospitals next year. A little Googling turned up its vendor, India-based Karishma, which focuses mostly on East Africa, Southeast Asia, and the Middle East, but which lists the USA as its #4 market, with partners IBM, Intel, and Oracle and a US office in Virginia. They offer every kind of system that a hospital would need from what I can tell. The clinical decision support system sounds really cool. This might be a company to watch.

Henry Ford Health System chooses Apollo PACS.

A stock analyst says newly public Emdeon is a “melting platform” whose clearinghouse business is threatened by new competitors (athenahealth) and HIEs, speculating that providers will bypass clearinghouses and simply submit claims directly to payors. You don’t often see a new issue getting a “sell” rating.

I’m behind again, so be patient if you’ve e-mailed. We’ve got some good stuff coming, but it takes more time than you might think. I love every minute, but there just aren’t enough of them available.

Seventeen Bangkok hospitals will use a single EMR, with one benefit being the ability to attract medical tourists. IBM is involved.

You have to like the name of this long-term care physician system: PAR 3 EMR.

Sharp HealthCare is the subject of a press release by ColdFusion Web framework / content management vendor PaperThin, which says the health system redeveloped all its Intranet and Internet pages using its CommonSpot CMS.

North Carolina wants $40 million of federal money to build an HIE, $20-30 million to hire 40 employees for nine regional extension centers, and $28 million for a broadband network for medical images.

National Library of Medicine launches the Newborn Screening Coding and Terminology Guide, intended to help states move forward with common standards for including newborn screening information in EMRs.

Children’s National Medical Center (DC) gets a $150 million donation from the government of Abu Dhabi to create the Sheikh Zayed Institute for Pediatric Surgical Innovation.

E-mail me.

HERtalk by Inga

From: Miss Manager “Re: Epic prepares for a Wild, Wild UGM. Please share fashion tips for western wear, thank you!” Miss Manager sent over this link to the Verona paper detailing Epic’s user group meeting next week, which features a Wild, Wild West theme. First, I am so glad Miss Manager inquired about fashion, since I know far more about that than I do the Epic software. Obviously, boots are a must. I have some adorable Steve Maddens with spurs, so I am bummed I wasn’t invited to attend. Other than that, you can never go wrong with lots of rhinestones and studs. For those of you more focused on HIT than fashion, here are some interesting details to note. Epic is foregoing a traditional keynote speaker, choosing to “not go overboard” in light of the poor economy. The company is offering “recession pricing” of $300 per person, versus the last year’s $600 fee. Expected attendance is 3,000 plus the company’s 3,400 staff. Needless to say, the area’s 2,500 hotel rooms are going fast, and the Super 8 and Holiday Inn Express are already booked.

3M Health Information Systems releases a new application to covert ICD-9 based applications to IC-10.

JPS Health Network (TX) selects Order Optimizer as its evidence-based order set and clinical decision support platform.

I’d love to know who wrote this. Maybe it was Mr. H himself.

Ochsner Health Systems (LA) goes live on DocuSys Anesthesia Information Management and Anesthesia Drug Management at its 41 anesthetizing locations.

Lots of apologies in the media these days: Joe Wilson, Kanye West, Serena Williams. Now Cleveland Clinic’s CEO also says he’s sorry if his recent comments on obesity caused any offense. Could Mr. H also be trying to make amends with the disabled after he recently accused the elderly of wasting government money on free scooters?

CliniComp names Stephen Armstrong VP of marketing. Armstrong is former VP of marketing and founding executive of Patient Care Technology Systems.

EHRtv.com posts 40 videos from the Allscripts Client Experience, including Glen Tullman’s keynote address and several client interviews.

Healthcare analytics company MedAssurant acquires fellow analytics vendor Catalyst Technologies. The merger creates the country’s largest company providing administrative and hybrid medical record data review and analysis.

Methodist Health System (TX) agrees to implement Webmedx’s Transcription Outsourcing Service and Enterprise software solution. The system will interface with Methodist’s EHR.

I understand that pharmacies would prefer you hang up the cell phone and talk to the pharmacist when picking up your meds. However, I think this Illinois CVS pharmacy is stretching the truth a bit with its posted signs claiming they’re unable to help customers on cell phones “due to HIPAA regulations.”

The Minnesota HIE is named a finalist for a Minnesota High Tech Association 2009 Tekne Award. The HIE is up for the Innovative Collaboration of the Year award.

The Premier healthcare alliance becomes the first group-purchasing organization to contract with AirStrip Technologies. The AirstripOB product provides providers real-time remote access to such data as maternal contractions and fetal heart rates.

Streamline Health announces its Q2 numbers: $18K loss, compared to a $429K loss last year; quarterly revenue fell 16% to $4.1 million, compared to $4.9 million in 2008.

St. Vincent Health (IN) expands it use of MedAssets’ RCM products to improve contract management, charge capture ad recovery, and claims management.

Adventist Health System signs up to implement Dolvey Systems’ computer-assisted coding solution. Fusion CAC will be installed in Adventist’s 33 hospitals to enhance both the inpatient and outpatient coding process.

Sentara Healthcare moves a fifth hospital to Epic’s EHR with its recent go-live at  Sentara Williamsburg (VA.) Sentara is investing over $230 million in the project for its seven acute care facilities and 380 clinics.

Novant Health plans to roll out MEDai’s PinPoint Review predictive modeling solution across its nine hospitals. Novant will use the tool to identify and manage its inpatient populations while patients are still in the hospital.

Here’s some promising news: at last week’s HITSP board meeting, committee chairman Dr. John Halamka predicted the cost of developing health data exchanges are likely to fall as providers begin adopting standards. Halamka is betting that interfaces that today might cost $20,000 to $30,000 might in time fall to $5,000 to $10,000.

E-mail Inga.

News 9/16/09

From Herb Alpert: “Re: Eclipsys. They are designating three business partners that will replace their own professional services people. Eclipsys is emphasizing speed-to-value, pushing cookie cutter implementations. They listed the partners last week on their Partners page, but appear to have removed that page from their site.” I know that Orchestrate Healthcare picked up some of their people and used them on their SCM/eLink project at UC Irvine (someone from there told me).

From Roger Dodger: “Re: videos. These hit the big vendor mentality on the head.” The animated videos are pretty funny (Video 1, Video 2). Guess along with me which vendor the animated CIO is talking about. “Our front-end processes blow and your 1970s-build application is the problem. The competition is killing us with ease of access and the payors are denying every claim we send them. When is your effing next generation system going to be ready?”

From William Faulkner: “Re: Epic. I can tell you without much discomfort that expectations are high and few places give 20-somethings this much autonomy. I have truly enjoyed working for one of the two hottest companies in one of the hottest industries despite little healthcare experience. The employment structure is incredibly flat, so high turnover and burnout have put five-year vets in fairly senior positions, which keeps new hires motivated. KLAS is king – I must have seen our KLAS ratings 15 times in training. Everyone does get an office, in my case fully equipped with an office mate.”

From Been There, Done That: “Re: Caymans. It’s been a while since I heard of Cayman Island Healthcare! At one point, the old CIO from U of Miami was ‘consulting’ there and bringing in his old friends from Cerner.” Brand new CIO Dale Sanders posted a comment to Monday’s post, so I e-mailed to ask him for an update. Nothing heard so far, but I’m sure he’s busy.

The Health IT Standards Committee submits its recommended EHR privacy and security standards. The initial set is basic, but by 2013, EHRs would be required to use HL7 BRAC role-based access control, security assertion markup language, and WS-Trust for secure exchange of Simple Object Access Protocol messages.

Several new events were added to the HIStalk Calendar (and you can add yours for free, of course). Among them is a September 22 free Webinar entitled Understanding State and National HIT Policy, sponsored by eHealth Initiative and featuring John Glaser.

Weird News Andy likes this story detailing Medicare’s stance on buying assistive technology for patients with speech problems. They will buy an $8,000 desktop PC whose only function is generating speech from text, but not a $150 iPhone app that does something similar. Personally, I’m riding the fence here because I keep remembering those “free scooter” commercials that beg any Medicare recipient with any kind of walking problem to get their sporty ride, courtesy of taxpayers. And if it’s that great of a device, maybe patients should spend their own money on it instead of relying on Medicare to cover every little thing.

Retired hospital CEO and current hospital consultant Ronald Gade, MD joins the board of Doctations.

Hybrid EMR vendor SRSsoft is named to the Inc. 5000 list of fastest growing private companies in America.

Newt Gingrich does a video pitch for StatCom, remarkably coincident with StatCom’s ponying up big bucks to join Newt’s civic-sounding yet entirely for-profit Center for Health Transformation.

IASIS Healthcare implements Sentillion single sign-on in seven of its 15 facilities, yielding a 60% reduction in password reset calls to the help desk. They say they’ll have all 15 running by the end of the year.

Inga and I thought it would be interesting to get a look at eClinicalWorks from the customer perspective, so she attended their user group meeting in Las Vegas this week. Her updates are on HIStalk Practice: #1, #2, #3, where she also covers some eCW announcements, including opening some new offices.

Speaking of eCW, Children’s Boston announces that its Indivo/MyChildren’s PHR will bring in data from both the hospital’s Cerner system and the eCW system used by its physician group. It will use eClinicalWorks Electronic Health Exchange.

Athenahealth announces its guarantee that physician users will be able to quality for HITECH incentives, offering them six months of service free if not. The announcement covers in some detail the complex corporate accounting that’s required to offer something like that, which is interesting in itself. Jonathan Bush quotes Malcolm Gladwell in saying it takes 3% to reach a tipping point, so he’s hoping the program takes the company over the top.

Swedish Medical Center (WA) takes an equity position in 72-doctor multi-specialty group Minor & James Medical, citing their belief that healthcare reform will require cooperation beyond having hospitals simply buy practices. The local newspaper article speculates that the group will move to Swedish’s Epic system, which sounded possible if not likely when I interviewed Swedish CIO Janice Newell a couple of weeks ago.

I visited my doctor recently and have to say I was impressed with the practice’s EMR use. He conducted the whole session with both of us looking at the monitor, walking me through labs and meds (sounds simple, but it was amazingly effective and the display was great even on his puny 15” or so monitor). He mentioned that he would never put a keyboard or monitor between him and a patient, which was cool. I had a sleep study done awhile back and he pulled up the on-screen transcription from the polysomnography people and walked me through their findings. I needed a prescription refilled and he shot that off electronically, saying he was a big fan of e-prescribing, especially for drug interaction checking. The practice is just starting to use speech recognition, which he seemed to like, and also templates, which he seemed to hate (he said he refuses to use them because they create reams of worthless junk data in the EMR). He likes his EMR, I’m in fine health, and we’re both happy. He also said he would definitely get the H1N1 flu shot when it comes out, just in case you’re waffling like me.

A Buffalo group gets a $1 million grant to develop a data sharing pilot project.

Spacelabs announces its Sentinel cardiology information system.

The West Virginia Health information Network delays its RFP for creating a statewide HIE as it figures out how stimulus money and meaningful use definition could change its plans. The new date is November.

Odd lawsuit: a hospital stages a fake pharmacy stickup as a drill without telling employees. A pharmacy technician is suing the hospital and its parent company for false imprisonment, claiming the drill’s aftermath required her to have ongoing therapy for depression, anxiety, panic disorders, post-traumatic stress syndrome, and emotional distress.

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Healthcare IT from the Investor’s Chair 9/15/09

Thanks to all who commented on my earlier posting, I appreciated all the feedback and look forward to an ongoing dialogue here courtesy of Mr. HIStalk and the lovely Inga. I’ll compile all questions asked and answer one or two with each posting in addition to my current topic.

With the recent stock market recovery, companies are once again going public (or, as they say on the Street, “the IPO window is open”). Emdeon returned to the public market with a successful IPO in mid-August and Healthport recently filed its prospectus with the SEC. I’ll sound off on both of those shortly, but I’m sure some might appreciate a plain English translation of what I just said along with how it happens.

Following my last post, Healthfreak asked, When does an investment banker tell a company to go in for an IPO or plain loan from a bank?

First, traditionally there were two types of banks — commercial banks (loans) and investment banks (IPOs). Both did much more, of course, but the Glass-Steagall act signed in 1933 drew strict firewalls between the two. While Glass-Steagall was repealed by the Gramm-Leach-Bliley Act of 1999 (and we can see what fun that led to in the financial world of late), let’s assume it’s still in place as different bankers within the a larger bank that offers both services still do different things.

Why would a company go public? It’s expensive, intrusive, and, as the leadership of such companies as Epic, Meditech, or eClinicalworks would likely attest, requires a dramatically increased focus on short-term results over potential long-term benefits. Not to mention it means anyone with a Web browser can learn what senior management is paid.

Companies typically go public for two reasons: they need the money for corporate purposes (such as developing a product, expanding a sales force, or making an acquisition) or they want to provide liquidity to investors or shareholders. Microsoft, for example, never needed additional capital, so its IPO was to allow its employees and founders to ultimately sell stock. Even if existing shareholders aren’t selling stock in the IPO, part of the goal is to create liquidity and a marketplace so they ultimately can, be they founders, employees, or investors.

A loan makes more sense if the company needs growth capital and has, importantly, a business that will generate sufficient cash flow to ensure the loan’s repayment, and if the owners don’t want to give up any control by selling stock. In the case of, say, a biotech or early-stage software company, the business is perceived as too risky to loan to, but is often financeable, as equity investors will take on significantly more risk (in exchange, of course, for significantly higher return potential). Incidentally, the economics of running IPOs are inherently more attractive than loaning money, hence the spate of commercial banks buying investment banks — Citi, Bank of America, and Chase, to name a few.

What’s the process? It typically begins with the company and its board of directors selecting the underwriting team (aka, “syndicate”) by conducting what is fondly known as a “bake-off”. This is a grueling ordeal for both sides, where the company invites a large number of investment banks to come pitch for the business. The banks are often pre-screened based on the firm’s reputation, the quality of the research analysts they have covering the space, and how successful the bankers have been at showing love to management and the private investors.

Bake-offs consist of 60-90 minute sessions during which a team of bankers from each firm parades through the company’s boardroom and explains, through dramatic interpretation of huge PowerPoint decks, why their firm should be part of the underwriting team and, ideally, lead the process.

In an act that has become almost ritual, each bank comes in and presents their firm’s credentials and skills in taking companies public as well as which buy-side accounts they would expect to participate in the wonderful stock offering. Each firm has, in effect, the same map of the country with the same mutual and hedge funds highlighted and talks about their special relationship with the buyers. “But we’re not here to talk about ourselves, we’re here to talk about HIStalkCo” the senior team member says (typically the more the merrier in these meetings, as it shows the prospective firm’s view that this is a client worth dragging senior people across the country for).

The bankers then drop to their knees to talk about what a wonderful company HIStalkCo is (“transformational” and “game-changing” are always good words) and how they would position the story to prospective investors. Prior to Elliot Spitzer’s intervention, this part was done by the research analyst, but subsequently, the bankers have had to play that role, with varying degrees of success.

Next comes the part the investors really care about: stating just how much the bankers think the company is worth.

Here’s where people lean forward. As I shared in an earlier post, stocks trade on their earnings potential and so the company has already shared its projections with the bankers to help them prepare their valuation analysis. I’ll note that at this point one assumes that management’s projections are gospel and (at this point) never challenges them.

(Incidentally, everyone seems to ignore the fact that management’s projections rarely see the light of day — prudent analysts always “haircut” management’s forecasts to help ensure the company can actually achieve them, and valuation is ultimately driven off those projections.)

To predict value, the bankers define a “comp group”, a peer group of similar companies with similar characteristics. The assumption is that similar companies will trade at similar multiples of earnings / revenues / EBITDA, and it’s not an unreasonable assumption. Of course HIStalkCo will trade at the high end of its peer group, so one assumes a similar forward price-earnings multiple and then applies a 15% “IPO Discount” to reach your best guess of the likely value of the stock once it’s publicly traded. The reason for the IPO discount is that portfolio managers need to be compensated for taking the risk inherent in an untried stock. For some reason, it’s always 15% — I’ve often wondered why (perhaps it’s like 186,000 miles per second or other laws of nature).

The fun part in valuation, however, is choosing the comps themselves in such a way as to maximize the predicted value. Everyone wants to hear their company is worth a huge amount, so this is where it gets laid on the thickest. Every software-as-a-service (SaaS) company is comped to salesforce.com. Every HCIT company is comped to athenahealth or whoever the high flyer-du-jour happens to be. Desperate to win the battle of the value, some bankers were comparing Emdeon to Mastercard to goose the expected value — after all, they both process transactions!

It astounds me that companies seem to give so much credence to this part of the presentation, because picking an underwriter based on their take on value is like picking a realtor based on what they tell you your house is worth. As I’ve said in more than one pitch (stating the obvious), it’s the buyers that will set value here, not the bankers.

After all this bragging, positioning, discussing the marketing plan, and valuation, the board room has become a bored room and it’s time to thank the bankers for their thoughtful work and invite the next group in. Then, most likely, hear a presentation that has 90% overlap with all the rest. Finally it’s time to chose the lucky team and move to the next phase.

Time to start writing the prospectus? Sorry, there’s still the happy task of informing the winners, consoling (and justifying decisions) to the losers, and then dividing the hoped-for spoils of victory. Companies, in effect, typically pay the underwriters 7% of the offering proceeds. For a $200 million IPO, that means there’s $14 million to go around. How it’s divided is, as you’d expect, is topic near and dear to everyone’s hearts.

IPOs have a lead manager who typically does most of the work — running drafting sessions, coordinating diligence, scheduling investor meetings (the “road show”), taking orders from accounts, and ultimately setting the price. Not unreasonably, they want a good chunk of the fees for those services — sometimes as much as 70% (way too much, IMO).

There’s also some prestige associated with it. Lead-managed deals are tracked and give bragging rights, so the phenomenon of “co-lead managers” emerged. After negotiating with the lead (aka, bookrunning manager) on how much they get, the company needs to divide what’s left with the co-managers. Each co-manager will insist that they need more — for fairness’s sake, to “motivate the organization to pay attention to the deal”, or due to precedence.

Start writing? Not yet. Besides how much they make on the deal, the banks also care about what order they appear on the cover as that’s another source of prestige and bragging rights. While names on the prospectus cover are first set by order of how big a share of the underwriting the banks receive, after that, it’s due to “precedence”, and it really matters to the banks.

(Please don’t laugh — in my banking career, I’m sure I spent literally hours pleading for a better placement on various prospectus covers even though there was no extra money involved. I even had junior bankers research the vaunted precedence to prove that William Blair was listed under B, not W, and my counterparts no doubt did the same to prove the opposite! Why do the banks care? Candidly, I always wondered.)

Now that the underwriting team has been chosen, we’ll take a short break and my next topic will take us from the organizational meeting through pricing the deal and beyond.

In the mean time, RustBelt Fan asks, What are the signs and symptoms that my vendor is being shopped for buyers?

Ideally, there should be none. Part of a banker’s job is trying to minimize the potential of a leak. As you can expect, that’s a challenge, as information exchange is the lifeblood of the Street. However, while investors and companies might find out, it’s much harder for customers and employees to learn it.

I first encountered HIStalk a number of years ago when a client of mine whose business we were selling called us on the carpet for allegedly leaking information to Mr. HIStalk. The blog had almost perfect information about the process. I confessed with embarrassment that I’d actually never read it (nor had any of my colleagues). But, needless to say, I started reading it then.

Bottom line, RBF — in a skillful process, you rarely can tell. But remember, where there are outside investors, there’s an ultimate need for them to get liquidity in their investment, either through a sale or IPO. Whether you’re talking to a potential vendor or employer, I don’t think asking about investor plans, or, in fact, the state of the company’s balance sheet, should be taboo. As a customer, you’re making a commitment to a vendor, and while a sale of the company might not impact it, hearing what the vendor says can never hurt. Just keep the grain of salt in mind, as they’re often not able to predict what investors will want them to do.

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 9/14/09

From Ex-Cerner Guy: “Re: Cerner. Not only does Cerner re-sell the data they collect, but it’s part of their Lighthouse agreement and the client gets to pay for the privilege of giving their data away. Look closely at the wording of the agreement — it’s in there. It’s good to read their contracts closely. It’s more fun to sit in on the negotiations and watch the squirming.”

From The PACS Designer: “Re: Govt 2.0 Summit. Tim O’Reilly, of Web 2.0 fame and founder of O’Reilly Media, had some interesting comments at the Gov 2.0 Summit about turning government into a platform to foster true innovation in the years to come.” Tim’s got some shopworn analogies about the iPhone and Twitter in case you haven’t had enough of those, making the point that third-party products should plug into the “government platform” to build citizen services, no different than the Interstate system and the Internet (oops, more analogies). All I could think of was the cool movie Startup.com that documented the quick ride up and equally quick ride down of Govworks.com, which was going to make the founders zillionaires by allowing people to pay parking tickets online. Where were you during the dot-com wars?

From Needs_Gas: “Re: Eclipsys. A recruiter says they have a new model and will be partnering with third-party firms to provide services.” Unverified.

From Luke O’Scyte: “Re: anonymization. There is no such thing as real anonymization any more due to the science of re-identification. You can uniquely identify 87% of Americans with only zip code, date of birth, and gender. Release of such information by companies like Cerner should not be allowed.” I’ve covered that topic before, but it’s worth another mention: all you need is a second database that state or federal governments sell cheap and you can re-identify most of the records in a “de-identified” set. Luke sent a link to a fun article describing a well-intentioned 1990s mandate from Massachusetts state government to release anonymized data covering state employee hospitalizations, which sounded great until a grad student mailed the medical history of the governor to his office. She had easily obtained his full record of his diagnoses and prescriptions by matching the anonymized employee data to a voter database she bought for $20. Only six people in Cambridge shared his birth date, only three were men, and only one (the governor) lived in his ZIP code. That grad student was Latanya Sweeney, now a noted Carnegie Mellon professor and privacy technology expert.

The Conficter worm shuts down takes down all hospital information systems in the Cayman Islands. What’s most interesting about the story, though, is that the article quotes new CIO Dale Sanders, who has been on the job less than a week and who, until recently, was CIO at Northwestern Medical Faculty Foundation. I’m interested in how he ended up there since that sounds like a fun move. I’ve been to the Caymans several times and my impressions are (a) it’s beautiful with stunning green-blue water great snorkeling; (b) it’s also horrendously expensive and has a bad exchange rate on the US-to-Cayman dollar, and (c) it’s an international haven for tax-dodging corporations and shady banks (was that redundant?) whose physical presence is a post office box. Oh, and it has a turtle farm and rum cakes.

Opinions about working at Epic are mixed on Job Vent, which is always entertaining as well as hardly reliable. General observations of those posting: (a) they hire only easily controlled new grads of any major; (b) job evaluations and promotions are based only on hours worked; (c) if you quit to work for a customer after the mandatory one-year waiting period specified in the contracts of customers, you are an untouchable who isn’t allowed to interact with current employees; (d) the money, benefits, and the non-cubicle environment is nice for new grads. Some of the posters claim a 1984-type environment where employee conversations and Web activity are monitored, warning of the “thought police.” One pro-Epic cheerleader claims, “We hire scary-smart people, so if they can’t cut it at Epic, they will still be a rock star somewhere else” which maybe means in a different industry since 22-year-old philosophy grads with zero work experience of any kind aren’t exactly in high demand in HIT. As a capitalist, though, I like the model: pay a little more than you have do, bring people to a location where they have few career alternatives, demand more than you should expect, proclaim cheap meals and snacks a benefit instead of a way to get extra hours out of employees who might actually leave for lunch otherwise, keep enough quirk on hand to fool wide-eyed noobs into thinking that wintry Wisconsin farmland is a hip Silicon Valley Midwest, and keep a big file of backup resumes to feed the churn. It’s working for Epic and, greenhorns or not, they innovate more than their competitors.

Cerner will hire 12,000 new employees by 2020, Neal Patterson says to the government of KCMO to soothe the civic feathers he ruffled by choosing the Kansas side of the border for his soccer and HIT complex.

Thanks to Kronos for becoming an HIStalk Platinum Sponsor. The Chelmsford, MA company offers a wide range of workforce management systems that optimize the cost of delivering quality care, minimize risk due to noncompliance with requirements, and maximize productivity. Some of its applications include timekeeping, human resources management, payroll, workforce analytics, employee scheduling, and absence management. They have several research and case study papers on their site. My thanks to Kronos for supporting HIStalk and its readers.

Results from my poll about vendors notifying customers when their software has patient-endangering problem: 37% said their vendors were bad about that, 39% said mediocre, 25% said good. New poll to your right: how much impact will Dell have on the healthcare IT market now that it will offer EMR hardware, software, and services?

I like this idea: an online debate on whether to implement CPOE vs. barcoded medication administration first. It features two highly regarded pharmacists with informatics expertise. 

I think I may have joked before that RHIOs might as well try for ARRA grants as regional extension centers since they often don’t have a business model otherwise. Apparently it’s no joke: the Harrisburg Health Information Exchange (PA) submits its grant request. 

Another reason to ignore stock analysts who cover industries they clearly know nothing about: this article covering Dell’s announcement about reselling EMRs is full of eye-rolling inaccuracies: (a) the headline says Dell will “make” electronic records; (b) it calls EMRs “the device”; and (c) it opines that Dell’s big competitors will be Google and Microsoft, apparently confusing PHRs with EMRs.

An odd lineup on yesterday’s CBS News Sunday Morning: “Dennis Quaid discusses electronic medical records; the end of ‘Guiding Light’; poetry; upcoming fall films.” Dennis’s G.I. Joe did great until word got around, disappearing without a trace after three weeks. He’s up next in the sci-fi (or is it Syfy?) thriller Pandorum, which opens September 25. The trailer looks lame to me, but my taste varies considerably from the apparent mainstream.

Merge Health extends its agreement with Russian medical equipment vendor Rossyln Medical, which will integrate Merge’s PACS technologies into its custom solutions.

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News 9/11/09

From Chi Lover: “Re: Eclipsys. Eclipsys is having another round of layoffs today (9/10/09). How can they sustain their implementations with so few staff?” Unverified. Another rumor making the rounds is that Allscripts is thinking about buying Eclipsys, but I mention that purely for entertainment rather than business value since lots of signs point to the likely inaccuracy of that speculation.

From Bobby Orr: “Re: Cerner. I’m disappointed in your thoughts that Neal would do anything that is not motivated by money. Cerner would compile a massive database of patients that could de-identified and sold to the pharma companies for research, trending, etc. Go with the cynical version because it is great business idea that big pharma would be willing to pay big dollars for. The stock is not blowing everyone out of the water because Neal has bad business ideas.” You’re probably right, especially with all the non-proprietary ways the government could get surveillance data (I let my cynicism down for one moment and got busted!) One reader commented on the article, asking how Cerner would deduce H1N1 given that there’s no ICD-9 code for it; another replied that they would simply be looking at ED admissions in which the patient has a temperature that’s a certain amount above normal. If that’s all it does, then it’s worthless.

From Who Pays For EHRs? Patients: “Re: Cerner. People might have forgotten that Cerner already is selling patient data to pharma and there really isn’t any such thing as anonymized data. I guess no one is buying Cerner, so they need to do something.”

From Sr Health Integration Tech: “Re: Cerner’s H1N1 surveillance tool. I believe the CDC already has the capability, known as BioSense. It takes HL7 messages, which are made anonymous prior to transmission, and the aggregated data is analyzed for the region to determine if a ‘biological incident’ exists.” That brings back a memory that UPMC had developed a biosurveillance tool for the CDC or NIH years ago (I remember downloading it). I don’t know if it’s the same one.

From Cal Worthington: “Re: HIEs exchanging data. From what I’ve seen at many of the state-wide HIE conferences being put together to respond to the HITECH act, only the PhD/MDs are salivating over the HIE to HIE exchange because of the research they are doing. Most are professing my patient imperative, ‘the closer to the patient the faster the information is needed’ — which I believe cannot be done in a cost-effective way as you get farther and farther away from the patient’s home turf. However, I do believe that certain CMS, CDC, SSA, and research data could be exchanged in that manner, making reporting a behind-the-scenes activity to healthcare delivery. Once that happens, we’ll get better data without the administrative overhead. HIEs are effective collaboration tools in a community of healthcare providers with significant overlapping patient populations.”

From Mike Mills: “Re: iPhone emergency apps. I bike a lot, so I bought the Road ID, a wrist bracelet with my wife’s name and number and an 800 number and PIN. The system ‘talks’ to the EMT and tells them my name, blood type, any medical conditions, meds I am on, allergies, etc. That is much better and easier than a phone app, easier to find, and they make one version of the wrist band that is nice looking so you can wear it all the time.” Pretty cool for $9.99 a year. EMTs call the phone number or go to the Web page on the bracelet and a text-to-speech app reads off the information.

From Colorado Kid: “Re: Steve Hess. He left Christiana Care and joined the University of Colorado Hospital as CIO.” Thanks to the several readers who passed that info along. I feel like John Walsh for tracking him down publicly.

From The PACS Designer: “Re: wait times. As we digitize more health information, we start to see more innovations migrate to the Web. Middlesex Hospital (CT) is one institution that is going digital in their Emergency Department when it comes to posting wait times on the web for treatments which exclude real emergency situations.”

dbMotion, Allscripts, and Initiate Systems will host a Healthcare IT Executive Summit later this month in San Francisco. The topic is, of course, ARRA, which has dislodged every other topic from every HIT event (maybe HIMSS will be nothing but people talking about Meaningful Use and getting government money). It’s invitation-only, so if you didn’t get one, join the club.

Readers have added quite a few events to the HIStalk Calendar in the last few days, so check them out or add your own events for free (I keep saying “for free” since I don’t think everyone has caught on).

Listening: brand new from Phish, who shows they’re more than spaced-out live jammers. Lots of little 70s prog bits in there. Meanwhile, the music industry’s only possible savior is a group whose last album was recorded in primitive tape equipment nearly 40 years ago, the 50%-still-alive Beatles. Quality really does last, apparently.

Midwest Orthopaedics chooses SRS after taking its free EMR free trial.

Dell gets into the PM/EMR business, offering a sponsored solution to hospital-affiliated doctor groups that can include hosting, HIE services, a monthly lease payment, onsite services such as practice and workflow assessments, and 24×7 hardware and software support. Tufts and Memorial Hermann were early adopters. Partners include eClinicalWorks and Perot. That’s bigger news than the Sam’s Club announcement, I think, since Dell is offering everything for one monthly payment and practices need a lot of support. We’ll have our interview with Bill Shickolovich, CIO at Tufts-New England Medical Center, posted shortly.

The Dell story made The New York Times, which dug deeper to see what other vendors are doing. GE will roll out a hosted version of its systems in a few months, eClinicalWorks has 10 data centers for hosting, athenahealth will announce a marketing drive and technical assistance program within the next three weeks, IBM is creating a cloud-based service for EMRs, and Verizon started a 500-employee healthcare unit that will offer hosting and data sharing.

Construction will start soon in Wyandotte County, KS on an 18,500-seat soccer stadium and a 4,000-employee Cerner office park with 600,00 square feet of office space. The $414 million project, funded by bond money, covers the two organizations that Neal Patterson and Cliff Illig own most of — Cerner and the pro soccer team there. Not shown: the pizza delivery man observation platform atop the giant ticking clock.

The CRIMSON Initiative, a physician profiling system sold oddly enough by The Advisory Board Company who bought the company last year, announces that it’s being used by over 200 hospitals. One hospital CEO is quoted strangely: “If I had the ear of President Obama, I would tell him that we need two things, a national fishing holiday and the CRIMSON application.” He also calls it “a diamond in the rough,” implying there’s something “rough” about it.

The Physicians’ Drug Reference (PDR) is merging with the Health Care Notification Network to form PDR Network, offering the online drug reference and FDA provider alerts. A reader reported in May that something was up with Medfusion and Medem, Medfusion bought Medem’s health services business in July, and former Medem CEO Ed Fotsch is now listed as CEO of the new PDR Network.

The cost to McKesson to provide security to John Hammergren: $402K per year, the fifth-highest cost in the Fortune 100, way more than the cost of protecting the CEOs of ExxonMobil and the car companies.

Rockingham Memorial Hospital (VA) chooses NextGen’s PM, EMR, imaging, and community health solutions.

I missed this: Medicity CEO Kipp Lassetter, MD spoke Wednesday at the Robert W. Baird Health Care Conference.

Who believes this? Delnor Hospital (IL) says it hasn’t had a medication error in 15 months. I guarantee I could snoop around for an hour and find several, although maybe they really meant medication-related sentinel events.

Halo Monitoring announces that its home monitoring and personal alert system can send data to Microsoft’s HealthVault.

Informatics Corporation of America brings on three new regional sales directors for its ICA CareAlign data sharing and portal solution.

The State of Kentucky opens registration for its e-Health Summit, which is Wednesday at the Hyatt in Louisville. John Glaser is on the agenda (warning: PDF) representing ONCHIT.

GE Healthcare announces its plan to develop wireless monitoring systems it calls Body Sensor Networks, replacing hard-wired medical monitors with wireless versions that could be used anywhere in a hospital or at home. The company has also petitioned the FCC to create a dedicated frequency band for low-power, short-range monitoring systems. That sounds like a great alternative to moving patients around in the hospital just to get them to a monitor-covered location.

Insurance company WellPoint apparently has cleaned up its much-publicized software glitches that nearly drove the company out of business, receiving notice from CMS this week that it can resume selling its Medicare insurance plans.

Mediware announces Q4 numbers: revenue up 4.3%, EPS $0.07 vs. $0.04.

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HERtalk by Inga

Fall River Health Services (SD) alerts patients they are converting to Meditech Client Server EMR this week, a change that will allow them to connect with Rapid City Regional Hospital.

The DoD signs a contract with CliniComp to deploy its Essentris inpatient clinical documentation package at 36 additional military treatment facilities.

West Park Healthcare Centre (Toronto), Northeast Georgia Health Systems, and Hunterdon Medical Center (NJ) are awarded 2009 QuadraMed User Excellence in Software Technology awards. The award recognizes success in maximizing operational efficiencies and delivering high quality through QuadraMed technologies.

Weeks after MetroSouth Medical Center hosts a first year anniversary barbecue, the Blue Island, IL hospital lays off 120 employees. Just a month ago the Chicago Tribune reported things were looking up at the former St. Francis Hospital & Health Center. Now administrators are blaming the decline in patients for creating additional financial pressures.

E-mail Inga.

News 9/9/09

From Cynical CIO: “Re: Cerner. Interesting initiative. What’s in it for them?” Click the graphic above to see the letter from HHS Secretary Kathleen Sebelius to Cerner CEO Neal Patterson, taking him up on his offer to create an H1N1 surveillance network made up of Cerner clients. Attached to the letter was Cerner’s pitch to its customers, asking them to sign an agreement allowing Cerner to distribute HIPAA-compliant aggregated data from their facilities. It sounds kind of cool. Benefit to Cerner? Well, Cerner got face time with Sebelius, did her sort of a favor, and may get unspecified IT vendor benefit someday. Add that to having a former Cerner director as President Carter’s … err, President Obama’s healthcare reform czar and you’ve got friends in high places who are spraying great gouts of taxpayer dollars directly at healthcare IT. Still, I’d say Cerner’s intentions were more noble and focused primarily toward their clients and their patients, so I tend to believe their claims of sincerity.

From Michael: “Re: Texas Toast. A certain high profile technology / billing service company issued walking orders to 30 practice management billing employees at 2:00 PM Thursday. Word on the street is that physicians are ‘heated in Houston’. Silicon Valley VC types have learned that hand-to-hand combat the physician office billing trenches is a different kind of war. The VC types ‘donated’ $13.8 million to a lost cause in March of ‘08. I’m wondering about the physicians, their cash flows, and how many physician-initiated lawsuits are on the dockets.”

From Bells are Ringing: “Re: UPMC. From their site: ‘Alcatel-Lucent, a telecommunications industry powerhouse, has played an important role in delivering innovative communications platforms, including multimedia and data infrastructures, wireless and wireline broadband access, and full network optimization.’ Fact: so-called high tech telecom has been disruptive to care processes at the new Children’s Hospital since inhabitation in May. Shhhhh.” UPMC and Alcatel-Lucent are joint venture partners, so there’s no chance of discouraging words being heard.

From Fred: “Re: Meditech. Their latest technology first was known as Focus (internally), then C/S 6.0, and the latest is Advanced Technology. You wonder how long they spent thinking about this one.” That name makes me think of the IBM PC AT, which wasn’t advanced for very long. Interesting: did 6.0 sound too much like an easy upgrade when it wasn’t, or maybe was it a good marketing opportunity to rebadge a big technology change to impress the market? I have to say I like the strategy even though the name is kind of white bread. I’d have gone with Meditech Optimized FOcus , or MOFO for short. Quick, no peeking — which name do you remember, theirs or mine?

From Mike Mills: “Re: HIEs exchanging data. Maybe the people living in those regions could get stimulus funds for travelling to the other regions, where they could get sick, so that the providers could actually have a reason to view clinical data for someone who lives four hours away!” I tend to agree that the “unconscious in the ED while on vacation” is a stretch, but somehow people always assume that happens a lot. I figure it’s 0.005% of the healthcare that raises the interoperability cost by maybe 25,000 times over just connecting everybody in a single region, but everybody likes irrelevant analogies like those involving cell phone service or ATMs.

From Mick: “Re: Steve Hess at Christiana Care. What happened to him?” Nothing that I’ve heard. His name is still on some recent press releases and his LinkedIn profile says he’s still there.

Listening: relatively new music from David Byrne and Brian Eno, reader-suggested. I’m not a huge fan of either (maybe more of their former bands, Talking Heads and Roxy Music, respectively), but it sounds pretty good.

HealthHiway, an India-based HIE platform vendor that offers connectivity to doctors in India for as little as $200 per year, gets $4 million in funding from Greylock Partners.

I’ve been getting hammered lately by vendors and organizations wanting me to provide free advertising. For Webinars and conferences, you can add them to my events calendar yourself at no charge. I won’t link to your survey, run your press release if it doesn’t interest me, or give you space for your promotional article, sorry. Everybody would stop reading if I cluttered it up with all that stuff like lots of industry sites do.

Craneware announces FY09 results, with sales up 68%, revenue up 23%, and profit up 29%. I just now remembered that I was on the hospital IT steering committee that approved what must have been one of their first US sales going back at least eight years ago. They had a pretty good story even then.

Inga is turning into Weird News Inga, having sent me this: a 65-year-old man gives the finger at a healthcare rally — literally. Healthcare reform advocates and protesters in California get into the stereotypical heated discussion (likely armed with lots of emotion and minimal facts) when a pro-reformer allegedly confronts an anti-reformer. The anti-reformer, saying he “felt threatened”, punches the pro-reformer in the nose. They get into a full-on fight and the pro-reformer bites off the anti-reformer’s pinky. It’s nice to know that such an important issue is being debated with civility by well-informed citizenry. I’m beginning to think that 90% of Americans don’t have the intelligence or knowledge to debate laws, vote, or serve on a jury, being intellectually suited only to vote contestants off reality shows.

The US Patent Office grants TeraMedica a patent for its Evercore solution and its concept of Clinical Information Lifecycle Management. 

Regenstrief EMR pioneer, HL7 co-founder, LOINC developer, and IOM member Clem McDonald receives the President’s Medal for Excellence from Indiana University. He’s now director of The Lister Hill National Center for Biomedical Communications, a research organization that’s part of the National Library of Medicine.

A great PR gimmick: the MyMedicalRecords PHR people offer to reimburse subscribers up to $5,000 if they get H1N1. The relationship between the offer and the product is tenuous at best, but it’s kind of fresh.

Up to 11% of doctors aren’t offering immunizations because insurance pays less than the cost of the vaccine itself. Studies show doctors send patients to public health clinics instead, but parents don’t often follow up and kids aren’t being immunized. CDC is very interested, having observed that half of kids with measles were seeing doctors, but didn’t get the shot.

Which of these doesn’t belong with the others: Eclipsys, athenahealth, HIStalk Practice, and Sage. The answer: none — all of those organizations (and others) are sponsoring the AAP Pediatric Office of the Future exhibit at the American Academy of Pediatrics conference in Washington, DC October 17-20. This isn’t one of those lame “media sponsor” deals where all you do is run free ads. HIStalk Practice is a real, “I’m writing a check” sponsor in support of our regular contributor, Dr. Gregg Alexander. Now I doubt you’ll start making travel plans just because HIStalk Practice is involved, but if you’re going to the conference anyway, check it out and maybe find Gregg to say hi. There’s no booth or anything, just a PC running a presentation that I haven’t figured out yet.

Norwalk Hospital (CT) CIO Jamie Mooney is named as a mentor for Columbia’s technology management program.

Former Eclipsys SVP Keith Figlioli is named SVP of the healthcare informatics division of Premier. He has no informatics background that I can discern.

From Weird News Andy: in Australia, Queensland Health has the answer to patient harm caused by overworked medical residents whose on-call shifts run up to 80 hours: drink six cups of coffee a day and eat more sugar. Maybe they should have added regular trips outside for a smoke or maybe a snort of cocaine.

Doctors from St. Vincent’s Hospital in Manhattan develop an AIDS exposure treatment widget that will be available throughout New York State. They treat exposure “as a gunshot wound in terms of urgency”, saying that infection risk is reduced by 80% if treatment is started immediately.

The Social Security Administration gives a former IBM futurist his first job as CIO, putting him charge of a $1.3 billion IT budget. He’s a good blogger, so maybe that sealed the deal.

Just as I suspected: using Facebook is a good mental workout that keeps your mind sharp, while texting, reading Tweets, and watching YouTube make you stupid. Evidence abounds.

The Army’s MC4 battlefield EMR wins two government technology awards. 

Fidel Castro editorializes on healthcare in Cuba, railing against Philips for offering discounts on medical equipment for Cuba and Venezuela, but backing off when the British government started investigating the patented software and parts it was sending there. They’re buying instead from Siemens, which is hardly shocking.

Former 3M executive Alan Wittmer joins Mediware as SVP of corporate development.

Ambulance chasers increased their TV advertising by 1,400% in the past four years.

E-mail me.

HERtalk by Inga

The nation’s unemployment rate increases to 9.7% in August. Also up: the number of jobs in healthcare, with the industry adding 28,000 more last month. Since the recession began in December 2007, the sector has added 544,000 new jobs. The biggest growth areas are in ambulatory care, nursing, and residential care.

Given the current employment situation, it’s not too surprising that more college students are showing interest in healthcare informatics and information management. Colleges offer 270 accredited programs (53 at the bachelor’s level) and another 30 are expected to be certified by the end of the year.

Healthcare data analytics company Verisk Health acquires TierMed Systems. The acquisition will allow Verisk to offer TierMed’s HEDIS reporting solution.

 
Here is a new iPhone app that sounds kinda cool, but I wonder if it will take off? For $2.99, you can buy ICEbeacon, which allows you to add family/physician contacts, allergies, medical conditions, and current meds. You also get a sticker to put on your phone, which alerts emergency personnel how to access the information. Personally, I don’t want to put a sticker on my phone. And do EMTs spend much time looking for patients’ phones?

The Department of Defense Military Health System extends its 16-year relationship with EDS, signing an $8.1 million, 12-month add-on contract. EDS will make technical enhancement to to DHIMS systems.

Christ Hospital (OH) implements EpicCare Ambulatory EMR at its 35-physician medical group and regional therapy centers. The hospital is also giving community physicians the opportunity to purchase the EMR and connect to the hospital’s system. When I went to the hospital’s Web site, I noticed they have end-user training roadmaps that can accessed (not sure if that is by design or mistake). The level of detail is pretty impressive.

The local newspaper discusses the recent Epic live at Carilion Franklin Memorial Hospital (VA) and its sounds as if all went smoothly. The hospital’s IT director is quoted as saying, “No one has cried, and that’s a good thing.” Yup.

I see the AMA has set up a Facebook page to communicate updates to physicians and patients. I guess I am not social media-savvy enough to appreciate using Facebook to get news from groups like AMA or HIMSS. I’d rather use Facebook to learn what my friends are up to (stuff like, “I washed the dog today,” and “My daughter had her first soccer game”). I also got yet another request in my Inga inbox to set up an account. I guess I could and then post things like, “Boy, was that CIO I interviewed today boring!” or take some inane quizzes like, “Which shoe are you?” Or not.

E-mail Inga.

News 9/04/09

Children’s Boston releases free iPhone infectious disease outbreak application
Rosemary Kennedy leaves Siemens Healthcare for National Quality Forum
Three HIEs are sharing data

From HomeCareMD: “Re: PDF Healthcare. Our small house call practice has been using PDF charts and CCRs for five years and love the convenience and universal applicability of Adobe files. However, it is still hard to direct-admit a patient to a hospital from a house call by sending the PDFs of images and chart elements in advance so the receiving hospitalist / institution has proof of the clinical state signed by the referring physician. All our regional hospitals use silo EMRs which block out any e-mails or attachments unless you pay to play on their medical staff and/or pay to create middleware. My understanding is that ONCHIT is about to break up this cartel-like behavior by requiring realistic ‘interoperability’ standards in such settings. Let’s hope they do. Even HIPAA has reduced requirements in urgent care situations.”

From RockStar: “Re: meaningful use. To Winchester: not sure about your angst. We find MU to be straightforward and have assured our CEO that we will be compliant with all 2015 objectives and measures. Can you be more specific about your concerns?” Personally, I think too many organizations are waiting for what is likely to be an unsurprising set of criteria only to find that they’re too late to get up and running in time.

From The PACS Designer: “Re: Web 2.0 popularity. While we haven’t seen  many Web 2.0 solutions in the healthcare space, there is much more being done elsewhere that has been bringing value back to the institutions that employed Web 2.0 concepts. McKinsey & Company recently polled almost 1,700 executives and found that most are benefiting from the Web 2.0 experience. Healthcare will be joining these early adopters in the coming years since collaboration can only bring more high quality digital solutions to healthcare practices!”

Listening: Nick Cave and the Bad Seeds, bleak but insightful theatrical dirges, one of my all-time favorites. 

I love the online photo celebration of Meditech’s 40th anniversary (check out the “dial up table” shot). I’m still hoping for that Neil Pappalardo interview one of these days. Also announced (albeit belatedly) is that some of the company’s execs met with David Blumenthal sometime before Vice President Biden’s grant announcements back in August at Mount Sinai Hospital in Chicago (a Meditech customer).

Speaking of interviews, I thought I had an inside connection that would get me one with Patrick Soon-Shiong, the billionaire who’s donating $1 billion for “the Bell Labs of healthcare,” but he shot me down.

Healthland partners with the Performance Management Institute to offer an executive information system for its small hospital customers, touting its ability to provide evidence of meaningful use.

Froedtert & The Medical College of Wisconsin credits its applications from Surgical Information Systems with reducing surgical late charges from 43% to 1.1%.

It’s a busy month for HIT meetings and Webinars according to my online calendar. You can add your event for free, you know, which will put it on every page of HIStalk.

Newcastle Hospitals NHS Foundation Trust is delaying its big-bang Cerner go-live via its vendor, UPMC. I just realized that it’s an odd, two-way street: UPMC is implementing HIT systems overseas, while Cerner, through its employee clinic, is delivering patient care.

August was a good month for HIStalk readership, especially since summers are always slow. It was the third-busiest month ever, in fact (barely missing the #2 spot), increased somewhere between 40 and 50% over August 2008. You never know with other sites copying what they see here. Luckily for me it’s harder than it looks, especially for someone who doesn’t have industry background or experience, so they aren’t putting a dent in readership. Thanks for reading. I don’t advertise, so if you want to help, e-mail your colleagues a link, possibly lying and telling them I ran an expose’ about them. That should get me one page view, anyway.

Ohio Pain Clinic creates a virtual clinic with free online patient tools such as videos, activity tracking, and a full electronic medical records system designed specifically for pain medicine. The $1 million EMR system was paid for by outside investors, which is probably an interesting story on its own.

Weird News Andy notices that another hospital decided to Tweet a live surgery. The fact that the Tweeter was a hospital media relations specialist is a good indication that the motivation was right out of some hip marketing newsletter, but the patient’s family said it was nice for them, at least. Of course, if a marketing person sat through all surgeries, they could convene a private family conference call or something instead of using Twitter for the whole world to see, but that just wouldn’t be as cool to report back to the New Media people. Wonder what the plan was if the patient died on the table? And how do you top that — a Tweeted Code Blue?

Children’s Boston develops a free iPhone application to show infectious disease outbreaks in real time, complete with alerts when the bugs are approaching. They call it “participatory epidemiology”. I guess you head for the uninfected hills when you get the beep.

The Pfizer whistleblower will be paid $52 million. Correction: he and his lawyers will be paid $52 million, which probably means he’ll end up owing money.

Richard Tayrien, DO is named chief health information officer of HCA, a newly created position overseeing EMR development and implementation that reports to CMO Jonathan Perlin. He’ll come over from Catholic Healthcare West, where he’s been VP of clinical information systems. Some of the sloppy fact-checking rags apparently don’t understand osteopathic medicine, taking the “Dr.” bait and titling him an MD (although the press release could have been more helpful and said so since “Dr.” covers a huge swath of non-specific ground, but it did say he graduated from a school of osteopathic medicine rather than an allopathic school).

An interesting snip from an interview with the CEO of the best-known medical tourism hospital in the world, Thailand’s Bumrungrad International Hospital (he also shot me down, or more precisely, ignored me completely when I e-mailed to suggest an interview a year or two ago). Anyway, “In 2007, Microsoft was looking to enter the health care arena … and it purchased the H2000 software from a company called Global Care Solutions and they renamed it Amalga HIS. As part of that transaction, we became a partner with Microsoft to develop some of the next generation of the software, which will be a totally digital version…. We’ve identified 37 modules that are the core of the offering and we’ve got various teams working on all of those and some of them have already migrated [to the new modules]. We have different releases coming out, about two a year, over the next to year so that we will be a totally digital hospital … But it requires doctors to type in these things and it’s not easy to get doctors to do that. It could also take something away from the doctor-patient interaction if the doctor has his head buried in a computer rather than looking at the patient and having a dialogue with the patient…. Hospitals, not just our hospital but I think hospitals everywhere, are facing this challenge.”

A laptop containing information on 40,000 patients from the Naval Hospital in Pensacola, FL is missing from the pharmacy department. It was beat up, so they’re thinking (praying) that maybe somebody had it destroyed but didn’t do the paperwork.

HERtalk by Inga

The American Dental Association and HL7 agree to develop joint HIT standards, which should be of great interest to EMR vendors. The goal would be to create consistent IT standards and enhance the coordination of care between medical and dental practices. Does this mean, perhaps, that ambulatory practice management systems might one day be suitable for dental offices?

The public healthcare IT programs for Boston and Denver are named winners of the 2009 Davies Award of Excellence in Public Health. Boston was recognized for its syndromic surveillance system that enables officials to track diseases seen in emergency rooms across the city. Denver was honored for its integrated health information system that includes a patient-accessible web portal for lab results.

Norton Healthcare (KY) hires MEDSEEK to rebuild its consumer website. The official press release says that Norton “partnered with MEDSEEK to accelerate its eHealth ecoSystem strategy”, which meant nothing to me. You kind of have to read a paragraph or two down to understand that Norton is really just building a better website. When did it get so hip to come up with confusing names?

Rosemary Kennedy RN leaves her Siemens Healthcare job as chief nursing informatics officer to be named senior director of nursing and healthcare informatics for the National Quality Forum.

Here’s a shocker: the 30% of doctors who earn $250K or more and significantly more satisfied with their careers than those making less money. Overall, pediatricians represent the most satisfied specialty. Hopefully you (or your doctor) are not one of the 15% “very dissatisfied” with his/her career.

Three HIEs are now able to share data, which I think is pretty exciting stuff. HealthBridge from Cincinnati, Indiana HIE from Indianapolis, and HealthLINC from Bloomington are now able to send to one another data on their combined 12 million patients.

Spartanburg Regional System (SC) plans to deploy Concerro’s shift management system, a component of Premier health alliance’s LaborConnect program. 

Teleradiology company Franklin & Seidelmann Subspecialty Radiology raises $12.5 million to expand into new markets and add services.

Allscripts sends out a tweet that 83 people attended its EHR Stimulus tour stop in Las Vegas today. There seems like there should be some clever gambling joke in there somewhere, but it’s not coming to me.

This settles it. I am learning Spanish so I can spend a few of my early retirement years in Mexico. Thousands of Americans have already headed down there, lured by the flat $250 a year fee for a health care plan with no limits, courtesy of the Mexican Social Security Institute. The plan has no deductibles, free meds, free tests, eyeglasses, and dental work. The biggest question left to figure out is mountains or beach.

E-mail Inga.

News 9/2/09

Medsphere gets $12 million in funding
AHIMA Foundatation gets $1.2 million HHS grant
Nurse develops iPod nursing reference

From Winchester: “Re: Meaningful Use. I’m surprised we’re not seeing more debate on Meaningful Use given the stakes involved. Readers, I hope you’ll chime in: (a) are you delaying given the vagueness of MU? (b) what do you most wish was clarified? (c) do you anticipate major changes by December? (d) are your vendors giving you all the right assurances? (e) is there a scary scenario where you’ll have to tell your CEO you’re not going to achieve MU after all?”

From CDiff: “Re: NHS. Gives another meaning to rationing.” UK researchers find that prisoners are fed better than hospital patients, even though hospitals spend more on food. A quote: “If you are using food as a treatment, it’s not working.”

From Nicole: “Re: EHRs. You did a series of short interviews with several EHR vendors. Can you tell me where to find that?” The interviews with 12 vendor executives ran on HIStalk Practice as a five-part series called EMR Vendor Executives on HITECH. They’re here: 1, 2, 3, 4, 5. 

From Back Pocket: “Re: Navin Haffty newsletter. The newsletter questions KLAS results. Aren’t KLAS results from clients? So, John Haffty is questioning Meditech client comments.” The Meditech consulting company principal complains that a particular magazine’s story about Meditech’s Version 6.0 is “more dramatic and pessimistic” than the KLAS report it cites, which he characterizes as contributing “to unnecessary and misleading negativity and one can only wonder whose purposes are being served.” I’m just happy than an HIT magazine didn’t cheerlead for the entire article, frankly. We know which self-serving interests are at stake: the magazine’s (to get and keep readers) and the consulting company’s (to get and keep Meditech customers). Meditech is at a crossroads with 6.0, which is a really difficult upgrade, readers have told me. It’s a natural time for customers to re-evaluate their options. I’m pretty sure they will not use a free magazine’s article as a key decision-making tool (nor a vendor’s free newsletter either, I would hope). I score the magazine criticism as Messenger 1, Would-Be Shooter 0.

From Hank Kingsley: “Re: HIStalk logo. I don’t think the doctor should be smoking a pipe!” Man, healthcare IT people are so literal. It’s supposed to be ironic, OK? As I’ve explained before, I told the graphics person to give me something very 50s, with the reflector thingie, the square jaw, the old-school white coat, and the pipe with wispy smoke. Ward Cleaver, MD, you know?

From Beulah Balbricker: “Re: comments. Reader comments start off with ‘Re: some topic’. Are they initiating these remarks on their own or responding to specific news items?” Could be either. It’s like a letter to the editor that starts with their subject (which is whatever the Re: says) and a short comment, with all of that in quotation marks and in blue. Whatever follows is my reply. People usually e-mail about something I wrote in a recent HIStalk posting, but sometimes they just send something they want to say.

From Gary Numan: “Re: non-disclosures. A peer of mine was just asked to sign a non-disclosure to get trained in GA-released (not Beta) EMR software from Siemens, so it does exist.”

From Gregg Alexander: “Re: Healthcare Crisis News with Rosalie Michaels. Debuts September 1. A Colbert-esque take on the ‘crisis’, though Rosalie is far more attractive than Mr. Colbert.” I think it proves that everything is fascinating and amusing when a former Mrs. Arizona reads it while smiling and wearing a deep-cleavage clingy black shirt. It’s sponsored by the No Insurance Club, which is really a prepaid doctor visit plan that costs $480 for 12 visits per year, but only has a handful of doctors across the country (I’d be suspicious of doctors willing to work that cheap) and does not cover emergency room, hospital, or specialist visits (so it’s really more of a selective uninsurance program that covers doctors but goes bare on hospitals).

From The PACS Designer: “Re: As the Software as a service (SaaS) marketplace evolves, we are going to see low cost solutions appear for consideration as a service. One that has appeared recently is a security service called the Egress Switch. The UK firm offering this service uses e-mail addresses to validate each member of a secure network, and then encrypts the messages to meet the needed security level for the application being used by the validated members of the group.”

Atlanta Women’s Specialists puts out a press release about its EMR capabilities and its ability to exchange information with other medical practices via the Medicity Novo Grid. It can post and flag abnormal test results within 24 hours and to send prenatal records directly to the hospital. The practice will deploy to smart phones as well.

TeraMedica will offer its Evercore medical imaging system to the healthcare customers of technology solutions vendor Logicalis.

Epic finally works out a deal to get the Epic.com domain from the company that owned it (epicsystems.com still works too). 

A MEDSEEK Webinar next Wednesday features an eHealth Director talking about whether your hospital needs one of those.

Atlantic General Hospital (MD) signs a deal for Keane Optimum Patcom and other apps. Another Keane client, 25-bed Montgomery County Memorial Hospital (IA), is mentioned in an article about IT investments in small hospitals.

Baylor Medical Center at Frisco (TX) chooses Orchestrate Healthcare and Vitalize Consulting Solutions to roll out a new clinical and technical architecture.

The Columbus paper covers the diagnostic image sharing capability of some Columbus-area providers. A doc from the radiologist group complains that Ohio State isn’t one of them.

Jobs: McKesson Paragon Consultants, Clinical Business Analyst, Associate RIS Administrator.

Orion Health and Cisco announce a public health reporting and notification solution.

California can’t manage its fiscal crisis, but has time to legislate the speed with which managed care plans see patients. New regs require that routine PCP visits be scheduled within 10 business days, specialists 15 days, and urgent care appointments within two days. After-hours emergency calls must be returned within 10 minutes. Sounds good except physician payments keep going down and so does their number, both problems that can’t just be lawyered out of existence.

Another example of lawyers fixing everything: the attorney general of Kansas files suit against a non-profit hospital, its board, and its corporate parent. The charge: it’s going broke and will close. The AG is mad that the hospital hasn’t transferred its critical access designation to some other entity that otherwise couldn’t survive financially in Pawnee County.

A nursing professor and her husband develop Nursetabs, a pocket reference for the iPod Touch. They’re in Michigan, I found out after only 10 minutes of digging through the rube newspaper’s site to finally find something that mentioned which of the 50 states Livingston is in.

E-mail me.

HERtalk by Inga

Saint Barnabas Health Care System (NJ) selects MedAssets to provide revenue cycle process re-engineering services.

Medsphere secures $12 million in a secondary round of VC funding, to be used for ongoing development and expansion efforts.

Greenway and RelayHeath introduce a new partnership that will leverage Relayhealth’s Virtual Information Exchange to provide Greenway clients access to lab results, radiology reports, and transcribed documents from their community health systems.

Speaking of Greenway, the company announces its 11th consecutive fiscal year of positive growth, ending its 2009 fiscal year with a 38% increase in sales over 2008 and 88% over 2007. Ever since I can remember, Greenway competitors have loved to discuss how the privately help Greenway wouldn’t be able to make it long term, that they would run out of money and never turn a profit. While higher sales do not necessarily equate to increased profits (or any profits, for that matter), you have to hand it to Greenway for its tenacity and continued growth. There are a lot of sunset companies out there that would have loved eleven years of positive growth.

eClinicalWork partners with Correctional Medical Services (CMS) to provide EMR solutions to correctional facilities affiliated with CMS. eCW already provides its EHR to Rikers Island in New York.

Jeffrey L. Sunshine is named VP and CMIO of University Hospitals (OH) after serving in these roles on an interim basis since November 2008.

athenahealth’s Maine Operation Center is named one of the 2009 Best Places to Work in Maine.

Sheila M. Sanders takes over as VP for information services and CIO for Wake Forest University Baptist Medical Center (NC.) Sanders most recently served in a similar capacity at the University of Alabama at Birmingham.

If you are feeling the need to get up to speed on the upcoming ICD-10 coding system, you can review the new fact sheet being offered by CMS. I assumed it was going to be dry and technical, but actually found it to be easy to understand, nicely laid out, and informative.

QuadraMed names Bonnie Cassidy VP of Health Information Management Consulting Services, to direct the expansion of QuadraMed’s HIM services business and lead the company’s consulting team. Cassidy is the president-elect of AHIMA and formerly worked for CCHIT in certification development and program delivery.

HHS awards the AHIMA Foundation a $1.2 million grant to continue its state-wide HIE consensus project project.

A study finds that the quality of care provided by retail clinics is on par with physicians’ offices and urgent care centers, yet treatment costs were significantly less, although the study covered only sore throats, ear infections, and UTIs. The cost of care was 30-40% less than in a doctor’s office and 80% lower than in an ER.

Oklahoma State University Medical Center selects Lawson S3 Enterprise Financial Management and Supply Chain Management suites. The Medical Center, by the way, was recently purchased from Ardent Health Services by a City of Tulsa trust.

If you are reading HIStalk, you are likely already involved with HIT. Fortunately, the Bureau of Labor Statistics says it’s a good field to find a job in right now, with employment for medical records and HIT technicians expected to grow faster than average for all occupations with an 18% increase through 2016. Within the field, there are different 125 job titles in more than 40 settings, but expect the most opportunities to be in integration, programming, project management, and training.

Stephens Memorial Hospital (TX) plans to add a new EMR in time to qualify for stimulus incentives. The 44-bed hospital will pay CPSI $443,286 for the new technology.

Look for state and local governments to increase their spending on HIT over the next few years. INPUT forecasts that state and local government investment in HIT will grow at a compound annual growth rate of 4.6% between 2009 and 2014, from today’s 7.6 billion to $9.6 billion. Spending on EMRs will grow from $850 million in 2009 to $1.85 billion in 2014.

As of this week, Medina General Hospital (OH)  is officially affiliated with Cleveland Clinic hospital. Now known as Medina Hospital, the community hospital is receiving $40 million in capital investments from Cleveland Clinic and will implement MyChart within the next year to 18 months.

I am fascinated by this new “intelligent” pill organizer that beeps or calls / e-mails patients (or family members) to alert them to comply with treatment regimens. In addition to reminding patients when to take what medications, the MedMinder also produces weekly or monthly reports of missed medication. It’s being offered to consumers for $77 plus $30/month for support and wireless connection. Sort of pricey if you are on a fixed income, but kids of aging baby boomers might find it a worthy investment for their folks. However, I am sure that plenty of patients will find it annoying and will resent the intrusion.

E-mail Inga.

Being John Glaser 8/31/09

If you had to answer the question below in one sentence, what would you say?

What is the fundamental contribution of information technology?

My answer — information technology enables complexity.

Our personal financial assets are much more complex that those of our grandparents; savings accounts have been replaced by retirement plans and mutual funds that can automatically shift assets based on a person’s risk tolerance. Handwritten flight manifests have been replaced by the ability of an individual to book air travel involving multiple stops and carriers. Weather forecasting based on seasonal expectations and reports from adjacent states has been replaced by sophisticated models. Complex activities such as sending a satellite to Jupiter, non-invasively observing metabolism in the brain, and simulating the interactions between proteins would not be possible without information technology.

These problems of healthcare cost, safety and quality are based in and exacerbated by the complexity of healthcare. The knowledge domain of medicine is vast and evolves rapidly. Patients with complex acute problems and multiple chronic diseases will be seen by many providers within a short period of time and undergo several parallel treatments. The delivery system is highly fragmented and dominated by small physician groups and hospitals. Standardized care processes have multiple varieties. Managed care contract provisions can fill volumes.

Information technology can be applied to enable the complexity in healthcare. Clinical decision support and clinical documentation applications can assist the provider in keeping up with medical evidence. Results management systems can highlight the patient data that deserves the most attention. Interoperable electronic health records can support the coordination of multiple providers taking care of an elderly patient. Telemedicine can assist patients and providers in joint management of chronic disease.

Maybe that’s the fundamental contribution of information technology in healthcare. It might enable the current complexity to actually work.

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

Monday Morning Update 8/31/09

VA plans emerging technology research center
iSoft lays off in England
Children’s Pittsburgh leads peds hospitals in HIT

From Scott: “Re: Joint Commission and nondisclosure. Yesterday’s Sentinel Event Alert provides further support for providers’ rejection of vendor nondisclosure clauses that could limit the sharing of information on software problems that have patient safety implications. The Joint Commission’s previous Sentinel Alert, Safely implementing health information and converging technologies, is also worthwhile reading for providers who might rush to deploy EHR systems in response to federal incentives.” Joint Commission should be all over healthcare IT in the context of patient care. It would give customers a way to collectively pressure their vendors (with regard to design and disclosure, for example). For vendors, it’s still better than having the FDA in your shop. For patients, Joint Commission is the one group that looks out for their best interests as a package, not just how technology is deployed and managed in a vacuum. And unlike HIMSS and its spawn, they have no vested vendor interest.

From Billy Roentgen: “Re: Stanford. Stanford is going live on Epic September 1, replacing Siemens Invision. Palo Alto Medical Group is going live on Epic at about the same time, replacing IDX. Epic is EVERYWHERE, starting in the physician’s office and carrying through to the hospital.” It’s easy to see with 20-20-hindsight why Epic owns the markets they choose to play in: (a) they built new products that reflected that inpatient-outpatient continuum while their competitors kept bolting on marginally useful features and acquisitions onto old platforms that were clearly unsuited for them; (b) they created MyChart before anyone cared about sharing data and PHRs; (c) they didn’t get bogged down in a Viet Nam of unsuitable customers by selling indiscriminately to just anyone; and (d) they ran their implementations firmly and protected customers from their own success-sapping indecision. Nobody else is even close, handing over the entire upper-end market to Epic without much resistance. Cerner had a shot but doesn’t seem to be selling much new business, while the reps from GE, Siemens, and McKesson might as well carry a white flag when they visit hospitals of more than 400 beds. Eclipsys is strong in the traditional inpatient core of CPOE, pharmacy, and nursing, but won’t get a foothold with customers who want a broad application line that covers outpatient in a single database. Epic owes its success to weak competition as much as anything else. In a perfect world, someone would step up to offer an Cadillac alternative, but for now, Epic is running its own Cash for Clunkers program (they get the cash).

From Joce: “Re: Logi-D. Heard a rumor that Stanley InnerSpace might have entered into an agreement to acquire Logi-D. Any truth to this?” I’m probably the wrong guy to ask since I don’t follow either company. Stanley makes carts and cabinets, Logi-D is a Canadian logistics consulting company specializing in the OR.

From The Nuge: “Re: claims. The reader’s comment hit the nail on the head, but that’s only a small part. Look at what happened with Emdeon and Aetna a few years back when they went exclusive (how can that even be legal?) Misys couldn’t send electronic claims to them for months! And what when PCN bought Versyss, declared bankrupty (iirc), was picked up by Medical Manager for pennies, and sold zillions of ambulatory claim events to WebMD? Very well orchestrated.”

From Kwame Mojito: “Re: GE. The nurse call group (formerly Dukane) has been sold internally from GE Security to GE Healthcare under the clinical systems division. It will be interesting to see if they can tie this into their Centricity product in a useful manner. To my knowledge, this will make GE the only EMR vendor who also owns a nurse call system.” And a theme park.

From Curious George: “Re: OSHA. I hear that hospitals are definitely on their toes in case an OSHA inspector drops in for a chat. Do you have any information on how many physician clinics are being targeted by OSHA? Have you heard of anyone who has and what their top five non-compliant issues were?” I’ll take a lifeline. Anyone?

From Ditka: “Re: sales. Greenway, according to a sales rep, is having the best year of their lives. Office Practicum is a small peds EMR with rabid fans and their pendulum is swinging mightily up. I keep seeing eCW everywhere. I’ve run into a bunch of e-MDs sales.” I had not heard of Office Practicum – looks cool (although I’d get those old TEPR awards off the front page). None of the others you listed are surprises.

From Norberg: “Re: sales. What can I say? It’s slow. The problem is that most organizations are almost singularly focused on ARRA. And because of the ambiguity around meaningful use, they’re doing nothing. I would hazard a guess that imaging and all other ancillary (read: non-EMR) solutions are not being given any attention / considerations by providers these days. If it’s not related to ARRA, it’s not getting done. If you’re the incumbent vendor at a facility, it’s probably high cotton for you there. But you can’t even get a meeting at a facility where you’re not the incumbent HIS/CIS vendor. I have some friends in the indy EMR space and they say they’re doing pretty well. I guess there are enough independent practices who are buying that the top 3-5 vendors are making out OK. But the large , monolithic vendors are struggling.”

A funny phony magazine cover from The Onion. Some good headlines: Researchers Quietly Chuckling At Placebo Group, Congress Deadlocked Over How To Not Provide Health Care, U.S. Government Stages Fake Coup To Wipe Out National Debt.

Children’s Hospital of Pittsburgh, says KLAS, is the pediatric hospital IT leader, coming in at #1 of the top five. Of course, it’s only the pre-season poll.

HealthPartners (IN) saved $430K in one year with its implementation of Epic and Merge Healthcare, which the local business paper concludes “is providing some proof for health reform advocates who say that electronic medical records can save providers money.” With a payback period that spans generations, I’d say that particular proof isn’t compelling.

A reader tells me his hospital’s Epic contract has no nondisclosure terms. That’s hard to believe given Epic’s legal lock on everything from employment to implementations, but that led me to a sobering thought: what if Cerner is the only company demanding that language in its contracts? Could this medico-legal brouhaha be over just one overzealous vendor’s contracting practices? A Fan was right in the last issue, though — being legally allowed to talk about known patient-endangering software defects is not worth much if (a) the vendor doesn’t tell you about them until you find them, and (b) the customers who are aware of the problem have no incentive or platform to get the word out to other customers (assuming the vendor isn’t doing it). In fact, some of the IT departments I’ve worked in kept the lid on known errors in a manner little different than the vendor themselves and for the same reasons – vanity, lack of resources to address the issue, and condescension toward end users who shouldn’t bother their pretty little heads with computer topics (which is actually sort of true – if you e-mail any of the big clinical departments about a computer problem, they drive you nuts with repeated uninformed questions and a flood of wildly unrelated problem reports that they suddenly observe and decide are related to the one you mentioned).  

Intellect Resources is doing a three-question HIT hiring survey of recruiters and hiring managers if you are one of those and want to chime in .

Institute for Safe Medication Practices weighs in with ample expertise on the Ohio pharmacist’s error that killed a child. If you’ve done FMEA or other root cause analysis, it won’t surprise you that the Swiss cheese holes aligned once again. Contributing issues: (a) the pharmacy computer system was down, causing the pharmacist to be swamped; (b) pharmacy staffing was short that day; (c) they were too busy to take breaks or even eat; (d) the technician who made the IV was distracted; and (e) a nurse called to get the IV early even though she didn’t really need it, causing everyone to rush it out without following the usual cautious procedure. ISMP likens sending the pharmacist to jail to Whack-a-Mole: “Marx notes that this child’s game is a telling depiction of how we set unrealistic expectations of perfection for each other and then unjustly respond to our fellow human beings who inevitably make mistakes. We play the game at work by writing disciplinary policies that literally outlaw human error.” The bottom line: nobody’s child is any safer now than that two-year-old was then.

The board of Phelps County Regional Hospital (MO) approves a measure that mandates physician CPOE usage.

An excellent Wired Magazine article makes a point that companies that can turn out “cheap but good enough” alternatives to expensive products can thrive, giving fresh-thinking startups a big advantage over their Goliath competitors who “believe the myth of quality” and fail to see "the rubric of accessibility”.  One example is a Kaiser experiment to put high-tech offices in strip malls. “In 2007, Flanagin and her colleagues wondered what would happen if, instead of building a hospital in a new area, Kaiser just leased space in a strip mall, set up a high tech office, and hired two doctors to staff it. Thanks to the digitization of records, patients could go to this ‘microclinic’ for most of their needs and seamlessly transition to a hospital farther away when necessary. So Flanagin and her team began a series of trials to see what such an office could do. They cut everything they could out of the clinics: no pharmacy, no radiology. They even explored cutting the receptionist in favor of an ATM-like kiosk where patients would check in with their Kaiser card. What they found is that the system performed very well. Two doctors working out of a microclinic could meet 80 percent of a typical patient’s needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist.” Makes perfect sense to me. Wouldn’t electronic triage be a lot more efficient and convenient to all involved?

University of Central Florida launches its 20-month master’s in healthcare informatics degree.

This can’t be entirely good news: iSoft will lay off up to 100 technical employees in England, but brags it will offset that by hiring up to 50 salespeople.

Odd: PACS vendor UltraRAD gets an FDA warning for “failure to validate computer software for its intended use.” The software that drew the warning: Microsoft’s SharePoint portal and the HEAT help desk system.

The VP of human resources at St. Joseph’s Medical Center (CA) is indicted for paying no income taxes in the past 12 years, also charged with altering the hospital’s computer records to reduce her withholding.

My last poll found that the employer of 18% of respondents is using Skype for some business purpose. Pretty interesting, although now the obvious question is “for what?” New poll to your right for providers: how good are your vendors of clinical systems at notifying you of patient-endangering problems and getting them fixed fast?

The VA is soliciting proposals to build a San Diego-based Emerging Health Technologies Advancement Center. Projects to be conducted there involve identity verification, interoperability, and developing an interface for patient consent directives.

Raj Dharampuriya, one of the founders of eClinicalWorks, is interviewed by India Knowledge @ Wharton. He mentions that the company has opened a Mumbai support center to handle US customers that run 24 hours a day, such as a prison. The company will hire 500 people in the next two years, most of them in implementation and support, and will open an office next month in San Francisco. He credits the Indian culture of the founders in helping them focus on their goal of building a business and changing the delivery of healthcare. He still practices medicine part time and says he’s in the top 10% of performers according to BCBS.

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News 8/28/09

CEO donates $1 billion to create “Bell Labs of healthcare”
Investors seek HIT companies that improve provider cash flow
Organizations partner to create next-generation LIS

From Roger Murdock: “Can you figure out a way to shake the truth out of HIT vendors and consultants? It seems to me that sales and acquisitions of anything HIT have really stalled since the beginning of the year. What do you think? I know vendors are reluctant to say anything other than ‘Sales are through the roof!’, but I don’t think so.” I don’t think so either, in most cases. Some companies, especially those with big market share and some diversification, are doing OK. Most, I’m guessing, are limping along as meaningful use uncertainty and capital constraints keep customers on the sidelines, at least for now. I think you’ll see the rich and the best get richer, while those with mediocre leadership, uninspiring products, and a shrinking war chest will find it hard to keep the vampires away until daylight finally comes. Vendors, please leave a comment (anonymous is OK) about your experience – is it boom times, so-so, or bust?

From Vilma Banky: “Re: MUSC. Funny, but I can remember community hospitals and vendor executives saying that they didn’t need anything that one of those big tertiary care or academic hospitals might need. MUSC provides care across a wide spectrum of patients in the Charleston area. I just can’t imagine them not needing everything for clinical documentation or medication administration. There are relatively standard charting requirement or needs (as well as medication administration needs).” I think Frank was saying that he doesn’t necessarily want it all from a single vendor. I’ve interviewed him twice and I really like him, by the way. I can never tell how someone comes across in the written interview transcript, but I can tell you that he impresses me as honest, sincere, and respectful.

From The PACS Designer: “Re: another WebOS. WebOS platforms are gaining more popularity, and this month SourceForge has named eyeOS as project of the month. The eyeOS  application was created in Spain and is an open source Web desktop that would be good for testing potential cloud applications.”

From Seeking Truth: “Re: Cigna’s decision to stop receiving electronic claims via the Emdeon clearinghouse. The battle is presumably over the fees Emdeon charges payers to receive electronic claims. Cigna doesn’t want to pay and Emdeon doesn’t want to offer a lower price. Emdeon and Cigna may resolve this price battle, or alternatively, Emdeon may ‘reclassify’ the payer as ‘non-participating’ payer (similar to Medicare and Medicaid, which are prevented from paying clearinghouse fees). This reclassification may allow Emdeon to charge providers a higher per claim charge per their contract terms with the provider. The Cigna e-mail indicates other options available to providers, but those options require a vendor change, which may involve other costs to the provider community. Obviously, the healthcare industry is being hammered to ‘reduce costs’ and this may be a payer response to that pressure. As a publically traded company, Emdeon will try to preserve their revenue, though clearinghouse charges may be difficult to justify. Since the advent of HIPAA Title II – Transactions and Code Sets (TCS), clearinghouses have had growing difficulty justifying transaction charges incurred by both providers and payers (consider how many ownership changes for Emdeon, NDC Health, Per Se’ and other clearinghouse vendors since 2002). The upcoming ANSI 5010 conversion may also influence how payers and providers exchange transactions. Dare I say, ‘never a dull moment in healthcare EDI.’” 

From Ex-Cerner Guy: “Re: Waterbury to Meditech. Waterbury hosts site visits and reference calls for Cerner and WH Clinicians are happy. Could be for Patient Financials / Rev Cycle, but even then, I doubt it.” Me too. A reader’s got a line on a source there who may give us the real scoop, which I’m betting is no scoop since I doubt they’re switching.

From A Fan: “Re: vendor disclosure. We’re coming at it from the wrong angle. The real issue here is not what your vendor is preventing you from disclosing, but rather what your vendor discloses to you (whether or not it came from another client). The other thing I wonder is, of the issues that are reported to someone like Dr. Koppel, how many make it to the vendor? There’s no question vendors gear development towards sales, but as we all know, health care has arguably as much bureaucracy as government and the feedback loop from real users to vendors is not great.” I know my vendor doesn’t seem to care much about issues we report, even those with patient safety implications. Their excuse always is: (a) it’s working like we designed it, as suckily as that might well be; (b) nobody else has reported it, so it can’t be much of a problem; (c) you’re doing weird stuff, so stop it; (d) we begrudgingly acknowledge that it’s a problem, but we plan to give you an unrealistic workaround and mark it as a future development project until you simply wear down; and (e) it will take at least a year to get a quick fix into your hands, so that automatically makes it unimportant since you’re stuck with it until then. I’ll also say that none of my vendors have ever been very good at proactively letting customers know about issues reported by others, meaning you go through a ton of testing and documentation to place the neatly tied package into their laps only to be told they already knew about the problem. If your vendor is better than mine, tell me.

All Children’s Hospital (FL)will open its new building in December (a very cool set of daily construction pictures is here – check out the Time Lapse option) and will use the Pediatric Edition of the Patient Life System by GetWellNetwork.

SNOMED Terminology Solutions is offering a free course by teleconference, SNOMED Clinical Terms Basics. New courses offered: Introduction to Terminology and Classifications and Introduction to Mapping.

I’m guesting (is that a word?) at Inside Healthcare Computing with an editorial called Lessons from Shark Tank — Beware of Vendors Borrowing Money or Going Public, where I drew my inspiration from (what else?) a TV show. Here’s a snip: “It also makes me wonder how many dull, average companies got that way because they took someone’s cash, put the founders out to pasture, and set all the fun, smart ideas aside and turned themselves into a bad mutual fund run by second-tier MBA school graduates.” I also worked in a fun reference to, as I call him, Dead Billy Mays.

I guess a wheezing economy has led us to this TV news headline, which refers to temporary jobs at a McKesson H1N1 vaccine center: Swine Flu Brings Jobs to West Sacramento.

Sunquest, Mass General, and Partners will jointly develop a new generation of LIS that focuses on anatomic and clinical pathology. I’ve said for years that if you want to see inarguable success in getting benefits from IT, find yourself some lab people. It’s no accident that the first really useful and clinically-focused hospital systems were LISs, back in the day when “nursing systems” meant online requisitions (aka, “order communication”). The most advanced automation of its kind is in the big reference labs, where you see a lot of computers and not so many people handling pipettes and swabbing agar plates. Instead of complaining about automation, laboratorians embraced it, designed it, extended it (rules capability, standard interfaces, repositories, barcoding, digital imaging, FDA-regulated instrument interfaces, portable data collection, RFID), and are now on the cutting edge of genomics, clinical alerting, and data warehousing. Among all providers and ancillary departments in hospitals, labs are about the only ones that we don’t have to be embarrassed by when talking to people from other sectors that are decades ahead of healthcare. The MGH pathology informatics doc said that tomorrow’s labs will “utilize advanced diagnostic and information management technologies, such as digital pathology, molecular studies, business intelligence and service-oriented architectures to simplify and strengthen the informatics infrastructure.” That ball you saw going over the Green Monster was Sunquest smacking one out of the park in a blockbuster boost to the company.

You know when a press release says somebody “applauds” some government action, they’re smelling cash. The HIMSS Electronic Health Record Association “responded with enthusiasm” (salivation) to Uncle Sam’s decision to donate $1.2 billion in freshly printed and rapidly devaluing currency to pay for the software its members sell. According to the “About” section, membership is open only to HIMSS Corporate Members. Should a non-profit, advocacy-heavy member organization like HIMSS really be running a vendor trade group while claiming to be impartial and patient-centered? As a provider, should I be paying dues to an organization that sells my information to vendors (mailing lists, HIMSS Analytics survey results, conference information), organizes those vendors to influence government policy, and runs Webinars and sales pitches on their behalf that are aimed at getting us poor provider members to buy stuff from its far more lucrative vendor members? It’s Ladies’ Night – I’m getting cheap drinks, but only if I can stand being constantly groped by those paying full price for that privilege.

Peace Health expects to get $30 million from HITECH.

This is one of those times where I say that I’m a bit behind despite working absurd hours, so if you’ve e-mailed me about something lately, be patient – I read every e-mail and respond appropriately, but it might be a bit slow in coming (working two full-time jobs is sometimes challenging).

Another vendor heard from who does not put non-disclosure language in its contracts: Eclipsys. They join Meditech and Medsphere. So. what say you, Cerner, Epic, and McKesson? 

Inga connected with one of our old pals at Noteworthy Medical Systems (they used to be a sponsor pre-CompuGroup) since a reader asked about the Cleveland office. She says it’s alive and well and nobody has moved to Phoenix, although all locations have had some restructuring.

If you don’t read HIStalk Practice, you missed this excellent piece, DrLyle’s Meaningful Discussion about Meaningful Use. Put your e-mail address on that page if you want updates when we write something new on HIStalk Practice – it has its own e-mail list separate from the HIStalk one. We have some fine sponsors, guest writers, and interviews there – like HIStalk, but more oriented toward physician practices.

Sparrow Hospital (MI) kicks off its EMR project.

A sweet deal for Misys PLC CEO Mike Lawrie: his contract requires him to be paid in dollars, so the significant drop in pound against the dollar didn’t cost him loss of several hundred thousand dollars of buying power. With a projected US 10-year deficit now up to $9 trillion, I don’t think he’ll have that problem for long.

In India, Apollo Group of Hospitals has started on its IBM-led “Health Superhighway” connectivity project. It’s also working on a unique ID number project. I’m pretty sure I’ve mentioned both before, but it’s still pretty cool.

A WSJ blog on venture capital says investors are looking for opportunity at the intersection of healthcare and IT (that’s us). It credits athenahealth and its $1.3 billion market cap for increasing investor interest, also juiced by HITECH headlines. As we’ve said here before, though, investors want companies that can improve the cash flow of providers, not those trying to sell a nice-to-have product.

Dayton Children’s (OH) goes live with its $27 million Epic project.

So why isn’t this making headlines? A drug company billionaire CEO/MD is donating $1 billion of the $3 billion he made from the sale of his company “to create the Bell Labs of healthcare”. Some quotes from him: “The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid … The idea is to actually go across the country and bring scientists, mathematicians, computer scientists, engineers, biologists, clinicians, surgeons, oncologists, pathologists, all together. And really integrate, truly integrate, information from the basic science to the bench to the clinic … So I’ve started funding and bringing together computer scientist to implement the grid, in an open architecture for the country … We have now the opportunity to jump-start health care, straight into molecular world. Or having the integrated, open-source software system that allows access to the 200-300 Legacy systems of software. So my great concern is, if we go ahead and implement a plan that just says, ‘OK, everybody just has an electronic medical record, with 200 proprietary systems, that don’t talk to each other by its nature.’” This is truly amazing, fascinating, and inspiring all at once. If anyone has a connection, I’d like to interview this guy (maybe sucking up a little in a quest to become Official Blogger of the Bell Labs of Healthcare at a significant salary).

Everyone thinks Cache’ is a healthcare-only MUMPS thing, but here’s proof that they’re wrong: a private bank for rich people selects it to run its Web-based banking system.

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HERtalk by Inga

Christiana Care Health System (DE) selects Patient Care Technology Systems’ Amelior Tracker system to automate the management and tracking of its hospital assets.

Five hundred doctors with Jefferson University Physicians  (PA) will soon be live on Allscripts EHR.

The newly public Emdeon signs a 15-lease for a new data center in Nashville. Emdeon, whose IPO raised $367 million, will rent  34,200 square feet for $39,500 a month, making the lease value more than $8 million.

Thanks to Mike and those crazy guys at Compuware for sending over their latest Youtube creation. This Rockstar CIO interview is definitely worth a 41-second diversion. And since I was amused enough to watch it over and over, I’ll give the company a little pitch for a survey of hospital clinical system users they’re doing that should take about 60 seconds or less of your time.

Covenant Medical Center (IA) agrees to pay $4.5 million to settle alleged violations to the Stark Law and submitting false Medicare claims. The federal lawsuit claimed the hospital paid the five specialists “above fair market value” for their services at rates that were “commercially unreasonable.”  The government claims the physicians, who referred patients to the hospital,  were among the highest paid hospital-employed physicians in the entire country. Records show the doctors were each paid between $633,000 and $2.1 million.

A couple of traditional ambulatory vendors announce they are now offering HIE functionality. Greenway Medical introduces PrimeEnterprise, which enables a community of Greenway customers to share select clinical and financial data. Also, Rabbit Healthcare Systems implements the first phase of its HIE solution, going live with data exchange between McKesson’s Lynx Mobile Inventory Management System, GenPath Reference Lab, and Docuda’s ERCard patient product (it doesn’t sound like an HIE, but that’s what they say).

The Stevens Institute of Technology (NJ) plans to use a $2.8 million grant from HHS to create an electronic system to boost the care of women of color with HIV/AIDS.

The Northwest Pennsylvania AIDS Alliance was also a recipient of grant money to support their IT projects. The HRSA awarded the alliance $45,188, which will allow it to create a new computer network and permit real time access to the Lab Tracker database.

More consolidation in the medical transcription world: Transcend Services will pay $16.2 million in cash and stock to acquire Medical Dictation Services.

The National Quality Forum endorses 18 standards for measuring quality and safety metrics for over-the-counter and prescription medications.

A friend was diagnosed with the H1N1 swine flu, which got me surfing a bit, just to assess the likelihood that I, too, might end up being bedridden. Fortunately my friend is now fine and I seemingly dodged the bullet. Anyway, I found this cool flu-tracker map that allows you to see the the number of suspected and confirmed cases in your community. Or, perhaps to figure out what vacation spots to avoid.

Another ex-hospital worker is arrested for allegedly stealing personal information from patients. The former Our Lady of the Lake Regional Medical Center (LA) employee opened 46 debit cards and filed fraudulent income tax returns. He also received $20,000 from fraudulent claims.

Researchers now believe that women with stronger thighs might be better protected from knee pain. Surely my thigh abundance is related to strength. Thus, I’m no longer going to obsess about the size of my thighs; rather, I’ll now be thankful that they are helping to preserve my articulatio genu.

E-mail Inga.

News 8/26/09

From Limber Lob: “Re: VistA. The key thing about VistA is not that it’s open source, but that the VA developers and users were joined at the hip during VistA’s three-decade long evolution. I worry about today’s vendors who have ‘architects’ in California or Florida and developers in Poland, India or elsewhere who know little about the users of the software they develop. The VA’s process from the outset in the late 1970s was to have front-line users work closely with the system developers to tweak and tune the applications to meet the needs of the caregivers caring for the patients.” Excellent point. I’m not too interested in the definition of open source (beyond that it’s free), but VistA doesn’t seem to fit the model as I understand it. It was built by VA employees at a cost of billions in salaries and other costs and is free only because it’s in the public domain, not because a multi-national bunch of spare bedroom programmers decided to donate their time to a cool project. For that reason, it’s probably a mistake to tout VistA as a shining example of how open source development works. It’s also no coincidence that arguably the two best and most widely used clinical systems ever (VistaA and TDS) were created in exactly the same environment – techies on the ground working with clinicians for years at a time. Vendors don’t do that any more, shipping specs overseas and giving clinicians only limited involvement at the beginning and again at the end. Or, putting a bunch of coding kids together with a Foosball table and letting them talk to the salespeople about what will move on the market. Too bad.

From CrazyRumorMan: “Re: Waterbury. Waterbury Hospital is rumored close to signing with Meditech to replace Cerner. This despite the successful rollout of the majority of the Cerner Millennium suite in just the last 2 years. I would say the IT decision makers at WH may have a screw loose.” Unverified. That’s a lot of wasted money and effort if it’s true, so I’ll presume it isn’t (and if it is, I’d like to interview someone there and find out what led them to that decision).

From Scot Silverstein: “Re: NPfIT. A question I’d like to ask the new head of ONC, Dr. Blumenthal. With all the funds being steered to HIT. how will the US national program avoid the problems that occurred in the UK’s national IT program?” The ONCHIT head (see how I inadvertently mock its regrettably late realization of the phonetic implications of its acronym?) is welcome to respond here. It’s a good question since NPfIT seemingly did everything right (rigorous planning, aggressive bid terms that nearly bankrupted its ‘”successful” bidders, and supercharged project management). The federal government’s track record of big IT projects is pretty bad, especially since it keeps hiring the same underperforming big contractors whose core competency is working the good old boy system.

Kathleen Sebelius visits Ohio State to check out its Epic system. Her father, John J. Gilligan, was governor of Ohio from 1971-75, making them the first father-daughter pair of governors (she from Kansas, of course).

From Weird News Andy: a UK man’s appendix ruptures three weeks after NHS surgeons claimed they removed it. WNA likes this quote: “A spokesman for Great Western Hospital . . . was unable to confirm what, if anything, was removed in the first operation.” The patient must have a black cloud over his head: not only did the rupture leave him with a serious infection, it also got him fired when his employer refused to believe that he needed time off to have his appendix removed a second time. Also from WNA: NHS is so desperate for off-hours doctors that it’s flying them in from all over Europe at hourly rates of up to $165. One of them, a Nigerian working on three hours of sleep, had two patients die on his very first shift – one after he gave the patient a tenfold overdose of morphine, the other who died of a heart attack after he declined to admit her.

Geisinger will implement the eICU program of Philips VISICU.

A Discovery Channel article mentions OpenMRS, an EMR for the developing world, and includes a couple of podcasts. I’ve mentioned it several times, such as the program in Rwanda to train developers for it and a college intern project to develop a touch screen interface for it.

Saint Vincent Hospital (MA) begins using the RFID-based surgical sponge detection system from RF Surgical Systems, which they say costs about $15 per case.

In what must be pretty big news for a vendor of software for chiropractors, Future Health issues a press release to announce that it has hired a former Eclipsys programmer.

New York hospitals line up in a “mad dash for digital cash”, as the headline says. Interesting factoids: (a) Montefiore has spent $200 million on its EMR; (b) the 180-bed New York Downtown Hospital can earn up to $8 million in federal incentive payments, as an example; (c) a Columbia doctor says he had to reduce his patient load by 60% when he first starting using an EMR and even now is only back up to 80% of what he could do on paper; and (d) experts say some doctors see EMRs as “a ploy to find out how much money doctors are making.”

The usual housekeeping reminders: your lifeline to breaking news and smirky humor is your e-mail address in the Subscribe to Updates box at the top right of the page (I don’t send anything except update notices to that list of 4,578 confirmed subscribers, even though companies ask me all the time). Please take a moment to peruse and possibly click the adverts (isn’t that very Continental-sounding?) of those brave sponsors who convince their financial guardians to send checks to an anonymous blogger’s PO box that could be forwarded to Lithuania for all they know. You will find a Search HIStalk box to your right that will invoke the power of Google to effortlessly search the 6.5 years and millions of words of HIStalk. Inga and I love rumors, news, guest articles, new sponsors, and shameless fawning , so you can click the hideous green Rumor Report box just below the search box or just e-mail me. And here’s the magic secret I keep forgetting to share on how to get a list of previous postings: just click the Archives link at the top of the page (I bet there are readers who think I purge all but the five most recent postings that make up the front page, so I’ll take the blame for that). Most importantly, thanks to the real stars: our commenters, guest writers, sponsors, and readers (that’s you). You have no idea how important you are.

Blessing Hospital (IL) signs with CareTech Solutions for its Web content management system and BoardNet board of trustees communications portal.

A Seattle public radio station’s investigation finds that 15 non-profit executives in the area made at least $1 million in 2007, seven of them from Swedish Medical Center.

Paging Dr. Halamka: VeriChip, smelling stimulus money, will try again to sell medical records-containing implantable RFID chips readable by an ED hand-held scanner. I see nothing to make me think that turkey will fly the second time around, especially given that they proudly state that only 500 people have signed up so far. Not that it’s a bad idea (pet chips are big business), but they didn’t market it well (or to the right audience). As an indication of just how committed to healthcare the company is, it also wants to invest in green energy.

Creighton University files a patent for “a novel, electronic program to coordinate patient health care.” It’s some kind of daily diary that’s monitored electronically by caregivers. They even made up a word for the people who meet with the patient monthly – an “ambulatist”.

An English teaching hospital is reviewing its ED system after discovering that someone altered patient records to make it appear that they were seen within government’s standard of four hours.

Odd malpractice award: a “rogue dentist” treating a 28-year-old woman’s cracked tooth removes all 16 of her upper dentia for some unstated reason. The jury awards her $2 million.

E-mail me.

HERtalk by Inga

A coding error leads the VA to mistakenly notify 1,200 veterans they have Lou Gehrig’s disease. Whoops. The panicked veterans were later informed of the error and assured they were not suffering from the generally fatal disease.

PatientKeeper announces that its user community has grown more than 60% in the last year. In addition, the company has increased staff 23% and is planning to add another 20-30% over the next six months.

Phoenix Children’s Hospital achieves 99% CPOE adoption with its Eclipsys Sunrise Acute Care system. The hospital’s CEO says that during their go-live, they reached a 95% adoption rate and are now placing an average of 3,250 orders electronically each day.

Another pediatric hospital is just getting started on its EHR project. Children’s Medical Center of Dallas is embarking on a $60 million project will eventually allow them to connect their Epic EHR to three other hospital systems in the Dallas area.

Next time you are depressed, you might consider sending an instant message to your therapist. Researchers conclude that “online cognitive behavioral therapy” (which sounds like a fancy way of saying you are IM’ing with your therapist) is an effective means of treating depression.

This might make you depressed: the cost of health insurance is skyrocketing. Between 2000 and 2009, the cost of a family premium provided by an employer increased 95.2%. And, plans today have higher deductibles and co-pays. Unfortunately, our incomes have only grown an average of 17.5% over the same period.

No less depressing: the White House and CBO project a $1.5 trillion budget deficit for 2009. That figure is 11.2% of the country’s GDP, making it the highest deficit since WWII. OMB director Peter Orszag says fixing health care costs is critical because “the federal government simply cannot be put on a fiscally sustainable path without slowing the rate of health care cost growth in the long run.”

Not feeling sorry for him if he’s depressed — Neal Patterson. The Cerner CEO cashes in on $320,600 worth of company stock. That’s on top of his $65,000 sale earlier this month. Stock is trading about $10/share higher than a year ago and closed at $64 on Tuesday.

St. Cloud Surgical Center selects Wolters Kluwer’s ProVation EHR for perioperative documentation and patient charting.

Ulrich Medical Concepts becomes the first Certified Integration Partner for ICA.

NaviNet offers its HIE solution at no charge to all state governments and US territories. More than 770,000 providers use NaviNet (formerly NaviMedix) for claims processing.

A Princeton junior and his recently graduated brother are awarded a $100,000 grant to expand an iPhone application to monitor diabetes. Their iAbetes Web 2.0 Diabetes Management System allows patients to record food intake, blood sugar readings, and insulin injections. The application interacts with a Web site that can be accessed by patients and their providers. The only award I won as a college junior was runner-up in a fraternity’s Miss Toga contest.

The state of Ohio seems to think its healthcare workers are bigger bigots than the rest of the population. The state senate is considering legislation requiring nurses, doctors, and other healthcare professions to take cultural competency training. Other states apparently have similar laws on the book. Why target just health professionals?

The FTC finalizes its rules for reporting data breeches for personal health records. Beginning September 24th, PRH vendors and entities that offer third-party EHRs must notify consumers when the security of their PHR data is breached.

Advocate Health Care System (IL) implements CPM Marketing Group’s physician relationship management system. The application will help Advocate manage its physician relationships and provide analytics and reporting. 

Tuality Healthcare (OR) celebrates its first complete year live on Cerner’s EMR. The 167-bed hospital says the system has strengthened patient safety and improved the quality of interactions between patients and providers.

iMedX, a transcription provider and developer of TurboRecord and TurboScribe, purchases competitor Worldtech. The combined entity serves several thousand physicians in hospitals and medical clinics nationwide.

EMR vendor Noteworthy Medical Systems internally raises $4 million to smooth the transition after its partial acquisition by CompuGROUP. The company also moved its headquarters from Cleveland to Phoenix, which is apparently closer to the bulk of its clients.

Sparrow Health System (MI) officially announces the launch of its multi-million dollar EHR project. Last year JohnnyReb tipped us off that Epic was the vendor of choice over McKesson. Sparrow says its $10 million phase one will start with physician offices by early next year.

Physician adoption and achieving meaningful use requirements now dominate purchasing decisions for community hospitals, according to a new KLAS report. In the under-200 bed market, cost and infrastructure requirements are no longer the top priorities. Instead, executives are now considering more complex and expensive options. Though Meditech and McKesson dominate this market, community hospitals are now considering Cerner, Eclipsys, Epic and Siemens — all vendors that traditionally paid them little attention.

Email Inga.

HITlaw 8/24/09

Non-Disclosure Agreements

I am weighing in on the recent flurry of activity on HIStalk regarding non-disclosure clauses in software agreements that preclude a customer from discussing or revealing problems with a vendor’s software.

Any worthwhile attorney reviewing agreements for a provider client should flag such an inclusion and require its deletion. Something like that should scream for attention to the savvy IT person, be it the CIO, the consultant, or the attorney.

Executives — when negotiating a contract, really think through the obligations. Where a clause requires education of your entire staff (such as telling them that they cannot disclose a serious software problem), just imagine giving that talk to your chief medical officer. If you find yourself not being able to defend or justify the offending term, you know what to do — get rid of it.

I cannot think of a more self-serving “requirement” in the paperwork that establishes the vendor-client relationship (some would say partnership). Imagine a high profile hospital negotiating with any vendor. The vendor is salivating, not just for the potential sale, but for the huge publicity it hopes to gain at some point by announcing that the high-profile hospital is running its software.

Certainly that vendor does not offer to keep secret the fact that the hospital runs its software in exchange for the hospital keeping errors or defects quiet. I personally find this offensive. I am not speaking for Meditech, but in speaking for myself, in the 20 years I spent negotiating tens of thousands of agreements for Meditech, I never once included such language in any agreement with any customer.

Imagine an ER physician who comes across a dangerous software malfunction. That physician may moonlight across town at another ER. Suppose that hospital has the same software vendor. Assuming the physician knows about the disclosure restriction (which is unlikely), you have placed the physician in a horrible situation. Should he or she abide by a software contract’s egregious terms and risk the health and safety of patients? Or, do what it is right (and required under the Hippocratic oath, I would say) and let the staff at the second hospital know about the software malfunction? In the more likely scenario, if the physician has no idea the restriction exists and divulges the existence of the problem, then the hospital is in breach of its agreement with the vendor.

Also consider the CIO, who you hopefully want collaborating with other CIOs on all things HIT related. You’re putting pressure on them as they sit at a table with other CIOs with the same software system, knowing this problem exists, but not being able (contractually) to divulge the information.

For a little perspective, let’s remember that the errors or malfunctions we are most concerned about are the ones directly involving patient care. A misaligned billing form does not rise to the level of concern as a bad dose amount. However, the non-disclosure terms do not differentiate, I am sure, in permitting disclosure of severe problems and restricting disclosure of minor ones. That makes no sense, which tends to enforce the assumption that the vendors using such restrictions wish to keep critical issues from the public because they fear the negative exposure that may result.

I say boo hoo. The vendor selected the market and designed the software. The vendor takes the profits. The vendor should stand behind its products, bad or good. The profit/loss reports do not differentiate. Neither should disclosures about software performance.

Just as a vendor should be proud of a good endorsement by any customer, so should the vendor permit free disclosure of serious problems. Not in a headline-grabbing, gossipy manner, but in a manner befitting this industry for the care of patients and avoidance of harm to those patients.

Providers should dust off their agreements and check to see if any such language is included. If so, call the vendor and demand an amendment deleting the provision. Better yet, vendors should be able to identify customers with such terms and do the right thing — provide the amendment without being asked.

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

Monday Morning Update 8/24/09

Former VA CIO’s assistant named by OIG for paying unapproved bonuses
Cleveland Clinic wants a new technology-enabled revenue stream
Government’s “Connect” tool to be modified to allow Medicaid data exchange

From Brian Wagner: “Re: Mount Sinai Biden visit. They actually did hold a conference call for reporters and other interested members of the public just minutes after the meeting in Chicago wrapped up. Unfortunately, all the reporters wanted to ask about meaningful use and certification, not about the $1.2 billion in extraordinarily essential infrastructure funding that will be going to regional extension centers and state grants. Read the application materials for the government. The documents are actually really interesting in laying out their vision.” Good information – there’s a lot of detail there. I’m smelling opportunity – the average Regional Center grant will be $8.5 million, with a range of $1 to $30 million. You have to be a nonprofit, but that’s easy to set up (think HIMSS will get involved somehow?) If you’re a shaky vendor or struggling consulting firm, you could fill out the paperwork and see if you win the lottery. I might want to throw in with you. Brian’s with eHealth Initative, by the way.

From @hightechattorney: “Re: Lance Armstrong is getting on the health IT bandwagon. ‘While everyone’s trying to fix the healthcare system in the USA, let’s make all medical records electronic. It is nearly 2010 after all.’ Posted on Twitter today by Lance after finishing a stage at the tour of Ireland.” Did you ever notice that Twitter postings sound eerily like those SNL sketches in which Larry King blurts out stream-of-consciousness non-sequiturs? And since Lance is shining his considerable expertise on healthcare IT, I’ll reciprocate by providing my expert opinion on his field: let’s replace bicycles and people who are paid astronomical sums to ride them with modern technology like motorcycles or cars. It is nearly 2010, after all. See how easy it is to opine confidently about something you don’t understand?

From Mr. RIS: “Re: Sunquest radiology information system. It seems they’ve sunsetted it. They let go all the development, support, and the one final domain expert on Friday. Clock is on to see who picks up this business.” Unverified, but we’ll ask. I can see it both ways: I liked the product as a long-ago customer, but it’s a little outside their core business. UPDATE: Not true, according to Sunquest. “The Radiology Information System is, and will continue to be, an important part of Sunquest’s diagnostic information solution portfolio. No one was let go Friday, in fact, we are actively recruiting to fill open positions.”

Listening: Radio Paradise, live, human-hosted streaming radio recommended by a reader. Lots of bands I’ve recommended are on the playlist: Silversun Pickups, Tori Amos, Peter Gabriel, Heather Nova, Leonard Cohen, and The Pixies. Like college radio, it’s a bizarre segue of music that sounds like it was randomly chosen by a wasted DJ: just now, it was Henry Mancini’s Pink Panther Theme followed by Pink Floyd’s Time from Dark Side of the Moon (maybe the next song will be Get the Party Started by Pink, continuing the color theme).

Consulting firm and HIStalk Platinum Sponsor Virtelligence is in the ten-company hunt to be named National Minority Small Business Person of the Year by the Small Business Administration. It’s on the Healthcare Informatics Top 100 list as well.

Inga connected with the CEO of the HIE vendor that people are gossiping about. He said he’s anxious to be interviewed, so we sent some questions Monday, some of them probing (why do we keep getting an answering machine on the 24-hour support line, what’s up with the company’s credit reports, etc.) Nothing heard so far.

The nonprofit Digital Pathology Association announces its formation and its first meeting, September 13-15 in San Diego. I got the notice from Sunquest, a DPA founding sponsor. Personally, I’m sorry that HIMSS outgrew San Diego since it’s a great conference town.

UCSD signs an agreement with a technical school in India to build a 300-bed hospital there.

WTAE in Pittsburgh covers the Health Buddy home monitoring system, which comes as a small appliance that sends information to a Web application. It has a long list of health management programs: CHF with various complications, anticoagulation, CHF, diabetes, etc. It has a USB and infrared connection to medical devices. A simulated demo is here. It’s by Bosch, the spark plug people.

Observations from the video of the Sebelius “paperless hospital” Omaha visit: (a) the nurse educator showing her the tablet PC gets in a couple of unintentional plugs for the C5 computer and Pyxis (b) Sebelius looks kind of snotty to me, never smiling except when she uncorks a tiny one when talking directly to the camera at the end, even looking distinctly uncomfortable while pretending to comfort a patient during the photo op; and (c) I have to decide whether I’m annoyed that the guy talking about industrial engineers referred to “processEEZ” instead of “processESS”, which always makes me think that somebody’s “puttin’ on airs”, as Southerners say. I Googled to see what they are using at the hospital’s parent, Alegent, and it looks like Soarian and NextGen on the inpatient and ambulatory side, respectively. If Siemens wasn’t so darned cold and stodgy, they would be all over this. They should hire me to be their obnoxious yet anxious to please online presence since theirs is about as inviting as a Berlin winter.

The VA’s IT department is the weekend’s top story, and not in a good way: the OIG says the former executive assistant of former VA CIO Bob Howard “acted as if she was given a blank checkbook” in paying “unusual and often absurd” bonuses totalling $24 million over two years (including $60K to herself plus $140K in tuition benefits to family members and friends). The VA also paid $37,000 in travel costs for a woman that Howard admits having screwed around with. Howard, you may recall, was the Bush political appointee and former government contractor executive who demanded complete control over all of the VA’s $2 billion IT program and decided it should dump its acclaimed VistA software in favor of buying commercial applications. His two-year VA legacy will apparently be as uninspiring as most of the people Bush appointed, consisting of disastrous security breaches, floundering IT projects, ill-advised attempts to dump the most successful EMR in history, and cheating on his wife. That’s a shame for a two-tour Vietnam vet and retired major general who should have known and done better for the veterans he was hired to serve.

Philippine hospitals lag in EMR adoption because of the cost of software, but one medical center bucks the trend by using an open source system.

The State of Virginia finally names a CIO to replace the one it fired after he suggested not paying Northrop Grumman’s big privatization contract because it was doing a crappy job even while asking for more money than was agreed on. In what is surely a bad sign, Northrop Grumman praises the new guy.

Best Buy looks interested in getting into the wireless health device business with Microsoft (I missed the announcement, but this guy didn’t).

My most recent survey results: 90% of you think more EMR vendors will increase their promises of future EMR certification and/or Meaningful Use compliance. New poll to your right: is your employer using the Skype VoIP service for any official purpose?

I see the AHA’s for-profit shill AHA Solutions is still out there “endorsing” products and selling services to vendors. There ought to be a law: nonprofits should not be allowed to affiliate with for-profit organizations (hello, AMA?)

Speaking of for-profit nonprofits, UPMC is the frontrunner to get a taxpayer-and-GE funded $830 million vaccine factory. UPMC’s CEO, who made $4.5 million last year, has already gotten face time with Joe Biden, Kathleen Sebelius, and the free-spending Homeland Security people to make his case.

Like Microsoft’s Bing, Yahoo’s search engine is accused of violating federal and state laws by accepting advertising by illegal drug vendors posing as legitimate online pharmacies. Seems silly to me; they can’t possibly check the good character of everybody who wants to run a text ad. If that’s the expectation, say goodbye to Craigslist, which in the few times I’ve tried to use it, seems to be about 90% shady. In the mean time, I see that the DEA is taking out its own Google ads tied to drug keywords.

I’ve tried to use Facebook lately and it was mildly interesting to connect with people I went to high school with (most of whom I don’t even remember, to be honest), but it’s getting as annoying as Twitter. Reason: people keep wasting time with online crap like FarmVille, pointless online tests, and “Which WKRP Personality are You?” results that clutter up the page. Americans seem uniquely suited to taking potentially useful technology (TV, cell phones, the Internet) and dumbing it down to the lowest possible level of triteness. Most of the Twitter followers I’ve gotten lately are porn sites and companies urged by their marketing people to attempt hipness. I thought lame blogs (is that redundant?) were as low as we could go, but Twitter makes the typical cheese sandwich blog look like War and Peace.

I’m not a big David Brailer fan (I can’t put my finger on it, but he just seems kind of arrogant), but he’s good for sound bites that I agree with: “I’m still shocked that there is a business argument for electronic medical records because it kills the very thing that makes hospitals money. The way we pay for health care penalizes efficiency.” OK, I’m warming up to him.

Parkland Hospital starts eliminating 200 jobs, giving its EMR a bad name by crediting it for the cutbacks, “As we have rolled out more components of electronic medical records, more of those [clerical] functions have been replaced.”

The HIT Standards Committee recommends using either ICD-9 or SNOMED to meet 2011 EMR standards, but wants to incent providers to move to SNOMED by 2015.

An Epocrates survey of medical students has some interesting findings from tomorrow’s doctors. They like mobile devices, with 45% of them using an iPhone or Touch and 60% of the non-users saying they’ll buy one of those Apple products within a year. They give medical schools an A- (up from a B) exposing them to technology, with 84% saying they’ve had EMR exposure and 90% saying use of an EMR will influence their practice choice. Over 70% of them said the US healthcare system sucks and 90% say drug salespeople are scumbag liars (I’m paraphrasing, but accurately).

A former network administrator for a hospital in Australia pleads guilty to voyeurism, choosing the geek’s method of planting a video camera in hospital restroom.

We had a big go-live at my hospital recently, giving me a chance to ruminate (no pun intended) on the most important assignment: what’s on the war room food menu? My tips: (a) if you bring bagels, skip the stinky “everything” ones loaded with garlic since the room and the breath of the participants reek of it for hours; (b) don’t cheap out and make people buy their own drinks from the nearest soda machine and also buy about 10 to 1 diet since it always runs out fast; (c) nobody likes pasta salad because it’s oily and full of olives, so get potato salad or, even better, kettle chips; (d) pizza is the cheap and easy option because they deliver, but you don’t want a roomful of IT people stuffed with greasy cheese, pepperoni, and hot peppers to be stuck in an airless room for hours; and (e) you can never have too many kinds of cookies and candy, at least until the analysts freak out on a sugar high and then crash just as you need their full attention to fix some IT disaster. It’s an IT low point to be covering the night shift and subsisting on hardening bagels and weird sandwiches (vegetarian, bloody rare roast beef) that everybody has passed on throughout the day. Other war room disasters: setting up in an office building where the air conditioning shuts off automatically for the weekend, forgetting to bring a hub so everybody can plug their laptops in, and quickly running out of toilet tissue in the nearest restroom that usually goes unused over the weekend.

Cleveland Clinic’s “Chief Emerging Business Officer” says they’ll develop a new revenue stream by selling eICU services and possibly home health telemedicine. As another of those nonprofits that seem anxious to make money, they had a $246 million profit on their latest federal forms, run a bunch of for-profit subsidiaries, and paid several multi-million dollar salaries.

ONCHIT (I know they keep trying to call themselves ONC because they don’t like the sounded-out version of the acronym they chose, but I don’t care) will modify its Connect software to allow states to share their Medicaid information over the Nationwide Health Information Network.

Sloppy physician handwriting is blamed in a Florida hospital lawsuit in which a pregnant inpatient was mistakenly given the abortion-inducing drug alprostadil instead of the labor-slowing drug that was intended, causing her to deliver her two-months-premature baby in her bedpan.

HIMSS tries to drum up member support for having people run around Washington to bug the aides of politicians about using taxpayer money for healthcare IT (haven’t they done enough?). Its Policy Summit kicks off with a “PREP Rally” with a reception “to discuss your future Hill strategy”, which I’m pretty sure the average dues-paying HIMSS member doesn’t have. I notice the HIMSS recap of recent news carefully omits those involving CCHIT’s ongoing marginalization.

E-mail me.

News 8/21/09

Obama people bring healthcare PR show to Chicago bearing taxpayer gifts
Research article: eICUs may or may not work, but we didn’t really have time to check that out
Medsphere gets a sale

From I.T. Guy: “Re: Cape Cod Hospital. Apparently they made the decision to pull the plug on Meditech after a long relationship and install McKesson.” Unverified.

From Jules Verne: “Re: Check out these earnings.” Ancillary systems vendor Aspyra (warning: their site has loud and gratuitous Yanni-type music to accompany an otherwise stark site) files a horrendous 10-Q: a loss of $1.6 million on revenue of $2.1 million. The company says it will have losses and negative cash flows for the foreseeable future, meaning it needs financing or to sell shares (not likely: 12 million shares are already out and trading at 19 cents, 66% off the year-ago price, valuing the whole shebang at just over $2 million). I might have to ask our new financial expert Ben Rooks to lay out what options the company has (beyond the obvious – sending everyone home).

From Dr. T: “Re: hospital in Taiwan using the PBX-to-Skype gateway. I had been to this hospital and seen this working. It is very effective and the carts are battery operated with standing space for the nurse to actually ride it. The cart accommodates a fixed touch screen along with MAR drugs.” I’m getting a brainstorm … nurse golf carts with a built-in Pyxis machine, a Skype headset, and maybe a drink holder and MP3 player. They can be like those golf course ladies who sell snacks to the people pretending to exercise by riding around on carts of their own and swinging a club occasionally between beers. Patients pop their “give me drugs” bedside button, the nurse gets a Skype message, the eMAR pops open the onboard Pyxis and pops out the med, and the nurse careens off to dispatch it to the patient. Actually, the Taiwan hospital does have a pretty good idea, although Segways would be cooler.

From Sylvester Stallione: “Re: boards. Are you an advisor or board member of any companies that you haven’t disclosed? I don’t see it mentioned on your About page.” I’m not. Nobody really is interested in me as me, only as Mr. HIStalk, and that’s not happening. Sometimes companies ask for advice, but in the rare cases where I have the time and interest to do it, it’s free (and of corresponding value).

Vice President Joe Biden, HHS Secretary Kathleen Sebelius, and ONCHIT head David Blumenthal visit Mount Sinai Hospital in Chicago to talk up the administration’s healthcare reform programs and to announce $1.2 billion in ARRA grants for Health Information Technology Regional Extension Centers and state-level information sharing projects. The public wasn’t invited and the dignitaries wouldn’t take questions from reporters. Maybe I’m cynical (OK, I’m cynical for sure), but it mostly seemed like a PR visit to put some positive spin on the administration’s floundering healthcare reform program, sending the politicians with some Uncle Sam financial lollipops to hand out. The best quote came from an ED nurse at the financially dying hospital, which recently had less than two days’ cash in the bank: “We’re spit at. We’re swung at. We’re kicked. We have urinals thrown at us. We have bedpans thrown at us." That’s always the bad side of some of us paying for the care of others like we do for welfare and other entitlement programs: sometimes the recipients are nasty ingrates that make us wish we’d spent the money on someone who appreciates it.

Hospitals using electronic ICU systems like those sold by VISICU/Philips think they are improving safety and outcomes, but a 100-hospital study of those facilities shows no improvement, according to a Robert Wood Johnson Foundation study. But here’s the kicker: it appears that the methodology used was to just do a bunch of interviews about why hospitals bought the technology and ask their opinions about the benefits received. I didn’t see anything in the article suggesting that the authors actually looked at outcomes data of any sort. So, the conclusion isn not that eICUs don’t work, it’s that hospitals that use them think they do; therefore, they don’t see the need to do outcomes studies of their own (notice also that the article appears in Health Affairs, which is a health policy journal, not a clinical journal). Here are the takeaways: (a) nobody knows if widespread adoption of eICUs would save money, improve outcomes, or increase intensivist coverage (even after reading this article, which you might think would try to answer that question); (b) hospitals use eICUs to improve outcomes and utilization of specialists; (c) eICUs would work better if they were more interoperable with other clinical systems (gee, I wonder why clinical systems vendors aren’t more cooperative about interfacing to the product of a competitor like Philips?); (d) hospitals that don’t use them don’t believe they are worth the effort and cost (duh, and why even bother surveying those who don’t have them?); (e) here’s the money shot: “All ten respondents from eICU hospitals were enthusiastic about the technology’s impact on ICU performance, particularly on quality and safety. They all emphasized the benefits of redundant processes in the care of critically ill patients, whose clinical conditions can worsen rapidly.” So why in the world would the opinions of the non-adopters be relevant in any way? If you were considering buying a particular car, which would influence your decision: (a) asking 100 owners of that model if they like it and having every one of them say yes, or (b) asking 100 people who don’t even own a car at all why they haven’t bought one? The article doesn’t even answer the question that serves as its title: “Does telemonitoring of patients – the eICU – improve intensive care?” It seems like a pitch to have further eICU studies funded by government grants. The organizations with which the authors are affiliated get most of their income from grants. I suspect correlation, if not causality.

Informatics Corporation of America will add XML-based quality reporting capabilities from Mark Logic to its clinical portal.

NextGen gets several community health centers as new customers. ARRA will help a lot of them pay for new IT systems, so it’s a market that could be pretty hot.

HP, which bought EDS for almost $14 billion less than a year ago, is whacking the top-heavy salaries of the former EDS employees to be in line with what other HPers make, which is also a lot less since they cut salaries on the HP side in February. Some employees will take a hit of more than 30%.

Adena Health System (OH) extends its contract with MEDSEEK to automate physician referrals and to let patients view estimated out-of-pocket expenses before tests or procedures are performed.

The just-finished and sold out e-MDs user conference in Austin provided CME credits to physician attendees, which was apparently well received.

Scot Silverstein had a great idea to follow up on my “should I disclose vendor non-disclosure terms”. His thoughts: I shouldn’t have to do that because vendors should, as he says eloquently, “in an atmosphere of transparency and in deference to patients safety and to hospital governance, should gladly and transparently do so if such language exists in their contracts.” Great idea. OK, here’s what I know: Medsphere says it does not put nondisclosure language in its contracts. A reliable Meditech source says they don’t either. So here’s the challenge to Cerner, Epic, Eclipsys, McKesson, and other vendors of clinical systems: tell me that your standard contracts don’t prohibit customers from freely talking about software defects that could have patient safety implications and I’ll proudly announce that on your behalf right here. Or if your contracts do include such language, tell me why. I still feel creepy that when I worked for a vendor long ago, we were instructed to lie to customers who were anxiously reporting patient-endangering bugs, resulting in some wildly over-the-top telephone histrionics by thespianically challenged support reps. A typical overheard conversation: “Oh, you’re kidding – you don’t get a warning when entering that order?” (meanwhile, the rep is giving adjoining cube mates a laughing nod and making an overtly suggestive up-and-down fist movement that indicates a serious lack of concern that somebody’s loved one may be at risk because we as the scumbag vendor didn’t want to admit defects that would get us sued or replaced).

Medsphere gets a sale to 60-bed Beauregard Memorial Hospital (LA).

Weird News Andy found this article, which describes the previously illegal practice of hospitals paying doctors a cut of whatever cost savings their treatments generate. CMS is testing the practice in, as you might expect, graft and corruption rich New Jersey, where the concept of healthcare vig is well established in a less reputable way.

”Experts” in Australia say that too-rapid implementation of e-prescribing could compromise patient safety, citing a government study that found one hospital’s system doubled the rate of medication errors because it defaulted to the maximum dose and auto-refilled.

CMS is shopping for claims auto-denial software that will cut the $10 billion in improper payments it paid in 2007. These are the folks urging adoption of patient-critical computer systems, right?

OhioHealth goes live on a remotely hosted version of the EMPI of Initiate Systems, running on the interoperability platform of Accenx.

Garden City Hospital (MI) contracts with CareTech Solutions to support new AMICAS radiology workflow modules.

The backup generator fails at Fletcher Allen Health Care, taking its Epic system offline.

Capital Health CIO Gene Grochala is intereviewed about its implementation of Keane’s clinical system, which he called “a diamond in the rough … a sleeper” that the hospital’s clinicians scored 93 on a 100-point scale.

Cardinal Health’s Q4 numbers: revenue up 10%, EPS $0.86 vs. $0.96, but meeting expectations. The sexy part of its business will be spun off on August 31 as Carefusion, leaving Cardinal as basically a warehouse and truck delivery operation for drugs.

Sometimes I wonder if doctors pay attention to pre-med economics: this one is proud to do his own network wiring and PC maintenance, thus turning his own valuable time into that of a $30 an hour technician. You can’t accumulate wealth if your time is spent doing low-value chores like computer programming or screwing around with PCs, which is really more of an expensive hobby than a frugal handyman gesture when the only thing you have to sell is your time.

Odd lawsuit: a patient given what appears to be a single dose of the very common sedative Ambien during a hospital sleep study sues the hospital, claiming the drug blinded and paralyzed him. Ambien is not known to cause either problem.

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