Monday Morning Update 9/22/08

From Reality CCHIT: "Re: CCHIT participation from vendors. Let’s be clear about the goals of vendor representatives participating on CCHIT commissions and committees. The primary role of these participants is to watch out for the interests of their employer. That may mean adding onerous requirements already met by their company that sets a higher bar for less well-funded competitors or making the case against functionality their employer doesn’t have. A secondary role is to be the first to know what’s coming for technology that will take months or years to complete. Finally, participation looks good on resumes and RFPs."

From Medicman: "Re: Misys. Despite the financing issues with the Misys/Allscripts merger, Misys reps were in Raleigh earlier this week being trained on the Allscripts products. Someone is fairly confident this will go through." It probably will, although who knows what it will cost to get financing in this market. Analysts would say that the expected benefits outweigh the deal’s cost. I would say "expected" rarely proves to be the case. I can’t think of even one good strategic decision that Misys Healthcare has ever made (buying CPR, selling CPR, botching Sunquest, botching ClearPractice, copping out by relabeling iMedica instead of building or acquiring its own product, etc.) Maybe the best value of the merger won’t be the vaunted PM/EMR cross-selling opportunities, but rather clearing out what appears to be several corner offices worth of underperforming executive talent.

It’s not news to HIStalk’s readers since we told you on 9/15 after reader tips, but Eclipsys will acquire physician EMR vendor MediNotes for $45 million in cash and stock. I interviewed MediNotes CEO Don Schoen two years ago, where he said, "This is a huge market with potential and some people will benefit greatly from it. I hope to be one of them." Sounds like that’s what happened.

Parts of Microsoft’s new post-Seinfeld ad campaign were made on a Mac, geeky sleuths have determined. The article says the "Vista sucks, but less than you think" campaign (I made that up, but it has a nice ring, I think) will cost $300 million. The self-congratulatory article announcing the campaign basically says that Microsoft will copy everything that Apple does: hip ads, in-store kiosks, and free expert bars. That’s going to be a tough sell given that Windows 7 hints are already being dropped. Vista could be the next Windows ME. I’m running it on my laptop (not by choice since it was bundled) and it’s working fine, although I don’t really do much on it.

IT folks at the Houston VA hospital scrambled to prepare for Hurricane Ike and are now trying to recover 35 PCs lost when its Galveston clinic was destroyed. "As the storm approached, employees transmitted hourly updates of patient records over a VA network to the Little Rock facility, he said. They continued to do so the weekend the storm hit. Seventeen of the hospital’s 40 technology employees and 23 family members camped out in the facility’s library and server room from Friday, Sept. 12 until the evening of Sunday, Sept. 14, to keep vital computer systems running."

Allscripts sells its Physicians Interactive business unit, which pushes drug company sales pitches to doctors over the web.

Housekeeping: the Google Search box to your right lets you dig through over five years’ worth of HIStalk. Put your e-mail address in the Subscribe to Updates box to get blasts when I write something new (sometimes it’s breaking news, so you will often be the first to know). Click the ugly green Rumor Report graphic to securely and anonymously send me those secrets you’re itching to tell. And, as always, thanks to readers and sponsors for keeping the HIStalk flame lit.

A woman bringing her disabled veteran father to the Boise VA hospital refills her mug with soda from the cafeteria as usual, for which she has always been charged $1 or $1.50 even though no refill price is posted. On a recent visit, the cashier tells her it will be $3.80. The woman refuses to pay, the manager says they won’t take the soda back, and the woman dumps it on the counter and leaves. A reporter calls to tell her that two federal charges have been filed against her, each of which carries a maximum sentence of up to six months in jail. She claims she was identified by looking up her father’s electronic medical records. "They should not have used a veteran’s medical records to find me," she told reporters.

The government of Belize signs a contract for a national health record that will connect every citizen and the entire health sector. "The BHIS consists of a set of mostly interdependent modules surrounding the central Electronic Health Record (HER) and Admissions-Discharge-Transfer functions. The chief functions of BHIS key modules are, electronic health record and admission discharge transfer, clinician order entry, financial, maternal child health, HIV/AIDS, laboratory and testing, supply chain management, public health and human resources." Careful readers will notice the EHR/HER transposition, which surely means Microsoft Word was used to compose the story.

Hamilton Health Sciences, an Ontario hospital group, builds a technology hub for its IT department and vendor test bed. It’s doing innovation work around mobile caregiver technology.

Doctors in Scotland report great success with their Mobile Clinical Assistants, which I assume is the Motion C5.

UCI Medical Center (CA) overhauls its anesthesia information systems by bringing in SIS, putting an end to handwritten reports last week.

Apollo Hospitals, which operates 41 for-profit hospitals in India, will develop a centralized patient records repository in which birth-to-death records are indexed by an Apollo-assigned patient identifier.  

UMDNJ made up a no-work job to keep a powerful former state senator from going to work for a competing hospital, an administration official testified Wednesday. The former senator is charged with bribery and fraud for steering $12 million of public money to UMDNJ in return for the job. The dean of the medical school arranged the job, which officials said was created when the school hired high-salaried doctors for a cancer institute that it lost to Cooper University Hospital when that hospital’s own power broker, "the political boss of South Jersey," shifted the project to Cooper. Do you suppose sick patients realize how much sleazy jockeying is being done by seemingly reputable organizations?

New York eHealth Collaborative issues proposed guidelines for patient consent for electronic data interchange. Public comments are welcome through October 3.

Vermont Information Technology Leaders capitulates to state government demands that it reduce its board size, cutting back from 21 to 11.

E-mail me.

News 9/19/08

From The PACS Designer: "Re: cloud map. Peter Laird, who works for Oracle, has done an excellent job of creating a ‘Visual Map of Cloud Computing’ which gives you the full spectrum of the cloud environment. His map details suppliers of the types of clouds, storage, integration, value-add, and SaaS applications." Link.

From Deb Ridement: "Re: Misys. Both CEOs are way out on a limb with no turning back. If Misys, which has contacts with the CEOs of every bank and lending institution, can’t get the money, the banking industry really is in the toilet. That also says volumes about the HCIT industry and US economy. Employees and shareholders of both companies must be holding their breath."

From Inside Outsider: "Re: GE’s HPA. GE seems to be pushing HPA and they believe that the product exceeds what is in the market, particularly with the CBO product that combines both the hospital and physician billing. In fact, GE reiterated this at their GE Summit this summer."

From GE Centricity HPA Customer: "Re: HPA. I’m a senior IT person at a GE HPA site. At last month’s GE Healthcare Users Summit, Centricity Business leadership stated the HPA billing system was the go-forward billing system for hospital customers. As such, they are continuing to enhance and support HPA. This was the same message GE leadership gave us in March in a private executive briefing. They implied they would be migrating their clients using the old Phamis / CareCast hospital billing system to HPA. But, it was pretty clear Carecast sites hadn’t gotten the message yet. Moreover, I don’t think GE has figured out how to migrate everyone."

From Interested: "Re: GE. Has GE made a big sale EMR in India?"

From Justasquirrel: "Re: the Evanston / NorthShore moniker. They have a contractor going through everything in Epic using Chronicles to change the name on every document. I wonder how much money they are investing in changing all letterhead, business cards, invoices, etc.?"

University of Iowa Hospitals and Clinics votes down the Vocera VoIP communication system for what sounds like a bizarre reason: "There are certain areas of the hospital that cell-phone use is prohibited, for example. Whatever technology you install, you have to make sure that it’s not going to harm patients." I’m going to assume that the reporter or spokesperson got in over his head in trying to explain it because surely the hospital hasn’t found previously undocumented interference issues with the wireless network they’re already running.

Center for Information Technology Leadership says (warning: PDF) that a recent report by the Congressional Budget Office, which concluded that previous analyses (including CITL’s) overstated the benefits of IT in healthcare, is wrong. I admit that I’d probably go with CBO’s assessment, only because I never believe the optimistic outcomes industry folks usually predict. I’ve been jaded by hospitals creating expectations for big savings and improved outcomes, but failing to do anything to actually deliver them.

Former Cernerite Guillermo Moreno joins kiosk vendor Aurillion.

Someone from Microsoft e-mailed to say they had located and removed the PHI-containing Amalga/Azyxxi presentation that an HIStalk reader had reported to us and, sure enough, it’s no longer available via a Google search. Somehow it got out on the Web with some full patient names, diagnoses, EKG strips, and other confidential patient information.

Speaking of Amalga, El Camino Hospital buys it.

David Brailer’s Health Evolution Partners invests in Chrysalis Ventures.

HIMSS supports its big vendor constituency by declining to support the healthcare IT bill that Pete Stark just introduced. HIMSS doesn’t want a new group usurping HITSP’s work and is against the idea of the low-cost open source systems called for in the bill. In other words, the screwed up healthcare system we have has been berry, berry good to HIMSS and all the other member groups out there, so they aren’t about to advocate widespread reform that might reduce their own influence. You can’t blame them, I guess, but it’s a shame that AHA, AMA, HIMSS, etc. talk about real change to improve outcomes and reduce cost, but only in ways that don’t threaten the big money folks.

Mass General will cut 200 jobs.

E-mail me.

HERtalk by Inga

From ORLabRat: “Re: Seinfeld show. Did you notice that Jerry’s computer (on the table by the window) morphed from what looked like a Mac to a PC somewhere around the third season? My timing could be off, but it’s interesting now that he’s a Microsoft pitchman.” I never noticed, truthfully. However, there it is on the desk in the back. Looks like a PC to me.

From Elsie EHR: “Re: Justin Long. As you mentioned, Justin Long — the Apple computer nerd cutie — is known for his role in Dodge Ball; certainly a classic in the genre of ‘nerds band together to save the (choose one) neighborhood / school / summer camp / nursing home / gym / world from corporate goons.’ However, he’s better known for his appearance last year’s explosion-filled Bruce Willis epic, Live Free or Die Hard, in which Long played a (drumroll, please) computer nerd cutie who joins a Luddite cop (Willis) to save the world from evil hackers.” Those Apple guys are marketing geniuses!

Meanwhile, just days after Jerry Seinfeld cashed his $10 million check for his Microsoft spots, Gates and company are pulling the ads (claiming it was all part of the original advertising plan). Yeah, right. Obviously those MS guys read my post on Tuesday.

CCHIT announces eight new commissioners and the reappointment of five others of its 21-member board. The appointees were selected from 85 applications and will serve two-year terms. Among the new folks is Sarah T. Corley, MD, CMO for HIStalk sponsor NextGen. CCHIT also announced it will begin its new HIE certification program on October 1.

According to a poll, 63% of us spend our lunch at the desk plowing through e-mails. Compare that to the 20% who lunch with colleagues or friends, the 8% who work out, and the 9% who have a working lunch with colleagues / prospects / partners. Remember the good old days before e-mail, voice mail, and virtual offices when we actually went to lunch with the office crowd?

Not to bring up the taboo world of politics or anything, but the whole Sarah Palin phenomenon got me curious about how many women are in HIT’s higher ranks. Rich Correll, CHIME president and CEO, informed me that only about 25% of his organization’s healthcare information executive members are female (Rick says he remembers when CHIME was 90% men, so at least the trend is going in the right direction). That is still probably much better than the stats with healthcare IT vendors.

If you are curious what is going on in post-Ike Galveston and UTMB in particular, ER Dr. Angela Gardner has been posting interesting (if not depressing) updates. “80% of the island is damaged. UTMB is not seeing patients of any type at this point. DMAT teams are providing any necessary care. There is no electricity, no running water, and not enough fuel to start pumping water out of the flooded areas. Many of the emergency generators were damaged by storm. Phone lines and Internet connectivity are spotty. Even cell phone coverage is unreliable. Today, UTMB estimates re-opening the doors with a skeleton crew next week. Services will be added as it becomes possible. It is just a guess that we may not be able to have inpatients for 4 to 6 weeks. Full operability of all the hospitals/clinics/outpatient services/area clinics will probably take months. Much of the operability of the hospital depends on the time it takes for the city/county infrastructure to be rebuilt. This is emergency medicine’s surge capacity nightmare. The nearest fully functional hospital is 60 miles away.”

Cardinal Health is awarding more than $1 million in grants to help health care providers improve patient safety and health care quality. Last year Cardinal offered a similar program that resulted in grants ranging from $5,000 to $50,000.

Enterprise portal provider MEDSEEK announces its eMarketing Advisor service to assist hospitals improve web site effectiveness.

The Center for Studying Health System Change finds that, despite relaxed Stark laws, hospitals are not rushing to assist physicians with EMR costs. The Robert Wood Johnson Foundation-sponsored study found limited hospital budgets, conflicting projects, and lack of physician interest were all contributing factors. The third point goes back to a often discussed point that even a free (or almost free) EMR still isn’t enough to entice some doctors.

Note to Dysf(n): if “Tim” is a palindrome, perhaps “Inga” is actually “Agni”. (For the record, I’ve been told more than once that I am "hot").

E-mail Inga.

News 9/17/08

From Rogue: "Re: Epic clients. Children’s Omaha, Fairview, Carilion Clinic, Sisters of Mercy Health System, Ohio State University Medical Center, Children’s Hospital of Philadelphia, Sutter Health, Cleveland Clinic. I cheated – I read the User Group Meeting brochure. Some of the dozens presenting." Thanks to all those who named clients, most of them in the comments to the earlier article asking for some names.

From Pistol Pete: "Re: Adventist. John McLendon, CIO of Bayfront Health System, is leaving to take the CIO job at Adventist Health System. No word on where Tim Thompson landed this time."

From The PACS Designer: "Re: presentation software. Mr. H has posted about TechSmith’s SnagIt being one of his favorite inexpensive software tools for capturing images and text for use elsewhere. TPD has also used SnagIt and has noticed the improvements to another TechSmith software tool called Camtasia Studio 5 that provides for better video presentations. The software would be a good solution for numerous medical image files that require additional annotation of data elements from CT and other modalities." Link. I’m a longtime Camtasia user as well and I agree that it’s just great. I have, in fact, used it to capture and annotate cine loops from PACS as you mentioned. It streams in Flash, so it’s fast and high quality.

From Rudy Washington: "Re: GE. Does anyone have any insights as to the future of GE’s HPA patient accounting system? HPA was originally developed by IDX many years ago. Are they migrating current clients to a new patient accounting system or do they plan to enhance and support HPA?"

Going back to the Misys-Lehman mess, some now-tarnished names were all over the March announcement. Lehman Brothers brought the money and Goldman Sachs brought the advice. I think there’s little doubt that only two outcomes are likely in the few weeks until the scheduled shareholder vote: (a) ValueAct Capital jumps in with the cash, or (b) the deal falls apart completely because conditions are terrible and the merger will be reevaluated in an entirely new and harsher light by both lenders and shareholders. Given a long and nearly unbroken string of Misys incompetence and/or bad luck, I wouldn’t want to bet either way.

Speaking of Lehman, they spent $309 million on IT in the most recent quarter. Other than the bankruptcy thing, I’m sure they’re happy to be Most Wired.

Conditions are are grim in Galveston, but at least UTMB’s IT department gets some nice kudos right on the main hospital web page. Sounds like they did a great job in recovering vital IT capabilities.

I don’t watch HIStalk’s stats too much, but Inga does, so she’s just squirming to have me mention that we’re on track for a record number of page views and visits this month unless everybody stops reading at once. So, please don’t.

The Madison paper runs a pun-laden preview of Epic’s user group meeting, currently underway with 3,900 attendees.

Listening: Hyppio FM, a hard-rocking Helsinki radio station that my little Aluratek thingie turned up. You can click the Listen link on the web page and tune in from there if you don’t have the gadget.

Pete Stark introduces a new HIT bill that would charge the federal government with creating standards and "creation of an open source HIT system that will be made available at little or not cost to providers." Open source expert Roger Maduro sent me this: "There are several sections recommending the use of open source software. It references VistA as a model but it leaves the door open to other open source solutions. This is a very big step for Congress."

Cerner gets its first Latin American customer, a 200-bed hospital in Chile.

Another Indian hospital mob attack: a doctor is assaulted over admission of a patient.

Little Company of Mary (CA) gets a local paper writeup for its medication management systems: smart pumps, a dispensing machine, and a barcoding packager.

I was looking at the results of a survey in which Alan Greenspan was voted most responsible for today’s dire economic conditions. You can ask him about that when he keynotes at HIMSS, at least if we’re not all selling apples on corners by then.

Microsoft may spin poor Vista sales, but actions speak louder than words: they’re already getting ready for developer testing of Windows 7. I’m sure those handful of hospitals actually thinking about rolling out Vista will pass now. I also noticed that MSFT is selling perennial cash cow Office Ultimate 2007 (including Access and Publisher) for just $60 to anybody with a .EDU e-mail address, which seems desperate (it’s a real perpetual license, not a subscription). Maybe they should replace Ballmer with Jerry Seinfeld.

Computer disks full of NHS employee information are lost in the mail while headed off to payroll outsourcer McKesson.

GE Healthcare and Cerner are going after a big PACS contract in Ireland valued at up to $175 million.

Evanston Northwestern Healthcare, convinced by its marketing people that having a sensible, descriptive, and correctly spelled name is so 1990s, "rebrands" itself NorthShore University HealthSystem (they apparently have something against the space). The hospital claims it had "outgrown" its name (huh?) and offers this marketing gibberish as a half-hearted excuse: "The core of the new name/brand is ‘NorthShore,’ according to the firm. NorthShore not only signifies a geographic area — and a much broader terrain than ‘Evanston’ — but also serves as a state of mind. Prestige, quality and a favorable destination are a few of the attributes people say come to mind with the name NorthShore." What NorthShore brings to my mind is painfully obvious attempt at trendiness and a preoccupation with marketing BS. Just do your damned job and patients will show up in droves (the hospital is probably already full, for that matter, making the entire exercise even closer to pointless).

Speaking of rebranding, Dairyland is now Healthland (which we told you earlier). The company also announced the acquisition of Advanced Professional Software (which we told you earlier).

Jobs: Cerner CPOE Consultant, EHR Account Management Associate, Regional Sales Manager – South, Cerner CCL Custom Report Writer. Sign up for weekly job blasts here.

You know this article is going to fun from its subtitle: "Soldiers at the military hospital languished in part due to incompatible databases and dismal record keeping. Welcome to the Pentagon’s $20 billion medical-records boondoggle." It’s critical of AHLTA, saying it should never have been allowed to continue in the presence of the far superior VistA and did so only because of DoD arrogance. It also mentions a couple of things that I reported here long ago: that CHCS II was renamed AHLTA only because nobody could stand it and that former CIO Lt. Colonel Mike Fravell cranked out a $300K system that was better than the $5 billion AHLTA, which got him shipped off to South Korea for questioning the value of fat cat contractors like Northrop Grumman.

I’ve heard no announcement, but according to bid documents, the Mississippi Coastal HIE has chosen Medicity for its proof of concept, six-county RFP, with a three-year value not to exceed $3.5 million.

Who knew that Mayo Clinic is doing a joint venture with a disease management software vendor in the Netherlands?

Idiotic hospital lawsuit: Missouri hospitals are suing American Tobacco for $8 billion, claiming that they should be reimbursed for uncompensated care rendered to smokers.

E-mail me.

HERtalk by Inga

Here are some thoughts about the whole Seinfeld/Microsoft/Apple discussion and whether Seinfeld is the right guy to deliver Microsoft’s marketing message. I loved Seinfeld. It was a classic 90s show. If you are over the age of 30, you can probably name all the main characters. Maybe you watched Seinfeld while you were sitting in front of your TV with your new 4.3 lb IBM ThinkPad 701C (50MHz 486DX2, 14.4 kbps modem, 540MB hard drive with 8MB RAM) with its very stable Windows 95 OS. When you see Jerry on those commercials, it just reminds you of those good old days when Bill Gates was first named the world’s richest person. Compare that to Justin Long, the Apple cutie (in a computer-nerd sort of way). Other than the Apple commercials, he is known for some silly movies, including the Dodgeball: A True Underdog Story. If you missed the movie, the basic story line is that the small local gym misfits enter a dodgeball tournament to save the gym from the big corporate health fitness chain. Anyway, with those images in mind, does anyone really think paying millions for Jerry was a genius decision?

Nuance announces the release of Dragon Medical 10, which is said to recognize dictation nearly twice as fast as previous releases and to be 20% more accurate. Also included are new medical vocabularies, improved EMR integration, and regional accent support.

Secure authentication enthusiasts might enjoy this article. After the initial roll-out of its Epic system, Children’s Hospital Medical Center (OH) incorporated both RSA’s Secure ID tokens and Sentillion Identix fingerprint readers for medication prescribing and dispensing.

Pattie A. Clay Regional Medical Center, Princeton Healthcare System, Riverview Hospital, and Frederick Memorial Healthcare System are named 2008 QUEST Award winners. The QuadraMed-sponsored awards honor hospitals for innovative and impressive use of QuadraMed products.

Cerner completes its first sale in Latin America. Clínica Las Condes in Santiago de Chile will implement Millennium at its 220 bed hospital.

HP announces restructuring plans following the EDS acquisition. HP plans a 7.5% staff reduction (24,600 employees) worldwide over the next three years. Nearly half of the cuts will be in the US.

Speaking of layoffs, MedZilla.com reports that in August more than 25,000 new jobs were created in health care, with about 14,000 being hospital-based positions.

CAQH announces that providers now have a source for checking patient deductible balances online, at the point of care, and potentially any health plan. Insurers participating in the voluntary program cover an estimated 130 million lives.

Sounds like the Epic’s user group meeting is quite the affair. The event is following a Much Ado About Healthcare theme and Judy apparently dressed as Portia (of “Merchant of Venice” fame) as she welcomed attendees. Word is that having an extra 3,900 people in Verona caused some traffic snarls. On the agenda: Steven Levitt and Roy Blount, Jr. Meals are under a temporary tent and Epic is running 100 shuttle buses, according to local reports. If you are there, send us a update from the field.

athenahealth extends it business process services agreement with Perot Systems for an additional five years, extending a seven-year relationship.

Next time you need a massage, head over to the hospital. Health Forum, a subsidiary of the American Hospital Association releases a survey indicating that more than 37% of hospitals offer one or more complementary and alternative medicine services, with massage therapy taking one of the top spots.

E-mail Inga.

Misys Postpones Allscripts Merger Meeting Due to Lehman Brothers Collapse

Misys PLC announced this afternoon in London that it will delay its its scheduled September 22 extraordinary general meeting to approve its merger with Allscripts until October 6. Its lead advisor, Lehman Brothers, filed for Chapter 11 bankruptcy protection yesterday, leaving Misys scrambling for the $330 million it needs to pay off existing shareholders of Allscripts under terms of the merger agreement.

The analyst who led the story had this to say earlier today, before the meeting date was changed:

"The major cash outgoing is the $330m dividend to be paid to Allscripts’ shareholders five days after the deal closes (around 1 October). So we imagine Misys has some two weeks to find funding in a tricky (and possibly expensive) market. It is unclear whether the EGM [on 22 September to ratify the deal] can proceed if the facilities are no longer in place, but we would assume so.

"While this must be the worst two weeks of the crunch so far to go shopping for a $305m facility, we assume one is available at some price and as such we imagine the deal should still go through. Certainly Misys must be working overtime to ensure it does. Its own healthcare business was already in sharp decline. It has stopped investing in R&D in its own business and we suspect business has continued to be poor. Quite apart from any break fees (£7.1m), the business would not be in good shape on its own. While we do not believe that will happen, the risk has just increased."

CIO Unplugged – 9/15/08

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Staying Tethered to a Disconnected World
By Ed Marx

Much has been written about the multi generational workplace. Thanks to advances in science, health, and technology, most institutes encompass a blend of 3 generations with the delivery of a fourth (Gen Z) on the way. Heck, even the age of my running group back in Cleveland ranged from teen through every decade to include the 60s. That made it fun, and inspiring.

With the exception of two individuals, my current leadership team is made up of baby boomers—though in truth, I overlap the Gen X periphery. That likely classifies us as average in this regard. Raised by the “greatest generation,” we have observed and participated in the most rapid advances the world has ever known, across all disciplines. For the first time in history, we now lead a vibrant force of multiple generations. This adds fresh challenges and opportunities.

If your leadership team is anything like ours, you’re struggling to ensure a sense of connectedness in an untethered culture. I am blessed to be part of an IT team that is nationally recognized as one of the best in areas of innovation, leadership, and infrastructure. Just this year, we ranked in the “Top 50” places to work across all industries (Computerworld). Be that as it may, fostering connectedness within a team that telecommutes extensively and where the focus has shifted to performance, as opposed to time in a cube, remains a daunting task. The Boomer leader’s comfort zone requires everyone to see each other daily and nurture a home-away-from-home feeling, while Gen X and Y don’t necessarily desire that environment. Is having a “best friend at work” (Gallup Research) still the most important criteria for connectedness in a post-modern workforce? What can leaders do to reconcile this conundrum so performance remains high and connectedness manifests itself in ways motivating to all generations?

Here is what we do.

· Social Networking- Encourage the use of networks such as Facebook and LinkedIn and develop your own networks within each

· Technology- Provide communication tools such as IM, VPN and video

· High Touch- As much as I value technology, I still handwrite an average of 10 cards per week

· Dinners- Have people over regularly

We purchased a second dining room table and extra place settings a few years ago so we could serve 40 people at one time.

Singles, including single parents and their kids, have been invited on many a Thanksgiving and Christmas to celebrate with us.

· Parties- Hold two huge shindigs each year for all staff, one of which is formal and includes significant others

We host smaller parties at our home to celebrate successes. Ideally, these include the employees’ families

· Play- Volleyball tournaments, foosball, kickball

This fall: six vs. six soccer

· Give- Take numerous opportunities to come together and give

Sometimes we help one of our own who is dealing with a personal struggle.

We participate in United Way and food drives, etc.

· Community- Volunteer with Habitat for Humanity, building homes or at various local outreach centers

· Phone Calls- Well-timed phone calls to chat with colleagues has proven critical

· Voice Mails- Stay an extra thirty minutes one evening and leave voice mails for individuals on different levels, thanking them for their impact

· Book Studies- Have numerous book studies taking place all the time, which brings people together to discuss specific topics

· Events- Most organizations have some sort of season tickets whether for the opera or local sports team.

Whenever possible, I take advantage of these and give first priority to non-management staff. While I find some of the events are boring (baseball is way too slow), I love hosting these activities simply to connect

· MBWA- For in office employees, walk through work areas regularly

My assistant knows that sometimes it takes me 45 minutes to return from a meeting a few hundred yards away because I love to engage my team

· Unique Meeting Places- Why hold meetings in boring conference rooms? Especially for teleworkers. Meet at Starbucks or Paneras

· Big Dates- Acknowledge your leadership’s birthdays and employment anniversaries

· Lead by Example- I work from home weekly and use all the aforementioned technologies and actions to foster connectedness.

· Transparency- Regardless of the medium, be transparent. Show your warts. Be human. Remove the formalities. A true leader earns respect by respecting others

For those who respond to this by asking “what about work?” I say look at our performance. Additionally, I firmly believe, and my experience will attest, the team that incorporates such connectedness will outperform those who insist it is all about butts in seats.

Do you want to reach across all generations and connect to a disconnected world? Incorporate compassion, acts of kindness, empathy, laughter, and fun into your workplace. Revamp your culture, watch performance improve, and then join us on the list of best places to work. See ya there!

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

Misys, iMedica Reach EMR Agreement

iMedica announced this afternoon that it has reached an agreement with Misys Healthcare Systems that will grant Misys a license for iMedica PRM 2008 PM/EMR and the SP1 release to follow. Misys and iMedica will not share further software enhancements and Misys will not be entitled to future iMedica releases beyond SP1.

Misys will pay iMedica $12 million in cash and all remaining royalties due under the original agreement between the companies. In addition, Misys will give up its 18.4% ownership stake in iMedica.

Monday Morning Update 9/15/08

From Epic Gossiper: "Re: Epic. We all read about Epic’s elitist, snobbish way of picking customers, but now it seems there is reason behind this madness. Is it true that Epic refuses to work with hospitals of fewer than 500 beds? Another case of success intoxication or just down to earth good business practice?"

From TiredCIO: "Re: naming rights. It’s amazing what a non-profit healthcare organization can find to spend money on. Parkview Health System buys naming rights to a new minor league stadium." I’m with you there. The Indiana hospital lays out $3 million over 10 years to name the new ballpark of the current Fort Wayne Wizards to Parkview Field. Half of the money goes to the city, half to the team. I bet you could find quotes somewhere in which hospital executives moaned mournfully about how hard it is to keep the lights on given their financial hardship. Their argument: (a) they want to be a good corporate partner (do people really expect their large hospital bills to be used in a Robin Hood like manner and spent on community projects that they wouldn’t support on their own?) and (b) they can market services to a captive audience (hospitals marketing their services gives me the creeps, I have to say). On the other hand, the hospital showed an $82 million profit in its most recent tax year (time to drop those aspirin from $8 to $7?) The CEO made $600K. I’m really beginning to believe that the model of having "nonprofit" hospitals billing the heck out of private insurance and government is responsible for much of what’s broken in healthcare.

Detroit Medical Center’s Cerner systems go down in at least four hospitals on Friday.

Someone who should know says it’s Eclipsys that’s working on a deal to acquire MediNotes. That would be the first Eclipsys foray into PM/EMR systems, I believe, if it actually happens. 

Inga contacted Bill Bates, CEO of digiChart, to ask about the layoff rumors (60% of staff cut loose) that we mentioned on Thursday. Here’s his e-mail response: "For several months, digiChart, Inc. has sought creative opportunities to expand its sales force, automate software development and streamline implementation and training of new clients. As a result of these opportunities, digiChart was able to decrease its staff and gain the benefits of a wider distribution and training model. Like Southwest Airlines — a contrary business model to the standard airline model — digiChart, Inc. has identified ways to gain efficiencies at lower costs. As a result of these strategic decisions and its committed employees, digiChart, Inc. will achieve another level of growth."

Listening: The Kilaueas, an obscure German surf rock band I ran across. Also, Elvis Costello, a favorite I’d forgotten about until I saw him on some TV special the other night. He’s one angry little Brit.

Emdeon files for a $460 million IPO.

Welcome to HIStalk Gold Sponsor Red Hat of Raleigh, NC. I have to admit that, years ago, I never thought that open source would be popular in hospitals or that Red Hat would be a household name in them, but they proved me wrong, creating a highly successful company whose market cap is $3.5 billion at the moment. You can read about their SOA solutions for healthcare here (warning: PDF). Thanks to Red Hat.

UTMB says it weathered Hurricane Ike fairly well, with only one minor injury but unknown campus damage. They’re on generator, of course, and providing only ED services. From the hurricane updates, it sounds as though they were quite well prepared. Hospital updates from the area are welcome.

If you’re not getting updates when I write something new, just drop your e-mail address in the Subscribe to Updates box to your right. The mailing list has nearly 3,000 confirmed subscribers, all of whom will know important stuff before you do if you don’t sign up. You should see the server light up when I send a new e-mail blast, especially if it’s a news story (I don’t waste your time e-mailing out questionable news. If you get a blast, it’s important). Send the HIStalk link to your friends, too (your enemies already know about it, probably).

Providence Health & Services and Inland Northwest Health Services move their squabble to court, with a key element of the spat being MEDITECH. I’m not interested enough to wade through all the corporate entities named in the articles or what the MEDITECH argument is all about, but feel free.

Philips will acquire Alpha X-Ray Technologies, an India-based cardiology imaging vendor.

I finally saw one of the Jerry Seinfeld ads for Microsoft (the shoe store one) and it was just dumb (long, pointless, and tragically un-hip). What a waste of $10 million. Does Microsoft really think that Jerry is happenin’ enough to out-cool Apple, even with bonus bad acting from Bill Gates? Steve Jobs can take both of them with one pancreas tied behind his back. It’s not cool enough to be viral and not focused enough to sell anything (it never mentions the product or company). An expensive embarrassment all around. Microsoft IS your father’s Oldsmobile, I’m sorry to say.

UCSF Medical Center starts a $1.6 billion, 289-bed hospital project. Is it not possible to render quality medical services for less than $5.5 million per bed just for the physical plant? Those buildings seem to be nonprofit executive’s way of memorializing themselves as an emotional substitute for the shares that their publicly traded counterparts give themselves (or maybe it’s one of those "mine is bigger than yours" things).

Siemens may lose another medical equipment deal amid claims of bribery, this time in India. Wipro Health said its technology was better and cheaper, but authorities rigged the bidding at the last minute so that only Siemens could qualify (Wipro got Strogered, in other words).

Wednesday is Readers Write day, so dip your quill and tell us what’s on your mind. I’ll also have a cool interview on Monday and, coming soon, the first HIStalk online CEO chat (once certain news is announced).

Vendor Deals and Announcements

• Stillwater Medical Center (OK) has administered more than one million doses since 2004 using IntelliDOT’s BMA solution. Stillwater was IntelliDOT’s first customer to implement the solution. IntelliDOT, by the way, made the “100 Best Places to Work in Healthcare” list.
• Medicalis signs a distribution agreement with MedLink International, giving MedLink the ability to offer Medicalis solutions to its radiology customers.
• CapMed is now offering “smart messaging” to its PHR users. This feature will analyze inputted information and provide gaps-in-care notices for relevant treatment options and reminders.
• Tony Bellomo takes the helm as TriZetto’s new president.
• Affiliates in Imaging (CA) selects AG Mednet’s diagnostic imaging network.
• The Minnesota HIE will use Covisint technology to build its e-health exchange.
• Alameda County Medical Center implements Concerro’s web-based staffing services to manage nursing shifts.
• AmeriHealth New Jersey is sponsoring the NJ HIE. HxTechnologies is building the exchange.
• GE Healthcare introduces Centricity Enterprise Orders and Pharmacy, which provides customizable order sets and embedded real-time clinical decision support. The new module was created in partnership with the Mayo Clinic, University of Virginia, and UCSF.
• Valley Baptist Health System (TX) selects Trintech’s ClearContracts Payer Compliance suite to more accurately calculate managed care and government payments.
• Sisters of Mercy Health System completes implementation of an upgrade firewall from Palo Alto Networks. The new security infrastructure serves Mercy’s 28,000 employees across seven states.
• Virtual Radiologic announces the addition of Brian F. Sullivan to its board of directors.
• The 1,300-bed Wake Forest University Baptist Medical Center (NC) is now wire-free following the installation of a 900-access-point wireless LAN.
• Picis announces a new webinar series featuring healthcare providers, IT execs, and clinical managers. Participants will be discussing best practices for using healthcare IT in the high-acuity environment.
• Eclipsys names Bill Bregar as VP of Quality and Total Quality Management. Bregar is leaving Philips to take this newly created role.
• Perot Systems has successfully rolled out a hospital information system in multiple hospitals and primary care centers in Abu Dhabi.
• athenahealth completes its acquisition of MedicalMessing.net for $7.7 million in cash.
• El Camino Hospital selects ITelagen to provide healthcare IT and EMR support for the hospital’s independent physicians.
• Siemens Soarian Financials customers can use payer validation edits and rules within the revenue cycle workflows. A new agreement with the SSI Group for its ClickON LinX product provides Siemens clients with new claims management tools.
• McKesson introduces InvestiClaim, a new web-based fraud and abuse detection and management application for health plans.
• Adam Gale is taking over as President of KLAS Enterprises, replacing Kent Gale.
• Mercy Merced Medication Center (CA) contracts with Thomas Reuters to use the Clinical Xpert CareFocus solution. CareFocus allows physicians to rapidly identify high-risk patients within the active hospital census.
• WakeMed Health and Hospitals (NC) selects Peopleclick to automate their recruitment and hiring process.

E-mail me.

News 9/12/08

From Elliot Carlin: "Re: Kaiser. Bob Newhart is a friend of mine and he says this Dr. Tupperman is a urologist at the Rimpo Medical Arts Center in Chicago. Bob says Dr. Tupperman has yet to chip in his $575,000-per-doc share of the RimpoConnect [over]budget so far. Budget numbers ($3.2 billion before 2006 + $1.7 billion for 2006 + $1.6 billion for 2007 + $1.5 billion estimate for 2008) / 13,750 docs." Good work on catching the Bob Newhart reference I slyly inserted as a phony name (and inserting one of your own since I didn’t know that Rimpo was the name of the practice on the show). That $575K is the per-doc cost of HealthConnect if you divide the cost by the number of physicians.

From Kaimuki: "Re: RHN. It looks like Revolution Health Network & Everyday Health are going down the altar." I’m finding it hard to get interested in that shotgun wedding. Free websites that claim success based on page views instead of profits seem doomed to fail. Google raised the bar on those expectations when it was cool, free, and highly profitable all at once.

From Betsy: "Re: workshop. The Cooperative Exchange is doing a workshop in DC on Wednesday Sept. 24th. Wondered if you might give mention of it for anyone within driving distance? Agenda is pretty impressive. Check it out at www.cooperativeexchange.com. Also, I have an interview idea The SSI Group, Inc."  The meeting is about revenue cycle management. I tried SSI once before for an interview and they didn’t even respond to the e-mail, so I’m banning them (symbolically since they were already ignoring me).

From Rudy Polanksi: "Re: bloodbath. digiChart in Nashville, TN fired 40 people yesterday, leaving ~ 27 folks left." Unverified. Inga is seeking a company response.

From Jane: "Re: Epic. I’m doing an internal presentation for work and wanted to know if your readers could provide a list of some of Epic’s clients. I know about Stanford, Allina, Geisinger, and Kaiser." There are so many that I don’t even know where to start, so let’s divvy up the work and each reader contribute a couple in a comment until we get a bunch.

From Miss Pittman: "Re: possible HIPAA violation. I was doing a search on Microsoft Amalga and found what appears to be PHI on the web." It certainly does look like PHI. One screen shot with key information blurred out still includes zip codes for patients over 89, which is a HIPAA no-no unless I’m mistaken. More seriously, several more shots weren’t whited out at all, showing what appears to be a full set of ICD-9 codes and EKG strips for a patient whose name matched someone I Googled on the web, right down to the approximate same age and his address in DC where Azyxxi was born at Medstar. Well, they appear to have goofed, although I didn’t verify. I thought about e-mailing the guy to confirm they’re his records, but that seemed tacky (I bet that newspaper and TV reporters would do it since Microsoft’s name right is on there). I don’t like seeing people get sued over honest mistakes.

From Denver Umlaut: "Re: my favorite Web tools. www.jott.com – the basic service is free (it just left Beta – it’s worth paying for ), with reasonable plans that add options. AWESOME service – email yourself, set reminders, get alarm emails/calls/texts, for anything, from anyone, anywhere, all with your phone. I call their number and can say "Jott HISTalk", speak the message, and it would e-mail you the transcribed message along with an attached copy of the recording. It’s awesome for tracking and task management – anytime I have a thought I can’t forget, I Jott myself and get an email/task/text depending on my settings. http://www.grandcentral.com/ – you get one phone number (free), all your calls go to it, and you tell it what number to pass them through to – so you can designate a phone as active, and all calls go to it. Or you can set all work calls to go to your cell, and all other calls to your home line. Plus, when it puts a call through, it gives you the option to accept, accept and record, pass to voicemail, or pass to voicemail and listen in. And it’s free. www.xobni.com – resource intensive but awesome Outlook plug-in that trends e-mail and provides really cool features."

Agfa’s board says stories claiming it will sell off its healthcare unit are not true.

Hey, whose ad is this? Why, it’s that of brand new HIStalk Platinum Sponsor CareTech Solutions, I do believe. They’re in Troy, MI and offer a variety of IT services (including outsourcing), HIM services, web-based applications, and cabling and wiring services. They also offer outsourced help desk services that include staffing by certified professionals and analysts with healthcare and healthcare application experience. Thanks to CareTech Solutions for supporting HIStalk and its readers.

And speaking of sponsors, thanks much to Renaissance Resource Associates and Novo Innovations for upgrading their HIStalk sponsorships to Platinum level. We like those votes of confidence.

ISO publishes a Health Information Security Management standard.

Jobs: Regional Sales Manager, Healthcare IT Sales, Clinical Consultant, Sales and Marketing, Consultant, Account Manager.

Medsphere is having its First Annual Collaborative Healthcare Forum on October 2 in NYC, with John Halamka there to talk up open source applications like VistA (which he doesn’t use at his place, but he does have other open source stuff there).

Hong Kong will spend $4.5 million USD for security technology and will make hospital CEOs responsible for information security and privacy following a series of hospital breaches. 

Shahid the Healthcare IT Guy referenced these truly outstanding articles on how to do a startup demo (Part 1, Part 2). Vendors should study this as though another set of stone tablets just got handed down. I like this: "Horrible ways to start your presentation: a) Talk about your bio and your business accomplishments. (We don’t care, we can talk about that later if your product is any good.) b) Talk about the market size. (We don’t care, we can talk about that later if your product is any good.) c) Give an overview of the competitive landscape. (We don’t care, we can talk about that later if your product is any good.)"

Reporter inquiries: if you can help with sources for these stories that various publications want to write, e-mail me. Hospitals that have outsourced some part of IT but then brought it back in-house; hospital CIOs willing to talk about recovering from one of the recent floods or hurricanes; and hospitals doing creative things with low-cost data mining or dashboards. Thanks.

Newcastle NHS breaks ranks from NPfIT, going with UPMC for its Cerner-based systems, even though it will cost them more (but get them live quicker). Odd: "Therefore we believe they have got – and this is part of the reason we partnered with them – a tremendous amount of clout with Cerner. They have the ability to influence the way that product is developed. We are hoping that through that relationship we will get a version of the product that’s more advanced than the ones that have currently been implemented." They had to go to another customer to get clout despite being a customer themselves?

I gotta talk to this guy: Geary Davis, a biomedical engineer, Dartmouth MBA, and former hospital CIO, is now a practitioner of Chinese Energetic Medicine and acupuncture. You know there are some good stories there.

I’d watch this company: HIM vendor Precyse Solutions puts Pam Arlotto and Carl Witonsky on its advisory board, giving them a lot of strategic horsepower.

Norton Healthcare goes live with Sentillion Vergence for SSO.

Augusta Medical Center is using a flu pandemic prediction system developed by students at James Madison University. You’ve probably never heard of the university or the town it’s in, Harrisonburg, VA, but it’s a super school and a nice town, up the road from another really excellent school, Washington and Lee University, although I don’t know why I’m telling you this except that I’ve been on both campuses and was impressed.

A Columbia Memorial Hospital (NY) employee and her boyfriend are arrested for posting the names, addresses, and Social Security numbers of family members of the man’s former girlfriend on MySpace. The woman got the information from the hospital’s computer system.

Goldman Sachs predicts a drop in IT spending this year, but says winners will be Apple, Oracle, Red Hat, and Google. Losers: Microsoft, IT employees, and onsite service providers.

Odd hospital lawsuit: a woman visiting a hospital claims she was knocked to the ground by faulty automatic ED doors. She was treated and sent home, only to return with "head, neck, back, and leg problems" that required "extensive treatment," resulting in her husband’s loss of consortium. They’re suing. Maybe he needs the money for alternate sources of consortium.

E-mail me.

HERtalk by Inga

From Former Soccer Mom: “Re: Sarah Palin. Loved your comments. She may very well be the first female president someday.”

From EMR Gal: “Re: mail bag. I love the mail bag. ‘Governors with five kids simply don’t have time for botox’- classic. Loved all of them. Perfect.”

From Manly Man: “Re: swine. Oh, Inga. A pig? Really? Ouch. I like your responses, though. Will this be a regular feature? I like your portrait as well.” As I mentioned in yesterday’s post, if it weren’t for Mr. H’s suggestion we get some “hottie” to provide psychiatric commentary, the mail bag piece would never have come about. Let us know if you think it should have a permanent place on the blog (do we just need to stick to HIT?) Meanwhile, if you have any neuroses you would like analyzed, drop me a note.

From Thriving in CA: “Re: A little correction to your post. Patrick Heim is the Chief Information Security Officer here at Kaiser (CISO), not the CIO. The CIO here is Philip Fasano. Keep up the good work…” Whoops – sorry about that.

With mandatory evacuations in place for Galveston, TX in preparation for Hurricane Ike, UTMB closes its clinics, cancels classes, and evacuates patients.

Modern Healthcare releases its “Best Places to Work in Healthcare” report that includes 100 companies. Is your employer there? Do they deserve to be?

Virtual Radiologic announces the addition of Brian F. Sullivan to its board.

MSNBC was running the replay of the Today Show’s actual September 11, 2001 broadcast this morning. I was actually watching the Today Show that morning, so reliving the whole plane/tower thing was pretty creepy (and disturbing and sad). I’m sure we all have stories about how that day affected us. I hope we never forget them.

Marlin Equity Partners is the winning bidder in an auction for bankrupt MedAvant Healthcare Solutions. The $24.35 million transaction is scheduled to close September 22.

Researchers find that Botox helps in the treatment of migraines. Coincidentally, I feel a bit of a headache coming on.

eHealth Initiative releases its 2008 Fifth Annual Survey of HIEs, which includes responses from 130 community-based initiatives. Some key findings: operational HIEs have increased 31% over last year (to 42); 82% claim developing a sustainable business model is moderately to very difficult; and 69% of the operational exchanges report reductions in health care costs.

Picis announces a new webinar series featuring healthcare providers, IT execs, and clinical managers. Participants will be discussing best practices for using healthcare IT in the high-acuity environment.

E-mail Inga.

News 9/10/08

From The PACS Designer: "Re: cloud basics. Since the number of Cloud solutions being introduced is increasing with each passing month, TPD thought it would be good for HIStalkers to have a place to go for an education in this new web concept.  Earlier this year, ReadWriteWeb had an excellent post on the subject after an Amazon Cloud outage occurred." Link.

From Dr. Lisa Cutty: "Re: Epic. Nice find on Epic’s interview technique." Link. Epic paid all the guy’s interview travel costs, which is cool, although he didn’t like the behavioral interviewing questions or the usual HR nonsense: "After this was the interview by HR. and this was the worst ever. nothing to do with my field. no real point to these questions either, just the standard bullshit HR questions." I’d read it quick if you’re interested because I’ll bet it’s coming down shortly.

From Thru the grapevine: "Re: Siemens. 200 more laid off by Siemens. This time it hit the sales force." Unverified. The last time somebody claimed more layoffs had happened, we asked around and couldn’t verify it, so I’m skeptical. Confirmation welcome.

From Joker: "Re: the $100M for ONE (1) Soarian module. Is this a joke? Can we know the name of the hospital that is so generous in its investment strategy?"

From Beltbuster: "Re: Allscripts-Misys. With the pending merger, the entire sales force (Misys, Touchworks, A4, etc.) is being flown to Phoenix for four nights. If I was a stockholder, I would wonder why the meeting was not in Chicago (Allscripts home) or Raleigh (Misys). I’m sure they’re trying to rev up the engines for Q4 performance for the combined entity, but I would have to imagine this junket will be a fairly expensive endeavor. It’s yet another example of wasteful spending (acquisition of ECIN, Advantix legacy PM, Amicore …)"

From James West: "Re: online storage. I think Chrome can still use some Firefox extensions. If so, simply install Gspace and you can use all your Gmail storage like a network drive. I love it! I sync files I use on multiple computers with my Gmail and have key documents available at any computer I go to. It’s all in your inbox, so to access anything all you need is Gmail, not Gspace." I tried Gspace and it works just like an FTP client, although I kept getting errors (even in Firefox) so I wasn’t able to save anything. Worth another try, though, since Gmail comes with 2GB of storage and you can open multiple free accounts that Gspace can use.

From HIT Guy: "Re: format. I have to disagree about the new layout. It makes HIStalk a lot less legible. Certainly you more than deserve the success and the sponsors, but the actual content now looks uncomfortably sandwiched between two ginormous columns of (gulp!) flashing ads." I’m still fine-tuning (thanks, Maia, for the idea of adding vertical space between the ads), but let me explain the ads on the right. Medicity and eScription were HIStalk’s first sponsors, so I gave them one small little perk of having their ads in the same spot all the time, figuring they made it all possible by taking that first brave step back in the Stone Age. No other ads will be placed on the right side. All of the other comments about the changes have been positive. I kept readability front of mind (text not too wide, not too closely line spaced, no ads inside the text, etc.) I’ve got a guy making a setup change that’s supposed to make the database calls more efficient and hopefully speed up page loading even more. Here’s proof that Medicity was #1 in this screenshot from July 2005 (minus the graphic). eScription came on board not long after and so did some other cool sponsors who like what we do enough to support it, which I appreciate a lot.

Inga and I don’t solicit sponsors, in case you were wondering how that works. When someone e-mails me asking for info, I e-mail back an amateurish and irreverent PDF that Inga and I threw together describing what we do (which they already know, of course, or they wouldn’t be asking), and companies either say they want to sponsor or they don’t based strictly on that one e-mailed PDF. Sometimes companies sponsor right after we mention them. That’s not coincidental, but it’s also not intentional: they are just shocked at the response from you readers (not braggin’, just sayin’). We never (and I mean NEVER) think about catching a potential sponsor’s eye when we pick stuff to write about. Nobody’s accusing us, but I just wanted to go on the record. Having sponsors is a by-product of what we do, not the reason we do it.

Former QuadraMed CFO David Piazza is a former-no-more. He’ll stick around after all, having withdrawn his August 8 resignation.

Tomorrow is Readers Write day, I just remembered. I’ve got a cool piece a doc sent in that gives an insider’s perspective on an extremely large EMR implementation (cough**KP**cough). Your prose is still welcome, though.

Pegasus Imaging Corporation files suit against Allscripts, claiming intellectual property infringement over licensing fees for a Pegasus development toolkit. According to the company’s site, its image compression technologies are used by GE, McKesson, Philips, Siemens, and Toshiba.

Mobile Data Software is awarded a $10 million PM/EMR contract with the US military that includes best medical practices, a global infrastructure, data mining, and integration with a central repository. All for military dogs, 3,000 of them, or $3,333 per dog.

I got an e-mail invitation from Carolyn Clancy from AHRQ inviting me to attend an EHR safety conference in DC in October. What was cool: (a) I have no idea why they would ask me; (b) they offered to pay all travel costs, probably figuring the current administration has put the country so deeply in debt that my night at the Omni Shoreham wouldn’t really matter; (c) a bunch of industry luminaries were copied on the e-mail, so I’ve got all kinds of e-mail addresses in case I feel the need to mind-meld with Charles Safran or Rob Kolodner. I’m kidding, but it was nice of them to ask. I was impressed until I saw journalist types on the list, which means I’m probably supposed to sit with the reporters and provide exposure, not thought leadership. It was like that when I took freshman journalism in high school: the cheerleaders were all over me when I was taking newspaper or yearbook pictures, but they headed off with the jocks the instant I ran out of film.

HIMSS starts sending e-mail reminders for the annual conference a full seven months before it starts, hoping you’ll plan to leave spring where you are to go back to winter in Chicago. Dennis Quaid is a keynoter, so you can ask him if he’s certain that ex-wife Meg Ryan wasn’t faking her intimate ecstasies with him like she did with Billy Crystal in When Harry Met Sally. HIMSS has some good deals on hotels for a change, beating the usual travel sites, but you’ll still pay $250 or so for anything that’s on the shuttle route and not cohabitated by crack addicts.

Just what you’ve been waiting for in choosing a strategic HIT partner: a list of which Fortune 100 companies are on Twitter. Great news: McKesson is, so you can … well, damned if I know why you’d want to Twitter a big company (or anyone else, for that matter). Maybe I just don’t get it. I don’t even send text messages on the cell phone (they’re 10 cents each on my plan and I’m cheap, plus the keyboard is terrible).

Does this sound like a real degree? University of Michigan offers a master’s in social computing. Maybe students get credit for wasting time on Facebook or Twitter.

ADAC …. er, Eclipsys … brings on Bill Bregar as VP of quality. Like everyone else there since Andy Eckert took over, he spent time at ADAC. They were a Baldrige winner before Philips bought them out, so he’s got some cred.

Charge master guys Craneware says it has 950 US hospital customers and profit and revenue were up in the 25% neighborhood for the fiscal year.

Sage’s Intergy EHR tops an ambulatory EHR report. "There is a perception within the industry that Intergy EHR is just the old Medical Manager product that Sage acquired in 2006, but that isn’t the case at all. Intergy is entirely new and users are making excellent use of it to achieve higher quality of care and better outcomes."

iMedica CEO Michael Nissenbaum checks in on the acquisition rumors: "Since your pages are being filled with rumors, let me state a fact: We are not being acquired! Hope to share more with you in the coming weeks, but since your pages, and lips of competing reps are raising this issue in the market, it just is not true." Scumbag reps. Prospects, if a salesperson brings in vague rumors to steer you away from your preferred vendor, send ’em packing, even if the rumors are from a pretty good source (like here, for example). If news hasn’t been publicly announced, it shouldn’t impact your decision (you could have bought last week, after all, before the latest buzz that could turn out to be untrue).

MedcomSoft has a new plan: "… sharpen the focus of its sales activities in an effort to target customers with the highest probability of yielding immediate returns." Wow, those Raymond James guys really know how to bust it out. If that’s a new plan, everyone involved with the previous one should be thrown out.

Eastern Oklahoma Medical Center goes live on CPSI’s documentation system. I wasn’t there, but the Poteau Daily News was and took this picture.

I’ve got an interview I’ll be running soon. Know anyone I should talk to next? Let me know.

Speaking of thrown out, that’s what the governor of Vermont and several legislators want done with the entire board of Vermont Information Technology Leaders. Outgoing board member Larry Ramunno disagrees, saying it’s a private, not-for-profit organization and the politicians can keep the $2.8 million VITL wanted from the state if they don’t like it.

An arrest warrant is issued for an MD Anderson clerk accused of stealing patient identities.

E-mail me.

HERtalk by Inga

From Justin Barnes: “Re: the renaming of EHRA. Members of the HIMSS EHR Association join together to work with unified efforts and with a single voice for the nationwide adoption of electronic health records. Our collaborative initiatives are aligned with the goals of medical services providers, member companies and other organizations to facilitate the interoperable and secure exchange of patient health information. Thus the name Electronic Health Record Association or EHRA best reflects the contributions and overall objectives of the association and its constituents." When Barnes sent us a note last week, Mr. H thought we had called the organization by the name wrong. Thanks to this explanation by the EHR Association chairman, the name confusion is no more.

From Eric Fishman: “Re: speech recognition. Inga, we put together a brief, and I believe entertaining, video on speech recognition. If you have three minutes, please take a look. Hope you enjoy watching it as much as we enjoyed making it.” Link. Eric is president of EHRConsultant and this little YouTube clip is pretty cute.

Trizetto promotes Tony Bellomo to president. He replaces Kathleen Earley, who arrived at Trizetto four years ago after executive management stints at IBM and AT&T and is leaving to “pursue other interests.” Someone needs to come up with another euphemism for “we pushed ‘em out.”

The 1,300-bed Wake Forest University Baptist Medical Center (NC) is now wire-free, following the installation of a 900-access-point wireless LAN. The total project cost was just under $900,000.

The Dutch are requiring all providers of children’s healthcare to use electronic patient files by the end of 2009.

The Heath Information Trust Alliance announces the addition of two new executive council members. Kaiser Permanente CIO Patrick Heim and BCBS Massachusetts VP Robert Mandel, MD are now part of the team working to create a Common Security Framework for PHRs.

The Minnesota Health Information Exchange contracts with Covisint to build an e-health exchange.

Perot Systems has successfully rolled out a hospital information system in multiple hospitals and primary care centers in Abu Dhabi.

Doctors ordered three times as many CT scans last year than they did in 1995. A Los Angeles Times article notes that scanner manufacturers like Siemens and GE tout the ease of making money with the devices: two scans a day can pay for a machine and its operation over a five-year period and 10 scans a day bring in more than $400,000 a year profit.

If you need a personal DNA scanning service, Google-backed 23andMe just cut its price from $999 to $399. The company hopes to attract more customers and expand its database of individual genetic profiles. The profiles are then sold to medical researchers, the guys with the real money.

HIStalk reader and former Sonitor exec Don Zeppenfeld is appointed VP of sales and marketing for LOGICARE.

An MGMA study finds that practice leaders are frustrated with Medicare’s PQRI. Problems include lack of data for improving patient outcomes and the administrative burden of participating. In addition, the feedback reports are difficult to access and are not timely.

Philips attempts to expand its market share in emerging countries with an acquisition of an India-based cardiovascular X-ray company.

E-mail Inga.

Monday Morning Update 9/8/08

From Wendy O. Williams: "Re: HMS. We are looking at HMS to supply our patient and clinical software. Does anyone have pro/cons with them? Who else should we look at? We are a 200-bed community hospital in Georgia." I’ll let others comment, but I’d say Meditech, McKesson Paragon, Dairyland, and possibly Medsphere are worth a look. 

From Billy T. Kidd: "Re: Misys-Allscripts. Interesting note, but the wrong vendor is listed. This rumor is not true." Several folks have chimed in saying an acquisition is afoot, but speculating that the intended company is iMedica, not MediNotes. That would make perfect sense since that company already has its reseller Misys over a barrel. If you recall from my interview with iMedica CEO Michael Nissenbaum in July (who is quite impressive, I think), he said he wasn’t interested in selling now, but that’s primarily because his former employer Millbrook left money on the table by selling out too early to GE. In other words, whip out the big checkbook, boys. And to confuse the issue, someone who should know (and who is intentionally obtuse) claims the name of the company going after MediNotes starts with an E (per CCHIT’s Ambulatory 2007 spec, that would limit it to eCast, eClinicalWorks, e-MDs, Eclipsys, EHS, and Epic).

From EMRObserver: "Re: Allscripts. Allscripts is all about marketing. How many Touchworks references are there in the entire country? They talk a great game. It would be interesting to go back and and look at press releases or HIStalk interviews to see what happened to certain commitments. Didn’t Stanley Crane mention an Allscripts User Interface to connect to any device two years ago? Has anyone seen anything from this? How about Wolters-Kluwer and the content they were provdiing for Allscripts products? The company seems to rush to get press releases to the market and never fulfills their commitments after the fact. This company has some very good talent with leadership that sells vision but can never deliver the goods."

From Nick Nemmers: "Re: the MED3000 story you mentioned. Nearly two years ago, MED3OOO discovered fraudulent activity on the part of one of its employees and several of her associates who were not employed by the company. MED3OOO immediately reported the matter to authorities and has cooperated with officials to hold the persons accountable for their actions. MED3OOO promptly notified the affected client and fully reimbursed the client for the fraudulent activity. MED3OOO is committed to corporate compliance in all of its business operations and continues to focus efforts to detect and prevent activity of this nature." Nick’s the marketing manager for MED3000. Bottom line: MED3000 tipped off the FBI early, resulting in nine indictments last week.

From Sal Lanuto: "Re: JJWild. I wanted to take this opportunity to reach out to all of you, and also respond to a comment posted yesterday by ‘Barney Miller’. As I’m sure you all know it’s been over a year since JJWild was acquired by Perot Systems. At that time, I made a commitment to JJWild/Perot Systems, MEDITECH, and our customers that I would stay with the company for at least a year to ensure a smooth transition. With the integration now essentially complete, I have decided to transition to the position of Senior Advisor to Berk Smith, who will now assume the position of CEO. Over the past year, we have focused on leveraging the synergies and scale available to us as part of Perot Systems to provide greater value and more options to the MEDITECH community in the areas of both technology integration and application related professional services. And we will continue to leverage the company’s strengths to enhance our ability to help you implement, operate, and optimize your MEDITECH system. With a lengthy track record of success within Perot Systems and extensive experience in healthcare, Berk Smith is in the best position to fully leverage the combined capabilities. I am confident that Berk, working in collaboration with me, Dick, and the rest of the senior management team at JJWild, will do a great job leading the new combined organization moving forward. The senior management team, including Dick Fitzpatrick, remains in place. It’s been a great experience running JJWild for the last 20 years. When I joined the company, I became the fifth employee. It has been immensely gratifying to work with all of you. Thank you for all the wonderful memories. I look forward to many more to come. My best, Sal Lanuto."

The ad resizing part of the site revamp is done (whew!) and I think the page looks better. I had the layout changed to push more content to the top of the page, reduced the ad size to give them more exposure while making them less intimidating, and upgraded the adserver software for more efficient page loading (I have another step to take there, though). Thanks to all the HIStalk sponsors who, in addition to sponsoring, remade their ads to fit the new design going back several months when we first started this project. I can’t thank them enough. If you’d like to chime in, click their ads and check out their offerings since they make HIStalk possible. Thanks, too, to Inga for coordinating all the communication that was needed (frankly, I think companies sponsor just because they like talking to her, which is reason aplenty, of course).

Jack Horner, CIO and interim CEO at Major Hospital (IN), is locked in as interim CEO for a full year.

Welcome to new HIStalk Platinum sponsor MEDSEEK, the Birmingham, AL experts on web-enabled hospital services like clinical portals, consumer-facing websites, and employee portals. Check out their blog and what looks like a freshly designed site (well, that’s the business they’re in, so that’s not shocking). Welcome and thanks to MEDSEEK.

Agfa says it will sell its healthcare business by the end of the year, possibly in a "controlled auction" involving pre-screened takeover candidates.

Point-of-care patient payment processor (man, that’s a lot of Ps) mPay Gateway raises $6.75 million in Series B funding.

Idiotic lawsuit, happy ending: a man playing touch football at an alcohol treatment program runs into a brick wall while going out for a pass, breaking his arm. He sues the hospital for $175,000, saying it was negligent in choosing the field. The jury took less than an hour to dismiss the case and bill the man for court costs, saying the hospital told players to be careful and he should have controlled himself.

Odd lawsuit: a used car dealer returns gunfire against someone shooting at him. Police arrest a 19-year-old suspect who tells police officers that his forehead is bruised from being elbowed in a basketball game. More than a week after the shooting, he visits the ED to be treated for a gunshot wound to the head. Police wanted the bullet fragment in his head as evidence, so they obtained a search warrant to have it removed surgically. The suspect is now suing the surgeon who operated, claiming he did not give surgical consent.

Forbes names seven technologies that could change healthcare. Some IT-type technologies on the list: PatientKeeper‘s mobile physician system, remote image access company Hx Technologies, the InnoCentive research challenge site for scientists,and Aethon‘s mobile robots for hospitals. The InnoCentive site sucked me in because it’s got some interesting challenges posted, like Kraft’s RFP for "technology for making bakeable cheese fillers for baked snack products."

Hello and thanks to new HIStalk Platinum sponsor InteGreat. The Pittsburgh-based company developed the modular IC-Chart EHR (CCHIT certified) and related applications for electronic prescribing, document imaging, clinical documentation, patient portal, ancillary orders, and disaster recovery. There’s a good chance you know at least one of the executives given their long history in the industry. Thanks to InteGreat for keeping the HIStalk keyboard clicking.

An interesting memory stick survey in the UK: "In a study conducted in one London hospital … 92 of 105 doctors surveyed carried memory sticks .. Some 79 of these memory sticks held confidential patient information, but only five doctors had followed NHS rules and encrypted their data."

Something the Google Chrome browser can do: put a web address directly onto the desktop or start menu using Google Gears. Wonder if any web-based HIT vendors use it?

Technology mostly found only in museums and hospitals: fax machines, pneumatic tube systems, and numeric pagers. Well, at least bank drive-throughs use pneumatic tubes.

Kaiser Permanente will announce Monday its $5 million donation to Atlanta’s Grady Memorial Hospital.

It’s a medical soap opera at for-profit Pinnacle Healthcare (IL). The CEO tried to get rid of the company’s former chairman and co-founder, who has enough shares of stock to fire the CEO. That former chairman, who is an orthopedic surgeon, already admitted sexual misconduct with a patient. The CEO’s attorney found her confidential client e-mails in the hands of the other side’s lawyer, who claimed it was fair game because it was received on a company computer.

Vendor Deals and Announcements

• Randolph Medical Center (AL) selects Dairyland Health to facilitate the exchange of patient data.
• The 60+ provider Suncoast Medical Clinic selects athenahealth as its practice management service provider.
• Methodist Hospital (CA) announces the successfully activation of Eclipsys Sunrise Clinical Manager. Within six weeks, 1300 users were trained. Next on tap is adding clinical and nursing documentation.
• mPay Gateway secures $6.75 million in VC funding. mPay Gateway provides web-based software to facilitate point of care electronic patient payments.
• Park Ridge Hospital (NC) implements MEDSEEK’s physician portal, marking completion of the phase of Western NCHIE’s first ehealth initiative.
• The 881- bed Huntsville Hospital (AL) implements GE’s Centricity Enterprise Solution.
• Hayes Management Consulting is named to the Inc. 5000 list of fastest-growing companies in America.
• Surgical Information Systems is chosen as the perioperative software provider for 410-bed MetroSouth Medical Center (IL).
• TeleTracking Technologies and VHA are partnering to offer VHA’s alliance members TeleTracking’s patient flow automation technology.
• Information and BI-provider Wolters Kluwer Health is acquiring UpToDate, an evidence-based electronic clinical resource provider.
• Centre Medical and Surgical Associates (PA) has selected Allscripts EHR and PM for its 69 providers.
• CliniComp will provide its Essentris Perinatal Solution to Tenet Healthcare. Initially seven of Tenet’s facilities will deploy the solution.

E-mail me.

News 9/5/08

From Barney Miller: "Re: JJWild. Sal Lanuto and Dick Fitzpatrick have officially left JJWild and Perot has completed takeover of day to day operations." Unverified. Both are still pictured on the web page. We’ll ask the company.

From Dumbfounded: "Re: Misys-Allscripts. Anticipate an announcement that Allscripts-Misys merged debacle will purchase an EMR company now that the iMedica deal has soured. The company being acquired was based in Tampa, now headquartered in Iowa via a merger announced earlier this year at HIMSS. Plain English: Allscripts-Misys is in talks to buy MediNotes." Unverified. Their February announcement at HIMSS was the acquisition of Bond Technologies. That would be a good move for the merged companies, I think, at least at the right price. But, consider it an unfounded rumor until someone says otherwise.

I’m still working with the Google Chrome browser and have changed my tune. It’s really fast and clean, a non-geek’s browser that just gets the job done without fuss. Here’s my take on it. Part of Google’s motivation is to protect its ad revenue by not letting Microsoft or even the Firefox people control its destiny. But, far beyond that is its interest in creating a pseudo-desktop that’s free of anything that Microsoft makes. Chrome is the first browser written with optimization of AJAX and Javascript in mind, so it’s lightning fast on Google Apps, iGoogle, widgets, etc. With Gears, you can save information to the desktop and work offline (the only killer app they’re missing, which is puzzling, is online storage linked to your Gmail account). Google now controls everything from web apps down the desktop, with nobody else’s software necessarily in between, a Google OS if you will (Chrome will be used in Google’s Android smart phone, too). That not only removes Microsoft dependencies, it kicks them squarely in the crotch for cash cow sales of Office and makes Google search ubiquitous. It may not be the best browser right now for surfing (neither is IE), but when it comes to running Web 2.0 applications, it’s king.

Listening: After Forever, my all-time favorite that isn’t on any music service or even my Russian MP3 purchase site, so I usually resort to bootlegs. I was tuned into Swedish metal station One-Eleven on my new gadget when it came up, leading to embarrassingly non-hip, four-limbed spastic movements on my part as I air-drummed.

MEDSEEK is named #1 in KLAS among clinical portals.

Robert DeLoach, formerly of McKesson and Siemens, joins Stoltenberg Consulting.

Caritas Christi names Todd Rothenhaus, MD as CIO. He was CMIO before, I believe. He used to write a "Survival Guide" series for medical interns.

The HIMSS Financial Systems Steering Committee releases an interesting paper (warning: PDF) that basically tells the government that it’s wasting time and money trying to build the Nationwide Health information Network (NHIN) when the existing HIPAA transaction processing backbone already has adequate capacity to handle clinical transactions. It’s kind of of ballsy and I like it (one headline: Why Are We Building ANOTHER Highway?). It even basically says decision makers either have a vested interest in NHIN or aren’t even smart enough to know about the "existing, fully functional information highway." My only criticism of the paper is that an Emdeon VP chaired the committee, which looks like a conflict even if it isn’t. But enough of my knee-jerk, anti-establishment reaction: send me your thoughts for the next Readers Write.

GE Healthcare announces Centricity Enterprise Monitored Care, developed with UCSF to integrate monitor information into the EMR.

Cerner foots the bill for a Republican Convention reception honoring Bob Dole.

Jobs: Consultant (GA), Clinical Consultant, Sales and Marketing (CA), Senior Technical Analyst (TX), Sales Executive (GA).

A couple of new text ads to your right. Orchestrate Healthcare announces its 91.6 KLAS score for integration, while First Choice Professionals offers expert help with Boston WorkStation (BWS) projects.

Tenet will deploy ClinicComp’s Essentris Perinatal in seven hospitals.

Design Clinicals will co-sponsor a medication reconciliation webinar on Thursday, September 25, at 2:00 PM Eastern. Good speakers: Dewey Howell, MD, PhD from Design Clinicals and Jeannell Mansur, PharmD of Joint Commission Resources.

Wolters Kluwer Health, coming to the startling conclusion that the UpToDate medical reference product was the only one it hadn’t already acquired, buys it.

This WSJ doc decries the financial disincentives for managing chronic diseases. He includes a half-hearted EMR compliment: "My office has invested heavily in an electronic medical record to track and monitor chronic conditions with little financial return. Still, the system helped me notice that a patient’s control of his diabetes had been slipping for a year."

Paul Peabody, CIO at Beaumont Hospitals, says HIPAA was supposed to provide records portability, yet doctors aren’t interested in information from PHRs. I would quibble a little with that: the P in HIPAA (of which there’s just one) was for the portability of insurance, not patient information (i.e., you leave your job, your insurance doesn’t change, an expectation which has indeed been a bust and therefore made all of the enabling security and privacy stuff mostly irrelevant for its intended purpose).

Ted Shortliffe replaces the retiring Don Detmer as CEO of AMIA.

Another Indian hospital mob attack over claimed negligence, this time with pictures.

Dr. Wes says EMR users are "our most expensive typing pool." He also touches on my gripe: the EMR is full of computer-generated crap that looks impressive in its volume and verbiage, but does nothing to affect patient outcomes. "The rest above is for Medicare and has been added repetitively and identically by countless other individuals, all whom enter the same content to assure achieving the maximum amount billed by law for their services. Not that any of it is read, mind you, but it’d better be there, lest the Medicare auditors descend on your facility."

China Information Security Technology will acquire the majority share of a hospital software company. Tidbit: the HIS market in China is estimated at up to $2.3 billion a year, with double that for PACS.

New Mexico’s Department of Health is using an EMR in all of its offices.

Cerner is involved in a genetic marker study that will look at adverse drug events: hepatotoxicity, skin rashes, and prolonged QT intervals. Sounds like Cerner is sharing patient data since the announcement mentions "open up a new, more scalable research channel to enroll subjects in this vital research." Some of the founding members of Cerner’s co-sponsor International Serious Adverse Events Consortium are seven of the biggest drug companies, encouraged by FDA to perform such research. They promise that the results will be placed into the public domain.

Among other questions about its finances, a Republican senator wants to know why Michelle Obama got such a whopper of a raise (to $317K) at nonprofit University of Chicago Medical Center.

Boeing’s $500 million terrorist tracking system (you know who the customer for that price – we are) is, according to a House committee, a complete failure that can’t even do a Boolean search. Rumor is it’s being shut down, joining the standard rumors of conflict of interest, poor oversight, and uncontrolled expenses. Uncle Sam keeps getting ripped off by the same handful of fat cat contractors and its own poor oversight, but unlike a real business, it just prints more money to waste.

E-mail me.

HERtalk by Inga

From Justin Barnes: “Re: recent lab summit. As the chairman of the HIMSS EHR Association (EHRA), I’d like to clarify an earlier post regarding our recent lab summit.  We feel it was a very productive meeting with all parties contributing to an overall understanding of the issues facing HIT lab interoperability. The laboratory companies, EHR software providers, and many other stakeholders are making progress in an area of interoperability that has numerous variables and is quite complex. The EHR Association is confident that, in time, we will find the consensus that moves the industry toward a fully interoperable work flow for electronic laboratory orders and results.”

From ORLabRat: “Re: laboratory connectivity. I love all the responses to the lab topic. Good stuff. I’m also a big fan of HerTalk (including Inga Radio), and really enjoy the chemistry and banter with Mr. H.” By the way, if you liked Duffy on Inga Radio, you will love Adele. I wonder what’s up with all these one-name lovelies?

Fist bumping? Oh, please. Get real. Look me in the eye and shake my hand firmly, just like your daddy taught you. Otherwise, I risk breaking a nail.

Motley Fool notes that Quality Systems’ stock price has climbed 32% over the last four weeks. The analyst suggests the rise is a result of recent strong performance by its biggest division, NextGen, which grew revenue 34% in the last quarter. The piece also suggests the industry may be “recession-proof,” a notion that plenty of other vendors would argue.

Piper Jaffray downgrades Allscripts from "buy" to "neutral," citing a survey indicating 43% of all clients and 88% of practices of over 100 physicians are cautious about the pending merger with Misys. However, 90% of Allscripts clients are happy with the products and 75% with the company. Among Misys clients, 86% are happy with the product, but only 61% with the company.

In the battle for title of worst press release, I nominate this one based on its extraordinarily long first sentence: “MedCom USA, Inc. (OTC Bulletin Board: EMED) a leading provider of HIPAA compliant healthcare and financial transaction solutions for the healthcare industry, which recently signed letters of intent to acquire PayMed USA, LLC and Absolute Medical Software Systems, a leading provider of HIPAA compliant medical, dental, healthcare and financial transaction solutions for the healthcare and dental industry is pleased to announce that it has appointed four additional board members of whom three are independent and one is an inside member.” Got all that?

A MED3000 employee and eight others are indicted on theft and wire fraud charges for allegedly preparing false insurance claims, claiming to be providers. MED3000 issued over $100,000 in checks to the employee’s boyfriend and others before the FBI got involved.

In an attempt to be cool like Mr. H, I downloaded Google Chrome. I found one issue that may be a deal-breaker for me. Chrome won’t let me have two separate Gmail accounts up at up at one time (to protect user privacy.) I currently have IE open with one Gmail account and the other one in Chrome. Seems like a goofy solution. (And don’t bother advising me to open all my Gmail accounts in one view, because when you have a dissociative identity disorder, it gets way too confusing).

Mediware announces its 2008 fiscal year results ending June 30th. Total earnings were $728,000, which is a 69% decrease over 2007 ($.09/share vs. $.29/share.) Revenues slipped 4.3%. CEO Kelly Mann (who clearly must be a glass-half-full type of person) is pleased with Mediware’s progress in fiscal 2008.

A recently released AHRQ report on telehealth concludes it can improve patient outcomes, but it isn’t always easy to implement. The home monitoring devices used with one project failed so regularly that one-third of the patients stopped using them. Poor resolution with transmitted video provided additional challenges.

Ladies take note: researchers have found a genetic variant that affects a man’s attachment hormone (called vasopressin). Vasopressin-challenged men seem to have a higher tendency for infidelity, have weaker relationships, and more marital problems. Pre-marital genetic testing, anyone?

E-mail Inga.

News 9/3/08

From Cherry Forever: "Re: RHIOs vs. PHRs. Another big difference is that RHIOS are controlled by the providers. They can add or remove data as they will. PHRs are controlled by patients – very different business model. The RHIOs sell themselves to providers as ‘safe places’ to share data. PHRs will have a harder time doing that. Also, RHIOs tend to be focused on data from a given region. PHRs are not, though that could be fixed by giving PHRs feed from the various RHIOs. Some RHIOs are set up as federated models (with a centralized index and a service API to call the provider data base when records are needed). I don’t see provider CIOs as lining up to allow random PHRs to call their data bases. It’s hard enough to get RHIO access, very hard.  They are also likely to want to limit the data that is fed to the PHR; it won’t be the same data set that is sent to the RHIO."

From Sarah P. Admirer: "Re: Sarah. Say what you will about Sarah P. Cheap shot to not editorialize on candidates equally, though." Actually the cheap shot was at former unsuccessful candidate Jeanne Patterson. Without the Cerner connection, I wouldn’t have had the slightest interest.

From The PACS Designer: "Re: OpenMRS Touchscreen. TPD posted a writeup recently about OpenMRS software that is used mainly outside of the U.S. and is gaining in popularity. Now, interns from Trinity College, Wesleyan University, Connecticut College, the University of Hartford, and the University of Connecticut have completed The Touchscreen Toolkit Project and four other software projects that can serve a variety of humanitarian applications, from Hartford to Africa to Sri Lanka. The Touchscreen Toolkit Project is a part of the Humanitarian Free Open Source Software (HFOSS) project. The toolkit is being implemented in the Open Medical Record System (OpenMRS) project as a module that will allow clinicians to use OpenMRS with a touchscreen." Link1, Link 2, Link 3.

Listening: to this gadget, which is streaming my old favorite Aural Moon progressive radio, one of the 13,000 streaming stations it runs. It’s just a USB drive with some jukebox software and predefined links to streaming radio stations, but it’s still cool (and the tiniest USB device I’ve seen, barely bigger than the plug itself). I got it from Buy.com for $24.99 and free shipping. Plug it in, up comes the jukebox with search by genre, name, or location. A couple of clicks and I’m looking at a list of 486 stations in China, followed by a supposedly alternative station that’s playing a bad, non-English duet of Rhinestone Cowboy.

An ED admission prediction tool is being used in Australia to forecast demand for staffing and OR time.

Tomorrow is Readers Write day, so if you’ve got something to say, send it my way (rhyming unintentional).

A Computerworld article says that hospitals aren’t using supply chain automation like they should, calling healthcare "dinosaurian." Reasons: low budgets, acceptance of labor-intensive processes, lack of a big player like Wal-Mart, and lack of standards. One multi-hospital client spent eight times what it could have if all of its buyers purchased together at the most favorable price. Good article.

Peter Bodtke, vice president of non-profit WorldVista, will ride his motorcycle 11,000 miles throughout eight Central American countries to promote awareness of VistA. He’s doing all of South America next year. He’s looking for donations and sponsors to help pay for the trip.

Google rolled out the beta (isn’t everything Google in permanent beta?) of its new IE-killer browser, Chrome. I’m running it and it’s a bit sparse and slightly buggy, but I’m sure that won’t last. Like the new IE, it has Porn Mode (i.e., "incognito"). They were supposedly anxious to get Chrome out because IE’s Porn Mode won’t let Google collect stats and user habits for advertising targeting. It’s not ready to be a permanent replacement for Firefox (it seems to be slower except on Javascript-heavy sites) but it’s worth playing around with.

A hotly debated issue: is the fist bump an acceptable form of business greeting?

Federal investigators hit the road for Indiana, making unannounced hospital visits to audit billing for the back surgery called kyphoplasty after whistleblowers brought billing issues to Uncle’s attention.

Send me your news, rumors, and ideas. I read every e-mail.

E-mail me.

HERtalk by Inga

e-MDs founder Dr. David Winn is stepping down from his CEO role and will assume the role of Chairman of the Board. Dr. Michael Stearns, who has been serving as President will now add CEO to his title. Winn says he will expand his medical missionary work in foreign countries and other philanthropic endeavors. e-MDs also just hired Maria Rudolph as VP of Business Development. Rudolph previously worked at Cerner, Quadramed, and a couple of medical associations.

King’s Daughters Medical Center (KY) claims its ED wait times have been cut from an average of 220 minutes to 118. The hospital attributes most of the increased efficiency to the implementation of its T-System EMR.

Medicity is spinning off a new venture named Allviant which will develop a product called CarePass. The new group will be based in Scottsdale. It will focus on designing tools to help consumers interact with providers and ultimately reducing the time patients spend waiting, calling, and filling out forms.

NQF endorses nine national voluntary consensus standards for HIT. The areas included are eRx, EHR, interoperability, care management, quality registries, and the medical home. Will the endorsements have any effect?

Last week I asked some questions about labs, lab standards, etc. Thanks for all the great words of wisdom on obviously a hot topic. I am compiling a few of the responses into one piece for our Readers Write posting on Wednesday. Here are a couple thoughts to consider until then. “I think that labs agree we all need to work together to bring faster adoption. Following a recent EHRVA lab summit with participants from multiple affected parties, everyone agreed we needed to develop a use case to send to ONC. Now it appears the labs are banding together to block their support because they don’t want to invest in it.” Another: “There actually has been a great deal of work done in recent years in an attempt to establish a standard. While the HL-7 specifications are typically used for results communications, the individual lab providers themselves have different terminologies/codification of results within that specification. The ELINCS initiative attempts to set this straight.”

I had to visit my local Apple store today (note that one can only drop an iPhone so many times before it starts to have problems). In case you decided to wait until the stores were less frenzied over 3G sales, you best keep waiting. It was packed at 11:00 a.m. with lots of happy shoppers.

Gustav thankfully was not Katrina, but still has created some chaos. Twelve Louisiana hospitals are considering moving 800 patients because they don’t have air conditioning. Meanwhile, at least three Iowa hospitals have asked for over $4 million from the Rebuild Iowa Advisory Commission to restore facilities flooded earlier this summer.

I plan to watch some convention coverage tonight. For those interested in mixing fashion in with your political viewing, Cindy McCain is all about haute couture. I just wish we could see more of her shoes.

E-mail Inga.

Monday Morning Update 9/1/08

From The PACS Designer: "Re: stackable switches. When constructing a network, developers use Ethernet routers and switches to create the user networks of PCs. Now, there is a new 3com switch being advertised that provides better redundancy. When connected to each other through a stack, they provide hot swappable units to insure networks remain up during component failures." Link.

From The Skeptic: "Re: Siemens. To Leyden, you are absolutely right – Siemens’ HIS days are numbered. Their experiment with Clinical PowerPoint didn’t conclude with a good outcome. But knowing Cerner as well as I do, I would not laugh all the way to Leeds or to any other location on this planet. Modules that are supposed to be ‘seamlessly’ integrated are NOT. Interfaces are inconsistent, like they originated from different vendors. Users need to document the same info again and again. If I had the resources and courage, I would short their stock."

From Attendy: "Re: Epic’s UGM. Mr. HIStalk, are you attending?" No, I’m not an Epic user.

From Dave: "Re: Eclipsys. Eclipsys laid off its entire Alliance team today (Thursday) that focused on its best clients." Unverified.

From Epic Calculator: "Re: Epic revenue. Revenue per Employee at Epic is a bit over 153k (using the data published on HIStalk). It is OK, but not stellar or in anyway spectacular. Software companies go from 150K for the SMALL ones to 220k and up for the LARGE ones. Just some food for thought for the potential investor out there." Thanks, I meant to run the calc myself. I’m a little surprised that they don’t excel there. Meditech’s at $131,000 by my calculation, low in the range.

Yes, I’m laboring on Labor Day. Apropos, yes?

Listening: The Makers, angry garage-glam, Stones meet Stooges. And one of my favorites, long defunct Moxy Fruvous: witty, harmonizing Canadians (they play it serious on the greate Thornhill, although some old-time fans couldn’t handle the change).

A trustee of Regional Medical Center (SC) questions the hospital’s choice of Cerner over Meditech, complaining that at $12 million vs. $4.5 million, "I don’t think we got the low bid, folks." The CIO claims that Cerner underbid Meditech overall, $11.9 million vs. $12.1 million (that’s hard to believe). Some trustees complained that they didn’t get to go to Kansas City to see Millennium first hand, which would seem to indicate some misunderstanding of the role of a trustee. 

Not surprising except to those who think healthcare is free if you don’t feel like paying: clinics are dropping patients who aren’t paying their bills, many of them with self-chosen high deductible plans who knew the risk of paying out of pocket going in. I believe it’s safe to say that, very soon, it will be the rule rather than the exception to make patients pay for care upfront since so many refuse to pay afterward.

A liberal group’s blog draws a savage but amusing parallel between McCain VP pick Sarah Palin and failed congressional candidate Jeanne (Mrs. Neal) Patterson: "She came off looking like a Tupperware lady who had read too much Ayn Rand."

Bayfront Health System (FL) is looking for a RN-Clinical Informatics/Transformation Leader. Since nobody ever seems to finish transforming, it’s probably a good gig.

Another example of Microsoft’s desperation and/or willingness to litigate rather than innovate: they apply for and receive a patent for "Page Up/Page Down." Maybe they’ll send out a little trademark symbol for your keyboard keys.

Asian doctors are turning cell phones into a mini Wii Fit. COPDers walk to software-driven music that optimizes their lung capacity, with reports going back to doctors. One-year hospital admissions were 22 of 24 in the control group, but only 2 of 22 in the control group.

There’s a new text ad to your right from the folks at Sun, which now owns the database that powers the Internet, MySQL. The ad mentions FairWarning, an interesting sounding EHR surveillance tool for privacy issues. I hereby contribute my more memorable product name, Snoop Doppler, or for the appliance version, the Britney Box.

Gustav is headed toward the Gulf Coast at this writing, just what New Orleans doesn’t need. The former Charity Hospital, now University Hospital, still has its electrical systems in the basement and it’s sitting in a natural depression. Labor Day hurricanes are always nasty, it seems. Here’s a positive thought to those in its path, especially those hospitals that, as always, are the beacon of safety and healing for those affected. While everybody else hunkers down with their families, hospital workers leave theirs to help strangers. The final 85 unclaimed Katrina bodies were symbolically buried Friday just ahead of the Gustav evacuation.

BIDMC will share its patient portal data with Microsoft’s HealthVault.

Mt. Sinai (NY) will redesign its smartcards to follow CCR standards, hoping other hospitals will do the same to allow exchange data (is that a RHIO in your pocket, or are you just glad to see me?)

Meditech-owned Prowse Farm, a historic site in Canton, MA, is throwing a fundraising doo-wop outdoor concert on on Saturday, September 13. Funds will be used for development of its museum and education center. I’m a big doo-wop fan and seeing Gene Pitt and the Jive Five alone should be worth it. See the live video of "My True Story" here although "These Golden Rings" and "Do You Hear Wedding Bells?" are better; they changed to soul music later, charting with "What Time is It?". I don’t know of any doo-wop group whose entire lineup contributed like the Jive Five’s. Epic’s campus gets a lot of attention, but this view of Meditech’s from Prowse Farms (by ophis) is more interesting if you like history and non-flat ground.

Hawaii Medical Center files bankruptcy after Siemens Finance declines to extend its $5.5 million loan.

London trust hospitals are apparently gearing up to seek damages from BT and/or Cerner over system problems.

I hope you have (or had) a nice holiday. Thanks for reading.

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News 8/29/08

From Violet Baudelaire: "Re: RHIOs/PHRs. Are the goals so different between the RHIOs and PHR vendors that they will stay separate, or do you envision a time that they will merge? From a data collection perspective, are they not collecting mostly the same information from/to providers and payers, but only organizing and distributing it for different audiences and users?" The biggest differentiator of PHRs is that they give patients a place to record their own information, but certainly that function could be rolled up into RHIOs (and nobody in their right mind really expects patients to do that anyway). The biggest value of PHRs is potential direct-to-consumer advertising, so PHRs will desperately try to stay separate, hoping that RHIOs and system vendors don’t build the equivalent capabilities into their systems and squeeze them out of the revenue picture. That’s my guess, anyway.

From Tad Paoli: "Re: Howard Industries. Point-of-care cart manufacturer. 600 illegal aliens were arrested and the plant shut down." The newspaper stories rattled of a bunch of odd stuff made there, but I didn’t realize they did carts. The Mississippi plant is where fellow workers applauded as the illegals were hauled off by immigration, Legal workers claimed the illegal workers were getting preferential treatment and even the union was recruiting them. The company’s site indicates that the Howard Medical division sells computing and charting stations, COWs, scanners, and mobile devices.

From Blond Adonis: "Re: Epic. You buy the idea that Judy does not own a controlling interest in the company? And you are smoking what?" Pork shoulder, preferably over hickory, while watching college football (it’s back!) and drinking a Yuengling. 

From Paranoid Googler: "Re: HIStalk search. Did you change the search engine on the back end from Google? And on a different note – regarding the guy who is so busy he wants you to write less, I bet I am as busy as he is and I want you to write …more. Actually, the size of the blog as it is today is just perfect, and don’t let any annular muscle tell you otherwise." Ha … he said "annular muscle." Before today’s redesign, there was an old search box on the upper left (it had always been there) that didn’t do a Google search. The one in the right column was a Google site search. Now, the Google one is the only one left since I had the other one removed. Jeez, that was confusing.

From Lance Tenor: "Re: free cataract surgery in India. Even as 29 people were fighting to get back their vision at Joseph Eye Hospital in Tiruchirapalli after cataract surgery, 34 more people, who also underwent the operation at the same hospital, were admitted to Villupuram government hospital after they complained of blurred vision." Nine will lose their eyesight permanently, leading protestors to break into the hospital and trash it. The culprit is preliminarily identified as infected saline ophthalmic solution. It reminded me of an old story about traveling con men in India who would claim to cure cataracts. They would poke the eyes of patients with a briar or stick and drain out the fluid. Patients could miraculously see again, they paid the con men, the con men skipped town, and the patients went blind right after since draining the milky fluid is a temporary solution and the eye poking caused even worse damage.

Pardon our dust as the site changes, but hopefully you’re noticing some benefits even though we’re not quite finished. The smoking doc graphic is smaller, the top links are now horizontal to push articles further up on the page, the comments work better, and the page loads faster. Next step: resized ads.

The potential class action lawsuit against McKesson that alleged drug price-fixing (along with First DataBank) has been dismissed by a federal judge. That was a huge exposure that could have been disastrous.

I saw no announcement, but I noticed that LingoLogix, the natural language processing company we profiled in April, has been acquired by Cerner. Or at least I think it was: the August 1 announcement was on their site this morning, but is gone now (but the commented out HTML below from their main page proves it). The contact page also says Cerner. Hey, I’d be proud of it. Maybe Cerner found them through HIStalk.

I don’t get the ‘tude: the local paper in SD headlines the locals who were "stung" because Medicare accidentally overpaid them and now wants the money back. "Somebody who did this (made the error) should pay it back," said one recipient who already spent the money.

Jobs: Director, Clinical System Architecture (WA), EMR Implementation Associate (MA), Cerner CPOE Consultant (any location), SeeBeyond/Sun Health Systems Integration (any location). Sign up for weekly job blasts.

Cisco buys Linux-based Microsoft Exchange alternative PostPath for $215 million, saying it will add e-mail and calendaring services to WebEx, another Cisco acquisition from last year. PostPath was pretty aggressive about claiming its 100% compatibility with Exchange and was getting traction there, so surely Cisco will spank Microsoft a little by continuing to sell it for that purpose. I know several hospitals that are running it, finding it exactly the same as Exchange except for the price.

Nortel announces its "office on a stick" product (Nortel Secure Portable Office) that puts authentication, a VPN, and a virtual desktop on a USB key. When the key is removed, data and applications are removed with it.

I haven’t research it thoroughly, but this desktop remote control software can be downloaded free for personal use. A lifetime business license is $699. Pretty cool, maybe, for remote support or team projects.

A New Zealand health network bans iPhones, citing security risks and admitting that doctors aren’t happy about it.

Heartland Health, trying to clamp down on identify theft and insurance fraud, requires patients to show photo ID each time they appear for treatment. I think they’re in Missouri, but the goobers at the local paper are apparently so agog at the concept that someone from more than five miles away might be reading their site that they don’t put their location on it anywhere.

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HERtalk by Inga

From Former Road Warrior: “Re: Misys/Allscripts. I have friends working at both of these companies. Each camp seems to believe their products will survive the merger and the sunset products will come from the other company. Meanwhile, salespeople are being told to expect some territory changes as the two sales teams are merged. Glad I don’t work at either company right now.” I am with you there. I read the following comment in the Raleigh area business journal: “The company also has strongly hinted that local layoffs should be expected, with Misys CEO Mike Lawrie telling analysts the day the deal was announced that they could ‘let your imagination run wild’ about potential synergies in the Triangle.” I’d be running wild all the way to Kinko’s to clean up my resume.

From Scott Shreve: “Re: Perot and Medsphere. HIStalk just recorded its 1.5 millionth hit. Besides the snarky commentary, HISTalk (and the lovely new addition of HERTalk) has continued to gain readership with its deadpan commentary that is always dead-on. As the readership has grown, the quality of the tips and the accuracy of the insight has also increased. I believe nearly everyone with a need to know turns to HIStalk when they need to know.” We thank Scott for the shout-out, which he made recently on his Crossover Health blog. Scott also makes an interesting prediction that Perot will buy Medsphere.

From Vendor Exec: “Re: ICD10 effect. I think ICD10 will be very hard on the older vendors. I would hope that most of the newer vendors planned for it (we did, as we knew it would come eventually). I think it will cause a squeeze on vendors more than anything, as it will have a significant cost associated with it. I do not think it will really hurt EMR sales, though, as I think the vendors will just have to suck it up and do it. I do think that it might push some clients into asking their hospital to help via Stark. In that way, I think it might help drive EMR sales.” While I’m sure most vendors have been planning for this change, I stand by my original assertion that we’ll see a number of product sunsets by companies supporting multiple similar solutions. Say goodbye to some of those oldies but arguably goodies (at least in the day) such as vintage Medical Manager and Misys PM.

From Wompa1: "Re: Duffy and Inga. She has a real retro sound to her music. I haven’t heard anything (recent) that comes close to her style. I might have to start listening to more Inga Radio.” Wompa1 is such the Renaissance man. On top of his regular thoughtful HIT commentary, he appreciates great music and has whipped out a follow-up Inga love sonnet (ok, maybe it’s not a love sonnet, but it made me feel loved nonetheless): “Inga the incognito, illuminating, intrepid investigator of industry intelligence. Tirelessly trudging through online tomes…”

There have been a few posts of late regarding standards (CCHIT and others.) It reminded me of a recent conversation with a friend who is in the EMR implementation trenches. As a vendor, the complexities of lab connectivity are giving him fits. The way he explains it, all parties agree that sharing lab data creates a more complete patient record (and presumably leads to better care.) However, each lab has its own set of standards, meaning each lab requires a unique interface. And because of mergers and acquisitions over times, the national labs typically have multiple products and a variety of “standards” (in other words, just because you have a Lab ABC interface functioning in Dallas does not mean it will work in Seattle because Lab ABC products may differ). The underlying issue is who pays for whatever changes are necessary to develop a standard and the required interfaces. Currently, he claims, there are no mandated standards, thus no pretty fix. So, I am left wondering if anyone can shed some light on this. Are lab standards an issue one of the various work groups is addressing? Are the labs on board?

And speaking of standards, the SEC is considering requiring all publicly listed American companies to move from US accounting standards to international model instead. That GAAP stuff always gave me fits when I was in college, so I say good riddance.

Carilion Health System (VA) makes the front page of the Wall Street Journal. Critics claim Carilion’s monopoly in Roanoke has led to care that costs as much as four times more than other regional providers. And if they turn to the local paper for solace, the big story there is that Carilion’s CEO was paid $2.27 million last year.

I went with some girlfriends this week to see the movie Mama Mia. It’s a total chick flick that left my pals and me dancing and singing on the way home. If you are guy wanting to understand the stuff of female fantasies (e.g. rekindled lost love, hunky men on remote Greek islands, looking glamorous while singing at the top of your lungs), then buy a movie ticket, sit in the back, and observe middle aged women letting loose.

Sage Software Healthcare names former Cerner VP Lindy Benton as COO.

It appears as if Google Earth has more uses than simply checking out your home on the Web (or your boss’s home). Olympic cyclist Kristin Armstrong details how she used the application to help with a gold medal (I included a photo of Kristin because I bet Mr. H overlooked this one on TV. If you missed his Inside Healthcare Computing editorial yesterday, he only noticed the beach volleyball babes).

The CHIME folks tell me that CIO registration is up for their 2008 Fall CIO Forum in Henderson, NV in October, despite concerns over rising travel costs. And for budget conscious vendors, CHIME has a new entry level Foundation membership option. The Associate level member is $20,000 a year, far less than the $75K Premier level. I suppose you can’t knock an organization for having high fees that prevent vendor membership from outnumbering the CIOs (like at HIMSS, for example). I have actually been to a CHIME meeting in the past and am sorry my own rising travel cost concerns will keep me home this year. They are a fun, smart bunch.

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News 8/27/08

From Truthtailor: "Re: Dairyland. At Dairyland’s User Group conference this week, they officially announced the acquisition of APS, making them the largest HIS provider to community hospitals. Also, they have re-branded — they are now Healthland." That news isn’t on the company’s site and the old name is still there. Too bad … they could have gotten some nice exposure in conjunction with the announcement. I see they have registered healthland.com, even though there’s no site there yet. Lots of companies use that name, so hopefully they’ve set some cash aside to fight off the inevitable ceasing-and-desisting.

From Bavarian Pretzel: "Re: German engineering. It seems the old ossified politics-of-obstruction SMS camp has taken over from the Germans. If we had some solid German leadership and engineering, perhaps Soarian would actually soar."

From Freddy Mae: "Re: Emageon. Anyone who wants the story can go to the investor’s page to access all SEC documents. Message boards feature interesting opinions, some very well reasoned, but they are only guessing. When — or if — Emageon gets new owners will be a decision of its board." Link. The company sounds like gangbusters on the Investor Presentation on that page.

From Peter Potamus: "Re: HIStalk. Write less, I’m a busy man." I bet you’re no busier than I am. All you have to do is read (try writing and see how long that takes). If you don’t have a few minutes three times a week to get fully up to speed on everything that’s happening (and likely to happen) in the industry, then you probably won’t be busy for long.

From The PACS Designer: "Re: teamwork. While the so-called fight over who owns PACS and other systems can get acrimonious, it really should be focusing on teamwork amongst the various players in IT and the departments. One way to break down silo walls is to have department members and IT personnel share some time each week in each others department to get educated on daily activities. Beth Israel Deaconess Medical Center has a program called SPIRIT which addresses department problems and gets various others evolved to solve a problem that can help other departments as well. Paul Levy, CEO of BIDMC, posted a piece on ‘Lean is not about dieting’ on his Running a Hospital blog that gives you an idea of what the program is all about." Link.

Listening:

Australia’s IBA Health, which bought iSoft and its big-everywhere-but-here Lorenzo hospital system, says the new version due out in November will be opened up to outside applications developers.

One of the folks at Pragmatic Marketing, a regular HIStalk reader, saw my mention of the book Tuned In (which I said I was going to buy once I hit $25 in Amazon stuff to earn free shipping) and sent copies to Inga and me. Its premise is that vendors have to connect with the general public (not customers or salespeople) to identify problems whose solution is likely to be profitable. Like most books of its type, it sometimes stretches its arguments a bit, but I  liked it because it’s refreshing. I enjoyed the Understand Buyer Personas chapter. The book also echoed something I’ve been saying for years: vendors spend too much time letting existing customers drive product development instead of soliciting fresh solution ideas from the non-customer public (example from the book: if you had interviewed Walkman users in the pre-iPod days, none of them would have said, "Invent an iPod." They would whine about the buttons or something trivial while Steve Jobs and Apple ate your lunch). I skimmed it closely, but it’s worth a more detailed read that I’ll be giving it shortly.

The TEPR people launch the Center for Cell Phone Applications in Healthcare, which they somehow turn into the obligatory acronym but make it C-PAHC. I don’t like acronyms, but especially those that are contrived to spell out something that they really don’t spell out at all (hint: pick a name short enough not to need an acronym and you won’t have to force-fit one). They’re already hawking membership and conferences, one of which is in India. MRI has one of those fake blogs that’s just a place for unnamed editors to post press releases.

Right as we talk here about the minimal influence that Revolution Health has had on healthcare (and its own profits), Modern Healthcare’s readers vote Steve Case as the most powerful person in healthcare. All kinds of regrettable quotes fawn on about Steve’s vision, how he’s going to reform the system, and how he has a huge impact on health IT throughout the entire world (he’s no Bill Gates, that’s for sure). Judy Faulkner is 50 spots below Steve (huh?) Steve Lieber is #92. Deb Peel is #72 (#4 last year). Careful readers will note that those named swing wildly from year to year: Case wasn’t even on the list last year (and hasn’t done much since). Brailer was #1 in 2004, then skipped town. It’s just another cheap magazine trick to sell ads with and lure readers with breezy reading and pretty pictures, right up there with People’s "Most Beautiful People" or any article that features a "By the Numbers" sidebar for morons.

My Inside Healthcare Computing guest editorial this week (coming out Wednesday): The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now. Here’s a sample of the highly analytical thought leadership I exhibit there in weekly prose: "In fact, I might be the only American who didn’t watch any of the Olympics, other than a little of the women’s nude … uhh, beach … volleyball (I think the US beat some other teams, but I’m not really sure since they kept running back and forth under the net while I was distracted)." The newsletter people will be happy to sign you up for a subscription or sell you The Best of Mr. HIStalk, Vol. 2, which, disappointingly, has resulted in no offers of a Hollywood script deal, a one-man Broadway show, or groupie liaisons. Well, it’s early.

PHNS names Dan Allison, formerly of EDS, as CEO. Chick Young steps down from that role, but sticks around as board chair.

The Allscripts-Misys merger or spinoff or acquisition or whatever it is (too complex for me, that’s for sure) will occur somewhere around September 26, this article predicts. I know you’ll be shocked, but Misys hints strongly that some of the locals will be Six Forked after the synergy shower starts spewing.

Wisconsin papers are enamored with Epics jobs, revenue, and culture, so here’s yet another installment. Factoids: 3,250 employees, $250 million payroll expense, $500 million revenue, a supposed Wall Street valuation of $1.2 billion (heck, even IDX was worth that to GE), and 98% of its 50,000 annual job applicants are turned away. Best factoid of all: Judy owns 43% of the shares, so even at that way-too-low valuation, that’s a cool $516 million (I’d always worry that the impatient spawn might slip something in the peanut butter).

Strange: if NASA ever sends astronauts to Mars (doubtful, given poor results so far and nearly limitless spending), communications will take too long to provide psychological counseling. Answer: software you can talk to, like an "interpersonal conflict widget." Sounds like that old Eliza software program.

A New Zealand woman dies after some sort of e-prescribing mixup in which she was given chemo meds with incorrect instructions. The software vendor punted, saying its product is like a typewriter and the doctor and pharmacist have to provide the judgment.

This is mildly interesting, though maybe marginally useful: a USP web page lets you type in a drug name, then lists reported errors confusing that drug with the others listed. I’m not sure why a group as authoritative as USP capitalizes generic names in its press release, though.

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HERtalk by Inga

Greenway Medical Technologies announces a 47% increase in sales in FY08.

IntelliDOT completes implementation of its wireless handheld BPOC products at Providence Healthcare Network (TX), integrating with Epic for the first time.

Samuel H. Adams is announced as new senior VP of sales for North America for Picis. Company co-founder Liz Popovich is now executive VP for international operations. Adams was president and CEO of St. Croix Systems and has had multiple roles at Lawson Software. Of course, I am curious about the beer and patriot connection. I wonder how many times a day Sam gets asked about that?

New to Inga Radio: Duffy (Welsh singer-songwriter, sort of Dusty Springfield-ish) and Sam Bush (bluegrass).

Nueterra Healthcare (KS) selects McKesson’s Paragon HIS and Horizon PACS systems for three new community hospitals.

More psychiatric hospital problems. After two Tampa General Hospital patients killed themselves, federal investigators find at least five patients sleeping in a psych unit hallway. The hospital isn’t talking, but a lawyer for the dead patients points to understaffing as a key problem.

Alabama state employees who don’t take care of their obesity or other health issues risk paying a $25 a month charge for health insurance.

The Washington Post has a piece on a growing trend for physicians to re-invent their practices to improve patient care. The article focuses on a couple of “micro-practices” that have used technology to improve wait times and patient care.

NextGen parent Quality Systems (QSI) announces that all three major proxy voting advisory services recommend that shareholders vote for all the QSI board nominees, saying that company performance suggests that change is unwarranted.

Streamline Health Solutions announces its Q2 numbers: revenue rose 51% and net losses fell from $1.1 million ($0.12/share) to $0.4 million ($0.05/share).

A former UW computer science professor is quoted as saying, “Epic Systems hires more people every month than all the biotech companies in Wisconsin combined." UW-Madison is trying to recruit more computer science grads to meet the area’s current and future needs.

USC Care Medical Group licenses several Lawson software packages. Here is an observation about the odd nature of press releases: Lawson just made this announcement though the deal was signed in May. Guess the PR department needed some good stuff to mention.

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Monday Morning Update 8/25/08

From Adam: "Re: Emageon. Not a rumor per se, but Emageon skipped the Q2 earnings press release and conference call. That usually means something is up. However, they also issued some scary language about the proxy fight and suitor search impacting sales. My question: deal or no deal?" I’ll defer to experts like Sonomaca (or any reader with info).

From Kaimuki: "Re: Revolution Health. On the blocks." Another potential dot-bomb 2.0 casualty, although this one has Steve Case’s AOL money and unfocused ambition behind it. He dumped AOL on Time Warner as they needlessly panicked over kids with web sites, so maybe he’ll unload this dog, too (actually the online part is OK, it’s the remainder that isn’t working). It might have been successful if he hadn’t been blathering on about resorts and all kinds of unrelated stuff, although outsiders trying to mount a healthcare revolution (no pun intended) usually fall on their faces in a pool of melted arrogance. Hopefully someone with knowledge and patience will buy the relevant parts and do something useful with them, although it’s the same old business model of running ads.

From byter: "Re: confirming Dairyland gobbling APS of Waco." Link. The deal was done August 1, the web page says.

From Roger Lapin: "Re: EMRs. What do you feel are the biggest hurdles in implementation and training for new systems in facilities today?" I’m mostly a hospital systems guy, so there I’d say lack of customer resource allocation, inadequate change management capabilities, product-user disconnect, and lack of resources to free users up to be trained effectively. Feel free to chime in.

From Dinah Shore: "Re: Cisco. They seem to be a big fan of PHRs, but I’m not sure I buy it. It almost sounds like they’re trying to justify the money spent. I have my health record on a memory stick … wow, I feel better already!" I would bet that the pilot group was voluntary, meaning self-selectors probably more acutely interested in managing their health. Unless the comparison was made individually to the pilot group pre- and post-project expenses, I would say the claimed ROI is irrelevant since the self-selectors probably already had lower average expenses. I’d need to see the data.

From byter: "Re: Sisters of Mercy Health System, St. Louis. They are requiring vendors to register at vendormate.com and pay an annual fee to do business with them." I hadn’t heard of Vendormate, which offers vendor credentialing and compliance solutions. It’s an ingenious business model run by mostly Georgia boys. Worth a look. 

From Soarian Cynic: "Re: Soarian. Our hospital contracted six years ago for Soarian financials. We are a large, metropolitan teaching hospital. We were recently told by our Siemens reps that the Soarian Financials will not be ready for hospitals like ours for another two years at least. They want us to sign up for five more years of Invision, just in case Soarian takes that long. No apologies, no regrets, no embarrassment. The reps did indicate that Siemens would still make money off us, Soarian or not. I’ve had this conversation with Siemens three times in the last five years. Every two years, Soarian is promised another two years out. So much for German engineering!"

Thanks to Ed Marx, CIO at Texas Health Resources, who gave HIStalk a mention in his blog as something he reads. I checked my e-mail archive and we’ve swapped notes going back to at least mid-2005. I’m always interested in increasing the number of CIO readers, so maybe Ed’s mention will bring them in (and I’m to other suggestions on how to do that).

The chairman and a third of the board members of University of Maryland Medical System resign as the organization struggles with governance between the medical school and the health system. This article says issues include doctor dissatisfaction with bottom-line emphasis and the governor’s appointing of board members without its input. It’s an interesting point: hospitals are one of few non-profits that operate under the business model, where they don’t pay taxes but have huge business-related income. Nearly all other non-profits are charities relying on outside support. When you think about a non-profit being a $2 billion dollar a year business like UMMS, that’s kind of weird, especially when hospitals that size sometimes pay CEOs $1 million or more a year in salary (according to tax records, the CIO job there pays $400K and UMMS, in fact, paid its CEO $2.6 million in the last tax year and some of the VPs are pulling down nearly a million). But, it supports building fancy buildings better than ringing a bell at Christmas.

Looks like the Allscripts-Misys flirtation is close to being consummated.

Jobs: Clinical Systems Analyst (IN), Director of Business Development (MA), PeopleSoft Technical and Security Admin (MA).

The federal appeals court may overturn state rulings in three New England states that allowed drug companies to continue to mine prescription records for marketing purposes (think IMS, Verispan, and McKesson). Interesting point: AMA makes tons of money from licensing its databases, which are used to match prescription data to individual doctors. In other words, profiting by selling the data of its members (we can identify with that in our industry, right?)

ED systems vendor Forerun gets $1.35 million in venture capital. The company was a BIDMC spinoff, I believe, using their homegrown ED Dashboard that was then commercialized.

Sign up to your right for HIStalk updates or the Brev+IT newsletter.

A New England technology journal profiles Premise Corp.

I didn’t scour the 2008 Inc 5000 list carefully, but I know Vitalize Consulting Solutions (353% growth) is on it. So is Hayes Management Consulting (79% growth). Congratulations. I like to think their sponsoring of HIStalk helped a little, but that’s just me.

At least two more incidents (from Google’s cache) of mobs charging hospitals in India. This time it was after patients died after being refused treatment, but usually it’s over claims of malpractice.

Medicare made its medical equipment fraud rate look good by instructing auditors to skip steps that could have detected it, such as matching invoices to doctors’ orders. In one example, a patient who had received one of those fun electric scooters hawked on TV to Medicare recipients said he hadn’t asked for it and wasn’t using it and the doctor listed as the prescriber didn’t know anything about it. Oddly enough, the patient’s wife got a scooter of her own, also unrequested. Rep. Pete Stark said, "This agency is incompetent."

I really dislike unions, so this struck me as typical. A UK hospital installs self-serve kiosks to speed up patient admissions. The union whines: "Unison will be looking at the trial very carefully to fully assess whether it is of real benefit to the patient experience or whether it is just cost-cutting. In today’s computer driven world, do we truly need a further erosion of the ‘personal touch’ that is so essential to the delivery of a positive health care experience?" I don’t know how much personal touch patients get from union members in the UK, but unionized hospitals I’ve been in have had openly defiant employees, bad housekeeping, and constant clashes with management trying to keep employee paychecks coming by making improvements.

Cedars-Sinai wants sidekick-turned-deadbeat Ed McMahon to prove his lawsuit allegations. He’s claiming he’s out of work because of an undiagnosed broken neck. Here’s hoping I’m not still trying to bag a bloopers show or walk-in bathtub commercial gig at 85.

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News 8/22/08

From Lloyd Bridges: "Re: ADT + EMR go-live. This is becoming far more standard as sites being converted are increasingly complex. OHSU replaced A2K and LCR big bang (all rev apps and majority of clinicals) with Epic. CPOE 6 weeks later. Slower implementations tend to get pushed by ever increasing  optimization cycles."

From Caroline Mulford: "Re: Dairyland. Rumor has it Dairyland is or has purchased APS out of Waco, TX?" I saw no announcements and nothing on Dairyland’s site, but APS’s is down.

From Otis Day: "Re: Siemens layoffs. I was speaking to Soarian Clinicals. However, I am hands-on familiar with both Financials and Clinicals. I happen to be quite close to someone who works in a multi-hospital site and they have had successful implementations (not to be confused with installation). This site also delayed implementation of some software deliveries, but not due to software availability. Mr. Judd doesn’t mention why Medicorp delayed their go-live. I do agree that Siemens is looking to improve short-term and milk INVISION. And why should Siemens care, or the customer, for that matter? If the customer is happy (and paying their invoices), where’s the problem? Does Mr. Judd suggest this is a negative situation?"

Listening: new Alice Cooper, still doing the mascara-and-codpiece shtick at 60. If you liked it then, you’ll like it now.

Microsoft pays Jerry Seinfeld $10 million to try to stop the bleeding, with Chris Rock and Will Farrell being considered to help him out. What a joke (and I’m not talking about Jerry’s material). Vista’s not selling, you can get most of Office 2007 for $99 with a "wink wink, I’m a student" discount, and the hottest Microsoft offering is an XP downgrade from Vista. Maybe Jerry will have some boffo lines about Amalga.

National Review, which I read on occasion, is sticking to the "healthcare can be saved with competition" mantra. "According to HHS Secretary Michael Leavitt, Medicare rents an oxygen concentrator at the price quoted above [$7,000 over three years] — with Medicare patients shelling out a 20-percent co-payment for the rental ($1,418) — that it could buy outright for only $600. When Medicare was set to implement a competitive bidding program for DME last month, Congress killed it."

CoxHealth (MO) mentions its homegrown bed board system as part of its Innovator Award. Looks pretty cool. Bruce Robison is the CIO there.

At least one doc is unhappy that Nuance has blocked the use of Dragon Naturally Speaking with EMRs in Version 10. "We found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical." In other words, you have to buy the much more expensive Medical version for reasons that are financial rather than technical. 

Open source vendors Pentaho (business intelligence) and Open Medical Record System (EMR) will work together and integrate their products.

Xoova, a physician research site for consumers and poster child for those convinced that all it takes to change healthcare is a web site and a Foosball table, is apparently defunct. All that’s left is a blog whose last entry was in February, full of braggadocio and hipness right as the slow augering in was underway despite rosy press releases that mostly bragged on site hits. The company sniffed that it was "much more of a Health 2.0 site" than its competitors (which are still around, 1.0 apparently being more profitable). I can’t decide which is lamer, their name or the story behind it: "XO = hugs and kisses. OO = ‘you,’ as in, ‘this site is for you, you people out there seeking medical care and you doctors out there who wish to share your philosophy of care.’ Ova is both a Latin word for egg and a medical term for what happens to be the largest cell in the human body. And Va? Va means ‘go.’" If all that isn’t dot-bomb enough for you, they were even bragging on their Herman Miller chairs, the shark tank, and their proximity (in no way except physical) to Google. Most of these hip new companies are looking for buyers, not paying customers. In this economy, they’re likely to be riding those Herman Millers right into the toilet.

USA Today publishes hospital death rates online for MI, CHF, and pneumonia.

Your federal tax dollars at work: $300,000 for a Wisconsin pre-RHIO of some kind.

A reader pointed me to the court filing in which Epic apparently prevailed over patent leeches Acacia Research. My take: vendors, get yourselves a good lawyer and they will turn tail and run since there are plenty of other marks to shake down (like Siemens and GE) who will just pay up and write it off as a cost of doing business. The last thing Acacia wants to do is either have their patent (and gravy train) threatened. I hope Epic tore them a new one.

Intel is offering $100,000 for the best technology solution in global healthcare. Craig Barrett’s example: a PhD who created a cheap digital whiteboard from a Nintendo Wiimote (free download). You have until September 30 to register and January 31 to get your submission in. Pretty darned cool. "Barrett compared the world’ healthcare system to an ancient mainframe. ‘The hospital is the mainframe,’ he said. ‘If you get sick, you go to the hospital. What we need to do is bring the PC to the healthcare system.’"

Speaking of Craig Barrett, he rips the government on failing to encourage innovation and quality education (roger that) and also demos an unnamed PHR at the Intel Developers’ Forum.

Great news: 86% of people remember ads stuck on hospital walls or on wall-mounted monitors. That’s probably at least double the percentage that remember what doctors tell them.

GE Healthcare gets another FDA warning letter.

Remember this as you’re paying Oracle maintenance: Crazy Larry exercises a few options, netting him $544 million. Not to worry: at current prices, he’s still got $26 billion worth of shares.

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HERtalk by Inga

From dogofwar: “Re: Picis Survey. The announcement says that 87% believe a government-run EHR is the answer, but the slide shows the opposite.” Good observation. That 87% pro-government EHR number was buried in the press release and I thought it was surprising. I checked with the Picis folks and they confirmed that the write-up had an error. The text should say, “Close to 90 percent said government-run EHRs are NOT the answer, when questioned, but many expressed interest in joint funding from the private and public sectors.”

Sonitor is awarded a 2008 North American Frost & Sullivan award for Emerging Company of the Year based on its contributions to the RTLS industry and improved US market presence.

I had asked readers to comment on the impact of the ICD-10 transition and MGMA provided a response (OK, perhaps they weren’t responded to me, but the timing seems coincidental.) MGMA issues a statement that while they support the move, the proposed timeline is “not workable” due to the extensive changes required of health care facilities and insurance carriers. MGMA estimates that 95% of medical practices will have to purchase software upgrades or new software to accommodate the changes. Stay tuned.

HealthSouth is nw offering free wireless Internet access, courtesy of a new agreement with Wayport.

Good Samaritan Hospital is live on MEDSEEK’s eConnect clinical portal, enabling its 600 physicians anytime/anywhere access to disparate IS systems through one gateway.

Waukesha Memorial Hospital is installing RF monitoring systems in its pediatric and maternity wards to product infants and children from abduction (what a sad world we live in). RF Technologies is the vendor providing transmitters for patients’ wrists or ankles. The setup also includes receivers that track when a patient moves too close to a doorway, setting off an alarm and locking doors immediately.

Halifax Regional Medical Center (NC) integrates IntelliDOT BMA with their Meditech HIS. Caregivers will utilize a wireless handheld barcode point of care device.

MemorialCare Medical Centers (CA) contracts with Accenx to provide an interoperability platform for its physician outreach program.

Kryptiq (healthcare connectivity provider) acquires Secure Network Solutions (administrative workflows such as appointment reminders, waitlist management, and electronic billing statements.)

GE Healthcare recognizes six healthcare organizations for their innovative use of Centricity products.

Eclipsys announces Ali Zarzour as VP and GM of Middle East operations. He comes from Microsoft, where he served as a healthcare industry manager in the Middle East and Africa.

Five Sharp HealthCare hospitals are deploying Premier healthcare alliance’s SafetySurveillor infection control and pharmacy modules to track and prevent healthcare-associated infections and optimize antibiotic use. It sounds like cool technology that apparently 200 hospitals are using nationwide. Anyone have any comments on whether it works as advertised?

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