SEC Moves on HSS Primary Shareholder Stanford International Bank

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

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

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

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

Monday Morning Update 2/16/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HITECH Provisions of the Stimulus Package
By Dr. Herzenstube

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

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

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

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

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

E-mail me.

Being John Glaser 2/14/09

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

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

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

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

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

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

News 2/13/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another Vendor You Won’t See at the HIMSS Conference

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

How’s business?

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

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

Has Picis pulled out of HIMSS?

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Healthvision closes the fourth quarter with 22 new client engagements.

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

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

E-mail Inga.

News 2/11/09

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

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

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

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

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

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

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

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

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

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

Listening: Seether, South African metallish grunge.

IBA/iSoft gets two contract extensions with Netherlands hospitals.

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

MD Leader 2/10/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday Morning Update 2/9/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Report from the Field
Nick van Terheyden on TEPR

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

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

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

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

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

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

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

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

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

MEDITECH Pulls Out of HIMSS 2009

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

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

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

News 2/6/09

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

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

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

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

Community Medical Center (PA) signs for SIS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

News 2/4/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Daschle Withdraws from Consideration for HHS Secretary

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

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

Being John Glaser 2/3/09

An Alternative Plan for $20B

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

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

For Healthcare Providers

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

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

For HIT Professionals

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

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

Patients

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

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

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

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

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

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

What Usability Is and How to Recognize It

By Jim Bradford, Ph.D.
The Bradford Report

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

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

Mental Models and the Psychology of Geeks

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

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

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

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

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

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

The Informed Consumer—How to Recognize Usability

Affordance

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

Prescriptive Feedback

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

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

Task Fit

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

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

The Bottom Line

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

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

Monday Morning Update 2/2/09

From Sam Axe: "Re: Scott & White. I am reasonably certain that GE/IDX is supporting the physician revenue cycle – not the hospital, which remains Siemens Invision. The GE article referenced in the response agrees with that and I believe they are probably accurate in their claims around the physician revenue cycle in academic medical centers." Thanks. I wish the press release had been more clear since both the customer and vendor in this case have separate offerings for inpatients and outpatients.

From Blago: "Re: Big shake-up at GE HCIT. Vishal Wanchoo out as CEO." Not according to Jennifer, a GE spokesperson and Inga’s new BFF, who said, "absolutely not." Inga was tickled, though, that Jennifer knew who she was when she called, even though she had thought Inga was someone I just made up. Now I’m inspired to invent up a huge staff of imaginary people, a seeming force to be reckoned with instead of some guy hunched over a PC for immoderate hours each day. Jade and Mariposa, massage my shoulders as I type, yes?

From Spanky: "Re: stimulus. How are pediatric providers going to get reimbursed for EHR use when they don’t bill Medicare?"

 

January’s HIStalk traffic set a new record, up about 40% from a year ago. Thanks for reading.

Listening: The Connells, jangle pop from Raleigh, NC since 1984.

Two Utah hospitals buck the trend and open up new expansions.

I heard from a CIO reader whose hospital, a big place, is 100% CPOE. I said I’d never heard of one doing all oncology and neonatal orders on a general CPOE system, but there’s at least that one. I agreed not to provide specifics, but I’ve asked for more information since I know many of us would like to know how they did it.

Who knew? The owner of ambulatory EMR vendor Purkinje, according to their site, is the famous VC billionaire John Doerr, backer of Compaq, Netscape, Sun, Amazon, Google, and others. His brother is the CMO and chairman of the executive board. John Doerr put $10 million into the company in 2007. The logo on the site now says GenesysMD even though the Purkinje name is used otherwise, so the company name appears to be changing (just confirmed with Margalit, the company’s product management director, who’s like me and working on the computer at 11:30 at night). Their deal: $399 per provider per month for software, unlimited support, hosting, interfaces, all clinical content (CPT, ICD9, First DataBank, etc.) and free training and implementation for users who sign up in February.

Over on HIStech Report, Inga interviewed John Shagoury of Nuance Communications.

DrM made a year-by-year table of payments and penalties for the House’s stimulus bill that just passed. I inserted it as a graphic above, so click to enlarge.

Hospital and employee information in Japan is exposed on the Internet when an employee copies data from a damaged flash drive to his PC, forgets the file is still there, then fires up his file sharing software at home. That’s happened before in Japan, I seem to vaguely remember. They love that Winny P2P client over there.

Speaking of which, a Computerworld article mentions on the danger of data exposure from peer-to-peer file sharing, citing a study in which a researcher found a document with full data on 9,000 lab patients, 350 mb of data from an anesthesia group, and an 82-field worksheet on 20,000 hospital patients. The last sentence is a little shot: "The range of health care information floating on P2P networks and the variety of sources from which it is being leaked highlight the disorganized and decentralized manner in which health care data is being collected, stored, used and shared, he said."

Here I go and run an interview with Peter Waegemann and he fails to tell me that they’re renaming TEPR to M-Health Conference. HITgeek has an idea: "If TEPR is changing its name, perhaps you could hold a contest or survey for what it should be."

A University of Chicago study finds that 90% of hospitalized patients couldn’t correctly name even one of the doctors taking care of them. Three quarters had no idea and 60% of the rest were wrong. Academic medical centers have a gaggle of people rounding in teams, of course, popping in for a few minutes once or twice a day, so maybe that’s not surprising.

Here’s an example of how insurance has corrupted the whole idea of patient responsibility: an LA Times article marvels that practices using real-time adjudication "can, and sometimes do, ask patients to pay those costs at the time of service." Shocking! Why can’t medical practices be like restaurants, gas stations, and mall stores in just letting people take what they want, walk out, and be billed sometime later to pay whatever amount is convenient? That should be the #1 step in healthcare reform — get patients to understand that healthcare isn’t free just because you have (or once had) an insurance card. The insurance companies escape consumer wrath because it’s the doctor’s office who has to come collecting what they didn’t pay.

The IT department was at fault in the recent PC virus infection in England, incorrectly configuring antivirus software on some PCs and failing to get AV updates to some of them, an outside IT auditor finds.

If you want to know how the HIT industry is doing, forget all those publicly traded companies with a mishmash of products and businesses and look at the software-only company that has the most hospital customers: MEDITECH, which 2,200 hospitals are running today. For FY08: revenue was up just under 6%, but net income dropped 60%, mostly on investments (I hear that). Interesting: CEO Neil Pappalardo and CFO Barbara Manzolillo asked that the Board give them only the same bonuses other employees get and not the special Director bonuses since the company didn’t do very well, reducing their paychecks by 64% and 52%, respectively, over their 2007 comp. Neil’s shares are worth over $500 million even at the internally set share price that the militant shareholders always complain is artificially low.

A WV doctor and former town mayor is ordered to repay an insurance company $180,000 for blood tests and injections that patients never received. The doctor blames his billing staff and software, says he has nothing to do with billing, and that judges discriminated against him. He was nailed in 2007 for underreporting income from 2000-2002, when he also worked as a day trader.

GE Healthcare is following its Burlington layoffs with mandatory unpaid employee furloughs.

Hospital layoffs: Clearfield Hospital (PA), 33; Saint Joseph Medical Center (PA), 40.

Sure to fuel the healthcare debate: is it a good use of healthcare resources to provide expensive fertility treatments and preemie care to an unmarried, apparently unemployed, and bankrupt woman in her 30s and her new octuplets that bring her up to 14 children, all of them conceived through in vitro fertilization? She’s trying to be self-sufficient, though: she wants $2 million and a career as a TV child expert from either Oprah or Good Morning America in return for her story.

I don’t get how magazines think. An article mentions that Philips sold CPACS to a hospital in Saudi Arabia, but the headline in SmartBrief says "Philips strikes a partnership with Saudi Arabian hospital." If that’s the case, I struck a partnership with the local sports bar at lunch today when I bought a very good burger there. Just because salespeople murmur the P word to make prospects comfortable doesn’t mean there’s a legal agreement to share expenses and profits. Anything else is called "a sale." Funny thing is, the article it referenced called it that — SmartBrief added the "partnership" line.

CPSI announces Q4 numbers: revenue up 14%, EPS $0.45 vs. $0.36, falling short of earnings expectations but raising guidance and declaring a dividend.

MEDSEEK announces a 47% increase in contracts and a 33% increase in licenses for 2008, referencing its KLAS 2008 Category Leader status in clinical portals.

California is out of money, so it plans to stop paying bills Sunday. The controller whines that withholding money from Californians will delay economic recovery, blaming everybody except the state itself. CA is $25 billion short for 2009, unemployment is 9.3%, and median home prices are down 50% in less than two years. Like Florida, they weren’t complaining during the boom that benefited them, but can’t accept the idea that the good times have already rolled.

Amanda Adkins, a 34-year-old Cerner executive, is named chairwoman of the Kansas Republican Party. It probably wasn’t a total shock since she was the only candidate.

E-mail me.

News 1/30/09

From Dr. Strangelove: "Re: medical education. Medical care & physicians take a lickin’ on this study of revamping their education. The issue was never getting enough physicians trained – it was getting them to work anywhere except the big cities where they could make enough money to stay entrenched in the social class created for them in the last half of the 20th century (and pay off medical school). Their attitude… well… that’s another thing entirely. It has to do with ‘the chief god in charge’ formula taught to them in medical school and in part to the kind of personality profiles it takes to survive medical school, an internship, and residency." A sentence from the report (warning: PDF) that advocates the reform of medical education: "The overarching theme that coursed through the discussions was the urgent desire to bring medical education into better alignment with societal needs and expectations."

From MM: "Re: vendor calls. The vendor calls and e-mails have gotten completely out of hand. A confluence of a new year and a very slow economy has everyone with anything to sell trying to make contact. My assistant, who is good at spotting the legitimate calls from random sales calls, has been tricked a few times this month. I can’t take it any more! Anyone else feeling a high level of sales activity?"

From Chef Tony: "Re: sponsor ads. We’re a sponsor and I’m a reader. I really dislike the animated ads, too. Nobody is hanging around to read each screens change. I deal with huge NYC agencies whose designer kids are often clueless about what gets information out to the target market. Unless it’s Super Bowl Sunday, educate or inform with ads, not entertain."

From Doug Dinsdale: "Re: Allscripts. A stock board posting claims that Allscripts Healthmatics and Allscripts Professional were scheduled to lose CCHIT certification last week. Is that true?" I don’t think so, but I’m sure Allscripts will clarify. According to the CCHIT Certified Ambulatory EHR 2007 list, both products were certified a year ago. I’m working from memory here, but I think certification is good for two years, i.e. even though CCHIT issues new criteria every year, vendors don’t have to recertify (with one exception: Stark and anti-kickback donations require products to have been certified within the past 12 months, but not necessarily on the current criteria, and extensions are available). You just have to pay CCHIT’s annual maintenance fee (huh? CCHIT requires payment of a maintenance fee even when a vendor doesn’t use any certification services, which was the justification for the fee in the first place?) For stimulus purposes, I think both products are good for another year in any case. I’m sure someone with a more expert opinion than mine can help.

From Friend of Tim: "Re: it’s a good thing you’re a nice guy." Link. Michael Arrington, the "surly and macho" founder of the Silicon Valley blog TechCrunch that carries quite a bit of investor influence, takes a leave of absence after receiving death threats and having someone walk up to him at a conference and spit in his face. I am a nice guy – thanks for noticing (cynical and juvenile, sure, but we all have our crosses to bear).

From Dinger: "Re: Baylor/Perot. Any word on how it’s going? I’m hearing rumblings."

From Paul Molitor: "Re: HITECH. I have to respectfully disagree with John Glaser’s interpretation of HITECH. You get the same compensation per clinician regardless of when that clinician starts to use an EHR. The declining payment schedule per ‘eligible professional’ begins with the ‘payment year’ in which that professional becomes a ‘meaningful EHR user’. The start of the declining schedule is not anchored in a specific calendar year and the schedule applies to each individual. A relevant excerpt from Sec. 4311: ‘(ii) AMOUNT- Subject to clause (iii), the applicable amount specified in this subparagraph for an eligible professional is as follows: (I) For the first payment year for such professional, $15,000. (II) For the second payment year for such professional, $12,000.’ See here for the full text."

From Moose Haas: "Re: MRI/TEPR. Completely washed up. Went to their event last year. It had to be one of the worst events I’ve ever attended. Rumor is MRI is being shopped, but no takers." I appreciate Peter Waegemann’s taking the time to share some thoughts (several  of which I agree with). 

From Sam Butcher: "Re: physician practices delaying EMR purchases. Many groups will delay. Those interested in EMRs for business or clinical reasons have already bought. The remaining ones are resisting change claiming EMRs cost too much or aren’t better than paper. These are the same groups that resisted electronic claims years ago. It’s no surprise that many of these practices are poorly managed. The same paralysis happened with practice management stimulus during the debate over Hillarycare." That’s an interesting observation. As much as I don’t believe the Most Wired hype, it would be interesting to compare the quality and profitability of non-technology using practices to the others. There are certainly plenty of badly managed practices out there (one way to identify them is to check the name tag of the least competent person in the reception area: if that person’s last name is the same as the doctor’s, expect the worst).

From Carpluv: "Re: physician practices delaying EMR purchases. Obamanations, grand idea for financial help for EHRs, has stopped the buyers in their tracks. They’re all waiting for the handout. Great momentum change!"

From Elsie EHR: "Re: physician practices delaying EMR purchases. Same song, different year. On July 21, 2005, the NY Times ran an article about the VA’s VistA system titled ‘U.S. Will Offer Doctors Free Electronic Records System.’ The article, which was widely quoted and reprinted, painted a rosy picture of the ‘free’ system. It was eagerly read by practitioners who were actively looking for an EHR as well as those who were on the fence. All that press prompted thousands of physicians to put their EHR plans on hold so that they could ‘wait and see’ what free goodies the government would provide. Some are still waiting." Link. That’s the most over-hyped and under-delivered part of Brailer’s original plan — giving away VistA (hospital and office) to legions of clamoring providers. Flop (see: Free Kittens).

From E. Buzz Miller: "Re: event. Will there be an HIStalk reception at HIMSS this year?" Wow, lots of people have been e-mailing that question, so thanks for the anticipation! I believe that’s affirmative, so keep Monday evening free. I’m hoping to line up a couple of notable speakers, maybe (and/or holding a spot for a HISsies winner or two if they’re game). For those who went last year, I’m open to suggestions on how to maximize the networking opportunities or anything else that would make it more meaningful and memorable. I never really asked attendees what they liked best or how to make it better, so now I am. Some people would just put out food and drinks, but I’m too neurotic to just let it unfold.

From Trimaxion: "Re: Stanford. Stanford Hospital has again delayed its Epic CPOE Oncology (Beacon) go-live of their Comprehensive Cancer Center. They have serious patient safety concerns, need new development, and can’t scale the complexity of the site." Unverified, but I know some Stanford folks read and may reply. I can’t say I know of any oncology app that isn’t a work in progress, though. The protocols and pre-dose monitoring and calculations are a bear. Even the so-called "100% CPOE" hospitals usually punt on oncology (and some or all of peds, like NICU).

From Bobby Peru: "Re: layoffs. Keep up reporting them." An interesting counterpoint from Think Positive: "I would propose to you that it is no longer news worthy or interesting news if another company has a layoff. I agree in better economic times this type of insight into a company’s fortunes or failures is helpful guidance to your readers." Think Positive is right, I believe, because it is indeed neither newsworthy or all that insightful that a vendor lays off staff these days, unlike the pre-recession when such activity might foretell future problems or shifts in strategy. Maybe this is a happy medium: I’ll keep reporting layoffs (provider and vendor) only if they have been reported elsewhere. Is that good, or should I follow Bobby’s suggestion and keep running whatever I hear? Let me know.

In the meantime, in the absence of a ruling, Omnicell supposedly dismissed somewhere between several dozen and a hundred field support employees on Wednesday, but an official number of 101 was given with its Q4 report: revenue up 7.1%, EPS $0.10 vs $0.09. Those are darned good numbers if you ask me, but cutting payroll is the most common hunkering down for weathering the economic storm overhead. Cold, but smart.

It’s your last chance to cast your HISsies ballot.

Listening: brand new alternative hard rock from Hoobastank, who kind of disappeared after one hit several years ago. I like it a lot – it’s harder than their older stuff. I still hate the name, though.

Intellect Resources has a new newsletter, which I always enjoy. The "traveling Flat Healthcare IT Man" piece is fun – wish I’d thought of it for HIStalk (it’s from a children’s book called Flat Stanley). They also have a new website with both HIT positions and candidates.

A huge win for GE: Scott & White chooses Centricity Business (the old IDX billing system, I assume) for patient access, revenue cycle management, and BI.

Jobs: Cerner Clinical Systems Analyst, Pre-Sales Engineer, EHR Clinical Trainer and Implementations, IT Director. There are some nice positions and employers posted.

Here’s an interesting example of commitment to healthcare: El Camino Hospital is purchasing the physical plant of Community Hospital of Los Gatos, putting current ECH CMIO Eric Pifer in charge there. ECH is taking over June 1 when Tenet’s lease runs out, but Tenet said, screw it, we’re closing the hospital on April 10 because it’s losing money anyway and we’d rather just cut and run. Employees thought they were finally going to be safe under ECH, but now they’re all getting the axe. ECH says they can’t get it ready to re-open until the fall. As a for-profit company, it’s the right business decision for Tenet, I suppose.

Humana will contribute provider incentives to encourage participation in the Wisconsin HIE (would one sound that out as WHEE or WHY?)

While I’m thinking about it, I’d like to thank the companies that sponsor HIStalk and HIStalk Practice. It takes guts to put your ad (flashy or not) beside some of the stuff I write. For most of them, it’s not a sterile transaction handled by detached PR people — it’s company executives who want to support what we do and who pull the strings to get the bean counters to write a check to a vaguely untrustworthy-looking enterprise working out of a PO box. Make your own decision on what to buy or from whom, but if you get the chance, thank them for their support.

Investor’s Business Daily covers athenahealth in an article purportedly about subscription EMRs, but mostly about ATHN stock.

If you’ve e-mailed me lately, hang in there and I’ll get back to you. It’s nearly impossible for me to do much more than skim the inbox until the weekends since HIStalk, HIStalk Practice, and HIStech Report are kind of in full swing at the moment (there will be record readership in HIStalk this month, which is surprising since the first several days were a long holiday weekend for most folks).

Speaking of CHLG, I heard this from Vendor Val: "El Camino Hospital plans to bring CHLG up on their Eclipsys Sunrise computer system and introduce physician order entry. Great news – for their competitors. CPOE had some success at El Camino because the city subsidizes the hospital and the hospital subsidizes the close-knit Independent Physicians of El Camino with free eClinicalWorks. Of course these MDs are very tech-savvy and have link-ups with the hospital’s Eclipsys Sunrise systems and can view lab data, medical histories, and procedures from the comfort of their own offices (they attract a lot of Stanford Hospital doctors who cut their teeth on computer glitches, spotty interfaces, and lots of downtime). But Los Gatos is a diverse collection of paper-happy independent physician practices who have no incentive to invest in technology and many are aging retirees with no interest in learning new programs."

Nextgov reports that Rob Kolodner will be staying on as ONCHIT.

California’s ED doctors sue the state, claiming that the ED system will collapse without additional funding. The state is ranked last in ED access and 43rd in ED payment. The docs claim EDs are getting the state’s burden of caring for the poor and elderly dumped on them. The state’s Department of Health Care Services had a cheery response: more budget cuts are likely, with proposals on the table to cut Medi-Cal’s budget by $1.1 billion and cutting physician reimbursement on March 1. I’m no expert, but this sounds like a seriously explosive situation there since I remember how ugly the King-Drew situation got.

Rich Elmore reminds me that his blog post mentioned the possibility of delayed provider EMR decisions because of Uncle Sam’s potential golden handshake.

St. Luke’s Regional Medical Center (ID) restructures its 28 IT positions into 18, forcing incumbents to play musical chairs to decide which 10 get the boot. It seems that hospitals are falling into one of two camps: (a) those who have big-ticket IT projects underway and aren’t about to jeopardize them to save a few IT salaries, and (b) those who never really believed that technology was all that valuable and are robbing the IT operational and capital budgets for more critical needs.

A UK survey calculates that dry cleaners there found an estimated 9,000 USB sticks, some no doubt full of sensitive information, that were left in the pockets of clothing dropped off.

E-mail me.

HERtalk by Inga

From Comforter: “Re: layoffs. Cabell Huntington laid off between 30 and 40 middle managers a couple of weeks ago, saving between $3 and $4 million per year. Many were-long time employees, with more than 20 years of service. One questioned how the hospital could have committed $40 million to Cerner a couple of years ago, but now finds itself in dire straits. Security escorted the employees out of the building immediately, standard policy for sure, but compounding the duress of getting fired.” The local paper reports that 40 jobs were eliminated earlier this month.

From Jason: “Re: Faxton-St. Luke’s Healthcare. You may have already heard, but Faxton St. Luke’s is an Eclipsys client.” Thanks for the correction. I erroneously said they had Cerner.

From Inside Outsider: “Re: Rob Kill. Is the new CEO of Virtual Radiologic Corporation really named Rob Kill? First time I’ve ever heard of a person named for breaking two commandments." Funny, although I bet Rob’s heard it too many times to do anything except grimace and give a polite, dry two-beat chuckle (HAH ha).

From Ziggy: "Re: Hospital marketing. With all the troubling economic news, budget cuts, and all, I am wondering the effect on hospital marketing? What are other hospitals finding to be most effective for the money?” Medicare fraud?

Sometimes it’s the little things about a company that can turn you off. Last September, I semi-seriously made fun of this Med Com USA press release because the first sentence went on forever. Lo and behold, here’s a new one just about like it: “MedCom USA, Inc. (OTCBulletinBoard: 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 an additional board member resulting in three independent board members and one inside member.” But what annoyed me the most was that in order to open their Web site with my Chrome browser, I was required to upgrade to a newer version of Flash (which I blew off, because I decided I didn’t need to see their site that badly.) If you read the press release, you’ll notice they had some high-level turnover, so I’ll give them the benefit of the doubt and assume they haven’t had a chance to focus much on marketing.

With the meltdown of Satyam Computer Services, other outsources like EDS, Perot, and ACS hope to pick up a few new clients. One consultant estimates Satyam will lose $2 billion worth of business to competitors over the next two to four months.

Tennessee expands its medical video network to allow physicians to treat pregnant women in rural counties. BCBS of Tennessee Health Foundation has provided $1.8 million in funding to allow perinatologists to view live ultrasounds remotely.

HIMSS announces its support for HIT provisions under consideration by Congress, citing three reaons: 1) the economy will benefit as jobs are created; 2) patients will benefit because of increased safety, and, 3) doctors will benefit because it reduces the current cost barriers. They don’t mention this, but of course it would be helpful to their 350 corporate members (and thus they themselves) as well.

A survey finds that hospitals and health systems are cutting back on both capital spending and unprofitable healthcare services. Hospitals are worried about declining investment values, shrinking margins, and stagnant philanthropy. This report reminds me of our own little survey to your right. If you are a vendor or a hospital, let us know what effect the economy is having on your world.

I wonder if this is just a co-incidence? Mr. H and I start using Twitter to keep abreast with all things HIT. Three weeks later Twitter seeks to raise at least $20 million in Series D funding. That’s a bunch of tweets.

The U.S. Bureau of Labor Statistics reports that retail prices for hospitals increased 5.9% in 2008, compared to 8.3% the year before. Wholesale prices for hospital services increased 1.5%, compared to 3.9% in 2007.

A CDC report finds that the total number of outpatient surgeries increased from 1996 to 2006, from 20.8 million to 34.7 million visits. Outpatient surgery visits accounted for about one half of all surgery visits in 1996, but nearly two thirds of all surgery visits in 2006.

Eastern Maine Medical Center announces 76 job cuts, reductions in overtime, and holds on several projects. The hospital was a 2008 Davies Award winner. The local paper also noted that the hospital’s CEO received almost $700K in compensation and benefits last year.

Wetzel County Hospital (WV) receives government approval to seek up to $6 million in bonds, which includes $175,000 to upgrade its CPSI EMR and Payroll applications.

Trustees with Regional Medical Center (SC) approve a $78,000 contract with HIMformatics to oversee its Cerner IT project.

Tenet Healthcare says it expects a Q4 net income of $5 million and $63 million in earnings for 2008.

Would the average person pay $20 to e-mail a medical specialist for advice?  A physician group is betting on it, having launched a Web site designed to give anyone with a medical question the chance to receive medical advice, medical recommendations, and medical information from specialized medical doctors. 

Revenue cycle management company MTBC outfits its own airplane to be a flying promotional platform. Well, why not? Guess it beats the yellow pages, especially if you’re marketing to pilots.

Norton Healthcare (KY) selects Unibased Systems Architecture to provide resource management software and services.

ICA announces the deployment of its data and technology aggregation solution at Lourdes Hospital (KY).

E-mail Inga.

Being John Glaser 1/29/09

The current version of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the larger economic stimulus legislation, will alter the HIT industry and the IT plans of our organizations.

For outpatient electronic health records, the Act puts some non-trivial money on the table. A provider who uses a certified EHR can get a maximum (through Medicare) of:

This totals $41,000. This will clearly increase interest in adoption and could represent a lot of revenue for a provider organization.

To get this money, a provider must demonstrate that they are meaningfully using health information technology. What does "meaningfully" mean?

• Using e-prescribing
• Connecting through HIEs to improve the quality and coordination of care
• Submitting information on clinical quality measures.

While we might be more or less clear about what e-prescribing means, clarification is clearly needed about what we mean by the second and third criteria.

It is anticipated that HHS will spend 2009 providing specifics and clarity about what providers have to do to demonstrate meaningful use. This means that most providers will have one year – 2010 – to finish EHR implementation and put in place the infrastructure, applications, training, etc. needed to get the as much of the incentive money as possible.

This is a tall order. And it means that providers should start moving now (if they aren’t already) even though the dust has yet to settle on the specifics.

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