News 4/4/08

From Stu Mascarpone: "Re: Siemens. Even after flying in its entire top brass to NJ, Siemens in now only a clicking clock away from losing one of its key flagship Soarian clients, HIMSS President’s Award-winner Hackensack Univ Med Ctr. After basically turning nothing on since 2004, HUMC is now in negotiations with Epic. The kicker: Epic is telling HUMC, which has an IT department of over 100 FTEs, that it is understaffed. So, before the Epic project can start, the hospital has to hire in excess of 50 FTEs and then send them to Madison to become Epic certified. Total cost is already estimated at well over $100M." Unverified. Makes sense on the staffing though. I can’t imagine installing Epic or any other big system with just a handful of reassigned staff and 100 total in the shop sounds light. Scrimping on help after spending millions on the system doesn’t make sense since the project will never get done. But, that’s an argument for considering all costs carefully upfront instead of just taking a hiring leap of faith after you’ve signed the deal.

From Gatorray: "Re: your article on CIOs. There are other factors involved in the success or failure of a project. One that drives me nuts — having the IT department off-site. I know space is at a premium in the hospital, but sticking all of us IT types in another building away from the main campus removes us from the care-giving environment. It helps foster an us vs. them attitude." I’m with you there. It’s cool being off in the geek building where you can wear flip-flops and leave campus for lunch easier, but you’re just another vendor at that point. It’s much easier for users to hate people they never see face to face. 

From Tina Recruiter: "Re: McKesson. They reorganize every year, change sales leadership every year, change sales strategy every year. Why would this year be any different?  The resumes are flowing on the streets, so something must be happening. BTW does anyone know what is happening with the McKesson ED product?" I had another company tell me they’re getting snowed under with Misys resumes (other than the recruiter I mentioned a couple of days ago), so it’s not just McKesson, I’m thinking.

From Carl Kibble: "Re: Cerner picture. If Neal Patterson reads HIStalk, he must be beside himself (again) because your picture of the Cerner headquarters shows the parking lot (scroll to the left or right) as 98% empty. It must have been about 5:05 PM. No pizza deliveries to be seen either." I meant to comment on that, but I figured those parking spaces must be for visitors since most companies make the help park out back. I doubt he reads, although if I were a shareholder or employee, I’d want him to.

Listening: Wolfmother. Aussie Zep/Sabbath clones.

Welcome and thanks to new HIStalk Gold Sponsor Renaissance Resource Associates. They’re in University Place, WA and provide consultants for projects involving Epic, Centricity, Picis, Sunrise Clinical Manager, and other hospital systems. They’ve got some positions available too, I noticed.

Take your last fond look at Merge Healthcare as it slips into likely oblivion. Shares are at $0.52, the company adds to its thick Nasdaq folder a delisting notice because of share price, and just-announced Q4 revenue was a paltry $15.6 million with EPS was -$0.28 vs. -$0.93. Improving, but they’re bleeding cash and not exactly inspiring confidence in prospects (if there are any). Stick a fork in ’em, I’ll predict.

Medicity just sent out its latest electronic newsletter, which I always enjoy. The company did 10 million clinical transactions in the last quarter, has 97,000 physician users, announced Hospital Sisters Health System as a customer, and hired Gifford Boyce-Smith as CMO. They also mentioned my positive comments about their booth, which I thought was very cool, and included a picture that I’m stealing since the HIMSS Police made me holster my camera before I could take one. Looks like you’re headed up the stairs of a spaceship.

If you’re a hospital CIO or IT manager, please take my medical device survey for our little white paper project. Thanks. 

More HIPAA problems at UCLA Medical Center: the hospital fires an employee for selling information from Farah Fawcett’s chart to a tabloid. The rag got the ultimate scoop — reporting her cancer relapse even before she’d had the chance to tell her family and friends. It’s like drugs, though: you will never win trying to curtail supply instead of reducing demand – all that does is raise the price. Most of the country seems to be preoccupied with reality TV and gossip sites, too busy to worry about war, the economy, or their own financial future.

Doctors order inappropriate lab tests because of computers, including ordering prostate screening levels like PSA on teenagers who don’t need them.

Teddy Kennedy and the usual suspects urge passage of what must be the hundredth health IT bill, of which the previous 99 have gone down in flames. It would codify ONCHIT, give the office $5 million a year, and provide IT grants. Among the rosy verbiage was nothing about the bill’s cost: $692 million (when it was originally proposed in 2005, anyway).

GE Healthcare will shut down its Tampa office, with 72 jobs moving to Milwaukee and to Finland.

Royal Bolton Hospital (UK) goes live with the Ascribe web pharmacy system in 12 weeks.

Philips signs a research partnership with 5,000-bed West China Hospital, one of the largest in the world, to develop medical imaging procedures and cardiovascular monitoring.

OK, here’s a couple of hospital pictures from Google Street View to guess. I’ve been to both campuses and I recognize them – how about you?

  
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Inga’s Update

Mobile computing supplier Socket Mobile announces the results of an “informal” survey conducted during HIMSS. The top concern of HIT professionals is apparently improving patient care, with 1/3 mentioning bedside POC as their top IT initiative. Lack of employee computer proficiency and cost factors were the chief impediments to implementations. The survey also noted that most institutions were considering laptops and COWs, not handheld devices like Socket Mobile sells.

Saint Clare’s Health System says it has saved thousands of dollars a year on paper costs using DB Technology RAS and RASi for enterprise-wide data and report management system. I am sure that saving “thousands” is a good thing, but for an organization the size of St. Clare’s (four hospitals), I sure hope the “thousands” are more like $90,000 than $3,000.

“What Nurses Want” — a completely electronic health record, which they believe will give them more time for patient care and improve patient safety and quality of care.

For those of you who tried but were unable to read Ed Marx’s CIO Unplugged blog. Ed, as well as his editor, dropped me a note saying there were some technical difficulties and the link is now working. I suspect the outage was related to a flood of his HIStalk fans visiting his site, but Ed was too modest to admit that was the issue.

And if you were trying to check out the Soarian user group I mentioned earlier this week, here is the correct link: www.soarianusers.com.

Perot Systems names John Hummel its new CTO for global healthcare. Hummel was most recently CIO of the California Prison Healthcare Receivership and Sutter Health CIO prior to that.

Lehigh Valley Hospital-Cedar Crest is using Patient Care Technology’s Amelior ORTracker in its perioperative department. The automatic tracking software uses an ultrasound indoor positioning system from Patient Care’s business partner Sonitor Technologies.

Six facilities have signed a total of $3.2 million in contracts with RIS/PACs vendor DR Systems. The contracts range from $195,000 to $1.1 million.

Only five VC-backed staged IPOs came out in Q1, the lowest number in about five years. Of the five, four were medical device or biotech companies and one was a computer security technology company.

I suppose looking at IPO numbers is as good a way as any for gauging the state of the economy. My next door neighbor surveyed our regular UPS and Fedex drivers, who both said their companies are laying off drivers and consolidating routes to cut costs. Personally, I have found that getting in for a pedicure is easier than ever, so I am blaming (thanking?) the economy, too.

E-mail Inga.

An Argument Against Giving CIOs Control Over Clinical Systems Projects

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in June 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

It’s hardly news that clinical system implementations in hospitals fail with astonishing regularity. Sometimes they explode in a huge fireball of organizational upheaval. Other times, they simply fail to deliver the benefits everyone expected. By failing, I’m referring to not just the IT part of the project, but the overall change management required to be successful.

It seems we as an industry don’t learn well from our past mistakes. We keep making the same ones over and over again. Many of those I’ve seen involve the role of the hospital CIO in the project.

CIOs rarely have a clinical background, most often having risen through the ranks of programming, managing, or consulting. I’m therefore postulating that they should not be given control over major clinical system implementations.

CIOs don’t always have the respect of physicians, nurses, and those other key clinical personnel actually carrying out the organization’s mission. They may be recognized as holding authority over needed hardware and software tools, but to most clinicians, the CIO is the besuited mid-level functionary whose job it is to say “no” to IT requesters who did not pay adequate homage when defining for themselves which technology tools would improve patient care. Since IT controls the budget, innovation is allowed only if committee-approved.

Some CIOs I’ve known made it their personal mission to set clinicians straight, convinced that without their wise paternal oversight, the wacky clinicians can’t be trusted with money or system selection power. Clinicians armed with reams of objective and factual system data are overridden with logic such as “It just doesn’t feel right” or “I know that company from another job or my peers,” which seems reasonable other than it fails to prevent the train wreck most of the time.

CIOs like to make executive decisions even when they’re ill equipped to do so. Since IT executives have little influence when they’re not making big decisions, they tend to relish the chance to buck convention or override carefully designed committees. Their veto power is absolute.

IT executives fear for their jobs, much more than they fear for the well-being of patients. They’ll override nurse informatics people nearly all of the time and MDs 50% of the time when it comes to delaying an implementation when faced with dangerous shortcomings. The most common reasons: (1) we’ve spent the money, so we have to go live; (2) it’s bad and not likely to get better, so we might as well go live, or (3) I promised my peers this system would work and I won’t tell them differently.

Should CIOs be involved in clinical systems projects? I honestly don’t know. Programmer-trained logic doesn’t add much value. Neither does having been involved with a similar project somewhere else or sporting an MBA. Golfing and free lunch vendor relationships seem to hurt more than they help.

Some of our big-name CIOs were directly involved in some of our big-name clinical systems failures, although the ensuing spin often hid that fact from everyone except the hospital employees and medical staff. Whether they made wise decisions or worried mostly about the Dilbert-esque world of timesheets and timelines I can’t say. But they’ve failed enough times that it’s worth trying something new.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission.  To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 4/2/08

From Jackie Chiles: "Re: McKesson. It’s probably not really a rumor anymore, but McKesson is acquiring Rosebud Solutions, a maker of tracking software for tissue, instruments, scopes, etc.  Press release will likely hit today. The Rosebud booth at AORN conference has the McK logo hanging above it.Another more juicy nugget that I have heard from several independent sources is that McKesson is making some major changes in its salesforce, with some significant restructuring likely. One well-placed source told me McKesson’s cost of sales is about double its competitors due to current sales force structure." Here’s a link to the press release on Rosebud.

From Sophie Winslett: "Re: RHIOs in Europe. They’re not that monolithic in the UK and Canada. Primary care providers are in their own clinics in the UK.  Even though it is a single payer system, they all buy their own IT systems. The UK is trying to get them to standardize on a few systems to provide competition and flexibility while limiting the number of interfaces, but each doc decides on their own. In Canada, hospitals the hospitals I’m familiar with are the equivalent of non-profit groups (such as you would see in a metropolitan Catholic consortium in the US). They are not directly owned by the government and they all made their own informatics decisions."

From EasyRHIO: "Re: RHIOs in Europe. There is already a country with a nationwide RHIO for all eight million citizens. All clinics in the country are connected and most hospitals are connected with the remainder rapidly deploying. Welcome to Kaiser country, my friend."

From Amanda Rada-Range: "Re: Brev+IT. I quite enjoy this – thanks for publishing it. You might have heard that AWP stands for ain’t what’s paid." Amanda was commenting on the latest issue’s lead story.

From Lester Bangs: "Re: Axolotl. Axolotl has won the Queens NYC HIE contract, which adds to their dominance in NY state — they also have Buffalo and Rochester, which are also live. Check the details of the press release for what they are doing — EMRLite, e-Rx. It’s not just results reporting."

From Chang Kai Shek: "Re: Epic campus. Looked pretty basic, but cool drive-through. Do you have other vendors’ campuses?" Well I mapped Cerner’s campus and found a drive-through just for you. Here’s a shot (if that design feature stays that way for more than four hours, I’d suggest going to the company infirmary). Thanks to the power of the Internet, I also found Judy Faulkner’s house with drive-by pictures and its appraised value (surprisingly modest), but that’s nobody’s business, of course, including mine. I’m thinking I’ll do a series featuring hospital pictures – what do you think? You could try to guess the hospital from its exterior.

Greenway Medical announces expanded support for PQRI/P4P programs.

If you want a copy of the 101 Healthcare IT Marketing Ideas booklet I mentioned, e-mail Steve Bennett (he said it was OK to give his e-mail, although he may regret that once he starts licking a mountain of envelopes and stamps).

Heard: Hayes Management Consulting is working with a Fortune 100 company to develop an employee health clinic — consumer-centric, paperless, and with an EMR linked directly to medical devices.

CIOs or other hospital IT execs: help me out by completing a questionnaire on medical devices and IT. We’ve got a crackerjack group working on a white paper and we need some input. Thanks.

Jobs: Clinical Applications Analyst Lab (WA), Business Analyst (CO), Centricity Senior Healthcare Consultant (CA), Client Manager (TN).

I thought Dennis Quaid was just being a self-centered movie star in his ripping of the medical system after his twins were overdosed with heparin at Cedars-Sinai. He’s changing my mind: he implies he won’t sue the hospital if it does the right thing — implement bedside barcoding of medications (from his foundation page). He also seems to have a handle on the "system problems, non-punitive culture" concept: "Individually, the doctor, nurse, pharmacist, or other staff members, who commit these unintended medical errors, are not bad people. Indeed choosing a career devoted to curing the sick and easing the suffering of others is one of life’s highest callings. But these health care professionals are working in, and are sometimes victims themselves, of a broken health care system that has become more and more obsessed with the threat of exposure to liability and protecting it’s bottom line rather than being vigilant about correcting the flaws in that system that are the root cause of that very exposure." Damn well said, although this quote surely means he hasn’t seen the barcoding products currently available: "They have a bar code system in every checkout stand of every supermarket in the country. How could it be so complicated, and so expensive?"

A UK health minister admits that work on Cerner Millennium in the South has stopped because of contract disputes with Fujitsu and Cerner.

Problems in Australia, where devices set their clocks back for fall (seasons are backwards from us down there, remember) even though daylight savings time had been extended by a week in New South Wales.

It was hard to tell with all their goofy April Fool’s announcements, but Google is apparently serious that its Google Docs word processor can now be used offline, courtesy of the Google Gears project.

Here’s a pretty interesting look at telehealth in India. Interesting comment: "Technology has never been, and never will be, a stumbling block to progress in telemedicine." Another: "We should, however, remember that a fool with a tool is still a fool, and ultimately therefore it is the individual, not the technology, that can make or break the system." Sounds like they’ve got some great ideas over there. How long before someone starts offering telemedicine consultations from there at low rates?

Fun: a Wales hospital has had its own radio station for entertaining patients for 40 years.

A VA patient who nearly had unnecessary surgery because a nurse mistakenly read an old lab result proposes a software solution that the VA is considering: modify VistA to show only current lab results unless users explicitly request older ones.

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Inga’s Update

McKesson announces its acquisition of Rosebud Solutions, which provides software to track and manage surgical instruments and implant materials.

StatCom hires former Siemens and Lawson sales executive Michael Holland to head up sales and marketing.

David Brailer’s Health Evolution Partners launches a $200 million investment fund aimed at early stage and venture companies. The fund’s advisors include a former US Surgeon General, a past Kaiser CEO/President, a Leapfrog Group founder, and a founder/CEO of The Health Technology Center. Former Partech International/First Consulting/Accenture executive Roy Ziegler will lead the group. I guess when you have been a healthcare IT czar, you’re able to get all sorts of folks to come to your party.

Elmhurst and Queens Hospital Centers plan to make a go of a RHIO using Axolotl’s Elysium technology. The project is expected to take three years.

I am not sure how significant this news is, but I smiled a bit at the press release. gMed announces the launch of a new EMR product called gCardio, which the company claims is a solution that “thinks like a cardiologist.” Hmmm.

Cardiac Science announces that its HeartCentrix ECG software is certified with NextGen and the two have already deployed their first installation. Meanwhile, Cardiac Science also just signed a letter of intent to start working on a similar connectivity model with the Misys MyWay product.

Nuance announces the release of Dictaphone healthcare division’s Veriphy-Ready HL7 Integration Server to automate the closed-loop communication process.

Picis announces version 8.1 of its total perioperative automation and critical care applications.

Soarian clients have a new users’ forum available at www.soarian.com. Formed with the help of Stoltenberg Consulting, the group will initially focus on question posting/answering and discussion.

Health Management Associates and Novant Health announce a partnership in which Novant will purchase a 27% stake in HMA. The two organizations will co-manage 16 hospitals.

Sachi Rath asked if there were other CIOs besides Halamka writing blogs. Check out Ed Marx’s CIO Unplugged. I like Ed because he’s a regular HIStalk reader.

A Dell issue or sign of the times? Dell announces actions to restore its competitive advantage and drive $3 billion in cost savings. Included in the plans is the closing of its Austin desktop manufacturing facility, eliminating 900 jobs.

E-mail Inga.

Monday Morning Update 3/31/08

From Up to You: "Re: Scott Wallace. From a magazine: Wallace said he will continue to work in the area of healthcare IT at, ‘something really exciting, but I’m not quite ready to announce it yet. I’ve got another six weeks of really intensive work before I can announce it.’" NAHIT seems to want to reinvent itself following (and may related to) his departure. So, where’s he going?

From Tree Adams: "Re: RHIOs in Europe. Points worth mentioning: (1) Taxpayer money and government are the only available sources of funding and administration in a cradle-to-grave welfare state; (2) Might it be easier to introduce a single, electronic solution within an existing nationalized bureaucracy when compared to our disparate, private organizations?; (3) Is it theoretically easier to finance and implement technology when the populations in question are so small (less than 10 million)? But go ahead and keep comparing them to our model."

From The PACS Designer: "Re: Philips acquisitions. TPD is impressed by the recent acquisitions of Emergin, Visicu, Respironics, and Tomcat  With the addition of these four, it appears a move by Philips toward the center of the IT process in the enterprise. The mini-EMR mentioned in my HIStalk interview may have to be revised to a main player in the EMR competition!"

Listening: new B52s, the first album with all four members in 16 years. If you liked Cosmic Thing, this is for you – the always-cute, beehived Kate and Cindy still sound young when they soar on the harmonies. Bet they’d play a mean HIStalk party next HIMSS.

A reader pointed out that the Rumor Report button wasn’t working all of a sudden, so I made a new one and moved the form to a new page. It now loads instantly and takes you back to the "new" HIStalk page. So, send me a rumor.

Why Epic is so expensive: take a virtual drive through its new campus Google Street View (the car-mounted 3D camera thing). Nice buildings surrounded by endless muddy fields, but it probably looks better now (or will by summer).

Cool booklet: Steve Bennett, VP of Snelling Executive Search and Chuck Christian, CIO of Good Samaritan Hospital have published 101 Healthcare IT Marketing Ideas and sent me a copy (I had mentioned their quest for reader ideas, although I don’t know if they received any). Item #38: "Station the Help Desk in the cafeteria for a day." Fun. Some of my smarter IT management ideas have involved internal marketing, so I can vouch for these 101 as useful for ensuring IT department visibility and CIO job security. I don’t know how you can get your copy, but I expect the Snelling folks can hook you up. 

Execs may like the Allscripts-Misys merger idea, but the sales natives are apparently restless. Resumes from both companies are hitting the street in great numbers, a recruiter tells me.

Your federal tax dollars at waste: a for-profit hospital in New Jersey gets $500K for PACS upgrades. The hospital won’t peg a completion date until it can take another lap around the trough for more federal money. A real estate development company bought the bankrupt hospital in October. Maybe New Jersey has hospitals that aren’t bankrupt, under investigation, or both, but those aren’t making the papers.

A bunch of New York RHIOs gets $105 million in grants.

I mentioned that AT&T’s booth at HIMSS was busy, with a lot of potential partners sidling up as well. If you wonder what the company’s healthcare strategy is, check out my HIStech Report interview (just posted).

A demonstration project says its "best practices" processes reduced medication administration errors by 56%, but of course leaves off the most important stat: how many of those would have caused patient harm? Most people miss the point that a "medication error" is usually something as benign as not being given your daily 8 a.m. laxative until 8:30. Fixing that doesn’t do … well, you know.

More jobs: Account Executive (NC), Revenue Cycle and Operations (MA), Healthcare IT Project Manager (FL), RVP Sales (Western US), Information Security Manager (CA), MUMPS/Cache’ Software engineer (VA), Epic/Bridges Senior Integration Analyst (MA).

Deborah Moore, a former RN and CEO of Accustat EMR of of Myrtle Beach, SC, is named as state Small Business Person of the Year (I assume it’s the business that’s small and not her).

LSU wants a $250 per semester tuition increase on top of $43 million extra it’s getting from the state. They plan to spend $20 million for a new hospital EMR system.

I was looking for a lesser-known EMR vendor and found them on the list of 321 covered by EHR Scope. I didn’t realize there were so many.

Strange hospital lawsuit: Dongwoo Chang, a UC Davis neurosurgeon, accuses his supervisor Jan Paul Muizelaar of incompetence and practicing illegally. UCD suspends Chang citing his high complication rate and being a general pain in the ass. Chang is suing UCD’s top physician officers, saying he was fired in retaliation and that his own death rate and number of malpractice suits is zero, compared to Muizelaar’s high numbers of each. Makes you feel real good about needing trauma work done there.

HHS launches a hospital comparison site that includes process of care measures and patient survey results (when available). I doubt most patients would understand the clinical measures (although they can review bathroom cleanliness and noise), but providers might find competitive bragging rights therein. Unmotivated newspaper reporters are already crafting stories around how the local hospitals did, I’ve noticed.

Sad: a man whose mother died at Doctors Hospital (GA) in 2004 after what he believed was substandard care returns to the ICU armed to the teeth, killing a nurse, a secretary, and a bystander. I’m scared to say it out loud, but I’m surprised that it doesn’t happen more often with all the wackos that pass through hospital doors.

The charitable foundation started by IDX co-founder Bob Hoehl donates $1 million to a Vermont literacy organization.

Vermont Information Technology Leaders changes its mind – it now backs a surcharge on medical claims to pay for physician EMRs. Getting doctors to use them wasn’t mentioned.

Oracle’s Larry Ellison is bonkers, but smart: he successfully challenges the tax valuation of his $200 million Japanese-themed estate, arguing that Larryland is so bizarre that it’s worth a lot less than he paid. Result: he’ll pay taxes on only $65 million, earning him a $3 million refund.

ZDNet says Janet Dillione, CEO of Siemens Medical Solutions,was the smartest person at HIMSS, apparently because the reporter thought she looked a little like Hillary Clinton and because of her daringly insightful predictions such as "PHRs will be popular" and "Healthcare IT needs to change." ZDNet fawns over Soarian, apparently unaware that nobody’s buying it.

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Thoughts from the HIStalk 2008 Reader Survey

Thanks to those to responded. Inga and I pored over your survey submissions endlessly, so your time was well spent.

Not surprising: about 4% of readers are CEOs and 4% are CIOs, not much different than last year. As to the degree that HIStalk influences your perception of products and companies, 8.7% said none, 68.6% said some, 22.7% said a lot. The most popular HIStalk elements (in order) are news, rumors, and humor.

Surprising: to the true/false question of whether reading about a company in HIStalk raises interest or appreciation for those companies, 80.3% said yes (that’s a lot). Best of all, to the question of whether reading HIStalk helped you do your job better in the past year, 75.4% said yes (a 10% jump from last year). I don’t know of any organizations or publications that can claim that strong of an endorsement, so that’s pretty darned cool.

The comments were nearly universally complimentary (thanks for that). Some specific themes I teased out: you would like to see more interviews with non-CEO/CIO types, such as clinicians and non-hospital IT leaders (we’ll work on that). You’d like to see more activity in HIStalk Discussion (so would I.) You suggested a raffle or other incentive for readers who recommend new HIStalk readers (good idea). You suggested changing the sponsor ads (smaller, simpler, different layout) which we will review with the sponsors since they’re the ones keeping the virtual presses running. You asked me to highlight small, innovative vendors who might not make your radar otherwise, another good idea (if you know one or are one, check in).

You also gave us a couple of great ideas for major, separate offerings that we may do if I can figure out how create extra hours in the day. Since I work full time, I’m close to maxing out at maybe 90 hours a week, so maybe it’s time to hire more helpers or something. The ideas were good and have been suggested before, so I’m confident they would be successful.

Inga’s Update

Cerner is participating in a community outreach program that will bring in 45 Kansas City area high school students for half their school day. The curriculum will focus on teaching students the skills necessary to succeed in the workforce, particularly team work and problem solving. Good stuff.

The chairman, CEO, and CFO of Misys show enough confidence in the company’s direction to pull out their checkbooks and make substantial purchases of additional shares.

The chief of neurosurgery at Brigham and Women’s Hospital is accused of sexual discrimination in a lawsuit filed by a female surgeon who believes she was denied promotions in favor of male colleagues with less experience. Whether true or not, the chief definitely has odd taste in office decor and at a minimum has been accused of having a pretty annoying sense of humor. (I will leave my “men are pigs” comments to myself.)

MD Anderson is implementing MedAptus’s Facility Charge Capture and Infusion Services modules. Eight infusion centers will initially use the programs for reconciling the charge review, approval, and transmission processes.

E-mail Inga.

News 3/28/08

From Cherry Rojas: “Re: PHR fiasco. The State of Washington issued a $2 million dollar RFP for a demonstration project to link the EMS system in four counties to PHRs last fall. An out of state vendor won it December 12 using smart cards to verify patient ID and to hold their critical patient information, readable by portable reader. Two in-state consultants who wanted to sell the state proprietary software and (and who sat on the Health Information Infrastructure Advisory Board) got their legislators to cancel the RFP before the contract could be signed in February. SMART Association, the apparently successful vendor, had no idea it was an inside game. All references to the RFP have been pulled down from the DIS web site (but we have copies). How will we ever change healthcare if it’s just another inside game? Some DIS staffers were so upset that they were ready to quit.”

From Bruce: “Ars Technica, a popular tech news web site, has posted an interesting article on EHRs and PHR. Very high level, but it’s interesting to see this hit the mainstream tech community.” Link.

From Up to You: “Re: Scott Wallace stepping down as NAHIT CEO. This was WAY overdue.”

From Dutch Treat: “Re: PHR/EHR. EMC and InterSystems are testing the PHR/EHR waters in Northern Europe. IBM runs Denmark. Who’s next? Case in point: unlike RHIOs in in the USA, governance and funds make a difference in Euroland.” Link 1, Link 2.

From Art Vandelay: “Re: dumb EMRs. Many specialists using Epic find the EMR dumb until more configuration is done. This is always a tough position for hospitals or medical groups rolling out Epic. In the typical Epic EMR implementation, the first step is to focus on primary care in the ambulatory setting and hospitalists in the hospital setting. To make it more usable by the specialty physicians, a second round of tailoring then occurs. It is much easier for the implementation team to initially go with SmartText macros for notes and a few order sets for specialists. The team comes back again later with more focused templates for specialists. This causes many headaches in organizations without strong leadership, a large team, and good content management capabilities. By now, a couple of years have gone by and it is time for an upgrade, so progress may stall while the upgrade is tested. Still later comes the health maintenance reminders with the specialists saying, ‘WOW, you mean I get to use some of the discrete data I entered?’ Next, comes the focus on making sense of the order set and template proliferation. Few places take content management seriously and later have clean-up to do. It may or may not be time for another upgrade or the roll out of more specialty models. At last, many places then get to publishing queries in Clarity (data warehouse) for more advanced users to use in delivering care where some reminders may not exist. As with larger clinical systems, it is a toolkit. If the organization doesn’t have the right size team to match the hospital or clinic’s desire to implement and strong sponsorship to focus attention on the goals of the implementation, it is a rough uphill climb. It takes time, money, super-users, technology resources and a strong infrastructure to deliver the product. A place implementing an EMR can learn from Allina and Kaiser. Allina seems to have had great super user involvement. Kaiser has a content management discipline and content teams to quickly go area-by-area.”

I got an e-mail from Bryan Walser, MD, JD, CEO of Perlegen Sciences, Inc. about the company’s activities with the unnamed EMR vendor. Actually, it was the same “letter to the editor” sent to other publications, so I don’t see much point in running it here. I asked him for an interview and he declined. I’m mostly interested in the EMR vendor, of course, and I’m still trying to find out who it is.Design Clinicals has a new web site, I noticed.

Philips will buy Irish cardiology software vendor TOMCAT Systems. Lots of informatics activity in Ireland, it seems (field trip!)

Information Week digs around the Gnutella file-sharing network using LimeWire peer-to-peer software to see if business documents might actually be found there. Downloaded:  banking passwords, credit card numbers, credit reports, tax returns, cell phone numbers of senators, meeting notes, and medical documents listing patient names with HIV status. The default setup of those P2P clients is often confusing about which PC folders you’ll be sharing with the world, so it’s likely that employees were so anxious to start downloading that they were sloppy in its setup.

Jobs: EMR Developer, Clinical Improvement Analyst, Meditech Clinical Consultants, Physician Liaison. There’s a ton of new jobs listed, I see, so take a look and sign up to get Gwen’s weekly job listing.

A few folks missed the HISsies cartoon, so I’m listing the winners below.

HIStalk readership will break another record this month. It’s nearly there already with four days left in March. Sitemeter projects 66,796 visits and 101,700 page views. Thanks to those who read, sponsor, e-mail me stuff, and spread the word among colleagues. It means a lot. I’ll have an update on the broad themes from the reader survey in a couple of days. One of them: everybody loves Inga (and rightly so).

New text ad to your right: InteGREAT Healthcare, which offers consulting services in the areas of application integration and interoperability.

California will delay for two years its plan to track prescription drugs to prevent counterfeiting, moving it back to January 1, 2011. Everybody in the drug supply chain said they wouldn’t be ready and would have to stop selling drugs in California (riiiiight). How about that nimble pharma industry, of which Pfizer says it will need 5-7 years just to put serial numbers on its products, even though it’s already doing that for some of its high-profit drugs like Viagra?

Allscripts files a new 8-K that describes the mechanics of its proposed merger with Misys Healthcare. It says the per-share value to MDRX shareholders is $14.30 to $16.20, an 85% premium to the share price the day before the announcement. Shares closed today at $9.06 if you want in.

Cerner shares hit a 52-week low today. Share in athenahealth are dropping, too, and PSS sold some of its pre-IPO stake Wednesday. Nothing’s going to do consistently well in this market, of course.

Former Harvard Vanguard CIO Tom Congoran will fill in as CFO of Massachusetts practice group Atrius Health, which has cleaned house on its executive team after parting ways with former CEO Debra Geihsler.

Harvey Picker, founder of the Picker Institute that promotes measurement of the way patients experience healthcare, has died at 92.

Cambridge Consultants says its Vena single-chip platform can allow medical devices to transmit data wirelessly for less than $10.

RemedyMD will integrate the disease models and biospecimen management system of GulfStream Bioinformatics Corp. into its Investigate research software.

The all-lower-case api software (annoying, yes?) acquires EPEPCS, a tool that estimates required nursing hours and skill mix.

E-mail me.

Inga’s Update

Dr. Deborah Peel’s Patient Privacy Rights organization has posted a summary outlining each remaining presidential candidate’s stand on patient privacy. It’s worth a read if the topic concerns you.

Mediware announces that its blood management software systems are ready to accommodate ISBT 128 labeling.

Oshsner Health System is implementing new DocuSys technology for pre and post surgical care. The solutions will be used across Oschner’s 28 operating room and 15 other anesthetizing locations.

Some not-so-good news for McKesson. A US District court certifies a $7 billion nationwide class-action lawsuit against McKesson on behalf of consumers and third-party payers. It has the potential to be the third largest class action suit in the US. It charges McKesson engaged in a scheme to fraudulently inflate the price of more than 400 prescription drugs.

While it’s unlikely to cover the extra $7 billion, McKesson is partnering with Clorox to develop and promote disinfection protocols for mobile equipment and handheld devices.

Nebraska’s Great Plains Regional Medical Center selects Eclipsys Sunrise Clinical Essential for EMR and medication management. They’ll add additional Sunrise products after Essentials is deployed.

Thank you Wheaties Gal for sending me this link for an inspiring new bingo game. “This does not have to do with big mergers or company layoffs- has to do more with passing time in those boring IT meetings where they think nothing of rattling off acronyms and trying to put together sentences around the latest business buzzwords. Here is a site that you can print out ‘B-S Bingo’ cards. I think you would have to be careful not to yell out (like the girl in the TV commercial). Some meetings I have been in lately, I could get a cover-all in 30 minutes- or less.” I am on the same page as you on this, Wheaties Gal. Going forward, for all mission critical enterprises Mr. H and I will simply set our goals, leverage our resources, and just get it done.

Speaking of getting it done, I was making up some pretty charts for Mr. H showing the growth in readers over the last 18 months. The number of monthly visits has doubled during that time period, which is pretty darned impressive. So keep telling your friends because it sure seems to make Mr. H happy!

E-mail Inga.

HISsies 2008 Winners

Smartest vendor strategic move
athenahealth, for its initial public offering (IPO)

Stupidest vendor strategic move
Medseek, for laying off employees right before Christmas

Most impressive vendor sales deal
Epic, Cedars-Sinai

Best healthcare IT vendor
athenahealth

Worst healthcare IT vendor
Cerner

Best provider healthcare IT organization
MD Anderson

Vendor most likely to be acquired in 2008
Allscripts

HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
athenahealth

Most promising technology development
Software as a Service/Service Oriented Architecture

Most overrated technology
RHIOs

Biggest HIS-related news story of the year
athenahealth’s IPO

Best speaker you heard at a conference in 2007
Jonathan Bush

Most impressive vendor at the HIMSS Annual Conference in 2007
athenahealth

Most overused buzzword
Interoperability

Most effective CIO in a healthcare provider organization
Judy Middleton, William Osler Health Centre

HIS industry figure with whom you’d most like to have a few beers
Jonathan Bush, athenahealth

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
Jonathan Bush, athenahealth

You and Vendors Stop Groping Each Other — Pass on Swag, Keep Your Integrity

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in September 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Stanford Hospital last week joined the growing number of academic medical centers that prohibit their physicians from accepting gifts from drug company salespeople. The reps aren’t even allowed on campus, except by appointment to conduct product inservices.

Bravo to Stanford. Physicians think they’re too savvy to be influenced by free lunches, rounds of golf, or drug samples, but drug companies know better – subtle bribery works. If it didn’t, they’d stop. A $100 staff lunch influences even a $500K a year doctor whose prescriptions for one medical condition might generate thousands of dollars a week of business for the drug company.

I’ve taken my share of IT vendor goodies: junkets, executive dinners, trips on private jets, and one memorable evening spent in an internationally known billionaire’s back yard. Having thereby flouted the rules of propriety myself, I’m qualified to issue my first-ever standards of conduct for CIOs and other provider-side executives.

The most important fact is this: it doesn’t matter whether your acceptance of vendor swag is improper; it matters only that it might appear improper to an outsider, like the attorney of a bid-losing vendor who’s suing you for tortuous interference or the 60 Minutes camera crew accosting you on your way to drop the kids off at school.

It’s obvious, but if your organization is sending out RFIs or RFPs or is otherwise involved in system selection, accepting anything is unwise. Even speaking to vendor reps is not smart. Don’t let vendors provide free lunches or giveaways for employees attending demos. Vendors shouldn’t pay for your site visits – if you can afford their product, you can spend your organization’s own money on flights and hotels. Besides, spurned vendors aren’t nearly as chummy afterwards, I’ve found.

Otherwise, lunches are always OK, whether one-on-one or group. Stuff for the IT department is OK, like shirts, food brought in, or sports tickets. This is the IT version of the unrestricted grants that drug companies offer, where you accept small items without reciprocating and the chance of undue influence is minimal. Corporate ethics people are usually OK with this, as long as the gifts aren’t for the specific benefit of an individual.

On the other hand, it’s never OK to solicit stuff from a vendor: free software from the Microsoft rep, donations for a pet cause, money for a department party, or entry fees for a fundraiser. Vendor strong-arming is tacky.

I also don’t like the idea that vendors buy access by sponsoring conferences and giveaways for HIMSS and CHIME, but that’s apparently a hopeless cause. It looks like Halloween, except the trick-or-treaters are wearing suits or conscientiously casual golf apparel.

Spouse trips are out. So are ridiculously transparent junkets, phony advisory board conferences, honoraria, or a visit to the German countryside to see your future PACS system being assembled. It’s tempting when all your cross-town colleagues are lining up at the feed trough, but it’s still wrong, don’t you think?

Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels: with flattery, rapt listening, and a shower of baubles. You know what they really want. Surely your integrity is worth enough that you won’t sell it that cheaply, especially knowing that they won’t respect you in the morning.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission.  To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 3/26/08

From Mitch Router: “Re: PatientsLikeMe. This really isn’t my bailiwick, but I thought your readers might be interested. It’s easy to see why doctors and researchers (in particular) would not like PatientsLikeMe.com. As a social network, great. But without scientific scrutiny collated anecdotal data may well be “interesting-in –> mathematical model + statistics –> garbage-out.” Link. An interesting New York Times article on PatientsLikeMe, where patients with a handful of specific conditions are posting detailed information about their treatments, right down to drug dosages correlated to their symptoms. It’s advertising-free, but hoping to sell information to drug companies (of course). The article has some interesting thoughts on the privacy implications of such a service and physician questions about having patients take actions based on what other patients report.

From The PACS Designer: “Re: creating your PHR. TPD has been a member of the ASTM International Healthcare Informatics E31 Committee for some time and worked with others to create the Continuity of Care Record or CCR.  Now, anyone can create their own PHR using the CCR format by using the Consumer Empowerment National Demonstration website called CEND PHR, sponsored by the American Academy of Family Physicians Center for Health Information Technology. After you creating an ID and password, you will find the following categories available for inputting your health information: Personal, Emergency contact, Insurance, Primary physician, Problems, Medications, Allergies, Family history, and Social history. After completing entries into the PHR, you can save the file and then access your PHR Portable Document File (PDF) for local printing and also save an XML file to a storage location.” Link.

From Mrs. Brown’s Lovely Daughter: “Re: McKesson Paragon. It’s cleaning Meditech’s clock in a number of regions. Key replacement announcement pending”

From Bearly Stern: “Re: Allscripts-Misys. The amazing thing about the Allscripts-Misys merger is that it could have happened years ago. John McConnell repeatedly pitched the idea to Goldberg and Skelton, but they were so focused on becoming a mini-Cerner or Epic that they squandered $500M and a huge lead in the ambulatory space. Was there any real growth or value added to Misys from year 2000 onward? Leadership’s main ideas were cutting cost as a growth strategy and making it prohibitive for existing practice management clients to buy a non-Misys (read: workable) EMR. This while touting ‘interoperability’ in a failed strategy to connect the products of three business units.”

From Esther: “Re: data mining. I CANNOT confirm the vendor, but I can tell you, as an ex-[company] employee, that [company] is very interested in data mining of patient information. Prior to the opening of the [company] employee clinic, we were told at a town hall meeting that any lab work done in our clinic could and would be used for a DNA project [company] was working on. Trust me – you could hear a pin drop during that announcement. There was a lot of uneasiness expressed after the meeting, but as far as I know, no one ever took them to task on it. Those of us who were truly concerned made sure that we didn’t get any blood work done on the premises!” I expunged the company name since it’s a bit of a hot topic right now and I don’t want to cast any unearned aspersions, but you can probably figure out who she’s talking about. Unconfirmed and still waiting on the smoking gun. Possible clue: four million patients? That’s a big footprint. Maybe it’s a clearinghouse owned by an EMR vendor – the Perlegen press release didn’t say it was EMR data, only an EMR vendor, and it refers to an “information warehouse” that would imply either hosted systems or a transaction database. Hmm.

From Dutch Treat: “Re: data mining. What about this company helping the pharma sector?” Link. IntrinsiQQ LLC, the company behind web-based chemotherapy dosing system IntelliDose, didn’t rack up enough paid monthly subscribers, so it started selling de-identified information about drug usage to drug companies. At least the drug companies don’t have plans to re-identify data or contact patients. Still, patients not only have to trust a company with which they have no legal relationship, they probably don’t even know their data is being bought and sold. Somebody could start a nice little company testing and certifying de-identification processes.

From Larry Lonesome: “Re: development. I would be interested in the perspective of users/purchasers of clinical applications, as well as developers of these applications, regarding AJAX application development versus smart client versus any other relevant methodology. Do hospitals have a preferred technology platform? Is AJAX development robust enough to handle the heavy lifting of clinical applications? Does a .NET smart client really solve deployment issues as neatly as a web application?”

Recommended: if you’re a Firefox user like me, upgrade now to the Beta 4 version. I don’t generally use beta releases, but this one’s a screamer (many times faster in Google Docs and other AJAX-type apps). Most plug-ins aren’t available yet for the Beta version, but all I really use is the Google toolbar and it already has a Google search box. Zero problems here.

Girish Kumar of eClinicalWorks passed along a short comment on the Mass BCBS conclusion that EMRs aren’t worth their cost to doctors. He says that eCW has a 95% adoption rate and that most of the physicians using their system would say they’re better off with it than before.

Reminder: if you’re not getting e-mail updates, put your e-mail address in the “Subscribe to Updates” box to your right, even if you’ve already subscribed from the old site (which is no longer being updated, thus not sending out e-mails). If you’re not sure, sign up anyway – it will tell you if your address is already on the list and you won’t get double e-mails.

Intercepted e-mail: Kaiser’s medical group will start a pilot this summer of a thumb drive-based Personal Electronic Medical Record for emergency use. Files are encrypted and read-only, printable to PDF. Contains a concise record of hospitalizations, allergies, doctors, visits, labs, problems, and demographics. Sounds pretty cool.

Tennessee Medicaid will pilot e-prescribing using Cerner software.

Donna Krause is named CIO at Truman Memorial Veterans’ Hospital, having worked her way up from pharmacy aide over a 25-year career there. Congratulations – darned impressive.

Financial Times says investors are skeptical of the proposed Allscripts-Misys merger, with investors passing on the new shares issued to fund it, leaving ValuAct Capital to eat them themselves. From the piece: “… suggesting US shareholders either don’t believe Misys Healthcare is worth this much, don’t believe the deal will go through, don’t understand it, or don’t trust a management that has presided over 64 per cent share price decline over the course of the year.” They missed one: that continued Misys involvement might actually be negative to the business Allscripts was already doing.

The CEO of MedAssets is team director of the US Olympic wrestling squad. Something else to wrestle with: its Q4 numbers, Revenue up 45.7%, EPS -$0.20 vs. -$0.16. Shares are down a third since the December IPO, with a market cap of $706 million.

Stolen, unencrypted, PHI-containing laptop #650 or so: NIH.

An Australian hospital is accused of hiring a nurse to manipulate the “time seen” ED triage data to make the hospital look better.

Robert Wiebe, formerly of the VA, is named SVP/CMO of Catholic Healthcare West.

E-mail me.

Inga’s Update

Lynn County Hospital District (TX) selects Opus Healthcare Solution’s OpusClinicalSuite for its patient information system. The three rural hospitals within the district will use OpusClinicalSuite ASP.

Design Clinicals adds a new client in Iowa. Myrtue Medical Center (IA) is implementing its MedsTracker medication management program.

Medinotes partners with Hawaii’s Akamai Practice Management to provide EMR to small, independent practices. Akamai is a practice management and reimbursement service provider.

digiChart’s OB-GYN Version 7.0 is the latest EMR ambulatory package to receive CCHIT certification.

I suppose because it is such an important use of our tax dollars, HHS just opened a second public comment period to define the following terms: EMR, EHR, PRH, HIE, and RHIO. Actually HIE has already been defined as “the process of electronic health information exchange, not a governing function or entity” so HHS now needs names for a sixth term that will describe “the function or entity that governs health information exchange beyond the confines of a specific regionally based community.” Personally I think Mr. H and I should have opened the blog up and gotten readers to define the terms and then pocketed the millions HHS is spending on this project.

Transcription system provider Healthcare Technologies is partnering with GSA vendor Network Federal. The agreement will facilitate the delivery of HTI’s medical transcription programs to federal, state and local government healthcare customers.

EMR Dude sent me a link to his blog “The Crabby Daddy,” where he provides some commentary on the Allscripts-Misys deal, noting his ties to both companies (he worked at Medic and A4 and now Allscripts.) His take is that the market was in need of consolidation and sends a reminder to the new management that “people enjoy working for a company where quality of life and a fun factor are present.” Probably a good reminder if Misys is involved. Remember this post from a few months back? “From Dan Panama: Re: Misys. Vern said at the business update yesterday that an overwhelming number employees in the employee survey said they are not having fun anymore. Vern’s response: ‘You have to earn the right to have fun.'”

And while I was on Crabby Daddy’s site, I noticed a post about the Common Ground Clinic going live on EMR. This is one of the New Orleans clinics that received funding from HIMSS (and Allscripts in this case) to fund EMRs in the Katrina aftermath. It’s led me to wonder how many other clinics have successfully gone live as part of the HIMSS Katrina Phoenix project and what applications they are using.

I sat in during part of HIMSS’s first virtual conference last year and found it interesting enough, especially for a person who lacks the discipline to listen to a webcast without checking e-mail and taking the occasional phone call in between things. I am almost positive that the first time around that you had to pay a fee if you wanted to participate in the education sessions for CME credits. However, for this third one coming up April 23-24, I notice the whole event is free. Plus there seems to be a strong list of speakers, including Jonathan Bush, Matthew Holt, and John Halamka. I have to assume the exhibitor packages (which start at $5,000) are selling like hotcakes or else HIMSS wouldn’t be offering the conference at no charge.

I am sad to report that I a clear loser in the basketball pool. I knew my selection of Duke was risky, but who would have guessed they wouldn’t make it past the second round. My sole consolation at this point is that I am ahead of Mr. H, but given North Carolina is his top choice he still has a good chance for a strong finish. I’m cheering for Davidson here on out.

E-mail Inga.

Monday Morning Update 3/24/08

From Fresh Prince: “Re: P4P. There are several patient satisfaction measures in P4P that makes it a horse of a very different color. Medicare will hold back 5% of total Medicare payments, then you have to ‘earn’ it back through quality measures, like patient satisfaction surveys. I think it’s inevitable that it will turn hospitals upside down more so than DRGs in 1983. Think about this: you can give the patient the best medical care on the planet, but if he/she has to wait four weeks for an appointment, gets bumped due to ER cases, or has to sit outside X-ray for an hour, do you think they’ll say they are satisfied? Oh yeah, and what about that hospital food? There isn’t an HIS system out there ready to deal with it.”

From Artie Lange: “Re: eClinicalWorks. eCW may have implemented their systems in MA, but looks like they aren’t working. I wish you would have asked their CEO a question on this.” Link. Reported here earlier – Mass BCBS says EMRs aren’t worth the cost to doctors. But, that has nothing to do with eCW or any other EMR not working. In fact, it says the opposite – that EMRs provide value to everybody except the physician who’s expected to foot the bill. I agree that I should have asked Girish about this – it’s a conundrum that isn’t going away soon and I bet he has an interesting take on it. Maybe he’ll respond.

From LaToya Jackson: “Re: Walnut Creek. I’ve heard that there is a big Epic implementation going on in Walnut Creek, CA. I think this would have to be Kaiser or John Muir. Kaiser is a known Epic site but, I thought that JM was a McKesson shop. Anyone know who is doing the project?”  

Intercepted e-mail snips about Misys/Allscripts: “Misys has a huge client base running the old +Medic/Tiger product. In the new environment this old COBOL based system cannot survive for long. Just think of the product mix/mess these guys are in. +Medic/Tiger, Misys Vision PM, Misys EMR, Healthmatics PM, Healthmatics EMR, Touchworks EMR (and all the jumbled pieces that make up Touchworks), Imedica. What the heck will they be selling, and what will they sunset? [A Misys rep who lost a deal] had offered a 60% discount!!! … The two ugliest people in town just got married, and it’s scary to think of what the kids are going to look like.” A bit exuberant, perhaps, but I tend to agree in general. Few will buy until the dust settles, which will take at least a year. Neither company was exactly tearing it up on sales, so now competitors have another weapon to create FUD in the minds of those hospital CIOs and big practice administrators who tend to buy stuff like theirs. Does having Misys involved make Allscripts more attractive to prospects or vice versa? It wouldn’t to me.

To put the Allscripts dilemma into perspective, here’s how the shares of some publicly traded HIT companies did over the past year, sorted from best to worst.

Eclipsys – up 2%
Dow Jones Industrial Average – no change
McKesson – down 3%
Nasdaq Composite – down 8%
Quality Systems (NextGen) – down 18%
Cerner – down 31%
QuadraMed – down 36%
Misys – down 41%
Allscripts – down 66%

The two worst-performing companies will hold a shotgun wedding, with the one that’s burned through 2/3 of its shareholder value in the past few weeks providing all the management talent under the board oversight of former competitor that’s down 41%. I’m not seeing the magic, especially looking at the science fair of products soon to be under one roof. People keep talking about “footprint” and “combined sales”, but what would make you like the two companies combined that you didn’t like about them separately? Or, what synergies will help them boost sales against the same formidable competitors like eClinicalWorks, e-MDs, athenahealth, and NextGen? Sure, the Misys customer base has low EMR penetration, but so does the entire industry – that doesn’t mean they’re going to buy an EMR from Allscripts or anybody else, especially at high prices. Allscripts keeps trying to sell vision instead of results, while Misys just wants to protect its big but steadily eroding maintenance revenue from old sales. And the kicker is that fickle investors who were quick to bail out on Allscripts will now have even higher expectations for the MDRX/newco shares after all the flowery talk about synergies.

So, here are my predictions. Odds that the Misys/Allscripts merger will get shareholder approval (especially with John McConnell as a major MDRX shareholder): 60%. Odds that the proposed management team will survive a year intact: 40%. Odds that the market cap of MDRX will increase in one year after the deal closes: 20%. But, I’ve been wrong before.

Jobs: Business Intelligence Analyst Developer, Senior Network Analyst, Senior PR Account Executive, Sales Executive – Healthcare IT. Sign up for weekly job alerts.

I messed up a couple of Inga’s links in the last issue, so those are fixed now. It wasn’t a devious ploy to get more readers for Scott Shreeve’s blog since that’s where the links mistakenly pointed.

Great idea: the Michael J. Fox Foundation offers up to $1 million in grants for the development of web-based clinical assessment tools for patients with Parkinson’s disease, which will allow clinical research to be performed without the burden of patient travel. Proposals are due May 14 and funding will be available in October. Thanks for that tip from the guys at Healthcare IT Transition Group, who also report that their cartoon announcing the HISsies winners has been viewed more than 2,000 times (the connection being, of course, that they portrayed Jonathan Bush as Marty McFly from Back to the Future in the cartoon because he kind of looks like MJF).

UCLA’s psych hospital, fresh off the Britney Spears debacle and a new incident where patient photos were published on a social networking site, bans cell phones and laptops.

Guess HIMSS gave up on the idea of blogging live from the conference. Its HIMSS Live! site now brings up a “page not found” error, although HIMSS still owns the domain. And speaking of fun domain name facts to know and tell, who knew that Cerner has pre-emptively registered CERNERSUCKS.COM?

Speaking of HIMSS, I checked the hotel site for HIMSS09. The cheapest Chicago hotel is $225 a night. I may Priceline it since that’s worked before.

A couple of folks expressed interest in producing something about medical device connectivity. I’m thinking we could put together an informal white paper for CIOs from multiple viewpoints. If you’re interested in helping, e-mail me. I’m curious to see if we can harness the collective knowledge of HIStalk’s readers to create something useful for the industry.

Inga wants me to brag on how well she and I are doing (for now) in the unnamed vendor’s NCAA basketball pool. We may have peaked Friday night, when a lucky Siena pick over Vandy (time for McKesson to buy the team?) propelled me to #1, with Inga right on my heels at #3. She was quick to conclude, “You and I are clearly geniuses.” Some bad luck since sent us to #2 and #8, respectively, and I’ve got some early losers going deep that will hurt me. I’m thinking of handicapping the pool by choosing schools that aren’t on the Most Wired Hospitals list.

Speaking of Inga, she’s in touch with HIStalk’s sponsors regularly and reminded me of something important. Some sponsors are interested only in page views and ad clicks like with any other advertisement (which is fine), but many/most of them support HIStalk because they believe in what we do. I can’t explain how gratifying that is. Magazines and other online sources would kill to have our loyal sponsors and readers. Just in case I haven’t said it lately, I sure do appreciate it. Thank you.

Deborah Peel renders an opinion on the data mining agreement signed by genetic medicine vendor Perlegen and an unnamed EMR vendor, calling it The New Tuskegee.  I want to know who that EMR vendor is. Everybody seems to be beaming about their data deal, so let’s name names. If you know (and especially if you have documentation to prove it), use the confidential Rumor Report to your right to tell me about it. It’s ironic that the EMR vendor is demanding privacy about its deal to sell patient information.

British researchers are working on an enhancement to the Da Vinci robotic surgeon that will allow it to be controlled by the surgeon’s eye movements.

Rural hospitals in Tanzania are using the Internet, scanners, and digital cameras to connect with a referral hospital for telemedicine services, important in a country where transportation to the hospital can cost several months’ of the average wage.

It took a TV station’s intervention, but a Sentara Norfolk ED patient finally gets his medical record corrected to show that he had not, in fact, delivered twins there.

SafeMed, a San Diego decision support engine vendor, will provide Google Health’s drug interaction and treatment recommendation capabilities. Former Amicore CEO and Microsoft manager Richard Noffsinger is CEO. For those who say nobody ever sells anything at the HIMSS conference, Google execs happened to pass SafeMed’s HIMSS06 booth in San Diego and asked for a demo, which was followed by a deal.

Harris Corporation gets an HHS contract to plug federal healthcare agencies into the Nationwide Health Information Network.

I’m sure it will offend someone, but I’m still wishing you a Happy Easter in a non-denominational, rabbits-and-eggs sort of way.

E-mail me.

News 3/21/08

From Gail Kafka: "Re: P4P. Do you or your readers have any data on the Patient Reported Outcomes market and the IT providers in it? I rarely see articles on this topic unless they are from academia or IHI/IOM. If P4P comes to be, which seems inevitable with consumer cost and awareness increasing, then why isn’t there more chatter about measuring performance from the patient’s perspective?"

From Larry Lezure: "Re: Misys/Allscripts. It’s a reshuffle of the deck with two players holding bad cards. All they have in common is overpriced products and getting their asses kicked by eCW, which will benefit even more as they try to retire products. The most interest part of the story is currency arbitrage — a UK company getting a big discount because of the low value of the dollar against the pound." New poll to your right: is the merger a good idea? So far, 76% say no.

From Stan Zloty: "Re: Medcomsoft. I know eCW doesnt like athena’s EMR, but looks like Medcomsoft sure does." Link. The Canadian EMR vendor gives up on direct sales and seeks partners to create an athenahealth-like business model.

From Nicholas Birdcage: "Re: medical devices. With today’s mention of device connectivity as well as Isarona, any thoughts at doing a piece on the players in these market?" I like the idea, but would need some help since I haven’t followed it all that closely.

Intellect Resources will host a webinar on becoming an independent consultant on March 25 at 8:00 Eastern. They’re also starting e-mail newsletters for job seekers and employers, with sample issues coming soon.

I hope everybody made the transition off the old Blog City HIStalk site. Put your e-mail in the "Subscribe to Updates" box to your right if you aren’t getting an e-mail blast when I write something new. You can sign up for the Brev+IT newsletter over to your right, too. And in looking over there, I just realized that HIStalk’s fifth birthday is coming in June.

My editorial this week in Inside Healthcare Computing: "In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System." A CIO e-mailed me to say he liked it, so I’m relieved (I bet the free mags don’t work a Speedo reference into many headlines, at least unless it’s one of those lame puns they love).

The New England chapter of HIMSS will host a killer HIT forum (warning: PDF) in Norwood, MA on April 9. Speakers: Senator Richard Moore, Blackford Middleton, Karen Bell, Francois de Brantes, Girish Kumar, and Jonathan Bush (there are other big names, including CEOs). Frankly, I like the lineup better than HIMSS, plus it’s one big day for $80. I should have had an HIStalk bash there.

Maine Medical’s CEO, Vince Conti, quits for unnamed reasons.

More on Misys/Allscripts. Most of the UK analysts think Misys is paying too much, while most US analysts think Allscripts sold out too cheap. Since the deal has to be approved by shareholders, that could come up in the voting. And, it’s subject to Allscripts getting a better offer, which has happened with similar companies (iSoft, for instance). I doubt John McConnell would make a run of his own on MDRX, but I wouldn’t rule it out. I just have this vague feeling that it isn’t over yet, especially since the response from all camps has been underwhelming.

Stock and HIT expert Sonomaca had some good thoughts on the Allscripts stock message board. He says it will help Allscripts because the company can focus on long-term strategy and not quarterly results. Also, since the market seems unimpressed from the current share price, ValueAct Capital could buy up more of the company. From his calculations, Allscripts shareholders get a Misys Healthcare for four cents per share, based on the one-time dividend (or, looking at the other side of the coin, the market is valuing the combined company at just $4.40 per share, or 10x earnings). Maybe that’s why the Brits were howling.

And in more Allscripts news, former star customer Tennessee Oncology is suing them.

Orion’s Rhapsody integration engine will be used to integrate systems in Saudi Arabia.

A Minnesota hospital admits that a chart error caused surgeons to remove the wrong kidney from a cancer patient, leaving the patient with only its still-cancerous twin.

E-mail me.

Art Vandelay on Cerner

As Mr. HIStalk noted, Cerner is diversifying its revenue streams in a coming bear market. Cerner’s medical device and drug-development are long lead-time investments with major barriers to entry. The barriers include human capital, systems, and process & procedure knowledge to navigate regulations. They also have to handle new competitors. I see this strategy being copied by all the major clinical systems vendors.

The approach we will likely see from vendors will evolve to full venture capital investments. There is power in using some of the de-identified data that should be captured with the vendors’ systems to find potential investments. The vendors can then use the data to prove the value of further investment independent of the necessary FDA regulations (ex: 21 CFR 11). This could keep investors interested. To make this real for everyone, only organizations with "Stage 6" EMR deployment can reliably make this happen.

For Medical Devices, expect copycats to mimic Cerner’s CareAware or Cisco’s Cisco Compatible Extensions (CCX) strategies. Vendors will likely certify and partner as opposed to developing medical devices.

Is this a distraction from their core business? You bet it is. The vendors will view it as a necessary strategy to preserve their publicly traded prospects in a bear market.

What does this mean? Three things. First, R&D will be negatively impacted. The enhancements you expect from your vendors will be slower in coming. Expect the vendors to ask you to share the burden of investment for new functionality saying it is beyond standard maintenance arrangements. In other words, "great idea, you want the function, help us develop it (with your human AND financial resources)." Second, the privately-held companies will be even better positioned to weather the storm. Third, companies that are already diversified (ex: McKesson, Cardinal) have a chance to catch-up or pass their competitors if they focus their investments.

Inga’s Update

For the parsimonious (like Mr. H) here is a great list of free or cheap software products, with substitutes for such programs as Word and Adobe Photoshop plus anti-virus tools.

Time Magazine also published a recent article, Is shrink-wrapped software dead? which included a handy side-by-side comparison of the free solution versus the commercial option. The article’s title reminds me of the bright yellow tee shirt Jonathan Bush was seen wearing at HIMSS which said "Software Is Dead" – to the 4th power. Apparently Jonathan tried to convince his PR handlers to let him to wear the shirt for his CNBC interview conducted during the conference, but eventually was persuaded to wear a more Street-pleasing coat and tie.

I guess I didn’t sound pathetic enough when asking for advice on the NCAA basketball brackets. I had to fly solo on my selections and ended up picking Duke to take it all. I actually hope I am wrong because I have a favorite team I’d rather see crowned, but I wasn’t willing to risk my $10 bet on them.

From Nasty Parts: “I was one of the early guys calling the Misys/Allscripts merger. I’ve been talking to guys from both sides of that divide. Here’s the scary part: both of them think they are in charge. Could be a slow motion train wreck. Wait until the long knives come out and folks start fighting for their areas of authority -  it won’t be pretty. Plus, we are not even yet talking about product go-forward strategies.” If Nasty is right, maybe John McConnell was the smart one to get out of the way now.

From Poo Flinging Monkeys: “Most Allscripts folks feel like they are getting the short end of the stick, as the big M is generally seen as a dead carp around someone’s neck. There are a LOT of folks who migrated from Misys to Allscripts who groaned out loud at the announcement. The Misys folks are a bit relieved as the last few months and years really have been obviously leading up to SOMETHING, but nobody knew what. All knew Vern was coming in, stripping it down, and selling it off. Most think that Misys EMR should have died a while back. The Allscripts product will be the flagship EMR and there will be an obvious push to get the Tiger folks introduced to it. Big open market there. The Allscripts PM is okay, but generally not as shiny and end user intuitive as Tiger, so there will probably be a push to interface those 2 products while sun-downing the Misys EMR product.” Heard that Misys had a town hall meeting for employees today. I doubt that Vern has answers to all the questions, particularly the one that employees are asking most: how does this affect me?

And if you haven’t heard enough on the topic, check out Scott Shreve’s posting at Crossover Health entitled The Lawrie Dowry: Misys Acquires Allscripts in Rushed Marriage. Lots of interesting points out the new “Allscripts-Misys-I-am-NOT-giving-up-my-name Health Care Systems” company.

Minnesota law will require all healthcare providers to use an EMR by 2015. It provides six-year, no-interest loans to help providers get there. The first two loan recipients are Swift County-Benson Hospital and Mille Lacs Health System, which are borrowing a combined $2.3 million.

I haven’t heard if Dr. Peel is gnashing her teeth on this one or not, but genetic research company Perlegen Sciences announces a collaboration with an unnamed EMR vendor for access to the clinical treatment and outcomes data on about four million patients. The information will be supplied from the EMR vendor’s information warehouse. Perlegen will use highly specific inclusion and exclusion criteria to identify and develop genetic markets for predicting patients’ likely response to specific medication treatments. What I find curious is that the EMR vendor remains anonymous. If this particular EMR company believes providing the data is ethical and not in violation of any customer agreements, why not allow themselves to be named?

Duke University will implement Premise’s PatientFlow Platform to facilitate patient flow across its three hospitals.

Big controversy brewing in Texas over who owns the ankle. Seems like podiatrists and medical doctors are both claiming it’s theirs to treat and are going to court to let a judge decide. Lawyers for the podiatrists claim “you don’t have an ankle” because is really part of the foot…no foot, no ankle. Of course the orthopedic surgeons say that if ankles don’t exist then why do podiatrists want to operate on them. Quite the conundrum obviously. I have been told I have nice ankles and I don’t think my feet are nearly as attractive, so I’m thinking I will go with the MDs on this. If the podiatrists win then I’ll have one less appealing asset.

E-mail Inga.

Let Patients Control Their Healthcare Data: Give Them an Al Gore Lockbox

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in February 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

I’ll confess that I’m paying minimal attention to the RHIO craze. Everybody’s starting one, conferences are showcasing speakers who’ve done nothing more than announce theirs, and tiny grants are getting the whole industry atwitter. It’s like living the dot-com frenzy all over again, irrational exuberance and all.

I’m not against RHIOs, but they’re as annoying as CPOE was awhile back, taking resources away from projects that could provide more benefits to patients without the minefields.

I recently interviewed Denni McColm, an award-winning CIO of a 74-bed rural hospital no different than 80% of those out there. Oh, except that they’re 100% paperless and 100% CPOE, something virtually none of the celebrity CIOs and Taj Mahospitals have been able to accomplish. I’ll listen to her, thanks.

First, Denni believes that organizations should be banned from using the word “interoperability” until they can bring their own electronic information to the table. If your IT house isn’t in order, RHIOs don’t need you. Anything short of everyone’s contributing information equally will cause the whole concept to collapse like an imploded 1960s Las Vegas hotel, so paper jockeys need not apply. Work instead on projects that will help your patients more than the begrudging swapping of routine lab reports with your cross-town competitor. Or, integrate all those systems you already have. Your admission ticket should be a checklist of what data elements you can supply electronically right now.

Second, Denni advocates a patient-centric RHIO model instead of the common payor-centric one. Do you like insurance companies enough to let them control patient information?

By patient-centered, I don’t mean personal health records. People are too irresponsible to reliably collect and store data with life and death importance. On the other hand, they could be given control over the trusted information generated by hospitals, physician practices, and other providers.

Suppose everything resided in an Al Gore-type lockbox that contains everything from discrete electronic data to scanned documents fed over the Internet. Either the patient controls the key (similar to a password) or only they can initiate data delivery to a provider. If they don’t want you to see it, you won’t.

This model makes most privacy concerns go away. It avoids the largely unsolved problem of how you assign some sort of universally mandated patient identifier (aka “political suicide”) to sort out the throngs of people sharing the same name. The patient simply says, “send my data to Dr. Jones” and it’s done. They keep control and there’s no arbitrary “regional” service area beyond which lies a medical no-man’s land.

Maybe some RHIOs work this way. Like I said, I don’t follow them. And, if I can’t see a quick and obvious patient payoff, I probably won’t start following them any time soon. I’ve got plenty of challenges working on clinical system projects that will hopefully save lives right now.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission.  To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 3/19/08

From Joe Bob: “Re: consultants working on percentage of savings. I find it not only deplorable, but outright thievery and total ignorance. Children’s Hospital National Medical Center is an example. They were a top pediatrics hospital, then a new CEO hired consultants based on percentage of savings. The hospital is out of top 20. P.S. Hasn’t everyone had enough of HIMSS and their organization, or is it just me?”

From The PACS Designer: “Re: One Portal. TPD mentioned the concept of looking at personal health information in the same light as a personal online banking account. Now it comes to light that Denmark has had an online health portal for recording your health history called One Portal since 2003. It could be used as a model for other countries to emulate and get the PHR/EMR process started as an online solution.” Link.

From Niven David: “Re: economic concerns. I would have to imagine many vendors and hospitals are seeing an impact from current economic concerns, with sales slowing and hospitals tightening the purse strings. Any comments or perspectives?”

From Reggie: “Re: Allscripts. There is a rumor that McConnell quit the Allscripts board in disgust at what he felt was a low-ball offer.” It must sting. Allscripts, Glen Tullman, and John McConnell were on top of the world and McConnell’s former company Misys was on the ropes. Suddenly, one bad earnings report sends MDRX stock reeling from the high 20s to below $10, allowing Misys to gain control on the cheap. What could be lower on the HIT totem pole than having Misys as your new daddy? I bet Glen Tullman won’t like reporting to the board-controlling Brits very much. Can two struggling companies combine to make one good one while maintaining their traditionally high prices, complex technologies, and indifferent customer bases, not to mention keeping their antsy shareholders happy as the inevitable product and people consolidations occur? In this market, with nimble competitors nipping at their heels, and with the current economy, let’s just say they’ve got plenty of work to do. I expected a much better outcome for Allscripts. Mothers, don’t let your children grow up to be publicly traded.

Update: John McConnell did resign in protest from the Allscripts board Monday night. See the comment I posted at the end of this article.

From Reggie: “Re: Allscripts. There is a meeting in New York tomorrow where both Misys and Allscripts management teams will answer analyst questions. I am not clear on whether this was an emergency meeting designed to convince obviously skeptical Allscripts shareholders that this is a good deal. On paper, this is a $13 deal, which is why Tullman described it as a ‘big premium.’  Since the stock closed at $9.75, the market has priced in $3.25 worth of doubt about the combined entity’s prospects. Clearly what Allscripts needed was the help of a big operator like GE, Perot, CERN, or EDS. Were any of these companies interested?” Surely others peeked up their skirt and passed before Misys got a turn, although the overused prospect of synergy has led to many a troubled marriage.

From the conference call announcing Allscripts-Misys Healthcare Solutions, Inc. (boy, talk about an uninspiring first decision – that name reeks, at least when it’s not screaming “YOU give up your name – we’re not budging on ours.”) Sounds like some products will not be developed further (the first step to sunsetting, of course). Synergies are predicted. They like the idea of selling into the minimally EMR’ed Misys customer base (which Inga suspects means that Misys EMR and A4’s EMR are goners – they can’t walk in the prospect’s door waving competing systems). They talked about merging a year ago, but Allscripts was too expensive (the stock market took care of that little problem). I heard the two companies huddled hard for days right before HIMSS, which I assume means they desperately wanted to make the announcement there.

Someone sent me the communication sent from Misys to customers. Other than the sudden love between two formerly bitter competitors, the most interesting point was the standard boilerplate, “connect all stakeholders through the continuum of care.” Wasn’t the utterly failed Connect strategy of Misys supposed to do that? And do stakeholders, in the form of customers anyway, really care about connecting to the rest of the continuum of care? Only if you’re trying to sell to hospitals and their affiliated practices, which the new, badly named company will try to do.

Lost in the shuffle: Misys PayerPath and Home Care. They probably should deal off the latter to Sunquest or somebody, but PayerPath has promise with a bigger sales footprint (unless they sell it off for cash to QuadraMed or McKesson, which wouldn’t surprise me since it isn’t even being mentioned in all the pleasantries).

HIStalk ran plenty of speculation from readers that the Misys-Allscripts deal would happen. I admit that I was skeptical, but I said all along that bringing in ValueAct Capital was a sign that Misys wanted to shed its healthcare lines. All of you who called the shot early – nice going. Nobody else was even talking about it until it ran here. Even the high-powered analysts at the HIStalk HIMSS event were buzzing a little because I’d mentioned it the night before, plus HIStalk readers had just voted Allscripts “most likely to be acquired.” Smart readers. I didn’t mention it, but the Allscripts PR person tried to get me to kill the HISsies because Allscripts didn’t want to be named as an acquisition target. For good reason, as it turns out.

Connectologist (you know him) posted a very nice writeup in HIStalk Discussion about medical device connectivity. This stood out: “A perfect day for an IT person is to fix every problem that comes up from their desk, monitoring systems, rebooting servers, documenting support, etc. A perfect day for a biomed is to go to the point of care and work one on one with clinicians solving problems with training, problem diagnosis, and repairs. This is part of the ‘great divide’ between biomeds and IT.” Worth a read.  

Thanks to the 134 of you who responded to my consultant survey. Great information. I’ve e-mailed out the results to those who participated and supplied an e-mail address. A reader already contacted me and said the results were helpful in making a career decision, so he or she appreciates it. Also, thanks if you completed my reader survey, which I’ve now closed. I saw some very nice comments there, so I’ll have more about that once I’ve digested your thoughts.

Fair Warning did a webcast last week on EMR privacy and compliance challenges, including HIPAA enforcement. John Wade was one of the presenters and over 400 folks tuned in. It’s archived for playback.

Jobs: Manager of Lab and Pharmacy IT, Clinical Information Systems Analyst, Manager of Clinical Support Systems. That first listing had an ingenious leadoff: “If you attended the HISTALK party at HIMSS, you know that the ‘most significant IT sale of 2007’ was the Epic contract with Cedars Sinai. I guess that would make these the ‘most significant HCIT job opportunities of 2008’. Read on.”

Medical device data integrator iSirona gets a $1 million private placement. Joining its board are industry long-timers Carl Witonsky and Jim Hall.

Ohio State and Wake Forest Baptist choose the ClairVia staffing system from AtStaff.

Little doubt about it: the iPhone will be big in healthcare.

Thailand medical tourism hospital Bumrungrad International, birthplace of what’s now called Microsoft Amalga, installs the first robotic drug management system in Asia, going with Swisslog. The hospital’s CEO, Mack Banner, appears to be an American from his educational background, which I didn’t realize.

The Australian Medical Council will move its Visual Basic systems to the web-based Ruby on Rails platform.

Merge Healthcare delays yet another SEC filing, this time its annual report. I swear its accountant must be a moonlighting shoe salesman from the local H&R Block.

Holy Cross Hospital (FL) chooses the E/Point ED charging application from LYNX Medical Systems (aka Picis).

Two doctors who were sued for $67 million by John Ritter’s family are acquitted. The family already received $14 million in settlements from other clinicians and a hospital. I don’t mean to speak ill of the dead, but I never found his mugging, camera-aware style anything more than annoying, but to each his own. It’s still a shame, of course. Maybe he really would have made another $67 million in future earnings like the suit claimed. Your Honor, I call Adam Sandler to the stand.

What else could they mess up? Haywood Regional Medical Center (NC) fires a nurse and former Army lieutenant colonel for giving state inspectors information about hospital medical errors committed there, saying the Army taught her to discuss and fix problems, not hide them. She’s suing. So is another former hospital employee turned whistleblower who was canned for giving CMS information about medication errors (CMS agreed and stopped reimbursement to the hospital). The loss of 68% of the hospital’s revenue led to the resignation of the hospital’s CEO, board chair, HR director, and nursing VP. Now the hospital is fighting the press to keep the former CEO’s compensation private despite its being public record. The board is thinking about selling the facility. Good idea.

E-mail me.

Inga’s Update

DR Systems announces nine new contracts for Unity RIS/PACS worth more than $3.8 million.

Thomson Healthcare releases its 15th annual 100 Top Hospitals. To come up with the winners, Thomson analyzes data from Medicare Provider Analysis and Review data for 2005 and 2006 and Medicare cost reports for 2006 and evaluates hospitals on eight measures of clinical quality, operating efficiency and financial performance.

Does anyone care to explain this MedCom Soft press release for me? Is there: 1) no real message at all; 2) an announcement they want to increase US marketing efforts; or 3) a well-hidden announcement about “right-sizing” the organization?

Walgreens announces its new Health and Wellness division that will manage its health centers and pharmacies located at large-company work sites. They are also buying a couple of companies providing work site health centers, raising their total number of work site and retail health clinics to 500. Walgreens estimates the potential for onsite work site clinics will grow to 7,600 corporate campuses with at least 1,000 employees each.

One of our fun sponsors asked Mr. H and me to participate in a NCAA basketball pool (I am not naming them in case the IRS reads this blog, even though they claim winnings go to charity). I was hum-ho on the whole thing until I read this section of the memo sent to all employees: “This year, we have added a Group Message Board option, which is a convenient outlet for those of you who may want to elaborate on their respective bracket picking strategies, defend seemingly half-witted picks, talk smack, or just have daily alternative to your Mr. HISTalk addiction.” I may have to participate to ensure folks don’t inappropriately make basketball more important than HIT gossip. Since I like winning and don’t really consider asking for advice equates to cheating, feel free to send me your best picks.

From Insider Outsider: “In regards to your note about Bill Gates appearing before the US House Committee on Science and Technology, and his predictions, my only response is …yawn. Bill G. has never been one to have very good or accurate predictions. He is usually very general – ‘technology will get smaller and faster’ (duh) or he is very wrong ‘within 5 years, all computers will use voice commands and the mouse will disappear’. Billy G. predicted that spam would be solved in 2 years (still waiting), that OS/2 would be the most important operating system of all time, that no one would ever need more than 640k of memory, etc. Yeah, he’s gotten some right, but even a broken clock is right twice a day. He made his fortune by buying someone else’s technology and reselling it. He’s the used car dealer of technology. As for the future, his best picture of the future is to look at what Steve Jobs is doing and to copy that.” Yeah, but he’s rich. Doesn’t that count for something?

My favorite part of the interview with eClinicalWorks Girish Kumar Navani was is brief commentary on various vendors. You have to be pretty confident to swagger the way he did.

Thanks for all the Linked-in invitations. (Do people like Linked-in and other network sites because it makes them believe they are popular – or at least have friends?) Regardless, it helps me with my swagger.

E-mail Inga.

Allscripts, Misys Healthcare to Merge

Misys announced this morning in London that it will spin off its US-based Misys Healthcare Systems and merge it with Allscripts, paying $330 million in cash for a 54.5% stake in the combined entity through a complex financing arrangement that also involves hedge fund ValueAct Capital, which will underwrite a new share placement to finance the transaction.

Glen Tullman of Allscripts will remain CEO, while Misys CEO Mike Lawrie will become chairman of the board. Misys will appoint six board members, with four from Allscripts. Allscripts shares will continue to trade under the MDRX ticker and the new company’s headquarters will be in Chicago.

The announced name of the new company is Allscripts-Misys Healthcare Solutions Inc.

Misys shares are up 20% on the London Stock Exchange.

Monday Morning Update 3/17/08

From Irwin M. Fletcher: "Re: Interactive Care. Do you or your readers have any knowledge and/or opinion of Interactive Care? They are a newer entrant to the telemedicine arena." I don’t think I’ve heard of them. Website here.  

From Terry Tate: "Re: consultants. I can’t believe I am saying this, since I have never been a fan of them. However, over the years I have learned that few hospitals have the people and skills needed to make the process improvements needed to optimize their HIS systems, and MUST turn to consultants. Since most will work on a percentage of the savings, this can be a win for everyone." I didn’t realize that most would work for a percentage. If so, I can still see some hospital folks still balking because they aren’t comfortable placing a value on even those improvements that involve critical success measures (maybe because they’ll be unable to actually capitalize on them or because reimbursement quirks mean they really can’t). Example: a hospital says its #1 priority is to reduce medical errors. I’m selling systems and services that I claim can help you do that to the tune of a 50% reduction and I want $500,000 or $1 million or whatever. What’s it worth to you? How many hospitals would happily write the check even when benefits exceed that amount? It’s as shortsighted as a vendor that thinks paying sales commissions is bad.

From Scot Silverstein: "Re: CMIO war stories book. I am one of those CMIOs. Expect stories a bit more PC than at my website on health IT difficulties, but with more analytics. I kept detailed analytics out of my web site, because 1) the lessons are obvious to all but the most obtuse; and 2) the best techniques for avoiding project failures cannot be learned from a book or website. You have to live it. But first, you have to accept that clinical computing projects are complex sociotechnical endeavors in unforgiving medical environments that happen to involve computers, not IT projects that happen to involve doctors. The book will be a good step in giving ‘gut understanding’ to those words to a wider audience."

From The Shelton Shadow: "Re: NPfIT. The NPfIT has started to prove that the effort to computerize healthcare in the UK is providing savings that will be significant in the years to come and attract attention from all over the world." Link.

Robert Miller, a director of QuadraMed, is named to the new board of Grady Memorial Hospital (GA), along with the CEO of Waffle House (if you’ve ever eaten in one, and I’m certainly not suggesting you do, you might be surprised to find that a corporate structure exists behind the equally tattooed short order cook and waitress who run the entire place.)

Physician, health thyself: a Westborough, MA psychiatrist loses her medical license for good after assaulting hospital police officers and hospital staff. She was taking psych call for UMass and refused to leave a party when paged. The medical director relieved her but she came in later and refused to leave when security guards told her. She was arrested screaming and kicking the officers involved. She was committed but released after two days.

E-mail me.

Blogger Boy on Exhibiting at HIMSS

Blogger Boy, a vendor person who thinks I know his identity even though I don’t, took a three-year hiatus since last describing his HIMSS conference experience. Here’s his account from Orlando.

Another HIMSS has come and gone. Here are some musings from a small vendor on the main aisle.

Thanks to all of you who came into our booth. Although most of you were there searching for items to take home to your kids (or to prove where you were) instead of a new Hospital Information System, we still appreciate it. All of you who registered at our booth either for the drawing you failed to attend on Thursday morning or because you felt bad just taking our giveaways (yes, all both of you), we still appreciate it. We love meeting new people who may one day remember when the need arises that we have a marvelous, function-rich system written entirely in the newer languages (even IF Mr. HIStalk is not impressed by that!). Silly me, I always thought mumps was a virus.

Traffic was light for us this year. We are always trying to find that combination it takes to get you into the booth for something other than a free pen. Again, we love having the opportunity to show our products even if you are not in a buying mode. This is such a small market that one day we figure you’ll give us a shot after the big guys make you mad with their ridiculous license fees, drawn out and overpriced implementations, and poor customer service.

On another subject, any one who thinks contracts are signed at HIMSS is misinformed. Oh, I am certain that decisions are set based on expensive gifts, dinners, and more exposure than most potential clients will see at any time in the future of their relationship with that vendor. But no one, and I mean NO ONE, comes to HIMSS to select a system. It continues to be our belief that most of you come to spend a few days away from home (and/or the family) at the hospital’s expense having a good time. Yes I know YOU actually come for the sessions and to see all the new stuff at the exhibit hall. I am talking about everyone else.

That is why there is not a single vendor who will complain about the show being in Chicago next April. Hell, we’d like them to have it there in February! Then instead of chasing Mickey or Shamu, maybe you guys would come into the exhibit hall and buy something from us. Oh wait, that’s right — you don’t do that either! But seriously, we do figure the number of people we’ll lose to golf during exhibit hall hours will decrease next year. While you can play in the snow, it takes an awful lot of mercurochrome to coat the balls so you can find them for 18 holes (related from drunken experience). Our biggest fear is that we will get snowed in and not be able to get home for Good Friday, the real reason HIMSS was moved to a Sunday start date for Chicago.

For just a second, place yourself into our shoes. Even the smallest of vendors is spending several hundred thousand dollars to exhibit at this show. So we come there and spend a pile of money, all the while hoping against hope that we’ll get some good leads. Then we spend the time and money over the next 18 months cultivating those leads, doing demos, meeting with the 15 different selection committees at each location, only to find that a salesman from one of the big vendors came in, planted some scary thoughts with key decision makers (AKA lies) and they wind up going with the big overpriced vendor because it is "safe". I guess it depends on how you define safe!

I see more and more often, high-profile CIOs are losing their jobs because of implementations that either never happened or never seemed to have an end in sight. Maybe next year we’ll get that one lead that we close before the end of the year! If I sound cynical, I apologize, but you guys are tough!

We did enjoy searching out all of the HIStalk ribbons. Many in our booth had at least four. I was only able to get three for my badge. It generated a lot of conversation. I hope HIStalk will do something similar for the next show. Sorry we missed your shindig. Let me know if it needs a sponsor next year. Do you give HIMSS points?

And to wrap up, trust me, we vendors know how you feel about being bugged. I swore I would move out of the country if one more offshore development person came by our booth to speak with me. I am now fielding no less than 10 calls a day from other vendors to whom I was simply cordial at the show. It is funny to hear them describe to me how enamored I was with their products. I simply don’t remember it that way in most cases! So when you get the letter from me thanking you for visiting our booth, just indulge me a little. Read it, then toss it. Who knows? One day you may want a vendor who has a great product, gives terrific service and does this because they love what they do.

Inga’s Update

You knew it was only a matter of time. UCLA Medical Center will fire 13 employees and suspend another six others for checking out Britney Spears’ medical records. Six physicians also apparently took a peek and face discipline as well. I can’t decide if I would have done the same thing in their shoes since I’m the nosy type. I might have just waited to read all about it in the juicy rags at the grocery checkout stand.

Mike Leavitt was in Pittsburgh this week stumping for the expansion of EHR systems in physician offices. An interesting number I hadn’t heard before was that the Medicare P4P project he promotes could provide physicians up to $58K over five years if they meet certain benchmarks of quality care. It’s not a ton of money, but for a primary care provider making $150K a year, that equates to a bonus of about 7.5%.

Bill Gates appears before the US House Committee on Science and Technology and makes some interesting technology predictions. The future includes tablet devices in place of textbooks in schools, natural user interfaces with sophisticated voice recognition software, and computers with the ability to recognize objects and people. Additionally, data centers will need less human intervention and software development will require less code.

HHS and AHRQ hand out $5 million of your money to Brigham and Women’s Hospital and Yale University School of Medicine to help develop and implement best practices using clinical decision support.

Mdical transcription and workflow software provider MedQuist supposedly had a nationwide system failure this week. For about a day, system issues prevented received transcription to be properly routed internally. Will vendors promoting in-house systems use this anecdote as a reason to avoid ASP software providers?

Investor’s Business Daily interviews Allscript’s Glen Tullman, who claims Allscripts’ stock price drop (almost 50% since the first of the year) is a result of not properly managing the Street’s expectations. He also indicates analysts are still predicting more than 40% earnings growth.

By adding MedBasics Family Health Centers to its network, CIGNA gives a thumbs up to retail health clinics. Other carriers will likely follow CIGNA’s lead, despite opposition from some medical organizations that believe the retail clinics should have more restrictions.

Coincidentally, Las Vegas-based Medical Marts just closed a dozen clinics last month after losing VC backing. Unlike most of the other retail clinic models, Medical Marts were staffed with physicians rather than nurse practitioners.

The 300-physician Carle Clinic Association selects D2 Sales’ new My Patient Passport ExpressT kiosk system for patient check-in and payment.

Not to have Mr. H outdo me at everything, I wanted to point out that I also have a profile on Linked In. Not surprisingly, his profile is far more witty and well-thought out than mine, but connect with me anyway. It makes me believe you care.

E-mail Inga.

News 3/14/08

From Gesundheit: "Re: CHW. Ben Williams, CIO at CHW, is changing the IT outsourcing model. They will insource part of the operations from Perot and eventually bring 40-50% of the functions in-house. With 800-900 Perot people on the account, major changes are coming."

From No Name in PA: "Re: UB. Any truth to the rumor that University of Buffalo has just signed with Epic as an EMR?" If it’s Epic and a rumored sale involving a hospital of over 400 beds, it’s usually true, but maybe someone will confirm. In fact, a second reader asked the same question, so there’s your smoke. Fire, anyone?

From Former High Level Exec: "Re: Eclipsys. I just heard that ECLP is going to outsource to India their Sales and Marketing responses to RFIs and RFPs. Can this even be possible for a sane executive to consider?"

From Mikey Likes It: "Re: consultant survey. Poorly worded question: does your company typically lay off or bench people when there is a gap in business? It should be multiple choice, not yes/no. Some companies will lay off immediately, some after a month, etc. Some will keep consultants on the bench for quite a while, maybe send them to training during that time. Whether and how long you’ll be on the bench is a BIG indicator of the company’s loyalty to their employees and their overall corporate culture. Good question when evaluating firms: ‘What’s the longest any consultant has been on the bench in the past 12 months?’ The longer the time compared to other firms, the better the attitudes, mutual loyalty, and likely the happier and more productive the consultants. Would you fire a bunch of nurses if the inpatient census dropped for a couple weeks?"

From The Real Deal: "Re: consultant survey. What every consultant should want to know is what percentage of the hourly rate goes to the company. It appears to be between 30 and 50%, which seems like a lot for job placement. Consultants eventually make their way to independent consulting to get a larger slice of the pie. You start out at more than you made at a facility or vendor, but over time, after you’ve developed knowledge, spent years on planes, and disconnected with family and friends, you start to question how much your time should be worth. The company values you at a high price when selling you to the hospital, but doesn’t place that same value on you as their employee."

Listening: The Concretes, Swedish pop. Mazzy Star meets The Supremes.

Unrelated: one of the funniest phony news stories I’ve read.

Great Red Hat Summit speaker lineup: BIDMC CIO John Halamka and a writer for The Simpsons.

McFarland Clinic (IA) picks Epic. Does anybody else ever win a deal any more? Of course, it’s kind of like taking candy from a baby when most of your competitors voluntarily carry the smothering baggage of being publicly traded.

Sounds interesting: NVivo qualitative research analysis software, which now handles media files. Free trial download. Costs a few hundred dollars. There are lots of cool, cheap data discovery tools coming out that can read just about any data source.

Big numbers for QuadraMed, but with an asterisk: revenue up 31%, EPS $0.68 vs. $0.05. Without a one-time tax treatment, earnings were flat. The company projects a revenue increase of 6-10% for 2008. The stock is down 4% after hours, a little above its 52-week low.

CDC issues $38 million in NHIN trial grants: Indiana University School of Medicine, SAIC, and Health Research, Inc.

Allscripts signs a deal to distribute its product to 1,000 physicians in Hawaii. Shares are still down 4% on the day.

Odd lawsuit: a fired hospital employee is suing her former employer, claiming she was fired because she was shipping out to Iraq with the National Guard. Her job: chaplain. Go ahead and make out the check.

E-mail me.

Art Vandelay on IT and Process Change

Mr. HIStalk has a great editorial in the latest Inside Healthcare Computing electronic update. The tagline is, "Everybody Hates Their IT Department: Where Alignment, Control, and Honesty Collide." The two-line summary is that IT is in the position to execute leadership’s vision, within a set timeframe and budget and usually with imperfect technologies. IT’s typical approach lacks the finesse to deliver in the middleman role between the users and leadership.

In the current Information Week, there is a short article about Jeanne Ross’ current thinking on IT. She is part of the IT Governance study team. If you haven’t read that book, I highly recommend it. She comments that systems will never deliver full-value without process change. CIOs are uniquely positioned be strategic execution officers responsible for delivering the change. The article stops short of providing advice about how to get the job done.

Two thoughts. To Mr. HISTalk’s point, IT organizations with expertise in process change that can effectively influence the users can get the job done. Those who don’t or can’t always have an uphill battle. The only means of getting through this challenge is highly involved and influential senior leadership; drafting cross-silo thinking users into the project; supporting them with process analysis staff who back recommended changes with hard data (i.e., turn-around time is "x" hours); and lastly, with incentives.

Second, the problem is intensified in this time of enterprise clinical systems, where change is required across business silos. The most difficult changes involve cross-silo handoffs, communication, and accountability. Implementing a department-based system is always easier.

How will organizations who are in the middle of implementing enterprise systems handle the current economic challenges? Will they back-pedal and focus on departmental systems? Will they try and eat the elephant faster to just get ‘er done? Will they try to eat the elephant slower, focusing on high-value processes? That still requires bigger bites when the system changes business processes.

Another option: focus on revenue cycle through the small systems that improve their aging systems. Somehow they have to cover the recurring costs of the enterprise clinical system they bought.

Inga’s Update

The University of Michigan selects McKesson’s Horizon Medical Imaging PACS for its three-hospital, nine-clinic health system. Expected go-live is early summer 2008.

Mark D. Barner is named Ascension Health’s new CIO after serving almost a year as interim CIO. He has had several leadership roles within Ascension and spent 19 years with EDS.

The Ohio State Medical Society releases the terms for its Standards of Excellence Program, plus the list of participating vendors. Allscripts, e-MDs, Greenway, iMedica, Misys, and Sage have all agreed to include OSMS’s "physician-friendly" terms and provide OSMS members with preferred pricing. Some of the special terms: the inclusion of upgrades in service agreements, a cap on maintenance fee equal to the CPI index plus 3%, stepped payment plans, and compliance with OSMS’s e-Rx requirements.

The U.S. Chamber of Commerce hosts an HIT forum bringing together stakeholders from government and private industry. The focus was on how businesses could improve healthcare quality and value for their employees with investment in healthcare IT.

I have been skiing for the last few days (with a very cute boy, I might add) and thus have been blissfully out of touch with much of the news of the world, much less the HIT world. Fortunately I had no need for direct contact with any healthcare facilities, though I do have plenty of aches and pains. Back to reality next week…

E-mail Inga.

Don’t Look Now, Your Loop is Open

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in September 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Three babies dead in Indiana, overdosed with the wrong heparin product in a hospital not using bedside barcode verification of meds. Technology failed them, plain and simple.

Ten years ago, nursing and pharmacy systems didn’t talk to each other (pharmacists and nurses didn’t either, but that’s another story.) Finally, everyone agreed that was pretty stupid, so vendors did a little bit of integration to make systems look like they did. The electronic Medication Administration Record (eMAR) was born, although most hospitals stuck with once-a-day printed versions for a several reasons, most of them illogical.

Along came CPOE, usually hung awkwardly off of those same nursing and pharmacy systems. It was (and is) expensive, rarely used, and inefficiently designed for physicians, but it caught the eye of well-intentioned hospital executives who were blissfully unaware that all those CPOE-preventable errors weren’t the ones harming patients anyway. I like to think of it as the Job Security Act for Chief Medical Informatics Officers, who, like the painters assigned to the Golden Gate Bridge, have job security because their work will never be finished.

Even if you buy the ubiquitous vendor buzzword “closed loop,” don’t kid yourself. The dent in harmful medication errors has been slight. It may have even gone up. Why? Because nurses still walk a tightrope without a net, armed only with limited drug knowledge, paper records updated with pens, and a wide-open candy machine of increasingly dangerous drugs … uhhh, I mean decentralized medication distribution cabinets.

We bought the technology least likely to be used, that addresses errors least likely to be harmful, and deployed it in patient care areas least likely to make serious errors in the first place. And while we’re still making payments on that stuff and trying to strong-arm clinicians to use it, we’re still harming patients.

But let’s look on the positive side. Technology is the only hope of improving the situation.

If you’re a vendor with an integrated bedside verification system, get those sales guys on the road because I guarantee you’ll sell a bunch of them in the next year if yours is any good. Guarantee, I said. The Indiana errors will be the pin that pops the CPOE bubble, making even the big-picture types understand that they’ve been chasing the wrong solution.

If you sell add-on tools for electronic MARs or have the expertise to consult in that or any other patient safety area, polish up your shingle. Plenty of organizations need your help.

If your company is one of few selling medication distribution cabinets, get some real informatics people designing improvements instead of those engineers more concerned with servo motors and drawer design instead of intelligent software.

And if you’re Cerner, congratulations! You bought Bridge Medical and their bedside technology just at the right time and announced plans for your own line of medication distribution cabinets. You’ve got a widely installed customer base who wanted closed loop meds. If you don’t mess it up, you could build a huge business on the other half of the loop, the one that isn’t closed. I guarantee that, too.

But for goodness sake, let’s all of us agree not to dawdle. There are already too many parents out there who won’t get to celebrate their baby’s first birthday.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 3/12/08

From Buffy V. Slayer: "Re: consultant survey. The items don’t really reflect what’s good and bad about being a consultant other than the hours. Performance expectations are really the killer with each manager trying to meet sales goal and people jockeying for credit on the same account. Those with the sharpest elbows get the credit and those who don’t make the goals are pushed out. The responsiveness of IT support and publications is remarkable and none of the firms I’ve worked for skimped on accommodations or per diem, which is important when you’re exhausted and need a quiet room and something decent to eat. What I liked best is the change to work with really, really smart people, but we had little or no time for education. Very Darwinian." The consultant survey has 73 responses, so jump on if you’d like to see the individual responses with company names (but not those of respondents, of course – add your e-mail address at the end and I’ll remove that and send it out blinded). Least liked aspect so far? New hire training. Sends consultants on engagements unprepared? 34%. Average salary, billable hours, and whether the consultant would recommend working for his or her employer? Fill out the survey and you’ll find out. Obviously the reader who asked me to do this (and who provided the questions) has struck a nerve. Some of the companies sound kind of suck-o to work for, but that’s life.

From Tupac Addae: "Re: MagicJack. Now that I’m working from home with only a cell phone, I dreamed to be able to plug in my old desk phone somewhere other than a money-wasting landline. I’m SO PLEASED to have been clued into MagicJack by Mr. HIStalk’s mention. It arrived a couple of days after purchase, the phone number goes with me wherever I go, it comes with voice mail and even 911 service, and it works with my desk and cordless phones. They’re working on richer features now, like the ability to change your phone number at will. Very, very cool and I appreciate your cluing me in. It’s hard to imagine how landline companies can compete with $20 a year."

From Andy: "Re: GPS. Considering that non-DoD GPS systems are accurate to one meter, I wonder what is actually going on in this article from China?" Link. It says a US surgeon will show visiting Chinese orthopods how he uses GPS to "precisely measure legs and make sure they are even." Either something got lost in translation or it’s our leg that’s being pulled. Why would you use an orbiting satellite to measure a leg instead of a tape measure?

From The PACS Designer: "Re: virtual appliance. What a nice article posted by Shahid Shah. In essence, a virtual appliance can be an ‘enterprise cloud’ that provides numerous services to clients while simplifying the IT maintenance issues. TPD has been posting about clouds as a way of improving service offerings at a lower total cost once implemented. While there may be some backlash from users, it can quickly disappear once the user gets accustomed to this new concept. The virtual appliance can be a win-win for provider and users with a well defined roll-out plan that is gradual in nature and allows users to adjust to a different operating platform."

I had played around and put a Mr. HIStalk entry on LinkedIn just for grins awhile back, which I promptly forgot about until a couple of readers recently found my profile and connected. I’m not sure how much value an anonymous contact with a guy using a profile picture of The Unknown Comic will have for your business or social prospects, but I’ll approve any invitations that come my way if you’re interested. Maybe I’ll need a job one of these days.

Speaking of surveys, please fill out my HIStalk reader survey. Thanks.

I’ll not be posting new entries to the old Blog City site going forward, so if you’re reading on the new one for the first time, make sure to put your e-mail address in the "Subscribe to Updates" box at your upper right so you’ll know when I write something new (and the Brev+IT one just below that if you’d like the weekly e-mail newsletter, which several folks on the survey have said they like).

Jobs: Sales Executive – Workflow Solutions, Systems Analyst – Clinical Applications, Senior PR Copywriter. Gwen will e-mail you openings each week if you sign up. This week’s had Gwen with a Photoshopped leprechaun hat and a caption of "Gwen Darling, Irish Lass."

This is fun: Spencer Hamons, CIO of SLV Regional Medical Center (CO), is doing a Weekly News sort of podcast about healthcare IT. He’s also a professional voice-over guy, so it sounds great. I told him I was really sprawling back and relaxing since his voice is so soothing and so is the piano music he uses in the background (say, you don’t suppose he’s actually playing and talking at the same time?)

Update on the HIMSS Stage 6 EMR hospitals: Meditech has two customers in the 11: Citizens Memorial Healthcare (MO, home of one of my favorite CIOs, Denni McColm) and St. Agnes Healthcare (MD). Now if the Meditech folks could just hook a brother up with a Neil Pappalardo interview …

Deborah Peel, an AARP lobbyist, and an ONCHIT person debate federal privacy legislation in this video.

Another sign that Cerner is scrambling for growth: now it’s in the drug development business, sponsoring research into a dry powder inhaler technology, for which it has an option to become the exclusive licensee. Sounds like they want to become Cardinal Health or McKesson with their med cabinets and life sciences stuff.

Nice award, but an odd quote about a FirstHealth (NC) nurse who an ED award: "His work with McKesson (a health care services company) is just one example. He also built a beautiful chart rack, and his ability to work with multiple people and personalities in the ED has made him a true leader in our department." First thing I thought of: it’s odd to mention his carpentry skills. Second: was Sybil in their ED?

Red Hat announces that Florida Hospital is running Linux, JBoss, and several other technologies.

Patient throughput systems vendor PeriOptimum will partner with Sonitor Technologies for marketing a combined RTLS, being installed at Women’s Hospital (LA).

Washington Post runs an article on PHRs. Nothing new, but mainstream.

This is a little freaky: a sensor necklace detects magnet-implanted pills as they traverse your esophagus, time-stamping the med you took and reminding you of those you missed.

Massachusetts hospitals line up against a privacy bill that would allow people to block access to their medical records, inspect access records, and block their use for marketing. Ostensible reason: nobody will buy EMRs if they can’t just sling PHI everywhere. We’re getting into a touchy area here: if experts say your health could be jeopardized by your not approving records access, is it still your right to opt out? I’m going with yes. That just smacks of what should be an obsolete concept: "we doctors and hospitals are way smarter than you, so we’ll decide no matter what your personal wishes are." Maybe that’s what all the fuss against privacy bills is about: trying not to cede control to patients.

Who knew that Meditech owns a historic horse farm?

An RN turned malpractice attorney describes the "positive force of litigation" by enumerating the huge judgments she’s won against providers. Now she’s advocating expanded training for pharmacy technicians, even though their work is checked by a pharmacist and training doesn’t prevent doctors, RNs, and pharmacists from making similar errors. Quote: "We would all agree that the technician should be be held accountable." In other words, pharmacy technicians make too little money to be worth suing, so with more training, maybe malpractice insurance will become standard and lawsuits against them will become more lucrative. She was a nurse only while working her way through law school, so I’m sure she never made a mistake even without the positive force of litigation.

Speaking of litigation, the patient whose heart was cooked by an overheated cardiac catheter with known problems is awarded $40.1 million. Oddly enough, Providence Everett Medical Center (WA) was awarded $310,000 in the suit, claiming the monitor company damaged their reputation. I always weigh these awards by thinking, "Would I suffer what the litigant did for the amount of the award, and if so, maybe it’s excessive?" In this case, no way.

Kudos to CSC staff in the UK, who donated money for a children’s hospital there.

E-mail me.

Inga’s Update

Parkland Health and Hospital Systems (Dallas) partners with Affiliated Computer Services for a seven-year, $41 million contract to outsource its IT services. ACS will supply infrastructure support including data center operations, network monitoring and management, asset tracking, and help desk support. ACS also won a contract renewal with the Missouri HealthNet Division to provide HER and pharmacy benefits management. That contract could be worth up to $57 million over 10 years.

Children’s Hospital Boston is implementing RFID for inventory management for high cost devices and supplies within the surgical department. The selected product is Mobile Aspects’s iRISupply.

iSoft becomes Sentillion’s first European healthcare channel partner to distribute its SSO, context management and user provisioning solutions.

MediNotes is named the Technology Association of Iowa’s Prometheus Award for top software company in the medium-size category. MediNotes’ CEO and President Donald G. Schoen received the organization’s CEO of the Year award.

Picis announces the availability of a podcast of “Forward-Thinking CIOs Debate Hot Issues Facing Hospitals in 2008.” Panelists include multiple Picis CIO’s including HISsie award winner Judy Middleton of Osler Health Center.

E-mail Inga.

Monday Morning Update 3/10/08

From Katie Jane: "Re: specialty hospitals. Congress wants to create a bill making insurers equalize physical and mental health benefits, which will in turn increase some government health programs. Since the bill will effectively ban specialty hospitals, they go ahead and assume those hospitals cause higher healthcare costs and the ‘savings’ of closing them will pay for the budget gap. Insanity." Link. Here’s a snip: "Big hospitals say specialty hospitals drive up costs because the doctors who own facilities have an incentive to over treat patients with expensive procedures. Specialty hospital proponents disagree. They counter that if smaller facilities were banned patients would be forced to go to big hospitals, which they say deliver lower-quality and thus costlier care."

From Lazlo Hollyfeld: "Re: EMR. This was reported today in regards to the pending Medicare physician payments cuts (10.6% as of July 1, another 5.4% on of January 1). ‘MGMA members reported that they will suffer further operational damage as a result of payment instability and the projected double-digit reductions to Medicare physician payments … More than two-thirds of respondents described how they will sacrifice or postpone information technology (IT) and equipment investments.’ While it is highly unlikely that these cuts will actually be enacted, even a portion of these cuts could pose a huge problem for the ambulatory HIT market in ’09 and beyond. Arguably the most important thing looming over the market right now." 

From Bignurse: "Re: EMR. I took my family member to a new specialist, where he was handed six sheets of paper and asked to hand-write his demographics, medical conditions, allergies, and medications. Funny, he had just written all of the same information on paper earlier this week in the previous doctor’s office who referred him! Imagine my surprise when I learned that the specialist has one of the top-name, expensive EMRs (overkill in a single-physician office?), but after three years, the patient history is still on paper. In fact, the entire time I was there, the doctor never turned the EMR monitor on. What’s wrong with this picture? It will never get better until patients like my relative walk into a doctor’s office and refuse to fill out another paper form!" Want to bet that it was a hospital that provided that expensive and unused EMR? That Mass BCBS article that Inga quoted says it all: doctors don’t get much EMR benefit, so requiring EMR use for bonus programs doesn’t make sense. You can’t make a small business buy software that doesn’t pay its way no matter how much society might benefit. It would be great if paint stores recorded your custom colors on an electronic personal profile that was shared among them all, allowing you to stroll into any Home Depot or Sherwin Williams and have your records immediately available, but that’s not happening for exactly the same reasons. Unless enough customers demand it, of course.

From TenaciousD: "Re: Stanford and Legacy. I heard that the Epic Stanford project is running at $180M for total costs. I also heard that Epic is telling potential clients (specifically an academic in the northeast) that Stanford is their beta for anesthesia. I will be curious how the implementation delays will affect Epic delivering anesthesia. Regarding Legacy, the article said that they expect Epic to cost about $10M over the next 3-4 years. That is the biggest Bull SH**. I know for a fact they told the CIO straight up it would cost $200M to replace Cerner and implement across all facilities." I wondered if Epic would bother with a $10 million deal. Wouldn’t it be great, knowing that software has zero incremental cost for a new customer,to still turn your nose up at a customer who only has $10 million to spend?

From Janie Lane: "Re: Midland Memorial’s EMR Stage 6. Somebody needs to talk about this when talking about the Epics of the world, where customers drop $10 to $50 million when OpenVista could do the job at a fraction of the price. If there were enough folks who lined up behind VistA to move it forward as a true open source project, it would be the default system of choice." Note the list of 11 Stage 6 hospitals and the conspicuous absence of nearly all of those big-spending hospitals. All the poster children academic medical centers haven’t made the cut, but 74-bed Citizens Memorial Hospital and Denni McColm have. We’re worshiping the wrong HIT role models. It’s kind of like translational medicine — choose a vendor for results achieved, not far-reaching vision. If you’re a CIO, you’ll be long fired before that vision ever ships.

From Bodie: "Re: Park Nicollet. They’re going from GE to Epic. It will take place over a couple of years, but it’s a done deal. They are running LastWord. Perhaps they figured they might as well take the pain once rather than moving to Centricity."

From Inside Outsider: "Did you catch any of the news following Apple’s announcement of their Software Development Kit for the iPhone yesterday? Looks like they’re going to release a really slick SDK that is easy to use and allows for rapid development. One of the companies that received the SDK early was Epocrates, which created a drug lookup app using the SDK and SQLite. They created it in less than 2 weeks. It will be  interesting to see if the medical industry jumps on this new platform." I’m betting yes. Never underestimate Apple’s ability to create an entirely new market by doing the opposite of what most tech companies do: giving geeky stuff mass appeal and style while hiding the nuts and bolts. I wish they’d build clinical systems. Mark it down: iPhone apps will be everywhere at HIMSS09. Here’s a link to the Epocrates story.

From Jack Ripper: "Re: your 2/18 mention of MagicJack. Perhaps you should refrain from endorsing products. I purchased it and still haven’t seen it and there is no support information." I wouldn’t say I endorsed the VoIP phone gadget (since I haven’t used it)  but I did say it looked cool. I’d give it a little more time, then contact your credit card company and dispute the charge. I’ve gotten my money back every time I’ve done that. And if you ever receive it, it just won a PC Magazine Editor’s Choice award, so I wasn’t the only one that liked it. 

From Steve-O: "Re: Brailer. Believe me, he’s smug every single day."

From CPR CIA: "Re: QuadraMed. Signed Quadramed as a sponsor, huh? I hope that you stay as open / honest about the state of CPR going forward as you were before taking their cash." No problem there. I liked CPR the last time I saw it years ago, but it was a train wreck even before Misys got its fumbling fingers on it. The years of neglect haven’t been kind, so let’s hope QD is up to the challenge. It does have superb user design and strong physician support. QuadraMed at least got it off its oddball database and onto Cache’. The offshoring decision is a gamble, but QuadraMed has some urgency in getting the job done and throwing low-cost Indians into the fray may provide the troop surge needed to make CPR sellable. Upgrading Affinity users is important, but if CPR’s big academic medical center users feel neglected, they’ll bail, so QuadraMed will need to develop an ivory tower worship competency to mollify them. As everyone knows, the biggest pain-in-the-ass IT customers are (1) academic medical centers, followed by (2) children’s hospitals, both for the same reason: they are irrationally convinced that their bizarrely inefficient and sometimes safety-endangering practices are better than everyone else’s. So, you have to hack your application to shut them up even though every other customer uses it just fine.

From Kate Bradley: "Re: consultants. Quite a few consultants read HIStalk. Would you consider running a survey of them to see what it’s like working for their current or previous employers? It’s sometimes tough to find out the nitty gritty from people already working there." I’m a sucker for taking on more work when it sounds fun. If you’re a consultant, please take my two-minute survey about your current and previous employers and I’ll e-mail you the survey results.

We spring forward tonight. Good luck to you IT folks on call.

Kleiner Perkins Caulfield & Byers creates the $100 million iFund to invest in companies developing high-impact ideas for Apple’s iPhone and iPod touch. Apple will be involved as well.

Cerner says KLAS has ranked Millennium as #1 in overall value proposition scores for CPOE and #1 in "deep" physician CPOE usage. Also from KLAS: 100% of Cerner’s remote hosting clients recommend that option.

Jobs: Senior PR Account Executive, Siemens Soarian Consultant, Network Analyst, Senior Business Analyst.

Privacy warrior Deborah Peel has an opinion letter in the Atlanta newspaper. Excerpts: "Most Americans think HIPAA protects their health data. Wrong. Those Americans should read the fine print issued earlier in this decade by rule makers who, reversing the intent of Congress, eliminated the right of patient consent over how their data is used for treatment, payment or health care operations … The foremost beneficiaries of widespread availability of health data will not be patients. It will be employers who will use that data in helping to determine hiring. It may be credit firms. It will be the data-mining firms that will use that data to push their wares on consumers." What I would do if I were her: hire a researcher to reference the source of every claim she makes. She’s a doc appealing to a medical and technical audience, so it would be nice to see the same factual rigor that you might expect in a journal article. The ‘can you prove that?’ questions are distracting from her message.

Article tidbit: MD Anderson used iRise visualization software to design its homegrown EMR, claiming it cut development time by half.

E-mail me.

Inga’s Update

Go-live for Cerner Millennium at Barts and the London NHS Trust is rumored to be pushed back again due to supposedly outstanding issues with the software. The trust has been testing the product since August 2007.

The Greater Rochester RHIO launches online sharing services enabling medical offices to access patients’ lab reports, radiology results, and medication history. Patients can’t view their own information (yet?) but can request an audit to see who has accessed their record.

From Political Pundit: "Re: Beacon Survey. I like it. Execs are torn over whether to vote for the person who will subsidize their field of industry or the person who will exchange fewer personal liberties for the soup kitchen of the welfare state. Maybe the question should have been: which candidate do you think will bully for the most taxpayer dollars to be thrown at HIT projects?"

Check out Neil Versel’s podcast interview with Jonathan Bush. I found it both informative and fun. I love how Jonathan rambles back and forth between the serious and the insane. He also mentions Mr. H and me at the start, which of course made me smile.

E-mail Inga.

Shahid Shah on Using Virtual Machines for Easy Open Source Deployment

Shahid Shad is the CEO of Netspective and writes The Healthcare IT Guy.

The open source movement in healthcare technology is growing by leaps and bounds from where it was only five years ago. However, open source software is often difficult to install and get up running, so "trying it out" is not so trivial. I know many CIOs and senior executives who would love to try out open source, but the knowledge required causes IT staff to push back. Most open source software today needs web servers, application servers, database servers, etc. all working in tandem, just to conduct a trial. On the commercial side, things are a little better, but still complicated.

Given how hard it is to install open source solutions, I strongly suggest that the use of virtual machine software like VMware, which is now free for many licensing options, would make it significantly easier for customers to try out software. Other options like Microsoft’s Virtual PC 2007, which is also free, might also be beneficial.

A virtual machine (VM) engine is a piece of software technology that dates back from the mainframe era. It basically allows multiple logical operating systems (a "virtual machine") to operate on a single physical machine. Assuming you have enough memory and processor power, you could have a Linux or Windows "host computer" that would allow multiple Windows 95, 98, NT, XP, Linux, etc "client virtual machines" to run as separate windows at the same time. On my workstation, I often run several virtual machines at the same time. The technology is stable, almost ubiquitous, and very slick.

For almost a decade, I’ve been advising my clients, most of which develop software for a living, to use virtual machines to help improve quality, test multiple operating systems on a single machine, produce "snapshots" of an operating environment for installations and training, and many other uses. I also started suggesting as early as a few years ago that software vendors should create a "virtual machine image" of a system that has their software, database, network, etc. all pre-installed and pre-configured.

VMware has a free version that can take a machine image and launch it on any modern computer. This bundling of an operating system with a pre-configured, special-purpose application is called a "virtual appliance". Cute name, but virtual appliances take literally minutes to run (it usually takes longer to download them than to actually run them). In a virtual appliance, there’s no installation step. You just turn it on and you’re ready to run the software immediately.

For Windows-based offerings, there might be licensing issues from Microsoft (a vendor can’t just create a virtual machine client image with Windows without licensing it appropriately). However, for any software that runs on Linux, that’s not a problem – just bundle the operating system fully configured to run your software along with whatever else is needed and give your customer a "single click" launch and test capability.

The folks from Medsphere, VISTA, ClearHealth, and other open source groups should take this advice. The virtual machine client model forgiving a trial version would change the trial deployment model dramatically and give you leg up on your competition. You could offer a "five minute" install regardless of how complex your software is.

There are already hundreds of other virtual appliances out there in the broad non-healthcare market. It’s time for the healthcare IT sector to create its own virtual appliances to ease the management and maintenance burden on already tired staff.