News 12/5/07

From Jill Purity: “Re: Epic. Lots of prestigious organizations have bought Epic, run wildly over budget, and don’t get all sites live. Have they got a full inpatient site live or not? It seems that with Epic, the hospitals get blamed and not the vendor, where for everybody else, the reverse is true. Why does Epic always emerge squeaky clean?” I’m just riffing here since I don’t know for sure, but Epic’s contracts put most of the burden on the client (wisely, if you ask me). If things go sour, Epic can say they did all they promised. Epic is the only vendor doing so well that they can put that in a contract and get the customer to sign. Their competitors are so desperate that they’ll guarantee all kinds of outcomes outside their control, like physician use of CPOE, cost savings, and improvement in turnaround time. Also, why would a customer who’s already spent the money broadcast their dissatisfaction to the world? They’re big and well-known enough such that a little extra push won’t help them get anything out of Epic anyway, arrogant enough to not want to look stupid, and rich enough to just swallow the cost no matter what. Also, keep in mind that Epic is head and shoulders above all its competitors in KLAS, where its users could blast them anonymously if they chose, so let’s not discount that maybe Epic has a better product and methodology even though its customers, big names aside, are at least as clueless as hospitals with less cachet (or Cache’, for you merry punsters).

From Seth Davis: “Re: Eclipsys. The primary investment firm behind Eclipsys, General Atlantic, dumped a lot of their stock this week, maybe all of it. They still have a board seat, at least for now. Probably not a near-term Eclipsys crisis, just a feeling that now was a good time to get out.”

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 any more. Vern’s response: ‘You have to earn the right to have fun.’ He also said that the banking division had a tough first half because of housing woes.”

Dennis Quaid and his wife file suit against Baxter Healthcare, manufactures of the heparin vials with which their newborn twins were overdosed at Cedars-Sinai in a drug mixup. Oddly, they aren’t suing the hospital for making the mistake, maybe because the babies are fine. Even though Baxter sent providers a warning letter that the hospital supposedly ignored, the Quaids say that wasn’t enough and they should have recalled the vials. Says they aren’t looking for money, but that’s standard ambulance-chaser boilerplate. Baxter’s response: “Company spokeswoman Deborah Spak says the issue is not product-related, but instead concerns improper use of a product. She says no amount of differentiation in packaging will replace the value of hospital staff carefully reviewing and reading a drug name and dose before dispensing and administering it.” I’m with Baxter on this one. If anyone should have learned from the Indianapolis deaths, it was Cedars. And there’s no need for the Quaids to “save other children from this fate” since the packaging was changed earlier this year. Cedars made the call to keep using the old stuff and their employees gave the wrong product.

Lots of HIT jobs (75 or so) have been posted at HealthcareITJobs.com in its first few days, everything from ambulatory system analysts to sales execs to CIOs. The five most recent are listed to your right and the first Hot Jobs e-mail has gone out (sign up here).

Ambulatory systems from Epic and e-Medsys earn CCHIT 2007 certification.

Sage Software joins the e-Prescribing Controlled Substances Coalition, which is trying to get federal laws changed that prohibit e-prescribing of controlled drugs. The ban is kind of silly given the immense problem with forged handwritten prescriptions and the retrievability of those prescriptions for DEA audits. The government wants providers to eat the cost of automating, but won’t make the same requirement of its own departments, apparently.

Fred Trotter has started a blog about healthcare IT in Houston. He’d appreciate getting any local stories and a chance to meet folks there in a monthly meeting he’s planning to set up. I’m sure there are lots of HIT’ers there, at least judging from the massive healthcare canyon that is Fannin Street, so say hi to Fred.

Lucida Healthcare IT brings on Cheryl Alpert as director of marketing. She’s been marketing VP for several companies, including Yahoo and DataBroadcasting. Also joining the company is Mike Lucey, director of business development, who has held positions at Forrester Research, Meditech, and McKesson.

Privacy advocate Deborah Peel advises residents of Lufkin, Texas to avoid the local hospital, which just implemented McKesson’s clinical systems, until they research how the hospital and/or McKesson will handle their data. “People from Lufkin should really think twice before going into the hospital until they know whether their health data will be disclosed without consent and until they know whether the technology vendor contract allows data mining and sale of their sensitive health records.” She claims by name that GE, Siemens, and Cerner reserve that right in their contracts. “This is a way that vendors and hospitals use to help pay for expensive technology infrastructure — they turn around and sell sensitive patient records. The records are sold to employers and insurers, that then use the data to discriminate against people in jobs and insurance coverage.” Assuming those vendors aren’t selling records, I’d protest vigorously for being characterized publicly as such. Sometimes her comments are kind of over the top, reminding me that she’s a psychiatrist.

In what must be the highest software version level in history, Siemens announces INVISION 27.

Omnicell announces SinglePointe, which isn’t defined until the fourth paragraph of the press release. If the conjoined word name wasn’t enough, the oh-so-Brit E at the end raises the annoyance bar, like those cutesy, woodsy-sounding names for cookie-cutter subdivisions in which all flora and fauna are ironically destroyed to erect boring beige boxes, like “Heron Pointe” or “Rivermonte.”

Guess who’s going paperless with their medical records retrieval and management? Some Chicago ambulance chasers.

The Raleigh office of Sunquest Information Systems leases new office space, presumably to vacate the Misys building. Seems odd to have a Raleigh office when the company is in Tucson and odder still to have the CEO working from there.

A Massachusetts entrepreneur is offering a $10 million prize for anyone who can come up with software that can map the genetic codes of 100 people in 10 days for $10,000 or less per genome. “There’s a lot of talk about personalized medicine … But to get there, we’re going to have to be able to do rapid and cost-effective genome sequencing. And for that, we’re going to need a new technology. People are going to remember who did this.”

HHS secretary Mike Leavitt says doctors should have to adopt EMRs to avoid a 10% reimbursement drop scheduled for January 1.

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Inga’s Update

From Randy: “Re: cell phone death. It has now been discovered that this report was inaccurate and a fellow worker ran over the man that died. The cell phone had nothing to do with the death.” Link. Guess we all feel safer taking calls. Another reader pointed out my poor choice of words when noting that “fortunately” the phone was only sold in Korea. I actually wouldn’t want the Koreans or anyone else to risk death by cell phone.

Automated pharmacy system provider ForHealth raises $9 million in new capital funding. The company announces its new IntelliFlow IV Room Workflow Manager solution for managing and tracking I.V. dosing.

A new must-have tool for every road warrior: a service you can launch on your mobile phone browser to help you find the nearest bathroom by city and street address. Brilliant.

eClinicalWorks makes a sale to Redwood Community Health Coalition, California’s largest network of non-profit community health centers.

Desert Regional Medical Center in Palm Springs will purchase the Cerner RxStation for medication automation.

Wyndgate Technologies, a division of Global Med Technologies, licenses its SateTractTX transfusion management system to Sheridan Memorial Hospital in Wyoming.

Annals of Internal Medicine publishes the results of a survey on physician professionalism. One particularly troubling finding: although 96% of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not done so.

The Christ Hospital in Cincinnati signs a multi-year contract with Care Tech Solutions for IT infrastructure outsourcing, help desk, and web services.

E-mail Inga.

Philips To Acquire Emergin

Royal Philips Electronics NV announced this morning that it will acquire medical alarm and event notification software vendor Emergin of Boca Raton, FL for an undisclosed sum. The transaction is expected to close by the end of the year.

See also: HIStalk’s June interview with Emergin President and CEO Michael McNeal.

Monday Morning Update 12/3/07

Someone who should know tells me that the “Juan Garcia” rumor is true on two fronts: he served as a CIA drug interdiction guy in South America and he was approached about one or more GE leadership positions, although he’s got it pretty good at Eclip … I mean, the company at which “Juan Garcia” works.

Graham Barnes is named CEO of BidShift. Zero healthcare experience, according to the press release.

Courts may impose sanctions on Northern Westchester Hospital (NY) for destroying OR schedules. The hospital replaced its chief of anesthesiology, who of course brought in his own anesthesia group. The former group, which had served the hospital for over 25 years, accused the hospital of conspiring with the new chief to destroy their practice and is suing the hospital. They say the OR schedules would prove that the new group was given first shot at business.

A Flash video of the press conference announcing athenahealth’s purchases of a 53-acre campus in Maine features Jonathan Bush’s comments to the locals. Fast forward to 21:40 to bypass the politicians and get right to JB, who leads off with some well-delivered standup material. “Carol Woodcock’s here from Senator Collins office … thank you very much for coming and for all the help that Senator Collins has brought us. Thank you for the notes and the pictures and the grants and the cigars and Blair, waiting at the dock while I tried to find it to bring the kids because I didn’t have anyone to take care of the kids, but I wanted to get a look at the facility and, you know, I never really paid for what they did to the seats in your Suburban, Mark, and I apologize for that. I’ll make it up to you at some point … when people ask me, why Maine, and I don’t have all the witnesses, I usually … well, when people ask me anything, I use that as an opportunity to talk about myself more broadly, so why don’t I do that? We started athenahealth …” Luckily, all the politicians were sitting directly behind him, providing more convenient lip access to his posterior. Well, he is darned charismatic and politicians love job growth.

Speaking of videos, this one from a DC newscast says that the faculty practice at George Washington University is saving lots of paper after its move to Allscripts (calculated at 182,000 trees a year).

Listening: The Dictators, polished, good-natured, and influential New York proto-punk from the early 1970s. Reader tip.

Omnicell will buy mobile cart vendor Rioux Vision for $26 million in cash.

New poll to your right: should CIOs consider open source enterprise apps?

CTO John Bosco is promoted to CIO at The North Shore-LIJ Health System.

HealthcareITJobs.com drew quite a few position listings and advertiser interest at Friday’s kickoff. Check the jobs, sign up for weekly job alerts, and (if you’re an employer) post your jobs for free until January.

Vince Ciotti passes along news that Art Randall, former McAuto sales exec, has died of cancer. “Anyone who worked at McDonnell-Douglas couldn’t fail but remember Art’s great sense of humor, fiercely competitive spirit in the HIS sales world, and indomitable leadership style. In that primarily engineering-oriented aerospace firm, sales was not given as high priority as it deserved, and Art fought the good fight during his decades there, giving the ex-IBM sales crowd at rival SMS a run for their (your) money. What I remember most about Art was his incredible diverse talents: he could repair clocks, restore old cars, write articles on ANY subject in minutes, and give speeches that left audiences entertained and educated. A larger-than life, Protean charmer, Art will be sorely missed. Condolences to his many friends and family.” A scholarship fund in his memory can be reached at: USSVI, Attn: Art Randall, PO Box 3870, Silverdale, WA 98383.

Michael Malone is named president and COO of RemedyMD. Gary Kennedy remains chairman and CEO.

Health First (FL) will present at IHI next week, saying VISICU’s eICU system has saved 82 lives.

Dennis Tribble, CTO of ForHealth Technologies, is named chairman-elect of ASHP’s informatics and technology section.

Christ Hospital (OH), permitted by court order to pull out of Health Alliance, says Health Alliance threatened to cut off its information systems when the hospital started moving admissions offsite. The hospital has filed an injunction.

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Art Vandelay on Revenue Cycle Applications

Reader question: can you elaborate on your comments about revenue cycle product reinvigoration?

Vendors will soon re-architect aged revenue cycle platforms, such as INVISION, MedSeries4, STAR, HealthQuest, and Eclipsys SDK. These apps are older than most college graduates. Should we kick them out of the house or at least put them on notice that they need to improve? We will also need to prepare their “adopted mothers” (the staunch supporters of the app who are leery of change) for that possibility.

They do the basics pretty well. However, adding user interactive functions and meeting regulatory changes will be hard because of their aged architectures. Did any of these vendors add advanced work queues, compliance management, or contract management natively in their apps after all those years of being asked? No. They did it through Stockamp, HSS, Trego, or bolt-ons (Pathways Compliance Advisor, Contract Management). ICD-10, combined inpatient/outpatient payments, and medical error reporting are coming. They can either (a) build it in, or (b) bolt on to somebody else’s product. Old technologies encourage (b).

Many vendors have made minimal investment in revenue cycle products in the past five to 10 years. They’re collecting licensing fees and riding the hype wave to deliver new clinical systems. How many of them built those new clinical systems on their revenue cycle platform? Not a single one.

I expect that investments will shift between major clinical systems and revenue cycle systems.

News 11/30/07

From Bill Bandolero: “Re: Second Life. Patients are using it, clinicians are exploring it, and educational institutions are setting up shop.” Bill sent a link to a site he maintains that has a lot of links to Second Life healthcare sites, but he asked to stay anonymous, so just Google “second life healthcare” and you’ll find stuff.

From PNeddy: “Re: Second Life. Maybe Mr. HIStalk should open a shop in this neighborhood.” Link. Government agencies, including NASA, NIH, NLM, and CDC, are using Second Life for meetings and eventually for widespread communication. “Not far from Meteora is Health Info Island, a medical library and virtual hospital initially funded with a $40,000 National Library of Medicine (NLM) grant to a group called Library Alliance in Illinois to provide consumer health information services in virtual worlds. There are three buildings on the island, said NLM technical information specialist Laura Bartlett, a consumer health library, a medical library and a health and wellness center. Over time, the project will provide training programs, outreach to virtual medical communities, consumer health resources and one-on-one support to Second Life residents.” I’m always up for cool stuff, but I’m light on available time. If anyone can explain what I could do there and what it would take to hook me up, let me know.

From Dan: “Re: Rumor Report. Why does the rumor report redirect to the old HIStalk instead of HIStalk 2? Just curious.” You’ve reminded me that I need to fix that sometime. I’d already created the button and the Web form and just didn’t have time to change it over for the new site. It works great, so I placed it low on my to-do list. You would be amazed at how nice it is to have a secure Rumor Report form that requires Captcha verification to keep the spambots out, plus allows attachments. Before, I was getting dozens to hundreds of spam messages a day. Now, it’s zero. Your rumors and news tips reach me unmolested.

From Maria Cortez: “Re: HIPAA. I’ve heard a lot of dumb things justified by HIPAA, but yesterday I heard one of the best. Our local medicaid HMO has started a ‘high risk diabetic outreach’ program, where they send patients forms to bring to their MDs to fill out. The forms have no pre-printed information and all look the same, so if you see three patients the same day from the same plan, you have no idea which form belongs to which patient (I handwrote their names and MRNs to remind myself). When I inquired as to why they don’t just pre-print patient information on the form (since it’s obviously printed on the envelope they send it in), their response was that if someone else in the household opened the envelope (addressed to the patient), and read the pre-printed form, it would be a privacy violation. I then asked them why anyone’s name is ever printed on a health insurance form/bill/EOB, but they didn’t have a good answer.” Wasn’t this the kind of overzealous interpretation that scared us about HIPAA in the first place? We like the “minimally compliant” approach.

From Charlene O’Donahue: “Re: PHRs. Here’s a new Wharton article.” Link. It’s a good overview for non-HIT people, but I’m surprised that it missed health record banks completely. I’d also question one conclusion that says PHRs could be a bridge between EMRs. I just don’t see that happening.

From The PACS Designer: “Re: ZOHO. TPD has been experimenting with an office software application that is Web-based. It’s called ZOHO and mimics Office. It also provides downloads for Windows, Internet Explorer, and Firefox to link to your system files for transferring online work. It would be good for mobile users when they want to do quick transfers to their home or work based records or files. You can also share records online with others using this application.” I’ve heard great things about Zoho DB and Reports (online forms and databases) and it also has a project management application. The more I play around with stuff like this, the more it feels like the old days when networks were catching on, but many people were still stuck on unattached PCs. I’m using Google Apps so I can access HIStalk documents at work (you didn’t hear me say that) and Inga and I are coordinating some of the HIStech Report stuff on Google’s shared calendar. Plus, I do all e-mail on Gmail and Yahoo Mail. Without all those apps, the PC seems kind of isolated, sitting there running boring stuff off its local drive.

I’m excited to announce HealthcareITJobs.com, something I’ve been working on in partnership with healthcare media publisher Gente Corporation. People have been telling me for years that I should start a first-class HIT career resource center and I’m confident this will be it. Here’s how it came about: first, I was planning to just buy some cheap Internet script and throw something up. Second, as I reconsidered whether that would really meet my standards, I thought about signing on with one of the online job services, but realized it would be cluttered with non-healthcare IT jobs and all kinds of junk that I couldn’t control. Then, I linked up with Gente and it just clicked. This isn’t Monster or Careerbuilder – our career center is dedicated to healthcare IT pros and employeers seeking exceptional candidates. No blind ads, no clutter, no lightweight software. We’re running a world-class job board application and have a team of real people operating it (one of whom you know – me!) The jobs are right there to see on the main page without any “register first” BS. I had my checklist of the ideal job board and we’ve hit every item.

Here are some things you can do with HealthcareITJobs.com. First, click on over and sign up for weekly job alerts. Click around, check out the first group of posted jobs, and register as a job seeker or employer. If you’re an employer, here’s a deal for you: we’re offering free job postings through January, so give us a try. We’re also offering banner advertising with a 10% discount for our loyal HIStalk sponsors. Remember what I said about real people? Here’s one: Gwen Darling. She’s the expert who will be happy to help you with your job postings or advertising needs. I’ve put a link to the site to your right and, as soon as I get a few minutes, I’ll be listing some of the hot jobs right here in HIStalk. I know some of you are unhappy with your situation or have been downsized, so we’re going to do our best to give you some fresh job options for 2008.

And, as I need to say often, thank you sincerely for supporting HIStalk and related projects. It’s not about fame or money (I’m anonymous and a working stiff, after all). I do this because I need something creative to do after a long day at work and I have few other interests or talents. It’s immensely gratifying that you read, interact, and educate through this vehicle. Thank you.

Crescendoplayer sent over some speculation that’s juicy, although certainly not verified. He tells me that a certain software vendor executive, who I’ll refer to as Juan Garcia, is a former military strike leader who ran anti-drug missions in South America with the CIA. Says that exec is being courted by GE Healthcare to be CEO, although he already passed on a CTO offer from them last year. Other companies supposedly interested in his leadership: Microsoft, McKesson, and IBA. I’m cutting back on the details since I don’t have first-hand knowledge, but it’s a fun story if nothing more.

Will Weider sent over to a link to a story about athenahealth’s Jonathan Bush and his participation on a PBS program that took non-athletes and trained them to run the Boston Marathon. JB’s Marathon Diary is a fun read, although a little sad because he was going through a divorce at the time. “Well, my friend Pierre, who knew about the project, said I should. I was in a very suggestible place. [laughs] If someone told me to join the Moonies, I think I’d probably be a member right now. I was in, you know, a difficult place personally. And there was something reassuring about joining a group to do something healthy for me. Forced health, forced purging of all kinds. I think that was the main motivation. Pierre also told me I needed to meet girls and that there would be all these girls in the marathon. [laughs]” Will is unhappy that Jonathan finished in 3:52. “I trained much longer for my marathon and ran much slower. I now officially despise him. I am pretty sure that I will never buy anything from athenahealth. Perhaps I will add a question to my RFIs about the marathon times of their executives that I can use as a filtering criteria.” I e-mailed Will back: “I like the idea of showing preference to vendors whose executives are less athletic. I’m also on record as preferring those that are less attractive, less wealthy, and less intelligent. I have enough insecurities without realizing that some vendor sales VP is better than me in every important category!” To which Will replied, “Exactly. It is not a new concept. Everyone understands ‘client golf.’ We are just extending it a little.”

A bad smell forces the evacuation of one of McKesson’s Georgia offices. Any witty punchlines are up to you.

Industry regular Steve Roberts signs on with HealthPort as COO. He’s done stints at SDS, GE Healthcare, Allscripts, and McKesson.

An analyst thinks Emageon’s share price drop could attract merger or buyout offers.

Sunquest announces a sale to TriCore Reference Laboratories.

Embarrassing: surgeons at Rhode Island Hospital operate on the wrong side of a woman’s brain when a surgeon “misremembered” the CAT scan, the third such occurrence at the hospital so far this year. The state fined the hospital $50,000.

Somerset Pediatric Group (NJ) picks Sage Intergy.

South Florida has an epidemic of upper-middle class families, including their kids, who are hooked on prescription drugs willingly doled out by shady doctors operating from roadside pain management clinics. One such doctor had his medical license revoked and is working in a gas station while we waits to be tried for prescription drug trafficking, which could put him away for up to 75 years. “We wanted our market share … we didn’t wanna lose a patient.”

Greg Larkin MD, formerly of Eli Lilly, is named CMO of the Indiana Health Information Exchange.

Strange hospital lawsuit: a Chinese hospital insists on getting the husband’s signature on a surgical consent form before doing a C-section on his wife. He refuses at the last minute and the woman dies. Her mother is suing the husband and the hospital. The hospital says they coudn’t do anything without approval, although a legal expert says hospitals have the right to save a patient but are sometimes sued for doing so without the paperwork.

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Inga’s Update

From Dr. John J. Ryan, Founder, President and CEO, The Int’l. Assoc. of Dental and Medical Disciplines: “Inga, I am writing to tell you that we have no sponsors at the current time. Our organization is trying to remain financially independent for as long as we can. Though things may change at some point, we are giving the growing bundle of perks to attract educators and health care practitioners to share our mission of combining dental and medical under one umbrella to better treat every patient as a whole person. It is important for us to combine all disciplines to communicate on behalf of the best possible care and the IT giveaways can facilitate that. The Web Site, Hosting, and Email service is for every member, the IBM Thinkpads, however, are a limited number, for now. With members joining our group we can better build our donated services health care base and better help us can to find dental or medical donated care for such a person in need.” Dr. Ryan also mentioned they are looking for administrative volunteers to help find care for the uninsured.

Athenahealth is purchasing a 130,000 square foot office facility on 53 acres in Belfast, ME. The center will serve as a second operational service site

Sage reports its total revenues were up 24% over the previous year, though the healthcare group saw  just 1% growth.

Overheard: Big Brother is watching over sales reps at a certain vendor. Supposedly sales folks at this company are upset over a new policy that requires them to keep up to schedules in Outlook. Seems like management could find better ways to help salespeople sell then by micro-managing their calendars. Not to mention that if someone is producing, what difference does it make if they take an afternoon off to golf? And if they aren’t selling, why keep them around?

Delaware Health Net selects Allscripts HealthMatics Office for its 20-doctor, six-location network of community health centers.

Norman Physician Hospital Organization purchases eClinicalWorks for its 31 affiliated practices and 100 physicians.

Carestream Health and IBM announce plans to integrate Carestream’s radiology solutions and IBM’s Lotus Sametime software to facilitate rapid communication, including instant messaging and VoIP operations.

Visage Imaging will integrate Nuance’s Commissure RadWhere into its PACS and image interpretation software.

The Brooklyn Hospital Center, Brooklyn, NY will implement Eclipsys’ Sunrise Clinical Manager at its 463-bed facility.

A Korean quarry worker dies after his cell phone battery explodes. Fortunately, the phone is only sold in Korea.

E-mail Inga.

News 11/28/07

From Bignurse: “Re: chart errors. The article about the doctors finding incorrect information in their own medical charts reminded me of a ‘new paradigm’ for charting that I saw a few years ago in which the doctor-chart-patient are in a triangle, with doctor and patient sitting side-by-side and looking at the chart (an EMR) together. It makes perfect sense and would prevent incidents of ‘wrong patient, wrong chart’ as described in the article, but when I used to describe the ‘new paradigm for charting’ during EMR training sessions, people looked at me like I had three heads. It is anathema for medical folks to imagine letting patients see—much less contribute to – their own medical records.” Maybe we need an evaluative tool to determine just how capable and interested people are in participating in their own care. Otherwise, we just treat them equally like dull fools, at least unless the family intervenes. And I truly believe the days of “don’t worry your pretty little head about your records – that’s my job” are over. No one’s too scared to speak up any more. I say if you want to stroll around to the doctor’s side of the PC or hold out your hand for the chart when he or she’s done writing in it to take your own look, then that’s your right as a paying patient, no different than you’d expect than when dealing with a mechanic or plumber (although since doctors work on patients, not cars, they can’t put out those phony “insurance doesn’t allow customers in the garage” signs to keep pests from bothering the help).

From Hamilton Swan: “Re: Perot. Has Perot has adopted the IHE model for HIT standards, do they lean more toward the HL7 model, or are they agnostic?” I’ll ask for a lifeline on that one, if anyone knows.

From Gerry Fleck: “Re: reading list. I have found The Innovator”s Solution a powerfully useful way of thinking about what it is that we healthcare informaticians are really trying to enable and why the incumbents can find it daunting.” OK, I was hooked by the opening sentence of the first Amazon review: “The first two chapters of this book are so well thought out and beautifully written that reading them literally made my muscles ache and toes curl.” I’ve placed my order. Thanks for the recommendation – book report to follow.

From Theodore Millbank III: “Re: hospital guards. Kaiser does not allow any armed guards for the ED or anywhere else for that matter. I really dislike this policy.” I’d be nervous, especially after dark. If you work for a trauma center or inner city hospital, you need a front door security guard and an real, uniformed cop in the ED, in my opinion. There’s nothing like a couple of stabbed gangbangers dripping blood in the ED who regain enough moxie to continue their knife-fight from their gurneys, sandwiching a 110-pound female nurse between them in the process. Current example: police dropped off a drunk man in a New York hospital ED, where he broke out of restraints at 4 in the morning and beat two nurses with them, threw a computer at another nurse, and wailed on security guards with computer cords. Sounds like an effective, if inappropriate, use of technology.

From Art Vandelay: “Re: remote monitoring. Monitoring technologies allow disease management with human interventions (i.e., people watching your data and running reports with automated alerts). These people will likely sit in other countries (The World is Flat) and use mobile broadband capabilities to work with our phones, watches, and other on-the-person devices. This could offer interesting alternatives for chronic condition management and surgical recovery, although the FDA 510K challenges could be interesting.” Art mentions Bill Crounse’s blog entry on mobile devices.

From Harlan Pepper: “Re: CIO Summit. The one being discussed is not affiliated with CIO magazine. They made their logo look just like the magazine’s.” I’ll be darned. Compare CIO Magazine’s logo to the Summit‘s. That’s quite a coincidence. Harlan sent over a list of delegates who’ll be there, some of whom I know read HIStalk, so perhaps a critique will ensue.

Another sad news item involving a hospital IT leader. UPMC CIO Mark Hopkins died of cancer on November 13, the family announced yesterday. He was 47. Hopkins was named as one of ComputerWorld’s Premier 100 IT Leaders last year. He is survived by his wife Kimberly and two children. A memorial service will be held Saturday at noon at First Unitarian Church and a reception will follow at UPMC Shadyside’s Herberman Conference Center. In lieu of flowers, donations may be made to the Mark T. Hopkins Fund at the Baltimore Community Foundation.

Eric Rubino joins InfoLogix as COO. He was formerly COO of SAP Americas and Neoware.

Listening: Paramore, big-guitar chick rock. You have to like a song called “For a Pessimist, I’m Pretty Optimistic.”

Gaines Baty, president of recruiting firm and HIStalk supporter R. Gaines Baty Associates Inc., provides career guidance for employees of acquired companies in The Wall Street Journal.

Tom Visotsky, formerly of Concuity and 3M HIS, joins Medicare compliance and reimbursement solutions vendor CodeMap as EVP of business development.

A reader sent over John Glaser’s article in Harvard Business Review, a fictional case study in which an IDN’s CEO is asked to choose between a billion-dollar monolithic enterprise system and experimentation with service-oriented architecture. Without apparent irony, Kaiser CEO George Halvorson opines that the phony organization shouldn’t bet the farm on systems without a sound business case and that “extremely high levels of system availability are an absolute necessity.”

Reminder: Platinum Sponsor Picis is looking for topnotch talent, which I know is commonplace among HIStalk readers. Worth a look, I’d say.

Streamline Health’s Q3 numbers: revenue up 10%, EPS $0.00 vs. -$0.04.

A Tacoma Community College nursing professor uses the online world of Second Life to create ED simulation training. I tried Second Life once and was bored after a few minutes of fumbling around, but apparently it’s quite the hit, especially for nerds whose First Life isn’t what they’d hoped. If you’re a fan of it for medical or business reasons, feel free to send in a precis.

Health Data Services offers its FreeDOM PM/EMR at no charge to one- and two-doctor practices in Florida, the tenth state it serves. They make money from elective add-ons like claims processing, patient statements, support, and coding. Sounds like a good idea, although I know nothing about the product.

Cardinal Health recalls another model of its Alaris smart IV pump line, this time the biggie: the Medley, with 200,000 devices in the field.

Inga and I have been insanely busy lately with interviews, HIStech Report, and new and upgrading sponsors. If we’ve been inattentive to anyone who’s taken the time to e-mail, allow us to apologize and pledge to do better once we dig ourselves out from under the work we keep creating for ourselves. Here’s the lightning tour of reminders for the noobs: the Search function to your right covers the 4 1/2 years and millions of words of HIStalk, you can sign up for instant e-mail updates and the Brev+IT newsletter (current issue here) over there, and ping us if you’d like information about HIStech Report or sponsoring. The Rumor Report to your right is where you can tip us off to interesting news and rumors (you can even submit attachments and it’s anonymous, of course). Speaking of HIStech Report, I interviewed the guys from PringPierce Executive Search there, so check that out. In a day or two, I’ll also tell you about a new job service that I’m involved in that I think is pretty darned cool.

I wasn’t exaggerating on the “millions of words” above. So far this year, HIStalk is running well over 300,000 words, about six novels’ worth. That doesn’t count my editorializing, Brev+IT, HIStech Report, and so on. I knew I should have taken typing in high school.

Canadian physician EMR vendor Nightingale Informatix loses $1.4 million in Q2 on doubled revenue.

UPMC signs a seven-year, $70 million deal with Xerox for print and document management.

Atlanta’s Grady Hospital could close in the next few weeks, leaving the city’s poor with few options and Atlanta without a Level 1 trauma center. It’s running a $55 million deficit and needs $300 milllion in capital improvement. Its board wants local government to guarantee $200 million in new loans, although it’s a safe bet the money would never be paid back. In a sure sign of rational responsibility over the issue of privatization, community activists and showboating politicians scuffled with hospital security guards and were hauled off screaming in handcuffs, although in their defense the board did sound kind of high-handed in its decision-making.

A CDW Healthcare survey concludes that nurses understand the benefits of IT, but hate paper duplication, poorly designed systems, lack of input in selection and implementation decisions, and inadequate computer training. My experience validates every conclusion. Good work from a vendor you might not expect to care about such issues. You can download the report here.

E-mail me. It’s alway slow in December, so I can use good rumors, secrets, or thoughts.

Inga’s Update

Drs. DeBakey and Cooley have ended their 40 year feud. I never realized that the rift was over a stolen (artificial) heart. I guess at ages 99 and 87, they figured it was time to bury the scalpel. Heartwarming.

SCI announces that its Order Facilitator product won (warning: PDF) second place for “Best Technology Innovation for Continuum of Care” by Consumer Health World.

Fired Microsoft CIO Stuart L. Scott resurfaces as COO of Taylor, Bean & Whitaker Mortgage Corp. The company is based in Florida, but Scott is going to stay in Washington with his family (seven kids!)

Medsphere continues to add to their executive team. Former Athenahealth Chief Revenue Officer Rick Jung comes on board as Chief Marketing Officer. While he has an impressive resume, it looks like he has spent most of his time as a numbers guy. But, their new CMIO has spent most of his career with IT start-ups, so why not put a finance guy in the marketing role?

There is a new private investment firm focused on the healthcare. Cressey & Co. doesn’t have much of a web site up yet, but they do have former Senator Bill Frist as a partner.

I’ve read about the organization that is offering free IBM Thinkpads to attract doctors to their new association. The International Association of Dental and Medical Disciplines is offering this perk in addition to a free customized Web site, free Web site hosting, free email, and a free marketing package. The annual dues are $1899 and the perks about $5000. I looked all over the site for the catch (or at least an idea of who is providing the funding) but didn’t find any clues. Anyone know?

Hewlett Packard is giving the Lucile Packard Children’s Hospital $580K in HP equipment plus an additional $500K in cash for research.

E-mail Inga.

Monday Morning Update 11/26/07

From Jay G: “Re. CIO’s Healthcare CIO Summit. I got to attend the recent Scottsdale event. The resort location was quite impressive, but we didn’t have much time to enjoy the surroundings. The organizers had things scheduled from morning to evening, with roundtable presentations during lunch and vendor presentations during supper. Vendors reportedly paid over $30K to sponsor (which works out to ~$2,000 per 45-minute one-on-one session with a CIO). At that rate, the organizers were pretty aggressive about making sure that the guests got to their sessions. Vendors ranged from hardware (UPS) to implementation consultants. I heard positive comments from guests (‘learned about a variety of solutions’) as well as negative comments (‘waste of time’). Overall, it was an interesting example of how much vendors will pay for face time with a CIO.”

From CIO Guy: “Re: HBR. ave you seen the Case Study authored by Glaser in this month’s Harvard Business Review? It is a little quirky, but I think he did a good job overall. How did they choose the respondents?” I couldn’t find the article by searching on their site, but I like quirky.

From Former Misys Manager: “Re: Misys. Sunquest Announces New Investment and Market Focus for its Radiology Information System.” Link. Smart move. I expressed surprise that Misys sunsetted Flexirad and the PIM PACS broker in the first place. I expressed surprise once again when Sunquest re-emerged as a LIS-only vendor, having dumped rad, pharm, and clinical decision support apps along the way that were good, marginal, and immature but promising, respectively. The last radiology upgrade was in December 2006, so they can pick up the cycle pretty easily if they still have the right people. Their PE investors could consider acquisition targets that have complementary clinical offerings, like TheraDoc or E&C.

From The PACS Designer: “Re: what to read. TPD peruses the Ebling Library, Health Sciences Learning Center to find interesting reading material. Ebling is in Epicland at the University of Wisconsin-Madison, so it’s in the right location for healthcare research devotees although you need a UW-Madison ID to access the library remotely. There are over 1,900 biomedical and health sciences journals in the online library. If you find something good that HIStalk readers may benefit from, please post a comment so we all learn something new.” Link.

From Rich Kremsdorf: “Re: what to read. Here is a link to the reading list I maintain on my website. It was developed for MDs who find themselves in HIT leadership roles, but is more generally applicable.” Link.

From Duuude: “Re: informatics programs. I recommend UAB, which has done a good job of training eventual directors and CIOs in healthcare IT. It misses its founder, Merida Johns, but still does a good job.”

From The Shadow Chancellor: “Re: UK identity loss. This quote sums it up: ‘Let us be clear about the scale of this catastrophic mistake – the names, the addresses and the dates of birth of every child in the country are sitting on two computer discs that are apparently lost in the post, and the bank account details and National Insurance numbers of 10 million parents, guardians and carers have gone missing.” From this newspaper editorial: “Yet when asked if this fiasco effectively ends plans for identity cards, government ministers say no, still holding to a misplaced belief that ID cards will help make Britain safer. This is a contempt-ridden response. All politicians should be judged on their record. On anything to do with data and IT, this government has a woeful record, illustrated by the millions wasted on an NHS computer system that after years of consultancy fees still does less than a doctor with a notepad and a Biro. And the lessons learned here? There have been none. The plans for ID cards, with all the complexity of biometric data they are supposed to contain, are said to be still on course.” Biro is apparently Britspeak for a pen.

Tim Belec, VP of IT at Wheaton Franciscan Healthcare, was shot in the parking lot of the organization’s Glendale headquarters as he left work on Tuesday. A 17-year-old suspect approached Belec and robbed him of several items, then shot him twice in the chest with a .38 pistol. The 50-year-old Belec, a former police officer, gave authorities a description of the suspect and weapon, leading to his arrest. Belec was moved out of the ICU at Froedtert Hospital later in the week and no updates of his condition have been posted since, but he is expected to recover. Wheaton had recently increased security after vehicle break-ins and now plans to fence the property and hire additional security guards.

Bill Yasnoff sent over a link (warning: PDF) to a new report on health record banking called “Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered”, by The Information Technology and Innovation Foundation. I’m beginning to like the concept since it seems to address the major issues that are holding back information exchange (privacy concerns, technology challenges, business models).

I guessed wrong on the system used to inappropriately access celebrity medical records in New Zealand. Wrong Concerto – theirs was Orion Health‘s Concerto portal. Makes sense since both are from New Zealand.

I haven’t heard a word about the recent Virtual HIMSS.

Everybody’s read the headlines by now: the newborn twins of actor Dennis Quaid are given heparin 10,000 units instead of 10 units at Cedars-Sinai. They got a quick PTT and protamine doses and will probably be OK. I’m betting it was the same problem that happened in Indianapolis before, where pharmacy technicians loaded the wrong vial into the Pyxis dispensing cabinet and nurses didn’t pay attention to the label on the otherwise nearly identical vials. Barcoding, people.

McKesson VP and former Per-Se chief accounting officer Richard Flynt joins Immucor as CFO.

Healthcare organizations in Maine get a $3 million FCC grant to bring in broadband connectivity.

Baxa signs on as the exclusive reseller of software from MedKeeper that tracks the preparation and delivery of drug doses packaged in the hospital pharmacy. Everybody involved in MedKeeper used to work for Micromedex.

A Berlin hospital is involved in testing a brain-computer interface that could help people who are  paralyzed. It uses EEG signals to control a robotic arm, in essence making it a thought-controlled device.

UMass Med Center uses RFID to track stents and other devices via smart cabinets that inventory their contents and update them as items are removed.

A Michigan woman faces fraud charges for continuing to use employer-paid medical insurance for eight years after she was fired, running up $230,000 in expenses. She got on the county-paid BCBS plan, was fired after 10 days on the job, but kept getting new cards because the county screwed up.

The guy who started Hotmail and sold it to Microsoft for $400 million uses the money to launch a free, online semi-clone of Microsoft Office. That’s one irony; the other is that Microsoft itself set the legal precedent that may keep them from suing him over look and feel issues, from a 1994 ruling that Apple lost to Microsoft claiming that Mac graphics were copied for Windows. Trivia that I didn’t know until now: they guy came up with the name Hotmail as the sounding out of HTML. Great quote: “We are just a few years away from the end of the shrink-wrapped software business. By 2010, people will not be buying software.” I signed up for an invitation, so I’ll let you know.

The New York Times magazine has a fascinating look at how drug companies get private doctors to pimp their wares to colleagues. $500 for a one-hour lunch chat, luxurious “training” (i.e., brainwashing) that includes Broadway tickets and cash, and buddying-up with the local drug reps who grade their selling performance. Startling: 25% of US doctors get paychecks from drug companies for pushing their goods. “Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called ‘prescription data-mining,’ in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies.”

Doctors, when they are patients anyway, think doctors do a sloppy job with paper medical records. One doctor quoted had a cheek lump that went away, but his chart said he’d had a stroke.

Sumter Regional is doing great in the “Win an MRI” contest with 136,000 votes, well ahead of second place Lockport Memorial’s 73,000. But, voting runs through December 31, so they would appreciate some clicks, I’m sure. While you’re there, check out Othello Community Hospital’s (WA) “MR Chick Magnet”, which is pretty funny in the prevalent “we’re hayseeds” genre.

What HIT people are reading:

Redefining Healthcare
The New CIO Leader: Setting the Agenda and Delivering the Results
Crossing the Chasm
The Innovator’s Dilemma
How Doctors Think

E-mail me.

Art Vandelay on the Near-Term Vendor Frontier

We can see the intermediate strategy emerging for a number of vendors. Two strategies ago, vendors were working on a set of bolt-on applications targeted at work-queue and workflow enabling the old-and-tired applications in our environments. Some vendors elected to partner for bolt-ons, others elected to build them, and still others had a foot in both worlds. Representative strategies were to add billing and collection queues and registration and authorization queues for payer-rule intensive areas ( i.e., high-end diagnostics, surgeries). The next strategy was to provide visual workflow aids (i.e., bed boards) and visual integration of information (i.e., patient context enabling any best-of-breed applications in the environment, portals) as well as pursue the enhancement or re-architecture of general-use clinical systems ( i.e., systems supporting order entry, general documentation, not specific departments).

We are on the verge of another strategy shift, one back towards a focus on the functions enabling departments and the emergence of the next stage of integration with real-time location systems (RTLS). The major single-source clinical system vendors ( i.e., Cerner, Eclipsys, Epic) have poor capabilities that enable the workflows and effectiveness of “specific-use departments” or care delivery areas (i.e., cardiology, emergency department, lab, oncology, pharmacy, radiology, procedural medicine). As the deployments in the “general-use care delivery areas” ( i.e., ICUs, medical-surgical floors, ambulatory primary care) progress, the focus will turn back to the “specific-use departments” who “took one for the team” and are now swimming in the inefficiency of a single-source system. The single-source vendors can choose to address the issue and keep their customers happy and engaged, or they can continue to short-change these areas.

Vendors who short-changed these areas, or who can execute two major strategies concurrently, will likely focus on the acquisition of or partnering with vendors on RTLS. Health care, as an industry, is usually behind other major industries. Real-time feedback and visualization has been a focus of other industries for over 5 years now. We are just getting to this. The next stage of RTLS integration will involve the visualization of and enablement of tasks and workflows on a macro-basis, not just focused in a “specific-use department.” This next stage of integration will involve visualization of orders, pending activities ( i.e., documentation, medication administration, transport), patient health status and staff workload. Beyond this, I can see the systems evolving to show or predict the picture hours in advance to help sequence future tasks and determine if additional staff are needed.

On the far horizon is the reinvigoration of revenue cycle systems, it is inevitable as the disenchantment with the broad yet not deep clinical systems will grow and the economic situation in the country becomes more challenged.  As always, the million-dollar question is, “Can vendors evolve or will there be more strange appendages and vestigial structures bolted-on to an inflexible architecture?”

News 11/21/07

From Dr. Lisa Cutty: “Re: Agfa. We had a big rumor going around at MEDICA. GE buying Agfa Healthcare and they wanna announce at RSNA. Confirmation, anyone?”

From Fish n’ Chips: “Re: Sutter. Does the $500+mil Epic install at Sutter include the cost of maintaining the old systems for the next 10 years or so? Seems that Judy doesn’t want her database polluted with legacy data. The solution? Keep the old boxes running for next xx number of years.”

From Nasty Parts: “Re: SureScripts. I understand that one of the primary factors standing in the way of EMR vendors getting current CCHIT certification is that they are mandated to use Surescripts. I know this is an issue for several vendors that already have other solutions for this area. My question is why a vendor-neutral organization is in essence giving a monopoly to another company. Why the mandate?”

From Thaddeus Balbricker: “Re: reading list. I recently re-read ‘Healthcare in the New Millennium’ by Ian Morrison. Do readers have a recommended reading list or would they share what they’re reading?” Good question. Have recommendations of the healthcare, business, or IT variety? Use the Rumor Report to your right to send them my way and I’ll compile. I’m always on the lookout for something to read.

From Millie McPilli: “Re: CIO’s Healthcare CIO Summit. Anybody have vendor or attendee feedback?” Link. I’m interested myself, if you’ve participated, please give me your opinion.

From Wompa1: “Re: DUI story. It would be interesting if the hospital’s information could be used as evidence. Hospitals working in concert with law enforcement? It sounds like they already believe they are part of the government.” And the odd thing: maybe they are, depending on organizational structure. Remember that Nassau University Medical Center CIO who got in trouble for taking hockey tickets from Cerner who claimed she didn’t know she was a public official? That may well have been true given the complex organizational structure issues involving publicly funded hospitals.

From A Competitive Kaiser Doc: “Re: Sutter. Competitively speaking, I see this as a win for Kaiser. How so?If Kaiser spends several billion without reasonable return and Sutter avoids that trap, Kaiser would lose, relatively speaking.” Sounds like a rousing RIO testimonial: “Spent billions with minimal benefit, but still less than our competitors.” I don’t actually know about the “minimal benefit” part, but HIT history leans that way.

From The PACS Designer: “Re: PACS/RIS. Lately TPD has been asked about which is more important, PACS or RIS, to department flow. While RIS has been around more frequently in hospitals and is more stable, it is still important to have a good RIS in place when contemplating a new PACS install. What has changed recently is PACS is being interfaced to existing RISs at a much more frequent number of institutions, so there are more questions about which is the best solution for the most efficient interface. If a RIS is in place and a PACS is to be added, it is important that the RIS/PACS interface be fully tested before going live with the new system. To avoid the requirement for an interface, I advise buyers it would be good to also consider buying a PACS with RIS from the same supplier so a proven solution that has already been installed and  resulted in happy customers will limit the need to use an existing RIS. I tell potential buyers that both systems are important, but the integration between the two systems is even more important.”

Scot Silverstein sent a note about AMIA vs. HIMSS. I like his comparison that postulates that, as a trade show, HIMSS is based on an identifiable management information systems culture. “It is process and control oriented, which in many circumstances it needs to be, and has some of the characteristics of a religion (e.g., dogma, central tenets that must not be challenged, a belief that its approaches are the best approaches and even the only approaches to any information problem at hand). It is very different from the culture of medicine and medical informatics. The latter cultures take the scientific method seriously, are probing, inventive, and results-oriented. In MIS, it seems there’s a belief that you can get to the moon in a balloon if there’s enough workflow analyses, process, and people put to work on the problem. In the medical culture, there’s just no time for committee meetings and K-T analyses in cardiac arrest situations.” That’s interesting, and probably correct (although maybe a bit MIS-heavy than today’s shops) from my observations: IT folks decry physicians and the culture that teaches them to behave in certain ways, but IT has its own set of beliefs that probably drive doctors equally nuts. The standoff: IT overrides the docs and the docs refuse to play. Someone could write an interesting article on how to recognize and mitigate those behaviors in a way that would increase the chances of clinical IT project success.

Someone who should know sent positive comments about CEO James Burgess of Mediware, saying he is great to work for and will take any role needed and will meet with anyone. Says he’s honest with clients and didn’t come into Mediware with the attitude that he was the expert and anyone who didn’t agree could hit the street. Glad to know that. I don’t know him and haven’t been critical other than to observe that he’s been involved with layoffs at more than one company (which in healthcare IT just means you’ve worked at more than one since, unfortunately, most of the big ones like to dump staff to prop up earnings).

The Revere Group is a new HIStalk Platinum Sponsor, for which I’m most grateful. The company has grown amazingly since its 1992 founding into a major global consulting force. In its healthcare vertical, The Revere Group provides services to providers, payors, life science companies, and associations. They have lots of case studies and white papers on their site. You may have seen the August announcement of the company’s acquisition of consulting firm Tryarc, LLC. The Revere Group has a skilled Microsoft Solutions Practice (Gold Certified) covering all the cool stuff: SharePoint, BizTalk, SQL Server, Visual Studio, System Center, and more. I notice they also have a full-service Microsoft BI group that handles SQL Server, Transact-SQL, and other BI/OLAP expertise, too, and I don’t know of many hospitals who don’t have a lot riding on their BI programs (and more coming with all the quality and outcomes data analysis needed). Anyway, it’s great to have The Revere Group on board with HIStalk and its readers, for which I thank them.

I received some excellent feedback on informatics programs. Greg suggests first checking this list of programs that have received federal funding through NLM. Among the schools on it that he recommends as first tier: Stanford, Yale, Indiana, Harvard, Columbia, OHSU, Pitt, Vanderbilt, and Utah (the first column contains the programs most likely greared toward provider computing, I would think). The second resource is AMIA’s list of programs, which contains those additional schools that arguably would comprise the second tier of programs, which Greg says could be programs that lost a strong leader or that may have cobbled together a degree by mixing a few IT courses with a splash of healthcare. The good news: degrees from either list will probably be just fine for working in healthcare IT. If your goal is to be an academic or researcher, then schools on the first list would be safer. Sara is in Northwestern’s MMI distance learning program, along with consultants, physicians, nurses, and hospital executives. She says the program is challenging and requires coordinating group work, but the professors are supportive. Michael also recommends the NLM-sponsored programs since they focus more on academic topics, such as vocabularies and natural language processing, but not necessarily general or project management. He says the four programs I originally mentioned are relatively new, so the NLM programs will provide networking and instant recognition which worked great for him. For training of a more professional nature instead of academic, he recommends consider the 10×10 program from AMIA first. He also mentions that many CMIOs don’t have formal training.

Former Carilion CIO and KLASser Greg Walton has taken El Camino Hospital’s CIO position, I’m told.

The 31 IT employees of Wyoming Valley Health Care System (PA) move into a new building they’ll share with the School of Nurse Anesthesia. No jokes about both groups putting people to sleep, please.

A hospital in Denmark uses Hyland OnBase to share electronic medical records. I like its EMR system name: Cosmic EHR.

Listening: Saxon, old pop-tinged metal. Driving music.

UK’s NPfIT has lost almost all its physician support: down to 23% of GPs (compared to 56% three years ago). Fewer than half now think it should be an NHS priority, down from 80% five years ago.

An interesting profile of 94-year-old Morrie Collen, a father of electronic medical records (he built a system in 1969) and a founding member of the Permanente Medical Group.

New Zealand healthcare workers are disciplined for using an electronic medical records system to look up the records of celebrities. The system wasn’t fully named, but it appears to be Canadian vendor CHCA’s Concerto. Doesn’t matter which system, of course, but I was curious.

MetroHealth (OH) signs with AT&T for an Aruba wireless network and security solution.

23andMe, the company owned by the wife of Google co-founder Sergey Brin, launches its $999 personal genetic profiling service.

Odd: Chinese doctors warn viewers of the pirated version of the latest Ang Lee movie not to try the sexual positions shown, which censors cut from the theatrical release, unless they have gymnastics or yoga experience.

I’ll probably skip writing Thursday since nothing much will be happening and few would read anyway, but I’ll make sure to have a Monday Morning Update to get you reconnected next week. If you’re going to RSNA, bundle up and travel safely. Thanks for reading. It’s never a chore to interact with so many smart people. Happy Thanksgiving.

E-mail me.

Inga’s Update

The Ohio State Medical Association will begin a process in January that allows EMR vendors to certify their sales contracts with a Standards of Excellence designation. For example, the contracts must allow for refunds if implementations “fail,” must allow for installment payment based on achieved milestones, and must allow software license transfers. The Coker Group helped with the project that is designed to make contracts more physician-friendly. It will be fun to see what vendors balk because the requirements don’t align with their objectives.

The Minnesota Medical Association is also in the news for publishing a report on the state’s P4P programs. Their conclusion: “Although research on the efficacy of these P4P programs to improve the quality of care is increasing, there is little evidence about their value that is statistically significant or overwhelming.” The Association also had some recommended steps for improving P4P programs, including common measurement sets and financial incentive for EMRs.

Kings County Hospital in Brooklyn will use MediKiosk self-service kiosks in the ER for check-in and triage. I personally think this technology is cool, but I wonder how well the masses are embracing it?

The FCC announces (warning: PDF) the 69 winners that will share $417 million in grants to promote broadband telecommunications. Recipients come from 42 states and 3 US territories.

It’s a great time of year to reflect on the many gifts in my life and give thanks for the good stuff. Most of my “stuff” sounds pretty simple but I’m happy for simplicity:

I am thankful that I’m healthy, have great friends and family, and never have to worry about having enough money for food or shelter.

I am thankful to live in a country where I can feel safe and have had the freedom to choose where and how I live, where I’ve had great educational opportunities, and where I’ve had the chance to choose my career (more than once!)

I am thankful for the opportunity to work with Mr. H. I am really not trying to suck up … I have been having an amazingly fun time the last few months and I have had the chance to grow and learn. How lucky is that?

E-mail Inga.

Monday Morning Update 11/19/07

From Holly: “Re: HIPAA. On the heels of Piedmont Hospital, Cedars-Sinai in Los Angeles is number two to be undergoing a HIPAA Audit by the government.” Unconfirmed, but that’s interesting. I didn’t hear what came out of the Piedmont visit. Gartner could do an interesting hype cycle on HIPAA. Phase I was everybody panicking and hiring consultants and attending endless HIPAA preparation seminars, along with promoting some obscure HIM or compliance person to a higher paying HIPAA Czar position. Then, it kicked in with NPPs, employee training, and transaction set software upgrades. Next, it dropped out of the picture entirely when it became clear that the administration wasn’t keen on actively hunting down violators. Most recently, the formerly timid providers and agencies are piping up to say that it really has impeded information flow and needs to be revisited. Somewhere in all that is the Insurance Portability part that got the whole mess going.

From Amber Waves: “Re: AMIA. I vastly prefer it to HIMSS. It is much more practical, in my mind, with way less focus on vendors and way more on what is really working – whether vendor-driven or homegrown. They have lots of opportunities for interaction with people who are really working hard on the tough informatics issues. Some of the solutions are not yet in the vendor products, but they will be soon and it is great to see in advance what types of real implementation issues are going to be coming along.” I also noticed that AMIA will take its 10×10 informatics education program global, now shooting for training 20,000 informaticists by 2020.

From Jack Horner: “Re: AMIA. Another great panel was ‘Integrating Informatics Into the Enterprise’, with John Glaser, Bill Stead, Marc Overhage, and Charlie Safran. The first two basically proved why Vanderbilt and Partners have the biggest informatics departments. Partners is also impressive in that it has avoided vendors for its EMR system and also that its IT department actually funds small, internal research grants. Bill Stead gave one of the best descriptions of the field informatics I’ve seen. Also notable: the empty Misys booth in the exhibition hall. Maybe you could get the NLM to give out ‘I Am Mr Histalk’ buttons at the 2008 conference?” OK, you’ve just about convinced me. I probably won’t attend the meetings (although you never know) but maybe I’ll join. It does sound more practical than I remember and I just might be an informaticist, depending on who’s defining. Its CEO salary: $256K.

From Keyser Size: “Re: layoffs. In Atlanta, the air is cool and brisk, leaves are turning red and gold, the holiday spirit is all around. It is also fall at McKesson, where around 250 employees were given their pink slips this week.” Unconfirmed.

From Nasty Parts: “Re: Allscripts. The culture of Allscripts is very micromanagement. I understand that Glenn Tullman himself regularly dials members of the sales force to quiz them on competitors, elevator speech etc. He also has his product manager making similar calls. All of this on top of the daily pipeline reports that the sales guys have to deliver.” That’s probably annoying to a sales guy used to being a lone wolf, but I give him credit for getting involved in the details. If he wasn’t, someone would claim that he was distant and disconnected.

From Justen Deal: “Re: Universal Rules for Big EMR Rollouts™. Went ahead and trademarked it for you.” Justen comments on the big Epic projects at Kaiser and Sutter, calculating that HealthConnect will end up costing $9 billion over ten years, just a bit higher than its original $1.8 billion estimate. Hey, maybe I could work that Universal Rules thing like Letterman’s Top 10. Actually, that list just kind of spewed out because I was tired, so two minutes later, I was trying to figure out how it got on the screen. I must have been channeling some dead HIT cynic.

A reader asks about medical informatics programs, specifically those of Northwestern, UIC, SUNY Downstate, and UMNDNJ. Good question. Which programs are good nationally, maybe both those intended for full-time study and programs better for working adults? Are they worth the cost and effort required? I’m curious myself. Let me know.

Allscripts must have allowed its web domain to lapse, at least temporarily, or maybe somebody hijacked their DNS. I went there yesterday and got one of those fake search engine sites littered with Adsense ads. Same result when I Googled and clicked on the several links listed. It’s working now.

Amcom Software will merge with telecommunications provider XTEND Communications.

MedAvant’s Q3 numbers: revenue down 25%, EPS -$0.38 vs. -$0.12.

Microsoft gets an Azyxxi sale to St. Joseph Health System (CA).

Odd hospital lawsuit: a man arrested for drunk driving after a car crash refuses to submit to a blood alcohol level. After his release, his wife took him to a local hospital to get the test “to satisfy his own curiosity.” He failed, so the hospital notified the police because they thought they were supposed to. He changed his plea to guilty, spent a couple of days in jail, and lost his license for a year. He’s now suing the hospital for emotional distress and economic damage, claiming it violated HIPAA by disclosing information when it didn’t have to (he claims he wasn’t being treated at the time). What are the odds that he even paid for the test?

Visionary Medical System announces it has met the interoperability requirements of the Novo Grid by Novo Innovations, allowing its EMR product to view hospital information along with the practice’s health records.

CPSI announces the migration of its hospital system (the applications and database tiers) to Red Hat Linux, offering customers royalty-free licensing, portability, and broad industry support. The GUI will remain ClientWare on Windows.

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Inga’s Update

I have to admit I am sad that everyone thinks Mr. H is right with his universal EMR rollout rules. Does this mean everyone who talks about their success stories aren’t telling the whole truth?

From Tracy: “Is the President and COO’s name really Rob Kill? Man, his parents must have been in a bad mood during the baby naming process. I’m glad I’m not in charge of PR or brand management at that company!” Yep, it really is. I heard his brothers are Chase and Hunter.

Northern Louisiana is establishing a new e-health initiative with the help of IBM, Carefx, Initiate Systems, and the Louisiana Rural Hospital Coalition, Inc. Louisiana taxpayers are providing the initial funding.

Former Accuro Healthcare Solutions and QuadraMed execs announce the formation of a new company, Panacea Health Solutions. They’ll focus on helping hospitals improve their financial performance.

Unless Mr. H, who doesn’t like to give his projects too many shameless plugs, I am happy to shamelessly ask people to contact me for the HIStech Report scoop. We are already working on reports for four or five companies. If you want to be included in the pre-HIMSS editions, let us know soon.

E-mail Inga.

News 11/16/07

From HIT Insider: “Re: Sutter. Haven’t seen this article on Sutter Health wasting millions on its Epic installation yet.” Link. Sutter’s original estimate to install Epic in six hospitals: $150 million. Current estimate: $500 million and going up. Nearly $100 million for one hospital? Says they learned from Kaiser’s mistakes.

Mr. HIStalk’s universal rules for big EMR rollouts:

1. Your hospital will pledge to make major processes changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

4. You’ll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You’ll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you’ll refused to apply them because you’re scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

From Dastwood Biouf: “Re: AMIA. AMIA’s annual meeting wrapped up this week in Chicago. It had over 2,000 attendees. AMIA still has a reputation for being full of pointy-headed navel-gazers more concerned with abstract topics than solving real-life issues in health care. If that was ever true, it’s certainly not now. The academic rigor is definitely there, but the focus is on everything from dealing with vendors to doing clinical decision support in distributed health information networks. Other highlights were a demonstration of context-sensitive “infobuttons” linking from EHRs to knowledge resources like UpToDate using the new HL7 Infobutton standard and a discussion of privacy policies around RHIOs. Oh, and also an announcement and panel discussion about AMIA’s latest initiative: establishing Applied Clinical Informatics as a formal medical specialty. Good stuff all around. AMIA is a great organization that deserves to have a higher profile than it does.” I’ve started to join a few times, but I always balk at the $250 a year. That darned HIMSS has set the bar high by selling out to Diamond Members, thus keeping dues for the little people low in the process. AMIA’s still worth it, I think, so I may pony up.

From Tom C. “Re: Eclipsys. Cardinal Health may buy Eclipsys. Cardinal likes the way McKesson is leveraging the old HBOC division.” Bet they liked it even better back in 1999, when their arch-competitor took it in the shorts as the HBOC house of cards finally collapsed, wiping out $9 billion of market equity in one exciting day and forcing the writedown of hundreds of millions of dollars worth of fictional accounting.

From PoBoy: “Re: Healthvision sales price. Quovadx determined fair market value is $7.42M. After payment of @ $4.87M of Healthvision’s indebtedness (primarily to VHA and a bank) and @ $1.23M of transaction expenses in connection with the merger, the remaining net equity value of Healthvision is @ $1.32M. Healthvision’s Series E Preferred Stockholder was entitled to receive the entire net equity. None of the other stockholders were entitled to receive any proceeds.” I assume General Atlantic was the stockholder, but I was too lazy to look it up. And to think that, according to Scott Decker, it had a value of between $1 and $2 billion back in the dot-com days. Like he said in my interview, too bad they didn’t go public quickly then.

Pictures of Kiowa County Hospital in Greensburg, KS from May 4, 2007, from a presentation by administrator Mary Sweet. 68 employees lost their homes. That bottom picture is of HIM, yet 95% of the paper records were saved because a cement wall fell on them and protected them. Her tips: have a plan to bring in storage pods if needed, make sure the building code footprint is current, use employee picture IDs with an extra copy kept at home, develop plans to save vital items, have contracts in place for temporary buildings and bathroom facilities, make sure patient beds fit in the elevator, and don’t keep your backup tape across town – the tornado’s 200+ mph winds destroyed 95% of the town and the tapes, too. Pictures of the town are here. Ten people were killed. Sad.

Was I the only one who didn’t notice that consulting outfit Kurt Salmon Associates sold out to a UK consulting company last month for $125 million?

I got wrapped up watching Eric Fishman’s videos showing Dragon NaturallySpeaking working with several EMR products in several specialties. Though the speech recognition part is cool and it’s clear that it works really well (you actually see the narrator’s voice dictating and running the app), I liked being able to see someone actually going through eClinicalWorks, e-MDs, etc. so I could see what their screens looked like. Putting those out there was pure genius – seeing speech recognition driving the screens is fun.

I’m hearing that Dairyland laid off around 30 people this past Monday, with developers, architects, and PMs the hardest hit. This could be like a sports trivia question: what CEO laid off dozens of people at two different companies in the same year? (answer: James Burgess, 2007: Mediware and Dairyland).

The Healthcare IT Transition Group guys amuse me yet again (no, they’re not a sponsor – I just think they’re funny). Marty covers the CCS conference from Beverly Hills. In a wickedly funny summary, he postulates that Canadians live longer because all meat keeps better in the freezer, describes Eclipsys CEO Andy Eckert as “… like the guy in high school who was both valedictorian and captain of the football team. The kind of guy who you just couldn’t help liking, even as he drove off with your girlfriend in his red Camaro.”, and Jonathan Bush as Alex P. Keaton with ADHD and a software company (“he chewed up the scenery like William Shatner on steroids.”)

McKesson Provider Technologies is criticized by the health department for moving quickly out of its Queensbury, NY building after an employee claimed to have Legionnaire’s Disease. The health department says no one has reported the disease as the law requires, the landlord has been told nothing, and the health department said McKesson had been “less than forthcoming.”

Former Duke University associate CIO Iain Sanderson is named CMIO at Health Sciences South Carolina.

EHRVA releases a free quick start guide for the Continuity of Care Document standard.

Misys tries to drum up some enthusiasm for the iMedica EMR it licensed. What it says: some resellers said they’d sell it and some MGMA attendees saw it demonstrated. Not well written: the headline is a dead giveaway for the commercial that follows and it lapses into the first person in the eighth paragraph as though some unseen press release god suddenly began speaking to you directly from your monitor. Bet they didn’t feature as many compliments about the same system when iMedica was selling it against the old Misys warhorses (like this one, in which a practice paid over $150,000 to get five doctors on Misys).

Medsphere hires Edmund Billings, MD as CMO, who appears to have bailed out of medicine early in his career to start IT companies (like Oceania). I don’t know that I’d have made him CMO, but maybe a marketing or development guy. He’ll be a good asset to them nonetheless, I suspect.

Cardinal Health announces a 340B software package.

Ambulance chasers file a class action suit against FCG for taking $365 million in cash for the company. It’s not enough, they say, despite the 30% premium to market price at the announcement. It was not mentioned whether they kept a straight face.

HIStech Report has caught the eye of a few companies and PR firms. I’m not making a pitch, but simply mentioning that companies who are interested in the pre-HIMSS period of January and February contact Inga stat because we’re going to book it up fast, I think. We’ll have a “Mr. HIStalk Goes to HIMSS” writeup that accompanies it.

MediNotes says its small-practice EMR system interfaces with 76 practice management systems. My interview with CEO Don Schoen is here.

EnovateIT announces an agreement that gives Language Access Network the right to provide its two-way video system to EnovateIT’s 1,100 hospital customers.

Pioneers Memorial Hospital (CA) chooses Optio’s document-based EHR.

IBM will acquire Cognos for $4.9 billion in cash. Pretty much all of the BI companies have been swooped up except privately held SAS. They’re probably next (Oracle?)

It’s a holiday coming up, and one of few that somebody doesn’t protest about. I’ve got planning to do (HISsies, the HIMSS get-together we’re hoping to put on, and the announcement of a new service in the next handful of days). I’ll still be writing here, of course, since that’s what I do. If you’re heading out of town, be safe and enjoy the time with your family and loved ones.

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Inga’s Update

Larry: Regarding your comments on Allscripts third quarter projections and the question: Do you think the ambulatory market is slowing? I think that it has to do with Stark relaxation. My guess is that 1) physicians/groups are not buying as much because they are waiting to see if the hospitals will foot the bill and 2) hospitals/health systems take longer to make decisions and are still planning their strategies and budgets.

I think those are pretty good guesses. Hospitals establish strategies years in advance and many were not anticipating needing to have a strategy for offering EMR to community physicians. Those strategies and budgets are not created overnight.

A UMass Memorial Center doctor is arrested for soliciting sex, but claims he was just gathering information on STDs. No word if his wife bought that story.

La atención oradores españoles: Averigüe UnBuenDoctor.com, un nuevo sitio web del español Idioma que permite a usuarios a buscar para la información de asistencia sanitaria y recursos.

Chuck Noland and his buddy Wilson might have liked this. Telemedicine comes to Tristan da Cunha, a remote island 1,665 miles off Cape Town, South Africa. It is only accessible by boat and it takes a week to get there. But, thanks to IBM, UPMC, and Beacon Equity Partners, the island’s only physician can get advanced medical assistance when caring for the 270 residents. I am adding this one to my list of places Mr. H can send me for interviews (once he gets his $2 billion for going public.)

Speaking of UPMC, the Vatican blesses its merger with Mercy Hospital.

McKesson will provide PACS for 22 Shriners Hospitals for Children. I love the Shriners. Not only do they wear cool hats and get to ride funny bikes in parades, they provide free specialty pediatric care. Love it.

Virtual Radiologic Corporation, a provider of remote diagnostic image interpretation services raises $68 million for its IPO. Rob Kill, former Misys Physician Systems president, is Virtual’s president and COO. Bet he is happy how things turned out for him.

E-mail Inga.

News 11/14/07

From TGIG (Thank God I’m Gone): “Re: Misys Connect. Just one of many great decisions. How about taking a pass on NextGen; how about putting a Windows overlay on Medic PM but keeping the underlying COBOL code; how about stopping the bidding for MedicaLogic (now Centricity) at $25M; how about firing the guy from GE running Physicians Systems who was exceeding his numbers; how about putting  his “Peter Principle” buddy in charge of BD? Misys is where it is due to lack of leadership and a failure to make courageous decisions. The new leadership can do no worse.” Jon Phillips thinks they’re doing better, but with some unknowns in front of them.

From Sonomaca: “Re: Jon Phillips. I’m interested in the payer tech side of HCIT. Would like to know Jon’s views of present and future here. Companies in the space are Medecision, Click4Care (private), Kryptiq, Trizetto, and bigger companies such as DST and McKesson. Also, will UnitedHealth spin off Ingenix at some point. What’s that business worth? Also, what about the CDHC platforms such as CareGain (Fiserv), ConnectYourCare (Express Scripts), HealthEquity, ASI (DST). Also, banks such as BofA are getting into this, in part because of huge opportunities in financing consumer HC debt.”

From Money Money: “Re: Healthvision. Anyone know or can guess how much it sold for?” I have no idea, but I’ll guess with everyone else. Reported revenue was in the $20 million range but trending down from all appearances, so I’d say it was worth maybe $25-30 million tops given the employee losses and cash flow struggles. I’m sure there was some debt involved.

From The PACS Designer: “Re: Google Android. Google is muscling its way into the mobile phone marketplace by releasing Android, its free and open sourced software stack for the mobile marketplace. Healthcare institutions will most likely show some interest once there is a stable platform for mobile viewing and some new options developed that will benefit daily work routines. Developers will be going after Android’s Software Development Kit (SDK) since Sergey Brin, Google’s president, is offering $10 million for the best new design applications using Android as the platform for new mobile features. Google hopes to challenge Microsoft’s Windows Mobile 5 (WM5) by enticing independent developers to work to improve the  application’s functionality with new features. Since 3D is the newest software that has penetrated the healthcare workspace, it would be nice to have 3D images viewable on your mobile phone. The YouTube video shows a 3D application running on their new platform.”

From Inside Outsider: “Re: Andreessen’s Stanford gift. This is not like the old Bill Gates (prior to Melissa coming into the picture), where he’d donate 100,000 copies of MS Word to poor schools, then write off the donation at full cost. This is a real monetary gift and he should be commended. Think of how much less giving there would be if someone decided who we had to donate to. We should not look a gift horse in the mouth, even if it is giving to a better-off hospital.”

Speaking of alternative practice models, Bruce Friedman has an interesting piece (and I’m not just saying that because he quotes me) on a company that provides medical services by telephone. You get a telephone consultation and prescriptions for $35. Sounds like small potatoes until you notice the headline on their site – they just signed up their millionth customer. Imagine the cost savings if prescriptions didn’t require prescriptions (is it reasonable to require a prescription for drugs that might hurt you but not for alcohol, fast cars, dangerous power tools, and handguns?)

Listening: new from The Hives.

QuadraMed’s Q3: revenue flat, EPS -$0.01 vs. $0.08, some of the loss from the expense of buying Misys CPR.

Several new profiles are in flight for HIStech Report. The interview with Novo’s Robert Connely is fun, of course. Great HIMSS product previews are coming.

Initiate Systems announces plans for a $75 million IPO, with heavy hitter Goldman Sachs bringing them out. The company also announces Initiate Master Data Service version 8.0.

My newsletter editorial for tomorrow: “Two Economic Theories That Explain Why Epic’s Competitors Had Better Improve Fast.”

Sage Software Healthcare announces John Lopiano as division president. He’s new to healthcare, it appears, with previous stints at Spinet Associates, Xerox, and IBM. A West Pointer, which we like here.

Post-acute care services provider CareCentric announces that CEO John Festa and CFO Lyle Newkirk are gone. Says it’s part of a plan “to refocus the company on operations, software development, and infrastructure.” Wonder what were they focused on before?

Symantec announces some kind of healthcare provider package with software and stuff.

The Kansas City paper covers Mediware’s retooling, including a new CEO, restructuring, product retirement, and layoffs.

Industry longtimer Kerry de Vallette joins HealthPort as SVP of Solution Sales.

Thomson announces PDRhealth, an online version of the Physicians’ Desk Reference with some health tools added on (can yet another PHR be far behind?)

Government Health IT, probably my favorite online HIT publication, runs a well-written profile on Brent James of IHC.

Odd: a Florida cardiologist’s office is raided by the DEA, he’s named in several civil lawsuits, and his office manager is shot dead by a coworker who later kills herself. Now, his physician partner gets a court order and takes all the equipment from their angiography practice. The partner had started an EMR company at one time (I’m guessing it was AutoMedicWorks).

The Healthcare IT Transition Group, fresh off their report urging RHIOs to find local funding instead of relying on federal grants, announces a new resource directory to make that easier. It’s $395 per region, which seems like a pretty good deal. Those guys must be busy all the time.

Allina is urging staff to take PTO and will probably have layoffs by Christmas. Its 2004 tax form shows a $198 million profit, an $835 million warchest, and a CEO compensation of $1.4 million. For all that (plus the $249 million Epic project) I would have expected something more creative. But, hospitals have zero willpower when it comes to position control (at least of the preventive persuasion).

An Oregon community college and Asante Health System join forces to offer informatics training, with plans to expand it to a certificate and then associate’s degree program. It’s not exactly what I’d call informatics since it has no clinical component mentioned and the maximum pay at Asante will be $19 an hour, so it’s more like field support and training for applications. Sounds like a good program, though.

Steve Starkey of Healthcare Management Systems is promoted to COO.

State funded UT Southwestern takes heat after the local newspaper obtains a list of 6,400 wealthy, influential, and connected people who would be given concierge-like VIP treatment if admitted. Other hospitals contacted rationalized their own VIP lists, saying that UTS went too far by including people with whom it had no relationship, according to an overheard conversation between the pot and the kettle. I like the frankness of a county commissioner who found out that he was on the list when the paper called: “I get there at 7 a.m. and there’s not much of a wait. Ain’t nobody hardly at work. I’m glad I’m on somebody’s VIP list, because I’m damn sure I don’t have any money.” The hospital’s president does: he gets a $1.1 million salary, according to tax records.

Oracle will offer freely downloadable server virtualization software starting on November 14, knocking down VMware’s share price.

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Inga’s Update

Turbulence at Medquist continues. Three independent directors announce their resignation amid concerns over the potential sale of the company. Costa Brava Partnership III, a five percent stakeholder, wants to inspect the books. And, the company lost $8.9 million in the third quarter.

Meditech Chairman Neil Pappalardo donates $2.5 million to Korea Advanced Institute of Science and Technology. The university plans to build a medical center with the funds. No word as to whether they plan to use Meditech products at the new facility, but perhaps Michael Dell can advise him on this strategy.

The Georgia Department of Community Health announces winners of $853K in grants to promote EHR and electronic prescribing initiatives. One of the four facilities was Sumter Regional, which received $250K.

Sentillion announces a new Channel Partner Program and already has at least three initial members. The company also reveals that it signed six new customers in the third quarter and now has 335,000 live users.

Oschner Health System in New Orleans goes live with master patient indexing for 2.7 million records across 10 hospitals and 32 health centers. IBM and Initiate Systems helped create the EMPI.

An ambulatory vendor employee commented that his company missed their third quarter projections, though not as badly as Allscripts. His question: “Do you think the ambulatory market is slowing?” I personally don’t have the answer to that question, but I am curious what readers think. Despite missing projections, Allscripts earnings were up 26% from the same period in 2006 and QSI’s were up 16%. I doubt Misys and Sage will announce similar growth, however.

The FCC announces a proposal to fund a $400 million Rural Health Care Pilot Project to deploy broadband telehealth networks. The project would target rural and underserved communities and is designed to facilitate telemedicine programs.

Perhaps the FCC read this report before making their announcement. The Center for Information Technology Leadership conducted a study that found a national implementation of telehealth technologies could save $4.28 billion in annually, including $912 million in patient travel costs. AT&T helped pay for the study.

SCI Solutions will provide its Order Facilitator solution to HCA’s TriStar Health System, which includes 18 facilities.

E-mail Inga.

Art Vandelay on IT Project Work

I wanted to comment on a great topic and pending analysis to be completed by Will Weider.

Will would like to determine how much effectiveness he is receiving from his IT staff time spent on project work. Competing demands lead to sub-optimized use of his staff’s time. No project assembly line exists to ensure that work is contiguously and effectively sequenced for his staff.

What factors drive the lack of effectiveness of work in health care IT organizations? From my experience, it is a combination of the following:

1. Effective IT governance. Who, how, and how quickly can decisions be made that are binding in order to prioritize projects?
2. Tactical prioritization of resources. Day-to-day prioritization of resources doing the project and operational tasks.
3. Effectively estimating, measuring and communicating resource capacity within or outside of IT. Who is truly available to do what?
4. Vendor providing qualified resources. Experienced and trained people who are capable of mapping the capabilities of a product to the client’s goals while addressing the unique characteristics of a client’s environment.
5. Evolving project scope and requirements. May impact project approval and re-approval, which leads to idle time for resources while decisions are made.
6. The lack of early determination of product fit ( i.e., usability,technical, response time) with the resources, processes and technology capabilities of the organization. Results in potential idle time as issues regarding product fit are resolved.

To speak in statistical terms, these are the factors (in my opinion) driving a good R-squared if we were to model this relationship. Your organizations may have other factors that may be “statistically significant” driving ineffectiveness. The other factors likely involve your organization’s competitive environment, financial situation, leadership styles, cultural norms, and a lack of standardization in resource roles, technology capabilities and processes.

Monday Morning Update 11/12/07

From Red: “Re: KUMED. Cerner should be getting the last laugh with EPIC and KUMED. KUMED is going live with EPIC on Sunday night. However, they have apparently killed their budget for support staff. Their project manager (must be a Cerner lover) is putting the EPIC kids up at a 40-something buck a night motel. Judy and Carl heard and said that customers can make their employees stay anywhere they want. They should just suggest putting a whole brood in one room like a college slumber party- that would save even more.” Send me a picture!

From B: “Re: Epic. Epic doesn’t deal. If Cedars is convinced Epic is the way to go, this really won’t hurt them at all. This all goes back to Epic’s corporate philosophy concept, i.e. stay private, don’t do deals, and be frugal (a big reason for the presentation on the math behind building the new facility at UGM).The story goes that one of the first customers we signed bartered for a pretty good deal. A short while later, another organization didn’t barter with us at all and took the worse price. Judy didn’t think this was fair and changed the policy to only offer deals to regional (WI), research/children’s hospitals, and hospitals that serve the indigent.” I will add this to Mr. HIStalk’s hard-knocks MBA curriculum for the benefit of Cerner, Eclipsys, McKesson, and others: if your competitor can charge whatever they want and still beat you, your product needs work.

From Pogue: “Re: HIMSS. How about a daily report on booth giveaways? Who has the nicest toy to take back home to the kids, who has the single worst item you’d NEVER put on display on your desk, who has the giveaway most seen being played with as folks saunter the aisles, etc. Now THAT would be some real exhibit floor value!!” I like it. Maybe I’ll collect everything they put out and run photos for comparison (and then leave it all in the room for the maid to toss). I could get a Trinket Update up Monday so folks would know where to cruise the rest of the week.

From The PACS Designer: “Re: OpenMRS. There’s a new movement internationally to get medical records developed for third world countries and its called Open Medical Record System, or OpenMRS. The World Health Organization (WHO), the Centers for Disease Control (CDC), and others are involved, so there is some serious development work going on. They are looking for volunteers to speed the development effort.” Link 1, Link 2.

Roger Maduro sent over a very nice electronic newsletter he writes called VistA and Open Healthcare News. Topics like Medsphere and the VA’s Cerner decision are important, so you might want to sign up for a free subscription. Just send an e-mail to subscribe@lxis.com.

Speaking of open source, the new VP of open source at Misys responds to a Scott Shreeve posting about Misys Connect. See if you can interpret Scott’s closely guarded position based on words I pulled from his piece: perverse, land grab, confusion, silly, desperation. In his reply, the Misys guy says that Connect is live at only two sites (and this was to be Tom Skelton’s bet-the-bank company strategy?) and, basically, that it was open sourced because there were few customers with Misys products on both ends to care. I bet the community is really lining up to work free on that.

Scott also comments on the VA’s replacement of VistA lab with Cerner. That inspired me to put a new poll to your right: should the VA keep VistA, rewrite it, or replace it with commercial systems?

Photo: Associated Press

Veterans Day is Sunday, November 11.

A reader I’ll leave anonymous asked for an opinion. The customer had complained that a vendor’s app requires a 1280×1024 display resolution, limiting the ability to use it efficiently on tablets (they don’t provide vertical scroll bars, either) and therefore it requires dedicated workstations. The vendor replied that while that was true, the customer could use unsupported third party screen changer apps that are known to work. The customer’s question: is that an acceptable answer? Opinions welcome, but here’s mine: yes. The vendor suggested a third-party solution that supposedly works, so I’d try that. It would be nice to add the scroll bars, though (sounds simple). I always ask this question: would most customers be willing to give up other enhancements and fixes to get that change instead? If not, then it isn’t in the vendor’s best interest to develop it, other than in a competition-free world. I wish it weren’t true, but vendors are in the business of selling new systems and keeping current customers from defecting. If a change doesn’t contribute toward either, it shouldn’t be done.

Netscape co-founder and serial entrepreneur Mark Andreessen donates $27.5 million for a new ED at Stanford. Ever notice that celebrities and rich folks always put their money into hospitals that don’t need it, i.e. the kind of swanky places in which they themselves might inhabit an off-limits VIP suite? Doesn’t anyone care about tiny, struggling backwater hospitals taking care of average Americans? Certainly their largesse would go much further there. From its latest publicly available tax forms, Stanford Hospital made a $132 million profit in 2005, paid its CIO $465K, paid Perot $38 million to run IT, gave an ad agency $2 million for advertising, and paid the CEO $1.2 million. My heartstrings are untugged.

Sales: North Mississippi Health, Eclipsys Sunrise. Carolinas Medical Center-NorthEast, Allscripts Healthmatics ED.

University of North Carolina Health Care gets coverage on local TV for its use of an unnamed system that allows referring physicians to receive electronic updates when their patients are admitted and followed by hospitalists.

A University of Toledo pharmacology professor starts a company that puts pharmacists in medical practices to follow up with diabetics. He’s working with a vendor to develop a custom EMR application.

RXHub proudly announces (its words) that it has paid money to Newt Gingricht’s for-profit company. Why is that something to be proud of?

Latest non-news headline: CCHIT’s chairman is happy with CCHIT’s work.

Odd hospital lawsuit: a Kentucky hospital is sued for failing to render proper care to a woman bitten by a rattlesnake during an illegal snake-handling church service.

People in Buffalo are thrilled that their Congressmen have brought the US taxpayer bacon home. “The House has approved a spending bill for labor and health programs and military construction that includes a treasure trove of earmarks for Western New York — including projects that prompted Republican Reps. Thomas M. Reynolds and Randy Kuhl to buck the White House and support it. Nearly $4 million would go to local hospitals and agencies in the bill, which faces an uncertain future because President Bush is threatening to veto it.” Well, at least those politicians are freely spending dollars that will be worth next to nothing soon enough, also their doing. Expect a mammoth Canadian influx to Florida this winter since the once-mighty US dollar now buys only 94 cents Canadian. We’ll be like Southerners wheelbarrowing Confederate money across the border to Montreal to afford poutine.

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News 11/9/07

From Larry Kubiac: “Re: Emageon. Why is Emageon totally tanking in the market? Is it technology? Channel? Poor management?” Q3 numbers: revenue down 31%, EPS -$0.20 vs. -$0.01. Market cap is down to $100 million. As CEOs always do, Chuck Jett terms the quarter “disappointing”, but predicts impending wonderfulness. Given that shares are down 71% in the last year, I’d say it had better be soon.

From Grace Musso: “Re: HITSP. I heard HITSP has finally adopted a set of national security and privacy standards. It’s a big deal, but nobody’s talking about it.” I know we have readers with security and privacy expertise, so comments are welcome.

From Mikey Randall: “Re: HIStalk. Rumor is you’ve sold everything to a big media company. Confirm or deny.” Honestly, how does this stuff get started? Deny. I’m just some guy who sits in a spare bedroom in front of a computer for way too much time. Money doesn’t interest me and I have no other nerdy hobbies to occupy my time, so I’m not going anywhere. But, while we’re on the subject, please peruse and click the sponsor ads to your left to see what they’re up to. That support keeps me behind a closed door (not selling out to media companies) while Mrs. HIStalk watches dull celebrities tripping the light fantastic on TV. Although I have to timidly confess: Marie Osmond in a glittery dress kind of raises my eyebrow.

From Frank Lemmer: “Re: Dynamic Imaging. Does anyone know the terms of the GE/Dynamic Imaging transaction? Either the price paid and/or DI’s revenues?”

From Jerry Steiner: “Re: Microsoft. Interesting observation about CIO departure at Microsoft. Kevin Turner and Stuart Scott were ‘keynote interviewees’ at the InformationWeek 500 conference in September. Attendee comments afterward were typically ‘what a bizarre team: Wal-Mart and GE running IT at Microsoft!’ They really talked up what a great team they were, how much ‘in sync’ they were with each other, what great things they were doing at Microsoft, etc. Oops, maybe not. Be interested in what readers think about the various CIO-type conferences that are held each year — InformationWeek, Computerworld, CIO, CHIME, HIMSS and a new one that popped up this year, Healthcare CIO Summit.”

From Parker Lewis: “Re: Cedars-Sinai going with Epic.” Link. Cedars says it will enter discussions with Epic with the intent to sign by the end of the year (hint: you don’t get a deal with that kind of poker face). What I wrote about their homegrown CPOE system in 2005: “Washington Post has a post-mortem on the Cedars-Sinai CPOE debacle of 2002 (their $34 million, homegrown CPOE system was canned after just three months when physicians revolted.) Lessons learned: the app was slow and clunky (orders that took three minutes to write required 30 minutes to enter,) physicians weren’t involved in setup decisions, training was inadequate, clinical alerts drove the docs batty, and the hospital went for a ‘big bang’ implementation (and the bang was indeed pretty damn big.) They aren’t in any hurry to try again. Now that we’ve got a few failures behind us as an industry, someone should be documenting the lessons learned for the benefit of those behind them on the treacherous path to CPOE nirvana.”

Somebody asked about who’s funding the Health Record Banking Alliance. I e-mailed CEO Bill Yasnoff and he got right back with me. It’s a non-profit trade association, collecting what Bill says are dues payments from members for the first time. No other funding sources, he says. Another reader noticed the federal language says “encourage,” which presumably means no taxpayer dollars are involved in subsidizing health record trusts … yet. I’m still looking for a critical overview of the concept if someone with expertise is so inclined.

The Fall CCS is over, but maybe you’re interested in presenting at the spring version, to be held in May in DC. Also announced for 2008: an HIT Investment Forum. I eat that investment stuff up, even though I don’t understand most of it.

Federal agents seize the luxury cars and bank accounts of a New York couple after charging their company with selling pirated imaging software to hospitals. GE Healthcare and MedWeb have testified in the case.

You may have missed Jay Parkinson’s response (in a comment) to a reader who said he was wrong in thinking he’s not a HIPAA covered entity. According to documents on CMS’s site, you’re a covered entity only if you submit payment transactions electronically. He doesn’t, so he’s not. He mentions that he does have to abide by state privacy laws that are not pre-empted by HIPAA. I’m pretty sure from his well-formulated answer that his statement about not being covered by HIPAA was not a off-the-cuff comment. He’s done his homework.

Some folks observed that the VA’s purchase of Cerner’s LIS is puzzling, given the renown its self-developed VistA system gets. You may recall that VA brass wanted to spend hundreds of millions to rewrite VistA a few years ago, claiming they couldn’t get MUMPS programmers (at any price??) They backed down, but obviously are still smitten with the idea of dumping or rewriting VistA. The Cerner purchase seems to indicate the former. They’ve had problems with downtime lately, which could either be a reason to seek new systems or a convenient excuse for doing so. One way or another, VistA seems doomed within VA, although potentially living on in its open source incarnation.

FCG’s final quarterly results now that they’ve been acquired by CSC: revenue unchanged, EPS $0.75 vs. $0.12, but earnings were increased mostly due to some one-time benefits.

HIStalk Platinum Sponsor Picis is looking for a few good men and women. Click the ad to your left to check out positions available in sales, project management, implementation, software engineering, technical writing, and more.

Mark Stevens is named interim executive director of the Pennsylvania eHealth Initiative.

A third Louisville-area hospital will use robots from InTouch Health to provide remote physician consultations.

Oregon hospitals can use a Regional Mobile Satellite Trailer network to continue with Internet and VoIP services when their own systems are down. Its Honda generator can run for a week on a five-gallon can of gas. Great idea, especially with the cost shared. Anyone doubt that Internet access is a critical utility?

Opus Healthcare Solutions announces GA of its OpusMobility wireless clinical system for PDAs and cell phones. Included in its suite: clinical documentation, order management, CPOE, medication administration, and physician portal.

Hx Technologies (PA) announces the free open source licensing of its Xebra platform for Web-based distribution and viewing of medical images. It’s IHE XDS-I compliant, which is a pretty big deal if you checked out IHE’s demos at HIMSS. “‘Xebra was born of the restrictions and closed nature of current imaging distribution software which have combined to drive commoditization and complacency while erecting barriers to innovation,’ said Dr. Elliot Menschik, HxTI President and COO. ‘This situation is not unlike what was seen in the broader IT industry when a single proprietary web browser dominated. Just as it took the upstart open source Firefox to breath new life into browsers, we see the public release and free licensing of Xebra as the start of an effort to reintroduce innovation into the imaging side of the healthcare IT industry.'”

HealthSouth sells its remaining stake in 250-employee software developer Source Medical, started by HealthSouth’s own executives.

VISICU’s Q3 numbers: revenue up 23%, EPS $0.08 vs. $0.07.

Non-profit (snicker) Kaiser Permanente made $654 million profit in Q3, racking up its nine-month total to $2.5 billion. The CFO tries to keep a straight face in describing the member-serving investments that will be made and the comfort those billions will give Kaiser when it faces the kind of imminent financial disaster that is predicted when talking to reporters. Kaiser isn’t quite up to Exxon-like profits, but they’re getting close. I’m sure, as in Exxon’s case, the excess will be distributed back to those who overpaid to allow it. And while Kaiser’s CEO was collecting an award for diversity, it was paying $180,000 to settle an EEOC-backed L&D nurse’s civil rights suit that claimed Kaiser took back her promotion when they found out she was pregnant.

WebMD’s Q3: revenue up 31%, EPS $0.19 vs. $0.01. Apparently keen to completely baffle the stock market and its shareholders, the already-confusing structure will get more complicated: “WebMD also stated that its majority stockholder HLTH Corp., will likely propose a merger in which it would become part of WebMD.”

RFID vendor InfoLogic announces Q3 numbers: revenue up 26%, EPS -$0.02 vs. $0.02.

E-mail me.

Introducing HIStech Report

Vendors often ask Inga or me about running an interview when they introduce a new product or service. We explain that we don’t really do interviews for that reason – they have to be of someone genuinely interesting who’s willing to cover a wide range of non-commercial topics to enlighten us.

We agreed,however, that a forum for that purpose would be useful. So, we created one. Allow us to introduce HIStech Report, an offshoot of HIStalk that’s geared toward healthcare IT product and service news.

We think differently here, so instead of running the usual dry press releases, we’ll do an real interview with a company executive, asking the same kind of questions you’d ask about the product or service. We’ll have more space for photos and illustrations, with a cool new site and format. We’ve also got a very talented graphic artist who packages the result in a highly professional reprint format (warning: PDF) for downloading.

Robert Connely, CEO of Novo Innovations, agreed to be our first subject. His previous HIStalk interview was a hit, so we were anxious to catch up.

Companies always want HIMSS exposure during January and February, so this is the place. We’ve also got plans for a downloadable HIMSS exhibit guide with companies that have been featured (maybe including some of those secret party invitations or extra-special goody coupons).

Inga would be happy to provide information to interested companies. We think it’s a good read.

Inga’s Update

A reader asked today why everyone is so focused on what I look like (are you?) This particular reader was actually more curious what Mr. H looked like. Is it just human nature to be curious if the picture in our mind matches reality? I am a person who is always disappointed by movies after reading the book. Because I prefer to continue imagining Mr. H looks a lot like George Clooney, I won’t ask him to post his photo.

Probably because I think Mr. H is the premier HIT authority, I don’t read too many other blogs. But, I did read John Halamka’s recent post on Life as a Healthcare CIO. He writes about “The Dark Side of Going Public.” Having spent most of my years working for public companies, he was very spot on regarding Ronco sales tactics on the last day of the quarter and employee obsession with stock options. While I know lots of people who profited from stock options, I wasn’t so lucky, though I probably had enough to wallpaper my office.

Hisjunkie: Re: your note on Mediware revenue announcement, on their investor call, they also said they signed a deal with USA to move their surgery clients over to the USA’s ORMS product. I think it includes some incentives for hospitals moving over. So, if you’re a Mediware client, you can go from the worst KLAS-rated system to the best! Nice to see Mediware didn’t just leave clients high and dry. There’s a press release at USA web site (unibased.com).

Boston Scientific and GE Healthcare announce the industry’s first patient data integration between an EMR and a cardiac rhythm management remote monitoring system.

HCA Inc.’s third-quarter net income rises 25% to $300 million from $240 million a year earlier. Results included big gains from the sale of two Swiss hospitals.Allscripts also announces earnings. Income and revenue are both up, with predicted annualized revenue growth of 25%. Third-quarter adjusted earnings were $6.7 million, or 11 cents a share, though analysts were predicting 15 cents a share.

E-mail Inga.

News 11/7/07

From Clarisse O’Shaughnessy: “Re: CCHIT. Here’s a new article on inpatient EHRs.” Link. CCHIT announces the first six inpatient clinical systems to earn its approval: CPSI, Eclipsys, Epic, and HMS. Two products were given conditional approval waiting on their first live site (as I interpret it): Prognosis Health and Siemens Soarian. Not on the list, obviously: Cerner, Meditech, McKesson, GE, and several more. The next round will be announced in January. Soarian gets outed in the process: it earns certification, but has to admit to having no live sites for its “pre-market” product (it seems like ten years’ of HIMSS Soarian PowerPoints, but is probably less).

From Merrick Jamison-Smythe: “Re: Phoenix. Phoenix Technologies just announced HyperSpace, treading on the toes of Epic Systems’ portal.” Link. I’m not getting the Epic portal connection. Looks like a way for PC makers to create instant-on applications that work like mini-appliances, independently of the operating system (you can run e-mail by pressing one key, even if the PC is off). That would change the paradigm of portable computing, where waiting for Windows to churn through all its startup steps is like watching paint dry. Did anyone really expect that, even with rocket-speed CPUs and mega-memory, bootup still takes longer than it did on a Commodore 64? It’s like hand-cranking a Model T.

From Curious: “Re: products. Which in your experiences is the best health IT product ever? Could you please run a poll on it?” That’s always hard because each product has different audiences, so finding someone who can knowledgably vote across all of them is uncommon. Plus, vendors stuff the ballot box. If someone wants to nominate a “best ever” product, send in your reasoning and I’ll consider a poll.

From Oliver Pike: “Re: Gartner. I am suprised no one has written about the Gartner CPR and Magic Quadrant report that recently was released. Similar to the last CPR, Cerner and Epic are the highest rated solution for broad functionality with all other major vendor’s being a generation behind (according to Gartner). I am never quite sure how much impact these Gartner reports have on hospitals’ decisions regarding these EMR vendors. Have you ever talked to Gartner about their view of the vendor market? What do your readers think about these reports? Worthwhile, or generally ignored?” I’ve been in healthcare IT for a long time, mostly in big IDN IT management, and I’ve never seen any Gartner report. I’ve never heard their reports discussed, don’t know anyone who works there, and don’t really know what services they offer to hospitals. I stopped by their HIMSS booth once, took forever to get someone’s attention (it was all guys in suits engrossed in each other), gave them contact information so they could delivery a bounty of wonderfulness to me, and never heard from them again. From that personal experience, I consider them to be irrelevant, which is too bad since the Hype Cycle is pure genious. Your mileage may vary.

From LBMC: “Re: Misys. How much longer will I care about / read the HIStalk website, now that I can do so without fear of corporate reprisal? Signed, LMBC (Left Misys By Choice – I know, not the usual exit path).” Need a little danger to spice up our liaisons, do we? Want Inga to wear a maid’s outfit? You can pretend that I send reader logs to Misys, thus raising the possibility of a bad reference downstream. That’s the best I can do. Besides, it’s the former employees who have the most fun reading here. Maybe they’re just a lot happier being elsewhere.

From Ralph Hinckley: “Re: new job. Scott Decker, former Healthvision CEO, is now SVP at NextGen.” Glad to hear that.

From The Alchemist: “Re: health record trust. If rumors had legs, then this one would undoubtedly walk up to you and bonk you on the head. Wake up! Your legislators will take good  care of you   H.R.2991 Independent Health Record Trust Act of 2007 (introduced in House).” Link. Health record trusts are going to be a hot topic, I’m pretty sure: independent, non-profit organizations that would house your electronic medical records just like a bank houses your money. Benefit: the bank analogy is easy and attractive for everybody to understand. Interesting snips: the patient controls who can access their information, the IHRT can charge account fees to participants or access fees for data users, and IHRTs would be certified by the Federal Trade Commission. Cerner’s all for it and has a summary of the bill. If you’re an expert, write up the pros and cons and I’ll run them here. I haven’t thought about IHRTs enough to have an opinion yet, but there’s an appealing quality about an independent, trusted fiduciary, especially if insurance companies, employers, and the government can’t poke around. Bill Yasnoff has a pretty good bank analogy. Drive-through PHI deposits?

From HIS Fan: “Re: concierge medicine. Here’s an interesting blog post.” Link. Here’s my foolproof medical practice idea: just give cash-paying patients whatever they want since they’re the ones paying. No one likes going to the doctor, so charge $1,000 a year for never allowing (much less requiring) the patient to come in, wait, undress, and fidget. No physicians, no preventive care, no ongoing monitoring. Just send that check and your prescriptions will come back in the mail in a Netflix-like practice model. By the time the patient figures out they were ill-served by not getting care, they’ll probably be dead (or seeking another doctor, anway). Wouldn’t it be refreshing to refuse to get on the scale, to say no to anything that hurts or is embarrassing, to demand several years’ worth of undated prescriptions to have filled whenever you damn well please, and to take whatever drug samples interest you from the goodie box? Now that’s consumer-driven healthcare.

From Doodles Dendritis: “Re: CIO. Peter Garrison, the CIO and a Senior VP at St. Vincent’s Catholic Medical Centers (now just one hospital), left the hospital as of October 30. A new CEO joined over the summer and reorganizations were announced last week. The role of the CIO was eliminated. Sounds odd, but that’s what I heard. The health system just emerged from bankruptcy, so cost saving does not appear to be the motive. Four executives were let go.”

The Jay Parkinson interview went over big (thanks, Jay, for squeezing me in before Colbert!) I saw incoming hits from StumbleUpon (which I’ve used and liked), from the FormSpring site (the forms tool he mentioned), and from Chris Webb’s media site. That boy’s going to be a star.

The White Stone Group announces OptiVox Advisor, which documents the quality, accuracy, and consistency of information hand-offs as required by the National Patient Safety Goals. It works with OptiVox, of course, which is a telephone-based, voice-prompted system for automating the exchange of information between caregivers.

The Kaiser IT layoffs in Pleasanton are confirmed. That’s old news for regular readers, of course. Justen Deal wrote about it, along with an interesting piece on rescission (the cancelling of a patient’s insurance after the fact). Regulators forced the non-profit Kaiser to reinstate an insurance policy: “The woman and her family had Kaiser coverage through her employer for 20 years. When she left her job, the family purchased from Kaiser a continuation plan commonly known as COBRA that is protected by a federal law. After that expired, the woman and her family bought individual coverage from Kaiser. Four months after the switch, the HMO dumped her. Kaiser claimed she omitted information about her health from the application the HMO required her to fill out when it sold her the individual plan. Kaiser also threatened to report her to law enforcement for fraud and billed her for $13,000 worth of treatment.” The punch line: the woman’s condition that Kaiser claims it wasn’t told about was being treated by its own doctors (allegedly).

I was checking the website of HIStalk Platinum Sponsor MedMatica Consulting Associates. Nice testimonials, including this one from Reading Health System: “MedMatica Consulting Associates delivered exactly what they proposed; experienced personnel, based locally at a very competitive professional service fee.” Do me a favor: click on their ad to your left and visit their site. Nice folks.

The Fall 2007 edition of EHR Scope is now available: 240 EHR vendor listings, SaaS discussion, pediatric EHR coverage, and a Fred Trotter article on open source. It’s a free PDF download.

Cerner says KU Hospital let the city of Kansas City down by picking Epic. CIO Gregory Ator said that’s tough, the docs liked Epic a whole lot better, even at a higher price.

Cardinal Health’s Q1 numbers: revenue up 5%, EPS $0.82 vs. $0.66, but missing estimates and resulting in the firing of the supply chain CEO.

Microsoft fires its CIO for violating unspecified company policies (running Google Apps? Peeking at Bill Gates’ HealthVault records?)

Montefiore Medical Center picks Picis CareSuite for periop.

Doctors are feeling the heat to run EMRs, that is, if you believe a doctor survey that talked only to those already running EMRs.

EMR vendor PracticeIT promotes CIO Rich Steinle to CEO.

AMA picks up on the work of our pals at Healthcare IT Transition Group, who dared state what now seems obvious: RHIOs are overly reliant on hospitals and federal grants to pay their bills instead of tapping into foundations and other local charitable support. The boys even gave a shout out to Inga and me in honor of the millionth HIStalk visitor. They’re fun because, in addition to being healthcare geeks, Marty is a poet and Michael is an expert on opera and a cartoonist. It’s good having a few characters in the biz.

So, who is this Prognosis Health Information System whose inpatient EMR earned CCHIT certification before some of the big boys? I found a link to their site from CCHIT’s, which had little info, but then I found this one from Googling their Houston address. Clients listed include St. Vincent’s Manhattan (Jay Parkinson’s residency site) and Midland Memorial (which is on Medsphere now, as far as I know). Execs are listed on the page and I don’t know any of them. Sounds like a behavioral system primarily, judging from the emphasis on the security of comments in their FAQs. Well, they made a little history yesterday, anyway.

Another virtual bud, Ross Koppel at Penn, gets quoted on the sociotechnical aspects of healthcare. Example: a hospital bought a bunch of COWs for nurses, then put in new patient room sinks that were too big for the carts to get around (doh!). He also mentions an IT system that required 22 screens to see all of a patient’s meds. TDS, no doubt, since that app’s character-based screen featured huge uppercase fonts, short text lines, and a short display length, meaning anything you wanted to enter took several ugly screens that were originally designed for light pens, not mice or keyboards. I’ve argued for years that TDS would be alive and kicking today if Eclipsys could have somehow reformatted the screens to better utilize the real estate and minimize the flipping.

E-mail me. I live for it.

Inga’s Update

Some of the suggestions for HIStalk’s big HIMSS splash have been quite funny! There are a lot of creative people out there (many with obviously too much time on their hands). And while they may make Mr. H laugh, I am automatically sending to my spam folder any emails that have the words have “Inga” and “stripper” in the same sentence.

Mediware announces some good revenue numbers. Their fiscal Q1 numbers are up 27% over last year and income. Net income for the quarter was $463K versus $164K last year (5 cents a share vs. 2 cents.)

An increasing number of patients are losing faith in the health system and are concerned about the risk of infections while in the hospital. Those are the results announced by a UK-based organization that asked British patients their opinions of the UK health system.

If you are interested in voting in HL7’s survey for PHR standards, you have until December 1st. Not an HL7 member? You can still vote, but have to pay a $50 “administrative fee.” Seems to me if you are a stakeholder with a particular agenda and lots of money, you can pony up some cash and have some votes work in your favor.

Kaiser Permanente announces its own PHR, My health manager.

Cerner wins a nine-year contract with the VA to provide Millennium PathNet to 150 hospitals and 800 clinics. It will be Cerner’s largest Pathnet installation.

E-mail Inga.

Monday Morning Update 11/5/07

From Matthew Holt: “Re: millionth visitor. Inga, I wish I was as clever as you thought I am! I’m just feeling guilty that I’m speding too much time working and not enough flying my  paraglider. BTW why doesn’t Mr HIStalk make his Sitemeter logs public?” Easy answer on Sitemeter: I’m trying to stay anonymous and Sitemeter would display my IP address, location, and (if I got on from work), my employer to the world. That actually happened once before (a vendor told my former employer) and I’d rather not deal with that again. I can’t imagine what’s in there that would interest anyone since it barely interests me, other than to see who’s linking to HIStalk.

From hit-investor: “Re: athenahealth. Guess the street liked ATHN’s earnings as it popped almost 11% on Friday to a 52-week high. Folks like their recurring rev model and SaaS network approach compared to Allscripts and Nextgen, which do not have a network strategy – hence lower valuation, not to mention these guys keep missing their numbers.” I must be jaded by Google since I thought a 33% revenue rise was just OK. But, they’re making money out of the gate and that’s unusual. I can see why the model of making money only as a small percentage of what your customers get is attractive (why would anyone cancel?) It’s certainly refreshing to see that instead of the usual “give us $20 million and we’ll send you some CDs” approach. I think the message is that a company willing to go on the hook with their customer for the expected benefits can do very well. But, athena’s system is plug and play and creates benefits automatically, while most hospital systems contribute only maybe 10% to the expected outcome (process change drives the rest). Think of it as HIT insurance: with traditional systems, your deductible is very high. The value of the shares Jonathan Bush still owns: $36 million.

From Lazlo Hollyfield: “Re: MGMA. The vendor hall was pretty sparse (tumbleweeds last Sunday and late Tuesday afternoon) and heard some grumblings from the vendors about it. Nowhere near the level of HIMSS. Seems that vendors had to do their work ahead of the show. Two positives, though. The leads are usually high quality and legit. Plus, a bunch of vendors mentioned that it great a great opportunity to concentrate on B2B relationships and see if there was anything really innovative. The conference attendees are mostly physician practice executives, but I didn’t see a bunch of practice executives who were MDs. Mostly business people. Seem much more savvy than your typical physician practices, though. They have already installed an EMR or are in the process of installing an EMR. Interested in a few topics educational topics and mainly socializing. Biggest themes I heard repeatedly mentioned and discussed: real-time claims, P4P, Medicare cuts, and patient-centered practice.” Thanks for the report. I always wondered why doctors don’t get someone else to manage their practices (other than their wives or mistresses, anyway) because they’re usually terrible businesspeople, despite their own flattering self-assessment. By the way, I’ll be posting my interview with “house call doctor” Jay Parkinson in a day or two. He has no office, no staff, no equipment, and takes minimal insurance, but he’s doing very well and enjoying his practice. He’s fun, and about to become a TV personality, as you’ll read shortly.

From Kip Wilson: “Re: Sunquest anonymous customer. The name is anonymous because this client does not allow their name to be used in public press releases. This client is in a big city in a rust belt state on one of the Great Lakes. Sunquest people tell me that they researched Cerner, Eclipsys, Epic, etc., and that these firms sometimes have press releases without company names, too.” It makes a crappy press release no matter who else is doing it. It just looks desperate to announce a sale in which the customer refuses to be named (how do we know it’s legit? how impressed should we be without having any details) Maybe they should include the CIO’s picture with a bag over his or her head.

From Frank Poggio: “Re: how to market IT internally. 1) stop pushing technology; 2) stop pushing departments to a ‘single’ solution and focus on their needs first, IT’s second; 3) get out into the departments and learn/understand their issues; 4) then, propose solutions, not technology; 5) if they don’t ‘see’ the solution as you do … go back to #2.”

From Isabelle Hammond: “Re: terms. Any comments on the recently announced project funded by the Office of the National Coordinator to create consensus definitions for the terms  EHR, EMR, PHR, HIE, and RHIO? Think it’s needed, or just nonsense? I’ve already heard that some folks at HL7 aren’t pleased about it.” Seems like a harmless waste of taxpayer dollars, I guess. While we jaw about the differences between EMR/EHR and HIE/RHIO on HIStalk, is anyone really all that confused, to the point of “impeding progress” as ONCHIT’s Karen Bell suggests? Is that why RHIOs (or is it HIEs?) are failing?

Speaking of NAHIT’s terminology project, the press release itself is loaded with business-babble BS (not a good sign for a terminology project announcement). My Bullfighter software summarized as follows: “Diagnosis: You overwhelmingly embrace obfuscation and don’t want the reader to understand anything you have to say. Your writing lavishes a preponderance of dependent clauses and compound negatives upon the reader, whose cognitive load not infrequently exceeds the purported benefit of the substance of the article. Syntax incorporates numerous collections of items juxtaposed or in series that demand persistence and not a little unqualified expertise on the part of all intended recipients of the author’s communications. In fact, such machinations inevitably prove detrimental to comprehension and sabotage the imparting of any and all knowledge. Your condition is irreversible.” NAHIT’s marketing person is running the project and an outside group is providing “collaboration tools and services” (guess e-mail and the telephone can’t meet the demanding needs). Apparently, defining five ubiquitous terms is a daunting challenge.

From Gunsmoke: “Re: Perot layoffs. To be accurate, Perot Systems did announce 650 layoffs in their press release: ‘These actions will include the termination of employment of approximately 650 associates.’ The number 425 is also mentioned later inthe release as being ‘beneficial to future earnings.’ I’m not sure what that says about the other 225!”

People keep writing about Misys Connect without understanding what it is. It’s not an EMR, a practice managment system, a portal, or anything that would interest a physician. It’s a connectivity tool that uses the federated model (you decide with whom to share your practice’s data). What a doctor would need to use it: (1) an EMR (big hurdle right there); (2) an interest in sharing information with somebody else, like a hospital (maybe an even bigger hurdle); (3) technical resources to get it connected, especially if your EMR isn’t Misys (Misys hopes to profit from either the resources or the Misys EMR option). Also what it isn’t: likely to spur EMR adoption.

Booked my HIMSS hotel this week. I’ll say one thing about Orlando: hotels are cheap. I’ve also got a potential sponsor for some kind of HIStalk reader event, details not yet determined. It never occurred to me that someone might want to help out, so I appreciate that and I hope it works out. I’ve also received some good PR ideas, some involving strippers (those suggestions always catch my eye).

I’m still playing Love’s live “Forever Changes” concert album nearly constantly. Want to see the 58-year-old Arthur Lee (now deceased) rocking a festival crowd in Europe with his 36-year-old music? I’ve played it at least 100 times and I’m still amazed.

A JAMA reader editorial called “The GAAP in Quality Measurement and Reporting” says that standards for quality reporting need to be better defined since public reporting puts money on the line (and therefore encourages favorable self-interpretation). Also mentioned: some widely used measures don’t correlate well with outcomes, checking a box that smoking cessation counseling was done says little about its quality or impact, and having an order for DVT prophylaxis isn’t the same as knowing it was actually given every day. Thanks to CMIO Mike for sending it my way.

The set of TV’s Grey’s Anatomy now features Epic Systems, which provided screen shots for the show’s hospital computers.

A New York health official says EMR systems, including CCHIT-certified ones, are missing four features needed for population-based health: structured data collection, the ability to create registry lists, built-in quality measurement, and decision support tools. It says it’s working with its unnamed vendor (eClinicalWorks) to implement those features.

Virtua Healthcare (NJ) claims its planned $500 million medical campus will transform healthcare. Mostly it sounded like tablet PCs, cameras in rooms, and patient records access. Half a billion dollars for 368 beds is quite a Taj Mahospital, but after all, they had to have a hotel and conference center. GE’s providing the IT, which apparently caused doctors to get giddy with anticipation for all the time they’ll save (we’ll check back later).

Siemens is restructuring worldwide, with thousands of layoffs coming. You’re too late if you didn’t already get your bribe.

A New Zealand hospital loses everything on its storage area network when two disks fail.

Odd lawsuit: a dentist’s drill bit breaks off during a tooth extraction. He tries to pull it out, but pushes it through the patient’s sinus and lodges it near her eye. The patient claims he told her she would sneeze it out eventually, but then told her to go the ER. The woman claims the dentist was dancing to the song “Car Wash” that playing on the radio at the time.

Philips will sell its 70% stake in transcription company MedQuist, for which it paid $1.2 billion in 2000 (now worth about 75% less). Philips has figured out how to make millions in healthcare IT: start with billions and wait for the accounting scandal. You know Nuance will be all over that one.

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Inga’s Update

Misys’ Center for Community Health Leadership selected Tampa Bay for a $3 million software grant. The grant will be used to accelerate EHR adoption.

Speaking of Misys, their top guy Vern Davenport is quoted in Health Data Management as saying building community connectivity before most physician groups have implemented EHRs “is solving the wrong problem.” Now we know why Misys is giving away Connect! I guess Vern realized the reason no one was buying Connect was because communities didn’t any doctors for connecting. So, why not give away a product that doesn’t solve the right problem?

Boston-area Healthcare South selects Nightingale for their EMR/PM ASP solution. Healthcare South is a 45-provider group practice and over the next 2-1/2 years will pay $475K, plus training and implementation costs.

Eclipsys Sunrise Clinical Manager and Sunrise Pharmacy are up and running at Trinitas Hospital in Elizabeth, NJ. Trinitas is using Eclipsys’ remote hosting services to process more than 6,500 orders daily.

Summa Health Care is also operational on Eclipsys Clinical Manager and Knowledge-Based CPOE. Summa claims more than 95% physician adoption after four weeks of use. Summa has also collected some interesting before and after stats, both clinical and financial.

Third quarter results for Eclipsys: revenues up 11.5% over Q3 2006. Net income was $8.9 million or $.17/share compared to $5.6 million and $.11/share last year.

E-mail Inga.

News 11/2/07

From The PACS Designer: “Re: SaaS. The fairly young industry of Software as a Service (SaaS) is experiencing renewed focus for several reasons. The most prominent is DRA-2005, which has many institutions struggling to avoid losing money from operations. With SaaS, the spending can be from operating budgets, thus avoiding the RFP capital expenditures process. Also, since SaaS can be ordered for specified time periods, you can avoid the forklift upgrade scenario which has been all too common. When signing up for SaaS, it is important that data belonging to the buyer is addressed in the purchasing agreement to protect the institution and also patient confidentiality  Other benefits of SaaS are educating the user on new concepts, exposing weaknesses in current operations, and improving the integration of existing processes.”

From DRPend: “Re: who should run clinical systems projects. The best choice would be A & B One of my first projects was as a system manager implementing a new lab system in a hospital that was using paper forms. One of my first tasks was to integrate with the hospital’s IT department and make use of shared resources. I handled clinical decisions and they handled IT decisions and the project went quite well. Who was in charge? Doesn’t matter. The doctors and patients got what was needed and we all were better off for it.”

From ERMurse: “Re: UCDMC. Congratulations to UCDMC for consolidating all their IS operations under one CIO. Tinstman (who now works as a Senior Advisor, aka consultant’s consultant at HealthTech in San Francisco) only ran the CIS portion. CIS, IS, and Campus IT had separate CIOs, for lack of a better term. The new org structure brings them together. Hopefully Minear is up for the task of uniting three kingdoms. On a less flattering note for UCDMC, their Customer Service (Help Desk) manager and another IS employee have been fired and are under criminal investigation accused of diverting high value equiptment and selling it on Ebay and Craigslist.” Link. Someone sent me an internal e-mail about the investigation in which IT employees were cautioned to decline to comment to reporters (good idea). The hospital refused to let the TV station inside to ask questions (another good idea).

From Larry Cotton: “Re: guerrilla activities at HIMSS. I can’t help thinking of the ploy in The Thomas Crown Affair (at least the Pierce Brosnan one) where a whole *bunch* of people wear similar outfits to confuse people. I’m sure you and Inga look just like Brosnan and Renee Russo. Do you look good in a derby?” Does anyone, other than John Steed from The Avengers, or maybe Mr. French from Family Affair, look good in a derby? HIMSS shameless PR activity ideas are welcome (nothing that would get me arrested or escorted off the property, please – a hallmark of a memorable prank is that it has to be good-natured and fun).

Sumter Regional Hospital is doing well in the contest to win an MRI. Discovered: once you’ve watched their video the first time and voted, you can vote on subsequent days without watching first. Just click the Vote button beside the video (without launching it). Sumter has 54,000 votes compared to 24,000 for #2, but voting isn’t over until December 31. The CEO writes an article about it for the local paper. The hospitals almost-new MRI got destroyed along with everything else in the tornado, he says.

Misys shuffles Charles Lambert out the door and brings in Ron Scarboro as CFO. He’s spent time at TriZetto and A4.

The layoffs at Perot Systems were related to Q3 earnings: revenue up 12%, EPS $0.20 vs. $0.00, missing expectations of $0.22. Loss of the Triad contract upon that company’s merger with Community Health Systems hurt them, obviously, even though that deal was break-even for Q3, according to the announcement. Perot claims headcount reduction of 425, Forbes says 650, and others confirmed the 1,000 I heard. Hardly a bloodbath given its 21,000 employees, unless you’re one of those affected, anyway. The stock hit a 52-week low today.

Thanks to hitpUNDIT for submitting a Rumor Report form to alert me of the CSC-FCG announcement. I’m usually at work when stuff like this is announced early on a weekday, so it’s the Rumor Report forms or e-mails that usually let me know something has happened. Much appreciated. I usually manage to scoop almost everybody for that reason, getting an e-mail update out quickly.

New hires at Lucida Healthcare: Wesley Knox joins as career advisor (former VP of MaxIT, Primetech Consulting, and Per-Se) and Alex Johnas as director of professional services (formerly with IBM Healthlink, Hayes Management Consulting, and East Boston Neighborhood Health Center). Bruce Cerullo hires great people.

A reader who’s doing a HIMSS presentation on marketing the hospital IT department internally would appreciate any ideas from readers who have come up with cool ways to do this. My contribution: an IT Annual Report, and IT Report Card, a system-naming contest (lame), and a CIO blog. Anybody have other ideas? Submit by e-mail or by the Rumor Report form to your right.

VISICU gets a new patent for its technologies, apparently putting the annoying challenges behind it for good. I mentioned the company’s technology indirectly in my editorial for Inside Healthcare Computing this week: “Outsourcing Pharmacist Order Entry: Why Technology-Driven Clinician Virtualization Will Increase Costs Instead of Lowering Them.” The publisher says someone observed that I’m too cynical, although this was one of my less-cynical editorials. The good news is that there are plenty of naive cheerleaders and company shills out there to offset my darkness. Plus, on those rare occasions where I’m slightly positive, you know I’m really stoked.

McKesson’s Q2 numbers: revenue up 9%, EPS $0.83 vs. $0.75. Shares were up 13% Wednesday and gave back a little today in a hugely down market.

HIMSS signs a deal with the Saudi Association for Health Informatics to offer training there.

Yesterday was the last day at Epic Systems for former Madison mayor and liberal activist Paul Soglin.

ZDNet says Misys is now an open source HIT competitor to Medsphere, missing the point completely that all they’re offering is some interoperability software, something the average doctor has never heard of and doesn’t want. I would be at least a tiny bit impressed if the company open sourced something that might actually increase EMR adoption, like one of its stable of poorly selling EMR applications. This is like someone claiming to be an open source evangelist because they loaded Firefox onto their Vista/Office PC.

The former compliance officer of Queen’s Medical Center (HI) is indicted for mail fraud after awarding $600,000 worth of compliance and HIPAA consulting contracts to companies she started. She says everybody knew the deal when they signed the agreements. She’s going after another $2.2 million for services she said she provided to the hospital.

Listening: Andromeda, Swedish prog-metal.

AMICAS Q3: revenue up 13%, EPS $0.01 vs. $0.01.

The Army’s MC4 combat EMR is rolled out to the Air Force’s 332nd Expeditionary Medical Support Group and an Air Force hospital in Iraq.

Meditech’s Q3 report: revenue up 6%, EPS $0.59 vs. $0.61. Services revenue saved what would have been a rare bad quarter.

SAP says it will release e-health solutions in Europe, whatever that means (no clinical systems, the CEO says). Pilots will start in December, apparently mostly in Germany. The company admitted that its joint US project with Siemens went nowhere, er, “it would be exaggerated to say that we are fully satisfied with how things developed.” Anyone shocked? That’s like a restaurant serving liver with a broccoli sauce.

Speaking of Siemens partners, patient monitor maker Draegerwerk AG’s shares tank after poor results from the chunk of Draeger Medical it bought from Siemen AG. We Americans were the problem once again.

GE Healthcare will work with an art school on home healthcare solutions.

Siemens and Merrill Lynch put in a bid of $275 million to buy three small California hospitals, intentions unknown.

InterSystems receives a 2007 Pro Bono Award for its support of The Legal Aid Society through donation of Cache’ technology and services.

Quality Systems’s Q2 numbers: revenue up 21%, EPS $0.35 vs. $0.30. Its NextGen division contributed $15.7 million in profit, with revenue up 23% and net income up 12%.

BridgeForward announces an embeddable version of its ClearSpan Server interface engine at MGMA. Sounds cool and eScription’s Paul Egerman chips in some nice comments. I see the founder and CEO had the same roles at MicroScript, later bought by high-flyer and eventual flop New Era of Networks NEON, which ended up as part of Sybase.

I’ve lauded Sunquest mostly just for bringing back the old name, but now it’s time to take them to task: the company issues a glowing sales announcement but refuses to give the customer’s name. Was someone ashamed? Will the implementors wear blindfolds? Is good news so scarce that partial news will have to do?

I’ve grown weary of reporting the accounting debacles of Merge Technologies (restatements, delisting threats, etc.). They’re restating again, driving an already pitiful market cap and share price even lower: $63 million and $1.96, respectively.

E-mail me.

Inga’s Update

From Inside Outsider: I read your post on HIStalk about the HIT executive trying to hook up with the young ladies at the conference. I have to ask: Do you think this is an isolated incident? It seems that every conference I’ve ever been to has the illicit hookups going on. You’d almost expect that they would have a bulletin board for people looking for people, it happens so often. I think that some go to the conferences and never go to a meeting. And the funny thing is that the people think they are being sly and that no one knows. EVERYONE KNOWS!!!

Mediware announces they paid about $5.2 million for newly acquired Integrated Marketing Solutions.

I was glad to see that I wasn’t the only person unimpressed by the HHS/CMS plan to provide 1200 physicians bonuses for quality reporting using EMRs. At least a couple of industry big-wigs agree with me that a program that offers incentives for less than 1% of US doctors is a pretty small gesture.

athenahealth announces Q3 results. Revenue was up 33% year on year, quarterly adjusted EBITDA was $4.2 million (16% of revenue) and their first quarter of net income ($500k). GAAP net loss for the first three quarters combined was $5.6 million.

Matthew Holt sent in a note about a graphical inaccuracy in Medicity’s parachute ad. My first thought was, “Who cares?” followed by, “Why would Matt waste his time pointing that out instead of working on his 2.0 updates?” Then I noticed he submitted his post around 3 a.m. Wednesday, just about the time HIStalk’s 1,000,000^th visitor came by. Matt Holt was trying to be HIStalk’s millionth visitor! Thought it was kind of sweet of him, actually. Made me a bit ver clemped once I put it all together.

E-mail Inga.

CSC To Acquire First Consulting Group

Computer Sciences Corporation announced this morning that it will acquire First Consulting Group for $365 million in cash, subject to shareholder and regulatory approval.

“By taking this step, we have notably accelerated our healthcare business plan and advanced toward our goal of transforming healthcare through the use of information technology,” said Russ Owen, president of CSC’s Americas Commercial Group. “The CSC-First Consulting Group combination reinforces our commitment to bring innovative solutions to healthcare payer, provider and life sciences clients and offers increased flexibility in our global healthcare service delivery capability.”

News 10/31/07

From Dr. Lisa Cutty: “Re: Microsoft. Microsoft to Acquire Innovative Healthcare Technology and Assets From Global Care Solutions. Does MS really want to enter the battled HIS arena?” Link. MSFT buys the application developer that built systems for big-name medical tourism magnet Bumrungrad International Hospital. For the dirt on the company, see here from alleged employees, and a few more comments here including some shots at Cerner and others. I don’t know why Microsoft wants to be in this business either, although maybe Azyxxi needs a little brother.

From Big Fan: “Re: first mover advantage. Check out Bruce Freidman’s column from the weekend. Great insight. He’s also from University of Michigan, the lab side, and was department head when they decided to back out their Millennium PathNet upgrade. I’d like to hear his explanation for that.” Bruce argues that companies that develop their own IT systems often regret it because commercial offerings will eventually surpass them. He cites an article that claims Wal-Mart’s much-lauded internally developed IT systems now place the company at a disadvantage. I don’t know that I necessarily agree since even a short-term competitive advantage may make self-developed applications worth it, but it’s an interesting discussion.

From M_Miller: “Re: Misys. Steve Lohr, the leading software writer for the New York Times, slams Misys’ open source idea. Everyone knows that Newt is paid to give these quotes to Misys and Allscripts as part of his lame group, but man, Misys just can’t catch a break. The piece then goes on to call out athena’s model and Jonathan Bush’s take on what needs to be done.” The article agrees with me: dumping a poor-selling product onto the open source market doesn’t usually work. There’s no passionate developer community behind it. The article mentions Gartner’s Wes Rishel, who was “unimpressed” and who brought up that users would be clinicians, not the usual techies who embrace that kind of stuff (so he says, anyway, although that’s not what I thought Connect was). He likes Web-based SaaS technology. Sad that the Connect strategy was the supposed future of Misys Healthcare just a few months ago and now the related accoutrements have been donated like a rusted out Chevette.

And speaking of Misys, CFO Charles Lambert has been officially announced as departing, I’m told.

Former University of Maryland Medical Center CIO Mike Minear is named CIO of UC Davis Health System. If you want excruciating detail of what he’s being paid, see here (warning: PDF). He replaces Tom Tinstman (previous HIStalk mentions here).

This week’s Brev+IT is here. Sign up to your right.

Listening: new Coheed & Cambria. I’m in a prog-metal mood.

KU Hospital and KU Medical Center did nothing wrong in choosing a $50 million hospital system from Epic Systems despite a lower bid from Cerner, according to a report by state auditors. Cerner was somewhere between $1 million and $12 million cheaper than Epic over five years, but users had a strong preference for Epic.

The folks at Medicity, always anxious to be helpful, think they may have a few “I Am Mr. HIStalk” buttons laying around and offered to mail one to Lacey Underall if so. No promises, Lacey, but send me an address and we’ll see. I’m still trying to think of something fun and slighly guerrilla-ish to do at HIMSS. Many I should hire an obnoxious band to play on a flatbed truck outside the convention center (I’d be stealing the idea from Howard Stern). Or, I could offer speakers an under-the-table $50 to slip an HIStalk pitch into their PowerPoints and claim it was a mistake (it was a proud moment last year when my man John Glaser wore his button up on stage). Inga and I will be running around causing anonymous trouble, I guess.

A big year for SCI Solutions – their biggest ever, actually. They signed 33 new contracts, including Sutter, UVA, and Health First. Nice.

Justen Deal has thoughts on Kaiser’s potential outsourcing, “Together Again: KP and IBM.” He mentions IBM’s offshore presence (could that be a way for KP to offshore without taking the black eye it might bring?) Spoiler: Justen thinks that bringing in IBM would be good for both KP and Epic.

Rumor: Perot is laying off 1,000 people. Reason unknown.

Want to follow HIT stocks? I made a page with the big HIT stocks listed and a 20-minute delayed quote. Bookmark it if you’re so inclined.

The local paper profiles eClinicalWorks: 32 profitable quarters, 3,000 customers, 600% revenue growth in three years up to $38 million, and a tripling of employees to 550 in two years.

Miami Children’s hires a former GE Healthcare guy as CEO: M. Narendra Kini, MD.

To your right is a new poll: who should run clinical systems projects in hospitals? And to your left is a new Gold Sponsor, AT&T, which has mobility and wireless offerings for healthcare organizations. Hey, they’re my cell provider, so here’s a shout out and thanks for supporting HIStalk.

Sumter Regional Hospital is in first place to win an MRI machine. You can vote daily through December 31.

E-mail me. Happy Halloween, if you’re into evil undead and candy.


Inga’s Update

I reached out to a few folks asking their opinion of the status of the Kaiser/Epic implementation. Here is a note from someone who has been involved:

So the truth is that KP has successfully implemented more software in the past three years than they had in the previous 10 years. When you think about their size and compare that to anyone else, this has got to amaze anyone who really knows what this takes. They have had to industrialize their infrastructure to support the heavier load, and there have been a few hiccups with that infrastructure work, but they have already realized enormous benefits of this investment … it has been an unqualified success. Every installation of electronic health records requires physicians to significantly change their behavior in order to adopt and optimize the use of the system. The vast majority of KP docs who have used the system for more than six months adamantly reject any thoughts of going back to paper, but the changes involved in a deployment of this size invariably results in individual physicians who actively and vocally resist the change. The most surprising thing is how quickly the overwhelming majority of docs get past this reflex resistance to change.

If anyone else cares to share an opinion, we are happy to listen.

I have been mulling over the announcement that the HHS and CMS will pay 1,200 physicians for reporting quality measures using their EHRs. The government is calling it the “largest step yet” for boosting physician adoption (though if the country has 800,000 active physicians, helping 1,200 doesn’t seem that big a step.) The program will supposedly pay for itself with the reduction of duplication tests, ER visits, and medication errors. I realize that some private insurance companies offer quality care bonuses, but if there was that much of a savings wouldn’t all the insurance companies be jumping on the bonus bandwagon? I am all for using EMRs and agree they can improve care. But is there enough to this initiative to have any real affect?

All you ambulatory fans know that the MGMA has been in full swing this week in Philadelphia. Consequently, vendors are making numerous company and product announcements. A sampling:

Greenway Medical Technologies announces that Q1 sales were up 64% over the previous year.

Athenahealth announces that the 38-provider orthopedic clinic Campbell Clinic selected athenahealth’s PM and collection solutions.

Offering software as a service is suddenly fashionable. Sage Healthcare, Allscripts, and McKesson all announced new ASP offerings for their EMR/PM solutions.

Remember eClinicalWorks? From December until May, ECW was announcing one major deal after another. Since the summer, little news has been reported (Busy implementing? Marketing department on vacation? No big sales to announce?) ECW reappeared this week, announcing their partnership with the Hudson Valley HIE to provide the member doctors ECW’s EMR/PM system.

What is old is hip again! Demand for vinyl records is on the rise. Music purists are convincing more people that the sound quality is superior with analog recordings compared to the digital CD. I would bet money that Mr. H has a huge stack of Pink Floyd and Jimi Hendrix albums that he secretly listens to while writing HIStalk posts.

Heard that at a user conference not so long ago, a certain married, male HIT executive was busy sending text messages to some participants at 3 a.m., asking if they were “ready to party.” Anyone care to guess whether or not the recipients were young, attractive, and female (and if they ignored the message?)

Another fun game – fill in the blanks. I heard that [executive] is asking [beancounter] to do some things regarding revenue recognition that [beancounter] is not comfortable with; e.g., recognizing revenue a little on the early side. And, [company] just downgraded their forecast.

E-mail Inga.