Monday Morning Update 6/2/08

From Dr. Know: "Re: Stanford. Spoke with a physician at Stanford today. They recently went live with Epic. The physicians are in revolt: ‘takes too much time and is very difficult to use.’  Also, if you admit a pediatric patient through the ER and they need to be admitted into the children’s hospital, all of the information needs to be re-entered manually from paper, as Lucille Packard runs Cerner and it is not interfaced with Epic, which is running at Stanford Hospital."

From kcstar: "Re: Jay Parkinson. For all of your fawning, it seems he was more of a self-promoter than a physician. The outcome was predictable, and as he even stated, ‘unsustainable’." Link. I interviewed him, but I wouldn’t say I fawned. He has some good ideas and I like the idea of going off the grid (as Scott Shreeve says), but he’s not fault-free. He thinks he’s got the entire system figured out despite being a new med school grad, he seems to be a bit smug, his kind of medical practice has zero relevance to the 99.99% of the country that’s not in New York City treating young and healthy hipsters for the occasional sniffle, and he seems to hate just about everything and everybody involved in medicine outside his little world. For a brand new doctor, he’s shrewdly wangled his 15 minutes of fame, but can his "tear it down and start over" ideas scale and is he really the best spokesperson for changing medicine just because he does magazine interviews and blogs and sometimes finds time to see a patient for cash? Time will tell. Give him credit for some pretty fresh ideas, at least, even though his experience with the non-fresh ones is minimal. I’m happy he took the time to be interviewed here since few in the industry had heard of him back in November and the ensuing debate was interesting.

Speaking of 15 minutes of fame, Dann, who started the HIStalk Fan Club on LinkedIn, let me know that it’s up to 58 members, which I find astounding and immensely gratifying (especially when I see the roster of highly accomplished folks who signed up – thanks!) I keep thinking I should offer something in return, like dibs on signing up for the HIMSS shindig or something (which, FYI, looks to be on track). Having a fan club is pretty darned cool, especially since being anonymous eliminates the possibility of egomania.

I do my share of Neal Patterson ribbing, but I’m also on record as being a fan in many ways (started Cerner and stuck around, didn’t sell out to some conglomerate, says whatever he damn well pleases). Case in point: Google is sweet-talking Cerner about jumping on the shaky Google Health bandwagon, but Neal is keeping them at arm’s length since he doesn’t buy the PHR concept, which he calls "electronic shoeboxes" that put the onus on consumers for record-keeping. I’m with Neal on that one. Consumers might use healthcare search engines and social networks, but they aren’t going to keep reliable medical records.

If you get Healthcare IT News, your information is available to anyone willing to pay $150 per thousand addresses for list rental. HIMSS calls the publication a "member benefit," i.e. you get a subscription by default to boost its ad rates, but apparently the benefit isn’t entirely yours. I must be the only person who has thousands of industry e-mail addresses that I won’t share with anyone.

Ah, to have minimally inquisitive publications willing to print whatever companies send over. Health Imaging News crows about McKesson’s "unveiling" of MyPacs.net. A 10-second Google fact-check would have shown that to be false: the original journal article describing its development was accepted in 2001 and the site was announced at RSNA 2002. Unless "unveil" means "bought the original company and put out a press release," it most certainly was not just unveiled.

Fundraising software vendor Blackbaud, whose products are used by many hospital foundations, will buy struggling competitor Kintera for $46 million in cash.

The 12-hospital group in Canada whose MEDITECH systems were down is back online. The company blames a corrupted file, but the media report says two US hospitals had the same problem at the same time. Seems suspicious that three customers all had corrupted files simultaneously.

Wyoming is considering allowing CNAs to administer medications, but only for specific drugs, most of them non-prescription. A waste of time, it would appear, since patients seldom need only those meds, so the nurse would have to go behind them to finish the med pass anyway.

Ontario will invest $109 million to improve ED efficiency, with part of the money set aside for IT.

Thanks for reading. If you aren’t getting the e-mail update or Brev+IT, you can sign up to your right (and I won’t sell your information). I’m always interested in rumors or thoughts, easily submitted by clicking that big green Rumor Report box to your right.

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Art Vandelay’s 10 Tips for Finding IT Budget Cuts

1. Create a list of all contracts. Detail the benefits of the components to the business. Document the key terms. Be sure to include the impact of canceling and restarting maintenance. Look for consolidation opportunities. Also look for areas of low impact if a cut occurred. Possibly negotiate longer-term maintenance deals (ex: go from one-year maintenance to three-year). Review contracts for network carrier services, cellular and wireless data, pagers, real estate leases, and power.

2. Review your application inventory and document functions. Look for overlaps and apps with few benefits. Consider the cost of consolidation and migration.

3. Review the project inventory budget impact. Consider initial and recurring costs. Look for overlaps, low tangible benefits, and those with long paybacks. Consider leasing hardware or software. Also consider risk-based contracts for services.

4. Create chargeback reports if you aren’t doing so. This requires developing a list of all costs and an allocation method. Look for business units with an inordinate amount of costs with little tangible return. In more progressive organizations, the reports allow leaders to monitor and adjust their variable costs with some explanation of the impact.

5. Create a database of staff ratings including true performance reviews. Next, align the output with the project inventory and application importance or benefits. Identify staff that can be cross-trained to pick-up other projects in the pipeline if a staff reduction occurs.

6. Run a zero-based budget with a fair-minded financial analyst involved. Note the areas where cuts occur so you are ready if asked.

7. Analyze the use of your reporting applications. Provide real examples of where the tools can benefit this type of analysis, such as staffing, lost revenue, cost reporting, and supplies.

8. Consider virtualization and consolidation. Potentially related benefits include reduced power consumption, heat generation, and maintenance costs Align hardware with key benefits. Focus investments in hardware on those platforms benefiting the business the most as well as where you have the most skills.

9. Bid all hardware purchases even if it moves them away from your standard suppliers. Minimally, this gives you leverage to keep your suppliers honest.

10. Consider use of open source software where you have or can buy or build skills.

News 5/30/08

From Moses: "Re: CCHIT. Big changes for 2008 CCHIT ambulatory certification criteria that goes into effect with the first application window 07/01/08. Two new extensions to the base certification, Child Health and Cardiovascular. Certified status good for two years as opposed to current three. Lots of new interoperable functional requirements." Link. The two new extensions are optional, but enhanced interoperability is not (sending and receiving patient summaries per HITSP standards). And, did you notice that those exciting new NAHIT acronym definitions differentiate the term EHR from EMR by basically saying that CCHIT-certified EMRs are by definition EHRs, but everything else is an EMR? Seems a bit self-referential. I personally think EHR is a standard no vendor has yet reached (longitudinal, containing health and not just medical records, accessible for reading and updating by all providers from pharmacies to acupuncturists, and contributing to aggregate data sources). But, who am I to argue with BearingPoint, especially when I’m not the one getting $500K?

From Craig Garrison: "Re: Misys. The end of their fiscal year is May 31 and apparently only about 10% of the sales force is expected to achieve quota. Bet that a number of salespeople become available for hire over the next few weeks (some by their own choosing and some to Misys choosing)."

From The PACS Designer: "Re: miniPACS. A new miniPACS has been developed by researchers in South Korea. The team at Seoul National University Bundang Hospital reports that the miniPACS they developed is wireless and saves time when compared to manual archiving of digital records. The researchers utilized a laptop computer with 802.11b wireless LAN functionality and incorporated internally developed DICOM modality and storage server modules. The mean time interval from image acquisition to main PACS server storage was five minutes and 42.4 seconds when the wireless miniPACS was used, compared with 38 minutes and 25.5 seconds without." Link.

From Curious: "Re: downtime. Last week, while visiting a patient at Hillcrest Medical Center in Tulsa Oklahoma (an Ardent facility), I heard the nursing staff complaining of their system being down. Being the curious HIS professional, I could not resist inquiring as to the nature of the problem. They were told the downtime was the result of a fire at the Nashville data center.  Also, they were told it could last several days. Not sure what happened, my friend was discharged the next day. Sounded like big news! Does anyone know if Ardent or McKesson made an announcement or possibly declared a sentinel event?" Perhaps Inga can make an inquiry.

Hartford Hospital will repay $800,000 to Medicare for chemotherapy overcharging. I don’t know why hospitals don’t complain more about the ridiculously complex software and process requirements just to get bills out to the feds, which I’m guessing gave Hartford heartburn. Example: now they want NDC numbers and complex package size calculations every time outpatients get drugs. Nobody barcode scans outpatients (surgery, cath, etc.) Nobody except the caregiver knows exactly what they used to prepare an individual patient’s dose. It’s nearly impossible to follow the guidelines about package size choice and wastage. Imagine the clinical good that could be built into systems if they weren’t constantly being overhauled just to keep Uncle Sam happy. Anybody complaining about how far behind healthcare IT is compared to other industries should have to sit through an overview of how grouper and case mix programs work. No industry I know of has to spend so much automation energy just to create an invoice.

This article on practice EMR adoption is more interesting when it talks about the inpatient EMR cost of a couple of hospitals: Texas Health Resources ($200 million) and Baylor ($240 million.)

Scott Shreeve noticed that Ingenix apparently plans to go open source with its analytics tools. Check this quote: "I think it is because we don’t define ourselves by our products alone, but the problems we solve and the imagination of our people and clients. Believe it or not, our employees would rather be known to our clients for solving bigger problems and being known as industry leaders than for competing based on proprietary data and methodologies. This represents a whole new way of thinking for us if we are willing to improve." That’s pretty cool. I’ve asked for an interview, so we’ll see.

Inga mentions below that Fujitsu is pulling out of its NHS contract (following Accenture, of course, which already retreated tail between legs). BT is the heir apparent, but here’s the rub: like Fujitsu, BT uses Cerner as its subcontractor for the London region. Some NHS folks have been bitterly and vocally opposed to Cerner Millennium, possibly the point that NHS could decide not to choose another contractor at all, letting the trusts go their own way. I’ve said all along that localization issues would be a struggle for Cerner and that iSoft had plenty of problems before it ever hooked up with NHS. Are there any vendors left ready to step up to the plate immediately with a greater chance of success? Just one: Epic. Here’s why that makes sense: they’ve proven through Kaiser that they can handle massive deployments, they’ve been rumored to have an interest in going international, it’s by far the highest KLAS-rated system, and just about every large US health system making a clinical systems decision seems to pick Epic these days and they’re all doing just fine (other than the monstrous cost). If they want to expand outside the US, the UK is the obvious choice, especially since it’s big business in one swoop. I don’t have any information (insider or otherwise), but if Millennium comes under serious UK fire, I bet Judy will be on a plane (if she hasn’t already been). CERN shares were down 2.7% today.

Proof that spell check still requires human oversight: this press release. Sunshine Medical Clinic became SunShine Medial Clinic, which implemented Electronic Medial Records software. And course, you just know that mistakes of that magnitude will conclude with a HIPPA gaffe and you won’t be disappointed. I could point out a few more errors, but that’s plenty.

A new problem: researchers are getting caught Photoshopping the images they submit to journals.

Jobs: Clinical Applications Specialist (MA), Database Administrator/Architect (MA), HL7 Interface Analyst (TX), Medical Billing Professionals (CO), Service Specialist (TX). Gwen writes a fun, chatty weekly newsletter with all the jobs that even I read, for which you can sign up here.

Orion Health is offering a white paper about the use of its integration products with MEDITECH.

Cardinal Health may have one of its drug warehouses shut down by the Ohio board of pharmacy for selling large quantities of controlled substances to a company that was peddling them on the Internet.

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Inga’s Update

The EEOC files a federal class action lawsuit against John Muir Health (CA), claiming that it didn’t hire at least seven nurses based on a doctor’s incorrect diagnosis of latex allergies. The lawsuit contends the organization acted "with malice and/or reckless indifference to (the nurses’) federally protected rights."

NHS terminates its $1.8 billion contract with Fujitsu for EHR implementation at a southern England hospital following a dispute over the government’s demands for more flexibility over the system being installed. NHS and Fujitsu could not agree on payment terms for the changes.

Meanwhile, the CEO of Worthing and Southlands Hospital says its Cerner Millennium system is still suffering from “inferior functionality,” leading to “significant level of discontent among clinicians.” He also goes on to say the hospital is unable to satisfactorily capture, record, and bill all activity. Sounds like they’ve got themselves one big ole mess over there.

Moses Taylor Hospital replaces Microsoft Exchange with Linux-based Exchange clone PostPath. The IT staff claims PostPath was half the price and is working well for its 700 users.

A few days ago, we mentioned the city of San Francisco is suing McKesson for allegedly conspiring to artificially inflate wholesale drug prices. Now Connecticut has followed its lead with a similar suit.

Microsoft announces it has bumped its funding an additional $1.5 million for its HealthVault Be Well awards, designed to “encourage innovative online solutions to address significant health issues.” If I were Mr. H, I would probably say something cynical, like Microsoft is simply trying to pay more companies to interface with HealthVault. Since I am Inga, I will instead say kudos for any effort to improve health and outcomes for patients.

Berger Health Systems announces its successful deployment of the PatientKeeper Platform and Physician Portal.

Aetna is named the top payer for its business dealings with physicians in athenahealth’s latest PayerView rankings, which are based on actual claims performance for athenahealth providers. The State of New York’s Medicaid program ranked last in the nation due to its complex patient referral authorization requirements, slow or non-existent reimbursement policies, insistence on the use of proprietary medical claims forms, and confusing and paper-based billing requirements.

A computer crash Monday affects 12 northwest Ontario hospitals. The hospital issued this statement Tuesday: “We currently know that this is not a hardware issue, but is rather an issue related to software code. Our vendor, Meditech, is working diligently to remedy the situation. The delivery of patient care will be slowed as a result of this interruption of service. Expect longer waits, especially in the Emergency Department.” Officials also say the outage poses no risk to patients or their data (assuming you are not bleeding to death in the ER, I suppose). They also claim it’s difficult to project when the problem will be fixed.

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News 5/28/08

From drNurse: "Re: new site. Thanks for the best blog in the world! Fabulous news! HIStalk makes my day. Have you seen this? (It showed up on the AMIA OpenSource working group list…)  Pretty funny, and, sadly true. One of our faculty just wrote to ask if they have an academic advisory board. They need one, don’t you think?!" Link, and also its sister site. Somebody mocked up a pretty fun parody of CCHIT and EMR vendors. Given the carefully hidden registration information, the elaborate site design, and the flurry of blog mentions that surely aren’t coincidental, I’m betting it’s a viral marketing project of a vendor. I got quite a few e-mails about both sites. I think they do need an advisory board and you and I should be on it (for an appropriate stipend and travel to exotic meeting locales, of course). Thanks for your ultra-nice comments, by the way.

From Charles Bronson: "Re: RHG. They laid off their entire Employer Group business unit on Thursday, 21 people representing most of the seasoned health care people." Unverified, but I’ll ask Inga to check it out.

From HIS_Grue: "Re: Philips selling MedQuist. MedQuist is the world’s largest medical transcription company and would be larger if the Cbay/MedQuist merger goes through. The new MedQuist transcription platform has speech recognition technology from Philips firmly embedded in it and MedQuist resells products from Philips. The plan mostly worked, other than the litigation issues that caused selling for a loss and taking away near-term revenue gains."

From Rogue: "Re: retail clinics. In the 80s and 90s, it was all about walk-in clinics or, as they were so horribly monikered, ‘Doc in the Boxes’. Having consulted to 20 or so of them, they were very different from today’s retail clinics. They were staffed by physicians and the well-done ones partnered with the local medical staff for PCP and specialist referrals. However, the best revenue models relied on 1/3 of patients being repeat customers, so there was inherent conflict in trying to hook everyone up with local medical staff for an ongoing relationship. Hospital-sponsored clinics had to wrestle with economic viability vs. peace with the medical staff. Today’s clinics can learn from the walk-ins. Those I saw never had an electronic record and it was a cash/credit card business – here’s your superbill, you go hassle the insurance company."

I got a response from Dossia’s PR firm about the reader’s speculation that they would part ways with Indivo, which the CHIP people denied last week. "Dossia has no plans to change from using Indivo as its core technology and is working closely with the Children’s Hospital team to deliver the next release of Dossia; to that end we are even moving into the same office space in Cambridge." Sounds like that rumor has been put to rest.

That RAND study that Cerner paid for and quotes widely (claiming HIT will save $77 billion a year) is hogwash (warning: PDF), according to the Congressional Budget Office. Criticisms: (a) it estimated potential impact, not likely impact; (b) it excluded studies that didn’t show positive HIT effects; and (c) it used 2004 adoption trends. The benefits, it says, will mostly accrue to integrated delivery systems, which are, not coincidentally, the only constituency installing them in significant numbers. CBO was equally critical of a similar study by the Center for Information Technology Leadership, declaring its assumptions to be "overly optimistic." The conclusion is exactly what you’d expect: it’s not the systems, it’s what providers do with them that might provide benefits, and they are more likely to improve quality than save money. And you know what? Improved quality is reason enough.

Listening: new from The BellRays, fierce soul from California, like Tina Turner backed by the best indie band you’ve ever heard. Check the second video if you’re sick of lip-synching posers. My highest rating.

Consumer Health World gives (warning: PDF) the Order Facilitator product of SCI Solutions an award for "Best Web Tool for Promoting Community."

Inga and I are getting more user-submitted material (which we like), so we’ve decided to give those writings their own issue of HIStalk once a week or so (on a day we don’t usually write). Send in your editorial or other commentary (under 500 words and subject to editing) and maybe we’ll feature them on Reader Day. Informative, amusing, sarcastic … it’s up to you.

Final results of the CIO education poll: 57% say no Master’s degree is needed, 43% think it is (if you don’t have one, hope your future boss is in the slight majority). New poll to your right: will NAHIT’s freshly minted abbreviations increase HIT adoption? Not to show my cards, but my guest editorial in the newsletter tomorrow is entitled Hello, NAHIT? Wanna Buy My Dictionary for $29 Billion? Here’s a snip: "Note: it is law that every healthcare IT article written by dull reporters or unimaginative academics must start with one of two opening lines, either, (a) ‘In 2004, President George Bush called for every American to have electronic health records by 2014’ or, (b) ‘In its landmark 1999 report To Err is Human, the Institute of Medicine said that medical errors kill 98,000 Americans each year.’ Spoiler: this one goes with (a)."

A CIO told me a curious story about a new computer virus he’s seen that isn’t in McAfee’s definition files. Microsoft says they’ve seen it only in healthcare. If you’ve had a similar experience, let me know and maybe we can figure out if there’s a common software exploit or geographic area.

Robertson Research Institute (MI) releases a new version of its medical diagnosis software NxOpinion, which is marketed primarily outside the US.

Best wishes and thanks to James Liska, 42, a biomedical equipment manager at Lawrence & Memorial Hospital of New London, CT and sergeant in the Connecticut National Guard, shipping out for the Middle East next month with his unit. Hospital CIO Kim Kalajainen took time to attend an employer appreciation event Friday at Fort Dix, leading to the article I ran across.

Cerner announces a Millennium go-live at a 468-bed Johns Hopkins-affiliated hospital in United Arab Emirates.

Medsphere is offering a June 4 webinar on Midland Memorial Hospital’s reaching Stage 6 of the HIMSS Analytics EMR Adoption Model.

McKesson’s CERME makes this hospital software coordinator’s Bad, Bad Software list. "During this debacle, the tech guy informed me that the database name ‘Care_Enhance_Review_Manager’ was unacceptable. (It’s a frickin database name. It’s frickin acceptable) How do I know it’s frickin acceptable? Because it was THEIR previous tech person who frickin named it that and it worked for years that way. So anyway, this guy insists on creating a new database with the proper name ‘cerme’. Hmm… why not just rename the old one? BECAUSE HE DIDN’T KNOW HOW TO FIX IT." It’s amusing and honest, which means someone will probably demand it be taken down.

And speaking of McKesson, this is odd: the company reimburses CEO John Hammergren for his lawyer’s time in convincing them to boost Hammergren’s pay.

MedAvant will sell its lab results reporting business to focus on EDI.

Thailand-based medical tourism hospital Bumrungrad International will rent laptops to patients, hinting that it may eventually use conferencing applications to connect patients to caregivers.

Two employees of Maimonides Medical Center (NY) are arrested for patient identity theft and using a doctor’s PC to set up an account at Neiman Marcus.

Former GEMS IT CFO Brian Gladden is named CFO of Dell.

Odd: a British hospital RN loses her license for offering sexual services via a web site, then meeting with an undercover reporter posing as a john while wearing her hospital uniform (complete with badge) and using her real name.

New appointees to the HHS’s National Committee on Vital Health Statistics: Harry Reynolds, BCBS of NC; Mark Hornbrook, Kaiser Permanente; Blackford Middleton, Center for Information Technology Leadership; Walter Suarez, Institute for HIPAA/HIT Education and Research; and Sallie Hunt Milam, chief privacy officer for WV and executive director of the WV Health Information Network. NCVHS advises HHS on health data, statistics, and national health information policy.

I hope you had a nice holiday (and flew your flag). I did nothing work-related for two whole days, a personal best that left me bored but rested.

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Inga’s Update

We can land an aircraft on Mars, but we can’t get rid of the ants in NASA’s computers. Ants are infiltrating computer systems in NASA’s Texas area and knocking systems offline. Sounds like a movie waiting to be made.

Neal Patterson is bullish about Cerner and healthcare IT companies in generally, predicting continued growth in the industry. The comments were made at Cerner’s annual shareholder’s meeting last week.

A British newspaper publishes a few of the top medical errors at Norfolk and Norwich University Hospital. Most were the result of human error and were medication incidents (sound familiar?) However, the accidental gluing of a patient’s eyelid sounds pretty unusual.

Meanwhile in the UK, the NHS has announced full deployment of their new EHR system has been delayed an additional four years, until 2014-15.

CCHIT announces the 2008 Ambulatory EHR certification requirements. The new criteria include additional interoperability requirements. Also new are optional certifications in pediatrics and cardiovascular medicine. Look for announcements on the inpatient requirements sometime in June.

The Advisory Board Company purchases Crimson, a provider of data, analytics and business intelligence software to hospitals, health systems, and physician clinics.

Imprivata releases results from its Identity Management Trends in Healthcare 2008 survey of 171 healthcare IT decision makers. On the rise: tools for accessing applications and networks regardless of location in and out of an organization’s facility. Password management and application security are productivity obstacles.

NextGen announces (warning: PDF) that Health Management Associates will utilize its revenue cycle management services. Healthcare Management already uses NetGen’s PM and EPM solutions.

Dutch scientists claim they have completed the first sequencing of an individual woman’s DNA. Since 2001, the DNA of four men has been sequenced, lending proof to the theory that women are harder to figure out.

E-mail Inga.

News 5/23/08

From Garrnut: "Re: TEPR. TEPR was a bust. Not very well managed. Badges were hard to read (titles were bigger than company  names – who cares about them when you can’t tell where someone is from?) Exhibits were few and small and staffed by 10-year-olds. Sessions were repetitive and some were downright boring. I read somewhere that they’re trying to shake the boring stuff and broaden it like a poor man’s HIMSS for 2009. The one and only time I went years ago, it was horrible, fraught with logistical problems and bad speakers who would have emptied a HIMSS local chapter meeting room in about 60 seconds (no lie: one poorly credentialed speaker was so badly prepared that within 10 minutes, an irritated audience member had hijacked his session and turned it into a freeform discussion group while the presenter watched helplessly from the podium). I’m not entirely convinced that the vendor awards (you must be present to win) and gimmicky product shootouts really require a whole separate conference. They had a few good speakers this year, but the vast majority of presenters were vendor people. I’ve never known anyone who has attended, but someone must go (HIM people trying to get into IT, maybe?)

From Intel_Inside: "Re: Dossia. Dossia has fired Indivo/Children’s Hospital and is now working with a third partner." Not true, according to the two CHIP sources we contacted. I tried Dossia and haven’t heard back, but unless the scoop is so hot that the CHIP folks haven’t been told, this looks to be wrong. Confirmation welcome, however.

From DRPend: "Re: soup story. I could be mistaken, but I think that pretty much any meat-based soup contains body fluids, albeit not human. Seems strange though, I have done coliform counts on restaurant food, but never a fluid analysis." Reminds me of an old story about Adolf Hitler. Right as people started sipping bouillon at dinner, he’d squick them out by referring to it as "corpse tea." What a funster.

From The PACS Designer: "Re: PACS/RIS integration. TPD has done numerous posts on the various aspects of integrating PACS and RIS. As we are seeing more installations of PACS, it would be a good time to mention how important an integrated system PACS/RIS is for improving radiology efficiency and workflow processes. Since more modalities are now tied to the PACS/RIS, it would be best for a fully integrated system from the same manufacturer, which in turn will eliminate the need for custom application interfaces to the older systems."

From Alex Handris: "Re: retail clinics. Back in the 90s, consultants suggested that hospitals sponsor retail clinics to serve the community and bring in new patients. There was a HUGE pushback from their attendings, who saw it as a threat to their office practices. No one seems to be mentioning this, but I bet it’s still an issue."

If you’re thinking about presenting as HIMSS09, your proposal is due May 30. They could use better presentations, so jump right in. Maybe I’ll submit a scientific topic and then get up there and instead pitch HIStalk shamelessly for the entire session, flanked by Fake Ingas.

WebMD plans to outdo real science with ad-support crapware, as evidenced by the 10 most popular articles being sought by its dimwitted audience (note the preponderance of headlines that promise pictures or lists for those who need to rest their lips before forging ahead): 10 Surprising Health Benefits of Sex, The Flat Belly Diet, Pictures of Adult Skin Problems, 6 Serious Medical Symptoms, Sex Myths vs. the Facts, Learn How to Spot Bedbugs, 12 Embarrassing Body Problems, 7 Causes of Fatigue, Personal Questions from Women, View Common Childhood Skin Problems. And these are the people who are supposed to maintain their own medical records online?

Have fun this weekend and don’t forget those who lost a lifetime of weekends on your behalf. You may not agree with the jobs they’re ordered to perform, but respect the soldiers and sailors who do it for their country, allowing the rest of us to remain blissfully unaware of the horrors of war and of being maimed or killed on hostile, distant soil. Fly the flag, thank a veteran and their family, and remember the fallen this Memorial Day, even if for only a minute, OK?

 
Photo: Charles Dharapak/AP

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Inga’s Update

CDW selects EnovateIT for its Sapphire Partner Program. Sapphire partners typically provide in industries that represent emerging trends in the technology marketplace.

From Wompa1: “I appreciate your defense of Dr. Peel. Why is it that privacy advocates and civil libertarians are always lumped in with the tin-foil hat crowd? Thanks for your rebuttal to the bleating of the sheep that don’t ever concern themselves with corporate or government entities accessing their private information. I understand that practitioners have a ‘work product’ that becomes the health record. However, the individual is paying for that work, either directly or through an insurance company. Should that individual have no say in how it is used? No one wants an employer having access to their health records, but this is a direct result of allowing the employer to provide your medical coverage. Would we rather have the government (at any level) providing that coverage and accessing the information? Dr. Peel is contributing to the discussion in positive ways, her detractors’ whining notwithstanding.” Wompa1 shares some additional thoughts on Dr. Peel, Matthew Holt, insurance, and discrimination on the Forum.

From Computer Nurse: “As a female and a nurse informaticist, I am concerned that this survey is billed as an ‘HIT’ survey, when in fact the survey population consisted of 633 readers of Health Imaging & IT and subscribers of Health Imaging News. The results are in no way representative of the vast variety of specialties involved in HIT, especially those in other clinical areas outside of radiology/imaging. The survey should be renamed ‘The Imaging in HIT Salary Survey’.”

EMR vendor Pulse Systems is a new reseller for Stratus Technologies and their 99.999 % uptime ftServer fault-tolerant servers.

Constellation Software increases its stake in Mediware to almost 14%, making it one of the company’s largest shareholders.

Troubled Merge Healthcare enters into a private financing deal with with Merrick RIS, netting Merge $16 million to be used to settle a class action securities lawsuit. Merrick RIS gets to replace five Merge board members with its own people.

The official definition of electronic medical record: "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization." For more official definitions, check out the National Alliance for HIT’s report, “Defining Key Health Information Technology Terms.” Thanks to the OHC, who funded this multi-month project, no one should ever again be confused by the terms EMR, EHR, PHR, HIE, and RHIO.

Private equity firm Lindsay Goldberg is investing $75 million in Ambulatory Services of America for future expansion. Nashville-based ASA provides alternate-site health care services.

The federal government is spending about $2 million of our money on full-page newspaper ads to inform consumers of hospital satisfaction rates for more than 2,500 hospitals. The ads note patient ratings on two measures of quality of care, including the percentage of patients who always got help when they needed it and the percentage of patients who got antibiotics one hour before surgery. The rankings don’t include hundreds of hospitals who didn’t release patient satisfaction scores.

In case I get carried away sipping adult beverages on the beach this weekend and forget to send Mr. H an update, hope everyone has a happy and safe Memorial Day. And take a moment to memorialize those who have sacrificed to give the rest of us the freedom to play in the surf and enjoy our good lives.

E-mail Inga.

News 5/21/08

From Mr. Green Jeans: "Re: retail clinics. They are partnering with local health systems, like Wal-Mart with Memorial Hermann and Bon Secour. I believe CVS is doing the same in some markets. The slower uptake is due to the challenge they face in becoming profitable and having secure operational infrastructure in place to handle self-pay and the commercial carriers, which many are now accepting. This is why, in my opinion, you saw CVS/MinuteClinic (which has over 50% of the retail clinic market) select athenahealth to handle PM and billing a few weeks ago. Getting paid and not have billing nightmares for patients is key. The EMR play here is small, as they only conduct a finite number of procedures. The billing and back-office operations are critical to shorten the time between opening a clinic and it becoming viable. The big boys (WM and CVS) are figuring this out."

From K.K. Kallenbach: "Re: comments. Where do the comments in HIStalk come from?" Since this is your comment, now you know! Readers e-mail me or use the Rumor Report (to your right) to send news, rumors, comments, documents, pictures, etc. If they’re good, I run them here (anonymized, of course). Some folks click the Comment link at the end of an article and post their own comments (click the same Comments link at the end of an entry to show them). A very few messages are posted in HIStalk Discussion (usually idiot foreign spammers selling electronics whose messages I have to delete), but we always wish more folks would post there since reading and replying are easier.

From Dr. BeanTown: "Re: Google Health. Dr. Halamka has moved BIDMC live. Curious what your thoughts are." If PHRs have a chance of succeeding, it will be because hospitals allow patients to populate PHRs with their reliable data without it being burdensome (patient-entered data is not worth much in most cases). I like BIDMC’s willingness to lead the pack and I would trust Halamka more than almost anyone to be the patient’s advocate and to be honest in assessing how well it works. It’s slightly odd to use a patient-controlled technology as an intermediary between sophisticated practitioner IT systems (i.e., the patient as the interface engine), but maybe that will serve as a good privacy tollbooth (and Halamka seems thoughtful about privacy as well). With a few big places jumping on board, PHRs will either sink or swim quickly, I would think. If patients aren’t interested, expect the former, so part of BIDMC’s job, I’m guessing, is promoting it. It’s an Internet technology, so a quick market share grab is the main strategy.

From CareGuy: "Re: RHIO. Vermont’s only RHIO failing?" Link. State government wants Vermont Information Technology Leaders to reduce the size of its 21-member board, hire a CEO, and speed up its work. The state tacked on a medical claims fee that will give the private VITL $27 million over seven years, so they’re getting more involved. Doesn’t sound like they’re failing, though.

From Poo Flinging Monkeys: "Re: Misys. Layoffs Monday, almost a dozen folks in implementation, most with a least 10 years." Unverified, but reported by at least four readers.

From Madrigal: "Re: MEDITECH. Their new Southcoast office opened Tuesday in Fall River, MA. Picture attached." Thanks for the pic – nice building!

Listening: Under the Flood, hard-rocking newcomers from Charlottesville, VA.

Say hello to new HIStalk Platinum Sponsor Loftware of Portsmouth, NH. Its products include technologies to manage label printing, barcodes, RFID labels, and retail labels. They have a nice case study from Johns Hopkins on their site involving a lab management system for tracking research samples. Their VP of marketing has a strong healthcare IT background, including as a Health Language, Inc. co-founder and member of HIMSS, AMIA, and AMA. The company is the world’s second largest employer of RFID-certified staff. Welcome to Loftware and thanks for supporting HIStalk and its readers.

Tanya Townsend has been named shared services CIO at St. Mary’s Hospital Medical Center and St. Vincent Hospital (WI). She was at St. Clare’s when I interviewed her in November. Maybe HIStalk made her famous!

Shafiq Rab is named VP/CIO of Orange Regional Medical Center (NY).

Jobs: EMR Developer (FL), Clinical Applications Analyst Lab (WA), Senior Web Developer (DC), Pharmaceutical Informaticist (TX). You can sign up for a weekly e-mail since there’s too many jobs to list here.

San Francisco’s city attorney and a local health plan for low-income residents file suit against McKesson, alleging price fixing. It’s related the Massachusetts suit from 2005 involving average wholesale price of prescription drugs.

Wireless asset tracking vendor InfoLogix acquires Aware Interweave, a provider of mobile information applications for SAP users.

Quality Systems Inc. (NextGen) will acquire revenue management company Healthcare Strategic Initiatives of St. Louis, MO to augment its NextGen Practice Solutions revenue cycle management services business.

VISICU (aka Philips) announces the results of a 156-hospital remote ICU monitoring study: the mortality rate was 9.6% vs. 13.5% nationally, supposedly representing over 7,000 saved lives in the sample.

An Erlanger Hospital (TN) board member and former Tennessee senator walks out of a meeting of the board’s finance committee over an outsourcing proposal from PHNS. The CIO says IT employees favor the move (I’d be surprised if so) but another board member says the contract doesn’t adequately address their future. Says the hospital’s data center will be shifted to the one PHNS runs, which sounds great until the hospital decides to end the outsourcing arrangement (which nearly always happens) and they don’t have a data center or the capital to build one. Perot was also a contender for the business.

An e-mail making the rounds in Kansas City claims "a friend" became sick on soup from a local restaurant, which was analyzed (by a hospital … riiiiight) and found to contain body fluids. It’s surely an urban legend, of course, since hospitals don’t test soup for diseases. What’s interesting, though, is that the newspaper’s original version of the story (cached on Google) included this snip: "The e-mail chain lists smiles@cerner as one of the originators, but a spokeswoman for North Kansas City-based Cerner Corp. said it was not a valid Cerner e-mail address and the name of the e-mailer was not a Cerner employee," but the story was changed afterward – the current version is missing that sentence. That e-mail address may not be valid at this moment (or at all, actually, since it was missing the .com at the end) but the brochure (warning: PDF) for Cerner’s 2008 user conference lists that e-mail address (with the .com) and the employee’s name it belonged to — it was the contact person for canceling exhibit space. None of this matters one iota except I thought the changed story seemed sinister.

The Shared Health statewide information exchange in Tennessee will use software agent technology from Novo Innovations for integration.

Sentillion announces new Q1 customers that include Baptist Birmingham, Hawaii Pacific, UNC Health System, and University of Chicago.

Hey, thanks a lot for reading, e-mailing me, and recommending HIStalk to others. It means a lot to me. Without you, I’d just be downstairs pretending to be interested in watching Kristi Yamaguchi dance.

E-mail me.

Inga’s Update

I have been reading the comments bashing privacy advocate Dr. Deborah Peel and decided it was time to weigh in. I have talked to Dr. Peel a couple of times and was actually surprised she was not the crazy zealot I expected. Instead, she is passionate, well-spoken, and makes some good arguments. She is not against PHRs or using data for medical and genetic studies. She believes that health data belongs to the patient and they should decide who gets it. In other words, it is my decision whether or not everyone may look at all my information, or, whether no one can access my mental health records. Peel is a psychiatrist and became an advocate after having many patients pay for services in cash because they didn’t want their employers to know they were under psychiatric care. Peel also advocates a “break the glass” option should you end up in the ED. I understand that if patients must provide approval before anyone accesses their information (de-identified or not) then it complicates many things, but I can’t say I disagree that I should own my own medical information. I also agree with Matthew Holt and his suggestion that we should also be looking harder at banning discrimination based on health information—especially with regard to insurance coverage.

Speaking of privacy, I played with the new Google Health site and it seems quite friendly and easy to use. However, when you sign up you must agree to give Google “a license to use and distribute (your information) in connection with Google Health and other Google services.” The disclosure also reminds users that HIPAA rules don’t apply to them. I decided I need more warm fuzzies than that before sharing all my medical secrets.

I’ve been amused by how many readers have mentioned they share my shoe passion and have gotten some great tips for places to buy shoes! For example, Saturday morning I got this note from Marlo Thomas: “I thought about you on Friday afternoon. I was the new DSW at Cascade Station, down the street from the Portland airport. Other great DSW stores: San Fran, the store just off Union Square, and Cincinnati, the Rookwood location. Both these are multi-story facilities with ‘better than average’ brands and selection.” I must confess the e-mail sent me into deep shoe envy and I had to go to my nearby DSW to purchase this very sexy pair of black strappy sandals. I was going to take a picture of them to post but I decided Mr. H wouldn’t go for it since he is a sensible shoe kind of guy.

The Detroit News reports that Wayne State University Physician Group is cutting 80 clerical positions following its outsourcing agreement with athenahealth.

eClinicalworks announces a sale to Georgia’s second-largest GI group.

Collaborative Software Initiative (CSI) announces it has released the first open source, web-based infectious disease reporting and management system. The State of Utah Department of Health is piloting.

A federal appeals court upholds a previous ruling that a North Texas IPA engaged in unlawful price-fixing in its negotiations with various health insurers.

Compuware announces its Q4 and fiscal year earnings (ending March 31.) For the year, revenues were flat and income was down 15%. The better news was a 38% increase in software license revenues for Q4 and the overall better than projected Q4 numbers.

Tennessee Medicaid contracts with ACS for a five-year, $156 million deal to manage its data and ongoing systems operations.

Several people have indicated TEPR is on its last leg, but nonetheless, it has announced its 2008 Outstanding HealthIT solutions. Winners include CapMed (Best PHR), MediNotes Clinician Supply Chain Manager (Hot Products), and Doctations and eMedicalFiles (tie – EMR Systems Best Meeting Medicolegal Requirements). Does anyone select an EMR product because it best meets medicolegal requirements?

Valley Baptist Medical Center in Brownsville claims its cardiology and radiology departments are saving $28,000 a month since replacing film with digitized images on EMC systems.

UPMC CEO Jeffrey Romoff was paid $3.95 million in 2007, which is 20% higher than the year before. Not-for-profit UPMC actually paid 11 people more than $1 million last year. All I can say is that these numbers are staggering. Mothers, the time has passed for urging your daughter to find a nice doctor to marry – the real money is in administration.

On a not-totally-unrelated note, check out the results from Health Imaging’s 2008 HIT salary survey. Not surprisingly, CIOs earn the most ($180-200K) and system administrators the least ($40-50K). Interesting statistic: you could hire 100 system administrators or one Jeffrey Romoff for the same money!

E-mail Inga.

Monday Morning Update 5/19/08

From Save Us Blue: "Re: Emageon. Bloody proxy fight coming between EMAG and OPP in June." Link. Oliver Press Partners, which owns almost 17% of Emageon’s shares, files an SEC notice that it’s going after shareholder proxy votes to replace three directors whose terms are expiring, proposing its own people as replacements. Shares are 78% off their 52-week high and the market cap is $49 million.

From Tom Servo: "Re: MedcomSoft. The ambulatory EMR vendor’s Q3 results were ugly and contained this statement – ‘As at March 31, 2008, the Company had working capital of $257,613 and a shareholders’ equity of $517,976, which is not sufficient to sustain operations over the next 12 months.’ Its product is Best in KLAS 2007 for 1-5 physician groups." Link. I like the idea of an EMR built around Medcin coding, but maybe the company’s results indicate that it’s not a big hit in small practices (i.e., like pretty much all EMRs, it doesn’t increase your productivity or profit, so buyers aren’t lining up). It sounds like an excellent product, though, and its KLAS scores and client comments are outstanding. At the current Toronto Stock Exchange share price, you could buy the whole company for around $8 million, a fraction of what it would cost to build the product, so maybe someone will.

Listening: Black Rebel Motorcycle Club, garage rock from a band with the usual problems (addiction, creative differences, inconsistency). Reader-recommend, sounds pretty good. Trivia: the singer’s father was the leader of 80s rockers The Call.

Former McKesson CIO Cheryl Smith is now CEO of utility.net, a California startup that offers broadband access over power lines.

Misys qualifies for the Ohio State Medical Association’s Standards of Excellence program of user-friendly contract terms for purchasers of physician EMRs.

An analyst says that the Allscripts-Misys merger will provide an $850 million opportunity for Allscripts because of the 110,000 physicians who use Misys. That values each doc at around $7,000 to the new company. I don’t buy it. Same products, same companies that doctors already either want or don’t, plus customers of Misys have shown little propensity to want to buy anything else from the company. Both companies know how hard it is to sell EMRs, especially ones that aren’t cheap or easy to use.

Did I miss this when it was announced three weeks ago? Intel’s SOA Expressway for Healthcare is a "codeless" integration solution that allows data sharing across its network, like for RHIOs or hospital networks. Partners include Oracle and Red Hat.

Researchers develop a chip that will accurately diagnose a heart attack by having the patient spit into a tube.

Canadian EMR vendor Healthscreen Solutions gets $4.25 million in financing. From the CEO’s LinkedIn profile, he appears to be 27 or so.

MedAvant files an extension on its 10-Q, which isn’t usually a good sign.

Baxter, the company that supplies half the US supply of the vitally important blood thinner heparin, is rumored to be considering getting out of that business after taking a hit due to contaminated product from China and lawsuits like that of Dennis Quaid. Product shortages are now a concern, as are potential mistakes due to unfamiliar packages turned loose on nurses as hospitals scramble to find other sources. Somebody will probably sue Baxter for that too.

State auditors in Washington hire auditors to review the purchase of Empire Health Services by the for-profit Community Health Systems, Inc. Part of the concern is the value placed on Empire’s stake in Inland Northwest Health Services, which includes a $45 million EMR business called Information Management Resources. Empire pays $5.2 million a year for computer services from INHS, which is $3-5 million under market price, and CHSI would keep that discount based on the original valuation.

MediNotes will demonstrate its new inventory application at TEPR this week. I assume it’s a module for the recently acquired Bond Clinician EMR.

Talyst, which just got a new interim CEO and $20 million in investor money, confirms that it has cut 11 of its 154 positions after missing sales numbers. Sounds like the new investors are intent on getting their money back.

An unspecified clinical system finally goes live in Prince Edward Island, Canada hospitals at 140% over budget. I’m willing to take a fact-finding trip since I’ve always wanted to see Anne of Green Gables country and a friend who did said it was great. In summer, that is.

Virginia Commonwealth will use InnerWireless Horizon wireless technology and PatientKeeper physician applications in its new $192 million Critical Care Hospital (rendering below from VCUMC).

A Long Beach newspaper article covers Long Beach Memorial Medical Center’s $62 million EMR implementation. The vendor isn’t named, but I think it’s Epic.

NPfIT is running at least four years behind schedule, the National Audit Office says. iSoft’s Lorenzo (now owned by IBA Health)  is implied to be the main culprit. Total cost is now estimated at $25 billion US.

Humility of Mary Health Partners (OH) will be a test site for billing software developed by another Youngstown firm,  ERIS Medical Technologies. That company apparently is coy about who’s running it, given that the "Who We Are" page doesn’t, in fact, say who they are. You could check the News page, but there’s no news there.

Nuance announces a web-based BI tool called RadCube that uses natural language processing to parse dictation. 

I read every e-mail you send. I really do. If it’s gushy and suck-uppy, I respond in kind if I have time. If it’s nasty, I delete it. And if it’s juicy or opinionated, I used it right here on HIStalk.

E-mail me.

Art Vandelay on The Surprising State of Retail Clinics

For all the hype and attention around retail clinics, myself included, I find their slow uptake surprising. I believe this is due to five factors.

1. There has been little branding. With such a drastic change, consumers require education to know the what, who, where, why, and how much for the service.

2. The clinics are poorly placed, away from the pharmacy and the front of the store. They are competing for prime sales shelf real estate. The retailers know that products on prime shelves will sell, but clinics have no such guarantee. This is especially true of grocery store clinics, which are barely distinguishable from the optical store, "kidz" cuts, and bank storefronts that were already there.

3. The lemmings came out. Rather than look at the market drivers and develop a plan, the copycat competitors immediately made their decisions to get in the business. Not everyone needs to be a first mover, but the lack of original thought caused overbuilding and now closures, taking away money that could have been used for branding.

4. Clinics aren’t partnering with local health systems, which could offer low-cost brand association and visibility and possibly a staffing safety net. Referrals to a more capable health system would create at least the illusion of value and continuity of the care experience.

5. High-deductible health plans, which were supposed to drive retail clinic usage, have had minimal uptake, accounting for only 5% of health plan enrollment.

The PACS Designer’s Open Source Software Review

Xchart is a project created by the Open Healthcare Group to create an electronic medical record that is easier to use than paper. XChart can be viewed with a web browser and requires minimal training. It supports open standards.

XChart uses an XML repository because:

1. It is becoming ubiquitous and easy to use.
2. It is portable across operating systems and languages.
3. XML can be transformed via XSLT into many presentation formats, including HTML for rendering within browsers and WML for wireless devices. Using XML, a portable and ubiquitous information system can be created.

Xchart appears to have resources on the web that are quite detailed, so an experienced XML user should be employed to download and install the Xchart files. One puzzling aspect of this open software application is the absence of any history of bug fixes. The last activity anywhere to be found for Xchart was 2005. Also the "XML and Healthcare" link and some other links are not working on the site. If you plan on going forward with this application install, try to find a current user for hand-holding purposes.

TPD Usefulness Rating:  5.

Links:
http://www.openhealth.org/XChart/
http://www.openhealth.org/index.htm

News 5/16/08

From The Alchemist: "Re: innovative care models. A new RWJ grant-funded site focuses on them. I wish them success and hope to see more models. Innovative HIT models could quell my progressive cynicism." Link. Example: the "12-Bed Hospital," where a RN serves as "clinical CEO" in a hospital unit. Here’s a progressive IT model that I’ve thought about: what if the IT department was stripped down to just infrastructure and technical services, with everything else residing in and managed by user departments? Should IT really be its own department when just about every aspect of it, including all the benefit realization, requires committed user resources and strategic alignment?

From Dave Stallworth: "Re: your own fan club. I started an HIStalk Fan Club group in LinkedIn." I never thought I’d have a fan club. I can’t wait to tell Mrs. HIStalk (I’ll leave out the "one member so far" part to make sure she’s suitably impressed). Just so Inga doesn’t pout, she’s part of the package, I assume. Thanks for doing it. I assume anyone interested can find it (I’m a LinkedIn noob, so I have no idea). Should we send dues?

From Nasty Parts: "Re: GE. GE is enforcing non-compete agreements. Of course, most companies out there nowadays make you sign one, but rarely are they enforced. Apparently GE has started sending letters to former employees."

From Ann Farrell: "Re: Microsoft. I sent them this: ‘While I appreciate Microsoft’s desire to be a visionary in healthcare IT, it would be great if they’d touch base with the Planet Earth now and then. The need, value, and practical application for printer-generated medications is something I can only assume the techies at MS dreamed up and prioritized to hype in some ‘visioning’ session. If they’d just make their core OS (Vista) stable enough for patient care environment and solve real problems – some present for decades through many iterations of ‘new technology’ – then you’ll get our attention."    

From The PACS Designer: "Re: cloud computing. TPD was surprised to find that Amazon sells web services through its Elastic Compute Cloud (EC2).  Also was surprised to find Red Hat is one of its partners, especially after the HIStalk interview with Dave Nesvisky. Anyway, surfing over to the Red Hat site highlighted a posting about cloud computing. Since it also covers the basics, thought it would be useful reading for HIStalkers." Links:  Red Hat, Amazon.

Listening: The Kooks, Brit power pop.

Some folks from Cottage Hospital will present a free May 28 webinar on teleradiology in critical access hospitals. Click Virtual Radiologic’s sponsor ad to your left to sign up.

Former Eclipsys VP John Adams is named COO/EVP of a marketing company.

St. Barnabas (NY) goes with Eclipsys for ED, pharmacy, and KBA.

Proventys, which sells software that tailors chemotherapy doses using EMR information, raises $5.65 million in VC money, hires a CEO, and announces that McKesson will use its technologies.

McKesson CEO John Hammergren endorses a healthcare reform plan under the Healthcare Leadership Council banner. Who’s in that group: giant companies making big money off the GDP-sucking system we have now (drug companies, big hospital systems that don’t pay taxes, purchasing groups, and supply companies.) The "reform" seems mostly to get Uncle Sam to pay for more insurance to keep the gravy train rolling along. I assume (but don’t know for sure) that it’s the same group listed here as shuttling members of Congress all over the place for "fact-finding" and spending millions (warning: PDF) on lobbyists. Other startlingly fresh ideas from the group: everybody should buy more IT and the government should reduce manufacturer liability. HLC linked up with other organizations to form a "Confidentiality Coalition" that, despite the name, tried to weaken it by petitioning HHS to drop the accounting of disclosures provision of HIPAA, declaring it "extremely burdensome and costly" (apparently it’s too much trouble to track who’s snooping around medical records, even using that fancy technology that everybody needs more of to save healthcare).

Celebrity-fawning politicians call on Dennis Quaid to educate them about medication errors. More specifically, his interest in getting around federal restrictions on suing drug companies at the state level over FDA-approved products. He believes the heparin label his twins’ nurse didn’t bother to read wasn’t big enough, so Baxter needs to write him a check (not the nurse or hospital). Guess even his millions won’t win him an HLC invitation after that.

The big headline says nurses "acknowledge" fatigue leading to mistakes in a "new study," but it should have been past tense: the just-released study came from a survey of 2004 incidents. Does it really take four years to tabulate a survey and write it up?

Microsoft bought a hospital system from Thailand, so now they need engineers to work on it. Interesting comments about HealthVault: "… while attitudes to sharing information varied, although in the US he said he believed that Microsoft had overcome resistance to sharing health information. The real question was the business model, and who would pay for the service?"

Pharmacy automation vendor Talyst gets $20 million in financing commitments. The CEO just left, leading to speculation that his resignation was a condition of getting the money. Surely Cardinal Health would like to buy them at some point.

More complaints about the New Zealand surgery system that’s being reviewed after patient safety complaints. A sore point: IT people are running the system instead of real users. "She claims patients are now being prepped for the wrong procedures. One was allegedly told by IT staff without a doctor’s say so to stop taking medication. Another needing a knee operation was given a letter for a dental procedure." I’ve known plenty of nurses and other clinicians who’ve been out of patient care for 10 years or more who still insist on providing medical advice and services from the IT department, with varying levels of quality, so I’m not entirely shocked.

Two BIDMC doctors, a husband-and-wife, warn that EMRs often contain meaningless cut-and-pasted and templated text instead of anything insightful and focused, leading physicians to skimp on diagnosis and history-taking.

I keep hearing that TEPR is on its last legs, so maybe this is the confirmation. A vendor doctor will give five different presentations there. I noticed that HIMSS, too, loaded up its agenda with vendor people last time, often as co-presenters, but sometimes speaking alone (which was highly unusual a few years back). I’m sure they know their stuff, but I skip those sessions every time since I don’t want to spend the whole time watching for bias, avoidable or otherwise.

A West Virginia doctor who won several awards and started an EMR company gets canned from his job as medical director of a community health center.

A controversy in Saudi Arabia, as pictures of a hospital’s celebration are posted online that appear to show "gender mixing." An inquiry found that males and females were seated together in the same hall, which is illegal, but the hospital director was let off with a warning instead of being removed as had been threatened.

Jobs: Quality Assurance Engineer (GA), Wireless Networking Consultant (PA), Revenue Cycle Consultant (FL).

Odd lawsuit: a patient being treated in the ED after an on-the-job accident alerts doctors of his HIV status. He claims he overheard one of them tell his boss, which the doctor denied at first, but  later admitted, saying she mistook his boss for a neurologist. The man claims he was left with crippling anxiety, which got him fired after a seven-month work absence. He’s suing the hospital, but not the former employer.

Odder: a 25-year-old female student gets off with probation after nearly killing her boyfriend during drunken sex. He asked her to carve a heart-shaped symbol onto his chest since they were regular practitioners of "body modification," but she pushed the knife too deep, piercing his heart. He lived, leaving the happy couple free to reproduce.

E-mail me.

Inga’s Update

Cerner is one of 52 employers nationally to receive the Best Employers for Healthy Lifestyles award from the National Business Group on Health. With its on-site healthcare clinic, fitness center, and various wellness and conditioning programs, Cerner appears quite committed to promoting healthy lifestyles (no pizza jokes, please).

Another workplace focused on improving employee health is Opus Healthcare. I hear that 20-odd participants have collectively lost almost 800 pounds on a company-wide weight-loss initiative.

The 32-provider Clopton Clinic (AR) replaces a legacy EMR/PM for Allscripts’ products. Happy conversion!

Exempla Lutheran Medical Center and St. Joseph Hospital go live on Picis ED PulseCheck.

If you are interested in learning more about your prescription drugs, check out the latest service from HealthGrades. You can find out what meds are most prescribed within a particular class and what drugs are in and out of fashion. I actually was curious to check out my various psychotherapeutic drugs, but it looks like it is not quite operational.

Emageon loses $4.6 million ($0.21 a share) in the last quarter. This compares to a $1.8 million loss the same period last year. Revenue was also down almost 30% from the previous year. The CEO blames market conditions.

Grady Health System is installing MedAssets’ supply chain management solutions.

The San Antonio Metropolitan Health District is partnering with Vermedx for a diabetic intervention pilot program that will create a city-wide registry and map patient conditions. The project involves at least 50,000 diabetic patients

Using a computer can help drug abusers abstain longer, according to a Yale study. Those receiving computer-assisted cognitive behavioral therapy training plus traditional counseling had significantly fewer positive drug tests than those receiving counseling alone.

Eclipsys names John T. Casey and Craig Macnab to its board. Casey is chairman of Medcath and Macnab’s CEO for National Retail Properties and a former Per-Se board member.

HHS’ Office for Civil Rights has produced a pretty chart detailing enforcement results from April 14, 2003 through the end of 2007. Of the 32,594 complaints over the years, only two resulted in criminal convictions.

E-mail Inga.

CIO Unplugged – 5/15/08

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

Memorial Day. What is our Legacy?
By Ed Marx

As the son of a Holocaust survivor, I was raised under unique circumstances. A couple of years following my father’s escape from a concentration camp, the Red Cross reconnected him with family in the United States. Soon after his trans-Atlantic journey through New York harbor past Lady Liberty, he was drafted in the US Army and granted citizenship. Given his fluency in German and French, he was stationed in Germany where he met my mother. Mom had survived frequent bombings and lost her father on the Russian front. Although raising us predominantly as Germans, my parents instilled in me and my siblings a high value for freedom and democracy—the kind of blessed lifestyle men had sacrificed for before my time.

It was no surprise that many of us kids later joined the armed forces, in part to give back to the country that gave our family opportunity and hope since our arrival in the mid 70’s. I vividly recall the shock of my introduction to military life at age 17. Less than 24 hours following high school graduation, my long locks had been shaved, I was doing push-ups in Ft. Dix, and some guy in a funny hat was yelling at me.

I survived. And my love for country and my respect for those who had given their lives for the good of our nation had been richly deepened. In the subsequent 15 years of service as a Reservist, I never had the opportunity to lead troops into combat; something for which I am both thankful and disappointed. Those of you who have been there understand the sentiment.

In April 2007, I had the most unexpected honor. I was in Washington DC on business and spent some time sightseeing with fellow/former Army officers. One gentleman was the recently retired commanding officer of the Army battalion charged with guarding Arlington Cemetery, including the Tomb of the Unknown Soldier. He had prearranged for a couple of us to lay the flowered wreath at the Tomb during the evening changing of the guard. I still get the chills as I recollect that moment: escorted between sober, armed soldiers; laying a measly garland of flowers before a solemn tomb; silently saying “thank you” for the millionth time to men of sacrifice with no identity, lost but never forgotten. (I’m one of those citizens who still tears up at the sight of our flag and the anthem of our great country, so this was as good as it gets.)

The Memorial Day Service my family and I attended this weekend reminded me of the brevity and sanctity of life. Was not life meant to be lived with relevance and significance? Are we living in such a way that benefactors will take time to reflect on our contributions? For some that will mean laying down life in battle, defending our freedoms. For others, service and sacrifice will have a different flavor. Whatever we are called to do, let us impact people positively and serve the forthcoming generations.

I later began to personalize these thoughts in terms of my career. Will fellow employees, customers, and patients remember Edward Marx, 5, 10, or even 50 years from now? Not necessarily the name, but what about the long-term impact? Oh, may it be! Let my employer be a better place for teaching, healing, and discovering as a result of my leadership. Let the decisions I preside over have lasting beneficial effect. May I treat others in such a way that their children and their children’s children will benefit. May I always keep the long-term in mind to avoid compromise or complacency. Let me leave my employer a better place than when I arrived. Yes, my time here will have mattered!

If no one remembered my name, would they place a metaphoric wreath at my tomb in honor of the legacy I left behind?

What about you? What will your legacy be?

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

McKesson Acquires Vivalog LLC

McKesson announced this afternoon that it has acquired Vivalog Technologies, a Seattle-based provider of Web-based knowledge management applications for imaging that includes the MyPACS.net reference site for case sharing. That site is visited by 70,000 imaging professionals monthly, according to the announcement.

From the press release: "With the addition of these solutions, McKesson’s information technology-based enterprise imaging offering continues to lead the industry in enabling healthcare facilities to provide better, safer care. McKesson’s enterprise imaging solutions offer unprecedented data sharing, connecting the entire care team and speeding the diagnostic process – from ordering a procedure to distributing reports and diagnoses. McKesson intends to continue to leverage the excellent standards-based connectivity of the Vivalog product set in order to allow the widest possible benefit to healthcare institutions."

News 5/14/08

From IsItTrue: "Re: Hersher. It appears Betsy Hersher is selling off to Furst Group. A look at the Hersher website shows very few searches and virtually no staff." I e-mailed for confirmation, but got no reply. You are right – they have only four IT executive position listings and the home page says, "We are actively moving into career coaching and organizational coaching and consulting."

From Mick Ronson: "Re: QuadraMed. Look out for news from one of their biggest clients that will affect the future of QCPR."

From Doc Image: "Re: 1500s. To help Samantha Sang brainstorm ways to fax 1500s, I would suggest looking at fax server software. I work for a document imaging company, and while I have
never seen an organization go from EMR to fax server, I know many of our customers will configure a third party fax server as a printer, and then ‘print’ documents stored by our software to fax. I would assume that you could do the same with an EMR or billing system, but you know what they say about assumptions …"

From Deloitte’s Tush: "Re: CCS Summit. I saw a story about a panel on secondary use (or ‘reuse’) of healthcare information from this conference. Reading the agenda, it looks like a good one. I was wondering if the HISTalk community has any experience with / reviews of it?" Link. Sometime I’ve got to get out of my routine and actually attend conferences, although it’s tough to get time off from work. I only go to HIMSS, so I miss stuff (including some cool blogging opportunities).

From Alyssa: "Re: your marital status. It doesn’t bother me – let’s get together." Thanks for the thought and the pic (nice), but I’m pretty sure Mrs. HIStalk wouldn’t be up for it.

From Cesar Geronimo: "Re: Labcorp. They are likely to buy the outreach labs from Stanford and Carilion."

From Hannah: "Re: TeraMedica. I’m new to the site from Australia and looking for assistance. Anyone used Evercore?"

For those who left pithy comments on their LinkedIn contact requests, I just now realized that I could have replied (I should have read the manual). No slight intended. Anyway, here’s a fun one left just now: "I’ve begun to read HIStalk religiously (or at least a couple times a week) since I figured out that you guys knew things I didn’t know about the company I work for, weeks before I knew it. The wisdom of the crowds indeed. Me love you long time."

Misys shares continue to rise on more speculation that competitors (banking software, not healthcare, of course) will make a play for them. The company seems anxious to get its Allscripts merger done, but an acquisition or even the possibility of one could complicate it. If Misys were to be acquired, you would have to expect the healthcare division (merged or not) to go on the block since it’s not their core business (for Misys either, but that’s another story).

Listening: The Last Shadow Puppets, new, 60’s-sounding Brit pop, like Gerry and the Pacemakers with an orchestra. Cheery. Like it lots.

Philips keeps finding monitoring companies to buy, this time one in Brazil. Philips announces it will acquire Dixtal Biomedica e Tecnologia, which makes hospital monitoring equipment.

Healthcare IT Transition Group releases a report about implementation of the National Provider Identifier. Marty summarizes: "Things look bad, of course, as they always do for nationwide HIT implementation. But this time we’ve got worse news — adding more time to the project is probably the worst thing we could do (though it is the most predictable course of action by CMS)." He’s offering a BOSO – buy one and they’ll send one free to a trading partner of your choice.

Eclipsys opens an office in Pune, India, its second in that country.

Jobs: Revenue Cycle Consultant (FL), Eclipsys Clinical Consultants (national), Technical Healthcare Consultant (CO).

OSF Homecare (IL) buys McKesson Horizon Homecare.

HP will acquire Electronic Data Systems (started by Ross Perot in 1962) for $13.2 billion in cash, apparently fulfilling a desire to get into the data center and custom software development business as an IBM competitor. Bad news if you work for EDS since HP says it will lay off bunches of people to try to make the deal work, adding on to the 15,000 HP already ditched since HP’s CEO came on board to replace Carly Fiorina in 2005.

Unions and other groups rally against New Jersey’s proposed healthcare program cuts. Everybody’s concerned (mostly about their own self-interest) but nobody seems to want to pay in the form of personally lower wages or higher taxes. In other words, they’re in favor of somebody else picking up the tab, which describes healthcare in a nutshell.

A New Zealand hospital will be investigated after the head of anesthesia complains its new surgery system is unsafe.

A Microsoft guy says printers could be like mini-pharmacies, mixing custom drugs from their cartridges.

Unrelated: is there a razor blade cartel? A pack of razor blades costs more than an MP3 player, is now stored under lock and key in the grocery store, and the last ones I got were in one of those plastic clamshells that require scissors to crack into. Surely they cost a tiny fraction of their price to manufacture, so why doesn’t someone undercut? I’m thinking about finding an overseas supplier and selling them over the web.

A Libertarian group doesn’t think much of Hillary Clinton and EMRs, apparently: "Clinton plans to pay for the remaining $50 billion by eliminating waste and inefficiency. Her ideas include all the latest fads–electronic medical records systems (designed in Washington, DC of course), pay-for-performance (bureaucrats telling doctors how to practice medicine), and evidence-based medicine (more bureaucrats telling doctors how to practice medicine). Have ideas like these saved money anywhere before? Not that anyone can verify."

A Med Flight helicopter crash kills a surgeon, nurse, and pilot from the University of Wisconsin Hospital. The 37-year-old doctor leaves his ED physician wife and toddlers aged 3 and 5. Sad.

Emageon’s Q1 numbers: revenue down 30%, EPS -$0.21 vs. -$0.09. Imaging business is sucko, obviously.

Stuff you can do here: use the Google box to your right to search through HIStalk going back to 2003 (has it been that long?) Drop your name in either or both signup boxes for e-mail updates or the Brev+IT newsletter. You can send me new or rumors anonymously, of course. Make some sponsors happy and click the ads to your left to see what cool stuff they’re doing. And lastly, pat yourself on the back for reading HIStalk – Inga and I appreciate it a lot. We love you long time.

E-mail me.

Inga’s Update

When Mr. H indicated that he and I needed additional LinkedIn contacts for self-validation, what he really meant was he was tired of always having to come up with creative ways to praise me since I am so neurotic and insecure. So, he figured that if I had more contacts, I would feel more loved. Well, let me tell you, the love is now flowing! I’m not sure how many new contacts I’ve gotten in the last week, but it seems like perhaps 30. I am now connected to 70 people!! I was feeling pretty heady and perhaps even validated until I happened to notice that Mr. H now has 87 connections. Fortunately LinkedIn has this cool feature that lets you see what connections another person has that you don’t so, at least I now know who is snubbing me. (Big sigh … life as the undercard).

Sage Healthcare is a new reseller of the NCR MediKiosk product. The MediKiosk and Intergy EHR will be integrated later this year to allow patients to complete their own office visit check-ins and demographic updates, as well as electronically sign consent forms.

Tawam Hospital in UAE has successfully implemented multiple Cerner Millennium solutions, with more hospitals and clinics to follow over the next year.

The Wisconsin Pharmacy Quality Collaborative launches its Pharmacy Quality Collaborative and is using McKesson’s newly developed Medication Therapy Management (MTM) software to connect pharmacies, physicians, and payors.

CHIME names Sharon F. Canner as director of advocacy programs to lead CHIME’s government affairs activities. She comes from HIMSS, where she was director for corporate relations and the EHR Vendors Association. I noticed in a certain publication that she “declined to provide her age.” I personally wouldn’t have considered her age if I hadn’t read that, but now I am left wondering if she is really, really young or really, really old. Would a man ever decline to give his age?

The Chicago Tribune runs an interesting article that looks at the struggles of for-profit hospitals in the Chicago market in light of the recent announcement that MSMC Investors and Transition Healthcare are planning to purchase St. Francis Hospital.

CDW Healthcare announces it is collaborating with Beth Israel Deaconess Medical to provide more than 300 affiliated physician practices access to the hospital’s EHR/PM software.

Memorial Hermann Healthcare System is partnering with AirStrip Technologies to provide OBs with real-time waveform data from L&Ds onto PDAs and Smartphones. I am all for technology, but if I were in labor I am pretty sure I would just as soon have a nurse call the doctor to say, “Get over here now!”

Completed: the first data exchange between LSU Health Science Center and Delhi Hospital. Using Dairyland Healthcare technology, the exchange is a milestone in a state-wide Louisiana Rural Hospital Coalition project to provide EHR and telemedicine services to rural communities.

Dr. Deb Peel dropped us a note saying that 25 members of the Coalition for Patient Privacy are urging Congress not to pass e-Rx unless the data mining and sale of Americans’ prescriptions to insurers and employers is stopped. “Prescriptions should be used for the single purpose of obtaining medicines — nothing else without informed consent.” Dr. Peel indicates the current legislation is hidden into another “must-pass” bill. She’s supposed to be on Dan Rather’s show tonight.

Ardent Health Services selects Surgical Information Systems’ perioperative system for its 10 hospitals across New Mexico and Oklahoma.

IPA Monarch Healthcare in California chooses NextGen’s PM/EMR suite for its 2,200 independent physicians across Orange County.

The LA Times reports that 14 more UCLA Medical Center staffers have been implicated for snooping, including four physicians. I wonder if the physicians will get any more than a hand slap this time.

Finally, I was very distressed to read that, in addition to having to pay ever-increasing amounts to fill up my car, the price of shoes is anticipated to rise 10-15% over the next year. What’s next – chocolate?

E-mail Inga.

Monday Morning Update 5/12/08

From Irwin M. Fletcher: "Re: degrees. Inga hit the nail on the head: if you could get HONEST responses from people, those with advanced degrees would say it was required (self-validating) and those without degrees would say the school of hard knocks is the best alma mater. An advanced degree isn’t as much about what you learn, but the personal and/or professional commitment you are demonstrating."

From Befuddled: "Re: Secretary Leavitt. Interesting that he is finally getting it and  looking beyond EMR industry rhetoric. ‘I think it’s important to remember that the goal here isn’t [EHRs]. The goal is to transform the sector of health care into a system of health care, a system that provides consumers with information about the quality and cost of their care." Link. I take it as more of an endorsement of EMRs, but as a tool toward an end that doesn’t stop with checking off the "we’ve implemented one" box. His closing comment says so: "Health information technology is an enabler of better quality, lower costs, fewer mistakes and more convenience … The goal is the value that the records produce, not just the existence of the records."

From Concerned Customer: "Re: Merge Healthcare. Any news or rumors as to what will happen? They are our PACS vendor and things are not looking too rosy." The company’s market cap is less than $12 million, its auditors expressed doubt last month that it can continue without a cash influx, the low share price triggered a Nasdaq de-listing notice, and management has said they will consider "all strategic options" as they try to stop the bleeding with layoffs. A new report says that cash is down to $8.5 million on March 31 and the company has no credit to finance what it said was its only hope, a new teleradiology business. Also in Friday’s report is a statement that the company may be forced into bankruptcy on June 30 (headlines like those don’t exactly enthuse prospects). Shares dropped another 10% to $0.35 Friday. I would expect you’ll see worse support and development because of the job cuts, which nearly always drive off the best workers who have other options. Then, it’s wait and see as to whether they’ll limp into bankruptcy (which could last years), sell out to another vendor or to private equity, or start a long recovery. I’d like to say something reassuring, but these particular tea leaves are ugly. If you’re already a customer, though, I’d sit tight since you don’t have a lot of options anyway.

From Luvvin It: "Re: maybe it won’t be Allscripts-Misys. From the Telegraph: Software group Misys firmed 9¼ to 174¼p amid rumours of a possible bid in the range of 210p-220p per share."

From Samantha Sang: "Re: 1500s. Has anyone heard of  any medical billing services or EMR/billing software able to fax all of the their 1500s? Seems like a cool and obvious idea, but I’d never thought of it until recently."

From Blogreader: "Re: advance degree. See this post." Link. Scot Silverstein doesn’t usually have good things to say about CIOs and IT departments, so if you don’t want to start your Monday morning sputtering and flinging your coffee at your monitor, don’t click the link. He often makes harsh observations from the context of "the IT people didn’t hire me, so they must be insular fools who hate doctors" angle, but he does make an occasional point.

I knew I was about to be embarrassed when the e-mail subject read, "A bit late, but thanks – Steph from Johns Hopkins." I had made a silly comment the other day about her HISsies CIO of the Year win awhile back, joking about not hearing from her (and having no reason to expect to since readers voted her in). She reads HIStalk, as I now know. Doh! She sent a gracious, fun, and appreciative e-mail that made me feel like a real doofus for shooting off my mouth. She says HIStalk is "superb," which makes me regret some of my more sophomoric writings (or maybe she was referring to those?) Anyway, my new BFF (as Inga says) Steph was ultra-cool about it, even signing off with "Listening: Memory Almost Full, Paul McCartney." She gave me a Listening! It made my day.

Speaking of HISsies winners, the 2006 Industry Figure of the Year writes about the 2007 winner: Justen Deal comments on athenahealth.

Idiotic lawsuit: a man drives his car through a chain link fence and into a river, trapping his 75-year-old mother-in-law underwater for 30 minutes before police and firefighters can get her out. The town honors her rescuers as heroes in a formal awards ceremony, but the woman and her family sue the town, a selectman, her rescuers, the police chief, an architect, an engineer, and her son-in-law, complaining that the area needed concrete barriers and the city should have had its own team of divers so she could have been rescued more quickly. She was quoted as saying family members commonly sue each other after accidents to collect insurance. She just settled for $870,000.

EHR Scope’s spring issue is now available, with articles on security, evidence-based medicine, and the usual comprehensive list of EMRs.

Inga and I have approved a bunch of LinkedIn requests, which we find fun (it’s like counting how many yearbook signatures you got compared to everybody else, although I suppose today’s high schoolers probably just text each other instead of actually placing pen to paper). One request had this comment, which says it all for me: "I totally dig your blog! I give it to my staff as assigned reading. Please connect with me so we can both pretend Linked In is meaningful in some way:)" I’m admiring my 72 high-powered connections and feeling pretty full of myself right about now.

Maryland’s Health Care Commission endorses two health information exchange proposals, one of them from Erickson Retirement Communities and Baltimore’s three largest hospital systems that would involve Microsoft, GE Healthcare, and HealthUnity.

The Tampa paper runs an article on the use of PatientKeeper’s Mobile Clinical Results on smartphones at Oak Hill Hospital via the company’s deal with HCA.

The mesmeric Gwen at HealthcareITJobs gets a lot of e-mail questions, one of which she told me about: "Is Mr. HIStalk happily married?" I was preening like a peacock for about ten seconds as I pictured a longing female aroused by my manly journalistic bicep-flexing. Re-reading, however,  led me to a more likely interpretation: can that jackass’s wife really have tolerated him for all those years? I know — amazing, right? I’m shocked every morning when I reach over to Mrs. HIStalk’s side of the bed and find her instead of a note.

QuadraMed’s Q1 numbers: revenue up 21%, EPS -$0.02 vs. $0.03. I didn’t hear the conference call, but the message boards are reporting that QCPR is the focus and they’ll be selling off their pharmacy system (the old PharmPro, if I recall, which earned a mystifying #1 in KLAS at one point despite being one of the more primitive ones I’ve seen). They’re planning a reverse stock split.

The Irish Blood Transfusion service is ripped by auditors for buying the Progresa system that ran four years late and over budget before it was abandoned.

Friday wasn’t a good day for Central DuPage Hospital (IL). Backhoe operators took out an underground power line, leaving the hospital on generator for four hours. During that time, an electrical surge caused a computer monitor in an hospital office building to overheat, leading to an evacuation.

A reader suggested running a survey to see which hospitals have folks reading HIStalk. Those listed on the responses are here. What an impressive group you are!

E-mail me.

Art Vandelay on TCO (Total Cost of Onerous-Ship)

Kaiser’s announcement about its annual maintenance costs is déjà vu. I often feel it is the "total cost of onerous-ship" in my organization. Kaiser’s maintenance for HealthConnect is right in the middle of the range we see for TCO, which ranges from 20 to 36% of the cost of installation. (Before you fall off your chairs, I am very detailed in the costs I include, right down to power and cooling, percentage of time operations staff spend on monitoring, usage of tapes, and partial FTEs of support staff).

The wide variation in our TCO is driven mostly by the maintenance contract we negotiate with the vendor. The next largest driver is the human resources we need to maintain the application and supporting hardware. For example, clustered databases, redundant servers, and those with bi-directional interfaces typically require the most support. The rest of the costs are relatively minimal.

Two observations. Kaiser’s costs are not out of range by my calculation, but I would have expected more efficiency from their scale. Maybe their geographic distribution eats into their efficiencies. I would bet they will begin to look at more offshore support if their financial prospects don’t improve. They will likely also be eagerly awaiting Epic’s web browser client transition. That would hopefully move them away from one of the world’s largest Citrix farms.

Second, if users are looking for a real return on investment, the TCO can be a large hurdle to jump. In Kaiser’s case, the investment in the system has to cover the 25% maintenance (forever) and then be large enough to pay back a $4B investment in a reasonable amount of time. That can be a daunting proposition. By my calculations, a 50% annual ROI would break-even in 10 years when considering depreciation in the mix. A 50% annual ROI without depreciation would break-even in 7 years.

The PACS Designer’s Open Source Software Review

FileZilla is file transfer software for those who do frequent transfers. It uses File Transfer Protocol (FTP), which can be slow for large files over 10GB, so if you are transferring large files frequently, you would be better off with a Network File System software package. Setup can be tricky depending on your particular system’s configuration. Support from users appears to be good and recent posts of problems have been answered rather quickly. FileZilla is a software platform in the SourceForge.net community.

Features of FileZilla include:

Ease of use
Supports FTP, FTP over SSL/TLS (FTPS), and SSH File Transfer Protocol (SFTP)
Cross-platform. Runs on Windows, Linux, *BSD, OSX and more
Available in many languages
Supports resume and transfer of large files >4GB
Powerful Site Manager and transfer queue
Drag & drop support
Configurable Speed limits
Filename filters
Network configuration wizard
Remote file editing
Keep-alive
FTP-Proxy support

File sharing is becoming more popular in recent years, so saving time is important. It would be best to try FileZilla with a select number of users before deployment to a larger group.

TPD Usefulness Rating:  7.

http://wiki.filezilla-project.org/Main_Page
http://sourceforge.net/projects/filezilla

News 5/9/08

From Beantown Johnny: "Re: Nuance. Any truth to the rumor that there’s been a sales shake-up?" Not that I’ve heard, but I’m not well connected there. I always figure it’s safe to speculate on a sales shake-up since just about every vendor tinkers with that function now and then. That’s part of being in business and of being in sales. Life goes on.

From The PACS Designer: "Re: Oracle’s new offering. Oracle has released a large number of SOA solutions recently and now just announced another called Oracle Data Integration Suite. It offers a open, standards-based integration platform that connects heterogeneous data sources and applications." Link. TPD sure likes that Oracle stuff even though he’s an open source guy.

From Dr. CIO: "Re: advance degree. I don’t know why you are so hung up about advanced degrees. Personally, I would rather hire based upon experience and emotional intelligence rather than sheepskin. Example of no degree (undergrad) superstars: Gates, Ellison, Dell, Jobs … I rest my case." Well, that case you rested wasn’t made too well — nobody hired any of the folks you listed. We’d all agree that it makes little difference for entrepreneurs who start a company, but we might disagree on mid-level executives. Wanna bet that Microsoft, Oracle, etc. require advanced degrees for some jobs, rightly or wrongly, even though those founders don’t have them? And if your boss has one and you want to move up someday — think about it. I’m the poster child for educated but unmotivated, by the way, so I hear you. It shouldn’t matter, but then again, neither should good looks or connections.

From Brian Boyfanno: "Re: HIMSS. Can I sign up for your 2009 event now?" Jeez, didn’t we just have that? Nothing’s decided yet since it takes a sponsor, location, and all kinds of stuff. If there is an event, I’ll move you to the head of the line. I’m happy it’s already on your mind, though.

Johns Hopkins CIO Stephanie Reel is named as one of Maryland’s Top 100 women. I’m sure that’s a trivial honor compared to winning her HISsies CIO of the Year award a few years back. I expect she’ll e-mail her appreciation for that nearly any day now.

Listening: Awesome Color, Stooges-type (Iggy, not Three) psychedelic rock.

Did I maybe just forget that HIMSS has a CIO? Says it does here. I don’t know a lot of their folks.

Speaking of HIMSS, when did they get into the hard-selling, vendor-specific Webinar business? This one’s about PC FTP software, which seems like an odd thing for HIMSS to shill. Personally, I use FileZilla, which is free and works fine (my shillin’ is free).

I wasn’t interested enough to type the long organization names, but some group names a McKesson guy and a Wal-Mart guy as co-chairs of another big-named group. The press release is like a densely constructed stone wall that defies ocular penetration, but it’s got something to do with HIEs.

If you’re a LinkedIn user desperate for contacts, Inga and I approve all requests because we’re desperate for approval, too. Search on HIStalk and up we’ll come.

If you aren’t getting e-mail updates when I write something new, just plop your name and e-mail address in the Subscribe to Updates box to your right. You’ll impress your colleagues with your mastery of current HIT events.

Memorial Hermann will use OB waveform monitoring software AirStrip OB.

McKesson donates PracticePartner to Father Joe’s Villages, a non-profit supporting the homeless.

I’m really excited that just about all the healthcare IT vendors are turning in good numbers. It’s a tough market and apt to get tougher, but they’re looking good for now.

Former QuadraMed HR VP Donna Klein takes the same role at biologics company BioReliance.

Jobs: Technical Support Analyst (CA), Clinical Informatics and Physician Liaison (OK), Project Manager – Healthcare (GA). Weekly job alert signup.

IBM and Siemens will help hospitals reduce energy consumption, but only if they use MedSeries4, which should narrow the list down quite a bit.

I know it’s nerd heresy, but Microsoft and Yahoo don’t interest me much, individually or collectively. I’ve never used the search engine of either one, haven’t bought anything from either company in years (except for my $20 upgraded Yahoo e-mail account), and I could name a ton of much more interesting companies than those two wrinkling dowagers and their desperate, fumbling attempts to mate. At least that never-ending story is an alternative to the daily "gas hits a new high" headline.

Donal Quinn is named head of the diagnostics division of Siemens.

A UC Berkeley engineer moves most of the technology of medical imaging into a central server, allowing creation of a cheap, portable scanner that plugs into a cell phone. The scanner will be $1,000 and the whole setup around $70,000, making it viable in poor countries and rural areas.

The secret to running a health information exchange, according to two executive directors, is hitting up the state for money. The one from Maine says they’ll never be self-sustaining.

Bizarre lawsuit: a nurse brought in to fix Howard University Hospital’s ED after a reporter’s death there led to charges of mismanagement is suing the hospital for $4 million, claiming sexual harassment. She says the new doctor in charge of the ED referred to himself as "a pimp" and used unspecified derogatory terms for the ED nurses (that doesn’t take much imagination to figure out). She says he sent her flowers for a job well done, but signed the card BD, short for "Big Daddy," the name he insisted on being called by nurses.

And another: a patient hospitalized after her fourth suicide attempt is suing Medical Mercy Center-Clinton (IA) for worsening her depression. A nurse helping her to the bathroom allegedly told her, "You need to use a more lethal method. I’m sorry, I just hate it when people are a drain on society." The nurse apologized by letter, throwing water on the theory that doing so stops lawsuits.

E-mail me.

Inga’s Update

From Sparky: "Re: ASU WOW-mobile. It was wonderful to see my alma mater mentioned on HIStalk! I’ll take the opportunity to plug the ASU School of Computing and Informatics, which matriculated its first class of graduate students in biomedical informatics this past fall. The new program has recruited world-class faculty and is affiliated with the recently-opened Phoenix campus of the University of Arizona College of Medicine, the Translational Genomics Research Institute (TGen), and the Mayo Clinic in Scottsdale. Look for great research and great people coming out of this program in the near future.”

CSC opens First Consulting Group Viet Nam.

Sage Software’s profits beat analysts’ forecasts, up 9%, which matches its revenue increase. The company points out that the healthcare division that didn’t perform too well: revenues were down 11%, gross profit down 8%, and EBITA down 46%. Management says the numbers disguise a lot of the behind-the-scenes actions to turn things around. They have lots of physician users because of acquisitions, so it’s a big footprint.

Stratus Technologies names JJWild  its Partner of the Year for the Americas sales region. JJWild has quadrupled their sales of Stratus’ ftServers to Meditech clients over the last year.

I voted for Mr. H as one of the “100 Most Powerful” in healthcare and hope you take a second to do so as well. He works hard and all he asks in return is that you read his blog. It would amuse him to potentially upset Modern Healthcare’s apple cart with a nomination.

HHS hands out an additional $600,000 to six new participants in the trial NHIN implementations. The new folks all represent good-size communities and include the Cleveland Clinic, Kaiser, HealthLink, Health RHIO, and Health LINC, and Community Health Information Collaborative

Picis announces the European launch of its Total Perioperative Automation solutions The Institut Mutualiste Montsouris has been working with Picis to customize the software for the French market.

I’m guessing that all those passionate Mac users out there will be happy to hear this news. EMR vendor Spring Medical Systems announces a new HL7 compliant interface with MacPractice MD PM’s system.

After reading about all the swanky new amenities at Henry Ford’s new West Bloomfield hospital, I am trying to narrow down what body-enhancing procedure I might have so that I can score a couple of nights’ stay. New rooms will have flat screen TVs, refrigerators, laptop computer tables, security safes, and a feng shui design to make patients feel connected to nature. Oh, and high-quality dining options, including 24-hour room service! Beats the Hampton Inn, for sure!

Eclipsys beat Wall Street’s expectation despite a Q1 net income that fell from a year ago. Due to some extraordinary costs, income was only $.01 a share versus $.04 last year. However, revenue was up 10%, and non-GAAP net income grew 25%.

There is a survey on the right asking if it is important that a hospital CIO have a Master’s degree in some field of study. I think we should have also asked if the responder had a Master’s – it would be interesting to see how that affected votes. I don’t know about CIOs in particular, but generally I believe having an advanced degree can’t hurt you. I think it can open doors (rightly or wrongly) and can be an indication of tenacity and ambition. It’s not a guarantee that a person is smarter or works harder than the next person, but if all other things are equal it, can’t hurt you. (And yes, I have an advanced degree and the greatest job ever… so there you go!)

E-mail Inga.

Getting Spanked by Car Maker CEOs: Even Detroit Thinks Healthcare’s Innovation and Productivity are Bad

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

Big-company CEOs have healthcare on their mind. I know that because they keep insulting us in the national media. We’re too expensive and we underutilize technology, they’re telling the world. It’s our fault that jobs are moving offshore, not their own corporate greed or inefficiency.

My first reaction: who do they think they are? We’re getting lectures on innovation, productivity, and cost control from GM? If I wanted that kind of advice, I’d go to Toyota.

Unfortunately, they’re right. The healthcare price increase merry-go-round has to stop eventually. Most of the job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with their healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching the show from China or India by then.

Businesses want to force computers on us, dragging us kicking and screaming out of the dark ages. Unfortunately, software doesn’t automatically bring increased productivity and lower cost. If it did, all of those hospital dollars spent on Microsoft Office and Windows would have made us stunningly more effective instead of just giving employees something to screw around with as a pleasant productivity alternative.

I’d like to think that computerization can really reduce costs, but I haven’t seen it happen anywhere yet. I keep hearing about all of those showcase sites buying the latest and greatest, but the correlation to bottom line and quality outcomes is murky at best. Where’s the average 100-300 bed hospital that has seen its overall costs drop 30% because of software? You’d know them because every other hospital in town would be out of business.

Hospitals can cut expenses in three ways, all of them at their local level. They can manage labor, which is by far their largest expense. They can go after the utilization and cost of drugs and supplies. They can control physician practice variation. I’m glad I said “can” instead of “do” because, for various reasons, these things don’t happen. Software can’t fix them because they’re management problems, although given desperate enough circumstances, they could be fixed.

I’m glad much of our recent IT investment relates to patient safety and outcomes. I hope electronic medical records really do become a standard, with all the information sharing that the RHIO people keep yapping about. But when it comes to drastic cost reductions driven solely by buying and implementing software, I’d say that’s wishful thinking. There’s a lot of work to be done fixing the system and its underlying misaligned incentives before we even try to automate it. No business became a world-beater just by installing SAP, even if they were lucky enough to not be one of those that went bankrupt trying.

I do see a ray of hope in being called out by big-company CEOs. As hard as it is to have change forced on you, I think that time is here. I work in a hospital, but I’m also the occasional patient and medical bill-payer. When wearing those hats, I’m just as mad and frustrated with the system as those CEOs and I bet you are, too. Healthcare is too expensive, too bureaucratic, and too unimpressive in benefits delivered. As a software guy, I’m pretty sure that fix will take more than just people like me.

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

News 5/7/08

From Devin Valencia: "Re: athenahealth. Not only did athena blow out numbers, they announced on the call they signed a national account with CVS/MinuteClinic." Q1: revenue up 36%, EPS $0.05 vs. -$0.55. 

From Katrina Leskanich: "Re: TEPR. TEPR sent out an e-mail recently offering 2-for-1 registration and a free registration to anyone who previously purchased a ticket. Is there any question that they are having trouble drawing crowds? Attendance has been down for several years running and they look to be on their last legs."

From Moondogg: "Re: HIStech Report. It seems to be paid advertising." You’re partially correct. Vendors pay us to develop and conduct an interview with an executive about a specific product. I put it over there to make that clear. Still, we ask whatever we want and we conduct them just like our normal interviews, so vendors aren’t supplying the content. I think the result is a good read.

From Destiny St. Claire: "Re: Sage. I hear former Misys VP Jim Skladany is joining Sage as new West Coast VP of Sales."

From Visitor 211: "Re: layout. I noticed the banner ads go far down the page, beyond the article." We’re doing a little bit of redesign to improve the layout, so stay tuned. It’s definitely a (good) problem to have that many sponsors.

From Bradley Beeswax: "Re: Fletcher Allen. They’ve picked their man to run their $57 million Epic implementation." Link. Chuck Podesta, from Caritas Christi, is named CIO of Fletcher Allen Health Care (VT). He doesn’t have an advanced degree, I noticed, since that’s the hot topic here (and the subject of a new poll to your right).

My opinion: CIOs should have advanced degrees, not because the coursework will be used every day, but because it’s so easy to earn accredited MBAs and other degrees nontraditionally and inexpensively that I’m suspicious why a highly paid senior executive can’t be bothered to do it. A bachelor’s degree is like a high school diploma was 20 years ago and MBA studies have real-world relevance. Education is a standard bio entry and thus it drives first impressions. Heck, half the IT worker bees have advanced degrees these days. Still, I know exactly who’ll say what: CIOs without advanced degrees will say that nobody remembers their courses anyway, that hard knocks is the best teacher, and that they’re a shining example of why a bachelor’s degree is OK. Those with the degree will tell you how useful it is, why there’s no excuse not to get one, and how few hospital people make VP without a Master’s. Both will provide examples of great people without degrees and bad ones who have them. And in every case, whatever credential that person holds is exactly the minimum they would recommend for the job.

In Australia, Victoria’s Department of Human Services gets a bailout of $100 million US for its HealthSmart project, which is two years behind schedule and way over budget. Much of the core technology is Cerner Millennium, not that there’s anything wrong with that.

Jobs: HIT – Senior Internal Consultant (TN), Application Analyst II (VA), Soarian Clinicals Consultant.

Kaiser says its HealthConnect outpatient rollout is finished, with all 8.7 million enrollees having access, but inpatient is installed in only 13 of 36 hospitals. They admit to its $4 billion cost, which I believe was angrily denied when that number was first estimated by outsiders. Maintenance is $1 billion (!!). The hospitals and health plan announce a 64% net income drop in Q1 because of investment losses. Still, a $250 million quarterly profit for a "non-profit" in one quarter isn’t too shabby (imagine if they weren’t spending $1 billion on HealthConnect maintenance).

TriZetto’s CFO Bob Barbieri quits for "personal reasons" (probably because Apax had another "person" in mind to take his chair). I’ve never seen the "personal reasons" excuse laid on so strong as to put it in a press release headline, so naturally I’m skeptical. Maybe publicly traded company bean counters are too conservative for privately held companies.

McKesson’s Q4 numbers: revenue up 9%, EPS $1.05 vs. $0.85, beating expectations of $1.00. Technology revenue was up 19% to $806 million. Shares were up nearly 8% today. Nice.

A hospital information system company in India wins an IBM public sector award.

Say, wouldn’t it be a hoot if some anonymous blowhard was named one of the 100 Most Powerful People in Healthcare? You can nominate me here (by Friday). I’m sure the magazine people will squelch it, but what the heck. I’ll even helpfully show you what to fill in so the votes can be tabulated before being discarded scornfully – click the pic. I’m thinking I shouldn’t reserve the tux quite yet.

CMS is piloting PHRs in South Carolina.

Mobile systems vendor InfoLogix acquires Delta Health Systems, a cost containment consultant with an executive information system.

Strange: a woman Twitters her labor status in real time from a hospital.

E-mail me.

Inga’s Update

Members of the Connecticut State Medical Society can now receive discounted pricing for athenahealth’s PM service. Interesting to me is that the discount does not extend to athenahealth’s EMR.

VHA, Inc. claims to have provided member health organizations more than $1.3 billion in savings in 2007, which is more than any of its competitors. Revenues and operating income were up 7.5% and 8.3% respectively.

The 46-doctor Greensboro Radiology group will implement InterSystems Ensemble for its enterprise-wide integration platform.

The latest products earning CCHIT Ambulatory 2007 certification include Allscripts Touchworks 11.1; Cerner Millennium PowerChart/PowerWorks EMR V. 2007; Eclipsys Sunrise Ambulatory v. 4.5C (pre-market conditional certification); Healthport EMR v.9.0; and ChartMaker V. 3.0.5. Looking over the list of certified vendors, a couple of major players I’m not seeing include GE’s Centricity and athenahealth.

Privately held Greenway Medical Technologies announces a 52% increase in sales bookings for their fiscal quarter ending March 31st compared to 2007.

Concord Hospital in NH will use Juniper Networks for its network infrastructure. The network will include the connection of 11 total sites, including various healthcare centers, clinics, and physician offices.

CMS announces the six vendors participating in its physician quality reporting initiative. Allscripts, Anceta, Cerner, DocSite, eClinicalWorks, and NextGen are providing data pulled from EHRs to measure quality data reporting capabilities.

Intermountain Healthcare signs a multi-year agreement with Novo Innovations to enhance information exchanges between Intermountain’s hospital systems and physician practices without EMRs. Novo’s software is already being used to connect several affiliated practices with existing EMRs.

Japanese hospitals and clinics are not adopting medical records as fast as the government would like, with only about 10% of each automated as of February 2007. Thirty-one percent of the 400+ bed hospitals had an EMR, far less than the government’s 60% goal for that group. The primary barrier: cost.

Mediware reports more dismal financial numbers. Profits are down 62% from the same quarter last year and sales were down 52%. About the only thing upbeat was the CEO’s comment that the company was “executing plans to build a strong foundation for future growth.”

An Australian doctor recommends that the government pay up to $47,000 for kidney donations to resolve organ shortages. The rationale is that in the long run, thousands of lives and billions of dollars in care would be saved. Guess it would pay for a pretty nice vacation if anyone over here is interested.

I like the new health care van belonging to ASU’s College of Nursing & Healthcare Innovation. A $700,000 UnitedHealthcare grant paid for the WOW-mobile (stands for Wellness on Wheels) that will bring primary care services to underserved Arizona communities. The rest of the grant money, by the way, will be used for pediatric obesity and child-teen mental health programs.

E-mail Inga.

Monday Morning Update 5/5/08

From Frazier Thomas: "Re: Misys. I read the the Misys press release about Daughters of Charity. Vern makes a reference, twice in fact, to Daughter’s Of Charity ‘Hospital’. I wonder if he even knows there is no such Daughters Of Charity HOSPITAL? It’s a whole health system, Vern. I guess I should cut him a break. He’s probably got a whole lot on his mind wondering what kind of employee he’ll be for Glen."

From Labrat: "Re: Baylor. The shake-up is true and relates to a conflict of interest issue. The BHCS rumor mill suggests that criminal charges could be pending."

From Up to You: "Re: NAHIT. More info on NAHIT and its stasis following Scott Wallace’s departure at the end of March. Includes some info on the organization’s financials, too." Link (although Modern Healthcare, despite carpet bombing the industry with free paper copies, inexplicably locks its online version behind registration, so you may not be able to read it).

From I-Wish: "Re: paper. Today I visited a new doctor. I downloaded my CCR-compliant medical history from my PHR to an encrypted memory stick. I arrived 10 minutes before my appointment time and handed the memory stick to the receptionist, who uploaded my medical history into the office EMR. I was immediately taken back to the exam room to see the doctor. Then I woke up!! In reality, I arrived 30 minutes before my appointment, filled out 20 pages of  information that required me to put my name, SSN, DOB and insurance number on every page. I then waited an additional 40 minutes to get into the exam room and spent nine minutes with the doctor and was out the door and done! I have been working in Healthcare IT for 15 years now and nothing seems to have changed in the average doctor’s office for the $ billions spent. My dream is to have one doctor visit in my lifetime that does not require a piece of paper! I am a baby-boomer and it doesn’t look good. Maybe for my grandchildren?"

From Terminal Stare: "Re: CIO credentials. Have you noticed how many new CIOs don’t even have a graduate degree these days? No clinical credentials and minimal education – remind me again why they’re paid more than doctors?"

Thanks to HISJunkie, whose HTP/RelayHealth tip gave HIStalk readers the news at least 12 hours ahead of everyone else. Transaction processor HTP and its 65 employees will stay in Columbus under the RelayHealth name.

McKesson will pay $13 million in civil penalties for failing to report suspicious pharmacy sales of controlled substances to the DEA.

University of Michigan Health System finishes its online order entry project, claiming a 29% reduction in medication errors and a 40% drop in turnaround time for urgent meds. None of the press releases mentioned who their vendor is and the intrepid reporters didn’t ask that painfully obvious question, but I believe it’s Eclipsys Sunrise Clinical Manager.

McGill University develops an automated anesthesia system it calls McSleepy that continuously monitors and adjusts anesthesia doses in response to patient conditions. Pretty darned cool.

This ought to get Deb Peel stirred up: UCSF not only inadvertently opens up patient information over the Internet, it does so while sharing patient data with a for-profit company that targets potential hospital donors. UCSF admits turning over information on 31,000 patients over several years to Target America. It paid that company $12,000 a year to match patient names against lists of known donors, board members, and community service supporters (as well as street addresses) so the rich ones could be hit up for donations (what the marketing types call "receiving our messages and ongoing communication"). Information about 6,000 patients was open to Google searches for three months. UCSF didn’t announce its problem until six months after it found out. Too bad Britney wasn’t on their list – they could have scored a nice privacy gaffe trifecta.

Former Deloitte manager Maria Russo will join Jewish Hospital & St. Mary’s HealthCare (KY) as CIO.

Wal-Mart will make some kind of big healthcare announcement Monday morning at 8:30 Eastern. It must be about prescription pricing since the company’s $4 generic guy is on the agenda.

NovaRad signs a RIS/PACS deal with a 1,500-bed hospital in India.

LMS Medical, the Canadian vendor of the CALM patient safety software for OB, will delist its shares from AMEX, but continue trading them on TSX.

Highly annoying: you get a teaser e-mail headline about some "10 Biggest Career Suicide Moves" or "5 Most Important Technologies You’ve Never Heard Of," so you get suckered into clicking the link. When you get there, it’s some idiotic vanity cartoon presentation that you have to click through one page at a time. I don’t have the time or interest in sitting through some crappy video, podcast, or slideshow. I like to skim, not be held captive, even though web guys keep trying to turn the Internet into TV (which I don’t watch for the same reason). There’s no video or audio on HIStalk for a carefully thought out reason: those are for people whose lips move when they read. You’d need at least 60 minutes to get what you could read on HIStalk in five. That extra 55 minutes is my gift to you.

St. Jude Medical signs a deal with Microsoft to work on integrating data from implantable devices with HealthVault.

Strange: a 56-year-old musician in a Steely Dan cover band dies of liver failure after being turned down for a transplant because of marijuana use. His use of it, ironically, was medically approved for his hepatitis pain.

Fresenius Medical Care (Germany) earns CCHIT ambulatory EHR approval of its Acumen EMR software for nephrologists.

Senior citizens are apparently doddering fools who require a SeniorPC, a dumbed down offering from Microsoft. "Think of it as a simplified way to do it all: e-mailing, word processing, plus managing prescriptions, finances, travel planning and photos. There are even word games and number games for keeping the puzzle skills sharp." Yep, Grandpa can just sit back in his drool-covered Barcalounger in his Sansabelt pants and Velcro tennis shoes and punch the optional oversized keys to order prescription refills, do crossword puzzles, and look at pictures of dead relatives, pretty much life’s rich bounty for those in God’s waiting room, at least as Microsoft apparently sees it. Maybe there’s a large print option for games, porn, and celebritard gossip for the more tuned-in geezers. Getting old sucks, but you don’t have to go down without a fight.

Six more organizations get ONCHIT money for NHIN demonstration projects, including the financially strapped Cleveland Clinic and Kaiser Permanente.

E-mail me.

CalRHIO
By Kipp Lassetter MD, Chairman and CEO of Medicity

Regarding the reader comment about CalRHIO, I’d like to set the record straight for HIStalk’s readers. Having won the CalRHIO selection process, I can say that Medicity has never been asked to “pay” CalRHIO anything. What we did offer CalRHIO as part of our RFP response was assistance in building a sustainable model and with network development activities with the expectation that we would be paid back with the success of the network. Their has been ZERO financial exchange between CalRHIO and Medicity or between any of our anticipated subcontractors (Perot, HP, etc.).

We do understand that while we were willing to go “at risk” for our services, other vendors were proposing large fees to cover these activities with no guarantee that the activities would be productive or successful. We feel we prevailed because we were the most qualified to partner with CalRHIO. CalPERS recently has performed extensive due diligence on the CalRHIO business model and value proposition. For those readers that are not familiar with CalPERS, they are the third largest purchaser of health care services in the nation and currently have around $250 billion under management for the benefit of their members.

Both the national healthcare consulting firms of Watson Wyatt, and Mercer were involved in evaluation effort on behalf of CalPERS. The fact that CalPERS came to the decision to “DIRECT” their health plans to participate is far more than CalRHIO “hype”. There is an old country saying that summarizes the comments very well: “the dogs bark, but the caravan moves on".

Bar-Coded Medication Verification
By Laureen O’Brien, CIO, Providence Health & Health Services, Oregon Region

I recently read the Brev-IT commentary about bar-coded medication verification (BMV) systems that claimed they are "generally primitive, hellishly difficult to implement, and badly designed from a nurse workflow perspective".  I can agree with only one of these claims — they are hellishly difficult to implement.

These systems are anything but "primitive," as they integrate information from multiple systems (ADT, pharmacy, nursing) to allow the use of technology (barcode readers) to quickly validate the "5 rights" of medication safety (right patient, drug, dose, route and time) to prevent medication administration errors.

And what is required to gain this safety after BMV is implemented? The nurse must sign on to the system or scan his/her ID badge, scan the patient’s wrist band, and scan the barcode on the medication. Within seconds, the nurse knows the "5 rights" have been verified or knows there is a problem.

When fully implemented and fully utilized, these systems are proven to enhance patient safety and reduce the risk of medication errors. Granted, implementing a new task into the nurse’s work flow adds time to their already busy schedule. But in healthcare, since when is taking more time to do a task safely considered an unacceptable workflow? I would think that doing something unsafe would require workflow adjustments to correct the unsafe practices. 

Try to find a patient who will argue in favor of the nurse not practicing safe medication administration so the nurse had a better "workflow". I’ve scanned the literature and have yet to find that argument. There are lots of articles that speak to nurses getting around the BMV systems and the safety they impart. Why are these discussions so often referenced? We know that use of a BMV system can and does prevent medication errors.

It is 2008. These systems have been available since the late 1980s. There are really no good excuses for not implementing them.

If your hospital is not doing BMV and not planning on doing BMV, shame on you. Your long-term financial status may be in jeopardy, as informed patients start looking to facilities that do use safe medication practices. You know that BMV systems provide enhanced safety, your board knows it, and the public is becoming more educated daily.

Hellishly difficult to implement? You bet, but no more so than implementing any clinical IT system. It is implementing change. Change is difficult. It is also the right thing to do.

News 5/2/08

From Bman: “Re: Baylor. Rumor has it another major shakeup has happened at Baylor in Dallas. Most of technology management up to the VP have been escorted to the door. Does it never stop there?”

From Benny Hinn: “Re: UM. Any fresh insight on the hullabaloo? They were hired to start the new Institute of Health Informatics (IHI) at the U. This isn’t they way I was hoping informatics was going to make headlines, but I guess any press is good press.” Two former Georgia Tech professors, a husband-and-wife team that brought big grants to GT, leave for University of Minnesota. They’re under state investigation for fraud because they paid $80,000 in GT money to the wife’s brother. Tech is also claiming they started full time in Minnesota on October 1 but are still drawing GT checks. Tech paid them a combined $400K per year. Maybe informatics is so hot that profs are being wooed like football coaches.

From Larry Finkelstein: “Re: WHCC. I went to the World Health Care Congress conference in DC recently and was very impressed as to the depth of breakout small group discussions. Most of the 1,300 (so we are told) attendees were CEOs, COOs, CIOs and the spin level was at a fairly tolerable level. My favorite session was a couple hours with Denise Cortese of Mayo fame in an intimate open discussion with maybe 30 people talking about how to fix healthcare.”

From unionjack: “Re: UPMC in the UK. It all sounds very mysterious. Surely Epic won’t allow a third party to implement their apps. It must be Cerner and the others then. Why all the hush-hush? And what is UPMC up to?” They’ve installed more stuff in their own place than most vendors, so they’re qualified. The article strongly hinted that they’re looking for financial growth outside the US, something the average hospital isn’t thinking about. It does kind of stretch the definition of a non-profit whose mission is improve health since it’s local taxes they aren’t paying.

From Will Weider: “Re: my picture in USA Today. All I could think was that this has to improve my chances of winning a HISsie next year.” Will is still bummed that he lost the Best CIO HISsies award. He goes on record saying what Microsoft hates to hear (but should get used to hearing): “I wouldn’t put on Vista if it was free,” referring to Ministry Health Care’s 14,000 desktops. John Halamka is quoted too, saying BIDMC will skip Vista because XP’s running fine.

From Amy: “Re: RHIOs. I’m not sure how much better a chance at success CalRHIO actually has. They wanted one big integrator to pay ~$2m to play in their sandbox, ditto for another vendor. How sustainable will that be over time? Tons of good hype though – they are great at that.”

From HISJunkie: “Re: HTP. Just heard that RelayHealth (McKesson) bought HTP, the revenue cycle/claims scrubbing firm out of Ohio.” Listening: The Apples in stereo. Sunny Denver pop. Like crossing the Beatles with ELO.

Sign up for e-mail updates and the weekly Brev+IT newsletter to your right, if you’re so inclined. If you’re new, that Google search box over there digs through five years’ worth of HIStalk (well, it will be five years next month, anyway). The obnoxiously green Rumor Report button will take you to a secure, anonymous reporting form that will even accept attachments if you have juicy stuff to send my way (no dirty pics, please – I meant rumors and secrets). And as always, thank you for reading and recommending HIStalk. I’m always buried in work, but feel free to e-mail me – I guarantee I’ll read it and I’ll try to reply.

John Glaser touts linking genetic information to EMRs. I like the idea, although there’s still a ton of work to do in just linking EMR information to EMR information.

Jobs: Sales Executive – Workflow Solutions, Regional Sales Manager SE, Epic Pharmacy Consultant, Credentialing Verification Specialist. Sign up for the weekly job blast here.

New poll to your right: are you seeing the negative effects of business conditions at work? I’m not in my hospital (yet), but lots of businesses have shut down not far from my house (including two fast food restaurants, which is unusual). The good news is that the world’s appetite is insatiable and we farm like nobody’s business in the good old USA, so unless they’re planning to eat their highly valued currencies, they’ll need to send some of it our way. Money talks, but so does wheat (as the former Soviet Union found out).

Thanks to new HIStalk Gold Sponsor Virtual Radiologic. The Minneapolis company provides around-the-clock radiology interpretation services. Here‘s a story about them. More related to HIT, they offer vRad Enterprise Connect, a fully hosted RIS/PACS solution for big rad groups interesting in rolling out teleradiology. Former Misys Healthcare guy Rob Kill is the company’s president and COO and most of the management team is physicians. I appreciate Virtual Radiologic’s support of HIStalk and its readers.

Community Hospital of Los Gatos (CA, 143 beds)  is testing a PDA system for physicians from Validus Medical Systems. Never heard of the company, but its board looks strong. Here‘s a newspaper story about the CEO’s interest in technology.

Allscripts misses estimates yet again: revenue up 11%, EPS $0.09 after special items vs. $.08, but analysts expected $0.11. Share price didn’t change much, probably because software sales weren’t too bad despite the company’s problems with TouchWorks. Apparently it was announced during the call that the Misys merger might close this summer (which is soon, just in case May slipped up on you).

The iPhone in Healthcare: hot.

Perot Systems announces Q1 numbers: revenue up 15%, EPS $0.23 vs. $0.19, beating estimates of $0.22.

Cardinal Health announced today: revenue up 5%, EPS $1.02 vs. -$.01, exceeding analyst expectations of $1.00. Shares are up 6%.

A former Johns Hopkins professor and physician files suit against the university and hospital for sexual harassment and gender discrimination, claiming that a male colleague had what he called his “T&A display” for a screensaver, that another had “wall to wall” provocative photos, and that inflated condoms were left on her chair. She also claims that her female boss screamed at her and asked why she wouldn’t cry “like a normal woman.” Her bio and picture are still up on the Hopkins site, but I’m not saying a word.

UnitedHealthCare gives El Rio Community Health Center (AZ) $200,000 for a connectivity project.

The CEO of Siemens says the US healthcare market will improve next year. Guess that means he’s hoping the government’s cost containment efforts on imaging will go away. Good for Siemens and GE, bad for everybody else who’s paying.

The Fort Worth paper goes after tax-supported JPS Health Network’s charity claims. The system claimed to have seen 850,000 patients, but it was actually just 157,000 unique patients. It claimed it spent $75 million more for charity care than it was given, but that didn’t include “tens of millions” of extra taxpayer dollars it received for it. The health system claimed to have provided $439 million in charity care in one year, but based its numbers on charges, not cost (which the paper claims was less than $25 million). The health system bragged on 15,000 trauma admissions, but when challenged, said a computer glitch caused an error — the actual number was 1/10 that figure. Doh!

Hospital lawsuit: a New York doctor was hired as a top administrator at Atlanta’s Grady Memorial Hospital, so he quit his job and moved at Grady’s expense in October. The hospital called the night before his first day and said he didn’t have a job after all. The money-losing hospital’s former CEO (later fired) had hired him without board approval, offering him “excessive” compensation of $800K and a 15-month severance package. The doctor wants over $1 million in severance and damages. His fired almost-boss is suing for $2 million in severance himself.

E-mail me.

Inga’s Update

As if we needed more proof that healthcare is in a mess, the AHA notes that uncompensated care nationwide has increased by 44% to $31.2 billion in 2006 since 2000. Not surprisingly, bad debt is rising as well, so more hospitals are requiring upfront payment before performing care. I actually agree with the up-front approach in theory, but not sure where that leaves the masses of under- or uninsured. And, sadly, I don’t think the next White House occupant will be able to fix the system any time soon. For some reason, the whole issue is making me particularly gloomy today. How many more jobs will be outsourced and/or hospitals closed before things get better? Oh well, guess I will go back to worrying about more mundane concerns, like the $80 it just cost me to fill up my SUV.

Besides, how can I fret over such things when I could be rejoicing that David Blaine held his breath for over 17 minutes on Oprah, David Cook is poised to win American Idol, and Tony Romo and Jessica Simpson are in love? I guess I really am happy to see that celebrity-snooping hospital employee from UCLA is being indicted for supplying us with the inside information we all wanted to know.

Sentillion’s context management solution technology is now patented.

Heritage Ministries Management Company (NY) is deploying Vocollect’s AccuNurse voice-assisted technology across its three skilled nursing facilities.

A study of 100 minimally invasive coronary bypass surgery patients indicates that robots provide better care than surgeons. Researchers at The University of Maryland Medical Center determined that the use of a DaVinci robot resulted in shorter hospital stays and faster recovery for patients, as well as fewer complications and a better chance that the new bypass vessels will stay open. Plus it is apparently cheaper. No mention of who writes the better chart note.

Aloha means goodbye for 89 employees at Hawaii Medical Center. Perot has been contracted to handle the hospital’s business office, call center, health information management, and admissions departments beginning June 28th.

Hospira acquires Sculptor Development Technologies, developers of the bar code med administration system VeriScan Rx.

The Daughters of Charity Health Systems will offer Misys MyWay to its physician practices. For the next three months, apparently (why only three, I wonder?), interested physicians can contract for the hosted solution at a “subsidized rate.” Daughters has also been offering a hosted version of Misys Vision/EMR product for the last couple of years.

ThedaCare (WI) is spending $90 million over the next three years upgrading technology, re-designing patient rooms, and eliminating nursing stations in its two hospitals. Officials predict the changes will reduce patients’ length of stay by 21% and overall cost of care by one-third.

Sharp Healthcare is selling its Sharp Mission Park Medical Center to Scripps Health. The combined group of Sharp Mission Park and Scripps Mercy Medical will form a new 100-physician entity specializing in FP, peds, and internal medicine.

From California Dreaming: “Great blog. I just wanted to send a quick note to say that I have really enjoyed reading your blog. The HIS field is somewhat new to me (I came from the higher education sector). Over the past few weeks I have been trying to immerse myself into as much information and knowledge as I can, and your blog has definitely helped. I’m not sure if anyone sends a ‘Thank You’ to blogs… but I felt the need to show my appreciation.” I am not clear on blog etiquette either (though I see a potential opportunity there.) In any case, we are glad you are reading. Tell your friends.

E-mail Inga.

2006 is Year of the RHIO, but Now-Gauche Technologies Can Help Patients Today

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

Every HIMSS Annual Conference is the “Year of the Something.” CPOE, PDAs, networks, wireless, or CHINs. Newly minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.

Sometimes the Something booms, although often only after several years. Sometimes it disappears without a whimper. Neither outcome dampens the enthusiasm of HIMSS, consultants, and vendors to push a new, carefully orchestrated Something each year, likely because fewer people would attend conferences, hire consultants, and buy new products otherwise. Maybe they learned that from the car makers.

This is the Year of the RHIO. I’m not against that, but it would be nice if organizations finished implementing yesterday’s fads first, like CPOE and electronic medical records. Those are still a hopeful dream for the vast majority of hospitals. And, we know they can deliver value today.

At least some of the RHIO hype appears to be genuine (unlike the Year of the PDA, which everyone knew was a joke.) It seems that technologies developed by Connecting for Health and IHE will allow RHIOs to interconnect, at least according to groups chewing through government grant money. The enthusiasm is palpable, although those with functional memories will recall that technology problems weren’t what ended the Year of the CHIN in the first place.

Eventually, RHIOs will provide patient benefit (at least 3-5 years from now, I expect.) In the meantime, they could become CPOE redux: encouraging premature interest in immature products by unprepared organizations, consuming resources and organizational energies that could have been spent on more worthwhile projects.

Most hospitals still haven’t implemented bedside barcoding, smart IV pumps, electronic MARs, and clinical decision support, all comparatively inexpensive slam dunks compared to CPOE. But, we convinced ourselves to lead with CPOE through some bizarre logic and we’re still trying to get physicians to use it years later, passing up some great patient safety opportunities along the way.

In any case, RHIOs are about to morph from a science fair project run by grant-fueled big contractors to the mainstream. Uncle Sam is sending just one receiver downfield and it’s RHIOs. Whether you’re ready doesn’t matter. That virtually no doctors have EMRs that can contribute or use clinical data doesn’t matter. That hospital clinical systems still capture only a small percentage of electronic data doesn’t matter. What does matter is that RHIOs are hot and hospital executives will be encouraged to hop on the bandwagon.

I think many RHIOs will go right down the toilet through lack of a sustainable financing model, poor governance, or a general lack of interest in cooperating with barely tolerated competitors. Those that are successful will at least spur demand for better clinical systems in all settings. That’s good: according to several HIMSS speakers this week, we’re turning our backs on those systems just as they are becoming good enough to use.

Let’s celebrate the shockingly fast progress that’s been made on RHIOs. Clearly lots of good work has been done. But, remember that your first obligation is to ensure good outcomes for patients under your facility’s care right now. We need to finish implementing all those now-gauche technologies that didn’t make the HIMSS hot list this year.

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