Monday Morning Update 10/22/07

Investors weren’t happy that Cerner missed Q3 revenue expectations and also lowered guidance last week, even though profit was up 34%. Shares dropped 9% Friday.

An anonymous source (someone affected) says that over 100 people have been laid off from Kaiser’s IT department.

Another source tells me that Bronx-Lebanon’s Eclipsys deal was booked at $32.5 million, to answer a reader’s question.

The fox joins the chickens: the SEC director who went after McKesson HBOC for fraud will quit to work for a private investment company as its general counsel.

News bits from Medicity: their client Delaware Health Information Network gets an NHIN trial implementation grant, Medicity’s headcount will have tripled in less than three years, its product suite now supports all LDAP-compliant directory services, and it just opened a new 24×7 Network Operations Center. I had missed that CEO Kipp Lassetter will be on a panel at the Collaboration Communications Summit in Beverly Hills (November 5-6), of which HIStalk is a media partner.

An interesting report (warning: PDF) called “The Relationship Between Electronic Health Records and Patient Safety”, from Canada Health Infoway. Overview: evidence that clinical systems improve patient safety is incomplete, clinical systems may have unintended consequences, implementation should be incremental to let providers adjust, and expectations must be realistic.

Don’t forget the poll to your right on PHRs. I’m interested to know who’s using them. I only know that I’m not.

Let’s hear it for those sponsors who keep the HIStalk well flowing. Click over and take a look, and if you’re their customer, please tell them you appreciate their support of HIStalk.

Design Clinicals, LLC
EnovateIT
eScription
Hayes Management Consulting
Healthcare Growth Partners
Healthia Consulting
Inside Healthcare Computing
Intellect Resources
InterSystems
John Muir Health
Lucida Healthcare IT Group
Medicity
MedMatica Consulting Associates
Noteworthy Medical Systems
Novo Innovations
Picis
Premise
Pring|Pierce Executive Search
SCI Solutions
Sentillion
SolCom
Stratus Technologies
The White Stone Group, Inc.EHRConsultant

Baylor Health Care is #15 on the 2007 Information Week 500, the highest ranked health care system at one spot behind Google.

Surely it’s not just me: spam filters are rejecting an awful lot of e-mails. How many times lately has something you’ve sent not arrived, or has someone sworn they sent you an e-mail that you never received? I suspect those server-based spam tools are too tightly wound to let all the real e-mails through.

Another odd Misys press release: its extensive research reveals that doctors don’t use EMRs because they’re expensive and hard to use. A shocker, I know, especially coming from a company often known for trying to sell expensive, hard to use products. Here’s the research methodology used: Misys watched a bunch of cheaper, better competitors brutalize it in the marketplace. Great conclusion, but too late to keep those horses in the barn.

A European project will monitor patients at home, using sensors that report environment as well as physiology.

As I already mentioned, Medsphere settled its lawsuit with the Shreeves. You have to assume that (a) either new CEO Mike Doyle said he wasn’t coming unless they took that blot off the company’s record, or (b) it was a Ken Kizer vs. the founders grudge match with no possible winners, so his leaving the CEO post was related in some way. It’s too bad the distraction couldn’t have been ended sooner. Medsphere already had enough challenges before the suit.

Here’s yet another smart card pilot for medical records. Seems like everybody’s been trying to make smart cards do something useful for 20 years or so now. This latest one at least carries more information than just a medical record number, but it’s really just a PHR on a card that the patient can’t update, i.e. like a floppy-carrying sneakernet. Siemens is paying for the pilot.

Cardinal Health’s Medicine Shoppe will run up to 500 clinics in India’s urban slums, complete with a pharmacy, lab testing, and a doctor.

CPSI’s Q3 numbers: revenue up 2.6%, EPS $0.30 vs. $0.32.

E-mail me.

Inga’s Update

John Hallock of athenahealth dropped me a note letting me know that athena had actually announced one other group live on athenaClinicals. FirstHealth Family Center in NC is up and running at its seven facilities.

Earlier this week Mr. H mentioned a Misys press release about EMRs that he said “contains no news.” Basically true, but I what I found interesting is that the article promotes hosted EMRs, an offering Misys won’t be selling until the iMedica arrangement is finalized (not expected until November), If I were a Misys prospect buying EMR today, I might be scratching my head asking why Vern is promoting hosted solutions when they aren’t selling one yet.

Columbia University’s physician group, the Faculty Practice Organization (FPO) of the College of Physicians and Surgeons, signs a management and consulting agreement with Greencastle Consulting. Greencastle will manage FPO’s roll-out of the Allscripts TouchWorks EHR.

Medical Economics has an interesting article titled “Avoiding EHR Sticker Shock.” It provides some insight as to why various solutions may appear to have such different costs. It also suggests some less obvious components the buyer should consider when calculating the total cost of ownership.

E-mail Inga.

Art Vandelay’s Thoughts on Worker Benefits and Technology

Art Vandelay is a hospital-based technologist and HIStalk contributor.

I find the move by General Motors (GM), now Chrylser/Cerberus, and the United Auto Workers (UAW) very telling about the future of worker health care benefits and soon, very telling about the future of consumer-centric health care technology. In the end-state of the deal with GM, the UAW will assume the responsibility for retiree health benefits over the next few years. Although many other businesses have begun to reduce or eliminate their retiree health care and pension exposure, this is the first major visible movement in an industry that has reacted with the speed of a tortoise in the face of major cost challenges.

The situation for GM is daunting. For every able-bodied worker, there are four retirees. This is basically the same demographic trend that many European countries and, to a lesser extent, the U.S. face. The obvious effect of this is a growing number of Medicare beneficiaries with fewer resources paying into Medicare, while healthcare costs outpace “revenue”, i.e. our tax dollars. The moves we see from the UAW will likely be the same we see in other slow-moving industries for employees and retirees, as well as with Medicare. Undoubtedly, the UAW will push health savings account and high-deductible health maintenance organization-based plans. Both options are associated with the “consumer-directed movement”, although there are varied findings about the effectiveness of these plans depending upon one’s viewpoint ( i.e., consumer cost, payer/employer cost, quality, satisfaction).

So what can we expect as technologists?

1. There will be an unprecedented, albeit slow-moving, pressure to provide information about (first) cost, (second) quality and (third) access to care in a consumer-friendly manner. I stress, in a consumer-friendly manner. How many of us have had to explain bills, referral and authorization requirements, and the provider industry’s broken processes to parents, friends, and relatives not “in-the-know”? We will be pushed as technologists to:

• Provide natural language interfaces to knowledge bases of frequently asked questions, including providing our users with content management tools to rapidly add, edit and tag new consumer questions and our organization’s answers.
• Partner more tightly with our clinical and administrative counterparts to understand and standardize our data as well as our competitors’ available data (likely facilitated by health plans).
• Provide more data in real-time regarding cost, quality and access as opposed to data that are months or weeks old.
• Provide analysis models taking the real-time data to predict cost, quality and access challenges before they occur.
• Provide multi-factorial, consumer-friendly decision-making tools so they can use information to make educated decisions about providers and treatment options (perhaps with weighting or in conjunction with national benchmarks). Health plans will likely provide similar tools for treatment options (maybe competing tools with different outcomes) as well as tools to compare providers. Consider the challenges that group practices and other organizations with employed providers will face if they are compared to one another, as opposed to being compared as groups (everyone will want access to the provider with the best cost/quality outcome).
• Work with health plans and the government to define normalized cost and quality information for reporting (expect registry upon registry to arise – all with slightly different data definitions creating different extract, transform and load (ETL) requirements).

2. There will be an unprecedented demand to drive the work of the key knowledge workers to other, less trained, or more focused but lower-paid resources. This will be seen in as increased demand for nurse practitioners and physician assistants in many additional care settings. Nurses will likely become the care coordination coaches for the inpatient experience, running entire teams of partially specialized resources. Other disciplines with limited use of technicians will likely develop the roles. These will result in rapidly changing staffing models. We will be pushed as technologists to:

• Define role-based access relationships for users (consider this a wake-up call for those of us with applications that do not have fine-grained role-based access control).
• Provide aids in applications to guide users through the use of a system or the execution of processes, including the integration and use of workflows.
• Provide activity-based cost decision support to validate that these new staffing models make sense.
• Provide interfaces or maybe even create web service-based mash-up applications to support these new processes.
• Include these alternative providers in enterprise scheduling systems (or create and possibly host enterprise scheduling systems for our organization and our partners)

3. There will be unprecedented demand for personalization in consumer web sites provided by both providers and payers, dare I say the re-emergence of the portal. From a provider-centric viewpoint, we will be pushed as technologists to:

• Provide tools that measure and deliver enhanced access (i.e., self-scheduling, virtual, remote or electronic visits).
• Provide tools that measure and track progress towards our desired outcomes as patients (i.e., personal care planning tools, disease management tools). Unfortunately, according to recent findings, patients with chronic conditions are using the web less than those without chronic conditions.
• Provide patient-access to their records.
• Provide the ability for patients to estimate, pay, dispute, and view their bills on-line.
• Remember that all our patients aren’t web savvy, have physical impairments or speak other languages. Some of us will be asked to provide access to these tools via telecommunications technologies ( i.e., voice XML – VXML) and other means that meet the patients’ requirements.

4. There will be unprecedented demand for resources to assist patients move through the complexity of the health care system. Call them care navigators, concierges, or coaches, these resources may be free or they may be paid third parties. We will be pushed as technologists to:

• Provide tools to facilitate the communication between the care navigators and patients. Think internet-enabled call center tools (i.e., instant messaging, intelligent conversation avatars, call distribution and management software, referral management software, message tracking software). Customer relationship management (CRM) software will really come to health care to aid with the navigation, document the patient conversation, and to cross-sell our organization’s and partners’ services.
• b. Provide tools that integrate the documented messages into the computerized patient record when required.
• Provide tools that track and document patient and family preferences for care (i.e., locations close to work and home, preferred providers, preferred treatments, willingness to use alternative medicine and care extenders).
• Provide the knowledgebases mentioned in #1 for these care navigators.

5. There will be unprecedented demand for computerized patient records that support outreach to affiliated physicians and data exchange. Eventually, when consumers wake up and payers listen to the demands of the consumers, some level of standards-based electronic data exchange between providers (think HL7’s Continuity of Care Record – CCR) will be required. Therefore, as technologists, we will be expected to provide computerized patient records for our organizations, our partner physician organizations, and ensure these applications support the CCR.

A change is upon us. There will be no shortage or work or demands for investment – can anyone say job security?

Medsphere, Shreeve Lawsuit Settled

Medsphere will announce this morning that it has settled its lawsuit against founders Scott and Steve Shreeve.

News 10/19/07

From Rogue: “Re: HIMSS. The ‘HIMSS alliance with some kind of emergency response group’ grew out of COMCARE’s participation in a HIMSS work Group on health IT for emergency responders. The Work Group published a white paper a few months back (available on the HIMSS website) outlining the patient data issues confronting emergency responders in emergency and disaster situations.”

From Laurie Strode: “Re: Insight. The McKesson Insight user group conference is underway in Atlanta. I’ve attended this conference several times, but not this year (due to scheduling conflicts). It has usually been a good use of time, excellent educational sessions put on by a wide rage of users ranging from nurses and physicians to analysts and consultants.” Link. Somebody ask a question of the keynote and loudly and clearly reference HIStalk, please. Free PR, you know. Is Charlie McCall there?

From The PACS Designer: “Re: Oracle. As a final post on the Oracle Database 11g software, TPD wanted to leave HIStalk readers the web link that lists the features previously mentioned plus some other nice features of this new software offering.” Link.

From Annie Brackett: “Re: Inga. Someone asked me at a cocktail party recently, out of nowhere, ‘Are you Inga’? EVERYONE knew what they meant. I said not hardly, but was flattered. I thought that Inga would be pleased. She’s now like one of those stars that goes by one name, but everyone knows them … Cher, Madonna , Britney, etc.” Well, now you’ve gone and swelled her head with her newfound anonymous fame. Note her news items below – she’s noticeably saucier than usual. Isn’t she fun? Now she’ll want an entourage.

From Lindsey Wallace: “Re: Sunquest. What happened to their other products?” You must be an old-timer. The new Sunquest has deconstructed itself back to its very early roots, selling only lab-related applications. Pharmacy, radiology, Clinical Events Manager, etc. have all been history for some time. I remember a great writeup in Investor’s Business Daily about CEM — right before they pulled the plug on it. Flexirad used to be pretty good, pharmacy not so much. All on the ash heap of IT history. Just laboratorian stuff now.

John has some good stuff on Google Health (“the vision is gone”), HealthVault (“the cupboards were bare”), and Dossia (“… there is a ton of cynicism regarding what the true motivations are of the employers that are sponsoring Dossia.”) I see that, like me, John’s working the cynicism space. Good reading, although I must point out that, despite John’s indifference to Google’s message, VP Marissa Mayer (who was doing the talking) is not only a Stanford MSCS, but an awarded Stanford programming instructor, and not terribly hard to look at besides. She joined in 1999 as one of the first 20 employees, so I’m sure she’s loaded, too. A pretty, rich, 32-year-old geek … well, life’s just unfair.

Speaking of Google, Q3 numbers just came in: revenue up 57% to $4.23 billion, EPS $3.38 vs. $2.36. Yep, that’s over a billion dollars’ profit in one quarter. The company added over 2,100 employees in the quarter, pushing them up to 16,000.

WebMD wasn’t so lucky. Its shares toileted, down 14%, after the company missed Q3 estimates. More importantly, though, was an announcement that the company had signed a multi-year agreement with Yahoo for seach and advertising. That means no Google takeover, which means no one wants wildly overpriced WBMD stock (PE of 236).

Cerner’s Q3 numbers, also just announced: revenue up 8%, EPS $0.43 vs. $0.33. The value of Neal’s shares: $371 million. Makes me remember that it will be HISsies time soon (The Pie).

And speaking of Cerner, this looks like it might be a video made at Cerner’s bash at HIMSS. Despite entertainment featuring two soul groups missing all but one original member each (who sound good anyway, I noticed), the chick on the right is obviously getting down with her bad self and the one gesticulating at her beer looks a little bit like Marcia Brady.

Ben Williams is named CIO for Catholic Healthcare West, coming over from St. Joseph Health System in Orange, CA. Must have been some good money – he was making $644K at St. Joseph in 2005, according to federal forms. No vows of poverty at the new place, either – the president was paid $4.5 million and almost all the VPs were over $1 million, according to the most recent forms. Actually, I was more eloquent back in February: “Humble servant CEO Lloyd Dean made $5.8 million in compensation and benefits in 2005. Read that again slowly … the guy running a nonprofit hospital group out-earned most publicly traded company CEOs. So much for a vow of poverty. Even their HR VP made $1.9 million. What the hell is that all about? You’re telling me that a Catholic-run hospital group has to pay $1.9 million a year to get someone to run HR? And they’re supposed to be a non-profit? Ridiculous. Excessive. Embarrassing. I’m not out of adjectives, but I’ll stop.”

Listening: new VAST.

My thought while driving to work today: widespread lack of IT success in hospitals may be due to the never-ending threat of healthcare personnel shortages (despite the skills of multi-million dollar HR VPs slaving away). Hospitals have a lot of licensed employees who could work in any number of places, most of whom are expected to use IT systems as part of their jobs. What are the odds that hospitals will strong-arm them into changing their work processes as part of a software implementation? Nobody tells nurses, pharmacists, rad techs, etc. what to do because they’ll just jump ship for a competitor or better job. High-paid executives (see above) aren’t about to lift a bedpan, so it’s better to tread lightly when it comes to imposing order. And without that, IT will surely fail. IT is the only industry I can think of where the most highly educated, mission critical, short supply professionals are the ones expected to tickle the computer ivories. I’m not sure I disagree with Reid Conant’s ‘scribe’ model of letting somebody else do the typing. At least with expendable staff you’d have a shot at repeatable processes.

If you want to play around with a mashup tool for non-geeks, Microsoft just release Popfly to beta. Do something interesting with it and let me know.

I haven’t done a poll for a long time, so I figured it was time. To your right: do you keep a PHR?

I’m hearing that Kaiser Permanente has laid off some IT folks at Pleasanton. Feel free to let me know using the anonymous Rumor Report to your right (I’m fanatical about keeping sources anonymous). Layoffs are their business, but the interest, of course, is whether they’re clearing the decks for outsourcing.

William Osler Health Centre in Toronto will implement SolComHealth e-HIM software from SolCom, integrating it with the hospital’s MedSeek portal and Meditech clinical system. I noticed a new SolCom web design while I was cruising, too.

Patient flow system vendor Premise held its three-day user group meeting last week in Mystic, Connecticut.

Even CNET weighs in on Medsphere’s lawsuit against its founders. “Still, customer wins like these would be all the sweeter if the company’s board could come to a peaceful resolution with its founders, Scott and Steve Shreeve. There is blame on both sides, but nothing that justifies a $50 million lawsuit against two entrepreneurs who created what the board manages today. It’s time to resolve the past.” I have never seen a company blacken its own eye so stubbornly and intently, just as it was trying to bootstrap up out of obscurity. That and its “we’re open source, but only if you don’t look too closely” waffling aren’t winning it any friends (or customers, most likely). Soothe the egos, fire the lawyers, make a decision whether you really want to be open source or not, and sell some damn software. We all want to like you, so don’t make it so hard for us. That’s Mr. HIStalk’s free management consultation.

British hospitals, stung by poor financial reviews by NHS, blame software that lengthened patient wait times and prevented cancer patients from being seen promptly. The software was not named, but I believe it may have contributed not only to their delays, but to someone’s $371 million fortoona.

E-mail me.

Inga’s Update

Some of my postings have not made the last couple of HIStalk issues. I am prone to paranoia attacks and initially thought Mr. H was censoring me. Turns out my email was not working (somehow I felt better knowing that it was Yahoo censoring me.) I am happily back online, freeing my energy to be paranoid about other things.

Speaking of paranoia, I think the Greenway folks may have some issues thinking folks don’t take them seriously enough. Greenway releases an announcement that it has “further established itself as a leader in the healthcare information technology (HIT) industry with its latest testimony before the U.S. House of Representatives Committee on Science and Technology.” Greenway’s vice president of marketing and governmental affairs, Justin Barnes, testified last month, along with execs from HCA, AIHMA, and GE, plus a Yale School of Medicine physician/professor.

dbMotion executive Ilan Freedman makes some interesting comparisons between the French HIE initiatives compared to what is going on in the US. I told Mr. H I would be willing to visit France to assess the situation and report back to HIStalk readers. Hmm … that must have been one of the many lost emails because he never responded back.

Re: Epic photos. Someone tell me what the big chicken is all about. I found it a bit creepy.

Only a blessing from the Vatican stands in the way of a merger between UPMC and Catholic-run Mercy Hospital of Pittsburgh. The FTC just approved the deal, as did the PA Attorney General.

Medseek announces new software agreements and consulting projects with 13 hospital systems.

Nuance makes yet another acquisition – the 10th this year, by my count. Guess that is one way to grow your business. Vocada, a provider of critical test result management solutions, is the Nuance’s latest purchase.

Medsphere contracts with another community hospital for its open source-based EHR systems and services. Century City Doctors Hospital in Los Angeles will implement OpenVista EHR at its 120-bed acute care facility.

e-MDs announces a new president, Dr. Michael Stearns. Founder Dr. David Winn will stay on as CEO and chairman of the board. One thing I admire about e-MDs is its commitment to having numerous clinicians on staff. That is not to say that Dr. Stearns, a neurologist, will necessarily make a great president, but I am sure he understands the needs of physicians.

Finally, at least one person acknowledges they agree with me, at least in part, that Microsoft’s HealthVault has some merit. Dr. Douglas Krell sent this note: “I’d like to agree in part, with your appraisal of Microsoft’s HealthVault PHR. I also agree with Dr. Singh that in the beginning, many of the PHR users may be likely to be the worried well, those with real chronic illness, and the Quicken users. But from the physicians’ point of view, I believe that it will be our job to educate and encourage people to make use of these systems to track and interpret their own health data.  We’ve always found that people who actively participate in their own care will be healthier. We need to support those efforts.  It will help us to practice and advise patients more efficiently.  We ARE paid for using these systems to the degree that the more patients we see, the more data we can review and process, the greater our productivity.  Ultimately the better patient care we’ll be able to provide.  Some people will ignore our advice but nevertheless, we should be advocating the adoption of this bit of information technology.”

Is it me, or are all the harshest PHR critics those in the HIT space? Is it because deep down we still want to be the ones to hold the keys to the patients’ records? Do we consider the products too immature to be useful? Do we not trust patients with this information? I remember in the early 80’s when ATMs first became available, you could only use your own bank’s ATM since they weren’t connected. Now you can access your money from any ATM in the world. The point is we have to start somewhere and I think we need more leadership from healthcare providers and HIT to move PRH adoption forward. Otherwise, then years from now, healthcare will be the only industry that still uses fax machines.

I suppose if you use a name like hatchet_guy one shouldn’t expect a lot of feel-good postings. Earlier this week HG commented on the vendor conference mentioned last week and suggested the vendor had a number of problems. I talked to one of the customers mentioned and was told the report was “definitely not accurate” and any issues they had were “temporary” (the individual suggested the posting was so off that it wasn’t worth discussing).

The Hughston Clinic selects athenaClinicals for its nine orthopedic locations throughout Georgia and Alabama. The clinic was already utilizing athenahealth’s billing and PM services. I could be wrong, but I think this is the first EMR client that athenahealth has announced this year.

E-mail Inga (new address because Yahoo Mail eats my messages).

News 10/17/07

From G-Ray: “Re: RHIOs. I was wondering if your readers have any real information on the differences (if any) between HIEs and RHIOs.”

From Miles J. Bennell: “Re: Epic’s campus. I thought you would find these interesting. A client visiting Epic’s campus and took these pictures. Nice looking campus, although I really question their taste in art (see the very large chicken picture).” Link. Definitely cow-tipping country. Like Microsoft’s relocating intentionally to the dreary Northwest to keep the non-work distractions down, the location is perfect for getting fun-loving kids to work too many hours. Like in My Cousin Vinny, “I bet the Chinese food in this town is terrible.”

From Martin Jensen: “Re: HealthVault. While I was away at a conference last week, my partner took it as an opportunity to learn animation. He posted his first cartoon on our new HITCHtv.net website. I think you’ll enjoy it. Check out ‘HealthFault from Microsoft.'” Link. Those Healthcare IT Transition Group folks (Michael and Marty) are funny and smart. I haven’t figured out exactly how their business model works, but it’s fun.

From John Harris: “Re: MSFT. Even Harvard experts think MSFT can sovle the HIT ‘problem’. I did post a link for him back to your blog as recommended reading from an expert on the industry :-)” Link. The Harvard Business Online guy asks the question, “Is Microsoft’s approach on target or do you favor a government-led solution?” Do we only get two choices?

Listening: I was premature in calling Ziggy Stardust the best album ever. I’m now convinced it’s Forever Changes, circa 1967, by Love. Remarkably fresh and brilliant from the tragic, late Arthur Lee and bandmates. I’ve played it constantly for two days.

Scott Shreeve evaluates doctor social networking site Sermo: “Knowledge Prostitution Enabling Aggregated Voyeurism: Is This a Business Model?” Sermo is allowing drug companies to buy their way into the site to influence its doctor members. It’s like Internet porn with (clothed) docs being watched with creepy intensity by salivating drug companies. Big Pharma 2.0.

My newsletter editorial going out tomorrow: “Where Good Products Go to Die: The Elephant’s Graveyard of Conglomerate-Acquired Products.” Finish this sentence: “Base on that title, surely company being referred to is ____”.

EHRConsultant is offering free educational videos on the use of speech recognition software and EHRs, divided by vendor and specialty.

Cerner’s user conference drew 6,700 attendees to Kansas City last week.

Michael Stearns is promoted to president of e-MDs.

Noteworthy Medical Systems names former Eclipsys CEO Paul Ruflin as its new president and COO.

Speaking of Eclipsys, the company is bailing on Boca and moving its headquarters to Atlanta. I guess the traffic wasn’t bad enough there.

Mediware will buy Integrated Marketing Solutions, which sells software for blood donation centers.

Picis announces the release of CareSuite Extelligence Anesthesia 3.0, its anesthesia care business analytics system. The OR version is coming soon.

HIMSS ties the knot with some kind of emergency medical response advocacy group. Roger, Rampart 1.

Here’s a Misys press release about EMRs that contains no news. Maybe that’s why it’s running only on some German stock site.

Microsoft gets further into Cisco’s unified communications business.

The medical division of Philips turns in a disappointing Q3, blaming US regulatory changes for imaging systems.

InterSystems gets a big Cache’ deal with the VA.

Reminders: there are two signups to your right, the first one for e-mail updates when I write something new here, the second for the Brev+IT weekly newsletter (latest issue here, although folks on the list got it Sunday). The Search box to your right will dig through 4+ years of HIStalk to find a company, product, or person that might interest you. E-mail me if you want sponsor information, have interesting news or rumors, or have some other reason to make contact (I read them all).

Monday Morning Update 10/15/07

From CraigD: “Re: Sunquest. As of 10/11/07, Misys Healthcare is now known as Sunquest again. However, they still have the same management that is driving them into the ground. The previous management was a lot better.” The “new Sunquest” is unveiled, as Sunquest Information Systems re-forms as a privately held corporation by Vista Equity Partners, the new private equity owners of the former Misys Healthcare lineup of lab, radiology, and pharmacy systems. The new/old name is a great move that I’ve advocated here previously, writing off the sorry Misys chapter of the company’s history as an unfortunate decision by all involved. Richard Atkin has been named president and CEO, a move I don’t get since he ran the division under Misys. I would have expected (and advocated) new management all around, starting at the top, but I understand the need to keep the customers from getting anxious at the prospect of wholesale change right out of the gate.

From Lauren Graham: “Re: CHIME conference in San Antonio last week. It was my first time attending. I have been impressed at my colleagues’ commitment to their careers and their willingness to share best practices. I had the opportunity to meet Judy Faulkner of Epic and found her unexpectedly down to earth and approachable. I was surprised that there were no vendor exhibits, but having the vendors around at the social functions and meetings was perhaps better because it felt more personable and less like a sales job. There was a lot of chatter about aging baby boomers, with a speaker recommending that we hold on to our older workers because there aren’t as many younger workers to take their places (the youngsters tend to go from job to job and like to be self-employed). A lot of hospitals and health care systems are talking about relaxed Stark laws, but many just don’t know where to start. A number of us are unsure if we should adopt a standard solution or promote multiple alternatives and if we should provide the hosting. Also, no one has a perfect solution for handling physicians who already have EMRs.”

From Steve Forbes: “Re: NextGen. NextGen/Quality Systems all the way up to #5 on Forbes Best Small Businesses list. Look out, Under Armour!” Link. Very nice. I see Advisory Board came in at #46.

From The PACS Designer: “Re: PHRs. Since a PHR is your diary of your health conditions and other important health information such as insurance coverage, allergies, inoculations, and other histories of treatment, it is vital that the record be protected from unauthorized viewers. PHR access will be in the total control of the creator of that record, just like an online bank account is controlled by the depositors. When you want a healthcare provider to know your history, you will enter a ‘Linking ID’ provided by the treatment professional into your PHR for a given time period so you can obtain quality healthcare services. Also, if you have a healthcare advocate, you would want them to have an ID to access your health record. Since you completely control the input of information, you are liable for any discrepancies should something adverse happen to you from not informing the care provider beforehand.”

From hatchet_guy: “Re: the vendor conference you mentioned. Call UPMC and ask about the 2007 code release, where the word is that lawyers are involved. Call Clarian – if ‘Lights On’ was so great or Release 2007 so strong, why did they turn the product off? Call Boston Kid’s ask why they stopped their project. The reason for the ‘strong commitment’ to the 2007 code release is they F’ed it up so bad that they a) are afraid to release anything else, and b) have so many fixes to apply to the code level that it is now a student body right to even get things fixed. It was the right decision, but not for the reasons they are spinning.” All unverified, I add cautiously. I’ve had no reports from any of the hospitals mentioned (despite asking). Since some hospitals are doing OK (or at least say they are), it can’t be all bad. Inga will happily chat with any customer willing to provide a first-person report.

From MSFT Doubter: “Re: Healthvault. Interesting note in the Business Week article about HealthVault and Azyxxi. ‘Peter Neupert, head of head of Microsoft’s Health Solutions Group, figures he can build a business that generates ‘a billion-plus’ in revenue from HealthVault as well as another business that sells software to hospitals.’ Wouldn’t $1 billion make them almost as big as Cerner?” Link. Other than that quote, the article is pretty much a waste (who says ‘file server’ when talking about the Internet, or believes that hospitals are likely to send data to HealthVault?) Cerner is at about $1.5 billion in revenue, so that would make HealthVault a little smaller business if Neupert’s guess is good. I notice all the talk is about ad revenue, which is pretty much what I’ve said here: HealthVault is a Microsoft attempt to get into the sexy ad game like Google and nothing more. This is not a Gates Foundation project to benefit humanity, other than that subset of it holding MSFT shares.

From Steve Stifler: “Re: Google-WebMD. I spoke to a high level source at each firm who would be ‘people familiar with the situation’ if they were being quoted on the record, which they are not. I am told with 100% certainty by both parties, independent of each other, that there is no deal and will be none any time soon. It seems that WBMD and GOOG entered into a search partnership many months ago, at which time GOOG did some DD on WBMD and were unimpressed. Unlike MSFT, WBMD has no new, innovative, or interesting technology that can help GOOG. In fact, it’s just a big portal of content from other people and a brand created in the dot com era. My GOOG contact told me that they felt like they could re-create WBMD’s entire offering in a week and that they already get more traffic via health searches than WBMD. GOOG wants someone with innovative technology and they are likely to go the MSFT route – buy it and add to it. There is no ‘killer app’ at WBMD. Also, my GOOG contact noted that. because of the HLTH ownership issue and all the recent WBMD acqusitions, its a financial mess. Its not going to happen, folks.” HLTH stock rocketed up on huge volume Wednesday, but then backed off. Lots of people are ricocheting the rumor back and forth, which started with a bored stock reporter’s fantasy with nothing new since. Still, the rumor has legs and it Google hates to lose to Microsoft. If there’s any truth to it at all, it will be consummated or not based on WebMD’s asking price per set of eyeballs since Google thinks in terms of Web traffic and stickiness for that kind of site.

From p_anon: “Re: RSS feed for comments. Hook a brother up!” Try this for reading comments posted to HIStalk2.

From Pony Boy: “Re: Healthvision. I’m sure you’ve already heard, but Scott Decker left Healthvision on Friday.”

Epic’s Lucy project steals HealthVault’s thunder in a Wisconsin newspaper story. “Epic also is working on a project called Lucy. For patients with more than one main health care provider, such as someone who is seeing a specialist, Lucy will link up the different health care charts, Rana said. A patient who changes doctors and moves to a non-Epic system will be able to keep his or her electronic medical records and pass them along … Epic’s Lucy will also offer a voluntary health diary that’s open to anyone, even non-Epic users. But the big difference is that it will link back to a health care provider who’s using an Epic system, Rana said. Microsoft’s HealthVault doesn’t do that, at least for now, he said.” Epic is already ahead of everyone else with MyChart, a patient PHR window into information stored on Epic’s systems (which, given Epic’s customer base of the largest IDNs and medical centers, already gives it a huge advantage). Given Epic’s hospital and ambulatory system focus, along with the company’s clinical capabilities, it’s likely that its PHR-related products will be far better than those from Microsoft and Google. For everybody but Epic, the metric is ad sales volume, not patient outcomes.

Sage fires its North American execs. CEO Ron Verni and CFO Jim Eckstaedt are shown the door because the British accounting software company hasn’t sufficiently cracked the US market (sound familiar?) Investors responded by enthusiastically dumping shares.

Is another RHIO/HIE type vendor putting itself on the block? I’m hearing faint rumblings. I don’t know the company, but the supposed acquirer (whose name I do know) is big in physician systems and the deal could supposedly be done within a couple of weeks. If that secret is tearing you up inside, you can always talk to me.

Palisades Medical Centre (NJ) suspends at least 27 employees, including seven nurses, who couldn’t resist peeking at George Clooney’s chart while he was being treated for motorcycle injuries. Clooney was classy, saying he would hope that privacy could be upheld without suspending hospital employees. The 30-day suspension is without pay.

Baird Capital Partners has acquired ED coding and billing vendor MedData and replaced CEO Richard Pugh with a company man.

Cerner’s ProVision imaging workstation gets FDA marketing approval.

Jewish Hospital of Louisville turns its IT department over to Perot in a 10-year deal. A handful of employees will stay with the hospital for strategic planning, another handful who didn’t want to work for Perot were laid off, and the remaining 110 are guaranteed a year before Perot either lays off or transfers an unnamed number of them that have already been deemed excessive.

Bizarre: MyFreeImplants.com has a single focus: “Win a Free Boob Job”, or, in the apparent vernacular used by those providing testimonials, achieving “Hooterville”. The social networking concept is employed (Cleavage 2.0?): women post photos and make themselves available for private contact with “benefactors” who donate to their worthy cause. It’s all noble, you understand: “Please, let us help you to become all that you are capable of. Change your life for the better, one step at a time.” That such a site exists speaks volumes about everything that is both right and wrong in America.

New CCHIT commissioners: Linda Hogan (Pittsburgh Mercy), Rick Ratliff (SureScripts), David Ross (Public Health Informatics Institute).

Aetna CIO Meg McCarthy, once a less lucratively compensated provider-sider (you have to be a middleman to make money in this business), gets profiled.

GE Healthcare’s profits drop slightly in Q3. CEO Jeff Immelt blames the government for exercising fiscal responsibility by capping Medicare imaging payments. Despite that wound-licking, the company manages to scrounge a few pennies together from its $692 million quarterly profit to buy Dynamic Imaging, a vendor of Web-based RIS/PACS.

Health First (FL) will implement the access management suite from SCI Solutions.

E-mail me.

Inga’s Update

First things first. I am pretty sure I would have tried to sneak a peek at George’s records, too. There has to be some sort of HIPAA exemption if the patient is one of the most gorgeous men on earth.

An Allscripts employee sent me a note saying their stock went up, even though the overall market declined. Clearly it was a result of Glen ringing the NASDAQ bell.

And speaking of them, Allscripts announces that 100 physicians in Southern California will begin using their products. The buyer is Lakeside Systems, Inc., one of California’s largest healthcare associations.

HIStalk sponsor Picis announces Abington Memorial Hospital has implemented Picis ED PulseCheck.

Medical transcription provider SPi announces a new Best Shore program that allows clients to choose where their work will be done – the US, offshore, or both. I didn’t see any pricing information on their Web site, but you just know there has to be premium for selecting the US.

E-mail Inga.

News 10/10/07

From Will Weider: “Re: EMR. You mentioned the Marshfield Clinic as a developer of their own EHR. I have blogged about them in the past.” Link.

From Economist: “Re: pricing. I am trying to figure out how pricing for software applications usually works in this industry. There are two issues I am unclear about: Is pricing usually done according to the number of users or in another way? If it is done by users, is it usually done by named/registered users or concurrent/active users? Do vendors offer a set of predefined software packages or do they offer a variety of modules and let you “pick and mix” according to your needs?” I’ve done a lot of contracts and they were almost always based on occupied or licensed beds, although Epic and Cerner started the trend of increasing fees based on volume of lab tests, patient days, etc. (I dislike that a lot because you can’t budget for it and you are paying more for exactly the same product and service, a disincentive to use it more widely). I’ve seen concurrent users listed on occasion, although that’s more common for underlying technologies like database licenses. All vendors I’ve seen offer a long list of applications, for which one can likely negotiate a discount (from the fictional list price) for purchasing multiples of them. The main thing to remember is to look at total cost over an expected life of 7-10 years since implementation services, annual content fees, maintenance fees, and third party licenses quickly eclipse the upfront capital cost.

From Sanka Coffie: “Re: Intel. Intel recently launched a website to help it keep abreast of industry trends. It had used it internally, but decided to open it to the public. My point is, if you click on the Healthcare site, there are no entries. Kind of says it all for leading software technology – zip, nada for healthcare. Just had to share.” Link.

From Cigarettes and Water: “Re: Micromedex. Rumor has it that Thomson Healthcare is looking to sell its Micromedex business unit, which generates approxiately $40 million in earnings on $120 million in revenue. The problem is that it’s not growing significantly and is probably at its most valuable. Thomson continues to organize itself around solutions for preformance management.”

From The Cooler King: “Re: a certain UK practice management company not named Misys. The rumor inside is that the whole company is up for sale this time, but the healthcare division may have a better breakup value to interested parties.”

From Just Asking: “Re: HIT Summit. I am surprised to see your support for HIT Summit. Seems like just another boondoggle for CIOs and vendors at one of the most exclusive hotels around. Sounded like you were going to go?” I’ve been to two conferences like this one and found them worthwhile for executives with broad strategic interests, networking interest, and budget. It’s very much like flying in first class: great for making important contacts in a much more intimate setting than the usual conference, a more relaxing and upscale experience, but not necessarily for everyone. With the HIStalk discount, the registration fee and hotel will run less than $2,000. Not cheap, but not way out of line, plus you could always pick a less expensive hotel. I won’t be there, but at least one reader is going and offered to report back. The speaker lineup is impressive.

From Whitby Bevil Sr.: “Re: WebMD. I heard from a reputable source that Google is in acquisition discussions with WebMD. This would be an interesting counter move to Mr Softie’s HealthVault. It may also explain why Google’s top healthcare person recently left without much explanation.” Wouldn’t surprise me a bit. I’ve heard similar rumblings.

From Josef Grool: “Re: EMRs. Isn’t there a software entrepreneur out there who would fund an X-prize for hospital EMRs, then sell it through a non-profit? The current 12 vendors all have such significant shortcomings that a well-funded team could probably build a much better system without all the baggage. Ambulatory EMR systems are much better than any acute systems.”

Barry Schoenbart, MD, medical director for Reliance Software Systems and an old friend of HIStalk, wrote me about Care Plus Next Generation, the clinical system his company is developing for Henry Ford Health System. It will include a full-featured EMR for both inpatient and outpatient care venues. Modules include EMR/EHR, result delivery, order entry, clinical documentation, physician portal, document imaging and document management, and care coordination and reporting. Community physicians will be able to order labs and rads electronically. User acceptance testing is starting and Ford will go live in May. RelWare will sell the system commercially as RelWare’s OneRecord. Good update.

William Crawford from Children’s Hospital Informatics Program in Boston e-mailed about Dossia, for which CHIP has taken over PHR development. “First, factually: Dossia is neither being developed by, or operated by, the employers. It’s being developed by CHIP, based on the Indivo platform. Indivo is open source and always has been, and it will continue to be so. That’s about as transparent as it gets. Founder company employers have no role in operating the system, either – the only people who will have access to the operational system will be CHIP technical operations staff and selected employees of our hosting partner. Just to make it really clear, further in the article you’ll also see that Colin Evans directly goes on record saying that the employers will never have access to the data. Second, philosophically: I find it very hard to believe that anyone from the Dossia Founders Group would have asked for back door access to employee healthcare data. It doesn’t make sense – the entire purpose of engaging outside partners to create the system was to make absolutely sure employees could trust that nobody would be looking over their shoulders. The goal here is to give millions of employees tools to better navigate the healthcare system and make more informed choices about health and wellness. That’s much, much more valuable than any decision that could be made around a single employee–or any value that could be realized by selling data out the back door. So Dossia won’t be doing either of those things, and CHIP certainly won’t be enabling them to do so. One of the main points of alignment between CHIP and Dossia is that the employers would not have access to the information stored by Dossia. That’s why we call it a Personally Controlled Health Record – we really are letting patients make the decisions about who sees their data. And it’s not an obligatory system, either – nobody has to opt into having a Dossia record.” Thanks for that. While I believe patient privacy is in good hands with CHIP’s development efforts, there will always be that patient suspicion (unfounded or not) that centralizing patient information electronically could be tempting to those who could benefit financially from it. Maybe the result will be that fewer users will sign up, or that the information they record will be incomplete. Reassurance will be important.

My newsletter editorial for Wednesday: “Smoking the CIO-Doctor Peace Pipe: Let Practices Choose Their Own PM/EMR Gift”.

EnovateIT signs a big deal with TriHealth (OH) for 125 wall-mounted articulating arms and 125 point-of-care carts.

Mitem announces Blue Iris eLaborate 8.6, its Web-based hospital orders and results application for physician offices.

TeleTracking announces increases in patient flow software sales and revenue over the past six months.

Seton Family of Hospitals upgrades its emergency messaging system from React Systems.

SAP will buy Business Objects for $6.8 billion, guaranteeing software vendors and customers that Crystal Reports will get even more expensive for producing labels and reports.

North Carolina Healthcare Information and Communications Alliance (NCHICA) gets a HHS contract to develop NHIN interfaces and transaction sets.

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Inga’s Update

Three Georgia nurses are fired for HIPAA violations. Apparently the trio was intrigued by a patient in the SICU who had a knife through his skull. They used their cell phones to take pictures.

Ascension Health, Catholic Health Initiatives (CHI) and Catholic Health East (CHE) have joined together to form CHV II, LP a $200 million VC fund focused on investments in the healthcare industry. This is the second fund venture for Ascension and the first for CHI and CHE. They will target expansion to late stage medical device companies, and healthcare technology and service companies.

Siemens announces that they really do have clients using their EDM and Soarian HIM solutions. If you are going to the AHIMA, you can visit the Siemens booth and talk to some of their real clients. (Did anyone else reading this press release interpret their main message as, “We have clients”? Or maybe I am just turning cynical like Mr. H.)

Set your DVR’s to CNBC! Wednesday morning at 9:30 a.m. ET Allscripts CEO Glen Tullman is presiding over the NASDAQ opening bell.

Eclipsys announces that SingHealth, the largest healthcare provider in Singapore, has selected Sunrise Clinical Manager.


E-mail Inga.

Monday Morning Update 10/8/07

From The PACS Designer: “Re: Oracle RAT. A new feature of Oracle 11g is Oracle Real Application Testing, or O-RAT. If you need to make frequent changes to your database applications, O-RAT makes it easier to identify and quickly fix any problems that may be occurring in the production system. One nice feature allows you to capture the production section that needs repair and bring back to the testing platform for analysis and testing of the changes you made to fix any problems. Also new in O-RAT is an SQL Analyzer to do more with fixing and improving performance of any SQL executions.” 

From Jake Ryan: “Re: HealthVault. Why anyone thinks our industry should connect patients to doctors before we connect doctors to their own data via other doctors and hospitals constantly blows my mind.” That’s where everyone thinks the money is – consumer advertising. Nobody pays doctors extra for demanding the full set of data that they know is available. Nobody pays insurance companies less if they don’t insist on it. Ads have a simpler revenue model – you make money for showing them or getting people to click on them. Whether that turns out to be beneficial to the clicker or clickee doesn’t matter. Until they stop clicking.

From Samantha Baker: “Re: HealthVault. I couldn’t agree more with your Healthvault comments. What strikes me is that technology companies often don’t understand that people have relationships with physicians, not Web sites.” PHRs are a pipe dream until (a) doctors can get paid for delivering care electronically; (b) access to patient-maintained information from the practice’s EMR is seamless; (c) information can be imported into the EMR to become part of the legal medical record; (d) patients and application vendors get serious about making data collection easy and error-proof; and (e) a firewall is created that keeps insurance companies and employers from digging around patient information to use it against them. I’m not even mentioning privacy concerns since those are obvious. The healthcare model is built around your driving to the doctor’s office, even when your needs could be addressed via electronic means. Parallel: there may be a few people who use TurboTax religously and constantly throughout the year and then make a CPA appointment to review their records at tax time, but not many. Plus, CPAs accept what you give them at face value, while doctors insist on observing it for themselves. Like much of the practice of medicine, you won’t change that unless you change medical education.

PHR counterpoint: the worst that can happen is that no one will use them. Surely they don’t cost much to build for a big company like Google or Microsoft. The search engine alone will more than pay the bills, most likely. These companies aren’t tied to healthcare anyway, so why not take a shot and walk away if it flops? Once the site is built, keeping it running even with few users is easy. Maybe enough of those little old ladies who love going to the doctor will keep PHRs with the same fanaticism as scrapbooking, clicking on enough ads to keep advertisers paying. That’s hardly a healthcare revolution, but then again, that’s not what motivates advertisers or Microsoft. And, the spur in medical device connectivity is a good thing.

From Farmer Ted: “Re: ‘I’ll Have What He’s Having’. With such a major investment and one that has the potential to be significantly disruptive and impact patient safety, can you blame people for the approaches that have been taken in purchasing systems?” Not really, especially since the minefields are many. However, hospitals like to think that continually seeking more information will lead to a better decision. There’s only a dozen or fewer clinical systems vendors out there, so it’s not an infinite universe of possibilities (although the one option they often should choose, i.e. not buying anything, is often given the shortest shrift). If a vendor can produce even one hospital that is achieving great clinical or financial results while using its software, then (a) it’s good enough; or (b) software isn’t a critical factor in that outcome anyway. In fact, I’ll postulate that the search process is of far more value in giving a hospital information about itself than about potential vendors. However, that discovery may lead hospitals to believe that identifying the problem, plus simultaneously looking at systems that claim to solve it, means that the problem is nearly solved. Unfortunately, ain’t so, usually for organizational reasons, not technical ones.

Speaking of HealthVault, Bill Gates has an editorial in the Wall Street Journal. It’s grand and eloquent in scope in its observation of human endeavor and frailty, skillfully masking the message that Microsoft is getting sand kicked in its face by Google and everybody else and needs a new advertising platform. It has the obligatory IOM quotes, healthcare crisis boilerplate, fragmented information examples, etc. Bill claims that HealthVault “will undoubtedly improve the quality of medical care and lower cost.” I’m doubting, so prove me wrong in a research study. Or, why not go at risk for a percentage of the savings instead of charging for ad space?

Last on HealthVault: lots of people hate Microsoft. Blue screen of death. Microsoft Bob. Forced upgrades. Browser security holes. Antitrust issues. Internet tollgate. Assume people buy into PHRs on a big scale. Of all the companies offering PHRs, which one would they trust least with their most personal information? Some Ukrainain hater will have it hacked by this time next week, I suspect.

A couple of readers e-mailed me with the names of a few customers of Unibased Systems Architecture. To clarify: I wasn’t doubting that they have customers, but I am saying that I don’t know who those customers are, have never heard USA mentioned in a CIO’s presentation, and haven’t gotten any e-mails requesting or offering information about them. Their site lists three new customers the past year. I talked to them once years again, but we bought from a competitor.

Speaking of USA, they get a mention in the St. Louis newspaper, which unfortunately managed to misspell the company’s name in its headline. It is a weird and unwieldy name, I’ll admit.

Some NHS trusts want to break ranks from Cerner Millennium for mental health applications.

McKesson announces Horizon Homecare Wound Advisor. Says its integrated. Could be since it’s home care, but when you see Horizon, always ask: Were all modules developed internally by the same company? Are the development offices in different cities? Is more than one database required? Can the integrated suite run without an interface engine or HL7 processor? Can the entire app be upgraded in one step and by one team? How many ADT feeds are required? Does every client run all the pieces, and if not, how are they disconnected from the mix? Are multiple copies of any table stored? Does any system in the package have different data rules, i.e. dumbing down configuration data so the most backward system in the chain can understand it? Are user tables maintained in just place? Well, I could go on, but you get the picture.

Eclipsys is having its user group meeting starting Sunday (October 7) in Orlando.

Listening: The Clash, London Calling.

Interesting comment from J.D. Kleinke of Omnimedix, the company that was originally developing the Dossia PHR application for big employers, among them Wal-Mart and Intel. “We don’t believe a system that is developed and operated by employers will be trusted by employees.” Based on that, I’d bet that privacy issues were somehow involved in the parting of ways and eventual lawsuits between Dossia and Omnimedix. Maybe the employer-led Dossia wanted keys to the PHR’s back door?

Tennessee vendor Aionex gets some angel investor money. The company is 12 years old, the product seven, and it’s still trying to get going. Advice: lay off the techie buzzwords unless you think programmers are making purchasing decisions. Example from the first paragraph of the home page: “The APRP core is a relational database and data repository for monitoring and modeling process results.” OK, I give up: what are you selling and why should I care?

You know who Philips should buy? Varian Medical Systems. Just a thought.

I forgot to gloat about the Healthvision acquisition scoop: a reader tipped me off long before the official announcement, meaning you read it here on September 14 instead of October 3.
VA had some VistA disruptions in August, ranging from 15 minutes to nine hours. Interesting, but hardly headline-worthy. I’ve never worked in a hospital that didn’t occasionally have outages like that. There are so many points of failure, especially in a regional deployment, and so little money for redundancy that I’d be surprised at five-nines application availability anywhere other than in the data center. Notice I didn’t pile on Kaiser during their HealthConnect downtime problems last year, which I found unremarkable for an IT environment of their size and scope.

Perot Systems loses its Triad Hospitals IT contracts following that hospital group’s acquisition by Community Health Systems.

Shares in athenahealth keep going up: $39.39 at Friday’s close, up $3.09. Tim Draper, inventor of viral marketing by e-mail, has $156 million worth. That’s not how he made his bundle, though: he was an investor in Hotmail and a bunch of other tech companies, also including Skype, for which eBay paid way too much.

E-mail me.

Inga’s Update

Thank you, XLT is Groovy, for enlightening me on Epic’s document manager status. “Epic doesn’t have a DM solution that works at large customer sites. Almost all of their customers go with one of the big DM vendors & interface the pointers to the documents into the system. It works well. Epic does have “EpicScan,” which can be used for low-volume scanning needs.  But most customers don’t use it – it moves too slowly to meet their needs.” So it does bring up more questions in my mind (would customers prefer a fully integrated offering?) but I won’t go there.

The endless iSOFT saga appears to be ending. Shareholders approve the $411 million takeover bid from IBA Health. The final merger is scheduled for completion October 30th.

I have enjoyed reading all the news and commentary about HealthVault. Obviously quite a few people are like Mr. H and see it as just a bunch of hoopla. But I am a bit of a Pollyanna and I like a few aspects. For example:

• Until Thursday of this week, I bet millions of folks never gave any thought to maintaining their own personal health record electronically. If nothing else, Microsoft was stirred the PHR pot a bit and raised awareness – for good or bad. (That being said, my 70’s+ parents have not called to tell me they are ready to use a PHR, though a friend with a special needs child was pretty excited about the concept.)
• I love the device integration aspect. Makes me want to go out and buy a heart monitor just to see how it all works. (And I am sure Bill Gates and friends were betting there were a lot of folks like me.) I could see using HealthVault for this feature alone.
• It’s free. Well, at least to consumers. And likely to healthcare providers. I think EMR companies would have a hard time charging for a HealthVault “interface.” Instead they may be driven to make products “HealthVault-ready.” Personally I like that aspect, too.

Ok, so I see it may all be a pipe dream and never catch on and there are still a lot of missing links. And I have no idea if HealthVault is the best product (will Google’s be better?) or if one day all consumers will want to want to keep their own PHR (perhaps in the next generation). But, I must thank Microsoft for the announcement because now I have a HIT topic I can discuss with strange men in bars over cocktails.

HHS awards $22.5 million in contracts to nine HIEs participating in trial implementations of the Nationwide Health Information Network. I look forward to reading more about how my tax dollars are being allocated when Mike Leavitt posts commentary on his blog.

Inga Chats with Ed Marx About Soarian

Over the past few months, some less than favorable commentary has been posted about the Siemens Soarian application. A couple of “in the know” Soarian users suggested we talk with CIO Edward Marx of the University Hospital Systems in Cleveland, since UH system runs the Soarian revenue cycle products. Ed was happy to share his thoughts with HIStalk, in part because he “wanted to set the record straight” about what was going on at his facility. Ed has headed off to Texas Health Resources in the DFW area to take over as CIO. We thank Ed for making time between packing to discuss the Soarian project at his outgoing 2,000 bed, seven hospital system (and wish him luck!)

Inga: Can you provide with some background on your relationship with Siemens?

Ed: We have been a partner of Siemens for 20+ years and running classic applications like Invision. We decided that we were ready to install a new revenue cycle application for everyone, hospitals and physicians. We selected Soarian after our selection process in 2002 and we have been in the process of implementing over the last two years. We have two out of seven sites up, and will add five more over the next year and a half. We had purchased hospitals with legacy systems, so we ended up replacing QuadraMed, Invision, and a homegrown system, all for Soarian.

During the selection process, who else did you look at?

We were using IDX on the physicians’ side, so we looked at IDX at the time. I wasn’t actually involved at the time, but Soarian and IDX were the finalists.

Why was Soarian selected?

The fact that it offered a single database, a single application could handle both the physician and acute components, rather than require a lot of interfaces. We wanted a single MPI and single database. No one else could, and maybe still cannot today, make the same claim. One of the key drivers was the architecture. At the time they were the only vendor building a system from the ground up rather than re-packaging older systems.

Has it lived up to expectations?

We have had a long-term relationship with Siemens. We knew that going into a new product wouldn’t be smooth and we went with eyes wide open, and we knew that going in that it would take more time. We knew if we had purchased a more mature product it might take less time. There is no doubt about it has taken longer, but we are getting the product we wanted. Being able to work directly with the vendor in a partnership in the design is worth some of the pain.

Overall, what is the satisfaction level of the users in your organization?

Overall we haven’t done a survey of them, but they are pleased. In some cases, it is replacing paper records – hand-written appointments – and in some replacing mainframes. As with any radical change in applications, there are change management issues. People are use to doing things a certain way and change causes anxiety. They are a couple of people in the organization that are adamantly against changes and they are the ones that are probably posting to HIStalk. What happened when we implemented Oracle eBusiness Suite was similar – we also had big change management issues. It took six months to a year – maybe two years – to understand the value of it. Now people don’t know how they ever did what they did before Oracle. I think it will be the same thing with Soarian and with EHR, when we get there.

Which modules would you say are fully developed versus those that still need work?

You probably need to talk with Liz Novak, the VP directly leading this and has more direct knowledge. But, the scheduling module had some logic issues that have since been corrected. Issues that were causing slow-downs. As we find them through testing or during go-live, they are very responsive to make the corrections.

I assume you communicate with other Soarian users. Are there other happy users?

We have extensive communication with other sites. Most of them wish that implementation went faster. The pipeline that is coming down with Siemens is huge. And that is not just marketing rhetoric – I’ve seen plenty of things to suggest it is accurate. There are other users similar to us that are working through implementations and going live. Everyone wishes it could be three years faster, but that is the nature of products of new products.

What are some of the most exciting recent product announcements?

The thing that brings us the most comfort is that there are more institutions going live and their pipeline is quite large. The more customers using the product, the better the product becomes. It seems the product is finally rolling. There is a certain build up before you get the inertia of an initiative. They have now hit the tipping point, so the future looks very bright. We have been live on two sites for a year and are very pleased with the progress.

What have you heard is on the development agenda?

I struggle to give you specifics, but they do have regular releases that we have helped develop and test. New releases are coming every six months, but I can’t articulate well what they are. They have a published schedule and they are starting to hit their dates. With each release, there are that much more feature/functions.

Everyone agrees that the workflow engine is unsurpassed in healthcare, but that doesn’t seem to result in sales. Do you think users undervalue that aspect of the software or are users not really committed to redesigning processes to be workflow-driven?

I think they have made more sales than people think. I have been privy to this list. My concern was that have they tested enough in terms of volume. We are fairly large, so we pressed them pretty hard to be sure they could handle our volume. I have seen up close and personal their testing processes and was privy to a lot of detail in terms of volume and it is impressive. I think they have hit their tipping point and you will see them more and more of them as they hit the implementations.

What Soarian direction is provided from the Malvern office vs. the Siemens AG executives in Germany? How strategic is Soarian in a big company like Siemens?

Good question. I may not be the best one to answer the question, but from what I can tell, there were a lot of best practices and processes brought over from Europe in terms of design and development and discipline. I think it has now kind of shifted back to Malvern in terms of specific directions.

You said you are implementing Eclipsys for clinical. Why not Soarian?

We looked at Siemens. We looked through a robust process at a number of vendors. We tried to determine, “Is there an integrated solution out there today that is rich enough to displace our Soarian as revenue cycle and rich enough to replace Eclipsys?” I am really into integrated solutions as are some other executives. We looked at Epic and IDX, and after a thorough analysis with heavy reliance on our customer base, we didn’t think Siemens was strong enough on clinicals to replace Eclipsys and Eclipsys wasn’t strong enough on the revenue cycle, so we went with the best-of-breed approach. Vendors are getting closer to it, but a year and half ago, we didn’t think anyone could do it real well.

With Eclipsys, our first live will be on the ED Tracking module in December. Our hospitals go up with orders in late 2008. It is going very well, but the project is young. It is a four-year process and we are still in year one.

Anything additional you want to add?

Well, you are getting this from me. A lot of people have written in that Soarian is not ready, there is no one live. That is myth that needed to be dispelled. The other thing is, they do have a very active pipeline and we share development notes. The volume is pretty impressive from new customers. It is true that not everyone is satisfied, but no one ever is carte blanche. There are always change management issues, but at the end of the day, you have to work with your customers and ensure you are doing the right thing and the majority will come to find the benefits of the new applications. But, you won’t ever satisfy everyone.

E-mail Inga.

News 10/5/07

From Joe Bob Priddy: “Re: Battery Ventures/Quovadx acquiring Healthvision. So far, they have purchased two questionable assets under the theory that if you tie two boat anchors together, maybe they’ll float. Maybe three or four anchors is the key.” I love succinct cynicism about the company’s acquisition plans. I was offered an interview with Quovadx’s CEO, so I’ll stay neutral like a journalist until I hear first-hand.

From Gunga Din: “Re: the former El Camino CEO. He was fired from Legacy Health System after a tenure of 18 months.”

From O.W. Shaddock: “Re: physicians on planes. I got the dreaded tap on the shoulder on a recent long flight, where I stabilized a patient who was later met by an ambulance on the tarmac. The airline’s response was tremendous: food and gift packets for my family, moved us to business class, gave us a $250 certificate for the in-flight catalog, let us off the plane first, and sent three bottles of wine with a thank you note. I don’t sent a bill to the state when I’m first on the scene of an accident, but this sense of entitlement has become more prevalent in the physician community at a time when overall volunteerism and social responsiblity is on the rise. On the other hand, treatment was delayed 40 minutes waiting for the airline’s on-call physician to give permission to open a surprisingly skimpy drug box, I was unable to speak to him directly because passengers aren’t allowed in the cockpit, and many cars today come equipped with a better first aid kit than a plane holding 500+ passengers – no otoscope or ophthalmoscope.” I’m doing everything I can… and stop calling me Shirley. A little doctor-plane humor for you.

From Duude: “Re: your editorial, ‘I’ll Have What He’s Having’. I discussed this with my aunt, who used to be in the industry. She asked how the industry was going, whether hospitals are doing a better job in system selection, etc. I had the misfortune of telling her that health systems still follow the pack, still rely on vendor products more through past associations rather than a comprehensive and unbiased system selection process, C-level backroom deals, pissy-pant ‘not feeling current vendor love’ feelings, etc. It was interesting to see her reaction when she realized nothing has changed. We all know that C-level people from the more controversial system selections read HIStalk. I dare them (Kaiser, Stanford, etc.) to refute me. Explain your system selection criteria and let us believe that it really didn’t have to do with ‘I know Neal’ or ‘the system next door is using Vendor Y, so we need to also.’”

I heard from Lynn Vogel, CIO of MD Anderson, when I mentioned their EMR development work. He tells me that the redesign of their ClinicStation EMR suite is going great. It’s now off VB6 and fully SOA and .NET driven, with up to 4,000 service calls a second (!). Interestingly, MDA is following a vendor-like quarterly release schedule, with a faculty committee overseeing the agenda. Lynn also says that SOA is letting them link the EMR to their research software, even though much of that is open source. He also mentions that the CIOs of four big hospital development shops will speak at AMIA in Chicago: Lynn, John Glaser of Partners, Bill Stead of Vanderbilt, and Justin Starren from Marshfield Clinic. I’ve argued previously that hospitals are too reluctant to do their own development (or contract it out), so that’s an interesting topic (how can you excel competitively when you’re using the same off-the-rack systems as everyone else, at least if you really believe that IT is strategic?)

Microsoft is the star of the day for introducing its HealthVault PHR and health search engine tweaks. The HealthVault Search is OK and has a scrapbook feature to save stuff you find, although the results are already peppered with ads (if you have medical issues with a certain male body part, the ‘sponsored sites’ can help you with just one claimed outcome). I still think PHRs are a waste of time since patients won’t keep them and doctors won’t really use them (is it illogical to keep a Web-based record that you can talk to your doctor about only by making a weeks-ahead appointment and sitting in front of him or her?) The Connection Center is a good idea, assuming it works (plug and play medical devices, anyone?) The need to have Windows Live ID, however, will kill what little interest there is. I used to curse emotionally and loudly about Passport and Wallet, previous (and also bad) attempts to lock users into some sort of mindless and proprietary Microsoft loyalty. My reaction to all the HealthVault hoopla: it’s like watching a once-vibrant and edgy man turn gradually into a doddering senior citizen that the whippersnappers make fun of without his catching on. I’m just not finding Microsoft to be all that relevant to what I want to do any more, either on my PC or on the Web. HealthVault won’t change my mind. Hotshot companies always want to profit from healthcare without getting into the ugly trenches of care delivery, contracting, procurement, and labor management, cherry-picking the fun consumer stuff and building a business model on advertising.

Speaking of HealthVault, you may have noticed that its PHR isn’t really that at all, it’s just a document repository. A later announcement today may have explained that: CapMed will create an “In Case of Emergency” (ICE) PHR for HealthVault. icePHR will provide users with a custom URL that emergency providers can securely access. A demo is on the site. It seems to hold basic contact, condition, and allergy info. They sell it for $9.95 a year. It’s maybe enough to help a paramedic, that is, if they have an Internet-connected laptop to use while you’re convulsing on the floor, if you’re coherent enough to tell them about it, and if you’ve kept it up to date (like a piece of paper strapped into a MedicAlert tube, in other words). Maybe I’m just being curmudgeonly, but this looks like a solution in search of a problem. I can’t imagine either patients or doctors taking PHRs seriously enough to trust for making treatment decisions.

Listening to now: The Apparitions. Recommended by a reader. Sounds good, kind of Frank Black meets The Magic Numbers. Also, the best album in history: Bowie’s Ziggy Stardust. I’m desk-drumming.

A milestone for eScription: the company’s product now handles over a billion lines of transcription a year. They’re at AHIMA in Philadelphia next week, booth 225 if you’re inclined to drop by and say hello. If you meet Paul Egerman and don’t leave happy, I’ll reimburse you for your footstep mileage.

Speaking of AHIMA, it gets a $10 million CMS contract to evaluate the possible changeover from ICD-9 to ICD-10.

Wow, am I ever humbled by Scott Shreeve’s writeup in honor of HIStalk’s soon-to-be millionth visitor. My version of blogging is lonely and free of feedback (other than e-mail), so it’s sure nice to hear it mentioned as though it’s something real, not just the empty screen in an empty room that I see from this end. I’m not emotional, but it choked me up a little after I got over being embarrassed by the attention. Right back at you, Scott.

Cerner has their big Health Conference cranking up this weekend, with 400 education sessions led by Cerner customers. What’s cool: chief marketing officer Don Trigg is hooking me up with some attendees on a live call Monday evening for a report. I’ve never attended, but colleagues who’ve attended in previous years speak highly of it. I’ll have to think of insightful questions to pose to them.

Lightning round housekeeping stuff that I always forget: use Search to your right to zip through four years’ of HIStalk, sign up also to your right for instant E-mail updates (at the top) or the Brev+IT newsletter (below that). E-mail me for a sponsor packet. Feel free to e-mail me otherwise, although I confess I’m absolutely buried in jobs (day and other) and can’t always reply. And no, I won’t send you a picture of Inga (ask her yourself).

Unibased Systems Architecture brags on its KLAS surgery system scores. I honestly don’t know a single hospital that uses it, even though it’s perpetually up there. I’m taking away points for using the word “space” four times in a short press release. I can’t help but think of sleazy, dot-com salespeople when someone lobs out a “space” instead of “market”, as in “I’m in the dogfood space” or “I specialize in the porn space”.

Carilion uses software from Scalent Systems to roll out Citrix boxes for its Epic implementation. “They’re allowing you to re-provision a virtual server very quickly — within five minutes.”

Who knew Glen Tullman’s big brother is a CEO, too? Both are on the agenda of a Chicago business event. Hope Howard doesn’t embarrass Glen on stage by holding him down and giving him noogies.

Mediware adds to its stack of Nasdaq notifications, but says this one doesn’t threaten delisting.

E-mail me.

Inga’s Update

Nuance Communications, Inc. acquires Commissure. Nuance provides speech and imaging solutions (they are the ones that bought Dictaphone awhile back). Commissure provides speech-enabled radiology workflow optimization and data analysis solutions. Also this week, Nuance announced a new president of their Enterprise Division, Wes Hayden, who had been president and CEO of Alcatel-Lucent’s Genesys Telecommunications Laboratories unit.

Advocate Home Health Services, the home care and hospice division of Advocate Health Care, selects Misys Homecare for their 250 home health associations and 225 support employees in the Chicago area. It is interesting to me that, despite all the turbulence among the physician and hospital divisions, the home care group has kept such a low profile.
McKesson announces a new Web-based BI tool for health information management departments.

Since joining HIStalk I have come to the realization that there is an award for everything. (Guess it is kind of like all the kids on all the soccer teams getting trophies.) McKesson and Kaiser Permanente are two of nine organizations receiving the Electronic Product Environmental Assessment Tool (EPEAT) Green Electronics Champion awards. The winners have moved to EPEAT-certified equipment, which is more energy efficient. Between McKesson and KP, the energy savings is enough to power about 5000 homes per year. (Which actually is pretty impressive.)

Hyland Software will provide a document management solution to integrate with Epic EMR at Texas Children’s Hospitals and clinics. Maybe this is a silly question but doesn’t Epic have a DM system as part of their offering?

E-mail Inga.

Microsoft To Announce HealthVault PHR

Microsoft will announce this morning its HealthVault personal health record. From the site’s beta page, the service will also include a search engine and device drivers that will allow uploading information from home monitoring equipment such as blood glucose and blood pressure monitors.

Quovadx Acquires Healthvision

Integration vendor Quovadx announced this morning that it has acquired health information exchange vendor Healthvision of Irving, TX. Quovadx CEO Russell Fleischer says the company will make further acquisitions, saying “We anticipate this transaction will be the first of many.”

News 10/3/07

From Seth Maxwell: “Re: El Camino Hospital. This discussion triggered by a routine board seat newspaper story is full of venom.” Wow – anonymous accusations of board corruption, conflict of interest, and substandard care, some of which involve IT. A compelling read, although as fiction and for entertainment purposes only since nothing is substantiated.

From The PACS Designer: “Re: Total Recall. Another new feature of Oracle Database 11g is Total Recall(TR). This feature allows users to view queries for specified time periods, which will speed data analysis and reduce the need to write custom programs to retrieve the data to be analyzed by database users. TR also aids information lifecycle management by highlighting data that can be compressed due to its age and lack of inquiry activity. Still another added feature is Flashback data archive that permits change tracking to improve retrieval times.”

In response to my “who’s developing an EMR” question, Dr. Quiz says Henry Ford Medical System is. p_anon says ditto for MD Anderson. More information, please.

My newsletter editorial this week: “I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming.” Shell out a few measly bucks and you’ll get a big old weekly load of me at my best plus a great newsletter besides.

Microsoft and Allscripts are making some kind of announcement Wednesday morning.

This week’s Brev+IT. Get it hot off the press in your e-mail inbox next time by signing up here.

InfoLogix, the mobility and RFID company that just started trading on Nasdaq, acquires consulting firm Healthcare Informatics Associates (WA) for $16.5 million.

Microsoft is offering Office Live Workspace, its Office-extending answer to Google Docs. TechCrunch isn’t impressed: “Microsoft has failed to understand the real power of Google Docs – easy, no hassle document creation, collaboration and access from the browser. And it will take them another two years of fidgeting before they really get scared and react properly. Microsoft is falling into the classic trap of failing to realize the disruptive nature of a new competitive technology, instead focusing on the massive revenues it generates from their aging Office suite.”

Hot conference. November 5-6. Beverly Hills. Harris, Sands, Holmquest, Kennedy, Marchibroda, Wade, Miller, Bush, Tullman, Eckert, and other industry leaders. Former CEO attendee comment: “The most useful conference I have attended in a long time. The rich mix of perspectives and experience in Healthcare IT made for the best of conferences.” Discount code HISTALK2020 will get you a $750 registration rate because I’m a “media partner”, which got HIStalk mentioned in a press release. I’ll have a report from there, I think.

Sounds like a good read: How Doctors Think.

GE Healthcare, taking heat in India for pushing sales of ultrasound machines for illegally (in that country) determining fetal gender, says it will listen to suggestions. Indian culture prefers breadwinning sons to dowry-requiring daughters, which has led to the selective abortion of millions of female fetuses.

Siemens Medical Solutions signs a joint venture deal with a 40-employee Japanese hospital EMR vendor, hoping to get a piece of the clinical systems action over there. Says the company has 30 hospital customers, which seems like a heavy support load for 40 employees.

Henry Schein continues its tear of software acquisitions, this time picking up Software of Excellence International, a New Zealand dental software vendor.

A senator urges the VA and DoD to speed up integration of their respective EMR systems, not scheduled to be finished until 2015.

Merge Healthcare announces its April user group meeting. It will be held in a Las Vegas casino, reminding attendees of a reasonable alternative to buying Merge shares that at least offers free drinks while watching your bankroll disappear.

E-mail me.

Inga’s Update

Félicitations to dbMotion for being selected to provide an interoperability platform to extend the Franche-Comté regional health information exchange.

Iron Mountain, the information storage and protection giant, acquires RMS Services, a $27 million records management company that provides outsourced file room solutions for hospitals. Terms of the deal were not disclosed.

Eclipsys Corporation announces the appointment of Victoria Bradley as the company’s Chief Nursing Informatics Officer. Bradley is an RN, DNP, and a HIMSS fellow, and the current vice chair for HIMSS. She most recently has been director of patient information for the University of Kentucky.

Thanks to Polly, obviously a baseball purist, who pointed out that the thing with the baseball jerseys/team names in not universally true. So, I restate my comment to say “traditionally” this is what they do. And I remain amazed that it took me until the ripe old age of 29 to figure that out.

Monday Morning Update 10/1/07

From EMRNurse: “Re: Epic. Reporting from the Emergency Nurses Association conference in Salt Lake City. Lots of IT vendors, most of the big ones that have ED or Health System wide products. One seems to be missing – Epic. There is also a group forming to write a best practices document on ED applications. See the ENA technology listserv for details in the next few weeks. It can be found at ENA.org.”

From Phillip Elliott: “Re: tamper-proof prescriptions. I disagree that the tamper-proof paper script mandate is anti-EMR. Making paper harder to work with should drive people to e-prescribe, no?”

From Mike Bossy: “Re: Siemens. Bobby Orr wonders about Siemens’ focus with MS4, Soarian, and INVISION. What about their relationship with NextGen? Is NextGen their partner du jour until they toss them aside when their EMR is finally ready (or they think it is ready)? Where does Soarian Clinicals end and NextGen EMR start for Siemens customers?”

From The PACS Designer: “Re: iGUARD. iGuard keeps you updated on the latest findings on drug interactions and their side effects along with any new safety alerts. There’s a live webcast October 4th on this subject.” I tried it and was less than impressed. You enter your list of drugs and then wait for an e-mail back on each one, but most of mine said to wait several days for a response. All I could figure out that it does is flag a “risk rating” once you finally get the e-mail, but I’m not sure exactly what benefit that offers. Ask your pharmacist, look up your drug on any of thousands of patient information sites, buy a drug reference book — all provide more actionable information. I don’t see the point of it at all, but that’s just my opinion.

From HITman: “Re: HIPAA. What Ivinson Memorial Hospital is doing is right on track with HIPAA. Employees, when it comes to their own medical records, are no different than any other patient under HIPAA. They must follow the same policies and procedures to request access to their records. The reasoning that they have a computer password or the key to the file room doesn’t make them exempt from HIPAA. Covered entities must protect PHI. They must treat every record the same and every patient the same. Accessing records outside the scope of the minimum necessary or the need to know the information in order to perform job duties is not allowed under HIPAA. Kudos to IMH for sticking to their guns and HIPAA!”

From Philip Rivers: “Re: Ted Borris. Ted came to QuadraMed with CPR. We are excited to have him.”

John has a summary of this week’s AHRQ meeting. Nuggets: research hasn’t proven that healthcare IT improves quality, NHIN is a pipe dream, PHR privacy is getting no attention, and AHRQ-sponsored studies show that e-prescribing doesn’t reduce adverse drug events. I’m not surprised since AHRQ’s HIT studies are usually inconclusive at best. Could it be because it’s the user and not the system that drives the results, especially when looking at an unrelated marketbasket of healthcare organizations as though it were a population-based healthcare study? IT, if deployed wisely with process change, can sometimes make good organizations better. That’s it. Anyone who expects more is being naive. It isn’t what you have, but how you use it, a concept that somehow seems lost in the pre-purchase optimism of hospitals convinced that their carefully aimed checkbook can painlessly cure all organizational ills.

Scott Shreeve opines on athenahealth’s IPO. I like reading his stuff because he’s so energetic and positive. It’s like the standard war movie scene where the wisecracking fresh recruits are marching excitedly off to battle and pass a returning group of battle-weary veterans whose gaunt faces show the horrors of war they’ve witnessed and possibly committed. I realize I’m in that latter group.

Advice from a BI consultant to providers: “Stop thinking like a healthcare company. Providers are notorious for making known vendors and established consultants their trusted advisors. Instead, they should think like retailers. ‘Cerner and McKesson don’t have all the answers,’ one HMO administrator confided to me recently, as if it were a secret. ‘What we’d really like to know is what McDonald’s and Target are doing.'”

Thoughts on the healthcare IT vertical market from the perspective of Microsoft channel partners: “Moreover, some larger hospitals are hiring partners to build their EMR applications from scratch. Once you factor in annual maintenance fees, Velu says, some packaged EMR products can actually cost more over their lifetimes than handmade systems do … Hospitals, for example, tend to be wary of risk. ‘They’re followers, not leaders’ … Doctors can be tough customers too. ‘They’re notoriously cheap’, says Summers.” I don’t know of any hospitals building EMR applications from scratch. If you do, let me know, because I’d be interested to learn more.

A hospital CFO blames its new Dairyland system for not getting bills out on time. From the article: “The hospital has had many problems getting its issues solved with the software company.” Somehow I doubt it’s all Dairyland’s fault since they’ve installed quite a few systems in their time, but every patient accounting implementation starts out rough.

Strange: a UK government official was late for a hospital construction group picture, so his image was Photoshopped in (not all that skillfully, judging from the result). The kicker: he’d just scolded the press for faking footage.

The Australian Medical Association wants airlines to pay doctors who treat fellow passengers or upgrade physician passengers upfront for being “on call”. Once doctor was refused an upgrade for helping vomiting fellow passengers, so she sent the airline a bill.

A big UK hospital will use Sentillion for single sign-on and context management.

Thanks to these sponsor supporters of HIStalk. Please click their ads to your left and consider their offerings. I admire their bravery in convincing the beancounters to send money off to some anonymous blogger. Anyway, these vendors support HIStalk, so I appreciate your support of them in return.

Design Clinicals, LLC
EHRConsultant
EnovateIT
eScription
Hayes Management Consulting
Healthcare Growth Partners
Healthia Consulting
Inside Healthcare Computing
Intellect Resources
InterSystems
John Muir Health
Lucida Healthcare IT Group
Medicity
MedMatica Consulting Associates
Noteworthy Medical Systems
Novo Innovations
Picis
Premise
Pring|Pierce Executive Search
R. Gaines Baty Associates
SCI Solutions
Sentillion
SolCom
Stratus Technologies
The White Stone Group, Inc.

Inga’s Update

Sue Ellen Mischke: Ever noticed there are two HMAs and they couldn’t be more different except their names are exactly the same? Health Management Associates, the hospital chain. For-profit to the nth degree. Then, Health Management Associates (www.healthmanagement.com) the consulting firm, which specializes in public hospitals, public health departments, and Medicaid agencies. They couldn’t pick customers with less money if they tried. Actually, I never quite put that together, but that is a great observation. I’m learning that I am not always great at observing little details. Like I just found out yesterday that when a major league baseball team plays at home, their jerseys say the team name (e.g., Yankees), but, when they are away, the jerseys say the name of their city. Who knew?

The market for physician financial information systems is expected to grow from $3.5 billion in 2006 to an anticipated $6.22 billion by 2013. This according to a Research and Markets study.

Susquehanna Health, the first facility to go live on both Soarian Clinicals and Financials, has signed on with Siemens for additional technology and service solutions. The Williamsport, PA-based health system plans a “facility revamp” project to be completed over the next five years.

E-mail Inga.

News 9/28/07

From Bobby Orr: “Re: Siemens. There were some positive postings about the old MedSeries 4 a week or so ago. If they are now developing MS4 again, along with Soarian and Novius, and supporting their huge Invision base, doesn’t that make them a little bit unfocused? Where is the R&D really going for the future? Is anyone else confused by what they are doing?”

From Brad Majors: “Re: tamper-proof prescriptions. How’s this for punishing EMR users? New York mandated ‘official’ prescriptions two years ago, giving hospitals using EMRs two options: use double-tray, secure printers, or put ‘official’ state stickers on the printed prescriptions. Hospitals mostly went with the sticker option to avoid replacing printers. CMS regulations go into effect October 1 and those stickers won’t be available until the end of October or in November. How could they not have considered hospitals with EMRs?” The Senate stepped in at the last minute to delay implementation for six months. Stickers on paper prescriptions? Only in healthcare. We might as well drip wax to seal parchment scrolls.

From Janet Weiss: “Re: KLAS report on nursing adoption. The lead clinical system vendors had pathetic scores, with the highest score 23.3 out of a possible 40. EMRs pretty much suck for nurses. All that rush to market and to re-create the paper chart while meeting Wall Street numbers. Well, this is what we get.” Someone sent me a copy of GE Healthcare’s internal response to the KLAS report, in which the company seems collectively embarrassed for the whole industry: “None of the vendors evaluated performed above the level of a ‘D’ grade. The overall results of the vendor scores speak to the fact that as an industry we are not sufficiently focused on how IT supports the nurses’ work in delivering patient care. No vendor should be pleased with the results.” Kudos to KLAS for doing the study and GE for coming clean, even thought it only bought the problems along with IDX. Now would any of GE’s nursing system competitors care to take the same level of public responsibility by admitting that they’ve done a lousy job in meeting the needs of healthcare’s largest and arguably most important constituency? On the other hand, it might not have mattered: in most places I’ve worked, nurses were frequently asked for input on software and project plans, but were invariably overrruled by a CIO who could not accept the fact that collective user wisdom might exceed their own. I honestly can’t recall even once when nursing’s choice ended up being purchased, always for some CIO-friendly reason like hardware platform or resume-building cachet.

Oldie but goodie: Neal Patterson on David Brailer, circa November 2005: “He wants to create new entities without true business models … That’s not sustainable … His model [is that of] Beltway bandits – a group of people who live off government grants. He’s aligned himself with the grant babies.” Could he have been any more correct, or any ballsier saying something as outrageous as that in the RHIO hand-holding frenzy two years ago?

More good Cliff and Neal quotes in IBD, although one isn’t true: Neal claims the last time the word ’employee’ was used at Cerner was when he met with pharmaceutical bigwig Ewing Kauffman, who called them ‘associates’. Only if that meeting came after the infamous “tick tock” e-mail, in which Neal used it repeatedly and sarcastically (and capitalized for extra effect).

Heard: Ted Borris, assistant general counsel of Misys Healthcare, has left the company.

Listening: new H.I.M and Entwine. Both from Finland, coincidentally.

DTE Consulting (stands for Down to Earth), started in 2005 by former Lourdes Hospital (KY) CIO Gary Wood, will work with Optio on forms projects.

The voting public, not surprisingly, isn’t really all that interested in healthcare IT. Mitt Romney’s domestic policy director was honest: “I think it’s fair to say that’s not the sexiest issue in the world.” Do what vendors do: bring on the booth babes!

Johns Hopkins will install TeraMedica‘s Evercore clinical content manager.

This doesn’t sound right: looking at your own medical records is a HIPAA violation? This hospital is putting the fear of God into employees, using Meditech’s HIPAA auditing capabilities to scare them into confessing for looking at their own records online. Sounds like a compliance officer on a power trip.

An Indianapolis in-store retail clinic chain backed by Cardinal Health is kaput. Corner Care locked the doors and left creditors unpaid.

New York’s state health department offers $106 million in grants for RHIO-type projects. I’ll defer to Neal on that one.

The University of North Carolina’s Institute of Pharmacogenomics and Individualized Therapy implements a genotyping analysis system from InforSense. Cool: it analyzes information from DNA analyses, EMRs, and other databases to individualize drug therapy. How it works otherwise: the drug company SWAGs a dose that seems to work when given to a bunch of patients, then hopes no one dies when lots more people start swallowing it after free-lunch docs start cranking out the scripts. Now you know why progressive health systems are working to integrate genomic information into their clinical data repositories (and why the next step will be to use it for clinical decision support). See if this doesn’t sound like a clinical system.

My editorial this week over at the newsletter: “Lay Your Hands on the TV to Be Healed: The Emergence of the Superstar Remote Physician.” I may not be the most insightful editorialist, but I bet I’m the only one working a Suzanne Somers reference into a healthcare IT paper.

Lucida Healthcare IT rolls out a new Web site, which includes an Express Application for consultants looking for opportunities and a Resource Request Form for hospitals that need resources.

PSS World Medical, which picked up 4.6% of athenahealth pre-IPO, sees its investment go from $22.5 million in July to $52.2 million two months later. The market cap of athenahealth: about $1 billion, a little less than Allscripts and Eclipsys. Sweet.

E-mail. I’ll read it, but the rest depends on what you have to say.

Inga’s Update

This article didn’t surprise me too much. Few women hold high academic positions at the top science and engineering research universities. And, women have more advancement barriers than men in the corporate world. The chancellor of UC Berkeley notes that this puts the US at a competitive disadvantage worldwide. Discrimination, lack of female role models, and lack of corporate champions were some of the reasons cited. Just this week I happened to be looking at the web sites of a couple of the major computer vendors – one had no women executives (14 men) and the other had just two women out of the 16 execs. I doubt it is because women aren’t interested in the jobs.

Mr. H listening to Megan McCauley? I have shoes that look older than her. Try some Paolo Nutini. He may not be much older than Megan, but he sure looks adorable. Something for the ladies to enjoy while working to take over corporate America.

Bassett Healthcare in Cooperstown, NY selects McKesson for additional products for its four hospitals and 23 community health centers. Bassett is already using Horizon Patient Folder and Medical Imaging solutions. The latest contract is for CPOE and clinical decision support, bar-code medication administration and a Web-based business intelligence tool.

GE Financial Services and the Healthcare Financial Management Association (HFMA) release a study suggesting that hospitals will make themselves more competitive if they make strategic investments in technology. Furthermore, hospitals shouldn’t wait around for policy changes or public or private funding for projects such as EHR. Don’t you just know that GE Financial was dying to add something in the press release saying how much they would love you to borrow money from them to finance all those technology projects?

Surescripts announces a Prescriber Vendor Advisory Council made up of 10 EMR/eRx vendor executives. Their mission is to advise SureScripts on programs designed to increase the adoption and use of e-prescribing.

Health Management Associates (HMA) has contracted with NextGen for the purchase of software licenses for EMR and enterprise practice management. This is a second phase purchase of the NextGen products for HMA, which owns and operate 59 hospitals and medical centers. Earlier this month we mentioned that a class action lawsuit had been filed against HMA, charging it with insider trading.

MedComSoft announces year-end financials through June 30th. Revenues went up 59% over the previous year, expenses grew 27%, and their net loss increased by 18% ($4.5 million.)

From the Archives of Internal Medicine: a new study by the RAND questions the value of preventative health exams. It doesn’t say stop going to the doctor – it just suggests we can’t assume the value outweighs the costs for every patient.

Here are IBM’s predictions for the top healthcare industry trends over the next five to 10 years:

• Secure sharing of patient data with interoperability
• Fully-informed diagnosis (shared between all care-givers while preserving patient privacy)
• Speeding drugs to market
• Stemming the spread of pandemics

And of course IBM has announced all sorts of radical innovations that will address the changing landscape.

E-mail Inga.

News 9/26/07

From John Stryker: “Re: Wal-Mart. Any speculation on who Wal-mart will choose as a vendor? I hear that they are down to three and plan to decide this week.” Maybe a Chinese software firm willing to sell systems for $200 each? Actually, I have no idea. If you do, spill. I bet Eric Fishman knows since he dropped hints when I asked him about retailers and the new wave of vendors.

From Desert HISer: “Re: QuadraMed. QuadraMed’s long-time customer, Sun Health in Phoenix, may be at risk with the recent announcement that Banner Health would be acquiring  them. In an article in the AZ Republic, Banner Health was quoted that IT upgrades would be a high priority for Sun Health under Banner’s ownership and Banner is not a QuadraMed customer.”

From PTSD: “Re: CE. Illinois passed a new Nurse Practice Act requiring professional nurses to have CE courses to maintain their license. Almost half of the states out there do not require nurses to take CE to maintain their license.” Surprising. I assumed all states required CE.

Vince Ciotti checked in to drop some kudos about two small but innovative clinical systems vendors: VisualMED and IntraNexus. On VisualMED, Vince found their system functional, robust for nursing documentation, and designed by a great MD, Art Gelston. I’ve seen their system and have met Art and agree on both counts. Vince mentions that one hospital is using VisualMED as a clinical front-end to Meditech and it was apparently designed to work that way for any other system. I interviewed CEO Gerard Dab last year. I know less (nothing, actually) about IntraNexus, the keepers of the old SMS Allegra system, but the company is introducing a new system called Sapphire. There are few clinical systems to choose from and fewer still that don’t cost gazillions, so give these a look if you’re so inclined.

While I’m talking about Vince, I’ll give him a plug: H.I.S. Professionals will be having its “Mini-HIMSS” in Chicago on October 3-4. He invited Inga to cover it for HIStalk, but I don’t think she’ll be able to go.

Listening to now: Megan McCauley.

Found: Kim Pederson, former Excellian VP at Allina. I wanted to see what she’s up to after Allina won the Davies Award for the Epic implementation she led. She left Allina in June (right after I interviewed her) and has hung out a consulting shingle as KP Healthcare Consultants, she told me in an e-mail. On the Davies win: “I’m thrilled about the Davies Award. I had a great team that gave it their all and they deserve the recognition. I couldn’t be more pleased.” On her new business: “I’m focusing in healthcare. My two big experience areas are large scale implementations and revenue cycle. The work I’m doing to date is around project assessment & improvement, strategy, planning and budgets, executive level coaching, project governance, risk management, and scope management. I’m looking to help organizations at the start of their implementations get set up to succeed and to go to troubled implementations to help get them back on the right track.” She put in Epic in a 11-hospital, 350-employee, $250 million program and won the Davies doing it, so you might want to contact her if your project needs help.

Amazing: Microsoft wants to buy 5% of Facebook for $500 million, thereby valuing the three-year-old, teen-heavy social networking site at $10 billion. The founder and CEO is 23. Too bad we’re wasting our time working on systems that save lives.

The folks at eScription tell me they’ve earned their first speech recognition patent. Their AutoScript background speech recognition uses “adaptive playback speed” to intelligently adjust audio speed based on the transcriptionist’s editing proficiency, their efficiency with that clinician, and their preference for playback speed. It was developed under code name “The Lucy Chocolate Factory”, referring to the Lucy episode where she’s unable to keep up with the assembly line. User quote about the system’s ability to learn the preferences of transcriptionists: “The speed increments are slowly introduced so you are not even aware of them until you notice your gain in productivity.” Nice.

Frank Pecaitis and Medsphere have parted ways, I hear. He’s working for GE Healthcare as GM/VP of Sales.

In the UK, a newspaper runs some examples of NHS errors. One of those listed: “A further incident involved a software company failing to activate a neonatal screening system, leading to a series of false negative results.”

Confirmed: Epic will start work on a Web transition shortly, but has yet to choose a development tool. Their previous switch from character-based to GUI wasn’t too smooth, I’m told (hearing the words “hyperspace transition” apparently causes early customers to seize involuntarily), so they’re taking it slow.

QuadraMed closed its Misys CPR acquisition yesterday, so that’s probably why some San Bernardino CPR staff were let go.

Stock of RFID vendor InfoLogix began trading on Nasdaq Monday. Market cap is $91 million, not bad.

Duplicate patient records caused a Nightingale Informatix health department system to delay some test results in Nova Scotia.

Cardinal Health CEO Kerry Clark will replace founder Robert Walter as chairman. A painful tidbit in the announcement, since I owned CAH stock in the 1980s: “An investment of $10,000 in Cardinal Health stock at the time of its public offering in 1983 would be worth $8.2 million in 2007, an appreciation of more than 80,000 percent.”

Inga’s Update

I heard Epic invited 3500 of their closest friends to an open house to tour the new facility. Since I didn’t make the guest list, I was wondering if any readers were invited and if they cared to share their impressions.

And speaking of Epic, I was amused by a blog I came across called, The Rantings of an Angry Security Kitteh. (I know “kitteh” is some sort of urban lingo, but I don’t get it.) Anyway, the writer is apparently an Epic employee who sat in on some of the recent user group meetings and was less than impressed with one of the speakers.

Mr. H suggested we might want to “wangle” an interview from Isacc Kohane of Children’s Hospital Informatics Program of Boston. This is the organization that is taking over development of the personal health record program for Dossia, after Omnimedix and Dossia split sheets. I asked “Zak” Kohane for his impressions, to which he commented: “Many years ago, when I was single and dating, I found that it was not a good idea early on in a relationship to probe too deeply into prior relationships. Also, even I knew enough to not ask her why she had chosen me. I might not like the answer.” Obviously this does not give us any more insights into the issue, but it sure makes me wish I had dated Zak back in the day.

A study by the Center for Studying Health System Change (HSC) found significant variation in IT adoption exists across specialties. Highest usage specialty: oncology, followed by internal medicine and family practice. Lowest IT adopters: ophthalmology, followed by psychiatry and orthopedics. If you are an EMR vendor, this study provides some good insights.

What does this suggest about the state of RHIOs? The Patient Safety Institute (PSI) is closing shop. PSI was founded six years ago to provide the healthcare industry with a commonly owned, inclusive network utility to support RHIOs and provide ready access to patient healthcare information. PSI promoted a private sector self-funding model similar to that used in the financial services industry, but claims that in the end the model proved to be ahead of its time, pointing to lack of cooperation between parties as a primary issue. So what, if any, RHIO business model(s) will ultimately prove financially successful and widely embraced?

E-mail Inga.

Monday Morning Update 9/24/07

From Dr. Lisa Cuddy: “Re: Philips entering the European HIS market. A likely target may be Agfa. No revenue growth, no big sales, but solid installed base. There are rumors about divesting the Agfa healthcare group and potential bidders are GE, Philips and 3M.”

From The PACS Designer: “Re: Oracle 11g Advanced Compression. The subject of compression stirs a lot of debate when discussing digital image files and what degree of compression to use without destroying the technical composition of the reviewed file. Oracle isn’t addressing image compression in 11g, but they are addressing compression techniques to speed overall system performance, such as cache memory and I/O query/retrieve from your database archive. Oracle 11g has the capability to do table compression to more efficiently use storage resources and, at the same time, improve overall access time to satisfy the ever-increasing demand for faster results from large databases. Another new feature is to store frequent transaction requests in cache memory so that the next request is processed sooner by requiring less information from the archive.”

From Art Vandelay: “Re: Joel Diamond of dbMotion interview. How is your product different from 3M’s Clinical Data Repository with configurable workstation, health data dictionary, and alert writer?” Joel was gracious to provide a response. “First of all, let me congratulate you for your fantastic HIStalk interview. I wanted to respond to your ever-insightful commentary and question. While we don’t comment on specific competitors in the public domain, I would like to answer your question in a general sense by pointing out that the dbMotion product is unique in that it is one of the only solutions on the market today which addresses the interoperability problem in an end-to-end manner. Other products can provide partial solutions, such as a centralized patient view (portal), messaging, or result delivery. dbMotion, on the other hand, provides a complete platform that doesn’t stop there — it goes a few steps further by enabling its customers to maximally leverage their existing IT infrastructure to address current and future needs. Our SOA architecture and sole focus on interoperability allows us to address all aspects of this complicated arena, including security, vocabularies, and semantic knowledge. We often find that alternative solutions involve assembling together a set of tools which are normally sold and thus often operated independently. Even then, most companies still need to add components from external vendors to provide necessary functionality. We also pride ourselves in the fact that our solution is pragmatic in that it was built to serve imperfect environments– not just those that have ideal interfaces and harmonization of technologies.”

From Dave Unger: “Re: Bronx-Lebanon. I saw ECLP announced the deal. Any idea of deal size?” You heard it here first, of course, from Inside View, although In the Know was wrong just a few weeks earlier when he/she called Cerner as the winner. I haven’t heard the contract size so far, but I bet I will.

From EMR Guy: “Re: CCHIT. I heard the 2007 CCHIT certification process was much more difficult than previous years, and that one of the reasons why so few vendors entered the certification process was because it was so difficult. In other words, that many vendors could ‘get away’ with promoting their 2006 certification, leaving the impression that they were recently certified.” For that or other reason, 2007 certificants are in far fewer supply, with many vendors still displaying 2006 stickers (or none at all). Some would say that’s what CCHIT intended – make it easy to get that first stamp of approval, then rely on competitive pressure to move vendors up the ladder to meet increasingly tough standards. It’s interesting that newer, smaller, cheaper vendors have already nailed the 2007 standards, while older, larger, more expensive ones haven’t. The guard is indeed changing.

From Bud Kruger: “Re: Quovadx. Likely based on the Latin quo vadis, which means ‘where are you going?'” Good name for an interface engine company like Quovadx if so, although their product name Cloverleaf is better.

From Joe Seluchi: “Re: Eclipsys. Are you hearing anything about Sunrise XA performance or how the early adopters of Sunrise Pharmacy are doing?” I’ve spoken to one Sunrise user and one Sunrise Pharmacy user (not the same hospital). The first said they were having performance issues, but didn’t elaborate. The second seemed pretty happy with pharmacy, but also didn’t elaborate. First person reports are welcome.

From Steven McCroskey: “Re: Rep. Murtha. John Murtha of PA, the guy who brings home all the bacon to the Johnstown area, including government money for HIT research through a Conemaugh Health System spin-off, is named one of the most corrupt in Congress by Citizens for Responsibility and Ethics Washington.” Murtha was already identified as having more earmark projects (i.e., wasteful pork barrel projects) for his home district than anyone else in Congress. He moved up from “dishonorable member” to “corrupt” after charging across the House floor to threaten a fellow Congressman for questioning a $23 million Murtha pet project, the National Drug Intelligence Center, to be located in the high tech mecca of Johnstown, PA. I knew about Conemaugh subsidiary InforMedx Group, which was doing some kind of simple research for the DoD using grant money (i.e., your federal tax dollars) that Murtha arranged. One company employee, I notice, is named Murtha. Probably a coincidence.

From D. C. Simonton: “Re: Epic. Epic reported at their annual conference that they’re planning to move to a web-based client from their current Windows/Citrix approach. They claim it will take them 5-7 years to complete the transition!” Appreciated, unverified, confirmation welcome.

From Ted Striker: “Re: QuadraMed. San Bernardino layoffs rumored – several project managers, developers, customer support people, managers, and a director.” Unverified.

Want to help kick some crippling disease ass? Click here and watch the four-minute “Augie’s Quest” video on ALS. For your time, Allscripts CEO Glen Tullman will donate $1 to ALS research, along with another donor who will do the same. Your four minutes thus contributes $2, each and every time you watch the video. Pass it on – it’s Glen’s money going toward a good cause.

I got a fun e-mail from Danny Sands of Cisco after our interview. I’d told him that, based on the experience of others I’ve interviewed, he’d hear from lots of folks quickly, and likely some who had been out of touch for awhile. He e-mailed today: “I was on the road and finally had time to read the interview. Thanks. Based on e-mails I received, I am impressed with how many read HIStalk. Someone I hadn’t seen in years happen to run into my mother and told her about it!” That’s cool. Made my day.

I haven’t recently mentioned my weekly editorials for Inside Healthcare Computing, a long-time HIStalk sponsor and, as I’ve said before, the only HIT (or IT, for that matter) publication that I’ve ever paid to receive. Good news, opinion, and fact-finding. The only place I know of that you can get a detailed description (pricing and terms) of what hospitals paid for Cerner, McKesson, Eclipsys, etc., nimbly pried from reluctant fingers using state and federal open records laws for journalists. Anyway, what I’ve opined recently on their platform:

• Healthcare Software: No, You May NOT Have It Your Way
• The HIT “Trendulum” Starts its Swing Back to Administrative Systems
• Private Investors Will Create Competitive Newcomers
• Google Health: Does Anyone Still Care?

Several folks responded to the “Judy in a wedding dress and mock ceremony with new customers” rumor. Fact: the Wedding March is played over Epic’s PA system when someone signs. That’s it. The point missed by those who e-mailed me to decry this as a ridiculous rumor: Epic’s so quirky that non-employees didn’t bat an eyelash at the idea. That’s the trouble with eccentricity – it isn’t always selective. (Say, maybe I just coined a new GE product name – Eccentricity. Or, what you could call a deinstall: Ex-Centricity). And as one reader offers, “Epic sees customer relationships as marriages. But, as Phillips found out, Epic is usually pretty good at writing pre-nups as well.”

A couple of new Picis deals: Mercy Medical Center of Baltimore chooses perioperative automation and Kennedy Memorial (NJ) goes with ED PulseCheck.

Killer IPO: athenahealth. Shares were priced at $18 (above the expected $14-16 range), but demand pushed the IPO-price to over $35, a quick double and the best first-day gain of 2007. Great news, unless you were an insider and noticed that your big-name underwriters obviously set the open too low and let early buyers take the profits. In their defense, the company is losing money with $80 million in revenue, so maybe the unexpected share demand was irrational. Jonathan Bush has $25 million worth.

Cerner co-founder Cliff Illig on entrepreneurship: “Impatience is a virtue. Have a constant sense of urgency.” The article included a tidbit I didn’t know: the founders renamed the original Paterson, Gorup, Illig and Associates to Cerner, which they took from the Latin cernere, meaning ‘to sift or understand’. Cliff again: “We had a list of things we knew something about, a list of things we didn’t know anything about. One of the things we didn’t know anything about was health care.” And this statement, which some would say still reflects reality: “And to us it always seemed like if you were going to start something you needed to go sell something. So very early on, we went and sold a lab system that didn’t exist.” Good article, good thoughts.

Seton Family Hospitals (TX) outsources infrastructure management to Dell. Seems odd, although cynics might point out that one of Seton’s hospitals is Dell Children’s Medical Center, named for the Michael & Susan Dell Foundation that paid for it. Probably a coincidence.

Here’s the press release announcing the November 5-6 conference I mentioned in a text ad to your right. An executive-level HIStalk reader has already let me know he’ll be attending, so I hope to get a report. The speaker lineup is “sick” (I heard that word used by a college student at a football game this weekend and it apparently has a superbly positive connotation, so I’ll throw it out there as a hip nod to young readers not likely to be attending a C-level conference like this anyway). HIStalk is a media sponsor (we swap ads, in other words). I wouldn’t have done it if the agenda wasn’t strong.

I tried to get an update from Kim Pederson after Allina’s Davies win, but the e-mail address I have isn’t working. A couple of readers asked what she was doing now, but it looks like I won’t be finding out after all.

Welcome to new HIStalk Gold Sponsor Premise of Farmington, CT. The company’s products deal with the urgent hospital issues of patient throughput and business analytics. Products: Bed Management Dashboard, BedXPress Dashboard, Transport Dashboard, Executive Dashboard, and Asset Management Dashhboard. Great case studies and testimonials are on the site. I mentioned a couple of weeks ago that the company doubled its customer base in the last year and had a 100% “would buy again” customer ranking from KLAS. I’m really interested in products like these (having worked on a throughput project in the past), so I hope to interview CEO Eric Rosow about best practices. I don’t know of any hospital that doesn’t have all these problems. Welcome and thanks to Premise for supporting HIStalk and its readers.

Epic’s user group meeting is over. Report, anyone? A Judy quote to users on the $150 million Phase I campus cost: “We try to be extremely careful with your money. (But) sometimes, it’s counter intuitive [because of private office productivity gains] … In five years, the buildings are paid for. The buildings, parking, artwork, everything. In five years, we’re rent-free.” Also mentioned: a PHR project code named Lucy, Epic’s first international customer in Netherlands (home of Philips), and the company’s 2006 revenue of $370 million.

Speaking of Epic, Fletcher Allen Health Care wants to spend $57 million on Epic. Ironic: IDX founder Rich Tarrant is a big wheel there, although he’s downplayed his influence after some of its management went to jail over lying to regulators about construction costs.

Misys says revenue was up, although healthcare’s only mention is to once again label it as underperforming and losing ground with a 2% drop in revenue.

For the ten people who still care, Leapfrog announces its CPOE-centric top hospitals. Even Leapfrog says only 10% have implemented CPOE, which is a testament to its lack of clout. If the CPOE pioneers weren’t coming back with arrows in their backs, Leapfrog wouldn’t have to arm-twist.

MedAvant will provide claims connectivity with Aetna.

Siemens gets a Soarian sale in Germany.

The federal government awards $4 billion in CMS IT contracts to the same vendors it always chooses, although none them are in Johnstown, PA.

E-mail me.

Inga’s Update

Skeptic posted a note that was critical of the many excesses at HIMSS. Skeptic’s opinion was that all those big costs ultimately damage healthcare. “It’s never made sense to me,” Skeptic says.

While I agree that there may be too many wasted dollars being spent at HIMSS (and other shows), I am not convinced it is all money wasted (though it goes without saying that a far better use of a company’s marketing dollar would to be an HIStalk sponsor, but I digress …) Here are some reasons I believe a vendor can justify an “investment” in HIMSS sponsorships, exhibits, and the rest:

• The least expensive booth is $2,700. Last year over 24,000 folks attended HIMSS. There are many, many smaller shows out there that charge a similar amount and have only a few hundred attendees. Less than $9 a body is pretty cheap. (Yes, I do realize there are additional costs above the booth rental.)
• The exhibit fees subsidize the cost of the conference. The attendance fees are already high – how much higher would fees be without the sponsorships? If the fees were significantly higher, would attendance be affected? I think so.
• Last year there were over 900 vendors. Sometimes it takes more than free pens to differentiate yourself from the pack and attract people your way. Is it necessary to host big extravagant parties? Perhaps not necessary, but it can make some sense when you have so many clients and prospects all in one place at one time with nothing better to do than go back to a hotel room and order room service.

I suppose an argument could be made that there should be rules restricting vendors from giving away any items worth more than $5 and not allowing complimentary espresso or cocktails (sounds boring). And, maybe it doesn’t all have to “make sense.” If some people have moral objections to the excesses of some vendors, it is their right not to do business with them. I think generally people are smart enough not to be swayed by big marketing dollars when it comes down to making the most important business decisions. If the vendors want to spend big money, then all the more fun for the masses. (I just want to make sure I get an invite to some of the really good parties).

A reader forwarded me a note about a new website being launched, www.medziva.com. It’s still in its early stages, but it appears it will be a site where consumers can inquire about particular labs and lab tests. In terms of addressing the growing trends of consumer-driven healthcare I think the concept is good. I suppose sites such as WebMD provide information about different types of tests or recommended tests for particular diagnoses, but, this site will also allow discussion of the benefits of the labs themselves. Will this be a trend we see more of?

eClinicalWorks has opened a new office in the Big Apple. In April, eCW signed a $19.8 million deal with the NYC Department of Health and Mental Hygiene to provide EMR/PM to 1,300 physicians. eCW will have about 30 employees initially in the new facilities in order to better manage the NYC project.

ACS announces the promotion of Kevin Kyser to CFO. Kyser had previously served as the VP of Finance. He replaces John Rexford, who will remain an Executive VP over key corporate development initiatives, including mergers and acquisitions.

E-mail Inga.

News 9/19/07

From The PACS Designer: “Re: Oracle 11g partitioning. Oracle has a new feature in Database 11g which they call Enhanced Partitioning. Through this new technique, you can create large object files (LOBs) for things such as resource scheduling and other institution activities. The LOBs can then be encrypted to protect them for HIPAA and other security purposes and also give management a view of the organization’s activity daily, weekly, or for other time periods. For example, you can create large object files for the summer vacation periods of July 1 to Labor Day for each year using Oracle’s new enhanced security option SecureFiles to do trend analysis on the efficiency of various departments during the peak vacation period of the summer.”

From Kesuke Miyagi: “Re: CCHIT. Here’s a chance for your readers to put their money where there mouths are and participate in the CCHIT public comment period. Stakeholders can share their opinions with the groups that are actively developing the 2008 certification criteria. I’m new to CCHIT, but have really been impressed at the openness and integrity of the certification development process.” Link.

From Yancy Derringer: “Re: Kaiser Permanente. Adrienne Edens is out at KP and replaced by Diane Comer, CTO from Firemans Fund. Looks like the second of mass changes by CIO Phil Fasano. He is a major proponent of outsourcing and Comer got all her name recognition from doing a major outsourcing at FF.”

From Rogue: “Re: Siemens MedSeries 4. It still runs on an AS/400, though ones much more powerful than those of yesteryear. You’d be surprised how it’s grown from green screen through Web-GUI to Web-capable. When I worked with it for awhile earlier this year, I was very impressed. One nice option – you own/manage the hardware or Siemens hosts it and all you need is a fat T1 or T3 line. Practical for the small IT departments.” Thanks for that update. I thought Siemens nearly sold it off a few times over the years and I’d heard nothing. I’m not claiming I hear everything, but it doesn’t seem like Siemens is very good at getting the word out.

From Ali Mills: “Re: MS4. Siemens has been investing in MS4 clinicals. Growth on top of 425+ customers, huge R&D, 21 new hospitals last year. MS4’s mantra is ‘three clicks to patient information’. MS4 beat out Meditech, McKesson, Cerner, and Epic at Texas Scottish Rite. IBM has pumped over $1 billion into iSeries (formerly AS/400) in two years. Glad to hear the story getting out.”

From Daniel Larusso: “Re: Epic. I’ve heard that when a new customer signs, there’s a mock marriage ceremony in Madison, complete with Judy in a white dress and with wedding cake. That’s just plain weird if true.” I’ve heard that, but not lately. Seems gauche to wear white in more than one wedding. Confirmation, anyone? Maybe some wedding pictures or the little happy plastic couple from the top of the cake?

From Terry: “Re: Craneware. The company has IPO’d in London.” Link. I’m familiar with their charge master maintenance product and it’s good.

This conference sounds cool: Transforming Healthcare through Health Information Technology, The Most Exclusive Summit for Healthcare Leaders on November 5-6. I got a flattering e-mail asking HIStalk to be a media sponsor, which caught me by surprise because I’ve never been asked. What that means: I let you know about the conference (which I would have done anyway) and they mention HIStalk (looks funny up there with all those real companies). What caught my eye in the first place: the speaker lineup, some of whom I’ve interviewed: Martin Harris of Cleveland Clinic, Danny Sands from Cisco, Don Holmquest from CalRHIO, John Wade from St. Luke’s, Holly Miller from UHHS, Neil Martin from UCLA, Jonathan Bush from athenahealth, Jeff McCaulley from Wolters Kluwer Health, Glenn Tullman from Allscripts, and Andy Eckert from Eclipsys, among many other big names from notable organizations. I’ve been to intimate conferences like these a couple of times and they’re a blast, with upscale amenities, personalized presentations, and casual access to industry bigwigs (it’s like a VIP pass to HIMSS). Sweet location, too: the five-diamond Peninsula Beverly Hills (great spouse trip). Another part of the deal was a discount for HIStalk readers: use code HISTALK2020 online or by phone and you’ll get a $750 registration rate. I put up a text ad to your right to remind you. Maybe you could write it off by turning in a first-person HIStalk report.

Clarification: I said that Visicu was dropped from the Inc. 500. True, but misleading. The original newspaper article said, “Other companies dropped off the list entirely due to going public, not being able to maintain the rapid growth or some other reason. That occurred to Visicu.” A couple of readers pointed out that the poorly worded sentence was trying to say that Visicu was dropped because the company went public, which I breezed right over.

Those who signed up for Brev+IT got it by e-mail Saturday. If you like what you see, sign up for your own free copy each week.

I knew Isabel CEO Jason Maude would respond better than I could to the reader who mentioned the lack of PubMed articles about the company’s diagnosis product. “So far, around 20 articles have appeared in peer-reviewed journals, including a study entitled ‘Validation of a diagnostic reminder system in emergency medicine: a multi-centre study’ which appears 5th on PubMed if you enter ‘Isabel’ as the search term. I would argue that Isabel is, in fact, one of the most validated healthcare IT products around. You can see the full extent of the published work on our website … in 10-12% cases that a physician uses Isabel, he/she is reminded of an important diagnosis that he had not thought of. When done live across three hospitals, it was found that, in 25% of these case,s it turned out the be the actual final diagnosis.”

Now here’s a story I bet you haven’t heard elsewhere. A reader clued me in that the ambulatory EMR products of several legacy vendors are not eligible for the Stark exception because their CCHIT certifications are over a year old (they didn’t earn 2007 certification yet, in other words). The only 2007 certified ambulatory products are Medent 18, eClinicalWorks, e-MDs, Greenway PrimeSuite, McKesson Practice Partner, NextGen, and Purkinje CareSeries. Hospitals can’t provide doctors with any other system under Stark unless they earned 2006 certification less than a year ago. That means you can’t, at this moment, give doctors Allscripts Healthmatics and TouchWorks, Cerner PowerChart, Epic Ambulatory EMR, GE Centricity, McKesson Horizon Ambulatory Care, Misys EMR, and Sage Intergy EHR, among others. Check CCHIT’s page for products with a date more than a year ago and not listed on the 2007 page. According to HHS, “The exception and safe harbor provide that EHR software will be ‘deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the [physician/recipient].'” Bet you won’t read that in the certification-bragging brochures, especially since these are the kinds of legacy vendors that hospital CIOs flock to.

Heard: Phreesia gets $10 million in funding. The company offers free (adware-supported) wireless touch-screen devices to physician offices that replace clipboard check-in forms for patients.

A eHealth Vulnerability Reporting Program study questions the security of EMR systems. Among the issues: systems allow penetration with standard tools, vendors don’t tell customers about security holes, and no industry watchdog creates and monitors standards.

Big employer healthcare coalition Dossia, after falling out with Omnimedix Institute, turns to Children’s Hospital Informatics Program of Boston to pick up development of its personal health record application. That’s Isaac Kohane’s shop. He e-mailed me once as an HIStalk reader, so maybe an interview can be wangled.

Everybody’s piling on the big guy. First Google threatened Microsoft Office by offering an enterprise version of Google Apps for a low price. Now IBM will offer a free download of Lotus Symphony, apparently developed from Star Office/OpenOffice.org. We old-timers remember the DOS version of Lotus Symphony/Jazz from the 80s, although not all that fondly.

Interesting thought: could MP3 recorders replace stethoscopes? Apparently the sound quality is higher, the files can be computer analyzed, and of course you have a digital record for later review (assuming legacy EMR vendors had a way to integrate MP3 files with other clinical data, that is).

Congrats to HIStalk reader (and occasional commenter) and Penn researcher Ross Koppel, PhD, who has published a new article in JAMIA on the unintended consequences of healthcare information technology. Ross and colleagues worked with AHRQ in developing guidelines for identifying those automation-induced safety issues. His 2005 JAMA article had vendors howling, mostly Eclipsys because the problems he catalogued were TDS-related even thought he was making a general point, but you’d be hard pressed to find anyone today who would disagree with the overall idea that HIT can cause new problems even as it’s solving others. My comments on a similar article remain the most-read HIStalk piece ever.

A hospital director in Japan who implemented the first hospital EMR system in that country has been arrested for accepting a contractor’s bribe of a plasma TV.

The CEO of the informatics group of Philips says the company may offer an EMR product, but only in Europe because competition here is too stiff (as Epic taught them). An acquisition is likely, he says.

Internet-based hospital report cards have old, incomplete, and conflicting data, a new study says.

Orion Health says the company is New Zealand’s largest developer of exported software.

E-mail me. I sound knowledgeable on occasion only because smart readers tip me off.

Monday Morning Update 9/17/07

From Dusty Wong: “Re: Quovadx. How in the world it THAT pronounced? Is this the company where Superman’s impish pest, Mr. Mxyzptlk, works?” Kwo-VAD-ix. Guess they didn’t have to worry about taking a name somebody else already owned.

From An HHC Employee: “Re: CPR. As a Misys CPR user (NYC HHC), I am stunned to see Quadramed’s optimism about the product, especially being tied up in Cache’. Misys has been promising the Cache’ transition for many years, but never came through with it. Is Quadramed lacking in due diligence, or just talking up the same game Misys was? The CPR product is good for integration, but is years behind in other features – not Web-enabled, no way to easily integrate decision support, the list goes on.”

From Lester Golub: “Re: Isabel. I’ve never seen a product with such a huge popular press vs. biomedical literature imbalance. I’ve never seen a peer-reviewed article on Isabel and the stuff on their website, though positive regarding the product, doesn’t appear to have made it to anything indexed in PubMed.”

From John Winger: “Re: Misys/West Michigan Physicians Network. From the hospital side, it’s largely a Cerner/McKesson town. I seem to remember hearing recently that there’s a collective effort underway to subsidize physician technology adoption, but I thought that was a Cerner-based effort. Curious how Misys will do. I do know they had already lost one big account in that area.”

Investors are supposedly excited about next week’s athenahealth IPO, mostly because of the company’s recurring revenue model that’s based on a percentage of physician collections. We’ll know for sure soon.

Those same investors are also supposedly bullish on WebMD, speculating (no pun intended) that Adam Bosworth’s departure from Google means the company will shift its strategy to buying market share (i.e, WebMD) instead of building its own healthcare products.

HIMSS announces the 2007 Davies Award winners: Allina Hospitals & Clinics, Minneapolis, MN (organizational), Valdez Family Clinic, San Antonio, TX and Village Health Partners, Plano, TX (ambulatory), Illinois-National Electronic Disease Surveillance System, Springfield, IL and Institute for Family Health, New York, NY (public health). Kim Pederson of Allina talked about their Epic implementation in this HIStalk interview.

West Penn Allegheny Health System (PA) chooses Allscripts for its 165 physicians.

Revenue cycle vendor MedSynergies names John Payne CIO, coming over from Perot.

Jobs:

CIO, Bethesda Healthcare (FL)
VP, UPMC (PA)
Sales Executive, PM/EMR
Senior Implementation Project Manager (PA)
McKesson Horizon Clinicals Consultants (AL)
Patient Care Informatics Officer, Methodist Healthcare (TN)

Philips consolidates into three organizations, one of them being healthcare, and sells its stake in Nuance Communications.

This physician’s practice was at a loss when its PM/EMR system went offline because of a server problem, “.. going back to the dark ages. Paper receipts. Paper-only records. Vestiges of a bygone era.” That would be a great, feel-good EMR testimonial showing that not all docs are paper-bound. Except that he’s a veterinarian.

GE Healthcare gloms off the questionable US News & World Report‘s Best Hospitals issue, or actually the Honor Roll subset of it. It says GE is “humbled”, although that’s a bit of a stretch since that claim was made in an entirely self-serving press release. Does anyone believe that Centricity had anything to do their success? What’s the percentage of the also-rans using Centricity?

A CNN article on hospital infections and TheraDoc’s infection and antibiotic software contains a buried fact I hadn’t heard: TheraDoc customer UPMC has bought 22% of the company.

IT workers with server virtualization experience are in high demand.

Visicu falls off Inc.’s list of the 500 fastest growing businesses.

I didn’t know it was even still being sold: Texas Scottish Rite Hospital for Children buys Siemens MedSeries 4. I assume it’s still running on an AS/400.

Loma Linda University Health Care will use open source OLAP business intelligence software from Pentaho, replacing Access and Excel for that purpose. I’d never heard of the Orlando company, but I liked them instantly because of the founder’s two-sentence intro that includes: “you can usually find him near an empty Captain Morgan bottle or wandering around in the woods with his GPS receiver.” Ditto the title of one founder: “chief geek”. Or, this FAQ snip: “What do the Dodo, Hispaniolan Edible Rat, and the Syrian Wild Ass have in common? They are extinct. Like the Dodo, Hispaniolan Edible Rat, and Syrian Wild Rat; competition, innovation and choice will become extinct if Microsoft Corporation hit their goal of attaining 100% of the Business Intelligence market.”

E-mail me.

Inga’s Update

Thank you, Big Nurse, for forwarding me this note: “Not sure if this is of interest to you, but here’s some information on a recent report from the University of Rochester that appears to provide evidence of ROI associated with an Allscripts (Touchworks) EMR implementation. I hadn’t seen this information mentioned elsewhere (maybe I missed it), but it seems to offer valid evidence, though I am only able to read the abstract. It was cited in an article in Crain’s Health Pulse as a rationale for North General Hospital in NYC to go forward with its plans to implement an EMR, even though they are nearly bankrupt.” I found the original study, apparently first published in the Journal of the American College of Surgeons. The study involved 28 physicians across five offices and looked at the capital investment, plus various administrative tasks (chart pulls, support staff salary, and transcription costs) and efficiency aspects (days in A/R, etc.). The bottom line: the system paid for itself in 16 months and provided an ongoing annual savings of $9,983 per provider with a neutral impact on efficiency and billing.

First Consulting Group, Inc. completes the sale of its FirstGateways product business to MedPlus. FCG is selling off this segment that has been losing money and expects to realize approximately $8 million of after-tax cash proceeds from the transaction.

Nigerian officials are ordering their banks to stop using attractive women to persuade customers to open accounts. Apparently the unacceptable practices include employing beautiful ladies and giving them targets to meet. I wonder what would happen if HIMSS banned vendors from hiring beautiful women to increase booth traffic? Would there be a revolt from all those techy types?

Make Inga happy.