Monday Morning Update 5/19/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Art Vandelay on The Surprising State of Retail Clinics

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

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

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

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

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

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

The PACS Designer’s Open Source Software Review

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

XChart uses an XML repository because:

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

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

TPD Usefulness Rating:  5.

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

News 5/16/08

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

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

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

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

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

Listening: The Kooks, Brit power pop.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

CIO Unplugged – 5/15/08

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

Memorial Day. What is our Legacy?
By Ed Marx

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

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

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

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

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

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

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

What about you? What will your legacy be?

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

McKesson Acquires Vivalog LLC

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

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

News 5/14/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

OSF Homecare (IL) buys McKesson Horizon Homecare.

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Monday Morning Update 5/12/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

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

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

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

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

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

The PACS Designer’s Open Source Software Review

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

Features of FileZilla include:

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

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

TPD Usefulness Rating:  7.

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

News 5/9/08

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

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

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

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

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

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

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

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

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

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

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

Memorial Hermann will use OB waveform monitoring software AirStrip OB.

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

CSC opens First Consulting Group Viet Nam.

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

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

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

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

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

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

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

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

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

E-mail Inga.

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

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

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

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

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

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

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

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

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

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

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

News 5/7/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CMS is piloting PHRs in South Carolina.

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

Monday Morning Update 5/5/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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CalRHIO
By Kipp Lassetter MD, Chairman and CEO of Medicity

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

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

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

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

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

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

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

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

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

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

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

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

News 5/2/08

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The iPhone in Healthcare: hot.

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

Sentillion’s context management solution technology is now patented.

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

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

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

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

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

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

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

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

E-mail Inga.

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

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

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

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

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

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

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

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

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

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

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

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

News 4/30/08

From Kinky Friedman: “Re: Misys. Misys announced this weekend that Vern is staying on board after the merger in a yet-undefined role. Mike Etue and Glen are thrilled.”

From CaryObserver: “Re: Allscripts. It will be interesting to see Allscripts Q1 results and the market reaction. My guess is deals stalled due to the announcement and things will get blamed on timing issues rather than execution issues. How many quarters will they miss before management is held accountable?” Well, a bad quarter now could jeopardize the deal, anyway. The Brits were already whining that MDRX was being overvalued, so that would be ammo.

From Delores del Rio: “Re: RHIOs. Not that another RHIO going under is news, but it’s (just) slightly more interesting when it’s out of Silicon Valley. I don’t feel the need to comment much myself since it’ll be easy for others to do so.” Link. California’s Smart Health is worm food after two uninspiring years. Board member Richard Levy (also chairman of the board of Varian Medical Systems) is quoted as saying that breathy estimates of RHIO cost savings will never happen, especially with the big California acute care players like Sutter and Kaiser building their own interconnected systems. Even Daughters of Charity CIO Richard Hutsell took a kick at the still-warm corpse: “There was no economic model that said this makes sense. Who is going to be the one in charge, to manage it and iron out all those millions of details?” CalRHIO’s got a much better chance because it reaches beyond areas of local competition and may have learned from the funding mistakes of its predecessors.

From The PACS Designer: “Re: Web 2.0 magazine. TPD thought HIStalk readers might want to brag to their peers about seeing one of the first of a string of new ways to read magazines and books online. Cardiovascular Business Magazine is one of the first to employ reading their magazine as it would look in your hands. To go to a featured article on the front page, click on it and you’ll be brought to the article’s first page. To proceed to the next page, move your cursor to the lower right hand corner and drag the page to your left. Have some fun exploring and reading online!” Link. There’s probably a medical records analogy in there — the paper metaphor was so strong that somebody took the latest, sexiest technologies just to emulate it on-screen. Can I get a chisel and stone tablet plug-in for Word? 

Listening: The Czars. Big, haunting vocals over lush melodies. If a guy could sing Paint the Moon like John Grant, he’d need one of those deli ticket dispensers to make the smitten ladies wait their turn to idolize him.

Epic launches its next big construction project in Verona, getting Campus 2 underway. The local paper says the company is up to 3,000 employees (tripled in five years) and over $500 million in annual revenue. The article took some nice shots at Epic’s competitors, noting Epic’s KLAS ratings, its disdain for publicly traded companies, its six sales reps, its unwillingness to negotiate prices, and its resistance to selling out or going public. The new digs will add 1,700 offices to the 1,500 built in Campus 1 in 2006. Here’s a story about the Epic treehouse (the picture below is from the Wisconsin State Journal). Thanks to the reader who sent the links over – cool stuff.

Daughters of Charity chooses SIS’s perioperative solution.

Vendors and consultants, meet your newest competitor: University of Pittsburgh Medical Center. UPMC will install five clinical applications in 14 months in three UK hospitals under the banner of a for-profit company it formed last year. UPMC and the hospitals have also formed a joint venture to sell IT services to other UK hospitals. Per CIO Dan Drawbaugh: “The Newcastle contract is the first of what we hope will be many international agreements for our information technology services.” They have an unfair advantage in that they run every information system known to mankind, so they’re certainly living the vendor-agnostic creed.

Presidential candidate (and my choice, not that it matters) Ron Paul endorses B.J. Lawson for a North Carolina House seat. Both men are physicians and graduates of Duke University School of Medicine. Lawson was a founder of mobile computing vendor MercuryMD, sold to Thomson in June 2006.

Industry long-timer Dale Chernich is named CIO of WestCare Health System in Sylva, NC. I know he used to be with Dynamic Control and I think he was somewhere in PA for awhile (Hershey, maybe?) and most recently at Medical College of Georgia.

Picis will have a May 14 webinar on its Perioperative Dashboard. A customer will be presenting. Since they e-mailed me a press release, I felt empowered to conveniently ignored the copyright warnings at the beginning of their online demo and take a screen shot because I though it looked cool. You can click to enlarge, at least until they tell me to yank it down.

May is “Legacy Free” Day, according to a New York medical society. CMS and HIMSS want clearinghouses to send NPI in the provider identifier field of claims. CMS information is here. NPI is required starting May 23.

Penn White is named medical director of WiFiMed Holdings.

My editorial this week at the newsletter: “The First Lesson I Learned Working for a Vendor: Products Don’t Need to Be Great, Just Good Enough.” I’m obviously still holding some grudges toward the crappy vendor I worked for years ago.

BidShift apparently felt its conjoined name was too descriptive of what it offers, so, like every other company before it, it dug out a Latin dictionary and came up with Concerro. That will no doubt strengthen its brand recognition among people who have been dead for centuries.

Community Hospital of Bremen (IN) gets $500K of someone else’s money (yours, specifically, if you pay federal taxes) to buy more Meditech stuff.

Wall Street Journal has an article on healthcare security lapses. Not much new, but it does mention that HHS has yet to levy even one HIPAA fine, although some incidents have resulted in criminal prosecution.

A survey of second-year medical residents in Canada says that 75% of them want to use EMRs.

Here’s a fun piece about medical tourism from the perspective of several patients who not only used it, but enjoyed it. Mentioned: grocery chain Hannaford Bros.. which offers overseas procedures for which it pays the employee’s share of the bill, flies the employee and a companion to Singapore, and pays for two weeks in a hotel for recovery. “He was blown away by how patients were treated – each are picked up at the airport by limousine and get to stay in hospital suites complete with mini-fridges. Physicians are always prompt; their bonuses are tied to how long they keep patients waiting.”

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Inga’s Update

Quest Communications CEO Edward A. Mueller is named to McKesson’s board of directors. He was formerly CEO of Williams-Sonoma, which sounds like a much more fun gig. McKesson also announces that more than 10 community hospitals have signed on for its Paragon HIS solution and Practice Partner EMR/PM during the past year.

Qatar University pharmacy students will use Cerner’s Academic Education Solutions for EMR practice.

A survey of European general practitioners finds that 87% use a computer, 70% the Internet, and 66% for consultations.

David Brailer and his Health Evolution Partners firm announce their first investment. Evolution is providing an eight-figure financing commitment to e-Rx company Prematics. Brailer will join the company’s board.

Misys partners with Wolters Kluwer Health to enhance the clinical content of MyWay.

Sunquest opens a new London office as its international headquarters. The company has 17 UK hospitals using its systems.

The Indiana HIE is considering taking its expertise outside of the state to share with other markets. Leaders would like to see its model become the national norm. It may not be a bad idea given its success financially (self-sustaining without grants and donations; the 39 participating hospitals pay service fees, but not the 8,500 physicians).

Premier will promote Eclipsys solutions to its 1700 hospital members.

The 18-doctor Florida Cardiology group is implementing Sage’s Intergy EHR and PM. The software will be web-based and available across the group’s eight locations.

E-mail Inga.

Monday Morning Update 4/28/08

From Hates to Lose Things: "Re: stolen medical records. Sounds like the records that were stolen were encrypted. At least they are using their EMR if they already have 2 M records backed up!" Link. Thieves break into an archive company’s truck and steal backup tapes containing two million medical records from the University of Miami. It took the company two days to tell the university and another month for UM’s School of Medicine to post a public alert. At least backups are hard to do anything with. UM has stopped transporting tapes offsite, great unless they get nailed with a hurricane again or have some other local catastrophe.

From Orlando Portale: "Re: Second Life. Important to remember that Second Life (SL) is a rich 3D development platform, some what analgous to Java or C++. So, one’s impression of Second Life really comes down to the quality of the design and user experience of the particular property you are experiencing. Currently there are a limited number of Second Life healthcare examples — check out the UK. NHS Poly Clinic or Virtual Palomar West (disclaimer: that’s ours)." The problem is that you (apparently) have to register first, choose a name and avatar, and do all that geeky stuff before you can ever get to somebody’s site. Nobody’s going to do that. It needs to be as simple and fast as getting on a webinar to attract that same executive level user. I’m sure it’s fine once you get there.

From MilitaryMD: "Re: CliniComp. FACT: Haudenschild is definitely back as CEO, having gone through four management teams in four years. He has reconstituted the same team that delivered buggy code and poor customer service in the 2001 era. Severe morale problems among the staff, expect those with alternatives to bail. OPINION: Most likely, he just gave up on selling the company and will try to squeeze whatever profit he can out of the existing and  contractually committed customer base by trimming staff and under-delivering on service and new releases." Inga spoke to a colleague who officially confirmed through the company that he’s CEO again.

From Pippi Longstocking: "Re: Cerner. I hear that Cerner has been sniffing around HIMSS trying to re-engage with sponsorships, ads, off-site events, etc., but that HIMSS has rebuffed them, saying no exhibit, no opportunities."

Listening: Ours. Depending on the tune, sounds like U2, The Doors, or Radiohead. Impress your friends with music they’ll like by someone they’ve never heard of.

McKesson will lay off 114 employees on July 11 at its Gilbert, AZ office. I think that’s where some of the former Per-Se transaction processing people work.

Sharon Pfaff is named CIO of Cancer Care Ontario (Canada).

The Leapfrog Group (remember them?) announces its CPOE Evaluation Tool.

Steve Lieber of HIMSS says doctors won’t trust PHRs. I’ve been saying that all along, but he’s got more vested interest since EMR vendors pay HIMSS while PHR vendors probably won’t. He’s right, though: duplicated tests don’t cost a doctor or patient anything, so why should the doc put themselves at risk by trusting someone else’s information, no matter what the source? I bet they redo a lot of tests even when the paper records are right there in front of them. That’s how defensive medicine works.

E-mail me

Art Vandelay on Yet Another Reason to Use What We Have

Not to be doom and gloom, but there is a major storm on the horizon. A number of organizations have gone on a capital spending binge. Interest rates are adjusting up. This is just like over-buying a house with an adjustable rate mortgage. For health care organizations, the binge usually involves major new facilities and major information systems. Large depreciation expenses are (or will be) coming our way. This will impact the bottom-line financials that lenders review.

Interest rates will adjust in a troubling way if the binge did not result in a return on investment that matches the depreciation and overhead of the investment. Consider that Park Nicollette is paying an extra $5-6M on its debt a year due to a recent rate adjustment. I believe we will see some de-installs of EMRs given the lack of tangible returns to offset the ongoing costs.

If the scenario above sounds like your organization, it is a good time to develop your budget contingency plans beyond the typical 1-3% cut. The finance department will be knocking on your door soon. When I develop my lists, I categorize the opportunities into cuts, consolidations, efficiencies, and growth opportunities. The last three areas usually take money to make or save money. Remember, "No company ever shrank to greatness". 

The PACS Designer on Open Source Software

OpenEMR is a software platform in the SourceForge.net community.  Contributors give their time to enhancing software solutions by continually updating performance issues, which is good in one sense, but may be less good for the end user. If your office has an experienced geek who is willing to submit change proposals regularly to the OpenEMR community, then it may be a solution to consider for your staff.

As with anything that is free, there are some negatives, so tread gingerly when considering OpenEMR.  Also, OpenEMR shouldn’t be confused with OpenEHR which is from "The openEHR Foundation", a not-for-profit company, with its founding shareholders being the University College London, UK and Ocean Informatics pty, Australia.

The OpenEMR consists of appointment scheduling; patient registration; payment and insurance tracking, processing, and collecting; charting and record keeping; prescription writing; laboratory tracking; patient check-in/check-out, tracking and handling.

Installing OpenEMR on a Windows 2003 server can be challenging for the less experienced installer.  Hiring the services of a professional in this area of software development is highly recommended.

In conclusion, you have to be extremely cautious when a free solution has had only had minimal usage in the last few years. Also, bugs found several years ago still have no responses with fixes, so you would be wise not to extend an effort to use OpenEMR without help from outside service providers.

TPD Usefulness Rating: 3.

openEMR site.

Inga’s Update

The 265 bed Washington Hospital (PA) implements MobileMD’s HIE and EA solutions to connect to its physician community. The 33 participating practices can receive a variety of reports real time even if they don’t have an EMR.

A couple of weeks ago I mentioned the closure of an Ohio mental health facility because they owed McKesson $13,500 for some medication. Fortunately the police took off the padlocks at least temporarily while they negotiate with McKesson. While I am all for everyone paying their bills, why is McKesson going to such extremes to collect an amount equal to two days of John Hammergren’s compensation?

VC firm Psilos Group commits a $13 million investment in HealthEdge.

I am on a little weekend vacation and my Internet connection is weak, so I’ve told Mr. H I have to cut my post short. I also happen to be at one of those spots that requires you to start happy hour early , so there is that issue, too.

E-mail Inga.

News 4/25/08

From Sharp-End: "Re: bedside barcoding. I’m interested in talking to people from hospitals who have purchased BPOC systems or are looking. Questions: how important is system price vs. total cost? Is your implementation queued behind that of other clinical applications from the same vendor? Have you assessed total costs?" If you’re willing to swap e-mails or chat with Sharp-End (who’s an independent consultant), e-mail me and I’ll connect you.

From Little Enos: "Re: CliniComp. Rumor has it that owner Chris Haudenschild is back on top as CEO. They have acquired some great deals without him running the mother ship. Can you confirm? Why now? They’ve turned over several CEOs." We’ll try to confirm. I used to mention it when they changed CEOs, but it got old.

From The PACS Designer: "Re: Web 2.0. The mainstream media are starting to pickup on the Web 2.0 theme due to the Web 2.0 Conference being held in San Francisco. The BBC reports that ‘Web 2.0 is set to be embraced by Enterprise 2.0 as businesses prepare to spend nearly $5 billion by 2013 on social networking tools and over half of the companies in North America and Europe see Web 2.0 as a priority for next year’.  TPD has posted numerous comments about Web 2.0 in the past and is happy to see the concept gaining some traction with financial backing from the C-level types." Link.

From Bird Fidrych: "Re: Cerner. I was telling a friend what a great read HIStalk is and how much I enjoy it. She sniffed that you’re a paid shill of Cerner’s and have no credibility. Say it ain’t so, Joe!" It ain’t. The only vendor money I get comes from those companies whose ads are staring at you on the left. I’m surprised someone would even make that claim given the ripping Cerner often takes here (not to mention the pretty good record of accuracy I have, which would seem to squash the "no credibility" theory). She’s sniffing, all right.

Listening: Sinch, thinking man’s metal/prog/alt from Philly.

CalPERS, the retiree system for 1.2 million retired California public employees, announces that it will support CalRHIO’s statewide RHIO. Medicity is involved, I assume, since CalRHIO uses its technology.

AHA’s for-profit subsidiary endorses Vocera badge communicators (in return for? …) That got me interested in digging: the "non-profit" parent AHA took in $102 million in one year, according to its most recent federal records, enjoyed an $18 million annual profit, has $126 million in assets, and paid its CEO $1.9 million. That CEO was previously a member of Healthcare Research Development Institute, an "exclusive club" that got the attention of state attorneys general (here’s the story from The New York Times and here’s the list of the pocket-liners who couldn’t eke out a living on their massive non-profit hospital salaries alone). Gary Mecklenburg was its CEO; he was also the CEO of Northwestern Memorial who earned $16.4 million as a parting gift (the hospital’s CIO got $665K in comp that same year, close to a record). We’re not exactly talking vows-of-poverty nuns selflessly taking care of the sick, are we?

Speaking of salaries, NHS’s Richard Granger was so good that it will take two civil servants to replace him (his was the highest-paying job in British government). They’re adding a CIO position in addition to the Director slot, each advertised at an annual salary of $400,000 (at current exchange rates, which values US dollars at slightly less than Confederate ones).

Cerner’s shares get a nice pop after the earnings announcement, going from the high 30s to today’s close at $46.49. Now if Neal will just send over my check for shilling, we’ll be all set.

Medsphere announces an OpenVista go-live at Lakin Hospital (WV).

CPSI’s just-announced Q1 numbers: revenue up 13.8%, EPS $0.33 vs. $0.24. Sweet.

Jerome Grossman, whose long list of civic and educational accomplishments includes co-founding Meditech, has died of cancer at 68. I wrote about his lawsuit against the company in 2004.

Transaction processor MedAvant (aka ProxyMed) gets a nastygram from its auditors: they think the company’s about to go belly-up. Market cap is below $14 million. The CFO just quit, revenue is down, losses are up. Other than that, it’s going great.

GE’s Jeff Immelt makes excuses about the company’s performance, ending with a tag line of "building the best products." Ironic in healthcare IT, of course, since its products are at or near the bottom in most of the important KLAS categories (well, technically speaking, it bought them instead of built them, so maybe that’s his out).

Microsoft’s Q3 numbers: revenue flat, EPS $0.47 vs. $0.50.

The CEO of the healthcare business of  Siemens quits after an investigation finds new evidence of corruption in the former Siemens Medical Solutions Group. At least 10 countries are investigating the company for bribery.

Varian Medical Systems’ Q2 numbers: revenue up 19%, EPS $0.56 vs. $0.46.

FDA problems didn’t help GE’s financial performance. Now, the agency has warned Philips Medical Systems about manufacturing practices in an Ohio plant.

Shares of WebMD Health tank after the company warns of weak advertising demand. The stock was down 12.2% Wednesday. Earnings will be announced on May 6.

E-mail me.

Art Vandelay on VistA Outages

The VA’s recent experiences with server consolidation are not surprising. The root cause for one of the incidents is no different than the Parkland experience with their Epic outage (operator error). The VA’s other major incident was caused by a hardware failure.

In my experience, the two other common causes of outages are human failure to execute some manual task during an upgrade or poorly written software (ex: memory leak, runaway process). When consolidating servers, testing is a must. Back-up/restores, fail-over, and monitoring must all be tested in the backroom. User downtime processes and the communication plan should also be tested.

With M platforms, the monitoring and automation tools are rarely present. Epic has actually put a significant amount of effort into building the "RedAlert" Toolkit to assist its users. I am not sure if the VA has done the same development. I have also found the attention and rigor behind smaller and distributed environments is usually lacking.

In the non-M world, the architectures are usually already integrated with monitoring tools at various layers. This includes the OS, app. server and database layers. These vendors have also matured enough to provide the basic SNMP traps. Those of us from the early mainframe era were in a similar position and "rolled our own" utilities. Now these utilities can be purchased at exorbitant prices from IBM and CA.

To compound the problem of a lack of tools for M platforms, I rarely see the mainframe rigor in the client-server and web environments. The rigor comes with documentation, change control procedures, well-understood dependencies, defined testing plans and separate environments. It is a must to test these plans in the real world.

News 4/23/08

From SurprisewithSmile: "Re: NHS. It looks like a side effect of the ‘credit crunch’ is the UK Government doesn’t want to spend any more money on IT for its nationalised healthcare system. So the NHS and its suppliers are going to be locked into their obsolete contracts until this recession ends or they lose patience. The rumour at the UK Healthcare IT conference (HC2008) is that the NHS will reduce the scale of the national programme by allowing healthcare organisations to choose systems from the new framework contract rather than having to take the integrated systems that have had delivery problems and delays for the last four years." Link.

From Serrenity: "Re: SecondLife. I found your comment on SecondLife to be a little bit disparaging and a little offensive. I think that your characterization of SecondLife as pertaining only to Internet hermits and those desperate for phony friendships and cybersex. Wow, talk about a low-ball punch. I mean, I would have expected such luddite thinking and stereotyping for some other blogs, but from a technology forum? No." I know it has many fans, but I just don’t see casual business users doing anything than ordering the hip young techies to stick a site out there. I gave it a couple of hours, during which time I loaded a 35 meg client that ran like molasses on my PC, tried to get my headset to work in it (I’m not picturing CEOs in headsets), and went halfway through a tutorial and tried to figure out the mass of messages and controls required to perform even the simplest tasks (flying was cool). Pretty much like The Sims to this untrained eye, which is why I stopped playing around with that after about the same two hours (I admit that I have a short attention span, but I have do more computer geekiness than the average businessperson).

From The PACS Designer: "Re: CCR. The Continuity of Care Record or CCR will start to be employed going forward as sort of a passport of your health symptoms. Since it is carried or transmitted from one provider to another, you can help improve care if the new provider has as much detail as possible about your health history and the prior health experiences of your family."

From Marty Puccio: "Re: comments. Is there a way to access the site other than histalk2.com that automatically loads all of the comments?" Not that I know of, although that would be nice. The best way to see them is to click the e-mail update link. You can also click the article’s title to open a new page with comments displayed. Speaking of which, if you don’t get the updates, stick your e-mail and name in the "Subscribe to Updates" box to your upper right (and the Brev-IT e-mail newsletter signup box right below it if you’re so inclined – here’s the latest issue).

From Larry Zito: "Re: name that hospital. Looks like Winnie Palmer Hospital (Orlando Regional Medical Center). It’s a little less ominous in the daylight." Right you are, according to the reader who sent in the pic.

From Dr. Dobbs: "Re: AJAX frameworks. Here are some links to show how far they’ve come." Links: Screencast, sample Javascript widgets, desktop emulation, comparison of AJAX frameworks.

Listening: The Frost, late 60s Detroit psychedelia. Kind of Grand Funkish.

We did a fun interview with Rob Seliger, CEO of Sentillion, over on HIStech Report.

Jobs: Marketing Director (any location), Account Manager (UT), IT Director (NC).

Picis announces ED PulseCheck 4.0.

Great Q1 numbers for Cerner: revenue up 5%, EPS $0.44 vs. $0.34, beating estimates by 3 cents. I’m delighted to have been wrong — I thought sure they would turn in a bad quarter and, as the industry’s bellwether, foretell bad times coming for all. Congratulations to everyone there. CERN shares are up over 7.5% in after-hours trading. We’ll see shortly if its competitors fared equally well.

A bad Wall Street day for Omnicell, whose announced lower expectations led to a 30% haircut in the share price. Market cap’s down to $417 million with a PE of 16 even at the lowered earnings estimate. I don’t buy individual stocks, but this one looks like a deal (either as a shareholder or an acquirer).

Here’s an interesting story on the virtual physician visits offered by RelayHealth.

GE’s Jeff Immelt is taking big heat (some of it from predecessor Jack Welch) for the company’s recent and surprising downturn. Conde’ Nast Portfolio has an interesting recap of GE’s problems (too big and conglomeratized for investors to reward with anything but a pitiful PE) and suggestions to streamline the structure. "Nobody really understands your Healthcare business, so you can get rid of it however Wanchoo sees fit."

Sumter Regional CEO David Seagraves provides a somber update to the destroyed hospital’s financial situation.

Sad: a patient in a mental hospital for the elderly hangs herself by stringing a computer cord around her neck and raising it with an overhead motorized bed lift.

Australia’s Queensland Health is suing TrakHealth and its new owner InterSystems for misrepresentation. That follows TrakHealth’s earlier lawsuit against Queensland Health for cancelling its contract.

E-mail me.

Computer Sciences Corporation establishes a dedicated healthcare sector, leveraging its 2007 First Consulting Group acquisition. CSC veteran Deward Watts will lead the new business unit.

McKesson announces the availability of its integrated workforce management suite. Regular HIStalk readers know all about it since we did an HIStech Report on the suite right before HIMSS.

Since I am plugging HIStalk productions, I encourage you read the LingoLogix review posted Monday. We are starting a new series called HIStalk 911 to provide high level observations and recommendations for newer, emerging and/or smaller companies (at no charge and not available to sponsors just so everybody knows there’s no mutual back-scratching or anything). Since it was our first one, we are dying to know readers’ opinions, both in response to our comments and to the company itself. Thanks to LingoLogix, by the way, who asked us to take this peek under the hood.

Michael B. Kaufman, former Eclipsys executive VP, is named to the board of Premise Corporation. I was impressed to read in their press release that Premise grew revenue a whopping 260% in 2007 and 2265% over five years.

Unity Health Care in Washington DC selects eCW for EMR/PM. Unity has over 100 providers across 31 locations.

Seems the Seppos are not the only ones with HIT implementation issues. The Aussie’s HealthSmart project is at least two years behind schedule with more than half the budget spent and only 24% of the planned installations complete. The “cornerstone” of the project is implementation of Cerner’s Millennium clinical suite, which is not yet operational at any of the participating hospitals.

Connecticut IPA Fairfield (CT) County Physician Management Corporation and Norwalk Hospital select NextGen’s EMR/PM for its 200 member physicians.

MediCorp Health Systems (VA) purchases Sunquest’s LIS for a new Stafford hospital next year. MediCorp already uses Sunquest products at its Fredericksburg facility.

MEDecision names Tim Wallace as interim president and COO. Former president John Capobianco resigned last year. The company also named a former Horizon BCBS executive medical director as executive VP and CMO.

I looked over the newly announced Fortune 500 list, scanning for healthcare-related companies, and found a few familiar names. GE ranked as the country’s third largest publicly traded company, HCA was 31st, and EDS came in 43rd. GE was also the second most profitable. Cardinal Health was named the 19th fastest growing and McKesson is considered the 13th best bang for the buck (based on revenues per dollar assets.)

E-mail Inga.

HIStalk 911: LingoLogix

Company
LingoLogix
25 Highland Park Village #100 509
Dallas, TX 75205
214.252.9522
www.lingologix.com

Product
GoCode computer assisted coding for ambulatory encounter notes.

The Elevator Pitch (provided by the company)
"Improved compliance, revenue, and speed to billing – automatically for ambulatory patient encounter notes, with our Natural Language Processing (NLP) solution, GoCode from LingoLogix.  Physicians do their documentation while GoCode works in the background, without requiring providers to change the way they work.  New intelligence, reporting, knowledge extraction from narrative, free-text digital medical content.  We can work with an EMR or without one, real-time or batch mode, ASP or behind the firewall – no problem. And, the Chief Compliance Officer will be impressed with our consistent coding accuracy that has been demonstrated against audit to exceed 90% accuracy in automatic E&M, ICD9, and CPT coding extraction."

First Impressions
We went right to the the company’s web site, of course. It’s very serious and low key. Can we figure out what the company does and why customers and prospects should care? Let’s jump in.

The good news about all the smarmy criticism that follows: we think GoCode is pretty cool, at least judging from our CIO-level, first-pass review. It passes the first-sniff test. The customer we talked to raves about its ability to bill fairly and consistently (which usually means increased revenue) for its target customer, large organizations that do outpatient billing. Compliance is important, but nobody likes buying compliance solutions, so let’s go with Get the revenue you’re entitled to through accurate, defensible billing advertising approach. Is that the message being sent? Let’s take a look.

The most important web real estate (top left of the home page) has some stock art and a tagline, "The Science of Specialized Languages." That’s not much of a come-on, at least until the company gets huge and has offerings in many industries. It’s true, it’s bold, and it’s broad, but it’s not the best use of the 30 seconds of a casual reader’s attention that you’re apt to get. Redesign the front page with a clearer call to action and a single, constantly repeated message.

We’re serious about the 30 seconds rule. It’s like a date – the evening’s outcome is usually decided in that same 30 seconds. Spend more time creating a shorter message. 

Under The Company, it says, "“LingoLogix was formed in 2002 for the purpose of taking core technology developed at The Mayo Clinic to market.” Nobody’s going to buy just because Mayo wanted to make money. Isn’t your purpose to assure doctors they are coding accurately for maximize reimbursement? Prospects like customers whose very specific mission aligns with theirs. Name-dropping Mayo is fine, but not here. Would you go to a doctor who says, "I went into medicine because I wanted to drive a Porsche?"

Neither is the unremarkable history of the company and the year-old press releases in the News section of the front page. What are you selling? Am I a prospect? Has nothing happened in the year since the last press release went out? What do you want me to do next?

We would write sexier press releases. The news isn’t that the customer signed the agreement to use the product, but that they state that it’s "more accurate than human coders." This is a great story badly told. Don’t be afraid to market yourself – tune the message, focus on what’s newsworthy, and give the press ideas for stories that will generate free PR. 99% of press releases are terribly written, guaranteeing that no reporter in their right mind will do anything except move on quickly.

Since we’re lost at this point, we’ll click on Products. That’s a misnomer – there’s only one (and there’s nothing wrong with that – it shows focus). If I do enough clicking, I can find more specific information. The downloadable brochure is good, but it’s hidden away and is in the PDF form that clickers often avoid. It also doesn’t match what’s on the site – it’s better in identifying benefits, though it stops short of saying it helps you get your money. The testimonials are good and should be on the main site.

It’s better to repeat one focused message than to spray out several of them. Tell me (again) what problem I have and how you’ll solve it. Give me a bullet list of key features (reduces the need for coding specialists, works with free-text dictation without templates, etc.)

There’s a link for Demos. Oops – it’s just a signup form, free of the immediate gratification I’m seeking. Few people will do that. I’m doing you a favor looking for information – why stick a salesperson in between me and what I want to see? Is it top secret? Why can’t I just look at a video or PowerPoint on my own? The product section actually has a link in microscopic letters that links to a screen shot, but there needs to be more of that and it should be easier to find.

Surely something here is innovative (what was that "science of specialized languages" bit?) so where are the white papers, testimonials, architecture descriptions, etc.?

There’s no mention of a sales and marketing executive or of any strategic partners who will resell the product. Prospects might not care, but investors might, so we would talk a little about the distribution channel.

If you redesign the web site, go Web 2.0 and hire a pro. Simplify the message. Make it appealing. Strip away everything that doesn’t add value. Put your best foot forward in 30 seconds or less.

Identify the Problem, The Audience, and Their Fears
The first question we ask a company that’s looking for marketing help: who’s your target decision-maker? What pushes their button? How do you find them and get your message in front of them?

It’s not clear from the LingoLogix site, but its customer tells us the company has three influencers to reach: the CIO, the outpatient manager, and the compliance officer. Since their agendas are wildly dissimilar, why not provide each with a link to click and then hit them with a targeted message? One size does not fit all.

We would say that CFOs and COOs (hospital or large practice) would be the best contacts. They own revenue and compliance issues and have authority to buy a solution. They think big picture. Regardless of title, find out who owns revenue and compliance issues – and that’s not likely to be the CIO, whose only role is probably to veto if the technology is risky.

And like most hospitals, the first question is "who else is using it?" Your customer sites are excellent.

We like the OIG/compliance pitch, but until a provider is busted, how do they know they have a problem? Nobody buys compliance solutions proactively, at least not since HIPAA was found to be a toothless tiger. And in our experience, compliance officers don’t have a lot of clout when it comes to changing systems or workflow. It’s the secondary message to improving billing accuracy, especially since most organizations underbill, according to your customer. Focus on the incremental revenue opportunity, but use compliance as the nobler way to get that message across without making the prospect feel greedy.

Here’s what we’d want to see: some kind of checklist or online worksheet that tells me if I have the problem you’re solving. People buy solutions. That implies problems. How do I know I have one?

Say what you’re selling me – often. A computer product? Peace of mind? Enhanced revenue? Pick an honest yet sexy marketing message and sprinkle it liberally everywhere.

This is the area we’d focus on first since it spans all aspects of marketing the product, not just the web site.

Management Credentials
A small company’s executive team and board attract three audiences: customers, partners, and investors. LingoLogix has a strong team when it comes to investors, but not so strong for customers and partners.

We’d like to see more operational healthcare experience represented. If you’re selling solutions for billing and compliance, get people with impressive experience in those areas. General business experience in leadership gives the perception that a company is a technology vendor rather than a solution provider, which the company clearly isn’t – it has real-life, deep domain offerings. We’d make that statement more strongly, perhaps with a strong advisory board of provider-siders. Get people who are similar to your target prospects.

It’s a well-credentialed team. Get some heavy healthcare experience as an advisory board and it would be much stronger. Or, have a third party "expert" from a well-known consulting company review the product and provide a quote about how great it is (assuming they think it is).

Focus on Results
We see a lot about what the product does, but not enough about what benefits the customer enjoys from its use (and from its customer, there are many). The customer says the ROI is impressive, so tell me about it (or better yet, give me tools to predict it at my place). Show me the workflow before and after. Let me feel what it would be like running it.

ROI is important when it comes to passing that first hurdle. Put it in the prospect’s face.

Business Benefit is Strategic
No problems here. Customers don’t often buy solutions that don’t align with strategy. Who wouldn’t want revenue enhancement and compliance assurance? Companies often miss that point – even a great product won’t get a second glance if it doesn’t solve a strategic problem. This one’s a natural.

Innovation – Why Are You Better?
We recommend more information here. We don’t know who the competitors are or what our strategic alternatives might be. Tell us! You don’t need to be innovative from a technology standpoint (people buy solutions, not gadgets), but give the CIO something to grab onto – architectural diagrams, interfacing information, hosted vs. locally installed, etc.

And if the rules-driven NLP is more sophisticated than the usual text decomposition (which the customer says it is), then tell the CIO. Just don’t expect the rest of the customer’s people to care. They want results.

Do you have any services, support, updates, etc.? Do clients like it?

From what the customer tells us, GoCode is damned impressive at consistently and accurately creating accurate charges from documentation, easily measured and monitored by running it against "gold standard" documents of known quality. That might the most compelling sales point available. Remember Kasparov vs. IBM’s Deep Blue chess matches? Even people who didn’t follow chess got interested in the man vs. machine angle. Pit expert coders against GoCode and publicize the results (no matter who wins). The PR possibilities are endless and the resulting message is razor sharp.

Or, hitting the compliance angle, get statements from neutral third parties on the value of having an unbiased, consistent billing tool vs. humans. The customer has done that. Or, offer an accuracy guarantee or to appear with the customer if billing is called into question.

While doctors aren’t heavily involved in the decision, the customer tells us there’s a strong argument for them. Billing more procedures accurately means higher numbers,which may mean bigger bonuses with no extra work whatsoever. Physicians could help seal the deal.

We wouldn’t talk yet about the tool’s obvious potential to build or mine data warehouses. That would just confuse customers. Stick with the single message.

Conclusion
LingoLogix has a happy prestigious customer, an apparently highly functional product that delivers big strategic benefit, and some smart technology people. Like many or most small companies, they’re still working on their message and positioning.

We like the company’s chances of success. Few have the big-name reference sites that LingoLogix has, plus the strong possibility of some huge deals upcoming. Bring on some sales and marketing expertise after the next big sale, we say, and go looking for investor money if you need it. And be ready to build a strong support organization for a wider user base.

We’re most encouraged that LingoLogix opened themselves up for our critique. We said we wouldn’t mince words (we said it would be like Kitchen Nightmares, where Gordon Ramsay rips into a restaurant to help make it better). We’re confident that the average decision-maker would have similar reactions to ours, although they wouldn’t make recommendations for improvement – they would just move on if they didn’t get the picture quickly.

Now It’s Your Turn …
We said upfront that we would give LingoLogix the chance to respond to our observations and recommendations. Secondly, and arguably most importantly, we offered the expert opinions of HIStalk’s readers. We gave our thoughts for free and invite you to do the same.

Do you agree or disagree with what we said? What advice would you give LingoLogix? What else should they know about their market? What partnerships should they seek?

Add your comments below. I guarantee that a lot of people, including everyone at LingoLogix, will be hanging on your every word.