News 12/19/07

From Saas Man: “Re: athenahealth. Here is a link to a recent CNBC interview with athenahealth’s Bush on other companies doing what they do – all about execution. As someone who follows the SaaS industry, I can say comfortably that athenahealth is light years ahead of any HIT vendor and I would put them up with other SaaS superstars like Salesforce.com. They understand it has so little to do with software except that it needs to be one app and centrally hosted that is how they inject their acquired knowledge into their clients’ workflow to get the results they are known for in the industry and on Wall Street. In my opinion, you will see them connecting to more and more payers and labs etc and then building out their network in ways that traditional HIT software vendors can not with just hosting an app  – it has to all be integrated and centralized. I doubt HIT vendors will jeopardize their software margins to do the heavy lifting.” Link. “Healthcare’s got to get onto a network,” Jonathan Bush says. Good interview, although mostly a quick sound byte sampling since they obviously were in a short segment. On real-time adjudication: “Can you imagine if the Gap had to wait 30 days to decide what to charge you for the jeans?” On traditional competitors: “They can’t keep the knowledge in that software current every day.”

From Art Vandelay: “Re: VISICU. Philips makes another bold move by acquiring VISICU. Both Emergin and VISICU are covered in their press release. Philips is serious about integration and the services they offer. VISICU has a pioneering remote monitoring outsourcing service. Their product has solid data capture and real-time decision support functionality. They lack a broad critical care system providing robust flowsheets, charting, task coordination and orders. Philips has a critical care system in the CareVue product it acquired from HP. Combining the two could position them to extend into new areas ( i.e., NICU, Clinical Decision Units). Too bad the Epic partnership didn’t pan-out. Epic and the Philips applications and devices with the integration could have been a killer offering. SpaceLabs Medical is a common partner of Emergin and VISICU – new acquisition? Another move that could put the competition on-notice would be to buy-out Globestar (similar to Emergin) or Capsule Technologie. Perhaps these are their next steps?”

Stiill need convincing that real-world medical device connectivity is the next battleground (as Laurent Rotival strongly suggested)? Cerner brings 32 medical device to KC to get briefed on its CareAware connectivity kit.

The White Stone Group’s OptiVox communications handoff product is featured in a customer’s presentation at the IHI forum just ended in Orlando, describing their 75% reduction in admission time for ED patients.

Listening: Jessica Prouty Band. Hard-rocking and tight pop-metal, a la Evanescence, Lacuna Coil, or Nightwish. Funny thing is that everybody in the band is aged 12 to 14, but they don’t sound like it. Mom’s an HIStalk reader (she’s in the the HIT industry). Amazon has the MP3 single, coming soon to iTunes. I listen to music like this quite a bit and it’s very good.

New ads to your right: Dragon Medical’s on sale and a discharge referral product is ready for your perusal. Check it out.

Six London trusts finish their rollout of surgery systems from Picis.

Now here’s a fascinating story (unverified for now, but the source is solid and I’m trying to get the technical party involved to go on record with me). A few years ago, Vendor A was selling de-identified patient data to Vendor B. Vendor A found that Vendor B had figured out a way to re-identify the patient data and was selling in that form (!) Vendor A cut them off, claiming they were breaking state privacy laws. Vendor B countersued for breach of contract. Supposedly a security expert who had been called to testify took Vendor A’s file and, using nothing more than a desktop PC and a voter registration database purchased over the Web by credit card, was able to re-identify somewhere between half and 3/4 of the records, instantly destroying the illusion that de-identified data is permanently anonymous.

Another privacy story, coming from another credible source (not Deb Peel, even though it’s about her). Peel was giving a presentation and mentioned a huge insurance company’s plan to sell de-identified patient data to employers without consent. She was interrupted loudly in mid-sentence by someone from that company who tried to argue, saying the data was to be used for all kinds of noble purposes. Trouble is, she’d talked to someone at the insurance company already and was told the sole purpose of the database was to save money for employers (and make money for the insurance company, obviously). Doh! You know those guys have heavy duty data miners looking for fun projects.

I hear that SCI Solutions has moved up to #6 in KLAS’s list of top vendors, a big jump up from #11.

MedMatica Consulting Associates is named to the INC.’s list of 5,000 fastest-growing private companies.

AHRQ gives KP a $600,000 grant to study the role of EMRs (HealthConnect, in their case) in heart disease prevention (do they really need taxpayer money?) The Kaiser guy brags on how HealthConnect lowers medical costs, so expect those premium reductions any day now.

The local newspaper profiles the doc and programmer who developed ChartConnect, a Web-based community patient records system that they say connects 80% of the providers in their area. They’ve already received (and declined) a buyout offer from McKesson (apparently a handful of big companies will own the entire industry in a few years).

Congress is considering a $2 billion IT budget for the VA, creating the hope of an early Christmas present for the usual technology trough-lappers.

Australia will create an integration testing and accreditation lab to verify vendor claims of interoperability.

I know some folks will be taking off early for a Christmas break. I’ll be here as usual, but in case you don’t check back in, have a wonderful holiday.

E-mail me.

Inga’s Update

Former Cerner VP of worldwide sales and business development Michael Mickens is named VP of sales and client services for etrials. Chuck Piccirillo, who previously worked at Hill-Rom, Kodak, and Carestream Health was named VP of product development.

Surescripts President and CEO Kevin Hutchinson is leaving the company at the end of January. The press release doesn’t indicate where he’s going or why, but does have plenty of quotes from board members singing his praises. Rick Ratliff, SureScripts COO, will serve as acting CEO.

McKesson CEO John Hammergren sells a few company shares and nets $3.5MM. I wouldn’t mind being on his Christmas list.

Misys announces that, in addition to selling its MyWay solution as a hosted service, practices can now buy the solution for on-site installation.

Sunquest earns an impressive fourth straight year as Best in KLAS for its Sunquest LIS. Good for them for still being able to deliver strong support, even in the face of the turmoil of an ownership change.

Other notable KLAS honors: eScription earns top honors for transcription and back-end speech recognition, Hayes Management is named overall leader in the Professional Services segment with #1 rankings in Planning and Assessment and Technical Consulting.

Another VC company makes its debut. Santé Ventures has $100 million in committed capital to invest in seed and early-stage companies developing new medical technologies and healthcare services. The managing directors include former Ascension Health president and CEO Douglas French and a former Ascension hospital CMIO Joe Cunningham.

Quadramed’s board of directors authorizes the repurchase of up to $5 million of common stock.

A new report predicts healthcare IT spending over the next couple of years will be greater than investments in service or building expansions or acquisitions. Three out of four of the 464 hospital executives participating in the survey indicated they will acquire or upgrade new equipment worth more than $500,000 over the next two years and 65% will be making major IS investments. If you are selling, the best place to be is in the Northeast, where 96% of the hospitals are investing in new technologies and 89% in IS.

Since my post last week about the Mac O/S, a couple of amusing things have happened. First, all these Mac people have come out of the woodwork to advise me on all things Mac, including its reliability and all the cool features (fortunately I already knew you guys were fanatics). The second (and really not amusing) thing is my latest Microsoft update is giving me fits with Internet Explorer (lock ups, can’t reach sites, etc.) No, I am not ready to dump my nice laptop, but do wonder which one of you secret Mac fans is sabotaged my system.

The Madison, WI paper has an article on the tasty cuisine at the Epic cafeteria. The best perk seems to be the ability to raid the fridge if you work past 7 p.m.

E-mail Inga.

Philips To Acquire Visicu for $430 Million

Royal Philips Electronics NV announced this morning in Europe that it intends to acquire ICU monitoring systems vendor Visicu for $430 million in cash, strengthening Philips’ position in patient monitoring. The company’s offer of $12 per share represents a 35% premium to yesterday’s closing price.

Baltimore-based Visicu earned $9 million on sales of $36 million over the past year. In the 20 months since its IPO, Visicu shares have dropped from nearly $25 to below $9. Its board has approved the acquisition and recommends that its shareholders approve it.

From the CEO of Philips Healthcare: “Today’s deal builds on Philips’ announcement two weeks ago that we’re acquiring another clinical IT company, Emergin. Philips is a market leader in patient monitoring systems in the hospital, so we know the challenges our customers face – rising patient numbers, staff shortages and concerns about patient safety. By investing in clinical IT solutions like those offered by Visicu and Emergin, we believe we can offer customers more attractive patient monitoring solutions that improve hospital productivity as well as patient outcomes. So making these investments we believe will drive further growth in our patient monitoring business.”

Monday Morning Update 12/17/07

From Sterling Moss: “Re: cranky doctors. Docs may be cranky because they are smart and don’t make as much money as the salesmen who push drugs at them (or the lawyers in BMWs, or the venture capitalists, or …). However, cranky or not, just because doctors are ‘smart’ doesn’t mean they are adept at business or money making. In fact, the opposite is just as likely. From my own personal experience as a doctor involved in starting my own manufacturing company and participating in someone else’s startup and working as a sales consultant for yet a third company, I can attest I and my medical colleagues are not very adept at the skills necessary in making money in the non-clinical world. Maybe this is just the best we can be.”

From Grant Beesknees: “Re: physician incomes. I’m a physician and I think Ian Morrison is a little off. Anyone can get earning statistics for the US Bureau of Labor Statistics. On average, physicians out-earn any other career group. Additionally, physicians out-earn their peers practicing in almost any other country you can think of. So, I don’t think there is much for most doctors to be angry about in terms of their total income. Now, if top doctors want to compare themselves only to graduates of the top business schools or top law schools, then they might find that they don’t compare as favorably. However, many in the business or legal world spend years working their way up the ladder until they take responsibility for multi-million or multi-billion dollar organizations, along the way, out-earning physicians. I don’t know for sure, but I think that most physicians’ practices are substantially smaller enterprises. Even so, physicians can reach the higher earning levels of their profession rapidly even if they don’t provide a particularly high standard of care or produce results. In other industries, that is somewhat less likely. In my opinion, in America, doctors earn a good living without too much risk and generally deserve what they earn.”

From Julius L’Orange: “Re: NextGen business services. I think the little announcement you made about NextGen business services deserves some more attention. Did athenahealth think that the ‘standard’ ambulatory EMR vendors were just going to sit and watch them? You can bet Allscripts, GE, and eCW are all gearing up to offer some sort of RCM service via their PM systems in the coming months, thus making sure their current customers don’t feel the pull to AH, but more importantly, capturing other customers who like the SaaS model for RCM, but want a more mature EMR than AH currently has.”

From Art Vandelay: “Re: nurse barcoding. I believe nurses are defensive about the comparison to a grocery store clerk because nothing substantial is being done to change their situation. At least the grocery store clerk’s technology tool belt has grown to increase precision and efficiency. Nurses are working with outdated processes and supported by outdated models of staff roles, training, and technology. We analyze one small area at a time, followed by a rush to introduce technology. Examples include the continued proliferation of individual-use devices and singularly focused decision-support tools in support of metrics. The most promising work I have seen is from the American Academy of Nursing through a Robert Wood Johnson grant. Maybe the momentum from this work can be parlayed into a win for nurses, staff, and patients.”

From DrCool: “Re: selling patient data. In July 2007, Paul Tang said that ‘some electronic health record and personal health record vendors have placed in their contracts stipulations that would obligate healthcare providers to violate privacy rules.’ He further said that he has personally seen the contract language, but declined to identify the vendors or how he came to see the offending contract provisions. ‘That wouldn’t be fair,’ Tang said. ‘It’s just those things are in there.’ I’m sorry – Tang is acting as a patient privacy expert, and is saying that he knows of potential illegal activity, but it would not be fair TO THE VENDORS to reveal who is doing this? The arguments would be more powerful if they were specific. And it seems much more likely these days that the main privacy problems we have are people leaving unprotected laptops full of data in their back seats. Have we ever really had a story where an EMR vendor or any other business entity actually sold identified patient data since HIPAA was passed? Finally, as a minuscule investor in IMS, and even as a physician, I have to admit that it does not surprise me, nor even bother me, that the pharma companies know what I prescribe. It is not like they have access to specific patient data (apparently, they used to, but that has changed). I’m a capitalist by nature and every other business gets to use data intelligence to figure out how to do things better. I have no problems letting the pharma people do the same. If it bothers a doc too much, they can ban pharma reps from their office. No one is making them see the Pfizer barbies.”

Speaking of selling data, guess what companies are among those trying to block a Maine law that would let physicians decide individually whether to allow data-miners to sell their prescribing information to drug companies? McKesson, Wolters Kluwer Health, SureScripts, Cardinal Health, NAHIT, and the eHealth Initiative. Money certainly drives the first four, but why are non-profits and supposed industry advocates NAHIT and eHI weighing in on a practice that shouldn’t concern them? Ditto, probably: some of their members are data-sellers and buyers who profit from the practice by pushing high-margin but not necessarily optimal drugs. Too bad patients themselves aren’t profitable – they might have more advocates if they were.

Sumter Regional is looking good to win the MRI machine, but give them some votes just to make sure. They’ll know in a couple of weeks.

EnovateIT moves to its new headquarters in Ferndale, MI.

Misys says its healthcare division showed slight growth in the six months ending November 30.

CDC is developing technical standards for sending healthcare-associated infection data to its National Healthcare Safety Network.

IBM is running several healthcare IT projects in India: data sharing, wireless hospital access, medication sensors, and drug supply chain tracking.

athenahealth kicks co-founder Todd Park upstairs, creating a Chief Athenista position and giving him a board seat, but removing him from the management team.

E-mail me.

News 12/14/07

From Diablo Cody: “Re: HITSP. Does anyone expect interoperability in that real world on which HITSP touches down infrequently? In a recent presentation, there was a massive number of acronyms, 250 organizations involved without any real accountability, conflicting agendas, and success that depends on volunteerism. They must have got their advice from HIMSS, who has a lock on the well-paid generals and a volunteer army.”

From TheInsider: “Re: Azyxxi. I believe Azyxxi is playing ‘hard to get’ for a good reason. I hear Azyxxi is only a work in progress that’s not ready for delivery. If you offered to pay the full price for having it delivered tomorrow, Microsoft would probably not be able to deliver. The announcements about new ‘clients’ are basically development partners which are not paying for the product (and might even be getting something in return for their participation in Redmond’s productization efforts). BTW, this is not a new approach for MS. In other industries that they entered as an ISV, they usually created premature hype to slow down the market (put it into a kind of holding pattern) as a strategy to hamper their potential competitors’ efforts before they actually have a product to deliver.”

From Betty Grissom: “Re: Meditech with another vendor’s clinicals. This idea floated for a decade, with vendors starry-eyed about 25% of market share in the US and 40%+ in Canada. At least three vendors tried. Eclipsys had a dedicated team for several years, working with Osler and SHAMS group. They branded the solution ECA (Eclipsys Clinical Advantage) and gave it a big marketing campaign and sales blitz. They didn’t get a single sale. Plus, the price points couldn’t work. 90%+ of the Meditech base bought integration (not interfaces), low cost, and simplicity and would have lost all three. Clinicians may be frustrated with Meditech’s ‘good enough’ approach to clinicals in a CFO-driven selection, but ECA was actually the worst of both worlds, losing most of Meditech’s good points with the work and cost of a bolt-on.”

From The Shadow Chancellor: “Re: Linux. Looks like McKesson is planning on jumping off the Microsoft bandwagon and on to Linux for its users as well as for its backend applications.” Link. McKesson VP Michael Simpson says hospitals will be ready to run Linux on the desktop in 3-4 years, following good success with McKesson’s Red Hat Linux server option for most of its apps.

From Fish n’ Chips: “Re: Sutter. Sutter nurses on strike again. Management’s solution? Free food (breakfast, lunch, dinner)for those who don’t strike.” The two-day strike started today, but some hospitals will lock nurses out for three more days afterward. Interesting: full-time nurses at Marin General earn $104K a year, but 96% of the nurses aren’t full-timers. Part of their beef seems to be a health questionnaire, which the union claimed could be sent to the employees’ insurance carrier without consent.

From Rhio D. Dollaro: “Re: tanking RHIOs. HIMSS disbanded its RHIO committee and turned it over to eHI, which has completely different goals, to wither. The techies were running the asylum. When asked about business case, all they could come up with was, ‘it’s good for all’.

From Art Vandelay: “Re: RHIO failures. I attended a set of meetings for our local health information exchanges (HIE). The first stumbling blocks were the politics and the leveling of the data competitive advantage a few organizations experienced. These issues weren’t resolved before the lack of a sustainable business model and funds for initial investment seem to have really impacted the project. We never really got around to the privacy concerns. Without a government mandate or a realignment of incentives, this just isn’t going to happen soon. I see this concept coming-back in about 5-10 years, once the vast majority of the country has baseline clinical data repositories installed and functioning and the standards committees have had time to meet and align. Very localized initiatives where hospitals exchange data with their affiliated physicians’ computerized medical records are likely to start springing-up in the place of HIEs. This scope can be managed. Vendors to watch include Novo Innovations, Medicity, MedSeek and dBMotion. The technologies and services of these vendors seem to set them apart from others in the pack.”

From LW: “Re: selling patient data. One of your readers posted that Paul Tang keeps talking about vendors doing this, but there is no actual evidence. There actually is. At the August 2-3 meeting of the NCVHS Ad Hoc Workgroup on Secondary Data Uses, a testifier (Dr.Jeff Goldwein, from an oncology software vendor) said, ‘We also have external commercial partners that take the scrubbed de-identified data and sell to, and these are consulting and health care research firms that have significantinterest in real time patterns of care and the management of cancer patients. And our program members are cognizant of this, and they fully participate in this partnership. Since Dr. Tang sits on that committee, it may be exactly this that he apparently keeps referring to.” Link. I’m beginning to worry less about sellers of de-identified data. All that’s lost there is a chance to share profit with those selling it, but I expect that’s minimal since, as a reader commented, standalone data of uncertain quality isn’t worth much. I’m not really appalled by the practice, although I’d still insist on careful contractual wording. Since no one has mentioned selling identifiable data, I’m assuming that’s not happening. Maybe we should be most upset that physician prescribing data is sold to drug companies with doctor information intact, allowing target marketing by Pfizer Barbies for questionably cost effective drugs.

From Pat Watusi: “Re: barcoding. The new 2D imagers can parse through the mishmash of data held within the bar code. Given a little effort, the new readers can parse and display the desired information. Additionally, by implementing a bar code solution in association with the existing pharmacy or CIS application, adverse drug events can be reduced to zero.”

From Dingus McGee: “Re: barcode editorial. Your recent entry made me think of the attached article from Paul Harvey.” Interesting! I couldn’t find any reference to it on the web, so I copied the clip below that Dingus sent in. No copyright infringement intended in running it because I can’t even verify that it’s real. I didn’t see it before I wrote my editorial, but we make similar points.

Listening: Crash Kelly, new, 70s-sounding arena rock.

A reader sent a link to a good editorial by Ian Morrison called The Doctor Conundrum, which deals with unhappy physicians. “Let’s start at home. Consultants and futurists are paid four to five times what they would be in other countries; hospital CEOs, three to four times; administrators of all types, two to three times; and so on. CEOs of health plans who rack up $100 million-plus in compensation over the course of a career are well ahead of the cumulative earnings of all the ministers of health in the developed world. And then there are the sales men and women of America. I want my son to be a salesman because America rewards sales more than almost any other profession. There are armies of sales people in American health care, many of whom are making much higher incomes than the doctors they are calling on. These are just estimates: I urge someone with access to all these numbers (such as the compensation consultants) to publish them. Just wait and see how angry the doctors will be then.” Say, sounds like something a muckraker like me would enjoy running.

A couple of readers also sent a link to this piece, The Checklist, from The New Yorker. Peter Pronovost of Johns Hopkins created a simple checklist for preventing line infections, containing the same stuff everybody knows already, with miraculous results. “Within the first three months of the project, the infection rate in Michigan’s I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan’s infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist … I asked him how much it would cost for him to do for the whole country what he did for Michigan. About two million dollars, he said, maybe three, mostly for the technical work of signing up hospitals to participate state by state and coordinating a database to track the results. He’s already devised a plan to do it in all of Spain for less. ‘We could get I.C.U. checklists in use throughout the United States within two years, if the country wanted it,’ he said. So far, it seems, we don’t. The United States could have been the first to adopt medical checklists nationwide, but, instead, Spain will beat us. ‘I at least hope we’re not the last,’ Pronovost said.” This is a great article. Those of use who believe that the greatest value of CPOE is simply getting doctors to agree on order sets and common doses before arriving at the point of decision will be thrilled at the power of simply making and using checklists, the kind we IT types use all the time (anybody ever think of doing formal change management for patient care? I just made it up, but why not?) The list idea isn’t anti-IT, either. Why couldn’t systems link to Web pages on which lists (with visuals) are maintained to provide just-in-time advice and reminders? There’s an HIStalk interview slot waiting on Peter if he’s interested.

Add to the list of Computerworld’s 100 Premier 100 IT Leaders for 2008 Phil Chuang, CIO of Telecare Corporation. I missed him on the first pass because the company name didn’t register as being healthcare-related, but the company does behavioral healthcare. Congratulations.

Serial entrepreneur and visionary Scott Shreeve, now serving as CMO of MyMedLab, asked me to try the company’s services and report back. Now I’m not going to trundle off to get phlebotomized for just anyone, but in the interests of participative journalism and since Scott is a darned nice guy, I signed up on the site to have a General Health Screen done. It was slick: you choose the tests you want from a list of what’s offered, check out and pay online by credit card ($54, in this case, but Scott comped me), and then print out the lab requisition, instructions, and directions to the draw station. Off you go to Labcorp to get stuck, which in my case involved a short drive and exactly 19 minutes from leaving the car to getting back into it. The next day, your test results are online in a PHR-type application. Minuses: you don’t get an e-mail notice when your results are ready and the PHR application is pretty basic. Pluses: you don’t need a doctor’s order, it works just like you’re used to, Labcorp is everywhere, and the results display has some very good info on what your results mean. I don’t know how large the market is for people who want (or should have) a serum creatinine or drug level without a doctor’s involvement, but the price and convenience should make self-payers pay attention. Verdict: it was easier than I expected and with no drawbacks, with the added benefit of getting your own results and explanation for online access at any time.

Delano Regional Medical Center (CA) goes live with Sentillion’s Vergence Clinical Workstation.

NextGen announces its business service division, which will offer revenue cycle management services to physician practices via web-delivered software.

Catholic Health Initiatives chooses PatientKeeper’s physician system.

MedAssets raises $213 million in its IPO, selling at the top of the announced $14-16 range and popping up another 30% in today’s first day of trading.

Osler Health Centre installs Swisslog’s PillPick drug management system.

Medsphere finishes its OpenVista implementation at two state hospitals in West Virginia.

Some of the 119 jobs on HealthcareITJobs.com: Director of Clinical IT (MA), VP of Research Services (NC or PA), VP of Informatics and Reporting (FL), CDR Manager (CA), Pharmacy Clinical Support Manager (CA). Employers can post listings free through January.

ABC News does a story on the VA’s IT systems. “This hi-tech care isn’t just a godsend for patients; nobody loves it more than doctors. So why do VA hospitals, even with all their challenges, do this and private hospitals don’t? The difference is the VA’s life-long relationship with patients. It gives them a strong financial incentive to invest in technology that aids preventive medicine.” It says that only 5% of hospitals have electronic medical records, which is surely a mistake (sounds more like the CPOE or ambulatory EMR percentage).

Odd story: Easton Hospital was going to lay off its chaplain, but decided not to.

A Florida State University study says that IT-using community hospitals have better patient outcomes.

Ron Latta is named IT director at Rockingham Memorial Hospital (VA).

E-mail me. Where do you think all those cool reader comments above came from?

Inga’s Update

I loved Mr. H’s “Want To Anger a Nurse?” piece. I agree with Anonymous that the issue is less about how much more difficult it is to be a nurse than a grocery clerk, but how little hospitals and technology have done to make their jobs easier. Never having worked in a hospital, I learned a bit about some of the minutiae nurses must deal with. I bet they don’t teach a lot of that in nursing school to the wide-eyed youngsters who think nursing is all about saving lives. No wonder nurses get burned out so easily and we have a shortage.

Henry Ford Health System will use eHealth Global Technologies to digitize medical records and images from referring providers.

The VA places a $21.8 million order with QuadraMed to renew its Encoder Product Suite license plus training services.

The New Mexico VA Health Care System selects Picis perioperative automation. Picis president and CEO Todd Cozzens says the company is “quickly becoming the de facto standard for automating high-acuity areas of Veterans Affairs hospitals.”

From JimMac: “Quick thought on the Mac mystique you mention in your HIStalk posting today. If you’ve never used a Mac – especially Mac OS X – you can’t really be expected to understand it. It is kind of like walking around town in a bad pair of shoes with a pebble in one. Sure, it’s uncomfortable, but you don’t know any better. You figure that everyone has that discomfort. That’s Windows! Now, suddenly someone gives you a pair of shoes that are as comfortable as slippers, perform like the best running shoes, and look as good as a pair of Pradas. That’s the Mac.” You had me at Pradas.

E-mail Inga.

News 12/12/07

From Todd Taylor, MD: “Re: Azyxxi. Yes, Microsoft Azyxxi is for real and supported by 700 members of Microsoft’s health Solutions Group. There is an e-mail link on the www.azyxxi.com website above the tabs at the top right of the page (‘Contact us’).” Todd’s a Microsoft doc, so he might want to cover his ears while I slam his employer on behalf of the prospect who tried to explain nicely how clunky the site is instead of just taking his business elsewhere. Clicking the “Contact Us” link on the site takes you to a page for signing up for updates (what if I just want to e-mail a human being, not sign up for an autoresponder?) Click that link to get to a signup page. But, here’s the kicker: you can’t sign up without having a Windows Live ID! OK, let’s review: I’m a customer with an RFP, hot to send Microsoft some money. I nose around the Azyxxi site looking for a telephone number or e-mail address and finally notice the microsopic “contact us” link as my only option. I click it, and now I have to click again (after reading that I’m about to sign up for spam). Then, three clicks deep, I find that Microsoft doesn’t want to hear from a prospective customer who doesn’t have their crappy Windows Live ID. You’d think of those 700 people, somebody would recognize this as utterly arrogant and clueless. No wonder Google rules the world.

From Dana Moore: “Re: Centura. Since you have mentioned us on your site, I thought you would like to know that Centura Health has implemented MEDITECH at all 12 hospitals, effective December 1. We brought 11 hospitals live in 5 months.” Nice. Congratulations on a rapid-fire rollout. Big-hospital CIOs sniff at MEDITECH, but it works, it’s cheap, and it’s integrated. If it wasn’t for MEDITECH, the penetration of IT in hospitals probably wouldn’t be much better than it is in physician practices. And speaking of which, I’ll have a CIO interview soon that talks about bolting on more sophisticated specialty apps on top of MEDITECH to get the best of both worlds.

From Phineas Tutwiler: “Re: selling patient data. I’m surprised that you all are having this discussion about selling de-identified patient data. Somebody — the vendors or the hospitals — is currently selling identified patient data. My wife got dozens of catalogs from wig and breast prosthetic companies after breast cancer treatments/surgery. Any parent is inundated by hundreds of advertisements for baby formula, baby magazines, etc.” I thought most hospitals stopped that with HIPAA, although some felt there was a loophole based on the level of opt-in from the patient.

From Mr. Whipple: “Re: selling patient data. I am surprised that no one has brought up the fact that CMS licenses MEDPAR data back to vendors for various reasons, including distribution as part of the vendor’s application suite.”

From DrCool: “Re: selling patient data. Long time listener, first time caller. I remember signing a contract with Cerner years ago and seeing the language allowing them free access to sell de-identified data. We said no. They laughed and said most people don’t read the fine print and notice it, so they agreed to remove it. But, this should be no surprise. The HIT vendors want to figure out how to leverage things and this could be reasonable with appropriate safeguards (true de-identification), agreement from the customers, and compensation (either we get access to all de-identified data for our own research or we get a percentage of whatever money they make). If the privacy advocates want to focus on the issue of ensuring data is truly de-identified, that is great. However, Paul Tang and others are simply being fear-mongers when they claim they ‘know of’ companies selling identified data or have contracts allowing them to do so. If Paul actually has evidence, then he is an embarrassment to the HIT community if he does not share it. That goes for any of the privacy advocates. If they have evidence, let’s see it. If not, then focus on the real issues.”

From Kanye Diggett: “Re: barcoding. Given your past support of barcode solutions to improve patient safety, I thought you might find this article interesting. I was surprised to see that they quoted a past error rate. Not something hospitals typically volunteer to the public.” Link. Hopkins facility Howard County General Hospital resolves specimen labeling mistakes with barcoding, reducing errors to zero from 11 in the month before they started. A little Googling turns up the fact that the vendor was Iatric Systems and its MobiLab handheld phlebotomy system.

From Merriweather Tishman: “Re: demo data. The story of a customer recognizing their data in a demo smells strongly of urban legend. The companies I’ve worked for use strictly fictional patients created by their clinical staff for demos.”

Speaking of barcoding: why isn’t there outrage that drug manufacturers don’t follow any format when putting NDC numbers on their packages? They whined forever about having to comply, but suddenly became overachievers by inserting other junk within the bar code (because FDA wimped out on specifying a format, I suspect). Result: scan a drug’s bar code and the NDC is in there somewhere, but not predictably. Thank goodness the FDA and drug companies didn’t design UPCs or you’d never get through a grocery store checkout.

The folks DB Technology sent over information on their RAS and RASi products, which collect, aggregate, and distribute information from existing systems. A quote: “Today Siemens Invision automatically forwards the 35 Siemens reports to RAS. Once there, the RAS Data Extraction Module exports specific data elements from the reports to individual spreadsheets. Excel Macros, that automatically launch at the time of report capture, update the Master Daily Monitor spreadsheet.” Now I admit that I’m a sucker for tools like this that can solve many kinds of problems, but I still think this is pretty cool. I don’t know much about the company and I don’t usually give plug about stuff I haven’t used, but I see my bud Rod Neaveill is there (he used to be at Picis and was very nice about volunteering to hand out the “I Am Mr. HIStalk” buttons at HIMSS) so they deserve a little shout-out.

Computerworld’s 100 Premier IT Leaders 2008 includes Asif Ahmad (CIO, Duke University Health System), Eric Cowperthwaite (CISO, Providence Health & Services), David Dillehunt (CIO, FirstHealth of the Carolinas), Michael LeRoy (CIO, Detroit Medical Center), Michael Long (SVP, Siemens Medical Solutions), Marc Probst (CIO, Intermountain Healthcare), and Rick Warren (CIO, Foote Health System).

Lots of jobs at HealthcareITJobs.com: VP Client Services, IT Director, VP/CIO, Millennium analysts, and sales executives, to name a few.

Chris Perkins, former COO of Per-Se, will replace Grady Floyd as COO of Emageon.

Noobs: to your right is a Google search box that will scan 4.5 years’ worth of HIStalk for your desired keywords. Sign up for site updates and the Brev+IT newsletter over there, too. Check out HIStech Report for interviews about vendors and products (lots of those coming right before HIMSS). If you want sponsorship info, e-mail me, and if you want to tip me off to news or rumors, use the secure Rumor Report button to your right (which can hold an attachment if you’ve got super-secret documents of some kind). Lastly, please click the sponsor ads to your left and support the companies that support HIStalk since paying the bills out of my day job paycheck kind of sucked, making me crankier when I wrote.

WSJ runs a story on mobile VPN software that can maintain a connection under adverse circumstances that would kill a traditional VPN connection. St. Luke’s Episcopal is mentioned for its use of NetMotion‘s mobile VPN software to keeep laptop apps from crashing between access points.

MedAssets will IPO this week.

Dairyland Healthcare, fresh off its sale to Francisco Partners, brings in an executive team to work with new CEO James Burgess: Kevin Fahey as CFO (from Premise), Paul O’Toole as SVP of operations (from Mediware), Angela Franks as SVP of market development (from Lawson), and Mark Middendorf as SVP of sales (internal promotion).

Dell will ship its first tablet PC within the next few weeks, but will continue to sell slates from Motion Computing.

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Inga’s Update

Frost & Sullivan announces their Healthcare Opportunities industry excellence awards. There is a lot of excellence out there, so check out the link if you want to see the winners in about 30 different categories.

The CEO of a Connecticut nursing home chain is accused of taking $15 million in assets to purchase a yacht, three apartment buildings, a record label, and a lakefront home. The Haven Healthcare chain now finds itself in financial trouble and may be unable to recover.

MacPractice announces the availability of an EMR solution that is fully integrated with their practice management and runs on Mac OS X. I have never understood the Mac mystique, but know that there are a bunch of Mac fanatics out there. I thought it was interesting they included pricing information in their press release ($2500 though the end of the year plus $500 for annual support and updates.)

The Health Affairs folks release findings from a study on RHIO’s. The news is pretty bleak. Of 145 RHIO’s surveyed earlier in the year, 25% are now defunct. Only 20 were at least of moderate size and exchanging clinical data (mostly test results). Thirteen of the RHIOs received regular fees from participating organizations in order to support themselves and another eight relied heavily on grants.Their conclusion: It is unclear whether or not the current approach of offering small grants and waiting to see if they survive will work. My conclusion: Time for a different model if we ever want to see wide-scale HIEs.

Maybe Lee Barrett simply views the state of the RHIO world differently. He was just named to the board of directors for HTP, a company specializing in connecting healthcare communities.

eClinicalWorks is selected by the Mount Auburn Cambridge IPA in Massachusetts for their 230 physician members. They already have 18 sites and 70 doctors live.

Picis names Melissa Cruz as its new executive vice president and CFO. She replaces R. Scott Lentz, who will become senior vice president of business development.

Bright Medical, a 55-physician multispecialty group in Los Angeles, selects MED3000’s InteGreat EHR.

E-mail Inga.

Constance Gervais, RN on Nursing Information Systems

Constance (not her real name) followed up after writing this to observe that she had probably misunderstood one of my editorials, in which I argued that today’s systems weren’t designed to benefit nurses directly. She did, but I liked her response anyway.

I am a nurse who has been involved with clinical information systems for 25 years. I was very surprised at the commentary regarding HIS systems and their alleged negative impact on nursing. The reason I changed my career to information systems in the first place was that as an ICU nurse, I saw what information systems ‘could’ do to save nurses time, provide needed information to physicians in a timely manner, and reduce medical errors. I can remember at least three times when I administered the wrong medication dose to patients, nearly causing a fatality. Twice in my ICU, nurses made medication errors that actually ‘did’ cause patients to die; one was an overdose of insulin, the other an overdose of potassium.

Information systems at the bedside could have prevented ‘all’ of these errors. In one hospital in Virginia last year alone, eight patients had to be removed from the operating table after being anesthetized because information was not provided when and where it was needed prior to surgery. That issue was resolved with technology. I’m just one nurse. If you talk to any nurse, they can tell you about similar stories.

Not only can information systems save patients lives, they can also help standardize clinical practice and save cost for the healthcare organizations. Some nursing professionals may think that cost is not their problem, but I believe it is. After all, we are in the ‘business’ of delivering patient care, and that begins at the bedside. As a nurse, it always amazed me that we spent so many years developing financial systems, yet never controlled cost at the bedside where the decisions were being made. Unnecessary treatments, supply costs, and the cost of clinical errors significantly impact the profitability of a healthcare organization. Perhaps if we could save money by standardizing patient care practice, capturing supply usage, and preventing clinical errors, healthcare organizations would be able to afford more practitioners and support personnel at the bedside, thus making nursing a more attractive career path. I know from my experience as a recruiter that nurses and physicians prefer an organization with advanced clinical technology in place.

I walk into ORs in so many hospitals and see rooms stacked with supplies that are not being tracked or charged for appropriately, empty OR rooms during prime hours due to poor scheduling practices, nurses working overtime because rooms are not being utilized appropriately during the day, and surgeons not conscious of hospital cost using the most expensive implants designed to last 60 years on a 90-year-old person. You must understand that we cannot improve processes that we cannot measure. Management reporting without information systems is time-consuming and ineffective. Evidence-based analysis of clinical practice cannot be accomplished and improvements cannot be measured without information systems.

The problems arise when hospitals attempt to implement clinical systems without changing process. Many simply automate old processes, and yes, when that happens, it takes more time. Technology changes the way we practice, and processes have to be examined and re-engineered to take advantage of the new technology. Many hospitals do not take the time prior to implementing a system to examine current processes, understand what the issues are, and what define what they want to accomplish with the new technology.

Healthcare is a business. A significant factor in helping hospitals keep the doors open and afford staff is the ability to control cost. As a nurse and as an information systems professional, I take issue with this article and would challenge anyone who believes that it is a waste of time and money to use information systems technology to help manage patient care where patient care happens (at the bedside), prevent medical errors, and provide information when and where it is needed to support physicians clinical decision making process.  The biggest complaint I hear from physicians is “I don’t know what I need to know”.  I find that very disturbing.

Monday Morning Update 12/10/07

From Datamus: “Re: selling patient data. it is incredibly important to distinguish the use of properly de-identified data from identifiable data. Having worked to improve patient safety and quality, properly de-identified data for benchmarking and analysis is essential to study practice and improve performance. If we categorize the use of patient data without making this distinction, we risk a crucial tool in work to make care better, safer and more efficient. That said, if anyone is selling IDENTIFIABLE patient data without proper authorization from the patient, they should go to jail.” It would be interesting to see how de-identification works, given that it’s not a set of hard and fast rules (as I understand it, anyway). Example: a rare diagnosis in conjunction with ZIP code might make a patient identifiable, so that’s PHI even though those data fields usually aren’t. Same for an unusual treatments, lab tests, etc.

From Dan Devine: “Re: selling patient data. In 1994, when I signed a contract with [vendor] for their remote hosting option, they had language in their contract about taking de-identified data for studies and analysis. I added verbiage that required them to inform me and get my consent before doing so. I was never asked. That’s no guarantee that they didn’t, of course, but I never actually heard of a case where they had pooled data for anyone to study. Second, the state hospital association signed a deal with [vendor] a few years back which required state hospitals to install [vendor’s product] and then report ER data to them, which would then be utilized by the state for various biosurveillance reasons. However, the contract gave the vendor the right to sell or otherwise use for their own purposes all of the data collected. The CIOs were very upset with this, but the CEOs who make up the hospital association didn’t really think through it and signed the agreements. So, it was really the state hospital association that gave our data away. Many CIOs attempted to rewrite the contracts. Some may have been successful. Others I know were not. I can’t tell you that [vendor] ever sold or used the data, but they had the right to, unfortunately. But, it would have been de-identified, so that’s something.”

From Ms. Bankhead: “Re: selling patient data. I negotiated a contract with [vendor]. There was a clause in the contract that said that they had the right to obtain de-identified information and basically sell it. I have the contract with the terminology.”

From Rogue: “Re: selling patient data. God help any vendor proven to be doing that. It would be national news instantaneously (and thrusting Mr HIStalk into the national spotlight). Come to think of it – to heck with national outrage. I’ll strangle them myself. But maybe I should wait until AFTER I get them to speak in Orlando and try to justify such abhorent behavior. Hope it isn’t true.” We’re branching into two different answers to that question, it appears. So far, no one has said that vendors are selling identifiable patient data. But, it appears that the door is open for selling de-identified data. Theoretically, that isn’t a patient privacy risk specifically, but it does mean hospitals may not be aware of the practice and certainly aren’t being compensated. Contract terms either don’t specifically prohibit it or, in some cases, explicitly permit it.

• One HIT vendor that runs a clearinghouse is actively selling de-identified data, a reliable source tells me.
• Here’s a link (warning: PowerPoint) describing a GE program that uses client-provided, de-identified data for quality improvement work. I e-mailed the presentation’s author, Mike Lieberman MD, and received no reply.
• I also e-mailed Paul Tang MD of Palo Alto Medical Foundation since he had made it clear he knows of vendors that sell data, but I didn’t get a reply from him either.
• A former vendor sales exec shared this: “[Vendor] has it in every contract. It’s boilerplate stuff. At least several years ago, we would remove it if the client insisted, but in internal contract classes, we were told to really try to keep it in. The pitch was that it would really help the client because they would have access to the aggregate information collected (but of course they would be paying a fee to see the results of their own data).”
• I found this clause in a vendor contract: “Nothwithstanding the provisions of this Section 8, [vendor] and its subcontractors may disclose non-personally identifiable information provided that the disclosed information does not include a key or other mechanism that would enable the information to be re-identified.”

So, are vendors selling hospital data? Yes, so it appears. Some definitely reserve that right in contractual small print. Properly de-identified? Hopefully. If you’re signing a contact, I recommend not only looking for clauses that allow data selling, but insist on inserting one that prohibits it (or at least mandates disclosure to you case by case). Not just PHI or confidential information … anything. Why shouldn’t you know? It’s your data (or more precisely, your patients’ data).

From Lurker: “Re: patient data. Not exactly selling of patient data, but [vendor] regularly used their customer’s data in their demo system. Things came to a head some years back when they hosted many major customers at their new site for demos and training. In showing a patient, one of the customers in the audience recognized the data as their own. Not from the name, which had been changed, but from the date of birth and clinical details. Needless to say, the solids hit the fan.”

From Warren Treesmiter: “Re: Azyxxi. Is Azyxxi for real? I’m trying to send them a substantial RFP. Nice website, but devoid of any contact info. I sent the RFP to a few ‘health**@microsoft.com’ type of addresses, but no response.”

From Jonny Yokel: “Re: Philips/Emergin. I could not agree more with Art’s comments. He should, however, include HCTSi on his list. They are clearly a thought leader in the field. Just ask any of the Epic, Cerner, McKesson, Eclipsys, etc, sites that are talking with them.”

From Billy Joe Mantooth: “Re: Kaiser CTO. Remember Dave Watson, Kaiser Permanente’s last CTO? He was second fiddle to CIO Cliff Dodd and left very quietly during interim CIO Bruce Turkstra’s brief tenure. He’s joining MedeFinance. Any bets on when or where Cliff or Bruce will resurface?” Link.

The author of Dalai’s PACS Blog finds himself in hot water. He’s a radiologist who writes about PACS/RIS products, honestly and therefore not always positively. Someone from a big vendor supposedly complained about his criticism to the business manager of a clinic that uses Dalai’s radiology group. The BM told Dalai (via one of his partners) to pull those posts and if he didn’t like their equipment, maybe he shouldn’t be reading there. He did so (“a kinder, gentler blog”) but the vendor is taking intense heat from sympathetic radiologists who vow to boycott them on an Aunt Minnie discussion (registration required).

Parkland Memorial Hospital (TX) gets a restraining order against Document Management Systems, a paper medical records company that lost its contract with Parkland last summer. Parkland says the company demanded $2 million to keep its 3 million records organized until the contract expires in February. The company says that’s the cost of the software it developed for handling Parkland’s records.

Optio’s Q3 numbers: revenue down 10%, EPS -$0.01 vs. $0.05.

Convergence CT, a Hawaii software vendor, signs a deal to make its software available in Japan. Its data warehouse product identifies patients for clinical trials from provider data.

The government of Nigeria blacklists Siemens following bribery allegations.

An HIM employee of Rice Memorial Hospital (MN) has died of injuries received in a filing system accident.

Idiotic hospital lawsuit: an anesthesiologist facing 122 counts of medical malpractice files suit against a hospital, its parent company, and 17 individuals, demanding payments he says he earned before his privileges were suspended. His earlier suit was dismissed. A peer reviewer called him “a snake-oil salesman” and “criminal.” He’s asking for $531 million. His attorney is a physician-attorney who lost his own medical privileges for providing substandard care.

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Inga’s Update

As expected, no one sent me a note saying they agreed it was time to legislate electronic Rx!

Dr. M posted some thoughtful comments that suggested doctors would start using IT tools when the tools made their lives easier.

BigNurse said, “The only problem with mandating eRx is that it can be incredibly cumbersome and inefficient. I visited a major eRx company’s reference site and found 1) totally redundant paper and electronic processes running concurrently, 2) significant technical problems that had resulted in end user non-adoption, and 3) on the staff side, little understanding of system functionality and no system “ownership”. Further, there was no evidence that the eRx system had improved anything, in fact, after 2 years of use, their productivity was still hurting. Again, I wish eRx were the answer, but without improvements in implementation, I’m afraid it’s not.”

So, will the tools ever be efficient enough? I remember my first job where I had to start using a PC instead of a typewriter (ok, I am not 25.) I remember thinking how much more time it took to boot up the computer and save and print, etc. I would have been able to type the same thing on the typewriter in half the time. Did word processors and computers get better or did I just get used to the new technology? Or both? Was the turning point when I realized that if I found a typo I could correct it on the PC much easier than with White-out and retyping? I certainly don’t have the answer here and am not a clinician, but, I do believe that at some point the resistors will need to just jump in the water.

Apologies to the Indiana Medical Society and athenaHealth. A reader was gracious enough to inform me that my statement that the organization has over 840 member doctors was “correct” although they actually have a total of 8,400. I love being correct, though I guess correct is different than perfect. Hope none of those Hoosier docs feel slighted.

Dr. Blake also refrained from telling me I was wrong when quoting the Denver papers about Gregory Burfitt’s “resignation.” However, the official Centura press release actually said the board “terminated its contract” with Burfitt. The real version definitely sounds more scandalous.

A reader forwarded me a link to a new blog by TX Health Resource CIO Ed Marx (I liked Ed’s first post to CIO Unplugged, especially since he mentions his first job in healthcare started at 16 as a “sanitation engineer” in a medical clinic). My first job at an amusement park was equally glamorous and similar in function (though will a less lofty “sanitation engineer” title.) I thus see Ed as some sort of new soulmate, not to mention I enjoyed interviewing him about Soarian when he was leaving University Hospital in Cleveland.

E-mail Inga.

Lazlo Hollyfield on Revolution Health

I was surprised about the big deal that was made of Revolution Health’s two recent acquisitions. The feedback was “this was a savvy strategic move to add on to their existing services.” I beg to differ.

I don’t know if Revolution Health is pouring gasoline on Steve Case’s money, but I bet their cash burn rate is bleak. I see a company that is still pretty much a jumbled mess that is struggling to figure out what will make money, i.e. Healtheon, circa 2001.

They laid off a bunch of people recently (25% of your staff is nothing to blow off) and sold ConnectYourCare to ExpressScripts in October to raise cash and get rid of an asset that wasn’t getting enough traction in sales to banks, health plans, and employers due to the slow growth of the CDHP market.

As for their other businesses, I don’t see one area where they are excelling or making enough revenue. Extend Health isn’t getting enough customers and Revolution doesn’t pose any serious threat to eHealthInsurance in the individual health policy market. Revolution throught it would be so easily to sell individual health policies, but they were dead wrong. You really need to know the broker market well and be prepared to deal with all of the underwriting issues and myriad of regulations in 50 states.

As for CarePages and the most recent acquisitions, Google has actually gained market share in health search recently despite the emergence of a number of vertical health search engine companies and forays by IT companies like Microsoft and a few large media companies. Google is like a 50,000 degree sun right now in search. Companies in this space will either find some shade by focusing on a niche (e.g., Healthline’s recent attempts to focus on providing data to Medicare patients on benefits), become a small part of a bigger arm (e.g., Medstory as part of Microsoft’s overall health IT play), or wither and die. Maybe Revolution is counting on driving page views through user-generated content sites like CarePages, but that seems like a tough play too.

RediClinics is making some good headway as one of the leaders among retail clinics. But, even with the low startup costs, most retail clinics just don’t generate a ton of revenue. Most patients aren’t willing to pay $50-$60 OOP for a visit to a retail health clinic when they might only have a $10 or $20 copay in comparison to a visit with their doctor. Most retail health clinics have realized this and now have begun to accept the normal insurance carriers. The real kicker, though, is the diagnosis and treatment codes used to bill for retail health clinics are pretty low hanging fruit. Overall,it doesn’t just add up to a ton of dollars and basically is taking longer than expected to break even on retail health clinics. Optimistic break-even point right now is 18 months and in some cases much longer (say 27-36 months). Not the kind of revenue numbers you want if this is a core area of your business.

Basically I don’t see Revolution Health’s situation improving much in the near-term unless they really concentrate on one or two areas enough to challenge their principal competition in those spaces.

News 12/7/07

From Art Vandelay: “Re: Emergin. Nice move by Philips. Why build when you can buy the best? This puts a crimp in the competition’s next incremental strategy for their products. The strategy was to continue to increase safety by sending alarm notifications outside their systems – integration. This move will allow Philips to focus on creating a next-generation architecture for their products and leapfrogging their competition. Hey, what do you know, a big fish acquiring a value-added bolt-on. I am very surprised Emergin lasted this long as an independent without receiving an offer they couldn’t refuse. GE, Siemens, Johnson Controls, Draeger, Cisco, Ascom, or SpectraLink could also have been interested suitors. Now let’s see who tries to one-up the move by acquiring Capsule Technologie or vendors also playing some role in the integration market, such as Global Care Quest, Nuvon, Sensitron, LiveData, iMetrikus, Cain Medical, Delphi Medical, or Pervasa. Best wishes to Michael and the team. Now, only if Philips-Epic relationship would have worked-out (AnswerMan – there is one more for the Epic quota).”

From Dr. Lisa Cutty: “Re: Agfa. Agfa Pulls ORBIS From Dutch Market. According to the Dutch ehealth portal ICTzorg, Agfa decided to resign from the Dutch market. After a fit-gap analysis, Agfa learned that the international version of ORBIS HIS is not ready for the Dutch market. Where are the European next generation HIS products? Lorenzo delayed, Soarian delayed, ORBIS delayed … will the U.S. help Europe once again?” Link. She also mentions that General Atlantic sold only about a million of its 4.7 million Eclipsys shares, reported earlier this week as a potentially larger number.

From Lacey Underall: “Re: vendor support. When you’d call the vendor in the 80s, you’d get transferred to a techie who would resolve the problem on the phone. Now, vendors require that you learn how to use their software for problem tracking. Attach enough supporting evidence to take the case to the US Supreme Court, and they will come back and ask you for more. Last week, we installed code that didn’t work as we had hoped. I opened multiple cases and was invited to a conference call, during which the vendor’s person asked for case numbers. I told them I used their case reporting tool, so look them up. The response from a manager: ‘I don’t know that techie stuff. Please just send a list of the case numbers.'” I’m with you. First, customers of some vendors end up being their outsourced QA department since they don’t bother to test otherwise. Then, you have to log on to their clunky web tool, slogging through cryptic fields that a customer should never have to see. Then, they insist on working from that system, which you invariably download to Excel since they speak no other language when you talk to them, or they dump it into an RTF and e-mail it. Lastly, you not only better be able to repeatedly duplicate the problem and provide ironclad evidence if you don’t want your ticket closed immediately as ‘working as designed’ or ‘unable to duplicate’, you then have to explain it to the clueless help and test the usually dysfunctional and sloppy fix that results. The obvious goal: to put the burden of their mistake and its rectification (no pun intended) on the customer. You prove it, you help them fix it, you test it, you pay big maintenance fees for the privilege. I should name my vendor right here, which I’m betting is the same as yours since our experiences are identical.

Kaiser CIO Phil Fasano is interviewed on video by ZDNet. I asked Justen Deal for his impression just to get the counterpoint. Here are a few of his excerpted thoughts. “The interviewer says Fasano ‘parachuted in to fix some big problems.’ Interesting. KP has never really acknowledged that there were problems when he came. This interview doesn’t talk about any of them. It’s a lot of fun talk about Web 2.0, RFID, mobile computing, and social networking, all the glamorous buzzwords. The interviewer was excited about remote and mobile computing, but the extent of KP’s remote access infrastructure is its Cisco VPN Concentrator and the RSA SecurID tokens it rations out to worthy IT employees, managers, and a few doctors. As for mobile computing, KP is notoriously un-mobile. Tablets and PDAs just aren’t used in clinical settings at any of KP’s medical centers. Finally, I estimated last December on my blog that KP was spending $2.6 billion per year on IT, which KP disputed to anybody who would listen. But Fasano says in the interview it’s $3 billion a year. So, $330 per year, per member. The VA is at about $296 per individual, but has more than four times the number of medical centers and double the number of clinics. And, the UK’s NHS spends less than a third of what KP is spending per citizen (including NPfIT).” And speaking of Justen, a reader (someone from Kaiser) liked his scathing, well-research comments about Kaiser’s CEO.

OK, I need your help. Several folks who should know have told me that they’re sure that specific HIT software vendors are selling the patient data of their customers. Logistically, those vendors would need contractual permission and (for non-hosted systems) remote data access. If you have any (anonymous) proof of that practice, I’d sure like to hear about it. Contract terms would be good, first-hand knowledge even better. I’ve never heard of that happening, but I figure it’s a good time to either prove it or put it to rest.

GE, McKesson, and Microsoft are rumored to be interested in buying Canadian HIT applications and services vendor Emergis, but telecom company Telus may get it outright.

Former QuadraMed VP Michael Lanza is named EVP and general counsel of Selective Insurance Group.

Some idiot blogger is involved in a new online HIT job service.

Ronald Crall is named CIO of Quincy Medical Center (MA).

A group of healthcare companies will develop and use security practices developed with Health Information Trust Alliance.

Red Hat and HP will collaborate to facilitate healthcare data sharing in India. Interesting …

AHRQ releases 17 patient safety toolkits created from its research projects.

Cedars-Sinai, stung from being front-page tabloid fodder, abandons any pretense of offering a non-punitive culture. Everyone involved in the heparin overdosing of Dennis Quaid’s twins has been suspended and a reported 1,400 nurses will be required to attend special training. One story said that nurses have been warning the suits for years that staffing cutbacks and poor labeling were causing increasing numbers of medication errors.

Singapore’s HIE will be extended to community hospitals in the next few months, allowing public facility records to be viewed in community hospitals.

Survey: 60% of US adults think EMR benefits outweigh privacy concerns; 40% don’t. 75% want to be able to e-mail their doctor, but only if it’s free (apparently 25% don’t want that option even at no cost, proving that only idiots are sitting at home during the day, people willing to take a break from Jerry Springer to do telephone surveys).

The CareSpark RHIO chooses Wellogic’s physician portal.

Sunquest announces plans to expand its CoPathPlus anatomic pathology software.

Erie County Medical Center (NY) says the PeriOptimum wireless surgical patient tracking system is saving it big bucks, boosting OR utilization from 55% to 92%. Hospital CEO quote: “Think of it as a kind of air-traffic control system … You have 10 runways, 10 planes landing or taking off, 10 queued up waiting to take off, X-number in the air waiting to land. The rare commodity is the runway. The closer together you can get them landing and taking off, the more business you can do.”

Steve Case’s Revolution Health buys HealthTalk, a social network for those with chronic conditions (should it be called a social disease network?) and invests in fitness goal website vendor SparkPeople. Overnight futures prices were up for companies whose unimaginative names were created by simply jamming two words together (the company’s other businesses are CarePages, RediClinic, and Extend Health … how did they miss that last one?) And lest you think the companies are just a hobby for Steve to spend his AOL money, the young parent company gets serious and lays off a quarter of its staff, explaining “What you will see is a flatter organization, with a greater emphasis on revenue generation.” Aw, that’s so 1.0.

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Inga’s Update

“Differences in management philosophy” have led to Gregory Burfitt’s resignation as CEO of Centura Health after just over two years.

I have given up on Congress to pass any meaningful legislation about healthcare IT. (Now that I think about it, I am not sure about Congress’ ability to pass much meaningful legislation on anything, but I digress.) Despite my pessimism, I liked the new proposal that would require all doctors seeing Medicare patients to e-prescribe by 2011. It would also “bonus” doctors who use e-prescribing starting next year, although the bonus will likely be wiped out by lower Medicare reimbursements. Regardless, I say let’s get some legislation on the books and start forcing the HIT issue. E-Rx is probably one of the easiest tools to use in any EMR. If you have doctors resistant to technology, e-Rx is a great way to dip their toes in the pond. And obviously if you are able to convince a doctor that one aspect of an EMR is easy, then maybe the doc will move to other functions. E-Rx is also one aspect of automation that has great returns in terms of patient safety. It’s harder to argue that it’s not worth the money/effort. And if you get more doctors using e-Rx and the products are deficient, then there will be more voices crying for enhancements.

Meanwhile, check out Martin Jensen’s comments about the topics (especially if you want a totally different perspective!).

MedcomSoft adds James Haveman to its board. His background includes a stint as Senior Advisor for Health to the Ministry of Health in Iraq.

Statcom names Jim Rosenblum as executive vice president, products and chief technology officer. Rosenblum comes from Emmi Solutions and Allscripts before that.

athenahealth agrees to provide its practice management services to Indiana State Medical Association members. The organization has over 840 member doctors. Interesting that the press release doesn’t mention EMR. If athena is able to get a physician’s billing business, then its more likely to get the EMR as well. And, without having to discount.

E-mail Inga.

News 12/5/07

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

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

From Dan Panama: “Re: Misys. Vern said at the business update yesterday that an overwhelming number employees in the employee survey said they are not having fun any more. Vern’s response: ‘You have to earn the right to have fun.’ He also said that the banking division had a tough first half because of housing woes.”

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

E-mail Inga.

Philips To Acquire Emergin

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

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

Monday Morning Update 12/3/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Art Vandelay on Revenue Cycle Applications

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

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

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

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

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

News 11/30/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sunquest announces a sale to TriCore Reference Laboratories.

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

Somerset Pediatric Group (NJ) picks Sage Intergy.

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

News 11/28/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Inga’s Update

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

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

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

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

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

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

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

E-mail Inga.

Monday Morning Update 11/26/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What HIT people are reading:

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

E-mail me.

Art Vandelay on the Near-Term Vendor Frontier

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

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

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

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

News 11/21/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

E-mail Inga.

Monday Morning Update 11/19/07

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

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

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

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

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

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

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

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

Amcom Software will merge with telecommunications provider XTEND Communications.

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

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

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

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

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

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Inga’s Update

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

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

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

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

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

E-mail Inga.

News 11/16/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cardinal Health announces a 340B software package.

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

E-mail Inga.

News 11/14/07

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

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

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

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

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

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

Listening: new from The Hives.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Steve Starkey of Healthcare Management Systems is promoted to COO.

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

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

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

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

E-mail Inga.

Art Vandelay on IT Project Work

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

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

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

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

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