News 2/29/08

From Jay Mason: "Re: HIMSS. Thanks for the great event at HIMSS. I really enjoyed it. I have a question for you. Do you know who the largest ASP ambulatory practice management company is?" You’re welcome – thanks for coming. And, perhaps this is a trick question: the largest company, or the largest number of installed ASP clients? I know eCW has lots of ASP customers. athena’s are all ASP. I really don’t know, but I bet someone does and will tell me.

From HIMSS Road Warrior: "Re: HIMSS. You should probably have some form of HIMSS awards – best booth, worst booth, etc. I thought the McKesson booth was ridiculous. I have to imagine McKesson customers are wondering why they spend millions on a booth but struggle delivering a nice product. I found myself attracted to the smaller, more approachable booths. Picis was nice, knowledgeable people and had some good customer presentations. Epic was non-impressive as well as Oracle. PS – I saw many people with HIStalk stuff." Now that I’ve had a day to think about it, I’ll go with MCK for the worst booth; Cerner for the best big booth but, since they were on a different tangent, an honorable mention to Siemens; and Medicity for best overall for being innovative and well designed without being gaudy, although it’s tough to compare, especially when you know you didn’t see them all (I missed Picis, somehow). Wonder what they do with the retired ones? Sell them cheap to third world HIT vendors? Cannibalize them for parts?  Set them up in a special HIMSS Boat Show Simulation Room to have the glad-handers practice their smiles and small talk and Olympic badge-swiping?

I was happy to see all the HIStalk stuff, though I really couldn’t comprehend it all. As I was watching people at the Mr. HIStalk Shoe Shine in the Red Hat booth, I wanted to have a dialog with the shinees: Do you know what HIStalk is about? Are you disappointed by the real me because I’m not what you expected? Does it seem strange that my name’s on a shoe shine?

From Neal’s Pizza Guy: "Re: UK. Don Trigg to be named Cerner’s General Manager for UK and Ireland." I e-mailed congrats (with a question mark) to Don and he didn’t reply, so either he was heading out of town or your rumor is true and he can’t confirm it yet.

Happy leap year. It’s good to be home, although I’m always kind of depressed after HIMSS for some reason. I always feel like such a loser when seeing other people out there doing cool stuff (especially the young ones).

I put a new poll to your right about Cerner’s decision to drop out of the HIMSS09 exhibits. Good idea or bad? You know where I stand.

Matt, the founder of CME Networks, e-mailed after reading one of our HIMSS posts, so here’s a little plug.

An ASHP survey whose results were released at HIMSS shows that only 11% of pharmacy systems are not integrated or interfaced to other systems. Bedside barcoding was reported in use by 23%, which sounds high based on what other surveys have found.

Smart marketing: Eclipsys announces that two of its Sunrise users have achieved HIMSS Analytics EMR Stage 6, joining fewer than a dozen hospitals: full physician documentation in at least one unit and radiology PACS (and including the lower stages: EMAR/barcoding, CPOE, clinical decision support, etc.)

The Methodist Hospital of Houston picks Picis for periop.

Big-time investment guru Carl Witonsky (who also happens to be a pretty good guy from my limited experience) is named to Dairyland’s board. I hadn’t kept up: last time I checked, he was running CliniComp, but now he’s on Sentillion’s board, too. I envy those big-picture money people, especially when I’m mired in day job minutiae after my "Cinderella at the ball" moment at HIMSS.

Students in India and China can take an online HL7 certification prep course for $100. And probably will.

Philips realigns its entire informatics business, although lost in the numbing flurry of buzzwords is an explanation of what they actually did.

QuadraMed has ported QCPR to Cache’. Like with RelayHealth, we scooped that a little in their HIStech Report.

Lacy Thomas, the former CEO of University Medical Center (NV) is accused of awarding uncontested hospital contracts to unqualified friends, among them former Cook County Hospital CIO Greg Boone. Boone got $50,400 for an 25-minute PowerPoint IT evaluation that caused employees to "chuckle and laugh" because it was recycled information he got from three employee interviews over two days (well, he’s not the only consultant to do that). A UMC IT director complained that Boone was unqualified, but boss CIO Doug Northcutt, sharing a fear of unemployment like many of his peers, told him to pipe down. Prosecutors say taxpayers lost $10 million because of Thomas’s  shenanigans.

Kaiser says 10 hospitals are live on HealthConnect, with 23 to go. They finally admit a cost of $4 billion, although that could well be a low estimate.

Let’s give some more free PR to the urinal marketing people, just to annoy their competitors! Seal Shield announces a $40 dishwasher-safe mouse.I think they should run a HIMSS special and send a free banned urinal screen with every order, maybe framed like a gold record.

Elsevier begins marketing its clinical decision support applications that now include the former CPMRC of Eclipsys.

Medsphere announces an open source partnership with Tolven.

Former Medstat CEO Tim Murnane is named CEO of EVP/COO of NightHawk Radiology.

New York City claims its eClinicalWorks health records network will be the largest in the country, involving 200 doctors and 200,000 patients so far.

Inova Health signs an $8.3 million deal for Centricity EMR.

The analyst who upgraded athenahealth’s stock earlier this week says he’s hearing that eClinicalWorks may have hit the wall on its ability to scale up support and implementation. I looked back on my 2006 interview with Girish Kumar to see if he mentioned it, reminding me of what a good interview he did (check out his predictions and competitor evaluations). I know someone told me that in an interview about their company, so I’ll have to dig further.

E-mail me.

Sponsor Updates and Housekeeping

I’m thinking about shutting down the old HIStalk site at blog-city.com. Anybody have a reason I shouldn’t? I know some folks still read there, but I could send some reminders. It would make maintenance easier. I wouldn’t kill it since it’s got all the older articles, just not post to it.

I checked the HIStalk stats and February will set the record for most visits. Thanks for reading.

RelayHealth announces its Results Distribution Service, which we covered quite well, I think, in an HIStech Report interview. I should have asked Fake Inga to explain how it works.

AT&T will provide RFID asset tracking to Health First (FL).

Sage Software announces Intergy PM/EHR version 4.0.

Premise announces a partnership with Stryker Medical, contributing workflow and communications solutions to Stryker’s iBed project.

SXC Health Solutions will acquire National Medical Health Card Systems. Healthcare Growth Partners was strategic advisor to SXC.

NextGen’s EMR wins an MS-HUG innovation award in disease surveillance for its work with the Medical College of Wisconsin.

Art Vandelay on HealthVault

I took the plunge and played with HealthVault (HV). HV is not a PHR – it is a set of related health web services, schemas, and a storage service. Microsoft stated it is opening the toolkit and service. This follows its recent strategy for many of its other servers and portions of .NET. Codeplex will be the tool for sharing the open code.

The good: initial set of services, growing third party support for connected devices (BP cuffs, HgA1c monitors), cost of the service, and use of HL7’s CCD.

The acceptable: documentation, support forum, granularity of the security model, and basic service and XML schema testing.

The bad: no interactive debugging, error details, terminology services, overlaps in the data schema, and a confusing user interface. A number of issues exist with the Terminology services. This includes the lack of use of HITSP formats, the lack of terminology maps, and a lack of a consumer terminology engine. The confusing UI is less of an issue as Microsoft wants the partners’ developers to shield consumers from this layer of the tool.

The open questions: support responsibilities of Microsoft vs. partners, the number of hack attacks, and the intrusiveness of HV Search. HV Search is Microsoft’s sole revenue model.

Inga’s Update

It’s Wednesday afternoon and I am at the airport sitting at the gate. Don’t know how things will be Thursday but it took forever (more than an hour) to get my bag checked and go through security. It was ugly. Also ugly was my suitcase, which I could barely zip closed because of all the treasures I collected.

As I reflect on the last few days, it all has seemed a bit surreal. For example, walking by the booth for various sponsors and seeing the HIStalk signs prominently displayed – with my signature. And seeing various name tags and knowing that I have e-mailed or chatted with them. It hasn’t been that easy for me to keep my low profile, especially because my true nature is to go hug everyone!

If you are a sponsor, trust me, I stopped by. Michael, Dewey, Tina, Lauren, Don, Lynn and Bill – sorry I didn’t give you a hug. I did hug Tammi with AT&T because she helped me deliver the HIStalk signs to our sponsors.

Readers may not be aware of this, but it was also the first time Mr. H and I had met in person. He is just as funny and smart and warm-hearted as his posts suggest. Better really. He is not as gregarious as me, but I don’t think that surprised either one of us. We had fun sharing really gossip that was so juicy that it isn’t printable. I think he was amused and not surprised that I found attend several great after parties while he went to the hotel and made sure HIStalk got posted so that readers would get their fix.

Anyway, despite (or because) of all the fun and Internet access issues, I feel out of touch with real HIS news, so I look forward to catching up. Let us know your impressions of the meeting and make sure you have checked out the HISsies cartoon. The HIT Transition guys have asked what people have thought, so let us know.

E-mail Inga.

From HIMSS 2/27/08

I’ll be heading out later today and I was ready for a sitting break, so I thought I’d be one of those ultra-trendy guys and blog right from the event (that fad kind of died out, didn’t it?)

From John: "Re: HIMSS. Great event last night and congrats to Healthia for making it happen. Quite sure they got a lot of good will out of that one. Hats off for stepping up to the plate and Mr. HIStalk, I bet you’ll have more than a couple of your sponsors approach you to do something next year. Google has a surprisingly small 10’x20′ booth where they are doing VERY limited demos (capabilities of solution) to hordes of people. Whenever I went by, crowds were 4-5 people deep. Not surprised by Cerner bowing out in 2009. Seen similar actions taken by other anchor vendors in other industries, but they don’t stay away for long, at least not until this industry consolidates a lot more and penetration in the market is deeper. Still a lot of opportunities in the market. BTW, got a wonderful Polaroid picture with a Miss Inga (she called herself Leah) over at the RelayHealth booth. It will go up on the wall back at the office. Thanks RelayHealth and Inga." That particular Fake Inga’s name really is Leah, actually, so maybe she wanted you!

From PTSD: "Re: HIMSS. Great reception with two free drinks! Tote bags are a nice touch and at least have two handles and could be put over your shoulder (more manly color next year? 85% of vendors use blue in their logo/marketing). Hotter babes at the reception than in the booths! Great finger foods, although anything with conch in it scares me. We did need some extra tables to put empties on and the back of the room could have used a bag check person. Most frequent comment; ‘One man, shooting straight, made all of this happen.’ Then of course Jonathan broke out with his digital balls comment… Urinal Marketing, absolute genius as I had something to talk about to fellow urinal users (not that I normally do that). People (guys) were talking about it in the show room. Google is here, but states they are consumer oriented… trying to get buy in from HIS? Most booths are here for current clients and to get name recognition so that when people bring a vendor to their IS departments attention, hopefully they have at least seen the logo and know that the vendor was at HIMSS. Cool toys, T-Shirt that says ‘Why does my nose run,’ bouncy balls that light up (my two year old will love that) and a tool with Phillips and flat head screw drivers. Also, where do you get the light up lanyards? I’m glad you liked the totes – I may need to print your comments to present to Mrs. HIStalk when she comes after me with the Visa bill wondering why some company she never heard of charged us $1,000 (that gets you 400 of the tote bags, in case you were wondering). I liked the conch fritters, although the crab cakes were amazing (lots of spice and heat, surprisingly, which I like). I saw the light-up lanyard people, but I forget who it was. Urinal marketing: genius, but not so much that I’d strike up a conversation in there (plus, how will they market to the ladies?)

From FOSSer: "Re: FOSS. As I am not attending HIMSS, could you comment on any FOSS type of exhibits at HIMSS and the reception of FOSS solutions within healthcare?" I don’t follow that area much, but it seemed to me it definitely is picking up. Red Hat had good crowds (the Mr. HIStalk shoeshine chick was cute today, by the way) the two commercialized flavors of VistA were there, and Misys had the open source EMR and integration engine in their booth. I’m sure there were more examples in the sessions. If anyone wants to report, feel free.

From Bobby Orr: "Re: Cerner. I’m disappointed in your ability to be swayed by the Cerner marketing machine. I expected better. You let them post this nice HR message when they canned experienced people for more college students. And now the bravo to them for cutting costs by not spending money at HIMSS. As mentioned the other day on your site, I agreed the Cerner Health Conference (CHC) is a great educational event for their clients each year but understand this move is very simple. Stock not doing well equals cut costs and not spend on HIMSS because it’s not winning us extra business. Simple business decisions." I posted their HR response to their layoffs for one reason: it lets you judge for yourself what position you take. It was spin, sure, but at least you could decide for yourself. I would be surprised that their decision to not exhibit was based on money – a 3.5 billion market cap company can afford a nice HIMSS booth. My understanding (reading between the lines a bit) was that they were still prepared to participate in HIMSS in a very financially significant way, but in a different format that was more focused on education. I think they’ve come to the conclusion that the exhibit is formatted for hard selling, but the market is ready to move away from that (and if they save money, that makes it even more attractive.) Some companies exhibit only because they know how quickly the competition will spread rumors if they don’t (like when SMS pulled out years ago). Fear is the wrong reason to spend all that money that could be better used for R&D.

From Watcher: "Re: Cerner. Recall that SMS dropped out the year before they ended up selling. Charlie McCall told me at the time that he envied their ability to do that as he never saw the value of the show. McKesson, otoh, had so much neon I wonder if they’re contemplating spinning out provider technologies." That blue was painful. Everybody else has moved to light woods, soothing shades of green, and rounded edges like Danish furniture and suddenly here’s this monstrosity shouting, "I’M A MASSIVE WALL OF BLUE, DAMMIT, SO GET IN HERE AND BUY STUFF." I might rank it as the worst booth of the conference, especially given its footprint, although Epic’s was sure looking long in the tooth.

From Faith Popov: "Re: HIMSS. The Healthia shindig was great. The cartoon was cool. I went to the RelayHealth booth before the show for an ‘I’m not Inga’ button, but they were all out. I guess they were a hit!I had to laugh about the automatic soap … I noticed that too, and thought it was weird! Tip: There was a vendor in the 7000 area that was giving out free tiny smoothies." I noticed the smoothies this morning. I also sat through the OnBase magician again – that guy’s a riot in a smarmy, smug Mr. HIStalk kind of way. Which makes me think just now how few live performers were in booths: no fake fisherman statue, no Richard Simmons, not many magicians. I think Inga and I should pimp ourselves out as marketing consultants because I bet we could pack ’em in with some fresh booth ideas.

Reception pictures:

The dedicated Healthia folks working the reg desk, surrounded by HealthcareITJobs.com syringe pens and HIStalk tote bags. See how happy their people are?

Gwen and Eric. Eric works for Vitalize Consulting Solutions, which recently merged with Lucida. Mary Pat Fralick is still there, so if you’re still at the conference and want to say hi, they’re in Booth #1509.

Jonathan Bush accepting his HISsies awards. I like to think that a speaker’s gravitas and sincerity is enhanced by setting his beer right down on the podium as he speaks as if he will be quickly returning to it, don’t you agree? He was outstanding. He was on the networks this morning to talk athenahealth’s just-announced deal with Community Health Systems. HIMSS Watcher sent over a link to CNBC’s interview with him this morning and it’s a fun watch.

I saw some companies handing out their HIStech Report interviews. Cruise over and take a look. As a reminder, these are our usual interviews, but with questions written to help companies describe their product and its position in the market. They’re on a separate site because their purpose isn’t to be hard-hitting like the interviews here sometimes are, but rather to put a personal face on a product like you’d get talking to a company executive one on one.

Cool technology I saw #1: Design Clinicals.(Disclaimer: they’re a sponsor, but I cut them no slack for that and this is an area in which I have considerable expertise.) Now I’ll be honest: Dewey and Dasi are lovely and highly educated people, but I figured that, as a fairly new company, I’d have to paste on a phony smile while looking at some amateurish application (doctors sometimes think they’re technical as well as medical gods and do their own terrible design and programming). Their medication reconciliation tool, though, is elegant and system-independent. The design is very clean and easy to understand and their integration with the newest First DataBank tools is spot on. I interrupted them five minutes in and said, "You’re telling the wrong story on your site – you’ve got to get some Flash session demos up there because it’s a thousand times better than it sounds." They were already planning that. From a patient safety, physician, and patient point of view, this is the killer app for med rec as far as I’m concerned. I know how the under-the-covers stuff should work (like using NDC number vs. FDB RMID) and it passes the test. CPOE systems should have a user interface that’s as easy to follow and us as theirs. It ties into RelayHealth, I believe, to create a patient prescription profile from billing data in addition to other interface and manual entry. They just signed their fourth hospital yesterday. Most definitely worth a look if you’re struggling with med rec (which pretty much everyone is).

Cool technology I saw #2: Sonitor Technologies. (Disclaimer: they sponsor too, but I don’t care, although I only went through a quick demo). Their deal: ultrasound locators. Remember the story of how Post-Its came about because 3M had some crappy glue that wouldn’t stick well? Sonitor’s stuff works because it has a seeming shortcoming over RFID for locating objects: its signal can’t penetrate walls. What that means: it can locate objects down to the sub-room level. In the demo, they have a fake patient fall that triggers an alarm because the sensor detects movement away from the bed. You can watch in real time on a monitor as the booth people walk around while wearing their wristbands. They’re suggesting many uses: documenting that caregivers really did check on the patient every so often (and to bill for that) was an example. They’ve also got it set up for proximity-based PC security using the PC’s microphone to read the ultrasound from your tagged badge: when you walk up, it logs you on,and when you walk away, it logs you off. Pretty darned cool.

Cool technology I saw #3: Covisint. I stopped by because they announced a health information exchange deal with AT&T that will cover all of Tennessee. It’s a portal application that can be distributed by IPAs, hospitals, or larger groups. I can’t really describe it well, but it can tap into lots of systems (like EMRs and payor systems), has context to synch up separate apps, can plug in all kinds of widgets and let the doctor personalize his or her own screen, offers secure communication and file sharing, and can handle fax-outs and barcoded fax-backs with indexing. I was kind of overwhelmed so I didn’t get it all, but it was a very slick, lightweight application that anybody could use without training. There’s a lot of technology under the covers for authentication and personalization. I asked the guy why a hospital couldn’t use it to tie its affiliated docs into their data, solving the never-ending problem of unshared allergy, eligibility, and demographic information. He said it could be used for that with no problem (I didn’t ask what it cost).

The ever-loyal Inga filed her report below from a HIMSS "Surf the Net" station (does anyone still say "The Net?") because her connectivity hasn’t been working. I’m sure she’ll have more to say later.

E-mail me.

Inga’s Update

I spent a good part of Tuesday walking the exhibits. I talked to vendors at many of the smaller booths (including some HIStalk sponsors such as The White Stone Group, Stratus, Sonitor) and found booth traffic heavy all over the place. I chatted with the eCinicalWorks folks and they told me that their agreement with Wal-Mart precludes them from talking much about the whole thing and they preferred their clients to make those sort of announcements. A comment that made a bit more sense was that they do no outbound marketing (no email, direct mail, advertising, etc.) because they have all the business they can handle via word of mouth. Based on the traffic I saw there, that could very well be true. They also mention they rarely lose customers – maybe only 5% ever leave.

I played with a couple of the small tablet PCs, including Fujitsus, Dells, and Motions. Fujitsu had the smallest device that weighed about 1-1/2 pounds or something unbelievable like that. Dell’s included touch screen capability that was very slick. And Motion’s was a sealed device for infection control and had a built in scanner and biometrics.  So all different enough from another to prevent them from being "just another tablet."

Mr. H and I walked into the Sage Booth. We agreed they had the prettiest color booth. The sales guy was impressed that I knew of Medical Manager and Intergy and Peachtree. I was pleased I didn’t choke and forget the names…

I stopped by the dbMotion booth. Dr. Diamond was one of my first interviews for HIStalk and he was very funny. So I checked him and his crew out. They seemed quite busy showing the product to several big groups of people and Dr. Diamond was much cuter than the picture we had used.

I talked to the Relay Health Miss HIStalk and asked her if people had a clue was. She said many did (which was good). I told her who I was and that she was doing a good job being me, which I think she thought was funny (I don’t know if she believed me.)

E-mail Inga.

From HIMSS 2/26/08

I’m on convention center wireless, writing from the lobby since my hotel’s connection is dysfunctional. So, I can be verbose again (lucky you, huh?)

From Joe Mayo: "Re: Sunquest. Does the new Sunquest have a booth and what are you hearing about their Radiology Product?" They do have a booth, which I would characterize as small but tasteful. They had a little theater with a good speaker line-up and seemed to be getting a few folks in to hear the talks. I chatted briefly and they seemed to be nice folks. I like their logo. I haven’t heard anything about rad since they announced they’d resurrect it (wisely).

From Lori Loveless: "Re: booths. I thought you were absolutely on target with your comments on the booths. As you said, the Cerner booth was right on with them giving homage to their clients and partners. I too thought Siemens was well done and very open, they even asked me to sit and watch one of their presentations … which I have to say was also nicely done. What about Google?" You know, I didn’t even notice Google’s booth. I think I saw it yesterday and they were along a wall. I heard nothing about it, so the buzz factor might be less than you’d expect. I did finally get into Microsoft’s and wasn’t impressed … the little snot who finally deigned to show me Azyxxi wasn’t very good – it just looked like Excel from what I saw.

From Sal A. Selleck: "Re: your sponsors. Just thought you may want to share with your sponsors that their sponsorship money is well spent. I have been looking for implementation assistance and hadn’t come up with anyone through the usual sources. I Googled for consultants and hit a large dead end. I turned to your web site and have submitted requests to Healthia, MedMatica, and ICG. Don’t know if it will work out, but they have a chance to get in the door at my firm through their sponsorship on your site. I enjoy reading BrevIT and your site when I have the time. BrevIT is excellent." I appreciate that, although now I’m feeling guilty that I couldn’t get a BrevIt done Sunday because of my connectivity problems. Mike’s a big-system CIO, by the way.

From Tony Llama: "Re: urinals. Glad you ran the info about Seal Shield. No good deed goes unpunished, though. Turns out a competitor read about the urinal screens in HIStalk and complained to show management, who made them remove them. I guess no more chuckling in the men’s room . . ." So here’s a shout out to the loser competitor who doesn’t appreciate guerilla marketing: check out Seal Shield’s site, which has videos on their products. They have keyboards, infection control kits, antibacterial mouse pads, and Meditech keyboard overlays. And urinal screens, if you’re in need.

From Michael K. Fox: "Re: party. Party was great. Jonathan Bush was amazing. I stayed till today just to come last night." Jonathan had a great time, too, and lest I be repetitive, it was an honor to have him there (along with all of you, of course). Interesting news today: one of the big-name investment analysts who was at the party last night upgraded ATHN stock this morning, causing it to jump 10% today (I’m not taking credit, just saying). Also, athena just now announced a big deal with 125-hospital Community Health Systems, who will replace its PM systems with athenaCollector.

Scott Shreeve, who I’m sitting here talking to in the lobby as I write this, did a first-person recap of the reception and has some details. I’m hoping we can do something next April in Chicago. I told Shawna from Healthia that the coolest part was how well attendees meshed – it’s not like most vendor events where all you have in common is that you all bought the same stuff, so you end up talking shop all night.

One more time: I have to thank Healthia for putting on the event last night. I’m sure they had lots of other things to do, but they spent a great deal of energy working on the reception. Thanks to the very nice folks from there who worked the registration desk. I came undercover and they made a good impression. I know Healthia might be hiring consultants and I’ve written before how well they seem to treat them, so if you’re looking for a gig, I’d seriously listen to what they have to say and not just because they sponsor.

Just a quick recap of who’s got what HIStalk stuff in the booths. Healthia #4560 may have tote bags left. Ribbons are at DB Technology #4442, IntraNexus, Inc. #1851, Novo Innovations #4128, RSM McGladrey, Inc. #4038, and Stratus Technologies #569. RelayHealth may have some, but I’m not sure there (Miss HIStalk as doing great there today, having Polaroids made with admiring men – those RelayHealth people are fun). You can’t imagine the thrill that the fam will get when you proudly walk through the door and stick a badge ribbon on them, so take 1 or 200. Red Hat has a cool shoe shine stand labeled "Let Mr. HIStalk Shine Your Shoes" or something like that. 

Fred Trotter sent some comments about the open source movement of Misys. He’s actually at least mildly impressed, I think. They’ve got Tolven and OpenMRS in their interoperability demo and are giving exposure to the Mirth project (it’s an open source integration engine). If Fred approves, I do too. I had serious doubts about their intentions, but they may be serious.

I didn’t comment on Monday’s opening events. HIMSS did a really cool movie that wove songs from previous decades into HIT-related events. They had a live band that was pretty good, kind of a white bread "we’re moonlighting from our Disney day jobs" feel. Somebody had written a song called "It’s Our Time" or something like that, which was pretty good for the first couple of verses, uninteresting for the next several, and annoying for the next 50 or whatever it was (if the singer hadn’t been a good-looking female, it would have been as skull-pounding as "It’s a Small World.") Plus, they played again as everyone left, which they did rather quickly given the alternative. I never have a clue what value flag people add, so when all the painted-on gray suited people ran in with nondescript flags and waved them around, I was more puzzled than anything else. Bill Frist was the keynote and did a pretty good job, at least as well as possible given that you’re pitching cutting healthcare costs and helping the poor when your multi-million dollar mother lode came from running for-profit hospitals. I’d give him a B, boosting his score a little because he obviously personalized his talk (some speakers don’t) and did is own sometimes amateurish PowerPoints, which I found endearing. So, overall, is it really our time? That might be a stretch.

The HIT Transition Group guys wrote about the HISsies cartoon and included some back story for the noobs. They had already tripled their server capacity, but the incoming hits choked it, so they had to add a mirror. It was a big hit.

Confirmed: Cerner will not exhibit at HIMSS09. They believe that the future is all about customer experience and outcomes, not the "boat show" atmosphere that Jonathan Bush observed. They expressed interest in changing their participation to provide more education and customer involvement (I’ve been a little bit involved in their planning, for which I’d say kudos to them for asking my opinion as a proxy for all of you). For reasons I was asked not to mention, that won’t happen despite their best efforts. Bravo to them. The industry has matured past the Neon Gulch point of picturing yourself behind the wheel of the latest software wizardry, giving away Hummers, and even my much-beloved booth babes. Here’s a prediction: other vendors will follow Cerner’s lead, either because they support the concept or because they don’t see the value of spending big exhibit bucks and now have a way to save face in following the market leader in opting out. I have fun with Cerner and call them out with they screw up, but they get it. They’ve broken new ground the last few years in how they handled their exhibit and now they’ll make the biggest leap of all by abandoning the concept. Did I already say bravo to them?

Speaking of which, I’ve got some broad conclusions about the industry from what I saw and heard at HIMSS. I’ll write that up when I get time, but the teaser is that I think existing provider backlog, capital constraints, and declining revenues will hurt sales for the foreseeable future (and I’ve got some facts to back that up). I’ve theorized who will win and who will lose in that scenario, which I’ve validated with a few CEOs while I was here, and how the industry change as the rising slope levels off. There’s no killer app coming that I can see, so it’s time to digest what’s been bought. More to come.

Recommended exhibit to visit: the Department of Military Health. If you need a reality check from all the glitz, have a soldier in uniform demo the AHLTA-Mobile and AHLTA-Theater systems for wounded troops, calmly explaining that bullet wounds also usually involve thermal injuries from the friction-induced heat as the bullet pierces your skin.

Booth trend: Wii games as simulators. And: some fruit and water as snacks instead of the usually unhealthy stuff handed out at a health-related convention.

Odd bathroom factoid other than Seal Shield’s strainers: the convention center soap dispense is motion-activated, but the faucet requires pressing. Strange.

Best session of the conference so far: Deborah Peel on privacy. She is just amazingly rational, persuasive, and downright charming and self-effacing. I started out months ago calling her a flake, but I’m now a big fan. She mentioned that her group is starting a privacy certification process, with Microsoft’s HealthVault and eMDs being the first. She’s also lobbying to set privacy standards for e-prescribing. The industry probably doesn’t agree with her on all counts, but I figure it’s like politics: even if they meet in the middle, she’ll have done great work.

A few more booth observations: McKesson was really ugly blue with a disruptive traffic pattern, but it was big. Medsphere was dead. Misys had a cool booth. Abreon had a tiny one set up like a pet adoption center, with stuff animals (dogs) in cages. My favorite geek booth was SupCam or something like that, way over on one end, with a tiny DVD-quality camcorder that can stream over the web for $298. The guy said he was doing big business.

E-mail me.

Inga’s Update

Tuesday a.m. – I got up early and headed to the convention center in hopes of finding an Internet connection that worked. How nice to have free and fast Internet! It is pretty peaceful here at 7:30 a.m. I am enjoying overhearing a vendor at the next table make a pitch to a couple folks. Commerce at work!

I spent Monday afternoon walking the floor. Perhaps I should have taken the advice from my new friend Suzanne with Active Data Services (booth 3787) who advised me to wear my walking shoes rather than the more fashionable high heels.

Here are a few fun booths and people I encountered yesterday.

McKesson used their Enterprise Visibility system to display the diagram of their 110×110 foot booth. Cool way to show off their technology. Also walking through the McKesson booth, I saw someone wearing a “I’m Miss HIStalk” ribbon, which made me smile.

Every time I walked by the Motion Computing booth, people were three deep checking out their tablet presentations. Microsoft was the same way – I didn’t even try to get into the booth because it was so crazy busy.

VasTech (booth 1543) offered me a margarita early in the afternoon (I declined) but maybe I will go back today. Drank some good Starbucks at Allscripts (5145) instead followed by a fresh warm cookie from Wayport.

Perot had a fun set-up where people could pick up a paintbrush and brush a few strokes on a painting. Don’t know if there was sort of correlation with their marketing theme, but I liked it.

Red Hat is offering free shoe shines from “Mr. HISTalk.” Maybe I’ll stop by there today. And of course I saw the imposter Inga at Relay Health (who was looking lovely).

I asked both the folks in the Misys booth and Allscripts about the buyout rumor. Either it isn’t true or nobody at that level has a clue.

My favorite trinkets so far were my pig and frog from the White Stone Group, the Magic 8 ball from Modern Healthcare, and the wide variety of thumb drives. I hear that Microsoft has the biggest drives by the way – the 1GB variety.

Also worth a visit is the Compuware booth, where there is a real race car Corvette. If you like, you can take your picture with a beautiful young thing, or, a studly race car driver like I did.

I also managed to figure out what vendors had the softest and most convenient couches (Microsoft and Healthia were at least a couple I tried out).

So, on to the reception. Gosh I had a fun time! Thank you Healthia for throwing a great party!

I enjoyed overhearing various conversations, especially the ones involving speculation on who Mr. H and Inga might be. I was amused how many people thought Inga might be a man! Do they think my shoe fetish isn’t for real? Real men don’t pay too much attention to shoes, do they?

The best dressed guy was Scott Shreeve, who was adorable! He had the coolest shirt (kind of retro) and some very happening shoes (hmm … maybe HE is Inga.) Plus, he is as cute as can be.

Gwen Darling was one of the lovely blondes in the black dresses last night. Definitely on the best dressed list. There was also a younger lady in a white dress with red shoes. I didn’t see her name, but she had it working! She was with a lovely lady in a short black dress with a bow in the back and black shoes – quite a nice ensemble, too.

Of course there was Jonathan Bush, who simply stole my heart. Mr. H had said he was pretty funny and engaging, but I wasn’t prepared for this boyishly handsome ADD-type! He complimented Mr. H on the intelligence and honesty he has brought to the industry and recognized his leadership. Meanwhile he had us laughing with his “boat show” analogy and “digital balls” comments. If athenahealth has a speed boat in their booth next year, note that you read the prediction here first.

So possibly the funniest part of the evening for me was realizing that the gorgeous blond wearing the “Kiss Me I’m Inga” sash was pregnant! I surveyed a few folks and the consensus was that, in spite of her beauty and perfect looking backside, she was a member of the Angelina Jolie baby bump club. Mr. H swears he didn’t notice (men!) but I think he had the whole thing planned and was really trying to play some very funny joke. For the record, this Inga is not in the family way.

I am heading to the other end of the exhibit hall today – those poor guys in the 7000 booths.

E-mail Inga.

From HIMSS 2/25/08

From Larry Tate: “Re: the reception. Tim, Inga, Shawna, and the whole Healthia team: Thank you so much for a lovely evening! It was nice to rub elbows with the movers and the shakers. The food and drink choices were outstanding; the conversation was scintillating!” Thanks for coming. It was really cool seeing everybody enjoying each other’s company. I never know who reads, but looking around the room, I sure felt good about it (unless it was just a free drinks crowd, which is still OK).

From Quad Studer: “Re: marketing. Seal Shield in the 4000 aisle had submersible mice and keyboards, around $30. Simple idea given nosocomial infections and MRSA. They had an actual dishwasher in their booth which I thought was a pretty neat gimmick, but just saw something else even better. In the men’s room urinals they have placed blue plastic strainers (or whatever you call those things) that say ‘Your keyboard has 400 times more bacteria than this urinal – Seal Shield.’ Now THAT’s marketing. This came from someone I know, by the way, and not a shill. Ingenious and clever. We like. I think I saw that guy with a keyboard slung over his shoulder like a bandolero’s ammo belt.

From Andy: “Re: Cerner. Wondering if anyone has additional information on the rumor that Cerner is not going to attend the HIMSS conference next year? Looking at the booth strategy for next year, they are not included. That is going to leave a lot of C level executives looking around and wondering why thier vendor is not is attendance. Surely, it cannot simply be money?” I’ll probably get confirmation one way or another, but I doubt seriously it’s about money if they’re really not coming. Someone told me several vendors are considering opting out, and Cerner probably has the best reason in that they run an outstanding conference on their own, now right in KC. I’ll let you know what I hear, but I would like to encourage folks not to assume the worst if a vendor opts out of HIMSS since it may just not be a wise investment of their dollars, so they shouldn’t feel guilty for passing. Nobody signs contracts at HIMSS, nobody hears of a big vendor for the first time there, and not that many decision-makers leave with their minds made up. I’ve always said that exhibiting is more for the current customers than bagging new ones.

From XLT: “Re: offshoring. I was at Epic recently for training and sat next to a woman employed by Accenture who was from India. She was in-country for six months attending classes along with numerous other Indian Accenture employees. It seems that Accenture is creating an offshore capability for clinical system build.”

From Neal’s Pizza Guy: “Re: Cerner. Neal was in London last week and gave another bizarre town hall speech which none of the Cernerites could understand. At one point someone observed he’s started five different sentences and finished none of them.” I know he’s hard to listen to, but at least he’s the guy who started and runs the company. Polished hired guns with a holster full of Ivy League degrees and no soul would be much worse.

Some interesting comments were posted about the University Hospital downtime article in the newspaper. Someone who sounds like they know what happened said it was a connectivity issue outside the hospital’s control.

What a reception! If you came, thank you. If not, sorry you missed it because it was a blast. The room was packed and overflowing into the hall and the adjoining area. Two high-ranking folks who know me took me aside and said, “Do you know that this is the must-see event of the conference?” Another pointed out the line of big-name investment bankers rolling in. The food was outstanding (I’ve been living on Subway the last couple of days, so it was especially great to me, especially the crab cakes and carved turkey) and the beer was cold. But what was just completely gratifying to me was seeing all the conversation, the cards being exchanged, and the relaxation after a long day at HIMSS. My favorite moment: I had written a little recognition to the military members who had RSVPed, but everything beyond the first handful of words was drowned out in a roar of cheering and clapping and whistling for those serving. Thanks for that recognition – I wish more of them were there to hear it.

So, let’s talk HISsies. Those amazing guys at the Healthcare IT Transition Group made it into a cartoon, which is online on their Hitch-TV. They’re geniuses, for two reasons: they’re darned smart, but especially because they’ve figured out how to make a living having a blast working together. Their movie got a lot of laughs and applause in all the right places.

Spoiler: athenahealth and Jonathan Bush won 8 of the 18 awards. Jonathan was out guest speaker and what a guy he is! He showed up early stayed late, worked the room, and had a great time. I only wish I’d remembered to record his speech. My favorite quotes: “Digital Balls” (you had to be there) and “HIStalk is a network — that (the conference) is a boat show.” He hit some great topics in patient safety, the need to re-architect existing HIT platforms, and ribbed the Wall Streeters a little. What an utterly fun guy. The big TV network guys are always hounding him to death to go on national TV and here he spends his evening hanging out at some blogger’s reception. Thanks to him and to John Hallock, who just may be the best PR and strategy guy in the business. They brought some of the athenistas along and they were having fun and the CFO came over to chat, having no clue who I was. I’m proud that they could attend.

More thanks: Healthia for sponsoring the reception, handling tons of details, and staffing the event with Healthia team members (thanks especially to Shawna Schueller for overseeing the whole thing and Mike Tressler for handling the emcee duties). Thanks to Gwen Darling, who not only helped me personally with the event but who even outshone the models in good looks and grace. And, thanks to Miss HIStalk and Kiss Me, I’m Inga. Miss HIStalk will be in RelayHealth’s booth tomorrow, by the way.

AT&T announces that it will create a statewide information exchange in Tennessee.

Misys: nothing further heard on any Allscripts acquisition, so that sounds like a false alarm. Someone did confirm their offshoring of Level 1 support, although it’s going to an existing Misys operation in the Philippines instead of to India.

Link correction: the interview with SCI’s John Holton is here.

Gripe I heard today: the exhibitor badges aren’t blue any more, so salespeople were pitching to other exhibitors for a second until they realized.

Cool giveaway: MRV has a tiny key ring flashlight that’s powered by a hand crank. That will be Mrs. HIStalk’s very special gift when I get back home (that and a flash drive that someone was giving away since she asked me to track one of those down).

Acquisition announcement: Noteworthy Medical Systems will acquire MARS Medical.

Acquisition announcement: Eclipsys acquires budgeting software vendor EPSI.

Acquisition announcement: Medinotes acquires Bond Technologies. News only if you don’t read here since Dumbfounded told us two days ago.

Microsoft announces $3 million in available grants for add-ons to HealthVault.

There were a ton of other announcements, of course, most of them trivial. If one caught your eye as important, let me know since I haven’t had time to scour them carefully.

On with the booth reviews! Random notes about my first impressions follow. Let me know if you want me to look at specific ones.

eClinicalWorks: C. Not so great location, but they really don’t care since they’re selling like wildfire, including to Wal-Mart.

NextGen: didn’t get to see the game show, so since I was there for the girls, I’ll withhold judgment. Seemed pleasant.

Medicity – A. Very cool, chrome, two-story and modern. Had our HIStalk sign out, as did several vendors (we made them little color signs and Inga and I signed them).

Siemens – A. A monster light rack overhead, white and orange, huge, and an amazing theater.

Healthia – A. Few companies uses orange this year, so theirs stood out (most companies were into greens with light birch wood). Nice chairs. The folks were working the crowd well.

HMS – A. Last year’s diner theme with the sassy waitresses, my choice for Best Booth That Wasn’t County-Sized. It’s personal, the waitresses are fun, and it’s just cool.

Epic – C. Same old fireplace and stone.

Allscripts – B. a cool beaded curtain overhead and a coffee bar.

Medseek – B. Set up like a kitchen, kind of cool.

Cerner – A+. Best Booth That Was County Sized. It just said “All Together”, made up on close inspection of client hospital logos. No Cerner. No crowding. Huge expanse, some of it dedicated to simply providing seating for attendees well away from the salespeople. Absolute genius. The bigger and better the company, the less it has to shove its name and branding in your face. All those companies who thought they’d catch up this year by copying Cerner’s “customers doing the presentation” idea just got left sucking wind again.

EnovateIT: Know how I always say I can’t resist pawing their carts when I go buy? I watched passers-by doing it today. That Humanscale cart ought to be in an industrial design museum and their new med cart is an amazing shade of green. They chair they had out was a work of art. If you believe in value of esthestics and ergonomics, this is your Ferrari right here.

Sentillion – A. Had an upstairs, a coffee bar, the birch thing, and that green fish that I like.

TheraDoc: A. Popcorn. I didn’t make any other notes, but I must have liked something else about it since I’m not a big fan of popcorn.

Harris – A. Cool color-changing lights.

IntraNexus: A. Modern furniture, very open (giving them a nice double since I liked their bus wrapper best, too).

Eclipsys: A, but I had to think about it. Huge, pushed the salespeople to the perimeter. Great use of the KLAS CPOE adoption quadrant, although they should have put that on the main aisle and not the side.

3M – B.

Meditech – B. Nice design, good use of green, a little cramped.

Greenway – A. LED lights, excellent use of green (duh).

OnBase – A. Still one of my top two or three. The sports bar motif. Damned funny magician (and I usually hate those guys like clowns and mimes).

GE – B. Massive, all white, stark, cold.

QuadraMed – A. Open, sleek.

Microsoft – I have no idea because of the mob assembled in front of it. Right up there with Cisco in terms of having throngs.

RelayHealth – A, but their Miss HIStalk person scared the bejesus out of me. I was strolling by paying no attention whatsoever when I heard a loud “Are you Mr. HIStalk?” I froze and stammered, but that was just her stock question to get attendees to let her put a badge ribbon on. She was working the crowd very well. Nice booth, although security made me put my camera away when I took her picture.

Sunquest – B. Kind of cool, birch.

Beacon Partners – B+. Tropical, with shutters, plants, and comfy chairs.

Agfa – A, but boy did they and anybody in Aisle 7500 and up get screwed. Lots of non-glitzy displays (IHE, etc.) and clear around a wall full of restrooms. Traffic dropped hugely once you hit that barrier. Hope they got a lower rate because most everyone seemed to be turning back before those last aisles.

Cisco – A. Big crowd at the Unified Communications presentation and a cool InTouch robot around back.

AT&T – A. Cool telehealth camera and cart setup.

E-mail me.

HIMSS Sunday video

From HIMSS 2/24/08

It was a long day at HIMSS, but good. I got to the convention center very early and hung around outside some of the workshops (I’m sure I looked like a psycho lurker, but I wasn’t registered for anything, so I had to peek in). Those I saw had great attendance. The combined session of physicians, nurses, and pharmacists was huge, the venture fair was loaded with people, and I heard the project management workshop was good.

Say what you want about HIMSS, nobody runs a conference any better than those folks, at least that I’ve seen. I can’t imagine the logistics involved, but I can appreciate the result: I felt comfortable, welcome, and relaxed. Signage was excellent, the buses ran well (although it took forever to get to the hotel after the opening reception), and registration and tote bag pickup was lightning-fast.

Orlando’s far from being my favorite convention town, but the Orange County Convention Center is definitely my favorite. Lots of room, extremely well maintained, and helpful folks on hand. If it just had San Diego’s view …

The only negative is that it was darned humid in the convention center until mid-morning, so I’m thinking the AC is programmed to kick on later on Sundays. On the other hand, HIMSS had snacks and drinks out everywhere, even the fancy stuff like chocolate shavings and rock candy sticks for the coffee (I don’t drink coffee, so if I did, I’d want all that after-market stuff dumped in). It wasn’t many years ago that the folks in the Sunday workshops would starve because not only didn’t HIMSS provide food, there wasn’t any to be had because all the kiosks were closed. The situation is much improved. I still feel like a king when I can get a free soda on HIMSS Sunday.

Why healthcare costs keep increasing: a crummy convention center double cheeseburger and fries, which looked like it would taste the same as the paper boat it reposed it, was $10.75. Coffee was $3.52. Ball game food is better and cheaper.

I strolled by the venture capital fair to see what was going on. From the hall, all I could see was two groups: intense, fully suited young guys (at 7:30 a.m.) and casual older fellows who seemed to be having a blast. Guess which group was the guys with money? Hint: when you’re loaded, you can dress however you damn well please. I admire that.

The buses were wrapped in huge ads, of course (pic above). Microsoft had the most with Amalga, but the IntraNexus Sapphire ones were far cooler. While I was looking at the buses, I noticed some of the company reps loading in the usual cases of stuff. The ladies wore clothing ranging from casual to double-take revealing, so there’s a plus (well, in a few cases, anyway).

They were already handing out Monday’s Healthcare IT News, making me feel temporarily psychic again (no stock market or sports page, unfortunately, or I could have retired early). It had the usual lame, pun-filled headlines. I overheard one publications reporter, who looked about 20, explaining her background: “I don’t know anything about healthcare, but I did take biology in college.” Great.

I saw a fair number of people I know and another few that I know only through HIStalk. The only sponsor I saw was a guy in a Novo Innovations shirt.

I swung by the CIO meeting area and they’ve pretty much got the luxury track over there. They got their own tote bags, better lunch, and more goodies (not to mention their own lounge). That room looked packed, too. They get a free iPod if they sit through three focus group sessions. Rank has privileges.

Galvanon had their kiosks set out with maps and session guides. Great marketing idea. I fiddled around with one and they were pretty cool.

I’m still trying to figure out the tote bags. They were designed to be used as a day pack kind if deal, which I refuse to use since it just looks weird on anyone over 25, so I tried to carry it like the usual tote bag. It’s got one handle that’s on one side, which means it always feel like it’s off balance. You also can’t carry it open since the non-handle side just gaps open. I’m not a fan.

I saw a guy with a vendor CEO badge (I won’t mention which company, but it’s one whose commentary here isn’t consistently positive) peering intently at his laptop on a wireless connection. I sidled around behind him to see what was drawing his rapt attention and it was HIStalk.

I’m on a terrible Internet connection, which is driving me nuts. I should have stayed at the convention center to get this written since they had good Wi-Fi from what people were saying. They also have recharge stations for all of one’s gadgets.

Lots of people at my hotel and at the convention center were riding around on Segways, which were apparently a dismal flop everywhere but Orlando. The strangest was a guy cruising around outside by the buses and smoking like a chimney. It always strikes me as both funny and sad to see someone pedaling a bike and smoking, so this was similar.

Outside the speaker ready room: I saw two folks with a Cochise-like string of ribbonry, none of the the unauthorized HIStalk kind. I could decide if they were trying to be funny or really were that full of themselves.

The opening reception was pretty good. I took a little video, which I’ll post if I ever get on a non-hamster powered connection. I really like it when the reception is held outside, like in San Diego, and this one was in a dark ballroom, which felt like somebody’s very large basement rumpus room. The band was OK and celebrity imposters were on hand. RelayHealth’s Fake Inga (pic above) wasn’t getting a lot of attention that I noticed, but I couldn’t keep track of her. The memorable moment was when Real Inga and I approached her, got an “I Might Be Inga” ribbon, and asked her what the Inga thing was all about. Real Inga was tickled because Fake Inga gave some kind of evasive answer, like “It might be a person and it might be electronic, but you’ll have to visit the RelayHealth booth to find out.” She was pretty cute, but Real Inga’s got her beat.

Update: video is here. Not the best quality, but I was on the sly.

And yes, it seemed strange to hear the occasional HIStalk mention. That hasn’t really happened before. Real Inga and I were babbling like children at how strange it is to see Fake Inga and other evidence that we’re not just a figment of each other’s imagination, sitting in front of a keyboard for way too long each day.

Rumor heard: Allscripts will announce its acquisition of the remaining part of the healthcare business of Misys. Unverified and certainly questionable, but the sources were fair to good and there were more than one. Kind of makes sense.

Just one completely unnecessary reminder for those who RSVPed: Monday, 6 to 8 at the Peabody (it’s that giant, sun-blocking building that looms large from every window in the convention center lobby). No hints on the 7:30 guest speaker, but I believe an entourage is involved.

E-mail me.

From HIMSS 2/23/08

From Dumbfounded: “Re: Bond Technologies. Heard that Bond was being sold to MediNotes, with an announcement forthcoming.” Unverified.

From The PACS Designer: “Re: Digitally Connected Patient. TPD mentioned a new concept called Digitally Connected Patient or DCP in the HIStalk interview of last year. Now, Philips Research has released information on this subject. Here’s what they have to say ‘Philips Research’s main involvement in the MyHeart project so far has been the development of wearable electronics and body sensors that can unobtrusively detect and measure vital body signs such as heart rate and breathing rate, communicate and analyze the acquired data and provide feedback to users or health providers.’ It will be interesting to hear from actual users on the pluses and minuses of such a concept.” Link.

From Henry Paterno: “Re: MD On-Line. I ran across their site. Any info?” I’ve not heard of them. Anyone?

From Rogue: “Re: offshoring. Can anyone confirm or deny that FCG or other consulting firms offshore clinical system build work? Anyone have experience with such an approach? If your native language is not English, do the nuances of ECG vs EEG vs EMG translate OK?”

From MSC Fan: “Re: OpenVista. I am biased on this topic, BUT your one-line report on Century City Doctors Hospital’s Medsphere go-live doesn’t really do justice to the accomplishment.” Well, at least now you’ve had twice as much of an attaboy with this second line. Hopefully they did it for their own benefit, not to get mentioned in HIStalk.

From Lenny Dykstra: “Re: downtime in Utah. University Hospital’s EMR goes through a nine-hour downtime. They’re a Cerner outfit.” Link.

I’m in Orlando, where it wasn’t too hot (mid-70s) but pouring rain and then very humid. Looks like HIMSS will be in the original west complex of the Orange County Convention Center, not the new expansion on the Peabody side. The signs are already out in the airport and around the convention center. Obvious sales guys are rolling in. Tourists and traffic are everywhere, of course, with lots of kids bouncing off any available walls. The airport security line leaving MCO looked about a mile long, so I’ve got that to look forward to later in the week. If you’re headed down, travel safely.

A correction from Visicu: the Philips acquisition closed and the stock now void, but it remains a corporation with a new shareholder and board under Philips. The people, office, and name haven’t changed.

Scott Shreeve isn’t impressed with PracticeFusion’s announcement of having 100 physician users of its free EMR.

An SVP from Raymond James & Associates asked if I could link to a two-minute survey they’re doing on HIT vendors. I took it and it’s quick and painless.

DSS announces its VistA system called vxVistA.

Speaking of VistA, the VA says it desperately needs updating, getting it off MUMPS and onto the Web.

Tamper resistant prescription pads must be used for Medicare beneficiaries by April 1 after a six-month delay.

Healthvision says it signed 60 projects in Q4, some involving new customers.

Merge Healthcare’s Q4 numbers: revenue flat, EPS -$4.17 vs. -$0.33. The company will continue frantically dropping ballast to try to keep the balloon of the ground, saying it may sell off its non-US businesses.

E-mail me.

Sponsor Updates and Housekeeping

Care Management is the name of the newly launched clinician communication solution from Premise. Care Management is designed to improve patient flow by collecting and displaying data from various clinical systems and includes proactive alert and communication tools.

Design Clinicals announces MedsTracker 2.0, which includes enhancements to the medication reconciliation process.

Novo Innovations will announce Monday enhancements to make physician lab ordering easier.

Inga’s Update

I got a preview of Active Data Services (booth 3787) I’m Not INGA! Buttons and it has led me to wonder: if someone creates a 1500 buttons with your name on it, does it make you an icon? It’s all pretty heady.

GE Healthcare announces an $8.3 million agreement with Inova Health System in Virginia to provide 300 community physicians with Centricity EMR over the next four years.

Oakwood Healthcare in Michigan and Perot Systems announce that their implementation of NextGen’s EMR and EPM is delivering positive results and has increased revenue cycle and operational performance as well as cash collections. Perot is implementing NextGen’s products at Oakwood’s 38 physician practices.

Massachusetts Eye and Ear Infirmary selects McKesson’s Paragon community HIS and plan to implement the clinical, financial, and ancillary applications

E-mail Inga.

News 2/22/08

From CHOP Person: "Re: CTO. The positioned was already filled with someone who was brought on board several months ago and spent her time lying low while a reorganization of the training/learning organization occurred. End result: Talent and Learning Services headed by CTO. Means IS (EPic) training moved to HR, among other things."

From Chiquita Bonanno: "Re: MaxIT. Heard it was sold. Any truth to the rumor?" I haven’t heard anything.

From Darius Price: "Re: Lakeland Regional Medical Center in Florida. Heard they’re about to sign with Epic."

From H.I.S. Stalker: "Re: eClinicalWorks. Has anyone noticed that eClinicalWorks just got selected by Wal-Mart for their clinics?" Yes … everybody who read HIStalk last Thursday. I must write too much stuff because people are e-mailing me hot stories all the time that I’ve already mentioned. That’s OK — it makes me feel like a futurist.

From Silent Bob: "Re: Neil Pappalardo. Little known fact: he played lacrosse at MIT (defense). He also refused to cram for exams as he felt that last minute study gave an inaccurate reflection of his understanding of the subject." See? He’s the Bill Gates of our industry and needs to go on record (in more ways than one: I did a quick calculation of the value of his Meditech stock and it’s $502 million). He sits in a cube like the other ‘Techies and when I interviewed Howard Messing, he was writing a spell checker. 

From bmoregirl: "Re: Orion Health. Rumor is that Philips will acquire Orion Health in its quest to be the solutions provider birth to grave. Good move on their part if they do!" Unconfirmed, but feel free to chime in if you’ve got the goods.

From Steelers58: "Re: QuadraMed layoffs and offshoring. Funny how folks like Newman look at real-world events as catastrophic. QuadraMed will now be able to compete a little closer to the big guys by getting product to market quicker." Someone sent me an intercepted e-mail document, apparently QuadraMed’s talking points about the layoffs. Summary: outsourcing makes sense because higher demand means delivery has to be faster and cheaper, the offshoring decision has nothing to do with QCPR, and unnamed loudmouth bloggers (say, are my ears burning?) are wrong in stating that QCPR expertise is running low when QuadraMed still has over 40 product people, that Christine Stanfield was one of 12 analysts on the team, and over 30 engineers (15 old-timers) are working on QCPR. Actually I didn’t say that, a reader did, just to nitpick.

Short-term pain aside, there’s nothing wrong with offshoring, although a company has to quickly change its core competency from coding and QA to design and project management of code-to-spec techies who don’t know healthcare and, in some cases, English. Sometimes it works, sometimes not, and the obvious problem is that when it doesn’t, it’s hard to put a team back together stateside without losing years of momentum. I don’t have a strong opinion either way, especially since I bet no major HIT company (Epic, maybe?) hasn’t moved jobs offshore. You get more for your money, but not always better.

Open source business intelligence software vendor Pentaho of Orlando raises $12 million in Series C funding. You have to appreciate the one-paragraph bio of the founder that concludes, "… you can usually find him near an empty Captain Morgan bottle or wandering around in the woods with his GPS receiver." Or both. Pretty hot company, apparently.

Microsoft says it has opened its HealthVault platform to developers: open wrapper libraries, eventual release of the .NET SDK, and publishing of HealthVault’s XML interface protocol specs to allow developers to private label the service (as I understand it, anyway).

Google announces a pilot program with Cleveland Clinic that will allow invited patients to share their Epic MyChart personal health records with Google PHR. The announce suggests that information from other providers will be importable and viewable under the patient’s control. Google also starts a Healthcare Industry Knowledge Center that helps advertisers target healthcare consumers. Coincidence?

So, the two potentially big PHR players fire salvos, each entirely characteristic: Microsoft flashes geek-arousing but proprietary (.NET) techie toys and white papers while Google jumps right to go-live and monetization while hiding the gadgetry under the covers. I’d call it Google 3, Microsoft 1 early in the game. In fact, I’m taking away MSFT’s one point because you can’t sign up for HealthVault without having a Windows Live ID, another example of proprietary .NET crap that has raised more than a few privacy concerns (just the ticket for launching a PHR). 

Another score update: Peter Pronovost and patients 1; well-intentioned fools from HHS Office of Human Protections 0. HHS must have slapped some sense into OHRP because it has decided that since infection checklists are already being used, it’s no longer research (duh). "We do not want to stand in the way of quality improvement activities that pose minimal risks to subjects," its acting director says, backpedaling from its previous interest in doing exactly that until the uproar of reason became deafening. My interview here. Strangely, Peter says he got no feedback whatsoever from the HIStalk interview (people usually get overwhelmed afterward). I thought quality and IT were hand in hand, but maybe I misjudged.

I forgot to mention a vendor dishing up HIStalk swag at HIMSS: Active Data Services will be handing out "I’m Not Inga" buttons from Booth # 3787. Their plan is to have every person at the conference put one on except the ever-honest Inga, who will thus reveal her true identify. I’m glad I’m not the one dragging 26,000 buttons to the hall if so. I’ve never seen any mention of HIStalk at HIMSS other than those ill-fated buttons of two years ago, so it will seem strange to see all the HIStalk and Inga stuff. You have to remember that I’ve only ever even uttered the word HIStalk to maybe 4-5 people in my life outside of the interviews and I’ve have never seen it anywhere except on my computer screen. I’m not real sure what my reaction is going to be, to be honest. Creeped out, I’m guessing. Imagine Inga: she has no idea how anonymously famous she’ll be since this is all new to her.

And for you home-bound non-HIMSS attendees, the HISsies winners will be announced in a very different way, so check back here Monday night. I’ll be writing here every day, of course, with the kind of high-brow analysis that you can’t get elsewhere: who’s booth sucked, which booth babes were hot, how good or bad the opening session was, and whether anyone particularly impressed or annoyed me. That’s if the server can handle the load of readers, that is, since the big boy went to his knees in the crush of HIMSS traffic last year, requiring me to beef it up.

Money guy Julian Allen is named to QuadraMed’s board.

Medsphere brings OpenVista live at Century City Doctors Hospital (CA).

Premise Corporation’s bed management systems earn the endorsement of AHA.

Pick up a wristband and brochure on "A World Free of Medication Errors" at HIMSS and First DataBank will donate $5.00 to two non-profit medication error groups. I hadn’t heard of either group, but I see that Peter Pronovost is affiliated with the Josie King Foundation, started with some of the lawsuit proceeds after an 18-month-old died at Johns Hopkins from a medication error. FDB is in booth 3747, according to the HIMSS exhibitor list.

Charleston Area Medical Center (WV) says it won’t lay off employees or cut back on pay raises despite a $25 million verdict against it, won in a lawsuit by a local surgeon who said the hospital smeared his reputation and revoked his privileges over malpractice insurance. Or lack of it, actually, since he put up $1 million of his own money as a self-insurance fund instead of buying commercial insurance, which CAMC didn’t like. Guess he won’t need to work at all now.

Visicu and its EICU stock ticker are history. The company’s $427 million acquisition by Philips is a done deal.

Emageon’s Q4: revenue down 14.7%, EPS -$0.02 vs. $0.10.

E-mail me. I’m probably too busy to respond, I’m sorry to say, since I’m working absurd hours. But, I always read.

Sponsor Updates and Housekeeping

New interviews on HIStech Report: John Holton of SCI Solutions on access management, Perry Russoniello of McKesson on workforce management, and Jim Klein of QuadraMed on the company’s product line, including QCPR.

Jobs: Cerner Consultant, Microsoft SQL Report Writer, Application Developer.

eScription announces that three of the top four outsourced transcription companies in the KLAS year-end report are members of the eScription MTSO Alliance. eScription, of course, is #1 in its own KLAS category of Transcription and Back-End Speech Recognition.

Sonitor announces a single patient use wristband tag for its ultrasound locating system.

Inga’s Update

A UK hospital has abandoned use of its Cerner Millennium software in its ED, claiming it posed a clinical risk because it couldn’t do simple things like print labels for blood samples quickly.

Now here is something creative and fun to check out at HIMSS. BÖWE BELL + HOWELL will attempt to scan a half-mile long paper document equivalent in length to 2,880 standard, 8.5 x 11-inch sheets laid end to end. If they succeed, they will establish the Guinness World Record for scanning the longest document. So if you want to hang out for a couple hours watching a really long scan process, stop by Booth 4476 Monday afternoon.

Misys announces some recent sales, including an upgrade and EMR sale to 19-provider Lumberton Children’s Clinic, Misys Homecare 4.0 to Angel Home Health and Hospice, Tiger and EMR to nine-provider McAllen Surgeons, and Tiger and EMR to five doctor Central Wyoming Neurosurgery. 

Coincidentally, I just got the following note from Poo Flinging Monkeys: “Not so much a rumor … not sure if they intend to tell the clients, but Misys is moving Level 1 support, which includes simple client requests and scriptable support solutions, to India. No layoffs yet, but moving it all offshore can’t be far behind. Most feel that ole Vern is simply cleaning it up to be sold and will jump ship.”

From Nobody Important: “In regards to Merge Healthcare – refer back to HISTalk on 11/27/06. Some predictions were made." Good call – here is Mr. H’s old posting that Nobody Important is referring to: “I got a few e-mails concerning Ken Rardin, now CEO of Merge Healthcare. His past-company track record: offshoring, job cuts, merciless bottom line boosting, selling off assets in parcels. The first two have proven accurate at Merge. We’ll see on the second two.”

The title of this study makes it clear where the authors’ opinion on PRHs and privacy risks: Personal Health Records: Why Many PRHs Threaten Privacy. Published by The World Privacy Forum, they note a number of possible privacy concerns, including the probability that PHR records could be subpoenaed more easily than a traditional HIPAA-protected record and the risk that identified health information is released to commercial data brokers.

McKesson announces a new strategic relationship with Proventys, a provider of personalized medicine knowledge services. McKesson plans to incorporate Proventys’ predictive modeling features into their clinical decision support solutions.

Deloitte Center for Health Solutions publishes a study that finds American consumers want more from their health care system than they’re getting, including greater online connection to health care providers and medical records, customized insurance coverage, and wider access to emerging innovations, such as retail clinics. Sixty percent said they wanted online access to medical records, test results, and appointment scheduling; 25% would pay more for that service. I also was interested to see that 75% of the consumers want expanded use of in-home monitoring devices and online tools to reduce visits and allow individuals to be more active in their care.

A recent Siemens Healthcare IT Exchange newsletter includes current statistics for Soarian Implementations. They claim to have over 80 Soarian customers live with over 160 active implementations underway. They also provide a breakdown of the number of clients using various modules.

The Los Angeles city attorney files suit against Health Net Inc., charging “a wide range of unlawful, unfair and fraudulent acts and practices,” including secret schemes to drop patients needing expensive treatment.

Lots of loose ends to take care of before heading to Orlando, including making sure I have a big enough suitcase to bring home all those vendor trinkets! Well, and all the extra shoes. I have a feeling this won’t be a carry-on type trip for me. I’m looking forward to prowling around all the booths and striking up conversations with strangers. And if you have RSVP’d for the HIStalk party and are considering bagging it for a better offer, trust me when I say you won’t want to miss it! I will be the one laughing and drinking and thanking my lucky stars for having such a great job!

E-mail Inga.

News 2/20/08

From Felonious Monk: "Re: Ralph Korpman. He’s developing a PHR under the company name CentriHealth in Nashville. He left HDS/Medaphis/Per-Se to found HealthTrio, but fell out with his partner. His new company is keeping a low profile, delivering the PHR as a subcontractor for Anthem, Ketting (OH), and Florida Medicaid." He’s certainly a pioneer. Personally, I’d like to see him design another clinical system, but he didn’t have a lot of success with the first one, I guess.

From Billie Newman: "Re: CPR. QuadraMed is showing poor judgment laying off folks such as Christine Stanfield. The CPR product is powerful, but complex. Sending development offshore will not work, as the system is too complex and will require folks with in-depth knowledge to maintain/support/advance." 

From Duane Feckless: "Re: sales team. Who do you use to sell your sponsorships? Maybe we could help you out for a percentage." No need. Companies e-mail us – we don’t solicit sponsors, make calls, or follow up after sending a PDF info sheet. Vendors know who we are, so they’re either in or they’re not and our job doesn’t change either way. Inga and I are very happy with the sponsors we have and we’re not hustling for more.

From Animal Price: "Re: Sage. The West Coast VP of sales, a 13-year vet, leaves the company. The remaining four VPs of sales have less than seven years total EMR/PM sales experience and the senior VP is a marketing professional."

From Jay’s Friend: "Re: Jay Parkinson MD. I’ll try to bring my friend Jay to the HIStalk party. How will I know which lovely lass to introduce him to?" I’m sure none of the lovely lasses would object to being introduced, so just start a receiving line and we’ll make an announcement.

From Samantha Sang: "Re: Pronovost interview. This was incredible! If there was a literary award for excellent journalist reporting in a blog, I would nominate this piece." Well, Peter did all the work, but I’ll accept on his behalf. I’ll finally be ready for more interviews after HIMSS, so I’ll be on the hunt. My #1 choice: Neil Pappalardo of Meditech, just because he fascinates me and never does interviews. The industry deserves the chance to know him better.

Palomar Pomerado Health (CA) will unveil its Second Life-based online hospital next Monday at the HIMSS booth of its partner, Cisco, which underwrote half the cost.

Listening: Flyleaf, hard-rocking, chick-led, semi-Christian.

The HIStalk reception at HIMSS is sold out, so we’ve shut down the RSVP page. I was expecting a few dozen signups and secretly hoping for 100, so 400 is pretty darned special indeed. Thanks to Healthia Consulting for footing the bill and making the arrangements. Coming: 46 presidents/CEOs, 64 VPs, 8 CIOs, 3 CMIOs, 4 COOs, 6 CTOs, and lots of other cool folks. A couple of weeks from now, I’ll be scratching my head that Healthia offered to put it together and that so many people, a few of whom I’ve swapped e-mails with, were able to come together. We’ll have a very special Miss HIStalk and Inga, the HISsies announcements, and a big-name speaker at around 7:30. With all those high-powered attendees, I bet some deals will go down. I’ve got a couple of folks who say they’ll snap some pictures, but if you want to bring your camera and help out, that would be cool.

A couple of weeks ago, I offered to make Miss HIStalk available to hold court in vendor booths at HIMSS. I got no takers until now: Miss HIStalk will be in RelayHealth’s booth (#2663) on Tuesday, so if you find yourself missing her attractive company after Monday night (and you will), drop by and get yet another variation on the badge ribbon theme, this one specific to RelayHealth (hey, don’t say I didn’t offer to help you other vendors stand out in the crowd). In fact, RelayHealth was so moved by my clearly ingenious marketing strategies (bring cute girls) that they’ll have a "Miss HIStalk wannabe", as they told me, handing out still more badge ribbons with HIStalk-related phrases at the HIMSS opening reception Sunday evening (they’re sponsoring it). I tried to get a Mr. HIStalk for you ladies, but couldn’t find a source. Now the pressure’s on to come up with something fun for next year in Chicago (HIStalkapalooza?)

Speaking of HIMSS, I know that at least three M&A deals will be announced during the conference. One or two may actually come out this weekend. You may recall that I scooped the McKesson acquisition of Practice Partner before their HIMSS announcement last year (so if you know anything, spill it). In fact, I made another accurate prediction that same day in response to a comment Misys had made about their physician focus over their hospital lines: "Well, they have to dump those businesses now, right? Why else announce to the world (and your existing lab and CPR customers) that those product lines are also-rans? Must be great to be a Misys sales guy trying to beat the odds and move some of those systems, only to have the boss tell your prospects that they really aren’t important."

My editorial in this week’s Inside Healthcare Computing: "Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers." Scott Shreeve gave me the idea.

I was reading somebody’s HIT predictions for 2008 when it occurred to me: HIStalk has more smart readers than anyone I know, so maybe we could harness that brainpower to make better ones. I know the investment guys hang on every word, so it ought to be done right. I’m a provider-sider and don’t have a clue how to do this effectively, so if you’ve got experience, let me know.

Strange: a moonlighting pathologist in Canada develops what he says is innovative software to review Pap tests with better accuracy than tired pathologists. The newspaper discovered his invention while researching his frequent absences and reportedly shoddy work, which has forced Canadian authorities to review 15,000 cancer cases that he may have misdiagnosed while tending to his software project.

CSC, fresh off its acquisition of Covansys and FCG, will double its workforce in India to 32,000.

A Pittsburgh TV station ("Team 4" – precious) gets lathered up over HIPAA after investigating 378 Western PA claims and 80 violations that resulted in zero fines or prosecution. In fact, Team 4’s intrepid sleuths noticed that the list of complaints it got from HHS  included names, leading them to conclude that "the people in charge of enforcing the medical privacy law failed to follow their own rules." HHS politely reminded them that it isn’t covered by HIPAA.

The Ohio Board of Pharmacy is investigating e-prescribing errors.

E-mail me.

Sponsor Updates and Housekeeping

Sonitor Technologies announces the launch of its PC-Detector RTLS technology to be featured at HIMSS Booth #3815.

The Picis folks sent us a note about some of their prestigious clients who are presenting case studies at HIMSS: St. Luke’s Episcopal Health System, Abington Memorial, MD Anderson, William Osler Health, Stormont-Vail Healthcare, and Group Health Cooperative will present at Picis’ booth, #2849.

Stratus Technologies announces a new “medical grade” class of servers proven to be capable of delivering uninterrupted 24/7 access to digital data and information and can support virtualization.

Greenway Medical Technologies is selected by 27-provider group and FQHC PrimaryPlus of Kentucky and Ohio. Though their press release didn’t specifically say this, the suggestion is this may be Greenway’s first FQHC sale and they are trying to pursue more.

AmSurg, who own a majority interest in 170 ambulatory surgery centers across the country, is implementing (warning: PDF) NextGen EMR/EPM. The AmSurg centers focus primarily on gastroenterology, ophthalmology, and orthopedic specialty procedures.

A medical device maker in Minneapolis sues a competitor, claiming its business was damaged after the company raided its sales force. Apparently 11 reps moved from one company to the other between May and January of this year.

athenahealth’s latest client is Therapeutic Associates in Portland, OR. The physical therapy and rehab organization, which has over 150 providers and 65 locations in the Pacific Northwest, will use athenahealth’s on-demand practice management and billing services.

Correction to an item last week on PatientKeeper. HCA will be implementing PatientKeeper’s physician portal and not patient portal.

REACT Systems announces a strategic partnership with Santa Clara Valley Medical Center and the Seton Family of Hospitals. REACT provides critical response notification systems.

Would you (or your elderly relative) pay $5 a month to get real time updates on their doctors? Healthgrades is offering (warning: PDF) a new “Watchdog” e-mail alert service that will let patients know if there are any changes in disciplinary actions, malpractice judgments, and updated patient ratings. Maybe I just don’t go to the doctor enough or just don’t care enough about the statistics to pay even $5 a month for that type information.

I’m a fan of green initiatives, so I was pleased to read a Philips announcement of a 33% increase in sales of green products in 2007, including a 35% rise in its healthcare division. The biggest boost came from MRI scanner range plus patient monitors. The Philips MRI scanner Achieva 3.0T X-series has a 32% reduction in its environmental impact and the IntelliVue MMS X2 Patient Monitor consumes 52% less energy.

I’d like to see the results of this survey, so I will probably participate. Beacon Partners will ask HIMSS attendees four questions about which presidential candidate they think will most positively impact the industry.

I am trying to decide what to pack for HIMSS and was reminded how glad I am not to wear some boring company shirt that matches everyone else’s and really designed to look best on a man. Individuality and self-expression in fashion is so invigorating! Which led me to a thought that I should warn the fashion conscious that I plan to be take copious notes on who is wearing hot outfits to the HIStalk party next week, as well as who needs to be turned into the fashion police. If you are one of the unlucky forced to wear the corporate uniform, I promise to be kind, although I will give bonus points to any who are able to spice up and personalize some lame company golf shirt.

E-mail Inga.

Monday Morning Update 02/18/08

From Rorey Wheeler: "Re: HIMMS. To your point about e-mails from companies bragging they’ll be at ‘HIMMS’, as a sometime HIT vendor software executive, it is also terribly motivating <to quickly find a trash can> to receive material touting ‘HIPPA’ compliance." I used to rail on ‘HIPPA’ press releases in HIStalk, but it was so easy to find examples that I lost interest. I wouldn’t do business with those companies on principal alone, even if it is their marketing people screwing up.

From TenaciousD: "Re: CHOP CIO. I hear the CIO leaving may be due to the Epic EMR implementation taking too long and supposedly going to the board for another $25-30 million to finish it. They signed with Epic in 2003 and have very little to show for it." Unverified. TD also says that he’s hearing that Judy Faulkner is spending time in France wooing a potential global client for Epic.

From Steve Stifler: "Re: Microsoft Amalga. Here we go again … Let’s see, in my 30-plus years in HIS, we’ve had only a ‘few’ system vendors try this. NCR, Honeywell, DEC, Oracle, SAP, and, oh yes, IBM (several times, as I recall). Basically the hardware guys (now the op systems guys) come to the conclusion that the apps people do not know how to do it right, so we’ll show ’em. Can Mr Softie succeed where these behemoths of their day could not? In my opinion, not likely. It takes a lot more to succeed than a big wallet and a big name. Maybe they are NOT shooting for the US market, but international, where HIT is far less mature (intractable?)"

From Jim Levenstein: "Re: Eclipsys earnings call. They mentioned Sunrise 5.0 and its integrated revenue cycle. Anybody have feedback on that release?"

Not HIT-related, but something cool I ran across: MightyJack, a tiny box with a USB plug on one end and a standard phone jack on the other. Unlimited calls to the US and Canada using a regular telephone run $20 a year ($40 for the first year including the box itself), including an answering service that works offline, an incoming number, and other goodies. Skype-killer, highly rated from what I saw. I was thinking about setting up one of my old PCs as a "phone server," just running a broadband connection, MightyJack, and a cordless telephone base. You roadies could take it along and save your cell minutes. I use a Skype-powered VoIP phone on my PC and laptop, which works fine, but unlimited calls run $36 a year, an inbound number is extra, and there’s no offline answering capability.

A reader sent over a CPOE study on error reduction in response to my comment that clinical systems don’t ever seem to reduce the cost of healthcare to patients. I don’t doubt the study, but it wasn’t as broad as I wanted. Hospitals always tout their IT, but never do a rigorous study to prove that systems (a) improve care, and by that I mean broad-based outcomes like mortality or quality of life measures, not just task improvement; or (b) truly save money to the point that the hospital passes those savings along to its customers (certainly many factors impact this, but why spend millions if you don’t expect to save at least as much?) Anything else is nice, but secondary. Like those prognosticators who said we’d all be working five hours a week because PCs would make us so efficient, I’m not buying it in many cases (and it’s not the vendors’ fault: it’s up to hospitals to buy the right ones and use them to get the job done). You wouldn’t use a drug or medical device without clear-cut evidence of its effectiveness and benefits, but nobody expects that with IT because hospitals can’t abide reproducible processes (except Licking Memorial Hospital, which earned ISO certification in 2005 – anyone know how that’s worked for them?)

Right as I ranted above, I ran across this article (warning: PDF) that looked at mortality in ESRD patients pre- and post-EMR implementation, finding big reductions in mortality and cost at a dialysis unit affiliated with New York Presbyterian. Their system was Disease Manager Plus from MIQS. I need to study the article a bit more.

I can’t explain who needs to know or why, but if you have a C-level contact for any potential big player PHR vendors, let me know.

E-mail me.

Sponsor Updates and Housekeeping

HIStech Report interviews: Design Clinicals,  EnovateIT, Healthia Consulting, McKesson Horizon Enterprise Visibility, PringPierce Executive Search, Sage Software, Stratus Technologies, The White Stone Group. You can download PDFs with full information from each interview. Also, seem my HIMSS page with reception info, giveaway locations, and writeups about companies that support HIStalk (or download a PDF to print and take along).

Jobs: Practice Director – McKesson Practice, Precision 2000 Support Analyst, Senior Consulting Manager, Network Analyst. One of our listing employers said they were inundated with responses to their HealthcareITJobs.com  listing, so we know folks are reading. Thanks.

Welcome to new HIStalk Platinum Sponsor Greenway Medical Technologies of Carrollton, GA, whose PrimeSuite EHR earned Best in KLAS 2007 for ambulatory EMR in 6-25 doc practices. It’s also CCHIT certified through Ambulatory 2007. Other products include PrimePatient (patient portal), PrimeExchange (interoperability), PrimeResearch (clinical research networking), PrimeMobile (mobile desktop), PrimeARM (revenue cycle management), and extensive services and support. They must be doing something right since Q2 sales just announced were up 52% over 2007 and 83% over 2006. I notice they have lots of good Southerners on the management team, so I’d say drop by their HIMSS booth at least for some high-bandwidth conversation about barbeque or college football (Georgia vs. Georgia Tech or Auburn vs. Alabama should raise the intensity level). I love the South, so I may lead the discourse over sampler bowls of grits for you Yankees and Left Coasters. They’re in Booth # 1263. Thanks to Greenway for supporting HIStalk and its readers.

Dale Sanders had post mentioning Northwestern’s "buy and develop" strategy. I agree with this concept. It is a practical means of delivering a full solution when using a broad "big box" system (ex: Cerner, Epic) in a large organization. Any vendor has functional deficits. There are four ways of dealing with deficits – a manual workflow, suck it up and use the system, use a best-of-breed system, or develop a system in-house. For major deficits in an area, using best-of-breed systems is a common approach (for ex: surgery, ED). For minor functional deficits or cross-area workflows, in-house development appears to be on the rebound.

Examples of cross-area workflow issues include the management of clinical pathways or discharges from care settings. An example of a minor functional deficit is information exchange. To resolve these issues or deficits, organizations are turning to vendor’s software development kits or web services. A very recent example of this is UPMC’s Smart Room. UPMC has enabled a unique workflow by using multiple vendors’ services and some custom development.

This type of in-house development has been common outside of health care for some time (for ex: with major ERP systems). The challenge is maintaining the integration as the systems evolve. I am optimistic that organizations will be open-minded about using development to address functional deficits and workflow issues.

Inga’s Update

St. Francis Health Center, part of the Sisters of Charity of Leavenworth Health System, is implementing (warning: PDF) eWebHealth’s EHR.

HCA selects PatientKeeper’s integrated patient portal, which will  integrate with its Meditech systems plus a wide variety of others.

This article suggests that at least one major Mediware shareholder is using the board of directors to put the company up for sale. Apparently Cannell Capital, which owns almost 13% of the company, sent the board a letter illustrating how cheap the company was on both an absolute and relative basis.

Merge Technology announces its “rightsizing” initiative, which is just a fancy way of saying they are laying off about 160 people worldwide and not replacing another 20 who left due to attrition. Forty-five of the affected are in North America with the other 115 are offshore. The final "right size" for the workforce appears to be 440. The changes are expected to save Merge about $12 million this year. Merge is also closing its Burlington, MA office. I checked out the salaries of the top five execs for Merge and was pleased their total pay (at least in 2006) averaged a reasonable $238K. 

E-mail Inga.

News 2/15/08

From B. A. Strothers: “Re: CHOP. CHOP’s CIO announced he is leaving effective April 1 (no joke). The Children’s Hospital of Philadelphia is conducting a national search for CIO and the newly created position of CTO. It’s a terrific opportunity for someone who can take charge and who wants to do something special at a very special institution.”

From Charles Chips: “Re: your PC. You said you Microsoft isn’t important on your PC. Linux bigot!” Nope, no Linux here. Like more people than you realize, I just run very few local apps any more for home use. I’d much rather run Web-based stuff that’s just as good, free or cheap, and that I can access from any PC. I used to hang around the software store and keep current with everything from office suites to photo editing utilities. That seems incredibly primitive now. I want to be on the grid, not bound to a specific PC (especially at upgrade or system crash time). Personal productivity apps installed on a local PC? So 1995. As long as I’ve got a broadband connection, I don’t need much of anything on the desktop. In fact, I could easily run Linux. The network is the computer, don’t you know.

Listening: PJ Harvey.

Microsoft announces that it’s now in the HIS business, renaming Azyxxi (thanks!) to Amalga and making up a new software category for it called Unified Intelligence Systems. Also in the new blended family is Microsoft Amalga HIS and RIS/PACS. I say “blended” because this is the Hospital 2000 software Microsoft bought from Global Care Solutions just three months ago, developed for Bumrungrad Hospital in Thailand.

Apparently Microsoft has studied our industry carefully because it followed all the longstanding rules with Amalga: (1) buy something that some hospital developed for its own use instead of doing your own R&D; (2) roll it out with much fanfare even though it’s got only a handful of live sites; (3) proclaim it to be integrated with the step-siblings; (4) start selling it quickly even though so little time has passed between its acquisition that there’s no way it’s really ready for production use; and (5) “upgrade” the hospital that developed it, at least on paper, so it can serve as a reference site so somebody might actually step forward to be its first paying customer. The whole enterprise had only 71 Thailand-based employees when Microsoft bought it, so one might logically question exactly how they’ll provide support and implementation services (unless one knows Microsoft, which nearly always pre-announces its intentions as a blocking or testing-the-waters move long before really having anything ready to go).

There’s an Amalga web page, by the way, but if you click the the Contact Us button and then choose your inquiry type, nothing happens if you use anything other than Internet Explorer.

The biggest beneficiary of Microsoft’s forced entry into the HIS applications business: Red Hat. You can bet that application vendors now competing with MSFT will be more than happy to steer prospects to non-Microsoft operating systems and databases.

Registration for the HIStalk reception Monday evening at HIMSS will be closing down no later than Wednesday 2/20 at noon or until we hit 400 RSVPs, whichever comes first (we’re at 250 or so now). If you’re waffling because you’re afraid it won’t be A-list, fear not: I counted 32 presidents or CEOs, 33 VPs, and a bunch of other Cs (CIO, CTO, CMIO, COO, etc.) on the list, along with investment people, press, academics, economists, and clinicians. And, not to mention our own Miss HIStalk and Inga and a celebrity speaker. We’ll be in the Florida III room on the convention level of the Peabody. Many thanks to Healthia Consulting for sponsoring this cool event. I remember when they first offered, we agreed we were worried about attendance, but for different reasons: I was picturing 10 lonely people staring at each other in an empty room, while Healthia envisioned hordes. Inga and I are really happy that everybody’s dropping by, especially since she’s obsessing about couture.

For HIMSS goodie-seekers: RSM McGladrey will have some “bonus” HIStalk badge ribbons of a different color/type than those I listed. Reason: the ones I mailed to them never made it, so they went out on their own (and at their own expense) to have new ones made in some different colors and choosing from a list of suggested pithy messages that I provided. All so you wouldn’t walk away crestfallen at their unintentionally bare cupbard. So, if you’re a collector, make sure to stop by Booth 4038 (along with those other companies who are graciously handing out ribbons: DB Technology #4442; IntraNexus #1851; Novo Innovations # 4128, and Stratus Technologies #569). And don’t forget Red Hat’s shoe-shining Inga and the possibility of some stuff at the Healthia booth (no guarantees since it may all be gone Monday night).

Inga mentions the Allscripts earnings announcement below, but in the mean time, investors are spooked by supposed issues getting the new version of TouchWorks installed. Sell volume on MDRX spiked hugely, dropping it from $15.39 to $11.27 and the market cap to $640 million (raising acquisition possibilities, some might speculate).

A province-wide Nova Scotia electronic health records system will use McKesson Horizon Physician Portal, Horizon Care Record, and Initiate Systems.

I don’t know about you, but I’ve received at least five e-mails from companies bragging that they’ll be exhibiting at “HIMMS”. Delete.

Wal-Mart’s co-branding deal with RediClinic for in-store clinics requires them to use PM/EMR software from eClinicalWorks.

Perot Systems is looking for HIT acquisitions in India.

Pick your villain: Prime Healthcare Services, owned by the oft-reviled Prem Reddy, sues Kaiser Permanente for “managing bills rather than managing care.” Reddy’s company, which takes over struggling hospitals, has been accused of cancelling insurance contracts, dropping needed services that don’t contribute enough profit, failing inspections, and turning away patients without insurance. Kaiser — well, you know already.

DiagnosisONE develops a disease surveillance system for use in Pakistan.

BCBS of Massachusetts will require hospitals to use CPOE to get maximum payments starting in 2012, claiming CPOE makes health care more affordable (case studies, please, where hospitals reduced prices after implementing?)

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Sponsor Updates and Housekeeping

I mentioned before the unSUMMIT on bedside barcoding, which has a very strong program. There’s an ad to your right for it. Considering our lukewarm progress on implementing it in hospitals industry-wide, it should be of widespread interest.

Reminders of stuff to your right: signup forms for electronic updates when I write something new and for the Brev+IT newsletter, Google Search to go back through the nearly five years and millions of words of HIStalk, and links to the jobs site, forums, etc.

Inga’s Update

Aetna announces it is the first healthcare organization to require its EDI vendors to be CORE compliant. CORE (the Committee on Operating Rules for Information Exchange) is working to develop more robust eligibility transaction rules. Call me a cynic, but I bet there is some hidden twist in here that will allow Aetna to delay paying claims.

Here is an announcement about a study funded by the CA HealthCare Foundation and conducted by CAQH as part of the CORE initiative. The study found that providers who routinely verify patient insurance eligibility and benefits through electronic or other means experience higher rates of paid accounts (I could have told them that).

The Misys Center for Community Health Leadership invites more healthcare organizations to apply for EHR software and service grants to build connected communities that facilitate clinical data exchange. The program has already awarded grants to New Haven, CT and Tampa, FL since 2006 and plans to ultimately distribute $10 million.

Microsoft Dynamics GP is selected by Holy Infant Hospital in SD to supply enterprise resource planning. Apparently Microsoft beat out Dairlyland, CPSI, and Quickbooks.

I am amazed by the number of (female) readers who have dropped me a note inquiring about the proper attire for the HIMSS cocktail party. Specifically, they want to know if Mr. H has provided a clothing allowance, if I plan to go cocktail attire or just the “convention” look, and especially what shoes I’m wearing. Well, you will all have to wait and see what fits into my suitcase because I haven’t quite figured out all the details. But feel free to continue asking me for fashion tips.

Allscripts announces its Q4 and year-end numbers, which were up from the previous year just about any way you look at it. Net income: up. Total revenue: up (including an 18% increase in software and related services.) Profits: up. However, the revenue numbers were below analyst expectations. Stock price: down 26%. Their 52-week high was exactly a year ago ($29/share) but looks like it will close around $11/share.

Allscripts EHR, by the way, will be installed at the 113-provider Mankato Clinic in Minnesota.

Eclipsys also announces Q4 numbers. Profits were up from $4.7M in 2006 to $24.2M, though excluding one-time costs and benefits, were $15.8M, up from $13.8M. Also excluding the one-timers, profit went from $30M in Q4 2006 to $43M in 2007. Sales grew almost 12%. The street was a bit kinder to them as the stock slip only about 6.5% (on a day the market lost about 1.5% as a whole.) Eclipsys also announces a new VP and GM for their Asia-Pacific operations. David J. van Eck will set up shop in Singapore. van Eck previously worked for Elekta AB and Oracle before that.

NextGen announces that Adventist Health System is expanded its commitment for EMR and PM software. Adventist plans to implement the products in all of its employed physician practices.

Quadramed makes its first sale of CPR since acquiring the product from Misys last year. Sibley Memorial Hospital will be upgrading from QuadraMed’s Affinity to QuadraMed CPR and plans to integrate it with with QuadraMed’s Patient Registration, Revenue Cycle Management and Electronic Document Management applications.

E-mail Inga.

News 2/13/08

From The PACS Designer: “Re: PACS Pioneer. TPD was saddened to hear that PACS pioneer Samuel Dwyer, PhD passed away recently. Sam’s early experimenting in creating a PACS and earning the title ‘Father of PACS’ eventually led to the creation of our DICOM standard as we know it today. He also influenced TPD’s early 1990s experimenting with how to come up with a better method of connecting radiology image systems to PACS and also improve teleradiology. TPD sends sincere condolences to the Dwyer family.”

Interested in my HIMSS party? I can’t divulge all the surprises, but we may have a very special guest speaker (a big name). You will also be impressed with two lovely ladies (Inga and Miss HIStalk) who will be chatting up my guests and posing for pictures with those interested. Food, drinks, announcement of the HISsies winners, a prize drawing, and an impressive list of attendees to chat with – it’s up to you, but I’d sign up now (I need to sign up myself, in fact, before Healthia tells me we’re maxed out on attendees). Also, the Red Hat people tell me that they’ll have their own Inga in their booth offering shoe shines (see Inga’s shoe fetish below), so I’m checking that out. Information on goodies and HIStalk-recommended booth stops here (warning: PDF) so you can take it along to the show floor.

A Wisconsin investment guy likes Epic as a company, but since it’s not publicly traded, he’s touting Cerner.

Sad story: a man undergoing bypass surgery has a monitor placed into his heart for monitoring. A known programming error in the monitor causes its catheter tip to heat up to 500 degrees, cooking his heart from the inside and requiring a transplant. The company that makes the monitor knew about the problem, but didn’t recall them. They admit the error. He’s suing. Nobody wins.

Steve Liebel MD, a Stanford oncologist and Varian Medical Systems board member, died last week in Hawaii of a heart attack.

An upcoming medical journal article looks at diabetes self-management software from Colorado software company PHCC.

An Iowa newspaper’s story on the local hospital’s Visicu implementation has a pretty cool picture of the system.

WebMD’s stock is struggling and its acquisition by major owner HLTH Corp. is in jeopardy.

Want to see what was going on with electronic medical records a few decades ago? See below.

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Sponsor Updates and Housekeeping

Welcome aboard to new HIStalk Gold sponsor Innovative Consulting Group of Evansville, IN. The company’s been around since 2002 and has an impressive client roster. Led by CEO Wayne Kinney, the company offers consulting for products from Siemens, McKesson, and Cerner; deployment and project management; integration; and management. Thanks to Innovative Consulting Group for support HIStalk and its readers – we appreciate it.

EnovateIT announces its SmartCart, the intelligent medication cart: compact, supporting multiple computer form factors, smart power management, and individually lockable patient med drawers. They sent over a picture and its very cool: blue and white, rounded edges, big wheels, and a stylish design. I’m definitely giving it a test drive at HIMSS since their stuff is satisfying to the touch.

Ensemble from InterSystems is named the #1 interface engine in the year-end KLAS report.

Inga’s Update

Red Hat announces that Beth Israel Deaconess Medical Center continues to move from HP-UX to Red Hat open source solutions, including Enterprise Linux, Global File System, Cluster Suite, and Network. Beth Israel is the home base for “he seems like a nice guy” John Halamka, who was just appointed to the board of analytical software provider SafeMed.

Healthcare Management Systems apparently beat out some of the bigger players and is selected by 50-bed Homer Memorial Hospital (LA) to provide its clinical and financial software.

Willis-Knight Health System claims it has saved $500K as a result of eliminating dictation and utilizing MEDHOST’s EDIS system across their four hospitals.

eClinicalWorks is selected to provide EMR/PM to more than 160 affiliated providers across 10 locations in San Mateo county in California. This initiative is grant funded, with support coming from sources that include Kaiser, Avon Foundation, Blue Shield, Safety Net Institute, San Mateo Medical Center Foundation, and the Sequoia Healthcare District Foundation.

When at HIMSS, please make time to visit my new BFF Suzanne with Active Data Services (booth 3787). She provided me with some super tips on Successful Show Shoe Management. For example: “A black bag is crucial to success. Contained in the black bag are two replacement pair of shoes. Lower heeled shoes to walk into the building, especially if you’re walking in with men. It’s hard to stay in front (you never want to follow) if you’re worried about a heel getting stuck in a pavement crack. Duck into the ladies room and upgrade to medium heels for walking around. When you are ready to party, putting the 5” heels on is a treat and instantly transforms you from “working girl” to “party girl”! There’s no sexy in comfortable shoes.” Suzanne says she will be handing out “I’m not Inga” pins (for both men and women!) You working girls may also want to ask her for the complete Successful Shoe Management Guide if you, too, are faced with the Great Shoe Dilemma.

Without healthcare, it’s likely that fax machines would have been put completely to pasture years ago. So here’s a product that should help save a few trees. Sfax by SecureCare Technologies is being marketed as a “truly paperless electronic fax management system for health care providers.” The product includes digital signature. While many/most EMRs offer similar functions, this looks like a good alternative for the 70%+ physicians that have yet to go paperless.

ProHEALTH Care of Associates of NY is investing $4.4 million for a bunch of GE Healthcare products, including EMR, EDI, RIS, Billing IT, and PET/CT imaging modality. ProHEALTH has nine sites and 88 physicians.

The AAFP publishes the results of a user satisfaction survey from 422 family physicians. Similar to a study they did two years ago, the physicians were self-selected and the authors note that “it is probably most useful to consider this report as the kind of information you might get if you could ask a few hundred colleagues how they like their EHR systems.” That being said, the colleagues seemed to like e-MDs, Practice Partners, Amazing Charts, and Praxis best. The FPs were least high on Allscripts Touchworks, Misys, and Cerner PowerChart.

E-mail Inga.

Monday Morning Update 2/11/08

From Bill Kilgore: “Re: Cerner. Cerner opens an office in Dublin is kind of ironic since the Irish don’t have the money or the emerging market as the Middle East. Maybe they should consider Doha since there is fresher growth market in new hospital construction.”

From Gob Bluth: “Re: QuadraMed. QuadraMed’s recent layoff and offshore decision is for the entire Quantim HIM Suite. Management told the remaining Quantim employees that ‘some of you will get the opportunity to go to India to train the new team members.’ Sounds a lot like POWs being forced to dig their own graves before being summarily executed.”

From HITPundit: “You are starting to cross the line where you exalt your sponsors every chance you get. You have no practical or actual knowledge of the sponsors other than what they tell you. Are you a bought blogger?” Well, I noticed your IP address is of a vendor and not a charity, so you’re not working for free either, right? I believe that close reading will prove that “exalting” just means mentioning them along with anything factual that I happen to know -that they’re nice people or that they’ve announced something. Nothing more. I don’t think you’ll find a case where I recommended them or their products specifically unless I actually do have first-hand experience with them as a customer, which I do in some cases. The rules I’ve followed for years are here. Sponsors get only one thing that non-sponsors don’t: I’ll sometimes mention their announcements. The agreement they sign even says so, that they’re fair game otherwise. I’ll compromise with you since I’ve been thinking about doing this anyway: I’ll put sponsor stuff in its own subsection of HIStalk. Worth a read, but you can skip it if you like (you could do that now, of course, but I’ll even mark it clearly for you). Fair enough?

From Dr. Lisa Cutty: “Re. Wikipedia. Hi, since the English Wikipedia page about HIS is sadly nonexistent, I would like to suggest to create a competition about who writes the best definition. The winner text will be published in Wikipedia. Come on folks, let’s define us…” Say, you’re treading on government contractor work there, young sportsman. OK, I suppose we can accept volunteers. Anyone?

From Jerry Riggs: “Re: Halamka. His reputation was made before the BIDMC fiasco (give Cisco some blame for that, too) and his response just burnished it. Since then, HITSP, NEHEN, Harvard Med. He does a lot. It helps that he doesn’t need to sleep like the rest of us mortals. I’ve known John for a long time. Sure, he’s got a firm grip on marketing and spin, but what top-notch senior executive doesn’t? The difference with John is that he backs it up with dedication to his work, an impressively deep fund of knowledge, plain well-spoken openness, and as you noted, exemplary graciousness. I’ve seen him post-talks, where he politely takes time to speak to just about everyone who comes up to him. Add another category, above ‘seems like a good guy.’ John is one.” I dare you to test him at HIMSS. Walk up at the IHE booth or wherever you see him and strike up an excruciatingly dull conversation and do most of the talking yourself, spouting the most asinine nonsense you can think of. I bet he’ll listen attentively and make you feel like his equal and compliment you on your perspective. That’s my experience, anyway, from watching him in action. I’m jealous of him too, but willing to give credit where it’s due. Maybe I’ll do the black turtleneck under black jacket thing at HIMSS as my homage.

From Festus Peashooter: “Re: QuadraMed. That’s right, they were the first to see the value of care based revenue cycle … but alas, all we hear about is that they are cutting back on Misys /CPR staff. But this always happens in an acquisition like this. The staff that remain need to ask themselves: would they be better off with a ‘dead’ product that would be limping along under Misys, left eventually to die on the vine, or are they in a better place now that someone has taken a real interest in keeping it going, even investing money trying to improve it? If you are a QuadraMed CPR employee today … which do you want?”

From Soul Survivor: “Re: QuadraMed. Why the surprise about layoffs from QuadraMed? Keith Hagen is from the Tom Skelton/Misys school of leadership: focus on management weaknesses and blame the staff. ABC – anyone but the CEO.”

From Murphy Blue: “Re: care-based revenue. I don’t know whether this will go anywhere, but it’s the first time I’ve seen prominent press about an insurer’s proposal to help with health care costs (while believing they can also help themselves…novel idea.)” Link.

SIS, which has been pretty quiet lately, brings on Chris Giglio as SVP of customer operations and Eric Nilsson as CTO, coming from McKesson and Infor, respectively.

McKesson will move 500 people from its Louisville and Broomfield (CO) offices to Westminster.

Jim Burton, formerly of FCG, takes a VP job with Emerging Health Information Technology.

Richard Granger of NHS is officially finished there, to be replaced with two positions: a CIO and a project executive for Connecting for Health.

Revolution Health claims its sites have passed WebMD as the #1 health property on the Web, but it doesn’t sound all that convincing that it means much.

E-mail me.

Inga’s Update

Thank you Imelda M. for reminding me that in addition to finding the perfect party outfit, there is the shoe dilemma as well. Do you wear the sensible shoes for walking around the convention hall all day or do you become a fashion slave and get the 5” spikes? You guys just don’t understand how hard it is ensure we are objects of your fantasies.

A dress makes no sense unless it inspires men to want to take it off you. ~Françoise Sagan

I clearly opened up a can of worms about the LA hospital issues. From Dr. Webber: “When MLK-Harbor was forced to close, 75% of their ED patients starting coming to Harbor-UCLA (where I work). We are in the same “system” but we don’t get their medical records, so often we have no idea what their primary care looks like. We have asked for additional resources from corporate to handle the influx of patients, but have received few useful additional resources. In fact, our CEO had to take a 10% budget cut on top of more patients from King. That’s insult upon injury. CMS was explicit in their exit interview. They stated (!) they knew the problem was not a fault of the hospital, as we can’t stop people from coming in to the ED, and we have only so many staffed beds and ICU/PCU beds to hold them. We have minutes from our Governing Body meetings where we are quite literally yelling for help, but have been ignored. MLK-Harbor. Olive View. Now Harbor-UCLA. CMS is sending a message to the LA County Board of Supervisors to get out of the healthcare business. Did you know that the last time JCAHO did an unannounced there were 10 surveyors? How many hospitals get that type of scrutiny?”

And from Dr. Shepherd: “The next time you’re in LA, I doubt if you become ill you’ll end up at a county hospital. They are the symptom, not the disease. The disease is massive overcrowding and it isn’t just in county hospitals. Coupled with a 20% nursing shortage in the state and mandated nursing ratios, no money, no staff and no interest from a board of supervisors that only respond to crises, the safety net for LA is a warning for the rest of the nation. Hey, board, you’ve got a crisis to deal with now! It is a mess. As a practicing ED MD for over 30 years, LA is NOT unique. As a patient, I’m scared. As a doctor, I’m fatalistically depressed. As a consumer, I’m mad as hell and I don’t want to take it anymore. I think everyone is looking for a solution, but not willing to be so drastic as to throw out the entire system and start over. Think about 20% of our healthcare dollars going to big insurance management and what could be done with it. We must also re-introduce personal responsibility and buy-in. ‘Americans are willing to consume all the healthcare someone else is willing to pay for.”’

The NHS says there is no cause for alarm over the misplacement of 6,000 smartcards for accessing patient records. Why do I feel good over the news that the US is not the only country with ridiculous security lapses?

St. Mary’s Medical Center in Huntington, WV renews its agreement with MED3000 to provide revenue cycle management, PM services, consulting, and coding services for their physicians.

Encentuate is selected by the 80-provider group Northwestern Memorial Physicians Group in Chicago to provide single sign-on and authentication services.

E-mail Inga.

Sponsor Updates and Housekeeping

Jobs: Network Analyst, Systems Support Applications Analyst, Director of IS.

Reminder: sign up to your right for instant updates when I write something new here or to receive the Brev+IT weekly newsletter in your inbox.

New postings at HIStech Report: EnovateIT mobile devices, Design Clinicals medication reconciliation, McKesson’s Horizon Expert Visibility, Sage Software, and Healthia Consulting. A good read before HIMSS.

Jerome H. Carter, MD, FACP Replies to Bignurse

I really enjoy your blog. I saw the post by BigNurse and thought I would respond since implementation problems are of particular interest to me.

The meaning of “implementation” is very important and is rarely formally defined for EHR projects. Heeks and Mundy published a white paper in the UK that I think addresses this matter quite well. They define types of implementation failures and by extension, successes. They define the following types of failures:

• The total failure of a system never implemented or in which a new system is implemented but immediately abandoned. A much-reported example is that of the London Ambulance Service’s new computerised despatching system. This suffered a catastrophic failure within hours of implementation, leaving paramedics unable to attend health care emergency victims in a timely manner (Health Committee, 1995).
• The partial failure of an initiative in which major goals are unattained or in which there are significant undesirable outcomes. Anderson (1997:87), for instance, cites the case of “An information system installed at the University of Virginia MedicalCenter [which] was implemented three years behind schedule at a cost that was three times the original estimate.”
• The sustainability failure of an initiative that succeeds initially but then fails after a year or so. Some of the case mix systems installed under the UK National Health Service’s Resource Management Initiative fall into this category. They were made fully operational and achieved some partial use but with limited enthusiasm from staff for using them. Ultimately, they were just switched off (HSMU, 1996).
• The replication failure of an initiative that succeeds in its pilot location but cannot be repeated elsewhere. Although presenters may not realise it at the time, every health informatics conference is jam-packed with replication failures about to happen; with wonderful innovations that are tested once and then disappear without trace. As an audience, we hear all about the pilot, but we tend not to hear about the replication failure.

In my experience partial failures are quite common with EHRs. Very common examples are:

• Key features are never utilized or under utilized (quality and preventive care features)
• Not all providers in the practice use the EHR for all patient documentation
• Features are never implemented or do not work (lab interfaces being the best example).

Partial implementations are costly in a number of ways because paper/electronic hybrids are more difficult to secure, search, analyze and maintain. Also, ROI is not maximized until the implementation is complete. From this perspective “go-live” is simply the start of an implementation.

Unfortunately, I have seen my share of “declared” implementations as well. These are situations in which an organization flails at an implementation until everyone is tired of it (or someone has been fired). They then “declare” that whatever state of implementation they have achieved is what was intended. Alternatively they look for the most palatable excuse for their lack of success (the doctors were uncooperative, the software did not work as expected, the CIO was not the “right person” for the task, our organization is unique.)

Practically, I believe that organizations would do well to use at least a two-tiered approach to defining a successful implementation. Level One success would occur when all patient data that originate at the practice site are entered directly into the system. Level Two would occur when key features/functions (e.g. quality/safety) are used by ALL providers as part of routine care.

A Level Three might then be defined as all patient data, whether external or internally generated, are in the system. However, this requires interoperability capability that is beyond organizational control. I would guesstimate that maybe only 10-15% of organizations make it to Level Two. IMHO.

Jerome Carter is a principal with Neck, Time, and Money Informatics, Inc., an EHR consulting firm based in Atlanta.

News 2/8/08

From Art Vandelay: “Re: Wal-Mart. Wal-Mart has now announced it will expand its partnerships with local non-profit care providers for some retail clinics. This is a potential boon for those who can win the business in the Wal-Mart, which provides a direct entry point for directing referrals to their diagnostic centers. As Wal-Mart launches the pilot to its Dossia Personal Health Record (PHR) based on Indivo, it will be interesting to see if this becomes an option for tracking of personal health information generated or reviewed at the retail clinic. I fully expect Microsoft to make a run at Wal-Mart with HealthVault if Dossia falters for technical reasons.”

From Kelli Bywater: “Re: Medseek. I was one of the 22% laid off in December. I hear it’s not going well there. The company supposedly is sub-leasing half its new space in Birmingham and in Solvang, CA. Some of us who were laid off are getting calls at home from AMEX regarding overdue balances on the company’s credit card. It is really too bad, as all four portals are good, just bad executive management and a VP of finance who can’t seem to get the numbers straight.” I figured it was only fair to give Medseek President Peter Kuhn a chance to respond since there are always two sides to a story, so I e-mailed him. He’s an avid HIStalk reader, he says, and says the company is investing in existing and new technologies, product management, client support, and the usual business needs. He’s still expecting double-digit revenue growth and hiring to support it, with cash flow and profits supporting all funding requirements. He says, “We believe in controlling our own destiny by operating the business with sound fundamentals and good solutions, and our December decisions were made to do just that. For what it’s worth we ended 2007 with an employee headcount commensurate with our 2007 revenues. We believe this is good business practice and the right way to operate a business to best support our clients and employees.” He didn’t exactly answer your specific questions, but presidents are big-picture people, after all. So, there are your two sides, for which I appreciate the contributions of both. 

From Bee Bop: “Re: Parkland. Is Parkland really dumping Perot for another outsourcing firm after the Epic failure last year?” Beats me, but I know some folks from there read here, so perhap an update will ensue.

From Bobby Orr: “Re: Cerner layoffs. Your 401K match was mandated to be in Cerner stock. You were not given options on that front, so you were forced to tie up your 401K with your company (at least it didn’t collapse like Enron). Pretty lame that Neal missed an earnings call.”

From Man in BlackBerry: “Re: Halamka. Nice guy. You talk about marketing and spin – Hillary or McCain should hire him. The guy that built his entire reputation off a major, debilitating crash that left Beth Israel and Harvard’s whole IT infrastructure down for two weeks. His mea culpa turned into a major InfoWorld cover story and he was the hero. Did he go to the Judy Faulkner school of reverse marketing?” I will say that his contributions otherwise have been exemplary (he was fairly new on the job when BIDMC went down hard). He’s accessible to the press, to be sure, but he also spends time and energy working with HITSP and other groups. I used to rip him for the downtime, his Verichip, etc. but his boss lauds his work highly and publicly (not all that common for a CIO) and I’ve seen him be quite gracious in talking to everyone interested in bending his ear about IHE or standards. I’m elevating him to the “seems like a good guy” camp, which is about as high as the cynical Mr. HIStalk’s rating system goes except for those who’ve made sainthood.

From Billy Bob Bob Carter: “Re: QuadraMed. I find it very funny that someone believes that it is all the employees’ fault when a company such as Misys or QuadraMed does not make money. Management is in control of the product, not analysts, programmers, QA, or tech pubs. QuadraMed RIFfed its people to make money by outsourcing its departments to India. No, people, CPR has gone down that route before and failed. The knowledge and skill set is with the people within the company itself, not people that work for $98 a month and cannot understand the industry, product or English. QuadraMed has taken any chance of being successful by kicking their employees and walking away. May the customers revolt and kick back.” Here’s the press release on the layoffs, or if you prefer, “In an effort to provide high quality, feature rich products to our clients in the least amount of time QuadraMed has re-allocated financial and personnel resources to expand our product development capacity.” QuadraMed axed 68 employees from QA, tech pub, and development, sending their work offshore to Tata. The stock is down a little.

The initial response to HIStalk’s reception at HIMSS on Monday, 2/25 is strong. I peeked at the signup list and I’m impressed: informatics people, clinicians, CIOs, VPs, media people, investment folks, and 10 CEOs (!) have RSVP’ed in just the first few days. I’m immensely flattered and I’m honored that you’ve chosen to spend a little time with the HIStalk crowd and the sure to be dolled up Inga (incognito, but lookin’ fine, I predict). If you’re reading this, you are invited – please RSVP here so we can haul in enough liquor and fancy food to keep you happy. Thanks to Healthia Consulting for sponsoring it. One day, I’ll sit back and marvel at the fact that a fine company in which I know no one volunteered to underwrite a lavish shindig for an anonymous, abrasive blogger and his readers, which is just about the coolest thing I’ve ever heard of. If you’ve never been to the Peabody Orlando, it’s really nice and is an easy stroll from the convention center (right on the property, pretty much).

A few more HIMSS housekeeping items. The HISsies awards will be announced at the reception, so bring your pies. I’ll have a couple of giveaway items at the reception that won’t be available elsewhere unless there are leftovers, but the others are listed on this page that I just made. It includes HIStalk’s sponsors and those vendors I’ve featured (or will be featuring shortly) in HIStech Report. Helping host the event along with the good folks from Healthia is Gwen Darling, also representing HealthcareITJobs.com. Gwen had a good door prize idea: we’ll give a lucky winner a full-scale interview in HIStalk (including your picture) plus a free big ad on HealthcareITJobs for your employer for any month in 2008. I’ts not a Hummer like those big-money guys hand out, but it’s still pretty cool.

Scott Shreeve is cautiously optimistic about the involvement of Misys in open source initiatives. I’m openly caustic about it, but it’s definitely his area of expertise and not mine. And speaking of fun bloggers, Marty Jensen of Healthcare IT Transition Group claims that Medicare’s National Provider Identifier runs afoul of HIPAA. I don’t always understand the nuances of billing, but I always enjoy reading his stuff.

Picis sent over a schedule of customer presentations at HIMSS. That’s interesting because Osler CIO Judy Middleton is on it, in the running as you know for the HISsies Best Provider CIO. Also on their agenda Lynn Vogel from MD Anderson, who I’ve swapped e-mails with a few times.

A survey by investment guys Leerink Swann suggests that big clinical vendors like Cerner, Eclipsys, and McKesson will benefit from the desire of hospitals to form a care-based revenue cycle management strategy, choosing integrated clinical and financial systems. I don’t understand how that helps Eclipsys, but I am surprised that QuadraMed wasn’t mentioned since they figured that out early and were the first to use the term “care-based revenue cycle,” at least as far as I know.

Scott Anderson of NextGen reseller KIG Healthcare Solutions sent over a press release describing a demonstration project his company is doing with two Illinois Critical Access Hospital Network (ICAHN) hospitals, partially funded by HHS. Planned: PACS, EMR, and NextGen’s Community Health Solution. ICAHN paid for the portal, while the hospitals will buy EMR licenses and training for their docs. He seemed nice enough, so I figured I’d give him a little plug.

IBM and Cerner will collaborate on putting BMJ Group’s order sets into Millennium. And speaking of Cerner, ComputerWeekly suggests that NHS is whitewashing problems with Millennium in England. From the Audit Commission, “Significant problems with the implementation of the Cerner system have resulted in poor data quality and a lack of robust information …” From NHS Cancer Services, “Current opinion regarding Cerner is that it will not support cancer data collection and reporting requirements for at least 5 years, possibly nearer 10 years.” From an NHS region, “Deployment problems at those sites that have implemented the [Cerner] system has created concern amongst those organisations in the deployment pipeline.” To be fair, big implementations are never pothole-free, so you never know if this is just the usual bellyaching about change or a hint of real problems.

Investment guy Jim Cramer isn’t a fan of CERN: “I am proud that I never went back, because it just keeps going down. I do not like the medical records business anymore.” The stock is actually up a little today, but still not far above its 52-week low.

VMware runs a press release about some of its big hospital customers that use its virtual desktop solutions.

Allscripts will distribute medical software from TeamPraxis, a Honolulu vendor that will take in up to $18 million from the deal.

E-mail me.

Inga’s Update

Design Clinicals announces Mary VanHoomissen as their new VP of Implementation. I actually had a chance to chat with Mary for an upcoming HIStechReport interview. I was impressed by her credentials (MBA, BSN, and RN) but she earned my respect for her obvious passionate commitment to the patient and safety in particular. Design Clinicals will its their own booth at HIMSS for the first time, by the way, so stop by and say hello to Mary.

Speaking of the HIMSS soiree, I am feeling the need to shop for that perfect outfit. Even if no one knows I’m Inga, a girl still needs to feel alluring (you ladies know what I’m talking about). So here’s my subtle hint that Mr. H might need to slip an extra Ben Franklin into my paycheck (the less material, the more expensive the outfit).

Tidewater Physicians Multispecialty Group in Virginia purchases NextGen PM and EMR for their 66 physicians across 23 locations.

Next time I am in LA, I’m just not going to get sick. In August, the county closed MLK-Harbor Hospital after it lost federal funding over lapses in care. Now Harbor-UCLA Medical Center faces a citation for an overcrowding crisis that is putting patients in jeopardy. And, the feds may also pull funding from Olive View-UCLA Medical Center because of deficiencies in care. Is there anyone in charge of fixing things?

Cerner opens an office in Dublin to serve its growing Irish presence.

Robert Wood Johnson University Hospital in NJ will implement Eclipsys Sunrise Clinical Manager at its 584-bed facility. Also, the Robert Wood Johnson Foundation has joined with the W.W. Kellogg foundation to donate almost $1MM for EMR and billing for school-based health centers in Greater New Orleans.

Healthport is now certified to connect to the SureScripts Pharmacy Health Information Exchange.

I found this press release a bit odd. Practice Fusion announces it has signed up over 100 practitioners across 70 practices since the end of October. All good. But then the CEO Ryan Howard supplies this comment: “Physicians are realizing they no longer have to be gouged by existing enterprise vendors, such as Misys.” Why pick on just Misys, and not Allscripts, NextGen, GE, etc.? I could understand if it were said in some off-the-cuff remark, but in a formal press release? Makes you wonder if he has some sort of axe to grind.

Numerous companies are announcing various 2007 performance results. Here are a few highlights:

• PatientKeeper announces a dramatic increase in its client base, including agreements with five major health systems. Additionally, they added six new applications and now serve 14,000 physicians.
• For the three-month period ending December 31st, the Sage Group says its performance was in line with expectations. The exception was their North American healthcare market, though they expect improved revenue growth in the medium term. Also, they’re still searching for a permanent North American CEO.
• Sentillion announces strong year-end results, including ten new customers in Q4. Other milestones: their ranking as the #1 SSO vendor by KLAS and the launch of a new channel reseller program.
• Greenway Medical Technologies announces a 52% year-on-year growth in quarterly bookings for its Q2 period ending December 31st. They also earned a #1 KLAS ranking for the 6-25 physician ambulatory EMR segment.
• NextGen’s parent company QSI posts numbers for their third quarter ending December 31st. The NextGen segment earned $44M in revenue, up 29% over the same period last year. Operating income was almost $18M, up 33% year-on-year.

E-mail Inga.

News 2/6/08

From The PACS Designer: “Re: Sun xVM. t looks now like virtualization may be the hot topic of 2008. In addition to Oracle that was mentioned in TPD’s last post, Sun Microsystems also is promoting Sun xVM as its virtualization solution for the enterprise. Jonathan Schwartz, Sun’s CEO and president, states, ‘xVM is our free, open source virtualization platform, which we unveiled at Oracle Open World, alongside our management platform, xVM Ops Center. xVM will virtualize Windows, Linux or Solaris, on either Dell, HP, IBM or Sun hardware.'” Link 1, Link 2.

From Sleepless: “Re: Cerner stock. Don’t forget that ‘realigned’ former associates also take it in the shorts x4 — lose your job, lose your 401K match, lose value in your 401K (it’s Cerner stock), and get to watch your stock purchase plan lose value since you’re handcuffed from selling your stock for a year.” Big mistake putting the bulk of your investment in one company’s stock, at least if you have a choice. Speaking of Cerner, here’s the transcript of last week’s earnings call. On Medicare cuts: “So we think given that there’s always been haves and have nots in healthcare. We tend to be fortunate enough to sell to the haves, and if this would become enacted, it clearly will hurt the have nots, which, fortunately for us, are not really our target market.” Now that’s a stirring and beautiful statement, to a beancounter anyway.

From Mel Cucamonga: “Re: QuadraMed. Huge axe is swinging right now at the San Bernardino (CPR) location of QuadraMed. So very sad. It is characterized as ‘almost everybody but Programming’ … and programming was already terribly, terribly thin.” Other sources report that QA, internal office support, data warehouse, and all the technical writers were hit, including some 20+ year employees.

From Jyoti Diot: “Re: QuadraMed. The RIF makes sense. New year, budget approved last week, and execution of that plan begins this week.The development talent in-house has not been all that impressive over the last few years. Why not partner with some development team that does it better than they can? The other side of it is if you’re proven not to be a marketing/sales organization, and now you’re saying your not a software development company … what exactly are you?”

From Salad Days: “Re: John Halamka. I was in an elevator that runs news and trivia on a screen (because God knows I need to be entertained and targeted for the 30 seconds I’m in there). BlackBerry has been running ads there that feature an exec with the tag line, ‘Just ask someone why they love their BlackBerry.’ Imagine my surprise when the Man in Black (Halamka, not Cash) turned up in one, listed as the CIO of Harvard Medical School. What next? Will he be on an LCD screen installed above a urinal?”

Sonomaca weighs in on Neal Patterson’s absence from the Cerner earnings call last week: “Always embarrassing when your leader refuses to show up for a bad call. That’s sort of like the CO hiding in the rear as the bloody battle commences. Oh, and the ‘traveling abroad’ thing: it’s pretty lame that a tech company can’t figure out how to dial-in its CEO from the UK or Dubai or wherever. I feel for the guys taking bullets on the call.”

I believe I’m safe in saying that the economy (and those running it) will continue to cause layoffs, both vendor and provider. It’s happening all over. It’s tough to take, but I know of few people who didn’t end up better off after being let go (not necessarily true of their former employers). Hang in there. It’s only fair that companies can quit you just like you can quit them (no Brokeback Mountain reference intended) so walk away strong and prove them wrong.

Care to join your fellow HIStalk readers at HIMSS? The HIStalk reception is at The Peabody Orlando, right next to the convention center, on Monday 2/25 from 6 to 8 in the evening. Gracious sponsor Healthia Consulting has posted the sign-up page, which I’d ask you to fill out to guarantee a spot. All the A-listers will be there, of course, hopefully some CEOs, CIOs, informatics people, doctors, celebrities, nurse, Inga, and anyone cool enough to read here. Note that you can put your “HIStalk Pseudonym” on the form and the Healthia folks will use that on your badge, just in case you want to keep it on the down-low like me (I’m such a slang-slinging hipster). Should be fun. I may get a couple of beers in me and start yelling to the world that I’m Mr. HIStalk in some sort of long-repressed purge.

Speaking of Healthia, I just posted an interview with CEO Glenn Galloway over on HIStech Report. If you’re a consultant or have yearnings to be, I would definitely check them out.

Here’s a nod to new HIStalk Gold Sponsor Sonitor Technologies, whose ad is to your left. They make ultrasound indoor positioning systems that can track people and equipment down to the room level. Their site has a creepy but effective “bat” analogy (I bring that up because I was watching one of my favorite movies, The Great Outdoors, last night and the key scene, such as it is, involves bat-chasing, or “radar-guided vermin” as Dan Aykroyd’s character Roman Craig says while cowering). So, back to Sonitor: my well-placed spies (not in Sonitor) tell me that the company’s locating technologies are the key component of the very cool UPMC Smart Bed project. Caregivers wear a tiny Sonitor ultrasound device and when they enter the patient’s room, their name displays on the wall-mounted monitor and clinical data pops up for them based on their role, all hands-free. The deal with ultrasound vs. RFID is that sound waves can fix locations more accurately because ultrasound has no reflectivity and doesn’t penetrate walls, which means the system knows what room the tag is in, not just what general area. OK, I’ll shut up now and welcome and thank Sonitor Technologies as an HIStalk sponsor. I appreciate every one of the companies that support my work. Thank you.

Face recognition in healthcare? Interesting.

I read an article today suggesting that Windows Vista is so bad that Microsoft is already leaking information about its replacement, Windows 7, finally realizing that Vista’s only customers are choiceless Best Buy laptop buyers, not corporate IT shops. I begrudingly bought a laptop with it and was ready to chuck it right in the trash – it wouldn’t recognize any USB devices, constantly prompting for a driver (uh, isn’t that the whole point of plug-and-play?) Finally, the same error gave me a hotfix alert this week and it’s now working. Still, if I could easily go back to XP, I would. Here’s the article’s parting shot: “For now, whether Microsoft likes it or not, XP, and not Vista, is the Windows those businesses will continue to use. And the companies that want to move on to a truly better operating system? They’ll be moving to Linux or Mac OS.”

A former US attorney from California is back in the same job after many years. In between, he defended HBOC’s Al Bergonzi, who sang like a castrato to avoid hard time. If you like to be a member of a very exclusive group, announce that you think Charlie McCall and his henchmen were innocent.

MEDSEEK claims massive demand drove its most successful year. Guess it wasn’t the reportedly equally massive pre-Chrismas layoffs. I suspect you’ll be hearing more about them when the HISsies winners are announced. but you never know.

Children’s Boston picks Perceptive Software’s ImageNow for document imaging.

Odd: bedside barcoding vendor IntelliDOT didn’t get enough responses to be included in KLAS’s barcoding report. The company laments that fact in a press release, but cites all the numbers that are statistically insignificant anyway. Surely KLAS can’t be happy with this quote: “Indeed, had IntelliDOT remained in the rankings in this year’s report, the company would have again earned the highest overall user satisfaction scores of all vendors listed, although the data would still reflect fewer than 15 unique organizations required by KLAS for full listing.” Isn’t the whole point of labeling results as statistically insignificant to get people to ignore them since they don’t mean anything? I’m pretty sure it isn’t intended to encourage press releases.

Speaking of press releases, MedeFile issues one that contains no news whatsoever except that it “today formally applauded U.S. Presidential hopefuls.” The company was excited, as you might expect, at the prospect that all the candidates pay occasional token lip service about EMRs (MedeFile’s in the PHR biz). How, exactly, does one “formally” applaud? Had we been witness to today’s applauding at the appointed hour, what would we have seen, exactly — tuxedo-wearing clappers, maybe screaming “Free Bird” at Hillary’s picture?

New FCG parent CSC reports preliminary Q3 results: revenue up 14.3%, EPS $1.05 vs. $0.85.

Physician systems vendor Unified Medical Informatics of Wilkes-Barre, PA shuts down after laying everyone off and saying it will not be able to repay a county loan.

TriZetto Group’s Q4 numbers: revenue up 32%, EPS $0.16 vs. $0.16. Shares were up nearly 5% today.

Maricopa Integrated Health System (AZ), stung by a bad Joint Commission visit that led to a preliminary denial of accreditation, refuses to release the report to the press, claiming it’s not a public record because it is in draft form and is protected under peer review laws. A hospital spokesperson already got caught lying to a newspaper in claiming that they had received no report.

Case management software vendor CH Mack gets a $4.2 million investment to take its Q Continuum software national.

President Bush flashes a tablet PC on which his massive $3.1 trillion spending plan lives, to be distributed to Congress over the Internet. So much for the huge surplus that was on track until he took office, now setting record deficits while cutting social services like Medicare. Here’s a good line: “Democrats joked that Bush cut back on the printed copies because he ran out of red ink.”

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Inga’s Update

The Brooklyn HIE will use Initiate’s Patient software for their master person indexing application. I also noticed that Initiate just hired a new CFO. Dan Kossmann has a strong background in public offerings and mergers and acquisitions, so it makes you wonder what Initiate is planning.

I am not a runner and fortunately don’t qualify for this offer but I thought it was cool. Medical device company Medtronics is offering up to 25 all expense paid trips for two to participate in the Twin Cities Marathon. Runners can come from anywhere around the world, but you personally have to have be benefitting from some sort of medical technology (insulin pump, heart value, etc.) to qualify.

Allscripts teams up with TeamPraxis to provide its new Clinical Quality Solution (CQS) for automating quality reporting requirements. The CQS also includes a physician dashboard feature.

David Corbett is named SAP’s new VP for US healthcare. Corbett previously spent time with Lawson Software and SMS/Siemens before that.

I will be glued to the TV tonight watching the Super Tuesday results. A must-read for the winners will be the newly released HIMSS Technology Briefing Book (warning: PDF) to understand the top HIT policy recommendations. The recommendations are listed on a single page, but the overachieving candidate can read through the other 130 pages for some HIT 101 and learn more about other HIMSS initiatives.

Compuware’s Covinist subsidiary claims it is now the world’s largest on-demand collaboration platform for lab and Rx sharing, following its acquisition of Hilgraeve that was announced today.

Mediware’s stock plunges 23% after reporting a second-quarter loss compared with earnings over the same period last year and lower revenue compared with last year. Q2 loss was $337K ($0.04 per share) compared to $905K gain ($0.11 per share) last year. Revenue for the quarter was down 23% ($8.7 million vs. $11.3.) Ouch. Mediware cites pipeline gaps and contracting delays.

A $6 million EMR install is going into Leon Medical, a large Medicare provider in south Florida. The costs include about $3 million for NextGen’s EMR and services and another $3 million for equipment. And I hear that NextGen is about to announce another big win.

E-mail Inga.

Monday Morning Update 2/4/08

Your gas dollars at work: check out Sidra Medical and Research Center, being built in Doha, Qatar as part of Education City and in affiliation with Cornell. Operational funding is $9 billion, an insider tells me, which doesn’t even include the construction cost of $2 billion for the 380-bed facility (but check out amazing virtual tour of how it will look on the site). It’s being overseen personally by Her Highness Sheikha Mozah bint Nasser Al Missned, Chair of Qatar Foundation and Consort to the Emir. Core sciences listed: functional and anatomic imaging; stem cell; genetic, genomic, and proteomic; bioinformatics; and tissue management systems. Opening 2011. All digital. They’re hiring if you don’t mind the heat (over 105 degrees in the summer).

Jobs: Director of IS in Arizona, Senior Software Engineer in WA, Business Analyst in CO.

Listening: Marmalade, psychedelic pop, circa 1967. You would know “Reflections of My Life” if you heard it.

New healthcare CIO blog: Dale Sanders of Northwestern Medical Faculty Foundation.

Health First (FL) chooses Eclipse Project Portfolio Management for starting up its project management office.

Cerner shares drop 10.3% Friday and hit a 52-week low after the company fails to meet Wall Street’s revenue expectations and forecasts weaker Q1 sales, even though earnings beat estimates by the usual penny. Good lesson: publicly traded companies waste time and energy managing the share price instead of the business.

McKesson shares also drop on Q3 numbers announced Thursday: revenue up 15%, EPS $0.68 vs. $0.80, with $0.11 due to one-time charges for “restructuring, severance, and pending legal settlements.” So, those of you they canned have extracted at least a little revenge, that is unless you’re also a stockholder, in which case your involuntary march-out has now doubly screwed you. At least it hurts John Hammergren more than you, unless you hold more than his $14 million worth.

I’m running a comment left by Deborah Peel below, so here’s a related reminder: she’ll speak at HIMSS on Tuesday, 2/26 at 2:15 on “The Privacy Imperative in Healthcare IT”. I’ve already marked that session as a must-see on by HIMSS dance card. I’ll admit once again that I assumed she was a paranoid flake until we swapped a couple of e-mails in which she was thoughtful, rational, and entirely logical. She’s not against healthcare IT, just the lack of attention to privacy it involves. I’m pretty sure if privacy were improved, she would happily disappear from the limelight.

Speaking of patient privacy: how many days will it take before somebody sells the current inpatient medical records of Britney Spears to trash magazines for the gratification of their undermotivated readers? It’s already been announced that she’s under psychiatric care, is on Adderall, and was taking up to 10 laxatives a day. How much more detailed can it get?

Wyse Technology announces its TCX Virtualizer, which allows virtualized desktop users to connect to USB devices.

University of Michigan is on a $1.75 billion construction spree, including a new $51 million data center for the health system.

Sparrow Health System (MI) rolls out the T SystemEV EDIS running on the Motion Computing C5 tablet PC.

I noticed that Misys is an anchor exhibitor at HIMSS. Since they sold off all their inpatient products, that’s a lot of space to show physician office stuff. If you need a place to take a break, I bet they’ll fill lots of the excess space with comfy chairs.

CPSI’s Q4 numbers: revenue down 6.9%, EPS $0.36 vs. $0.39. The company also declares a dividend, which always sends the message that investors are better off with cash for investing elsewhere instead of having the company do something useful with it, like improve its performance.

Medical Associates of Erie (PA) chooses MedAppz for community-based EHRs. I checked out the website to see who runs the company, but apparently it’s a guarded secret, with the “Who We Are” section failing to answer that question, containing only marketing-speak, trite slogans, and stock photos without listing who’s in charge, making it feel distant and impersonal. There’s no charge for that marketing consultation.

The Scottish Centre for Telehealth will pilot Cisco’s HealthPresence, a telemedicine platform built around Cisco’s acclaimed but expensive TelePresence videoconferencing system. For healthcare, it will interface to diagnostic and monitoring equipment. Cisco’s Danny Sands, MD discussed TelePresence in my September interview.

Microsoft wants to buy Yahoo for $45 billion to compete with Google, which is like a guy who’s jealous of his buddy’s gorgeous girlfriend hooking up with two unattractive ones in response.

Omnicell’s Q4: revenue up 35%, EPS $0.40 vs. $0.14. Shares tanked to a yearly low anyway, down nearly 23% on Friday, since investors don’t like declining order backlogs for hardware vendors. Analysts said Omnicell was talking up some big deals during the ASHP Midyear Clinical Meeting in December but failed to close the business in Q4.

Strange: a 31-year-old medical resident accused by her physician husband of bisexual affairs and drug abuse disappeared on September 10, 2001 after shopping at a department store. Investigators initially suspected she took advantage of the World Trade Center situation to skip town, but an appeals court declared her a September 11 victim last week despite no proof that she was in or near the area at the time. They want her name on the memorial. The family speculates she rushed in from her nearby home to help victims.

Leon Medical Center (FL) has started a $6 million NextGen implementation in its five Medicare clinics.

INVISION earns CCHIT’s inpatient EMR certification. The press release headline brags that it met 100% of the criteria, which of course is redundant since you can’t pass with anything less.

The Army’s MC4 combat medical records system hangs in there despite the widespread Internet outage in Asia and the Middle East last week. Combat hospitals had offline-ready systems to fall back on.

The quoted reply of athenahealth’s Jonathan Bush when asked at an IPO forum “how is the President related to you?”: “The President is my cousin, and he lobbied hard for the role and succeeded in the end. We took him. Sometimes we think about putting him back.”

Physician software user groups create a website to advocate allowing England’s physicians to choose their own clinical systems instead of being forced by patient care trusts to standardize.

Sonoma Valley Hospital (CA) blames its financial problems on a billing system outage that lasted several days.

West Virginia University Hospitals will go live on its $90 million Epic system on March 1.

Kaiser Permanente will be Oracle’s landlord in Pleasanton, CA, buying three Oracle buildings totalling 186,000 square feet and renting them back to the company.

E-mail me.

Deborah Peel, MD on Rogue’s Example of EMR Privacy Concerns

As far as I know, there are no existing EMRs that ensure consumers control all access to personal health information. This is a HUGE market opportunity. So, all of Rogue’s highly sensitive old medical records can and will be used, shared, and sold without his consent to discriminate against him and his children (depression has a genetic basis) because electronic health records systems were NEVER designed to ensure Americans longstanding legal and ethical rights to control access to PHI.

Electronic health information systems were not designed to replace paper medical records systems (whose function was SOLELY to help doctors care for patients). They were designed to deliver information to corporate end-users. It will be very difficult and expensive to successfully rebuild existing EHR systems to conform to existing strong state laws, common law, Constitutional law, tort and contract law, the physician-patient privilege, and medical ethics that all require informed consent.

Vendors, insurers, hospitals, drug companies, and data miners do not want new HIT systems that restore our rights to privacy because that will put an end to the billions in profits from the sale of stolen prescription, health, and claims data (IMS Health and the BCBS Blue Health Initiative come to mind).

The original HIPAA Privacy Rule required consent. But the consent requirement was gutted in 2002, legalizing the data mining and data theft that HIT systems were originally designed for. HIPAA is now the data miners’ DREAM regulation — because it puts “covered entities” in control of when PHI can be used for TPO, not consumers.

Learn what Congress and federal agencies are up to and what you can do to stop them from destroying your health privacy by signing up for our e-alerts.

In 2006 and 2007, Patient Privacy Rights and over 50 bipartisan national organizations in the Coalition for Patient Privacy urged Congress to restore Americans’ longstanding basic rights to privacy: i.e., our rights to control access to personal health information. The Coalition was the key force that stopped the HIT bills which had no rights to health privacy. We need your help in 2008.

Rogue, maybe you can sue the hospital (your employer) for disclosing your PHI under strong state laws that require informed consent before the disclosure of mental health records. But first, you will have to have audit trails to prove where your data went and also be able to prove how you were damaged. Good luck.

Or you can be an advocate and work with Patient Privacy Rights to restore and strengthen your privacy rights.

Inga’s Update

Bariatric surgeons take note: a proposed bill in the Mississippi legislature would prohibit food establishments from serving “obese” people. Shares for Gold’s Gym are up; McDonald’s shares down.

CoxHealth in Springfield, MO adds Krptiq ePrescribing solutions.

Less than a month after announcing a secondary public offering, athenahealth withdraws its registration. Seems as if the current market conditions created a risk that athena wouldn’t be able to sell the deal to investors at a price that made sense. Is this an isolated incident or a sign of the times?

Privacy rights “warrior” Dr. Deborah Peel is again in the news. Her Patient Privacy Rights organizations plans to evaluate EHRs and award seals of approvals for those that meet the organizations standards for protecting the privacy of personal health information.

Perot Systems announces it won over 90 revenue cycle solution contracts last year that resulted in the collection of over $2.4 billion in cash and the resolution of $4.6 billion in A/R for its clients.

E-mail Inga.

News 2/1/08

From Bignurse: “Re: EMR/EHR. Assuming that a completed implementation is characterized by some level of utilization, what would that level be? How would you experts define ‘implemented’? Should it be based on percentage of functionality used, attainment of predefined success metrics, etc.? And if so, what would you suggest?” Good question. Is “implemented” a word to use any time you’re live, or only if you’re getting usage and/or value you expected? Answers welcome, although if anyone from HHS is reading, please don’t engage one of those trough-lapping consulting firms to define it and then invoice me $500,000 like I was Uncle Sam or something.

From Phil R: “Re: RemedyMD. Not sure how much Kool-Aid that former staffer has been drinking, but the number of ex-Remedy employees sending resumes our way would suggest that they’re leaving en masse these days.”

From The PACS Designer: “Re: hospital labs. Hospital & Health Networks online magazine has an interesting article about hospital labs and how they can be outsourced to bring in much needed capital to alleviate the cash crunch hospitals are facing because of DRA cuts. Also another benefit would be to speed the transition to populating PHRs with lab results since most lab services have digital repositories of patient tests. Another revenue increasing option is for hospitals to offer their lab services to local physicians similar to what is being done by many hospitals in Michigan.” Link.

Confirmed: CEO Bob Cullen has left Thomson Healthcare “to pursue other opportunities,” according to a marketing contact Inga reached there. Mike Boswood is the new president and CEO, coming over from the company’s legal business side. A reader noticed the tip we ran from Curious George this week and asked to have it confirmed. We are responsive, yes?

Listening: Airbourne, Aussies that sound like AC/DC circa 1976 with some Spinal Tap cliches mixed in.

Interesting seminar: The Unsummit, three days on bedside barcoding with some really good-looking sessions (including a discussion with Julie Thao, the nurse whose admitted medication error led to her legal prosecution). April 30-May 2 in Austin, TX. I know some of the folks speaking and it should be good, plus I like barbeque and I’m sure there will be some.

January will set the record for most monthly visits to HIStalk, around 54,000 or so. Man, that’s a lot of readers, every one of whom I appreciate (along with the great sponsors who get what Inga and I are doing and want to support us). I don’t get all swell-headed about it since, from this chair, it’s more like a videogame than something real, just pecking on keyboards in a quiet room and never talking about it to anyone. Sometimes I’m tired after a long day at work, but this never gets old.

Jobs: MPI Project Manager, Account Executive Sales, VP Research Services, Online/Internet Marketing Manager.

Misys put its name on iMedica’s EMR, so it’s only natural that they won’t host it, either. If there’s innovation in there somewhere, it must be in marketing.

Southeastern Regional Medical Center (NC) signs up for the RadarFind RFID-based asset tracking system.

AMICAS signed more than 60 radiology and imaging contracts last year.

HHS Secretary Mike Leavitt’s editorial on healthcare information technology runs in the Memphis newspaper. Nothing new, but aimed at the lay public: EMRs, P4P, and the FCC’s rural broadband telemedicine grant program.

UPMC South Side’s department of medicine chair is sentenced to three years in prison after pleading guilty to possession of child pornography. UPMC says he won’t be coming back, naturally. And in Louisiana, a 72-year-old retired anesthesiolgist gets 16 1/2 years for trying to get what he thought was a 14-year-old girl online to send him dirty pictures. It’s just my perception, but after many years of working with doctors, there sure seem to be a disproportionate number of horndogs among them.

Speaking of doctors in trouble, a physician peer reviewer for NEJM is caught tipping off Avandia maker Glaxo that an article he was reviewing was about to blow the lid off the drug’s heart attack risk. He was a paid shill for Glaxo, racking up the usual doctor consulting and speaking fees to push their products on his peers. His excuse: “Why I sent it is a mystery. I don’t really understand it. I wasn’t feeling well. It was a bad judgment.” Is that a multiple choice excuse?

Four hospitals that previously employed nurse Charles Cullen, who admits to having killed at least 29 patients by injecting medication into random IV bags, argue that the victims’ families shouldn’t be allowed to sue them, even though they didn’t report his previous errors and investigation for tampering.

A University of Minnesota doctor is in trouble for losing a flash drive that contained his fertility patient data backup. It was supposed to be encrypted, but wasn’t.

University of Alberta researchers have developed a $1,000, shoebox-sized microchip system (i.e., “lab on a chip”) for performing lab and genetic tests.

Sumter Regional, the feel-good recipient of a lot of good press after its tornado damage and its grace under pressure afterward, has not-so-good news this time: 31 of its employees will be laid off Friday.

UnitedHealth Group’s PacifiCare insurance subsidiary faces fines of up to $1.33 billion for not paying claims, which caused some providers to stop accepting their patients. UnitedHealth, which bought the company for $9.2 billion two years ago, said they’re sorry. California’s insurance commissioner is obviously not in a forgiving mood: “After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims-paying process. We’re going to put an end to that. If PacifiCare can’t understand the ABCs of basic claims payment, maybe it will understand the dollars and cents of regulatory action.”

CAP puts the lab at Yakima Valley Memorial Hospital (WA) on probation after an unannounced inspector found a patient who was transfused with another patient’s blood because a lab tech misread a computer screen listing single-spaced lines of tests. Some of the changes involved software.

Great idea: a hospital installs wall-mounted “Yacker Trackers” that look like stop lights, turning yellow and then red when noise levels get too high in patient care areas.

Physician EMR vendor MedcomSoft closes a $500,000 private placement. Its shares trade on the Toronto Stock Exchange.

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Inga’s Update

Re: Rogue and his PHR/EMR concerns. I have had the opportunity to hear privacy advocate Dr. Deborah Peel speak on this very topic. Dr. Peel can be a bit extreme at times, but her overall position is that patient medical records belong to the patient and not the doctor and not the facility. Her belief is the government is capable of creating a national health record bank with “Fort Knox” type security and the patient regulates who gets to see what information.

I guess it was destiny that for Hopes and Deams to come together. HopeHealth, a SC FQHC and member of the Community Integrated Management Solutions IPA will be implementing DREAM EHR and CARE Disease Management solution from Visionary Medical Systems.

Cerner announces 2007 bookings were up 14% over 2006 and revenue up 10%. Fourth quarter bookings were up 5% over 2006 and revenue up 4%.

Healthgrades says (warning: PDF) that if you go to one of the top 5% of hospitals, you are nearly 1/3rd less likely to die. Their study claims 171,424 lives could have been saved and 9,671 major complications avoided between 2004 and 2006 if the quality of care at all hospitals matched the level of those in the top five percent. Will people consider this before their next hospitalization?

Trizetto wins a $100 million contract with Blue Shield of California for a system-wide technology upgrade.

The LA County DHS contracts with Sunqest to expand and transfer its existing Sunquest LIS to a new facility and implement and integrate new enterprise applications.

E-mail Inga.