News 10/5/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

E-mail Inga.

Microsoft To Announce HealthVault PHR

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

Quovadx Acquires Healthvision

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

News 10/3/07

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

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

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

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

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

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

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

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

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

Sounds like a good read: How Doctors Think.

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

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

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

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

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

E-mail me.

Inga’s Update

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

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

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

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

Monday Morning Update 10/1/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Inga’s Update

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

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

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

E-mail Inga.

News 9/28/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Inga’s Update

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.

News 9/26/07

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

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

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

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

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

Listening to now: Megan McCauley.

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

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

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

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

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

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

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

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

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

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

Inga’s Update

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

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

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

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

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

E-mail Inga.

Monday Morning Update 9/24/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MedAvant will provide claims connectivity with Aetna.

Siemens gets a Soarian sale in Germany.

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

E-mail me.

Inga’s Update

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

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

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

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

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

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

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

E-mail Inga.

News 9/19/07

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday Morning Update 9/17/07

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

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

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

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

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

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

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

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

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

Jobs:

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

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

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

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

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

IT workers with server virtualization experience are in high demand.

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

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

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

E-mail me.

Inga’s Update

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

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

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

Make Inga happy.

News 9/14/07

From The PACS Designer: “Re: Oracle Database 11g. It takes quite a bit of innovation to get TPD excited when it comes to healthcare IT. Oracle has just done that by releasing a new database solution called Oracle Database 11g. It appears to be just what the doctor ordered (no pun intended) when it comes to bringing healthcare some new exciting solutions for its diverse population of databases. One key feature is the ability to store DICOM image files along with other data parameters, such as XML, 3-D spatial data, and any other multimedia data to give users a central location for all of their data. TPD will be highlighting other new features in upcoming posts.”

From Health CIO: “Re: North Shore. I hear that North Shore Long Island Jewish Health System is looking for a new CIO. Anybody know who’s interested?”

Google’s main healthcare guy, VP Adam Bosworth, has left the company. It didn’t sound amicable, but you never know.

And speaking of Google, the company is working with Stanford and NASA to map the human body by scanning cadavers, with the possibility of an eventual Google Body that would be similar to Google Earth.

Sentillion announces its expreSSO single sign-on product for healthcare. Key points: “plug and go”, lower cost, graphical intelligent agent creation, support for graceful single sign-off, fast user switching on shared workstations, support for proximity authentication, password reset, and appliance-based deployment with five-nines uptime. I hope to get more info soon. Sounds pretty cool, especially if the price is good.

Rumor heard: Healthvision will announce the sale of the company in the next few days. I contacted CEO Scott Decker, who confirmed that Healthvision is in the final stages of negotiating a sale to a new investor. He couldn’t name that company, but I’ve heard it’s Quovadx, which went private in its own April sale to private equity firm Battery Ventures. Supposedly Verisign’s investment in Healthvision never panned out and employees have left in significant numbers after a June layoff. My February interview with Scott is here. I hope it works out for all involved.

When doing some vanity Googling, I ran across my own comments in Healthcare Informatics. I’d forgotten that I gave them permission to run some stuff I wrote awhile back called “Guide to RHIOs for CIOs in ten easy steps”. I appreciate the quote and the link.

Parkland’s use of ER kiosks from Galvanon makes MSNBC.

A Canadian company brings medical services to cell phones: dietitians who analyze meal snapshots sent in by users, on-demand conferencing with freelance nurses and doctors, and a baby application. Pulse and temperature can be transmitted and conversations are archived.

Scott L’Heureux, formerly of SIS, is named CEO of Jackson Therapy Partners, an Orlando-based therapy staffing firm. I didn’t realize until I looked at their site that they’re a sister company of throughput software vendor StatCom.

Rush-Copley Medical Group chooses athenahealth along with Eclipsys Sunrise Ambulatory Care.

Good Samaritan Hospital (CA) will use Medseek’s portal services.

Optio announces Q2 numbers: revenue down 2%, EPS -$0.05 vs. -$0.02.

Even newspapers can’t spell Misys. There’s just no excuse for spelling it “Mysis,” any more than there is for typing “gentamycin”.

Capgemini wants to profit from offering support services to enterprise users of Google Apps Premier Edition. That’s odd enough, but now Microsoft jumps into the fray, bashing the product and thereby instantly lending it credibility, like all competitors it tries to squash with trash talk. MSFT criticizes Google’s “perpetual beta,” which I would counter-argue is at least labeled as such, unlike Microsoft’s far-from-free trial balloons labeled as production-ready software instead of a series of desperately scheduled service packs. Actually, the version that Cap is pitching isn’t free; it’s $50 a year. Overall, I’d buy (or keep) Office instead unless I had rock-solid and limitless bandwidth (who wants to be called with the Internet is slow?) and didn’t have any Excel or Access power users. You could probably buy Office for what that $50 a year adds up to, although you’d still have to support its local installation. That doesn’t count Cap’s charges, either.

Midwest Medical Insurance Company will offer a premium credit to physician policyholders who use electronic medical records. Requirements for the 2-5% credit: the EMR must be CCHIT-certified, software updates must be current, 75% of docs in the practice must use it, it has to have been running for at least a year, and at least two of six listed EMR functions must be used.

A UK hospital is embarrassed when a hard drive containing patient information is sold on eBay. And speaking of breaches, here’s a first-person description of how a bored hospital visitor did some innocent hacking.

Miss Nebraska is a senior in bioinformatics at University of Nebraska-Omaha, which I thought was noteworthy enough to warrant a pic from her site. Some enterprising vendor could sponsor an appearance in their HIMSS booth, you know.

Inga’s Update

I feel I have arrived because I received my first email from Matthew Holt. Unfortunately, he was making fun of the fact that I am just now discovering Sermo, a company that he claims he practically made famous through his multiple mentions in THCB (he is making it hard to feel like a diva).

On the other hand, Mike H. was very appreciative of my “insights” on Sermo (Mike seems to understand that divas need appreciation). He also said: “Just read your post about Sermo.  I’ve been reading about them a bit lately and also think their business model is intriguing.  I ran across what appears to be a similar site that makes a similar claim about size (we’re the biggest …) You might be interested in looking at their site as well. It’s www.within3.com.” I did check out www.within3.com (I like the name) and it reminds me a bit of LinkedIn, but for physicians (and those in related fields.) It will be interesting to see in time to see if either of these models (or other similar ones) is sustaining.

eClinicalWorks is selected by the Sisters of Charity of Leavenworth Health System (SCLHS) to provide their EMR/PM solution, as well as their Patient Portal as part of the Ambulatory EHR initiative. The ECW system will be made available on a voluntary basis to its 200 employed physicians and the 5,000 physicians on staff. The ECW solution will interface with SCLHS’s existing GE Centricity hospital system. The ECW press release doesn’t really say if there is any dollar commitment involved or if the health system is providing the software to any of the physicians for free and/or a reduced cost.

In another vague press release, Misys announces that West Michigan Physicians Network (WMPN) in Grand Rapids has endorsed Misys EMR, Tiger, and Connect for their 450 member physicians. WMPN will be eligible for “pre-negotiated contract terms and favorable product pricing” for the solutions. No mention if the endorsement is exclusive.

And, in less vague EMR selection news, HealthPort announces that Biloxi, MS based Coastal Family Health Center and the Mississippi HealthSafeNet High Impact EHR project have selected HealthPort EMR for its regional EMR system. HealthPort is the company that was formed after Companion Technologies and SDS merged. The Mississippi project is made up of seven organizations and recently was granted $1.4 million by the Health Resources and Services Administration to fund the EHR and related projects.

Zotec Partners and EmPhysis Medical Management announce a merger. Both are in the practice management and billing fields, primarily focused on hospital-based physicians. As others have mentioned recently, the billing side of healthcare IT is not dead!

E-mail Miss HIStalk.

News 9/12/07

From The PACS Designer: “Re: ILM. One of the tools that can be used to better manage archives for data parameters is to employ ‘information lifecycle management’ techniques. Through ILM, you can prioritize data and image files by time periods so that you more effectively manage the speed of accessing those wanted recent files. As older files become less relevant, they can be compressed and stored in less expensive storage spaces, either onsite or at a remote storage facility provider. TPD will be highlighting the features of a new software database from Oracle, so watch for more postings on database management solutions.”

From Gwen Fabin-Blunt: “Re: that physician EMR company you keep mentioning. I hear that, in an attempt to reduce financial liabilities, management is trying to negotiate paying certain sales reps a reduced percentage of commissions owed if payments are made today, versus when clients pay. Additionally, management wants to reduce the number of vacation hours that can be rolled each year, again to reduce liabilities.” Doesn’t seem too harsh since employees still have the option. What I really dislike are those vendors that demand long hours or personal sacrifice like it was somehow your obligation to bail them out and keep management in bonuses. If they don’t have profit sharing, why is their lack of planning or resources your problem? If they need more than 40 hours a week of your time without paying for it, then they need to hire more people. Think WWCD (What Would Contractors Do).

From Byron Davies: “Re: codeine overdose. Turns out it was an unusual genetic profile (1% of Caucasions) that caused the mom to metabolize codeine into morphine. She was at home, not in the hospital.” Link. Few hospitals have systems that will catch drug-pregnancy and drug-lactation problems, not that it would have helped here. Maybe this will spur interest.

From Dominique Adikadika: “Re: Acermed. Dead and shut down for good. Got the letter today. The cause was lawsuits against them and the illness of one of their executives.” There’s always that risk when dealing with a non-publicly traded company or conglomerates. Of course, those larger companies could screw you as equally and quickly by sunsetting your product or by choking you slowly through ineptitude or lack of product focus. No matter who certifies, recommends, or guarantees a product, in the end it’s just you and your vendor because only they know what goes on behind their closed doors. Caveat emptor, especially in this consolidating physician systems market.

From Real World User: “Re: AJAX. The simple AJAX Solitaire game posted here seemed impressive for a web page, but was sluggish compared to the real thing. As a regular user of Yahoo Mail and Gmail, my sense is that at its best, AJAX makes web pages great, but it is always slower and more sluggish than a real program. This kind of sluggishness is fine if I am just checking e-mail, but it would drive me crazy if I had to see it all day in an EMR.” The Solitaire game is unusually graphics intensive since it shows large, full motion graphics. I don’t find it any worse than the usual Citrix front-end to healthcare apps and certainly better than the usual “click and wait a couple of beats” browser applications.

From Philip Rivers: “Re: QuadraMed. Here in San Diego. Just beat the Bears, so I stopped in on the QuadraMed User Group at the Harbor Sheraton. Looks like a good turnout and lots of buzz surrounding this new thing they call CPR. Clients are really saying nice things about what they see. As a player, I am impressed with the CPR clients and their presentations. I think we may have something here!!” I, too, am cautiously optimistic. QuadraMed has had its own troubles not unlike those of former CPR parent Misys, but at least not under current leadership. Whether they’re too late to save the aged patient remains to be seen.

From Glenn Welsch: “Re: Allscripts. When Allscripts makes a sale that isn’t an interface to an existing IDX installation, then you can consider them a player. That will show that the overall product is what the market is looking for. How many times do they sell a unified solution to a new client? Not many.”

From Tucker Livingston: “Re: McKesson. News about McKesson and First DataBank inflating drug $ seems to be few and far between. If the accusations are true, wouldn’t it be Medicaid fraud? Where are the feds?” Good question. If the government pays based on AWP, then they’re a customer like those others who could join the class action suit. Are criminal charges possible? I’m not sure, but I bet somebody out there does.

From Dr. Allan Pearl: “Re: physician systems. How well does hospital-small office system integration work? Have there been problems with compatibility when affiliated practices use different EMRs? Are EMRs in office practice really the next best thing since ballpoint pens, or just a way for number-crunching administrivia units to get physicians into the corral of quantified performance measurement? Sometimes the numbers seem to obscure more than they reveal, especially when demographics of patient population are not taken into consideration. Having the same health insurance plan, age and sex does not make for comparability of patient groups, nor does process measurement necessarily correlate with clinical outcome. These may be obvious public health research principles to some, but not to the majority of health administrators, in my experience.” My knowledge pales in comparison to that of some HIStalk readers, so I’ll invite their comments. What motivates hospitals to integrate affiliated docs into their systems and how well does it work?

From PMGuy: “Re: (company). Word on the street is that (company) is close to going away. As a client, this concerns me. I heard the entire consumer group quit after the contract with (company #2) was canceled due to non-payment. Heard it Friday from the support desk when I called to ask for help resetting a password.” I’m uncomfortable naming names, but it’s a struggling vendor who bet big and early on interoperability. I hope this is a false alarm, but I wouldn’t be surprised either way.

From John Wheelwright: “Re: Epic. Ian MacDougall will be the keynote speaker at Epic’s UGM.” Link. Starts September 17, 6,000 attendees expected, 5,500 of them from Kaiser (kidding).

Brev+IT top five stories this week:

#5 – Ingenix Acquires Healthia Consulting
#4 – Former Hospital Employee Sues After Data Loss Firing
#3 – SEC Interested in Germany’s Siemens Investigation Records
#2 – Report Says RHIO Market is Small Unless Philanthropy Kicks In
#1 – Mr. HIStalk Says Subscribe Here Free So You’ll Know Next Time

AmerisourceBergen will pay $21 million to former Bridge Medical shareholders who claimed it paid less than promised when it bought the company,sold in turn to Cerner in 2005.

VeriChip shares take a pounding after reports that federal regulators overlooked data suggesting that the company’s implantable RFID chips caused cancer in animal testing.

Speaking of VeriChip, here’s a picture of a guy with one stuck in his arm, John Halamka, CIO of Beth Israel Deaconness. It’s in the blog of his boss, Paul Levy, BIDMC CEO, and shows him standing on a big rock, supposedly keeping in touch with the office via BlackBerry.

Reminder: the search box to our right will plow happily through 4+ years of diarrhetic HIStalk output. I’ve mentioned just about every company and product here at least once, so give it a click. You can sign up for the e-mail update while you’re over there, too, so you get instant notification when I write something new.

Inga mentions the upcoming HIT investments of David Brailer’s private equity fund. Show how smart you are: e-mail me your choice of growing HIT-related companies in which you’d recommend he invest: software companies, service providers, whatever. Lots of private equity firms are looking for investment, so what companies are worth a look? Tell me why you like them. Maybe we’ll do some profiles of the lesser known.

Microsoft’s healthcare interest is outlined. Says they have 600 people working in healthcare. Maybe it’s been mentioned before, but I hadn’t heard it: Microsoft is working on a standard for personal health records, with announcements coming in the next few weeks. Acquisitions are coming, the article says.

PACSGEAR says it got its 600th customer. The product allows sending documents to PACS. I’m not a fan of all-capitalized company names, especially when the logo on their site has it in lower case, so I’ll attribute that annoying inconsistency to some confused marketing types.

Baylor docs can order images from their BlackBerry.

A Mayo doc says an “intelligent EHR” can populate an EMR using static text records, something he calls “minimally invasive informatics”.

Another RHIO is spawned, this time in Minnesota. They’re making the same mistakes their failing counterparts have made: trying to start out big, relying financially on the big hospitals and insurance companies that started it, and discouraging use by charging subscribers. The universal, ancient PR example is offered to the press: “You’re in the ED unconscious …”

Inga’s Update

Re: the new SCI ads. I noticed the superhero ad before Mr. H pointed it out and I really like it. When I first saw it, I wasn’t sure whose ad it was, so I had to watch it for a few moments until the SCI logo came up. Anyway, I think Bob LaBla is a scrooge for his comments … it is eye-catching and fun.

I just read something about a company called Sermo and became intrigued by their offering. The news bit I read concerned the $25 million in Series C funding they just raised, with Sermo labeled as “aggregators of healthcare information.” Checking out their website, they claim to be the largest online community of physicians and serve as a site where physicians can communicate to one another online to discuss “medical insights” and “improve patient outcomes.” There is a “top postings” section where physicians had made notes of complicated cases and asked for other physicians to provide feedback. Of course, I wondered where the money came from, especially since there were no ads on the site. I liked the wording of this: “Sermo’s business model is one of information arbitrage, the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare.” I didn’t get what that was saying (or not saying) the first few times I read it. Digging deeper, it appears they sell aggregated data to financial institutions, pharmaceutical companies, healthcare organizations, and government agencies – any organization that benefits from early insight into clinical events. Clients can also pay a subscription fee that enables them to post questions to the Sermo community. I thought the concept was pretty slick. I also noticed that the Cambridge, MA company was hiring, in case anyone is looking. The benefits look terrific – you can bring you dog to work, they have free catered lunch every day, and they have an Xbox (which reminds me – I am getting really, really good at Guitar Hero).

David Brailer and his Health Evolution Partners firm are ready to start giving money away. The health care private equity firm has commitments for $500 million to invest in late stage health care companies. Another $200 million will be invested in early stage ventures through partnerships with other investment funds.

Someone suggested that I might want to look at a particular company that offered some slick technology. Though I try pretty hard to fake it, I am not too much of a technology girl, so it didn’t take much to confuse me as to what this company did. I went to the guru, Mr. H, to help me understand it all. To which Mr. H made the wise commentary about many of the slick technology companies in general: “It’s no wonder people don’t get interested in all (this stuff) … they have zero marketing ability and just expect people to plow through the geeky exterior to get to the even geekier interior.” I thought it was a great observation that even the best technology is going to be overlooked unless some attention is given to the marketing side.

A class action lawsuit has been filed in Florida on behalf of purchasers of Health Management Associates Common stock. The suit alleges that certain company insiders sold over 900,000 shares of HMA stock for gross proceeds in excess of $17 million between January 17 and July 30, 2007.

The Doctors Clinic in Bremerton, WA selects Sage Healthcare for their 75-physicians multi-specialty medical group. The clinic will implement the Intergy suite of products for all EHR, practice management, analytical, and radiology management needs.

I really liked this story. Meditech is offering free classes in MAGIC programming in the community of Fall River, MA. Meditech is in the process of building a new site there and plans to move 500+ plus jobs into the area. Meditech needed more skilled programmers, so they worked with UMass Dartmouth to develop a program to provide a 30-hour course for participants. Though completing the course does not guarantee a job, it certainly will provide an opportunity for many. And Meditech has a new pool of trained programmers.

Poke Inga.

Monday Morning Update 9/10/07

From Inside View: “Re: Bronx Lebanon. Eclipsys won. Cerner, who everyone assumed was the winner a couple of months ago, was the surprise loser. But the biggest loser was GE. They should have won, could have won, but didn’t execute and their product is a mess. The rate at which GE is losing LastWord clients is alarming.” Unverified, I should mention. Thanks for the update.

From Abe Froman: “Re: Dubai. In Cerner’s presentation at the conference, they showed how CPOE cuts medication turnaround time from hours to 20 minutes. A hospital director there couldn’t understand how you can put the ordering process in the hands of a physician. What happens if he makes a mistake? In Dubai hospitals, pharmacists are simply glorified salesmen, dispensing whatever the order says. They do not question anything. The nurse provides the review when the order is transcribed, which doesn’t happen with CPOE. The conclusion was that Cerner doesn’t understand that market.”

I mentioned tee shirts that will be worn by former employees of a certain vendor at their “glad I’m out of there” reunion. Folks asked me to run a picture. If you want a look, see here and here.

I got an e-mail from Jason Maude, CEO of Isabel Healthcare, after I mentioned the press its diagnosis product receives. He recommends a book called Super Crunchers: Why Thinking-by-Numbers Is the New Way to Be Smart. It has a healthcare chapter that covers IHI’s 10,000 Lives campaign and devotes five pages to Isabel. A quote: “House makes excellent drama, but it’s no way to run a health care system. I’ve suggested to my friend Lisa Sanders, who recommends script ideas for the series, that House should have an episode in which the protagonist vies against data-based diagnostics ala Kasparov vs. the IBM computer. Isabel’s Dr. Joseph Britto doesn’t think it would work. ‘Each episode would be five or seven minutes instead of an hour,’ he explains. ‘I could see Isabel working much better with Grey’s Anatomy or ER where they have to make a lot of decisions under a lot of time pressure.’ Only in fiction does man beat the machine.”

Researchers involved in the development of relational databases now say they’re obsolete and should be considered legacy technology. Reason: row-oriented databases are slower than column-oriented ones, especially for data warehouses. I thought the article might mention Cache’ since it doesn’t have those performance issues (remember they used to call it a “post-relational database”) but the guys quoted have already started their own company, so they’re not likely to bring up competitors.

In the UK, Cerner suspends work on the new Millennium R2 release intended for the London and South trusts.

Check out the new SCI Solutions ad to your left. Kind of a cross between the old Batman and Austin Powers.

Computers stolen from a McKesson office in July contained the personal information of thousands of patients who had signed up for prescription assistance programs from drug companies. The company said it’s “not clear” whether the data was encrypted, which is a nice way of saying it wasn’t (few users encrypt their data).

MPI vendor Initiate Systems signs a deal with Capgemini UK for a children’s services application.

A VIASYS engineer has been charged with hacking the computer system of his employer in 2003. He started by deleting files of his EEG development coworkers, then went after the executives. He was finally caught by an outside firm who located the outdated computer he used along with its hard drive, which he kept locked in a desk drawer.

A UK hospital bans employee access to Facebook after heavy use degrades its network.

The latest issue of The White Stone Group’s newsletter is out (warning: PDF). They run a contest to see which hospital has overturned the largest single denial using their TRACE tracker and workflow software. The winner: a Georgia hospital recovered $452,000 when they showed documentation of precertification notification and response. Even more interesting was the “Taste of Trace” recipe for cheese grits souffle, which of course is the food of the gods for Southerners. If Mrs. HIStalk could cook, I’d dispatch her to the kitchen to whip up a batch, albeit using Velveeta instead of fancy cheddar.

The Northwest Medical Information Symposium will be held on September 13-14 in Spokane, WA. Speakers: Gingrich, Leavitt, and Frisse, among others. Meditech is even on board as an uncommon sponsor since the meeting is put on by its customer, Inland Northwest Health Services.

An investment analyst surveys US users of its Emdeon system and “… believes that concerns about falling demand from medical practices and possible glitches in the software are overdone. However, it said that it had uncovered evidence that the group, whose core business is accounting software for small firms, had made only mediocre efforts to market its medical software.”

Throughput software vendor Premise Corporation announces events from the first half of the year: client based doubled, 100% “would buy again” results from KLAS, 100% employee growth, new financing, and new operational and board leadership.

A mother sues the makers of Tylenol #3 when her newborn baby dies, apparently poisoned by the her codeine-containing breast milk. If your hospital flags breastfeeding moms and successfully issues CPOE or pharmacy lactation precautions for specific drugs, it would be the first I’ve seen. Tylenol #3 probably wouldn’t be on the list anyway since it’s not a common problem. FDA issued a warning last month.

I’m moving on to Brev+IT from here, so if you pounced on this e-mail notification, you might have time to sign up before I send it out.

E-mail me. How hard can it be?

News 9/7/07

From The PACS Designer: “Re: native DICOM. TSS makes a valid point about the use of private attributes. I’m not sure if the HIStalk community knows that the DICOM Workgroups are expanding into modalities that were not previously DICOM-enabled, such as Pathology Workgroup 26. As more modalities join the DICOM community, it becomes vitally important that we all operate from a common DICOM platform. Why shouldn’t it be native DICOM? Wouldn’t it be better for all of us to work as a team in the native DICOM community?”

From Dale Cooper: “Re: Dairyland. Now that Mediware has a new CEO (revolving door?), looks like Mr Burgess is going to help Vista capital try to get DHS in gear. IMHO – wrong guy, wrong time, wrong place … good luck.” Former Mediware CEO (until September 24, actually, but he’s taking the Mediware job now) James Burgess was just named CEO of Dairyland Healthcare Solutions a few minutes ago (6:17 PM Eastern). Actually, Dairyland is owned by Francisco Partners, but the confusion with Vista Equity is understandable since Vista has investments in SIS and the former Sunquest. Francisco also owned LYNX Medical Systems, but sold it to Picis in July.

Guess the Company, brought to you by Ex-(Company) and redacted to keep me out of trouble: “(Executive) is a pompous ass. He is the most arrogant person I have ever worked directly for. He has vision for this industry, but has a leadership style of complete dictatorship and surrounds himself with the politically focused. The ability to execute sucks. (Executive) thinks it’s services, it has always been his half-assed development team who consistently delivers terrible code. I feel sorry for anybody still there.” The funny thing is that when I run stuff like this, several folks always guess it’s their own company, so it’s not always as obvious as you might think.

Guess the Company II: some former employees of (company) are having a reunion and somebody sent over a picture of the tee shirts they’ll be wearing. They say: “Can’t build it? Have old technology? Tired of trying to convince people that you have a great personality?” There’s also a picture of a dead animal that I won’t name. I bet they’ll be carousing and trading war stories.

From Larry: “Re: Greenway. You mentioned that you were impressed by Greenway’s recent press release. I was wondering if you or any of your readers had any comments regarding the huge capital investments Greenway has received since inception ($80-$100 million, it seems). Is their EMR product and sales performance impressive given what they’ve had to work with?” I’ll defer to those who know more about it than I do.

From Leland Palmer: “Re: Bronx Lebanon. Any update on who’s winning the battle of the Bronx between Cerner and Eclipsys?” Readers?

Special thanks to Sentillion, EnovateIT, Pring|Pierce, and SCI Solutions. Inga and I decided to offer small text ads in our Brev+IT weekly newsletter to support some expansion we’ve got in mind for it. We offered four spots to current sponsors for terms up to one year. Within within 24 hours, these Platinum sponsors had signed on for the full year (we even had to turn a couple of others away). You can’t imagine how energizing it is to have that kind of support. We know these folks and they’re doing it for one reason: they like what we do and they respect HIStalk’s readers. We appreciate that very much and will soon have some new stuff to talk about as a result. Sign up and you’ll know the Top 5 stories each week, like last week’s: (5) Cerner in the UK, (4) Indian BPO acquisitions, (3) MedAssets IPO, (2) FDA’s access to DoD patient information, and the biggest story of the week, (1) … well, let’s keep at least one secret between just us 721 subscribers.

Thanks, too, to recently renewing HIStalk annual sponsors R. Gaines Baty Associates, Healthcare Growth Partners, Picis, Hayes Management Consulting, SolCom, and Novo Innovations. I’m a little old to be saying “you rock”, but you know you do.

Shortwave Coates and others were right several weeks ago with their rumor reports that Ingenix would acquire Healthia Consulting. It was announced yesterday. “We want to share with you today some exciting news – Healthia is going to become a part of Ingenix, a leading health information technology company. Since our inception, we’ve aimed solely at staying on the leading-edge of health care consulting, and as a result we have become nationally known and recognized for the services we’ve provided to the industry. With increasing levels of opportunity nationally, we sought capabilities that better serve our customers and provide challenging opportunities for our colleagues. Becoming part of the Ingenix family of companies does just that – retains our exclusive focus on health care while giving us broader and enhanced capabilities.” Ingenix bought Claredi and Lewin Group recently as well and was rumored here to be acquiring LighthouseMD, although I haven’t confirmed that so far. I was going to list their products and services, but it’s so long it’s arranged alphabetically like a telephone book. They are definitely growing. They got a gem with Healthia, so hopefully they won’t change it much.

Athenahealth’s $14-$16 IPO price will raise around $68 million or up to $115 million, depending on which reports you read, valuing the company at up to $550 million.Cerner is sponsoring and participating in a conference in Dubai. They’re also webcasting investor presentations live Friday morning and Tuesday afternoon.

Ray Moss is named VP/CIO of Valley Presbyterian Hospital (CA), leaving Perot’s Cedars-Sinai tech services group.

Keane gets a $1 million contract to install parts of InSight at Capital Health System (NJ).

CompuGroup’s CEO does an interview with eHealth Europe. On the company’s failed iSoft bid: “Everybody knows iSoft does have problems, both financially and with its products, and these kind of problems do not become less over time. Further more in our view it became more unrealistic to receive the voting power to implement our restructuring plans in time. The whole deal became too risky for my taste and doesn’t agree with my understanding of shareholder value.” He says CompuGroup is still looking for healthcare IT software companies to acquire.Good article: 10 signs that you’re not cut out to be an IT manager.

TeraMedica will distribute its “single patient snapshot” Evercore imaging software in the Asia Pacific, integrating with Healthinc‘s RIS.

Interesting: the 2003 law that limited the workweek of medical residents to 80 hours has had no impact (good or bad) on Medicare patient mortality.

Formedic is offering a free Medical History Questionnaire patient interview application to physician offices. There’s a recorded demo there. I’m not sure I’d lead off warning the patient to enter their “chief complaint” and not their “symptoms” (are patients supposed to know the difference?), but once you get past that screen, it gets better. Nothing tells you who the company is, the domain registration has privacy block on, and the only contact is an online form and 800 number, but the press release points to the main Formedic site.

Worldwide corruption investigations into Siemens may be heading here. The SEC has requested files from German authorities who are going after Siemens for up to a reported $1.4 billion in bribery and anti-trust violations. Just announced: China is looking into possible corruption involving the purchase of Siemens medical equipment there. If an investigation opens up here, you can bet their competitors will be subpoenaing everyone within 20 miles of hospitals where Siemens got the contract. I know would.

Hopkins gets its stolen laptop back with the medical records of several thousand cancer patients intact. Odd: a lawyer knew who had it, called the local newspaper to announce that he’d get it back, and turned the occasion into an opportunity to pitch his law office’s expansion into identify theft cases.

No question: the best vendor for getting good press is diagnosis software vendor Isabel. Nice product and it’s just stunning how well they get articles about it into the mainstream press. It’s in USA Today, which not only misquoted the price as $750 instead of $50,000 per year, but also said it was “highly rated” by HIMSS, which despite many ways of cozying up to vendors, doesn’t evaluate them as far as I know. HIStalk reader Gary Kantor, MD of Case Western was kind enough to review Isabel for HIStalk last year.

The Providence Health System IT employee whose car was burglarized in his driveway in late 2005, resulting in loss of patient data tapes, is suing the health system for $1 million. He says he was fired because he called the police, not for breaking policy.

RemedyMD has integrated medication dosing algorithms from Dimensional Dosing Systems into its electronic medical records software.

Mediware announces Q4 numbers: revenue up 14%, EPS $0.06 vs. $0.07. The company was crowing about its medication reconciliation product just a couple of weeks ago, but the earnings announcement says medication management product sales were slower than anticipated (that includes the eMar and WORx products, though).

A UK health department consolidates its application databases using InterSystems Ensemble.

E-mail me. But only if you want to.

Inga’s Update

Cerner has announced the keynotes for their upcoming health conference. The “star-studded line-up” includes John Kerry and Richard Teerlink (former Harley-Davidson chairman). Will you Cerner users rush to send in your registration now that you have the chance to hear these guys? – or are vendors better off not spending all that money for speakers that know next to nothing about the products you are using?

Last month I had noted that Allscripts had been announcing a number of big wins and wondered if sales were up suddenly up or if their PR machine was working overtime. A reader suggested it was the latter. However, yesterday they announced their largest EHR contract ever with the Columbia University Medical Center. Columbia will be implementing the system in their outpatient physician group and their future community-based IPA. Fortune magazine seems to agree with me, as well as they just named Allscripts #23 on their list of the 100 Fastest-Growing Companies for posting growth numbers as follows: EPS up 138%, revenue up 38%, and total return 48% (bummer that I don’t own any of their stock). In looking over the Fortune list, I didn’t notice any other HIT companies, by the way.

Check in with the fetching Inga.

News 9/5/07

From Pluvial Bitter: “Re: AJAX. AJAX stands for Asynchronous Javascript And XML. If you use Google’s GMail, you have seen AJAX in action. The way GMail is able to check for new messages without you having to refresh or reload your page is due to AJAX. Basically, AJAX applications can be set up to make calls to a server for updated information at either timed intervals or based on a user’s interaction with an AJAX web page. These calls to the server occur behind the scenes. My company uses AJAX for a Web-based smart calendar for physician practices. Let’s say you have a practice rule that states you cannot perform a surgical procedure after you have been on-call the previous day. If a user started to enter a surgical procedure, the AJAX coding would elimate all physicians who were on call the previous day as available options.” Interesting. It’s worked great everywhere I’ve used it except Yahoo Mail, which seems to be flaky (it lost my e-mails more than once, so I went back the old interface).

From John: “Re: Brev+IT. Just subscribed to Brev+IT and received my first issue last week – what a great read. Brev+IT is an excellent complement to HIStalk as it focus on just a few key stories, going into greater depth with some good pithy analysis on each story. Thanks Mr. HIStalk for this expansion of your already excellent service to the industry.” My pleasure. The subscriber list is like a Who’s Who of the industry, with 600 folks receiving it so far. The sign-up box is to your right. And for those getting it, you can help me out by forwarding it to others (we’re a low-rent operation here, so that’s what passes for an ad campaign in these parts).

From Millie Quivalent: “Re: FDA’s access to DoD patient data you mentioned in Brev+IT. Congress is pressuring DoD to merge its software with the VA’s, which they don’t want to do. By linking up with FDA, they have another arrow in their quiver.”

I’m getting interested in the announcement coming next Monday from Sentillion. If you’ve watched their ads to your left, they keep teasing a little more each time. I don’t know the secret, but I’m waiting with you. Cool ads.

Kelly Mann is named CEO of Mediware, coming over from 3M. I missed the announcement that Jonathan Churchill had resigned from the board, replaced by former Assistant Secretary of the Navy Richard Greco. Greco sounds interesting: 38 years old, former CFO of the Navy, big private equity guy, and degrees from Hopkins and Chicago. Anybody want to bet that Mediware will go private soon by selling out to private investors? MEDW’s market cap is low for being publicly traded and the company is struggling in an up market.

Cerner co-founder Cliff Illig gets interviewed by the KC paper about his and Neal’s pro soccer team. “Entrepreneurs, I think, do organization stuff different than companies that have been around for a long time. At Cerner we think of our organization as a bunch of teams. It’s much more of a peer-to-peer kind of a model as opposed to a rigid hierarchy where everybody has a boss. We have a lot of young people working for us. You bring those young people in and you make them part of the team and you give them a mission and it’s pretty impressive what they’ll go produce.” CERN Employees: what do you think?

The Delhi, India government has spent $3 million developing and testing a hospital software package that they didn’t know was available as a free download. “Talking to Newsline on condition of anonymity, the engineer said: ‘I’m surprised that people working on the project did not know about the website. It is easily available and quite popular. The huge waste of time and money could have been avoided.’ HIMS project in-charge Dr Vijay Rai, however, said he is not aware about the website. ‘The HIMS software is the best that we have.'” The screenshots look pretty good.

Bob Fabbio, the Austin, TX entrepreneur who started Tivoli Systems, is in the doctor house-call business, along with a doc who was involved in Revolution Health. His new company offers scheduled doctor visits 12 hours a day, seven days a week. Families pay $88 a month plus $75 per visit, not including labs and meds, but some are handled by nurse practitioners. Doesn’t seem like a good deal, especially compared to concierge medicine, but that’s just me.

A Maryland dialysis center operator will test implanting VeriChip RFID chips in patients to bring up their medical records when they visit.

Speaking of RFID, a patient safety expert says barcodes are better than RFID for medication safety. The article briefly mentions 2D barcodes, which I’ve worked with recently. They’re the tiny, dense squares that you sometimes see on post office envelopes. They can encode a ton of information (several hundred characters), are readable even if damaged and from any angle, and take up a fraction of the room needed for Code 39 or even Code 128 formats. Plus, super-fast scanners that can read those plus the old linear codes cost less than $200 (I’m partial to those from Hand Held Products). I’m sold on them, even though HIT vendors will probably take forever to implement them if their readers are serially connected instead of as a keyboard wedge.

Brazil’s government will offer a medical exam portal powered by TrakHealth, now owned by InterSystems. I’m beginning to think InterSystems was smart to buy that company a few months back.

E-mail me. I need your rumors and ideas. Inga is far more enchanting, so you can always ping her alternatively.

Inga’s Update

I saw Mr. H mentioned that Modern Healthcare came out with its list of the 100 most powerful people in healthcare and he expressed disappointment at being overlooked. I wonder if he and I were the only ones who voted for him?

Phillip Rivers sent me a note about the Quadramed acquisition of the Misys CPR product. Phil comes from the Quadramed camp and offers some great insights.

“My thoughts of CPR acquisition are the following: smart, smart, smart. It is the real deal. It really does what others say they do. I have so many prospects tell me they want “integration”. Well, here it is. This is robust, flexible and proven. What more would you want?

As for the business deal, when all the numbers are made public, I think we will see this was a no-brainer for QuadraMed. I had really questioned Misys and their decision to sell the acute market products. I didn’t understand why a company would sell off a profitable part of the business. Well, I spoke with some senior Misys executives in Raleigh and they put some perspective on this sale for me. They really believe that Misys, which is known for the ambulatory products, was not able to partner with other HIS companies to fully market and sell the ambulatory into the client base of Meditech, for example. This was due to Misys perceived “competition” with CPR and the Lab products.  Shedding these will allow Misys to develop the “Channel Partnerships”. Makes more sense to me in that light.

QuadraMed will be able to take the integrated Cache database that CPR and integrate their other top notch revenue cycle products running on Cache, which is a truly underrated,extremely reliable, fast, and stable database.”

If you missed Mr. H’s posting yesterday on the HIStalk Forum (Works Sucks, Then You Die: Finding Your “One Thing”) it is worth a read. From one who has gone from the “front lines” in this industry to a comfortable seat in the bleachers, it hit home. Here is my favorite nugget of wisdom: “Every person has one thing they do extraordinarily well. You will never be happy in your job unless the majority of your time involves doing that one thing. And if you do that one thing, money and success will find you, probably when you least expect it.” I am still figuring out that “one thing” and definitely looking forward to having that money find me. Meanwhile, I agree that life is too short to not to love what you are doing. (For the curious, I am definitely having fun at HIStalk).

The Healthcare IT Transition Group has released its annual survey (warning: PDF) that focuses on RHIO financing. I didn’t see the full report, but the summary has a few data points of interest.

• The estimate for RHIO technology expenditures for 2007 is (only) $128.6 million, which represents 0.7% of the total US HIT market. If that is a real number, then that is bad news for vendors targeting this market.
• Not surprisingly, 53% of the respondents reported that cash flow was a significant challenge (see first bullet point).
• 52% of the respondents indicated they were in the startup stage, 24% in the transition stage, and 24% in production.

IPC The Hospitalist Company Inc., a North Hollywood, Calif.-based network of hospitalist physicians, has filed for a $105 million IPO. Several venture capital firms have the biggest ownership shares today, including Bank of America, Morgenthaler Ventures, Bessemer Venture Partners, and CB Health Ventures. IPC has over 600 hospitalist physicians and over 900 employees in 16 states.

I attended the first HIMSS virtual conference earlier this year and probably won’t attend the next one. That being said, it was interesting to interact with the other attendees. Since there were so many folks online at one time, there was quite a bit of posting about a variety of different topics and people were able to make quick connections. There were a number of attendees who were hunting for jobs and a fair bit of posting around employment issues. I sat in on a couple of webinars, but I guess I really am not a webinar kind of girl. I find it difficult to stay focused on the speaker when I have e-mail popping up, etc. But I am sure it works great for some folks. For people who don’t have an opportunity to go to meetings in person, it’s not a bad way to get a taste of it. If you took the time, you could learn about some new technology, etc. In terms of the vendors, I didn’t see much provided that couldn’t be found from the web. Oh, and I didn’t win any door prizes. Big disappointment.

Say hi to Inga.

Monday Morning Update 9/3/07

From Timber Roller: “Re: AJAX. See this Solitaire application, which looks like a Windows program, but which has been implemented using only JavaScript, cascading style sheets, and DHTML … so-called AJAX. That’s why AJAX rocks: not because it’s solitaire, but because thick client-like applications can be implemented without having to load and configure software on the desktop. This site uses widgets from Yahoo’s UI library for the drag-and-drop stuff.” Link. A good time-waster if your employer removes Windows games by default. It works really well – impressive.

From Chuck Lumley: “Re: open source EHR initiative. openEHR is a fascinating (and apparently already internationally successful) open source EHR initiative started by an historical EHR thought leader — Dr. Clem MacDonald at the Regenstrief Institute in Indianapolis.” Link. The website makes it hard for non-geek, non-academics to know what the heck they’re talking about, but it looks like some sort of standard rather than an actual product. My only takeaway was that Ethidium Health Systems is using the specs in its Evolution EMR product. Actually, this presentation (warning: PDF) is a better intro, although still way deep in the programmer stuff.

From Rogue: “Re: Epic’s new learning center. It is clearly shaped like a treble clef sign (as in sheet music). Hitting a high note? High-pitched screams? Anyway, I do like the dollar sign analogy the best. What, no helipad?”

From The Shelton Shadow: “Re: private attributes. TSS has been investigating the use of private attributes in DICOM Conformance Statements. Private attributes can cause problems when trying to view the image files stored in archives. Everyone making new purchases should compare the private attributes section to other DICOM Conformance Statements. Siemens and Philips look to be in good shape since their current products have no private attributes. GE is another story – their products have 20-30. Non-GE viewers will miss the private attribute data stored in an archive. The only way to see them is to store them in the DICOM Header, which will create an archive with mixed image files. GE sales reps might promote their product as better, but you are increasing the likelihood of a forklift upgrade if you decide to move to a native DICOM format supplier.”

From Edward Koogle: “Re: Misys. The former Misys office in Johnstown, originally a Sid Goldblatt Sunquest office, closed today. Remaining employees will work from home until new owners QuadraMed and Vista decide what to do. It’s sad considering over 100 people worked there at one time.”

From SG: “Re: BPO outsourcing. On the same lines as MedAssist acquisition, Indian healthcare outsourcing company Apollo Health Street acquired a leading US-based medical billing outsourcing company – Zavata.” Link. Interesting quote: “Technopak’s Singh noted that Indian hospitals and those in the US were at different phases in their investment strategy. The Indian players seek health-care consultancy for business strategy, facility design, planning and, only then, turn to health-care information technology. Most US hospitals, meanwhile, are now spending on redesigning information technology systems.”

From Darla Mackadoo: “Re: Rabbit Healthcare Systems. Consultant recommends an oncology software EMR package to a couple of clients, including Lone Star Oncology (good size group). Oncology EMR goes belly up shortly after. Consultant makes a smart move and gathers folks together to create a new EMR for resale. Lone Star Oncology becomes a big stakeholder in Rabbit. Consultant/new President goes back to all those folks that had the old belly up product and sells them the new stuff. That’s what I heard, anyway.”

No consensus yet on “healthcare” vs. “health care”. Dictionaries differ. It’s probably not a good word to describe most hospitals and doctors anyway since few are worried about “health” as they are “episodic treatment of abnormalities”. That’s another argument.

Sean McDonald, the Pittsburgh entrepreneur who started hospital robotic drug packaging vendor Automated Healthcare and sold it to McKesson for $65 million, will take his new company public. Precision Therapeutics sells a test that helps choose the most effective cancer chemotherapy. UPMC people are involved, which got UPMC in trouble previously: one of its lab directors was medical director at Precision Therapeutics and was named in a lawsuit that claimed he sent them specimens unnecessarily for his own benefit. He quit the company, although I don’t know how the lawsuit turned out.

Nova Scotia’s health department is seeking bids for a RHIO-type project.

Jobs:

CIO, Phelps County Regional Medical Center (MO)
Executive Director, Wisconsin Health Information Exchange (WI)
CIO, Olean General Hospital (NY)
Technical Project Manager (DC)
Cerner Analyst (NC)
Implementation Consultants (MN)
VP of Clinical Transformation, BayCare (FL)
CIO, Delnor-Community Health System (IL)
CIO, Sacred Heart Health System (FL)
Meditech PCS, ED (National)
Centricity Healthcare Consultant (MA)

It was the perfect feel-good hospital story: San Diego Chargers running back LaDainian Tomlinson would serve as the celebrity spokesperson for publicly owned Palomar Pomerado Health. Everybody figured it was a nice charity gesture until a reporter probed, the hospital balked at giving details (apparently not quite getting the “publicly owned” part of their governance), and a public records request revealed that the $60 million athlete is being paid $2 million over five years for his celebrity services. When nonprofits start throwing big money at their “brand”, they’ve forgotten the mission (unless it was self-aggrandizement).

HIMSS will offer another Virtual Conference on November 6-7. The first was met with underwhelming response based on pre-conference estimates, but 2,200 people is still pretty good (will they come again?) It’s kind of like Second Life for HIT, I suppose. For vendors, HIMSS is offering the usual cornucopia of opportunities to send them money, including a $5,000 deal to put your logo on each e-mail confirmation (I’m positive that will kick-start record sales). HIStalk sponsorship is quite a deal in comparison. Somewhere in all that commercial feeding frenzy is some education, although of a modest nature. And timeshare-like bribes … err, door prizes. One session is blocked out for the “can’t avoid it if HIMSS is involved” RHIO topics, although with a slightly more cautionary tone than the rah-rah of years past (a curt nod to the expanding RHIO graveyard). Seems like an overly heavy reliance on vendor speakers for a not-free program if you ask me (two of the ten sessions have a McKesson presenter alone). Pass.

Brev+IT is coming with the Top 5 HIT stories this week. Sign up here.

E-mail me.

News 8/31/07

From Captain Grammar: “Re: spelling. I find it disturbing that an industry as small as ours can’t agree on how to spell our name. Is it ‘healthcare’ or ‘health care’?” I use the former, but as a staunchly traditionalist grammarian, I really should insist on separate words. Opinions?

Practice Fusion, the “free if you’ll look at Google ads” EMR, announces that it will put Healthline’s medical search toolbar on its application. It’s probably a good match – Healthline is a “free if you’ll look at Google ads” medical search engine. I’m really not getting the business model. Will doctors really click on ads for stuff related to the condition of the patients they’re treating? Would you want to see a doctor that has to Google your condition?

Speaking of which, my idea of giving away a free EMR by jamming drug company ads in the faces of doctors is too late. Amplus HealthNet has what it calls an EHR (not likely) that offers on-screen drug company logos. “Every time a physician clicks on brand content, payment to that pharmaceutical brand occurs. For a brand manager, physician-initiated contact indicates a strong possibility that s/he is preparing to prescribe a product. ROI thus becomes needs-driven, highly- focused and target-specific. Better yet, this occurs at a much lower fraction of cost than traditional journal ads.” Damned annoying Flash and stock music site, I’ll say. I’m guessing its “EHR” solution is a lightweight. And I still refuse to call products EHRs unless the vendor can prove that it’s not just an EMR renamed to seem cooler (none have so far).

And speaking of free EMRs, RemedyMD is making its EZ Office suite free. I interviewed CEO Gary Kennedy in April, getting some good business lessons in running a healthcare IT company in the process.

A RICO lawsuit against McKesson for its alleged involvement in inflating published benchmark drug costs via First DataBank is certified as class action.

The local paper runs a story on Canada’s new Brampton Civic Hospital and its technology, including a picture of William Osler CIO Judy Middleton.

A ValueAct Capital partner ups his stake in Misys PLC to nearly 14%.

Modern Healthcare names its 100 most powerful people in healthcare. Sure, it’s just way to get the attention of readers too distracted to read anything substantial and instead lure them with pictures and cute graphics (I’m thinking about doing an HIStalk “100 Biggest Idiots in Healthcare IT”). Privacy fanatic Deborah Peel is #4, Newt Gingrich is #25, McKesson CEO John Hammergren is #38, Kaiser’s George Halvorson is #60, Suzanne Delbanco is myteriously #69 (parting gift?), CCHIT’s Mark Leavitt is #79, and HIMSS’ Steve Lieber is #100. I’ll move my hopes to next year.

I’ve never heard of oncology practice systems vendor Rabbit Healthcare Systems (TX), but if they’re being honest about increasing last year’s $165K revenue to $750K this year, somebody must have. Rabbit’s revenues are multiplying! (sorry).

August will set another record for HIStalk visits and the millionth one will drop by in October or so. Thank you for reading and thanks to the sponsors who make it possible. If you’re a Brev+IT newsletter reader and like it, drop me a line with a comment or two that I can use for pitching it to those who don’t read (what?) Several folks are surprised that it isn’t just an HIStalk rehash – it’s got more background and opinion that I’ve got space for here. The five biggest stories in the most recent issue involve Epic, Siemens, iSoft, Cisco, and at #1 … well, you should really sign up.

The Johnstown paper writes an article about now-independent hospital Windber Medical Center (still working on that interview with CEO Nick). An early challenge: a $3.5 million computer system replacement for what Conemaugh was providing. One of these days I need to get back up that way, if for no other reason to eat at my old favorite Oakhurst Tea Room just down the road.

CompuGroup has pulled out, so iSoft goes to IBA. For now. I mentioned a fact no one else has observed: private equity firm General Atlantic has a stake in both CompuGroup and iSoft.

Speaking of private equity companies, the 20 highest-paid private equity fund managers in the US average $658 million in compensation (and that was in 2006). I’m guessing some exceeded $1 billion a year in compensation, making outrageous CEO salaries seem paltry by comparison. I suppose they’re worth it if they provide big returns to investors, but that means investors lost that huge skim. They’re like Milliken’s junk bond kings – livin’ large now, but subject to investor fear of unregulated markets.

An Indian outsourcing firm buys medical billing company MedAssist Holding (KY) for $330 million. They like that BPO business overseas.

Bart Ponze, director of computer services for LSU Health Sciences Center, has died of cancer. Condolences.

If you’re an Epic Systems customer, here’s what those high prices provide: a $100 million learning center seating 5,300. Some say it looks like a horseshoe, but to me, it’s either a question mark or dollar sign (both appropriate). Note the Godcam-view company logo on the roof. Maybe Judy should have made the “most powerful” list. (Thanks to Romeo for the link. Photo from builder J.P. Cullen & Sons, Inc.)

I’m here.

Inga’s Update

I was thrilled to get an e-mail yesterday from Ralph Nader!! I knew that HIStalk had wide readership, but never imagined that folks I have actually seen on TV would be reading. Anyway, his email was not that nice (he called my postings “average”) but he did have an interesting comment about the Misys/iMedica partnership:

“My dear … If you had bothered to research anything about iMedica and its offerings, you would have the answers to yours (and others) questions about “Why iMedica”. The Mysis sales guys (and gals) should be dancing in the streets!”

(See what I mean about it not being that nice, especially since I did say some good things about iMedica? Now that I think about it, I wonder if this guy really is Ralph Nader. I mean, he had a grammatical error and even spelled Misys wrong. What does “dear” Ralph know – he has lost the presidential election, like five times hasn’t he?)

A consultant who was not claiming some phony name also sent me a note about iMedica/Misys. He indicated that iMedica had been losing money and needed to raise capital, thus, from a cash infusion standpoint, the arrangement is beneficial to iMedica. However, beyond that, he did not see much advantage of the partnership for either vendor since they sell similar products. “I think it makes them both look desperate, especially Misys. You have to give credit to Nissenbaum (iMedica’s CEO) for making one of his competitors resell his software for agreeing to refer his clients to only a segment of what Misys offer, such as their EDI services. How would you react to a Misys sales rep that has been touting their wares, now coming at you with one of their competitor’s applications? What about all the small practices who just purchased Misys? Why would they go through a reseller when they can go direct to iMedica? I also suspect that the Misys field reps will be disenchanted with having something else to promote. I suspect they will devote a sales force that will only focus on the small practices, similar to how GE uses their VARs.”

Yet another e-mail this week came from Obiwan Kenobe (by the way, keep all that sweet e-mail coming … I get so excited to hear from you all!) Obiwan thought I was “absolutely correct” in my comments about what really matters when it comes to enjoying your job. “You took the words right out of my mouth. Having been a sales person in this business a long time, you are absolutely correct in your statement. I have worked at a number of well-known and not so well-known companies. I am having an incredible time and success and much, if not all of it, directly relates to the things you mentioned that really matters.” Obiwan also mentioned he worked for HIStalk sponsor SCI (and I really don’t think he was trying to give them an extra plug, or even suck up to his bosses – I think he just really likes his job.) “I have never worked for such a fine company as SCI. I have a simple philosophy – it starts at the top! I believe many organizations and the people who work there reflect the attitude of their CEO and senior level management. It all starts with John Holton, our CEO, and filters down.”

I played “Heart Full of Black” (by Burning Brides) on Guitar Hero for the first time today (Xbox360, for those of you not into such toys.) Gosh I was good. I am thinking if this gig with Mr. H doesn’t work out, I may look into some of those Guitar Hero contests and start a new career.

Microsoft’s Azyxxi announces a new contract with Novant Health, a North Carolina-based healthcare system that includes eight hospitals, two nursing homes, and an 800-physician medical group.

Inga’s waiting.