News 8/29/07

From The PACS Designer: “Re: middleware. TPD has commented on service-oriented architecture in the past and wanted to expand on it since it’s the ‘middleware’ software concept that employs SOA. Middleware is a term for software applications that allow various software programs to communicate with each other. Many HIStalk interviewees have discussed middleware. Since it is a fairly new concept, not much has been published about it, even though it’s growing rapidly according to Oracle, which recently stated that it is now a billion-dollar business for them. With the diverse environment within healthcare practices, it sounds like SOA middleware is the concept to bring healthcare new efficiencies for daily  activities that wasn’t available in the past. Oracle Magazine had an article about middleware in their July-August 2007 edition titled ‘Hands-free Management’.”

From XSQ: “Re: Windber. A few weeks ago, Mr. HIStalk posted a blurb about the Windber Medical Center breaking away from the Conemaugh Health System (CHS). Intresting note on CHS that it’s Sidney Goldblatt’s (of Sunquest) home turf and he’s on the board. I agree Nick Jacobs from WMC would be a great interview.” You’ll be pleased to know that CEO Nick Jacobs has agreed to do an HIStalk interview, which I sought at your suggestion. We just have to work around our full-time jobs to find a time.

From Stan Saber: “Re: GE. Are you hearing anything from the GE user group meeting in Boston? Any promises of what’s coming from IHC?” I haven’t heard anything, so I’d appreciate an update from someone who went.

From Neeve deMick: “Re: wireless. Wireless comes up in every market survey as a key obstacle to EMR adoption. Hospitals spend millions on EMR/IT, then get limited or no return because of poor networks. Many EMR benefits are tied to point-of-care and network performance and reliability. COWs sit in the hallways and trench nurses deal with poor solutions while their ‘most wired’ CIOs do national IT speeches. No wonder there is a huge disconnect between dollars spent and user adoption and satisfaction.”

From Jeese: “Re: iMedica. You have mentioned several times that iMedica was started by former Millbrook execs. This is not the case. The former Millbrook execs came to iMedica after Millbrook was sold to GE around 2002-2003. The company was already up and running with a product. Most of the current senior management at iMedica is made up of former Millbrook execs.”

From Bumblebeast: “Re: QuadraMed. The Keith Hagen interview makes interesting reading in light of two happenings since then: (a) Quantim has lost its VP of product management and three product managers, and (b) with the Misys CPR acquisition, you have to believe that Affinity will be relegated to the dust bin, especially since Affinity and Quantim couldn’t be integrated as easily as Quantim and other clinical systems.”

From Portia Control: “Re: IBA. I hear that a juicy scandal will be coming out related to IBA and a deal in Thailand.”

Sorry if you got multiple copies of the e-mail update message about Misys today. The good news is that I had found (and hopefully fixed) a hopelessly obscure server problem that may have explained why some folks haven’t been getting the updates. If you’re a Unix geek, it involves changing the batch submission to a cron job to avoid auto-killing and restarting the Apache HTTP services that run the bulk mail script after memory consumption redlines.

Motorola is suing wireless network vendor Aruba Networks for patent infringement.

I mentioned in Brev+IT what sounds like to me a big waste of taxpayer dollars paid to SAIC for building and maintaining the DoD’s AHLTA system. Someone who should know e-mailed me that the original bid spec specifically said that the public domain VistA could not be used because the DoD was jealous. DoD reneged later, allowing SAIC to use the free VistA for its $1 billion bid, tweaking it enough to ensure highly lucrative annual maintenance. If you’ve got first-hand info, let me know. I hate $900 hammer guys.

Wake Forest Baptist University Hospital (NC) will roll out (no pun intended) a ton of products from EnovateIT: infection control keyboards and mice, barcode scanners, wall mounted articulating arms, CPU holders, and med carts. I’ve been to that hospital (872 beds!) and it’s as highly regarded as Wake Forest University, which has the med school there.

Bruce Friedman was especially pithy in his open letter to Siemens and Intel about their decision to get into the blood banking software business in Malaysia. “Developing a blood bank computer system for even a single small hospital is a project that will reduce grown men to tears … Simple computer errors in blood banking software can easily kill patients. Blood bank software is the only healthcare software that the FDA has chosen to regulate. This regulatory environment plus the complexity of the software has caused many of the U.S. vendors, previously active in this area, to defer to a small number of domain experts.” Soarian blood banking, anyone? Better re-check those bids.Picis hires two new SVPs for professional services and R&D.

The fired CFO of Mee Memorial Hospital (CA) is accused of setting up an automatic electronic payment on the hospital’s account to pay off his personal credit card each month. He’s charged with stealing $96,000, which included donations to his church.

This article definitely sounds like an Intel informercial disguised as news. It’s supposedly about nurses and IT, but it has a lot of background on bit player Intel, including talk about their nursing research and the Motion computing device.

Design Clinicals will integrate FDB’s medical knowledge base into its MedsTracker medication reconciliation software.

A psych patient in physical restraints breaks loose from an orderly and gouges out his own eyes before the orderly can restrain him again. The patient’s guardian is suing for over $10 million. The hospital then billed him for the $2.2 million in care it delivered, which the plaintiff’s attorney calls “mean-spirited”. Only in hospitals is trying to collect what’s owed you considered to be a heinous insult, although granted the ridiculous prices charged to private pay patients almost put me on the patient’s side.

Congratulations to HIStalk reader Ed Marx, formerly CIO of Cleveland’s University Hospitals, just named today as SVP/CIO of Texas Health Resources. That’s where David Muntz was until a year ago when he left for Baylor. I like to think that Ed’s HIStalk-gained knowledge got him the new gig, but that’s a bit presumptious.

I’m here.

Inga’s Update

I loved the posting from Insider Outsider about loving his/her job. Made me wonder what readers believe are the best and worst jobs in this industry. My best job was probably a few years back when I got paid ridiculous sums of money to work trade shows and “demonstrate” software. I got to stay in great hotels, wear fabulous outfits, and always got offers for free dinners. There were some downsides, such as static cling and four-inch heels, but all in all, it was fun.

So, what makes a job “good?” I personally think company culture has a lot to do with it. As Insider Outsider said, more money could be made elsewhere, but it isn’t always about money. I think what really matters is working with people you like and respect, promoting a product or service that has value, and receiving a fair wage is worth more than being the best compensated programmer or salesperson or nurse in the industry.

The Professional Association of Health Care Office Management (PAHCOM) has negotiated a “discount” for members for athenahealth’s PM and EMR services. That part is not so interesting in and of itself, but I sure liked this quote from PAHCOM”s founder Richard Blanchette, a retired Lieutenant Commander in the US Navy’s Medical Department. “I would equate the operational capability of athenahealth to one that is so well coordinated that the U.S. Navy would be dutifully impressed.” (In layman’s terms, I think he was saying things were “ship shape” over at Jonathan Bush’s place).

Acer is buying Gateway Computers for $710 million. Does that mean all those cows will be put out to pasture?

MedAssets, Inc. has filed a $230 million IPO. MedAssets is an Alpharetta, GA-based provider of software to improve operating margin and cashflow for hospitals and health systems.

After all the weeks of rumors about Misys and who they may or may not purchase or partner with, it was interesting to hear that iMedica was the selected company. I have heard their product has a lot of functionality and offers all the bells and whistles that the Misys EMR product lacks (SQL, .net, and a single PM/EMR database.) It also sounds like an ASP offering is in the works as well. The announced plan is to offer the solution at the low end, where Misys EMR has had a hard time competing (due to price and dated technology). The biggest question I have is why would Misys announce this agreement today, while also stating in their press release that the “initial products, including ASP service offerings, will be announced this November?” It would seem to me that Misys is going to have a hard time selling too many systems – at least at the low end – until buyers see what the new offerings are all about. If I were a Misys salesperson I think I would be frustrated and wondering if the light at the end of the tunnel will ever come.

First Consulting Group wins a contract with NYC-based RHIO NYCLIX to build their RHIO infrastructure. FCG’s FristGateways technology will be used for the secure data exchange between provider organizations and the largest hospitals in Manhattan and the other boroughs. FCG will host the data.

A Moscow woman set fire to her ex-husband’s privates as he sat naked watching TV and drinking vodka last week (there’s a picture). While I don’t think it was a very nice thing to do (he claims it was “monstrously painful”) I don’t buy his story that he doesn’t know “what I did to deserve this.” Come on ladies, he “knows,” doesn’t he?

Inga’s waiting.

Misys Licenses Small Practice PM/EMR from iMedica

Misys Healthcare announced this morning that it will license practice management and electronic medical records products from iMedica. Misys will pay $8 million for minority ownership in iMedica plus $5 million in licensing fees. Misys will also get a seat on iMedica’s board of directors.

iMedica was founder by former Millbrook executives in 1998. Michael Nissenbaum is president and CEO.

New Misys-labeled product offerings, including an ASP product, will be announced in November. Misys CEO Mike Lawrie said the deal will allow the company to quickly market a small practice product, an area identified earlier as a weakness.

Monday Morning Update 8/27/07

From Lacey Underall: “Re: VA. I wish I could have been in the room when the House Appropriations Committee scolded the VA for buying vendor EMR systems that weren’t interoperable. I would have laughed out loud. Next time I am looking at systems, I am going to be requiring (particularly if they state HL7 compliant) that the vendor be able to receive and post every single transaction type that they send out. Currently, I am working with an Atlanta vendor that won’t accept any flowsheet data from other systems. They are trying to keep their clinical documentation close to home. We have several systems that allow the input of clinical data elements, however we have to send them into our clinical record as text blobs. The clinicians cannot trend that data in our clinical record. How about stepping up for patient care?” Well said. I like that idea of requiring vendors to receive and manage the same transactions they send. Vendors won’t integrate unless customers demand it, especially the broad-line ones that refuse to acknowledge that customers might cherry-pick.

From Inside Outsider: “Re: liking your job. I’ve been in the industry for 15 years or so. I worked for Sunquest back in the day when it was just growing beyond the Mom & Pop business of Sid’s to the bureaucratic mess it became prior to the Misys purchase. I got out and was happier for it. I moved to the business side of healthcare for a few years before moving to a small consulting company. I love my job. Been here for about 7.5 years so far. We are small, but we all work hard. The company does not push us to bill 80 hours a week, they pay us decent wages, and we can earn bonuses. There is not really much deadwood in the company, unlike everywhere else I’ve worked. We are out there to make other people’s jobs easier, despite many of the negative comments I’ve heard about consultants on your blog. Our customers like us, and I think we do a  good job. So yes, I do like my job. I could make more money out there in the ‘real world’, but I’d probably have to put on clothes every day and go to an office. I don’t want that, and I don’t need that. The owners of the company are awesome. I hope they never sell our company to a big company, because that will probably be the day I go.”

McKesson is hiring 120 people to call people to remind them to refill their high-profit prescription medications … uhh, I mean “to improve patient outcomes by increasing adherence to prescribed drug regimens.” The shocking thing about this practice is that it took manufacturers a long time to figure it out. I was arguing that it was a great business tactic 20 years ago. Why chase new patients when it’s cheaper to just keep current ones taking more of the same drugs under the banner of compliance?

West Penn goes live on Eclipsys and claims nearly 100% CPOE in just a few weeks.

This letter to the editor sounds like something I would have written: “One area that he and Michael Moore missed in the conversation on costs is hospital waste, inefficiency, lethargy and plain stupidity. In my 15 years in the industry, I have witnessed unbelievable waste and ridiculous decision-making on the part of hospital administrators and health care technocrats. For instance, my employer makes imaging software that easily outperforms the GEs and Siemenses of the world at one-tenth the cost. But key hospital decisions are not fully researched; the best solutions are shelved in favor of ‘this is how we have always done it.’ We live in an age of marketing, not of patient care, intelligent decision-making and financial discipline. Our hospitals could function as true health care institutions if they were not consistently in a battle to build Taj Mahals.” I agree, with a caveat: the really dumb and financially irresponsible decisions are made almost entirely by big hospitals and IDNs, whose large egos and bankrolls allow it to happen without disastrous consequences. Little hospitals don’t have that luxury or that motivation. I’ve seen greed, corruption, and stupidity first-hand in hospitals, but never in one under 200 beds.

Here’s a local story on an Ohio hospital’s smart IV pumps (which the article calls SmartPumps). It claims the hospital’s “chemical coordinator” had to “write software”.

Cardinal Health is recalling the Pyxis Anesthesia System 3500 because it can lock up while being rebooted. Only 17 hospitals use it.

This must have been interesting: the 20-year-old doctor asking a 14-year-old girl in a chat room for nude pictures was actually a 72-year-old doctor hitting on an undercover agent. One of the deceitful parties faces a minimum 15-year sentence.

FDA will get access to Department of Defense electronic medical records to monitor prescription drug usage. It isn’t mentioned whether patients have to consent.

iSoft is tired of the one-upping between prospective acquirers IBA and CompuGroup, so it says it will auction itself off if another bid is made.

A UK paper says the Cerner Millennium implementation at its first London trust is “besieged by problems”. Bigwigs called them “expected teething problems”. Worker bees weren’t so nice: “It is an American system and is so long-winded. It has not been adapted properly for British use. Every day someone bursts into tears in my office. One woman is thinking of retiring early because of it. These are not teething problems – the system is rubbish.” They must have some terse software over there.

Say, I wonder who this internal e-mail is referring to? “Blogs” are casually mentioned as part of a list, sort of like that scene in American Graffiti where underage Terry tries to buy liquor: “A Three Musketeers, and a ball point pen, one of those combs there, a pint of Old Harper, a couple of flashlight batteries and some beef jerky.” Anyway, the e-mail concludes, “I trust all of you to exercise good judgment”, which must not be exactly true since an e-mail warning was necessary. I don’t blame the company, though. They should be encouraged that I didn’t get a copy of it for nearly four hours … I often get stuff like this in minutes, so maybe the loose lips are tightening up.

Email me.

News 8/24/07

From Enid Keese: “Re: Initiate. Check out a link between Initiate and Provident Health Plan – Oregon & Northwest. That may be who acquired Initiate.” Hmm. Anyone?

From The PACS Designer: “Re: latency. TPD has dealt with network latencies in the past. Latencies are caused by too much traffic on a network and/or poor planning for daily usage. Some are quick to blame a vendor for not informing them of the network bandwidth required for an new application, but the real issue is the institution has not planned network expansion needs adequately in this new bandwidth-hogging era. Typically, network bandwidth usage peeks in the middle of the day between 9 A.M. and 4 P.M. for most institutions. One alternative is to install a second fiber optic link that isolates imaging file transmissions (which are large) from daily e-mail and system network usages. Whatever is decided, it should be adequate to satisfy network bandwidth needs for at least the next five years to insure adequate planning has been attempted.” Thanks as always, TPD. I like relevant learning squeezed into small bites. Maybe he should do his own “word of the day” type calendar for HIT noobs.

From Stella Hansen: “Re: employers. I think I worked at the same company as ‘Private Joker’. I agree with everything he said. He did forget to mention that this company starts employees at $22,800 per year for getting treated badly. You wanted to hear some good things about employers. Well, I’ve worked at two major software companies and a few consulting companies. After 18 years in the medical software industry, I finally found a company that I absolutely love! It’s called Lucida Healthcare IT. I’m not trying to advertise them in any way (I have no stake in it). I work there as a Senior Consultant and want people to know how great the people are who I work with. First of all, even though I work for the CIO, I feel like I work with him and not for him. Same goes with the Chairman, President and CEO. I love working with the people who get me the jobs as well. They all have a great sense of humor and we have fun working together. They just started this division in Sept. 2006. So far they’ve gotten me some great jobs. I was psyched to find out that I’d be working with different systems (Siemens, Partners, etc.) and not just Meditech and Picis. It gives me a different perspective of how other systems operate. Best of all … they pay well!” I’ll disclaim, since someone will criticize me otherwise: I don’t know Stella, she doesn’t know that Lucida is an HIStalk sponsor, and she’s not a shill (she used her real e-mail address). I’m also pretty sure she didn’t work at Private Joker’s company (for reasons I can’t divulge), but it sounds like she’s equally glad to be out.

From Nick Rails: “Re: RHIOs. Thought you would find this article interesting. I know you have commented on the demise of several high profile RHIOs across the country. I agree that. for the most part. these community health organizations were set up to fail (no defined business model to support itself once goverment funding ran out), but it is good to see different models actually work.” Link. The article says the Cerner project at Winona Health (MN) is a success. I hadn’t heard much about it lately. I know I was impressed when it was first announced.

I haven’t made music recommendations for awhile because a few readers complained (they must be really busy to begrudge me a couple of sentences out of a bunch). Listening to now: new Operator. Strong, hard-rocking album – could be the next Chili Peppers. Now back to your regularly scheduled programming.

I’ve been fussing about non-informative press releases, so here’s a good one for a change: privately held physician EMR vendor Greenway Medical Technologies announces a 41% revenue increase over FY06, 600 practices as customers, and its community EHR initiative. It has a good quote from the CEO, some comments about its growth, and product certification information. Good information, no flab, well done.

Here’s a reader’s idea I’ll run by you. Would you be interested in an ongoing HIStalk salary survey that would cover IT management, vendors, consultants, informatics, etc.? I can do it if folks would participate and find value (I’m not looking for busy work). Thoughts?

Misys announces another 22 layoffs in Raleigh (already reported here, but now official). They say (again) that no more are planned. Headcount is still higher than a year ago.

Odd UK news: hospital employees can’t leave work without changing back into street clothes. People complained after seeing them in bars. Personally, I like seeing uniformed lasses on liver rounds, but that’s just me.

Mercury Computer Systems announces a medical imaging subsidiary.

IBA Health said it would concede iSoft to CompuGroup. It lied. IBA raises its bid and says it will beat CompuGroup, which would make IBA the largest healthcare software company outside the US (Australia).

Industry longtimer George Giorgianni leaves DocuSys for Unibased Systems Architecture.

Congress is prepared to throw a lot of money at the VA and hope it uses it to improve veteran care: $109 billion in 2008 spending, of which $65 billion is discretionary. $1.9 billion of that would be for EMR and integration with DoD’s AHLTA. “In its measure, the House Appropriations Committee scolded VA for developing EMRs with programming language that is not compatible with Defense health systems. The committee report calls for blocking any expenditures on EMRs that won’t work with Defense systems. It also urges VA ‘to involve leading software companies’ so that veterans’ ‘will be interoperable with existing systems used by the private sector, and the report advocates ‘a portable EMR so that veterans may have a personal electronic record of their care.'” Those politicians need to get out more. Where in the world did they get the idea that vendor systems are interoperable or that programming languages are the culprit? They should be talking to an integrator. We’ve already amply established that software vendors have every incentive to keep their stuff proprietary and non-interoperable.

Siemens continues its undisputed world dominance when it comes to being investigated for bid-rigging. Add Indonesia to the list of countries going after the company. Several vendors bidding for a hospital project there were suddenly dropped, leaving Siemens free to overcharge as the lone bidder, the charges claim. Their KLAS PACS scores may offer an explanation: they’re dead last among 11 vendors and so far beneath #10 that they might as well not even be in the race. You’re gonna have a tough time moving that iron without cheating.

The Feds bust a South Florida infusion therapy billing company and charge it with $105 million in false Medicare claims. Medicare says anti-fraud software stopped $1.8 billion in false claims in two years. Scammers bribed homeless, HIV-positive people to let them bill Medicare for drugs. As a result, South Florida AIDS infusions cost $16,000 per patient compared to $2,000 in New York.

Mike Leavitt has already overcome a common blogger malady: not posting regularly. He’s toiling away at it, which is more than you can for many healthcare IT blogs, which just hang there un-updated in cyberspace with no goodbye or maybe an overly optimistic “be back soon” post.

I always read your e-mails.

Inga’s Update

The Wall Street had an interesting article about the trend for doctors to recommend bariatric surgery as a “cure” for diabetes. The surgery alleviates diabetes in almost 77% of the time. With 20 million Americans affected by diabetes, there is potential for a huge population to look towards surgery. Last year 177,600 people went under the knife. Just think how the face of healthcare would change if we had even a 25% decline in the diabetic population.

eClinicalworks makes Inc Magazine’s 26th annual 500 list of the fastest-growing private companies in the US. ECW was 34th and also the fourth fastest-growing company in the software industry. I just looked at the list quickly but also saw Hospital Partners of America at #3.

News 8/22/07

From Madrigal: “Re: Meditech. Meditech is teaching MAGIC programming at UMASS.” Link. The CONNECT people could use some help with HTML layout for non-IE browsers, obviously. Anyway, classes will be given in Fall River and Meditech may hire some of the grads for the new office there. Five weeks and 30 hours gets you MAGIC training plus an overview of healthcare informatics and maybe an entry level job. Not bad, depending on what you were doing before.

Art Vandelay, one of my favorite posters because he’s thoughtful and analytical, did a great writeup about Wal-Mart in healthcare in HIStalk Discussion. Good predictions: one-stop shopping, reselling its franchise model to employers, targeting small business, steering its own employees to in-house services, using technology to brand their operation as high throughput, rapid diagnostics, and several more. Art gets five stars for this one. It will make you think (maybe even enough to post a reply with your own predictions).

Private Joker e-mailed me from an old HIStalk post he ran across in which employees of a certain (name expunged) HIT company were ripping it. I extracted a few of the less inflammatory comments about his time there as an employee: “Worst time of my life … ones who stay have probably lost the edge to get out into the competitive market or are happy to be treated like dogs … totally unplanned and unrealistic deadlines … the software is full of bugs and the database and application architecture is so badly designed that a very robust RDMBS like Oracle 10g comes to a grinding halt … I’m glad I’m out of there and have regained some of my dignity and life back.” Makes me feel better about my job – how about you? In fact, if you really like your job and employer, how about giving me some details since I rarely get those?

A sartorial update from Paul Burmaster, who chides CIOs for casual dress at conferences: “I’m at a great CIO conference, not just for healthcare, and a few are walking around in shorts while everyone else is appropriate business/resort casual. I bet no one wears shorts during the sessions at CEO conferences. The black tie ceremony will be interesting.” A lot of them are former programmers, so shorter inseams alone aren’t as bad as it could be. Nothing’s more depressing than a balding, graying, paunching ex-flower child who still wears wire-rim glasses, hiking shoes, and a backpack. Can anyone look at a ponytail-wearing or do-ragged grandpa without suppressing a giggle?

Scott Shreeve points out that HHS Secretary Mike Leavitt has a blog. It actually sounds like maybe he writes it himself instead of having some overzealous staffer cranking out babbling politician-speak. He mentions AHIC 2.0, as he calls it. He allows approved comments, including one from some other blogger who incessantly pitches his own stuff under the pretext of commenting (I zap that stuff right out when I get it).

From Sales Reporter: “Re: HBOC. Even guys who weren’t the big fish had days of the month exceeding 31 for contracts in their sales regions. Ask any of the reps. Maybe following orders, but not innocently.”

From EMR-Dude: “Re: Allscripts. Seems you have missed the VP of Marketing for Allscripts depature. This link shows Guy Mansueto is now working local in Tampa. Maybe this is better for the family life.” Link.

Also from EMR-Dude: “Re: Allscripts. Misys/A4/Allscripts longtimer David Bond is leaving the Allscripts Healthmatics division at the end of the year. David has been the president of that division since John P. McConnell’s depature. Maybe Ray and David will resurface at some spinoff of Med3000, which is where Steve Ura (the old Chief Technology officer for A4) went this past summer.”

From Breakers: “Re: PHRs. I’m just not that excited about PHRs. I’m a physician, and it’s even a challenge for me to manage my mother’s health records, and I understand what all the terms mean. All but the most curious and persistent don’t have a clue what happened to them in any detail beyond ‘I had a virus’ or ‘the Xray was normal’.  I just can’t see people actively managing this kind of information. When it comes down to it, someone who is caring for them will manage the information for them, and we already have a chart for that.” I’m with you. Any plan for a useful PHR better include feeding it data, since most Americans don’t have the time, interest, or literacy to sit down and document anything you’d want to use for making treatment decisions. If it’s the electronic equivalent of stuffing your old tax receipts into a file folder, then it might work. Asking someone to describe how they PREPARED their taxes? No.

From Holy Crap: “Re: This is the first time I’ve seen a grammatical misprint on HIStalk. Are you not perfect? LOL. Also, have you thought about updating HIStalk2 a few days before Histalk so you migrate folks to the new look and feel?” Guilty as charged on the misprint – my fatigue was showing through. Here’s a recap on how the sites work: I consider the primary site to be the new one (you go there if you just type www.histalk.com in your browser, but the actual URL is www.histalk2.com). I still keep the old Blog-City one updated as a backup, but I can tell you I rarely look over there otherwise. For e-mail updates, I suggest signing up for the new one (the “Subscribe to Updates” option to your upper right) and if you’re still getting updates from Blog City, unsubscribe from that one via the link at the bottom of the e-mail. A little complicated, I know, but you’d be amazed at the number of new readers who’ve come over since I put the new site up (not uncommon with a migration to WordPress and a sexier design, I’m told).

And speaking of signing up, here’s one last sneak preview of the Brev+IT weekly newsletter. I’ve gotten quite a few positive comments, most noticing how it doesn’t really overlap with HIStalk at all (it’s a summary with more analysis of the five biggest stories of the week). Help me make it popular: sign up using the Brev+IT subscription box to your right (with the logo) and forward the e-mail to others who might be interested. It has 390 subscribers so far, but I’d feel better about spending the time if it had a few more.

And speaking of Wal-Mart, an HIStalk reader has started a blog called Healthcare IT: Analyst’s Views and he’s tackling the Wal-Mart topic, too. Blogging is hard work (even when it doesn’t look like it), so give him a click and some feedback. It’s lonely when you’re just getting started and no one (and I mean NO ONE, in the early 2003 days of HIStalk) is reading.

Terry Wilk is named VP/CIO at Henry Medical Center (GA). He comes from Southern Regional Medical Center (GA).

Three Scottish health boards sign up for Carestream Health (formerly Kodak) PACS.

Another non-news press release: Mediware announces that its medication reconcilation product “is exceeding expectations” (right at this minute?) but doesn’t bother to tell the reader what either the expectations or the sales were. I’m inferring that both were modest. As a PR professional who reads HIStalk pointed out, that’s usually the mark of a company that lets just anybody write up press releases with no oversight or professionalism since the pros know it should at least sound like imperative news even when it isn’t.

An Oregon heart surgeon who created one of the first surgery outcomes databases has died. Urlin Scott Page started what is now Axis Clinical Software in 1980 but had developed outcomes tracking software years before.

Partners Healthcare chooses AgilePath for service-oriented architecture consulting services.

Lean Six Sigma, like all quality fads, has been one-upped. Now there’s the new and improved Supply Six Sigma. It’s trademarked, of course, and proprietary consultants will tell you all about it once the meter starts running.

Siemens is named yet again as being the benificiary of a questionable hospital bidding process, this time in the Czech Republic. Three hospitals chose the low bidder, then expanded their bids and invited only Siemens to participate. The lame excuse of one hospital: nobody complained by the due date. Siemens won in one hospital despite a bid higher than that of Philips and Toshiba. At my old employer, they bribed damn near everybody involved with the PACS decision with phony fact-finding trips to Germany. Despite being ranked dead last by the selection team, they nearly won the bid anyway because the thankful junketeers were prepared to override the decision until cooler heads prevailed (the complex, “no capital required” contract was going to end up costing something like $50 million over a few years, our non-junketeer finance people nicely pointed out).

A couple of readers enjoyed the partial list of interviews I’ve done. Thus encouraged, here are the rest. I have my favorites and I enjoy re-reading them.

Peter van der Grinten, dbMotion
Robert Connely, Novo Innovations
David Blauer, Click4Care
Don Schoen, MediNotes
Andy Ury, Practice Partner
Glen Tullman, Allscripts
Girish Kumar, eClinicalWorks
Gerard Dab, VisualMED Solutions
Keith Hagen, QuadraMed
Denni McColm, Citizens Memorial Healthcare
Jon Phillips, Healthcare Growth Partners
BB Babowsky, Sales Guy Who’s Been Around
David Wortman, Mezzia
Kevin Fickenscher MD, Perot Systems
Editor of WhereTheMoneyGoes.com
Scott Shreeve, Medsphere
Erik Johnson, The Advisory Board Company
John Holton, SCI Solutions
Paul Egerman, eScription
Kipp Lassetter, Medicity
Mark Groper, DINMAR
Todd Cozzens, Picis
Howard Messing, Meditech

I read and appreciate every e-mail sent to me. If you have news, rumors, or opinion, why keep it to yourself? E-mail me, or use the anonymous Rumor Report to your right.

Inga’s Update

Sprint and GE Healthcare announce a collaboration to provide in-building wireless communications services to hospitals. The communication networks will leverage GE’s CARESCAPE Enterprise access and include Sprint handsets. Hospitals will require only one installation for voice and data communications over secure cellular, Wi-Fi and telemetry. You have to hand it to GE for their efforts to penetrate every area of healthcare.

I have been thinking about Mr. H’s question about what impact Wal-Mart’s in-store medical clinics will have. While Art_Vandelay definitely covered the topic extremely well, I thought I would throw out my less articulate and less well-thought out ponderings. Actually, I was thinking back on the days I use to travel quite a bit. When I was in a new town, I would often find myself looking for Starbucks for coffee and Fed-EX Kinkos for copies. Why? Because I knew exactly what those establishments had to offer. Over the years I had been sick on the road a couple of times and had to schedule a doctor’s visit. Rather than hunting to find a clinic, then wonder if they would take my insurance, and question what kind of care I would get, I think I would have preferred going to a Wal-Mart. Presumably there would be some consistency between clinics, including the quality of care and insurance options. Also, I would assume that if I had been to a Wal-Mart clinic in Topeka this week and Miami the next, my medical records would be available on line. I think consumers will embrace the concept, and, I am sure that at least the primary care world will feel the effects. Clinic hours convenient for working parents with sick kids or the “working sick”? Great! Free parking? Awesome! Socks on aisle two and paper towels on aisle 12? Works for me!

MediNotes releases the results of an internal study of their 4,300 clients’ top concerns for selecting an EMR. Top was the need for successful implementation and support, followed by total cost of ownership over a three- to five-year period, functionality and interoperability, IT expertise, and time necessary to make the paper-to-EMR transition. MediNotes also claims that they have achieved a 94% implementation success rate since January 2006, compared to 40-60% for all EMR’s. I am not sure how scientific their study was, but the purchasing concerns sound about right to me. In regard to the implementation success…I suppose the first question to ask for a definition of “implementation success.”

Yuma Regional Medical Center in Yuma, AZ contracts with MEDSEEK to develop an enterprise eHealth strategy called eMap.

Appalachian Regional Healthcare (ARH) announces it will deploy McKesson’s Horizon Ambulatory Care EHR system to more than 190 employed and affiliated physicians in rural communities across eastern Kentucky and West Virginia. ARH will offer the purchase of the EHR at substantially reduced rates to affiliated physicians in its service areas and will provide maintenance and technical support. ARH already had several McKesson products including pharmacy automation and a physician portal.

Inga’s listening.

Monday Morning Update 8/20/07

From The PACS Designer: “Re: ASM. The abbreviation ASM might not be familiar to most HIStalk readers, but it will be seen more as we migrate toward more enterprise-driven software platforms. ASM stands for Automatic Storage Management and is the software that controls how data and image files communicate with an archive. ASM is going be more commonly used with Ethernet and TCP/IP usage. Techworld Online Magazine had an article last year that explains ASM along with some technical format ideas for techies on how to set one up for enterprise usage.” Link.

From John: “Re: Wal-Mart. From the Wall Street Journal: ‘In health care, Wal-Mart sees itself providing an array of services and home-health equipment along with prescription eyeglasses and pharmaceuticals that it already sells according to a person familiar with the effort. ‘In five years, Wal-Mart wants to be on its way to becoming the No. 1 health-care company in America,’ that person said.’ The company said it will open up to 400 in-store clinics in the next three years, bringing them up to 2,000 within 5-7 years.” Now that’s interesting. They’ve got a lot of buying power, both as a healthcare provider and consumer. Will doctors and nurses end up having mostly retail chain employers, just like the majority of optometrists and pharmacists? Everybody’s speculating endlessly that Google might roll out a PHR, while plain old bricks-and-mortar Wal-Mart is quietly cornering care delivery itself. Hospitals, medical practices, and labs that are indifferent to providing value and paying attention to the customer experience should be concerned. You can argue smugly about how low-rent and plain they are, but you’ll have to take a spot in line behind all the nay-saying grocery stores, pet stores, clothing stores, and pharmacies that are being crushed under their wheels ahead of you. They’ll spend money on IT, too. Post your thoughts in HIStalk Discussion. What impact will the company have?

Michael e-mailed me about Medicity, wondering why the company is under the radar for many hospitals that have poor inpatient/ambulatory systems integration. I asked CEO Kipp Lassetter, who said Medicity is working hard to get the word out about clinical interoperability. Their numbers: over 300 hospital customers, 135 interfaces inbound to hospital systems, and 1,750 interfaces feeding data to PM/EMR systems. They’re managing 100 million clinical messages a year for hospitals, IDNs, LabCorp, and statewide information networks in Delaware and California. Maybe it’s too easy for CIOs to just call up their HIS vendor, although I don’t know that those companies will always have the right experience and motivation to get the job done.

Vince Ciotti mentions that H.I.S. Professionals will be offering another two-day “mini-HIMSS” in Chicago on October 3-4, with several HIS vendors doing presentations and demos. He says a lot of old friends contacted him after his interview here.

Welcome to new HIStalk Platinum Sponsor Sentillion, the folks who created healthcare single sign-on (ever notice how hard that is to type?) They’re in the Healthcare Informatics Top 100, have over 250,000 live users, and offer five-nines availability. I notice their Q2 was big for single sign-on, user provisioning, and virtualized remote access. They’ve got some big secret announcement coming soon, which I know only because they warned me cryptically, “We will need to change our ad often and on specific days – can you do that?” I guess we can all watch the ad together to see what’s coming (it mentions “expreSSO”, so take your best guess). Anyway, thanks to Sentillion for supporting HIStalk.

A reader suggested I run links to previous HIStalk interviews to make them easier to locate. The full list is here (25 CEOs so far, plus several other high-ranking and interesting folks), but here are the most recent ones:

Ken Creager, Meru Networks
Vince Ciotti, H.I.S. Professionals
Cindy Dullea, SCI Solutions and the United States Navy
Michael McNeal, Emergin
Kim Pederson, Allina Hospitals & Clinics
Toni Rienzi, NYU Medical Center
Stanley Crane, Allscripts
Adam Gale, KLAS
Ed Daihl, SIS
Jim Morrow MD, North Fulton Family Medicine
Gary Kennedy, RemedyMD
Dewey Howell, Design Clinicals
Glenn Galloway, Healthia Consulting
Mike Cottle, Sumter Regional Hospital
Scott Decker, Healthvision
Bruce Cerullo, Lucida
Jon Phillips, Healthcare Growth Partners
Justen Deal, Kaiser Permanente
Tom Skelton, Misys Healthcare
Jonathan Bush, athenahealth

Mike Smeraski, now at Eclipsys, pays $50,000 to settle the SEC’s stock fraud investigation against him from his HBOC days. I read over the charges awhile back and got the impression that his bosses were doing all the fraudulating, not him, and I’m guessing the relatively paltry $50K fine reflects that. The Big Fish is still swimming (or sailing) freely, of course.

QuadraMed releases Version 9.0 of the scheduling system formerly known as TempusOne.

Brookhaven is live on Soarian. If anyone from there has a first-hand report for me, I’m listening.

A reader asked about lobbyist spending by HIMSS, leading Adam (“long time fan, first time caller – er, e-mailer”) to send over its federal 990 form (disclaimer: I’m not an accountant, but I’m reading it as best I can, and HIMSS will be due to file a new 990 shortly). It shows $1 million in lobbying expense. Other high points: HIMSS had $31 million in revenue, with $17 million from the annual conference and $4.5 million from publishing. Membership dues are listed as bringing in $4.2 million. Expenses were $32 million. It paid about $10 million in salaries and bonuses, of which CEO Steve Lieber got $485K. The form says HIMSS owns $16.6 million in investments, mostly stocks (it doesn’t say which companies’ shares) and sold $42 million worth during the year (I don’t understand that huge number for sure). HIMSS Analytics took in $5.1 million. HIMSS paid $331,000 in credit card fees (!) and $3.2 million in consulting fees. The form says HIMSS made $317K from professional services and $752K from industry affairs, each line footnoted to say that’s from “representation of the society” in government affairs/health industry events, so I’m not sure who’s paying that. HIMSS owns a chunk of Medtech Publishing that it values at $544K, which brought in $89K of income. If you’re an accountant and want to give a more professional interpretation, I can send the PDF over.

LA’s Antelope Valley Hospital will migrate from 70 Dell servers to four virtualized IBM 3850s.

Epic’s $100 million learning center will open next month in Verona. The horseshoe-shaped building is painted red to resemble a barn. The auditorium seats 5,300 and will be nearly full for the company’s September user group meeting. Campus 2 is already underway and will cost the same as the recently opened Campus 1: $150 million. The treehouse will be open this fall (I’m still waiting on Judy’s offer to sit up there as the company scribe). The article says Epic’s revenue last year was $422 million, about a third of Cerner’s and a little more than Meditech’s.

Need evidence that most press releases are rarely newsworthy and sometimes don’t even involve news? Oracle fires off an urgent release that describes TheraDoc’s choice of Oracle for its database … seven years ago. I shall alert the media.

Cisco says hospitals its strongest sales growth is coming from hospitals, bringing in about $1 billion a year.

A software developer in a UK hospital goes to jail for downloading kiddie porn at work. He claims a virus did it.

InterSystems subsdiary TrakHealth gets a 10-year contract to provide an EHR in the UK. You may recall that InterSystems acquired the Australian company, a former development partner, this past May.

E-mail me. Or, use the Rumor Report to your right. I’m fastidiously confidential with sources, so you need not fear being outed. A reminder, too: I’ve been writing HIStalk for over four years and all of it can be searched using the Search box to your right. Thank you for reading.

News 8/17/07

From John Winger: “Re: Ingenix. Ingenix acquired LighthouseMD. Not sure when it will hit the wire, but I hear it’s public within Ingenix.” Thanks for that info. Does it seem like just about every semi-cool, little-known physician EMR vendor is getting bought or buying someone else? I admit I’m mostly a hospital guy, but I’ve never heard of most of these companies.

From Reggie Hammond: “Re: Misys. I hear that Misys is looking to do some sort of partnership with e-MDs. Misys wants to resell e-MD’s new ASP software. I think it makes sense because Misys has been wanting a lower-end ASP integrated PM/EMR option and the Amicore effort failed. Look for Kelley Schudy (former head of Physician System sales) to oversee the transition and then leave. Also, speaking of leaving Misys, three HR VPs have announced their resignation, though it is unclear if any/all will leave now or over the next few months.” Reselling a much hotter company’s software? How far the mighty have fallen.

From Billy Bear: “Re: Misys. After having been pared down to the bone to make the books look good for the Vista Equity buyout, Tucson support staff have been told the deal is contingent on their reducing the (large) volume of outstanding support calls. That may be true, but it’s more likely current management trying to shift the blame.” I doubt the deal hinges on it, although incentives may be in place. There’s nothing that keeps already antsy customers happier than demanding that terrified support reps prematurely close their support tickets.

From Cheryl: “Re: Google Health. Here are screen shots.” Link. Not much to look at. I bet it’s got a good personality.

I read an interesting editorial about Citrix’s purchase of virtualization software company XenSource for $500 million. Aimed at private equity guys, it argues that the VC model is less successful than incubating a company to begin with and (surprisingly and arguably) less risky. That’s an interesting thought since most companies jump in big only in later rounds. They also mention that Citrix probably wishes it had latched on before competitor VMWare did its own blockbuster IPO this week ($1.1. billion raised – priced at $29, now nearly double that).

I noticed that Lucida Healthcare IT has a new web page design. I know it’s geeky to watch for that kind of stuff, but it fascinates me. I think their current consultant openings page is new – lots of Meditech, Epic, clinicals, imaging, etc. They also offer a Personal Career Advisor and a Star Service Concierge Specialist to help consultants keep everything running smoothly, locating engagements, and structuring compensation. The site lists the engagement options that Bruce Cerullo talked about when I interviewed him.

And speaking of cool new sites, eScription has one, too. Will companies have to update yearly to keep up with new design styles, kind of like buying a new car every year? It’s looking that way, but the Web 2.0 stuff was the first big change in awhile.

SureScripts joins NACDS, NCPA, AAFP, MGMA, BCBS, and Intel to form The Center for Improving Medication Management. It will perform research on using electronic linking technologies (like that of SureScripts, let’s say) to improve prescribing, dispensing, and using medications as well as measuring outcomes. They’re talking about bringing in RAND for a study. If they can keep it non-proprietary, they could do some good work. E-prescribing and electronically managed refills will bring patient compliance issues (of which there are many) out of the closet.

Gerard Dab, CEO of VisualMED, is interviewed by the Wall Street Reporter. I liked their product when I saw it many years ago and I still think they’re kind of a cool company. I interviewed Gerard last year.

Barnet and Chase Farm Hospitals become the first London NHS facilities to go live on Cerner Millennium.

New executives at anesthesia software vendor DocuSys: Robert Watson, formerly of Concuity and Cerner, is named CEO. Joseph Heins is the new EVP/COO after previous stints at Eclipsys, Cerner, and Infoway. If you’re an up-and-comer suit, it’s obviously good to have worked at either Cerner or GE Healthcare since those folks are popping up everywhere. Does that mean we’ll end up with a boatload of companies just like those two?

Another former Eclipsyser, Noel Strong, is Mediware’s new CTO.

Google bundles Sun’s StarOffice in its Google Pack, meaning its price just went down from $70 to $0. I’ve used it (a little) and it’s a nice option when you otherwise have to pay for Office (like for your kid’s computer).

Transaction processor MedAvant announces Q2 numbers: revenue down slightly, EPS -$0.31 vs. -$0.14. That’s if I did the math right, since EPS wasn’t reported (I can see why).

The VA and DOD are issuing millions in healthcare IT contracts. The recipients aren’t surprising: Northrop Grumman and Booze Allen (oops, that’s Booz). Somehow noble-sounding government initiatives always end up meaning millions for SAIC, Accenture, BearingPoint, or all the other high-price, insider IT mercenaries out there. Not surprisingly, once their people are on the ground, the government never seems to find a way to dismiss them and do the work with its own employees.

Rodney Schutt, formerly of GE Healthcare, is named COO of Luminetx.

Siemens and Intel will co-develop an electronic blood banking system for Malaysia’s 334 hospitals.

Verus, the healthcare billing company that made itself a household name by allowing all kinds of data breaches involving its hospital clients, has shut down. Investors pulled their money and MedSeek has taken over some of its business. A spokersperson said it was really just one IT error that caused all the problems. The fifth hospital, Sky Lakes Medical Center (OR), announced a Verus-caused vulnerability today. You just know there’s some nerdy network engineer who screwed up and brought the whole company down in the process.

LA County supervisors vote unanimously to shut down Martin Luther King Jr.-Harbor Hospital (a.k.a. King-Drew, a.k.a medical cesspool). One supervisor said it best: “I don’t know how you’d be able to tell how stupid some of these people are. I mean when I read this, I can’t see how a nurse couldn’t mix medicine. I can’t see how she says, ‘I don’t know where to find this instrument.’ That is incomprehensible.” On the other hand, someone had to have hired that person and supervise them, so I’d blame the bosses. The closure plan is here (warning: PDF). Here’s the CMS report (warning: PDF).

Another flavor of medical tourism: US seniors are heading across the border to live in nursing homes in Mexico. And why not, for $1,300 a month? “Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.” I’m ready to head there now. If they have broadband, I can write HIStalk from there while sipping Dos Equis and eating carnitas and flan. The ladies are pretty there, too, although Mrs. HIStalk wouldn’t find that a plus.

Windber Medical Center (PA) cuts its ties with Conemaugh Health System and goes independent. CEO and blogger Nick Jacobs goes public with a plea to get the word out about Windber, although they’ll need local exposure instead of national to survive. A reader suggested I interview him. I’m game. I’ll evaluate and brag on its IT function if it’s any good.

IBA Health finally surrenders to CompuGroup on its attempted takeover of iSoft.

Philips buys RIS vendor XIMIS, whose site doesn’t say who runs the company. I hate that crap. Is it embarrassing or something? I’m going to start critiquing HIT-related web sites. Would that be entertaining or would you glaze over?

CMS is offering Web-based education for doctors interested in implementing EMRs for their practices.

Internet trade association USIIA opines on healthcare IT. Recommendations: more broadband, physician incentives for EMR adoption, and anti-Net neutrality. I was going to see who its members are, but in a delicious irony, its site was down. Maybe some of us healthcare geeks should return the favor and criticize how they run their industry.

News, rumors, HIStalk government contracts: e-mail me.

Inga’s Update

Ethidium is a company I hadn’t heard of until earlier this year when Take Care Health Systems (a Walgreen’s subsidiary) implemented their clinical software in 16 of their clinics, all of which are located in retail pharmacies. Ethidium has a line of products that include an ASP-based EMR, a personal health record (PHR) option with patient portal, and medical decision making tools. Now Ethidium announces it has acquired exclusive ownership of VLink health information exchange from Vaceris, which will enable Ethidium to offer connectivity needed by RHIOs, IPAs, etc. VLink is currently implemented by the 1700+ doctor Genesis Physician Group IPA in Dallas (oh by the way in HealthVision’s backyard.) No word as to whether Genesis is looking to offer their doctors an option for the Ethidium EMR solutions, but you have to believe they would love to. About three years ago Genesis had secured preferred pricing A4 health Systems/ Allscripts, GE Medical Systems (Centricity) and NextGen but the rumors are that not too many physicians took advantage of the offerings. I think Ethidium will be an interesting company to watch over the next few months.

WiFiMed Holdings Co. of Atlanta has completed its acquisition of JMJ Technologies Inc. JMJ is the developer of the EMR product EncounterPro.

Blue Shield of California announces it will award $31 million in pay-for-performance bonuses to medical groups and IPAs that showed performance improvements.

Talk to Inga.

News 8/15/07

From John Winger: “Re: Ingenix and Healthia. I don’t see the fit. Healthia’s focus is professional services, primarily Epic implementations although they do other work at United. Not too surprising to me that their CFO would be here – I’ve seen their COO on site and just assumed it was related to consulting business development.”

From Jessica Bradford: “Re: Initiate. Anybody making any bets about why Initiate is going public? Could it be that Oracle is shopping for a strong partner for their healthcare EMPI business? God knows Oracle has bought enough companies recently that acquiring one more wouldn’t be beyond their business strategy. Or could IBM be the suitor? Inquiring minds would sure like to know ….” Maybe the CIA, the company’s investor, wants to bank some cash before the next election.

From The PACS Designer: “Re: RFID. TPD has been following the trend of incorporating radio frequency identification tags (RFID) in healthcare processes. It appears to make sense since there is so much equipment in hospitals and sometimes it can’t be found when needed. The RFID industry is expecting increased business the rest of this year and next year, according to a recent Frost and Sullivan Report, as the solution is finding its way into an increased number of institutions other than the traditional distribution channels. Since healthcare needs to improve efficiencies due to tight budgets, RFID makes sense, where knowing the location of valuable equipment can guarantee having the right equipment at the right time and place in such places as the OR and ED department. By having things handled more efficiently, institutions can cut down on new purchases and help the budgeting process.”

From Peter Smythe: “Re: HIMSS. Since you mentioned the amount McKesson’s paid for lobbyists this year, it might be interesting to see what HIMSS is paying for lobbying and advocacy, instead of using member dues and fees to help its membership. It seems that HIMSS has become what it professes to be against. The organization caters to vendors and spends money on the lobbyists instead of catering to and educating its membership. The number of almost daily HIMSS emails to members is bordering on spam, with the vast majority selling something. It might be that it has grown too large to fulfill its primary mission or it might be the leadership is more interested in personal recognition. HIMSS could take your lead and offer an RSS feed and brief weekly email that offers value.” They don’t put their 990 forms online that I can find. I’ll see if we can’t scare up a copy.

The Portland, OR city-wide RHIO (Health Data Exchange Group) is comatose and not expected to survive. Nobody wants to pay the $3.4 million needed this year or the $150K annual cost that each hospital would have to chip in. CIO Dick Gibson of Legacy Health was honest in saying that, in addition to the costs, hospitals would lose up to $10 million in those avoided duplicate tests that they still get paid for. Those involved can’t even reach consensus on why it’s tanking, which isn’t a good sign.

Good news from Sumter Hospital. The insurance company has agreed to replacement of the destroyed building. There’s work yet to be done, but that’s encouraging. Fundraising is underway to cover the $10 million shortfall.

Updates from Medicity from their newsletter: the Delaware Health Information Network (a Medicity client) received its state funding, despite earlier reports suggesting otherwise. Medicity’s Clinical Clearinghouse is mentioned, an ASP solution that routes information from hospital clinical systems to physician EMRs. There’s also a new version of ProAccess, 4.0.

Thanks to the readers who tipped me off early on the Perot acquisition of JJWild. HIStalk ran it first, of course, both as a rumor and as fact (that second part because a reader somehow found the announcement buried on a public Perot site even before the press release hit the wire). $89 million? Sweet. That’s quite a testament both to JJWild and to Meditech. Where else could you build a business worth that with one vendor package as your focus? Perot picks it up for 1x revenue, although that’s probably a good for a consulting outfit. FCG’s market cap is $247 million, which is just less than 1x revenue, but they’re a publicly traded company.

The KLAS Mid-Year Report ranks eScription’s EditScript software #1 in Transcription and Back-End Speech Recognition with a score of 90.74. That’s four years in a row.

Last reminder for now: the Brev+IT weekly newsletter comes only to those who sign up to your right. Also: I have some interviews coming up, but would like to do more with those on the provider side (informatics, IT leadership, hospital visionaries, etc.) If you’re interested and interesting, let me know.

McKesson’s Relay Health announces its NotifyRX product. It sends critical drug company announcements to pharmacies, such as recalls and packaging changes.

Google Health has been previewed to a few clinicians, some of whom spilled the beans. What it contains: a health profile, suggested treatments, drug interaction lookup, exercise regimens, pages for sharing information, prescription and appointment reminders, and provider directories. It had better be more exciting than it sounds since just about every starry eyed kid with web skills has come up with these ideas already. It may be more like a consumer magazine than an IT application and those always put me to sleep.

Irish wireless applications vendor Valentia Technologies will open an office in Dubai’s Healthcare City in November.

Merge Healthcare will restate revenue and faces delisting yet again after delaying financial reports after a review of accounting rules for maintenance revenue.

A senior diplomat in Korea’s Chinese embassy dies after receiving a Rocephin IV injection that a Chinese clinic gave him for a stomach ache (for some reason).

A big shareholder in Quality Systems, Inc. complains to the SEC over board governance. I didn’t realize that the company’s market cap is $1 billion, pretty much all it from the NextGen product, I assume. Founder Sheldon Razin’s shares are worth $98 million.

Workers at a hospital in Scotland are taking heat over their YouTube video “MRSA”, which features staff dressed like the Village People and singing altered lyrics to “YMCA”. The hospital is the third highest source of healthcare-related infections in Scotland, so we were not amused over there. I couldn’t find the video.

News, your great ideas: e-mail me.

Inga’s Update

I have enjoyed reading the first couple of Brev+ITs. Even though I read every word of HIStalk, I must admit that some topics don’t interest me as much and/or I don’t understand it all (!) Thus even as HIStalk Queen (as Mr. H likes to call me), I find that the quick and dirty summary is very helpful.That being said, I found that I had a bit of difference in opinion from Mr. H last week when he applauded the recommendations for EMRs to include anti-fraud tools. Not that I disagree with the need to reduce fraud. However, shouldn’t HHS worry as much (or more) about such things as insurance underpayment as they are seeming to worry about fraud? Which is more prevalent – fraud or insurance underpayment? Am I being cynical to think that the big insurance company lobbies are behind the efforts to reduce fraud … yet another way to not pay out as much? If HHS is going to serve as Big Brother to watch for fraud from the providers, shouldn’t they also ensure EMRs assist providers to receiving all the reimbursement to which they are entitled?

Northrop Grunmman Corporation is awarded a $10.3 million contract with the Department of Defense to deploy, enhance, and maintain the Clinical and Health Data Repository initiative to help the Defense Department and VA share patient information.

Misys PLC founder and former Chairman Kevin Lomax is now Executive Chair of Enigmatec, a UK-based company that provides policy-driven automation solutions for resource management.

Private equity firm Galen Partners has raised $250 million for investing in healthcare information technology and outsourcing, medical devices, and specialty pharmaceutical companies. Hope they are HIStalk subscribers since our readers always let us know about the hottest companies and trends.

SugarCRM, a provider of commercial open source customer relationship management (CRM) software, announces finalists for their Best of SugarCRM awards. While this has next to nothing to do with HIT (a couple of finalists did include athenahealth and Purkinje), I liked the creative names of a couple of the other finalists: Geeks on the Way and Eject-Stop-Divide.

Speaking of athenahealth, I have been reading the various comments on the HIStalk Forum that Dr. Kato started. The discussion started when Dr. Kato asked for other readers’ impressions of athena’s PM and EMR solutions. There has been some great commentary, some of it more globally about PM/EMR’s rather than just athena. I am not all of with it all, but many good thoughts that anyone considering a PM/EMR vendor should consider. Some things that came to mind for me:

• Is it more important to pick a quality PM first or have an EMR that works for your doctors and practice? Personally, I believe that you must have an EMR that your doctors embrace or they won’t use it. Unfortunately, that means that the administrative and office staff could potentially end up with a billing system that is lacking some functionality (though truly most PMs all offer the basics).
• I definitely agree that it is best to make sure have your PM solidly in place before starting on EMR, though with a brand new startup practice, you often have to get both going simultaneously.
• I am glad to see that Dr. Kato is considering the financial stability of the vendors. Implementing an EMR and PM is too costly and disruptive to make a mistake.

Talk to Inga.

Perot Acquires JJWild for $89 Million

 Perot Systems has announced its acquisition of Meditech consultants JJWild of Canton, MA for $89 million in cash. According to Perot’s announcement, “The 190 JJWild associates will enhance and firmly position Perot Systems’ MEDITECH Solution Center as a market leader.”

Monday Morning Update 8/13/07

From Michael Vronsky: “Re: Holy Spirit Hospital. How about a follow up with Holy Spirit Hospital? I think you’d be pleasantly surprised what their CIO (Edith Hunter) and others have to say nine months later.” This was a replacement of Soarian with Eclipsys. I’ll ask Inga to look them up and report back.

I got e-mails from a couple of journalists who were nice enough to let me know that they use HIStalk as a source of story ideas and opinions. That came after a reader accused the HIT publications of stealing ideas from HIStalk. My server records show other incoming domains from HIT magazines, but at least these had the class to tell me. Should I call the others out publicly?

Burt Finkelstein, formerly of Cardinal Health and Johns Hopkins, joins VisualMED as Senior Pharmacist.

NextGen gets a mention in the Pawtucket (RI) newspaper when Blackstone Valley Community Health Center goes live, claiming to be the first place in the state with all electronic records. Most of the state government seemed to be on hand to see a demo (must be an election year).

EMR/PHR vendor Ethidium Health Systems announces its acquisition of the VLink health information exchange product from Vaceris.

McKesson spent $560K on federal lobbyists in the first half of this year.

The White Stone Group announces an upgrade to its TRACE communication tracking system for eligibility and benefits that allows capturing images of entire web pages, documents, and e-mails. TRACE can now fax those images directly to payors or physician offices to handle payment disputes. Payor changed their website since the service was rendered? You’ve got a picture as proof.

I’ll put out this week’s Brev+IT shortly. If you’re quick on your trigger finger on Saturday afternoon, it’s not too late to sign up to your right and get your copy. Otherwise, I’ll just tease you about how great it was next week. Hmm, what were the five most important HIT news events this week?

Marty Belscher joins Emerson Hospital of Concord, MA as VP/CIO. He comes from FCG. Seeing his Ed.D. credential made me remember that he worked on an engagement for me once. Seemed like a good guy.

WorldVistA EHR is CCHIT-certified, but still not ready for release. The issue: drafting a user agreement that allows them to modify the software as open source while avoiding nullification of its CCHIT certification. They’re also working out royalties for use of CPT and Zip codes. Somebody must be using it since CCHIT doesn’t certify products that aren’t GA and running.

Parkland Hospital (TX) is using background-checking software to catch patients who lie about their address or income to get free care to which they aren’t entitled. The system flagged 12,000 cases of potential fraud, they’re going after several hundred, and more than a dozen people have pleaded guilty and paid up. Oddly enough, most of those first prosecuted are small business owners from Middle Eastern countries, several of them related, who falsely claimed to live in Dallas County to get county charity care. One guy who owns nine Subway franchises and drives a Mercedes told the hospital he made $8 an hour as a sandwich maker. He paid his $47,000 bill in cash when caught. The criminals mostly seem indignant or indifferent since healthcare services, as we all know, are steadfastly viewed as free by those who can’t or won’t pay.

Another company no one’s heard of is offering free physician EMRs that will supposedly be supported by ad revenue. Actually, I’m probably the only one who’s never heard of them since the product is CCHIT certified. It’s apparently run by individuals too shy to list their names on the web page (why are companies so secretive about who’s in charge?) Here’s a free 60-second strategic consulting session from Mr. HIStalk: ad supported EMRs can work, but not by running crappy Google AdSense text ads like Practice Fusion is trying to do. You need to have a strong marketing arm that can develop ad packages specific to practitioners, like some of those Australian EMR companies have done. To really work, you’d have to throw ethics to the wind and jam the ads right into the care process: popping up medication commercials based on patient diagnosis, suggesting a competitor’s alternative when e-prescribing, or integrating permission-based marketing for patients. Companies would pay for that because it would work and many doctors are crass enough to go for it.

Consulting firm RTI tells ONCHIT that EMRs need more safeguards against fradulent billing.

Lawson Software’s CEO says software-as-a-service won’t live up to its hype.

Oracle says it’s too hard to figure out a pricing model for software running on virtual servers, so it will just keep collecting your money as usual, thanks.

Wisconsin Health Information Exchange has expanded its Executive Director role to full time and is seeking candidates. And, if you like the heat (geographical, not job-related), Qatar Hospital is looking for an executive director of health information systems.

Rumors and ideas? E-mail me.

News 8/10/07

From Joseph L. DiNardo: “Re: other sites. I notice that [name removed] has a story on private equity in healthcare IT. Other magazine stories and sites seem to just write about what you do, except later. They’re ripping you off.” Well, I could turn into Howard Stern and claim I invented the genre, but I won’t. Certainly I’ve noticed some remarkably coincident news and opinion pieces over the four years I’ve been writing HIStalk. I’ll attribute that to subsconscious influence, kind of like when one singer hears a song and writes another one very much like it. If I influence them, good for me.

From Doc Hilarity: “Re: you must be flying under the radar.” Link. Somebody wrote a program to chart out the healthcare “blogosphere” and HIStalk doesn’t look like a big deal on it. Reason: it counts links to and from. I don’t link to other sites and don’t expect anyone to link back to me. Here’s the stat that counts: HIStalk has more readers, page views, and sponsors than any site I know. If those slip, I’ll know I’ve left the Blogosphere and entered Suckitude USA.

From Shortwave Coates: “Re: Healthia Consulting. Healthia Consulting Sells to UHG? That was the word from some Ingenix employees (a division of United Health Group).The consulting company’s CFO, rarely seen at client sites, was visiting Ingenix this afternoon.” Since I’ve got Healthia contacts because they sponsor HIStalk, I sent it their way for a response. “As you may know, UHG and many of their companies / business segments, including UnitedHealthcare and Ingenix, are clients of ours, and our entire leadership team takes a strong interest in having close relationships with each of our customers to ensure the quality of our services meet and hopefully exceed expectations. Additionally, UnitedHealthcare manages our employee benefits, so our leadership team communicates with and/or meets with UHG staff regularly. Due to the strong reputation we’ve built in the industry, we do periodically get approached by companies across the industry about strategic partnerships the depth of interest in those relationships varies across the partnership spectrum. In the event we determine that a strategic partnership at any level with any organization is in our colleagues’ and clients’ best interests, we’ll let you know and work with you to publish complete and accurate information, so that the readers of HIStalk are informed.”

From Bill Hafner: “Re: Cerner. I saw the stock rocket upwards Wednesday. Looks like there was an Investor Day at the HQ on Tuesday. These financial guys came away thinking Cerner was doing pretty well. What do you think?” Bill attached a fancy report on the visit from stock guys Thomas Weisel Partners. Some quotes: “Tuesday, August 07, 2007, we met with Cerner management at its Kansas City headquarters. The highlight of our trip, by far, was the tour of CERN’s newest data center located on its corporate campus … Our trip to the Experience Theater was impressive. The company has always proclaimed that once it gets a potential customer to the Experience Theater, the probability of a customer win is high.” Sounds like the Tom boys were so wowed that they just about bought Millennium themselves instead of just CERN, like many CIOs so distracted by the carefully scripted Vision Center sizzle they forget to check the steak along with their checkbook. You’d think investment guys would be more cynically realistic, or at least not report back with such obviously fanboyism. What I think: less than that, certainly. Cerner is managed well and entrenched, but Epic is stealing a lot of their high-margin, big IDN business. They say they’ll make money in the UK, but I doubt it – no one has so far. They don’t play much in outpatient, still struggle with non-clinicals, and have taken only baby steps into non-provider markets to try to find another growth area to prop up the share price. Meditech has the entire low end of the market staked out already, so there’s nothing there for them. I expect clinical sales to dry up because those hospitals who can afford the ridiculous price tags have already shot their wad. If Cerner wants growth, they’ll have to buy it through acquisition. Just my opinion, of course. That fancy data center that the investors drooled over won’t sell much product, especially since most clients run their stuff locally anyway. It’s not that Cerner won’t make money; it’s just that the growth built into a lofty share price will be hard to sustain now that the numbers are a lot bigger.

From Cao Van: “Re: Piedmont. Any update on the OIG Audit?” I haven’t heard a thing.

It’s my pleasure to introduce you to Stratus Technologies, a brand new HIStalk Gold Sponsor. What they do: five-nines system availability, redundancy, and system monitoring and alerting. System availability is critical once you’ve installed all those EMR and real-time clinical systems, so these are the folks who can help. They’ve been around for 27 years and have a big presence in other continuous availability industries (six of the world’s 10 biggest banks and 14 of the 20 biggest telecom providers, for example). Stratus, of Maynard, MA, was the first to offer a 100% availability guarantee for Windows Server in 2002. All you need to remember: continuous availability=Stratus. Thanks to Stratus for supporting HIStalk and respecting its readers by doing so. I appreciate it.

And speaking of Stratus, they’ve got a case study from Orthopedic Center of St. Louis: “Bonner finds Stratus’ ActiveService architecture particularly helpful because it amounts to having ‘another staff member on call 24×7 to monitor the server .. ftServer system is constantly in touch with Stratus’ service center, which monitors its performance. If the server has a problem, it alerts the service center, which either corrects the problem remotely or sends a ‘hot swappable’ component to fix it … the ftServer, which comprises redundant components running in lockstep, continued to run the practice and clinical management systems with no interruption at any time, including during the replacement. When Bonner finished, the server automatically resynchronized and returned itself to full redundant operation.”

Remember those Bulgarian nurses and doctor who were arrested by the Libyan government in 1999 and charged with intentionally infecting 400 children with HIV? They were stuck in jail until last month, constantly threatened with execution unless Bulgaria sent Libya a few billion dollars, but finally were released last month. The Libyan government now sheepishly admits that their confessions were extracted by torture. “Yes, they were tortured by electricity and they were threatened that their family members would be targeted. But a lot of what the Palestinian doctor has claimed are merely lies.” 

Cerner gets a mention for its surgical tracking system that keeps families informed of the patient’s status. They get a card with a confidential number and can look at the patient’s status on a plasma screen in the surgical waiting room (like “PRE-A” or “OR” or “PACU”).

The St. Louis paper runs an article on Purkinje’s physician office dispensing system. I’m vehemently against that concept from a patient safety standpoint, especially when pitched as a revenue booster for doctors, but Purkinje supposedly has built safety checks into its electronic systems. Like Allscripts, Purkinje got into the business by acquiring a company already in it, back when they were Wellinx. I know next to nothing about them, but they sound like of interesting.

A reader e-mailed me to ask, “What are the top three HIT-centric publications that are well read and well respected?” I honestly couldn’t think of any. I don’t read any of them and my feeling is that most industry people don’t either. What little real news they carry is two months old by the time the issue goes out, plus the non-expert reporters just re-word the press releases anyway in most cases, keeping it friendly to advertisers. Of course, I’m biased.

QuadraMed announces not so great Q2 numbers: revenue up 7%, EPS $0.02 vs. $0.06. The stock headed south, trading near its 52-week low and now down 24% in a month. Some folks on the conference call claimed that Keith Hagen was wishy-washy on the financials of the Misys CPR product that QuadraMed bought, leading to speculation that the deal could be in danger once the bean-counters shine a harsh light on those books. Doubtful, but they still have to figure out how to make money from it.

Pravene Nath is named CMIO for NYU Medical Center. Mentioned by Toni Rienzi when Inga interviewed her. And when looking for that link, I ran across this oldie but goodie phony news issue of HIStalk, which had me cackling even though I wrote it.

HIMSS joins some trade associations in trying to get the President to override the ITC’s ban on imported 3G cell phones containing Qualcomm chips, claiming a threat to public safety. Broadcom probably doesn’t agree: it was their patent that Qualcomm infringed upon, according to a previous unanimous ITC ruling. Doesn’t sound like something HIMSS needs to be involved with. Guess their CPOE and RHIO work has been successfully completed and cell phones are the new imperative.

Merge Healthcare shoots off whatever toes it had left, announcing a delay in filing their Q2 report on the day it was due. Stock board speculation was coalesced around three themes: (a) top management is bailing out; (b) the company will be bought; or (c) everybody in charge is a moron.

Cardinal Health announces Q4 numbers after the bell: revenue up 5%, EPS $2.33 vs. $0.76, although most of that came from the sale of one of its business units to private equity star Blackstone Group.

Interesting: this Mac-based practice management system uses MySQL for its database.

Odd: a surgeon in federal prison for 51 months for healthcare fraud is suing Apple, claiming he invented the iPhone’s keyboard.

Former Sutter CEO Van Johnson joins the board of Visicu. Different Van Johnson: it’s not the slightly dense blonde guy (Lt. Steve Maryk) from The Caine Mutiny, I now know (although he’s still alive and will be 91 in two weeks, so here’s an HIStalk shout-out, you big lug).

Allscripts announces Q2: revenue up 17%, EPS $0.10 vs $0.05. The stock dropped; analysts expected $0.14.

Emageon’s Q2: revenue down 14.8%, EPS -$0.01 vs. -$0.04.

Odd lawsuit: a Nigerian man who took his sick neighbor to the hospital in Saudi Arabia has been arrested there for immoral behavior by Islamic religious police. Men aren’t allowed to associate with unrelated women, even when saving them.

News, rumors, blogosphere positioning developments: e-mail me.

News 8/8/07

From Victor Melling: “Re: Perot. Perot already has an offshore company dedicated to healthcare. Their plan to aggressively grow the healthcare organization has to include international initiatives. In the international market, you can’t just take something American and expect the rest of the world to follow. You do it with country-specific nationals, and in some countries, it will make the best business sense to acquire. Don’t forget the payer and government side of their healthcare biz. Services are a key.” Victor was talking about Perot’s $10 million acquisition in 2003 of Vision Healthsource. Back then, it was a 500-employee BPO company doing healthcare claims and billing. Thanks for that report.

From Stan Fields: “Re: Are you sick of Misys yet? Last week, four more senior folks left. Not sure if they chose to leave or were asked. All were long-timers and two were on the Wall of Fame. Either they’re cleaning out the old guard or the old guard has had enough.” I’m always uncomfortable naming names, so how about first names only: Tammy, Scott, Stephanie, and Karen. I think I am getting sick of Misys rumors, finally, although their diaspora should have wide influence on the industry.

From The PACS Designer: “Re: CafeScribe looks interesting, as it fosters the shared learning experience that permits updating of text material and experiences similar to how a wiki operates. Through this shared experience, healthcare IT users can expand their knowledge base and interact with others who share the same desire to learn.” Link.

I hope you enjoyed the interview with Vince Ciotti. I should have warned those of you who don’t know Vince that he speaks his mind. Sometimes he’s pulling your leg, sometimes not, but he’s always entertaining. He cracks me up.

Speaking of interviews, if you know someone interesting I should talk to, let me know. I learn a lot every time I do one.

I’d like to recognize a loyal HIStalk sponsor both old and new: InterSystems. Old, because InterSystems has been a Gold sponsor of HIStalk for some time. New, because they just upgraded to Platinum, for which Inga and I thank them very much. As in the case with Vince, I’ve been their customer, although they don’t know that because I’m anonymous. I’ve used Cache’ and it’s a smoking-hot database, running faultlessly under heavy, enterprise use at a big IDN I’ve worked in, and with minimal care and feeding on our part (say the words “Cache DBA” at my old shop and they’ll look at you blankly – it doesn’t need one). You know that already, of course, because it runs what seems like 80% of big healthcare apps already (Meditech, Epic, both lines of QuadraMed, etc.) Equally hot stuff are the company’s Ensemble integration platform and HealthShare for EHR data sharing. Anyway, many thanks to InterSystems for the vote of confidence. Say, I bet CEO Terry Ragon would be a great interview. He’s one of several Boston-area giants of the industry.

And speaking of CEOs, thanks to those who are recommending HIStalk sponsorship to their CEO peers in other companies. I’ve gotten several e-mails out of the blue from CEOs who start out by saying, “So-and-so tells me he loves your site and that I should really consider sponsoring …” I’m blessed. Thank you. That’s really cool.

I’ve received two unverified rumor reports claiming that a well-known Meditech consulting firm is about to be sold. One says the buyer is Perot Systems. I’m not naming names because I’ve received incorrect rumors about this company before. Still, the sources appear to be unrelated and Perot says they’re buying somebody. We’ll see.

Errata: I inadvertently cleaved off a zero from the UPMC server virtualization numbers last week. Their engineers estimated a server cost of $65,000, not $6,500. I said they estimated a cost 98.7% less than the software vendor’s server specs, but the actual number was 87% less (still not exactly chicken feed). I also got a follow-up from Marc Holland in response to some reader comments. He mentioned that UPMC’s high growth (25% in Wintel server count per year) plus software rollouts and end-of-life replacements mean they’re saving big bucks quickly. They’re also feeding an enterprise-wide SAN instead of direct-attached storage to cut costs even more (both cost per gigabyte and cost per usable GB due to easier provisioning from a central storage pool). Thanks, Marc.

Quality Systems (the NextGen ambulatory EMR people) reports Q1 numbers: revenue up 17%, EPS $0.29 vs. $0.28. Wall Street wanted $0.33, though, and the stock is down around 10% since the announcement.

DR Systems announces 10 new small-hospital RIS/PACS contracts worth $5.6 million.

Alberto Kywi is promoted from CIO at Cottage Hospital to SVP/CIO of Cottage Health System.

Cleveland Clinic names Sulaiman H. Sulaiman as CIO of its Abu Dhabi project.

The two organizers of the German HIT trade show ITeG are parting ways and arguing over its name. Issues: location, whether to add HIMSS-like educational sessions, and control.

Dell, Fujitsu, and Lenovo will offer hardware discounts to organizations that receive grants from the Center for Community Health Leadership of Misys.

Joseph Zaccagnino, former Yale-New Haven Hospital CEO, is named to the board of Premise Corporation. They sell throughput and patient flow applications: bed management, bed cleaning, transport, and executive dashboards.

I see quite a few folks signing up on my e-mail lists to your right. The first one is to get e-mail updates when I write something new here. The second is for the new Brev+IT (pronounced “brevity”) weekly newsletter, which you’ll get only if you sign up. Help me spread the word on that one by forwarding your copy to anyone else who might be interested, please. It’s aimed at C-levelers who might not enjoy the insider stuff here that the rest of us love. It looks deceptively simple, but the value is having culled out only the most important news of the week and added some perspective and opinion around it, all in a quick-read package that’s self-contained in an e-mail.

Laparoscopic gastric bypass patients at Sinai Hospital of Baltimore whose doctors used robots for bedside rounding had a mean length of stay of 1.26 vs. 2.33 days for traditional rounding.

A hospital in Belgium is using .NET-Java EE integration tools for its portal, developed on WebSphere and running on Linux with an Oracle database. They’re developing with Visual Studio and compiling to Java (!)

Cool: three foundations donate money to pay for a document-based EMR for behavioral provider for foster children in Kansas.

A Wall Street Journal story describes a neurovascular surgeon who bought an iPhone on launch day to access his practice’s EMR. I also like an unrelated tag-on at the bottom that ridicules common IT terms. “But the word implies that the ‘users’ are utterly dependent on the provider …Today, all the term does is emphasize technology at the expense of the task someone is trying to perform. To an IT person, you aren’t writing a message, you’re using email … We also hate the term ‘solution.’ IT people often say that they have a customer-relationship solution or a supply-chain solution. The word ‘solution’ not only doesn’t tell you what it does, but also doesn’t tell you what it is. A supply-chain solution might be software, but it might be a storage rack in a pickup truck, or it might be a cardboard box.” Amen, brother.

Craig Barrett’s horses aren’t the only ones with an EMR. “Horses treated by Hagyard will soon have electronic medical records that allow their veterinarians to see their history from anywhere in the country. Images taken by the practice’s 11 digital X-ray machines allow veterinarians in the field or working for bidders at horse sales to see a horse’s file from computer work stations set up on site. They can do endoscopies and bone scans, and soon will have MRI capability to help diagnose problems. There’s a hyperbaric oxygen chamber for treating horses with a variety of conditions and a treadmill on which to test respiratory function and lameness. A neonatal ICU cares for newborn foals. The babies get ‘their own little Tempur-Pedic mattresses,’ which tour guide O’Flynn says helps eliminate bed sores.” Say, I could be the first veterinary CIO. Sport horses apparently get better care than a lot of humans, but then again, they’re worth a lot more in real dollars, sadly enough. The short, whip-wielding guy on their back probably has no insurance. At least he won’t be put down if his leg breaks.

Amcom announces its Answering Service module for call center customers.

Bizarre: a Minnesota man decided he needed to have his testicles removed. When hospitals refused, he found some amateurs willing to tackle the job in his home. He awoke, bleeding, in a makeshift OR complete with medical supplies, specimen jars, and a camera. The impromptu surgeons had high-tailed it when police were called and the man wouldn’t name them. Larry, Moe, and Curly?

News, rumors, good HIT sales stories: e-mail me. Thank you for reading.

Monday Morning Update 8/6/07

From Morrie Kessler: “Re: Perot Systems. On the acquisition hunt? Any ideas of who it could be?” The company announces that Q2 revenue was up 11%, but EPS dropped to $0.18 vs. $0.21. As part of the announcement, Perot says it will acquire a company with $80-90 million in revenue in the next few weeks (OK, I need to know who … whisper it to me). They also mentioned a plan to acquire two or three companies each year in their focus areas, with an interest in expanding outside the US (i.e. “we need cheap offshore labor like FCG and those other guys”).

From Paul Cicero: “Re: Kaiser. Even the Kaiser-bashing Sac Bee pointed out that the surgeon accused of killing the mentally retarded, dying patient for the purpose of harvesting his organs, who actually didn’t die when they took him off life support and gave him a stunning amount of drugs in order to ease his assumed passage, wasn’t working as a Kaiser physician when he was performing his service. I know you are not a Kaiser basher, so I thought I’d point that out.” Thanks. I didn’t catch that in the story. That may keep Kaiser off the inevitable lawsuit list, although having him on staff and providing him with what I assume is the bulk of his livelihood can’t be good PR nonetheless.

From Buffy Patterson-Davis: “Re: Intel’s Craig Barrett. You are soooo right! He has been insufferable at the AHIC meetings that I have attended. Just ridiculous. He seems to think that attaching a few devices to a home health care network will solve the whole problem. I’m always impressed at how polite the clinicians are in the crowd when he is speaking – they never boo. I’ve heard a lot of corporate execs talking about health care lately and the bottom line has been a deep fury at having to spend money on the benefits. I mean, they are livid. They try to hide it, but it just bursts out. I sat next to the heir of a prominent company at a meeting and the resentment was plain. They just don’t want to pay. Period. They don’t want to pay taxes, either.”

From Billy Batts: “Re: UPMC. Interesting discussion about UPMC’s environment. A couple of comments: 1) cost savings and cost avoidance are very different. If you project sizable costs and then avoid them, that’s not the same as cost savings, which are usually measured from your existing cost base. Much of UPMC’s public statements about costs appear to be based more on avoidance than savings. And of course, there is somewhat of an incentive to project future costs as high as possible so that the avoidance of those costs looks really good. 2) Going from 40 servers at $500K down to six servers at $6.5K defies common sense. If UPMC’s engineers are really going to ‘roll out an application to additional sites’ and claim to be able to do it with a half dozen desktop machines, there is a major disconnect somewhere. So I wouldn’t necessarily bet on UPMC in this case. 3) Holland should be more cautious in his claims. We have been heavily virtualized with both servers and storage for several years, as is the case with other healthcare sites. It’s tiresome to keep hearing how far behind we are. Healthcare is arguably the most complex industry in our economy and our IT environments reflect this. Claiming that we should have the same technology environment as much simpler industries demonstrates a lack of appreciation for the challenges we face in our business, and is not a reflection of ‘how good we are’.”

And speaking of UPMC, Inga tried, at Art Vandelay’s suggestion, to connect with UPMC to talk about virtualization. She got a curt “no” in response to her request for an interview. We’ve got a few UPMC readers, so the first words I thought of (an old, crude saying) involve people you’d sleep with, but not bring home to meet the family. I guess we don’t have the cachet of those inexperienced kid journalists who’ve never worked a day in either healthcare or IT. Maybe I should ban UPMC’s IP address from reading here.

I’ll be writing and sending the first Brev+IT shortly. Consider this a beta test, just in case I mess up the formatting or e-mailing. I see 141 subscribers so far. I may post the first issue online to encourage (or discourage, depending on how it goes) new signups. UPDATE: First issue is here. Subscribe to your right if interested.

Sponsor website cruise: (1) I see that Healthia has some interesting consultant positions open for clinicals, surgery, pharmacy, radiology, and HIM, to name a few. If your consultant employer has chewed you up and spit you out, give them a look – they’ve got a great reputation for being employee-friendly. (2) EnovateIT has redesigned their site, I notice, and you can more easily find specific products from a front-page product selector. (3) You probably noticed EHRConsultant’s rotating ads to your left, which now describe the company’s main offerings: the EHRscope product guide, their Naturally Speaking product line with 12 medical vocabularies, and the flagship EHR Consultant service for matching physicians with EHRs. (4) Our friends at Pring|Pierce Executive Search are ready to apply their industy experience to place executive-level talent (sales, marketing, strategy) reliably, effectively, and professionally. (5) Providers who need assistance with strategic planning, operational assessments, patient safety, and contract negotiation (and who doesn’t) and at the right price (even better) should give a look at MedMatica Consulting Associates. They’ll put experienced, regional resources on the ground quickly and cost-effectively to energize your projects and maybe keep you from getting fired when your teams are in over their heads. (6) Last but not least, our colleagues at The White Stone Group can help with documenting and managing communications, such as in denials management and caregiver hand-off (Joint Commission, anyone?) Who couldn’t use a patient-indexed communications capture system that involves minimal IT headaches and slam-dunk ROI? Please help HIStalk by clicking sponsor ads to your left and checking out what they offer. They keep HIStalk coming free and I appreciate them.

I ran across a press release from Lucida Healthcare Group that describes cool technology they came up with for recruiting traveling nurses. They have trucks carrying mobile billboards that invite sending a cell phone text message for more information. Then, data from the GPS systems in the trucks is merged with the incoming call records to measure the effectiveness of each truck’s route, allowing re-routing for optimal ad response. That’s almost as good a testimonial for their savvy as their HIStalk sponsorship (shameless plug by me).

Alamance Regional (NC) chooses SIS surgery through their Eclipsys partnership.

Any Travel, Inc. may be suing Misys for supposedly trashing its El Dorado office buildings in Tucson, but apparently the damage wasn’t bad enough to discourage buyers. The property has been sold for $5.8 million to a company that will gut the buildings in turning them into a multi-tenant complex.

A physician systems consultant criticizes the industry in a letter to the editor of a Vermont newspaper: “What I saw, all too frequently, was a prime example of people in the computer technology field taking advantage of others that have little knowledge of the technology involved. I saw one office pay nearly $7,000 each for computers that were worth $300 and then buy software that was more than 10 years out of date … An electronic medical records system is just software in which a vast amount of information is saved and interlinked. Most modern commercial, off-the-shelf database management software can be programmed so easily that even complex networked or Internet-based software can be custom developed to create centralized software applications that service a large number of geographically dispersed offices.”

Scottsdale Healthcare (AZ) is piloting what its vendors say is the first patient room service meal system that checks dietary restrictions and allergies.

FCG reports lackluster Q2 numbers: flat revenue, EPS $0.12 vs $0.20. They tried hard in the announcement to confuse readers into comparing the current EPS with those from last quarter instead of Q2 ’06, or at least it appears to me. Shares jumped nearly 9% on the encouraging news that profits tanked, but not as bad as everybody expected.

A California judge orders jurors in a medical malpractice case not to see Michael Moore’s Sicko, which featured a similar case. Good advice they probably didn’t need: the movie has done only $22 million of business, although Moore’s deal is 50% of the gross, so his stomach is jiggling all the way to the bank. If it ends up doing as well as his previous movie, he’ll pocket over $100 million (plus a huge cut of DVD sales) for doing whatever it is he does. You have to love a socialist blowhard with a populist message who’s worth more than the captains of industry he hates (and who actually create jobs). Plus, his foundation (with minimal donations to actual causes) has owned shares in Halliburton, defense contracting giants, and even those carmakers he ripped in Roger and Me. He also claimed in a previous movie that he would “hire only black people,” but not even one has crept into the credits so far. And, he proclaims disdain for copyright laws, except when he’s demanding that people not download his own movies. “When Moore flew to London to visit people at the BBC or promote a film, he took the Concorde and stayed at the Ritz. But he also allegedly booked a room at a cheap hotel down the street where he could meet with journalists and pose as a ‘man of humble circumstances.” What a gasbag.

CPSI promotes Darrell West from controller to CFO.

I didn’t realize you cared so much for Clarion Health Center (PA) It was darned nice of you to send $100,000 of your Federal tax dollars to them to help pay for their EMR software.

Wisconsin hospitals are going crane-crazy erecting new Taj Mahospitals. Bet they’ll keep those diagnostic machines cranking to cover the $1 billion tab. In fact, a local business guy claims it’s driving up healthcare costs (duh) and that Milwaukee alone has more MRI machines than in all of Canada. Children’s Wisconsin wins the prize at a $2 million per bed project (children’s hospitals are always out of control financially because “it’s for the kids”, meaning “don’t dare question our budgets or we’ll drag out awww-inducing snapshots of tykes while you’re PowerPointing financial statements”). Here’s my theory: non-profit guys don’t get juicy stock options, so they spend the money building monuments to their own wonderfulness, convincing themselves it’s really for the patients or the community. The execs at places I’ve worked couldn’t wait to put on their honorary hard hats and run around the job site looking important. Hint: hire more nurses (or build a cheap, functional nursing school and graduate a lot more of them) if you want to do the community a favor. And, if you want to get really crazy, cut prices for the uninsured.

CareTech Solutions announces its BoardNet product, a secure communications portal for hospital board members.

Meditech’s latest quarterly SEC filings: revenue up 11.3%, EPS $0.67 vs. $0.59.

Talk to me.

Well, I’m embarrassed. I’ve never watched Mr. Ed (it seemed too stupid even among stupid TV shows), so I didn’t recognize the theme lyrics that Scot wrote were the originals. Still, that inspired him to compose his own, in honor of Craig Barrett and his EMR-powered horses.A horse is a horse
Of course, of course
And no one can talk to a horse of course
That is of course unless the horse
Has an equine EHR.

Go right to the source and ask the horse
He’ll give you the medical history that you’ll endorse
He’s always on a steady course
The horse has EHR!

People yakity-yak a streak
And waste your time of day,
But a horse will never speak
Unless he has something medical to say!

A horse is a horse
Of course, of course
And this one will complain about EHR privacy ’till his voice is hoarse
You never heard of a talking horse?
Well listen to this:
“I am a horse with EHR!”

Premier Healthcare Alliance names Randy Thomas vice president of Integrated Product Management and Marketing. She comes from IBM and, before, that TSI and Eclipsys.iMedica announces their customer based has increased 76% in the first six months of 2007 as 77 new clients have purchased their EMR/PM integrated solution. iMedica, based in Dallas, was started by several old Millbrook employees after GE acquired Millbrook. I have heard the iMedica product has functionality similar to GE Centricity (the old Millbrook product) but with lots of technological bells and whistles such as .NET.

Thanks to Bill Lynch of Axolotl, who took the time to write a note reminding me that despite Santa Barbara’s RHIO failure, there have been other efforts that are making good progress. “HIEs/RHIOs have been up and running, successfully, for quite a while. HealthBridge, Taconic/THINC, Quality Health Network and many others have shown what can be done if you build your HIE with committed partners, candid communications, clinician-first workflows, and proven technology.”

A couple in Arkansas just had their 17th child. Wow. Why, why, why? Guess it is not as odd as the lady in Mexico City who kept her dead husband in her bedside and had her adult son remove the worms every so often. Our little HIT world seems so ho-hum and mundane when you compare it to such “real world” happenings.

Inga’s listening.

News 8/3/07

From The PACS Designer: “Re: networks. TPD was perusing the computer network terrain looking for what’s new and possible as we increase connectivity across the  globe. Most of us are very familiar with Ethernet (created originally by Xerox and still going strong) as well as TCP/IP (Transmission Control Protocol/Internet Protocol). Well, there are some new networks brewing and they are called ‘Public Next Generation Network’, or NGN, and ‘Next Generation Corporate Network’ or NGCN. They have come about because of the demand for more security across the entire communications chain and we’ll be hearing more about them as we go forward. Link [warning: PDF].”

From Doc McGee: “Re: Misys. They have recruited Cory Eaves as EVP, CTO & CIO. His responsibilities will be to lead all things IT, internal and in product strategy and development. He held a similar position at ERP company SSA Global, which was buying struggling ERP companies left and right, not sunsetting any products, and leveraging maintenance revenue streams. That company’s vision was to bring the software together on two platforms and slowly raise maintenance fees and add capabilities to entice customers to upgrade. Cory knows his stuff and is pretty adept at navigating the often choppy waters between various product factions/groups in an organization as well as working with customers. He may be just what Misys needs right now to right this listing ship.”

From Anonymous Fan: “Re: athenahealth. Jonathan Bush and athenahealth are the cover story in this month’s Inc Magazine – regarding fun, their unique culture, how it is good for customers and business, and how he goes about managing his troops.Here is another link to him in a batman outfit and talking about some of the cool stuff the folks there do and how he connects fun to purpose.” The issue is on fun in the workplace. I was glad to see the mag add this caveat: “But don’t buy that karaoke machine yet. The common practice of treating sick cultures with a fun-graft–parties, silly hats, visits from Mister Softee–is insulting to employees and vaguely grotesque. For fun to thrive, meaningful work, competent management, fair compensation, and mutually respectful employees are table stakes. If you lack any of those, start there. Once the bread’s in place, come back and we’ll talk circuses.” Well said. I’ve worked in near-slave camp IT environments with carefully designated fun events prescribed by our little Hitler, sort of like Hawaiian Shirt Friday in Office Space, where a lobotomized corporate penguin passionlessly tries to connect (like Bill Lumbergh did) with the oppressed masses who yearn to cause him pain: “Oh, and remember, next Friday is Hawaiian shirt day, so, you know, if you want to, go ahead and wear a Hawaiian shirt and jeans.” There’s nothing more depressing than brain-dead galley slaves pretending to be festive while gobbling down cheap, cold pizza while dolled up in jollitywear and muttering obscenities about the clueless management team who thought their loyalty could be bought cheap.

From Scot Silverstein: “Re: Siemens. The Siemens cardiology system team I met in Germany were quite competent and ‘got it’ regarding what was needed. I’ve since found out those people are ‘no longer with the company’ and was told that part of the problems with the Soarian product was due to their influence. I rather think the problems were not the result of rigorous German engineering, but American IT practices.” And speaking of Scot, he had as good a time as I did ripping Intel’s Craig Barrett for his “my horses have EMRs” statement. Actually, he worked harder at it: he even composed new lyrics to the theme from Mr. Ed.

From Mike Kirby: “Re: CNMC. Kelly Styles, CIO of Children’s National Medical Center in DC, has ‘resigned to pursue other opportunities.’ Last day will be at the end of August.”

Marc Holland of Health Industry Insights dropped me a line about UPMC’s virtualization project, for which his company is providing validation services. He agrees with Art Vandelay that healthcare is two years’ behind other industries on virtualization. UPMC is projecting huge cost savings, although application vendors aren’t necessarily sharing their enthusiasm. One of their big ones (I mention them here a lot) was asked to quote hardware for rolling out an application to additional UPMC sites. They called for 40 servers at a $500,000 price. UPMC’s engineers estimated they could use virtualization to cut the hardware back to six servers for $6,500. The vendor refused to warranty that configuration, although they eventually agreed to four times the horsepower that UPMC recommended: 13 servers at around $250,000. Now assuming UPMC was right initially (I’d bet on them), their configuration was 98.7% less expensive, not to mention the future savings in maintenance, electricity, and software. Did that get your attention like it did mine?

Last chance to get this weekend’s inaugural Brev+IT newsletter. Sign up to your right. Judging from the number of signups, lots of folks are looking forward to it. Thanks, as usual, for the support. It’s not like I need the extra work, but it should be fun.

I got lots of interest in the reader’s request for a job description for Manager of Cardiovascular Informatics, all of it from folks who want a copy if I get one (which I haven’t so far). If you have one, several of us would apparently appreciate your sending it to me. The Rumor Report to your right will accept attachments, so use that if you’d rather.

Modern Healthcare reports that Suzanne Delblanco has resigned as CEO of Leapfrog Group, effective this fall. Since their ill-advised “CPOE or bust” stance made them initially threatening but ultimately irrelevant, you have to wonder where they go from here. They haven’t been in their heyday for years, but even in just the past two, their member count has dropped by 57%, according to current and archived versions of their web page. Most of their HIT vendor members bailed. Federal records show she was paid $179K, hardly generous by DC standards, although at just 39, I’m sure she has big paydays ahead.

At least this takes attention away from HealthConnect: a Kaiser Permanente surgeon is charged with intentionally killing a disabled patient with drugs in order to harvest his organs for transplant. Hootan Roozrokh, MD, quoted on his Kaiser web page as saying “I THRIVE by endeavoring to practice good karma,” faces eight years in prison (that’s all?)

The CEO of a hospital pricing company argues that ambulatory EMRs don’t make sense unless providers are paid fixed prices for quality. “Do we really expect that improvements in these processes will result in a cost justification for an EMR, or more globally, an improvement in the cost/quality profile of care for the country? If the entire country implemented EMRs overnight, would we see significant overall improvement in healthcare productivity, efficiency, quality and customer service?”

An Eclipsys shareholder is suing 20 past and present Eclipsys officers, claiming he and other shareholders were defrauded by option back-dating, insider trading, and falsified financial reports. I reported in May that the company said it had found evidence of back-dating, but claimed it was done by executives who left in 2006 (that’s still a corporate problem, it seems to me, but they didn’t seem to be worried when they said that). The shareholder submitted a lengthy list of trades and dates, claiming that the bigwigs enjoyed a 196% return on their options while regular shareholders lost 29% in the same period. Named: Cooper, Dipierro, Rudish, Wilson, Fife, Eckert, Coletti, Copple, Deady, Gomez, Etue, Hall, Patton, and Risenhoover (those are the ones I know, but there were a few more).

Speaking of Eclipsys, they announce Q2 numbers: revenue up 16%, EPS $0.11 vs. $0.03. Shares closed at $23.61 Wednesday, easily blowing through the 52-week high of $22.92.

Vince Ciotti sent over the 20th anniversary issue of the H.I.S. Professionals newsletter. Bob Pagnotta, Karl Sydor, and Vince started the company in 1987. “There are few companies in the healthcare IT industry, whether vendor or consulting, that have lasted 20 years, with all of the Big Eight consultants having fallen by the wayside along with countless other start-ups and ’boutique’ firms. What is equally amazing is that most of the firm’s original consultants are still active with the firm after 15 or more years.” They named their best hospital clients: Johns Hopkins, Meridian Health, and Sisters of Saint Francis. I was a client many years ago (Vince doesn’t know that since I’m anonymous, and now I know I wasn’t among their favorites) and they did a good job.

Former Cerner guy John Thompson lands as CEO of an ad software company.

Iowa Health System chooses Allscripts for ED software.

AMICAS Q2 numbers: revenue flat, EPS -$.01. vs. $0.01.

Rollout of the UK’s military EMR system begins. DmicP will eventually connect to the NHS system.

The trade group for state government CIOs says they should get more involved in RHIOs and NHIN.

Robert Goldstein, formerly of MDG Medical, joins Tennessee’s Shared Health RHIO as COO.

Talk to me.

CCHIT has so far added six vendors that have passed its 2007 ambulatory EMR certification criteria:

• Community Computer Service (MEDENT 17) 7/11/2007
• e-MDs, Inc. (e-MDs Solution Series 6.1.2) 7/18/2007
• Greenway Medical Technologies (PrimeSuite 2007 R2) 6/22/2007
• McKesson Provider Technologies (Practice Partner 9.2.1) 7/17/2007
• NextGen Healthcare Information Systems, Inc. (NextGen EMR 5.4.29) 6/25/2007
• Purkinje (CareSeries EHR 2.0) 7/27/2007

Vendors must pass 100% of the functionality, security, and interoperability requirements. The requirements are comprehensive – the functionality requirements alone run 46 pages. I expect many vendors to have a tough time getting certified. Will the market demand certified solutions when a doctor can be efficient and paperless using systems that don’t meet all the requirements?

Eclipsys signs a couple of new contracts. The University of Pennsylvania Health System (UPHS) extends their current agreement, adding pharmacy, med admin, KBC, and content from Zynx. Bayshore Community Hospital of Holmdel, NJ will implement patient financials, access management, and Sunrise Clinical Manager.

A reader had reported that customers weren’t able to get through to Sage. So far, I have sent an e-mail to Sage’s general inquiries e-mail (no response), plus attempted to call John Schoutsen, who is listed on the Web site as the company’s media and investment relations contact. Perhaps both the webmaster and Mr. Schoutsen were laid off, because the listed number is no longer working.

MED3000 acquires Pathology Service Associates (SC), which offers pathology revenue cycle management and practice management and marketing services. It has over 75 practice customers in 27 states, representing 400 pathologists.

Health Affairs publishes a “retrospective” titled “Lessons Learned from the Santa Barbara Project and Their Implications for Health Information Exchange.” Some conclusions are obvious: privacy should be addressed early; local support (especially financial) is critical; and implementation should be staged instead of big bang. “Initially, the vendor erred in its assessment that the technology needed to implement the Care Data Exchange (CDE) already existed in the market. Second, the vendor’s subsequent development and implementation of its own technology was slow and did not adequately define users’ functional requirements, which necessitated redesign and redevelopment of important functionality. Last, poor documentation and insufficient testing of the data interfaces meant that many of them had to be reworked, introducing further delays. In all, a development project scheduled to take three years took six; unfortunately, the boldess of the vision was not matched by a focused and efficient software development effort.” And thus, goodbye Santa Barbara, David Brailer, and CareScience; hello CHCF, Perot, and Medicity.

Inga’s listening.

News 8/1/07

From INVISIONforever: “Re: Soarian. I checked the Siemens website to see what it was saying about Soarian. Soarian Financials is no longer being touted as a solution for hospital and MD billing. Is this an error or a reflection of a diminished goal? Also, I was surprised to see Soarian Scheduling listed as a revenue cycle solution — it doesn’t even have an insurance master. Under Soarian Departmental Systems, only Cardiology is listed. If you compare this with their promises four years ago, the disparity is huge.” Speaking of Soarian financials, guess who’s just signed for them: Partners (!) They’ll implement scheduling, decision support, document management, community access, and payor connectivity. John Glaser had mentioned in an Inside Healthcare Computing interview that he had a big Siemens revenue cycle project upcoming and some SOA initiatives, but this caught me off guard. Certainly it’s a much-needed boost for Siemens, assuming that their stuff works, anyway.

From Hrundi V. Bakshi: “Re: Lawson. The Lawson project at Mayo was overrun and under functional. Many physicians are complaining. They can’t tell a consult/revisit/new patient from one encounter to another, much less from one facility charge to another. They can’t reconcile medicare patients from one facility to another. It’s often taking physicians 12-25 minutes per encounter to do documentation. The non-MD in charge doesn’t seem to ask doctors what makes sense. Mayo’s IT/Finance strategy needs some serious updating in personnel, vision, and education. They’re aptly set to be the laggard of adoption and questionable due diligence.”

From Molly Clutterbuck: “Re: Cisco and AHA. It’s not objective based on performance, so what’s it based on? Cisco is getting their clocks cleaned in healthcare by better performing vendors. First they bought a HIMSS user group, now they’ve paid for AHA’s ‘recommendation’. Those involved need to get off the speakers’ tour long enough to look at what’s happening with Cisco in wireless. I never knew the AHA to be all that interested in IT. Where have they been all these years?”

From Venny: “Re: Craig Barrett’s horses. Damn the EMR. To boost Intel, he needs to market chips to his four-legged friends. Who knew horses could read e-mails? Are cow chips next?”

From Bernard Stein: “Re: Misys. You are slow on the Misys news. More high level departures.” Maybe my former sources aren’t there any more since nobody’s spreading a little rumor love HIStalk’s way. I’ve not heard anything about exodi. But, Vern Davenport is hinting at acquisitions and says the realignment is 85% done. He agrees with boss Mike Lawrie (always a good idea) that the company’s healthcare “performance remains poor”.

July will be another record HIStalk month. So far: 51,416 visits, 88,156 page views (that doesn’t count RSS readers). Both measures doubled in the past year and trended highly up later in the month. And for that, I thank you and HIStalk’s sponsors.

I should also mention Brev+IT, the weekly e-mail newsletter that starts this weekend. Now about the name: I’m merciless when somebody makes a lame pun involving the letters IT, but it fit so well in this case that I’m willing to humbly accept the inevitable scorn. The main message I wanted to get across is that it will be highly concise, covering only the five most important stories of the week, and with background information and opinion to put it into context (thus the name, which I hope you’ll pronounce “brevity.” Get it? Or is that “Get IT”?) HIStalk is for industry lifers who love the insider stuff, while Brev+IT will get executives up to speed in minutes. See the sample. You’ll notice one tiny spot for a sponsor text ad, which I’ll most likely offer to existing Platinum sponsors at no extra charge. There’s a sign-up form to your right (on HIStalk2 only for now until my HTML guy gets it prettied up). Lots of folks are signing up already, so maybe it’s redundant for me to invite you to do the same.

The Wall Street Journal quotes Microsoft as saying it’s expanding its healthcare efforts: 20 new employees stateside (doctors and other clinicians) and 30 in China (developers). The healthcare group is supposedly given free rein as one of a handful of areas in which MSFT sees big potential.

A long-time reader is in need of a job description for Manager of Cardiovascular Informatics. If you have one, please shoot it to me. Thanks.

Bankrupt Bayonne Medical Center (NJ) finds a Santa Claus willing to pay for a new EMR system: you. Or more specifically, your Federal tax dollars.

Stanford University will offer AMIA’s 10×10 informatics program.

Rhode Island will create a statewide Health Information Exchange, with EDS as the primary contractor and InterSystems providing its HealthShare platform.

Talk to me.

TPD or Mr. HIStalk – any chance you can interview someone at UPMC about their lessons learned from virtualization? The early information is hitting the usual magazines, but it is a little sanitized for my taste. [Inga is working on that, Art. Good idea.]

Virtualization is the only way to get close to the necessary efficiency with the limitations of most of our cottage industry’s vendors. Even getting them to accept virtualization is a tough sell. But, even if you use it only for development purposes, it is cost effective. Less hardware, you use it only when you need it, and you have fewer physical server instances to patch.

For those of you who can’t do or sell anything without a maturity model, here is a first cut we can iterate as an industry. Who says we are not innovative?

Level 1
Can you help me spell that? I could heat a homeless shelter in Alaska from the number of servers (mostly Windows and Intel) I have in the data center.

Level 2
I am running VMWare for my developers on the PCs to test the five different versions of Windows clients on eight different PC hardware configurations we have out there. AND I approached my 300 vendors, of which 20 knew what I was talking about, five said they’d consider it if we upgraded to a current version from the one we run that’s four releases out-of-date, three said OK and they’d have their top tech guru contact me (that was seven months ago), two said they’d have to report me to their manager for using bad language, and one said they’d do it if we’d pay a higher maintenance fee.

Level 3
Just doing it without vendor blessing for all those fine two-tier, Windows server-based development servers. AND virtualizing tape back-up and storage (damn, TPD – you’re already to Level 3).

Level 4
After wasting five man-years of effort, outsourcing it to someone else and making it their problem, while paying too much for the service.

Level 5
Getting your ERP vendor to virtualize some of their 20 servers, storage, and tape devices. Come on now, you thought that we can even talk about a healthcare vendor doing this for another five years? The rest of the world has two years’ of experience on us right now.

Monday Morning Update 7/30/07

From Claude LaMont: “Re: Acermed. They sure appear to have closed up shop. A physician on our medical staff was teed up for hardware install this week. Tech never showed up. Doc called sales guy at home, only to be told that company told him on 7/20 that company had folded and he was terminated. Doc is out a bunch of cash for hardware he cannot use. Nice of the vendor to call, isn’t it?” So much for the idea that CCHIT-certified products are less risky for buyers. Neither, apparently, are those applications that are highly rated by self-proclaimed futurist Mark Anderson of AC Group, who’s taking shots broadside over at EMRUpdate for his company’s previous lofty rankings of Acermed. He posted one rebuttal: “We never had Acermed rated number 1”, but hasn’t posted again in the several days since a reader pointed out of this link or this one. One made this comment: “Mark, when you make your EMR evaluations transparent, no one will question the results. When an EMR that you highly rated goes belly up a few months after your positive rating, and you say you take into account financial viability of the company, people will wonder how good your ratings are.” Some were nastier, either accusing him of various improprieties or demanding to see his raw data (I got a few of those e-mails after we ran some comments he was nice enough to provide a few weeks back). In his defense, Anderson calls himself a futurist, not a clairvoyant, and Acermed’s problems may involve neither functionality nor financial viability. It sounds like a spat among the owners. Bad for their customers, bad for other PM/EMR vendors without a long corporate pedigree, and bad for CCHIT.

From Sore-Ian: “Re: Soarian sales. Siemens is a company known for fine German engineering. I wonder how much of the Soarian fiasco has to do with the old dysfunctional SMS culture and politics in Malvern dominating the German kultur? A conversation I had there a few months ago suggested the new people who had not been SMS’ers were looking for ways to deal with the latter’s American-big-bad-IT ways.”

From The PACS Designer: “Re: virtualization. TPD did a piece on virtualization earlier this year, but felt it was worth repeating. You will be hearing a lot about the use of virtualization to improve organizational efficiency over the next few years and some of the successes that institutions have achieved by going virtual. Yes, you will be hearing from department managers about how they need to keep their local storage solution, but with the newer software tools and faster networks, the attraction of redundant storage should make the conversion to the virtual world of storage even more palatable now. Setting up a virtual server through partitioning and making the storage archive a virtual application can save considerable amounts of money through such a venture. Also, the local storage solution can still be kept as a redundant archive to appease the manager when there is considerable resistance to change.”

From Paul Burmaster: “Re: CIOs. At the recent AHA Leadership Summit, you could pick out the CIOs by their dress. Wisdom suggests you should dress one or two levels up. Some yahoo was there in shorts, and yes, he was a CIO. I love to relax and be casual, but there’s a time to dress for success.” 

Atos Healthcare is released from its $500 million UK HNS diagnostic imaging contract after missing deadlines.

Visicu announces Q2 numbers: revenue up 21%, EPS $0.06 vs. $0.04.

McKesson announces for Q1: revenue up 5%, EPS $0.77 vs. $0.60. Technology revenue was up 49% and profits up 178%, great news for shareholders (maybe less so for customers whose payments made it possible).

Former IDX CFO Jack Kane is appointed to athenahealth’s board.

Cardinal Health pays a $35 million penalty to settle SEC charges of inflating revenue and earnings.

One recommendation of a Presidential commission reviewing the care of veterans is an online electronic medical record. Cleveland Clinic CIO Martin Harris is a member.

What the hell is the American Hospital Association doing running a for-profit subsidiary that shills vendor products to its members? “AHA Solutions, Inc. is a subsidiary of the American Hospital Association that collaborates with companies to create strategic financial, technology, regulatory, employee benefit, and insurance products and services for healthcare professionals.” I hadn’t heard about it until I noticed their ringing endorsement of Cisco, apparently rubber stamped by “a group of influential IT leaders from AHA member hospitals”. Is the implication that less-influential hospital IT professionals (i.e., unwashed rubes) can’t be trusted to make wise IT decisions? Or, that vendors who don’t pay financial tribute to AHA aren’t reliable? Let’s hope no one running a hospital IT shop is so clueless as to need AHA’s sponsor-fueled guidance. Looks like the AHA folks running the enterprise are marketing people with no stated healthcare background. Joint Commission does it, HIMSS does it, AHA does it … but that still doesn’t make it right. Non-profit hospitals should insist that those claiming to represent them be non-profit as well.

The former CEO of imaging vendor A.L.I. is having a ball with the $35 million he pocketed after McKesson bought the company in 2002.

Lawson’s Q4 numbers: revenue up 69%, EPS $0.04 vs. -$0.03, but the company cautioned on 2008 prospects.

Intel’s Craig Barrett issues more homespun sound bites about healthcare IT: “‘I have a ranch with 45 horses, and they all have electronic medical records, and they all get e-mail updates when their shots are needed,’ he told the summit.The difference is that veterinarians work in a competitive market that gives an advantage to those who adopt technology,while the health-care industry has much less incentive to change, Barrett explained in an interview afterward.” And this one: “It’s time for health care to turn from a mainframe-computer industry to a personal-computer industry.” Want to guess which one he sells chips for? Hey, do your part: buy AMD desktops and servers instead of Intel and invest the difference in charity care. That will send a message to Mr. Barrett and the horse he rode in on (even if he’s right, he’s awfully smug about it).

Talk to me.

Allscripts has been selected to provide its EMR to Urology Associates of North Texas, the country’s largest private urology group. The 50-doctor group had previously been using Penchart/Amicore and will integrate the Allscripts product with their old IDX Groupcast (Centricity Business) practice management product. Penchart/Amicore, by the way, is the product that Misys bought to develop as an ASP solution – and later dropped entirely. Though they don’t mention Misys by name, the UANT medical director was quoted as saying, “We’ve experienced what happens when vendors don’t keep up with changes in a dynamic industry.” Ouch.

Allscripts also made news last week when announcing a new initiative with Sprint to use smartphones to generate prescriptions in the exam room. Sprint will be donating up to 1,000 devices to prescribers who register for the National ePrescribing Patient Safety Iniative and activate NEPSI’s Web-based eRx NOW software.

Pioneer Medical Group of Cerritos, CA signs up with MED3000 for a five-year ASP hosted agreement for Allscripts Touchworks EMR. Pioneer Medical has over 50 providers in Los Angeles. (Either Allscripts is getting their PR machine in gear or they are in the midst of a good run.)

TriZetto names Robert G. Barbieri as the incoming CFO. Barbieri comes most recently from Lawson Software, where he served as CFO and Performance Officer. (Does his appointment mess up Mr. HIStalk’s – and Yahoo’s – theory that Misys is considering a TriZetto acquisition?)

Inga’s listening.

News 7/26/07

From Ambulatory_Vendor: “Re: Sage. Fallout from the layoffs? We’ve been receiving calls from Sage customers who have been unable to get support for weeks.” Unverified. I’ll ask Inga to follow up.

From Judith Beasley: “Re: Soarian. 2005, zero sales. 2006, zero sales. 2007, no sales yet. Soarian development costs are now over $150 million per year. Siemens can and will continue bleeding for a long time. The Susquehanna CIO is now a Siemens employee. Guess that will keep vitriolic e-mails from showing up in HIStalk.” Unverified. If anyone has facts, please elaborate.

From Mia Hottie: “Just a clarification on the Cerner product I mentioned yesterday. It’s not the Visicu-like remote monitoring product, but rather the ICU EMR that would compete with Picis or Sunrise Critical Care, for instance. Cerner announced iNet at least five years ago and, as usual, it was a toe in the water and was never been completed or well done.” Thanks.

From ExCPRUser: “Re: CPR. The combination of an archaic architecture (remember UltiMumps?) and lack of any real integration among CPOE, nursing, and rad/lab will eventually sink them.”

From RonA: “Re: QuadraMed and Vista Equity Partners. Dumb and dumber. Dumb: QuadraMed admits they can’t deliver a clinical product, throws in the towel, and buys an orphaned clinical system. HDS, Per-Se, and Misys couldn’t sell it, so what makes QD think they can? Dumber: Vista Equity Partners buys the junkyard of legacy standalone systems for $382M. Do you really think Vista Equity will invest more in these products? Both of these are feeble attempts to add value to challenged businesses and then sell it to someone even dumber.” 

From Jeff: “Re: KLAS. I think KLAS bends over backwards to provide an impartial opinion, but the key is that KLAS is only one indicator anyone should use to evaluate a vendor. There are many ways to substantiate or repute what a KLAS report might contain, so rather then ‘crying wolf’ because a vendor is not getting a great ranking, include in your opinion other factors, like making some reference calls, talking with the vendor about their vision vis-a-vis yours, and going to trade shows to see how others view the vendor. KLAS may not be perfect, but it is a great starting point for anyone.”

From Rufus: “Re: Anne Arundel. Rumor has it that Anne Arundel Medical Center (Annapolis, MD) might be ripping out Meditech and replacing it with Cerner. Their relatively new CIO is an ex-Cerner employee. Seems like a giant expense and burden. Questions: 1) true?  2) why?” Unverified.

From The Shelton Shadow: “Re: Lawson. TSS has been investigating a new possible takeover candidate who is partially in the healthcare space. That  company is Lawson Software. Don’t know yet who the suitor is, but one sign that something is up is that they have disabled their ‘Partner Network’ on their website. Only time will tell if it is one of the big players in healthcare or a private equity group.”

From Russel Ziskey: “Re: Google and the advisory team. Add Intuit to the list of organizations that maybe doesn’t get it. They announced a product over a year ago and nothing is released. Their division GM, head of bus dev/ strategy, and head of product dev are all gone. Also, the issue is not one of needing an RN to help think through what to get. The truth of the matter is that there are too many vendors from too many different angles trying to solve a need that doesn’t exist (let’s leverage our EMR, our claims data, whatever to deliver a PHR to consumers so they will manage their health and we will get $$). The reality is that consumers say they want a PHR (you have to – it’s like saying you should go to church). But, do you go every Sunday? Adoption is low, no one will pay, and standards certainly do not help – each player tries to protect their own interests.”

Cerner’s Q2 numbers: revenue up 17%, EPS $0.37 vs. $0.29, meeting expectations. The stock was down over 4% today as financial types realized that Cerner’s $26 million in NHS revenue brought along a 0% profit margin and decided the company’s expenses were too high.

OK, it’s usually pretty quiet on HIStalk in the evening. Right now, there are 51 readers on, some who’ve been there for more than 30 minutes (according to my stats service). Visitors from the past week would extrapolate to 61,889 per month, with 112,000 page views. Obviously, this will be a record month. Who knew there were 2,000 people each day who care enough about healthcare IT to hang around some anonymous guy’s blog? Join me in giving yourself a round of applause. And if you want to connect with each other, give HIStalk Discussion a spin.

University General Hospital Systems (TX) signs an exclusive agreement with Calence for network services. The press release uses the word “luxury” and “five-star” a little more than I’d like for a hospital chain, even if they are for-profit.

This ZDNet editorial is critical of the single announcement that Misys is considering an open source EMR release. “Its medical records product was already being pressured by OpenEMR, a GPL product … The current Misys Web site is terribly opaque. If Misys wants to compete effectively in open source that will have to change fast. Open source is more than free code, it’s a transparent way of doing business.”

University of Florida and IBM announce standards-based middleware to connect home monitoring devices to physician offices. “It would then be possible to buy a device off the shelf and by dialing a 1-800 phone number establish a connection between the device and one’s doctor. ‘The device itself becomes a service,’ he said.”

Cardinal Health says it has developed a better outcomes model for pay-for-performance programs. The big improvement came from adding lab data to the mix, which predicted mortality better than any other indicator, up to 67 times more important than administrative data.

FCG and InterSystems will jointly offer integration and business services to hospitals in India.

News, rumors, privaty equity investment opportunities: e-mail me.

Mr. HIStalk suggested I try to track down a CPR client to find out their perspective on the sale of the Misys CPR product to QuadraMed. I was lucky enough to catch Dave Paulson, Manager of Clinical System Support for St. Francis Health System in Tulsa, OK. He admitted he had plenty of thoughts on the whole situation and took the time to share them with our readers. Thanks, Dave!

What are your thoughts on the sale of CPR to QuadraMed?

I was very involved with the Misys leadership when they initially purchased Patient1 from Per-Se four years ago. I met with those guys and asked questions. With the Per-Se management, they had ideas but not resources to move the product forward. We were thrilled to hear what Misys management had to say. The CPR product is our lifeblood. It does everything. It’s huge for us and we need it to be continually developed and moved forward.

Misys said they realized they would do three things with regard to CPR and its development. They said, “We aren’t going to be invited to the dance unless we move from a proprietary platform to Cache’. We aren’t going to be asked to respond to RFPs because we are not Web-based. And, we have all these Sunquest lab clients now asking for the total package – they want integration with that product set.” So, those were the enhancements to be pushed by Misys.

Where Per-Se was not interested in supporting a user group for feedback, Misys was. I was very, very involved. Misys came in, devoted a lot of resources, but, about six months or a year ago, they had leadership changes and they ran out of steam when it came to focus on the CPR product. It wasn’t like some vendors that talk about things and don’t deliver. Misys just stopped talking about anything. Releases were pared down and delayed. And now, Misys has decided to be physician-focused.

We found ourselves back to where we were in the Per-Se days, but we need the vendor to move forth and advance the product. If it had been McKesson or GE or someone with products in the space to have bought CPR, it wouldn’t sit well with us. But it seems like, with QuadraMed, here is a vendor that has focus and wants to move things forward. My understanding is that the vendor staff that works on CPR is hearing good things thus far. They plan to keep people and they do have a good staff. I have not heard directly from anyone from QuadraMed yet.

I have talked to several other key CPR users in the last couple of days. We were frustrated that the CPR focus seemed to have been lost. Now people are cautiously optimistic that this is a good thing. This vendor gives us more reason to feel at ease than others.

Has the product been stable for you?

I think the product itself is stable. The one thing we really saw Misys bring to the table was improved quality of code. It just really became an issue of, “When will the next release with functionality that we want become available?” I assume that the same folks that have been working with us for the last eight years will continue and we won’t start getting support from a group that doesn’t know the product. That remains to be seen

When did you get your last update?

I think the last major release we took was about a year ago and they haven’t had one available since then. The next major release had been scheduled for release in August 2007, but that has been pushed back indefinitely. The next major release was planned for late 2006, then pushed to August 2007, then we were told they were pulling two major components and didn’t have a delivery date. The release is smaller and we don’t know when it will be available. You can appreciate frustration of the user community with something like that.

How fully are you using the system in nursing and ancillaries?

About as fully as it can be done. 100% of nursing staff is using it. The whole closed loop medication management process is fully online. Our Heart Hospital component is doing full CPOE and all the major ancillaries are using the medical records module. Sometimes I hear people say they need to look into getting single sign-on. I say, “What you need is one vendor.” It has worked well for us.

What is the CPOE utilization?

It is fully utilized in our Heart Hospital. We have three hospitals in Tulsa with 1,000 beds and the Heart Hospital has been our pilot.

Are orders being sent electronically from CPOE to pharmacy?

Yes. CPR does that fully. We have closed loop medication management.

Any problems with downtime or response time? Is the system solid?

Very solid. Really, no issues with down time and response time.

Have you ever considered switching to another system?

Yes, we have looked at that. We have had administrative changes and new management has asked if this is the horse we want to be on long term. You have to consider the cost to replace all that functionality. I cannot even fathom it. To try to replace full nursing documentation, all three major ancillaries … I don’t even know how you would do it. I can’t even imagine.

What are the best and worst things about CPR?

The best thing is the integrated nature and ability to view patient data from anywhere. The thing we have really needed from the vendor and which has been delayed multiple times is an enhancement to the clinical documentation toolset. We need it to provide more efficiency for nursing and physicians. We need something more EMR-like.

Secondarily, the pharmacy module needs to be updated and was to be included in the next release. The pharmacy module was one of the first modules to be ported to the Web. Our pharmacy folks are just still waiting for the changes. When I talk to people at QuadraMed, I will say those two areas need to continue to see focus.

Would you recommend CPR to others as it exists today?

Yes. Come and look at it if anyone needs to see what I just described. Cerner is going to talk about it, but we are going to show it to you.