News 3/2/11

From Less Than Grand: “Re: Dr. Gregg’s HIMSS review. I could not agree with you more. The show is lopsided with regards to the audience they are targeting. Though I have attended HIMSS many times in the past, it never fails to disappoint me that the show continues to leave out the physicians who represent the majority of physicians practicing (NOTE: these physicians also represent the majority of those without an EMR.) Great summary!”

From Kubrick’s Rube: “Re: Blue Cat Girls at HIMSS. I thought HIMSS had sunsetted those displays ten years ago, when an exhibitor no one remembers had a small Asian woman in a practically transparent body suit doing mind-blowing contortion. I heard HIMSS got the word out that this kind of entertainment wouldn’t be allowed, but I guess anything to fill the halls …”

From RIFeree: “Re: Vanguard Health Systems. The for-profit laid off 10% of corporate employees on Tuesday.” Unverified, but what appears to be the CEO’s internal e-mail is above (click to enlarge).

From Rockville: “Re: HIStalkapalooza. What a fantastic event! I have never laughed so hard at a trade show in all of my career. Jonathan Bush was one of the funniest, irreverent, and most ‘real’ executives I have met in a long time. I would enjoy working for him. The HISsies and other awards were very entertaining. Thanks for giving healthcare a personality!” His employees in attendance were sure having a swell time, I’ll say that, and that’s a good sign. He looks good in a sash, too (but doesn’t everybody?)

From StatMan: “Re: HIStalk stats. What’s the February number?” I don’t pay too much attention, but it was a record and greatly increased over February 2010. I’m beginning to think it’s like running a publicly traded company – you start to suck once you fixate on the numbers instead of doing whatever it is you’re supposed to be good at. I will have detailed reader survey results up shortly, though, which I do pay attention to. Otherwise, we just do our thing and anyone who wants to read is welcome.

From Art Vandelay: “Re: iPad. Awesome work on the iPad-themed version of HIStalk. You always amaze me with how current you continue to be with trends, news, tech, and I like your music picks too!” Art is observant. I upgraded the mobile format of all three sites (HIStalk, HIStalk Practice, and HIStalk Mobile) this week to provide a rich, functional, fast presentation for iPad, Android, BlackBerry, Palm, and Samsung (it was iPhone and iPod Touch only before). Once I pulled HIStalk up on the iPad I won at HIMSS, I was like, “This looks crappy,” and then realized I could probably figure out how to fix it in my vast amount of spare time. Which I did, and happily so since I know quite a few of you new iPad owners from HIMSS will be checking out HIStalk on your new toy.

From July Johnson: “Re: consumer group’s letter to ONC. I may be overly dramatic, but I believe this is a watershed moment. The battle lines have been drawn between the consumers of all walks of life who won’t accept the system as is any more and expect more for their $30B vs. the providers and IT vendors who want to get billions of $$$ to deliver what they should have delivered without incentives years ago. Reading these positions, it make all the flash and boat showmanship of HIMSS seem extremely hollow when you see what consumer/patients actually want from the system. Now that the mighty consumer/patient has been awakened, providers, vendors, and HIMSS will have no idea what hit them.” The groups include AARP, AFL-CIO, Consumers Union, SEIU, and several others. Their most interesting recommendations:

1. Make all Stage 1 Menu items required as Core for Stage 2.
2. Improve e-prescribing by encouraging fill-status messages from pharmacy back to the physician.
3. Raise the bar for use of evidence-based clinical decision support.
4. Require documentation of advance directive.
5. Raise the secure messaging bar in Stage 2 to 50% of patients who prefer electronic communication.
6. Hold providers accountable for using, not just offering, a patient portal.
7. Raise the bar on use of electronic tools for communicating with patients from 20% to 30%.
8. Add required experience of care patient and family surveys to Stage 2.
9. Require in Stage 2 a care plan that includes a list of team members, problem list, medication list, allergies, advance directive status, and patient preferences for language and communication.
10. Don’t let providers meet the HIE requirement in a “test” – make them provide a summary of care record for 30% of their patients who are transitioning to another care setting
11. Advance the incorporation of lab results into EHRs.
12. Provide a mechanism for patients to flag and correct their health information.
13. Encourage accessibility and usability standards so that disabled people can consumer health IT innovations.
14. Don’t be tempted to let providers slide on Meaningful Use just because their quality scores are good because quality measures aren’t meaningful to consumers and patients.

Also writing to ONC: eHealth Initiative, which wants increased emphasis on HIEs and better coordination between CMS and ONC on timelines. They make good points about needed clarifications (who’s a license professional when it comes to CPOE? how do you define “structured” lab data?”)

From The PACS Designer: “Re: Apple’s iOS 4.2 release. Apple’s iOS 4.2 has many new features that users will most likely want to use to expand the capabilities for their remote viewing activities. The free iOS 4.2 update brings all-new features to not only your iPhone 4, but also the iPad and iPod Touch.” Above is a video that TPD found.

From Privacy Concerns: “Re: EMR. This represents a creative use.” A PGY1 resident at Christiana Care performs unauthorized physical exams on six women and throws in some no-extra-charge fondling, all undocumented in the chart. Investigators found that he had checked out the electronic medical records of the women before the grope-fest. He’s been fired and warrants are out for his arrest on charges of unlawful sexual contact and patient abuse.

From MarylandSnow: “Re: RealAge. Not news, but since you mentioned it, they sell patient data to pharma along with ads.” I knew that upfront (it’s clear in the sign-up agreement) but I’m actually OK with it. I’m not so gullible that just getting a drug company’s e-mail pitch is going to make me doing anything I don’t want to do.

From Flatlander: “Re: reader’s comment about Lewis & Clark Health Information Exchange (LACIE). Since it wasn’t even mentioned in the article about Kathleen Sebelius, that probably came from the Cerner PR machine. LACIE uses a heavily subsidized HIE platform in exchange for being a national sales reference, and with all participants except one being from Heartland’s normal referral area, it’s hardly impressive and bears no resemblance to a self-sustainable HIE. MU’s Stage 1 HIE requirement is so low (strap a USB drive with one patient’s data on a pigeon’s leg), the one other LACIE participant (St. Luke’s) will be out of there once the incentive check is cashed since its northernmost hospital is a direct competitor of Heartland. St. Luke’s probably got a no-cost deal for the name recognition – they check the HIE box, take the money, and avoid system entanglement and getting their patients recruited.” Unverified.

Also from MarylandSnow: “Re: National eHealth Collaborative. Funding on the line? Although set up with a membership model, their sole funding is ONC – grandfathered in prior to HITECH. Standards and Policy committees with their own multi-million dollar funding have effectively taken over NEHC’s role.” That’s the AHIC Successor that does NHIN stuff.

From Without a Trace: “Re: Usability Symposium Sunday of HIMSS. The whole day was great, but Dr. Friedman from ONCHIT started the day with some big news: usability would be included in Stage 2 of Meaningful Use. The symposium also included speakers from AHRQ, FDA, NIST, Access Board, and big names like Dr. Rob Kolodner and Dr. Dean Sittig. The HIMSS Usability Group announced the release of a new white paper. I expected to read about the ONC’s announcement and news form the symposium in the HIMSS newspaper, but nothing. I can imagine that big vendors wouldn’t be happy about this – I wonder if they were behind squashing the news?” I’ve been darned impressed with the HIMSS Usability Task Force, especially since I bet the HIMSS suits grit their teeth every time they observe that the usability of current clinical software, much of it produced by their cash cow Diamond Members, isn’t very good. I found what appears to be the new white paper, Promoting Usability in Health Organizations: Usability Maturity Model, on the HIMSS site. I haven’t had time to review it yet, so jump in if you’d like to summarize (or I suppose I could try to swing an interview with someone involved in creating it). I still recommend a more dramatic first step: hire an independent firm to evaluate the usability of the top three EMRS in each of the hospital and practice markets and publish the results (you don’t need the permission or involvement of the vendor). Think that wouldn’t put the debate in the public eye?

From HISJunkie: “Re: Texas Health Resources offering HIT consulting services. Epic is doing what IBM did 35 years ago, turning every client into a hosting site (see SHAS circa 1975). Epic is allowing / encouraging the large medical centers to distribute its app on a host basis to almost any remote client (particularly if they are under 150 beds) without incurring a new acquisition or license fee. Just add more work stations and pay a small seat license increment and you can buy them in ‘bulk’. I spoke to several CIOs at HIMSS that are doing this for owned, managed, and non-affiliated facilities. All other vendors require you to pay a sizable new facility license fee. Epic says … not necessary. Oh, but along with the seat charge, they bump up your monthly support fee. How can Epic do this? If you’re a private company, cash is king, not revenue recognition. That’s why you do not see Cerner, McK, Allscripts, etc, do this — Wall Street wants the rev NOW! Epic can wait. Why would Epic forego a possible meaty license fee? They view this as incremental revenue that they would otherwise never see since it’s too costly to sell and support the small or mid-sized facility. (Watch out Healthland, CPSI, HMS, et al.) I predict in the next year you will see many IDNs that are running Epic do the very same as THR. Only trouble is, running a software / service operation is very different than running a facility-focused HIT department. I know, I’ve done both, and the balancing act can make you pull your hair out!” Even Judy critics have to admit she’s brilliant in turning high-paying customers into dealers who can make a little of their money back selling their services to small sites, and in doing so, spread Epic’s reach wider. It’s like creating an Amway sales downline – let someone else do all the sales work on your behalf. I bet the number they watch isn’t revenue or profit, but rather the number of beds or encounters covered – if that number keeps ramping up, the company has endless ways to monetize it down the road. It’s like viral marketing with high switching costs, not to mention that customers aren’t likely to complain publicly about Epic’s solutions when they’re trying to sell them themselves, either internally or externally.

Here’s the Siemens announcement of the hiring of Marc Overhage from Regenstrief and the Indiana HIE as the CMIO of Siemens HSBU under John Glaser.

Capitol Regional Medical Center (FL) will pilot a consumer smart phone app from Healthagen that lets patients who are headed to the hospital fill out information forms and indicate any special needs on their way. Not while driving and clutching their infarcted chests, hopefully.

Bethesda Health Group (MO) is working with Cerner to implement its BeyondNow software in a skilled nursing facility. Cerner acquired BeyondNow in 2003.

Megan provided this pic of her HIStalkapalooza prize-winning shoes since I know the ladies are following that intently. Inga posted a gallery on Facebook.

I ran the news blast earlier that ADP has acquired PM/EMR vendor AdvancedMD. That’s big news because it’s ADP’s first foray into healthcare, other than doing HR administrative work for practices, and they’re a huge company. AdvancedMD had arranged an interview with us beforehand. Below are some snippets from Inga’s notes of her call with Eric Morgan, president and CEO of AdvancedMD. I’m sure she’ll have more later.

I wanted to let you know you were the first ones we thought of. ADP, a company that most of us know, has done a lot of homework in looking at the marketplace and made a decision. They have had a strategy in place to look at adjacent opportunities to grow their business and this is one they have been looking at for well over a year … meaning the smaller to medium-sized physician space AdvancedMD targets and serves.

The matchup between the two companies is very strong. They are certainly focused on our cloud-based, SaaS offering. In fact, they narrowed the field of opportunities down pretty quickly by saying that was the way they wanted to go. They were not going to offer an on-premise approach, so this is very much compatible with what they do with the rest of their business.

The key is they saw value in the business we built here in serving these smaller physician offices. What we do is not easy to do efficiently and effectively. Certainly a lot of vendors in this space have struggled in this. They saw tremendous value in that. This is a big statement for healthcare IT that a company the likes of ADP has made a big commitment and investment in moving into the space from outside the traditional list of folks that you and I are used to talking about.

We will look how we work together and integrate products. All that is part of the plan. We are going to be rolling that out over time. For an ADP client who is interested in practice management or EMR, this makes a very good opportunity for the client to connect very quickly … physicians, much like on the hospital side, more and more will be looking to a trusted leader and a trusted brand. And that scaling of an organization is going to matter more and more … we believe this puts us in a very strong position to be able to give our customers the confidence that they are going with a very, very strong reputable organization like ADP and know that they have a long-term commitment and relationship and investment in the marketplace.

The reaction from the employees has really good. A lot of excitement and buzz here …We are of a size now that they are only a handful or two of folks that are actually bigger than us, yet there are hundreds and hundreds that are smaller than us. I think this puts us in a position to stake a claim among the leaders of the industry.

Inga and I expressed our mutual amazement at how many of our sponsors have been favorably acquired in the last year or two. She wants to get tee shirts made with a list. We can’t decide whether (a) desirable companies disproportionately sponsor HIStalk; (b) we help raise the interest level slightly among potential acquirers; or (c) companies intentionally raise their profile by sponsoring as a signal they are willing to talk, knowing that we have a lot the money people as readers (VCs, private equity, and investment bankers). Regardless, the number is a significant chunk of the total industry acquisitions. Not good for us, of course, since sometimes one sponsor buys another and that means we lose one.

Scottish charge master vendor software vendor Craneware, fresh off an acquisition that gives it a broader US presence, announces record performance for the first half of the year: revenue up 25%, profits up 30%. 

Deborah Gage is named president and CEO of MEDecision, replacing founder David St. Clair, who will remain on the board. She was previously CEO of healthcare payment technology vendor GTESS.

HERtalk by Inga

From DrLyle: “Re: Post-HIMSS. I agree with you about noticing that the buzz is shifting away from the big vendors and we are seeing the rise of the ‘peripheral companies’ which are creating products that build an ecosystem around the bigger HIT infrastructure. The base level is being set (just like Microsoft and Apple did with operating systems) and it’s time for the next generation of HIT companies to start creating the products that actually move the pointer from ‘up and running’ to actually usable and useful. The good ones will thrive and likely be acquired) while the bad ones will fade away quickly. There are books to be written and movies to be filmed about it all in the years to come.” I like the idea of movies being made about the thrilling world of HIT in the age of MU. Maybe Mr. H and I could cameo (for a large fee). I think I failed to say much about DrLyle as the Ryan Seacrest of the HIT Geeks Got Talent session. He was terrific and the brave souls who pitched their product in something like three minutes were all impressive. DrLyle will have to let us know who won.

ScriptRX raises $1 million of a $2 million offering. The 12-year-old company’s products include ScriptRx Writer, ScriptRX Discharge, and ScriptRx EMR for clinical documentation.

Madison County Memorial Hospital (FL) purchases Healthland’s EHR system. The 25-bed critical access hospital expects to be live and achieving Meaningful Use by July.

Elsevier/MEDai and dbMotion partner to provide dbMotion users with Elsevier/MEDai’s reporting and modeling tools.

HealthShare Montana partners with Covisint to for its statewide HIE.

Just another day at the office: a Georgia pain clinic patient becomes angry about her medication and chases her doctor and his female office manager down a hallway with her cane, threatening to rip the manager’s throat. The patient shoves another doctor trying to intervene before a second doctor is finally able to restrain her.

Gilbert Hospital (AZ) begins its implementation of Prognosis ChartAccess.

Surescripts, AHA, and the College of American Pathologists are awarded a grant by the CDC to connect hospital labs with public health agencies to electronically transmit data on reportable lab results. CDC is calling the initiative the Lab Interoperability Cooperative.

Anyone remember Sarah Kramer, the eHealth Ontario exec who left amidst charges of frivolous spending? ($25,000 to have a speech written; $50,000 to refurnish her office; $192,000 to a single consultant for five months of work.) She left eHealth a couple of years ago, taking her $317,000 severance package with her. She is now executive director of Strength to Strength, a third-party consulting team bringing Epic’s EHR to UCLA Health System.

A reader asked for some pics of the fabulous shoes at HIStalkapalooza. Here is a sampling. Not bad, huh?

New from KLAS: a first-time report on the infrastructure market, with an initial report on wireless communication systems. Execs at provider organizations are adopting VoIP cautiously and physicians are embracing new ways to use their mobile VoIP phones. Vendors included in the study are Ascom, Avaya, Cisco, Polycom and Vocera.

KLAS introduces two offerings that I wouldn’t mind having. KLAS Alert will give providers or vendors a monthly snapshot of satisfaction rating of one vendor or multiple vendors, depending on the subscription level. KLAS Connect will facilitate the connection between providers using similar technologies, giving them the chance to network or compare best practices (or perhaps collectively complain).

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Greenville Hospital System (SC) selects Oacis Health Data Warehouse from TELUS Health Solutions to provide analytics and reporting.
• Joe Mason joins Enterprise Software Deployment as VP of Strategic Alliances.
• Riverside Community Hospital (CA) chooses ProVationMD software for its gastroenterology procedure documentation and coding.
• Healthcare innovative Solutions introduces Pillars, a web-based CPOE workflow planner tool.
• Imprivata announces its integration with Epic’s authentication API.
• Lake Regional Medical Group (MO) will implement eClinicalWorks using implementation services from GroupOne Health Source.
• St. Joseph Health System (CA) joins with AT&T to implement a new telehealth project that will allow patients to consult with physicians remotely using AT&T Telepresence Solution.
• M*Modal partners with Greenway to integrate speech recognition into PrimeSUITE2011.
• DIVURGENT releases results of hospital industry’s first survey on business intelligence maturity.
• Novell partners with CynergisTek to create the industry’s first unified compliance and security monitoring solution for healthcare.
• St. Joseph’s Health System (CA) selects Allscripts’ Care Management and Homecare solutions to streamline patient movement through its 14 hospitals.
• Health Language launches LEAP I-10, a cloud-based ICD-10 conversion solution.
• University Health Systems of Eastern Carolina reduces labor costs using Concerro’s ShiftSelect.
• Madison Memorial Hospital (ID) chooses PatientKeeper’s CPOE to achieve ARRA-HITECH compliance.
• CapSite releases new research reports on PACS and teleradiology, with 21% and 31%, respectively, of providers looking to switch their current systems.
• Billian’s HealthDATA profiles Florida Hospital CIO Andy Crowder.

EPtalk by Dr. Jayne
 
There was an “Ask Dr. Jayne” question awhile back about those pesky doctors who insist on wearing their stethoscopes and white coats even though they rarely see patients. As I was camped out in the Orlando airport trying to catch a much-delayed flight to my frozen home, I witnessed not one, but TWO episodes of Health Professionals Gone Wild.

The first was an actual medical situation, where an inebriated would-be passenger took a spill and whacked her head on a large planter, splitting her forehead like a melon. An angel in pink scrubs jumped to her aid, applying Starbucks napkins to the wound until the gate agent arrived with first aid supplies, followed by the paramedics and lots of security folks who documented the event on film (alas, I didn’t, though, because that would be tacky). After the cleaning crew completed their multi-step decontamination process (which I was able to explain to several of the curious travelers around me who wanted to know exactly why it took so many people and so much stuff to clean it up).

I was waiting for something else to keep me from a post-HIMSS stupor when what to my wondering eyes did appear but three passengers coming off a flight wearing matching green scrubs, one of whom was actually wearing the white coat. Now this I had to photograph. I looked carefully and didn’t see any transplant coolers and they were loitering quite a bit before heading to baggage claim, so I don’t think they were in the organ procurement business. 

I never did figure it out. Maybe I should have one of those “submit a caption for this photo” contests. If you look closely, you can see one of the planters in the foreground. Sorry the second one is fuzzy — I was laughing too hard to take a decent picture.

After finally clearing the snow from my car (those of us who work in non-profit land park uncovered) I drove home through precipitation that was exactly the consistency of a frozen margarita. Hard to believe that a few hours earlier I was soaking up rays (with sunscreen, of course) in Orlando. As I went through the mail that had accumulated during the trip, I chuckled at the number of vendor and HIMSS-related mailings that were delivered on or after Monday the 21st. Nuance, SuccessEHS, and CapsaSolutions: you should ask for your marketing dollars back.

Now it’s back to the CMIO grind, with PQRS (aka PQRI) registry reporting at the top of my list. Having done claims-based reporting previously, many organizations are trying our hands at registry reporting this time around. It’s always interesting to wade through the data as it’s pulled out of the system, arguing with the doctors who insist they really did do everything for every metric on every patient even though the data says otherwise. It’s always the data that’s faulty, rather than the physician or the office processes, right?

Although some providers loathe clinical data reviews because it points out what they aren’t doing, I take the opportunity to remind them of the studies that have been done showing the sheer number of hours it would take a physician to deliver all the services that each patient could receive, based on the varying recommendations, guidelines, and mandates.

Frankly, without automated systems, I’m not sure how we kept it all straight. I used to have to wade through multiple flow sheets for multiple diseases rather than having a single cohesive presentation of the patient’s health status that could be graphed, manipulated, extracted, and e-mailed to the patient via a secure portal.

I’m hoping that my physicians who are “passive” participants of registry reporting enjoy the CMS payments they receive based on our data submission. Many of them have never participated in PQR-anything before, due to the annoying nature of claims-based reporting. Some of them have no idea that the hospital is reporting on their behalf.

I think once we go electronic, we tend to forget how painful it could be to document on paper and how arduous it was to extract data. (Not all of us, of course. I still have a couple folks begging to go back to the Golden Age of paper.)

And once the PQRI checkbox is complete, it’s onward to Meaningful Use. I’ll have to dust off my riot gear (and my favorite martini glass) because it looks to be an interesting year.

E-mail Dr. Jayne.

ADP Acquires AdvancedMD

HR, payroll, and benefits services provider ADP announced this afternoon that it has acquired AdvancedMD from Francisco Partners. The 200-employee, Salt Lake City-based AdvancedMD is a leading provider of practice management, revenue cycle, and electronic medical records systems. It has more than 10,000 physician users in 4,100 practices.

In the announcement, ADP positions itself as “an integrated, single-source provider of Medical Practice Optimization” for small- to mid-sized practices. The company’s Small Business Services group provides HR, payroll, and benefits services to 45,000 physicians in 13,500 practices.

ADP Chief Strategy Officer Jan Siegmund was quoted as saying, “With a trusted brand, best-in-class solutions, and experienced management team,AdvancedMD is a highly strategic fit with ADP and will enhance our offerings to small- and medium-sized medical clients.   A partnership with ADP means that physicians can dedicate themselves to what they care about most — patient care —while letting ADP take care of the rest.  With our newly combined team, ADP and AdvancedMD will compete effectively for the small- and mid-sized physician practice market, which is going through a rapid technology adoption cycle and moving aggressively toward outsourced solutions—clearly ADP’s strength.”

AdvancedMD was acquired by Francisco Partners in January 2008.

The acquisition appears to mark ADP’s entrance into the PM, EMR, and physician billing market. The company has $9 billion in annual revenue and a market cap of $24.5 billion.

More HIMSS Wrap-Up

Unlike other sites, I don’t re-run anything that has appear elsewhere. I’m making an exception in this case, however. Brad Dodge at healthcare marketing and PR company Dodge Communications did a fun writeup of the HIMSS exhibit hall that I thought deserved a broader audience. He gave the OK to run it here.

Did You Make the HIMSS Best and Worst List?
By Brad Dodge, Dodge Communications  

One of the most challenging elements of marketing communications is that it can be VERY subjective. When vendors are considering their investment to exhibit at a conference like HIMSS11, how important is it to have a brand new booth? Sure, it’s cool, but also expensive. Does the incremental investment bring in a commensurate number of leads into the booth? And how on earth do you measure that? How about a question like, “Thanks for coming into our booth. Would you have come by if our booth was 20% less cool? 40% less cool?” Didn’t think so.

So, no disrespect intended, let us acknowledge our best and worst of HIMSS awards. Don’t forget, there were more than 1,000 exhibitors, so if you think you were the worst in a category that we awarded to someone else, it’s probably because we didn’t see you. Which is for another conversation altogether on visibility.

WORST IMAGERY: The see-through head with colored veins running down to the spine at Cattails Software. Turns out that the entire brand identity is centered on the see-through head. Maybe it appeals to physicians. Not us.

MOST SURPRISINGLY NICE THEATER AREA: CDW. Very engaging, close to the aisle, nice little talk-show-interview area off to the side and very clean presentation technology.

WORST SIGNAGE: Merge Healthcare. A whole backdrop of patents that the company holds, we guess. They were too small to read, but big enough to look like we were supposed to be able to read them. If we hadn’t asked the guy what they were, we’d have never known. Lost opportunity.

MOST OBVIOUS CASE OF LITTLE-BOOTH-IN-A-BIG-SPACE: Healthwise. Refer back to our comments in the opening paragraph. Our opinion: if you’re going to the black tie event, you gotta spring for the tux.

MOST OVERUSED BRIBERY TOOL: The Apple® iPAD®. We lost count of how many vendors had stacks of them that they’d give/raffle to attendees who’d listen to the pitch. And don’t get us started talking about the misuse of the trademark.

WORST FASHION STATEMENT: As in the shortest skirt. As in who thought that was a good idea? We saw her at the ACS booth. We thought that booth babes had toned it down? Maybe their parent Xerox forced them into it.

WORST FLOOR PLAN FAUX-PAS: HIMSS interoperability showcase was WAYYY at the end of the hall, and it was a really cool exhibit. If you went a little bit past it, you’d be at Cape Canaveral. We think it should be the absolute center of the show floor.

HONORABLE MENTION FOR LONGEST USE OF THE TRUSS BOOTH: We’re sure there were OLDER booths in the hall, but nothing says 1990 like a booth built using trusses. We guess they’re still paying off the loan. Award goes to  ESRI. At least the booth staff wasn’t wearing leg warmers.

MOST OVERUSED ICON: The world. As in global healthcare. Get it? ESRI wins it again. Mainly because we didn’t write down the others.

MOST BLATANT DISREGARD FOR TRADEMARKS: This list is entirely too long to publish. For a taste, go here. What was so surprising is that every one of these companies would go ballistic is their own IP or trademarks were compromised similarly.

BEST GIVEAWAY THAT THE DODGE TEAM WANTED TO WIN: The waverunner at the SCC booth. We’re looking up SCC on Google, and once again are stumped by the acronym that’s shared by a zillion other organizations. Is it Spokane Community College? (first result) Scottsdale Community College? (second result) Seminole State College? (third result, and it’s not even an SCC!) Did you already see our opinions on the strength of acronyms in healthcare brands? So, we had to go to the HIMSS pocket guide to figure out who the winner is. SCC is SCC Soft Computer.

FRESHEST GRAPHICS: IBM. We know it’s a challenge to have noticeable graphics at a behemoth conference like HIMSS. We think IBM did a nice job. Colorful. Different. Link to healthcare.

BEST NOT-FEELING-THE-THEME: Epic. The stacked stone, jewel tones, solid-walled booth is obviously very expensive to build, ship and store. We felt like we were in the past. Does anyone care?

BEST NEW BOOTH DESIGN: We have to say that we liked the way that the long, narrow Moss headers were used in a number of new booths to pull the exhibits together without cramping the space. Allscripts and Ingenix both did a nice job at this.

All in all, we were thrilled to have a dozen of our employees at HIMSS11 meeting with clients, editors and others. We thought it was a great show and look forward to 2012 in Las Vegas.

Dr. Gregg "1 to 3 Docs" Goes to HIMSS (Part 1)

Amidst the ACO, ACA, MU, ONC, and HITECH BS buzz these days, it seems there is also a lot of chatter amongst HIT vendors, HIMSS helpers, and REC-related registrars about how to reach the 1 to 3 provider practices, how to get the bit players biting on the digital bait.

If my numbers are still accurate (I haven’t checked them in a few years,) the majority of healthcare in our country is still being delivered in the small practice and small community hospital setting. As I’ve long ranted, you can’t build a national health information network if over 60% of the network is ignored. Granted, we don’t have the glam and glitter of the giant groups and grandiose medical conglomerates, nor can we write those big, beautiful, multiply-zeroed checks that they can. But, we have one thing they don’t, one thing they need that only we can provide:

Us.

And, “they” need us. And, they’re starting to get that point. And, it’s about to get really interesting here in the trenches.

With that in mind, I thought it might be worthwhile to share a trench-eye view of the world of HIMSS11.

There’s really no other showcase for HIT left now that TEPR is pushing up digital daisies, no place else where you can see, en masse, what might be possible for a practice considering health IT options. And, what makes that sort of sad is the fact that the HIMSS conference doesn’t hold much draw for anyone from a 1-3 provider practice.

First off, HIMSS is an industry show, a vendor’s show. Even its timing during the work week bespeaks this. Unless you have a sugar daddy awaiting in the wings (or, unless you’re a committable geek like me,) you simply cannot justify losing thousands of dollars of income generation for the one or two or three work days that you’d need to sacrifice in order to go. Without a corporate expense account upon which to lean, it’s a bear trying to go to a conference held during work days. Most grunts prefer to save those times off for family vacations, not stuff which is essentially more work.

Secondly, HIMSS isn’t really 1-3 doc friendly. Seminars and educational sessions are targeted toward CIOs, CMIOs, CTOS, CEOs, other “O”s, and informatician-types who have no, or very little, interaction with or awareness of the little "o"s in the 1-3 provider world. I truly doubt many "1-3’ers" who are just considering the whole EHR thing would find much of value at their level during HIMSS. I doubt many of them think about ONC or HITECH unless they have to, which likely isn’t too often. I doubt many of them care a smidge about server-based versus SaaS. They mostly want to know how to do this digital redirection with as little pain as possible and get on about the business of being patient care providers.

Third, as others have opined, walking the HIMSS floor without "VC" stamped on your head or a green "PRESS" banner flying below your HIMSS badge may limit your ability to get a conversation started, at least in some vendors’ booths. I have had the notion that HIMSS exhibit hall exhibits are more designed for inter-exhibitor intercourse than any product promotion to potential end users. (Plus, just a little side note here: I understand how boring it can be in an exhibit booth with no visitors, but if I were a corporate CEO and saw someone representing my company’s interests with as much neglect and disrespect as some I saw on the HIMSS exhibit hall floor, there’d be a post-HIMSS Pink Slip Thursday pending.)

Bitch, moan, bitch, moan. As I said in my last post, I despise non-constructive whining. So, in keeping with that credo, and after a few more observations, I will be offering up some potential remedies next time in “1 to 3 Docs” Goes to HIMSS – Part 2.

From the trenches…

“Not engaging in ignorance is wisdom.” – Bodhidharma

E-mail Gregg.

From the standpoint of a clinician (a.k.a. "doctor"), HIMSS was — and usually is — a great opportunity to get an idea of the underlying forces that are shaping the development of health IT, whether substantive or faddish. However, these forces are all operating on a scale, and in an environment, pretty far removed from where actual healthcare happens, e.g. the doctor-patient relationship.  

To look at it in a more cynical fashion, make no mistake – this is a trade show where vendors of large information systems and hardware attempt to sell them to frequently non-clinical IT personnel. That said, I found many of the booth personnel to be reasonably friendly, but I can’t rule out a bit of selection bias.

At least in name, there were many educational sessions addressing operational and organizational challenges, but many of these ended up just being information-light or thinly disguised case studies of Vendor X’s product that lacked much depth. You’ll have to look elsewhere to learn about process innovation, re-engineering healthcare, etc.

That’s not to say that the conference is bad. Certainly not. You just have to keep in mind what it is and what it isn’t. HIMSS is kind of like Home Depot. It might be a great place to see new tools, but it’s not where you to go to learn how to build a house.  

As a clinician, I came away with an appreciation of a few things. In an effort to chase after the $$$($$$$$) sloshing around healthcare these days, many vendors have created products that clearly demonstrate a lack of understanding about what end users actually want and need.  Of course, given their real target audience, this might not matter to them.  Moreover, for the large subset of back-end systems and products, their application to healthcare is almost an aside. 

(Speaking of asides: yeah, we know you all create value and whatnot, but how are you different and/or better than the other 20 vendors in the exact same space? For that matter, what exactly is it that you do?) 

This shortcoming is often compounded by the fact that decisions regarding clinical systems are often — if not usually — made by non-clinicians looking out for their own interests. They’re not out to screw the clinicians, but if there’s any trade-off between the clinicians and the admin/IT side, we know who will win the tug-of-war.  

HIMSS provides great insight into understanding the what, how, and why of health IT development. Though unintentional, it’s also a good reminder that healthcare is rapidly shifting from small(er) collections of independent providers to large systems with a corresponding shift of decision-making away from the clinicians to a concentrated group of often non-clinical individuals. It’s a real bummer for people like me, but instead of denying reality we might as well learn how to play the game.

HIMSS Recap
By Evan Frankel

HIMSS ’11 is now officially behind me. Originally tasked with reporting on the HIStalkapalooza party, there was a conflict with my desire to punish my liver. Therefore, after a couple of days of recovery, feverish work to network and saunter the exhibit hall, all that is left is a newbie’s recap of the conference.

The last HIMSS I attended was quite some time ago. I was a much different person and the industry was in a much different place. What was once an informational and educational experience to be shared with industry peers and HIT professionals has warped into a testament to the power of marketing dollars and a commitment to further the sales of vaporware and roadmaps.

I thought I was prepared. I believed that my conviction to spend the entirety of each day in the exhibit hall (bless you Exhibitor badge, you keep me from winning prizes, but enable me to loiter whenever I please) was well meaning as I knew that I could easily download and review all sessions at a later time. In hindsight, I wish I wore a pedometer.

Clearly this is a rapidly evolving industry, what just a couple of months ago was a drive to Meaningful Use, federal inducement and incentive, and a push to make digital every last granule of data has altered course to focus on the eternally long list of problems already encountered. It seems like vendors wanted to talk about their few happy clients and wouldn’t admit to any struggles or lessons learned.

I visited, in one way or another, 84% of all of the booths on the floor (yes, that means I am without a voice today and shook almost 850 hands). I asked everything from the most basic question, “What do you do?” to engaging in hour-long conversations about the challenges companies have in retaining talent and clients. I am always impressed to see passion and conviction, it goes without saying that being in love with your company is an engaging trait.

I saw some things that not even ‘brain bleach’ can remove from memory, which is a shame. Not only is the overtly obvious booth-babe phenomenon here to stay, but the desire to at least make them conversant in their employer’s product or mission seems to no longer be even a slight priority. I am not leering at you, I am just floored that you are not able to help me in any way.

Even the most senior of executives were forced into booth duty, which could have been very refreshing, but in certain cases was both scary and cringe-inducing. Case in point: I was told by more than one vendor, in reference to long and close-to-failed EMR implementations, that they are a good thing since the vendor collects pay by the hour. I had another vendor tell me they sell implementation support and training time by the 100-hour block because anything else would nickel-and-dime the customer. When asked about small practices, there is not a per-hour rate (which would help me understand the profit margin on implementations, since the same company was hiring project managers and implementation staff). But at least they were honest, which couldn’t be said for all.

I did find a partner in crime on Tuesday. Armed with the exact same questions for the exact same vendor, we were able to get completely different answers to the same question. “Can I run this in my data center?” shouldn’t elicit both a Yes and a No. But I guess we could chalk that up to, “it’s all customizable”, which may be the mantra that I take to every meeting I ever attend. It sure beats committing to one answer or solution, I suppose.

To the gentleman who stood next to me at the Google booth and asked the employee what “this Google thing does”, as if he had never heard of them, thank you for being the funniest guy in the room. But it also made me sad, as their answer wasn’t, “Oh, we are here to take over the world, at least all of it that isn’t Europe.” That would’ve been super cool and probably more honest.

The best attraction that a booth could present, in my novice opinion, is the soft, ultra-plushy carpet. I have no idea if that was an up-sell from the convention center or not, but after logging 5+ miles each day on the concrete covered by a millimeter of carpet, a soft booth floor was welcome respite.

I tried to muster the energy to engage all of the hired booth talent as possible. I watched a man duct-tape his eyes shut and guess the serial numbers on a dollar bill. There is a lot of talent in that trick, but was it worth losing most of an eyebrow?

I saw comedy, three-card monte, and a bunch of artistic impressionism. Then I got tired of standing at the NHINDirect/Connect/Interoperability showcase and went back to the booths.

I don’t want to come off as angry, jaded, or a naysayer that we are getting further from solving most of our healthcare woes than we were before. However, if another person tells me all about the value they create with their solution without understanding the basic premise of entropy in the universe, I may beg HIMSS to administer an IQ test as part of registration. As a quick lesson, in order to create value, you must eliminate something, and I highly doubt it is your profit margin, so riddle me this — where did you get that value?

The booth demo on a large scale is a brilliant concept; it is akin to auditing a college course. You can come and go as you please and no one grades you on paying attention. In fact, if we were to require an assessment at the end of every 10 people or larger group demo, I would wager less than 1/3 could even get the product name right. Luckily next year is in Vegas, as I hope to actually find some action on these wagers (but I have a feeling I won’t be allowed back).

Speaking of Vegas, HIMSS executives predict a sharp increase in attendance in response to the location. I hope they market this correctly, as they should expect more registrants, not attendees. Vegas has a wonderful way to make you forget why you are there.

I will need to check, but I believe HIMSS will continue to be the same weekend as the “Great American Race”, which would have been a nice thing to know before I booked my travel plans. Not only would I have trekked to Daytona to see what the hubbub is about, but I am sure I could have had some easy pickings on making analogous the driving fast cars in circles to the current state of the HIT industry. Spinning tires until they explode? Banged-up, dented, smoking heaps of metal? That it takes 16 people to change a tire and fill a tank of gas? 100,000 people half-drunk standing in their own sweat? This is almost too easy.

Undeniably, HIMSS ’11 will be considered a success: record attendance, millions of dollars poured into the local taxi and livery economy, a significant dry-cleaning bill upon return for all those in attendance, and a chance for the industry to look inward and see how far we have come and have to go to increase adoption of tools that will improve patient care and health insurance company dividends.

For this naïve newbie to the industry, it was an overwhelming and underwhelming experience. I guess I ended up being whelmed in the end. There is so much noise, so much fear-mongering, so much confusion surrounding just about everything, that is no wonder we are going to Vegas next. For practices and hospitals making any technology decision these days, it is practically a crap-shoot. I would put my chips on another year of consolidation amongst vendors and a mix of success and horror stories from the institutions that adopt more technology.

In the end, it is what it is, no more or no less.

Pictures of HIStalkapaloozans
By David Polivka, Developer, Medicomp 

Pictures of HIStalkapaloozans
By Anthony Istrico

Monday Morning Update 2/28/11

From Terry: “Re: Oracle. We talked to an Oracle contact at HIMSS and their HIE vendor partner will be…Orion.” Unverified. 

From BurnedOutFromHIMSS: “Re: Tom Niehaus, president of CTG Healthcare. Just heard he’s joining Encore Health Resources. That’s a big blow to CTG and a great catch by Encore. I think very highly of him and he’ll be a good fit for the culture Ivo and Dana have built.” Verified by Ivo. Tom will be executive VP of business development reporting to Dana Sellers at Encore. Ivo says he’s known him for a couple of decades, thinks he’s one of the most effective executives in the industry, and says he has the integrity and character to fit well into Encore’s culture.

From McLean: “Re: McKesson. Rumors about that they will open source their platform and focus on solutions and services. Given the lack of market expansion they have experienced, this may be a sound decision, making them the Red Hat of IT as a compelling alternative to overpriced offerings from other vendors.” Unverified.

From Marlow Gates: “Re: Certify Data Systems. CEO is Mark Willard, a Brit. Last year he supposedly bagged some huge hospital systems with a system that doesn’t make the usual suspect list of HIE solutions because it doesn’t have a portal. They seem to be flying under the radar for as long as possible. They have some sort of arrangement with Cerner, but are doing direct deals as well. The management team is long on technical skills with not a lot of long time HIS regulars.” Inside Healthcare IT e-mailed to say they’ve written a couple of articles about the company, including one in the current issue that they’ll make available to the reader who asked about the company (assuming it wasn’t a company plant looking for PR).

From All Hat No Cattle: “Re: Cignet HIPAA penalty. Not a rumor, but a shocker.” The Office of Civil Rights fines Cignet Health (MD) $4.3 million for HIPAA violations, the first-ever civil penalty levied against a covered entity. The Cignet idiots not only refused to give 41 patients copies of their medical records over a one-year period, they then ignored OCR’s subpoena while making no effort to resolve the patient complaints. Cignet operates four clinics in southern Maryland and insurance operations in the UK, Nigeria, and Ghana. The Web site is pretty seedy-looking, I’d say, and includes a prominent link to franchising information, bragging that, “With Cignet health plan and Cignet discount card, Centers are sure to have a good percentage of cash paying, insurance claim free patients.” I can see the attraction of cash customers — some online sources say that Cignet was the subject of a Maryland Insurance Commissioner’s cease-and-desist order for selling phony insurance. Owner Dan Austin’s medical license had been revoked in 2000 after conviction of mail and loan fraud — I found the above in Maryland court records. He was running a student loan scam.

From Bob: “Re: HIMSS writeups. I certainly appreciate your writing up what you think are the most important, interesting, and amusing aspects of HIMSS. Indeed, I felt (almost) like I was there and didn’t really miss anything (of importance) … well, except for the Blue Cat babes, perhaps ;-)” It’s funny about the conference … you know going in that you’ll miss 90% of it, so you try to pick and choose wisely. That means you could randomly pick 10 attendees and none of them were probably in the same educational sessions, attending the same parties, or picking up the same valuable nuggets. Maybe that’s my niche for next year – debriefing a bunch of people on what they saw that was important just to get a collective opinion. Every year I feel like an outsider who missed the good stuff and I bet I’m not the only one.

From Kyoto: “Re: Allscripts good and bad news. The integration work is not only on the mark, but far exceeded client expectations during previews. Gomez came up with a new approach that allows seamless integration, going well beyond the usual tired approach. It’s also making its numbers. On the other hand, Enterprise EHR clients continue to complain about product quality and sales leadership is leaving. Lack of SCM sales is causing fear in its ability to expand in the community space, part of its key Connected Community strategy.” Unverified.

From InteropNotSilos: “Re: HHS Secretary Sebelius. After all the hot air at HIMSS, she goes home to see the Lewis and Clark Information Exchange, the only one operational in Missouri or Kansas.”

Listening: Pepper, Hawaii-based reggae/funk, sometimes reminiscent of Red Hot Chili Peppers.

These poll results don’t mean much since Allscripts encouraged its employees to vote for Stephanie Reel, but if you throw her out, it’s a pretty close race between John Halamka and Bill Bria. New poll to your right: if you went to the HIMSS conference, how was the quality of the educational sessions?

Jobs on the job board: VP Sales Central Region, Senior Software Engineer, Project Manager – Healthcare Implementation. On Healthcare IT Jobs: Senior Software Engineer, Senior Systems Analyst – Financial Systems, Project Manager.

Welcome to new HIStalk Gold Sponsor TeleTracking of Pittsburgh, PA, celebrating its 20th anniversary this month. The company focuses on patient flow automation, offering a variety of products for bed tracking, transport tracking, patient milestone tracking through procedure areas like OR and cath lab, the NaviCare OR perioperative solution, a work order management system, and the RadarFind RTLS for asset tracking. Conclusion: TeleTracking is all about squeezing out inefficiency, adding as much as 20% more capacity and collecting a wealth of operational data for making decisions. It’s the #1 KLAS-rated patient flow system and is used by 92% of US News and World Report’s Best Hospitals. Thanks to TeleTracking for supporting HIStalk.

Here’s a TeleTracking video I found on YouTube for my fellow visual learners.

Revenue cycle vendor MedAssets turned in Q4 numbers Friday: revenue up 17% to $106.9 million, EPS -$0.87 vs $0.17, wildly missing expectations of $0.22. Its 2011 forecast also missed expectations. Shares were punished, dropping 34% of their value by Friday’s market close.

In thinking about the lack of wellness emphasis at HIMSS, I thought a model I’ve used myself that works: RealAge. I took its test once, got hooked on the idea of getting a “you’re this old based on life expectancy” number, and started following some of its suggestions for changes to diet, exercise, and stress. I get an occasional e-mail recommending some course of action or product. Best of all, there’s a great business model since it sells advertising (it’s owned by Hearst). I know it’s ad-based, but I still find the information useful. Any wellness technology will need to be this user friendly to succeed, and may also need to blend social networking into its capabilities (which RealAge doesn’t really do as far as I know).

UNC Health Care (NC) chooses IBM for its private HIE. It’s funny how the definition of HIE has changed – now it takes one for UNC’s own doctors to share information with each other. Next thing you know it will take an HIE to send physician orders to departments. I guess choosing a single system was out of the question. 

MED3OOO had an iPad drawing Wednesday of HIMSS for HIStalk readers only. Congratulations to the winner, Susan Murray, director of application services for HCA. Nice! I have to say I’m liking mine quite a bit, too, although I’m just getting started with it. I have the iPad for a nice-sized screen and keyboard and then my iPod Touch that allows accessing everything from a tiny footprint, so I almost don’t need a desktop any more.

Inga found this HIMSS presentation disturbing. Wonder what was going through the minds of the Lawson suits when they green-lighted it?

Our shoe judge Lindsay has a day job with RelayHealth when she’s not evaluating footwear, but she obviously keeps her HIStalktapalooza responsibilities on her mind even there, showing the burdens of office inherent in wearing the Official Shoe Diva sash.

Tiny Schoolcraft Memorial Hospital (MI) will lay off 13 FTEs, a sizeable chunk of the 25-bed hospital’s 250-employee workforce. The reason: Medicaid reimbursement isn’t going up and they have to pay for an EMR upgrade. Says the CEO, “With this somewhat gloomy forecast, the hospital must continue to implement, at significant capital cost, an improvement to our Electronic Medical Record system, meeting additional criteria set by federal law … We qualify for EMR funding both for the hospital EMR and our Rural Clinic once we meet all of the (HHS) ‘meaningful use’ standards. We expect to meet the requirements with a 90-day qualifying period in both the hospital and the clinic by the end of the year. We hope to get most of our costs covered by the funding. Unfortunately, you must spend the money and meet the requirements before you get reimbursed. If the standard in not met by 2015, Medicare will reduce your payments.”

System integrators try to appease open source advocates who blame those companies for ignoring the British government’s call for more open source applications. The companies say it’s not their fault that the government signs enterprise software license agreements and lets vendor alliances dictate software stacks that exclude open source components. Examples given all pertain to healthcare: the Department of Health’s enterprise agreement with Microsoft and NPfIT’s Cerner contract that required the Oracle database, IBM hardware, and IBM’s WebSphere application server. One company’s rep threw out the FUD that open source software shouldn’t be used for anything mission critical, but the government said that talk needed to stop considering that the London Stock Exchange runs on open source software.

Thanks to Healthwise, a new HIStalk Platinum Sponsor. The Boise, ID company offers consumer-friendly patient education content for care managers and health coaches; an EMR-integrated patient education solution that helps meet Meaningful Use requirements; and health information content that integrates with personal health records, call center applications, portals, Web sites, and wellness applications. The content library is extensive: a health encyclopedia, decision aids, virtual coaching, medical illustrations, calculators, and slideshows. Mobile access content and tools are coming soon. Founder, chairman, and CEO Don Kemper and SVP Molly Mettler created the concept of “information therapy” in their 2002 book. The company offers a white paper called Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information Prescriptions. I have to say I’m impressed that the 36-year-old company’s mission is simple (empower people to care for themselves, give them a way to ask for help when they need it, and let them decline care they don’t need), that its executives are recognized public health experts, and that it’s a non-profit (!!) I forgot to look them up at HIMSS, so I might have to add Don Kemper to my interview list to learn more. Thanks to Healthwise for supporting HIStalk.

The folks at HealthHarbor e-mailed to say that HIStalk is their favorite industry blog and they recommended that their readers follow our daily HIMSS reports, so here’s a link back to their HIMSS writeup from a price transparency standpoing, just for being nice.

GE Healthcare and Capsule sign a deal to link GEHC’s Carescape patient monitors to Capsule’s Enterprise Device Connectivity Solution and Mobile Vitals plus.

This week’s company-wide e-mail from Kaiser’s George Halvorson focuses on HIMSS, mentioning that 35 of the 55 Stage 7 hospitals are Kaiser’s. He also mentioned a global HIT strategy document the company presented at the Davos World Economic Forum in Switzerland last month. The link provided was invalid, but I Googled and found what I assume is that PDF document here.

Ohio State University Medical Center’s CITIH (Center for IT Innovations in Healthcare) will convene its one-day HIT summit, Bridging Health IT Innovation, on April 18.

GE Healthcare announces iPad/iPhone access for Centricity Advance and Centricity Practice Solution.

A 27-year-old doctor in China using the alias Snooky is fired for comments she made about patients on a microblogging site, including, “The blood pressure of one patient has been dropping, and it seems that I might have to get up at midnight to dispose of the corpse. It’s not easy for me to keep my bed warm in such cold weather, so please don’t die until I get off work.”

Mass General will pay HHS $1 million to settle a HIPAA case in which a billing manager taking paper HIV/AIDS records home accidentally left them on the subway.

KLAS says 35% of ambulatory EMR users are replacing their systems. Most often considered to buy are Allscripts, Epic, and NextGen.

Imprivata announces vmWare View authentication and single sign-on agreements with Teradici and Dell. It also announces OneSign Anywhere for mobile devices as well as integration of its OneSign single sign-on and authentication platform with EpicCare.

Oracle announces Health Sciences Information Manager, an HIE solution that includes record location, information security, auditing, and NHIN Connect integration.

E-mail me.

2011 HISsies Winners

Smartest vendor strategic move
Allscripts buys Eclipsys

Stupidest vendor strategic move
McKesson’s Horizon Enterprise Revenue Management struggles

Best healthcare IT vendor
Epic

Worst healthcare IT vendor
GE Healthcare

Most fun healthcare IT vendor
athenahealth

Best leader of a vendor or consulting firm
Judy Faulkner, Epic

Best provider user of healthcare IT
Kaiser Permanente

Most promising technology development
Tablet (including iPad)

Most overrated technology
Cloud computing

Biggest HIT-related news story of the year
Meaningful Use

Most overused buzzword
Meaningful Use

”When ____ talks, people listen”
David Blumenthal, ONC

Most effective CIO in a healthcare provider organization
Ed Marx, Texas Health Resources

Most effective medical/clinical informatics professional
Martin Harris, Cleveland Clinic

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Lifetime Achievement Award
John Glaser, Siemens

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal, ONC

HIMSS Wrap-Up 2/24/11

From Just Saying: “Re: your Soarian demo. While pithy, this post would have been more honest if it had said, ‘I fell prey to the seductions of the attractive women and bright lights at the Siemens booth and I am so ashamed.’ Wouldn’t it have been just as valid to say ‘good to see Siemens playing offense again…Glaser seems to be making an impact already?’” Actually I wasn’t paying attention to the women or the lights – I was dragging along tired at the end of the day Wednesday and the rep stuck some 3D glasses out and promised the video would last only five minutes, just long enough for me to rest on what looked like comfortable benches (but weren’t). I didn’t find the video effective, but maybe some did. Actually, I already had an improving opinion of Soarian and the video didn’t really change it either way, but I was too tired and fidgety to want to sit through a demo, which was my real intention several times I passed the Siemens booth way down on the end (but somehow I never actually did it). I want Soarian to do well – we could use a respectably performing system that isn’t 30 years old. John Glaser did a little speech at the end of the video. He dropped by HIStalkapalooza, having warned me in advance that he wouldn’t be able to make it in time to accept his Lifetime Achievement Award in person before the band went on.

Just to show there’s no hard feelings, here’s a good consumer-oriented Soarian video from Yakima Valley Memorial Hospital that I found on YouTube. It’s more interesting than the 3D one if you ask me.

From LaVerne: “Re: Siemens. HHS lists Siemens as a certified vendor, but why do they list Enterprise Document Management as required additional software? How does that apply to Meaningful Use? MS4 is certified but does not require any document management product. Perceptive, Hyland, and other vendors don’t even modularly certify their DM products, so that might lead to the conclusion that Siemens has the only certified DM solution. Are they being intentionally mendacious or am I missing something?”

From Dolphins Fan: “Re: vendor attention. Once again, you guys did an awesome job of covering HIMSS — thanks! I can relate to your stories of being ignored by product vendors. I can think of several (Azzly and Phreesia immediately come to mind, but there were several others) where I felt if my nametag didn’t have ‘VC’ on it, I wasn’t worth talking to. As someone who provides significant guidance on many clients’ purchase decisions, it makes me wonder if these firms are actually driven by serving customers or just by scoring funding and being acquired.” I feel guilty going public with stories of unresponsive booth reps, but I’d want to know if I was the vendor. You get the feeling that nobody from management is overseeing, or if so, they aren’t very good managers (and in fact, some of the worst offenders were clearly the suits more interested in holding court with cronies than working prospects). Even Dr. Jayne’s CMIO badge couldn’t stir some of them. Let us read from the Book of Glengarry Glen Ross: “You got leads. Mitch and Murray paid good money. Get their names to sell them. You can’t close the leads you’re given, you can’t close %#*@, you ARE %#*@. Hit the bricks, pal, and beat it, ’cause you are going OUT … A guy don’t walk on the lot lest he wants to buy. They’re sitting out there waiting to give you their money. Are you gonna take it? Are you man enough to take it? What’s the problem, pal? … Always Be Closing.”

From Rodrigo Barnes: “Re: Certify Data Systems. Why don’t we hear more about them?” Never heard of them, sorry. I checked their management team and never heard of any of them, either. That doesn’t mean they aren’t good at whatever connectivity stuff they do, but maybe not so good at getting their story out.

From Northeastern CIO: “Re: HIStalkapalooza. Thanks to you, Inga, Dr. Jayne, and of course, Medicomp, for the wonderful HIStalkapalooza party. I enjoyed it, got to speak with several interesting folks, had fun watching the awards, and appreciated the food. You ordered great weather too, making it all the more difficult to return to the cold. As others continually state, you do great work and I appreciate being part of your expanding circle of colleagues.” Thanks! I bet lots of folks are missing the weather and the non-monochromatic Florida landscape.

From JL, MD: “Re: Microsoft. Go to silverlight.interknowlogy.com to view two videos that are part of the 2011 HIMSS Microsoft HSG presentations from today that demonstrate form-factor convergence for Surface, Windows 7, Windows 7 tablet, Windows Mobile for healthcare information display for patients and providers. A second video demonstrates the ability for a Windows 7 PC enabled with USB KINECT and custom healthcare gestures can display healthcare image data, and do 3D manipulation of coronary image data using gestures via KINECT without XBox 360.” I wish they hadn’t been so Microsofty in posting the videos in the annoying Silverlight format that takes a long time to load and requires a huge plug-in if you don’t already have it (I don’t mind it for apps, but it seems like overkill for a video). Had they done like every other vendor in the world and posted it on YouTube, I could have run it right here. Ever seen a Silverlight video go viral? Uh, no, and that’s why. So anyway, the videos are pretty cool. I saw a Surface at RelayHealth’s booth, but nobody seemed to be doing much with it. I have a feeling the other form factors are getting completely buried by the iPad with little hope of catching up, but I don’t claim to be an expert. Example: I saw dozens or hundreds of vendors raffling off iPads to hundreds of anxiously awaiting HIMSS attendees. I saw one giving away a KINECT and nobody offering the others.

Inga, Dr. Jayne, and I are home now. I won’t speak for the ladies, but I’m pretty beat since last night’s long post took me until midnight to finish and I was back up at 3:30 a.m. to get ready for the trip home. Maybe HIMSS is a fun week for some, but I’ve worked constantly since it started and slept little, including leaving HIStalkapalooza right after the band started so I could write that night’s recap. On the other hand, Mrs. HIStalk was waiting with open arms when I got home today and I’m calling it an early night tonight, so I expect conditions to improve steadily, at least until the pre-dawn commute to the hospital Friday morning. We’ll just clean up some loose ends tonight and I’ll be back in the usual swing Saturday for the Monday Morning Update.

And just to be clear, although nobody has complained: we write up what we think are the important, interesting, and amusing aspects of HIMSS. We don’t do it to make those who couldn’t attend feel left out – we do it so they’ll feel like they were there and didn’t really miss anything. I’m sensitive to reading about someone else’s good time, but it’s not that great a time when you’re taking notes all day and spending hours writing them up at night.

OK, was I the only one to do this (multiple times, in fact?) I was ambling along the exhibit hall aisle and rounded a corner a bit too sharply, stepping my inside foot into inches-deep swanky booth carpet and nearly falling over from the immediate, one-sided deceleration. Or this, a couple of times: I impulsively grabbed a freshly baked chocolate chip cookie from a booth and chomped down, but was horrified to get napalm-hot melted chocolate chips all over my teeth and fingers with no easy way to clean it off.

Since Medicomp was so gracious to sponsor HIStalkapalooza, I’ll give them a little more exposure with this video shot from the show floor as users went through brief Quippe training to earn their iPad (I’m in one snippet, I noticed). I think I recognize a couple of the docs who went on camera.

Here’s Vince Ciotti, debriefing after his industry history presentation Wednesday afternoon. I had joked that he should wear a Mike Brady costume to his presentation and sent him the link — darned if he didn’t do it. If he had some mascara, he’d look like Alice Cooper in his 70s heyday.

E-mail me.

HERtalk by Inga 

From Gossip Girl: “Re: Epic. A CIO to me explained Judy’s strategy. Epic is cutting the price on a lot of deals, especially the more prestigious health systems. If Epic has a couple of years that aren’t profitable, she can afford it and she doesn’t have investors to answer to. She realizes that these health systems make big HIT decisions only once every 10 or 15 years, so Epic needs to get in there now and hope that over time the health systems will keep buying more product. Meanwhile, the second-tier health systems see Epic getting all the wins and decide they need to get Epic, too. And those guys aren’t getting as sweet a deal as the top tier.”

From EMR vendor: “Re: HIStalk luncheon. Thank you for the great lunch today. I met some great people at my table and will have a follow up meeting with one of them.” Mr. H and I were thrilled to hear it provided a good networking opportunity. I mentioned in an earlier post that several competitors happened to sit at the same table and I and wondered how often folks like Girish Navani, Michael Sterns, and Evan Steele have lunched together. A reader suggested I’d be surprised how often it likely happens, since those folks collaborate as members of the EHR Association. For the record, two of these three told me they had never met the others before then.

From Greg Wilson: “Re: thanks. Just a quick note to convey my thanks. We had a lot of fun as a group and I had a lot of fun being a part of it. Very sincerely, thank you for the opportunity to be part of the ceremonies. It means a great deal to us.” Greg (regional sales VP for Salar) was the official HIStalk King and Queen judge and did an excellent job. I am not sure if we have complete video of his presentation, so you will have to trust me that it was wickedly funny. He gets bonus points for wearing his HIStalk Booth Babe sash in their booth for the rest of the show.

From Broke But Connected: “Re: exhibit hall Internet. Yes, it costs $1,500/day. We thought it was outrageous. I guess they figure whatever the traffic will bear! Do you think HIMSS gets a kickback on it???” Someone is clearly making serious money.

From Loyal Fan: “Re: HIStalkapalooza. It was great, but I think the music was a little too loud and it was too dark. The conference provides a great opportunity for people who haven’t seen each other in awhile to connect. They can listen to loud music at home.” That is great input. I’m sure that over the next few weeks Mr. H will continue to reflect on things and start thinking about next year.

Allscripts definitely had one of the most hopping booths. I liked its layout because it had a theater right in front and was quite open throughout. I hear Allscripts had over 1,000 people at their event at the Hard Rock Live (I had an invite, but missed it.) They also made a few product announcements, but they haven’t surfaced in my overflowing inbox yet.

I have concluded that I greatly favor the booths that are wide open with the product demo and people at the edges, as opposed to those that you have to enter in order to check out what they are offering. For example,the configuration of the booths for McKesson and Siemens (and to some extent NextGen) were a little intimidating. I almost felt I needed an invitation before walking in.

I thought Ingenix had a huge booth. Turns out it wasn’t quite as huge as I thought. They were right next to another vendor with the same red color scheme, so it appeared the two were one. Ingenix was featuring its various acquisitions and I just thought the vendor next to them was just another new division. Funny.

Orlando traffic, at least around the convention center, is insane. Fortunately my hotel was relatively close and I walked the 15-20 minutes most of the time. Wednesday I was weary and decided to ride the bus. Long story short, I got on the wrong bus and it took me 40 minutes to get back. After dropping off my things, I decided to take a cab back over to the Peabody. There was a limo in front and the guy said he had to drop a group off at the next hotel over and then would take me. So I shared the limo with artists who were performing for NextGen (they told me they practiced a lot). While it was fun chatting with them, that limo ride ended up taking at least 20 minutes because of the traffic. Sheesh.

JB walks the red carpet. Check out the gorgeous dress.

JB announcing the HISsies. Look at the size of the crowd.

I asked quite a few people what the “buzz” was. I think there is generally an agreement that we are past the Meaningful Use frenzy in terms of aligning with vendors. At this point, most people are either committed or at least pretty far down the line in the EHR selection process. Now people are looking a little more into the future and trying to figure out what tools they need for likely Stage 2 and 3 requirements (the HIE booths were busy) and for establishing ACOs. Meanwhile, everyone knows they must cut costs and improve care, and there are literally hundreds of niche vendors offering everything from tracking systems, infrastructure alternatives, and RCM add-on utilities. Obviously Meaningful Use and ICD-10 will remain the priorities for the next few years, but I think health systems are going to become increasingly interested in finding these more peripheral products, if they indeed offer a meaningful ROI or transform care. And likely the McKessons and Ingenixes will look to buy many of these smaller companies so they can sell more into their existing base. I wonder if over the next few years the number of individual HIMSS exhibitors actually declines.

I am now home and thanking my lucky stars that I don’t travel for a living. The Orlando airport was a zoo and it took me almost 30 minutes to go through security. While sitting at my gate, a couple guys (clearly vendors) were remarking that it looks like the economy has finally turned around, based on the heavy interest they saw this week. Maybe, maybe not, but that’s a pleasant thought to end the week.

 E-mail Inga.

Overheard HIStalkapalooza Comments
By Evan Frankel,  MD-IT (roving reporter wearing a memorable jacket)

Jonathan Bush:  “You can only interview me if you buy me a cigar. It is principled.”

DrLyle: “I can’t believe that people aren’t asking more questions. For smart people, they accept way too much.”

Dr. Gregg Alexander: “I have heard about college savings funds for children. I don’t have one.”

Dr. Christ Pavlatos: “The shiny and flashing buttons are lovely. As a trained medical doctor, a seizure episode could result from focusing too much on the flashing lights. I would think that the person that causes the seizure is required to resuscitate them — it’s only fair. The buttons are all conveniently located in the cardiopulmonary level, which is easy to focus too much eye attention on.”

Bill Fera, Ernst & Young: “Are you an HIStalker?”
Evan: “I am here, aren’t I?”
Bill: “Are you Mr H?”
Evan: “Nope, I am just a schmuck in a velvet jacket.”
Bill: “That you are. Baba Booey.”

Louann Whittenburg, Medicomp: “I love your coat. Is that velvet?”
Evan: “It is.”
Louann: “We are going to have fun tonight. I am very excited for people to get inside and start to drink, dance, and have a good time.”
Evan: "Me, too."
Louann: "I think your coat is awesome. It is perfect for this party."

Jonathan Bush: “I gotta be honest, I don’t actually read HIStalk. I have other people read it and I say, ‘What did it say?’ and then I am like, ‘Oh.’”

Jonathan Bush: “I did not know that Mr H takes the quotes verbatim from our conversations, and so I say all kinds of shit and I am expecting a lot of conversation back and forth between our PR guy and Mr H. on what he’ll actually  put up there. I mean, shame on me. It has happened more than once.”

Jonathan Bush: “We can’t predict anything. We don’t even know what Stage 2 Meaningful Use looks like. Do you think the ‘e’ at the end of Crowne makes it fancy?”

DrLyle: “I went to Washington and started asking them the tough questions. They don’t want to hear it. There is no easy answer to hard problems sometimes.”

Jonathan Bush: “I wouldn’t do anything that is resident on one device, iPad or otherwise. Make millions of little apps. The biggest growth prospect in healthcare is the little app. We want to drive business through our ecosystem where you do the R&D. You make hundreds of them and the one people all really like is the one that pays for all of the rest. Even if we grew our R&D department 30% each year we wouldn’t be able build all of the apps you can. Be agile, get them out there, get in front of the doctor. You just got the first interview on the athenahealth ecosystem. You kids take this stuff and go and make apps and make money. I don’t care. I can’t make it all and everyone else sucks. Figure out the APIs and then go build something cool.”

Dr. Amanda Heidemann: “It is great to see all these well-dressed people out for the night. I think it is hysterical how many people follow the blog and wanted to come to this party. Did you stop on the red carpet? I was so nervous. Can you go get me another glass of wine?”

Mrs. John (Denise) Glaser: “I think he (John) takes in all in stride. I mean, he is here. I actually believe John has a lot of respect for Jonathan Bush. It looks like you all are having a lot of fun. I like your jacket a lot.”

Jasmine Gee, athenahealth: “I am having a blast tonight. I think this is the most fun you can have at a conference. Why aren’t you dancing?”

Ash Gupta and Jonathan Baran of Healthfinch: “I am very happy to meet you, this is a real honor.” (they were talking about meeting Jonathan Bush and interrupting my private cigar and beer time with him. I wish they had said that about me.)

From HIMSS 2/23/11

From JJ Canuck: “Re: Oracle. I was visiting the Oracle booth (was trying to figure out their integration engine story … which is ‘coming out.’) The sales guy said they will announce a ‘big deal’ in the next week or so about a partnership with a ‘big vendor’ that will provide badly needed HIE capabilities and some other vague set of features. When I asked if it was Cerner, he just smiled, giving me the indication that I had made a good guess. Sore feet and off to Universal for the last wonkfest. Maybe I’ll throw-up that $9 bean burrito I had at lunch on the roller coaster with Neal Patterson sitting behind me. Daydreamin’.” You remind me that I forgot to complain about predatory convention center food pricing: a soda out of the machine was $3.25, a chicken salad sandwich was $9, and a banana was $3. That last one’s especially maddening since I buy a big bunch of them at Sam’s for half that amount.

From Jay: “Re: best marketing tee shirt ever. From backup vendor Mozy’s booth at HIMSS.” It’s a bit of a stretch, but almost funny. I tried their service a few months back and it was a pig on my PC, so I removed it and went with SugarSync.

From Andrea: “Re: HIStalk. LOVE LOVE HIStalk, you, and Inga. How would a small biz like us (VAR) compete with the big bad vendors unless we had inside dirt on them? Keep up the fantastic work and have fun at HIMSS!” Thanks — we love you right back.

From Fred: “Re: Meditech. Announced on Saturday that they would be getting modular or near modular certification for their HIS software. They reported that it just required some paperwork and would be completed soon.” I’ll mark this as Unverified since I was given related information off the record a couple of weeks ago.

From Leotards: “Re: Noteworthy. That’s a snarky comment made by an underperforming mid-level manager or sales rep no longer with CompuGroup Medical, I presume. Rick Mullins is gone; there’s been quite the shakeup of the existing C-suite amongst all the companies CompuGroup Medical US is merging into a single entity. Supernumerary chiefs of all stripes are being relieved of their individual fiefdoms as NoteWorthy,Healthport, Visionary HealthWare and Antek HealthWare are all subsumed by CompuGroup. Sweeping positive changes have been instituted, our flagship products are being strengthened and developed, and all this accomplished without sending out huge swaths of pink slips as sometimes happens with these acquisitions. I’m just a field rep in the trenches, but I’m quite pleased to now be part of CompuGroup Medical.” Unverified.

From J.B.: “Re: Meditech. The Meditech/LSS deal is finalized. They still haven’t straightened out any arrangements of staff, but LSS is still going to be called LSS.  It is now a ‘wholly owned subsidiary’ of Meditech.” Verified – Meditech has posted the news on their site.

From Dichotomy: “Re: HIStalkapalooza and sponsor lunch. You have to repeat these in Las Vegas! It was really great meeting together.” We’ll see how it goes, but I would definitely like to do both again. It was really nice (but nerve-wracking, especially for Inga) to briefly say hello to our sponsors and for me to be flanked by those lovely and whip-smart (but suddenly mute) ladies. Since I almost never see actual HIStalk readers in person, I asked for a show of hands of how many people felt they knew Inga, Dr. Jayne, and me personally even though we haven’t met. A surprising number of hands (a majority, I’d say, maybe more than that) went up. That was gratifying since we definitely feel connected to our readers and sponsors whether we’ve met them or not. I’m glad that comes across.

From Tech Doc: “Re: innovation. Saw Napochi at HIT X.0 Geeks Got Talent on Monday. Showed a 3D body module of their EMR used to map IVs and such which integrates with their flowsheet and physician note. Didn’t find a booth, but their website has a video of them demoing a touchscreen whiteboard replacement. Pretty neat stuff.”

From Kate the Sponsor: “Re: HIStalk. I just wanted to say thank you for the wonderful events at HIMSS! I really appreciate what you both do. HIStalkapalooza was a blast, loved the venue. I got there a little late, however, and missed the awards – are you going to post the full awards section on the site? I did see the highlights in the video Inga posted which were great. I’m sorry I missed the hilarious red carpet commentators — I felt like I was watching E! I also really enjoyed the sponsor lunch yesterday. It was great to break bread with fellow HIStalk fans and sponsors, but really the true highlight was having the three of you make an appearance. And, Inga, the handwritten thank you notes were so sweet. That must have really tired your hand out to write all those yourself, but the personal touch was really special. Thanks again for all you do for the industry, looking forward to next year!” Thanks for those nice words. I’ll get the HISsies list up when I get back to the comfort of a full-sized keyboard and dual monitors since there’s a lot of typing involved. I hope the lunch attendees whose notes were written by me (Inga and I split them) could read them since my handwriting is pretty bad. I said there that we are proud to be amateurish and my handwriting is a testimonial to sincerity backed by a total lack of polish.

From Suzanne: “Re: HIStalk. No doubt you are inundated with work, e-mails and miles and miles of walking this week, but I just wanted to send you a quick note to thank you for a great lunch today (and great party last night). We are thrilled to be new HIStalk sponsors – and not just because of free food and drinks! As a small, newcomer vendor in a tiny 10×10 booth at the far end of the hall and among the ocean of booths at HIMSS, it has quite literally been amazing how many people have come up to us, saying they have specifically sought us out.  When we ask how they have heard about us, many have said through HIStalk. I was a little skeptical of advertising on HIStalk at first, thinking that the majority of readers may be vendor types, but that is clearly not the case.” Thanks – you are too sweet. We won’t recommend a product we haven’t used ourselves, but we will get readers the information they need to allow them to qualify their own interest. I’m happy we can do that since it benefits both vendor and prospect. According to the survey I just finished, 83.4% of HIStalk readers say they have a higher level of interest in companies we’ve written about. That’s flat out amazing and we don’t take that responsibility lightly.

For me and many/most attendees, the HIMSS conference is over. Maybe you’ll see Michael J. Fox flying into MCO as you are flying out since he gets to speak to the few folks sticking around for Thursday sessions.

Tomorrow is traveling home day, and while I’ve really enjoyed being here, I’ll be even happier to get back to my familiar routine, PC, and wife. A ton of people were sitting in the grassy area outside the Lobby C area of the convention center this afternoon. It looked like a capitalist Woodstock as attendees in suits sprawled awkwardly in the grass (I saw one guy fully face down on the lawn, suit and all, reading a book). I bet most of the impromptu sunbathers were heading back to snow and gloom and figured they’d better get sun now or else wait a couple of months for it to find its way back to them. 

The weather was good today — it’s a perfect and breezy 78 as I write this close to sundown and kids are having a ball in the pool right outside my window. Walking back to my hotel, I could smell wood smoke from a steakhouse, blooming flowers, and a little tang of ocean salt in the air. For most folks going home, they’re going to be smelling smoke from the fireplace, flower-scented air fresheners in closed and airless rooms, and salt from the treated roadways. No wonder people like to vacation here, even though Orlando is culturally bankrupt, jammed with traffic, and filled with people who’ve lived her for decades and yet won’t quit calling New York and Ohio “home.” Those are issues that only the locals care about.

I’m behind on e-mails from the traveling, the conference, and our events, so bear with me as I try to catch up this weekend. I think people sometimes forget that it’s just me on the other end and I’m working a lot of hours.

Here’s the bad news for all you folks (including me) who are proudly taking new iPads home won as prizes this week: the iPad 2 comes out next week, so that new one you bagged this week is already obsolete even before you even get to strut it in front of your admiring families. Doh!

I got some e-mails from execs of some of the vendors I mentioned yesterday as ignoring my “I’d like a demo” booth body language to give them a second chance. I did so today, with mostly the same results. I should mention, however, that my title and hospital name on my badge wouldn’t necessarily make me a likely candidate, although the small font size makes it unlikely that they ignored me for that reason. Today was the last exhibit day and nobody was paying much attention to those of us still roaming the exhibits late into the afternoon. Mostly I saw reps talking on the phone or sitting together in their couch / table areas making dinner plans or cursing as they spoke animatedly among themselves (I’ve noted that young, male sales reps seem to curse a lot in each other’s company – it’s like using profane emoticons).

And speaking of that, I also do not identify myself to vendors, even those I exchange e-mails with or those who tell me to ask for the CEO or other executive personally. I’m a mystery shopper – I want to be treated exactly the same as anybody else (or as me in my day job role).

Our King and Queen judge Greg Wilson from Salar got this picture today with John Templin and his long string of badge ribbons. I’m not sure Greg knows the history – John does this every year, usually as he’s trying to raise money for the HIMSS Foundation. You saw him on stage this morning as the keynote started.

A CapSite survey finds that 23% of hospitals plan to use consulting help to get their clinical systems up and running.

Franciscan Alliance will roll out Epic at its 13 hospitals and 165 practices. The cost: more than $100 million over the next two years.

UK Healthcare will implement Allscripts EHR/PM and integrate it with a new version of its Sunrise inpatient EHR.

Jordan Hospital (MA) lays off four managers (IT, quality, pharmacy, and diagnostic services) and VP/CIO Dennis Fonseca.

New PatientKeeper CPOE customer: Madison Memorial Hospital (ID). Going live on the same product: Ashe Memorial Hospital (NC).

CollaborativeCARE Conference signs a deal to bring in HIMSS to run a one-day education program during its first conference this coming November.

Wednesday Keynotes – Kathleen Sebelius (HHS secretary) and David Blumenthal (national coordinator)

• I don’t know if I’ll ever get used to Steve Lieber’s spiked-up hair, which I noted as he read a suck-up HIMSS proclamation honoring Kathleen Sebelius for taking money away from taxpayers and giving it to much richer vendors and doctors.
• It’s a given: everyone in politics and government will always publicly praise their wise, hard-working, and selfless bosses (Sebelius-Obama, Blumenthal-Sebelius).
• Sebelius said that of 231 vendors of certified products, 2/3 of them have fewer than 50 employees, and “any one of them could be the next Google or Microsoft.” Really? With 230 competitors and few takers for most of them until the Cash for Clunkers EMR program came along? Maybe she meant the next Google Health or Microsoft HealthVault.
• She talked about the country’s health. I’d still argue that EMRs just make the treatment episodes arguably more efficient. It’s what people do when they’re not sitting in front of a provider that’s expensive. Someone should create a business model for wellness and population health. She didn’t mention any of those things.
• She said you can’t just advocate the technology – you must advocate an improved healthcare system.
• She lauded Blumenthal’s “doctor perspective” (he supposedly still sees the occasional patient, although he’s had muckety-muck Harvard jobs for so long it would be interesting to see how many and how well).
• Blumenthal was a pretty good speaker, just a bit quiet and monotonic and very careful with his words (I actually liked his style). He said he was naïve about what could be accomplished at last year’s HIMSS conference.
• He said 21,300 providers have signed up as Meaningful Users and $20 million has been paid out under Medicaid. The Medicare payments will start in May.
• He said the timetable for Stage 2 will be challenging, but reasonable and achievable.
• He cited 62 Regional Extension Centers enrolling 6,000 providers each week.
• He said that colleges have trained 3,400 people in HIT and the goal is 10,000 per year.
• “HIE is a team sport that requires local coaches.”
• He said the system was deficient in quality measures, population health, clinical decision support, and interoperability.

Exhibit Hall and Session Notes

• A reader asked me to check out Lawson. They were pitching ACO support, Cloverleaf, scheduling, HR management, and ERP. Their booth was pretty dead, but it was a bit early. They had coffee and popcorn. The booth looked nice (curvy yellow sofas and quiet demo areas) and the wall posters made it clear they have a lot of products. I can’t say I had a reaction either way.
• Another reader asked me to stop by Candelis Astra, which offers some kind of workflow cloud solution stuff for radiology and images. That’s all I know because of the five reps in the booth, two were on their phones and the other three were sitting around a table deep in their own conversation. One did pop around the corner and ask if I wanted a demo, but I was committed to walking away at that point. Still, they did ask, so I give them credit for that – I was just being stubborn.
• I dropped by Clairvia and still didn’t get much attention, but the over-the-shoulder demo I watched looked really strong and a big competitor admitted that when it comes to clinical scheduling and acuity, Clairvia is better. It’s a slick-looking product.
• I talked to one vendor’s rent-a-booth-babe. She says she likes HIMSS because it’s conservative. I asked what that meant and her answer was basically that this week’s vendor-employer didn’t make her come in nearly naked. Apparently vendors often do.
• The OnBase magic guy is the best ever. Not only is he funny and really good at riffing (“Step closer, the trolley is coming … I just saved  your life, dude”), he even knew a lot of product stuff, like when someone from HP was there and he knew details of OnBase’s partnership with them. I keep thinking maybe he’s an employee who just happens to know magic, but if so, he’s darned good.
• NCR had their HIStalk sign out. I played with their wayfinding kiosk and it was cool. The rep played me perfectly, letting me poke around while offering just enough conversation to make me feel engaged
• A reader asked me to find out what Epic’s Canto runs on. It’s iPad-only, the rep told me. I have to say those Epic kids are really pleasant and helpful.
• I like the big sign on Healthland’s booth: “We’re not for everyone – bringing a certified EHR to rural hospitals.” Bravo – how many companies would just leave it wide open in the hopes that Cleveland Clinic or someone like them might get fooled into buying it? I admire helping prospects qualify themselves. Well done.
• Orchestrate had their HIStalk sign out – thanks! I saw President Charlie Cook there.
• I looked over someone’s shoulder at Shareable Ink and it seemed pretty cool, but I didn’t really get to see any of the form-filling part, just the end result.
• A reader (or maybe it was the vendor – I forget) asked me to drop by Proxense, which does proximity-based security, I think. I’m guessing because the rep said hello and nothing else, so I did the same. I checked out their Web site and it’s not very well designed (note the hover text  over the Sales menu item that says “some sort of tagline about sales.”) and makes it hard to figure out what they do. They’re probably engineers from the looks of things.
• I stopped by HT Systems/PatientSecure several times and was anxious to see their palm biometrics in action, but that didn’t happen. There was some other company’s business development guy hogging their time (talking rather than listening). I think I would have saved that conversation for non-exhibit hours if I were him and if I were the company, I’d have some video or something since it’s a highly visual product and a conversation-starter (or so I assume, not having seen it). I’m pretty sure it’s cool.
• I watched a theatre presentation of Nuance’s new Healthcare Development Platform. It sounded interesting: products connect via HTTPS to Nuance to run speech recognition (support provided for iPad/iPhone/iPod Touch OS, Windows Mobile, and any browser). Five lines of code turns a text box into a speech recognition field that then runs its Clinical Language Understanding to extract structured data and map it. They’re offering a free 90-day developer’s license when it goes out of beta in March or April.
• The only good educational session I attended during the entire conference was today, a really good one on medication barcoding. It’s what you always hope for but rarely get at HIMSS – one guy describing in super-concentrated form all the problems his hospital solved when rolling out medication barcoding. I’ve never seen a session that was so meaty, full of real-life pearls, and pleasant to watch. The pocket guide says only Session 165, Still. Whoever Still is, kudos. No self-indulgent posturing, no fluff, no teasing in the hopes you’ll hire him or his company to finish the story – just really good experience shared. People actually clapped and meant it and the audience questions, instead of the usual droning pontificating, were insightful and on point. My faith in humanity was restored.
• A reader asked me to check out Success EHS, a Birmingham-based PM/EMR vendor. Like almost all Southern vendors, they were very nice and friendly. The product didn’t look all that much different than other EMRs, but it does run the MEDCIN engine and it had a cool Meaningful Use dashboard that shows real-time stats on how individual docs or groups are doing in hitting their numbers. Most impressive is that they charged nothing for that module or any of their Meaningful Use upgrades. I mentioned that I’d won an iPad and the young lady rushed off to give me a super-nice case for it, saying, “I bet you didn’t win one of these.”
• I dropped by former sponsor Apelon thinking I could find a few nuggets to mention just to be nice, but they didn’t have much to say.
• A pretty cool guy from Software AG skillfully pulled me from flowing exhibit traffic to chat. They’re the company giving away the electric guitar that Inga was bragging on playing. They have a rules-based SOA integration platform that can monitor streams of data and do trending and alerting. It’s a platform aimed at vendors and technically astute hospitals and I didn’t understand all of it, but they gave me a couple of cool books that I’m going to read: Process Intelligence for Dummies and SOA Adoption for Dummies.
• Siemens roped me into a five-minute 3D demo of Soarian that was a complete waste of time (and maybe not even a demo since I don’t recall seeing actual screens). The glasses were kind of cool, but the only 3D effects were some lists and video clips that looked like they were floating and the guy narrating live was a bit too over the top for me. It also seemed to be of the “we suck less than before” variety, proudly listing #2 in one category, “improving” in another, etc. I would have worked harder on the message and less on the medium.
• The best thing I saw all conference was Medicomp’s Quippe (pronounced “quip”, by the way), which I checked out only because Inga, Dr. Gregg, and Dr. Jayne were all raving about it and I figured I was the guy to neutralize the Kool-Aid (or IngaTinis) they’d obviously been given. Didn’t happen: it was way cooler than they said. It’s really iPad optimized, allowing dragging templates over to the work space, supporting insertion of pictures with a variety of annotation tools, and some proprietary gestures that are really cool. For example: drag on a vital signs table, write 101.5 with your fingertip on any blank part of the screen, draw a little L over the temperature field, and your 101.5 is instantly converted to text and dropped into the box (or you can use the on-screen keyboard if you’d rather). I don’t know much about ambulatory systems, but what impressed me most is that when you choose a given symptom, tabs open up unobtrusively that show previous encounters for that patient in which those same symptoms were reported. It’s just a very dynamic, fluid app that really wouldn’t work as well on a non-tablet platform. I’ll not call it a “game changer” since my cohorts have overused that phrase when referring to it, but I’ll call it as ingenious and as physician-friendly as anything I’ve ever seen. I saw another vendor’s implementation of the current MEDCIN engine and it was nice, but not in the same league (that vendor confided that they can’t wait to get their hands on Quippe to add it to their product).

E-mail me.

HERtalk by Inga

From The HIStalk Queen: “Re: HIStalk queen contest. My name is Janet Skinner from Skinner and Associates Executive Search and thank you! I won the HIStalk Queen contest and I wanted to thank you very much for the nice IPod Touch prize! Wanted to thank Dave Lareau and Medicomp for a fantastic party! Fun idea to include the shoe contest (what woman doesn’t love shoes?!) and the IngaTinis were fantastic, as you warned they would be. I must have had more than one if I pulled off winning the queen contest, but I think the group I was sitting with had a few too many IngaTinis of their own and their loud cheering tipped the scales in my favor. Would love to see the Histalkapolooza an annual event, great fun… and again, thanks so much for inviting us!” Hard to believe this was our fourth HIStalk party (though the first HIStalkapalooza).

Bill Fera, MD, of E and Y was our HIStalk King.

From Your Fan: “Re: Red Carpet Gals. The red carpet greeters are my CEO Jennifer Lyle and account manager Kara Heward of Software Testing Solutions. As a matter of fact, Jennifer won the Inga Loves My Shoes sash last year and still proudly displays it in her office. They had a fantastic time with the HIStalk readers who were great sports and the Medicomp men in the tuxes would have made Stacy & Clinton proud! We’re glad you had a great time and can’t wait to join you next year.”

The only way our shoe judge Lindsey of RelayHealth could have been more cute here was if she’d had more sleep Monday night and if you could have seen her gorgeous shoes.

Kronos: seriously, at least 100 people were in line trying to win one of the five iPads. I feel badly that I won one seeing how many people would have liked to win.

I shared a cab with the NextGen artist guys!

Assessments for the day:

• BlueCat: girls in cat woman suits. Really? I suppose they really looked fabulous and I am only jealous that I can’t pull it off like they could.
• David Blumenthal: watching paint dry probably could have been more exciting than listening to him as a keynote speaker.
• Meanwhile, Katherine Sebelius (who I swear was wearing the same suit as she does in all her head shots) was explaining to HIT professionals what healthcare reform and ARRA meant. Really? The place was packed and some folks had to watch on closed-circuit TV from the hallway.
• Thank you MEDecision for the Starbucks coffee. It was worth the 20-minute wait in line just to overhear Practice Fusion CMIO Robert brag that the company now has 70,000 users.
• The OnBase heckler was pretty good. He called out the “lady in pink” to come over and hear his deal. Very fun.
• IDS: good job and giving me the one-minute pitch you do.
• Pulse guy (who just started shaving last week): ask who your audience is before you start explaining why buying an EMR today is important. Most of us already are pretty familiar with Meaningful Use.
• From one very smart CEO: I figured out how much it cost us per hour to have people here and it is about $7,000. They better be standing on the corner of the booths trying to sell and not checking messages on their smart phones. Good advice that a lot of vendors should have heeded, including some that I kind of wanted to check out. Like CattailsMD, Azzly (the second time I came around), Wavelink, and a dozens of others.
• Thank you, Sage guy, for showing Health Unity. Yes, I noticed you looking at my shoes because you suspected I might be Inga. Integration is not all there yet (those blue screen errors are a dead giveaway) but the embedded integration will be cool.
• George at Sophos: I couldn’t pronounce your sexy Greek last name, but you were adorable.
• I loved the fondue at EDS. Wish more exhibitors (like Meaningful Use Monitor) had bottled water.
• Ingenious Medical: nothing like having a cute girl wearing high heeled blacked boots to bring in the crowd. Definitely not practical for a three-day show, but who the heck cares?

So much more to say, but Mr. H is ready to post. I will do my best to read my cryptic notes and share more tomorrow.

E-mail Inga.

EPtalk by Dr. Jayne

And now the end of HIMSS11 is upon us. I was surprised to see the exhibit hall as full as it was today. Usually by this point, folks are losing stamina, but at least around the noon hour there was still a veritable sea of navy blazers. I did see several ladies sporting running shoes with their suits, and although I stuck it out in the comfy yet stylish heels, I was a bit jealous.

I also saw quite a few people sporting the bright yellow clog slippers given out by ChipSoft. I stopped by to try to get a pair to mail to Inga as a gag gift, but was turned away empty-handed by the less-than-pleasant rep.

Several of you e-mailed over the past couple of days with thoughts on booths I should visit. I’m sorry I couldn’t get to them all. I gave preference to those that had a hook for why physicians would benefit from their products vs. those that just said, “Hey Jayne will you make an appointment with us?” It’s hard to make appointments when one is anonymous.

I ran into an old friend of mine, Vendor Boy, and asked him, as a veteran, what was the best thing he saw at the show. First place: the Epic booth. Second place: the kilt girls.

I agree with what Mr. H said yesterday. Many of the reps seemed tired and/or bored and some didn’t seem to care whether I was interested in talking about their products or not. I would have thought that with the badge scanners and RFID tracking there should have been some kind of “CMIO with purchasing and decision-making authority” alert like a Bat-Signal in the sky that could have shocked them back into action, but alas, several flat-lined. However, there were notable exceptions:

• OnBase, which does document management. With their sports bar theme, they were happy to tell me about their solutions. Our friendly bartender/rep was happy to show an iPad app that I didn’t see yesterday, which allowed quick on-screen approval of documents including annotation.
• Sage, which had a better showing today than when I tried to visit on Monday to see their new HIE solution.
• NCR, which was giving away autographed copies of the Newt Gingrich book Paper Kills 2.0 as a special HIStalk reader perk.
• Up to Date, which tried valiantly to entertain me while I waited to talk to a specific rep who I heard had a great story to tell, although I got pulled away and never did get to meet him.

I visited the 3M booth several times to try to find out about the new mobile app they told Mr. H they were launching. The people I talked to didn’t seem to know what I was talking about, but they did tell me about their coding support product that uses natural language processing to trigger patient care alerts from dictated text in EHR. Since I’ve seen a lot of care coordinators being let go recently (which seems short-sighted with Accountable Care breathing down our necks) that might be handy, but if that was supposed to be the mobile app, I’m not sure how mobile it was.

Personally I haven’t had good luck with the voice recognition software for mobile devices and most of our hospitals still use traditional dictation systems, so it’s not like the doctors are dictating daily notes directly into the system as they round.

TeraMedica had the guys in the colonial outfits with the tri-corner hats again today. Not sure how that plays with data migration, but they looked like they were having a better time than the ones who were in the booth on Monday.

I gave them a couple of days to spiff up, but Alcatel-Lucent still hadn’t ironed the white coats of the faux clinicians gracing their booth.

Emdeon awarded the iPad from their HIStalk reader-only drawing. The winner was very excited and even sent me a photo of the cute gift bag they packed it in. I’m always happy when someone goes beyond the expected, and delivering to the winner in style is much appreciated.

Props to the Hilton who accommodated my late check-out request and even smiled while doing it, allowing me to spend precious minutes poolside before I head back to the sleet and freezing rain that is surely covering my car. Maybe they could drive me home in this.

That’s a wrap for HIMSS11. See you next year in Vegas, baby!

E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

“It’s late and I have a huge headache (no, I don’t drink, so it’s not a HIStalkapalooza leftover,) so I hope my observations come through better than they feel through the throbbing behind my eyeballs.”

OK, that’s how my post for Monday night would have started if I had not somehow hit “Minimize” instead of “Send.” I awoke Tuesday morning wondering why my post was absent and found that the headache cloud had somehow short-circuited me more than I knew.

So now it’s about 1:00 AM on Wednesday morning and I have just gotten back to snow-covered Ohio (I have a practice to run) and out of my HIMSS suit. I see Mr. H, Inga, and Doc Jayne have already posted for the night while I was traveling, so I’ve again missed out. (Sigh.)

So, this’ll be a mishmash of Monday/Tuesday and since I’m not, as I’ve said, a real reporter, I hope you’ll forgive my mark-missing tardiness.

MONDAY

HIStalkapalooza was a ball! Mr. H and Medicomp built upon the great groundwork laid last year by Ivo Nelson and Encore with the friendly venue, excellent food, free drinks, and a rockin’ venue. The red carpet entry, the HIStalk limo rolling up and down, and the Batman-sign-esque HIStalk light on the wall across from BB King’s set a superb tone for J. Bush, Dave Lareau, John Glaser, and the Insomniacs to rock the house all the way out. (Seriously, the red carpet entry and the gorgeous and funny red carpet interviewer ladies would have made even Billy Bush proud.)

The HIMSS opening session left me sort of … well, I actually left it, so I suppose that tells you how much I felt I was gaining. The typical HIMSS HIT rock show multimedia wasn’t enough to make the retread of “look how much we’re doing for the world of healthcare” seem worth enduring … again.

The 1,000-plus exhibitors made it appear that the economic downturn is over, at least in the HIMSS-associated halls. Exhibits stretched for what seems like a mile and from floor to ceiling. In fact, with so many vendors flying banners, signs, and rotating “come-see-mes” from the exhibit hall rafters, they all sort of drown each other out and it makes it seem like less of a good idea. I mean, if it doesn’t help people see where you are from across the vast exhibit hall stretches, is it still a helpful way finder device?

I got to enjoy many great conversations with tons of vendors and noticed one really impressive thing throughout: not once, not one single time did any one of them mention Meaningful Use during any of the conversations. It is possible my ears have started to become numb to it, but I’m pretty sure none brought it up. Not exactly sure what that implies, but I did enjoy the respite.

Loved the MED3000 demo of their incorporation of Medicomp’s Quippe tool. Providers – if you haven’t seen it, you should absolutely make the effort to check it out at either MED3000, Pulse, or especially the Medicomp booth where you might actually have a chance to walk away with a free version of it on a free iPad. I think it is perhaps the first, honest-to-goodness game changer (I see where Inga used this same term in her Tuesday night post) in the world of HIT to come down the pike since Larry Weed. Indeed, Dr. Jay Andres at MED3000 told me every single provider he’d shown it to had all made the exact same queries after seeing it: 1) How soon can I get it? and 2) Is it really as easy as it looks here?

RemitDATA has become a big HIMSS sponsor and has a pretty cool offering (at a GREAT price point) to help docs evaluate the financial side of their practices. Sort of athenaCollector-ish, but from multiple data capture sources.

Thomson Reuters is working on some great stuff for health education (and more) and also has some of the nicest people!

Soapware’s Randall Oates has a great new approach to the medical scribe concept: the Medical Coordinator. The MC sits in another room and listens in to a patient-provider visit, capturing the data and coordinating associated care management issues. No in-the-room intrusion and the provider can focus 100% of the patient. Now, that’s attractive … I am going to look deeper into this one.

athenahealth always has such a fun crew at their booth. Jonathan Bush was holding court (I got an short audience) in the central couch pit. It was just too much fun watching the procession of folks flowing in and out and the antics of the inimitable JB.

I’ve more, but my head has gone from throb to cannon fire…more HIMSS views tomorrow.

TUESDAY

Despite his humble protestations, Mr. H did a FANTASTIC job with the oratory when he, Inga, and Dr. Jayne made their first ever live-and-in-person show at the HIStalk sponsors’ lunch Tuesday and Maggiano’s. Inga’s boots were incredible and you could even see her just beaming, even through the surgical mask. They say they were Nervous Nellies, but they must cover well because it didn’t show. There was an absolutely incredible turnout with an amazing assortment of vendor bigwigs from all about the HIT world. A few glitches with food service aside, I think they did a knockout job. Mr. H and Inga even hand-wrote personal messages on thank you cards to each of the attendees and I overheard many comments on how nice or how funny the remarks were. All I can say is if you were invited and didn’t make it by, you missed out.

I had a sit-down with Dana Sellers of Encore. She is just as delightful to talk with as Ivo. I love their corporate philosophy and, especially, their slogan of “100% Referenceability.” Make your clients happy – all of them, all of the time. High standards, but their growth and abilities to attract and keep quality IT folks in the current market when those peeps are getting hard to find seems to add validity to their approach.

GE Centricity Advance is now shooting for docs in my neck of the woods (small practices). They seem to have learned some good stuff since I last looked at Centricity and their Mobile version, which is coming in Q2, appears to build even further upon those lessons. (Honestly, I never liked the look of Centricity, but the new Advance and Mobile stuff … much better.)

The trick shots on the pool table at the Iatric booth were very cool.

Ingenix says they’re now looking to thicken the relationships that have spread out so much in their recent buying frenzy. The buying may continue (as it will across the whole HIT market, eh?) but they want those thin ties to strengthen as they work to establish more “integrationability” (my word) across their many arms. Expect some rebranding soon. I like their stated open-to-sharing mindset.

Thomson Reuters has some really cool clinical decision support tools out or coming for physicians, pharmacies, infection control, pediatrics, and more which all benefit from the “same source of truth.” (I like that line.)

MEDHOST touchscreen tools and floor plans for EDs are not in my every day realm, but I really liked how they look and feel.

The Man & Machine waterproof keyboards and mice demo with waterfalls running over these tools was simple, slick, and effective. Contagion control is as, if not more, vital than data capture, I would wager to say.

Onyx and Stinger Medical had some really cool-looking carts and display tools for hospitals that just looked smart.

I felt like Maxwell Smart in the Unity Medical “cone of silence.” I want one.

Lastly, I noted how irritated I kept feeling as I tried to take in as much as I could in my limited window of time at HIMSS. Then, a quick calculation helped me realize it was a “setup for failure” kind of event. With somewhere around 1,000 vendors, if you only spent one minute with each, it’d still take over 16.6 hours to see all there was to see. And, that doesn’t even include the Interoperability Showcase, the education sessions, assorted keynotes, or bathroom breaks.

What a show.

E-mail Gregg.

From HIMSS 2/22/11

From Another CIO: “Re: VIP lines. My title is CIO, but it isn’t worth the ink to print it if all of our staff aren’t working together to accomplish everything that needs to get done.  To this end, I am literally embarrassed to hear about a ‘VIP Line’ at the HIMSS conference and wouldn’t be caught dead in one.” I’m sure HIMSS rationalizes its VIP treatment of CIOs by citing the vendor bucks chipped in to provide them with closed-session speakers, food, break rooms, and other perks. It also used to bug me that there was always an area where vendors could book time with HIMSS-pimped CIOs if they were willing to pay the CIOs cash for a ‘briefing’ (i.e., I’ll pay you to listen to my sales pitch). I suppose their other excuse is that it’s even worse than that at CHIME but  nobody’s complaining because non-CIOs aren’t invited there. Some hospitals have strict policies against executives accepting vendor gifts (“touch that vendor demo bagel and you’re fired”) but the rules doesn’t seem to extend off campus.

From All Hat No Cattle: “Re: Marc Overhage of Regenstrief. Resigning and going to Siemens. We received the announcement earlier this week and had an emergency medical informatics faculty meeting yesterday. Bill Tierney is taking much more of a leadership position initially and the search committee for the next leader of Regenstrief Medical Informatics has been formed.  He is fast tracking this search and we still hope that the next Chair of my department will also be a high level medical informatician.” Apparently verified, at least according to people who said they saw Marc wearing a Siemens badge at HIMSS.

From Florida Flash: “Re: Noteworthy Medical Systems. Continues cratering. Rick Mullins is now the former president and CEO. I guess the bright idea of getting rid of all the sales force, using a lead gen company, and then hiring salespeople back to work the leads didn’t work too well.” Unverified. Rick Mullins is still listed on the executive roster. I should have asked the folks in the CompuGROUP booth today when I was checking them out since they own the company.

From Digger: “Re: ONC. It was asked in the physician symposium what would happen if docs just sit on the EMR sideline until penalties kick in, and then either retire or stop seeing Medicare patients. ONC gave a politician’s non-answer.” It’s a fair question – there is a built-in assumption that doctors will voluntarily give up money rather than opting out of Medicare or hanging up their stethoscope. I overheard someone’s recommendation about shifting value of EMRs back toward the provider and away from the insurance companies: charge patients a $5 per visit surcharge and build a marketing plan around explaining to patients why that’s a good value. I also had another reaction: if doctors had any kind of pricing power, maybe the EMR burden would be lessened since they could charge more to cover their lost productivity. I still like the model of paying them to contribute their data for others to use, which would provide incentive for them to choose whatever product best meets their needs and implement it in a way that optimizes those contributions of patient information. If you were paid X dollars for a contributed H&P or other data set, Uncle wouldn’t need to be in the EMR bribes business.

From Zensocrates: “Re: Allscripts. Encouraging votes for Stephanie Reel is funny given JHM is negotiating with Epic to replace SunriseXA.” Unverified, but commonly known, I think.

From InfoNurse: “Re: HIMSS. Is that Elvis! No, that’s Neal Patterson! By golly, he’s coming to HIMSS11 on Wednesday. Just a walk-through after the lovers’ quarrel and breakup with HIMSS in San Diego. Must be coming to get the pie.” Cerner was a little shifty in mentioning a HIMSS booth number, but it was actually in the IHE section and not a real Cerner booth on the regular exhibit floor. Someone told me Cerner has a room in the convention center, though. I think I knew that vendors can book rooms out of the public eye to entertain right in the convention center. Speaking of The Pie, Neal did win again and I need to post the other HISsie winners, but I may do that when I get back home where I’ve got a more comfortable keyboard.

From Jay: “Re: AHDI/CDIA. CEO Peter Preziosi resigns.” They say they’ll miss him “sorely” and the announcement is gushy in general, so it sounds like it was his choice. The former Medical Transcription Industry Association just rechristened itself as the Clinical Documentation Industry Association.

From Mobile CMIO: “Re: Epic Canto. I have a working sample of the iPad app. Even though it is version 1.0, it is fast, great interface, and embedded dictation tool. I expect this to be quickly and enthusiastically adopted by our medical staff when we go live.” I mentioned Canto yesterday when I saw a poster for it on the outside wall of Epic’s booth.

The big acquisition announcement of the conference so far: Harris Corporation will buy identity management and integration vendor Carefx for $155 million. Obviously Harris wants more of the healthcare IT market than just its government and military business. The deal must have been struck awhile back since the Carefx booth had printed Harris information today that wasn’t an obvious last-minute add on.

Our other rumor was correct: TriZetto will acquire revenue cycle management vendor Gateway EDI.

One more acquisition: Scottish charge master vendor Craneware buys ClaimTrust for $20 million. The Tennessee company offers revenue cycle and auditing solutions, allowing Craneware to inflate its tagline to “automated revenue integrity solutions.” According to the ClaimTrust site, hospital revenue cycle consultant Joe Ferro and his programmer wife started the company in 1998. A nice exit for them.

HIMSS released its online survey results today. The Meaningful Use chase continues to draw a disproportionate share of hospital attention despite possibly more financially critical projects such as ICD-10 and preparing for healthcare reform.

We had a little lunch today for our sponsors, with Inga, Dr. Jayne, and me appearing in disguise for anonymity purposes (lab coats, surgical caps and masks, and reflector thingies). Thanks to Dr. Gregg for coordinating and Ed Marx for delivering a speech before we slipped in, did our thing, and headed out (I don’t know what he talked about, but I’m confident it was excellent). I can’t say we deliver an inspiring or polished performance for several reasons: (a) we have never appeared as ourselves in person and we were quite nervous about that, especially Inga, who Dr. Jayne and I thought sure was going to throw up on the sidewalk on the way in; (b) I had just met Dr. Jayne for the first time in the car (I like her – a little bit sassy and brash in a doctorly way); (c) we weren’t really sure what we should talk about; and (d) we’re writers, not talkers, so our oratorical skills are modest at best and Inga and Jayne declined to say anything at all once we got in the room (thanks a lot, gals). It was great to see everybody, though, and we really appreciate the support and the chance to say so in person. It would have been really cool to hang out for awhile, but we’re paranoid about anonymity since we’d rather not become unexpectedly unemployed. Inga wore the fab boots that I got her for Christmas and pics of those are going viral, she says. On the way in, some guy did a double take while checking our getup and asked if there was anything he should know. I told him we had the outbreak nearly under control.

Thanks to Dr. Gregg for choosing BB King’s for HIStalkapalooza way back in the fall and working up the menus and details. I liked the scale of the venue and the acoustics were good. Above is a red carpet picture from reader Rick. Below are some reader pictures – thanks for those.

If you’re at HIMSS, here’s my recommendation of a cheap, fun local place to eat that’s an easy walk up the street just past Pointe Orlando (one of my pals urged me to share it with you after I took him there even though he was paying and trying to steer me to high-end places). I’ve eaten at Miller’s Ale House probably 40 times over the years and it’s always good. The beer selection and prices are amazing, the waitresses are cute and fun, and you’d be hard pressed to find a better entrée than the $12.50 Bahamian dolphin baked in a foil pouch with garlic, wine, Tabasco, and vegetables. The blackened grouper sandwich is good, too. Start off with the excellent conch chowder and you’ll feel like a Florida native. I’d invite you to eat with me there except my doctor disguise wasn’t all that comfortable.

AT&T’s ForHealth division announces new products and pilots: a smart phone interface for its Healthcare Community Online portal, telepresence, and mHealth Manager.

Passport Health Communications announces a partnership with Bayfront Medical Center (FL) to beta test its precertification / prior authorization product, OrderRite.

I forgot to mention this the other day with all the HIMSS crush: athenahealth names former AMICAS CEO Stephen Kahane, MD, MS as president of the company’s Enterprise Services Group.

Merge Healthcare CEO Jeff Surges brings over some of his former Allscripts colleagues: Steve Brewer as EVP of solutions and Steve Martin as SVP of sales (please hold the arrow-through-the-head jokes since I’m sure he’s heard them many times).

McKesson announces its $1.5 million funding for six mobile health projects related to diabetes. The next grant cycle starts in April.

The folks behind the Extormity EHR and SEEDIE certification parodies come out of the closet: it’s NoMoreClipboard.com.

Allscripts announces its version of the Apps Store and demonstrates “native” integration between Sunrise and its Enterprise and Professional EHRs. I don’t know what “native” means when you have products developed by different companies whose only commonality is current ownership, but I’ll assume it just means you don’t need an integration engine or middleware. I heard a couple of times today that they’re doing a really good job, although whether it will be enough to fight the Epic juggernaut is anybody’s guess (actually, I’ll guess no since it’s late in the game, but kudos for going after them).

Cedars-Sinai picks Encore Health Resources to help with the next stages of  its EHR implementation.

Keane Healthcare Solutions Division announces a mobile client for its Optimum system.

Ross Martin provides this picture of the next challenge for IBM’s Watson, accompanying his funny writeup. “They also believe there is a place for synthetic vocals in pop music today. Andy Aaron, who lead’s Watson’s speech team, says, ‘We’ve hired will.i.am as a consultant to figure out how he makes his voice do that cool, computery voice thing and mimic that.’ Apparently, IBMers have not discovered Anteres Auto-Tune.”

GetWellNetwork announces GA of GetWell@Home, which allows discharged patients to use care plans, teaching tools, and personal health information created for them in the hospital.

From an athenahealth-Sermo survey of physicians about EMRs: three-fourths say they’re good for patient care and two-thirds say they’re worth the money, but 60% say EMRs slow them down. Still, 95% of those docs surveyed will seek Meaningful Use money. Other concerns involve the future of small practices, the impact on patient care of the Affordable Care Act, and the quality of medicine in general down the road.

Drummond Group announces its certification program for hospital EHRs that cover multiple or self-developed applications. The whole “complete EHR” Meaningful Use issue came up in the X.0 session I attended today, where vendors either don’t seek modular certification or decline to sell their offerings piecemeal, making it unclear whether a provider using or owning only specific modules can still claim to be using a certified EHR. ONC really needs to clarify this since it’s a mess and integrated systems vendors have little incentive to clean it up.

Palomar Pomerado Health announces Medical Information Anytime Anywhere (I’ll give them one-time dispensation for making Anytime one word when it should be two). Vendors already offer their own iPhone and iPad apps, but the hospital’s product works can assemble a single view of information from multiple systems (vendors don’t offer that, of course). Cisco covered half of the $250K cost of developing the prototype, but it will take lots more cash to turn it into a stable, off-the-shelf product (which is the hurdle that 95% of hospital-developed apps can’t clear).

Voalté hires former Ritz Carlton quality director Gigi Gray as user experience manager.

Exhibit Hall and Session Notes

• CCT, which offers training contracting services with emphasis on clinical systems, is holding mock training classes on the hour in booth # 5769.
• NCR announces new versions of its portal and kiosk products.
• The X.0 people seemed crestfallen that their beloved Twitter feed was down, forcing people to actually ask their questions instead of Tweeting them.
• Someone’s session talked about cost savings from IT, leading me to ask myself this: cost savings to whom? If you cut costs, you’ll just increase insurance company profits in most cases. They don’t often reduce rates even when their costs goes down. And second, hospitals are so inefficient that they never reduce rates when their costs go down, either. Even if technology allows cost savings, who gets the money?
• In a session on mHealth, one thing was clear: much of the variation in cost and outcomes is because patients are non-compliant. I was thinking that perhaps that’s why our outcomes and costs are so bad compared to those of other countries – our people are fatter, less motivated, more likely to be stressed in their quest for consumer bliss, and often unwilling to make even modest effort to improve their own health. That’s not something that providers can influence very much.
• I checked out a couple of products in the New/Emerging Technology part of the exhibit hall. Oddly enough, people from these startups seemed mostly uninterested in connecting with people looking at their offerings and neither of them offered me a demo despite not having much else to demand their attention. Expert-24 had Virtual Expert, a decision tree generator that looked a good deal like Visio and can supposedly be used by non-programmers to build simple applications that collect information or step through decision support steps. Canadian vendor MedConnex had a simple EMR. I would have had more to share if they had shown more interest.
• I said yesterday that ESD was the most creative vendor given their tiny space, and that’s not even counting the ultra-cool sign I saw in their booth today that I missed then. It said, “Big brother is not watching you,” explaining that you could visit them without being tracked because they opted out of the idiotic HIMSS vendor technology to track attendees with RFID like stray cattle in the exhibit hall. Kudos to them.
• Clairvia didn’t offer a demo of their scheduling and acuity apps despite broad hints from me that I was interested and a conversation of several minutes in which I asked about it, but I can say it looked very cool on the screen I saw.
• I will say that in general, booth people seemed out of energy today. Many of them were fiddling with their phones, talking to each other instead of paying attention to passers-by, or just sitting and staring at the floor. Maybe vendors should send in a fresh team on Tuesdays since many of them were letting prospects walk away without getting any recognition. I keep thinking about the cost of buying a booth just to give reps a place to sit, chat with each other, or talk on the telephone.
• I got a nice pitch from Healthcare Innovative Solutions, which provides consulting services specific to CPOE and EHR. They have a a good story.
• A company called ESET was giving out personal one-year licenses for the company’s antivirus product. I’ve never heard of them, but they say they’re replacing McAfee and the big boys pretty often because their product is more lightweight and doesn’t download huge updates, with their average update being only 18K in size. I’m going to install the license they gave me on my PC at home. I wish I could replace the one at work since when it cranks up once a day, it sucks the life out of my laptop for a couple of hours, not good news when there’s a technical or clinical emergency to deal with.
• Blue Cat Networks had a couple of girls in sequiny, skin-tight costumes that could have passed for spray paint. Just saying. Like many of the pretty females working booths, they were a bit cold, which I guess is the result of being leered at all day.
• Prognosis also didn’t offer a demo or pay much attention despite my broad hints of interest, but the product looked good on the screen shots.
• The folks at C3 Partners explained their Meaningful Use Monitor, a tracking tool to document MU status, ready to submit (after Stage 1, which does not require anything more than attestation, apparently).
• Google had a crappy little booth with – no lie – black and white photocopied sheets about Google Health that had been cut in half. They had a total of four PCs for demoing, which was three more than they needed at that point in time.
• Stoltenberg Consulting was offering free chair massages, which I could definitely have used if they had picked up on my obvious interest (clearly I get miffed when I’m ignored, but at least unlike the average attendee, I can call them out publicly on behalf of all of us).
• MediQuant had an excellent magician with some fun product pitch mixed into his patter. Definitely worth checking out. The guy will read your nametag clear across the aisle and call you by name to get you drawn into his tricks. You won’t mind.
• SSI was the company from Inga’s picture that had females wearing evening gowns.
• Someone asked me what I thought the big theme is this year. I don’t think there is one. iPads are cool, but not all that different, ICD-10 and tools to migrate to it are obviously on everybody’s radar. Other than that, nothing would distinguish this year’s conference from the last two or three. Everybody’s talking innovation, but I don’t see much if it out on the show floor. You tell me – what’s the coolest thing you’ve seen?

I have no further HIStalk responsibilities and I’m not leaving until Thursday morning, so let me know if you’ve seen something I should check out.

E-mail me.

HERtalk by Inga

Yes folks, that is my brand new iPad. I was one of Medicomp’s lucky winners. And yes, Medicomp was our amazing HIStalkapalooza sponsor and they also made me the proud owner of a cool toy. Regardless, their new Quippe is a serious game changer. I looked at the technology that is embedded into MED3OOO’s Integreat product and was amazed. Today I saw Medicomp demonstrate it further and I am convinced that every EMR vendor needs to check out this technology. I haven’t seen any product with anything similar and I am convinced that it’s the way of the future. I realize that I am such raving without giving details, but I will have to go back to that another time.

So this is going to be a totally rambling post, so hold on for the ride.

HIStalkapalooza: OMG I had an amazingly fun time. I must ask Mr. H who the red carpet gals were, but they were gorgeous and hysterically funny. Check out the YouTube video and see for yourself. Many folks came dressed to the nines, including our Inga Loves My Shoes winners and all the finalists for HIStalk King and Queen. If you were a winner, send me a note so I can mention your name. Our judges Lindsey and Greg were the most adorable and funny things. If Lindsey hadn’t been a judge, her pink stilettos would have surely won.

Ingatinis: I had one in the SIS booth yesterday as well as one at BB King’s. The original won over the newbie, though that didn’t stop me from drinking them at BB King’s.

Mr. H, Dr. Jayne, and I treated our sponsors to lunch today. We made a brief appearance and Mr. H said a few words. I rarely get anxious or nervous, but I was a wreck this morning. Thanks to the 100 or so that showed up and showed us the love. One of the sponsors told me that his table included someone from eClinicalWorks, Allscripts, Greenway, and e-MDs, and the NextGen guy came over to say howdy. How often do guys like that break bread together? I wish I could have heard what was being said.

HIMSS isn’t over yet, but already the conference has hit a record number. 30,947 so far, compared to an estimated 27,800 last year in Atlanta.

There are over 1,000 exhibitors, which means it is virtually impossible to check them all out. However, I asked my new BFF Dr. Jayne to join me for a peek at a few EMRs. For whatever reason, we had difficulty getting anyone to show us stuff, usually because people were too busy. We tried to look at Azzly, which I had seen in MGMA in October. It’s brand new and is having its first practice go-live in a couple months. It is cloud-based, so our demo was over the Internet. Apparently the Internet connection was horrible and thus it was impossible to get a feel for the product. Azzly does not offer a local version as a compliment to its hosted version. It’s a little scary to think of all the potential problems of having an Internet-based only product, though everyone is going that direction.

Another vendor said he had to pay $1,500 a day for high-speed Internet access in the booth. I think I heard him right. Could that number be correct?

Dr. Jayne and I also tried to check out Practice Fusion. Apparently they had similar Internet issues and were only providing demos on one small screen. The cute young guy working the booth told me that only about four of their clients go for the ad-free version of their product. When I interviewed Practice Fusion CEO Ryan Howard a couple of months ago, he wouldn’t share that number, by the way.

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Software AG is raffling a hot-looking Fender electric guitar. I gave it a test drive and totally impressed the booth staff.

I did a quick walk through the Interoperability section. There was apparently a speaker at the little theater in there and the crowd was  20 people deep. If you look really hard, you can see a speck that looks like David Blumenthal.

Speaking of Blumenthal, am I the only person who has noticed that SRSsoft’s Evan Steele could be Blumenthal’s better-looking brother?

Second best “trinket” after the iPad: a stainless steel coffee traveler cup from MedAssurant.

Cute fedora hats at FormFast, I think. They are apparently giving them away. I am not sure what it all means, but they also have a pseudo-juggle thing going on in their booth with lots of foliage adornment.

So much more to say, but I scored an invite to one of the big parties, and well, what’s a girl to do?

E-mail Inga.

EPtalk by Dr. Jayne

The highlight of today was stopping by the HIStalk sponsor lunch with Mr. H and Inga.  I felt like a rock star arriving in the HIStalk limo, but the looks on the faces of other patrons at Pointe Orlando at seeing the three of us in our white coats and surgical caps was priceless. We appreciate your sponsorship and thanks to all of you for welcoming me as the newest member of the HIStalk family.

The best thing I saw in the exhibit hall today was Medicomp’s Quippe offering, which they were demoing on the iPad.  Using the MEDCIN Engine as its backbone, it allows for creation of dynamic templates for documenting patient care, allowing physicians to customize while still mapping to recognized findings behind the scenes so that it all works for coding, compliance, and interoperability. You can see it at work also at the MED3000 booth as they have integrated it into their product.  As many vendors move to map to SNOMED and other standards, this approach is one that should be given serious thought.

And as more and more physicians express a desire to have templates that build the note on the screen, this type of functionality should be easier and easier to integrate into existing products.  Of course, some docs still aren’t going to like it, and there will be the ever-present debate over whether findings should be documented in clinical terms vs. patient terms.

I’d be interested to see what physician readers think about this idea – knowing that patients are going to have more and more direct access to their charts, are you changing the way you document? This is a fundamental issue that all of us are grappling with. How are you handling it?  Since Medicomp also gave iPads loaded with Quippe to the physicians attending HIStalkapalooza, let us know how you like it after you have a chance to try it. Drop me a note and I’ll write it up.

Thumbs down to the food court today, when the machines ran out of Diet Pepsi.  Sounds like quite a few of us are trying to avoid the extra sugar that comes with the caffeine that keeps us going.  Even for those who choose the full-sugar versions, at least we’re burning some calories with the trek through the convention center.

I’m still tuckered out from HIStalkapalooza. It was nice to see so many “real” physicians in attendance and I enjoyed talking with some of you. I also enjoyed talking with those of you who are suits – it was nice to share war stories and make some new connections. 

The awards ceremony was priceless and this being my first HIStalk party, I’m glad my expectations were exceeded. Looking forward to many more to come!

Tonight I swung by the Compuware bash at Cuba Libre with my wingman. Great atmosphere (a little heavy on the cigars, though) and reasonably good Mojitos. Enjoyed the heavy dance beat and the excellent people-watching as the night wore on.

Tomorrow’s my last day at HIMSS11, so if there’s something you think should be on my "must see" list, e-mail me.

E-mail Dr. Jayne.

From HIMSS 2/21/11

From KR: “Re: HIStalkapalooza. Let me be the first – this event has to be the highlight of the week! The awards, by Bush, were absolutely fantastic. Could not have hard a better MC. Thanks so much for a great event!” You knew it was going to be good if you watched JB waiting to go on – he was like a horse that couldn’t wait to run a race (if horses drank beer beforehand, that is). He was amazing, although he may cringe when he sees his words played back from the multi-camera video recording that was being made.

From Bobby Orr: “Re: HIStalkapalooza. Great time, big fan a good blues band, thank you. Largest  HIMSS ever over 30K attendees, but only about 9k providers is what I understood but I’ll leave that to the HIStalk  team to confirm the numbers.” They said 31K in the opening session, but I bet most weren’t providers. We’ll try to get specifics.

From West Coast Viewer: “Re: CHW. Ben Williams, CIO at CHW, has resigned, effective 4/15/2011.” Unverified.

From Rodgrigo Barnes: “Re: Pennsylvania Health Information Exchange. Medicity contract cancelled.” Unverified. I need to get clarification from Medicity, but the purported e-mail suggests that the state didn’t like PHIX’s strategic plan or its selection of Medicity, which the e-mail said AT&T protested. Also claimed is that the contract value was about was $31.7 million, only $17.1 million of which would be be covered by federal taxpayer dollars. I’ll get more information. It sounded like budget was the big problem.

From VIP CIO: “Re: VIPs. I had the same reaction as you to the article about ‘VIP Treatment.’ The first rule of being an executive is to appear to be getting less special treatment than you are actually getting. I am e-mailing you from the VIP lounge at HIMSS. It is pretty simple, but in the mad house that is HIMSS, it is a great perk. While the lines at the coffee vendor stands are 40 people long, I was able to come in and get a free cup of hot coffee in a china mug. There is soda on ice and water, too. There are nine tables and four workstations with Internet-connected computers and printers. It is kind of quiet, people are avoiding eye contact. One more thing — ribbons are for people that lack self-esteem. I agree CMIOs are major players, but they don’t need a ribbon to prove it. If they want recognition they can carry their medical degree. Nobody in the lounge is wearing a ribbon. Again, we know that it is not good to call attention to our special treatment. Gotta go, the massage therapist is here (just kidding).” I’m a little bit miffed – I pay the same dues and conference registration fees as CIOs, so why am I an inferior HIMSS member who doesn’t get the same perks?  

Thanks to everybody who came to HIStalkapalooza. Thanks, too, to Dave Lareau and Medicomp, their events and video people, BB King’s, the Insomniacs, our red carpet greeters, our shoe and King/Queen contestants, and Jonathan Bush.  I left early and will be up late, as usual, but everybody seemed to be having fun. Personally, I found JB’s beer-fueled riffs to be the funniest thing I’ve heard in a long time – better than MS3TK. Since I’m writing this after several beers, please forgive any slip-ups. I bet nobody else left the event to work several more hours — that’s my excuse.

The limo will run 9 a.m until noon or so Tuesday, cruising around I-Drive. Flag it down and get a luxury ride to the convention center. I’ve ridden in it a couple of times now and it was pretty cool. That’s the very sweet Jan above who was driving today, although I’m not sure we’ll have her again tomorrow.

Medicomp gave away iPads with its new Quippe product to physicians attending HIStalkapalooza. Drop by their booth Tuesday and take a 20-minute training session and you’re in drawing for several more (both physicians and non-physicians will be chosen). I didn’t explain it well, but just stop by and they’ll fill you in.

I’m going to save all the news and other items since it’s getting really late. Here are some random observations from the day, most of them about booths.

• I got nothing from the opening session. I didn’t thing the videos and a capella guys were all that interesting. Robert Reich was too basic and to general to hold my attention. I’m sure he’s really smart, but his talk seemed dumbed down for people who pay zero attention to economics and politics. Not much healthcare in it, either, although obviously Medicare expenses can’t keep rising and he said so.
• Actually, I did get one thing from the opening session: frostbite. My teeth were chattering afterward and every room I was in was just as cold. Floridians crank that AC down for sure.
• I went to two other sessions. Both were terrible. I didn’t learn anything after sitting in sessions all morning.
• The Onyx people had a pretty cool booth, with the ladies wearing red dresses and one wearing a Cinderella-looking outfit. I don’t get it, but it was cute.
• Ingenix had a huge booth with the logos of their acquisitions on the sign – Picis, Axolotl, Lynx Medical, A-Life Medical, HER, and Ingenix Consulting.
• MEDSEEK had a nice two-story model with a guy from The Apprentice doing something or other.
• iMDsoft had sleek version with lots of coffee urns.
• A couple of the Salar guys gave me a booth pitch not knowing who I was. They did a great job, which smaller companies often don’t – they had their story down pat, talked benefits instead of features, and referenced client sites.
• OnBase had its usual sports bar and that smarmy but funny card trick guy, neither changed in the last decade, it seems, but still cool.
• Walden University had a Kinect soccer game where you could try to kick goals over animated opponents.
• Nuvon had oranges as giveaways and a couple of other vendors had apples. Good idea for a health-oriented conference.
• Unity Medical had cool “cones of silence” that looked like old-fashioned hair dryers, which allowed people standing under them to hear the audio from their videos even with exhibit hall noise. They provide instructional and motivational health videos that seemed pretty cool.
• Sage used a red color as a theme quite effectively.
• Awarepoint did a good pitch when I dropped by anonymously. The guy qualified my interest and need very quickly, then gave some good examples of similar deployments. Nicely done for just a casual chat that I didn’t even ask for.
• EDIMS – had a nice setup and a big presence for a mid-sized booth.
• Allscripts had a massive spread using their new green color. Looked good.
• Emdeon had pretty cool orange shirts and a café table setup. They were talking health information exchange.
• Medicomp had their HIStalk sign front and center. They also had a two-sided theater, one playing a recorded demo and the other live.
• Elsevier had a water cooler, something simple that you don’t often see.
• InSite One had an incrementing counter of studies and images done.
• MEDecision had some cool light-up panels and a real Starbucks setup.
• ESD had the most unusual items – flip flops, fondue, and wheatgrass. Nice people, too. I think they may have been the most creative with the space they had.
• Epic put out signs covering their KLAS scores. The lovely Maggie noticed me checking them out, told me that was her job to publicize their scores, and ran back to get me a handout of every sign on their booth walls. Obviously their KLAS scores are shockingly good, lots of green in a sea of competitor yellow and red, but the fact she was so attentive and tasked with managing their score displays impressed me. They still had the fireplace, the wacky art, and Judy hanging out. They also had a sign for Canto, an iPad-based physician dashboard with dictation and messaging (new, I think).
• Nuance had a theater presentation about the new CAPD product built with 3M.
• Enovate had its usual carts, wall mounts, and articulated arms. Very sexy and smooth. Nice people, too.
• Somebody had mini Moon Pies, but my writing is too sloppy to decipher who (looks like Med Worth, but it could be anything).
• Rubbermaid had a cool water cascade right in the middle of their booth.
• Merge had a bunch of cool stuff – kiosks, the Tesla car that you could get your picture taken in, a wall of candy, and video games.
• Clairvia had coffee, a nice demo area, and their HIStalk sign on the table.
• Airwatch had cool management tools for mobile devices like IT shops use for PCs, allowing iPads, iPhones, and any devices to be secured, updated, and managed. They’re new to healthcare, but other clients include Walmart and Coke. This was one of the more interesting things I saw. I talked to the co-founder and he definitely had his pitch down pat.
• GetWellNetwork had their peds application running – very colorful and fun for education and applications.
• IBM had a ton of people visiting their booth. They were pushing the Watson connection.
• Microsoft also had a lot of people, demoing Vergence, HealthVault, and some other stuff. Their signs spelled HIMSS  as HIMMS, though.
• Vocera had our sign out. They also did a nice demo for me on the fly, under their own version of the cone of silence to allow you to hear the device talking.
• CattailsMD was giving away some kind of Buzz Lightyear action figure.
• AT&T had loads of people. I looked at Connect, a learning portal that also streams video. The coolest part is that the tool auto-indexes the audio track of a video, allowing it to be searched by any word without a transcription or manual keyword step. I didn’t know technology like that existed. You’d think YouTube would have it given that it’s owned by Google
• Perceptive had our sign out and was demoing their imaging application.
• Advisory Board had a big booth, ironically just two booths down from that of HIMSS Analytics where Dave Garets left to go there.
• PatientKeeper had a big rack of mobile devices and an effective slogan, “Reinventing CPOE.” Lots of people were checking it out.
• e-MDs had our sign out – thanks!
• Vitalz had a race car simulator.
• SIS used color extremely well, dressing their female booth people in light blue sweaters and the guys in blue Oxford shirts, both making the red and white SIS logo really stand out. They also had very cool theater chairs in the same red. Best use of color for sure.
• Wolters Kluwer had a golf simulator.
• Sunquest had a large booth with that green color that I really like. Thanks for the Chapstick – I needed some.
• McKesson’s spread was huge. It also had a giant electric billboard. There was nothing muted about the color or the design.
• Siemens had a booth that needed its own ZIP code. The wall of lights must have been 20 feet tall.
• Medicity had a nice crowd and an HIStalk sign right on their main podium.
• RelWare had the Back to the Future DeLorean, accepting donations for Team Fox.
• Cumberland Consulting Group had our sign out. They were way down on the end in the 6900 row.
• SourceCorp was giving away small wooden baseball bats.
• MobileMD had a foot massage machine. They also talked about their 100% “would recommend” HIE solution.
• Orchestrate Healthcare had some cool yellow colors, including fresh flowers and bags. They also had our sign front and center.
• Lockheed Martin had a huge liquid nitrogen tank that was pretty scary to behold. I think (and hope) they were doing something with ice cream.
• Billian’s had our sign out and was giving out flash drives, the only ones I saw.
• RelayHealth’s booth was lit up in pink and each demo station was surrounded by shimmering curtains. I might give them the Best Design award. They had a lot of people checking them out.
• Alert had a long booth that was kind of confusing, but they did have cute white outfits and were demoing in some language that wasn’t English. I thought it was interesting
• Pulse had a nice booth and a card guy.
• Pepid had the first guy I’ve ever seen doing a theater presentation who read directly from index cards and didn’t even try to hide that fact.
• Chipsoft had the cute yellow shoes again.
• HCA had a booth to recruit people in informatics, pharmacy, Meaningful Use, and Meditech.
• HT Systems (the palm reader people) was one of the companies in the New and Emerging Technologies section, with stand-up areas instead of full booths. Check that area out since those are the up-and-comers everyone says they want to support. Also there was My Health Direct. Both companies had their HIStalk signs out.
• ONC had a sizeable booth. They were giving away money (kidding).
• MED3OOO had a couple of really cool giveaways – little preloaded bubblegum machines and a nice computer cleaner with one gadget for the screen and another for the keyboard.
• Success EHR had the nicest people I ran across, two cute girls making fresh popcorn.
• MedAssurant was making fancy coffee like café con leche and café cubano.

That’s all I have time for tonight. Back at it tomorrow. Hopefully folks will send me pictures from HIStalkapalooza since I didn’t bring a camera. I believe Medicomp was planning to have video from tonight running in their booth Tuesday, so drop by.  

E-mail me.

HERtalk by Inga

Just a super quick post before I start my beauty regime for HIStalkapalooza!

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A couple of pics of the nicely presented food at the reception last night. It’s hard to cook for 20,000, but I guess it was tasty enough.The best part of the evening: hanging out with Mr. H and critiquing the whole affair. I then joined some friends for one glass of wine (the glass never went empty, so I am assuming it was only one glass). Regardless, I made it to bed probably too late, but was up at 6:00 a.m. and in time for my painfully early 7:00 a.m. breakfast. Fortunately I arrived in style in the HIStalk limo, the interior of which is probably bigger than the bathroom in my budget hotel.

I’ll provide more details on my day tomorrow, but wanted to share some additional photos from the day.

He wins. ‘Nuff said.

I am guessing that she was concerned she wouldn’t have time to change clothes before the party tonight, so she wore her gown to the booth. Sorry I don’t remember the vendor, but the girls were good sports.

A little business meeting with the HIStalk sponsor sign prominently displayed. Thanks, iMDSoft.

Merge bought me lunch.

I thought the skirt was a wee short, but this guy thought it was worth looking at more than once.

I sat on the floor for awhile recharging my phone. What’s up with the official “recharging stations” having no power connected to them? I did find that by sitting on the floor I was nicely positioned to check out shoe fashions.

Much, much more later, including HIT X 2.0, commentary on exhibits and vendors, and some gossip. Look for big announcements probably tomorrow from Microsoft, Cisco, and perhaps Gateway EDI.

E-mail Inga.

EPtalk by Dr. Jayne

I was dying to post pictures today, but with my employer locking down my Facebook, it was difficult.  Inga beat me to the knight in shining armor, but be on the lookout for lots of other photos as she and I cruised the exhibit hall together.  Let me tell you, we saw some prime photo opportunities.

My goal today was to visit all of HIStalk’s sponsors.  I didn’t make it everywhere, but I did make it to quite a few.

A couple of shout outs:

• Iatric Systems (3601) is offering a special drawing for HIStalk readers, but also has a guy shooting trick pool shots.  Pretty entertaining!
• Enterprise Software Deployment (2777) not only has a special reader drawing, but also was giving away flip flops and sports sandals and had fondue in the booth.  Perfect for a mid-day pick-me-up!

Keep your eye out for the autographed (by Mr. H and Inga) signs alerting you to vendors who are HIStalk sponsors.  Be sure to tell them you read HIStalk.  Maybe next year I’ll get here early enough to put my physician-esque scrawl on some of them.

I said I’d be visiting Merge Healthcare to check out their kiosk solution, and was happy to find their Wall of Candy as well as a nice demo of their product.  I was a little concerned by the sales rep scanning her own drivers’ license and swiping a credit card, but I guess they can control where it goes.  I wonder, though, does the kiosk come in hot pink or zebra stripe?  They also have video games, including Big Buck Hunter.  Good for a break when you’re tired of walking the floor.

I visited Surgical Information Systems and was pleased to see that this year, not only were they serving the IngaTini but also the InterOpTini which is more my speed.  They also had chocolate covered everything, and I am the kind of girl that appreciates that.  Thanks again for the hospitality!

FormFast has a great Indiana Jones “Peril of the Untamed Workflow” theme and was throwing fedoras into the audience, but I wasn’t lucky enough to get one.

The “Best Badge” award goes to the attendee who replaced his first name with “Talk To Me” in bold letters.  I didn’t fully appreciate the value of that badge until I was given the brush off by a couple of vendors. 

News flash – you might want to find out a bit about the prospects that stop by so that you can make an educated pitch to them.  And if you can’t answer the questions, find someone in your booth who can, or schedule a follow up.  Trying to “fake it” is just really a bad idea and we can tell.

I enjoyed seeing so many members of the armed forces at HIMSS11 today and wanted to take the opportunity to thank all of you for your service to our country and around the world.  We appreciate each and every one of you and the excellent healthcare you provide to our troops and their families.  Seeing you puts everything in perspective and is an excellent reminder for those of us that tend to get focused on what in comparison are some fairly petty issues.  We’re not trying to keep systems up while caring for wounded on the battlefield or anything like that, and you deserve our utmost respect.

The big ticket of the day was of course HIStalkapalooza, and major thanks to Medicomp for their support.  It was a great bash and certainly one to remember. Thanks to my many new friends, especially Evan – your velvet jacket made my night.

E-mail Dr. Jayne.

From HIMSS 2/20/11

The weatherman calls for no snow today. Oh wait, HIMSS isn’t in Chicago this year – happily since it’s 35 degrees there but in the mid-70s in Orlando as I write this Sunday. I got out for a nice walk Sunday morning and it was perfect – green grass, swaying palms, colorful flowers, and egrets strutting around the fake water features and tacky tourist shops.

HIMSS is on the old side of the convention center again this year after being one of the first to use the new side when it opened a few years back. I think the old side is actually better, or at least I saw no drawbacks as I looked it over Sunday morning. it’s a pretty easy walk to the convention center form any of the I-Drive hotels between Sand Lake Road and Westwood Drive, as sidewalks are wide and crossings well laid out. 

Just a reminder: I hired a limo to cruise up and down I-Drive Monday and Tuesday mornings, so if you want a ride to the Convention Center, flag down the car with the HIStalk logo on the side and it will drop you off (sorry, the bar is not stocked – maybe next time when I book the one with the neon, massive sound system, and stripper pole). 

Badge pickup was easier than ever. HIMSS had e-mailed a barcode and you just waved it under the imager and out came your badge. I guess it was embarrassing for such a pro-automation organization like HIMSS to be running a conferenced on paper handouts, packaged symposia CDs, and forms.

I was happy to find that the convention center still has free WiFi, although it will probably be iffy once the whole world piles on it Monday morning. I saw plenty of food stand options and a good amount of seating in those areas (there’s never enough, but Orlando isn’t one of the convention centers that has almost none). The HIMSS people were zipping along at alarming speeds down the hallways on Segway-type standing tricycles for no apparent reason.

It’s worth making time to don casual attire (you can buy hideous tourist shorts and tee shirts if you didn’t bring warm weather clothes) and hit the street for a stroll. The mini-golf places are doing good business and all the restaurants have their patios open, so if it’s not summer where you came from, it is here. They were almost all totally booked Sunday evening, with big groups using large tables and in some cases buying the restaurant out (like we’re doing for BB King’s Monday night).

I checked out Pointe Orlando and it’s infinitely better than it was a few years ago.  BB King’s looks very nice, like all the other restaurants in the complex. It’s an easy walk or very short cab ride from the convention center and the surrounding hotels. There’s a parking garage attached if you’re planning to drive to HIStalkapalooza (easy on those IngaTinis if so, which is why I mentioned walking).

I dropped by CIO Forum area at W330, which always has free food and other goodies that the non-decision making peons don’t get (or as today’s Healthcare IT News headline surprisingly said, “Senior execs get VIP treatment.”) They already know that and the rest of us don’t like to feel less than special, so maybe that article should have been tossed. The CIO agenda didn’t look all that interesting, but the room seemed full and I saw quite a few familiar faces.

Speaking of Healthcare IT News, which was never afraid to tread the feel-good, self-congratulatory side of HIT, it’s just as cheerleaderly now that it’s owned by HIMSS. I think I made the day of the girl handing them out by actually taking a copy, instead of doing like everybody else and body-Englishing away from her thrust-out copy or mumbling, “already got one.” The “news” part of its title could be debated based on what’s in this issue, especially when some of the articles are about some vendor’s exhibit or product and contain nary a discouraging word

There’s a little picture of David Blumenthal on the front page – honestly, has the man never had another picture taken than the cocked-head, slightly-smirky one that runs ever single time he’s mentioned? It actually appears at least three times in the same issue.

Two different people reacted separately to me about a well-known industry figure who I won’t name: “Man, that guy is weird.” I can’t say I’m shocked.

I saw Judy Faulkner walking around wearing a purple cast on her left arm. I felt sorry for her, not because of the cast, but she was like Brad Pitt trying to see a movie or get on a plane – people kept stopping her to introduce themselves or to pester her in some way.  

I saw some small vendor women dragging huge cases bigger than themselves. It must be a pain to set up the booths and then work the show. Somehow I don’t think HIMSS is a place where vendor people have a lot of fun.

This year’s sappy conference tagline: Linking People, Potential and Progress (I abhor the ever-so-trendy omission of the second comma – it makes it harder to read). They should have included the fourth, most-important P in the HIMSS vocabulary: politics. Once again all things Meaningful Use and taxpayer handouts dominate the conference. Do medical conferences obsess on Medicare payments?

The opening reception was no different than those from past years, other than drinks were unlimited (!!) and no tickets were required (thus squelching an entire secondary market for unused tickets). The drinks were cheap wine and horrible beer (Bud and two others that I’d rather not remember). There was the usual soulless cover band playing away in decoration-free room with an acoustics-killing concrete floor (insert my usual airplane hangar reference here) and allegedly ethnic foods that, while probably better than usual for the opening reception, were mostly harmless filler with no real distinguishing characteristics. Mostly it was a staging area for dinner.

HERtalk by Inga

It’s Sunday afternoon and my first half day of HIMSS is behind me. I sat in a few different sessions today, even though I wasn’t technically eligible to listen in on all of them. Fortunately HIMSS has cute college students assigned as doorkeepers. I just smiled at them, walked into room, and acted like I owned HIMSS.

Today’s highlight: Aneesh Chopra. OMG he is hot! He’s got a great face, but is also tall and lean. And as a speaker, he is dynamic and charismatic. I was ready to say “Hallelujah, I love technology!” just to see if he’d notice me. But I refrained myself. I also observed outside of the session and he is clearly the funnest- guy-in-the-room-type guy. Aneesh, if you would like an invite to HIStalkapalooza, drop me an e-mail. Better yet, just drop by the party and just tell them “Inga’s new heartthrob is here.”

I did actually listen to Aneesh, by the way. He and Farzad Mostashari (ONC Deputy) shot on how HITECH is driving innovation for the market. The soft-spoken Mostashari, poor thing, seems plenty smart and all, but Aneesh is a hard speaker to follow. Their presentation was geared to individuals that perhaps didn’t have a deep understanding of the current state of the HIT market and all the implications of HITECH. It was interesting enough, but I didn’t learn much new.

I had a Judy Faulkner sighting. She seems to be sporting a purple cast on her left wrist. Fell out of the tree house, perhaps?

I feel quite nerdy saying this, but I got all tickled each time I saw an HIT celebrity like Martin Harris, John Glaser, Ed Marx, Lynn Vogel, and Marc Probst.

Overheard: lots of ACO discussions. Based on the number of times ACOs were mentioned today (and I was not in an ACO-specific session) I think we’re going to hear a lot about accountable care organizations this week.

I am having serious iPad envy. Quite a number of people seem to have them in sessions and the units seem so small and easy to tote. I must go sign up for every single exhibit booth contest.

Also overheard: plenty of concerns about healthcare going bankrupt. Healthcare reform won’t be repealed because no one has anything better. Meanwhile, we are going to be in for some kind of serious hurt if we can’t figure out a way to control costs and improve quality. The musings aren’t necessarily original but are definitely prolific.

I am thrilled to be meeting up with Mr. H to go to the cocktail reception. Surprisingly I don’t think he and have even spoken on the phone, much less seen each other, since last HIMSS. So it is quite a treat to get to spend some time together critiquing the HIMSS experience. Then I must go to bed early tonight because tomorrow is going to be a long day before one long and exciting evening!

E-mail Inga.

EPtalk by Dr. Jayne

After another delightful trip on my favorite on-time airline, I have arrived at HIMSS11.  I daresay these flights are always a bit more entertaining and less annoying with a vodka/cranberry cocktail.  Although most airlines don’t have in-flight entertainment unless you’re flying cross country, we did have a bit of drama with two passengers being escorted off the plane before we even left the gate.

It seems like every year these events get busier and more over the top.  I can’t tell whether no one has noticed we’re in a recession or whether they’re just trying to stimulate the economy.  Although it’s been great comparing notes with Inga to make sure the fun parties are equitably distributed between the ladies of HIStalk, frankly putting my agenda together for the week has been a bit like preparing for an amphibious assault.

I’m traveling with my work BFF who commented, “I’m not sure we’re going to survive this trip.  I have visions of ‘The Hangover’…”  So if you see a sassy CMIO passed out in the convention hall, please find the nearest AED and follow the instructions when you open the cover.

I’m most interested in the physician-focused sessions, of course, but also those around interoperability and HIE.  I have an aggressive list of booths to visit – if you have a gadget that promises to make my physician world easier, more connected, or more fun, I will be stopping by –  so make sure you show the physician attendees some love, because you never know when you might actually be visited by Dr. Jayne or her crew.

Registration was smooth but I was disappointed by the lack of CMIO ribbons for my lanyard.  The opening reception seemed low key — reasonably good band and well-behaved attendees — but then again the week is early.  No dessert, though – and I am a chocolate girl – so we were forced out to the traffic of International Drive to hunt our prey.

The downside of the day was discovering that my hospital IT department figured out I had the Facebook app on my BlackBerry and blocked it, so there will be no updates from the convention floor unless an intrepid reader has ideas. I’d have a hard time calling and asking them to open it up.

I’m off to get my beauty rest so I can be at my best to walk the HIStalkapalooza red carpet Monday night.  I’m excited at the number of actual physicians on the list and can’t wait to see you all on the other side of the velvet rope!

Have a question about medical informatics, electronic medical records, or whether the paper on the exam table is really changed with each new patient? E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

From back in my days as a rock-n-roll sound engineer, I have always loved the set up/tear down times better than the actual show. Same goes for when we put on the “Pediatric Office of the Future” in the exhibit hall for the American Academy of Pediatrics’ annual conference; the behind-the-scenes stuff is so much more fun. At least, for me it is.

That’s why I finagled my way into the HIMSS exhibit hall floor today as all the vendors were still in their pre-show frenzy. The HIStalk press pass wasn’t powerful enough to open the exhibit hall doors until actual show time begins on Monday, so I had to do a little smooth-talking. (I’ve learned a thing or two about shows and how to … well, maybe I’ll get in less trouble if I just stop there.)

I sent Mr. H a few of the almost obligatory shots of the convention center and the gigundo HIMSS logo and signage now adorning the Orange County Convention Center (West Concourse.) I couldn’t help also including a few shots from the exhibit hall, like the one below:

It’s just a random shot down the main corridor, but if you’ve never seen the exhibit hall pre-show controlled chaos, well, your bucket list just isn’t complete.

You can’t see the madness here because they’re pretty far along in the set up process, but the frenzy of union crews and forklifts, rolling travel cases and hydraulic lifts, show folks and vendor reps all makes for one truly entertaining phenomenon. (Actually, tear-down is even more impressive because stuff just flies apart, into its assigned shipping containers, and then out the loading dock doors faster than you can say “accountable care organization.”)

Anyway, the show is huge as always, celebrating HIMSS 50th year (really?) and, so far, seems much better organized and technologically adept than any I’ve seen before. (The tech abilities of some conventions are weak, to say the least; HIMSS seems to be getting a good grip on the concept.) Yes, I may change my opinion of that once the busloads of people hit and the masses overwhelm the walkways and meeting rooms, but on this pre-show day, it all looks very well put together here in Orlando.

– – – – – – – – – – – – –

Got to go to dinner last night with the good folks from Medicomp who are sponsoring this year’s already infamous HIStalkapalooza. I can say with 100% assuredness that if even a tenth of the event goes as they and Mr. H/Inga have planned, it’s going to go down in the annals of HIMSS history as one of the all-time great events ever. The team they’ve assembled is off-the-hook fun. The plans I’ve heard that Mr. H and Inga have set in motion are “memory book” material. I can’t wait. (I even brought my tux for Inga’s red carpet entrée!)

– – – – – – – – – – – – –

There is just so much to see and to hear and to take in here. All the pre-HIMSS marketing almost dulled my sense of anticipation. (It’s just tooooo much.) But, here on the eve of show time, the news and the people and the techno-geekiness are starting to re-enliven my senses. I’m looking forward to the hoopla.

But, I have one last question for the pre-HIMSS Marketeers before I head off to the opening reception: just what the h*** is an “embargoed” press release? Really? Do marketing people actually think that labeling some PR shout out as “secret” will make press people think they’re getting in on some super special sneak preview?

E-mail Gregg.

HITlaw 2/18/11

EHR Contracting Redux – Balance is Better

Hospitals and physician groups should review, research, and compare proposed vendor agreements during the EHR selection process. Too often, this critical step is left out of the selection process. Some prospects believe themselves to be too far down the road to back up and review their selection in light of unfavorable contract terms. Commencing review of contract terms after selection is extremely disadvantageous to the prospective customer.

Sometimes, however, it is not a factor of time or diligence, but rather market position, perception, or recognition that leads to the casual (non-diligent) review and treatment of a technology contract. For example, the small physician practice looking for EHR software may consider itself to be “mooing along with the other cattle," lining up for contracts and services from the EHR vendor selected by their affiliated hospital. They do not sweat over the EHR contract language because they assume the hospital and big practices have done the work, or if not, they are at least all in the same boat, which in my opinion is borderline negligent.

Next, some prospective customers do not raise important objections due to the “bigness” of the vendor involved. It is sad to agree that in many cases the little customer receives little attention. Important issues often get brushed aside with the somewhat careless, “We are too small to get concessions from the vendor” thought process.

Small HIT companies take similar risks in contract negotiations. They aren’t negotiating — they are jumping when the big prospect flexes. Some small-vendor executives courting the giant provider entities walk right over their poor sales folks’ backs on the way to the signing table, seemingly willing to sign anything asked of them.

Balance would be better. I’ve seen it too often when the big side does little or nothing contractually for the little side, yet cooperates when the other side is also a big player. Capitalism at its best? Survival of the fittest? Maybe so, but I dare to say that with the advent of HITECH and the injection of billions of dollars in reimbursement, this is not an absolute true free market at the present time. That’s OK, but from where I sit, the term “partnership” gets tossed around way too much without a corresponding balance in contract terms.

Commanding one of the most unusual perspectives in the HIT world through representation of hospitals, physician groups, and vendors, either directly or with select consulting firms, I find myself occasionally stepping back and taking a good hard look at the HIT acquisition process. This is one of those times.

Putting the above “Balance is Better” position into a practical example, let us consider the ever-popular “Limitation of Liability” language.

First, a quick lesson:

Indemnification (or “Hold Harmless”): This is when a party takes on legal / financial responsibility for a certain circumstance. For provider customers, determine what, if any, indemnifications are provided by your selected vendor (what they are agreeing to cover, or protect you from). Then determine what, if any, indemnifications the vendor requires from the customer (what they expect the customer to cover, or protect them from). Whichever side is providing the indemnification is legally on the hook for the costs if the circumstance comes to reality.

Limitation of Liability: Not the same as indemnification. Simply put, this is a declaration by a party that states, “I am not responsible for XYX.” Watch these carefully — VERY carefully. The heading for a contract section may read “Limitation of Liability” and include such limitations (often in ALL CAPS), but sometimes an indemnification of the vendor by the customer is also included, and as we all know, one of the things attorneys add at the end of a contract is a section titled “Headings not Controlling” (which to this day makes me chuckle … I sometimes ask to delete the title, which makes for an interesting conversation … but I digress).

Now, for the contract reviewer, look first at limitation of damages. Determine what the vendor disclaims. You will have no recourse from the vendor for these situations. Then look for indemnifications required from customer to vendor. These are critical, because it is not simply a matter of having no recourse, but rather an affirmative obligation that the customer is taking on. Finally, look for indemnifications from the vendor to the customer, which represent areas where the customer gains protection(s).

Prospective customers reviewing limitation of liability language will typically find an exclusion of all consequential, special, indirect, exemplary damages (think “over and above” the baseline direct damages). First question – is it mutual? If not, that is your first demand. Make the exclusion mutual. There is no reason not to request this. Fair is fair. There is also probably a limit on direct damages, which for perpetual licenses is usually the value of the contract, and for SaaS models, the value of one year of subscription fees.

If it were that simple we would be done, but it is not. Direct damages are fairly straightforward. It is the exceptions to the exclusion of all consequential damages that takes the time and expertise.

Carving out exceptions to the blanket disclaimer of consequential damages is part of the bargaining process. Arguably, whatever is good for one side should be considered for the other. The best example would be damages for a breach of confidentiality provisions, which the provider customer expects to be carved out from the disclaimer by vendor – meaning the vendor would be responsible for these damages.

Now here comes the balance part. The exclusion should then also be applied for customer’s breach of confidentiality regarding vendor’s material. Intentional acts or omissions and willful misconduct could collectively merit a mutual exclusion as well. Not all situations will be mutual however, and the best example would be damages for copyright / patent infringement, in which case the vendor should be willing to carve out an exception to the disclaimer on consequential damages.

In situations involving exceptions to disclaimers of consequential damages (which means where a party does agree it is responsible for these damages) it is important to note that intermediate levels of responsibility can be introduced. It does not have to be unlimited. Levels of applicable insurance coverage are often used as limits. This is all part of the negotiation process.

Once you have found all the limitations and indemnifications, map them out. Do the same for each vendor. Then compare. This should assist greatly in the selection process.

Projecting the total project cost is essential in any acquisition. It is critical that you note the potential additional costs (also known as risk) that you are taking on. This is an unavoidable exercise and enables IT leaders to make informed business decisions prior to executing the final agreement. Damages for which you may have no recourse and indemnifications for which you will be responsible are both critical components to risk assessment.

Now, if you’ve made it this far, here is your reward.

Amazingly, after a quick review of projects with which I have been involved over the past two years, I am stunned to report that the fairest (most balanced) contract terms regarding liability were those belonging to mid-sized HIT companies! Surprisingly, the very small companies and the behemoths act most alike in their attempts to disclaim most everything. The small because they have to, and the big because they can. Granted, this is by no means a comprehensive analysis of a majority of vendors in the industry, but it is an interesting slice.

What I think this means, to be philosophical about it, is that the medium companies have recently “made it.” They are very happy to be where they are and have not forgotten how they got there. They appreciate their position in the market and their balanced terms reflect their understanding and appreciation. Maybe I’m wrong, but it certainly made me feel good.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

HIStalk Interviews Ed Daihl, CEO, SIS

Edward R. Daihl is CEO of Surgical Information Systems of Alpharetta, GA.

Tell me about yourself and about SIS.

SIS was founded in 1996. We’re exclusively focused on the perioperative marketplace.

I joined the company in 2006 as a CEO, coming from various high-tech areas. My last couple of jobs were in the supply chain industry, CEO of a company called CAPS Logistics where we did everything from telling hotels where to put their new facilities to routing trucks for Walmart.

I’m proud of project we built that tracks wounded soldiers off the battlefield. We built a database that had 100% of all the transportation available to the military for taking patients to the hospitals and had 100% of the available beds and specialties by location and filled out a rule-based system for them. For example, if you had a broken back, you only landed once. We had soldiers that were landing up to three times with broken backs before they actually went into surgery before we built this system. I  got a lot of personal reward out of that.

I then had an opportunity to come and work at SIS as CEO and move into a healthcare field full time. I’ve enjoyed every minute of it.

Norwest Equity Partners acquired the company in January. Explain why one private equity firm would sell to another and how that affects the company and its customers.

Private equities usually have a goal of where they want to take the company. When they achieve that objective, they’re looking to move out. We had multiple strategic partners approach us unsolicited and ask to acquire SIS. We decided that we needed to do a formal process rather than just talking to one or two partners.

In that process, NEP decided to bid on the company and was the most aggressive bidder. What they saw was the potential to take us even further than it is today and keep us still laser-focused on the perioperative suite. They fully saw that 60% to 70% of the revenue in the hospital comes from the OR. They’re convinced – and so am I – that there’s a lot more for us to do in this marketplace, both here and internationally.

Looking at it from the outsider’s point of view, what is it that makes the business you’re in attractive and what will it take from your new partner to make it better?

A couple of things are very attractive about SIS. We are growing, and have historically grown, at a little bit over 18% in a marketplace that has a 9% growth. We were growing at twice the rate of the marketplace. We were #1 for 2010 in market share as far as new deals in the marketplace, at 21% market share here in the US. We’ve also developed a whole line of additional products that we’re just starting to field to the marketplace that will also drive up the revenue significantly. 

Last but probably most important is our position in anesthesia. We’re one of three companies that have an integrated anesthesia product with their perioperative suite. Epic, Cerner and ourselves are the only three. That leaves us as the only player you can go to if don’t want to implement someone else’s full enterprise-wise solution just to be able to put in the surgery and anesthesia solutions. 

The Millennium Report predicts a 27% compound annual growth rate for anesthesia information systems over the next five years. SIS is currently ranked #1 or #2 in KLAS for our anesthesia system, with over 94% of the respondents saying they’d buy SIS again. The combination of our position already established in the anesthesia and the rapid growth projected through the next five years was a significant reason for NEP’s investment in SIS.

What does the investment let you do now that you couldn’t before?

Two things fit the profile of NEP. Their mantra is about improving client satisfaction and significantly growing the company in the marketplace and gaining market share. I am working with them on a three-year strategic plan on how to significantly grow SIS faster than we have already, and we already are at two times the industry rate.

We will look at what can we do, what acquisitions we might want to make, what investments in technology that we want to make as an organization to enable us to grow more rapidly, plus how to improve our client satisfaction as we’re going. I really believe that that’s one of the key benchmarks for your success going forward. We have a 98% retention rate right now of our clients, but we want to improve client satisfaction even more and move forward.

Sometimes people overlook that private equity companies don’t provide just ownership, but also certain expertise and focus. What does NEP bring to the table?

Norwest has a very good research staff. We’re working on a strategic plan about adjacent markets we might want to move into. The data I need to make those decisions is available to me through them. They have a team that will work with me.

NEP will provide an executive member of my board who is an investor with Norwest and has been the CEO and chairman of a software firm that’s at $300-400 million a year in revenue. We have that expertise to bounce ideas off of and to work moving SIS even further.

The book The Ultimate Question talks about good profits and bad profits. Bad profits are ones that cause you to have lower client satisfaction. You need to run your company off of what’s called a Net Promoter Score, which is what percentage of your clients would say that they would recommend you to their best friend. You establish a Net Promoter Score goal of where you are and where you want to get to.

That’s one of the methodologies that NEP has used in several of their companies. We’re in the process of adopting it here. It requires to survey every one of your clients — not just paper surveys, but to physically calling them — and finding out what their satisfaction levels are and what you can do to improve.

We were doing our annual surveys with our clients, but we weren’t trying to develop a benchmark that we could say, “I’m improving every year.” I would just have a higher percentage of satisfied clients versus unsatisfied clients. Now we have a benchmark that will measure the whole company in improving client satisfaction.

When you look at your client base, what would you say are their most pressing issues in the OR/perioperative-type areas?

One is an ongoing shortage of staff. As you look at the increased volume that we’re getting in the surgery marketplace, there are fewer surgeons and nurses available to handle that volume.

The other is the reduction in reimbursement and the change in reimbursement rates. They need to be more efficient as an organization. You’ve got volumes going up and reimbursement going down, and then a shortage of labor.

There is a substantial market opportunity in anesthesia documentation, right?

Absolutely. From market reports and our own anesthesia advisory board where we have 11 independent anesthesiologists, we believe there’s only between 13% and 15% market penetration right now in anesthesia information systems. 

If you look at the pending Stage 2 of Meaningful Use, I don’t see how you can operate a hospital without having an anesthesia information system in place. You you need to track when you intubated the patient, what drugs you gave, what reactions you had to drugs, and be able to report that back in a digital format. I think that’s going to drive anesthesia adoption tremendously.

Would you say Meaningful Use has affected your business positively?

I’ll tell you truthfully, it’s been neutral in the mid term because everybody’s working on getting CPOE in place. That seems to be the highest priority for hitting Stage 1, which didn’t have a lot of things impacting the OR department.

But if you look at what’s coming in Stage 2, there’s a lot more specific items that will cause the uplift that’s going on in surgery and in anesthesia. The Continuity of Care Document, the CCD, is going to make our job a lot easier to integrate with all the HIS players in the marketplace.

You mentioned your two competitors with a single perioperative and anesthesia database. Both offer an entire hospital information systems, while SIS is a best-of-breed provider. What’s your take on integration and interoperability?

I think it’s extremely important. You can’t survive as a best-of-breed player unless you’re also the best in interoperability. That’s why three years ago we joined IHE at the highest levels. We’ve been demonstrating our ability to do discrete level transfers of data back and forth.

As a matter of fact, this year at the interoperability workshop at HIMSS, you’ll be seeing us pass discrete data back and forth between most of the major players, including Epic. We’ve been pleased to see that they’re having that open of an attitude. Epic wins a lot of deals in being the total solution for everything, but at the same time on the technical end, they’re actively participating in IHE. I think they see that it will not be a world that they’ll own 100% of every hospital they’re in.

You mentioned that you’ll have access to research to look at adjacent markets and other opportunities. Where do you see the future opportunities?

We’re going to stay laser-focused on the perioperative arena, but there are things right next to it. Like should we build out software that will aid cardiologists in particular, or aid organ transplants? I want to be the absolute expert in everything to do with surgery. 

We have had people ask us about moving our work flow product. KLAS tracks us in three areas; in our surgery product, in our anesthesia product, and in our work flow product, SIS Com. They’re all on the same database and all developed by us, but the SIS Com product can plug on top of anyone’s perioperative solution.

We’ve had people ask us about putting that on other vendor’s platforms and also taking that to other departments of the hospital. We’re looking at taking our product that’s based in the hospital, in the OR, and taking it more broadly across the hospital.

And then of course the whole anesthesia product line — moving into pain clinics, moving into mobile devices so that we can provide local anesthesia in what are not traditional locations.

Any final thoughts?

SIS is focused on the hospital OR. Quoting the CFO of one of my good clients, “The OR is the nuclear power plant of the hospital. If it’s going well, it provides all the electricity you need to make everything run smoothly throughout the rest of the hospital. But, if it blows up, you can’t run your hospital.”

We view the OR as the engine of the hospital. It’s also the area where you have the highest safety hazards. We look at improving the safety and improving the efficiency, and thus the profitability of our hospitals.

It’s been real interesting. In the last four years, we’ve added 53 new hospitals here in the United States. The #1 area we’ve grown in is an existing SIS hospital acquiring another hospital and putting SIS into that hospital. I really think that we impact the financial and performance and the quality of care delivered in a manner that’s helping our SIS-based hospitals grow in the marketplace, and us growing with them.

News 2/18/11

From Klinger: “Re: HIMSS. Here’s a link to a HIMSS presentation (PDF) on its policy priorities for 2011.” It says only around 20% of hospitals are at or above Stage 4 in the seven-stage EMR Adoption Model. There’s more stuff on policy that didn’t really interest me too much.

From Allscripts Person: “Re: your ONC poll. This explains the biased results.” Apparently someone from Allscripts sent an e-mail to all employees urging them to vote for Stephanie Reel. From the e-mail included, “To show our support for her, we want you to visit the HIStalk Blog and vote for Stephanie Reel … She is currently in the lead – let’s make make sure she wins!” She’s got 62% of the vote so far. I think she would do a fine job just like she’s done at Hopkins, although all of the ONC-heads so far have been physicians and she isn’t one. She would be good at establishing consensus since she’s responsible for IT throughout Hopkins, not just Johns Hopkins Medicine.

From WildcatWell: “Re: Apple. Does not want to get anywhere near the liability threshold of having the iPad as the hardware interface of choice for true EMR/CPOE encounter usage.”

The VA and DoD are closing in on agreement to use a single electronic medical records platform, according to VA CIO Roger Baker as quoted by the excellent NextGov. The article quotes a source as saying the winner will probably be the VA’s VistA, with the loser being DoD’s AHLTA. That’s a huge decision and a likely windfall for the usual contractors who will have to tweak whichever system wins to appease the pouting loser. The chair of the committee says the departments spent a combined $10 billion to create the two systems, which I’d bet is a low number intended to hide the real cost (especially of AHLTA, which is surely one of the biggest HIT boondoggles in history).

IBM, Nuance, and the University of Maryland School of Medicine are working to turn the Jeopardy-playing IBM Watson computer into a physician’s assistant, analyzing real-time information against the literature and making suggestions. They’re hoping the computer can make sense of the hodgepodge of scanned and discrete data and make it all searchable.

Parrish Medical Center (FL) chooses McKesson’s Horizon Clinicals, HERM, ambulatory EMR, and RelayHealth solutions.

Let’s have a word about our benevolent and fun HIStalkapalooza sponsor, Medicomp Systems. They’ll be talking at HIMSS about Quippe, their just-announced Web-enabled, browser-based, interoperable EMR tool that gives physicians a touch screen interface backed by the MEDCIN Engine for handling the codes needed for compliance and reimbursement. Check out the video above of it running on an iPad and stop by Medicomp’s booth (#2231, I believe) to check it out, meet the party architects, and maybe see some video shot at HIStalkapalooza running from Tuesday on (you never know what people will do after a few IngaTinis). We have quite a few practicing physicians coming to HIStalkapalooza and Medicomp will honor them during that event (hint: make sure to show up). That’s Dave Lareau starting off the video – he’ll be your emcee and will oversee the red carpet interviews. I haven’t told anyone but Inga this, but I had a beauty queen sash made for Dave that says, “I Paid For All of This.”

University of Kansas Hospital (with the illogical abbreviation of KUHA) and CSC announce their development of the CareVeillance clinical surveillance tool, which analyzes data from multiple systems to provide alerts and quality metrics.

Dave Miller, executive director of application systems at the University of Chicago Medical Center, tells me that he has accepted the position of Vice Chancellor for Information Technical Services/CIO at the University of Arkansas for Medical Sciences in Little Rock. 

A report suggests that the HITECH gold rush is hurting the PACS, RIS, and CVIS markets as hospitals divert IT budgets to fund EHRs. It predicts that vendors of those systems will have to discount as they fight a share of a smaller total market, at least through 2013.

On the HIStalk Job Board: Project Manager – Healthcare Implementation, Implementation Consultant, Healthcare Informatics Analyst. On Healthcare IT Jobs: RN Clinical Informatics Transformation, Director Implementations EHR/PM, VP Business Development, Meditech PCM Implementation Analyst.

Ivo, Dana, and the Encore Health Resources crew are famous for throwing relaxing, no-pressure, open-ended social events (“Pub Nights”) at HIMSS, where the game plan is basically: (a) anyone who feels like it just shows up and eats and drinks for as long as they want to hang around, and (b) Ivo pays. Our pal Amy says you are all invited, every night at 9:00 from Saturday through Wednesday except Monday, at the bar at Tommy Bahama’s. It’s right up the street from the convention center and hotels at Pointe Orlando, the same complex as BB King’s (swanky in a tropical way). Encore isn’t exhibiting at HIMSS, but I’m sure they wouldn’t mind talking shop with prospects, old friends, and potential consultants about their offerings (IT planning, EHR implementation and optimization, analytics, and project management). I’m planning to be there at least one night.

More HIMSS fun: if you’re staying in a hotel on or near International Drive north of the convention center, be on the lookout Monday and Tuesday morning for a limo with my smoking doc logo on both sides. It will be cruising the circuit between the convention center and Sand Lake Road, offering rides to the convention center to anyone who flags it down. I thought that would be a nice gesture to the folks staying in the less expensive hotels up the street who don’t have the luxury of the short stroll over from the Rosen or Peabody (not to mention that it’s good HIStalk PR to have the logo riding around in plain sight). Take advantage of it so I’ll feel like I got my money’s worth. I’m not sure of the color, but it’s a 10-passenger stretch and I doubt there will be many of those on I-Drive early in the morning.

Merge Healthcare announces Q4 numbers: revenue up 139%, EPS $0.10 vs. –$0.03. I interviewed new CEO Jeff Surges a couple of weeks ago.

Welcome to new HIStalk Gold Sponsor CCT Solutions, Ltd. of New York, NY (and London). This is an interesting business: the company provides software training for big clinical system rollouts like CPOE, clin doc, bar coding, etc. They can provide a large number of instructors plus 24×7 on-site go-live support, which hospitals are rarely staffed up to effectively do themselves. They’ve handled some impressive volumes, training 16,000 employees of Continuum Health Partners and proving up to 500 support staff. Some of their other clients include Beth Israel Medical Center, Broward Health, and Albert Einstein Health Network. They’ll be at HIMSS and would be happy to chat. Thanks to CCT Solutions for supporting HIStalk.

I got an e-mail from Grady Memorial Hospital (GA) SVP/CIO Deborah Cancilla, asking for a “retraction of the information posted” in my mention that the hospital was laying off EMR contractors to address a budget shortfall. I replied that I really couldn’t retract anything since all I did was link to AJC, which quoted CEO Michael Young directly (“Part of the staffing cuts will likely include temporary and contract workers who were brought in to set up the hospital’s new electronic medical record system, Young said”) but I would update my post with whichever of the three possibilities she would verify as the problem: (a) the paper misquoted Mr. Young; (b) Grady changed their mind on the “likely” cuts; or (c) Mr. Young’s statement was incorrect. Michael Young e-mailed me that he misspoke – the cuts won’t affect the contract workers. Deborah also wanted to clarify that the $40 million cost for Epic is the five-year budget. I appreciate the updates.

Thanks to new HIStalk Platinum Sponsor InSite One, now a Dell company. InSite One focuses on cloud-based digital medical data management solutions: data archiving, disaster recovery, and digital health data exchange. The company’s cloud-based, intelligent vendor-neutral archive and its disaster recovery services are offered from within Dell’s Unified Clinical Archive solution, which allows clinicians to share patient information regardless of the PACS, modality, or application that created it. I interviewed Mitchell Goldburgh, who talked about infrastructure simplification, the company’s one-time fee per image that allows customers to stay current on technology without spending capital or managing infrastructure, and the 3.6 billion objects and 54 million studies they are managing in a single archive. I learned a lot from that interview. Thanks to InSite One for supporting HIStalk.

Telemedicine systems vendor New Mexico Software will offer second opinion teleradiology services directly to consumer, charging the customer’s credit card to have one of its remote radiologists review their digital images.

FDA relaxes its pre-market review standards for low-risk medical devices, such as hardware that stores glucose meter readings or that sends lab results to nursing stations.

I’m not sure whether I’ll do a Sunday update from Orlando as a substitute for the Monday Morning Update. I’m sure I’ll run something, provided my hotel’s Internet connectivity is better than the last HIMSS in Orlando, where I had to sit around with the convention center cleaning people until late to latch onto the free WiFi to write HIStalk once it became clear that my hotel’s connectivity was worthless. Safe travels to everyone. If you’re staying home and your bosses are allegedly working hard at HIMSS, feel free to goof off next week. We’ll have lots of updates from Inga, Dr. Jayne, Dr. Gregg, and me.

E-mail me.

HERtalk by Inga

From Henrietta Winston: “Re: HIStalkapalooza. Tell Inga my most special shoes are placed out by my suitcase – ready to be packed. Unfortunately, my footwear is not as snazzy as as hers ): but I will wear jewelry that will make her claws come out!” Thanks for sending Mr. H this warning so he can hold me back, just in case. I failed to mention this before, but bling is absolutely encouraged to finish off your outfit Monday night!

Another day, another data breach. Charleston Area Medical Center warns of a “security incident” affecting 3,655 patients. Apparently a hospital-generated spreadsheet containing names, birth dates, addresses, and Social Security numbers popped up when a patient’s brother-in-law was searching for her address. The hospital says the data was viewable for four months and the site was viewed 94 times before it was shut down. Most hits came from authorized personnel, but one came from India, another from Germany, and a third from a private proxy service designed to anonymously download information from a Web site.

Strong Q4 numbers from athenahealth: revenues of $69.4 million compared to $54.4 last year, an increase of 27%. GAAP net income for the quarter was $7.3 million ($.21/share) and non-GAAP adjusted net income was $98.8 million ($.28/share). Analysts expected earnings of $.20/share and revenues of $67.60 million. athenahealth also mentions that as of December 31st it had 3,348 active providers using athenaClinicals, including 2,383 physicians, compared to 1,471 providers and 920 physicians at the end of 2009.

No surprise here:  achieving Meaningful Use is the top budget priority this year for 75% of hospitals. Over half say physician adoption of EMRs is the biggest obstacle for achieving that goal. The same Imprivata survey found that physicians are using more mobile devices and about half of hospitals either use or plan to deploy virtual desktop infrastructure.

HITArkansas narrows its list of supported EHR vendors to 12 finalists, including Allscripts, eClinicalWorks, e-MDs, Ingenix, McKesson, and Sage. The REC is now working with the vendors to establish pre-negotiated and vetted contracts based on a negotiated base price.

Two thousand clinicians and staff at Genesis Healthcare (OH) are using BIO-key fingerprint biometrics to establish identity in Genesis’s Epic software for meds administration. Genesis will also deploy fingerprint biometric user logon with Vergence, the SSO solution from Sentillion.

Intermountain Healthcare (UT) opens its Homer Warner Center for Informatics Research, which is dedicated to optimizing the use of information in health and biomedicine. The center employs about 60 people, but Intermountain CIO Marc Probst says they could add a couple hundred more over the next decade.

As others have  mentioned, my inbox is overflowing with pre-HIMSS press releases. I’ve said this before, but it bears repeating: your company needs to work on its marketing pitch if takes a reasonably smart person (like me) multiple reads to figure out what exactly the company is trying to sell. KISS, as it were.

Ingenious Med introduces an iPhone/iTouch/iPad app that gives users access to the Ingenious Med charge and data capture platform.

I believe this would qualify for a bad day at the office. An ER patient uses a doctor’s stethoscope in an attempt to strangle his doctor. Apparently the patient became combative during his exam, and when the doctor tried to use the stethoscope, the patient attempted to wrap it around the doctor’s neck. Felony assault charges are pending.

I spent about an hour today attempting to map out my HIMSS game plan. I am sure that I am overly ambitious and I’ll run out of time and energy long before I’ve seen it all. I’m wondering if I will really make that 7:00 a.m. breakfast (what was I thinking?) and even an 8:30 start time Tuesday sounds torturous (post-HIStalkapalooza and all). Then there are the 900+ exhibitors to check out. And of course I’ll need to make time for a few HIStalk updates so readers at home can live vicariously through my adventures. I’m exhausted just contemplating it all.

By the way, I downloaded HIMSS11 mobile app for my iPhone and it’s pretty handy. The best part is the ability to search for the room number of individual sessions as well as exhibitor booth numbers. Far better than carrying a paper schedule – or asking for help.

See you in Orlando!

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Mediserve client Burke Rehabilitation Hospital (NY) becomes the first post-acute care hospital in the country to achieve HIMSS Stage 6 certification.
• MedCentral Health System (OH) selects MobileMD to provide health information exchange to its medical community using the 4DX HIE product.
• McKesson awards Peninsula Regional Medical Center (MD) its 2011 Distinguished Achievement Award for Clinical Excellence based on its use of Horizon Clinicals to drive improvements in care. Peninsula decreased its sepsis-related mortalities 37% since October 2009 and attributes its use of technology and process change for saving 77 lives.
• MEDSEEK announces an 833% growth in sales in 2010. MEDSEEK also introduces ecoSmartTM, a targeted marketing solution with predictive modeling capabilities to customize a patient’s online experience based on user behavior.
• ICA releases a series of white papers offering guidance on health information exchanges, including issues on interoperability, technology, Meaningful Use, and privacy.
• Ashe Memorial Hospital (NC) deploys PatientKeeper CPOE and PatientKeeper Physician Portal. The hospital will next implement PatientKeeper NoteWriter.
• Beth Israel Deaconess Physician Organization contracts with Ingenix for its Impact Suite of software. The Impact solution will provide analytics to measure clinical performance and reduce variations in care.
• Picis announces its Perioperative and Critical Care solutions version 8.3, which includes automated medication interaction checks, a content library, and a quality reporting portal.
• InSite One completes integration testing at the IHE North American Connectathon and the InDex technology passed testing for conformance to the IHE technical frameworks. You can experience more of InSite One’s technology at the HIMSS Interoperability showcase.
• Enovate announces its e900 series of wall arms that allow clinicians to maintain eye contact with patients while working on the keyboard.
• New Brunswick’s Stan Cassidy Centre chooses Orion Health Patient Portal.
• EDIMS says it experienced a successful 2010, which included  a sale to Saint Barnabas Health Care Systems, New Jersey’s largest healthcare system. EDIMS also signed a unique agreement with Clara Maass Medical  Center (NJ) to provide onsite medical services at Red Bull Arena.
• Greenway Medical collaborates with HP to offer practices EHR solutions running PrimeSUITE 2011 EHR and HP hardware. Also, Greenway client Children’s Clinic of Muskogee (OK) is the first pediatric practice in the country to qualify for Meaningful Use funds. The clinic’s four providers are set to receive an $85,000 check, which will be handed out at the HIMSS conference.
• Orchestrate Healthcare will give away a free Apple MacBook Air at HIMSS. Booth 6151.
• Philips introduces a Philips Recorder for iPhones and iPads, which turns the device into a wireless dictation dictation recorder and works with the SpeechExec Enterprise suite.
• Shared Health and Health Language partner to use HLI’s Language Engine in Shared Health’s web-based applications and products. In case you missed it, Mr. H interviewed George Schwend of Health Language here.
• UNC Hospitals chooses Carefx’s Fusionfx Physician Insight Plus performance improvement dashboards.
• John Muir Health (JMH) and MuirLab contract for AT&T’s HIE solution, Healthcare Community Online.
• Speaking of AT&T, its partnership with Vitality to make Vitality Glowcaps (mentioned in a previous HIStalk) wins the 2011 Global Mobile Award.
• AHA Solutions announces an alliance with HIT research and advisory firm CapSite, which offers hospital executives due diligence and RFP information from hundreds of vendors.

EPtalk by Dr. Jayne

The pre-HIMSS mailings have finally tapered off, but I did receive two fairly funny “personalized” emails this week. The first was from a vendor whom I’ve repeatedly told that I am not interested in meeting with, addressed to me but sent to my brand new administrative assistant, who dutifully replied on my behalf, not realizing this was bulk mail and that if they really had a relationship with me and had left me a voice mail as they stated in the e-mail, that they wouldn’t now be spamming her.

The second one was from a voice recognition vendor with minimal proofreading skills, apparently missing the fact that EHR had been changed to HER before bulking it out. I hope their product has better translation abilities, but we shall see.

The first reader has responded to my challenge to create a funny Xtranormal clip about implementing technology in the healthcare realm. Love it!

Friday is the last day for the RelayHealth Facebook contest. I’m delighted to see wine and chocolates making the list, as my Valentine’s Day was a little lacking in both and I’m looking forward to making it up. RelayHealth published pictures of the gift bags for participants on their site – tres cute – so vote for your favorites (although they didn’t post my shameless attempt at entering myself, I’ll be sending an anonymous helper to try to score a gift bag, so be on the lookout). If you’re stumped for something to suggest, drop me an e-mail.

I’m off to pack my suitcase and wondering if I can meet the fashion bar that Inga has certainly raised, but wanted to share some recent reader questions before I head to warmer climates:

Dear Dr. Jayne,

What’s up with all these CMIOs who haven’t seen a patient in years, walking around in white coats with stethoscopes for necklaces? Just curious.

Dean

Dear Dean,

This just may be one of the greatest mysteries in health care. One thought is that these physicians are locked in an internal struggle between losing their clinical identity and realizing that they have become far too fluent in Administralian. Maybe this is their way of subconsciously saying, “Hey, don’t forget me, I really still am one of you!” I can sympathize with them when they have to walk through the hospital and see their colleagues on rounds being “real” doctors, although that doesn’t justify the behavior.

Unfortunately, this condition has another insidious manifestation. This is where doctors insist on wearing the white coat out of the clinical office for no reason whatsoever. I can understand if you have an administrative meeting and have to run from rounding or seeing patients to another on-campus building, but that doesn’t explain why one of my colleagues insists on wearing the white coat to administrative meetings at our building, which is a six-mile drive from the nearest patient care facility.

Personally, I think it’s just a bit pretentious. And kind of gross — let’s carry all the germs from the clinical space into the administrative space. (Although, I guess that’s a good cautionary tale for my staffers who don’t want to get a flu vaccine because they don’t work in direct patient care – reminding them that they have to work with these chaps when they visit the IT shop).

I think the worst version of this condition is shown in those poor souls who wear scrubs (complete with surgical shoe covers) outside the hospital. Really, you couldn’t take two seconds to take the booties off? Or you’re willing to bring the contamination of the outside world back into the operating theater? Is it really that critical to let the world know you work in an operating room?

If any of my other CMIO readers have theories, I’d love to hear them.

Dr. Jayne

Dear Dr. Jayne,

Thanks for your comments on doctors using the computer in the exam room. My doctor has been using a computer for years. It is attached to a wall mount right inside the exam room door. He stands up to type on it while he is talking to me. He looks at me, answers questions, then looks down to look over the record or type in information. Why is this so foreign to people? We work every day with people who are putting information into computers, from airlines to the pharmacy. I’m glad he can look to see how I’ve improved my weight, HDL, etc. over the years without bringing in a five-inch paper record (which they never did before anyway, just why you were there today).

Betsy

Dear Betsy,

Thanks for your note. I agree with you, but it still seems to be a big deal for some people. I always enjoy when patients tell me they’re glad that we have the computer or comment on a way it’s made a difference in their health care. I think it makes it more real to be able to show patients graphs of their blood pressure, weight, lab results, etc. I’ve also used it to launch videos on patient care sites to teach patients how to do certain exercises I’m recommending, or to research bits of info patients say they saw on a Web site.

It’s funny how accepting this has evolved over time. When I started my first “paperless practice,” our health system newsletter ran an article about the transition and what made us different. The CMO of my hospital made a big deal of editing out the comment where I said I used the Internet to research health concerns while in the room with the patient. He thought it made me sound like I didn’t have all the answers and that patients wouldn’t trust a doctor that had to look things up.

Fast forward a decade and now we have savvy, empowered patients that understand that we can’t know everything and expect us to not only be using the technology to find the most up to date information, but pushing it out to them via secure portals.

Dr. Jayne

Have a question about medical informatics, electronic medical records, or whether doctors would want their kids going to med school? E-mail Dr. Jayne.

HIStalk Interviews Jeff Kao, GM, NCR Healthcare

Jeffrey Kao is general manager of NCR Healthcare.

Tell me about yourself and about NCR Healthcare.

I’ve been in the healthcare IT world for quite a while. My career started in 1989. I was an executive inside with GE, went to IDX, and then transferred back to GE with the GE acquisition of IDX. My last assignment was with Hill-Rom, also in the healthcare information and nurse call communication.

NCR is best known as National Cash Register, but in the past 25-30 years, we’ve been best known as a self-service company. We want to empower our customers and patients and everybody associated with helping service the industry, whether it be in ATM, travel, or gaming. 

With all the transactions and all the need inside of healthcare, we’re becoming a bigger and bigger participant inside of healthcare. We’re eager to participate in the category and really empower the patients associated with servicing themselves in a very complex network that’s in need of revamping and modernization.

Most high-volume businesses like airlines, banks, and big box stores have an impressive array of customer-facing self-service technologies. How do hospitals and medical practices stack up and where do you think they’re going to go with it?

We are leading the technology frontier in many categories, but falling behind in others. Healthcare informatics is one of the particular cases. If you think about a high-volume transaction basis in any industry, I can’t think of any other where you can’t schedule an appointment online with physicians to speak of. You can do that in terms of servicing your car at Jiffy Lube today.

We’re still an industry that’s very antiquated and backward in terms of how we communicate with our customer or patients. Very little secure messaging occurs over the network. I can’t think of any other industry in which e-mail, SMS, and text messaging hasn’t transformed in terms of our transactions dealing with anybody. We are an industry dominated in terms of forms, informatics, and payers and all kinds of bureaucracies in which we are still dealing primarily with paper, imaging systems, and document management systems. 

By the nearest estimate — without even prescription drugs and so forth – with provider and hospital dealings every single day, there’s two billion transactions happening in a given year, but very few of them are automated and happen on a consistent basis in which we empower the consumer where the patients actually having to deal with the category of self-service. It’s all still very intensive. That’s why I think we’re prime in terms of automating the space with our expertise in other industries that we can bring some of these practices into healthcare.

You worked at IDX and GE. Do you think traditional vendors are focused on customer self-service or is it going to take a company like NCR to add that on?

It requires a complement of companies working together. In IDX, we were obviously big in terms of the provider space, automated provider workflows. But if you think about it, we really started with the healthcare informatics first. We started with the big customers first. We really didn’t take a perspective associated with what the consumer actually needs.

For example, I’ve relocated to Duluth, Georgia. Like in any relocation, our employees were looking for primary care providers, looking to embed ourselves, ingrain ourselves, and get the kids registered for schools. It was hard finding a primary care provider. It was hard to navigate through the system, We waited in line for six hours to basically get shot records updated for our kids. I think those are the kinds of things that have a predominant role for self-service.

It’s amazing. We moved our headquarters from Dayton, Ohio to Duluth, Georgia. We brought over about a thousand covered lives associated with our entity. Over and over again, the experience associated with providers is they offer little or no tools in terms of registering ourselves, in terms of understanding who our payers are, in terms of being able to register for appointments.

We provide a preventive care benefit to all of our employees, meaning physicals and so forth, are 100% paid for by employees. Yet overall, if you look at our employee experience, not a single provider has ever contacted us to go in and get a physical. With all the electronic medical record adoption, with all of the investments in healthcare IT, something as simple as contacting one of our employees, one of the kids, or one of our spouses to come in for an annual physical doesn’t occur on a regular basis. 

This is a primary role for us in, terms of providing self-service. At eight o’clock at night when I’m clearing my e-mail messages, a reminder that says, “Hey, you’re 40 years old, you really need to come in for a check-up. By the way, click on this link. Go in there and register yourself, provide the necessary demographic information, update your present patient history, and come on in, because I think the care of you and your family is important.”

I think something as simple as that doesn’t exist in our industry or any of the patient populations today. This is what we really need to transform, especially with the advent of healthcare reform and changes. Empowering the consumer to handle the most mundane transactions that we have to do every single day. That’s why we’re so excited about this category.

In most industries, there would be two reasons to use customer-facing technology. One would be for general efficiency, the other would be to give customers what they want. What do you see that healthcare customers want to be able to use that they typically can’t?

I think there are always three things. One is that you’ve got to deliver a service that your customers or your patients want. We all carry computers, we all carry tablets, we all carry smart phones and mobile devices. We want to interact for all the services that we do. Today it’s really naïve to think that any service industry would neglect self-service, whether it be online banking, checking in at an airport, and so forth. I think for the most part, everybody is going to demand technology.

If you think about retail health, take a look at Walgreens. Every Walgreens store offers prescriptions, but they’re going to get into the primary care space and taking care of providers. They’re going to offer online scheduling, they’re going to offer electronic forms, they’re going to offer online check-in. The employee clinics are doing it today at Cisco and so forth. I think consumers are going to drive that demand, first and foremost.

I think the second thing is, with 34 million people coming into the healthcare system, unless we continue with the practice that we have today, we’re going to drive up a huge amount of administrative costs if we don’t adapt a different practice associated with enabling the consumer to self-service themselves to cut the administrative burden. 

Thirdly, I think it’s the central part of the Obama administration in terms of cutting medical errors. What better way to prevent all of the redundant entering and keying in and scanning and documentation and printing and so forth, other than making sure that the person in charge of his own personal information enters it correctly into the system, is adequately documented, adequately categorized, adequately feeding into all the ancillary systems? I think this is where self-service has a primary role in terms of cutting administrative costs, enabling the consumers, and also making sure that it’s more accurate and more up to date, and giving the power back to the patient and providers in terms of time to care for each other.

You mentioned Walgreens. They have a financial interest in interacting in more creative ways with their customers than the average hospital or physician. Do you think that the lack of incentives is the reason that physicians and hospitals have not looked more at engagement-type technologies like Walgreens has?

I think that’s a great question. Engagement technologies …  any time you talk about physicians and hospitals, it’s a little bit different.

I think for the most part that physicians haven’t engaged because there hasn’t been a solution out there that services the way they need to purchase and support the technology. There are 850,000 physicians in the United States. That’s a big number. But primarily, these physicians are still in relatively small, aggregated groups. The last number I’ve seen, they’re still in five doc or less groups. For them to buy their technology the same as a hospital is very challenging. They don’t have a CIO, they don’t have IT space. For the most part, they have found their way onto the Web through some kind of hosting service, but to be able to manage technology the way the big IDNs do is very challenging.

This is where companies like NCR and others need to find a way to support them in their mission for self-service that doesn’t require them to buy millions of dollars of hardware and capital, but rather understands the way they want to practice medicine, the way they want to service their customers, and offer it in a holistic hosted way that doesn’t require them to support all this technology, but supports it for them. In fact, we need to be just more than a technology provider. We need to be a total solution provider.

I think that’s what’s going to enable a 20-doc group to offer a service to their patient population that allows them to self-service, that allows them to smart schedule, that when somebody logs in their system, they’re registering for their five-year old kid or a seven-year-old kid that knows that the patient’s going to prefer a time slot between two-thirty to five o’clock because that’s when they’re out of school. For a person that’s a working professional, they prefer to go in the morning or late at night so they can go before work or after work. For a retired person that has a little bit more schedule flexibility, maybe between the hours of ten and two. For the middle summer when the flu season’s not impacting the patient volume, to draw somebody in for a physical, or two weeks before school starts, to linearize that volume because everybody’s trying to get their physicals to participate in school sports or get their shot records updated so they can participate.

I think the systems are there. The logic is there. Those patterns exist inside the healthcare system, but we don’t provide the providers assistance to systematically manage the way their patients want to be treated. We know there are bottlenecks inside the healthcare system. The week before school starts, the pediatric offices are full because everybody’s trying to get their shot records and physicals done. There’s a way of linearizing that volume. In middle of summer, nobody has the flu — it’s the perfect time to run people through physicals and preventive care. But right now, it’s a lousy time. We’re in the height of the flu season. There are patterns associated with what we can do to help the physician practice associated with participating in self-service that will benefit the patient as well as enable provider their business practices.

When you talk to a hospital about self-service, they probably most often picture the kiosk, which I know you offer. If you look down the road and where kiosks are and where they might ultimately move to, where do you see that developing?

In terms of the hospital segment, the kiosk is an equally important participant, but that’s not the only technology. It has to be a hybrid of three technologies — the portal, the kiosk, and the mobile environment. Here’s why.
Think about our complex setting. I have a friend with breast cancer. If you think about what needs to go through the transaction, many of the forms and the preparation and so forth really need to happen in the comforts of our own homes, associated with basically entering the form, maybe the prep associated with the visit, preparation in terms of somebody to take you there and take you home from the hospital in an ambulatory visit. If you think about it, the visit really happens in terms of the preparation in terms of self-service, making sure of the insurance and demographics and so forth, because it’s a traumatic time already.

Once you update all the things that you can do online, what needs to happen associated with the kiosk is you need to know what happened on the Web so that the same experience continues when you go on the site. When you think about an oncology visit for a typical patient, the first visit may be checking in, just making sure that the hospital or the IDN knows that you are there, followed by a management of your visit for the whole day. It may be a visit to the lab to make sure they draw blood and do a white blood count. After that, you may have to wait for the results.

Depending on the result, then your workflow gets changed. It may be going to imaging, or it may be going to chemotherapy. After that, observation, and finally released to make sure that you are properly cared for and arrive home safely with somebody driving you home.

If you think about that experience as a holistic portal, the in-presence visit management experience requires not just one technology worth thinking about in terms of kiosks, but really managing expectation on the portal, managing forms and so forth so that you can streamline your visit, using the kiosk to basically take you from place to place making sure that your visit happens in a consistent, coherent way and you don’t bypass any of the procedures because the handoffs are very complex in healthcare. And then, finally the discharge and the scheduling of the next visit. 

Along the way, smart alerts can remind you where you need to be and what you need to do, because most of us walk around with a cell phone. I think that’s what our customer service, our self-service experience, inside the hospitals and physician offices, need to be. Many procedures are now outpatient, but the visits in a complex IDN setting are many-modal, many departments, highly complex. All these systems need to be tied together in terms of giving you a holistic view and holistic experience.

What you get in one setting, in one department, you need to carry forward to the next one. It makes no sense for you to do four stops and update your patient records, your demographics, your insurance, and your insurance cards, and everything else four times. That’s the waste inside of our systems and leads to a less than satisfactory and costly experience in terms of what the IDN or hospital or physician actually knows what’s going on with you.

When you look at the Meaningful Use emphasis on use of technology by providers, do you think that will create opportunities to push technology out to patients?

I definitely think so. If you can think about Meaningful Use, a major portion of it is updating the patient associated with the right information. I think EMRs and the traditional hospital information systems offer the foundation in making sure that all the information is electronically stored and compiled in a meaningful way.

But what Meaningful Use sometimes overlooks is that all the information is stored on a server somewhere. How do you intend to interact with your patients to provide the information meaningful to your patients? It does you no good to have the demographic information as well as the results on the computer. Moreover, you have to advise the patients. I think all the Meaningful Use criteria I have seen require a portal or some kind of informatics that gets back to the patient.

I think this is where we have an important role to play. Centered on our self-service strategy at NCR, it is really not how the information is stored or what information or technology the hospital or the physician has, but how do we enable the interaction between the information to the patient so we can empower the patient to have the right information? Allow them to enter the information. Have them manage their own visit. Have them manage their own care in a meaningful way with the technology that’s already embedded in the system.

I think that’s a little bit of a twist in terms of what we’re doing, but we intend to be a very strong participant in making all this electronic medical record and all this electronic data exchange meaningful to the patient.

Any final thoughts?

The moment is ripe in terms of a change in the way that medicine is practiced. I know many people talked about it in the past, but I consider self-service this way. It’s like making soup. We have 34 million people coming into the system, probably driving on the order half a billion additional transactions into the system, with probably declining reimbursement rates. The pressure associated with it is we’ve got to get better, more accurate, faster, and cheaper with how we care for this volume.

If you look at the industry over and over again, whatever segment we’ve looked into, people have gravitated to a self-service model to enable the consumer or the patient to do more, to have more accurate information. Over and over again, what industries have done is gone to the Web, gone to kiosks, and gone to mobile devices.

I think the moment is right for us, over the course of the next three years, to experience something that’s revolutionary in US healthcare associated with Meaningful Use, with adoption of self-service technology, whether it be portal, mobile, or in-presence with a kiosk. I don’t think there’s going to be one winner inside of these three technologies, but it’s going to be a combination of these technologies all working in a coherent way, reaching all the technology on one single platform that allows a unique patient experience. I think this is why it’s so exciting being inside self-service, inside healthcare IT right now. I think the moment is right for that tip.

HIStalk Interviews Janet Dillione and Jon Lindekugel

Janet Dillione is executive vice president and general manager of the healthcare division of Nuance. Jon Lindekugel is president of 3M Health Information Systems.

Nuance and 3M Health Information Systems announced this morning a broad, strategic partnership to deliver ICD-10-ready clinical documentation and coding solutions, starting with Computer-Assisted Physician Documentation, which combines Nuance’s speech recognition technology with 3M’s Clinical Documentation Improvement content.

CAPD allows physicians to dictate encounters in their own words while prompting them for any additional information needed for proper ICD-9 and ICD-10 coding, enabling clinical documentation improvement a the point of dictation. It was designed to accelerate the implementation of ICD-10.

I interviewed Janet Dillione and Jon Lindekugel Tuesday afternoon before the announcement.

Tell me what the announcement means in simple terms.

Janet: Nuance and 3M have decided to partner to go after very deep innovations around clinical documentation, specifically targeted at the physician. Both companies saw the same thing happening with the coming of ICD-10. We had similar ideas of how to blend the strengths of both companies together. We viewed each other’s strengths as very complimentary and several months ago, initiated conversations.

We think with our Computer-Assisted Physician Documentation, we are able to bring an incredible piece of innovation and a really time-saving, ground-breaking change to physicians and the way they will document with ICD-10.

Jon: The partnership combines 3M’s core strengths in coding and Clinical Documentation Improvement with Nuance’s advanced speech recognition and Clinical Language Understanding technology. With the combination, we think we’ll be able to make a step change in helping physicians capture accurate documentation, especially with the coming ICD-10 transition, and do so in a way that will leave the physician more time for patient care. And in the process, help facilities achieve full and appropriate reimbursement, accurate quality reporting, and ultimately, successfully make the transition to ICD-10.

In a nutshell, we’re taking 3M’s industry-leading Clinical Documentation Improvement approach, which a lot of hospitals rely on today in their HIM and documentation improvement departments, and applying all the technology that Nuance brings and its industry-leading technology to deliver that content to the point of care, to the physician.

Describe how Computer-Assisted Physician Documentation works and how it looks to the physician as they’re dictating.

Janet: If you’re a physician in your classic workflow, you can be using Dragon. We have several hundred thousand physicians using Dragon. Physicians like the dictation technical workflow. You’ll be dictating through Dragon and will be able to take both unstructured data from the narrative, apply Clinical Language Understanding to it, as well as bring in any data that may have come in through a template that’s up in that EHR. We will grab that data and pass it into the 3M CDIS clinical knowledge environment, where we will have an environment with Clinical Language Understanding.

Essentially, we will be able to send back out of that engine to the physician, “Did you mean CHF unspecified, or did you mean an acute MI? Did you mean this, or did you intend to say something else?” Really trying to replace what happens today, with manual follow-up, where the next day, hours later, or even post-discharge there’s a lot of manual intervention going on with these charts and people poring through the narrative as well as what’s coming through the templates to try to get accurate documentation, both for the patient quality and the reporting that’s required as well as reimbursement. They’ll be able to automate that entire work flow and do it at the moment that physician is there inside that work flow.

Jon: We believe we’ll be able to drive physician-sensitive prompts, a limited set of prompts, directly to the physician to improve the accuracy of documentation right at the point that documentation is occurring.

Is your sense that there will be an overall time savings for the physician compared to dictation and then follow-up questions?

Jon: Yes.

Janet: Absolutely. There should be time savings for the physician, not to mention the efficiency and savings for the overall delivery system. We should be able to reduce this manual back-end intervention that’s happening now.

Who’s the ideal prospect?

Janet: Any delivery system that needs to deliver patient care with physicians as ICD-10 is being implemented. I guess that means the US delivery system. [laughs]

Jon: Every hospital in the United States healthcare system will significantly benefit from CAPD, be it their physician community through CMIOs who are interested in automated tools to reduce administrative burden on physicians to the financial community, CFOs concerned about receiving accurate and full reimbursement, reducing compliance risk, and getting cost out of the system. From an IT perspective, CIOs who need to ensure accuracy and completeness of the information flowing through the EHR.

ICD-10 has caused people to seek alternatives to manual physician lookup of codes, especially since there will be so many more of them. How do you think this approach will be accepted by the market compared to lookups or other on-screen prompting?

Janet: I think you’re exactly right. That’s what was interesting as we began to talk to each other. The industry to date had been predominantly focused on the back side, trying to help the coders with a lot of tools, and 3M has some fantastic innovation there.

But when you began to really understand what happens with documentation and how that stuff gets clarified, you really find how many queries and pings and e-mails are hitting the physicians, some of which get answered and some of which don’t. That’s where we thought that we could really bring the efficiency and the real breakthrough. We have had the opportunity to validate this. We have shown a mock-up to some physicians and we’re typically getting an a-ha reaction of, “That’s what we needed.”

Jon: On the very specific topic of customer reaction, we were able to show it to seven customers, large delivery systems, last week. The feedback was unanimously positive and they immediately jump into a detailed design mode because, “This is exactly what we need, and here’s the 15 additional things you need to make this do.” It was pretty exciting to see.

The other thing that gets validated as we review it with customers is that the value of this as a passive ICD-10 training tool, frankly. By deploying this long before the actual October 2013 date, physicians, in effect, are being trained on the level of granularity that their documentation needs to include as we move to ICD-10. As we deploy this as an ICD-10 solution, it’s going to drive that education surrounding what’s needed in documentation, framing it in a passive way that isn’t a classroom lecture. It’s a real, live, on-the-job learning exercise for the physicians that will make the transition much smoother when we get to 2013.

For organizations that haven’t given as much thought to ICD-10 as they should have, what are the opportunities that it brings to them, assuming that CAPD makes it easier to capture the codes accurately and quickly?

Janet: ICD-10, because of the sheer scale of it, is forcing just about everybody to question how they do what they do today. There are estimates of almost a 50% reduction in efficiency on the coding side. That’s stunning. Even if you could afford the budget to increment your staff, there isn’t enough talent in the market.

Folks who have not started to look at it, when we make this announcement, I think it will show them a way to not only start to look where they had typically been looking, but also to really look for process innovation. How can we do things differently here? How can we do things more intelligently? How can we bring more of the intelligence up to the front part of the process?

Jon: On the cost side, we view this is as a direct means of driving training and accurate documentation upfront and we will take some cost out of the ICD-10 transition by deploying the solution upfront. On the other side of it, our computer-assisted coding will now be powered by the Nuance Clinical Language Understanding natural language processing module, which will take cost out of the back end for sure, offsetting some of the increased coding resource requirements surrounding ICD-10.

When we lay all that out, we really hope to offset the increased cost during the transition for the provider networks in a way that enables all of the advanced analytic work longer term that should be able to be done from the much more granular view of medical transactions and the delivery of healthcare.

Any concluding thoughts?

Janet: I think the industry will be a little bit surprised to see these two partners coming together. People will see how quickly this came together and how amazingly aligned the vision was with both companies. Jon and I actually met a matter of months ago and we started to see the synergies between these two companies. The teamwork has been fantastic and I can tell you that the organizations — the R&D folks, people who meet with customers every day — are positively pumped to get this out there and get this in front of the customers. We really think we’ve got something unique here.

Jon: It’s really just taking two great brands in the healthcare IT space that deliver great best-of-breed solutions and combining them in a way that really is going to solve some significant client problems and pain points. We’re just thrilled, both companies. Everybody involved is really excited about the opportunity. We just can’t wait to get the announcement out and get going on it.

News 2/16/11

From Wombat: “Re: Blumenthal replacement at ONC. Stephen L. Ondra, MD is the frontrunner.” Unverified. He’s a veteran, neurosurgeon, and senior policy advisor for health affairs at the VA. I doubt he’s a heavy EMR user, but I guess at ONC level that will always be the case. Maybe that should be a pre-requisite.

From CIO or CPA: “Re: Allscripts. Am I the only one that wonders about the Allscripts balance sheet? Nearly $1.6B out of a total of $2.4B assets is either intangibles or goodwill. There is also $460M of long term debt. This is a total of about 85 % of total assets. This compares to Cerner’s totals at about 21%. Seems like a large hole. What am I missing?”

From WildcatWell: “Re: Verizon Health Information Exchange. May offer its own MU-certified EMR to physicians who subscribe, use Verizon Business, FiOS, whatever. Info could then be pushed right into a doc’s home. Game changer, baby!”

From PureSpam: “Re: McKesson. Not a rumor – big layoff happening now (Tuesday morning).” Nasty Parts sent this on Monday: “Wholesale slaughter of the McKesson sales force on 2/15. Over 450 folks being let go.” Monday’s rumor from Doolittle specifically named McKesson, although I didn’t until I gave the company time to respond to my inquiry (they didn’t). I don’t have firm confirmation, but one insider places the number at 84% of the sales organization, or about 200 people. Supposedly a consulting firm convinced MCK that the client executive role was not worth keeping. I’ll let you know if they provide a statement.

From IKnowPlenty: “Re: vendor parties. Any insight about what they’re doing for entertainment? Keep up the good work – I enjoy every issue.” I haven’t followed the events too closely since I never have time to go. I think I signed up for the Allscripts party on Tuesday evening at Hard Rock Live with the hopes they’ll have name entertainment just in case I have time to attend, but in Orlando you usually end up with white-bread Disney day-jobbers doing an imitation of a band.

Just a brief note on HIStalkapalooza: it’s more than completely full from those who signed up during the designated period, so I can’t add more folks – sorry. I wish everybody could be there, but we just don’t have the room.

Kaiser’s George Halvorson extols the virtues of its new computerized clinical library in his organization-wide e-mail this week. It’s available everywhere to users, is being used 10,000 times per day, and in addition to references, also includes includes best practices, protocols, and links for using Kaiser services.

I feel odd mentioning new HIStalk Platinum Sponsor GE Healthcare since I don’t always have nice things to say about the company and they know their sponsorship won’t change that. Still, I was encouraged (and said so) a few weeks back when they were quick to reply honestly to a rumor I asked them about (true, as it turned out) and I admire them for supporting a somewhat loose cannon. Everybody knows GEHC, so let’s talk about what they’ll show you if you head over to that block-long booth they always have (#2401) at HIMSS: Centricity EMR solutions (Advance for small practices, Practice Solution for mid-sized ones, Centricity EMR for the big boys, and Enterprise for hospitals); eHealth Solutions (HIE, image exchange, and community desktop portal); digital pathology from its UPMC partnership; the Qualibria Clinical Knowledge Platform; and other tools (wireless devices, patient monitors, etc.) You can schedule a demo here (if it were me, I’d check out the HIE and Qualibria products since those are new, I think, and I don’t know a thing about either product) or head over to a theater presentation. Thanks to GE Healthcare for supporting an honest and opinionated HIStalk instead of some fawning publication or site.

Allscripts announces Q4 numbers: revenue up 87%, EPS –$0.03 vs. $0.10. The costs of the Eclipsys acquisition took MDRX into the red; otherwise, it would have beaten estimates at $0.20.

Valley Regional Hospital (NH) chooses the HMS hospital information system.

Orlando Health is partnering with Rothman Healthcare to evaluate the Rothman Index as an admissions patient surveillance tool and to enhance the effectiveness of the health system’s Rapid Response Team. I interviewed Michael Rothman in October and it was one of my better ones, if I do say so myself, because it’s an interesting product they’re creating and they’re doing it for passion, not money.

Quite a few of you filled out my reader survey – thanks. I only run it once a year, so this is your last chance to weigh in. I read every response and try to find time to run with a few of the ideas offered every year.

An ABC News piece covers a project by a former Stanford student to improve healthcare in Africa by setting up a telemedicine network based on text messages sent via discarded cell phones. I mentioned it last June when it was called FrontlineSMS:Medic. The new name is Medic Mobile.

Deborah Peel, MD of Patient Privacy Rights was scheduled to testify Tuesday before the PCAST work group of the HIT Policy Committee and HIT Standards Committee. Her group’s concerns: (a) universal data exchange formats without privacy consideration will make it easy to violate patient privacy; (b) it takes time to build privacy into systems; and (c) de-identification doesn’t really work very well.

University Hospitals (OH) will expand its deployment of the Allscripts EHR and Sunrise Enterprise.

A Boston Globe article covers patient harm caused by alarm fatigue with hospital patient monitors. It mentions a 15-bed unit at Johns Hopkins that averaged 942 critical alarms per day. It also cites a Mass General case in which a patient slowly died while experiencing a fatal heart attach after his cardiac monitor was turned off and staff did not respond to ongoing alarms triggered by his low heart rate. A nurse was quoted: “We have 17 types of alarms that can go off at any time .. It becomes … background.” Studies also found that up to 85% of the alerts are false alarms.

CSC’s big NPfIT contract is in danger of being cancelled over repeated missed implementation dates, some of the go-lives years overdue. NPfIT has gone through many vendors, some of them big, and I don’t know of any that made any money. It probably wouldn’t break CSC’s heart to be shown the door.

Privacy software developed by a Canadian researcher is being tested by two hospitals. It scores the likelihood of being able to identify a particular patient based on their available information and then selectively de-identifies the records as needed. I see by Googling that he’s already formed a company to sell it.

HHS launches the HealthIndicators.gov portal, opening up the HHS health indicators data vault to developers and researchers.

Billionaire Patrick Soon-Shiong makes another healthcare technology investment, this time in UK-based wireless monitoring device vendor Toumaz. The company will start by developing sports sensors, but will then look at wireless healthcare.

A Virginia hospital, hit by Facebook-posted rumors that patients were dying of sepsis contracted there, strikes back by saying “not true” on its own Facebook page. At least it doesn’t cost anything to argue on Facebook.

E-mail me.

HERtalk by Inga

From Fancy Nancy: “Re: HIStalkapalooza attire. I am so excited about the reception coming up and am wondering how formal people are dressing? I need your guidance and wisdom.” Fancy Nancy, I am so glad you asked. I hope that we see lots of velvet and taffeta and strappy high heels. If you can’t decide whether it’s worth it to pack that special outfit, here is something to consider: the two winners of the Inga Loves My Shoes contest will each receive a $100 gift certificate from Zappo’s, courtesy of Mr. H. Then there is the HIStalk King and Queen event for the the best-dressed attendees. These royal winners each take home iPod Touches (not the cheesy 8GB version, but the new 32GB model, complete with Facetime and HD video recording). Here is a hint, if you want to be in the running: don’t be late. We will have a red carpet entrance, and if you really want to strut your stuff, make sure you take a moment for a photo and chat with our red carpet interviewers. The formal presentation part of the evening will begin at 8:00 p.m. and our finalists will be selected by that time. To give you an idea of how high the bar is set for the shoe contest, our esteemed judge sent me the above photo of what will be adorning her feet. Meanwhile, our head judge for HIStalk King and Queen has been cramming to watch all eight seasons’ worth of “What Not to Wear” and to memorize all of Stacey and Clinton’s rules.

From Pretty in Pink: “Re: Winning party attire. Real men wear pink, so I am hoping that someone from my team will have a shot at HIStalk King.”  While we love you pink-pants-wearing guys, we hope you have time to change before heading to BB King’s. Of course, if you show up in a pink tux, our judges will likely make you a finalist.

A big thank you to everyone who shared with me news of other fun evening events during HIMSS.  Some of the hot parties include Cuba Libre for “music , dancing, food, and fun” and a casino night at one of the big hotels. It seems like I also saw something about an event at the Amway Center with appearances by Orlando Magic players, but I can’t find that e-mail. So much for staying in and ordering room service.

Misys Open Source Solutions will leverage technology from Apixio to improve data search and filter capabilities.

Allina Hospitals & Clinics (MN) deploys Mobility XE, a mobile VPN solution from NetMotion Wireless.

2010 was the second worst year in the last 15 for mass hospital layoffs , affecting a total of 10,490 individuals.

Nuance continues to be the “power player” in the speech recognition market, according to a new KLAS report. Nuance’s eScription was the highest rated back-end system, followed by Dolbey Fusion Speech. Nuance’s PowerScribe and RadWhere led the front-end speech segment, followed by MedQuist’s SpeechQ. KLAS says the speech recognition market is ripe for healthy growth, with only one in four hospitals employing the technology.

GE’s philanthropic organization, the GE Foundation, awards $500,000 to two Erie, PA-based community health centers to support increased access to quality healthcare. Meanwhile, GE Healthcare enters into a joint development and marketing agreement with SAS to use SAS Analytics in GE’s Patient Safety Organization to mine data on patient safety adverse or near-miss events.

Siemens Healthcare announces that five healthcare systems have contracted for Soarian systems, including Baptist St. Anthony’s Health System (TX), Peconic Bay Medical Center (NY), Children’s Hospital (LA), Touro Infirmary (LA), and MaineGeneral Health.

Ken Graham, the newly unemployed CEO of El Camino Hospital (CA), will receive almost $1 million in severance pay. El Camino’s board of directors fired Graham last week “without cause.” Nothing like a million bucks to ease the pain.

Did you have a chance to look through Mr. H’s Must See Vendors for HIMSS11? Here are two reasons it’s worth your time: 1) you will be amazed at the variety of products and services that encompass the HIT world; and  2) there are some pretty nifty giveaways. I have printed my PDF version so I know which booths to hit. If you are short on time, here are a few tips, starting with the offerings exclusively for HIStalk readers:

• Vitalize Consulting (3070) – if you connect a “link” on their Chain of Hope, they will donate $5 plus an additional $5 if you say you are a HIStalk reader.
• Virtelligence (2131), MED3OOO (917), Emdeon (2201), and Cumberland Consulting (6943) are each hosting special HIStalk reader-only drawings for iPads.
• Iatric Systems (3601) – (3) $50 iTunes gift cards for readers.
• Enterprise Software Deployment (2777) – special drawing for a Sonos Music System.
• Billian’s HealthDATA/Porter Research (4579) – snack packs to the first 100 HIStalk readers.
• API Healthcare (3463) – HIStalk reader-only drawing for a Dell Inspiron Mini Netbook.

For the HIStalk-exclusive goodies, you pretty much just need to mention you are a reader – no secret handshakes required. While you are touring the exhibit floor, here are a few other recommended stops:

• CareTech (1831) – raffling off a $1,000 donation to a recipient’s hospital foundation.
• Enovate (2738) – iPad giveaway.
• Enterprise Software Deployment (2777) – in addition to the HIStalk-only drawing, they are giving out cozy flip flops and a chance to win a FLIP camcorder.
• HT Systems/PatientSecure (218-10) – if you register to meet with them in advance, you have a chance to win an Android-based tablet PC.
• Keane (1548) – iPad giveaway.
• MEDecision (2563) – Starbucks coffee (!)
• Microsoft (3101) – Microsoft Arc Mouse giveaway.
• NCR (2805) – a singed copy of Paper Kills 2.0 by Next Gingrich to the first 25 people to schedule a booth appointment.
• NextGen (2163) – chances to win a smart phone or iPad. NextGen will also have “splash” artists creating works that will be given away.
• Sage (1713) – sign their Red by Sage Wall of Inspiration to commemorate someone’s life that’s been touched by heart disease, then get a chair massage.
• Wolters Kluwer (6162) – chance to win a trip for four to the US Masters in Augusta.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Design Clinicals now supports integration with GetWellNework, allowing hospital patients to use the in-room TV to request bedside delivery of prescribed meds.
• Clairvia says sales of its Care Value Management software grew 85% during the last six months of 2010.
• MEDecision is launching a mobile application that enables providers to access its Clinical Summaries through smart phones and electronic tablets.
• GetWellNetwork announces a record number of new contracts, upgrades, and expansions with new hospitals.
• The Boston Globe cites Nuance’s Dragon Medical software in an article titled, “Writing exactly what they say.”
• Riverside HealthCare (IL) selects the eClinicalWorks EHR.
• Five CareTech Solutions clients will share their experiences at HIMSS11.
• Colleen Hittle, managing partner at Anson Group, will be a featured panelist at Indiana University’s Life Sciences conference on February 25 in Indianapolis. Shout out to DigitalBeanCounter’s alma mater!
• Imprivata partners with Thales, an information systems security leader, to deliver high level SSO cryptographic security.
• Stan Cassidy Centre for Rehabilitation (SCCR) chooses Orion Health’s Patient Portal to improve communication between patients and providers.
• Access will demonstrate the new version of its electronic forms offering at HIMSS, which includes an iPad version.
• Siemens will conduct on-the-spot interviews of experienced talent  at their HIMSS booth, with a specific interest in candidates for product line management and enterprise services positions.
• Phelps County Regional Medical (MO) will replace its document management system with Perceptive Software’s ImageNow document management, imaging, and workflow solution, integrated with Meditech.

EPtalk by Dr. Jayne

Barely a week left before HIMSS and I’m still having fun opening the mail every day. However, being in a part of the US that’s been having some weather, I don’t envy my mail carrier dealing with the vendor postcard that was mailed in an 8×10 rigid envelope that required it be carried through the proverbial rain, snow, sleet, and hail to my front porch. Yes, you got my attention with that, but you also could have gotten my attention with a smaller mailing, like the new Rapid Rewards update mailing that Southwest Airlines just sent. The size of a standard CD case, it caught my attention and kept my mail carrier warm and dry in his truck.

Lawson also got my attention (but in a positive way) with their tagline “Top Performers Make the Difficult Look Easy” and photographs of the contortionists they’ll be featuring in their booth. Although fascinating, I have a hard time watching acrobats because it brings back memories of Gross Anatomy class and having to memorize the name of every muscle, bone, and tendon.

Reader Bill, a veteran of the healthcare marketing trenches, emailed Mr. H and me about marketing:

Some folks complain about your HIStalk banner ads; I have embraced them as interesting. Not because I am sold on their offerings – not in the least. But when clustered together and winking at me with their clever little Flash graphics as I scroll, they seem otherworldly, almost anthropomorphic – "look at me!" "No, look at me!”

Mesmerized, I am transported to nearly 100 drab marketing conference rooms where overworked copy and graphic drones are prodded by their regional or national suit to, "Gimme something that ‘pops.’ Stale coffee, half-eaten bagels and doughnuts, pencil sketches, and wads of paper strew the table. Projector images flip through the ridiculous and unrealistic royalty-free stock photos of too-pretty male and female models with stethoscopes posing as healthcare workers. Bright young graphics and PR managers all convinced that they have the next best attention-grabbing gimmick.

With that in mind, my pre-HIMSS Winner of the Week is Aventura, which grabbed my eye with their tag-team Halloween-hued envelopes. The orange envelope held a fairly standard piece, but I enjoyed their promise of fixing all my staff’s roaming profile and VDI issues “in a way that will loosen their hands from your throat.” I’m not so sure though about their promise to “do things that will make clinicians run up and kiss you.” The black envelope held an invite to yet another private hands-on demo where they plan to show “the ultimate technological feat: how to make clinicians think you’re a decent, thoughtful, kind-hearted person.” I give them an A+ for marketing and a gold star for being a vendor that understands my world.

One last thought on marketing: the issue with the RelayHealth Facebook contest to create a welcome gift basket for me has been fixed – it no longer tries to get you to upload a video. I was starting to feel cyber-neglected due to lack of submissions until a reader e-mailed about the issue. The contest ends on February 18th, and if your suggestion gets high votes, you win a prize. Right now the field is wide open, so you’re guaranteed to be a winner! (I did shamelessly seed it with my own entry, though.)

I heard from some readers responding to my challenge to share the one product, add-on, or offering that is indispensable for practice. Several suggested a vendor who is also on Mr. H’s “Must See” list, so I thought I’d share it in advance of HIMSS so those of you who are not familiar can be sure to check them out. Intelligent Medical Objects (also an HIStalk Platinum Sponsor) will be at Booth 3517. I’m already a user and can tell you they saved my sanity as a physician and my life as a CMIO, providing the biggest “win” I’ve ever delivered to my docs. (And no, I’m not on their payroll, before some of you ask. But they did buy me drinks once as my ‘real’ self.)

Enough HIMSS-induced prattle. I have two articles to share this week.

First, from the Journal of Family Practice February 2011 issue, the first published case report in the United States of teenage text-induced tendinitis (although they did get scooped by The Medical Journal of Australia). This fourteen-year-old was texting four hours a day using only one thumb. The authors cite data that shows injury is related to high thumb movement velocities, with females being faster texters than males and thus more symptomatic. Use of a two-thumb style was protective, as was (drum roll) limiting daily texting activities, slowing down, and watching posture.

Second, the Atlanta Journal-Constitution reports that two brand-new members of the Georgia senate have teamed up in an effort to force Medicaid clients (not sure why we can’t call them patients any more) to use an ID card with their photo and PHI on a data chip and to scan their fingerprints at the doctor’s office (at least they didn’t call us providers again).

Although I applaud legitimate efforts to fight fraud, I take issue with this proposed legislation for several reasons. First, doctors are already dealing with the unfunded mandate of Meaningful Use (anyone who believes this is a money-maker, we need to chat) and now you want us scanning fingerprints at $200 a device? Do you two newbie politicians have any idea about health IT or what it would take to implement this?

Second, they want the patient fingerprinted both on arrival and when they leave the office. Have they never heard of efficiency? Is the patient going to be a victim of identity theft while they are being treated? (Maybe our backless paper gowns can steal more than dignity!)

And third, this is going to be another reason why physicians and other providers are going to stop participating in the Medicaid program (as if low payments, administrative burdens, and medically complex patients with multiple socioeconomic factors influencing their care are not reason enough). The estimated program cost is $26 million. Vendors, start your engines!

Have a question about medical informatics, electronic medical records, or what good has ever come of turning your head and coughing? E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

Amidst the din, nay, cacophony of getting-close-to-HIMSS e-mails from marketers (and Marketeers) and the PR firm mouthpieces for all things HIT, it gets pretty difficult to wean the worthwhile from the worthless … and most appear more -less than -while. Filters are running full bore these day as I try to figure out which pre-HIMSS blasts actually contain any real value.

One made it through a few weeks ago, when the cacophony was more hubbub than holler. Several factors, especially the concise descriptors the e-mailer used, allowed it to reach through my mental blockade (which has become quite the barricade these days out of sheer volume overload necessity). I am happy that it did, because it helps me to honestly say that not all the pre-HIMSS hype is just hype. There’s a few who truly deserve to be noticed. Here’s how:

Today, I had a sneak peak demo of a product that will be rolled out at HIMSS which I am actually thrilled to see coming. VitalHealth Software, which is the result of a collaboration between Noaber (pronounced knob-er) Foundation out of the Netherlands and Minnesota-based Mayo Clinic, is rolling out VitalHealth EHR at HIMMS. I truly think it is an EHR that is going to make a lot of people stand up and take notice. It is Web 2.0 for EHRs, human user interface at the fore, stupid simple on the surface while kick-ass smart below decks, easy on the eyes, workflow-savvy. It is what an EHR should look and act like.

If you’re hitting HIMSS, I highly recommend taking a peek. If you’re a provider looking for an EHR tool that has been turned on a really smart lathe, it should almost be mandatory. It is flat-out cool.

——————

Pretty much every talking HIT head has had a chance to spout about David Blumenthal’s announced return to academia. (I can’t wait to hear what the buzz around the HIMSS water coolers will be about his replacement.) Sure, he has to head back to keep his spot on the Harvard starting lineup, but who knows what other thoughts may have traversed his mind as he saw the sands running low in the sabbatical hourglass? Here is one possible scenario that I just loved from an author (I only wish I’d written it) who prefers to remain anonymous:

“I think Dr. Blumenthal sees the writing on the wall. Excerpt from his recent internal dialogue:

Government David: ‘CMS says we gotta make ‘em go CCHIT before they NIST and, after that, make ’em achieve MU, build an HIE, become an ACO, and then get NCQA to issue new PCMH regs.’

Human David: ‘OMG, this is wack. AMF.’ (Adios, Mother ——-s.)”

——————

Another pre-HIMSS marketeering note: maybe it works differently on real reporters, folks who deal with this kind of “Hey, listen to me!” on a regular basis, but in my opinion, the incessant reiteration and second / third / fourth e-mails from PR companies trying to land an interview time for their clients is mostly just off-putting. Especially if the first e-mail blast was poorly drafted, impersonal, insincere, or one of the typical hastily performed cut-n-paste jobs that seem so common. I’ve had a fairly busy inbox for some time, but the pre-HIMSS blasts have probably doubled my Junk…er, Inbox files.

My suggestion: put the effort in the first time and odds would be way better that you won’t need the second, third, fourth, etc.

——————

Most of you may remember the now-defunct TEPR (Towards the Electronic Patient Record.) I remember how helpful and well-attended it was back in Salt Lake City in 2005. What once was a thriving HIT showcase and helpful place for providers looking to learn more and get hands-on product experience died an ignominious death after the poorly attended 2009 exhibition in Palm Springs. Granted, it supposedly morphed into mHealth, but mHealth doesn’t fill the same bill, not by a long shot.

All the pre-HIMSS blasts have prompted me to consider if there is any way that the thriving, almost bursting at the seams HIMSS conference could one day soon go the way of the once grand-ish TEPR. I mean, once the numbers have reversed and 85% of providers are working electronically and, especially, once the Obama-bucks have run dry, will there really be a need for this digital bacchanalia?

Not sure, but I’ll tell you what: I enjoyed TEPR in ’05 and I’ll betcha HIMSS ’11 is gonna be a ball – especially that HIStalk Reception!! Enjoy ‘em while you got ‘em.

E-mail Gregg.

HIStalk Interviews George Schwend, CEO, Health Language

George Schwend is president and CEO of Health Language.

Give me some background about yourself and about Health Language.

I started in healthcare after college in pharmaceutical sales, which was boring. I moved to clinical laboratory sales, my first introduction to IT. This was back in the 80s when there was Cerner and Sunquest and a company called LabForce that I got involved with and developed an IT system. It just fascinated me. Then I expanded into doing blood banking systems. 

My real excitement came when we got out of the application side and got involved with tools. I was the founder of the company that delivered an integration engine called Cloverleaf. I don’t know if you’re familiar with it.

I am.

We founded that company and delivered it. Cloverleaf has probably had more owners than any other product in healthcare IT over the years [laughs], but it’s a very successful product. It changed the way people integrated systems. 

Healthcare IT started out as islands of information. Everybody bought best-of-breed systems, and then somebody realized one day that they were doing an awful lot of data entry. They started doing point-to-point interfaces, which were ugly and expensive. We came up with the same concept at the same time that STC did with DataGate. We were competing products and that product has gone on.

We went public, went on to another company name. I did what you’re supposed to do at that point — I built a new house on a golf course on a lake [laughs].

As I was realizing I was never going to be a great golfer and I couldn’t catch all the fish, I started thinking about the next horizon. The next horizon came from thinking about what we accomplished with an integration engine and then what the next big problem was going to be. In the final analysis, we had integrated systems and we allowed data to move around, but we never integrated information.

What Health Language is all about is true interoperability. Integration engines move data around. Language Engine, which is our flagship product, actually integrates the data so it’s usable across the enterprise, wherever it goes, wherever it’s needed. Health Language has been a pretty big success and we are growing rapidly.

Tell me what the Language Engine does.

We manage and handle standards and vocabulary across applications. We use consumer-friendly terms. We have physician-friendly terms. 

The problem with communications in healthcare is everybody speaks their own healthcare dialect. Machines to people, to nurses, to doctors, to laboratorians — a lot of stuff can get lost in the translation. If you create a large set of content that embodies all the standards — the financial standards, the clinical standards, the specialty standards — and you put that in a large database and then create some technology that will serve that up to whatever user or to whatever event is happening and tag everything, you get very usable data across the entire enterprise.

How important is terminology to where Meaningful Use is going?

I think it’s hugely important. Technology has been there for a while. We’re doing really neat stuff with technology. The problem is that we haven’t done a whole to improve the data or the information. 

For Meaningful Use, we make the data far more usable. Even in the case of triggering alerts, if the wrong terms might be used and there’s not a database that says those two things are the same, you’re not going to trigger that alert. The efficiency or the effectiveness of the computerization of healthcare is not maximized unless the data is close to 100% readable by everybody that relies on it.

We see ourselves in a very horizontal technology — horizontal across healthcare. If anybody generates or stores or reads data, does statistical or outcomes analysis, clinical trials, or is in the payer sector … if they’re using healthcare data, we can make their current tools better and make the data they’re looking at much more usable.

Are you seeing more interest because interoperability means providers have to talk to each other now, just like systems needing to talk to each other created the need for the integration engine?

A tremendous amount. Interoperability, I’ve kiddingly said, is our middle name. If you take HL7 and what it does — and it’s a very critical piece of the pie — and then take SNOMED and the ICD and all of those and put those and put them in a mapped environment where all of those things are usable, you’ve got your interoperability. You’ve got portable records that can be read anywhere and understood anywhere. I think we play a very significant role in Meaningful Use.

You also offer an alternative to providers for looking up SNOMED and ICD-9 codes to create problem lists and documentation. What’s important about that other than provider satisfaction?

Let me explain our business. We have a large technology group at Health Language. We also have a large medically competent content team. That’s doctors, nurses, laboratorians, all the different regiments within healthcare specialty. They build content and our technology people build tools that automate that and make it easily accessible either sitting on a network or embedded by an application vendor.

In the case of ICD-9 or ICD-10, or in the case of Meaningful Use or Accountable Care Organizations — which, by the way, in my opinion is a new name for an HMO, isn’t it? [laughs] — that content group keeps everything current. It makes problem lists almost a standard product. We allow individual users to create and add to those problem lists or make their own unique problem list. We serve all that up with the Language Engine, making it available to all users across the spectrum.

Who are your competitors?

A number of folks are trying to do a really good job with delivering content, vocabulary, and standards. What differentiates HLI is that we are truly an IT company of equal stature to any IT company out there, as well as a content purveyor. I don’t think anybody comes close to the tools that we provide and a true engine technology to make the delivery and the maintenance reasonably manageable.

Content takes a long time to build, so I would think being the first mover gives you advantage.

We believe it does. We believe that’s why we’ve attracted so many new partnerships from the system integrators out there. There is probably not a major system integrator that we’re not partnering with right now. They make proposals to the insurance side of the industry for handling the transition from ICD-9 to ICD-10. A key component in their service package is that engine itself and then the content we can provide with it.

It was a big deal when government licensed SNOMED for all users and, more recently, Kaiser donated its Convergent Medical Terminology to HHS. How important were those developments?

Kaiser’s a major player. Kaiser was probably the stimulus for our company. A bunch of people from IBM’s Watson Research Center and Kaiser started to attack this terminology communications and vocabulary issue in healthcare. That became some of the core basis for what Kaiser ended up doing. Kaiser Rocky Mountain won the Davies Award for what they did.

When those people were done with that work, they were cut loose. We were just finishing up with Healthcare Communications, which was the Cloverleaf company. I started to think about where we should go next. I hired a whole bunch of those folks and many of them are still with us today. They had a real core expertise on managing vocabulary and standards.

We’ve gone light years from there, but to answer your question specifically, when anyone makes available a good quality content mix like Kaiser had, we applaud it. We were the first to put out a press release to commend them for making that available. Our tools can adopt any standard, any set of content, and manage those in concert with all the others. It just enhances our position and offering.

What are your thoughts on the technical specifications about nomenclature in Meaningful Use?

They’re all practical. They’re saying, “If you’re going to claim this Meaningful Use investment in IT, it’s got to do certain things,” and those things are all logical. I don’t see a problem with any of them and I don’t see why anyone else should. I think they just make medicine and healthcare better.

What’s the state of readiness for the conversion to ICD-10?

I won’t be the first to say I think we’re all behind the curve on it, but a lot of people are gearing up to try to make a very hard run. The sane thing to do would be run parallels on ICD-10 and ICD-9 for literally a year — through all the seasons, through all the types of things that are recorded and charged for, etc. — to make sure you’ve got it right.

We’ve done some really interesting things in putting our technology on a Web portal and allowing customers to manage their own mappings and use our mappings and modify them. Those things are of improving the speed to market of getting ready.

One criticism of ICD-10 is that it’s a huge list of codes that are more granular, but hard to pick from. Do you see that as an improved market for your product?

Yes, definitely. The granularity is a good thing for healthcare. Fifteen thousand to maybe 150,000 — that’s a major paradigm shift. That’s why I believe the tools are absolutely essential right now. And as you know, ICD-11 is not that far behind.

We’ve been doing international ICD-10 business with customers around the world for almost ten years now, so we’re very ICD-10 astute.

And that creates new product opportunities?

Yes. The more you have to juggle and plow through to get it right, the better it is to have tools that help work you through those, that give you logical maps, that make you think through, “Am I making the right connection here? Am I using the right codes"?” And hopefully getting no one in trouble with fraud and abuse issues down the road, almost by accident, because it’s such a complex problem.

Do you see new terminology developments that will be needed for interoperability, such as for genomics?

I don’t see anything on the immediate horizon. I think the real issue is that all of the standards are in constant change and flux. They’re constantly being changed. If you could envision a pile of pick-up sticks and every stick had a different standard on it … we’re managing something close to 180 different standards worldwide right now in our content base. Everybody isn’t using all of them, but people use varying numbers of how many standards they juggle in a given day and those standards can change daily, weekly, monthly, annually. 

Keeping it all mapped together and keeping it all usable so nothing breaks is an art form. That’s the real problem if you don’t approach the situation from an, “I need a solution that will take me long into the future and not a quick fix on how do I get from ICD-9 to ICD-10.” The demand for all kinds of vocabulary requirements and all kinds of different standards is going to get greater, not lesser.

What’s the current state of text analytics and do you think there are additional opportunities to leverage that?

We do a lot of natural language processing-like services. We are talking with a lot of the text, the voice, the natural language processing folks. We have a lot of projects going on. Nobody is, I think, 100% comfortable with where all of that is without some human intervention, but it’s getting closer all the time.

Do you think the PCAST report’s recommendation to turn existing data into discrete document data by tagging it could work?

The problems always come when what’s written is “pneumonia” vs. “no sign of pneumonia,” catching all those little innuendos and not getting into trouble and not just grabbing “pneumonia.” Do I think it’s possible? Yes, I do. I think it’s just a matter of time. I just don’t think we’re there yet.

There are two ways to solve the problem of everybody wanting coded data — either make the providers code the information going in or to try to code it on the back end. There’s not really any easy way to do it except maybe to use products like yours to make it more palatable on the front end.

That’s true, but we also do it on the back end, too. We’ve run historical databases through our Language Engine and gotten a very high turn — not 100%, so I’m always reluctant to hold up some false Holy Grail when somebody will ask me to make it work for them and we just can’t get to 100% — but we can do an awful lot of that today.

For aggregated studies or for public health type uses, it’s probably plenty good. You might not want to make an individual treatment decision from it, but I would assume that if you just had lots of data to plow through, you could make some general inferences that you’d be comfortable with.

I agree with you. That’s an excellent way to state it. You’re right.

Where do you take the business from here?

We see a tremendous amount of growth over the next couple of years. We believe that the need will continue to grow and we’ll continue to be intimately involved with all kinds of standard delivery across the entire spectrum.

We have some development projects that we hope to announce down the road. Right now, we’re very busy taking care of the high demand for ICD-9 to ICD-10 and Meaningful Use standards. 

We work with clinical application vendors. We work with system integrators. We work with individual hospitals like Partners in Boston and Ascension Healthcare. The more the government continues to try to move us into a more common world, the more of a need and the greater the need is going to be for what we do right now.

Any final thoughts?

Healthcare and the initiatives currently going on are the next quantum major step for healthcare and healthcare IT. Everything that’s being done today, everything that’s being required and requested, will move healthcare into truly the next generation. It’s an exciting time to be involved and I’m just glad we’re part of it.

HIStalk Interviews Steve Hau, President and CEO, Shareable Ink

Stephen S. Hau is president and CEO of Shareable Ink of Nashville, TN.

Tell me about yourself and about the company.

I’ve had the privilege of starting two very provocative healthcare IT companies. At the age of 25, I dropped out of a PhD program at Harvard to start a company called PatientKeeper. I started that with a physician friend of mine, Dr. Joe Bonventre. We founded that company based on a very simple observation — doctors are highly mobile professionals because they walk about three or four miles a day, they cross different care settings, juggle numerous information systems, and rarely sit in front of a desktop computer.

From that starting point, many people worked together to build a very interesting and valuable company. I spent over 12 years at PatientKeeper. I collaborated with some wonderful people, learned a lot, and formed some strong opinions about the industry that ultimately lead to my next venture.

About two years ago, I left PatientKeeper to start another healthcare IT company called Shareable Ink with another physician friend of mine, Dr. Vernon Huang. This time, the simple observation was twofold. One, healthcare will become more electronic, and I think everyone agrees with that. And two, without a new approach to healthcare IT, that transition to being electronic will be very, very difficult.

During the formation phases of Shareable Ink, I got very excited about the potential of digital pen and paper technology. As you might know, digital pen and paper technology utilizes a special ballpoint pen with a small camera embedded in it that’s capable of recording and transmitting the user’s pen strokes. I felt that if this basic technology could be augmented with the right software, we could deliver a hugely valuable tool for clinicians and healthcare organizations. 

I put the band back together, bringing back some very talented friends, including some amazing engineers. I’m a firm believer that great software is a balance between technology and psychology, I say this a lot. It’s really only when clinicians truly embrace the tools when the tools aren’t cumbersome to them that we can deliver the full potential and the benefits of IT.

Companies either say “Doctor, you have to enter everything, so here’s your keyboard and this is where you’re going to live your life from this point forward,” or they say, “We don’t believe in that. You never have to type anything. Doctors should be consuming data and not creating it.” You’re giving them an alternative.

That’s right. We look at digital pen and paper as an input modality into electronic systems. It’s not really an “either-or”, but a “both.”

We initially set out to explore three clinical settings: emergency departments; operating room, specifically anesthesia; and physician practices. The factoids are that 80% of ED is documented on paper, 93% of anesthesiologists document on paper, and the vast majority of small doctors’ offices document on paper.

In the ED space, we’ve partnered and have had a great success with T-System. Sunny, the CEO you interviewed recently, is a real visionary. T-System has 1,700 emergency departments using its paper templates. That’s almost every other emergency department in the country. Our joint product, DigitalShare, helps those EDs become more electronic and thereby shortens revenue cycles, improves compliance, enhances access to clinical records. We accomplish all this without any change of the physician behavior. The clinician literally doesn’t have to do anything differently. 

We’ve seen similar benefits with anesthesiologists. We recently announced that NorthStar Anesthesia had huge success with our product and decided to expand it to 34 hospitals.

In the coming weeks, you’ll hear an announcement from a very large, well-known, publicly traded EMR vendor. Their customers will now be able to use their current paper documentation templates as an optional input mechanism into EMRs.

In a way, your company exists because EMR usability is at least perceived to not be very good. Do you see your product as a happy medium that lets vendors avoid rewriting their products with usability in mind?

Digital pen and paper can be an option for getting the clinician’s information into those systems. Their analogy is dictation. It’s a longstanding challenge where the entire industry wants the electronic data, but at the same time, we have to be mindful that physicians have very specific workflows that they’re comfortable with. For a period of time – and it looks like this will continue – dictation has been a way for physicians to input information. I think digital pen and paper is another example.

I’m also a fan of tablet computing. We’ll be introducing our take on tablets later this year. I think that might be another physician-friendly input mechanism into the electronic system.

Do you see digital pen and paper competing with tablet PC handwriting recognition or electronic forms completely contained in a tablet? Is that a direction you want to go?

Absolutely. Our business is really about helping healthcare organizations become more electronic. We do that by providing tools that physicians are comfortable with using as a way of capturing information from the physician. Pen and paper may be a way to go, dictation may be a way to go, and tablets might be a way to go as well. We’ll support whatever physicians are comfortable using.

We’ve had a very different take on tablets, at least, in terms of what I’ve seen out there. I’ve seen a lot of vendors take their desktop applications and try to convert it into a tablet application. We take an approach where, frankly, physicians are already comfortable with a way of inputting information, so we will use tablets as a way to mirror current physician workflows. Where they might have been scribbling on a piece of paper, they’ll have a choice to either scribble using a digital pen or scribble with a stylus on a tablet.

People underestimate the importance of the visual cues that you get when you write something in your own handwriting. There’s a whole psychology around how you place it and how bold you write and whether you draw an arrow to it or whether you scribble a drawing along with it. Is that something that physicians miss when they’re forced to type?

Yes. What we hear frequently is that the physician-patient interaction changes quite a bit when you introduce a computer keyboard. What we’ve found is that by utilizing digital pen and paper, physicians get to maintain a workflow they’re accustomed to.

I’ve observed that the documentation process is often interactive. Physicians aren’t court stenographers, where they’re literally just transcribing a predictable stream of words. The documentation process can often be non-linear, where there are surprises and they jump around and make changes during the documentation process.

I can see where patients would perceive a physician writing as they speak to be paying extra close attention and being extra careful, whereas typing almost seems like you’re being ignored.

Right. We’ve heard that before. As a consumer of healthcare, I can appreciate that as well.

Where do you see the role of the digital pen and paper for providers trying to meet Meaningful Use requirements?

Shareable Ink currently supports Meaningful Use in several ways, including the capturing or recording of clinical quality measures required under Meaningful Use. As an example, in the ED setting, we help capture emergency department throughput. In the anesthesia setting, we help capture antibiotic administration prior to surgery, which is just a quality measure.

In broader terms, we support the move to Meaningful Use, because what we’ve observed is the more the hospital becomes electronic, the harder it is to deal with existing paper processes. Shareable Ink takes those paper processes that are difficult to automate and we make them electronic with hardly any impact on the otherwise busy IT department.

If the IT department is the gatekeeper as they sometimes are, what would be your pitch to them about the cost and the technology and the manpower required to implement digital pen and paper?

Shareable Ink has taken a unique approach in terms of how we deploy our technology. All our software is hosted off site. There isn’t software to install on PCs. That obviously shortens the initial installation process, but also the go-forward support. We offer our product as Software as a Service, so it’s very, very easy to get started and also quite reasonable to manage going forward.

The advantage of interacting directly with a computing device is that the programmer can provide edits and completion messages and warning messages as the form is being completed. Do you have those tools available?

Yes. Our software can provide immediate feedback, including decision support, through our companion Web application. In this particular configuration, a USB cradle is connected to a Web-capable computer, and within a few seconds of docking the digital pen into the cradle, the pen strokes are delivered to our remote servers where they’re processed. That feedback is provided to the clinician in a browser window.

You’ve identified anesthesia as a key market. How are they using digital pen and paper?

The anesthesia market is a great example. For decades, there have been these so-called AIMSs – anesthesia information management systems – that have been marketed to anesthesiologists. They have, for the most part, not been very successful. In fact, as I mentioned today, 93% of anesthesiologists document on something called an anesthesia record, which is for the most part a two-page piece of paper.

But with that said, there is a need to go electronic, especially these large anesthesia groups. They’re essentially service organizations that compete with each other on the basis of the quality of their work. But that data is hard to come by. A lot of provider groups hire FTEs to spot-check individual records to make sure they’re being compliant with best practices.

With the Shareable Ink approach, the anesthesiologist continues to do what he or she has done for years, which is documenting on a paper anesthesia record, but that document is converted electronically to data. That data is available to medical records, but that discrete data is also available for compliance checking, for providing anesthesiologists immediate feedback if records aren’t complete or if they’re not being compliant with certain measures, and when the data is aggregated, to provide the provider group an ability to evaluate all of their providers on an objective basis.

It occurred to me as you were saying that in a hospital, the higher the level of acuity or specialty, the more the physicians’ practice becomes less free-form and more form-driven. The ED, ICU, surgery, anesthesia — all of those are more form-driven than general medicine or some of the other broader specialties. Are there others you’ve thought of that are form-centric that would find an easier transition to digital pen and paper than to just say, “Here, start typing.”

That’s a great observation. I would say that so much of healthcare is form-based. I didn’t fully appreciate that until we started Shareable Ink. I’ve been in environments where physicians will bring out their highly customized form … I’ve got a couple of MIT degrees, so when I observed this, I thought, “Well, gosh, that’s not really intellectual property, that’s just lines on a piece of paper.”

With reflection and maybe some maturity in my thought process, what I discovered was that what these physicians are showing us is their most highly customized, specialized tools that they’ve built that simply work for them. Shareable Ink, to some extent, is about taking what works for physicians and turning it into electronic data that the industry and the market requires.

What did you learn from PatientKeeper that you’ve taken to Shareable Ink?

I learned a lot from PatientKeeper, but I think what I appreciate most is the psychology of software design. The reality is, at the end of the day, it’s not about necessarily the robustness of the technology, not necessarily about the level of sophistication of the code or algorithms behind the scenes. Where the rubber meets the road really is, is the tool ultimately physician-friendly? Is the tool something physicians can be very comfortable with and can begin using right out of the box without an instruction manual?

Where do you see the company and the product going out in the next few years?

The great news is that, in a short amount of time, we’ve won a lot of customers. Our focus right now is taking great care of our customers. As an additional benefit, is we’re learning a ton from our customers. Every day I’m being educated about the next generation of applications they would like us develop. Not only is our customer pipeline very strong, our product pipeline is also very, very robust.

Any concluding thoughts?

I appreciate the opportunity to be included in your blog. As I mentioned, everything we’ve learned about healthcare IT has come from candid conversations with customers and other leaders in the industry. The Shareable Ink suggestion box is always open and we’re eager to get candid feedback from the industry.