Monday Morning Update 3/22/10

From kITty: “Re: Detroit Medical Center. Sold to Vanguard Health Systems.” DMC signs a letter of intent to sell out to the for-profit Nashville chain, with the hospital’s CEO saying, “The nonprofit hospital model is killing health care in the city of Detroit.” It will be interesting to see how a for-profit operator can improve a situation in which the local economy is wrecked and the hospital is burdened with charity care. I assume from my long-ago, not fondly remembered experience in working for a for-profit hospital chain that the bean counters will run wild trying to cut costs and manipulate the patient mix for maximal profit, which is of course what for-profit companies do to benefit their shareholders, hopefully not at the expense of their customers (patients).

From mrsoul: “Re: today is Certified Nurses Day. Unlike CPHIMS, you actually have to verify education and experience BEFORE you can take the board exam. Re-certification does take effort and diligence. I am a CPHIMS too; but, I can tell you the RN-BC from ANCC testifies far more effort and experience to my peers. Happy vernal equinox!” Friday, March 19 was the day to recognize certified nurses, including those holding ANCC’s informatics nursing credential. If you are a board-certified RN, a belated happy Certified Nurses Day to you.

Trident Medical System (SC) goes live in the ED with Oacis HIE in a Carolina eHealth Alliance-sponsored program that connects 11 EDs. Trident is Columbia HCA’s hospital group and Oacis HIE connects their Meditech systems with each other and those of MUSC.

John McConnell, who made a couple of kings’ ransoms in selling out Medic Computer System and A4 and then bought golf courses, gets back in the software business. He’s buying a golf club management software vendor. Allscripts probably won’t be buying this one from him.

Parrish Medical Center (FL) claims a 31% reduction in mortality and a 77% drop in non-ICU code blue calls as it uses Clinical Xpert CareFocus from Thomson Reuters in a Six Sigma project involving its rapid response team. The software identifies patients at risk through an ongoing review of meds, results, vitals, orders, and other clinical data.

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Readers generally agree that companies aren’t doing themselves any favors by holding their press releases until HIMSS week, along with everyone else. Make the announcement before the conference, 68% of you said. New poll to your right: what influence does the HIMSS annual conference have on hospital IT buying decisions?

I notice that the visitor count will hit 3 million before long, so I assume Inga is preparing for her usual celebratory pomp and circumstance. She loves watching that counter.

TPD has updated his excellent list of healthcare iPhone applications with many new apps.

The acquisition of QuadraMed by Francisco Partners has been completed.

An interesting perspective from Indra Neil Sarkar, director of biomedical informatics at the University of Vermont College of Medicine, on the role of informatics related to EMRs:

AMIA is making very good headway in this community. There are only about 2,000 to 5,000 of us who are formally certified informaticians. Someone at a medium-sized hospital might have the title informatician, but they are really IT and not informatics. And if there is one term I have an issue with, it’s ‘health-IT,’ it’s the misnomer that we’re stuck with.

Informaticians need IT, but if you ask me to fix something on my computer, I am not a hardware guy. It’s a way of thinking. Many informaticians here fell into the field by accident. I grew up with computers and had strong ideas about the role of computers in microbiology. I am not a physician but I have a lot of interest in medicine. I had the notion I would spend most of my time in the lab using a computer on the side, but I have a dry lab, I don’t maintain a wet lab.

Creating data is not the problem; it’s understanding the data, and that is where AMIA fits in with its history. Its main meeting is more oriented toward electronic health records. This meeting is, ‘Let’s take EHRs and basic bioinformatics for granted. Now what can we do with the data?’

The Las Vegas newspaper reported on confidentiality breaches at University Medical Center a few months back, but this seems to stretching the point: an investigative piece reports that hospital managers don’t have good records of who has keys to the shred bins. The maximum fine for that egregious act: $400. Must have been a slow news day.

CHRISTUS Health engages MEDSEEK to develop its consumer portal and will eventually implement the company’s eHealth ecoSystem.

E-mail me.

News 3/19/10

From Ex-Cerner Guy: “Re: CPSI. I prospected heavily in Mid-Atlantic and Mid-West regions, and can vouch for the need for a CPSI or Intra-Nexus. Quite a few Meditech sites were looking around and they were only getting called back by the McK Paragon types. There is definitely a market and some pent-up demand.”

From Dan D: “Re: Tom Skelton. He has left MED3OOO for another opportunity.” Unverified.

From RJ McMurphy: “Re: putting HIMSS in perspective. Vendors representing half of the hospital HIS/EMR systems in America weren’t even present! If you look at the HIMSS Analytics report in Modern Healthcare for Jan. 2009, you’ll see Meditech with 26.7% market share, Cerner with 12.6, and Siemens with 9.5. That adds up to 48.7%. All three chose to opt out of HIMSS. Basically it’s become a hype circus — no buying influence really happens there. It was more important earlier in the market cycle when PowerPoint was the main operating system for EMR vendors. Now almost all buying is done by peer site reference and Internet data gathering. Organizations like HIMSS, KLAS, Gartner are trying to make themselves more relevant with lots of hype about trends, etc. The world has changed and I laud those three for opting out and saving their shareholders and stakeholders the cash!”

From Doug Dinsdale: “Re: Merge. Dr. Dalai challenges the CEO of Merge to explain why the purchase of Amicas isn’t going to ruin both companies.”

Cerner makes the S&P 500.

A reader sends this picture of a billboard one of his patients asked him about.

Haemonetics extends its $60 million offer for GlobalMed Technologies to give that company time to settle a shareholder lawsuit seeking to block the acquisition.

Tallahassee Memorial HealthCare (FL) chooses Allscripts PM/EHR for its 106 providers and 33 family medicine residents.

Singapore General Hospital wins the Microsoft HUG 2010 Innovation Award for “Best Use of Clinical Records – Inpatient” for its use of Eclipsys Sunrise Patient Flow, which improved bed placement time and reduced overhead.

A Weird News Andy find: a former dentist is accused of using paper clips instead of stainless steel posts inside the teeth of root canal patients, about which WNA says, “Maybe it’s for all those people who use paper to floss.”

More information on the HIMSS EHRA position on meaningful use is here.

McKesson announces a hosted storage option for Horizon Cardiology CVIS, with Cooper University Hospital (NJ) as an early adopter.

Software developed by Boston Medical Center, Northeastern University, and MIT that reduced readmissions by 30% is licensed for commercialization to Engineered Care Inc.

A new iPhone app called iResus walks users through emergency resuscitation, providing a metronome for timing chest compressions.

Nurse scheduling software vendor StaffKnex changes its name to OnShift. They apparently like conjoined words quite a bit.

Everything about this story is sad. A four-month-old Down’s baby dies in the UK after being given a tenfold overdose of the diuretic furosemide. The computerized warning issued to the doctor’s office is overridden by the receptionist. The pharmacist hears the technician questioning the dose with the prescriber, but doesn’t follow up. The neighbors of the parents, convinced they killed their own child, trash their house and steal all the baby’s belongings. Weeks later, the father kills himself by drug overdose. The coroner’s report finally came out this week, four years later, finding that the doctor and pharmacist were at fault.

Revenue cycle vendor Emdeon will acquire management consulting firm Healthcare Technology Management Services for $11 million.

At least somebody likes the proposed meaningful use criteria: AARP and Consumers Union.

Lexi-Comp releases its ON-HAND medical software for the Palm Pre and Pixi.

A KLAS report finds that 20% of smart pump buyers wouldn’t choose their current pump again, although 99% of CareFusion Alaris said they would. Still, the highest rated pump was the B. Braun Outlook.

Meridian Health (NJ) chooses CareAlign from Informatics Corporation of America to deliver an integrated clinical record to five hospitals.

MedFusion licenses LIS, molecular diagnostics, and AP software from Sunquest.

E-mail me.

HIStalk Interviews Mike Cannavo

Mike Cannavo, aka The PACSMan, is founder and president of Image Management Consultants.

Give me a brief history of PACS.

Well, for one, PACS finally works, so that’s a real good start. [laughs] Technology has finally caught up to the promises that were made over two decades ago about PAC systems allowing “any image any time, instantaneously,” although we’ve also become a lot more realistic on how we define instantaneously as well. Customers are also becoming much more educated, although the information they get from vendors is often biased towards a particular vendor’s PAC system. Unfortunately IT has very few resources for information, as most of this as been geared towards radiology.

Why is that?

Until a few years ago, radiology departments – heck, nearly all departments in the hospital for that matter — pretty much operated in a vacuum and made their own decisions. Now with the ultimate goal to have an EHR/HIE established by 2014, IT plays a much more important role in the decision-making process. Radiology still gets to call the shots on what works best for it, because like it or not, PACS still is a radiology-centric system, but IT needs to make sure it works well and plays together well with all the other clinical systems.

There aren’t a whole lot of IT specific resources available, but IT can get educated by going into the radiology community. I’ve had two series on Auntminnie.com titled “PACS Secrets” and “Building a Better PACS” that can be a good starting point. Start with the article titled “PACS and Marriage” and move on from there. It will no doubt bring you and Inga much closer together. [laughs]

Aunt Minnie’s PACS discussion forum is also an excellent resource. SIIM and the AHRA both have some incredible educational resources as well, although you usually have to be a member to access them. Many vendors and even HIMSS have begun virtual education using Webinars, though some are nothing but thinly veiled sales pitches — you have to look very closely at content. I also like Doctor Dalais’s blog as well – he is about a reverent as I am. [laughs]

What about RFPs?

RFPs are dramatically overrated. Now my fellow consultants might hate me for saying so, but a good technical spec that provides the vendor with a baseline to respond to send out to two vendors is about all you ever need. It need not be longer than six to ten pages tops and just needs to outline what you have, what you are looking for, and statements of a similar ilk.

I’ve seen RFPs that read like a New King James Version of the Bible and others that give so little information that they redefine worthless. One of my counterparts actually commented once: “Nothing like a meaty RFP to establish your creds” and I’m thinking, “For whom?” Shorter is always better with an RFP as long as all the information is there. Learn to KISS — Keep It Simple, Stupid.

Interestingly enough, vendors respond to 10-page and 100-page RFPs using the identical templated responses as well. That’s part of the problem we face today. Too many RFPs are being issued and questions are being answered without the right questions being asked orR answered, with the way the vendor answers more important that the question itself. A vendor also isn’t going to rewrite their DICOM conformance statement because you asked for something they can’t or don’t provide. But it is a nice try.

Is writing an RFP a mistake?

Not really, but it has also been my experience with any RFP — be it for a PACS, RIS, VNA, or whatever –  that what you see isn’t always what you get. Asking questions, even multiple choice questions, can still get you answers that don’t really address the client’s needs. A solid contract is much more important than the RFP.

Case in point: I recently had a client who did their own PACS RFP, a rather extensive, exhaustive document literally hundreds of pages long, with over 50 pages dedicated to the archive alone. The system they were buying was exceptionally large, addressed many sites, and cost several million dollars. I was engaged simply to do the contract review for them. When I added contract language relating to the archive being "vendor neutral" and containing nothing proprietary in it, the vendor balked.

We went back to the RFP response the client developed, and while the questions about the archive were properly asked, the way the vendor responded made Fred Astaire look like he had two left feet. Basically while they said they could do it that way they never said they did do it that way — and therein lies the issue — how you interpret a response? That is why I say for the most part, RFPs have very limited value. The contract is what you have to go to court with if need be, and is what needs to be made crystal clear.

Very few customers are also qualified by the vendors as to their readiness for PACS before the go into the RFP process as well. And who pays? The facility, by having to dedicate more internal resources on the project than they need to and also paying a consultant to go over mostly superfluous material. What you see is what you get- recognize that and you’ll save a bunch of time and money.

What if IT ran the RFP process?

It would only make it worse, in my opinion. IT understands IT and radiology understands radiology. This needs to be a team effort with everyone in the hospital working together.

The last project I got involved in where IT was in charge, I was ready to pull my hair out. The person overseeing the PACS evaluation process with IT in charge came to the facility from a Big Six consulting firm and had virtually no understanding of radiology. Process, on the other hand — my God, this person had process down pat. There was constant talk of putting information into this bucket and that silo. I felt like I was living in Hooterville and waiting for Lisa Douglas, Mr. Haney, Sam Drucker, and Arnold Ziffel (the pig) to show up.

We spent nearly a year going through a detailed highly scientific — by Big Six standards — statistical analysis of each of the four vendors being looked at closely, only to have the statistical difference be <0.02% between the top three vendors. I think four points separated them all out of 800+ possible points. But, by God, we did it scientifically. The funny thing was I told the radiology administrator this would happen before we even started, but alas, her hands were tied. This facility wasted over $100K in internal resources internally and nearly a year’s time getting back to their initial starting point.

So, no, IT should not be in charge. Again, this needs to be a team venture.

What are IT’s biggest mistakes relative to PACS?

Where do I start? Probably treating PACS the same way their do every other clinical system, although obviously there is some overlap. Radiologists need to feel comfortable with the workstation operation, so regardless of what IT thinks about the system, if the radiologists don’t like it the way the workstation operates or if they feel it will slow them down, they just won’t use it. And if they don’t use, it then that is just throwing away good money after bad. While no one part of the team should have over 50% vote, in the final decision-making process the system must fit the radiologists so unless you plan on changing radiology groups soon their vote means a lot.

I’ve seen a lot of mistakes made over the years, but thankfully, most were recoverable. One of my favorites was a CIO who insisted on entering into contract negotiations with two vendors at once. I said, “That’s not how it works in PACS” but we butted heads here big time. His thought process was that inviting both to the church it would make each work harder to be competitive.

In the vast majority of cases. this backfires big time. This wasn’t like The Bachelor where Jake had to choose between two of 16 beauties — will it be Vienna or Tenley? — to put a ring on their finger. This CIO wanted to take both to the altar in their gowns, bridal parties and families in tow, with the preacher looking at the groom asking, “Which of these women do you take to be your lawfully wedded wife?” Everyone will be shedding tears, but not everyone tears of joy. And I’ll be sitting there thinking, “Now what do I do now with this toaster and blender I got them as gifts?” That is such a waste of everyone’s time and money, but I, alas, didn’t call the shots.

What did you mean by customers being qualified?

An RFP or tech spec should never be put out on the street unless adequate monies have been both approved for the project and are available for release and a project plan has been developed. Most sites think nothing about putting something on the street as a feeler to test the waters on PACS costs. Unfortunately they either don’t realize (or don’t care) that responding to an RFP costs the vendors anywhere from $4,000-$10,000 per RFP in manpower costs alone. Following it up with on-site visits, customer site visits, etc. adds another $15-20,000 over the project term. So, you’re really looking at $20-30,000 for each RFP that is responded to. If a company has an outstanding track record, they stand to close maybe one out of three RFPs they respond to, so the first $60,000-90,000 of any PACS sales should be considered make-up revenue.

Maybe that explains why $15,000 workstations cost $85,000.

That’s a large part of it, but research and development and software application costs add to that bottom line cost as well. Vendors also need to make a slight margin on the sale too, but that’s all negotiable. [laughs]

Consultants don’t come cheap either, right?

The oats that have been through the horse come somewhat cheaper. [laughs]

There is a plethora of consultants out there today, many whose ink is still wet on the business cards they got at Office Max when they got laid off and figure, “If he can be a consultant, then by damn I can too.” Unfortunately, even the societies that deal with radiology and PACS that are supposed to look out for you don’t. All you need to do to be listed on most of these sites is join their organization or pay a monthly fee to be listed. Now there are disclaimers listed, but who really reads them?

Truth be known, there are less than a dozen of us who do PACS consulting on a full-time basis, not as a sideline business when we’re not out looking for a full-time job with a steady salary. But no one knows who they really are, so we all get a bad name when someone screws up. It’s the same way with IT consulting as well. That’s why I always talk with a client at length about their needs and the project before I even consider an engagement.

Three out of five potential clients who call me get their questions answered within the first hour of a phone call. We do that for free. One out of five potential clients I find I just can’t work with. They want to show me their watch to tell them the time. The remaining one out of five I end up engaging with in a project.

Sounds hard to make money turning away 80% of your prospects.

What we lack in financial input, we make up in volume. Eight customers a day and I can almost pay the phone bill! [laughs]

More than 90% of our end-user business is doing our quick and simple PACS Sanity Check. Most places are pretty sure what vendor they want or at least have it narrowed down to the two they want, so we look at the proposals a client has from the vendors, make sure they are indeed apples to apples comparisons and, if not make, sure they are by having them re-quoted, discuss the pros and cons of each proposal with the client, and then, once the client selects their vendor of choice, we help them with contract negotiations since the contract is unquestionably the most important part of any deal. No muss, no fuss, two weeks and $5K or less and they and we are both done. While all PACS projects are different, most of the things you do are the same and become templated, so why charge people out the wazoo to reinvent the wheel?

Because you can?

Hey now — you calling me a vendor? [laughs]

You’ve worked on a ton of PACS projects. How did they differ?

That’s like asking me how many women I dated in my youth that were different or what makes Inga so special. Why, everything about her, of course. [laughs] The answer, obviously, is all women are different, and while each has their own unique advantages and benefits, each also shares many common traits. The same holds true for PACS. All are different, but not necessarily from a system design standpoint. There are maybe a dozen or so templated system designs that vendors start with and then customize accordingly.

The politics or each site varies widely and is probably the most important issue to address. Frankly, designing a PAC system is like choosing from a Chinese menu — workstations from column A, servers column B, archives column C, etc. Put them together and you have the system design. Making it work is another story, although if you talk to vendors and customers alike, it all works together like magic, just like DICOM is magic and HL-7 is magic. Poof, it all works. Plug and pray, I mean plug and play. [laughs]

The concept of standards is advanced, but the reality is so far from the truth it’s not even funny. DICOM is the most non-standard standard ever developed, so much so that every vendor has to offer their own conformance statement  — this is what we agree to, this is what we don’t. Two vendors can consider themselves as DICOM-compliant, but if they don’t share conformance statements, it won’t work.

IHE, Integrating the Healthcare Environment, is the same way. It’s a great concept, but the execution leaves much to be desired from an ease of implementation standpoint. That is why very few vendors have adopted IHE. Ask around and you’ll see. That is also why VNAs, Vendor Neutral Archives, are growing in leaps and bounds.

It all seems to work at RSNA.

You also saw perfect images at RSNA and software that won’t be available until 2012 at the earliest. Anyone who makes the trek to Chicago knows RSNA is an acronym for Real System Not Available. Seeing it working and knowing what it took to make it work are two entirely different concepts. Yes, it all did work by 10 a.m. Sunday, but rest assured, it wasn’t all plug and play. But we are getting much better.

So PACS implementation schedules aren’t real?

I never said that. Just that implementation schedules are an approximation of when you can expect it to be in, not an etched-in-stone date and time. There is so much that can go wrong that you never expect.

I recall one engagement we did where we lost a month for one 2” hole in a wall. The problem was that none of us knew it was a fire wall. By the time we got the 16 different approvals needed to drill this silly hole, we lost 30 days. There are all sorts of challenges like that. Radiology Information System integrations also have their own set of challenges, requiring the RIS vendor, PACS vendor, and IT department all to be on the same page timetable wise. That almost never happens.

But it could.

When the moon aligns with Jupiter and men finally understand women, then, yes, it can happen, but you stand a better chance of winning the Lotto or Powerball than that happening anytime soon.

Managing expectations is a huge part of PACS. Unfortunately it’s also one of the biggest areas of failure that the industry has nourished.

PACS has been promoted as a cure-all for everything under the sun, but knowing what PACS can and can’t do is paramount to gaining wide-scale, facility-wide acceptance of PACS. Unfortunately there is so much misinformation about PACS that people have a hard time believing the facts.

I go crazy when people say PACS can reduce FTEs. Technically the FTE headcount may be reduced in the film and file room after a period of time, but the overall FTE budget ostensibly will remain the same. If the money coming out of your pocket isn’t different, then what’s the real benefit? The same holds true when people talk about time savings with computed and digital radiography, CR and DR, over analog film. Yes, the imaging process can be reduced by 40-60% over conventional film, but will you see a 40-60% reduction in FTEs or rooms required? No.

In generating a typical 10-12 minute chest film, you save the time associated with film processing and jacket merging, about two minutes on average. All the other processes — getting the patient in the room, positioning them, and even imaging them — remain the same whether analog, CR and DR. Ever been with a geriatric patient? It takes longer to get them in the room and positioned that it does generating the film, and that’s after telling him three times, “Turn to the left Mr. Jones — no, your other left” and then have him ask why he has to have this %&^*% x-ray when his #%^#&^ doctor doesn’t know what the ^&*(%*$ he’s talking about. In my next life I’m going to be a gerontologist. [laughs]

You’re on a roll.

There is massive confusion about CR vs. DR as well, and “pure” digital vs. analog vs. digital conversion. In a properly designed department, the difference between using DR and CR is about 30 seconds per procedure on a bad day. From a price standpoint, however, the differences are huge.

A single, moderate throughput CR reader costing $120K complete can be shared between two rooms, while DR is dedicated to a single room at a current cost of over $300K. $60K cost vs. $300K cost is a no brainer. Don’t have PACS? Even better — stick with film because your equipment cost is probably already fully amortized and we’re not Japan where they pay a premium for images generated digitally. The reimbursement for a general radiographic exam generated in analog or digital form, CR or DR, is exactly the same here in the US and it takes a whole lot of cases at $1.50 a case in film costs to justify either imaging modality on film costs alone.

I hear my detractors now — blasphemy! Burn him at the stake! What about tech costs? My answer: what about them? If you do two procedures per day or 30 procedures per day, one technologist should be able to handle it all. Volume increases? General radiographic procedures are generally declining in most facilities at a rate of 2-5% per year, with CTs taking their place. Even where there is growth, it’s in the low single digits. So why do you even need CR or DR?

There are a variety of arguments for CR in a PACS environment, but for DR to succeed as well, the price point needs to be comparable to CR or at the very most no more than 15-20% higher. Either that or HCFA needs to start reimbursing for digital radiographic procedures over analog, similar to what they are doing now with digital mammography.

You done yet?

Just call me Howard Beale. “I’m mad as hell and I’m not gonna take it any more!” [laughs] Ok, I’m done — for now.

What do you think are the biggest obstacles to future PACs growth?

Probably getting buy-in from all levels in a hospital. PACS is such a complex sale, yet more than 90% of the sales made today aren’t made based on what is the best technical solution for a facility, but based on political decisions. The squeaky wheel syndrome, so to speak.

Such as?

Ah, yes. Another thing no one wants to ever talk about in public, but we all know how politically correct you and I both are, so do I care? [laughs] We can spend days, weeks, months, or years doing technical assessments on a vendor, but if the chairman of the department doesn’t like the vendor you’ve selected, rest assured, it’s not going in. The same can be said for any number of key players on the “team” whose vote equals 51%. I’ve lost many a night’s sleep over situations like this one — not.

If that is the case, why even bother with an RFP?

I’ve asked that same question of my clients and was chewed out recently for asking if putting an RFP out on the streets was a CYA move for them. In hindsight, maybe I shouldn’t have e-mailed it, but … if the decision is made for a vendor already, let’s do a technical spec, send it out to the vendor of choice, and save a bunch of time and effort on our part, not to mention vendor’s time.

People will do whatever it takes to save their jobs.

Thank you for the reminder why I’ve been on my own for the past 25 years.

Are you this blunt with clients?

Clients pay me to provide them with informed, objective information and to get them the answers they need so they can make informed objective decisions. If they elect to make a decision that is politically motivated, that is their choice. I still get paid the same amount.

All I ask them is to give me the opportunity to protect them with a fairly tight contract so that when their choice fails, they have some recourse other than pointing to the consultant. Kevin Costner took the bullet for Whitney Houston in The Bodyguard. I’m not paid that much, nor are most of my clients as hot as Whitney either. [laughs] PACSMan singing: “And eye e eye e eye will always love you.”.

Isn’t it your job is to help them make the right choice?

If you want “the right choice,” call AT&T — I think they own the trademark on those words, although years ago back in 1986 one of my last “real” jobs, where I knew I’d have a paycheck from week to week, I tried to sell an AT&T PACS product called CommView that was anything but the right choice. My job and that of my counterparts is to get them information so they can make the final choice, not I. No consultant worth his or her weight in salt will make a vendor or product choice for the client.

Even if that choice is glaringly wrong?

Even if, in my not-so-humble opinion, it’s a wrong choice. There are no wrong decisions, just decisions whose outcomes you wish might have been different. I’ve dated enough women to know that. [laughs] The only wrong decision in PACS is not making any decision at all and playing catch up for the rest of your life.

I let my sons make most of their own decisions all the time as long as their lives are not in danger. It’s how they learn. Many are right. A few had outcomes that we wish had been different. We then discuss it afterwards what they could have or should have done it differently and what the outcome might have been had we done it differently.

Unfortunately, if you don’t go with what the department chairman wants or someone in administration wants, what was ostensibly the right decision will turn out as the “wrong” decision and can be just as devastating career-wise as blowing $2 million of the hospital’s money on a dead-end PAC system. End users need to take a combination of the Taco Bell and Nike approach — “Think outside the box” and then “Just do it.”[laughs]

Is there a  best vendor?

I wish there was a single vendor who was the best solution for everyone. I’d be working for them now. I wouldn’t last long in a structured environment, but it might be fun to try again.

Most vendors offer fairly solid solutions to customers’ needs. Finding sales reps who can properly articulate what those solutions specific to the client is another story, however. Vendor A’s products may “bring good things to light” but if they can’t articulate how their product meets their needs better than vendor B, vendor B will no doubt get the sale, provided of course that vendor B also has the political support behind them as well. There are no bad vendors or products — just lousy product specialists and sales reps and customers who don’t listen.

And politically correct consultants.

As Curly in the Three Stooges would say, “Why sointenly!!” I’ve had some great discussions with some on the men in my men’s group at church on how Jesus was both politically correct and politically incorrect depending on the situations He was in. I like to think I’m the same way. [laughs]

In this business, you have to believe in God because you’re always calling out His name in one way or another, thanking Him when things go right and invoking His name in so many different ways when things don’t. [laughs]Would you believe I run a sports ministry in my spare time for the past ten years now? If I were to hit the lottery, I’d probably be a stay at home dad with my sons, run the sports ministry full time, and do PACS consulting as a sideline.

News 3/17/10

From Harvey: “Re: CPSI. The small/rural hospital market has been dead money for years. However, the QSII/Opus deal may mark the start of a land grab there. Rumors are that Francisco will either IPO or sell Healthland this year, which tells you that there is demand for assets in this sector. My guess is that almost everything’s for sale in that space, including HMS and the indifferently-managed CPSI. Would love to see an interview with Francisco’s Ezra Perlman. He’s been a major mover and shaker, but rarely discusses HCIT publicly.” I agree (and I would be up for that interview). I overheard conversations at HIMSS about that largely untapped small-hospital market and some interesting players were named as being well positioned, such as IntraNexus.

From ZenSocrates: “Re: McKesson. Mike Myers, the McKesson executive responsible for the Clinical Documentation/Physician Order Entry product and a true pioneer of HIS, has announced his retirement for this July. The concern is that McKesson could not name a successor at the time of the announcement. As a customer, this concerns me greatly!!” Unverified.

From MckHappy: “Re: McKesson. McKesson and Jeremy Chandler are finally implementing the changes they had promised within the Horizon team. Mike Myers has announced his retirement effective July 1. Jim Nemecek is no longer VP over ambulatory. Cem Tanyel from Unisys will be named as the new head of development. Gerry McCarthy will add ambulatory to the physician solution line. The internal release focused on integration and eliminating the politics — errr, I mean development silos. Rumor going around is that portal and ambulatory development will be centralized in Boulder. The ARRA-certified release was shipped on-time to the pilot site last week.” Unverified, but if true, I wasn’t the only one observing the development silos and lack of staff stability.

From William Tell: “Re: HIMSS. I guess from what Lieber says, HIMSS is all things to all people.” An article quotes Steve Lieber as wanting to push into life sciences and payer markets, medical banking, PHRs, and workforce. I can only imagine the confusion as everybody tries to sell something to everybody else at the conferences. And in related world domination news, HIMSS Analytics is now working in Europe.

From Dickie Smothers: “Re: HIPAA. Check out 42 USC 1320d-6, which defines ‘A person who knowingly and in violation of this part … obtains individually identifiable health information relating to an individual …’ The term “person” is defined (in the main part of 1320) as an individual, a trust or estate, a partnership, or a corporation. I’ve read that because the above section applies only for a ‘violation of this part’, it only applies to those otherwise covered by HIPAA (since anyone else couldn’t ‘violate’ the provision). However, the HITECH changes in Section 13409 of the Act seem to broaden the applicability. Don’t think it was effective, however, last Thanksgiving. Nevertheless, a bright federal prosecutor could make a conspiracy charge or bribery charge stick if he/she wanted to. Just my opinion.” This relates to the story I mentioned in which a gossip site supposedly made 6,000 calls to the hospital Tiger Woods was in, trying to wangle his medical records from anyone willing to spill the beans for cash.

From Jack Flash: “Re: athenahealth. This is a very entertaining and insightful interview of a slightly buzzed Jonathan Bush at the HIStalk party. Greatest quote of the interview, on being asked about Healthcare Policy — ‘I love Obama’s package. He looks great.’” Definitely a fun watch.

From Radiology Ralph: “Re: DR systems debut of Unity CVIS. You mean DR Systems does something other than sue other radiology vendors for its ‘416 patent infringement? Go ‘Dominator!’” Just in case anyone doesn’t know the back story, DR Systems filed a slew of lawsuits in 2006 claiming patent infringement of a PACS reading station feature: eRad, NovaRad, Emageon, Fuji, GE, Philips, Siemens, Kodak, and others.

From Stifler’s Mom: “Re: Medicare. Good article on that 21% Medicare cut that happened, then got fixed, while we were partying in Atlanta. I don’t know how many doctors wandering the exhibits halls were leaving their wallets in their rooms, but I would have. Even with the ‘fix,’ if I were a doc, I’d be too nervous and reluctant to be spending any big bucks. No one at HIMSS was talking about a 21% pay cut in their already low Medicare reimbursement!”

From Meaningful Abuse: “Re: HIMSS attendance. If only 30% (~8,357) of the registrants came from healthcare provider setting, where did the other 70% (~19,500) come from? Isn’t this a healthcare setting information technology show? Only 11%(!) of the registrants were CIO/CTOs? Was that 11% of the healthcare provider attendees or 11% of the total registrants? Same question about CEOs… So, who do the vendors want to talk with? C-level decision-makers, not mid-level IT managers or staff. No wonder HIMSS vendors are chafed about the money they have to spend for their chunk o’ concrete.”

Several readers asked about the lyrics to Dr. HITECH’s Meaningful Yoose Rap. They are here and they are excellent.

Now that we’re over the HIMSS hump, I’m interested in doing some new interviews (with provider-siders especially encouraged). Or, your guest articles are welcome (more of those from providers would be especially welcome). I’m finally to the point that I can get to them.

The HIMSS EHR Association weighs in on meaningful use and incentives. That response wasn’t detailed, but it apparently urged simplification, reduced requirements for data collection, and allowing only one document standard.  

Not to be outdone, Markle Foundation has its say on the same topic. Some of their ideas: (a) set explicit health goals; (b) make the quality measures list more focused; (c) add new measures for priority health goals; (d) get rid of the all-or-none approach to incentives to encourage improvement without requiring hitting 100% of the proposed requirements; (e) streamline some of the calculation-heavy functional measures; (f) make electronic reporting requirements simpler; (g) focus on easy measures that improve patient engagement; (h) clarify that a secure download of patient information is acceptable; (h) get feedback into doctors’ hands quicker; and (i) clarify how hospital-based physicians can participate. I think they did a great job with good consensus and I would expect HHS to seriously consider their recommendations since they are less vendor- and product-centric and focus more on patients and providers. Kudos to them.

VA CIO Roger Baker lays it on the line for his IT staff: he’s happy to kill projects that miss deadlines or run into snags. That’s semi-good news for taxpayers, but the shining star of that policy cost a bundle, a failed patient scheduling application that cost $150 million.

In the UK, NHS’s medical director and NPfIT defender resigns his additional role as a director of an NHS software supplier after an anonymous blog commenter brings up the perception of a conflict of interest.

Jobs: EHR Business Systems Analyst (WA), Clinical Exec Physician – Sales Support (GA), Epic Revenue Cycle Manager (FL), Client Training and Support Specialist (MA). Some pretty good jobs are up on Healthcare IT Jobs, so take a look.

Akron General Health System signs an $11 million clinical systems upgrade contract with McKesson, including CPOE and Practice Partner.

A survey finds that 12% of employees knowingly violate IT department policies “in order to get their work done.” The survey appears to encourage outrage at irresponsible users, but IT policies that impede individual productivity in the never-ending quest for risk reduction should probably share some blame.

McGill University Health Centre launches its PHR, Unani.ca.

E-mail me.

HERtalk by Inga

After placing its EHR project on hold for a year, Sutter Health announces plans to spend $400 million and accelerate its Epic implementation over the next five years. Sutter intends to take five of its affiliated hospitals live on its Epic EHR in 2011. The health system has already rolled out EHR to the majority of its physician offices, as well as its Mills-Peninsula Health Services facility.

Preliminary registration numbers from HIMSS10 indicate attendance was up across the board. Professional registration grew 9% over 2009, though the total registration number was only 2% higher than last year.

The deadline to file comments on the latest meaningful use and certification criteria is now past, but not before multiple organizations filed last minute comments. CHIME, MGMA, CCHIT, and the AMA were just some of the many groups to submit public comments before the March 15th deadline.

CCHIT, by the way, says it is suspending any initial or incremental modular testing until it has an accredited Stage 1 ARRA test script to use. A note on its Web site also indicates that CCHIT is “confident” about its prospects for becoming accredited. Meanwhile, Drummond Group reaffirms its desire to be certified as a authorized testing and certification body and is making internal preparations in order to be ready for EHR testing later this year.

Columbia Basin Hospital (WA) agrees to outsource its IT support to Phoenix Health Systems and implement Phoenix’s Total IT Solution service line. The offering includes the implementation of Medsphere’s OpenVista EHR.

Meridian Health (NJ) selects ICA’s CareAlign solution to connect its five hospitals and its affiliated healthcare companies.

After delaying the release its numbers, athenahealth posts a decline in profits and jump in revenue for Q4 and 2009. athenahealth restated its financials going back to 2005 as a result of an internal accounting policy review, initiated by the company, and related to the timing of amortization for deferred implementation revenue. For Q4, revenue grew 33% over 2008’s numbers to $54.4 million. For the year, revenue jumped 38% to $188.5 million. Reported GAAP net income, however, fell 84% to $4.3 million in Q4, compared to $26.8 million a year ago; annual net income fell from $31.5 million to $9.3 million. The $.17/share earnings were in line with analyst expectations.

UMass Memorial Health Care selects Picis CareSuite for its five hospitals.

Wayne State University Physician Group (MI) contracts with NextGen Healthcare to deploy NextGen Practice Solutions. The 540-physician group already uses NextGen EHR.

Holland Hospital (MI) plans to implement the InterSystems Ensemble platform as its enterprise integration engine. The hospital plans to connect multiple systems across the facility and integrate its EMR with affiliated physician groups.

St. Joseph Medical Center (TX) implements Webmedx’s dictation and transcription platform, apparently within three days of a crash of its legacy systems.

Vitalize Consulting appoints Tim McMullen its executive VP of sales. McMullen most recently served as a VP at maxIT Healthcare and was a national VP and partner with First Consulting before that.

HIT consulting firm maxIT and the the medical device experts at Anson Group combine forces. The companies sign a partnership agreement aimed at providing vendors and providers expertise in the implementation of regulated medical devices connected to EMRs. Sounds like great timing, given the recent attention on EMRs and their possible regulation by the FDA.

CareTech Solutions signs a five-year infrastructure outsourcing agreement with Sibley Memorial Hospital (DC).

BCBS of Minnesota makes a bit of a mistake, accidentally publishing a customer’s personal medical information it a handbook for 95,000 members. The woman is now filing suit for the breach of privacy and violation of the Minnesota Health Records Act.  Her attorney calls it “one of the most blatant and egregious violations of medical privacy” that she’s ever heard of.

E-mail a limerick to Inga.

CIO Unplugged – 3/15/10

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Connected Health
By Ed Marx

One of my favorite preteen games was Connect Four, the vertical checkers game. The objective is to be the first to connect four of your checkers in a row. I often played it with my children when they were young, and inevitably one of them would bump the catcher base prematurely and send all the checkers rolling onto the table and floor. But, oh, the fun we had playing.

I’m now playing a new kind of Connect Four. I am not sure who first coined the term connected health, but I like it. Where my organization has labeled our mobility strategy “mHealth,” we call our connected health strategy “cHealth.”

“But,” you ask. “Is this really a strategy worth my promoting efforts?” What about the whiners and traditionalist? What about the departments that insist on doing things their way?

This is a do or die reality. In Going Mobile, I argued that we must drive mobile computing into our strategies or risk getting lost in backwoods roads and putting our organizations at a serious competitive disadvantage. A twin sister to mobility is connected health.

In his sentinel book “The Innovators Prescription,” Christensen advocates dropping the private-public debate. He says we need to disrupt the way in which healthcare is delivered today. He points out that the way to cut costs is to put care and insurance in the same bed. Emerging models include Accountable Care Organizations (ACO) and the medical home. Each of these requires the four traditional silos—hospitals, physicians, payors, and patients—to break down barriers and act as one entity for the sake of patient centered care.

Essentially, to Connect Four.

Today, healthcare suffers under a fragmented care network. Embedding connected health into our hospital’s strategic thinking and summarily executing that strategy will set future success in motion. And yes, we’ll have to brave those who try to tip the catcher base and disconnect all our checkers. But may we never be the cause of IT atrophy!

Health Information Exchange (HIE), while critical, is not the same thing as “cHealth.” Think of HIE as 1.0, and then bump “cHealth” to 2.0 status. HIE shares some common traits and can create the infrastructure, but “cHealth” disruptively advances the transformation of our healthcare ecosystem. The leader who settles for a business-as-usual attitude is probably stuck in HIE.

Let me give some “cHealth” examples. These are purposefully high level so not to divulge strategies specific to my employer.

Patient Portals
Personal Health Records
Mobile Connectedness
TeleHealth

• Between Physicians
• Between Hospitals
• Between Hospitals/Physicians
• Between Hospitals/Patients
• Between Physicians/Patients

Wellness Programs
Secure Messaging
Home Care
Remote Monitoring
Wireless Monitoring
Education
HIE
Payors

We all understand the fragmentation of healthcare processes and costs in existence today. “cHealth” provides alignment. By executing “cHealth,” we’ll have the connectedness necessary to actualize ACOs and Medical Homes—providing the highest quality of care at the lowest price point—Ultimate value.

Connect Four. Who would’ve guessed that we could learn so much from a kid’s game? Except now the stakes are much higher.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

HIMSS10: Party Like It’s 1999

By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make this editorial available from its newsletter.

Healthcare is different, everybody says, Well, it sure is when it comes to throwing the excessive bacchanal that is the HIMSS annual conference.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! Cocktail hour in the exhibit hall is just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

Monday Morning Update 3/15/10

From McMessy: “Re: McKesson report. The author of the report states ‘this channel check is not inconsistent with other checks we have made on MCK and its HCIT products.’ The client in the report indicated that its HERM implementation process started more than a year ago and may take another 18 months to complete. The hospital also said they are currently at HIMSS Stage 6 but that there are about seven Stage 1 criteria that the hospital still does not meet. Ouch!! Another ringing endorsement for HIMSS Analytics! Don’t you need to meet all the Stage 1 criteria before you can get to Stage 2-7?” Not really surprising considering the science fair of wildly different products that share the Horizon Clinicals nameplate, running decentralized development shops for what should be a single product suite, and never-ending employee turnover. But, it works fine in some places and some of their competitors have similar problems.

From The PACS Designer: “Re: HealthVault. Microsoft’s HealthVault application is now ready so that we can create our own PHR along with one for other family members. TPD has posted previously about Microsoft’s Silverlight application which is now part of HealthVault. Also within HealthVault is their Sharepoint application. If you have a Windows Live ID or OpenID you can use either ID to sign up.”

My FDA regulation poll drew quite a few responses, most of which expressed a belief that FDA will indeed step in to regulate healthcare IT in some form. New poll to your right: when a vendor has good news to announce in the weeks before HIMSS, should they announce it immediately, hold it until HIMSS week, or announce afterward? Most vendors hold their news until Monday of the conference, which I think is nuts, but you decide.

Speaking of FDA, it has set up a network of 350 hospitals and asked them to report problems with systems such as CPOE, EHRs, pharmacy systems, PACS, and others under its MedSun medical device safety network, according to a Huffington Post Investigative Fund article.

Inga already referenced Dr. HITECH’s Meaningful Yoose Rap, world premiered at the HIStalk reception at HIMSS, but I’ll embed the video again just in case you missed it. In case you didn’t notice, this was a flawless live performance by Ross Martin, MD, best known until now for his amazing Interoperetta.

And speaking of Inga, she did a marvelous job while I was R&Ring, don’t you think? I never thought I would find someone who could step right in, but we’ve been working together for three years now and she has blossomed wonderfully. I will apologize in advance for the likelihood that I will repeat something she has already mentioned since I’ve been out of touch for a week. Stats-wise, February barely missed setting an HIStalk record even though it was a short month, with 88,057 visits, 120,075 page views, and 5,346 e-mail subscribers. March is trending up. You contributed to those stats, so thanks for that.

As for me, I am rarin’ to go, batteries fully recharged and ecstatic to be back. And listening: Apples in Stereo, Denver-based power pop.

Inga mentioned that I was elated that former HBOC chair Charlie McCall is headed off to prison, which is true. Finally I can quit gritting my teeth when inserting “alleged” in in describing the massive fraud with which his train wreck of a company blighted the industry (although McKesson gets an assist for corporate stupidity in buying him out). It now looks like the decks have been cleared for McKesson to sue him for restitution, which would win them points in my book.

Community Health Solutions of America signs up for MEDai’s Risk Navigator, a predictive modeling suite that identifies high risk patients and tools to manage them.

InterSystems acquires its Italian healthcare implementation partner Prosa.

Former Shands CIO Bill Montgomery is named CIO of Hospital Sisters Health System.

Interesting: when Tiger Woods ended up in a Central Florida hospital, tabloid site TMZ made over 6,000 calls to the hospital within a few hours, dialing every possible number trying to find someone who would provide information. It even offered bribes to hourly workers hoping to get his medical records, the hospital said. It worked — the hospital fired several employees who accessed his records. I’m pretty sure nobody’s HIPAA policies could withstand that kind of attack. Nor am I sure why trying to get someone to violate HIPAA isn’t itself a punishable offense.

I don’t know where Weird News Andy finds this stuff: a Dutch nurses’ union launches a national campaign to remind the citizenry that its members do not routinely provide sexual services to patients. The “I Draw the Line Here” campaign was created after a female nurse observed co-workers offering gratification to a disabled male patient, who then tried to dismiss her because she would not do the same.

CTIA Wireless 2010, in Las Vegas next week, is running an Everywhere Healthcare 2010 track with some good sessions.

Hopefully everybody’s Daylight Saving Time switch went OK.

The Nashville Medical Trade Center, hoping to become a center for healthcare industry events, tried to use the HIMSS conference as a launching pad to get business tenants, but doesn’t seem to have had much immediate success according to this article.

DR Systems will debut its Unity cardiovascular information system this week at ACC.

The unSummit on point-of-care bar coding will be May 5-7 in Atlanta. 

Deborah Peel, MD is the subject of the cover story in Managed Healthcare Executive called Locking down privacy: where do we draw the line? “All 55,000 pharmacies in the United States are data-mined daily, and our identifiable prescription records have been sold for over 10 years. The theft of prescription information is why Congress was persuaded to include the ban on the sale of protected health information in the HITECH bill. I think that the industry is in denial because there is a huge, essentially unknown data-mining industry for health information."

The guys from the Access barbeque team sent over this picture, which has convinced me they should set up the smoker in the parking lot of the Orange County Convention Center at next year’s HIMSS conference. Give a prospect a plate of pulled pork and a beer and he will listed to what you have to say.

E-mail me.

News 3/12/10

HERtalk by Inga

From: Scoopy Sales “Re: Janet Dillione’s resignation. I see HIStalk scooped everyone on this and the ‘news professionals’ are just now reporting the story.” Ha! Mr. H will like that comment. Thanks again to the reader who tipped us off last Friday about Dillione’s resignation as CEO of Sieman’s HIT division.

From: PACSMan “Re: Dillione. I know you had run this yesterday but this confirmation came across just now. The timing is beyond strange- she gives a press conference 3 weeks ago, speaks at HIMSS and even has the damn thing podcast and now eaves to ‘pursue other opportunities’ after 27 combined years at SMS and Siemens. Something gives here- and I bet it ain’t pretty a ’tall….”

From: Mrs. Kravitz “Re: McKesson report.The recent Leerink Swann HC equity research report reads badly for McKesson. After talking to a CIO at a large client base they are pessimistic on McKesson’s ability to get to Stage 1 meaningful use; HEMR and Horizon Clinicals v10.3 still not GA despite representation to the contrary.” I don’t have access to the report. If you have an opinion, chime in.

I noticed that ComputerWeekly also  picked up a reader-supplied rumor, this one about a recent director-level resignation at iSoft. ComputerWeekly actually quoted HIStalk, then added iSoft’s confirmation that Keith Kirtland left for “personal reasons.”

Five Alegent Health hospitals implement Design Clinicals’ MedsTracker for electronic medication reconciliation. The CMO claims that an impressive 100% of the hospitals’ admissions and discharges were reconciled electronically on day two of the go-live.

The ONC publishes its proposed rule establishing two certifications programs to test and certify EHRs. CCHIT will not be granted grandfather status for testing, though they will likely be one of only a few organizations ready and able to qualify under the new program. Organizations wanting to qualify as an “ONC-Authorized Certification Body” for the “temporary” program would be required to submit an application and demonstrate its competency to test and certify EHRs. The temporary program could make it possible for full EHRs and EHR modules to secure certification as early as this summer. The temporary program would expire the first quarter of 2012 and replaced with a permanent program run by an outside certifying organization.

Children’s National Medical Center (DC) plans to implement Streamline Health’s Audit Integrity Manager Solution.

St. John’s Hospital – Eureka (CA) deploys Order Optimizer’s web-based clinical platform, allowing physicians to use evidence-based protocols at the point of care.

I see the folks at EHRtv have begun posting their vendor executive interviews from HIMSS. Dr. Eric Fishman poses some great questions to leaders from Nuance, M*Modal, Allscripts, Eclipsys, and NextGen in these face-paced and engaging spots.

The 17-physician Mountain Region Family Medicine (TN) completes its installation of Greenway’s Prime Patient EMR, with deployment assistance from BCTI and OnePartner.

Detroit Medical Center awards MedQuist a contract for transcription outsourcing services. Medquist will provide ED documentation at six of the health system’s facilities.

Rush University Medical Center (IL) agrees to pay more than $1.5 million to resolve a federal lawsuit. The suit alleges Rush violated the False Claims Act in connection with improperly designed leasing arrangements with several physicians.

DR HITECH live at Max Lagar’s in Atlanta, rapping about Meaningful Use. Doesn’t get better than this!

Weird News Andy sends over this story, which is actually more disconcerting than weird. The NHS, as it continues to create its national database of patient medical records, is suppose to give patients an opt out option before their information is added. Instead, doctors claim the government is rushing the project through and  patient information is being uploaded before  patients have a chance to object. Doctors also claim the government is not adequately educating patient on the database project, nor making the opt out option easy enough for patients to select.

The VA is busy working on Aviva, the next-generation version of its 20-year-old VistA EMR. Aviva is designed to be Web-enabled, modular in design, and capable of easy data exchange with other EMRs. Peter Levin, CTO for the VA, compares the project to “trying to replace a tin can on a string with a cell phone system.”

A former MedAssets contract employee, who used a fake identity to get her job, is accused of accessing the financial information of up to 2,400 patients. UTMB was a MedAssets billing service client at the time and Katina Rochelle Candrick is believed to have gathered social security numbers, dates of births, and credit card information on UTMB patients. Candrick has since been arrested.

In case you missed the actual HISsie Awards presentation, check out the presentation we ran at the reception last week. It’s loaded on SlideShare and apparently the transitions only work if you download it to your system. You’ll want to download it to fully experience the fun – as well as identify the winners and see the pie hit the face of a certain CEO. There is likely some way to post the slide show and have the transitions work correctly, but I am too lazy and too short on time to figure it out.

Provena Health (IL/IN) signs a seven year agreement with ARAMARK Healthcare. ARAMARK will provide clinical technology services for Provena’s six hospitals.

The folks at Surgical Information Systems asked me to let readers know they’ll be at the AORN meeting next week in Denver. If you’re attending, check out their session “Creating a Unified PeriAnesthesia Medical Record to Improve Clinical, Operational, and Financial Outcomes.”

Inova Health System (VA) names Ryan Bosch, MD, FACP, MBA its first Chief Medical Information Officer. Before joining Inova, Bosch worked as Director of General Internal Medicine at George Washington University Medical Faculty Associates.

Stemp Systems earns Preferred IT Vendor status from eClinicalWorks.

The public continues to weigh in with opinions on the latest meaningful use definitions. CMS posted a few additional comments last week and folks are still concerned that the bar is set too high, especially in the early years. The note below questions the exclusion of CPOE in the ED when measuring the total percentage of electronic order entry in a hospital:

The current proposed definition of meaningful use seems to exclude the use of CPOE in the ED as a measure of determining the current percentage of electronic order entry within the hospital setting. That doesn’t make a lot of sense if the purpose of the graduating meaningful use criteria are intended to promote and reward a hospital’s progress in deploying CPOE. Many hospitals will start with the ED to deploy CPOE because of it’s complexity and workflow. The current proposed definition will not recognize those organizations who are making good progress with CPOE simply because they may have started in the Emergency Department. That seems counterintuitive and not within the original spirit of advancing CPOE deployment to 100% within several years. In other words, who cares where an organization starts its deployment as long as progress and total percentages are actually achieved.

Mr. H is back home sometime this weekend. As gratifying as it is to know that HIStalk can stay afloat a few days without him, no one will be happier than me to have him back in charge, especially since he makes HIT so much more fun.

E-mail Inga.

News 3/10/10

HERtalk by Inga

From: Sioux Supporter “Re: Janet Dillione. I can confirm that Janet Dillione has resigned from Siemens. No announcement of new role or firm, but the announcement was made Friday.” Still unconfirmed, though a few readers have sent note with similar messages.

From: Big Mouth “Re: iSOFT. iSoft loses another senior executive from it’s flagship business unit. Just confirmed from internal source that Keith Kirtland, UK&I Commercial and Sales Director resigned earlier this month. This is the 4th sales director in as many years and is expected to have a destabilising effect on both the Wales Lab deal and overall sales in the UK for this troubled NPfIT supplier. In February,  iSOFT reported significant drops in both revenue and profit.  This resignation will certainly impact 2nd half results.”

From: Beauty “Re: Press Releases. To Beastly – I see you are putting the spin on the negative. Any which way you slice it – too many press releases = too little bang…leaving out ‘for the buck’ cuz we know you are still pulling down the bucks. Too much noise at HIMSS…and those who would be interested are too busy ‘doing’ HIMSS. As for me – I deliberately launched product before HIMSS…with press release…specifically to avoid the noise and being one of the 100 needles lost in the haystack. Hmmm – opinion of the those who are in the business of press releases…or those of us targeted by the press releases?  Listen to your audience. Let’s have a HIStalk vote on this one!” Personally I am just happy that it took less than a week for me to finally weed through all those releases.

From: William Tell “DoD and VA disconnect. Nice to know CPOE and electronic records are going to solve everything . . . as if.”

From: Curious “Re: Promise Healthcare. I am curious about your opinion of them.” Alas, I have no opinion since I know nothing about them. In the absence of the ever-wise Mr. H, perhaps readers can weigh in.

From: Emily Dickinson “Re: Medical Manager execs guilty. Two former executives of Medical Manager Health Systems Inc. have been convicted of federal securities fraud after a two-month trial in U.S. District Court in Charleston, SC.” The company’s former VP and COO John P. Sessions and former president John H. Kang were found guilty of conspiracy to commit mail, wire and securities fraud for their part in a scheme to inflate Medical Manager’s earnings by more than $16.8 million between 1997 and 2003. Sentencing will occur at a later date.

From: Mr. H “Re: Charles McCall heading to prison.That news made my day.” Really? I get one email from Mr. H in four days, and this is all he has to say. What’s up with that?

Quest Diagnostics and Surescripts team up to form an integrated service that combines lab and prescription information available to connected physicians. I suppose that means that if my grandmother in Washington goes to a doctor in Florida, the Florida doctor might be able to access Grannie’s lab and prescription data. Now we are getting somewhere.

Surescripts, by the way, reports that e-prescribing rates tripled from 2007 to 2009, with an estimated 18% of all eligible prescriptions now being sent electronically. The number of prescribers routing prescriptions doubled from 2008 to 2009, and now includes 25% of all office-based physicians.

Huntington Memorial Hospital (CA) plans to offer HuntingtonRx, a branded version of Allscripts stand-alone e-prescribing solution, to its 1,000 affiliated physicians.

Five hospitals select Summit Healthcare as their sole integration partner to assist with migrations from current Meditech platforms to Meditech 6.0.

Annapolis Pediatrics selects Sage Intergy suite to automate its clinical and financial operations. Annapolis Pediatrics is a four-location, 21 provider group.

Trinity Health (MI) deploys Medicity’s Novo Grid solution, establishing an HIE between almost 1,000 affiliated physicians. The headline of the press release claims this first stage took “9-1/2 weeks,” which happens to be the same amount of time it took Kim Basinger’s Elizabeth to walk away from Mickey Rourke’s John.

Sisters of St. Francis Health Services (IN) select Epic for its 13-hospital system.

Northwest Hospital & Medical Center (WA) contracts with dbMotion to create an interoperable patient record for both in-hospital and ambulatory care providers.

UPMC introduces an EHR application that runs on a BlackBerry smartphone. The program leverages the interoperability platform created by dbMotion and provides a single view of key patient data from multiple information systems.

Henry Schein launches ConnectHealth, which partners companies in the EHR, medical device and computer services sectors. Specifically it sounds as if the new program leverages Henry Schein’s partnerships with several vendors to implement EMR in physician offices. Partner vendors include Allscripts, Midmark, Welch Allyn, Siemens, Dell, and Medline.

The nice folks at Bridgehead Software have invited me to visit their booth at the World of Health IT event in Barcelona, March 15-18. Bummer that I have a manicure scheduled during that time so I will have to miss the event. If you are attending, visit the Bridgehead team at Stand #841 and sign up to win an iPad.

Speaking of Spain, Gestion Sanitaria de Mallorca in Palma selects Orion Health technology to serve as the backbone for its EHR. The EHR solution will be the first for community care in Spain.

We have a new interview on HIStalk Practice with Dr. Joel Feinman of Valley Medical Group in Massachusetts. He’s an EMR proponent on many levels, but especially in terms of providing patient care: “I don’t see how you can do that anymore without some kind of electronic system that actually works.” Check it out and sign up for e-mail updates while you are there.

Today I joined a conference call with the wonderful sponsors of last weeks HIStalk reception. After accounting for walk-ins and a few no shows, total attendance was about 430, making it our biggest bash ever. Thanks again to Encore, Evolvent, and Symantec for making it such a great event.

General Dynamics Information Technology hires Raymond Sullivan to serve as VP of HIT Solutions, tasked with business development for the federal government and commercial health organizations. Sullivan was previously executive director of the VA’s Office of Information and Technology.

Hospital nurses estimate they spend a quarter of their 12-hour shift on indirect patient care. Wow. While not providing direct patient care, nurses are working on regulatory requirements, handling lots of paperwork, and securing needed equipment and supplies. Solutions recommended by surveyed nurses include more ancillary staff support, better hospital-wide communications technology, and reductions in redundant regulatory requirements.

Anne Arundel Medical Center (MD) implements Corepoint Integration Engine to facilitate a migration to Epic’s HIS and improve clinical data exchange with community physicians and patients.

In what could be the greatest news of the decade, a report in the Archives of Internal Medicine finds that normal-weight women who drink a light to moderate amount of alcohol appear to gain less weight and have a lower risk of becoming overweight and obese than non-drinkers. On that note, I’m off to find a cocktail.

E-mail Inga.

HITlaw 3/9/10

Non-Compete Agreements

Non-compete agreements (NCAs) are designed to prevent individuals from leaving a company with valuable information and then using that information in a new job with a competitor of the company to the detriment of that original company/employer.

Sounds reasonable on its face. On the other side, what if you are the employee that with no malicious intent whatsoever, elects to change jobs and move on to bigger and better things? You should be free to do so, right? If on exiting your current job you are presented with the NCA that you signed when starting (and may have forgotten or misplaced) and you are a valuable developer, your soon-to-be former employer may be dropping more than a subtle hint in your lap.

So what is fair and reasonable in light of the two justifiable yet opposing positions?

This is the essence of the determination that courts must make in cases involving NCAs. In general terms, in order for an NCA to be “reasonable” it must protect an employer’s legitimate business interests while not unduly restricting the employee’s ability to work elsewhere. Other key considerations are length of time and geographical area (historically). The first part, protecting legitimate business interests, is satisfied if the employee involved had access to trade secrets of the former employer. Further, if the employer uses NCAs for only certain employees that have access to confidential material or trade secrets, they strengthen greatly their likelihood of support from the courts. As for length of time, six months to two years depending on the situation, is usually found to be acceptable. Anything longer than that would require a stiffer business reason for the restriction. Finally, geographic scope is considered. In the technology industry however, geographical area could include the entire US market. There has been some relaxing of the geographical scope restriction, which is why I used the parenthetical “historically” above.

Note that the NCA is a contract. All contracts must have “consideration”, or something of value, offered by each party and consequently accepted by the other party in order for the contract to be valid. If the NCA was a condition of employment at the point of hiring, then the promise of a job fills the consideration requirement. Introducing the NCA in an existing employer/employee relationship is different. Some courts have held that continued employment is sufficient consideration. In other cases, the execution of the NCA in conjunction with a raise or promotion has served to establish that sufficient consideration is present to enforce the NCA. An employee faced with the new (post-hiring) NCA requirement may not have any reasonable opportunity of negotiation. Some may however. If the employee is a valued software scientist, then ideally that individual could seek a severance package, providing an amount of money sufficient to offset the period of time in which they are prevented (by the NCA) from working in the same field for a competitor. As a general statement, the employee should always review the NCA carefully, even seek legal advice, in order to determine the restrictions imposed and the reasonableness of those restrictions.

The employer should make sure it is seeking to protect a legitimate business interest, and NOT just that it does not want competition. Lack of a justifiable business reason could be argued in the case of an employer having all employees sign an NCA, regardless of position, from receptionist to software engineer. Limited duration and geographical area are also helpful. An NCA of unlimited duration, where the employee can never work for a competitor, would work against the employer. In short, if the employer is careful to make the NCA as tight in scope as possible, in order to make the burden on the employee as little as possible, then they are in much better shape if the NCA is contested. If an NCA is too broad and lacks a sound business reason, its enforceability is strongly suspect.

Where a valid NCA exists, the new employer may also be susceptible to legal action by the former employer. Employers that lose key personnel to competitors often bring action against both the former employee (for violation of the NCA) and the new employer (for tortious interference with the prior relationship evidenced by the NCA). It is not unheard of for a new employer (that lures the key employee away) to belly up and take care of the employee’s anticipated defense, legal bills, and settlements with the former employer. I am not trying to scare people, but it should be understood that if an NCA is valid and you breach it, you are potentially liable for damages to your former employer. In addition, the former employer could seek an injunction preventing you from working for the new employer while the case is decided. Finally, if everything goes the former employer’s way, you could still be prevented from working for the competitor into the future. If you are the employee considering a job change and you asked directly if you signed and NCA, then obviously you must reveal the fact. If not asked and you do not volunteer the information, and the former employer sues the new employer, then the easiest way for the new employer to reduce its exposure is to terminate you. Not a welcome thought.

An interesting twist to consider is the situation where the employer terminates the employment relationship. Assuming that the NCA is valid and reasonable (see above), and would probably be upheld if the employee were the one terminating the relationship, then the issue really comes down to a restriction on the employee’s ability to make a living when the employer terminates employment other than for cause. Keeping in mind that we started with the assumption of a valid NCA, then strictly speaking, the employee is not free to ignore the NCA and the former employer could sue the employee, but then the court would have to look at the fact that the employee did not leave voluntarily and determine the reasonableness of limiting that individuals livelihood. My point is that being “let go” does not nullify the NCA, but enforcement by the former employer will be more difficult than if the employee left on their own.

Note that NCAs should not be feared, but they must be understood. In the HIT industry companies invent things and they try to sell more of these things to the industry than their competitors. They have a right to protect their inventions, know-how, trade secrets and customer bases. Anyone seeking to join such a company really should understand this going in. That said, it is not reasonable to expect a person to work for only one company in a given industry for their entire career. Some do, most do not. There is also the consideration of the type of work that the employee performs. The software scientist should have far more expectation of restriction on the ability to switch to a competitor than an administrative staff member.

Final Comments:

NCAs are not bad. If a company has something worth protecting, something essential to its business that if shared with a competitor would be damaging to its business, then they should be able to protect it. I don’t know how an employee would consider it “OK” to take that information elsewhere. I know it happens, but that does not make it right. Separately, we are all free to work wherever we choose. Absent the malicious factor, people should not be restricted from working for a competitor.

The problem is that you cannot unlock the brain of a software scientist, extract all they have learned at your company, then let them go on their way. Knowledge is retained and there is nothing we can do about that. I once saw it referred to by a BIG hardware/consulting company as “intellectual capital” (and I knew it was time to put that file down for the day). So even if nothing is physically removed, the secrets go right out the door in the scientist’s gray matter. Keeping them from using that knowledge to a competitor’s advantage is fair. Keeping them from earning a living doing what they like is unfair. It is a balancing act, a weighing of the consequences to each side, and a determination of fairness that the courts must perform when ruling on NCAs.

Please understand that even though I expound on valid or enforceable NCAs above, you must note that certain states basically do not permit NCAs (like California), others do but only in limited circumstances (New York and Virginia), while in others enforceability depends on the circumstances. This article has focused mainly on the individuals involved in the technology aspect of healthcare. Many states (like Massachusetts) clearly prohibit by law NCAs for physicians and nurses due to the fact that such agreements restrict a medical professional’s right to practice and also limit the patients’ right to choose their caregivers.

The NCA issue is heating up. Legislation has been proposed here in Massachusetts that would dramatically restrict NCAs by instituting strict guidelines, brightline determinations (clear “black & white” language) as well as safe harbor provisions. One very interesting aspect of the proposed legislation is that it would protect the employee residing in Massachusetts, even if the employer is not located in Massachusetts. I am watching closely as the bill winds its way through the legislature.

Finally, if you are faced with a situation involving an NCA and have serious concerns, please consult with an attorney or your local US Department of Labor office.

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

Monday Morning Update 3/8/10

HERtalk by Inga

From: HIS user “Re: Rumor. (The CEO for the HIT business unit) of a (large, international technology company) has resigned. Heard from multiple direct sources at the company. Was announced there Friday.” The CEO was at HIMSS and had a press conference as recently as Monday. I sent a note over the weekend to the company but not heard back. If it’s true, I suspect the company will share the news Monday.

From: Bean Town Gal Re: Highlights. “We attended the HIStalk party and it was a highlight of HIMSS. Nice to be in the fishbowl; surrounded by friends and competitors — and truly enjoying it. Great vibe — thank you to the sponsors — the spinach & artichoke dip was yummy, GREAT to sit down and rest the paws after a very long day …. but most of all, the intrigue and credibility that you & Mr. HIStalk create, will keep us coming back again.  Truly appreciate what you both do. Kudos and …. Love the shoes.”

From: Beastly “Re: Press Releases. As PR professionals we are compelled to issue press releases when our companies bring new products to the market that are worthy of acknowledgment. A true PR professional knows the difference between newsworthy and wasting a journalist’s time. We also have an ethical responsibility to advise our clients if and when their perception of news doesn’t merit coverage. Issuing press releases about non-news compares to the ‘boy who cried wolf,’ syndrome. For many within the healthcare industry, HIMSS is our Super Bowl. The opportunity to showcase the products we developed, believe in and are proud of. The media and most importantly our customers expect to see us with our best game. Companies don’t indiscriminately issue press releases – they plan product releases so that they coincide with HIMSS. If a product is ready two months before HIMSS, the HIMSS exhibitor companies traditionally wait for HIMSS to show and announce it.  And if the product won’t be consumer ready until a few months after HIMSS, the exhibitor will often develop a mock-up or engineering sample so it can be shown to the audience at HIMSS. The majority of us aren’t trying to waste your time; we’re inviting you to share our exuberance.”

From: Pat Avatar “Re: HITmen event. I was unimpressed with the “boys club” HITmen event. I think it was very unimaginative. Same people named over and over. A while back, Colin Powell was quoted along the lines of if any area was in need of imagination, it was healthcare. If we keep trotting out the same handful of people – we are truly in trouble. Enough of Tullman, Bush, the government appointees who are elevated only by title and not by progress, Halamka, and the usual short list. Why not have someone meet the challenge of recognizing the worker-bees – the ones really getting the job done – while the same people are the headliners. Besides, Inga and I are going to take over the world of healthcare and get something done.”

Note sure that I am going to take over the world of healthcare (or that I want to) but I am taking over HIStalk for the week. An exhausted Mr. H is taking took some well-deserved time off and hopefully cleansing his mind of the HIT world. If you have any news to share, be sure to send it my way since Mr. H is avoiding e-mail this week.

Last week MS HUG and Microsoft announced four winners of its annual Innovation Awards. SingHealth earned honors for the best use of inpatient clinical records use for levering its implementation of  Eclipsys Sunrise Patient Flow and CADI Scientific. Other winners included Brigham and Women’s Hospital, Doylestown Hospital, and Premera Blue Cross/Get Real Consulting.

Former McKesson Charles McCall is sentenced to 10 years prison and ordered to pay a $1 million fine for his part in a $8.6 billion fraud scheme.

Medicity and Emdeon collaborate to create the first “converged national HIE, leveraging Emdeon’s network of payers, providers, and pharmacies and Medicity’s iNexx Health 4.0 platform.

The Advisory Board Company enters an agreement to acquire Concuity, the healthcare-focused RCM software and services division of Trintech Group. Price: $34.5 million.

The Wall Street Journal reports that shares of Nuance Communications rose 5.7% Friday on rumors that Google is interested in buying Nuance Communications. There are lots of reasons why such a marriage would not make sense, but an acquisition of Nuance would certainly help Google increase its presence in the healthcare space.

McKesson is named the “World’s Most Admired” company in healthcare wholesalers sector in a survey by FORTUNE magazine and the Hay Group.  McKesson also made Corporate Responsibility Magazine’s list of 100 Best Corporate Citizens.

Start queuing up at your local Apple store: the Wi-Fi-enabled iPad goes on sale April 3, with pre-ordering starting March 12th. Suggested retail prices will range from $499 for the 16B model to $699 for the 64GB. The 3G equipped models will hit the market in late April, though you can also pre-order starting March 12th.

Lumetra PSO agrees to provide iSOFT’s AIMS incident management software to US healthcare organizations.

Bridgehead software unveils preliminary results of its Data Management Healthcheck 2010, reporting that only 6.5% of respondents use cloud storage as the destination media for their organization’s data. Only 33% say they are planning to adopt a cloud storage strategy for any data over the next 12-24 months. The biggest concern is security and availability of data using a cloud strategy.

A couple HIMSS education sessions I missed: “A Big, Hairy Audacious” CPOE Goal, and, It’s More than Pizza! Improving House Staff Adoption of CPOE. I wonder if the presenter for the second one got any snack tips from Mr. H.

Former RelayHealth COO Jeff Bairstow joins Journal Register Company as CFO.

RWJF awards over $2.4 million to five research teams studying how patient-recorded observations of daily living can be captured and integrated into clinical care.

Wellmont Health System (TN) names Kent Perry CIO and VP and Dr. Troy Sybert chief medical information.

Verizon Business launches The Verizon Medical Data Exchange, a platform that gives transcriptionists an interoperable tool for sharing digitized patient notes.

A fan files suit against the Kansas City Royals after being hit in the eye – by a hot dog. The team’s mascot (Sluggerrr) regularly fires hot dogs into the crowd, but one last year hit John Coomer in the eye, resulting in a detached retina and cataracts.So far his medical costs have exceeded $25,000. It’s unclear whether Cooner actually ate the errant hot dog.

E-mail Inga.

Merge Healthcare To Acquire AMICAS

AMICAS has agreed to terminate its previously announced agreement with Thoma Bravo and instead has entered into a merger agreement with Merge Healthcare, the company announced this morning. Merge will acquire all outstanding shares of AMICAS in an all-cash deal valued at $6.05 per share, a 35% premium to Thoma Bravo’s offer and a 39% premium to the average monthly share price.

"We are very pleased with this significant positive step toward successfully combining these two great companies," said Justin Dearborn, Merge CEO.  "Merge and AMICAS have strong histories of innovation in medical imaging software, experienced employees and engaged customers.  As a combined company, our suite of health IT solutions will encompass a broad range of medical and biopharmaceutical imaging solutions to meet the needs of today’s medical imaging providers.  In addition, Merge’s OEM and CAD technologies, international and eCommerce distribution channels, and additional market segments such as clinical trials provide new opportunities for AMICAS products and customers. On behalf of everyone at Merge, I look forward to welcoming and working closely with the AMICAS team."

HIStalk Interviews Charlie Harp

Charlie Harp is CEO of Clinical Architecture.

Tell me about the company.

I started Clinical Architecture about two and a half years ago, with our focus being primarily — I always use the term “plumbers” of healthcare information. What I mean by that is having worked in the industry, both from an end user perspective when I did clinical trials and hospital labs, to when I spent time at Hearst Business Media at First DataBank and Zynx on the content side. I’d worked with a lot of vendors that worked with a lot of organizations and I really thought that by creating a company like Clinical Architecture, we could help be a catalyst to improve the effectiveness of the implementation of content in the healthcare environment.

With Clinical Architecture, we started out doing mostly consulting, where we would work with content vendors and system vendors and end users to really focus on the problems they were having either with content design, integrating of clinical content or terminologies into their environments, or helping to manage some of the unexpected aspects of working with clinical content in a live environment. As we went through that process, we started seeing the same patterns over and over again. What we do as a solution provider is we try to provide what I call “plumbing solutions” to help with those common patterns of disconnection or dysfunction.

Most doctors do not find clinical warnings useful, even overriding most of the allergy warnings. How can that content be better used?

From my perspective — and I’m a simple country programmer, I’m not a clinical person — I’ve just been in this field for a while and I’ve seen a lot of dissatisfaction. I think a lot of it revolves around the fact that when you look at the content we have today and you look at the way that these healthcare systems have evolved, the content, when it was built and the structures that are still in use today, were built for a different audience. A lot of the clinical content that exists today, and a lot of the terminology, started out to support retail pharmacy, at least in the United States.

What happened is those content modules migrated their way into the inpatient and the practicing setting. It was put in front of physicians how a pharmacist, especially a pharmacist in a retail setting, deals with interruptions and deals with alerts. It is extremely different from how a physician does, or a nurse does, because their time constraints are very different. A physician is right there at the point of care trying to make decisions, and so if something isn’t really relevant, it’s not going to be perceived as useful.

I think that is where we are today. There’s another aspect there, too. Just to clarify, I think part of it was the electronic medical record was really not something that people felt was comprehensive. In fact, I remember speaking to a physician once who said that, “You know, Charlie, 40-60% of what I know about the patient is not in the computer — it’s in my head.” I think that’s been true for a long time.

I think that we’re at a point now where these electronic medical record systems are evolving. Whether they’re being driven by some of these incentives coming out of the Administration, or whether they’re being driven by just the need to resolve a lot of these medication problems or medication errors we’re having in healthcare — I don’t know, but I think the industry’s evolving. EMRs are evolving, and so that creates an opportunity for the clinical decision support content to evolve to be much more relevant. I think we’re just at the beginning of that era.

Do you think software vendors were too complacent in just letting the content providers tell them what they had and then just throwing it on the screen and calling it clinical decision support?

I don’t know that I would use the word complacent, but I think you’re right in that the content providers maybe didn’t have the content that the system vendors needed. The system vendor is in a Catch-22 because they develop this next-generation, cutting-edge system that requires a certain complexity and content to drive it and there’s nobody providing that kind of content. They’re on the hook to do it.

I’ve worked for content companies for a long time and it’s a lot of work. Building content and managing terminologies is definitely non-trivial. Clients might not like your content, so they might want to have the option to switch. You’re almost forced into a least common denominator position where you have to accommodate what’s available.

I’ve worked with a lot of content provider folks over the years. They’re all very noble and they’re trying to do the right thing and they work real hard, but when you try to introduce some new content, if there’s no place for it to go because no system is advanced enough to utilize it, that’s a Catch-22 as well. Developing new content is a non-trivial investment, and developing systems that are being driven on new content that doesn’t exist is a non-trivial proposition.

I think between the two, that’s where we’ve been stuck for a little while. I’m hopeful that a lot of the changes that are happening in healthcare today around improving the medical record will be the tipping point that we need to move forward.

I’ve always argued that there’s an attitude built into clinical decision support that says physicians can’t be trusted to determine what they need or find useful. What do you think would happen if individual doctors had the option to either detune the warnings for themselves personally, or to turn them off by saying, “I don’t want to see any more like this”?

I think that there’s nothing wrong with that. Once again, I’m not a clinical person, but I think that a lot of the clinical decision support is local. I think that the objective of a content provider is to provide a framework and a starter set and having the ability for the local population to tune certain things out. I mean, when you look at clinical alerts, there’s certain things that should never be done. Whether or not people should be allowed to turn that off and then woe be unto them if it results in something negative.

I guess that’s the option, but I think that the first thing we need to do in clinical decision support is make alerts that are much more contextually aware, because I think the physicians will be less likely to turn something off if every time they get an alert it was relevant to their patient and to what they’re doing. The other thing I think happens sometimes is you’ll have people that turn alerts off — so they give the physician the ability to just turn of a particular alert — because it’s not relevant to that patient, but it might be relevant to the next patient.

I think a lot of it has to do with our ability to apply alerts in a granular and effective way. If we can get better at that, then the physicians will be less likely to turn it off because every time it fires they say, “Wow, I’m glad I got that alert.” I don’t think that is the reaction you get today.

Do you think the content providers are concerned about their own legal liability, or some FDA interpretation that maybe they’re offering what sounds like a medical device? Do you think their incentive is to just alert for everything because not doing that could get them in more trouble?

I think that whenever you’re dealing in this space, there’s concern about liability. I think for some people, to err on the side of over-alerting in order to protect yourself. I don’t know that I would say that’s necessarily the case, but I think that part of the problem is when people create clinical content, they’re getting the content from somewhere.

For example, if I’m going to the package insert to drive all my clinical decision support, well, the package insert is really something that is designed around liability. So, one could argue that if something’s purely based on the package insert, it’s going to be alerting more often than not. I think the issue though, is I think it really has to do with what sources are available for information.

I remember once I was somewhere and somebody really wanted accurate pediatric dose checking and for neonates and for preemies. The problem, of course, is a lot of the data you get to drive clinical decision support comes from human trials and comes from case studies. Not all populations have case studies, and so sometimes it’s hard to come by really good information. So then you start leaning more on expert opinion, and sometimes people are concerned about how their advice is being carried forward into the point of care setting. But just in general, I don’t know that I would speak for how the content providers are positioning themselves in their content.

Given that whole emphasis on some grading of the studies and weighting of the evidence and the severity and all that, do you think there are opportunities for individual providers to create their own content based on local experience? In other words, I go to a doctor and say, “Here are some things we might do. Tell me what would be important to you in your practice.” Or is there any new use of content that isn’t the same old stuff? Is anybody doing anything creative with it?

I think what’s going to happen is … I mean, even when I was in my last job at First DataBank, we were seeing a lot of people who would use our content as a starting point, but they would also have you build and localize it. We actually built tools around localizing, and I think a lot of the system vendors and content vendors are moving to accommodate that.

I think it has to do with the fact that if you’re at a large teaching institution, you might have some additional rules in clinical decision support that you want to use to augment what’s coming from your vendor. You might also want to be able to turn off some of the things that are coming from your vendor because you just don’t agree with it. I think localization is something that’s going to start to happen.

But the other thing I think that’s going to start to happen is, as we improve the plumbing and we lower some of the barriers that the terminology creates, I think it creates an opportunity for other folks with new content to put that content out there; whether they’re a university or whether they’re a particular collaborative group. To put together content and make it available to people.

We’re not there, I don’t think, today. But I think that’s something that could happen in the future. I do believe that clinical decision support is local. In fact, when you look at the ARRA Meaningful Use, I like the introduction of the five rules because it almost says, “You really should be thinking about local and what kind of local things you need to look for.”

There was that point, maybe ten years ago, when Eclipsys bought the BICS rules from Brigham and Women’s. That never seemed to go anyplace and neither did the idea that there’s some open standard where individual providers can exchange Arden Syntax or whatever they’ve written their rules in. Is that ever going to catch on, that people will use rules that were created elsewhere? Or share rules via some sort of exchange process?

I’d like to see it happen, but I’m not sure it’s going to happen in the public domain. The only reason I say that is, building content … healthcare is constantly changing and building content is not easy. I really think the public sharing of information without some way to fund it and some dollars to help cover the costs of the content’s development, whereas I think it’s a great idea and I would like to see it happen, I just don’t know if it’s financially feasible. What happens is you create content and that content has a half-life and you need to be updating the content, and you need to maintain the content.

The other problem is if there’s some kind of sharing environment that’s driven by Sponsor A or Vendor A, Vendor B, if they’re a competitor, is not going to want to promote that and be compatible with that because it’s their competitors offering a standard. In fact, with Clinical Architecture, one of our goals was to be a neutral plumber to maybe help bring about a time when people can have general plumbing for sharing clinical decision support content without having to worry about their competitors and whether or not their competitor is behind it or not.

You mentioned the Meaningful Use proposed criteria. Do you think those proposed criteria and the reimbursement guidelines say enough about clinical decision support, and also the specific taxonomies and the architectures that they’re suggesting that is needed to go forward with it?

I think that they started us down a path where just saying that Meaningful Use means that the computer needs to do some of the heavy lifting, is really the way I read the direction of Meaningful Use. I think that there are things that computers and software are really good at when it comes to minutiae and tracking details and correlating data, as long as it has meaningful information with which to do it. I think that moving in that direction is good.

There are a lot of different definitions for what clinical decision support is. So I’ll be kind of narrow and say, “computerized rule checking around patient context to provide advice and alerts about something going on with a patient.” I think that there’s still a ways to go to evolve clinical decision support to be meaningful, because I think if we just perpetuate what we have today, you’ll still have people who get frustrated and turn it off.

I think when it comes to terminologies — I think that we’re a ways off from getting to the point where we don’t have multiple terminologies out there. Part of that is because of just the rate of change in healthcare is slow, and a lot of it has to do with the criticality of these systems. You can’t just unplug one and plug another one in, as I’m sure you well know. When you introduce something new, it takes time.

A lot of these third party terminologies are pretty ingrained; whether they’re a local terminology that someone builds, or whether they’re one they bought — they’re pretty ingrained. So, getting them out, if that ever happens, will take a while. The standard terminologies that are promoted in ARRA, whereas I think they’re a good start, need to evolve to really meet the demands of what we’re going to be asking them to do, as well.

Are we’re relying too much on content that was designed for billing, like ICD-9 and CPT codes, and trying to make it into something it never was intended to be?

Oh, I think so. I think that when you look at the general codes that are used most in healthcare today, the CPT, the ICD-9, and in the drug world, the NDC code — those were all really built around transactions and billing. But that’s kind of our roots. That’s where the US healthcare system came from is transactions and billing. What we’re trying to do is evolve into systems that are based upon a clinical framework.

If you look at other countries where they didn’t come from there, it’s very interesting to see how those systems have evolved because they look different than the systems we’re used to here in the states because they don’t have those aspects. Whenever you try to take data from the states and introduce it into those other countries they go, “Well, why does it look like this?” It’s because of where we came from.

I think that the danger is when we create new terminologies that are designed to be clinical terminologies, we need to evaluate the characteristics of those terminologies. I’ll give you an example, and I think I have a blog entry on this.

ICD-9 has a bunch of concatenated terms in it and they’re conditions or problems that are put together in a particular order because it facilitates billing activity. Well, when you look in SNOMED, we’ve started introducing those same types of concatenated terms. The problem is the concatenated term is very difficult to leverage when you’re doing clinical decision support because you’ve created a term with multiple meanings. Any time you have a term with multiple meanings; it results in things getting a little fuzzy.

It almost looks like, in some of these cases, the SNOMED CT codes — and I don’t know this for a fact — but it looks like they’ve shadowed ICD-9 to a certain degree. If SNOMED is going to be our clinical terminology, we shouldn’t be doing that. We should be saying, “Well, we want to treat this differently.” But it’s difficult because you can’t be precognitive and know everything that’s going to happen. There are a lot of unintended consequences when you create a terminology, but I do think that a lot of the problems we have stem from where we’ve come from with these terminologies.

You would think that the one giant test bed that’s out there that could maybe take a different direction would be the VA, since they don’t worry so much about billing and they’ve got clinical systems that are mature. Are they doing any work that would be innovative that might find its way into the average hospital?

They may be. I haven’t done a ton of work with the VA in these last couple of years, so I don’t know that I could give you a meaningful answer in that respect. If they’re not encumbered by some of the issues that a lot of these other systems are.

I actually think a place where things would be interesting is some of these newer systems, especially some of these Web-based systems that don’t come from a background of being charge capture systems. That’s one place to look. I think looking at the systems that are coming from other places, just to see what patterns they’re using to capture and deal with clinical information, I think, would be interesting.

Is metadata and semantic interoperability the next hurdle?

I’ve spent a lot of time in the last year working on interoperability, and I think that there’s a lot we can do with interoperability to get us to a next evolutionary step. I think, ultimately, if you have systems that are using whatever code they’re using locally and are loosely coupling to a standard for data exchange, interoperability becomes a lot easier.

For example, if I’m using content vendor code A or my own local codes, but in that dictionary in my system I also have the RXCUI. When I go to exchange data, if RXCUIs are comprehensive from RxNorm, then I can exchange data meaningfully. I think that between those points, in our utopian future and today, I think that there are some roles for metadata in understanding and correlating terms.

I think that the UMLS Metathesaurus and RxNorm are a good start, but a lot of people go to them thinking they’re the ultimate key to fixing the problem, but they’re really not, at least, not yet. It’s one of the reasons why we built our SYMEDICAL product. We were working with a bunch of clients and seeing the same pattern over and over again where they’re trying to exchange data.

There are really two problems today. One is to map from one terminology to another is an extremely manual and time consuming process. Because of that, the second problem occurs; which is if there’s something you don’t want to do because it’s long and painful, you put it off. So a lot of people will build a map and it’ll cover a certain percentage of the things they’re trying to exchange, and then two years later the map is severely out of date because code sets are constantly changing. Much more so than people think they do.

One of the reasons we built the product we built was to let the computer do some of the heavy lifting. It really leverages metadata and contextual parsing to do that, and it actually does a fairly good job. I think that when it comes to interoperability, having tools out there in the public domain like UMLS Metathesaurus and RxNorm help. Having tools that help domain experts at institutions, or vendors and facilitates the mapping process also helps. Then staying on top of it and not letting things go for a year before you get it updated again, especially now that we’re leveraging the electronic medical record and really pushing it more and more.

Who is your customer, and has their interest changed with the emphasis on clinical systems and Meaningful Use?

Our customer — like I said, we’re kind of a across the field. We work with content vendors, we work with system vendors, and we work with end users. But when it comes to the changes I’ve seen in the last year because of the HITECH initiative, I think that a lot of it has to do with it drives or prioritizes certain things to the top. There are a lot of things we should do as a healthcare industry. There are things that we should do, and then there are the things that someone’s willing to potentially pay us to do. What I think has happened is number one; raised more awareness, and it has given people an incentive to accelerate the process, which I think is good.

For example, we also help people implement content and get decision support up and running. In the last year, we’ve seen a lot of people who previously didn’t do decision support, didn’t have structured terminologies, are now really feeling the pressure to do so — which is good, because before everything was free text, and if people wanted to do checking, they really couldn’t, at least not in a computer-assisted way.

I also think when it comes to interoperability; there are people who probably don’t want to deal with interoperability. This forces the issue, which is also good. We’ve still got to sift through and decide about standards and formats and all those things, but putting the notion of interoperability forward is good because ultimately, for me, it drives Clinical Architecture. It’s one of our primary goals, which is about making healthcare more effective and improving patient safety. With interoperability the way it is today, there’s a lot of manual reentry, there’s a lot of free text information, there’s a lot of potential clerical error and human error.

Whereas, if you can increase the fidelity with which systems communicate with each other, and those codes are being exchanged more accurately, you increase the efficiency of the people that are actually trying to manage the movement of data. You increase the accuracy of the data that’s in the patient record. Therefore, when you do clinical decision support, or when you’re looking at things about the patient, you’re actually going to have a better picture of what’s going on. No clinical decision support will help you if you don’t have any coded data that can drive it.

Any final thoughts?

There’s a lot of people that build really good systems, and there’s a lot of people that build a lot of really great content. What I try to do with my contacts in the industry is to push them a little bit and say, “You know, I think we could do better.” I think there are things we can do, and it’s not easy.

Another quick sidebar is I think that one of the things that people aren’t really ready for, which I’m not sure they are, is if we ratchet up the electronic medical record, there’s a lot of housekeeping. In the past, and electronic medical record for a lot of systems, was probably an episodic transitional thing where the patient comes in, they leave, and you might pitch the electronic record until they come back the next time and they fill out the form again. But once you start persisting that and you’re relying on it over time, there’s a lot of housekeeping that goes along with that. There’s a lot of cleanup because the codes are always changing behind the scenes. Information’s always changing, rules are always changing.

I think the next big thing that’s going to happen to the industry is once they really start persisting and dealing with the reality of the medical record that’s coded and structured, they’re going to have to deal with “how do I make sure that it’s accurate as time goes by” I think that’s going to take a village. That’s where interoperability comes in, because ultimately, your electronic medical record is not just your doctor’s office, not just your pharmacy, not just the hospital. It’s the meaningful combination of all those things put together. It’ll be interesting.

News 3/5/10

From JT: “Re: speech recognition. I know of patient populations that might be able to use it because of disabilities. Any information you can share is greatly appreciated!” Dragon Naturally Speaking is the standard and the one I bought. It not only does an amazing job of hitting 99% accuracy right out of the box, but also allows controlling Windows functions by voice (like using Word’s menu bar, navigating files, etc.) I know the military puts it on laptops for recovering soldiers who can’t use their hands, giving them a way to use the PC, use e-mail, etc.

From The PACS Designer: “Re: Microsoft Windows Phone 7. InformationWeek has posted a video gallery for the new Windows Phone 7 application. It should give us a good comparison to Apple’s iPhone.”

From Anon: “Re: Epic. Last Monday, Luke O’Voron reported that Judy Faulkner used the HIS Policy Committee Privacy and Security Workgroup call that week to shill for Epic. The transcript is posted (warning: PDF) and I can’t find anything in it remotely like what Luke said. Do you read it the same way?” I don’t see anything that looks like shilling, so I’m not clear on the original reference either.

Listening: Band Marino, possibly defunct indie pop from the Orlando area. They sounded good on the Clemson radio station I was playing in the car this morning, so I checked them out. My favorite tune is here (video).

The strange courtship of Amicas continues. The Amicas board now decides that Merge’s offer of $6.05 is better than the $5.35 one from Thoma Bravo it previously supported (duh). So now it’s back to Thoma Bravo to make a new offer by Monday, which of course they should have done immediately instead of sitting around waiting to have their hand called. Amicas has pushed its shareholder meeting back from March 4 to March 16. PACSMan weighs in on Dalai’s PACS Blog, using one of my favorite movies (Wall Street) as a backdrop. He even quotes the Greed is Good speech that I could recite nearly verbatim like the guys in another great movie, Boiler Room.

Here’s Dr. HITECH, Ross Martin, MD, doing the world premiere of his excellent Meaningful Yoose Rap at the reception.

The VA and DoD disconnect their shared EMR connectivity after after data errors are discovered, first noticed by a doctor who wondered why a female patient had been prescribed an erectile dysfunction drug. As a risk manager pointed out, it’s a good thing at least one error was obvious enough to raise a flag.

Prompt Medical Systems, a “vendor” whose only asset is a CPT entry patent and whose only business is suing other vendors (it doesn’t even have a Web site that I could find), files suit against nearly everybody selling an EMR, extending a string of lawsuits going back to 2005. A Virginia investment banker apparently funds the lawsuits, filed in friendly Texas courts.

Lakeland Regional Medical Center (FL) selects API Healthcare’s time and attendance and remote hosting solutions. API also announces go-lives at seven provider organizations.

A Microsoft VP makes an odd suggestion: treat PC security as a public safety issue and collect taxes to fund “hospitals” that will remove viruses and reduce their spread. Seems like that’s their job, especially since Apple users aren’t having problems.

A survey says 58% of doctors not using EMRs now plan to buy within two years, but would prefer a hospital help cover the cost. Federal incentives and penalties were cited as the main adoption drivers.

Eclipsys announces Helios, its open architecture platform that exposes Sunrise Enterprise 5.5 to third-party developers. Already building add-ons: Microsoft, Capsule Tech, and Hill-Rom. A reader asked why I hadn’t mentioned it, with the main reason that John Gomez already talked about it here when I interviewed him right before Christmas. ECLP calls developers out in the Helios site: “An open invitation to innovate. Competitors welcome.”

Merge Healthcare and Mass General will partner to build a testing environment for mobile healthcare applications.

Odd lawsuit: an IHOP cook accidentally cuts off his fingertip, which nobody can find. It turns up in the fried chicken salad of a woman eating after-church brunch. She suing for $20.5 million.

E-mail me.

HERtalk by Inga

From Midwest Doc: “Re: roundtable with Blumenthal. I was one of about 40 physicians who somehow earned an invite to a roundtable with Dr. Blumenthal. I was impressed that he cared enough to ask our opinions. He had a politically correct answer for every question we posed of him, so maybe he is well suited for his job.”

From Day Tripper: “Re: ambulatory EMR vendors. I asked several EMR vendors if they have seen a big increase in buyers, especially now that we at least have the interim final use definitions. The general consensus is that many physicians are still dragging their feet.” I’ve heard that comment as well. Either because of fear or because it sounds like a good excuse, many physicians are waiting until the MU guidelines are truly final and the certifying entities are identified. Perhaps a minority of physicians are savvy to understand that the RECs will offer some free implementation services so they are waiting for those to ramp up. And, likely others are waiting to see what opportunities their hospitals may offer to affiliated physicians. In other words, if you are looking for an excuse to not move forward, there are plenty to choose from.

From Samantha Brown: “Re: shoe patrol. Inga, please tell me. Was Judy wearing Birkenstocks?” Gosh, I was so excited that she was there I failed to notice the shoes!!

From Justen Deal: “Re: HIStalk party. Overheard: ‘Judy and Jonathan in the same room? Isn’t that like matter and antimatter?’? One observation: The fact that Jonathan Bush was able to charm a crowd made up mostly of his competitors says a lot about his comedic timing. Secretly, nearly everybody in the room is terrified of him,since his business model scares the scheiße out of them. I think the atmosphere (read: the lager) helped reduce their fears, at least for the evening.”

From BFF in Footwear: “Re: Inga Loves My Shoes! I must say that last night’s party was incredible — two of my dreams came true. First, I got to meet and chat with a very gracious Judy Faulkner, a woman who has been my inspiration and a role model for building and growing my software company. And second, I received the industry award that I have coveted for years — the Inga Loves My Shoes. I will wear my sash proudly and strive to always be worthy of this honor.”

From Inga BFF: “Re: great reception. The venue was wonderful and good beer was involved, to boot! It was a high-powered crowd, and yet everyone was friendly and cordial. Please let your reception sponsors know that we truly appreciate what they did.”

Before HIMSS, I was sent a notification that I might want to attend the “CCHIT EHR Certification Town Hall.” I was quite frustrated Monday because I could not find the session either on the navigation kiosk or the paper schedule. I eventually found it, but learned the session had been renamed “EHR Certification Town Hall.” The CCHIT folks were still leading the session, but it was interesting that either CCHIT or HIMSS decided to drop CCHIT from the title. One of the more troubling points made was that the ONC is not expected to designate CCHIT or any other entity until late 2010, or even into 2011. Everyone assumes CCHIT will be one of the certifying bodies but until it is etched in stone, plenty of conservative buyers are going to wait for the final, final declarations.

I wonder if Mr. H and I were the only ones who noticed the HIStalk signs displayed at many of our sponsors’ booths? Thanks for the promotion.

I’m still wading through the endless number of e-mails and need some PR person to answer me this: why does every single vendor feel the need to issue press releases during HIMSS? Don’t companies realize their news is more likely to be overlooked because of the sheer volume being churned out by companies, PR people, and media outlets?  But what do I know? I’m just a blogger. If you haven’t had a chance to see some of the news highlights, hang on for these brief updates:

• CynergisTek announces a new data loss prevention solution that leverages its partnership with Code Green Networks.
• Gartner places Compuware in the “leaders” quadrant of its “Magic Quadrant for Application Performance Monitoring” report.
• The AMA and Ingenix form a partnership to offer the web-based Ingenix CareTrack through the AMA web site.The AMA says that they will be offering additional new technologies to help enhance physician practices. The AMA also announced a collaboration with Dell, which sounds as if it is part of this same physician-automation initiative.
• UPMC announces the development of new PHR technology created in collaboration with Google Health, Carnegie Mellon University, and dbMotion.
• Precyse Solutions introduces Catalyst, a front-end automated speech recognition product.
• NextGen introduces a special offer to provide rural and community hospitals free financials with a qualifying purchase of inpatient clinicals. The NextGen Clinicals, by the way, is the former OpusClinicalSuite. NextGen was also named a winner of an MS-HUG 2010 Innovation Award in the category of Interoperability/HIE for its work with Doylestown Hospital (PA) and the Doylestown Clinical Network.
• MGMA President and CIO William F. Jessee announces he will retire in the fall of 2011.
• Enterprise content management vendor Hyland Software acquires eWebHealth, a provider of hosted medical records workflow solutions.
• MED3OOO and Acryness announce a strategic partnership to provide the MED3OOO QuikBill patient billing solutions, powered by Acryness, to MED3OOO’s RCM and ASP practice management clients.
• CHIME awards fellowships to Pamela McNutt of Methodist Health System (TX) and Rick Schooler of Orlando Health (FL.)
• 4medica launches its Integrated Health Record designed to tie patient data from diverse care settings to create a single picture of an individual’s patient record.
• Fifty eldercare agencies join the Rochester RHIO, which is powered by Axolotl’s Elysium Exchange.
• Nuance introduces a suite of voice-enabled mobile solutions for smartphones including Dragon Medical Mobile Dictation, Search, Recorder, and SDK.
• Healthland releases an EDIMS for small community hospitals, as well as an Analytics solution.
• Covenant Health and Sharp Healthcare select Allscripts Care Management and Post Acute solutions for their hospitals and post-acute care facilities.

Posting from the HIMSS Facebook page on Tuesday, the day of the big snowstorm: “HIMSS 5K Fun Run has been moved Indoors. Please come to Hall A, A1 to register. Run starts at 4 p.m.” I wish I had seen the run.

Speaking of Facebook, if you have any great HIMSS pics you’d like to share, our HIStalk Fan page is waiting for you. I have uploaded a few that readers have forwarded, but haven’t had time to load all of them yet. Feel free to friend me since you can never have too many friends, right?

E-mail Your Friend Inga.

From HIMSS 3/3/10

From The PACS Designer: “Re: Panasonic C1 Toughbook. At HIMSS 2010, Panasonic announced an exciting new Toughbook called the C1. It has many features that on-the-go healthcare professionals will see as being attractive.”

From Joe: “Re: McKesson. Hunting season came early this year. Firings in the Physician Practice Solutions group.” Unverified.

We have a lot of HIMSS-related observations on HIStalk Mobile.

I’m still tired, but here are my impressions of HIMSS10:

• The emphasis was on money and business rather than patients for the most part (my low point: a session that rattled off dozens of government grant programs from ARRA right on down, which reminded me of that seedy guy with the Free Government Grants infomercial).
• For that reason, it was a rather passionless conference. It’s hard to get charged up by filling a room full of people who want to lap from the federal trough.
• The KLAS/HIMSS Analytics presentation was good, with the primary message being that adoption of EMR, CPOE, etc. is going well, but there’s a long way to go. Also, that several vendors and products, despite slick glossy materials, basically aren’t getting any traction at all and don’t enjoy much support from their customers. It was refreshing to sit in a HIMSS conference room and have some of the vendors with big booth spreads being called out as dragging down the market with their incompetence (the usual big conglomerates).
• Atlanta is a pretty good convention town and GWCC has nicer public areas (seats) than most convention centers, but the split exhibit hall should have been a showstopper. If you were a vendor on the C side, you missed a lot of traffic. Maybe HIMSS should have limited the space per vendor so they could all be squeezed in on the A/B side.
• Many vendors were so vague on what they were selling that it was hard to tell on a quick glance, which is about all they’ll get from most attendees. Broad, catchy statements may work in an ad, but on the show floor, there are 200 vendors claiming to sell an EMR and little way to figure out how they are different.
• As happens every year, vendor people in the hall seemed to have trouble focusing. It’s inevitable to get tired and maybe jaded, so the to-do I would give vendors is to bring more people and rotate them. I went to several large (expensive) booths and couldn’t get anybody’s attention, and in at least a couple, the person made me feel genuinely unwelcome, like maybe they were anxious to get back to their personal phone chats.
• A fun scavenger hunt would have been to try to find a presentation that didn’t have any of the above words in the slide deck: ARRA, HITECH, or Meaningful Use.
• Everybody got excited over certification announcements, but I found myself caring not at all. I overheard someone providing a good summary of certification: it sets the bar extremely low for real vendors with real customers, but keeps doctors from selling crappy EMRs written by their brothers-in-law.
• There was a lot of activity on the show floor, but I can’t really say I picked out any theme that didn’t involve stimulus money.
• Education presentations ranged from pretty good to pretty bad, which is par for the course.
• HIMSS ran the conference smoothly as usual.
• Despite frantic reporting from the exhibit hall(s), there really wasn’t all that much big news, which is why I didn’t mention much of it.
• I got to see a lot of familiar faces and that’s always nice.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Most effective CIO in a healthcare provider organization
John Glaser, Partners

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 Industry Figure of the Year
David Blumenthal

HERtalk by Inga

I am in the Atlanta airport, headed home, so this will be another quick post.

Overall impression of HIMSS10: fun, huge, and a lot of excitement in the industry. More on that in a second, but I will first throw out a few things that I found less than perfect:

• Someone made a comment to me that Atlanta must not have had big convention like this for some time because they seemed overwhelmed at times at the convention center. Long lines for food (except at the Asian place, which apparently ran out of noodles early in the day) and untidy restrooms were the biggest evidence of this.
• The two-exhibit hall thing needs some tweaking. All the vendors in "C" felt like the stepchildren. Why not split the bigger vendors evenly between the two halls so that one does not look so much like an afterthought? And, having the two halls so far apart was pretty inconvenient. More than one person told me they didn’t realize there was a second hall until they failed to find a particular vendor.
• Is there such thing as a convention center that doesn’t involve miles of walking to get from one area to the next?
• I found too many vendors unable to give you a 15-second elevator pitch about their company or offering. Maybe it would be too much to ask for vendors to also tell you in 15 seconds what is unique about your offering.

Other than that…good stuff. I have to admit the educational sessions are tough for me to sit through (I failed to last the whole time for any session I attended).  Perhaps I picked the wrong sessions.

The last three days have flown by. I spent a good amount in the exhibit hall, but didn’t see all I wanted to see. I did check out a few software products and I will share more on that later. Thanks to all the kind invites to stop by booths — I didn’t get a chance to look deeply at every one, unfortunately.

And I popped in to a few parties, including Eclipsys, Allscripts, and HITmen awards. The HITmen awards had some great sushi and a lot of A-listers in the industry. I thought Mr. H was winning some award, but apparently not. Someone will have to explain to me why his name was on the promotional material but he didn’t win one of the cool plaques.

The MEDecision folks told me there were expecting 2,000 to their party, which they said was to be the largest HIMSS party. If you went, tell us about it.

Tuesday night I got back to my hotel after a VERY long day and popped up HIStalk to read the latest post. I literally fell asleep with iPhone in hand. Good thing HIMSS only comes once a year.

E-mail Inga.

From HIMSS 3/2/10 (Part 2)

From Clingy: “Re: your party. You do realize that, last night, your party became the party that everybody will have — and want — to attend? I’m sure it already was that, but now everybody else will know that, too. I think you may have to resort to a lottery for invites in Orlando…  Or you may have to rent a stadium.” I really appreciate the nice comments about the party, but I’m passing the kudos along to Amy Glass and Inga since I was too busy to jump in during those final weeks to set it up. Actually, I’ll thank a third group: those who booed and cheered during the HISsies, who enjoyed each other’s company even though many of them are on-field competitors, and who made up a darned impressive group. It’s the only time I get to see who’s reading and it recharges me for another year. If Jonathan Bush doesn’t win something next time, I may have to stuff the ballot box just so he can chew the scenery again. He was supposed to be on for like five minutes, but turned it into its own extravaganza (recall that this was the first business day after ATHN shares gapped down, but you would never have known it from his hilarious performance surrounded by the stock analysts in the room).

From Jim: “Re: your party. The HIStalk party rocks! This was the best party I have been to in the 15 years I have been going to HIMSS events. People were having a genuine great time and mingling nicely – something that would happen at a party you want to go to, not you feel you have to go to. Can’t wait to come again next year!”

Above are a couple of pictures taken by Dr. Gregg Alexander of the bagpiper and Max Lager’s. I thought it was a very cool place – lots of brick and wood character, beer tanks, and genuinely attentive staff (I could barely set my beer down before someone wanted to bring me a new one, which was just fine with me). The DJ kept the music going without being obtrusive. I asked Inga to take the large poster that you can barely make out on the very left, which had a giant beer glass with the HIStalk logo. It looked like a great souvenir.

From Gregg Alexander: “Re: HIStalk reception. All those who attended can attest, all proper propers belong to Ivo, Inga, and Mr. H for organizing an exceptionally fun evening. Great job, guys, a truly fun time…thank you!” We had some recognition for direct caregivers during the reception and it’s guys like Dr. Gregg who ought to be honored. People forget how hard pediatricians work for a relative modest paycheck while the procedure guys need a wheelbarrow to get the cash to the bank.

I’m so proud of this picture by DrLyle and I’m moving Judy Faulkner of Epic way up on the cool-o-meter. I had e-mailed her ahead of time and told her Epic had won in several categories and she also in the category of “Industry Figure with Whom You Would Most Like to Drink a Few Beers.” She e-mailed back and said the strongest thing she drinks is milkshakes, but she might drop by (riiiight). On the 1% chance she actually would, Inga had her a “No Pie for Me” sash made to celebrate her “loss” to Cerner’s Neal Patterson for the “Industry Figure in Whose Face You Would Most Like to Throw a Pie.” I am totally shocked and honored that she and Carl Dvorak dropped by because I know she doesn’t really like that kind of stuff and there really wasn’t anything in it for her or Epic. She even joked around with Jonathan Bush. Judy, I had you figured for a pretty cool lady, but now I’m certain. Epic won all the “good” HISsies categories, so it was kind of like a KLAS report.

I think we’ve discovered a natural female attractant in those sashes. Someone sent in a pic of one of our male sash-wearers who wore it back to his own hotel and he was getting lots of female attention. I bet we get more volunteers next year.

From GG: “Re: Charlie Munger. How long until you and Inga get a $20,000 check?” Warren Buffet’s homespun partner reads Atul Gawande’s New Yorker article on healthcare costs, and then writes him a $20,000 check and sends it to the magazine, telling them to give it to Gawande, who then donated it to Brigham and Women’s. I had a nice chat today with some smart vendor people who observed how broken the HIT journalism model is (they refused to even call it journalism) and how hard it is for up-and-coming vendors to afford the megabuck ad spreads that seem to help get companies featured. I like scrappy newcomers, so they will always have a spot here if what they offer helps patients.

From KZ: “Re: have you checked out the race car simulator in the 3M HIS booth?” How did I miss that, especially when I’m running a text ad for it? Somehow I didn’t see it.

From HITMAN: “Re: David Blumenthal. Interesting – a large number of CIOs received an invitation last night at about 7:30 to attend a meeting with David Blumenthal this morning at 8:30. Apparently the response was large – they turned away many by e-mail and may have a second session set up for later Tuesday.  David opened the session with about three minutes of welcome and thanks then said he was there to listen to us. Of about 75 in the room, about 20 made comments about the need for federal leadership on master patient index, about the challenge of all-or-nothing meaningful use, about the need to include ED CPOE in meaningful use criteria, and about the compressed timeline we are working under. All were polite and he had two minutes of thanks at the end. He said he is not allow to comment about ongoing work and regulations, and was happy for the pointed feedback. Good that he asked for the feedback but it was all over the place and I am not sure how much he could have gotten from the session.” I heard some CMS people talking about it on the escalator.

Check out David Brooks’ HIMSS coverage on HIStalk Mobile.

Henry Schein announces its ConnectHealth initiative that packages products and services from a number of vendors for physician practices: Allscripts, Midmark, Siemens, Welch Allyn, Dell, and Medline.

Content management vendor Hyland (the OnBase people) acquires hosted medical workflow solutions vendor eWebHealth.

SIS introduces Anesthesia View, a new module in SIS Analytics. I asked someone in the booth today about the Inga-tinis and they said they were flying out the door yesterday evening.

Former QuadraMed CEO Keith Hagen is named COO of digital pathology solutions vendor Aperio.

The latest radio show from Intellect Resources interviews a number of HIT experts, including Texas Health CIO Ed Marx, on security.

Keane will offer EmpowerED as an ED module for its Optimum solution.

In the UK, NPfIT is trying to quickly sign billions in extension contracts with CSC and BT before the elections, hoping to keep the struggling program financially alive.

I forgot to mention it yesterday, but I attended the best HIMSS session I have ever seen, which few saw since it was on the military systems track. It was given by Rear Admiral Matthew L. Nathan MD, Commander, Navy Medicine National Capital Area, National Naval Medical Center on their pilot project for an integrated medical home. I can only say it was brilliant, covering the need for preventive care and EMR outreach programs as well as the practicalities of delivering medical services remotely (such as to a ship in the South China Sea, but with the same challenges as to a rural town). Given the military’s experience with the healthcare models we’ll probably need everywhere and considering his obvious capabilities, he ought to be leading the charge. While everybody else was slobbering over meaningful use, he was covering the real healthcare issues that stimulus money can’t fix.

HIMSS attendee count so far: 25,989, but fewer vendor people. I should also say, that despite my occasional disagreements with what HIMSS does, they are superb at managing conference logistics. I noticed no proceedings CD in the tote this year, but I assume they’re free online since I always review them later.

I have lots pictures and stuff that folks have sent, but I’m beat. Here’s a final little show floor wrap-up.

• I had a great visit with the people from enterprise forms management vendor Access, who not only have a great product, they also have a championship barbeque team that can cook hundreds of pounds of pork butt or brisket at a time. I naturally begged them to load up the 40-foot smoker at the next HIMSS and watch people pack the booth for a taste.
• MEDecision had nice umbrellas out to take, which was nice since it poured cold rain all morning and then snowed for most of the rest of the day.
• The Eclipsys booth was packed.
• I wanted to caress all the stuff in Enovate’s booth as usual since their carts have the sexiest curves you can imagine. They also had a cool green pony saddle seat that I spun around in a road test and it was sweet.
• Big crowd at Allscripts.
• For some reason, I found myself wanting coffee and a shoeshine a lot (back me up, guys).
• ICA had their HIStalk sign out and had a demo of their HIE solution running with Sevocity.
• iMDsoft’s telemedicine app was one of the coolest ones I saw.
• Keane had our sign out too – thanks!
• athenahealth’s booth was packed.
• The guy doing electronic caricatures at the Televox booth was fascinating to watch.
• Sunquest had our sign out, too, and I still like their green color and their bags.
• Picis had a crowd and also our sign out.

From HIMSS 3/2/10

HERtalk by Inga

From: Soda Pop Man “Re: HIStalk reception. All those who attended can attest, all proper propers belong to Ivo, Inga, and Mr. H for organizing an exceptionally fun evening. Great job, guys, a truly fun time…thank you!”

From: Evan Steele “Re: Sashes, strangers, and shoes. Thank you for a GREAT evening at Max Lager’s!  The sash was perfect (“HIStalk Certified” made for a great conversation piece)! Although I am not the type who easily mingles with strangers in a room, I found the HIStalk readers very approachable and I had some great conversations.

This will be a quick post as I have an 8:15 meeting (what was I thinking?) HIMSS has been predictably fast and furious with big crowds and lots of walking. Here are a few random impressions from Monday:

• Overheard in the ladies’ room: “Where the heck is the coat check?” I, too, had problems finding one. I am sure there’s at least one but the place is so huge that I wasn’t going to walk from one Hall C to Hall A just to dump my coat.
• I was a little bit disappointed with my interoperability booth tour. My presenter had some microphone problems so I couldn’t hear very well. And, too much time was spent with the overview of the whole interoperability concept, rather than demonstrating how it all worked. Still, it’s impressive that something like 70 vendors participated.
• The Blue Cat booth is offering a roller coaster-type experience, if you like that sort of thing. If you like eye-candy, they offer that as well.
• Hexaware had a unique booth concept with lots of plants on the ground, making the booth look a bit like a garden. They were promoting their green theme.
• Actuate is handing out $5 Starbucks gift cards, if you spend a few minutes chatting with them, like I did.
• I sat in on a Sage presentation in hopes of winning an iPod shuffle. I lost but the presentation was good (short and to the point.)
• I’ve noticed that the booths with the most activity are the HIE vendors. I rested my weary feet a bit and listened to an Ingenix presentation. When I stood up to leave I noticed there was a crowd three deep standing behind me. I saw similar crowds at Medicity, Axolotl, and dbMotion.
• PatientKeeper, Nuance and RelayHealth seem to have much bigger booths than in previous years.
• Chair massages can be found at DCS, which was near the McKesson booth
• As I walked by Bottomline Tech at about 3:45, folks were queuing up for cocktails. I waited until 4:00 and got an “Inga’tini from SIS. Highly recommended.
• Mr. H mentioned that the Google booth appeared slow. Not when I went by. Although I can’t figure out what they are offering that makes the crowd so curious.
• Chetu has a couple of gorillas in their booth. One of the guys working the booth told me they had wanted the gorillas to walk the floor wearing a Chetu sign. HIMSS nixed that idea. Apparently HIMSS thought some company might conclude that if one vendor could have gorillas walking around, then it would be acceptable to send forth girls in bikinis.

And, of course, the HIStalk reception was incredible. Thanks to all who attended and definitely to our hosts. Amy Glass with Encore rocks! Jonathan Bush was an incredibly funny announcer, which I believe our EHR-TV folks caught on tape. Yes, the very down-to-earth and friendly Judith Faulkner did stop by and even wore her sash that said, “No Pie for Me.” We awarded a couple of bonus sashes for great shoes. I checked out the shoes of both recipients and agree they were worthy of recognition. I’m hoping someone snapped a photo of the winning shoes.

I have lots of photos to post and will get to those in the next couple of days. More later!

E-mail Inga.