News 4/21/10

From You’ll Know Who: “Re: McKesson. Pat Blake (Pam Pure’s replacement) just announced that he has moved Sunny Sunyal to the dreaded position of ‘strategic initiatives’ and will move Dave Souerwine into the MPT President role. Dave is moving from Pittsburgh, where he ran Automation (home of the cabinets and AdminRx).” Unverified. No changes on the Web site yet. Obviously this would be huge news if it’s true. Update 4/21 1:00 PM Eastern: McKesson’s Web site has been updated, verifying the rumor as reported and giving Dave Souerwine’s start date as MPT president as April 10.

From Dmitri: “Re: Advisory Board. Dave Garets and Mike Davis, the band formerly known as Gartner Group’s non-physician Thought Leaders and HIMSS Analytics, are duplicating the Gartner model of research reports, access to analysts, targeted benchmarking services, and targeted consulting services. Interesting move in that they will bring a wider than just IT view to provider-side IT.” ABCO stock has recovered nicely from its March 2009 dip to less than $15, climbing back to $34.30 today for a cap of $530 million.

From amMUSEd: “Re: MUSE. It looks like only 100 or so customers are attending out of Meditech’s 1200ish installed, less than a dismal 10% attending their premiere conference. I wonder if all the confusion around the migration to Focus 6.0 has scared them away or whether the economy is just killing the event? Thoughts?”

From Gary Playa: “Re: recall. Did you see this?” I’m not familiar with the process or the site, but it appears that Picis has recalled its Caresuite version 5.1 modules for anesthesia, PACU, and critical care in Canada (which if I remember correctly, regulates medical software much like the US FDA regulates drugs). I found a long list of health-related recalls of many types on Health Canada’s site, so I’d take this more as an interesting observation of how Canadian medical software regulations work than anything specific to one vendor. I don’t see why we don’t have something like that in the US.

From Certifiable: “Re: Cerner. A rare big-hospital win of Cerner over Epic: Northwestern Memorial in Chicago.” I should mention that well-placed sources suggest that Cerner is not, in fact, at the Yale-New Haven table as a reader reported earlier. The hospital will either find the money for Epic or stick with Eclipsys.

From HIS Junkie: “Re: CMS. Stop the implementations  … just of the presses: ‘Medicare payments to acute-care hospitals for inpatient services will decline by 0.1% or $142 million in fiscal 2011 under a proposed rule issued by the CMS.’ Since the MU penalty is tied to the Medicare adjustment, that means if I don’t meet MU criteria, they will reduce my adjustment by 33%. So as a math major I know 33% * -0.1 = +3.3% increase! Really though, with CMS wanting to cut doc payments by 21% and now hospitals 0.1%, do we really expect there to be MU bonuses at the end of the EMR rainbow?”

A Calgary radiology professor’s company gets Health Canada approval for its iPhone medical image viewing application, now being tested at some American sites.

Speaking of Apple, its stock is flying after announcing a 90% increase in net income for Q2 with an amazing 8.7 million iPhones sold in the quarter. The three-year-old iPhone revenue contributed 40% of Apple’s total. Apple’s market cap is at $222 billion, not far behind Microsoft’s $275 billion.

Weird News Andy has competition from Bizarro Jim, who notes this story from Ireland in which a surgeon who mistakenly cut off a patient’s testicle instead of just the cyst growing on it was also charged with injecting himself with meds intended for a patient. Not to be outdone, WNA parries and thrusts with this story about a British woman with Foreign Accent Syndrome – following a severe migraine attack, she suddenly starts speaking with a Chinese accent, about which the inquisitive and insensitive WNA queries, “How does she ask for an Advil now?” And this, about which WNA  expresses hope that it isn’t near the food court: a mall celebrates Colorectal Cancer Awareness Month by erecting a 40-foot-long Coco the Colossal Colon that visitors can crawl through.

Apparently everyone wants to be WNA: EHR Geek finds this story about a 10-year-old boy who is nearly struck by a laptop that fell from a medical helicopter leaving the local hospital. EHR Geek wonders if there are HIPAA implications.

Kaweah Delta Health Care District (CA) will roll out 100 iPads within the next few weeks, loading them with e-mail, medical image viewers, and EKG viewers, all running under the Citrix virtual desktop. The hospital also says that 20 docs have already bought their own.

The National Cancer Institute will release a lightweight oncology EHR based on HL7 CDA, giving oncologists a way to push oncology encounter information through a Web interface that could send it to PHRs, to other providers, or directly to consumers. SAIC and Microsoft are providing assistance. NCI says it will meet Meaningful Use requirements, but whether it does or not, it sounds like a fantastic idea to me. Onc records are complex and vital from one visit to the next.

Indiana-based cardiology EHR vendor GEMMS will expand its headcount of 40 to more than 100 within the next five years, with hiring starting immediately.

The Securities and Exchange Commission launches an investigation into Jackson Health System (FL) to determine whether purchasers of $83 million worth of its A+ rated bonds were defrauded since the hospital announced a surprise $244 million loss right after the sale.

The Leapfrog Group selects Quantros to administer its online Leapfrog Hospital Survey, replacing Thomson Reuters.

A Canadian Medical Association article says lack of national standards is hurting EMR adoption:

Several physicians and academic experts say the political will to implement national standards appears non-existent. EHR vendors are fuming. Health Canada stepped into the fray by introducing new certification and licensing requirements, some of which are fuzzy. Canada Health Infoway, meanwhile, has thrown its hands into the air and says it has no authority to compel provinces to comply with national standards. And federal Auditor General Sheila Fraser will again wade into the murky EHR waters on Tuesday by updating a November 2009 report that concluded Infoway has had little success in removing interprovincial barriers and, therefore, little “assurance that EHR systems will be correctly implemented.”

The CEO of Westchester Medical Center (NY) is fined $3,000 for letting Cardinal Health, which runs the hospital’s pharmacy department, pay for his hotel and limo at a conference.

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HERtalk by Inga

From ImageThis: “Re: voice recognition. Love to awaken every day to read the HIStalk news, very useful and insightful. As a vendor, I was intrigued by the recently mentioned study on PACS and was wondering what sort of voice recognition tools hospitals will be buying for imaging. Appreciate any feedback.” I’m sure that we have readers who can discuss this more authoritatively than me, so I will defer to the voice/imaging gurus.

Lourdes Hospital (KY) says that 100 affiliated physicians (80%) have adopted the hospital’s Web-based clinical portal. Two years ago, the hospital contracted with ICA to aggregate electronic healthcare information for physician online access.

Emdeon reports that the electronic medical claims adoption rate is now 85%. Electronic remittance adoption stands at 46%.

Clinics of North Texas select Allscripts EHR and PM for its 35-physician group.

Like this: McKesson employees from 130 different locations will create 32,000 Stop Diabetes care packages to distribute to fourth- and fifth-grade students. The initiative, which is intended to encourage healthier eating and more active lifestyles, is part of McKesson’s annual Community Days corporate citizenship program.

GE Healthcare says it added 12 new Centricity Perinatal clients in Q1, on top of  its installed base of 1,500 hospitals and health systems. GE also just announced its overall Q1 numbers, which included flat sales for its US Healthcare division. Healthcare as a whole had a “strong quarter” with $3.8 billion in orders, up 5% from the previous year. Overall EPS was $.16 with revenue of $36.6 billion.

eClinicalWorks makes the annual Boston Business Journal Pacesetters list of the 50 fastest growing private companies in Massachusetts. eCW ranked number nine, based on revenue growth.

Radiology services provider Optimal IMX implements MobileMD’s HIE technology to provide HIT connectivity between its client facilities and the physician community.

MediConnect announces 20% growth in first quarter revenues, compared to Q1 2009. The company also recently completed its acquisition of the PassportMD PHI portal.

Physicians working in hospital-owned outpatient facilities will be eligible for stimulus incentive payments, assuming they demonstrate meaningful use of EHRs. Congress passed a new bill which gives more physicians the ability to quality for funds, including an additional 13-17% of family physicians. Physicians working primarily in the ER and in inpatient settings are still excluded. Meanwhile, Congressmen Patrick Kennedy and Tim Murphy introduce legislation allowing behavioral, mental health, and substance abuse treatment provides to qualify for meaningful use of EHRs.

Health Care Systems Inc. (HCS) intends to join the Helios by Eclipsys application development program and integrate HCS’s Medication Reconciliation software.

Texas Health Presbyterian Hospital-WJN hires PHNS to provide IT services.

Happy anniversary to HIStalk sponsor Stratus Technologies, which celebrates 30 years in business on May 5th. To mark the milestone, they found the client that has been running its high-availability Stratus server the longest with no unscheduled outages. The winner was a Michigan manufacturing firm that’s had the same server since 1993. In case you don’t recall what you were doing in 1993, note that Clinton was president, Intel shipped its first Pentium chips, and Whitney Houston topped the charts with “I Will Always Love You” (I am sure someone finds this last fact significant). Highmark has also been running a Stratus server for quite a while: the company installed its EDI server 2001 and hasn’t rebooted in four (!) years.

Michael Ball, PhD, joins BridgeHead Software’s executive team as SVP, North America. Before Bridgehead, Ball oversaw marketing, product management, and professional services for InfoMedics; he also spent time with Ardais Corporation as VP of sales and marketing.

Royal Philips Electronics releases its Q1 numbers, which included $270.8 million in net income, compared to last year’s $79.5 million loss. The Healthcare division grew equipment orders 20% over last year, though US orders rose only 7%. Most of the growth was driven by sales of clinical and imaging systems.

E-mail Inga.

HIStalk Interviews Pam McNutt

Pam McNutt is senior vice president and CIO at Methodist Health System of Dallas, TX.

What would you say are some of the good and bad points in the proposed Meaningful Use criteria?

Well, let’s start with the good. What’s good about this whole HITECH legislation, I think, is that HIEs, or Health Information Exchanges, are going to be planned out at the state or regional level in a little more solid form than they have in the past. I think that’s good. Prior to that, we had HIEs being formed in regions, in cities, and sometimes even multiple HIEs being developed inside a single metropolitan area. Now with the grants, the states will be putting some thought and planning into what their state’s health exchanges will look like. It will bring some order to things.

Now what’s going to be difficult about the regulations that came out, I think there are a few main points there. First is the all-or-nothing approach that was laid out by the Meaningful Use regulations. Both AHA and CHIME have commented pretty strongly on that; that we think it should be more of a building block approach, rather than all-or-nothing. Meaning that if you can achieve so many, and that number could be debatable, of the objectives laid out, then you could be deemed to have achieved Meaningful Use, rather than having to do every single objective and every single quality measure. We’re very hopeful that will be given serious consideration by CMS. We hope.

What changes do you think will be incorporated from all the thousands of comments made?

I think we’ve already seen something occurring. The issue about eligible providers. In many cases, outpatient clinics of hospitals were excluded under the current definition. My understanding is that there’s been legislation that has passed both House and Senate now that fix that problem and should make physicians who practice in outpatient clinics of hospitals eligible for the stimulus funding. So, we’re already seeing that change.

I think we will also see some changes in the quality reporting requirements. Asking providers to be able to install and use systems that electronically calculate all of the quality assurance measures is asking too much. The CMS has been asked to hold off on that requirement until they’re ready to accept it and process it in that fashion. I’m hopeful that we’ll see some relief on that front. I think those are the biggies.

Then the third item that I think everyone’s concerned about is the basic timing compression that’s going on here due to the delay in spelling out the certification process. Since providers must use certified records, that’s kind of your entry point to even be considered for stimulus funding. We’re going to need to have our system certified, potentially, as early as October 2010 for hospitals, January 2011 for providers — eligible professionals, physicians. Yet the certification rules and process will not be finalized until perhaps as late as June of this year.

That’s going to make it very difficult for hospitals and physicians to potentially have to upgrade their systems if their vendor’s requiring that to comply, or to get the certifications from their vendors. This also puts, I think, a lot of pressure on our vendors as well; having to go back and get their products re-certified, if you will, through a process that’s going to be different than the previously required CCHIT certification process. This presents some real challenges in timing.

What are your impressions about the proposed rule for creating the certification bodies through the EHR certification and testing?

I’m working with the CHIME Policy Steering Committee. I’m actually the Chair of the CHIME Policy Steering Committee, as well as serving on the American Hospital Association IT Advisory Committee. In both cases, these committees are concerned with any provision in the certification process that would drive more providers — hospitals or physicians — to have to go and obtain certification for their portfolio of systems on their own, rather than being able to rely on vendor certification.

In particular, there’s language in the NPRM on what constitutes a self-developed system. We are going to be commenting on that and asking that that be more precisely defined, such that a provider’s minor modification or enhancements to a certified system doesn’t throw them into the category of self-developed.

The fact that they’re opening it up to other entities — is that a step in the right direction?

It’s hard to say. There have been criticisms of CCHIT and there’s also been kudos to CCHIT. It’s difficult to say whether, in the long run, introducing more competition into that certification process is a good thing or a bad thing. They are adding, though, more rigor in the permanent certification process that’s being proposed; which is that you go through certification, then you have to go through testing and the introduction of a concept of a certification body needing to do some field surveillance to make sure that the product is actually being used in the field as it was intended. These three components together could make the certification process quite complex in the future.

Given all these questions that are still out there, do you think vendors and providers will be ready?

I would be very surprised to see any provider, hospital or physician, qualifying much sooner than perhaps this time next year. I’d be very surprised.

I hear many of my colleagues say that they will not qualify for Stage One stimulus funds until 2012 or 2013. Kind of towards the tail end of when Stage One is still in effect. I think that’s going to be pretty common.

What seem to be the biggest hang-ups?

I think it just depends on where the provider or the hospital is at right now with their IT implementation plan. Many people are just starting an implementation of a larger integrated solution. Some people have some pieces firmly in place. Like ourselves, we have many pieces of an integrated electronic record system in place, but we have implemented the modules in a different order than the Meaningful Use criteria are dictating.

We’re having to change our strategic IT plan to go, for instance, and elevate CPOE to be something that has to be done within a year; and perhaps, drop some of the other plans we already had to expand nursing or OR documentation into other areas of our operations. We’ve had to switch our priorities because of this. Any time you switch priorities, it takes some time to start up and get that project going. I think that’s what people are challenged by.

Will you be ready in time?

I really believe that in our organization, we will be able to achieve Stage One. Now whether its next year at this time, or whether it’s a little bit later, is not totally clear to me at this point. But I do believe we will obtain it within the next two years.

How do you see healthcare reform and the ARRA legislation? Are they competing with one another, or do they actually complement one another?

We were just talking about that exact topic this morning in a meeting. I think we have three different initiatives out there right now that are on a collision course. Those initiatives are this rush to adopt electronic health records by 2015, the ICD-10 conversion that’s to occur in 2013, and then the IT implications of healthcare reform. Specifically, in regards to the new reimbursement models, such as bundling episodes of care and accountable care organizations. You have all three of those pretty much converging at the same time, and they all have IT implications.

I do believe that some of the things that are being done in the HITECH Act to bring about standardized adoption of electronic health records could help with the new reimbursement model. However, there’s so much more needed to do that than what’s in the HITECH Act. So while they are complementary to some degree, trying to do them all at the same time has me very concerned, especially given that we have heard statistics of a shortage of over 50,000 people across the industry via the healthcare IT industry.

It makes you wonder — where are we going to get the human resources? If money were no object, where would you even get the human resources to do all the work? Plus, we also know that introducing too much change into your HIT applications and infrastructure can cause instability in their operation. That’s concerning — introducing too much change at once, not to mention all the process flow and workflow redesign that need to occur for healthcare IT to be used effectively.

What, in general, do you think Meditech hospitals are going to have to do to get ready for Meaningful Use?

I think, again, it depends on where they are in their software upgrade cycle. For us and for many others that were staying current with the MEDITECH products — I am on the most current release level, which is 5.6 — that will be able to deliver the Meaningful Use criteria from Meditech.

For other hospitals that have not upgraded recently, I think it’s going to be more difficult. It’s not just the Meditech hospitals. Really, you look at any vendor. The queues for people wanting upgrades are very long. We’re hearing 12-18 months just to get a project started. This isn’t just with Meditech. This is with any vendor, because they’re being overwhelmed by upgrade requests.

I think that in the long run, Meditech hospitals will be in good shape; that Meditech is going to see us through these Meaningful Use requirements. But it’s not going to be easy, especially when it comes to the quality metric reporting. This isn’t a technology issue, this is, in some cases, a workflow process issue back at your organization. You can have all the fields in the software that you need to populate to produce a metric, but how are you going to ensure that those data points are collected? How are you going to instill that discipline in your workforce?

What were some of the conclusions that you drew from the HIMSS conference?

As many have probably observed, the conference was largely about Meaningful Use. Some conclusions that I drew personally, was that data analytics are going to be incredibly important over the next 3-4 years.

On top of all these other things we have to do to meet Meaningful Use internally, we are going to have to start, if one hasn’t already, to dive deeply into your clinical data to understand and engage in the creation of dashboards and alerts and other things to keep your progress towards achieving your quality metrics at the forefront of everyone’s attention in your organization. That is going to require, I think, some very sophisticated data analytic tools.

That was probably my big takeaway besides Meaningful Use, Meaningful Use, Meaningful Use.

What are your biggest challenges and most important strategies at this moment?

For Methodist, we decided three things that we’re very actively pursuing. One, no surprise after what I just said, is really looking at our quality data analytics. Two is ramping up to do CPOE with our hospitalist group as our pilot. Of course, that is to meet Meaningful Use. Then the third really important strategy for Methodist is to reach out to our physicians and help them achieve Meaningful Use by offering a hosted electronic record solution to them. We have ramped up in a very big way to be able to offer that to our physicians. We are hosting NextGen for our affiliated physicians in the community and are gearing up to have 100 or more on within a year. We’re growing very rapidly.

I would say those are our three main strategic IT initiatives. Throw on top of that that we are building new hospitals and we are completely integrating one that we acquired last year and converting them to our HIT structure.

I don’t think that’s that unusual. I think a lot of us have all the other challenges. A lot of people have all the challenges we’ve already been talking about, but on top of that, I think many larger organizations across the country are being approached, as Methodist was, by standalone hospitals that are looking and saying, “I can’t navigate through all the complexity that’s coming at me. I need to partner with somebody that can quickly bring me solutions.” I don’t think I’m unique in having that challenge on top of all the other ones.

Monday Morning Update 4/19/10

From MisterEd: “Re: Yale-New Haven. The bulk of Cerner management is on site with CIO Mark Anderson. Epic’s not a sure thing yet.” Given Cerner’s ongoing dismal sales performance against Epic, plus the fact that YNHH has already been talking up Epic, I’d say Cerner’s chances are minimal, even though they offer the software for free to try for a rare big-hospital win. If I were YNHH, I’d consider Cerner only if I couldn’t find the money for Epic.

From The PACS Designer: “Re: iPad productivity apps. The iPad may not be on your list of must-haves, but you might change your mind if you saw some of the productivity apps for the iPad. TPD thinks that IT personnel may like a feature such as server management that Rackspace has designed for the iPad.”

From Dr. M: “Re: iPad. We found out that the iPad runs Epic! I am going to have to get one! Blanked out the patient and physician names.” Looks good on there, I have to say.

From Gotta Love Neal: “Re: Cerner. Is Cerner planning to manipulate HIT regulation to block small companies and upstarts from entering the market? This Duke distance MBA paper by a Cerner strategist provides a clue.” The PDF has been pulled down, apparently (the paper’s a year old) so the link is to a cached image of it I found. I wouldn’t put too much stock in an MBA paper that isn’t part of company policy, but here’s the part Gotta Love Neal called out, which doesn’t seem far from how it actually played out:

In the current environment, much of the strategy concerning the ARRA stimulus package depends on the details of government regulation. Specifically, the outcome of the definition of “meaningful use of EHR” will greatly impact the strategy that Cerner should adopt. The higher the regulatory burden placed on vendors the greater the advantage is to incumbent vendors. Therefore, it is a critical time to influence the direction of regulatory decision regarding “meaningful use”. In the coming months as Congress and Health and Human Services decide the details of the regulations, Cerner should invest resources to understand the direction of proposed regulations and partner with other incumbent firms to lobby the government to raise the regulatory hurdles as high as possible. Using the Healthcare Information and Management Systems Society (HIMSS) classification scheme for EHR adoption, Cerner should influence policy makers to set the meaningful use bar around stage 4 of 7 stages. This level would encourage even large academic hospitals, which currently average stage 2.5 adoption, to adopt new technologies to qualify for government incentives. It would also erect significant barriers to entry for new firms and encourage small, less technically capable and financially limited firms to exit the market. The message to government officials must not appear to be for the purposes of establishing barriers to entry, rather, it must suggest that meaningful cost savings and quality improvements cannot be achieved without a high standard of “meaningful use.”

Listening: Phoenix, indie pop from France. They’ll be at Bonnaroo and Lollapalooza. I’m not a big pop fan, but I like this OK.

VA renews its agreement to use McKesson’s InterQual evidence-based clinical content application.

I’m looking for a couple of HIStalk sponsors to test a sponsor-only job board that I had built. If you are interested, let me know.

An article in the just-published issue of Lancet looks at diabetes screening criteria using the Archimedes large-scale modeling tool that reviews EMR data such as physiology, disease, and interventions. The authors claim that a randomized clinical trial to generate the same information would have required following one million people for 45 years. It’s the first Lancet article based on a mathematical model rather than a clinical trial.

Thanks to the 191 hospital readers who have completed my three-question survey so far. If you haven’t, would you mind doing a quick, anonymous response for me? All it asks is your job description, employer, and employer’s location. It helps me understand who is reading. Thank you.

Forget my last poll in innovate HIT vendors since unknown pro-Eclipsys parties spammed it. New poll to your right: how many docs who buy EMRs will get all the HITECH money they’re expecting? Note that you can also leave comments on the poll itself, just in case you’re trying to sway someone.

Off topic: I’ve seen the future of TV and it’s not TV. Netflix now offers free, unlimited streaming of a pretty large library of movies and TV shows with any level of its traditional DVD-by-mail subscription. $8.99 per month gets you a free DVD that you swap out by mail as often as you like, but the streaming is the real draw. All you need is an WiFi capable DVD player, a videogame system (Wii, PS3, or XBox 360), or a $100 Roku HD streaming video player and you can watch a ton of video on demand 24×7. It’s fast, reliable, has some nice features like creating your instant queue on the Web, and is pretty high quality. I’m thinking about getting the Roku box since I played around with it this weekend and was instantly hooked. You don’t need cable or dish, you don’t need to buy channels you don’t watch, and you don’t have to watch commercials.

Nashville-based onFocus, which offers performance tracking systems for healthcare management, raises $3 million in Series C funding.

Oracle buys pharma drug development software vendor Phase Forward for $685 million, expanding its health business unit and possibly signaling its interest in other healthcare-related acquisitions.

Interesting: how hacker-resistant are implanted patient technologies such as insulin pumps? In a laboratory experiment, researchers used a computer and radio to access a cardiac defibrillator, killing the simulated patient. Some devices have a 15-foot wireless range with unencrypted signals. They’re talking about tattooing the embedded passwords onto the skin of patients so that caregivers could take control if needed.

We’ve got fresh news and interviews over on HIStalk Mobile for those who care about smart phones, mobile healthcare computing, and similar topics. It has its own e-mail list, so drop your e-mail address in the Subscribe to Updates box at the upper right of that page to jump on.

Doctors in Queensland, Australia are threatening to strike over underpayment caused by implementation of a new payroll system, specifically the Infor WorkBrain workforce management application. Experts from IBM, which managed the implementation, are being brought in from Canada to try to fix the problem.

Debra Medina, a libertarian activities, former medical billing company owner, former nurse, and former candidate for the Texas governor’s seat, shows up at a state committee meeting on health information exchange with a camcorder, apparently to call attention to privacy concerns.

Australia’s plan to issue a national healthcare identifier to all citizens starting July 1 is criticized by a senator, who notes that just 10 weeks out, the legislation hasn’t been introduced and vendors haven’t been chosen.

HHS’s open source Connect project that facilitates connecting IT systems to the Nationwide Health Information Network is named a finalist for an award recognizing innovative technologies that improve citizen services.

eClinicalWorks, in need of space for expansion of its headquarters, tentatively plans to stay in Westborough, MA with a move to another in-town site.

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Responses to Reader Question – Will Hospitals Offer Practice-Based Physicians A La Carte Systems or a Standard Enterprise Model of Software and Devices?

Response 1

I believe most will select a "standard" set of systems they feel they can support with their staff and if they have enough influence/control over their staff physicians, they’ll get majority buy-in; especially if they are leasing it at a "reasonable" price. I also think many physicians who admit the majority of their patients at a facility that offers that option will be very tempted because the research is already done and they can blame the facility and it’s system(s) if anything goes wrong and expect the facility’s support staff to resolve the problem without having to beef up their office staff substantially (or sufficiently). That could be a double-edged sword for the facility if they bite off more than they can chew and don’t set proper expectations or possibly don’t write a good contract and SLA. Otherwise, they have standardization and can brag about it. Obviously all this assumes the hospital/facility has done proper due diligence in selecting their vendors and already has good contracts and SLAs. I’ve heard and read of many multi-facility environments that have tried to support multiple systems and almost always talk about trying to migrate to a single set of favored solutions. Right or wrong, most view supporting multiple systems as more costly in the long run and it tends to spread the staff expertise too thinly. Moreover, they want to consolidate their IT operations and usually think they can reduce the headcount through "operational efficiency". It sells well to management but usually doesn’t work out as well as stated.

Response 2

think that the hospitals will offer a standard physician office rollout package, not an a-la-carte selection. After all, if the hospital has to support the physician users, they will want to keep things standardized. Trying to figure out which office uses which applications/features is too difficult.  The hospital’s support staff is probably already stretched too thin to take variability into account. Another consideration is pricing for the services offered. I think hospitals will want to keep this simple as well, so a standard package fits better for the pricing side.

How to Not Suck in an Interview
By Mr. HIStalk

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

I do a lot of interviews for HIStalk. Like a mother who loves all her children equally, I like to think that they’re all good, but let’s be realistic: I know that some of them have been spectacular duds.

Those clunkers sounded good on paper as I planned them, a no-holds-barred discussion with some vendor executive sporting a big title and enviable credentials. The end result, however, was about as exciting as uncomfortable first date conversation involving the weather. I swear I could hear the crickets chirping while I yawned through yet another boring, pedantic answer to a question that I hadn’t actually asked.

It’s especially hard with HIStalk because I run the transcripts of my interviews verbatim. I don’t edit out endless pontification, question-dodging, or rambling answers that tumble off the page like a jackknifed truck full of bricks. If someone says “sort of” every other sentence (and it seems that’s about half the people I interview these days), those warts are going to be out there for the whole world to see unless I’m so annoyed by the result that I break my own “no editing” rule.

It’s not like I don’t warn my interview subjects. I tell them to keep their answers short but animated, illustrate concepts with stories, fight the urge to constantly brag about the company and its products and instead let their answers do the talking, and to speak like a human and not a brochure.

They don’t always listen. They nearly always regret it afterward. And even if they don’t, I do, because readers usually complain.

My Rule #1 is this: when talking to vendor people, I will almost never interview anyone other than the CEO. Some of the worst interviews I’ve done were with VPs, usually because they were (a) clueless; (b) responsible for only a limited part of the business and therefore not really conversant about the big picture; or (c) so scared of being corporately backstabbed that they wouldn’t say anything that deviated from the marketing-approved talking points.

I don’t like interview subjects who over-prepare, which is why I won’t let them see my questions in advance. I want spontaneous answers and the chance to make up questions on the fly based on previous answers. I know I’m in trouble when I hear papers shuffling on the other end since that always means my subject is frantically digging through a stack of carefully scripted notes to find an answer that absolutely nobody will want to read because it’s … carefully scripted.

Executives also sometimes don’t prep, just getting on the phone at the time the marketing person told them to. Since they don’t have a clue about my audience or my own level of understanding, they sometimes dumb down their answers like I was from the local hippie weekly paper. No, I do not need to see your stick figure drawing of what CPOE is, thanks.

I learned the hard way to never allow a second person to sit in on the interview, even if the company is run by two inseparable and equal partners who can’t bear the thought of not speaking as one. It drives the transcriptionist crazy, they end up constantly enhancing each other’s comments pointlessly in an effort to wrest equal air time, and readers have no clue who’s talking and why it took two people to have so few original thoughts.

I’ve also learned by bad experience to never let the interview subject see the transcription draft before it runs. It’s tempting because they might catch a glaring transcription mistake caused by poor audio (usually because they insist on being interviewed on their cell phones), but their insecurity always moves them to convene an impromptu review panel, always led by a marketing person who insists on sticking trademark symbols on everything and making irrelevant punctuation changes (I always put a comma after the second item in a three-item series and no, I don’t care what reference says otherwise since I can find at least one that says it’s OK).

The answer to the first question sets the tone. I tell the subject that I’m going for about 20 minutes and will ask maybe 6-8 questions. The message is clear – don’t prattle on. Several years ago, in one of the worst interviews I’ve done, the guy hadn’t come up for air 10 minutes after I’d asked my usual “tell me about yourself” icebreaker question, still blabbing endlessly about his wondrous experiences at a bunch of companies. I’m pretty sure readers would rather draw their own conclusions about his abilities instead of listening to him recite them.

So my interview advice is succinct: develop a rapport with the interviewer, talk just enough, and always be fascinating. Heck, if you can do that, you’d make a great first date for someone, too.

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.

CIO Unplugged – 4/15/10

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

Do You Have What it Takes?
By Ed Marx

Interestingly, yet not surprisingly, my most popular posts are not on healthcare technology but on leadership. Evidently, industry challenges and solutions are secondary to the primal importance of management execution. In other words, you can have great ideas and vision but if you lack leadership, “Fergeddaboutdid”—as Johnny Depp humorously mimicked Al Pacino in Donnie Brasco.

We’re born questioning our existence, and many of us spend a lifetime searching for answers. Some of us never find them because of our insecurities that skew the process. While wrestling with my own fears, I’ve always asked this one question, which I believe is universal:

“Do I have what it takes?”

Athletes wrestle with the same question, especially right before an event. During my first Escape to Alcatraz, I sensed the vibrant energy flowing from the participants on the boat heading toward Alcatraz. We discussed race strategy, weather conditions, currents, and the great deals we got on our technically-advanced wetsuit. But as race time approached, an eerie silence took over. Some would call it the sound of focus. I’d argue it was the deafening throb of introspection. Do I have what it takes?

Last fall, I completed my first extreme adventure race. 40 miles of technical mountain bike trails, 13 miles of kayaking, 1 mile of river swimming and 20 miles of running, all integrated via traditional map and compass. Before the starter pistol fired, I listened to people sharing battle stories from the adventure race season. As the minutes wore down, I began to grasp the reality of my latest endeavor. Traversing unmarked trails, my three-man team would be on its own, finding the way with no support other than what we could carry. Do I have what it takes?

When I held our first child. When I first spoke in public. When I first led troops. When I took on my first CIO role and faced numerous challenges, I asked myself the question. I’ve tried to live in such a way that I can answer in the affirmative. I realize that having what it takes revolves largely around preparation, which breeds confidence. And, I’ll tell you what. When you’re floating two miles off shore between San Francisco and the frigid, shark-infested waters of the Pacific, you’d better be able to answer the question positively. Otherwise, fergeddaboutdid.

Simply put, we don’t rise to the occasion, we fall to the level of our preparation.

Where the athletic pursuit boasts physical demands, leadership carries the challenges of high stakes, decision-making, and time pressures, to name a few. I’m compelled to do everything within my control to be ready for whatever work throws at me. Some things I can’t prepare for, such as the perpetual supply of surprises, disappointments, crises. Nevertheless, I want to be equipped and confident to answer the ultimate question.

May 2nd of this year, I’m diving back into the frigid San Francisco Bay. I will ask myself the question. And despite my fear, I will put my face in the water and push one palm back after another. Same at work. Between the ACO, meaningful use, and the ever-evolving tech advances, I’m equipping myself.

Are you?

(Otherwise, fergeddaboutdid!)

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.”

News 4/16/10

From The PACS Designer: “Re: Google Documents. In a challenge to Microsoft Office, Google has expanded its online document offerings. TPD has been using the Google spreadsheet application for some time and now will be testing the new features as well as the usability of Google Presentations and Google Drawings.”

From Rysanwss: “Re: Yale-New Haven. An EVP made a formal announcement to the IT staff that Epic is in their future. No signed contract yet, but they are close.”

From Jobs: “Re: Apple iPad unpacking video. A staple of Star Trek movies is a long, slow tour around the exterior of the ship, showing the exquisite detail of nacelles, the phaser emitters, the gentle curves of the saucer section, etc. This scene is ‘trekkie foreplay’. The iPad video is the Apple version.”

O’Connor Hospital (CA), Orlando Health (FL), St. Vincent’s East (AL), Huntsville Hospital (AL), and UC-Irvine (CA) are recognized for excellence at the annual conference of Surgical Information Systems.

Sad news: Steve Tanaka, CIO of Palomar Pomerado Health (CA), drowned last week while on vacation on Costa Rica. He was 50. The hospital has created the Steve Tanaka Award for Excellence to honor his work and memory.

This story doesn’t inspire much confidence in healthcare IT security. Auditors reviewing the security of electronic patient records of Vancouver Coastal Health Authority found so many vulnerabilities in every area that they buried the report for six months, fearful that anyone reading it could start digging through its systems. “No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time. Almost all users have some access to confidential information about all clients in the database. Many clients’ full health information is accessible to a large number of users.”

Software developed at Brigham and Women’s Hospital to optimize the schedules of astronauts based on their sleep rhythms may have a role in healthcare, with potential use in creating employee schedules, predicting low-performing times to avoid errors, and using light therapy to  change natural sleep cycles. I found a free beta download here.

From Weird News Andy, who comments on his find as <predictable>The thought of an implantable chip just gets under my skin.</predictable>. PositiveID (formerly VeriChip) strikes a deal with the International Maritime Medical Association to offer its PHR to seafarers. WNA also found this story about the theft of 57 hard drives from BCBS Tennessee, now estimated to include records of 1 million patients.

Jobs: Cerner Build Specialist, Senior Product Marketing Manager, Regional VP Sales – HIT Consulting, Anesthesia Product Specialist.

Epic CEO Judy Faulkner will receive an honorary Doctor of Science degree on May 14 from her alma mater, the University of Wisconsin-Madison.

Sheehan Medical Cork Medical Centre, the first new private hospital to open in Cork, Ireland in 30 years, awards its IT contract to Meditech. The company has several other Irish clients.

Dennis Quaid has produced and narrated a documentary called “Chasing Zero: Winning the War on Healthcare Harm” that will air on the Discovery Channel next Saturday, April 24. It was inspired by the near-fatal heparin overdose given to his infant twins at Cedars-Sinai.

An Army doctor faces court martial after refusing deployment orders to Afghanistan, stating his belief that the orders are illegal because President Obama was not born in the US and therefore cannot serve as his commander-in-chief.

University of South Florida will hire 100 “e-ambassadors” for its stimulus-funded PaperFree Florida electronic medical records initiative.

Christoph Lehmann, MD, a Johns Hopkins neonatologist, is chosen as founding medical director of the Child Health Informatics Center, an American Academy of Pediatrics informatics group created in October 2009. That group will design a prototype model electronic pediatric health record.

A former medical records clerk of St. Peter’s Hospital (NY) is arrested for stealing patient information and shopping online using their credit card numbers. He was caught after ordering merchandise and forgetting to change the default shipping address, sending a package to the house of one of his victims, who realized someone else had ordered it using his credit card.

Oppenheimer upgrades shares of open source vendor Red Hat to outperform, while UBS flags the company as a compelling takeover target.

Odd lawsuit: the sister of a man accused of beating his parents to death sues the hospital for negligence in the death of their mother, claiming “wrongful death”.

E-mail me.

HERtalk by Inga

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Enterprise Software Development changes its name to Enterprise Software Deployment to better reflect the company’s evolved breadth of EHR implementation services. You can check out their good-looking new logo and ad to your left.

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

I don’t think I’d be starting a career in PACS sales any time soon, assuming the results of this CapSite Consulting study are accurate. Currently 96% of hospitals have already own PACS solutions and only 17% of the surveyed hospitals have plans to buy a new or replacement system. The biggest imaging IT spend in coming years will be for image archiving and storage, plus voice recognition tools. Almost half of hospitals with PACS cited functionality as the biggest weakness of their PACS.

CareTech Solutions doubles its number of Web Products and Services clients in fiscal year 2010, now serving over 150 hospitals.

Cardiology Associates (AL) picks Allscripts’ EHR for its 38 providers.The practice will tie the EHR into its existing Allscripts PM and document management systems.

Complete Women’s Imaging (NY) selects Merge Healthcare to provide a diagnostic imaging workflow solution, including Merge’s Fusion RIS/PACS MX.

Desert Orthopedics (OR) plans to implement SRS hybrid EMR for its 10 physicians.

The Heart Hospital of New Mexico chooses TeleHealth Services for interactive patient education services.

IDC Health Insights takes a peek at 14 HIE vendors and provides assessments on their offerings (for $4,500, you can get a copy of the report and fill us in on the details). For the most part, the 14 vendors were the ones I would have expected (Axolotl, dbMotion, Medicity, etc.) One surprise vendor was eClinicalWorks. I knew they had an HIE product, though it’s not heavily promoted. On the other hand, I know other ambulatory vendors like NextGen and Allscripts are trying to establish an HIE presence, yet were not included. A quote:

Typical of nascent markets, the HIE vendor market is volatile with new entrants and market consolidation. We can expect dramatic changes in the next 12 to 18 months as HIE technologies become a commodity and dominant players acquire their way into a crowded market currently made up of many small, privately held vendors.

The California Telehealth Network awards AT&T a $27 million contract to build a telecommunications network to connect hundreds of providers throughout the state.

Spheris wins court approval to sell its assets to fellow medical transcription vendor CBaySystems Holding for $116.3 million, which includes $98 million cash.

Here’s a good tax day story for you. The president of a San Diego medical billing company pleads guilty for failing to pay $2.5 million in employment taxes, even though the taxes had been withheld from employees pay checks. Anthony Vacchi, Jr faces up to five years prison.

E-mail Inga.

HIStalk Interviews Sanjaya Kumar

Sanjaya Kumar, MD, MPH is president, CEO, and CMO of Quantros.

Can you give me a two-minute summary of hospital-based pay-for-performance programs and how your applications help manage them?

It’s interesting that you say hospital-based pay-for-performance programs because I think the overall industry graduated into pay-for-performance, from the managed care all the way down to the physicians really having to basically be working within those programs. Now, definitely the hospitals are in the fringes of that, but I think, firmly, in my opinion, pay-for-performance now is moving into pay-for-results and pay-for-better-outcomes.

The way that our applications help support those needs for the hospitals that are participating in those programs is that we allow ready capture and aggregation of all of that data, either from secondary data sources, or they can actually input it into the applications for the different metrics that are supposed to be reported for the pay-for-performance programs from either CMS or Joint Commission. Primarily CMS. That data is reported quarterly.

The added benefit for our clients is that they can review all of that data in near real time, as well as compare and benchmark themselves with other hospitals in a blinded fashion, very readily. That’s one of the added values that we provide, so even before they’re able to see their results publicly reported out there for pay-for-performance, they can gauge and see how well they’re doing in comparison with others.

What impact do you think the publicly reported hospital quality and outcomes measures will have on the industry?

In the way that the information currently is made available, I think the impact is relatively slow in terms of its uptake. However, what it is a doing is that it’s increasing the degree of transparency around the reporting of all of these metrics and measures and education to the consumer of healthcare, in terms of their importance and their significance. Really, the metrics aside, I think the overall programs are helping to influence consumers in the way that they seek care, or where they seek care from.

I think it’s going to continue to shape that industry in terms of the transparency that needs to be there. It’s going to drive and motivate more and more hospitals to actually disclose some of all of the results to their local constituents and local marketplaces in order to influence purchasing behavior of either employer groups or health plans, in terms of how they’re contracting with them or in terms of where the consumers are seeking care from.

I think it will have a bigger influence, perhaps five years down the line, as this data begins to get even much more attention and begins to get publicized that much more. Today, the healthcare consumer is still very naïve about some or all of this.

Do you think they know the data’s out there and just don’t have much of a choice of where they go? Or, do you think they’re really unaware that there even is such a thing?

To a large extent, I think the awareness is coming about, but I think it’s slow on the uptake and slow on the marketing of some of all this information. The government could do, perhaps, more, in terms of highlighting the availability and where the data is made available from. More has to be done. I think more people need to get onto the bandwagon, in terms of shaping consumer attention to this.

Several years ago, the MedMARx database was used to generate a report suggesting that CPOE was creating quite a few medication-related errors. What are you seeing now from the database and with the FDA’s apparent interest in overseeing the whole safety issue with electronic health records, how do you see that playing out?

As you perhaps, know from the background, we actually acquired the MedMARx database about two years ago from the USP. We now currently manage that data registry. It’s got over 2 million records on medication errors and adverse drug reactions.

The same patterns that actually used to be there are still pretty much very evident. Meaning, although one of the patterns that has actually emerging and interestingly, we did an analysis for somebody that was actually writing an article in The Wall Street Journal a few months ago  that indicated that errors that basically are implicating CPOE systems definitely do occur, but the more serious type of events are being averted.

I’m meaning that more incidents that actually lead to major fatal harm are actually on the decline with the utilization of CPOE. Although, CPOE is still leading to a number of errors that are basically there within the medication error profiles.

I think that a real interesting conundrum over here is that there are multiple vendors for CPOE systems. I think CPOE systems need to be very carefully evaluated. I know that the Leapfrog Group, for example, has a CPOE evaluation tool that is made available to hospitals. For example, if they’re participating in the Leapfrog survey. I don’t know how much you know about the Leapfrog Group, but they’re all about transparency for safety and quality, in terms of practices that are out there and how safe institutions are. They actually make available a CPOE evaluation tool.

I think the FDA needs to look at tools like that very, very collaboratively, in terms of really encouraging the use of those tools to identify CPOE solutions that are right, that are fit, that are actually ready for use within point-of-care environment. There are a lot of CPOE systems out there that are not necessarily right that actually are leading to a lot of errors, or that are not catching errors, necessarily.

When we implement systems like CPOE, we automatically are almost aligned with clinicians just like a child with a calculator who doesn’t necessarily think through the computation they’re performing, but just believes in the answer that they are getting. That is the biggest problem with automation systems. We’re actually blinding the provider at the point of care with systems like that in order to believe them without having to really think through whether something is right or wrong.

I think utilization of CPOE evaluation type methodologies; critical review of those, the kind of errors that they lead into is very, very important as a go-forward strategy; especially if we are mandating that solutions like this be implemented, which is really pretty much what the ARRA, the HITECH Act, is providing for.

EHR adoption is going to create tons of electronic patient data from all these systems at some point. What do you think the best use is, both at the organizational level, and the population level, for all of that data that we’ll suddenly have available?

I think it will be a blessing for monitoring specific populations of interest. It will be of benefit to actually apply continuous quality improvement methodologies in place. It will be very, very important for organizations to actually utilize some or all of that digitized data to be able to tell more — regarding their own environment, regarding where care is actually being provided, how well care is being provided — from a combination of dimensions of interest: patient safety; quality; compliance with clinical care protocols; and adherence to certain standards of care from the perspective of providers, in terms of their outcomes that are actually occurring; and finances.

I mean, we shouldn’t forget that care should be really provided in a very cost-effective fashion. Today, it’s very, very difficult, for example, for an institution that is actually collecting all of the quality data, to actually even determine what the improved quality-to-cost ratio is. If they’re collecting all of this data to monitor and improve upon care for heart attack patients, if that is actually influencing a decrease in cost or length of stay for the institution, it’s very difficult for them to do that very readily today with the availability of data across all of these different dimensions. For the population-based level, it will become easier and easier to allow for such evaluation to occur.

I know that you have some products that relate to real-time surveillance. What are the results? What are hospitals doing with that?

Real-time surveillance, again, is applicable to only institutions that have good, digitized HL7-formatted data that is regularly available. Naturally, of course, that precludes the utilization of those tools today to perhaps less than 10% of the institutions within the United States. Those kinds of solutions really are easy to use, very readily configurable solutions that allow a clinician to set up rule sets — different rules that are very, very clinically sound, in terms of really what they’re looking for.

For example, a drug-bug mismatch. Based upon the data feed that is coming in from the lab, if a particular microbiology result basically indicated that a patient had a particular bug and was sensitive to a particular medication, it’s now going to look into the pharmacy order entry data set coming into the system to determine whether the right drug was actually being ordered for the patient. If the right drug is not being ordered for the patient, it will raise an alert. It will raise a flag. That flag is brought to the attention of the care provider.

Today, EMR systems do not have that degree of robust decision support rule sets built into them because it’s extremely customized and cumbersome to manage and maintain. The surveillance solutions that we provide take the HL7 data feeds and the clinician configures whatever rule sets that they want and have the alerts go out to the people that really need to be taking care of the patient.

I had one question about one of your products, your Clinical Café. Can you tell me about that?

That’s sort of like a pet project of mine that got conceptualized about three years ago at one of the IHI conferences. Really, the premise behind ClinicalCafe.com was to provide an environment … because Quantros services over 2,000 hospitals, we have a very rich collection of very like-minded people around quality, safety, compliance, operations, CMOs, and the like, that are basically part of the user community.

The idea was — how do we bring all of these people together in an environment where it can provide for them to connect with each other, be able to share best practices or information with each other so that they can collectively learn? Because what is working in one organization will probably benefit another organization. How can they be able to inform each other proactively, by setting up, maybe peer groups and things like that, so that they can collaborate? It’s sort of like creating an environment for utilizing social networking to really provide for a very rich collaboration for learning purposes and improvements in safety and quality. That was really the premise of Clinical Café.

It took about two years to actually gel the idea together. We launched ClincalCafe.com at the last IHI conference in December, the last one that was actually held, in 2009. We launched it over there and now we are integrating it with our applications to invite each and every user into the Clinical Café environment so that they can begin to interact with each other. It’s an open, shared, learning platform. It’s really not a proprietary platform. It’s really for any clinician, any provider, anybody interested in safety and quality, to be able to learn from each other as opposed to, perhaps, going to disparate sort of places.

Normally, learning is amongst each other. We tend to learn from each other much more readily. We share a lot of information with each other. Hopefully, the environment will provide for that. I would encourage you to sign up and become a member.

Anybody can become a member?

Anybody can become a member. The way that I like to introduce it is sort of like a Facebook for professionals within the healthcare community that are interested in improving safety and quality. I think, as of the last count, we had about 1,500 people that had already joined. It keeps on increasing by about 30-40 people every day. Hopefully, we’ll have a critical mass very soon.

This may be a question that you’re not comfortable with answering, but I’ll ask. If a hospital, from your perspective, wanted to make IT investments right now, with patient safety in mind, based on what you know and what you’ve seen and what your data tells you, what kind of technologies do you think would make the most sense?

There are lots of technologies that people are proposing out there for the point-of-care environment that I don’t think are necessarily ready. I think there needs to be a lot more critical evaluation done, in terms of the technologies that are being proposed out there. Very, very few vendors out there have ready technologies that would allow for very effective solutions at the level of point-of-care. A lot of the EMR systems out there are documentation systems. They’re not necessarily aligned for collection of very good, discrete data elements that can be utilized in a very meaningful fashion. We have to still evolve.

We should be very careful because some of these purchases are going to cost millions of dollars and they’re not necessarily that easy to replace because you’re going to embed them within the fabric of your enterprise. A number of people will have to work with them.

The other issue with a lot of point-of-care systems is clinicians are very, very averse to any new technology or change management. I think adoption of these technologies, ready usability if you have some of all of these technologies, is very, very important. I’ll highlight one key important point. For example, if I’m a physician and I’m practicing at three different institutions, and all of those three different institutions are using three different EMR or EHR systems, I now have to learn three different systems to interact with and actual work with. How can that EMR system just basically take my credentials and, perhaps make that into a common user interface for me that is to my liking?

I think technologies like that have to basically be researched, and I think we’re still at the very nascent stages of that evolution.

Over the next five years, what are your plans for the company?

The plan for our company is to continue to confirm our position as an industry leader, in terms of what we provide for furthering patient safety and quality and transparency for some of all of the data that we help our institutions collect and report. Our focus is squarely in terms of how do we bring about more actionable information for key stakeholders within institutions to be able to address patient safety, quality, and their business? The outcomes for improvements related to the implementation of EHRs or EMRs is basically safety and quality. That’s pretty much what everybody is proposing out there.

Our focus is squarely on that, and as a company, we are hoping that we’ll be the majority industry leader, in terms of really providing that very soon, I’m sure that if you follow us you’ll begin to see some of all of that even come about further.

Any other thoughts?

I do want to again highlight the value of environments like Clinical Café. I think in the new day and age of younger people that are actually beginning to interact with learning tools, or collaboration platforms, I think social media has a long way to go with it. I think mobile technology has a long way to go, in terms of furthering some advancements within healthcare that we, perhaps, have not necessarily taken. The work being done by organizations like Cisco in healthcare, with their collaboration platform, is very, very innovative as well as very entertaining to see that come about from a provider of hardware solutions like that.

I think the industry is going to want to see more and more, in terms of solutions like that, because they will provide for the easy, shared learning that needs to be there. We shouldn’t be closeted about certain things that are working within our environment and not really have them readily shared because they will save lives and improve the care that we provide to people. We all need to be able to benefit from all of that very readily.

I think technologies and the adoption that is currently being driven by the ARRA or the HITECH Act, yes, they push it very good. I applaud the push; I applaud the benefits that the government is actually providing for some or all of that. But it could also provide for a very ready environment for very rash decisions that might not necessarily further an organization’s goal because they’re really being pushed to that. Each and every organization doesn’t necessarily have the core capabilities to help address or evaluate each and every solution that they need to be implementing that is being required to meet all of the ARRA or the HITECH Act.

Four years is not necessarily a very long period of time to implement some of all of these solutions. I’m hoping that through your blogs and your talk, you actually are highlighting some of all of that, because it could push the industry in the wrong way as well.

News 4/14/10

From Dr. Know: “Re: California Nurses Association. We have been rolling out an electronic health record system and have been confronted with growing resistance from the nursing staff, which is heavily unionized. They continue to refer to this document (warning: PDF) published by the California Nurses Association, which says, ‘Don’t Automate.’” The union’s flyer says that healthcare IT is driven by the desire of employers to control workers, that EMRs are used to spy on employees, and that technology is intended to homogenize health professionals and patients like interchangeable machine parts. I don’t disagree with all of it, but it’s pretty over-the-top.

From Minute Man: “Re: Leagcy Health. Dick Gibson MD, senior VP and CIO of Legacy Health System in Portland, OR who spearheaded the purchase of Epic, has been let go. In addition, Carol Edwards, VP of information systems with 20+ years at Legacy Health, was let go at the same time. They both left at the end of March. The Epic implementation has encountered significant costs overruns and delays. The project manager is a consultant who has no prior Epic implementation experience. Interestingly, the same consultant managed the Cerner implementation at Legacy, which is being replaced with Epic.” Unverified.

From The PACS Designer: “Re: iPad first look. If you haven’t purchased and received your iPad yet, you may enjoy the arrival experience by viewing Fritz Nelson’s iPad delivery and first use out of the packaging in his review for InformationWeek. Also, the Apple Insider has a full review of all the features available on the iPad.”

The Methodist Hospital (TX) enhances its online patient experience by launching distributed authorship of content for Web visitors from MEDSEEK.

A hospital in Thailand says it will be among the world’s best after an IT investment of $1.5 million. It will run PeopleSoft financials and HR.

Vanderbilt researchers present a paper describing the privacy method they developed that generalizes genomic data in EMRs to prevent linking patients to their genetic profiles.

I closed out the poll to your right because it was getting spammed hard by respondents (or automated scripts) choosing Eclipsys as the most innovative vendor. The polls usually get around 200 votes and this one was up to 688, with Eclipsys getting 528 of those. You can decide whether you believe that result.

Healthcare Growth Partners releases its HIT market report for Q1 (warning: PDF).

The Wall Street Journal writes up HIEs, profiling the data sharing of Children’s Denver, Kaiser’s Colorado physician group, and Exempla, all of which use Epic and share information.

A doctor and EMR consulting company vendor criticizes Canada Health Infoway’s multi-billion dollar EHR project, citing low physician adoption. Among his criticisms: the “unconscious patient in the ED” is rare and hard to justify as a necessity; investments have been focused on hospitals instead of doctors’ offices where most care is provided; EMRs don’t help with referrals or consultations, which still require paper; and privacy issues and local legislation prohibits the free flow of information that the system was built around.

Speaking of Infoway, the specially created pension plan of its CEO has accumulated $1 million in benefits after six years on the job, not bad for running an organization with only 200 employees.

It’s not just medical doctors who suffer through EMR implementations – veterinarians have similar concerns. “They really pushed big at the conferences. They knew that they were going to be bought and had to make their numbers look good. I just don’t think they were ready to take on a practice like ours.”

The mother of a nationally known activist who died at UPMC Shadyside blames the hospital’s “unreliable and insufficiently tested” computer system, saying its faulty records resulted in his being given soup too soon after surgery, leading to his asphyxiation. She also claims the hospital released his information to a congressman without permission.

If you work for a hospital or health system, please complete my three-question anonymous survey: your job title, the name of your employer, and the location. It’s nice to know who’s reading.

A primary healthcare center and ED launch what they say is the first HIE in Georgia, with the organizations sharing medical records of uninsured patients to streamline delivery and reduce duplication of services.

E-mail me.

HERtalk by Inga

From CowCHIT: “Re: Karen Bell. She was just named Mark Leavitt’s replacement at CCHIT. Don’t know her myself, but … she can’t be any slimier than Leavitt seems.” Sounds like a glowing endorsement. She was most recently SVP of HIT services for Masspro, and before that was director of the Office of HIT Adoption and acting director of ONC. Because of her previous association with ONC, she’ll be unable to lobby for CCHIT in front of federal officials until November 2010.

e-MDs announces it has increased its employee count by 36% over the last year and experienced a 36.5% increase in organic sales since the start of 2010.

CliniComp says that three more US Army and Navy facilities deployed the Essentris EMR during the first quarter of this year.

CynergisTek launches its HIPAA/HITECH Security Compliance review solution for hospitals that qualify for SHIP grants from the Office of Rural Health Policy.

Eclipsys announces the release of Sunrise Enterprise 5.5, which the company says includes significant EHR updates. The new release includes Helios, the new Eclipsys open platform strategy that allows third parties to natively integrate their applications.

The Children’s Hospital at Montefiore (NY) will implement GetWellNetwork’s GetWellTown, the pediatric version of its Interactive Patient Care program.

Foundation Radiology Group appoints Tom Skelton CEO. Last month a reader tipped us off that Skelton was leaving MED3000, where he served as president of technology services.

HIE Health Advancement Collaborative of Central New York signs a multi-year agreement with Axolotl for its Elysium Exchange suite.

Thomas Jefferson University and Jefferson University Physicians select Allscripts and dbMotion to provide an integrated and interoperable EHR and population management solution.

Eight thousand Vancouver Coastal Health (BC) employees are now live on workforce management solutions from Kronos, including time and attendance and employee scheduling.

Catholic Health Initiatives chooses RelayHealth RevRunner for patient eligibility verification.

David Blumenthal wins his second big award in just over a month. In early March, Blumenthal won top HISsie honors as HIStalk’s Healthcare IT Industry Figure of the Year. He has now been named the Most Powerful Physician Executive in America by Modern Physician and Modern Healthcare readers. I’m sure the latter award, while not as prestigious as a HISsie, will still be coveted.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. I’m assuming I am just too old / uneducated and/or poor since I don’t have one. Mostly I am PHR-less because it seems like far too much work to maintain. However, just today I was thinking that it would be kind of cool if I had a PHR. I’m trying to buy health insurance and am needing to provide the evil insurance company TEN years’ worth of medical history. As in, every antibiotic for every strep throat or bronchitis attack, every outcome to every dermatologic encounter, and every little medical incident that I have either forgotten about or don’t care to share. Seriously? I have a new theory about why so many Americans are uninsured but that’s all a can of worms I don’t care to open. Suffice it to say that maybe – maybe — I’ll start looking into using a PHR.

A man sues medical device maker Stryker, claiming its artificial hip destroyed his sex life. He alleges that while having an intimate moment with his wife, the act was interrupted because the squeaking made her start laughing (how insensitive). About 750 individuals have also filed lawsuits, including a fellow who put a video of his squeaky hip on YouTube. If you check out the video, let me know if you think this guy is wearing Superman pajamas.

E-mail Inga.

Being John Glaser 4/12/10

Working with ONC on HITECH: Some Observations

I have spent a large portion of the last eleven months working with the Office of the National Coordinator for Healthcare Information Technology (ONC) to develop the regulations and grant programs that resulted from the HITECH legislation. This time and this work have led to four major observations.

The Power of Meaningful Use

For decades, the healthcare information technology industry has tracked adoption. How many hospitals have adopted CPOE? What is the adoption rate of personal health records?

While adoption is a measure of industry uptake of a technology, it has an obvious flaw. Adoption does not mean that providers are using the technology or that care is being improved. Adoption does not, per se, lead to complete problem lists or providers doing a good job of managing the health of their patients.

Meaningful Use is a very potent idea. It says that if our goal is care improvement, adoption is only relevant if the technology is used well.

Meaningful Use also stops short of initially basing incentives on changes in care outcomes. While providers must report quality data, early stages of Meaningful Use do not require that specific improvements in care occur. It was understood that broad care improvement will take more time than is likely to be achievable under the initial HITECH timetables. And it was understood that while EHRs are an essential foundation for care improvement, additional factors must also be present.

Most importantly, payment reform must happen — reimbursement that explicitly rewards providers for improvements in care quality, safety, and efficiency. The recently passed Health Reform legislation begins the process of the implementation of payment reform for federal programs.

Meaningful Use moves the industry away from a focus on adoption, but does not overstep that movement by leaping all the way to outcomes.

The Joint ONC/CMS Approach to Regulation/Rule Development

After HITECH passed. there was a need to develop the regulations (also known as rules) that translated the legislation into specifics, e.g., what are the specific things a provider would have to do to be considered a Meaningful User?

As it writes rules, the government must follow a core protocol. Those who are drafting the rule cannot talk, outside of government, about the draft language. The draft rule must be reviewed and approved by several government departments such as the Office of General Counsel. And the government must ask for comments, on a draft of the rule, from the public and it must read those comments.

While it followed that protocol, ONC (and CMS for Meaningful Use) made a critical strategic addition. They leveraged the Policy and Standards Committees (which were open to the public) to develop recommendations of the rule content. The Meaningful Use Work Group defined an approach to the 2011 (Stage 1) objectives and measures. The Certification and Adoption Workgroup developed recommendations for a new EHR certification process. The Workgroups of the Standard Committee developed recommended data, transaction, quality measures, and security standards.

Most of the time, government does not do this. Generally government staffs do not precede rule writing with external committee (and public) input.

Why did ONC do this?

First, the rule content is likely to be better if it is based on the contributions of individuals who represent the broad spectrum of stakeholders in healthcare. These individuals “live” the delivery, financing, supplying, and management of care every day. And their experiences and knowledge cannot help but make the rule better. Moreover, the discussion of rule specifics from different perspectives helps to ensure that the rule balances, as well as it can, the variety of stakeholder interests.

Second, it is good government. Good government is transparent. Government is put in place by the people and it exists to serve the people. The people should be able to “drop in” on regulation deliberations and government should minimize the times it closes the doors.

Third, it is a terrific example of risk mitigation. It is very difficult to develop, for example, the specifics of Meaningful Use in a way that understands the complexity of healthcare; its current reality and its aspirations. By seeking the advice of experts through Committees and Committee testimony and inviting the comments of all, the Government is asking about areas where the proposed rule may have unintended consequences or could lead to sub-optimal outcomes.

Fourth, it helped the industry know, as early as possible, the direction that the rules were likely to take. The recommendations of the Committees were presented in the summer of 2009. The draft rules were unveiled in the winter of 2010. Through its use of the Committees, ONC was trying to give the industry as much of a lead time as it could.

The Complexity and Scope of the Challenge

HITECH has resulted in two classes of ONC efforts: definition and implementation.

HITECH required that specifics (and hence rules) be defined for

• Meaningful Use
• The data, transactions, and measures standards needed for health information exchange and quality reporting
• Certification standards and the certification process, and
• Privacy and security.

While essential, rules are not enough. Other actions are needed if we are to have the broad achievement of Meaningful Use by providers across the country.

Most of the care in this country is delivered by small physician groups and hospitals; they do not have an IT staff. Regional Extension Centers have been established to provide necessary support to those providers.

A health information exchange infrastructure needs to be in place to support the secure movement of data necessary for the care of an individual patient and the management of populations by public health organizations. Funds have been given to the states to establish this infrastructure and a plan to establish an over-arching National Health Information Network (NHIN) is being developed.

The country will need to increase the size of the work force available to support the broad achievement of Meaningful Use. Funds are being awarded to educators to provide necessary training and curricula.

Beacon communities will help us understand how best to leverage the technology to improve the health of a community and will teach us how to address important issues of governance, data use, and coordination of care.

Advanced health information technology research centers (SHARP) will provide ground breaking research into the critical areas of security, new architectural models, decision support, and secondary uses of data.

These implementation activities are breathtaking in their scope and sophistication. And the activities are the result of a very astute assessment of the range of “levers” that should be applied to achieve Meaningful Use.

However, initiating that many diverse initiatives that individually and collectively have a significant impact on multiple parts of the industry comes with some risk.

It is not possible to launch this much activity of this scope with this many actors and have great certainty about the outcome. This uncertainty will be magnified by the actions of the private sector — hospitals, health plans, suppliers, and others that are engaging in a diverse array of often very imaginative implementation activities.

The ONC implementation plans are very good plans. But they bring complex and substantial change to the industry. Change of this magnitude will bring very real progress, but it will also bring a period of time that is likely to be bumpy.

When significant change is introduced, one plans as well as one can, ensures that one has a realistic appreciation of the uncertainty, and preserves the agility to change course as needed. And, most importantly, one makes sure that there is ongoing dialogue with all stakeholders about issues, answers, and progress.

The Caliber of Federal Government Employees

Perhaps like many of you, I might have had this mental image of a typical government employee — a person with a rubber stamp in their hand and a scowl on their face. That mental image is wrong.

The people I worked with at ONC, CMS, NLM, NIH, FDA, DoD, VA, and a host of other government agencies and departments are exceptional. They are very smart and skilled. They work incredibly hard. They feel a sense of urgency. And they care deeply about making the country better. They listen thoughtfully to the comments, testimony, feedback, and articles from those who care about healthcare because they want to get it right.

They made me proud of my government because my government (and yours) is them.

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 4/12/10

From Thad: “Re: Allscripts. Word is that an inside e-mail leaked out to a wider audience of employees than planned. It mentioned the pending merger of Allscripts with Eclipsys.” Inga tried to chase this rumor down, but of course nobody’s saying anything to confirm or deny. Several people have told us Microsoft will make a move on Eclipsys very soon, but I’m always skeptical about Eclipsys rumors because they come up every year or so. But if you asked me if either event is possible, I’d say yes, even though I don’t see the value in either scenario. ECLP announces results on May 4, which may or may not be relevant.

From J-Hi: “Re: meaningful use. Does anyone know a source that lists the 25 objectives and the comments submitted to CMS for each?”

From Tangelo: “Re: AFCEA military HIT conference. Between the speakers from HHS, VA, and DOD and the large government contractors lining up to suck on the HITECH teats, it’s embarrassing to see how disconnected they all are on the real issues of implementing HIT (meaningful use and HIE) at the community level.”

From PortlyChap: “Re: QuadraMed. Quadramed lost the last of its Affinity clients in Kentucky recently. Pattie A. Clay Regional Medical Center in Richmond recently signed a contract with Meditech. The only other Kentucky Quadramed Affinity client signed a contract with Meditech in December 2009.” Unverified.

Transcription provider Transcend bids $78 million for the bankrupt Spheris, slightly upping the $75 million offer on the table from CBay and Nuance. And in another interesting development, Oracle CEO Larry Ellison is apparently protesting the potential sale of Spheris to that second group because Oracle is a Spheris bankruptcy creditor and he doesn’t want its software transferred to the new owners. The auction for Spheris starts today (Monday).

I’ve almost finished getting the new search engine running. There’s a new “Search This Site” box to your upper right if you want to try it. It indexes all HIStalk-related sites in one search (HIStalk, HIStalk Practice, HIStech Report, and HIStalk Mobile).

I did a survey two years ago in which I asked readers who work for hospitals to tell me their position and where they work, just to give me a feel for who’s out there. I shared the list of hospitals here. It’s time for an update! If you work for a hospital or health system, please complete my survey that asks only three anonymous questions: your job title, your employer’s name, and the city/state it’s in. Thank you.

Opinion is mixed on the likely impact of the iPad on healthcare, which is still pretty good considering it’s primarily a consumer device. New poll to your right: which of the big hospital systems vendors is the most innovative?

Clarian Health Partners (IN) chooses MedVentive for its Clarian Quality Partners clinically integrated network, where its product will be used to analyze patient data for quality analysis and care improvement opportunities. Clarian Health Ventures will also invest in MedVentive, jumping into an oversubscribed $10 million Series C funding round that raises the company’s total to $18 million.

Not much has gone right lately at Miami’s Jackson Health System, so maybe this was inevitable. Its Lawson payroll conversion causes most of its employee paychecks to be incorrect, although by minor amounts. Lawson says the problem was in the system it replaced and its amounts are correct; the hospital says the new checks underpaid employees for working overtime.

Some of the rags got irrationally exuberant over the marginal news that McKesson will sell its Asia-Pacific subsidiary to Medibank. The editors should have known better – all that subsidiary does is run healthcare-related telephone hotlines and call centers in Australia and New Zealand. Impact in the US or to McKesson’s bottom line: pretty much zero.

I notice that Cerner shares are on a solid rise lately, including a 2.4% jump Friday. You could have doubled your money if you’d bought in exactly one year ago. Neal’s stake is worth right at a half billion dollars.

Misys turned in pretty good Q3 numbers Thursday, with its Allscripts ownership stake offsetting a soft market for its banking software.

A small but interesting study in Australia finds that informed consent delivered interactively via computer with illustrations and quiz questions improves patient understanding and turns the usual “sign here” paper process into a valuable educational too.

I really enjoyed the discussion about which systems a 200-bed hospital should consider. Here’s the next reader question that would benefit from your feedback: when hospitals are rolling out systems to physician practices, will they offer a menu of a la carte system and implementation options, or will the hospital offer only a standard enterprise model of software and devices? E-mail me your thoughts and I’ll compiled them as a follow-up.

St. Francis Hospital (OH) implements the Priority Consult patient navigation system for its breast care patients. The company, which I hadn’t heard of, has software to support patient-focused nurse navigation models for spine centers and breast care, facilitating intake, triage, and care coordination.

Pardee Hospital (NC) replaces its two forms management solutions with Access Enterprise Forms Management when it finds the original systems couldn’t product a patient wristband barcode small enough for newborns.

Justen Deal follows Canadian HIT more than I do, so he caught this story that I would have missed. Quebec’s opposition party says its EHR project is dead last in all of Canada. The pilot, due to be completed in 2008, “still isn’t working” even though all of Quebec was supposed to be live this year. It appears that 75% of the original $563 million budget has already been spent, critics say it’s going to cost at least $1 billion, and everybody who originally supported it is trying to distance themselves from it. Justen always cites my 2007 Universal Rules for Big EMR Rollouts, saying they should have read them up there, so I’ll repurpose below just in case anyone missed them the first time around.

Speaking of which, I love this Toronto Star article, Malawi’s $1 Million eHealth Miracle. It points out that while Ontario was spending $1 billion on eHealth with “almost zip” results, dirt-poor Malawi has the records of 1.1 million patients accessible in 10 locations throughout the country, thanks to a computer network put together by a non-profit created by a Canadian aid worker and his wife for a total cost of $1 million from their office above a 7/11. He bought obsolete computers from eBay, converted them to touch screens, and developed the patient registration app, which uses “health passports” that cut the hours-long lines. “It’s hot, dusty and hydro is intermittent. Health clinics are in the open air with no doors. We needed a computer system that would work in those conditions and be used by people who don’t have computer skills. The system works on the premise that if you can work a mobile phone, you can use a touch-screen computer.”

A Harvard research team finds that electronic medical records haven’t had much impact in improving care or reducing costs. The authors seem to begrudgingly acknowledge that there’s no turning back now that the government is throwing endless money at EMRs, acknowledging that meaningful use requirements will at least encourage them to be used and not just purchased.

Central Washington Hospital gets a local newspaper writeup for its Cerner go-live. I’ve been there – nice place, lots of apples at the right time of year.

E-mail me.

Mr. HIStalk’s Universal Rules for Big EMR Rollouts (From 2007)

1. Your hospital will pledge to make major process changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

4. You’ll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You’ll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you’ll refused to apply them because you’re scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

News 4/9/10

From Iommi: “Re: Advance for Health Information Executives. Have you heard that it’s shutting down?” A couple of readers, at least one of whom should know, told me it’s going down the tubes. It’s not a great time to be in the print publication business.

From RadioGuy: “Re: meaningful use and images. Can you comment on this article?” The Medical Imaging and Technology Alliance lobbies to have EMR integration of medical images included as a criterion for meaningful use, starting in 2013. Its white paper is here (warning: PDF). I can’t say I have strong feelings about the issue, so here are my off-the-cuff reactions: (a) MITA is a medical imaging vendor trade group, so that obviously influences their point of view since getting on the list would boost sales (although that’s arguably no more biased that having EMR vendor groups involved); (b) meaningful use was intended to increase EMR adoption, but I would think imaging doesn’t require that kind of incentive; (c) both doctors and patients clearly benefit from image availability, a case not so clearly made from EMRs, so misaligned incentives aren’t in play like they are for EMRs. Bottom line for me — it’s just trade group noise, albeit with some good underlying points.

From Kalispell: “Re: 200-bed hospital. Nobody mentioned Eclipsys because it’s not possible to use them for all solutions. I worked until recently in an Eclipsys hospital and pharmacy, radiology, and ambulatory are very weak. It’s not integrated like Epic or Cerner, say from radiology to SCM. Eclipsys doesn’t see billing as a primary role, so ancillaries will run into billing issues.” Unverified. I’d still rank it #1 for CPOE and clin doc, though. Another reader says Eclipsys doesn’t price Sunrise cheap enough for a 200-bed hospital.

From Arclight: “Re: you scooped the Miami Herald. An article popped up on the Miami Herald’s breaking news page 20 minutes ago about the death of PC inventor Ed Roberts. Breaking news? Really? Three days after it was posted on HIStalk? I have no idea how you manage to track and tabulate the freakish amount of data you condense for your loyal readers, but please keep up the good work. Your site should be required reading for anyone remotely connected to the HIS industry.” Thanks. I’m glad Ed didn’t go unnoticed. He may not have profited from the industry like Bill Gates, but he made it possible. 

From Diego: “Re: meaningful use final rule. Any idea when it will be final?” The comment period ended three weeks ago, but I don’t know how long it takes to review and incorporate those recommendations. Someone out there probably does and can share.

 

From Mark Moffitt: “Re: CDR/HIE model.” Image above – funny! Just in case the parody isn’t clear, it makes fun of reposing a local copy of patient data that’s already available at other locations, the equivalent of Google’s actually storing Web content rather than simply pointing to it.

Larry Nathanson MD, a BIDMC ED informatics doc, reviews the iPad for clinical app use, saying it lives up to high expectations and makes the iPhone seem “slow and inadequate.” He says it renders browser pages as fast as a laptop, supports easy typing, and hits close to the claimed 10-hour battery life. His only concern for ED use is durability. A commenter also reminds that Citrix Receiver and LogMeIn are both available for the iPad, allowing it to be used as a remote PC with full capability. Their ED app is Forerun EDIS, co-developed by BIDMC.

The usual reminders: put your e-mail in the Subscribe to Updates box to your right to get instant notification when something new is posted here (some of the 5,450 subscribers are probably your most feared competitors and you don’t want them to know first, do you?) There’s a search box over there too (and a new one coming – I bought a new search engine and am finishing up the installation). Your news, rumors, and opinions are always welcome (and will stay anonymous if you want). Make sure to read the interesting comments posted after each article and feel free to add your own. You can post your industry events to my calendar, catch up with mobile healthcare computing on HIStalk Mobile, and help me out by perusing the sponsor ads to your left and click those of interest. I genuinely appreciate your taking the time to read HIStalk.

NHS scales back its contract with BT, limiting the number of London trusts that can get Cerner and RiO. Scrapped: an ambulance solution and the previously acclaimed Map of Medicine visual care planning tool.

A reader sent a link to the full text version of the Health Affairs article in which David Brailer interviews David Blumenthal (ONCHIT-1 and ONCHIT-3, respectively). I notice Brailer’s bio omits his main credential that got him the ONCHIT job in the first place – starting up the Santa Barbara Project, a failed RHIO that started the whole interoperability craze, but died an ugly death without having ever exchanged even a single byte of information. Anyway, the article is definitely worth a read. Some snips:

• A good Blumenthal quote: “The purpose of health information technology is to support health reform, and it is part of that larger puzzle. It is not a stand-alone goal or an end in itself.”
• Interesting trivia: Blumenthal says it was Congress, not his office, that coined the term “meaningful use".
• Blumenthal says his office is working with other countries to begin discussions about international standards for sharing healthcare information.
• Brailer asks about lessons to be learned from NHS projects in England and gets an excellent and insightful answer. “One thing that is quite clear to me as I sit in the Hubert H. Humphrey Building in Washington is that no country — none of our Western peers — has attempted to create electronic health information for a country as large, diverse, complicated, wealthy, and dynamic as the United States.We are trying to create a nationwide, interoperable, private, and secure health information system for a country that extends from the Bering Straits to Key West, with more than 300 million people who by history and tradition and culture value local autonomy and need autonomy in order to manage their diverse local situations. And so that’s the tradition we inherit, that’s the method that we have to use, and we are working within those constraints.”

People mistakenly think the VA’s VistA was cheap to create since internal programmers did some of the work. It wasn’t, but it provided good ROI: a study by the Center for IT Leadership says VistA cost $4 billion over 10 years, but returned savings of $7 billion. The conclusion is that the VA spent more than a similar private sector organization would have, but got higher adoption and better care as a result (and low cost isn’t much consolation if you can’t get those things, of course). Nearly all the cost savings came from a reduction in duplicate tests and medical errors. And the good news, of course, is that your hospital can get that $4 billion system for $0 from Medsphere or some of the other companies that offer it license-free.

Listening: Metric,female-fronted indie from Canada, reader recommended. It’s so cool that readers suggest something I like about 80% of the time, which is saying a lot since I dislike 90% of what’s out there. Metric is a keeper. Try Satellite Mind on the player.

Catholic Health Services of Long Island files a certificate of need to spend $144 million on Epic for its five hospitals. It hopes to save $40 million a year in addition to the HITECH incentives, expecting length of stay to drop by a half-day.

The CIO of CMS says that companies that ask to link to its systems have such primitive IT security that it’s “almost embarrassing” and those systems are loaded with “basic amateur problems.” She says these are big-name companies, not mom-and-pops.

E-mail me.

HERtalk by Inga

From Cherry Blossom: “Re: Apple OS4. If you thought iPhone and iPad was big in healthcare, just wait until this summer. We haven’t dug into the guts of OS4, but if they can deliver on half of they have promised, the chains have been removed from developers and we are going to see some AMAZING apps.”  Well, I hope you are right in terms of improvements for app developers. In terms of simple end-users like me, I was glad to see that OS4 will support multi-tasking. The addition of unified e-mail is also a plus and something I’ll find handy as I float between my Inga World and Real Life. Bummer that Flash still is not an option, though.

HCA is preparing to file for  IPO that could yield $2.5 to $3 billion. About three years, ago HCA went private in a $33 billion leveraged buyout; an IPO would allow HCA pay off some of its ginormous $25.7 billion debt.

Allscripts releases its third quarter numbers: revenue of $179.9 million versus last year’s $160.7 million, which beats analyst estimates of $175 million. Profit came in at $18.5 million versus last year’s $13.3 million. Bookings grew 25% to $105.5 million.

I chatted with Allscripts CEO Glen Tullman a few days before the earnings’ announcement and he shared some thoughts on the Allscripts-Misys merger, one year later. He also provided his impressions on a few competitors (he believes Epic is “anti-innovation”), on industry consolidation (he sees “substantial” consolidation ahead). and Regional Extension Centers (he’s a fan).

MedQuist continues to lobby the Washington crowd to ensure that transcription is an acceptable method for getting information into EHRs.

Speaking of transcription, a reader sent over a newsletter by John Suender, who our reader claims is “THE guru of medical transcription M&A.” Suender speculates on what will happen with Spheris, which is in the midst of seeking bidders for a bankruptcy sale. His prediction: the most likely bidders are MedQuist, Nuance, and Transcend. He also estimates the new owner will pay around $125 million.

RelayHealth earns certification for its Payor Connectivity Services from the CAQH Committee on Operating Rules for Information Exchange (CORE) Phase II. The CORE certification means that RelayHealth’s provider customers can securely process electronic queries within 20 seconds and receive consistent patient administrative information.

Streamline Health Solutions announces Q4 net income of $1.59 million compared to the previous year’s net loss of $145k. Revenues came in at $6.28 million vs. $3.38 million.

Streamline Health also shares news of a new contract with East Orange General Hospital (NJ), which will implement Streamline’s health document workflow solution integrated with the hospital’s GE Centricity system.

Quality Systems makes Forbes annual list of America’s 25 Fastest-Growing Tech Companies, coming in at #23. I noticed that Red Hat also made the list at #19. To qualify, companies must have at least $25 million in sales, plus sales growth of at least 10% over the latest 12 months.

Doctors Hospital at Renaissance (TX) selects Encore Health Resources to provide project management, consulting, and advisory services for its implementation of Cerner clinicals.

HEALTHeLINK, the Western New York Clinical Information Exchange, selects Anakam Identity Suite to provide its authentication and identity management solution.

QuadraMed announces the general availability of its ICD-10 Simulator, developed to help coders prepare for the transition to ICD-10. Quantim ICD-10 Coding Simulator duplicates the ICD-10 coding environment to facilitate training. (Someone will need to explain what “Quantim” means.)

Central Washington Hospital goes live on its $22 million Cerner EHR.

Congrats to TELUS, parent company of HIStalk sponsor TELUS Health, for winning the 2010 Freeman Philanthropic Services Award for being the top philanthropic organization in the world.

Hennepin Healthcare System (MN) licenses Mediware’s Insight performance management software solution for its 900-bed hospital and clinic system.

E-mail Inga.

HIStalk Interviews John Halamka

John D. Halamka, MD, MS, is chief information officer of Beth Israel Deaconess Medical Center; chief information officer at Harvard Medical School; chairman of the New England Healthcare Exchange Network (NEHEN); chair of the US Healthcare Information Technology Standards Panel (HITSP)/co-chair of the HIT Standards Committee; and a practicing emergency physician.

How would you describe, if you had just a couple of minutes, how stimulus funding will change healthcare IT as an industry?

If I look at my own region, we have docs who were all waiting on electronic health record implementation because there wasn’t a value proposition. They said, well, gee, you know I can get this Stark safe harbor, I know the hospital can help out, but still, my office manager’s going to quit. I’m going to lose productivity for three months … what a hassle.

Now with the HIT stimulus funding, they say, “Wait a minute. I get 85% funded by the hospital and I get to keep the $44,000 when this is all done? OK, where do I sign up?” It’s truly accelerating physician adoption by motivating them to move forward.

What I really like about Meaningful Use is it is constructed so that the doctors are paid only when they’re done. That is, it isn’t go buy hardware and software and it’s going to be Christmas for vendors. It’s the fact that docs then have to e-prescribe, and docs are going to have to share data with patients, and docs are going to have to use quality measures. Only when you do that do you get paid.

The mindset of the clinician is, “Ah, I’m going to do it, and now I know exactly what I have to do. Help me out.” So I, as a hospital organization and my community, can work together to make all that happen. It’s an alignment of industry, academia, and practices like I’ve never seen before.

Do you think there’s a risk that they’ll get enticed enough to at least start the journey, but then because of usability issues or just lack of time, it will never really go anywhere?

I wrote a blog, which some people have criticized me for, that said I actually trust ONC. David Blumenthal and the gang he has put together are very good people. If what they discover is that, as we are actually rolling this thing out that there are barriers, then I believe they’re going to help everybody work through the barriers.

I really don’t think that this is a disconnected ONC that is going to force us to do things that are too hard and are going to first, people, as you described, to begin the journey and then fall off. What they’ll say is, “We’ll build the toolkit. We’ll help with the accelerators. We’ll break down the barriers. We’ll make sure you have the resources.” I actually feel good about people getting to the finish line.

Do you think it was a mistake to combine what should be a fairly thoughtful introduction of electronic health records with the urgency of stimulus funding?

My experience in healthcare IT is, unless you create a sense of urgency, nothing gets done. I would rather see us all move forward with great haste and get as far as we can, then along the way do a mid-course correction, than to say, “You know, we’re going to wait five years and then we can get it perfect.” There’s a lot to be said for moving the industry forward now.

These are not new products — they’re the same ones doctors didn’t want before. Do you think there will be some buyer’s remorse?

I love seeing the vendors react by creating new functionality. Certainly they’re much more open to healthcare information exchange and patient engagement than ever before, so in some respects, yeah. It may be products that have existed, but there are feature sets that have never existed.

Then with the modular EHR certification approach that’s been proposed, there’s a capacity for combining many EHR and EHR-lite together in a way that’ll get docs started. I think there’ll be new market entrants, but new features. I don’t think it’s going to be business as usual.

Will there be time for new market entrants given that people have to get on the train really quickly?

I’m now driving, actually, through Westborough, Mass. where eClinicalWorks is located. What I’m seeing these guys do is focus on patient portals. Something called provider-to-provider exchange. It’s like a Facebook function. They’re introducing all this new stuff very, very quickly.

I know the timeframes are crazy, but they have been able to innovate to adapt to ARRA requirements pretty rapidly. You’re seeing Athena move out its athenaClinicals product pretty rapidly. Software as a Service is becoming more and more common, and probably it’s because of thinner, Web-based Software as a Service architectures they can move fast enough to meet some of these deadlines.

What do you think is the majority of the work that needs to still be done to really get us down the path to getting potential benefits?

80% of what I do is people, training, workflow redesign, and process re-engineering. Only 20% is the technology stuff. When I write blogs about this stuff, I just focus on the workforce, focus on the people, and focus on the change management. That’s all the really hard work.

Yes, there are things that have to be done in Washington; and as you’ve seen coming out of ONC in the last week, consent models. How, if we’re going to do information exchange, do we ensure the patient controls the flow of their information? How do we do simple things like controlled substance e-prescribing, making sure that the workflow around writing Lipitor and writing OxyContin is pretty similar? How do we ensure that?

No interoperability’s ever going to be totally plug and play, but if it’s not USB drive kind of plug and play, can at least it be a couple hundred dollars, not a couple thousand dollars, to get a lab interface? It’s the work on specificity, on content, and transmission that still need to be done. All of this stuff on process transformation and workforce development, primarily, and then some of these things the Policy Committee and Standards Committee are doing on privacy, doing things like e-prescribing clean up and making the standards easier to use and more prescriptive.

Do you think federal funding makes it too easy to forget there are workflow changes involved?

I just met with these folks at Lawrence General and they had thought they were ready to go into a procurement phase. I said, well, let’s look at what Meaningful Use really requires. You know, what is your strategy for your local public health interface? What is your strategy for bi-directional data exchange for the community? “Oh yeah, this is a whole lot about workflow, isn’t it? It’s not about bits and bytes.”

As people begin to understand Meaningful Use, they really will understand the community and the workflow and not just the products.

You mentioned privacy. Are there currently debates going on about what form that should take or who should be involved?

I think there are two kinds of architectures that will protect privacy. One of my favorites, of course, is the idea that the medical home, the patient, becomes the steward of their own data. We send the data to them and they elect privacy preferences — who and what they’re going to share with.

Alternatively, of course, there is the clinician-to-clinician exchange. That is really going to require a persistent declaration of patient privacy preferences as to OK, if I the patient am not going to directly control it, how can I declare my preferences of those who do exchange data; whether it’s providers, payers, public health, etc. always use my declared privacy preferences when data is being exchanged?

The HIT Standards Committee, over the course of the next few months, is going to be taking testimony on what standards exist that will help support such a thing. That in combination with work on the policy side and such things as the consent white paper, I hope get us to a place where either EHR to EHR or EHR/PHR/EHR exchanges are ultimately controlled by patient preference.

You mentioned that a lot of data will be collected and exchanged. When will we start seeing the benefit of all the EHR-created data that isn’t out there now, and who do you think will use that to advance the practice of medicine?

Of course, 2011 is more about getting the data in electronic form to begin with; and 2013 more about getting data exchanged. But some beacon communities. some early adopters, I think, by 2011 are going to have substantial improvements in data sharing.

In the Boston area, I funded the creation of a quality registry for 1,560 providers that are loosely affiliated with Beth Israel Deaconess so that we begin to do all of our pay-for-performance, all of our PQRI and Meaningful Use reporting, as a community, rather than as a bunch of individual point-to-point connections. We’re doing public health reporting for the city of Boston in a common way as a community. All of this will be live in 2011. So for some, 2011. For many, 2013. For the majority, 2015.

Do you think there should be a relationship between having more technology and being able to deliver care less expensively?

That is a very good point. What we all want to achieve is high-value care where reimbursement is based on quality rather than quantity. I think the answer to your question is a couple-fold, but everything that I do these days is Software as a Service. I’m able to deliver an EHR at a lower cost than normal because the fact that I have so many clinicians sharing resources, sharing a data center, and sharing interfaces.

My hope is that I can at least, from my IT perspective, reduce the cost of implementing Meaningful Use. Then, we will gather data from a quality perspective that can be used in accountable care organizations and new mechanisms of reimbursement so that, as you pointed out, reimbursement will be fair based on the outcomes that are achieved.

Do you think technology is ready to help offset or mitigate in some way the shortage of primary care physicians?

This is an excellent point. What you hope, coming out of healthcare reform, is differential payments for primary caregivers and accountable care organizations. If I look at the Harvard Medical School experience, the number of folks going into specialty or procedural areas far exceeds those going into primary care. If you’re going to have effective reform, if you’re going to have lower costs, we need more primary caregivers.

Sure, as you point out, maybe technology can help us use extenders wisely so that whether that is some tasks can be delegated to nurse practitioners, physician assistants; some decision support can be offered in the Cloud so that we are delivering coordinated and better care more effectively by using technology rather than physician time for every intervention. All of this still presupposes that we have the primary caregivers who can actually be at the center of the medical home. In my view, you need to redo reimbursement so that the primary caregiver is the one making more than the specialist, not vice versa.

What about telemedicine?

We use telemedicine today to connect rural or community hospitals or emergency departments with downtown Boston for the provision of such things as stroke consultation in real-time for the administration of TPA in stroke. You’re able to leverage the academic health vendor in a far greater reach through the use of telemedicine.

I’ve had a lot of experimentation with remote visits, home monitoring, and again, leveraged telemedicine as a mechanism of making a primary care physician more efficient. Actually, the patients like it because they don’t have to travel into the city. Or, doing interventions like measuring blood pressure, measuring daily weight, and then having a team of nurses doing home care remotely and keep people out of the hospital. I certainly agree that telemedicine can have a role in reducing cost and using time more efficiently.

What do you think the Nationwide Health Information Network is going to look like and when will we start seeing it deliver benefits?

You’re probably familiar with the NHIN Direct efforts that have been kicked off over the last two weeks. The idea of a NHIN, obviously, it’s a set of policies and some open source technologies in reference to implementation to exchange data among various participants and provider, payer, government, etc. In NHIN Direct, the idea that there are some interactions that are simpler — pushing between two doctors, pushing to the patient.

Actually, what you hope is if this becomes a fairly thin, Web-based mechanism of sending data from point to point at very low cost. Here’s an idea. What if every person who wanted to participate in a patient/doctor exchange could sign up for a healthcare URL? Many people — Microsoft, Google, Dossia, who knows, various software vendors — could offer this health URL and all you need to use it is you take it to your doctor and say, “Doctor, here’s my health URL. Every time there’s an entry in my record in your office, push the data to this health URL.” There’s no HIE, there’s no transaction fee, there’s not a lot of complex business structure needed. It’s just an HTTPS post.

What I hope is that sure, for governments, for larger organizations, there will still be a NHIN that has quite a lot of security in its infrastructure, But you hope for a lot of connections that can be as simple as the home banking connection you have with an HTTPS post and it just bakes right in to every EHR.

Some of the folks that have gone into federal service work lately are interesting, like Todd Park and Don Berwick. What do you think that means that people who aren’t lifelong civil servants are popping up out of the private sector and going into federal work?

Knowing Aneesh and Todd and Don Berwick pretty well, these are people who have passion. They’re now able to see change is possible and resources are available. I think they believe that, in the current administration and the current time in history, it’s not business as usual and they’re willing to put in their energy and their passion to making change.

That’s why I write in my blog, these truly are the good old days of healthcare IT. I know I’m putting a significant portion of my time into state and federal efforts on a volunteer basis just because I believe I can make a difference.

You mentioned that you have a lot of respect for ONC as an insider to this whole process. Was the outcome what an idealistic person would have expected, or was this such an ugly compromise that nobody leaves happy?

I will tell you, sitting in the HIT Standards Committee and the Policy Committee and on calls with ONC; the amount of positive energy, as opposed to the amount of negative energy and compromise, is totally different than any other process I’ve been involved in in the past. People who have very different opinions come together and they say, “God, here’s what I want to achieve to improve patient care and quality and efficiency.” Everyone says, “Well, there’s two or three ways we could do it.” I’ve seen harmony rather than ugly compromise come out of each of these processes. That’s why I’m very optimistic.

When you look at your own organization, what are your biggest challenges and highest priorities at Beth Israel Deaconess?

I’ve laid out a 25-step plan to implement Meaningful Use across the organization. The hardest part of it is it is not just one actor. It is not just a hospital in an island. It’s ensuring that you have trust in your community so that you can do these data exchanges across the various providers, public health, payers, and government. It’s been relationship-building more than technology implementation, in my 25 projects, that’s my hard work.

Is there anything else you wanted to talk about?

I just have to say that you do a great service for humanity. Somebody has made this comment to me, that you have become not the National Enquirer, but The New York Times of our industry. It’s built on transparency. People, just like all the stuff I’m trying to work on, are no longer afraid of this special interest or that special interest. It’s everybody opening up and just trying to get the job done. I think you’ve been a big part of that.

News 4/7/10

From Dirt Farmer: “Re: iPad in healthcare. Since it’s a closed system, some non-Apple proprietary CPOE, EMR, and imaging apps may not run on it. Therefore, its use might be limited. Flash doesn’t work on any Apple device, but an Adobe rep tells me the company hopes to announce a relationship in 2011.”

From Jerry: “Re: system for a 200-bed hospital. No mention of Eclipsys. Is there a reason?” I don’t know much about their capabilities outside of their obvious strengths in CPOE and nursing documentation — the hospital was looking for a soup-to-nuts solution that covered everything from billing to ancillaries. None of the respondents mentioned them, either. If you work in a hospital of that size and are running an all-Eclipsys lineup, why not send me a little writeup of what you’re doing and how it’s working? I’m interested.

From Werner: “Re: system for a 200-bed hospital. Why didn’t Eclipsys show up? A very nice solution especially if looking ahead to meaningful use AND they have a remote hosted solution. What about OpenVista, a proven solution for smaller facilities and no major license cost (of course , except for ISM & extensions)?” Eclipsys, see above. I had OpenVista on my list originally, but couldn’t decide if it made sense for a hospital that needs a full set of applications and potentially a lot of hand-holding for implementation and maintenance, even if OpenVista would have minimal licensing costs. I could be persuaded, though.

From Midwest CIO: “Re: system for a 200-bed hospital. The way you phrased it, their only option is Paragon. It’s all Microsoft, so it’s easy to find resources to support it and it has a long life in front of it. I would put Keane on par with Paragon with respect to clinical functionality.”

The local newspaper writes up the Paragon go-live of Auburn Memorial Hospital (NY).

University of Medicine & Dentistry of New Jersey’s behavioral care organization chooses DSS to implement its vxVistA, an open source variant of the VA’s VistA.

A Harvard doctor creates an iPad application that allows him to monitor patient breathing via an ultrasound sensor he invented. He sees potential for using it to check asthmatic patients in their homes and to monitor sleeping infants.

The Army’s MC4 group is piloting a new version of the Theater Medical Data Store (TMDS) in Afghanistan that can also display the service member’s pre-deployment medical history from AHLTA.

Former RelayHealth VP Bob Katter joins First DataBank as VP of sales and marketing.

Lee Memorial Hospital (FL), expecting ARRA money to cover up to $40 million of its $70 million Epic implementation cost, finds that it isn’t eligible for up to $10 million of that taxpayer-funded windfall because it shares a Medicare provider number with its physician group. Congressman Connie Mack IV, who opposed the stimulus bill and yet is appalled that LMH might get less of it, says the hospital “shouldn’t be penalized for CMS’ interpretation of the definition of a hospital.”

HHS secretary Kathleen Sebelius visits Cincinnati Children’s Hospital Medical Center, admiring its $47 million Epic system and its patient portal.

Which reminds me: whatever happened to White House healthcare reform director and former Cerner board member Nancy Ann-DeParle? Healthcare reform was a hot topic, but I don’t recall seeing her name even once in the past several months (and a Google search backs me up on that).

Jobs: Epic Inpatient EMR Manager, Cerner Orders Consultant, EMR Implementation Specialist.

Health Affairs devotes its entire April issue to healthcare IT topics, although only subscribers can see most of it. It didn’t sound all that interesting, although I would have read David Brailer’s interviewed with his eventual ONCHIT replacement David Blumenthal (although I doubt anything controversial was said).

Odd medical problem: a man orders his favorite restaurant sandwich, the five-meat, three-cheese Wicked, except with double meat to celebrate his son’s performance in a talent show. His mouth locks up trying to take the first bite, at which time he begins punching his own jaw trying to loosen it up. He required surgical repair of double dislocation of the mandible.

E-mail me.

HERtalk by Inga

From Marge Schott: “Re: Streamline Health. In an SEC filing, the company said it won’t be renewing its contract with its sales SVP Scott Boyden. Probably a cost cutting move since Streamline continues to lose money.”

Centegra Health System (IL) says its Kronos workforce management software has saved the system over $1.6 million in labor costs. Centegra uses time and attendance and employee scheduling solutions, which have helped eliminate agency use and reduce overtime by 30%.

Blessing Hospital (IL) and University Health System of San Antonio earn Magnet Recognition by the American Nurses Credentialing Center for excellence in nursing and for providing high quality patient care at all levels of the hospital. Both facilities use Eclipsys.

Speaking of Eclipsys, the company is selected  by The Methodist Hospital of Houston to provide its HealthXchange product. HealthXchange, which is powered by Medicity, will connect Methodist’s acute care EHR with a network of disparate EHRs used by affiliated physicians. 

Picis extends its Microsoft Gold Certified Partner status with specialized competencies in business intelligence and data management solutions.

MedQuist partners with Artificial Medical Intelligence to provide computer-assisted coding within the MedQuist CodeRunner coding workflow platform.

HealthPort announces a money-back guarantee that its EHR software will meet certification requirements for Meaningful Use. Nothing against HealthPort, but I am done mentioning any of these money-back guarantees. I’ll quit worrying that there are still naive providers out there who believe that just because their software is “guaranteed” that they will be “guaranteed” stimulus money.

Thumbs up to Virginia, which becomes the 12th state to require health insurers to cover telemedicine services provided through interactive audio, video, or other media.

Auditors for LSU’s charity-run hospital system finds that its clinic overpaid an outside patient billing firm almost $350,000, while about $8.2 million in patient services were never billed. On top of that, LSU Interim Public Hospital has lost track of movable property originally worth $3.8 million. The overpayment occurred in 2007 when billing firm Healthcare Financial Services double-billed an invoice, both of which Medical Center of LA-NO paid. Less than half the money was recouped two years later. Of the $8.2 million never billed, about $1 million is still recoverable. Not surprisingly, leaders say new checks are being put in place.

AnMed Health (SC) picks Allscripts EHR for its 60 employed physicians and 40 affiliated physicians. AnMed currently provides Allscripts Tiger PM in a hosted model for the physicians and will offer the EHR through a similar setup.

Mercy Health Systems (PA) plans to implement NextGen EHR for its 70 providers across 31 locations. Later in 2010, Mercy will also deploy NextGen Health Information Exchange. The providers have used NextGen Practice Management for almost four years.

John Muir Health (CA) notifies almost 5,500 patients of a potential data breach following the theft of two laptops from a physician office. The hospital says the laptops were in a locked and guarded building and were password protected,  but did not have data encryption. Encryption software is now being installed on all the health system’s laptops.

Evolvent Technologies awards Harris Corporation an 10-month follow-on contract for ongoing enhancements to the DoD’s Healthcare Artifact and Image Management Solution (HAIMS) system.

Unity Medical says it will pilot its new Medical Video jLog for the Apple iPad at Florida Hospital for Children at Walt Disney Pavilion and St. Luke’s Health System (ID). The company provides short interactive videos that provide patients with an explanation of common procedures and treatments.

Passport Health Communications launches eCare Patient Access Suite, designed to help hospitals improve workflow and increase revenues.

E-mail Inga.

Readers Write 04/05/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Has Meaningful Use Already Lost All Meaning?
By Cynthia Porter

The release earlier this year of expanded meaningful use requirements has gotten the healthcare IT community in quite a tizzy. The phrase was on everyone’s lips before, during, and after HIMSS. It was obvious to me
that:

1. Everyone has a strong opinion about it;
2. Not everyone understands it; and
3. The recent passing of healthcare reform has left providers extremely anxious about how they and the vendors they do business with will comply with “it”, depending on what “it” ultimately turns out to be.

I know for a fact that hospital executives’ concerns about their institutions’ abilities to meet requirements and the overly aggressive timetables released as part of the expanded meaningful use requirements has increased exponentially since 2009, when the HITECH Act was initially released.

Nearly 80 percent of 150 hospital executives recently surveyed by Porter Research noted an increased rate of adoption for e-prescribing, patient portals, and EHRs. That’s a 20% increase from 2009, before the expanded requirements were published. So it’s safe to say that providers are jumping on the bandwagon.

Most, however, are worried that the wheels are going to fall off because vendors won’t have enough qualified employees and/or up-to-date resources to meet demand and requirements. One CIO we interviewed believes vendors “will be forced to spend more programming hours around the interoperability and security of their software versus the primary function, which is taking care of patients and making it easier for clinicians to utilize.”

And there’s the rub. Sure, the healthcare IT community will probably benefit from the political machinations going on in Washington, but will the patients? Will vendors rush to provide hospitals with technologies that could have used a few more months of development and trial? Will hospital staff have time to adequately train their IT people to use these new technologies? Will patients pay the price for a rush job?

It’s unfortunate that time will tell, because time is one thing patients don’t have.

Cynthia Porter is president of Porter Research.

Health Reform, Schmealth Reform – Freakin’ Pay Me
By Gregg Alexander

Down here in the primary care trenches, where the pudding meets the pavement (or some such mixed analogy), no matter how much we may want it to, health reform doesn’t seem like it will ever really get to addressing our needs.

What do I mean by that? Simple enough: it is getting virtually impossible to justify staying in traditional primary care any more and, health reform or no, HITECH or no, Congress just walked away and forgot about me and mine.

Despite our efforts to help bring the best we can to those we serve, what do we get? People, be they private insurers or Medicaid, self-pay or no-pay, hospitals, and even IT folks, all telling us what we can and can’t do. We’re told when we are and aren’t allowed to make medical recommendations based upon our knowledge and experience and then we’re told just how much we’re allowed to charge for our expertise. (Disregard whether or not we’ll even get paid anything at all for our time and trouble.)

We fight to get what we believe is appropriate care for our patients, regardless of their insurance or lack thereof. We struggle to make ends meet so that we can offer the advantages of a quality medical home and, perhaps, digital healthcare information management to our patients. We work far too many hours, away from our family and friends, just so we can feel good enough to sleep at night knowing we have done our best to help those who come to us for care.

And then…and then…Congress goes on break before postponing a 21.3% cut in Medicare payments. (Thank you, Senator Tom Coburn, R-OK.) Whether or not they repeal it when they return, CMS will likely withhold payments for at least 10 days before beginning to process those 21.3% reduced payments. For those affected, continuing this Sustainable Growth Rate (SGR) formula is anything but sustainable and quite the opposite of growth.

Ladies and gentlemen, if you’re not already aware, we have a shortage of primary care providers in America. Pushing us toward expensive technology adoption which may or may not truly be ready to really meet OUR needs while reducing the bottom-of-the-barrel payments with which we already struggle, is not going to solve any little piece of our giant healthcare crisis. It will make it much worse as more and more of us leave for less stressful and less beyond-our-control professional lives. All the while, we’ll leave little encouragement for the med school up-and-comers who will doubtful choose to join the ranks of careworn primary care.

Let us worry about dealing with the pressures of making medical decisions and allow us a reasonable income which doesn’t add to the strain. Elsewise…well…how long would you stick around after a 21% pay cut?

From the (weary) trenches…

“Pay me for my work, but I don’t do it for the money.” – Vanna Bonta

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

This Just In: HIRE Bill Signed! Could Hiring Tax Breaks Benefit Your Organization?
By Tiffany Crenshaw

On March 18, 2010, President Obama signed into law the Hiring Incentives to Restore Employment Act (HIRE). HIRE is a $17.5 billion jobs bill that the President says will bolster hiring and incent business owners, creating approximately 250,000 new jobs.

The bill was dramatically scaled back as it passed through the House and Senate, from $150 billion to less than $20 billion. Still, lawmakers say it is the first step in a series of bills designed to encourage job growth.

The Act offers two tax breaks to companies who hire recently unemployed workers, one in the form of a payroll tax exemption and the other in the form of a tax credit. Beginning March 19 and through the remainder of 2010, employers will not have to pay the 6.2% Social Security payroll tax on qualifying new hires. In addition, companies are entitled to a credit equal to 6.2% of an eligible employee’s total salary (up to $1,000) if that new hire is retained for at least 52 weeks consecutively.

To qualify for the tax breaks, new employees must be hired between February 3, 2010, and January 1, 2011. Each new hire must verify in writing that he or she was unemployed for a minimum of 60 consecutive days just prior to being hired. If the worker is replacing an employee in the same job role, he or she is not eligible, unless the previous employee was terminated for cause or voluntarily quit.

There is no doubt that these incentives may not help all companies, but HIRE is a start that could benefit your organization as well as the nation’s unemployment rate. Companies still experiencing depressed revenues due to economic slowdown may not benefit from the tax incentives, but others may find the tax savings to be a valuable advantage towards savings and growth.

Tiffany Crenshaw is CEO of Intellect Resources.

Monday Morning Update 4/5/10

ONCHIT announces $60 million in new grants (sounds like chicken feed in these stimulus-happy days, doesn’t it?) University of Illinois at Urbana-Champaign will look at security, Universe of Texas Health Science Center will study patient-centered cognitive support, Harvard takes on application and network architectures, and Mayo will review secondary use of EHR data while maintaining security and privacy. The last one sounds the most interesting to me.

Merge Healthcare sells $42 million of stock in a private placement to help pay for its proposed acquisition of Amicas.

Former QuadraMed VP Chris Callahan joins Sunquest as VP of product management.

Bill Gates composes a fascinating remembrance of Ed Roberts, inventor of the Altair computer and therefore the father of the PC, who died last week at 68. Of course, Bill and Paul Allen kind of screwed Ed legally to get the rights to sell BASIC to other companies even though they had sold Ed an exclusive license, but I guess Bill’s being sentimental now that he’s earned billions from it. I knew but maybe you didn’t that Ed was a country doctor in Georgia, having gone to med school at 41 and finishing first in his class after selling out his computer business in 1977.

Next, on a very special episode of Weird News Andy: two North Carolina doctors are reprimanded for performing a C-section on a woman who wasn’t pregnant. A resident misdiagnosed her “false pregnancy”, the docs tried for two days to induce labor without success, and they finally opened her up only to find no baby. Nobody had bothered to verify that she was indeed pregnant. In their defense, the resident supervision was complicated and false pregnancies are apparently quite believable without diagnostic verification.

Most of us agree that patients should control the use of their health information, although the question of “to what degree” would likely be more contentious. New poll to your right: what impact will the iPad have in healthcare?

CMS auditors conclude that “alarm fatigue” caused by incessant monitor beeping contributed to a patient’s death at Mass General in January. They also found that the patient’s bedside crisis alarm had been turned off. In response, the hospital has disabled the “off” buttons, put more speakers in nursing stations, and assigned nurses to watch monitors full time. While they were there, the Medicare inspectors also wrote up privacy violations, including having patient names on whiteboards and positioning in-room video monitors so that they were visible to visitors.

A two-year-old dies from a heparin overdose at Nebraska Medical Center. The hospital implements the usual after-the-fact changes that sound good, but really aren’t sustainable even for high-alert drugs like heparin: requiring a second nurse to verify the dose, having pharmacy observe the initiation of the bag, and turn on a hard stop on the infusion pumps.

Nuance announces availability of Dragon Dictation for iPad, available for free from the Apple App Store. It supports dictation and sending e-mails by voice.

E-mail me.

Recommended System for a 200-Bed Hospital with Minimal IT Resources

A reader asked me about which systems I would recommend for a 200-bed community hospital with minimal IT resources. Specifically mentioned were McKesson Paragon, Meditech 6.0, and Cerner Millennium. I assume the hospital wants a broad set of applications ranging from revenue cycle to CPOE. My answer, in essence, was this:

• I would definitely choose Paragon over Cerner, especially if there’s no legacy billing system that will be retained (Cerner ProFit is still problematic, I think). McKesson has done a good job in bringing Paragon back from its near-death experience and the field reports, while limited, are good. I think Cerner would be overkill for a 200-bed hospital.
• However, if billing isn’t important, then Cerner’s remote hosted product should at least be considered, even though it’s probably far more complex and than a 200-bed hospital would need. Cerner is notorious for coming well down from list price when pressed since they aren’t selling many new customers, so I wouldn’t pay much of a premium for it. It would also offer a lot capability for the future.
• Meditech 6.0 is a bit of an unknown since it’s new, but if CPOE is a criterion (as it probably should be), that’s the Meditech version they would want. Company performance has slipped a bit, but they are still eminently solid.
• I mentioned that CPSI is strong in that bed range, but that I don’t really know too much about their products.
• I suggested that for a different perspective, the hospital might want to take a look at IntraNexus Sapphire, which offers something a bit fresher than those obvious choices even though it’s not a big company like the others.

So I would rank them Paragon, Meditech 6.0, and remotely hosted Cerner. I didn’t rank Sapphire, but I would still give it a look.

I got 25 reader responses, summarized as follows.

• Most respondents, especially the CIOs, suggested Meditech.
• One comment said that Meditech is straightforward and easy to manage, with 6.0 getting good reviews. That reader also asked me about CPOE adoption. The HIMSS Analytics presentation at HIMSS showed a definite improvement in physician adoption under 6.0 vs. Magic. I think CPOE is important even though Meaningful Use so far requires only 10% penetration, so I don’t know if choosing Magic would make sense.
• A hospital CFO recommended Meditech without hesitation based on personal experience in three hospitals of under 300 beds, where Meditech replaced Siemens, McKesson, and Cerner. He said that Meditech beats Siemens and McKesson on functionality and cost (he didn’t name the specific McKesson product line, which could be Paragon, Series, or Star).
• A consultant also recommended Meditech, saying it’s generic, easy to install, requires minimal training, and requires low maintenance.
• A CIO said it’s Meditech hands down, “not the most advanced, but it will keep you out of trouble.” That’s a solid point – nobody fails with Meditech, so they get an implicit cost advantage due to reduced risk.
• An IT person from a 100-bed hospital provided an informative comment about Meditech C/S, to which the hospital had migrated two years ago from best-of-breed systems. They are very happy to have traded interfaces for integration. Putting in Meditech increased the IT staff from five to 10 employees.
• A CIO recommended Meditech, but said it won’t be cheap and 6.0 may still have kinks. He says Paragon’s functionality is a step up from Meditech, but that CPOE may not have been released yet. He also made a good point: Meditech is so widely deployed that it’s much easier to find independent implementation people.
• A consultant recommended CPSI, Healthland, and Meditech on the basis of integrating administrative, financial, and clinical applications without a lot of IT overhead. However, she also cautioned that prospects should push hard to get Meaningful Use criteria in the contract. She observed, correctly I think, that it’s amazing that big vendors can’t seem to figure out how to scale their pricing and delivery to serve this large market of small hospitals, although lower price points may have cooled their interest.
• A CIO had this interesting comment: “An affiliate relationship with an existing Epic customer. You get all the benefits of Epic without having to host.”
• A hospital IT director suggested the resource issue should put the hosted Cerner suite at the top of the list.
• One reader suggested two systems that I hadn’t thought too much about: CPSI and Siemens MedSeries4. I always forget that MS4 is still around, although I would certainly find out about CPOE usage.
• A reader suggested Paragon, noting that it’s being installed in larger hospitals and doing well.
• I liked this perspective from an IT director in a hospital of similar size and IT capabilities. She said they realized that their functionality requirements weren’t much different from those of bigger hospitals and the smaller vendors backed out for that reason, so they are looking at Millennium or Siemens Soarian and options for a quick build, remote hosting, and possibly outsourcing some of the application support to the vendor.
• A hospital IT project director suggested QuadraMed QCPR, saying it hasn’t been well marketed but noting that it has lots of functionality for both inpatient and outpatient clinicals as well as ancillary departments. She also noted its track record in big hospitals, its recent award in Saudi Arabia, and its configurability and rules engine.
• A consultant says his company usually recommends Meditech and Paragon and can host either. He does not recommend Siemens because the contracts are too restrictive.
• A hospital analyst suggested Cerner.One reader ranked them as Paragon, Meditech, and CPSI.
• A consultant said his choices in order would be CPSI, Paragon, and as a low third choice, Meditech.
• One reader gave his picks as MedSeries4, Meditech, and Paragon, all from larger companies with a better chance of survival.

Thanks very much to everyone who took the time to respond. This is excellent information for the reader (and for me). We ought to do this more often.

News 4/2/10

From The PACS Designer: “Re: Wall Street Journal iPad review. TPD has always admired Walt Mossberg’s technology reviews and he’s done another good one on the Apple iPad. The iPad is thinner than a netbook and weighs only 1.5 pounds. Walt was able to get eleven and a half hours on the battery before needing a recharge! If you want to be the first to have one, get in line early as supplies are limited due to production being offshore.”

From anesoptime: “Re: Epic. Go to epic.com today, April 1st. I’ve worked with many of the big EMR vendors and many niche vendors. This is one of the many reasons I will only work on Epic projects and for Epic clients. They have a sense of humor and they do everything first class or at least put their best foot forward.” Lots of folks e-mailed me about Epic’s brilliant home page replacement, full of phony April Fool’s news (click the image above to enlarge it if you missed it). More than one person was fooled by the “Company Reveals Plans to Go Public” headline, I’m told. Also on the page: Epic Issues First Press Release; Epic Offers Training Course in Cow Chip Throwing, Suggests You Duck; and Epic Offers Organic, Home-Grown Carrots as an ARRA Alternative for Docs. Truly inspired, irreverent, and right in character. They are the Google of HIT. Apparently the employees didn’t even know about it.

From zaphod bebblebox: “Re: CSC. Ouch! CSC and iSoft again miss a go-live date at critical first major activation site amidst comments of failed data loads and in excess of 100 software errors. CSC have been told by NHS that they will not receive expected substantial cash payments associated with this milestone and their hoped for contract reset will not be signed.  Both CSC and iSoft had previously told analysts that they were expecting these payments for their end of quarter results and that they would meet this milestone. More importantly, Morecambe Bay Trust have decided NOT to go-live on the software at any forseeable date.”

I just ran an interview I did Wednesday night with Gary Cohen, executive chairman and CEO of iSOFT. I asked him about the critical Morecambe Bay go-live. That’s important because it was announced today that the NHS-mandated deadline has been missed, meaning that primary contractor CSC will not be eligible to get a renegotiated deal and, in fact, may be in danger of being replaced (although in the UK, “with whom” is always a good question since all the usual contractors have already bailed). Judging from the rhetoric, I’d say it’s an NHS bluff, especially considering that the trust itself has some responsibility for its own state of readiness. Still, it puts the heat on CSC contactor iSOFT and its Lorenzo system, also discussed at length in my interview.

Listening: Michael McDermott, reader-recommended Irish-American folk/pop music. I like it.

CIO Unplugged – 4/1/10

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

Why Healthcare Innovation Sleeps
By Ed Marx

“That’s against the rules.” “We don’t allow that here.” “Were you this much trouble where you came from?” “You have great potential…if only you’d follow the process.” “That’s not the way we do things here. Who gave you permission to do that?”

Thoughts of preschool and kindergarten bring back fond memories. I spent three years attending French schools while living in Southern Germany. And I recall the schoolmasters’ many rules as they attempted to shape us into well-behaved and homogeneous boys and girls.

Thankfully, I didn’t turn out too homogeneous. I kept coloring outside the lines and still survived with my dreams and aspirations intact. Originality is an inexorable part of my DNA.

Apparently, I’m not alone.

Innovation is the rage today. More books on innovation exist than ever before. In the last few months, I’ve spotted at least a dozen major magazines with innovation in the headline. Organizations intellectually understand that they must innovate to achieve competitive differentiation and drive customer preference. Yet, creativity still sleeps, especially in healthcare. Oh, we talk about transformation with gusto. But we resist taking action on our dreams, which puts our survival at stake.

As mentioned, many books and articles offer explanations for the lack of innovation in healthcare, so I won’t repeat those. Rather, I’ll focus on what I believe is the primary reason for innovation sleepiness in healthcare—the systematic elimination of creativity in the very people we expect to innovate. We desire it. But once we see it, we fear it. Our fear turns into control. We either chase the innovators out or force them to conform. For those who stay, their passion is laid to rest.

This type of mental programming starts when we’re young. Rules and societal norms are forced upon us. Generally speaking, rules are important for reasons of safety and perhaps developing positive relations with peers. But in a quest for conformity, we inadvertently squelch the creativity in our children.

Some who survive this programming with their imaginations intact are labeled outcasts. Others with artistic talent find careers that suit their gifting (music, theatre, arts). A smaller number of survivors are those inspired scientists, businesspersons, and engineers who either seek out innovative firms or start their own. And any progressive firm that embraces the fusion of creative arts, business, and science doesn’t fit the programmed norm.

So, back up. Where does that leave the remaining survivors—those that end up in non-innovative industries and firms? I’ll apply the following opinions to healthcare. (As if you didn’t see that coming.)

Rather than rushing to embrace, healthcare organizations create innovation adverse environments to control innovation. Control innovation? Isn’t that an oxymoron? Consider the following as a few examples of this type of absurdity: designing identical and rigid performance evaluations for clinical staff and businesspersons alike—ignoring that each role requires different skills, talents, and models for success; requiring uniform décor and attire to the point offices and employees lack distinct character—and working styles are ignored. We expend more energy and resources on developing Policies and procedures than we do on innovation.

We call the above programming “fairness.” But is it? Rabbits might like carrot sticks for a reward, but the bear needs raw meat. And the innovator needs freedom.

Tension between innovation and conformity is necessary to bring progress to an organization. Challenge must never stop. To reestablish the needed balance in tension, we’ve got to wake up and tip the scales towards creativity.

Waking up from our slumber involves disrupting the current patterns. Some practical ideas:

Encourage Innovation

• Discuss innovation in every leadership message from CEO down
• Lead by example and innovate yourself
• Allow for and encourage respectful dissent
• Surround yourself with creative talent
• Actively participate in collaborative approaches
• Have both informal and formal outlets and fund it

Change Culture

• Allow Non-Conformity
• Embrace self-expression
• Reduce the burden of policy on policy
• Make accommodations for creativity and break rules
• Reward employees based on their role and contribution
• Allow for different compensation and incentive models
• Shelter innovators from political and administrative distractions
• Expect innovation from all clinical and business leaders
• Hire and reward for innovation
• Create cross generational and cross functional teams

Embrace Failure (non-patient care)

• Advocate merits of risk
• Remove fear and shame of failure
• Expect failure (to enable growth)
• Celebrate reasoned failure

Recommended Resources

Goffee & Jones on leading your smartest, most creative people in Clever

Kelly covering IDEO‘s strategies for beating the devil’s advocate & driving creativity throughout your organization in The Ten Faces of Innovation

Moore on how great companies innovate at every phase of their evolution in Dealing with Darwin

Buckingham and Coffman discuss why they do not hesitate to break virtually every rule held sacred by conventional wisdom in First, Break all the Rules

By the way, the quotes I used to open this blog post are not from my Kindergarten teacher. They’re from a collection of quotes I’ve received in the work place, an unconscious attempt at programming.

So I encourage you, press on with disruptive innovation and power ahead to transform healthcare.

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.”

HIStalk Interviews Gary Cohen

Gary Cohen is executive chairman and CEO of iSOFT of Sydney, Australia.

iSOFT is a significant global player in healthcare software, but not maybe as well known in the US. I’m interested if you have plans to increase the visibility and presence now that you’ve started with iSOFT Integration Systems.

I think that the US is the process of going through an enormous transformation both in healthcare reform, as we speak, and obviously in relation to some of the effects of the ARRA legislation in relation to how healthcare IT can change the way healthcare is delivered across the US. There is quite a lot of disruption, I suppose, in terms of the US health economy, which is bringing change.

I think that is probably the point I wanted to emphasize. I think that provides significant opening for us, I believe, particularly where we have specialized around socialized healthcare or healthcare that is more distributed rather than just obviously utilized in the hospital, or utilized in a private care facility, or whatever. But the movement of information around that network, whether it’s between the various facilities inside a hospital or the various facilities that can make it to a hospital or may interact with that hospital, such as community and so on.

The architecture and the way in which we have built our latest generation solution, Lorenzo, has obviously been around that socialized healthcare model. I think when you look at one of the requirements for Meaningful Use and a lot the climates for performance-type process; you’re going to need — particularly, as chronic illness processes involve a lot more interaction with many multidisciplinary people in a healthcare environment — solutions that enable that sort of coverage. I think that’s where we do see a significant value.

With that in mind, we think we have a technology that is probably quite suitable for the US environment. Therefore, we do look to the US in terms of increasing our exposure there in a variety of ways.

Can you tell me what areas that you’ll specifically target? Will Lorenzo ever be sold in the US, or will it be strictly integration tools?

The answer would be in the longer term, yes, we will be looking at a way of bringing Lorenzo into the US. It’s no secret that we’ve worked very closely with our partner CSC in the UK program delivering Lorenzo. CSC has made a very significant investment in getting to understand, from an integration and delivery point of view, the benefits of Lorenzo into the market. I think one of the things that we would see is that working with organizations like CSC, we believe have significant benefits to the US market. That is a longer-term plan.

I think that what we need to do is look at what is going to be available over the next 6-18 months that is going to be suitable for the market as against what might be available well beyond that time. I think there are various products and components from Lorenzo because it’s just, if you think of Lorenzo not as a simple solution, but an architecture and as a platform with many solutions, then we are able to reconfigure Lorenzo in a form that is more suitable to some parts of the US health economy. So, ignoring the integration solutions that we have — which we supply already in the US — which aren’t unimportant, but are one facet.

We are looking to build a suite of solutions with that integration engine and Lorenzo applications that might, for example, target health information exchanges, target aggregation solutions, target solutions that are able to provide an umbrella framework around which other disparate systems can be integrated. But at the same time, adopt workflow processes into that rather than simply just adopting an integration solution or adopting a viewing platform, in terms of how you might aggregate solutions up through a portal or whatever. Look at some similar ways that Microsoft is targeting to aggregate solutions, we would see similar ways of moving down that path.

I think aggregation and dashboard-type solutions, business intelligence, solutions that compliment that process; so if we were able to bring some added value into that equation, such as, we’ve got a multi-resource scheduling solution which we have recently added to our suite that would help enable some of these organizations to do things that they’re not doing today. If we can start to surround some of the aggregation and solution into a complex healthcare delivery, I think that we’ll fill a niche that will keep us busy for quite a few months.

Obviously, when you have the add-on or wraparound solutions, then you have to get in front of customers or find partners. What do you think it will take to be positioned to get the word out to compete while the money’s beginning to flow, but there’s a narrow window before it will be gone?

I’m probably a bit more sanguine in the sense that I don’t think it’s just going to be a short-term window. Inevitably, I believe it’s going to be a much longer-term window than people imagined. But there is a window, so let’s accept that. It is going to require probably a few things from us.

One, it’s going to require us to build a reasonable-sized platform in the US in one form or another. That could take a number of forms. That could take a form of — and these aren’t necessarily, mutually exclusive — investing more resources ourselves into the market, which is what we’re doing. We’re building not only what we’ve got around, what would be required in Boston, but we are bringing more and more resources out of our UK facility, our European facility.

With some of the people, rather than basing themselves in Europe; we’re relocating them and basing them in Boston. That’s starting to add some more high-level, intellectual-type fire power to that. We’ve recently recruited a senior operations director from Carestream who was formerly a CTO of Kodak in healthcare. He’s a global position, but based in the US as well. We’re starting to populate that.

Secondly, we are looking at a significant number of partnerships that we can engage within a more meaningful way, both from a distribution point of view as well as a technology point of view. Those discussions are becoming more critical and intense, and we hope to get some significant progress in those in the immediate future.

Three, we’re also looking at acquiring a platform. Obviously, that would in turn mean that we’ve made a more significant position in the US through that platform than we could leverage a lot of our own products and technology in that platform. That’s another discussion. I’m certainly not going into much more detail in that, but they are all on the table for consideration.

I don’t want to press you on the point, but when you said “consider acquisition of a platform,” did you mean a hospital information system or an integration platform?

I think for us, there are two parts to our business model. We have a lot of product outside the US, and many of those products, over a period of time, will be very valuable inside the US market. I’m not saying that they may not need to ultimately get referenceability in the US. You did ask me what else we require, and obviously referenceability inside the US is going to be important for us.

But then secondly, you need to have significant capability from sales and marketing and distribution, and so on, inside the US, in terms of scale. Obviously, that’s something that we’re giving serious consideration to how we achieve that scale from a sales and marketing point of view, and distribution.

The second element is in relation to technology. Most countries have technology that is very country specific because of functionality. If you look at most health information systems on a global stage, whether it’s the patient management system or it’s the financial solutions or whatever, there are certain things that are not ubiquitous and they require very point solutions. There’s no doubt that the US is equally prevalent with its own specific solutions for certain areas.

It may be useful for us to look at ways in which we could either partner or work — whether through acquisition or partnership — with companies that have certain solutions, but don’t have other solutions. That’s one of the things we’re closely focusing on, and those solutions would have to be complementary to our product suite. For example, if there is a hospital information system company in America, that, per se, doesn’t really add a lot of value because we have a lot of value elsewhere in the world, right? Just going and acquiring a HIS solution or partner with someone with HIS solutions wouldn’t necessarily be as complementary as something that might be more synergistic. They’re the sort of things we’re looking at.

How would you grade the progress that’s been made and the value that’s been delivered by the NPfIT project?

That’s a very pertinent question. If we strip all the emotion out it, and the political dramas and the theatrics that go around it, I think you’d have to say there are some parts of the UK program that have been enormously successful — have done very well. Other parts which are in progress, but for which the progress probably has not been as fast and as good as it should have been, from a holistic point of view. If you look at the overall arch, is the program — in terms of its over-arching ambitions and what it’s trying to do — a good program, and is it going to get there? I think the answer will be, absolutely, yes.

I think really, if you take all politics aside, I don’t think anybody would suggest that the program’s going to stop and it’s all going to go backwards; because really, there’ll be a no man’s land and they’ll not have any viable alternatives. By the way, that doesn’t necessarily mean that the end is worth it, but if you look at where they are trying to get toward, what they’re trying to achieve, I think it’s fair to say that the goals and what we set up is, and are, very good.

I think the problems exists that some of the ambitions in the way in which some of the things have been done have been too ambitious and probably haven’t had the necessary capabilities around their systems to do it as fast and at the pace in which the goals that were set by the NHS and by the government at the time and therefore, set forth expectations, in terms of time scales, that meant that it was much more difficult to deliver. Therefore, people could then always refer to the fact, “Well, you promised X on a particular date,” or, “You promised X within a year or two years.” Once you pass that date, you can always refer back, “Well, the program’s late.” The more you say it doesn’t make the program any later, necessarily. It just is late, right?

There’s no doubt that the development of the spines that connect the top and bottom of England together to enable records to be transmitted through the health network has been a very successful development. There’s no doubt that the connections of the primary care facilities onto that spine, and most of the hospital institutions onto that spine, have delivered enormous, potential capabilities in the way healthcare records can be transmitted, as well as the admission and flow of information into hospitals and so on, by doctors.

Thirdly, there is the digitization of radiology and some of the diagnostic solutions, has been very successful. The more difficult part of the program, if you like — and it’s difficult because it is complex, and probably the ambitions to do it — were to put in place the electronic health record solution in each hospital trust. To basically replace all the legacy systems that existed right throughout all those trusts. I think it’s that part of the program where the difficulties occurred. I think it’s that part of the program that probably should have been done in slightly different stages, but it is that part of the program which ultimately will lead to the biggest benefits, and ultimately will lead to a successful outcome. It is on track. It is late. They need to accelerate deployment and they need to accelerate some of the expectations around delivery.

I think the NHS have probably appreciated the complexity a lot more themselves, and have probably reshaped the program and are currently reshaping the program to ensure that it is going to be able to reach some of those goals more quickly. But that’s probably a small snapshot. I’m happy to elaborate if you want me to, but that’s basically a small snapshot.

It seems that in the UK, you can’t separate the politics from the technology. Do you think that there will be similar challenges in the US as the federal government gets more involved in healthcare IT and gets equally ambitious to roll out these huge national projects that are certainly going to involve some uncertainty and some huge expense?

In my opinion, healthcare is a social thing. At the end of the day, part of the problem is that you just can’t leave it to private industry to sort out the problem because it’s so interconnected to the political fabric of a country in one way or other. Whether directly or indirectly, we all contribute to the healthcare budget. You probably don’t really think about contributing to a budget of a large corporation, if you will. Healthcare always has a very large public sector element into it, in some form or other, whether subsidized or for social reasons.

Government does need to get involved, and I think part of the problem is government is never sure how evolve itself. Part of the experiment in the UK, which was probably good and equally bad, is that they got involved, but probably the way they got involved could have been better framed. The UK’s a very specialized thing because use of national healthcare system, principally, and controlled centrally even though it might be distributed through various bodies like NHS trusts and strategic health services and authorities and so on. It’s effectively a centralized controlled system; whereas the US is a far more fragmented, non-centralized controlled system where the central government tries to either help with policy designs and so on, but allows industry to make its way.

I think if the federal government or the national government in the US were to be far more active, in terms of programs and structures, then probably one of the things it would learn from the UK is, perhaps, to ensure that there is far more participation at an earlier stage. There’s far more buy-in, and there’s far more flexibility into the system. You need to have a system that doesn’t just pick winners, but allows the market to pick the winners while at the same time, ensuring that you encourage the market to go out and spend to pick those winners. You might put incentives and rules and programs in place, which is a bit like what ARRA’s trying to do, and then allow the market to do it.

It probably needs to be a bit further along than just where it is at the moment, but I think the more that a government tries to identify itself with one or two parties — even if they are the right parties — then everybody else is disenfranchised and they become enemies. Then they spend their life just chipping from the sidelines, which is fairly what happens in the UK today. It’s much better at the end of the day, I think, to allow the market forces to select that in a way that isn’t necessarily centrally driven, but the programs are centrally driven.

Richard Granger was really hard on NHS vendors, making them compete and telling them they would be replaced. But looking back, there almost weren’t any contractors left and now the government is trying to loosen up the payments because they were too tough. Was there a lesson learned about how hard you can push a vendor?

In my opinion, whether it’s at the smallest end of the scale or the largest end of the scale, you need a partnership for delivery of healthcare solutions of a complex level. You’re not going to a shop and buying a piece of commodity and walking out and you don’t have see the shop keeper again. If that works, or doesn’t, you don’t really have a relationship with the vendor of that software. You just put it in your system. It either works or doesn’t work. You might be pissed off with the vendor, but that’s a reputational issue. You don’t really have a relationship.

Complex healthcare delivery solutions at the level we’re talking about require a very significant interaction and partnership between the providers and the integrators and the government, or the providers of the services — the users. If you don’t have that partnership, and because you dictate terms that become more and more unreasonable, if that partnership starts to get one sided by either side, then basically that relationship starts breaking down as the complexities of the solution, which often requires a lot of flexibility, and as time goes on, changes of understanding of the market and things.

If you look at the UK, this was designed back in 2003, right? I think it got underway in 2004, six to seven years ago. So what’s happened in six to seven years? Requirements have changed. The economic circumstances have changed in governments and so on. If you don’t build in that flexibility in the relationship, then the whole thing becomes… You know, you can’t document it in a contract, so ultimately, the more you put contractual and the more you go one-sided, the more difficulty you ultimately create in that relationship.

There are a lot of observers that are putting a lot of importance on the Morecambe Bay go-live because of the payments that trigger and the deadline that supposedly is out there from NHS. Do you think that’s overestimating the importance of what’s going on there?

Morecambe Bay is going to go live. No one is suggesting that Morecambe Bay is not going live. The go-live in Morecambe Bay — and I really get a bit sensitive about this, particularly because the contractual arrangements — but you’re talking a very technical integration program where a lot of historical data on all systems has to be integrated into the new systems and training has to occur with a lot of people and so on. The last thing you want to do is go live and not have a successful integration.

In any program, or any delivery, if it was slipped today, a week, or even a month, everyone would say, “Well, OK, that’s not the end of the world.” But what happened is that Christine put a date there that was a bit of a mark in the ground for the go-live of Morecambe Bay for Lorenzo, with 1.9, in terms of importance for CSC.

I think leaving aside whatever contractual arrangements CSC has agreed with the NHS or not, the real issue is if Morecambe Bay are happy with the solution, which we know they are, and they have been testing it in their environment now for a number of months, and they’ve also been using the older version of Lorenzo. If the trust has made a commitment to go-live, which we know that it has, the fact it might be delayed by some weeks is leaving aside what contractual arrangements exist between CSC and the NHS because of the payments, that is not in any way a train wreck.

OK, yes, I would have preferred it to happen earlier, but the fact is that we are talking very groundbreaking and new technology at the same time, in a complex integrated trust environment. The one thing I can assure you is that, technically, the solution is working and delivered. So technically, the go-live has occurred in every other environment in the primary care trusts. So, it’s going to happen. I’m sure there’s going to be a fair degree of political emotion around it and rhetoric, for the reasons we’ve discussed earlier.

Of course, your company suffers from that because shareholders look at the uncertainty there and know that you’re a major player and significant part of the revenue and would have some concerns. Is there anything you can do to reassure them, or are they mislead into thinking that it’s that important?

We have to understand, number one, the NHS program represents today, for us, less than 20% of our total revenue. It’s not our total business. It’s a significant part of that business, but we’ve 80% of our business, and actually more than half of the UK revenue has got nothing to do with the national program. We’re quite a major player in quite a number of things, so I want to at least put it in context. But notwithstanding, you’re 100% right. There’s a lot of focus, there’s a lot of attention, and it gets a lot of air play even if it is only 20% of our total revenue because it’s seen to be a major growth engine and potentially, if it doesn’t work very well, a potential risk factor.

The reality is that in some ways, fortunately for me, my year end isn’t up until 30 June, and a lot of the major things and milestones and deliveries are all scheduled to take place between now and 30 June. I am not in any way looking to stress out or think that our investors should be stressing out. But unfortunately, there’s a lot of people who make lots of noise, and sometimes you just have to allow that noise to occur because what can you say other than to let the facts speak for themselves. Sometimes that just has to be the time period.

When you look ahead for five years or so, what are your plans for the company?

I think that we sit on an enormous potential for delivering health solutions, if I could call it, across the health continuum, in that we think that with the pool of intellectual capabilities that sits in our organization, together with the product know-how and technology that we’ve invested in, with what we can potentially create through building upon that. I think that we can be a world leader in healthcare IT and span the globe. Not just in the 40 countries we do today, but in a broader number. But also, be far more significant in some of those countries where we would obviously like to have significant influence, which hopefully must mean — we would like to think — that by that stage we would be a substantial player in the US market.

I think that the opportunity to achieve that means that we will need to grow and hopefully that growth will be commensurate with a very substantial profit returns to our shareholders and those who surround it. That’s certainly our aim, that’s certainly our intention, that’s certainly our desire. I think we’ve got a good team of people around us to help us achieve that. Even though we have challenges at the moment, and we’re not in the US, and also we’ve got the uncertainty around the national program, I think over the next 6-12 months a lot of that, I believe, will be behind us. I think that will really enable the company to propel its success further.