News 2/10/10

From Snow Bunny: “Re: Pittsburgh snowstorm. The snow flake power outage was severe and crippling at Jefferson Regional Medical Center. It caused all computer screens to go blank with no EMR for 20 hours. Check with your Siemens IT friends to reconcile the facts. Retaliation will be swift for the staff that leak the truth. I have not yet been able to determine the impact of the outage at the Canonsburg Hospital (above) on its EMR, but hospitals do not close their ERs just because they cannot do CT scans.” Unverified. If they had a snowstorm and power outages, I’m not sure that’s a Siemens problem.

From Sally: “Re: Allscripts. They announced a sales re-org a few days ago. Several long-term folks decided it was a good time to make an exit.” Unverified. Allscripts doesn’t confirm rumors, so that’s all I can say except lots of companies seem to be reorganizing their sales teams lately, most likely to frantically shore up the front lines for HITECH spending.

From Othello: “Re: ARRA/HITECH resources. HIPAA Survival Guide is useful.” I notice that HIStalk did not make their list of “TOP healthcare blogs”, which includes some not-so-stellar ones, so I’m not exactly sure why I’m giving them a free link.

From LPJ: “Re: HIMSS. I have been in contact with many IDN CIOs across the eastern US this past week inviting them to a HIMSS event. It may just be a weird coincidence, but an unbelievable number of CIOs are not making it to HIMSS because they are so swamped with large projects in the hospital or with ambulatory implementations.”

From Paulie: “Re: editorial. Did you read this one from [publication name omitted]? Pretty lame with some basic facts wrong.” Newspaper people write editorials that involve issues that affect us all, like taxes and crime, which makes sense. What doesn’t is sideliners who have never worked a day in either healthcare or technology who crank out impassioned, overly confident editorials that industry experts are supposed to find insightful. But if they can get readers, more power to them.

From Joe: “Re: VA. Some months ago, the VA announced that some dozen or so projects were being placed on hold, some of them where VistA had shortcomings and off-the-shelf software could be integrated.” I knew that, but what I haven’t heard is whether they’re moving forward with Cerner LIS or sticking with internal / fat cat contractor development.

From Svetlana: “Re: Scott McNealy at HIMSS 2005. He was a no-show for the opening address. The loyal Sun health care partners slated to be a part of his presentation were given the bum’s rush by HIMSS folk and left to deal with the nasty PR aftermath in the exhibit hall.” I guess that’s why I didn’t remember him. I figured I must have slept in or something since the opening session is usually pretty lame (all the HIMSS speakers just read their speeches off the TelePrompter, usually stumbling frequently). The opening keynoter this time is the CEO of Sprint Nextel, whose inspiring five-year stock performance (blue) against the Nasdaq (red) gives me a good reason to plan for some extra rest before bussing over for the first educational session.

SDI Diagnostic Imaging, a nighthawking radiology company, acquires Stratus Healthcare, another Florida company doing similar work. “Stratus’ software platform allows radiologists to do final reads and use a voice recognition system to dictate their findings directly into the patient’s medical record at the hospital, which will grow in importance with the push for more electronic medical records. It also could mean more direct billing of managed care companies for SDI’s services instead of billing the hospital or radiology group that is SDI’s client, Younger said.”

Maybe you are snowed in, tired of short days, or just struggling with the winter blahs in general. Here’s your cure: complete my reader survey. OK, that was a blatant come-on, but I really do study your responses closely and agonize over what I could be doing better after I read your comments and re-evaluate my self-worth. I only do it once a year, so think of this as Pledge Week at your local PBS station, with aging, overweight doo-wop singers in bad toupees and Popsicle-colored tuxes standing at the ready to sing the only the achievable low notes of Goodnite Sweetheart, Goodnite after the break.

An argument for electronic patient records, witnessed by me first hand: doctors, nurses, and ancillary employees trying to figure out how they can all use the same patient’s MAR simultaneously following the invariable search party it takes to locate it in the first place.

From The PACS Designer: “Re: Receiver for iPhone. Most of us are familiar with Citrix and its servers sending applications to your home or other locations. Now, Citrix has released Receiver for iPhone to send applications to a mobile device so you can have your applications any place you might be with your iPhone.” I first mentioned it in May 2009, but I think this is a new version.

Rep. John Murtha, the big-time bringer of federal pork (some of it healthcare IT-related) to the coalfields of Pennsylvania, dies of what appears to be a medical error. Reports suggest that his surgeon at National Naval Medical Center nicked his intestine or a blood vessel during a routine laparascopic gall bladder removal, causing his death from complications three days later.

I ran across CareCloud, some kind of start up that is not very descriptive of its business, a couple of days ago. I also notice that they’ll be pitching to investors at the Health IT Venture Fair at HIMSS. From the minimal description on its site, it sounds as though CareCloud sells cloud-based physician office systems (“a Web-based healthcare IT ecosystem”)with some social networking thrown in. Pretty much everyone on the executive team came from RCM vendor Avisena.

Jobs: Senior IT Systems Analyst (GA), Clinical Informatics Specialist – Pharmacy (MO), Director – Clinical Informatics (CA), Information Services Manager (VA).

Cerner reports Q4 numbers: revenue up 0.1%, EPS $0.71 vs. $0.86. Some of that was because of a one-time benefit from a year ago, but I would still say it’s a pretty poor quarter given all the company’s bravado about HITECH-fueled growth. They beat earnings estimates, though, and nearly everyone admits now (finally) that stimulus dollars won’t be hitting vendor bottom lines for some time.

A Weird News Andy find: a Texas hospital nurse writes a confidential letter to the Texas Medical Board, asking them to check on a doctor whose medical practice she thought was substandard. The doctor, who has been reprimanded several times by the hospital and fined by the medical board for running a phentermine-dispensing weight loss mill, gets her and another nurse fired. He then reports the nurse to his happy patient the sheriff, who hits her with a felony charge of misusing clinical information. She faces up to 10 years in prison for doing what she thought she was obligated to do as a nurse. The medical board sympathizes, saying “It’s sort of an alarming idea that somebody reporting a doctor of concern has to be afraid of criminal charges.” The nurses are suing the county, hospital, sheriff, doctor, and prosecutor for vindictive prosecution and violating their First Amendment rights.

The greenhorn manager’s guide to fixing every organizational problem: (a) draw up a new org chart that looks exactly like the one from five years ago, which was changed back then to fix every organizational problem; (b) implement more systems in which to document work, record time, and report status; (c) move people around and expect significant synergies to result; (d) hold pathetically transparent motivational sessions and team-building sessions among co-workers who dislike each other intensely; and (e) dismiss all longstanding, serious problems as requiring nothing more than fresh perspective, additional meetings, and focused prioritization. This is a composite of all the hospitals in which I’ve worked. I felt the need to share.

PC World mentions Microsoft Research’s work in using consumer products like the Xbox and Windows Mobile phones for health-related functions. “Researchers are also looking at how to automate the data transfer from complex records and choose or filter displayed information according to conditions such as whether the doctor or family members are in the room, which could be detected by sensors, Tan said. Xbox units could be used for those purposes, to present other health information and to let patients play games or access certain Internet services, including through body gestures enabled by Microsoft’s upcoming Project Natal control system, he said.”

Sometimes it seems that as many spare bedroom programmers are writing iPhone apps as there are people using them. This Mayo cardiologist taught himself programming and spent 200 hours writing his 99-cent app that lets users screw around with photos, like adding balloon messages, devil horns, or giant pectoral muscles.

Nuance announces Q1 results: revenue up 21%, EPS -$0.02 vs. -$0.11.

Tasmania’s Department of Health and Human Services has issued a request for tender for a system to create a longitudinal patient with HIE and business intelligence capabilities from its legacy systems, just in case any of you vendors are interested.

E-mail me.

HERtalk by Inga

Picis announces its 2009 highlights, which include the addition of 30 new IDNs, 83 CareSuite selections, and a doubling of LYNX revenue cycle customers. Mr. H mentioned the other day that Picis was of HIStalk’s first sponsors and that he interviewed President Todd Cozzens in 2005 (back when he still had to beg people to talk with an unknown blogger). Here is what Cozzens said five years ago:

We’ve got plenty of room for growth. These care areas (ED, ICU, OR) make up over 50% of a hospital’s revenue and expense, and only 7% of ICUs are automated so far. We’ve proven that we have the technology and usability levels for users to spend money to make money in these areas. We’re past the early adoption phase. Most of our OR revenue comes from replacing antiquated scheduling systems, but only 7-10% have automated anesthesia and PACU, so that’s an add-on at the same price as the scheduling system. ED is only 10% automated and a hot area for investment. So, there’s plenty of growth for this company in the next five years, continuing to do what we do extremely well.

East Cooper Medical Center (SC) plans to install Patient-Aware OR in its new hospital opening later this quarter.

Mediware announces its Q2 numbers: net income of $783,00, which is a 158% increase over last year; revenues of $10.8M, 8% higher than last year.

Providence Health & Services Washington Region selects Compuware’s EHR Service Delivery Solution to proactively resolve performance issues.

Citrus Memorial Health System (FL) upgrades its HIS to McKesson’s Paragon community HIS. Citrus will use McKesson’s remote hosting services and plans to connect its outpatient clinics that are running McKesson’s Practice Partner ambulatory EHR.

The University of Colorado Hospital is seeking to fill 75 new jobs as it implements its $67 million Epic project over the next three years. Average salary is $74K for positions that include analysts, project managers, business systems analysts, and computer technicians.

I also noticed that MEDecision is soliciting potential employees to schedule an interview with them during HIMSS. If the interview goes well, perhaps you’ll be invited to attend the big party they’re hosting at the Georgia Aquarium. (Unfortunately it is the same time as the HIStalk party or I’d be making plans to be there.)

Phytel raises $14.2 million in funding from investors, including Polaris Venture Partners, Caris, and LAH Investments. Phytel plans to use a portion of the funds to advance product development.

Also raising new funds: PatientSafe Solutions (formerly known as IntelliDOT), which closed on $30 million in Series B-1 financing and will use the money to complete its next generation product.

Concord Hospital (NH) is replacing its Sun Microsystems eGate solution with Orion Health Rhapsody Integration Engine.

Garden City Hospital (MI) integrates Dragon Medical with EmergisoftED in its ED. The hospital says its now creating “transcription-free clinical documentation.” CareTech Solutions provided the implementation training and support for the EmergisoftED and Dragon Medical integration.

The CIO at Wayne Memorial Hospital says their Imprivata OneSign SSO application has eliminated password management challenges and is providing secure access to data from more than 40 applications. Connected applications include MEDITECH 6.0, McKesson PACS, Nuance ESW, Kronos, NetLearning, OWA, and RadNet.

Nash Health Care initiates a 15-month Cerner clinical implementation nicknamed “On Track for ePatient Safety.” The hospital anticipates saving $8 million a year over five years following its March 2011 go-live.

Cook Children’s Health Care System (TX) signs up for multiple enterprise software solutions from Lawson Software.

A new KLAS report looks at 22 HIE vendors and concludes that most have only one, two or three validated sites. Axolotl has the most live HIE clients in the acute-to-acute space (seven validated.) Epic also had seven validated acute-to-acute sites, though all are Epic software customers. Among acute-to-ambulatory HIEs, Medicity’s Novo Grid leads the pack with 22 live HIE organizations; RelayHealth has eight live sites.

A few sponsor updates:

• CareTech Solutions names Colleen M. Hanley as VP of marketing, communications, and government affairs.
• Quality IT Partners wins an IT infrastructure contract with a major health system in the West.
• Home health provider SunCrest Healthcare selects Philips as its provider of telehealth monitors for home care patients.
• Rob Kolodner headlines a Sunquest-hosted breakfast March 2nd during HIMSS.
• BridgeHead Software is surveying hospitals and healthcare organizations to gauge the industry’s readiness for and response to IT growth and the data it produces. If you’d like to participate — and earn a chance to win an Apple iPad – you’ll find the survey here.
• The Children’s Center (OK) purchases QuadraMed CPR, including the Smart Start solution, CPOE, Long-Term Care and Rehab, and AcuityPlus.

Google plans to introduce a Facebook-ish feature that will make it easier for Gmail users to view media and status updates shared online by friends. I see this as a potentially very bad thing. First and foremost, I am in Gmail all day and I can’t imagine how I will get any work done when I see friends post things like they’ve gotten a new haircut and need feedback, or ask questions like what kind of wine goes best with Mexican, or even that Nordstroms is having a major shoe sale. Second, I am already entrenched in Facebook and I can’t make a switch now (same excuse used by a lot of providers using EMRs). And third, do I really, really need another way to communicate with people? One reason I am really looking forward to HIMSS because I’ll have a chance to talk to people face-to-face versus virtual communication. Who is shocked to know that Mr. H and I have only talked on the phone once in the last year? Yet I know he is always lurking on my Facebook.

Talk virtually to Inga.

Readers Write 2/8/10

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!

First Impressions of the iPad in Healthcare
By Trey Lauderdale

I don’t think we have ever seen a piece of technology as polarizing as the recently released Apple iPad. Being vice president of innovation at a healthcare-focused iPhone development company, I have received an unbelievable amount of feedback (some solicited, some not) on the good, the bad, and the ugly of the iPad’s potential uses in healthcare.

The first potential use models are the usual suspects we have all been hearing about for the last 3-6 months: entering data into the EMR, viewing medical images, observing patient data, managing alarms and alerts, etc, etc, etc. I could go on and on, but you already know all of these because they are available right now on your iPhone.

Don’t get me wrong — all of these functions are wonderful, but nothing here is really game-changing. I consider these the foundation of what is necessary to bring this device into healthcare in a useful manner.

In my opinion, the greatest impact this platform will have on healthcare is going to be from the creative juices squeezed out of the developer’s minds who will be writing applications specifically geared for the iPad and its potential use model.

You have got to look beyond version 1.0 of the iPad and into what it will become in the second, third, and onward generations of the device / platform. Apple tends to make significant improvements to their product between the first and second generation releases (2nd Gen iPhone >> 1st Gen iPhone). The limitations that have been brought up are all valid, but will be alleviated over time or through simple physical remedies.

It won’t survive in the hospital environment?

A robust, antimicrobial case will be out by the end of 2010 – it can almost be guaranteed.

No camera for image taking?

It will be there by Gen 2 (not for healthcare, but because consumers want it).

Too big to fit in a pocket?

The workflow model should not position this as an “always carried” device.

The one limitation that had me on the verge of throwing my MacBook across the office was the lack of background processing. While potentially the greatest shortcoming of the iPad, after some thought and analysis, it needs to be viewed as a mixed blessing. This device is going to have 1GHz of processing power focused on ONE application. The user experience in the currently open application is going to be amazing, assuming developers take time to re-factor their applications to fully leverage this “limitation.”

Through appropriate use of inter-app communication and data sharing, a great deal of the concerns brought on by no backgrounding can be bridged relatively easily. The key is going to be the foundational applications leveraging and creating open-source frameworks and standards that can be leveraged across multiple vendors in a collaborative environment.

The first day the iPad is released in March, all of the technology and applications are in place to enable a caregiver to view their patient’s vital monitoring waveform (Airstrip Technology), check the data against their EMR (Epic Haiku), and then send a quick message to an appropriate staff member asking them to take action on a potential event (Voalté).

While these currently reside as three separate applications, the experience provided to the end-user should not feel as such. The real power of the iPad (and even iPhone) platform is going to be a collaborative environment between the vendors that reside on the device. This collaboration will be of even greater importance with the iPad due to the greater amount of real estate the end user has to work with.

I can envision a hospital where an iPad is placed outside every hospital room displaying relevant information about the patient and their current vitals (REALLY decentralized monitoring). Clinicians grab the iPad as they enter the room, sign in with a quick series of hand gestures (or maybe take a quick picture of their ID?), and easily enter information into the open application regarding the patient’s current status. Messages and tasks can be dispatched to the right caregiver automatically from the iPad, and the clinician places the device back into the cradle once done with the patient. All of the pieces for this experience are currently in-place and ready to be tied together.

Apple has provided the revolutionary platform we could have only dreamed of 10 years ago. It is now our responsibility as application developers and IT system administrators to turn those dreams into reality and provide the end user experience our clinicians deserve.

Trey Lauderdale is vice president of innovation of Voalté of Sarasota, FL.

Interim is not Final
By Mountain Man

I don’t know about you, but my organization is asking a lot of questions about ARRA "now that it is finalized" and what we as an organization should do. Should we change our strategic plan? 

With all the hype and media around this pseudo-event, we certainly have the the eyes and ears of our executive team and board members. We have somewhat of a bully pulpit. We should use the awareness created to advance our causes of bringing safety and efficiencies to healthcare delivery and financial visibility  into the business. If we can tilt the spending towards an appropriate amount in order to complete our strategic plan, we should do so.

Here is the problem. “Interim” is defined by Wikipedia as “a temporary pause in a line of succession or event.” This does not sound very FINAL to me. So, Interim Final Rule really makes little sense.

Quit freaking out, people. NO ONE thinks we can hit the dates provided by the IFR. We should not reallocate all our resources to cover some part of the ARRA requirements that we left out of our strategic plans two years ago.

Most of us are working towards the general direction that the IFR is leading us. Keep doing what you are doing. Trust your plan and execute.

It is your STRATEGIC plan for a reason. Hitting an INTERIM suggested state is very TACTICAL and short-sighted.

If you are not headed in that general direction by now, then you should freak out.

They’re all Synonyms!
By Deborah Kohn

I don’t know how many times I delivered a presentation / authored a published article when I had to explain why two healthcare information technology (HIT) trade organizations (one so large that it won’t be mentioned in this article and the other, federally commissioned at taxpayer expense and no longer in existence) adopted definition differences between an electronic medical record (EMR) and an electronic health record (EHR).

This only further confused my healthcare professional audience / readership who, for years, have had a complete understanding that charts, records, patient charts, patient records, medical records, health records, etc. are synonyms! Walk into any hospital or clinician office and always one will hear an assortment of such synonyms without ever questioning the meanings.

True, in the late 20th century, synonyms of adjectives, such as computer, computerized, automated, or electronic were needed to differentiate between (what is known in the greater IT world as) analog vs. digital charts, records, patient charts, patient records, medical records, health records, etc. However, still the use of the synonyms of adjectives with the synonyms of nouns made no difference to practicing healthcare professionals, except to differentiate, when necessary, between analog, digital, or hybrid.

Thankfully, we might be getting close to ending this nonsense. Recently, one HIStalk reader correctly pointed out that NOWHERE in the 2009 American Recovery and Reinvestment Act (ARRA) with its Health Information Technology for Economic and Clinical Health (HITECH) Act is there a distinction made between an EMR and an EHR. Only the term electronic health record and acronym EHR is used — for health information exchanges, for hospitals, for physician offices. That’s probably because every healthcare industry-bred author / reader / interpreter of this legislation has a complete understanding of what is being conveyed.

On the floors or in clinic rooms, let’s continue to use whatever synonyms (adjectives and nouns) come to mind, because we’ll continue to understand what is being communicated. In addition, let’s give credit to the 2009 legislation for dealing one of the final blows to this “trade organization made up EHR/EMR” definition debate and all agree to use EHR (as used in the ARRA / HITECH legislation) as the standard terminology in presentations / published articles / vendor products, etc. Only then will we be able to move on to more important discussions.

Deborah Kohn is a principal with Dak Systems Consulting  of San Mateo, CA.

Licensing of EHR Systems: Contractual Considerations
By Robert Doe, JD

As a result of the incentive payments offered under the HITECH Act for implementing certain qualifying EHR systems, many healthcare entities are evaluating the various EHR systems that are available, taking into account the certification, interoperability, and meaningful use requirements. There are a number of considerations a healthcare organization should take into account during the process of choosing and contracting with an EHR vendor.

A healthcare organization should consider including certain warranties and representations in the agreement with the EHR vendor to help ensure that the system is capable of allowing the healthcare organization to receive the incentives (and avoid future penalties) associated with the adoption of an EHR on an ongoing basis for the term of the license. As a drafter and negotiator of license agreements on behalf of healthcare organizations, while some vendors claim to do so, I have seen reluctance on the part of EHR vendors to meaningfully warranty their systems with regard to these considerations.

One argument is that the criteria for receiving the incentive payments have not been clearly defined. Future requirements, the argument goes, could conceivably require significant investment in new functionality. In addition, a vendor may argue that it has no control over how the system is actually used within the healthcare organization.

With regard to the first argument, EHR vendors are receiving significant new business as a result of the HITECH Act. If they cannot warrant the functionality which is one of the main motivating factors for licensing the particular system chosen, they are in effect transferring the entire risk to the healthcare organization, which, at a minimum, should be shared by the parties. For a significant capital expenditure of this nature, care should be taken to produce the result which justifies the expenditure. As a result, this should be one of the first discussions a healthcare organization should have with the EHR vendor during contract negotiations.

Some vendors may offer warranty language that appears to address the subject matter, but from a legal perspective, doesn’t actually provide much in the way of legal rights. Some vendors may propose that the issue be addressed as part of maintenance and support. Keep in mind that the legal remedies may be significantly less for a breach of maintenance and support as opposed to a breach of warranty. The warranty language could also be crafted to take into account the situation where significant additional investment is required for the system to conform to HITECH’s requirements, allocating an agreed upon portion of the expense to the existing customer base.

With regard to the second argument, it’s true the vendor has no control over how the system is actually used by the healthcare organization, but the warranty language can be worded to ensure the system includes the necessary functionality to allow the healthcare organization to qualify for incentive payments and avoid future penalties.

In addition, many healthcare organizations are endeavoring to provide access to their EHR systems to other unrelated healthcare organization in their communities, as part of a regional health information organization, health information exchange, or otherwise. The underlying goal of many of these arrangements is to provide EHR technology to other local healthcare facilities that may not be able to afford such systems by themselves. Such arrangements may also help to lesson the financial burden. Whatever the reason, there are legal and licensing issues to consider.

Any healthcare organization that desires to provide access to a software application to another unrelated healthcare entity or clinician must be aware of the physician self referral prohibition (Section 1877 of the Social Security Act) commonly known as the Stark law, the federal anti-kickback statute, and, depending on the data being exchanged, the Health Insurance Portability and Accountability Act, commonly known as HIPAA. In addition, significant anti-trust issues could arise if the software allows the sublicensees to share financial information. These additional legal issues must be addressed with legal counsel prior to setting up such an access arrangement.

In addition, the agreement with the EHR vendor must contain specific provisions allowing the healthcare organization to provide access to the unrelated healthcare organization. Do not assume that you can provide access by simply executing the EHR vendor’s standard form license agreement. All license agreements contain a license grant section that specifies the parties and individuals that can use the software. In most instances, it is limited to employees of the legal entity that signs the contract.

In addition, most license agreements specifically prohibit the use of the software to process information for, or use the software on the behalf of, any third party. The contractual language allowing the healthcare organization to provide access to an unrelated organization can take many forms. It may be as simple as expanding the definition of an authorized software user to include any other individuals authorized to use the software. Alternatively, the license grant may specifically state that the licensee may sublicense or provide access to the software application to a third party and set forth the conditions under which it can do so. There will also need to be an agreement between the two healthcare organizations governing access to and use of the EHR system. Careful consideration should be put into the drafting of this document. There are a number of issues that could arise if not addressed in this agreement.

The HITECH Act incentives have increased demand for EHR systems. Often times the timeframe for implementing such systems is quicker than would ordinarily be the case. It has been my experience that taking the time now to address the legal and business issues will help avoid problems in the future.

Bob Doe is a founding member of BSSD, an information technology law firm located in Minneapolis, MN.

Monday Morning Update 2/8/10

From Nasty Parts: “Re: Sage. COO Lindy Benton resigned Thursday night.” Confirmed with Sage. Betty Otter-Nickerson starts as CEO this week.

From iSOFTen: “Re: UM Medical Centre in Kuala Lumpur, Malaysia. IBA/iSOFT have been invited to the exit door because of repeated product delivery failures. This casts long shadows over the future of their German-developed strategic lab product, planned for the still pending at Welsh procurement. And with regard to iSOFT’s alliance with Picis, it was because of IBA/iSOFTS’s product delivery failures.” Unverified.

Listening: Midlake, a Texas band that sounds like accessible, straightforward 60s pop meets the Flaming Lips.

I think it’s plainly obvious, but in case not: I use only phony names on the reader comments I post. Please do not pester your colleagues just because the phony name is similar to theirs since it most likely wasn’t their comment.

Tammi, our BFF from AT&T Mobility, said their “iPhone in Medicine” session was packed even after being moved to a larger room at the mHealth conference in Washington DC last week. mHealth Initiative is the group formed by former Medical Records Institute/TEPR people Peter Waegemann and Claudia Tessier when that group flamed out.

Weird News Andy ponders, “Where do babies come from? From iPhones, apparently.” After four years of trying to conceive, a couple hits pay dirt in just two months after using an iPhone menstrual calculator. Thank goodness humanity didn’t lapse into extinction before the iPhone came along to help it reproduce the species.

Yale New Haven Hospital chooses the document management solution of Perceptive Software for several departments.

The folks at Henry Schein Practice Solutions are offering a free, on-demand Webinar called 10 Questions to Ask your Electronic Dental Record Vendor. They’ve also hired Pete Cousins as national sales manager for Dentrix Enterprise. I’m sensing trouble because Pete is a big-time amateur golfer, which means if you want a customer’s game, he will probably thrash you despite his best intentions to keep it close.

Red Hat announces its February 10 Open Source Cloud Computing Forum, an all-day virtual forum hosted by its CTO that offers 12 half-hour technical presentations.

Sunquest will introduce its new BI solutions and physician portal at HIMSS.

We’ve mentioned some charity-related activities at HIMSS, so here’s one from Compuware and Covisint. The company will donate $10 to Habitat for Humanity for each attendee badge scan at their booth. It will also raffle off a $5,000 contribution to that same organization, which is the amount of money it takes to rehabilitate a home.

I guess Google can celebrate its big win over Microsoft in their respective HIStalk reader polls, with Google’s 65% negative rating in healthcare beating Microsoft’s 66%. New poll to your right, the last in the series: same question, this time about Cisco.

It’s that time of year again — please complete my HIStalk Reader Survey, won’t you? I read the response carefully and plan the whole next year based in what readers tell me, so your time won’t be wasted. Thanks.

This is the real payoff of EMRs, described in a well-written article in The Buffalo News. Buffalo Medical Group searches its database for patients at risk of abdominal aortic aneurysm. It identifies 2,000, of which 30 are found to have aneurysms that could burst at any time, which is nearly a certain death sentence. The article focuses on the benefits of the medical home concept, but also summarizes the concerns of its critics: “They also wonder if the concept is nothing more than a repackaging of managed care, bristle at the suggestion that doctors need financial incentives to do the right thing, and view the focus on efficiency as more appropriate for a factory.”

I don’t know about your hospital, but mine can’t give H1N1 vaccine away. I said early on that this latest scare might be as overblown as the Gerald Ford’s Great Swine Flu Epidemic of 1976, although I really doubted that. Other than putting some nice profits in the pockets of drug companies and McKesson, I’m struggling to decide if there was any benefit to getting everybody all worked up about it. It’s notoriously tough to predict pandemics, much less prevent them.

Kaiser Permanente is recognized with a security award from HITRUST, an organization that has a Kaiser security executive on its executive council. I Googled to see if HITRUST is a for-profit corporation as I expected; the only declaration I found saying it’s a non-profit came from Fierce Health IT, which I think is wrong. It looks to me like a regular business, despite a .net Web address and some noble mission statements. Its Web site says it is a “private, independent company” and its Texas incorporation records show its officers as a husband and wife. He’s founded a few other now-defunct corporately sponsored think tanks in the past.

An Epocrates survey finds that 20% of doctors say they’ll be buying an iPad within a year, good news for the company since it has already committed to creating an iPad version of its drug information software.

VirtualHealth Technologies completes the sale of its Secure eHealth secure messaging business and its VPS Holdings prescription drug monitoring business to Wound Management Technologies.That leaves the company with two primary business lines: EMRs and gold mines (insert joke here).

St. Joseph’s Hospital (WV) chooses eWebHIM from eWebHealth for scanning and HIM workflow.

Akron General jumps on the “show your ED wait times” bandwagon, putting them on its Web site and on billboards. The times reflect how long it takes for the doctor to see you, but most ED delays involve waiting for technicians, for labs or x-rays to come back, or for someone to get you signed out with prescriptions. Being called from the waiting area to the treatment room is only a small victory. Since they’re capturing the times from their EMR anyway, maybe they should measure arrival time to final disposition.

eClinical Works breaks the $100 million per year revenue barrier. I dug out my May 2006 interview with Girish Kumar Navani in which he boldly predicted $40 million in revenue for that year, a big jump from the previous year’s $25 million. And when I interviewed him in early 2008, they were at $60 million and he was predicting $500 million in annual revenue by 2018.

GE Healthcare names William Denman as chief medical officer. He’s coming over from Covidien, the Irish spinoff of Tyco Brands that sells healthcare products under the brands Kendall, Mallinckrodt, Puritan Bennett, and Syneture, among others.

Results look promising for the first-generation artificial pancreas for treatment of diabetes. It combines a blood glucose monitor with an insulin pump, creating a feedback loop that is managed by software.

The VA is budgeting $157 million next year to develop a Virtual Lifetime Electronic Record that will tie together data from the VA, DoD, and the private sector. DoD plans to spend $300 million to develop its part of the project. In more startling news, the VA will spend $347 million for HealtheVet, which it says is the “the future foundation of our electronic health record system” that will initially include a new clinical data repository, patient scheduling system, and pharmacy information system. On the VA’s VistA Web page, it calls HealtheVet “the VA’s next generation of VistA.” I never heard what happened with all those ambitious plans to replace VistA with commercial systems, so I don’t know where this money is going.

Sun’s big executives, including co-founder Scott McNealy, quit as the company is absorbed into Oracle. McNealy gave the opening address at HIMSS 2005 in Dallas. I don’t recall being impressed.

Odd lawsuit: a stripper gets drunk on the job and leaves the club despite its three attempts to stop her. She crashes her car, breaking her nose and back. Her injuries force her to stop stripping, so she sues the strip club for “wantonness.” The jury awards her $100,000, with her attorney declaring that “I think that it does speak to our community’s regard for safety”. The club’s lawyer disagrees: “Bottom line is she got herself drunk, had a terrible wreck, and wants someone else to pay for it.”

E-mail me.

HIStalk Interviews Scott Weingarten

Scott Weingarten, MD, MPH is president and CEO of Zynx Health.

What was your reaction when you saw the proposed Meaningful Use criteria?

When you look at what was published on December 30, I don’t think there were any huge surprises based on what we saw over the summer that was published in June and July. There was a continued focus on clinical decision support, which we anticipated based on the earlier information. We believe that that is a good thing.

We think clinical decision support can lead to improved quality and safety of care, as well as less costly care. We believe that’s where the greatest benefit will occur as a result of the investment in healthcare information technology. We were pleased to see that clinical decision support remain prominently featured in the December 30 publications.

Do you think the requirement to create five clinical decision support rules is a good step toward using systems to guide physicians?

I do. Initially, I believe it was one. Now it’s five. I think the bar is still very low for clinical support rules. I think in order to get the clinical return on investment and the cost benefits that the federal government would like to achieve, I think they’re going to need more than five, but I think it’s a good start.

To many doctors, when they hear clinical decision support, their experience or their perception is that it’s just intrusive, unhelpful, impersonal warnings that stop them from doing what they want to do. What has to be done to turn that into that vision of having it impact quality and cost?

They have to look carefully at both the sensitivity and the specificity of the clinical decision support, meaning, look at very carefully that there are as few false positives as possible. I think at least historically, largely with drug/drug interactions, there are many false positive alerts that in many cases can color our view about the value of clinical decision support.

When one goes beyond drug/drug alerts and really looks at the broader potential for clinical decision support, and if one really focuses on those aspects of care that provide great clinical benefit… For example, evidence-based clinical processes that have been shown to reduce mortality, reduce morbidity, and improve quality of life or safely reduce costs when one pays careful attention to the specificity, or ensuring that there are as few false positives as possible. I think the annoyance factor will go down and I think the benefits will increase.

Do you think it’s the content provider or the application vendor who needs to refine that sensitivity/specificity and the ultimate presentation of whatever the result was?

I think that it’s really teamwork. When I say teamwork or collaboration, I think the content vendor needs to really give a lot of thought to optimizing the sensitivity and specificity of the clinical decision support. I think the healthcare information technology supplier needs to have the functionality to optimize the specificity and sensitivity of clinical decisions.

Also the client, in some cases, can pick and choose which components of clinical decisions support that they would like to utilize. Thinking about the benefits, or them really analyzing the potential benefits of turning on clinical decision support, should occur before they select what form of clinical decision support.

A good example, as you mentioned earlier, would be the five rules. Making sure that the five rules are those that really will favorably impact care at their organization, have the greatest clinical benefit, and yet the rules will be as specific as possible.

One of the things that it seemed was fairly clear in the initial proposed criteria was that the rules needed to be user-maintainable rather than just a black box that you take as they come. Was that a surprise?

No, I think you want them to be maintained by the user because I think that different organizations, depending on local practice, there’ll be some rules that provide greater benefit than at other organizations.

Let me give you an example of what I mean. Let’s say an organization has already achieved the ceiling effect and eligible patients with chronic heart failure are being treated with either an ACE inhibitor or an ARB. Well, having a rule will provide very little benefit, just because the care is consistent with best practice or evidence-based practice. Another organization where they have not achieved those benefits, where far fewer appropriate patients are treated with ACE inhibitors or ARBs for chronic heart failure, may have an opportunity to save many lives by providing that rule.

Really, the point being that different organizations will achieve different benefits with different types of clinical decision support, depending on the size of the gap between optimal or evidence-based practice in their current practice. Practice varies, as I think has been very well described, organization to organization. Therefore, I think having the user select which clinical decision support rules have the potential to provide the greatest benefit for their organization, and potentially maintaining the information, to me, makes sense.

When hospital-based vs. practice-based doctors create their initial five rules, how will their priorities differ?

I think that the types of rules that are likely to be created in the ambulatory setting or by physicians in their offices will reflect the patterns of outpatient care. My guess is we will see a number of alerts and rules for chronic illness in the form of disease management rules or preventive care; where I think the rules will be quite different in the hospital, which will reflect acute illness requiring hospitalization.

My guess is in the ambulatory setting, we might see more rules related to chronic illnesses such as asthma or diabetes. In the hospital, we might see more rules and alerts that relate to the more common reasons why patients hospitalize, such as chronic heart failure or community acquired pneumonia.

What do you think about rules for nurses when charting or documenting?

There’s a fair amount of nursing practice that can be evidence-based. There are many good studies showing that certain nursing practices, when faithfully adhered to, will lead to better patient outcomes than other nursing practices.

Decades of nursing research support what processes are best for patients, and I think it makes a lot of sense to have rules and alerts to inform nurses, when appropriate. That will lead to the best possible nursing care. I would agree with that. I think alerts and rules are just as important for nurses as they are for physicians and other healthcare providers.

What kind of work has been done, or what kind of interest is there in background alerts based on collecting electronic data that indicate problems, the imminent harm type of rule?

My guess is that the initial rules may not be quite that sophisticated, but I think there’s tremendous benefit that can occur when these background rules — for example, will identify patients based on physiologic parameters, hemodynamic variables where they’re at risk of rapid clinical deterioration — to alert the physician to observe the patient closely and possibly prescribe new treatments.

I think that when we get there — when the field matures, when we’re consistently applying those rules — I think there’s great potential to quickly identify problems that may not have been identified by treating clinicians and to reduce morbidity and mortality. I think in the not-so-distant future there will be many more of those rules, and that will advance patient care significantly.

What advice would you give to hospitals, in general, about creation and maintenance of order sets?

I think it’s hard. One is I would advise them to create, update, and maintain order sets. There are good data in the scientific, peer-reviewed literature that shows that evidence-based order sets reduce mortality, reduce morbidity, and can safely reduce costs. I would advise hospitals to do it.

Second, is there are data showing that physician productivity can be increased when physicians use order sets for common diagnosis rather than write each order one by one. There’s the benefit of improving care and potentially improving productivity, but I think you need the order sets to be viewed as credible by the medical and nursing staff.

They have to be updated frequently. I think they have to be evidence-based. I think if they are not maintained and the information is highly perishable, that when the information goes out of date clinicians are smart and figure it out. They say, “Hey, how come this order set doesn’t reflect the findings in this article published in the New England Journal of Medicine a month ago? What’s going on here? Don’t we want to provide the best possible care to our patients?”

Clinicians, appropriately, can be critical when information in order sets is out of date. The organization needs to come up with a very methodical, disciplined approach to update and maintain the order sets and retain credibility with the clinicians.

There was a statement recently, by Eric Schmidt of Google, that seemed to imply that in his mind as a technologist, practice of medicine is simple as looking up reference information, correlating it to patient information, and out pops a diagnosis and a treatment plan. How can the art of medicine be reconciled with the support that software can provide to those who actually practice it?

I’m an internist. I’ve taken care of a number of patients in my life. Medical care is complicated. I think that it’s complicated for a number of reasons. 

In some cases, there may not be evidence to support a particular treatment decision. In some cases, the evidence might be conflicting. In other cases, the patient may have many co-morbid illnesses.

It’s often not as simple as a patient that has one illness and therefore, this recommendation will always work for this patient. Many patients who are hospitalized have many different co-morbid illnesses which increase the complexity of clinical decision support.

Then finally, patient preferences are very important. I may suggest to a patient that there’s a particular drug I would like the patient to take, but the patient may have had a bad experience with the drug in the past, or may know someone with a very bad experience from that drug in the past. Therefore, for that patient, that drug may not be the most appropriate.

I think medicine is highly complex. Evidence-based information is critically important to informed care; but at the end of the day, what evidence-based medicine does is inform the best possible care. Each doctor and nurse has to understand the preferences and beliefs of his or her patients to make sure that the care is individualized to lead to the best possible care for any individual patient.

Has the industry moved enough toward guiding the caregiver, rather than warning them of conditions? In other words, helping them make a decision, rather than telling that they’ve made the wrong one?

I think so. I think order sets will help guide clinicians to making the right decision. They really do not tell clinicians they’ve made the wrong decision, so I think as an industry we’re heading in the right direction. I think that’s exactly what you want to do. You want to guide them to make the right decisions, rather than you made the wrong decision.

News 2/5/10

From Farrell: “Re: Microsoft. Substitute Epic for Microsoft in this article and it holds true.” The article, written by a former Microsoft VP, observes that Microsoft is a “clumsy, uncompetitive innovator” whose products are “lampooned” and its marketing “inept” as it loses market share in nearly every important category, milking profits from Office and Windows but falling slowly into irrelevance otherwise. Company bureaucracy and infighting are blamed.

From Nell: “Re: McKesson. W-2 forms have always listed the employer as McKesson Corporation. The ones just sent out say McKesson Information Solutions LLC. I wonder if they are quietly preparing to spin off the HIT division?” I figured it was probably a Delaware corporation, so I check that state’s corporate database. That corporation was formed in 1974, so I don’t know why it’s suddenly showing up on W-2s. Could mean something, could mean nothing.

From Warren: “Re: QuadraMed layoffs. This is absolutely not true. There has been senior leadership change in sales, resulting in some realignment of the sales force, and two sales folks were let go. QuadraMed Sales is now better aligned to serve its clients. QuadraMed is absolutely committed to meeting Meaningful Use requirements for current and future QCPR customers. These types of rumors can be deal killers — please vet sources carefully before printing.” I held the first report I received suggesting layoffs and a change in the QCPR product just in case it was bogus. I then received two more saying the same thing. All three came from non-anonymous sources I’ve known for years who are also pro-QuadraMed. The official company contact told Inga last time we asked that they do not address rumors. We asked about this one anyway, but her e-mail bounced back as undeliverable. It’s tough to confirm when the company won’t talk. Still, I would be happy to hear that layoffs were minimal and that QCPR will live on. If it were me, I’d get an announcement out there.

From Doug Wallace: “Re: Dwight Schrute from The Office on EMRs. ‘I think one of the greatest things about modern America is the computerization of medical records. As a volunteer sheriff, I can look up anyone’s psychiatric records or surgical histories.’”

From FreddieMac: “Re: Cerner. In order to improve cash flow, the company is aggressively pursuing complete IT outsourcing deals (like MU) among its client hospitals through any any back door they can. Of course, they think RHO Millennium translates into knowing how to run all the other aspects of health IT. I believe they got Naples Community and are trying for some other academics. Beats the hell out of trying to compete with Epic for new sales.” It’s a good strategy, I think, and I expect it will open some doors to hospitals who don’t consider data center operations to be core. Not to mention that, as you noted, Epic is taking most of the pie anyway. (I just noticed that I said Cerner, Epic, and pie together … could that be a HISsies Freudian slip?)

From Mark: “Re: Dragon Naturally Speaking. I bought it on your first recommendation and absolutely love it. A product that lives up to its billing, just like HIStalk!" Another reader suggested that I note, probably unnecessarily, that I am using DNS for personal use, which is why it was cheap. For EMRs, you would need Dragon Medical, which comes with integration tools, a medical vocabulary, and a much larger price tag. My point is still valid: speech recognition absolutely works and is not just for geeks any more.

Mcesson announces Practice Partner Connect, an interoperability platform for users of its Practice Partner physician system.

Loma Linda University Medical Center chooses the MDaudit Hospital compliance and revenue risk mitigation system from Hayes Management Consulting.

eMix will launch its vendor-neutral medical imaging information exchange at HIMSS. The company is affiliated with DR Systems.

Janeen Cook says thanks for taking a look at her nursing video. She won the Vanderbilt School of Nursing student video contest with 560 views, saying, “One of my former team members said I was just like Susan Boyle. Wait a minute, I thought — is that a complement being thought of as frumpy and a bit odd? ”

Englewood Hospital and Medical Center (NJ) signs up for McKesson Horizon Clinicals and Horizon Enterprise Revenue Management.

I’m entering my second week or so of being ridiculously behind, so if you are expecting something from me, I’ll try to catch up over the weekend.

Arizona Regional Medical Center (AZ) chooses clinical and financial systems from HMS.

Mayo Clinic takes a minority position in Centerphase, a startup that will mine Mayo’s patient database to find patients who qualify for specific clinical drug trials.

eMids Technologies offers an “AGILE for ARRA” presentation at HIMSS that covers iterative product development. If you are involved in product development and delivery, you can sign up for the Tuesday morning breakfast at the “W” Hotel here.

This week’s e-mail from Kaiser Permanente CEO George Halvorson notes that of 16 organizations winning a Continuous Availability Award for computer uptime, Kaiser was the only healthcare winner. Two of its data centers that host clinical systems had 100% uptime for the full year, with overall availability of HealthConnect at over 99.9%.

Alert, the hospital information system vendor from Portugal that had fanboys swooning at HIMSS a few years ago and then promptly sank without a trace, signs its fourth hospital customer.  

Sentara CIO Bert Reese is interviewed on Cox Business TV, talking about EMRs and interoperability.

Please welcome Precyse Solutions, which has joined our merry band as a Platinum Sponsor of HIStalk. The Wayne, PA company offers a variety of HIM-related services: transcription, coding, consulting, outsourcing, oncology data management, audit, clinical documentation improvement, and its PrecyseAssist service to answer difficult coding and claims questions. You can download a variety of Webinars and presentations from their site for more information. Googling just to see what I’d said about them previously, I notice the company made my radar in mid-2008, when I said this: “I’d watch this company: HIM vendor Precyse Solutions puts Pam Arlotto and Carl Witonsky on its advisory board, giving them a lot of strategic horsepower.” Thanks to Precyse Solutions for their gracious support of HIStalk and those who read it.

A non-profit clinic run by an associate of a Louisiana Parish councilman overbilled West Jefferson Medical Center by $150,000 for its treatment of uninsured patients, an audit uncovers. Also discovered: the clinic had $100,000 in missing checks and undocumented purchases, spent $29,000 on parties, and gave $100,000 in interest-free loans to employees. The hospital has paid the clinic $4.2 million to keep patients out of its ED since 2004. The former clinic CEO says missing documentation for certain payments was caused by an accounting software virus.

We’re booming over at HIStalk Mobile, to the point that we could use some help. I’m interested in talking to a physician, resident, or med student who has good understanding of mobile health and would like to share their passion with our readers in some sort of paid arrangement. E-mail me. I also just remembered that I probably didn’t mention our latest HIStalk Mobile Founding Sponsor, Voalté, so thanks very much to the Men (and Women) in Pink for their support. 

College Park Family Care Center in Overland Park, KS wins a free radiology information system from Swearingen Software, chosen as the most deserving “hardship” radiology department.

Rich Helppie’s Santa Rosa Consulting announces (warning: PDF) its merger with CSA Consulting. Both companies are in Michigan.

Jobs: Information Services Manager (VA), Information Systems ERP Manager (WA), Clinical/EMR Project Manager (NC).

After-hours medical services come under fire in England after the recent death of a patient under the care of a sleep-deprived doctor brought over from Germany and put immediately to work with no rest. Computer problems are named as an issue since doctors can’t see each other’s records. The newspaper article cites a 2005 case in which a post-surgical patient spoke to six doctors by phone and saw two in person, only to die of undiagnosed septicemia.

The VA will freeze its $3.3 billion IT budget in FY11.

Canada reaches national consensus on using GS1 bar codes for drug products, led by the Institute for Safe Medication Practices and the Canadian Patient Safety Institute. The GS1 bar codes are smaller, hold more information, and can hold product-specific codes such as lot numbers and expiration dates that can be used to track products through the supply chain.

Meditech just released its annual report. Revenue was down 1%, the first drop in the five historical years listed. Product revenue dropped to $176 million from last year’s $186 million. Net income was way up at $81 million compared to a big investment-related drop in 2008, but still lagging compared to the past few years. Neil Pappalardo has 13.8 million shares worth $511 million at the internally set share price. I wouldn’t say the company is struggling, but the long string of growth numbers has clearly ended just as HIT spending increases. It will be interesting to see how well it competes for the small hospital business fueled by HITECH.

EnovateIT kicks off a dramatic expansion of its mobile and wall-mounted clinical workstation manufacturing facility, increasing its current space fivefold. The company also forecasts record 2010 sales and announced plans for further expansion later this year.

NHS Scotland will use TrakCare from InterSystems as its patient management system.

Informatics Corporation of America makes a white paper available called Health Care IT Investment Heightens Need For Effective Implementation.

A bizarre, only-in America lawsuit: Heart Attack Grill, a Arizona restaurant characterized as its attorney as “the originator of the medically-themed hamburger grill and restaurant” whose motto is “Taste Worth Dying For", files suit against Florida-based Heart Stoppers Sports Grill. The former has waitresses dressed as nurses serving Bypass Burgers and Jolt Cola, while the latter does the same for its Chili Chest Pain Fries. Another point requiring intellectual property interpretation: both restaurants offer free food to anybody weighing over 350 pounds.

E-mail me.

HERtalk by Inga

Picis and iSOFT form a strategic alliance that gives iSOFT the right to distribute, implement, and support selected Picis CareSuite solutions. iSOFT’s initial marketing focus will be on ICU and anesthesia in the UK, Ireland, Scandinavia, Australia, and New Zealand.

Design Clinicals’ MedsTracker medication reconciliation application is now fully integrated with Wellsoft’s Medication Verification & Exchange capabilities. CentraState Medical Center (NJ) was the first ED to employ the integrated solution.

Design Clinicals, by the way, gains an exclusive endorsement from the AHA for its MedsTracker program, having proved its ability to help health care organizations achieve organizational excellence.

I love the guys at Vitalize Consulting Solutions. Rather than spending thousands to throw a big party at HIMSS, the company has decided to donate funds to the Atlanta Community Food Bank. Of course I have nothing against big parties, but I like social consciousness as well. So, here is what VCS is doing. For every person who signs up to follow them on Twitter, joins their Facebook group, or leaves a comment on the “Help Us Help Atlanta” blog, they will donate $1 to the food bank. (do it now before you forget!) Or, you can pay them a visit at booth #5203 at HIMSS. Last year VCS had an equally cool program that allowed HIMSS attendees and VCS donate thousands of soup packets and money to the Chicago Food Bank.

Christiana Care Health System (DE) announces its go-live on CPOE at its Wilmington Hospital. The health system will soon  launch CPOE at its other facility, Christiana Hospital.

The US Patent and Trademark Office awards Medicity a patent for its agent-grid technology for health information exchange. The technology is the core of Medicity’s Novo Grid, which provides EHR integration and community-wide information exchange. We did a HIStech Report on Novo Innovations a couple of years ago,before it was purchased by Medicity. I remember at the time thinking that if it worked they way Robert Connely said it did, it was some hot technology. Guess the patent guys agreed.

The folks at EHR Scope blog did an awesome job summarizing our recent EHR executives series on the proposed meaningful use criteria. If you missed the series, the EHR Scope article succinctly outlines the bottom line opinion of each executive to each question. It’s interesting to see what vendors share similar philosophies on certain topics and who provided the more unique perspectives.

Edward Hospital in Naperville (IL) formally names Barbara Byrne, MD vice president of HIT. Byrne is former clinical director for CCHIT and was named a CCHIT commissioner just last month.

Would you pay $50 to text one question to one doctor? Truth On Call is hoping patients, or perhaps physicians in developing countries, will take advantage of the service. Patients text their questions on cell phones and the doctor texts back, receiving $10 for each question. The model sounds interesting, especially if you think about physicians in rural India needing a quick opinion from doctors in the US. But $50 per question per doctor? Seriously?

Here’s a more mainstream product that happens to be free. Text4Baby is a mHealth service designed for pregnant women and new moms through the baby’s first year. Expectant mothers can text “baby” to sign up for the service and receive three to four text messages a week that align with their due date. Federal CTO Aneesh Chopra is promoting its use to make sure moms-to-be and babies stay healthy. Voxiva created the system, mentioned by the company’s co-founder, chairman, and president Paul Meyer in our November interview.

I’m kind of glad that most of my plane rides are fairly boring. On the other hand, passengers on this flight had a bit more entertainment, when shortly after take-off, a man starts screaming, drops his pants, and attacks crew members. He later admits he overmedicated himself before take-off, downing a double dose of medical marijuana cookies.

E-mail Inga.

HIStalk Interviews Jim Giordano

Jim Giordano is president and CEO of CareTech Solutions.

What are the biggest problems hospital IT departments are having these days, and what are their greatest opportunities?

I think there are three areas that hospitals are challenged with from an IT perspective. The first is the complexity of the required systems that are now needed. The second is the return on investment focus. The third would be the timeframe for putting in this complex technology to meet the funding deadlines for the ARRA, the American Reinvestment and Recovery Act.

I think the opportunities for the hospitals’ provider networks are borne in these same challenges. They have the opportunity now to begin practicing medicine electronically, which would mean more patient data is available. There would be more patient data shared; it would reduce medical errors in that.

I also believe there’s an opportunity to show the ROI of these systems. I also believe one of the opportunities is for hospitals to take the meaningful use definition that exists and be able to put their plans together so that they can receive these payments that should start paying out in 2011.

What trends are you seeing in IT outsourcing?

We’re seeing a trend towards an interest in outsourcing discrete portions of what a CIO is responsible for in two areas — service desk and remote hosting. We’re seeing CIOs realize that no matter how bright and effective their staff is, they are in effect judged by how well the phone call goes when the user or clinician calls the service desk. The same with the implementation of these comprehensive EHRs and other high-availability systems, that the need for a service desk that operates 24/7 is essential for the user community, and frankly, for the CIO’s reputation.

On the remote hosting side, we’re seeing a lot of hospitals looking at the requirements for meaningful use. Looking at their data center and coming to the realization that it’s going to take a large capital investment to have their data center meet the needs for a comprehensive high-availability system, and they’re looking at other options for that. Moving some of those hosting opportunities to a firm that specializes in healthcare data center outsourcing.

To avoid the capital investment and to have their systems be part of a network that has all the redundancies and business continuity built into it, we’re seeing many CIOs now choosing that as an option.

How does the 24-hour help desk service benefit hospitals?

It provides consistency for the clinicians. Whether they’re working at the hospital at 3:00 in the afternoon or 3:00 in the morning, when they have an issue with the technology or with the application, they have a place to call to get their problems resolved.

The second thing is that it provides a better experience for the end user. They tend to be happier. They even tend to evaluate the CIO in a better perspective. It creates a better experience for the clinician. The 24-hour availability ensures that medicine can be practiced now, not only from a number of times, but from a number of different places. That they’re going to receive the consistent, excellent support that they need to do their jobs.

CareTech supports many Web sites. Are hospitals doing anything creative with them?

They are. It starts with the realization on the hospital’s side that the Web presence is a very important strategy for attracting patients and organizations. It seems that hospitals are understanding what the Secretary of Health and Human Services is saying — that 60% of the Internet traffic is healthcare-related.

What we’re seeing, especially in competitive environments, is that hospitals that understand that a Web strategy and a Web outreach in their community are essential to getting patients into their system. We’re seeing more budget and marketing moving towards a Web presence and some of the interactive Web strategies that are being applied to differentiate the hospital in their community.

What factors make a hospital ready for a successful CPOE implementation?

We approach CPOE assessment from a comprehensive point of view. It starts with the belief that if your processes aren’t well defined and very good, that automating that processes are going to get you an automated bad process. So we start with, first of all, a comprehensive look. We start the comprehensive look at the hospital’s processes. We will do interviews with the department heads, the applicable clinicians, and we’ll actually even survey a number of the end-users to find out where they are from a process standpoint.

We then prepare a gap analysis between what processes needs to be fixed, or we’ll suggest a process that needs to be fixed, and what the automation would look like given the system that they’ve selected. We go about working with the hospital teams to close those process gaps, and then put the technology in to ensure a successful CPOE implementation.

We’ve done this many times across the country, and we found that this upfront work is critical for a successful implementation. We’re also able to have our clients that are moving towards CPOE talk to our other clients that have been there and done that and it helps them smooth out the corners that they are struggling with right now. It helps for a better implementation once they understand all that’s involved in it.

What about the company’s recent “Best in KLAS” award for extensive IT outsourcing?

Well, first and foremost, we recognize that we won this award due to the dedication of the men and women of CareTech Solutions who really, truly, have embodied our motto. Our motto is “Whatever It Takes”, and we believe the results of the “Best in KLAS” designation is a result of the focus and the attention provided by all of our team members who are intensely focused on ensuring that our customer has the best IT experience.

We do a lot of things to ensure that our team members are informed in the direction that the company is heading. We do a lot to share the “Best in KLAS” experiences — or the “Whatever It Takes” experiences, as we call them — and ensure that they understand that in the service business it is critically important that the customer needs to be well taken care of.

What makes your company a good place to work?

The fact is we’ve made CareTech one of the best places to work. First, I would say that we’re in an exciting industry in an exciting time right now. For us, it starts with recruiting. We try to recruit the top people in our industry so that we’re assuring all of our team members that they’re working with well-educated, highly motivated people.

We think that creates a good environment for information technology professionals who really kind of enter into this industry wanting to do a good job. They realize at the end of the day that they’re serving patients and hospitals, and that is a noble mission for an IT professional. The people that are attracted to our industry, I think, and our profession are aware of that. We try to get the top 10% of those folks.

The other thing that we do is we try to provide a very competitive benefits package. Even though the economy right now is very difficult, we look to provide the best for our employees. We have been able to maintain a lot of our benefits and even increase some of those benefits; and make available training opportunities, educational opportunities, and retirement investment opportunities for our people.

Any other thoughts that you’d care to share about the company and industry?

I think this is a great time to be in this profession, in this industry. The public mandates in the American Recovery and Reinvestment Act have provided the funding for our industry to move forward. We’re seeing a mandate on the healthcare reform that has all roads leading to more technology to assist with the practice of medicine.

In fact, we like to say that line between the practice of medicine and technology is starting to blur. For information technology professionals that want to apply their trade in an industry that is helping move the healthcare agenda along, there’s no better time and no better opportunities right now for people in this business.

Spheris Files Bankruptcy, Plans CBay Asset Purchase

Clinical documentation and transcription vendor Spheris announced today that it has filed Chapter 11 bankruptcy in order to allow MedQuist and CBay, companies owned by CBaySystems Holdings LTD, to purchase its assets. Bids from other interested parties will be accepted, however. Spheris India is part of the transaction, but will not file bankruptcy.

Robert Butler, Chief Restructuring Officer of Spheris, stated, "Throughout the past year, Spheris has taken steps to strengthen its operations and customer service, and these initiatives are achieving solid results.  Spheris has also been engaged in constructive discussions with certain key constituents of the Company to identify ways to enhance financial flexibility for our operations.  We expect customers will continue to receive high-performing services through a company with a stronger capital structure."

Cracker predicted this action on December 9 on HIStalk:

From Cracker: “Re: Spheris. Warburg Pincus is looking to unload its albatross Spheris stake to CBay Systems, the largest medical transcription company in the US since their purchase of MedQuist in 2008. Spheris, second largest, recently ended a three-year run as a quasi-public company — public debt, not public stock. Uncompetitive technology and a heavy debt load handicap Spheris as medical transcription prices fall.”

We reported on December 17:

Daniel J. Kohl resigns as CEO of the struggling Spheris, a medical transcription service company. The company reported a 15% drop in revenue the first half of the year and ended its registration with the SEC in November. Likely adding fuel to the fire was the company’s poor showing in last week’s KLAS report on medical transcription service vendors. Amid customer complaints that Spheris was unable to resolve quality and technology issues, the company was ranked last in a field of 15.

IBM to Acquire Initiate Systems

IBM announced this morning that it will acquire Initiate Systems, a privately held identity management and data management tools vendor with a significant healthcare presence as well as products for government agencies.

"With the addition of Initiate’s software and its industry expertise, IBM will offer clients a comprehensive solution for delivering the information they need to improve the well-being of patients at a lower cost," said Arvind Krishna, general manager, Information Management, IBM. "Similarly, our government clients will now have even more capabilities for gathering and making use of information to serve citizens in a timely and efficient manner."  

Some of Initiate’s hospital customers include Ochsner Health System, UPMC, and Sutter Health. Initiate acquired interoperability technology vendor Accenx Technologies on October 30.

IBM competitor Informatica announced last week that it will acquire data integration systems vendor Siperian, leading to speculation that IBM would quickly follow with its Initiate move. The CEO of another data management competitor, Kalido, said this morning: “"By acquiring a niche vendor like Initiate, they bolster their portfolio of industry-specific tools that help integrate data, but do little to provide a stronger information management platform for their customers. This acquisition will be delivered like so many others; with dozens of IBM global services consultants to ‘knit’ the patchwork of tools together."

News 2/3/10

From Dweeb: “Re: Initiate Systems. For the past several years I’ve seen IBM and Initiate in partnerships deploying Initiate’s EMPI alongside IBM offerings. Recently, I’ve heard IBM plans to buy Initiate. Is this an old rumor or is there really something new around this?” Seeking Alpha says they’ve heard it’s happening, possibly as early as this week, and that IBM will pay big. In other words, it’s still a rumor so far.

From Claire Voyante’: “Re: QuadraMed QCPR. Hear they laid off about 19 of 40 in sales and are on support mode only. Are they committed to meeting all EHR requirements for clients to meet Meaningful Use? You should interview NYHH or LA County.” QuadraMed doesn’t comment on rumors, but I’ve heard this one from some pretty solid sources, all of which are saying the same thing. Sad if true, but companies have to make tough decisions based on what the market is telling them.

From Woody: “Re: Meaningful Use. It reflects physician-centric, not patient-centric thinking. They miss the point that after orders are entered, as good as they may be, someone has to actually carry them out appropriately, making constant assessments, interventions, and documenting outcomes. The largest provider group and largest base of EHR users – by far – has been left in the dust because of professional dysfunction and the fact they don’t get paid for services. RWJ ranks them last in the group of influencers.” I also dislike the insinuation that the lame, overused term “EHR” is now a catch-word for what I refuse to call anything except “clinical systems”. “Electronic health record” sounds more like a view-only portal than the far more complex systems that create all that information in the first place. And if you have CPOE but no documentation systems, do you still have an EHR?

From Sunshine: “Re: Tampa General Hospital. They have chosen Epic.” Unverified, but hardly shocking if true since nearly every purchase by hospitals I’ve heard of end up being Epic these days.

From Lisa Ramsey: “Re: McKesson Paragon. Didn’t they build it from scratch?” Sort of. HBOC rolled it out in 1996 as its “little system”, as client-server was considered in those mainframe/midrange days. McKesson nearly killed it off when it (like many HBOC offerings) turned out to be pretty crappy and rolled out too quickly. Instead of just marketing with even more gusto (cough ** Pathways ** cough), they actually fixed it and it turned out to be maybe their best product.

From The PACS Designer: “Re: The Doctor Dalai Show. All of of the hype around the announcement of the Apple iPad has even gotten Doctor Dalai to post a cute video piece about the iPad’s potential in Radiology, and also hurl a slam at the Good Enough team.”

This isn’t a car ad, it’s McKesson’s new physician EMR incentive: 0% interest for 12 months with 25% down or a $1,000 cash rebate for the first provider and $500 for each additional. It’s good for Practice Partner, Lytec MD, Medisoft, and the Pontiac Torrent. I could be wrong about that last one. Everybody rides!

The HIStalk reception sold out Sunday night. Thanks to those who signed up.

Thanks to long-time HIStalk sponsor Hayes Management Consulting, which has upgraded its Gold sponsorship to Platinum. The company is ranked Top Overall Professional Services Firm and Best in KLAS for Technical Services in KLAS Enterprise’s 2009 Top 20 Best in KLAS: Software & Professional Services report. I appreciate their long record of supporting HIStalk.

Michael Lee, MD, director of clinical informatics at Atrius Health, will speak at the Nuance CIO breakfast at HIMSS on Tuesday morning, March 2. His topic is a documentation strategy using eScription background speech recognition and Dragon Medical front-end speech recognition. CIOs can RSVP here. Nuance will also have people on hand to talk about a recent Fallon Clinic study showing $7,000 per year savings and a increase in quality, productivity, and satisfaction from using speech recognition instead of typing.

I mentioned it briefly, but I’m going to talk about Dragon Naturally Speaking one more time because a reader picked up my last mention, bought it, and thanked Inga effusively for turning him on to it. I’m usually indifferent to technology that I’ve bought, rarely putting anything in that elusive “change your life” category. DNS has made that list. I bought it on a lark ($59 with free shipping), never read any instructions, and figured I would just play around with it. I have used it nearly constantly every day since to write HIStalk and send e-mails. There’s no need to get into a lot of details, so here’s the conclusion: even with the occasional correction (and there aren’t many), I can still put out text probably twice as fast with no tired fingers – I just say what I’m thinking and out it comes on the screen without my sloppy typing getting between my brain and my screen. It reminds me of that old Twilight Zone episode I watched the other night where the first Darrin from Bewitched played a guy who got hit by a car and could suddenly hear everybody’s thoughts. Rarely does a cynic like me give an unqualified recommendation, but this is one. I’m thinking of buying a second copy since I don’t want to have to write from the laptop at HIMSS without it. I’m not mentioning it again since it gives me a competitive edge, so that is all.

It was Merger Monday this week, apparently. I’ve never seen three HIT-related acquisitions announced almost simultaneously. I saw a few readers cancelled their e-mail subscriptions because of the rapid-fire updates I sent, but I had to consider the potentially significant number of employees and customers affected who deserved the chance to know about it quickly. It’s not that hard to delete an e-mail without reading it. There’s another acquisition coming Thursday, so indulge me one more time. And if you’re having regrets (which you will when I get something hot that DOES interest you), just put your e-mail in the Subscribe to Updates box to your right and we will be BFFs again.

National eHealth Collaborative announces (warning: PDF) nine new board members, among them Brent James, John Tooker, Jon Perlin, and John Glaser (there are five more, but these are the names I recognized).

Justen Deal has an interesting take on the Apple iPad, saying people are overlooking its potential as a replacement for thin clients and computers on wheels.

A UK article profiles Christofer Toumazou, the guy whose company is developing a “wireless digital plaster” that can monitor patients at home, feeding a constant stream of information about body temperature, heart rate, and respiration to a base station or EMR. The first rollout will be in a hospital. Cardinal Health is involved.

I’m short on time tonight, so that’s it for me. E-mail me.

HERtalk by Inga

From DrLyle “Re: Top 50 HIT blogs. You made it!” Thanks, DrLyle, for pointing us somebody’s list of top HIT blog sites (usually just a scheme to get themselves back links from the grateful winners, but a win’s a win). I see DrLyle also made the Top 50.

PBnJ asked Mr. H what HIT publications he/she should subscribe. Mr. H said he hardly reads anything. On the other hand, I skim a ton of publications (all free) on a daily basis. I wouldn’t necessarily recommend that unless you plan to take my job (which, as far as I know, is not currently open.) There exists a wide variety of “HIT” publications out there, each targeting a slightly different audience (clinicians, IT types, the hospital space, ambulatory care, medical devices, vendor news, CIOs, CMIOs, etc.) I suggest you figure which niche interests you the most and start there. Of course you’ll want to round out your reading by making time for HIStalk, HIStalk Practice, and HIStalk Mobile.

Appalachian Regional Healthcare System (NC) completes a deployment of Lawson QuickStep Healthcare in under six months.

The 34-bed Hamilton Healthcare System (TX) selects Healthcare Management Systems’ clinical and financial automation solutions.

MEDSEEK reports its 2009 highlights: 58 new hospital clients, a 53% increase in one-year revenue backlog, a #1473 ranking on Inc. Magazine’s fastest growing private companies, and a third year on HCI’s 100 list. Over the last five years, MEDSEEK’s revenue has jumped 346%.

Microsoft and Siemens are hoping that HealthVault will be more popular in Germany than it’s been in the US. Siemens signed on to be the exclusive operation of HealthVault in Germany and will market the platform to developers, application providers, and device manufacturers.

More than 300,000 people have downloaded uHear onto their iPhone/iPod Touch, making it the most widely distributed hearing screening test ever. It’s free and available in French and English.

The Social Security Administration hands out $17.4 million in in ARRA funds to 15 HIEs, providers, and health IT firms. The new contracts will enhance networks and reduce the time to adjudicate disability claims.

National Health Services (CA), a 12-site FQHC, achieves 100% provider adoption on HealthPort’s EMR.

Streamline Health Solutions announces the general availability of its new accessANYware 5.0 document workflow solution. Version 5.0 is a ground-up re-architecture of Streamline’s flagship document workflow product and is built on a service-oriented architecture using Microsoft.NET framework.

Bruce Brandes joins AirStrip Technologies as chief sales officer. Brandes most recently served as VP of sales and field operations for HealthStream. He’s also served in similar capacities at Eclipsys, McKesson/HBOC, and IBM.

Sisters of St. Francis Healthcare Services goes live on ZynxOrder. The health system has consolidated and standardized 42 evidence-based order sets for use at its 13 hospitals and health systems.

A few sponsor updates:

• Mountain View Hospital (ID) expands its use of SRS EMR.
• e-MDs announces its Solution Series Chart product completed the 2010 Integrating Healthcare Enterprise Connectathon, which tested 138 HIT systems by 90 HIT vendors. e-MDs is also participating in the IHE Interoperability Showcase at HIMSS (Booth # 7955).
• Microsoft finalizes its acquisition of Sentillion into the Microsoft Health Solutions Group.
• The ED at Clara Maass Medical Center (NJ) upgrades to the latest version of EDIMS’ EHR, v2.6. The new version includes enhancements to drug interactions, an eDocuments scanning solution, an upgrade to charge capture determination, and a new iPhone integration feature.
• Picis launches a new corporate blog called Healthcare-exchange.com. The first post includes five predictions for 2010 by CEO (and HISsie nominee in a “good” category) Todd Cozzens. The first prediction: healthcare reform is dead. Future posts will focus on topical issues such as meaningful use and the new iPad and include commentary from industry experts.

StatCom appoints Mary Kay Thalken RN, MBA, as enterprise vice president. She’s the former COO and chief nurse executive of Bergen Mercy Medical Center.

Suddenly it is February and I am leaving for HIMSS is less than four weeks! How did that happen? Mr. H and I have been working on assorted HIMSS-related projects, like the HISsie Awards, sponsor recognition, and details of the HIStalk Bash. The last couple of years readers (female ones, of course) have sent me notes asking for advice on attire for the HIStalk party. Previously we’ve had everything from sexy cocktail (Mr. H’s preference) to the straight-off-the-convention-floor look (not a bad choice if you want everyone to know what vendor you work for or if you hate displaying your individualism.) I haven’t made a wardrobe selection yet (I am thinking this might be a good excuse to go shopping) but I can promise the shoes will be high and hot.

Here is something I likely won’t be doing during HIMSS: the 5K Fun Run/1 Mile Walk. Scheduled for Tuesday March 2 at 4:00, IntraNexus is sponsoring it for the fifth straight year. By Tuesday afternoon, I know I will be too weary to do anything but sip a glass of wine and write some posts for HIStalk. However, non-couch potatoes can sign up during HIMSS at IntraNexus’ booth #5221 (Hall B.) While you’re at their booth, you might want to check out the IntraNexus’s new solutions for the iPhone and touch screens.

I’m sorry I missed this event: In honor of American Heart Month, the California Association for Health, Physical Education, Recreation and Dance (CAHPERD) and Jamba Juice break the Guinness World Record for the “Most People Jumping/Skipping Rope at the Same Time.” That’s 89,000 people jumping simultaneously for 10 minutes. Quite a party.

E-mail Inga.

CIO Unplugged – 2/1/10

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

Leadership Equations
By Ed Marx

It was the department chairman, emergency medicine, University Hospitals Case Medical Center. “Ed, this is Dr.Michelson, do you know what is going on in our emergency department right now? He was so upset that I thought I was on speaker phone. I could tell he was calling from our pediatric level1trauma center. I politely ended the call. As a new CIO, I did not want to have impersonal relationships. I wanted to talk face to face.

There he was directing traffic and evaluating patients. One of the IT applications had failed which was wreaking havoc on their process flows. While there I noticed that we could alleviate some of the cramped conditions by updating their technology. While it took a couple of hours to restore the application, the next day we gave back additional space to the ED. Simple things like replacing monitors, PCs and printers.

I received a call the next day from the Chief Medical Officer. “Ed, I heard what happened yesterday. Nice work. That is the first time a CIO ever did something like this. Left the comfort of the ivory tower and walked the walk”. Soon the story went viral and the benefits to an eye to eye approach become clear. I would coin the term i2i and encouraged its adoption by all in my IT division. I started to live it. I stopped handling serious matters by email or phone. I did presentations of i2i for other departments. I was maturing as a leader.

I also began to use i2i for crucial conversations. I began to confront others i2i. We had a physician executive who routinely abused anyone who he believed stood in his way. Because he produced results, his behavior was tolerated. After exhausting escalations with chain of command and human resources, I took matters into my own hands. Over coffee, I mustered my courage and laid it out in no uncertain terms to this senior officer. He tried to look away but we connected i2i. He hid behind his coffee cup but my message landed. That was the last time he abused my staff.

I received a call from the medical director of one of our newborn intensive care units (NICU). This NICU is consistently ranked in the top 5 across the nation. After several attempts to get resolution on some technical matters, she and her administrative staff had become rightly exacerbated with IT. They had 20 mobile carts for their NICU and only 2 were operational. She stated that their nurses and physicians would literally stand in line to update charts and enter orders taking care of the sickest of the sick. I myself was growing angry listening. I had seen this escalate over the last couple of days and was certain IT had provided resolution. I told the medical director I would be right over. I called the Service Desk as I walked over to have the manager and 3 technicians meet me at the unit. I could not believe what I saw. All these beautiful tiny babies and sure enough, nurses and physicians waiting around to use the limited carts. The sides of the halls were littered with unusable carts as if a tornado had passed through. I became indigent. I approached the medical director and you could see the tears in her eyes because she was so upset. The only thing I knew what to do was to embrace her and we both cried. Frustration, anger, compassion. There was release. Someone cared. Now time to execute. I learned it was key to meet emotion for emotion, or e4e.

My staff arrived and I had them go to the other floors and see if we could borrow carts from other units. In 30 minutes we had 10 working carts. Others were replaced or repaired within 48 hours. I returned to our IT offices and my director and VP of operations were still talking about what to do. I replaced them.

i2i and e4e are part of my nature today. While there is no formula to leadership, these equations provide a reminder that at the end of the day, nothing demonstrates care and commitment like looking someone in the eye, and weeping with those that weep and laughing with those that laugh.

Technology is the easy stuff. You are not a leader because you know technology.

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.”

Readers Write 2/1/10

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!

Virtual Medical Devices and Vendor Liabilities
By Scot M. Silverstein, MD

I found the Jan. 20, 2010 news release on Sen. Grassley’s latest health IT industry inquiry, Sen. Grassley asks hospitals about experiences with federal health information technology program, quite interesting. Based upon direct experience in hospital IT and in Big Pharma, I believe the inquiry justified and potentially beneficial to ensure proper accountability for taxpayer money and for patient safety.

One statement in particular caught my attention. In question #9: the Senator’s letter of inquiry states “… for example, one vendor stated that it is accountable for the performance of its [clinical information technology] product as long as the client uses the product appropriately. Another vendor stated that it is not liable when harm or loss results from the client’s use of the product in diagnosing and/or treating patients.”

Denial of inclusion of explicit "hold harmless" provisions on the one hand, and statements about being "accountable for the performance of its HIT product as long as the client uses the product appropriately" and "not [being] liable when harm or loss results from the client’s use of the product in diagnosing and/or treating patients" on the other hand, are at odds.

An EMR and other clinical IT systems are virtual medical devices, that is, medical devices that happen to reside on a computer.

The first part of the quoted statement above dismisses virtual medical devices that don’t “use the client” properly, for example, through presenting a mission-hostile user experience. Human computer interaction is a science, and its quality has major effects on results. For example, the Air Force — for obvious reasons — has been concerned with HCI and long ago, even before the GUI, wrote a treatise on its importance in mission critical settings (“GUIDELINES FOR DESIGNING USER INTERFACE SOFTWARE”, August 1986, http://hcibib.org/sam/).

Some vendors have opined that they are not liable when their products are used outside their intended purpose. I am not sure how an EMR can be used for anything else other than the "intended purpose" — that is, providing information and providing some type of actionable advice or recommendation based on the information (for example, decision support). On the one hand, if non-validated changes are made by the customer that cause malfunction, a vendor is clearly not liable. On the other hand, if inherent design problems (such as in the display of information) confuse or misinform the user, these vendors seem to be excusing themselves from liability on the grounds that the user was “using the product inappropriately.”

This position will not sit well with clinicians.

On the second issue about use in diagnosing and/or treating patients, vendors may feel they are “not in the business” of diagnosing and treating patients, therefore they are not liable when their products are used for such purposes.

They may have been correct two decades ago, but are in error today. Yes, HIT vendors are in the business of diagnosing and treating patients; in fact they are in the business of practicing medicine — via machine proxy.

HIT vendors are in the business of practicing medicine in the same way my medical supervisors (when I was a trainee) or medical consultants (when I practiced) were in that business when I presented a case to them and they made an assessment and treatment recommendations on what I should do.

When errors in presentation of information or errors in advice-giving occur, a "learned intermediary" defense does not absolve the consultant unless the error is so gross as to be implausible (e.g., a male with toxemia of pregnancy, or a serum creatinine rising from 1.0 to 10.0 in 24 hours). A physician should not be expected, on the other hand, to be able to with 100% reliability detect when a computer — or consultant — is lying when they provide a falsely low INR blood-thinning value or false diagnoses of another patient.

To emphasize these points further, a small thought experiment is in order:

1. If I set up a shop where I was allowing patients to bring me records and I simply looked at the records and dispensed advice on what evaluations or treatments I thought they needed, or what was wrong with their current regimen, but did not go further than that (just being a consultant), would I be practicing medicine? (The answer is yes; I actually held this role in the performance of independent medical evaluations and required both licensure and malpractice insurance in my state to perform this function.)

2. If I were to stand in the corner of the clinic where the computer terminal is, and take its place, i.e., offering data and advice on evaluation and treatment (perhaps Maelzel’s Chess Player-style) in place of the machine, would I be practicing medicine? (The answer is yes.)

3. If the advice I offer is based simply on the advice of another, or on following to the letter the rules and algorithms provided by an HIT vendor’s code, becoming a human computer, so to speak — am I not an intermediary to the other person’s, or the HIT company’s collective practice of medicine? (The answer is yes.)

I believe today’s HIT products involve the practice of medicine by machine proxy.

Two additional points:

I’m reasonably certain the vendor(s) who claim "not being liable [for the performance of their product] when harm or loss results from the client’s use of the product in diagnosing and/or treating patients" also make claims in their P.R. or in executive speeches about how their products will transform/revolutionize medicine.

Claims of transforming or revolutionizing medicine via their products are irreconcilable to any reasonable person with their stated claim of non-liability for use of the products in diagnosing or treating patients. Unless, that is, these systems are intended only for playing games:

Furthermore — and this is perhaps the more important point — hospital executives have both a fiduciary responsibility to patients and practitioners, as well as Joint Commission safety standard obligations.

Would the executives be performing these duties in good faith if, for example, they sign a contract for a CT scanner or surgical equipment where the vendor disclaims liability when these tools are used in diagnosing and/or treating patients? I believe the very act of signing such contracts is a breach of healthcare executive responsibilities and obligations, at the very least by shifting an undue legal burden onto their own clinical staff and contractors, as well as potentially putting patients at risk with tools that vendors are not as highly motivated as they should be to make robust.

Imagine a pharmaceutical company saying "we are not liable for the performance of our products when used in the treatment of patients." Would you use their products?

Health IT should be no different, as I pointed out in my JAMA letter to the editor of July 22 2009 at http://jama.ama-assn.org/cgi/content/extract/302/4/382.

Finally, it seems a vendor claiming they are not liable when harm or loss results from the client’s use of the product in diagnosing and/or treating patients should put that disclaimer on every screen of their products. Do I hear volunteers?

Ultimately, I believe vendors would best serve themselves, their customers, their shareholders, and patients via considering and understanding these points. If a HIT vendor claims to be a partner to clinicians and clinical medicine, they should be willing to accept the responsibilities that accompany such a position.

Scot M. Silverstein, MD is with Drexel University, College of Information Science and Technology.

TPD’s Review of the Samsung N310 Netbook
By The PACS Designer

The Windows 7 Starter Edition software is the key operating system being employed for netbooks. Windows 7 Starter has all of the features of the Windows 7 system except the Aero user interface. The Aero feature primarily offers window transparency so that you can see below your current window similar to looking through a glass pane. Windows 7

Originally I was going to evaluate a Dell Windows 7 Wi-Fi Netbook, but due to some problems with their online ordering system, I decided to obtain a Samsung N310 Netbook from service provider AT&T for $199 after a mail-in rebate.

The Samsung N310 has a 10.1" WSVGA screen, 1GB of memory, and a 160GB hard drive. In its small form factor, it only weighs slightly over three pounds.

Other features of this netbook are an integrated webcam, a Samsung Recovery Solution that restores your system without a CD or DVD, and a method to download applications using Intel’s AppUp Center online service.

One other feature of the Samsung N310 is it offers a 60-day trial version of Microsoft Office Online.

I tested the download speed for Firefox, Chrome, and Internet Explorer. The following response times when downloading HIStalk were: Firefox – 12 seconds, Chrome – 18 seconds, Internet Explorer – 28 seconds. So using Firefox for your internet browser is the best choice for netbooks.

Using the N310 as a highly portable netbook makes it ideal for anyone who travels frequently and needs virtually continuous access to a network connection. However, the smaller screen form factor of 10.1" makes screen navigation more difficult thus you’ll find you are using Control + or Control – keys more often to see content better.

The AT&T network is the standard 3G cell phone system, and access is available anywhere there is cell phone connection towers. The AT&T 3G Network is a bit slower than a DSL solution, but not slow enough to deter its use by everyone.

If there is no cell phone service available, you can still access a Wi-Fi hot spot where your system indicates the possible connection opportunity.

The Windows 7 user interface is simple and easy to use as Microsoft has worked on this new software extensively to improve it over the previous Vista system.

As far as using this netbook daily, it still emulates the larger laptops because of its sizeable keyboard which can accommodate just about any size hand that would use the netbook.

Also, even with its reduced size touchpad, it still provides adequate space for all hand movements.

When it comes to healthcare, it appears to be a useable solution provided that network connectivity inside buildings is not sporadic or restricted.

Overall, the experience to date has been satisfactory, and I would highly recommend a netbook with Windows 7 Starter to anyone looking for a smaller system that is easily portable and uses a cell phone network provider for Internet access. I’m predicting that the Windows 7 netbook with its Intel Atom processor will be the hot product in the 2010 PC space! Windows 7 Popularity

Physician Reluctance to Share Data
By Joe A.

One issue that I do not believe has had enough exposure is what may be underlying the reticence of MDs sharing data. It is the 800-pound gorilla in the room that seems to be hiding behind the sheets – specifically,
malpractice reform.

There appear to be no protections for physicians that "share" data from those fishing for torts — open season for lawyers hunting for malpractice once the data is shared and available.

We are all too familiar with punitive lawsuits, from Mickey D’s coffee to asbestos to tobacco to plastic toys. Putting your clinical data in view seems to me will invite second guessing and lead inevitably to legal actions. If Obama wants HIEs to flourish, he must first work for malpractice reform — something that this current Democrat Congress has zero interest in pursuing, but which is a necessary predecessor to HIEs.

HMS Acquires MEDHOST

HealthTech Holdings, Inc., the parent company of community HIS vendor Healthcare Management Systems (HMS) based in Nashville, TN, announced this morning that it has acquired emergency department information system vendor MEDHOST of Addison, TX. HMS plans to develop an integrated EDIS for its hospital systems customers.

“This is a win-win transaction,” said Tom Stephenson, CEO of HMS. “We will work together to gain the benefits of collaboration and capitalize on each other’s strengths, bringing to market a truly customized and integrated product for our target market. HMS customers will benefit from the proven gains in productivity and safety brought on by automating emergency department visits. Moreover, MEDHOST’s automatic Charge Capture prevents lost charges and provides enhanced financial performance by calculating charges as care is documented. The system’s real-time notifications help keep ED clinicians and staff better informed about each patient’s status thereby improving quality of care.”

Concerro Acquires RES-Q

Shift bidding software vendor Concerro announced this morning that it has acquired RES-Q Healthcare Systems, vendor of the 2009 Best in KLAS staff/nurse scheduling system. The RES-Q software includes applications for personnel management, enterprise-wide employee scheduling and staffing, open shift, surgery department management and case scheduling, patient acuity classification, and productivity management and reporting.

“RES-Q’s award winning labor management and scheduling applications are the only solutions that align completely with Concerro’s strategy to help healthcare organizations control labor costs through optimization rather than reduction,” said Graham Barnes, CEO of Concerro. “This acquisition reinforces Concerro’s commitment to delivering the most cost-effective and innovative solutions for hospitals. Unlike other legacy software, our management systems improve both quality of life and the bottom line across an installed base of more than 500 hospital facilities.”

Haemonetics To Acquire Global Med Technologies

Blood management solutions vendor Haemonetics announced this morning that it will acquire Global Med Technologies for $60 million in an all-cash tender offer.

Brian Concannon, president and CEO of Haemonetics, said, "Efficient blood management is now being recognized as a critical component of improving clinical care while reducing cost, and Haemonetics is the only company positioned to address the needs of both the blood collection and transfusion markets.  Software is a key enabler for blood management, enhancing productivity, regulatory compliance and quality.  Global Med’s software offerings are a strategic complement to our existing products and will allow us to offer customers an end-to-end software solution for blood management, from donor recruitment to the patient transfusion."

Global Med’s companies include Wyndgate Technologies (donor center and transfusion systems), eDonor (donor relationship management), Hemo-Net (application service provider), PeopleMed (software validation services) and Inlog (donor, transfusion, and LIS technologies for European customers).

Monday Morning Update 2/1/10

From You’ll Know Who: “Re: Horizon Enterprise Revenue Management. Some observations from MCK’s January 26 conference call. It was said that HERM was designed ‘with an architecture similar to our clinical systems,’ which means it isn’t the same and not likely to be very integrated. Still scratching my head on the HERM amortization costs. Software revenue had to be deferred for ANY contract that mentioned HERM before it became GA. Now that it’s GA (supposedly), why is profit still declining and why did it trigger so much incremental amortization? McKesson tried to develop HERM quick and cheap in India, and when it didn’t work, executives were fired and the rumor now is that development is moving to Mexico. What happened to the original pilots, Gwinnett in Atlanta and Peninsula in Maryland?” All unverified. I still haven’t heard back from the Baptist CIO. I’ll say this: revenue cycle has been the Vietnam War of some big vendor superpowers. I was also thinking – is this the first product McKesson has actually built from scratch rather than bolted on from an acquisition? Maybe not, but I just can’t think of others.

From Lady IT: “Re: Sisters of Saint Francis. The rumor is true. I work for the vendor who is being displaced.” Hoosier is working there and agrees, saying Epic was chosen over McKesson.

From Bobby Orr: “Re: Rutland. They actually went Cerner for the EMR, not GE. Also, the vendor relationship movie was excellent. I think I’ve met some of those people in real life.” I thought that parody of bargain-seeking customers was funny, with excellent acting. Like my hero from the video says, we can do this!

From PeaPicker: “Re: CCHIT. Their committees haven’t met in a month and have done nearly nothing since early fall. CCHIT is completely focused on ARRA and has no interest in anything else.” Like the rest of the industry, unfortunately.

From Arnell: “Re: Riyadh Military Hospital. Is this a loss for QuadraMed? Saudi Arabian National Guard went live with then-Misys CPR in Fall 2004. Those implementations were also military hospitals. As a side note, it is interesting that when issues were created for that project, severity levels were determined by whether there was a member of the Royal Family involved as a patient or user.” Not much different than the small community hospitals I’ve worked in, where the entire facility went on red alert when a relative (even a distant one) of the hospital administrators or key doctors showed up. I’m not making this up: at one small hospital that was owned by a national for-profit chain, we management team members were convened in emergency session because the mother of our obnoxious eye surgeon had been admitted. Apparently the care those administrators oversaw for everybody else wasn’t good enough for people with connections. I wouldn’t exercise that privilege, though: I think you increase your chance for medical misadventure by breaking out of the routine.

From PBnJ: “Re: industry newbie. Which HIT publications should I subscribe to to learn, preferably free or low-cost ones?” You’re asking the wrong guy since I don’t read a single one of them, either hard copy or online, except for Inside Healthcare Computing. Try this test: go to the online site or current issue of any of them. Ask yourself, “Which stories gave me timely information that I can truly use in an informed manner?” Read the bios of the people involved – have they ever worked in healthcare? How quickly did the publication report on real news? Is the reporting balanced, or just typical fluff? If articles covered hospitals or people you know, were they accurately portrayed?

In honor of my intentionally politically incorrect logo, a reader sent links to smoking doctor posters from the 40s. I think I’ve run a couple of them before (Link 1, Link 2, Link 3). The guy above must be really good if the comparative size of his reflector is any indication. Using doctors to pitch cigarettes reminds me of the early days of the White Castle hamburger chain, which fed doctors and nurses workers free if they showed up in uniform, which inspired confidence in their product (kind of like the HIMSS conference). In those minimally regulated days before In-N-Out and Five Guys, people were wary of eating hamburgers in restaurants, probably for good reason. 

I ran across Audit Integrity, a free online tool that claims to be able to identify shareholder risk measured by “corporate integrity”, mostly related to accounting practices. The higher its AGR number (up to 99 since it’s a percentile), the better. I checked a few healthcare-related ones: Cerner (42), McKesson (5), Eclipsys (7), Quality Systems (54), athenahealth (99), Dell (2), and GE (1). I’m sure there is disagreement as to its criteria and usefulness, especially among the low-numbered companies.

Wales NHS will introduce a new clinical portal that allow clinicians to view patient data and perform limited order entry. It will eventually allow clinicians to see a patient’s health record that includes information from physician practices once they work out information governance issues. The guy in charge makes subtle fun of NPfIT and it’s big bang, big bucks strategy. Wales kept it simple and its price tag was under $5 million. The portal has an interesting privacy approach: patients have to give their consent every time someone tries to look at their record.

CPSI’s Q4 numbers: revenue up 5.3%, EPS $0.33 vs. $0.44. The company blames hospital uncertainty about meaningful use, among other factors, as the reason it missed estimates. CEO Boyd Douglas from the conference call: “I think there’s obviously there’s hesitation on the part of new system sales. Some of that is coming from waiting on again while we have got the interim final rule, we still don’t have the final rule. And I think frankly, there’s some degree of skepticism out there amongst some of these hospitals about whether the money is really available, whether they really think they can meet meaningful use, things like that. And I think that will certainly turn once you start seeing some money flow. But hopefully, it will turn sooner than that.”

Quarterly results for Quality Systems/NextGen: revenue up 14%, EPS $0.46 vs. $0.46. Investors didn’t like the absence of an ARRA-fueled jump, punishing the stock as shares dropped from over $60 to close Friday at $51.54.

Albert Einstein Healthcare gets a mention in the local business journal for its $100 million EMR project. It’s happy about the prospect of ARRA payments, but concerned that only 50 of its 350 owned physicians will be eligible for stimulus money. They say that doesn’t make sense because they use different tools in their practices than they do in the hospital. A Pennsylvania Medical Society spokesperson also expressed concerns about the 80% CPOE requirement for practices, saying that as an example, radiology centers are not covered by the rules and therefore have little incentive to receive electronic orders.

McKesson announces GA of Horizon Practice Plus 12.0.

Expensive politically correct action at Regional Medical Center (SC) results from its well-intentioned celebration of IT accomplishments, at which an employee in a gorilla suit handed out bananas at the “We’re Bananas For You” event. They always introduce their main speaker at those events with the sounds of “Hail to the Chief,” the timing of which offended someone whose outrage trigger meter must be set at 11. That’s good for an out-of-town diversity consultant, who gets a $78,000 contract to deliver a 2.5 hour mandatory employee in-service. Their Cerner implementation that was cause for celebration is going fairly well after some initial bumps.

The $28 million Epic implementation of Altru Health (ND) gets a mention in the local paper. A selling point: patients will get a single monthly bill that covers both clinic and hospital charges.

Omnicell’s Q4 results: revenue down 11.9%, EPS $0.02 vs. $0.10. They’ve had some big Pyxis replacement wins, but those haven’t helped the bottom line so far.

Patrick Soon-Shiong, the drug billionaire with a big interest in interoperability, announces the spinoff of Abraxis Health from Abraxis BioScience. The new company will deal in personalized healthcare and molecular profiling. According to the press release, “Abraxis Health plans to develop a proprietary model for the delivery of healthcare, requiring a unique global computer software and hardware infrastructure that integrates patient data management, bioinformatics, discovery, molecular medicine and clinical development. Abraxis Health currently is designing and acquiring the necessary infrastructure and plans to acquire and internally develop the hardware and software modules to organize and integrate the data streams that form the foundation of this interactive database.” I’ve heard rumors that his foundation provided financial support to CAeHC, which recently benefitted from the unseating of CalRHIO as California’s statewide interoperability organization. Whatever group controls that project will be the conduit for billions of federal stimulus dollars in addition to sitting on a potentially lucrative database of patient information.

Iatric Systems brings in Aprima as its PM/EMR partner for physician practices connecting to Meditech. Aprima, as I have to remind myself every time I read the name, is the former iMedica. I interviewed CEO Michael Nissenbaum in the summer of 2008. He’s a straight shooter, even when I asked him some very direct questions (some of the best I’ve come up with on the fly, if I may humbly and impartially suggest).

News from President Obama: stung by low approval numbers and voter backlash, healthcare is apparently no longer his administration’s showcase issue (since he didn’t mention it in his weekly address), replaced now by a new windmill at which to joust: reducing the crushing deficit that, according to him, is not his administration’s fault. I’m still anxious to be proved wrong about my Jimmy Carter reference from Inauguration Day.

A cardiologist is sentenced to four years in prison for underreporting taxes he owed on the estimated $40 million he made from day-trading in the late 1990s. He also has to cough up $16 million in back taxes, which must be extra painful since his portfolio went down in flames in 2000 along with the dot-bomb companies in which he was investing.

Billboards sprout up in South Florida as hospitals put up real-time ED wait times along busy highways, elbowing each other for market share of business that they always claim is a money-loser. Fast food restaurants and other businesses that rely on fast service don’t do this, of course, since McDonald’s would be out of business if they couldn’t promise fast service except when the sign says.

Inga did a really good interview with hand surgeon Neil Zimmerman, MD on HIStalk Practice:

But I’m very, very mobile now. I never know when I’m done with surgery. Some days it’s 1:00 p.m., some days it’s 4:00 p.m., but I just said, “Okay, I’m out of here,” because I can take my laptop, or I can even use my home computer and just VPN into our system and I’ve got every piece of paper that I can if I’m sitting in the office. For me, it got me out of the office today — I was done at 1:00 p.m. — it got me out about three hours earlier because I wasn’t sitting doing all my stuff there, which I normally would be, or taking home all those charts.

A preliminary report by the Massachusetts attorney general finds that insurance companies pay some hospitals and doctors twice the rate as others, with the main driver being the clout of the individual providers. “Everybody knows that there is dysfunction in the system, and nobody is happy with it. These rising costs are unsustainable. If we don’t do something about it, the only thing we’ll be able to afford is health care. No one will have money for food or housing.”

Michael Jackson’s father wants UCLA’s medical records pertaining to his son’s death so he can figure out how much to sue someone for. He claims there’s no doctor-patient privilege because MJ was long dead by the time he was taken to the hospital.

A British doctor living in Texas is in trouble for claiming a link between MMR vaccine and autism, which led to a resurgence of measles in England as moms passed on having their kids vaccinated. Lancet published his study that involved only 12 patients, including research in which he paid attendees at his son’s birthday party to give him blood samples. Reviewers say he was dishonest and irresponsible, noting that he was getting lawyer kickbacks from patients suing vaccine manufacturers. On the other hand, there’s a lot of money in traditional medicine that doesn’t want the apple cart upset, so who knows?

E-mail me.

News 1/29/10

From Ex-Cerner Guy: “Re: Yale New Haven. You’re not wrong, just early. Epic will unite all three facilities on a single enterprise-wide platform. Details are being worked out.” I have lots of moles feeding me information, some of them very well connected, so here’s the real story. YNHH recently hosted Epic demos and is actively discussing a system-wide implementation with them, but they are still working out the details and trying to figure out the money issues (back to rumor, someone told me over $150 million). They are reportedly not considering alternatives, possibly due to a strong desire to share data between the hospitals and their practices, which is an obvious Epic strong suit.

From Certifiable: “Re: Sisters of St. Francis. The chain of 10-12 hospitals in the northwest Indiana area has signed with Epic for virtually all applications.” Unverified.

From GoogleWave: “Re: HIMSS10. A Google Wave has been set up. You must have a GW account to access. Search for HIMSS10 and join.” HIMSS is always dabbling with Facebook or Twitter or whatever tech fad du jour their marketing people convince them is cool. I’ll bet money right now that, like its one-time experiment with live-blogging the conference, its Wave won’t be around for the next one.

From Jedi Knight: “Re: HITSP’s ‘wake’. I was there and it didn’t feel particularly sad to me. Everyone is wondering what the successor will be; HITSP2 or some other acronym. Somebody has to turn vague federal mandates into specific implementation guides, after all. My personal feeling is that whatever is next will be a lot more paid employees and fewer volunteers. There is a giant pile of money being dumped in here after all for the beltway bandits and lobbyists to jump into. It’s a shame for the volunteers, but also interesting to think that there is a core group of seemingly salaried standards people from federal agencies and large companies doing all this work. It was also interesting to watch the attendance over the years; a small group swelling to a large group as newcomers were sent in to figure out how to get some ARRA pie. Then, to dwindle back down to the diehards who did all the work.” The government has extended HITSP’s contract until April 30 (without further payment) so it can participate in HIMSS and the Interoperability Showcase. They are trying to convince the board members to stick around until the newly extended end of the line.

From Anthony: “Re: Boxtee. There is also a neat iPhone app for Boxee that allows you to use your phone as a remote for your laptop.”

From The PACS Designer: “Re: Microsoft Office 2010 Beta. If you are contemplating the purchase of Microsoft Office for a new PC, you might want to wait a bit. Microsoft has posted their new Microsoft Office 2010 Beta for everyone to view and also try some new added applications such as Microsoft Office Home and Business 2010.” That’s advice that I will use since I’m on a trial version of Student and Home or whatever the cheap version is called. I don’t have much choice but to either buy or re-install since, in typical Microsoft fashion, its installer assured me that my existing Office XP installation would not be affected, but now I can’t open any of the old versions without getting the dreaded “Preparing to Install” error that means it really did. Be cautious if you try the Beta. Since I don’t often say nice things about Microsoft, here’s one: OneNote is darned cool, although they don’t really seem to understand how to market it since it’s rarely mentioned.

From Mallory Keaton: “Re: showcase. Whatever happened to your idea of having a (not) HIMSS event to showcase selected new healthcare-related technologies? One or two days in a non-expensive setting. It was, and still is, a great idea.” I’m going to reply personally to Mallory, but here’s my problem: I was really stoked about the “unconference” idea, but I have no time between my hospital job and HIStalk. I’m long on ideas, short on time, unless I go part time at work or learn to Halamka-nap instead of sleeping for six hours. I guess I could contract with someone to do the heavy lifting, but that’s another management headache right there.

From JN: “Re: logo. Am I the only person who thinks that your graphic of a presumed doctor smoking a pipe is a little over the top? Do you have any plans to change it?” (a) yes; (b) no. Actually some other folks obsess over the logo (“he’s SMOKING and it’s 2010, for God’s sake”) without seeing the anachronistic 1950s irony that I strongly signaled with the Ben Casey head reflector thingie. On the other hand, I like hearing that criticism because I know I’m getting new readers — the old ones have heard me explain it many times in the past (use the search box to your right to find “reflector” and you will see). My HIStalk Mobile logo guy is not smoking, so at least I’m showing progress.

From David: “Re: Meaningful Use. Do you know where the technical specifications for the quality measures are located?” Some information is in the incentive program document, but maybe someone knows a better source.

From Sinead: “Re: HIT worker shortage. How does the situation bode for us with new undergraduate degrees in healthcare informatics? Is there a place for us without healthcare experience, or are those degrees suited only for currently employed nurses or clinical workers?” I’ve been asked that question a couple of times in the last few days. First of all, you are always better off with more credentials and yours is a timely degree. However, as you noted, when employers look for “informatics” employees, that often means nurses with no formal informatics education (maybe an ANCC certification or 10×100 at best) or perhaps a dabbling doctor, but with hands-on implementation experience and peer credibility. The health systems in which I’ve worked (big ones) did not have formally educated informatics employees that I can recall. Perhaps you have technical experience such as programming or project management? Reader input, please.

The RSVP page for the HIStalk reception at HIMSS is now open. We’ve maxed out signups pretty fast in years past only to have a mountain of leftover name badges of people who RSVP’ed but didn’t come, so please don’t take up a spot if you aren’t sure you can come. Your hosts are Encore Health Resources, Symantec, and Evolvent, so thanks very much to them. I’m not exactly sure what’s on the agenda beyond lots of food and drinks, but it doesn’t matter anyway because the attendees are scintillating on their own.

Hamilton Healthcare System (TX) signs up for applications from Healthcare Management Systems.

eHealth Initiative announces new board members, including Robert Marotta, Esq. of WebMD (chair) and William Jessee, MD of MGMA (vice chair).

The American Occupational Therapy Association is working with Cedaron Medical to develop and EMR and documentation system for OTs.

I’m not a fan of unions, but congratulations to the Teamsters, who get McKesson’s shareholders to agree that the company can’t pay John Hammergren’s family big money when he dies without first calling a shareholder vote. He’s already got $80 million in retirement money socked away on top of his $29 million annual income last year, but his family would have received another $3.5 million at his demise, not to mention another $30+ million in posthumous benefits that aren’t impacted by this new policy. MCK shares are up 139% since he took over in 2001, which isn’t terrible (about the same as competitor Amerisourcebergen) but still behind HIT competitors such as Cerner (up 366%) or Quality Systems/NextGen (up over 2300%).

I am honored to report that Vocera has joined HIStalk Mobile as a Founding Sponsor. David Brooks and I appreciate their support. We have other Founding Sponsors on board to announce shortly. In the mean time, e-mail me your thoughts about the iPad in healthcare, although I’m taking into account that in my January 2007 poll, 84% of you said the iPhone would have little to no impact on healthcare (doh!)

AT&T reports Q4 numbers: revenue down 0.7%, earnings of $3 billion, up 26%. Also announced: the company will spend an additional $2 billion in wireless network improvements this year, it added 2.7 million new customers in Q4, it activated 3.1 million new iPhones, and it’s offering an unlimited iPad data plan for $30 per month.

A couple of readers e-mailed me about the McKesson earnings announcement, wondering if the company is having problems with Horizon Enterprise Revenue Management since they wrote off some of their investment. I’ve e-mailed the CIO at Baptist Health System (KY) to see how well they’re doing as the first go-live, but haven’t heard back. As one reader wants to know, “is HERM following ProFit and Soarian?”

Riyadh Military Hospital in Saudi Arabia will implement Web-based clinical systems from ICT Health.

An interesting Q&A with Dan Rosen, assistant vice chancellor for personalized medicine at Vanderbilt, about its DNA sample database called BioVu and the Vanderbilt Electronic Systems for Pharmacogenomic Assessment:

The second thing we want is for BioVu to act like a giant clinical laboratory. The idea is that we all see the increasing robust science of genetic or genomic variation as ultimately coming to the bedside … It’s a pretty commonly held vision that at some point in the future a doctor will write a prescription and the electronic health system will say, ‘That’s the wrong drug,’ or ‘That’s the wrong dose of the drug for that patient,’ or ‘This particular patient doesn’t have the disease that you think they have because of genetic variations of some type.’ While people talk about that kind of vision, actually executing it presents a lot of practical problems, such as which genetic variants would you actually want to act on? What would be the strength of evidence? How expensive is it to do this? What information technology challenges are there? How do you store huge amounts of genetic data on huge numbers of patients, and access it rapidly?

Also going Epic: Genesis Healthcare System (OH), although the article isn’t clear on whether it’s inpatient, practice, or both.

E-mail me.

HERtalk by Inga

From YellowPad: “Re:iPad. I am interested to hear what HIStalk and its readers have to say about the iPad. I’m not sure why the market needs yet another device in addition to laptops, Kindles, and smartphones. On the other hand, Steve Jobs hasn’t made too many mistakes. My nine-year-old daughter wants one — that speaks volumes.” Like your daughter, I think it looks really cool and I’d love to have one to play with. However, it remains to be seen whether it can achieve widespread HIT adoption given its unique size, its price, and its lack of features compared to a notebook. I told Mr. H that I couldn’t see myself slipping the iPad into my purse on the way to a cocktail party, like I do my iPhone. And I wouldn’t want to use it all day, given the on-screen keyboard. However, if I traveled more, I’d like having one to take on the plane because it would make me look really hip.

From Weird Andy: “Re: $7 million to track down stolen hard drives. Well, yes, I bet there are some other people who think that it is a stimulus. However, instead of having a choice of where the $7M would be used, whether to buy equipment, reduce layoffs, improve facilities, or other options.”  All true, although in this case it was an (evil) insurance company that had the disk drives stolen and is now spending money for damage control. I bet those 700 temp employees aren’t complaining.

Rutland Regional Medical Center (VT) kicks off its $15 million EHR initiative and announces the project’s code name: SNOW (Simple Navigation to Online Wisdom). The project is scheduled to take 19 months to complete. I’m assuming GE is the vendor, since last fall Rutland agreed to serve as a national host site for hospitals considering GE products.

A Dell-sponsored survey by HIMSS Analytics concludes that data center demands for small and medium hospitals will increase 20-50% over the next two years. I’m sure Dell and its investors liked those results.

Valley Medical Center (WA) licenses Sunquest Collection Manager to automate specimen collection. Sunquest also recently installed its LIS and ICE Desktop solutions at employee clinics for the global airline Emirates.

Officials with University Medical Center (NV) say that personal information on traffic accident victims has probably been leaked from its trauma center. For more than three months last year, someone allegedly was selling patient information to personal injury attorneys. The FBI is involved.

McKesson and HP announce they are collaborating to accelerate EHR adoption among independent physician practices. The companies are bundling McKesson clinical and PM applications with HP solutions and including training, implementation, and local support. The program will be executed through HP distributor Tech Data. Good move, I’d say. McKesson seems to recognize that most practices, unlike hospitals, lack the internal resources required to coordinate the technical aspects of an EHR installation. And, despite how popular SaaS is becoming, there are plenty of providers who still insist on an in-house server. Offering a turnkey solution is going to appeal to a large constituency. HP is also a winner here because it’ll have a chance to increase its footprint in the small physician office space, a market where they’ve not been much of a player.

A reader forwarded me this link to a blog compiled by Texas Orthopedics. Several of their physicians and other Texas clinicians are currently in Haiti helping earthquake victims. A few excerpts from real life heroes in action:

• Our team performed around 14 surgeries today with 16-17 in-house patients remaining. The RNs and doctors will be taking turns over night to stay with these patients and take care of them.
• The ORs at the Haitian hospital are like open out houses. Enclosed spaces with slits in the top of the walls to the outside. Our team converted a room into a two-bed OR with AC and an autoclave.
• Today two women were getting their amputations revised, which involves cutting more of the leg off. They had spinals and were in no pain. Both of the women started singing a Haitian hymn while the saw blades were going.
• Dr. Scott Smith from Texas Ortho group is hilarious. He is using his iPhone to entertain the kids in the village. He’s becoming a superstar!

McKesson announces the general availability of its Horizon Practice Plus 12.0 practice management system.

CareTech Solutions is providing healthcare help desk services to Mercy Memorial Hospital System (MI) and just implemented a Service Request Catalog to automate service requests.

Epocrates claims that over 350 medical centers and universities now use its mobile clinical and decision support software.

Odd lawsuit: A woman sues her oral surgeon for leaving an inch-long piece of steel in a mouth wound during a tooth extraction. Despite ongoing complaints of pain, nosebleeds, and sinus infections, she was told her reactions were normal and she needed to stop complaining. Eleven months later, after experiencing numbness and dizziness, she went to the ER and doctors found the metal piece. The steel has since been surgically removed.

E-mail Inga.

An HIT Moment with … Ford Phillips

An HIT Moment with ... is a quick interview with someone we find interesting. Ford Phillips is the owner of River Bend Marketing.  

How is healthcare IT marketing different today than it used to be?

Technology and social behavior are the driving forces behind the changes in marketing. In the mid-70s when I started, we had limited media at our disposal, so I used multiple forms of direct mail and print advertising to get my marketing messages to potential clients. Of course, we used press releases, but they served a different purpose during that era. Printing and postage were inexpensive and print ads were reasonably priced. We lived for the postman’s daily delivery of our BRC cards.

There were only about five or six trade magazines focused on healthcare at that time. Modern Healthcare came along in 1976, I believe, and Computers in Hospitals started in 1980. That magazine is today’s Health Management Technology. I was a charter advertiser in both of those magazines.

The advent of the Internet in the early 1980s changed everything, including marketing. Web sites became a company’s window to the world and e-mail addresses assumed a “golden glow.” Today almost every marketing medium my company uses is electronically generated and distributed.

For all of my clients in 2009, I did one large, print direct mail campaign. Everything else was electronic. Almost everyone one of my clients is using some form of social network marketing, something unheard of just two or three years ago. The methodology has changed in 30 years, but objective has not — get the right message in the right hands as cost-effectively as possible.

People often think that "marketing" and "advertising" are the same thing. How would you explain the difference?

People mix up the definitions because they do meld together in the minds of most people. That said, I have always used the following definitions for marketing and advertising. Marketing entails creating and communicating specific messages that position a company and its products’ value, features, and benefits in such a manner as to create a need for that product in the minds of potential end users.

When you pay to get that message disseminated through any medium, that’s advertising.

ARRA has unleashed a flurry of vendor press releases and programs such as interest-free loans and certification guarantees. What impact has this had on vendors and their prospects?

I have read all of the offers. The vendors are simply trying to use the smell of government money to attract as many prospects as possible. Some of the vendors are sounding a little desperate. An interest-free loan? Their products must be extremely expensive. And, how can you guarantee something that is still unknown?

I’m certain the poor physicians are as confused as ever about the benefits of EMRs. EMR technology has been available, in some form or other, for a good while. The percentage rate for adoptions is still in the teens. There must be multiple reasons for that.

The economy is down, but healthcare IT is up. How has that affected your business? What are the right and wrong marketing actions that vendors might take in response?

The majority of my clients see the benefits of continuing a strong marketing communications program in any economic environment. We lost a few clients at the beginning of the downturn. Most of those were due to reduced investor financing.

The right thing to do in a down market is the right thing to do in an up market. In a nutshell, keep your marketing communications program focused. Identify three or four optimum marketing messages and target those messages to prospects who you know can benefit from your product.

Stay on your messages; don’t dilute them. Use the most cost-effective and varied communications strategies you can afford to disseminate your marketing messages to the target audiences.

What are the most important things about the healthcare IT market that new entrants and startups should know?

Be flexible in your planning and execution and be prepared to change directions quickly. Nothing will remain the same, industry-wise or technology-wise. If you remain flexible and can adapt to change, you will be successful in the healthcare marketplace. Not a single technology platform that my clients’ products use today was even envisioned when I started in this industry 30 years ago.