News 12/11/09

From Mogall: “Re: Sentillion. Word on the street is $200 million for the purchase of Sentillion. It will be interesting to see if anyone hears the Sentillion name again.” If I were guessing, I’d say the name will fade away from widespread use since Microsoft likes its own brand, but the technology and the people will do fine under the Microsoft banner, perhaps jump-starting a concept in which Amalga UIS is the “control panel” that launches various applications and databases and tie them together with CCOW (sort of like making iGoogle or MSN your home page). It’s a good strategy — it’s time for the best-of-breed pendulum to swing back, and visual/virtual integration provides customers with a lot of options, including interoperability. Microsoft has been working with Sentillion since at least early summer, so that peek up their skirt must have stirred up some ideas.

Speaking of which, thanks to Peter Neupert and Rob Seliger for inviting me to chat with them about the acquisition the day before it was announced. A reader had tipped me off, so when Jenn from Sentillion e-mailed to see if I was available, I probably startled her a little by speculating that it must be Microsoft announcement time. I was surprised to see quite a few folks on and reading HIStalk on so early when I posted the article (since I was bound to an after-midnight embargo), so I jotted down some of their locations: UK, Ontario, India, Dubai, Austria, Sri Lanka, Australia, and what must have been a bunch of night shifters or insomniacs right here in the US.

From Fashionista: “Re: Dr. Halamka’s blog. If there was ever a day to read it, today is it. He itemizes each piece of the $1,500 outfit he wore to meetings today … serenity now.” He always says he rarely sleeps, but I think he might need a nap or a jet lag cure judging from his obsessive ensemble: a Gortex suit, a Kevlar shirt, and vegan boots (who knew?), all donned before riding a folding bike to work in sub-freezing Boston blizzard. Maybe the Kevlar is for protection the next time the BIDMC network goes down.

From Tim: “Re: Christmas ornament. Or is that YOUR name?” Inga and I use names sometimes. They aren’t necessarily the ones on our birth certificates, not that it matters.

From TV’s Frank: “Re: AHIP. Surely Karen Ignagni’s hugely oversized income has nothing to do with the health insurance industry and its cost to the system.” She’s the president and CEO of AHIP, a trade group and lobbying organization for insurance companies. According to a Modern Healthcare article, she was paid $1.9 million last year. AHIP lost  $4.6 million after spending $1 million on lobbyists, $2.5 million on lawyers, and $10 million on consultants. AHIP got snippy with a Mother Jones reporter a few weeks back when she asked the company what Ignagni’s coverage and copay is. I’m sure she’s like members of Congress — convinced she is qualified to decide what insurance dozens of millions of us can have, but secure in the knowledge that she’ll never have to stoop so low anyway (that’s Point #16 by Dan Fields – everybody in government should be required to use whatever health system they cobble together for the rest of us).

From Thomas Servo: “Re: Healthvision. A good source says Battery Ventures will close the sale of the company around New Year’s.” Unverified.

From RoadWarrior: “Re: Allina. Heard through the grapevine that they are out for RFP on a new LIS. Rumor is that ‘integration’ has been touted as a high priority, but McKesson and SCC have been engaged.” Unverified.

I mentioned that I like reader pictures related to HIT, so here are a couple from Joe of Clarian Arnett Hospital in Lafayette, IN.

Cerner wins its five-year-old patent dispute with Visicu (now Philips). I enlisted an attorney to give a legal overview of it way back in December 2004.

Keane will implement RCM for Atlantic General Hospital (MD).

Listening: The Volebeats, who must be really obscure since they’re barely on the Web at all. Sounding good, with finely crafted, brooding jangle indie pop like R.E.M. at their best. I’m also anxiously watching the mail for delivery of some DVDs that I didn’t know existed, but now crave: homebrew recordings of Mystery Science Theater 3000, one of my favorite TV shows ever.

Hayes Management Consulting has developed a hospital version of its RAC auditing tool called MDaudit Hospital. Webinar signup is here.

SCI Solutions announces that it signed 51 new contracts with 76 hospitals this year for its Order Facilitator, Schedule Maximizer, and Revenue Accelerator.

CCHIT announces three new board members and five new commissioners: On the board are Lori Evans (ActiveHealth), William Jesse (MGMA), and Stephen Klasko (University of South Florida). New commissioners are Patricia Becker (University HealthSystem Consortium), Barbara Byrne (Edward Hospital), Timothy Elwell (Misys Open Source Solutions), Jay Srini (UPMC), and Grace Terrell (Cornerstone Health Care). That’s a pretty strong lineup considering the heat that CCHIT has been taking. It must have been a quick turnaround for Bobbie Byrne since she just quit her CCHIT job this month, but is now a commissioner.

Vanderbilt joint venture partner Acuitec releases an iPhone version of its Vigilance messaging system for high-acuity providers.

John McInally, formerly of biotech company CollabRX, joins MetroHealth (OH), replacing the retired Vince Miller. He was also CIO of Lucile Packard Children’s Hospital at one time.

A Weird News Andy find, although not a happy one: a woman drinks herself into a stupor while celebrating her 20th birthday and is taken to the ED of Uniontown Hospital (PA). The doctor leaves her passed out on the floor with her legs tucked under her for 12 hours, she claims, with the lack of circulation eventually requiring her legs to be amputated at the knee. She’s suing the hospital and the doctor.

A reader in his early 20s asked me for some education and career advice, also suggesting that a good interview question would be to ask industry veterans what they would do if they were starting fresh in HIT. Feel free to comment or Readers Write me on his behalf.

Kansas, following the federal government’s lead of trying to buy its way out of a recession, throws more money at Cerner and Neal’s soccer team, freeing up an immediate $47 million in cash of its $230 million incentive to start construction on the $414 million project.

Maybe lawyers could be our main export, at least to Singapore. A woman who was overdosed on chemo by a hospital receives a cordial visit of apology from the country’s health minister. She said she was touched. Her husband is philosophical, telling the two pharmacists who made the error, “You will have much more to achieve. Do not allow a single mistake to be a permanent psychological barrier. Just focus on helping more patients and serving them well.” He also urged the hospital not to fire them. I can’t even imagine that here. The injuries from the lawyers trying to leap over each other to get to the bedside would be widespread.

The Georgia inspector general gets involved after Business Computer Applications of Atlanta wins a big contract to develop a prison EMR despite a bid that is double that of eClinicalWorks, the second-ranked vendor. Someone from the Atlanta company hinted to an evaluation team member that he might be hired if BCA got the bid. In fact, it played out exactly that way, with the employee going to work for the vendor less than a month after the company was chosen on the basis of subjective evaluation to which that employee contributed.

Interesting conjecture in Charlie McCall’s case: did his high-powered legal team intentionally allow an attorney to be seated on the jury, knowing they might be able to find something to challenge later just in case he lost? Charlie’s team is demanding a new trial, claiming the jury foreperson, an attorney, improperly defined a term for her fellow jurors. The judge doesn’t seem impressed. “Please, Mr. Wells, you knew when you left her on the jury she was a lawyer … This is such a mess you’re inviting.”

iSoft sells its first PACS system to a customer in Germany. The company also said it may hire up to 500 new employees in Australia. The managing director, in complaining that innovative businesses often are acquired or sold to an overseas company, also admitted that half of iSoft’s 4,700 employees are in India.

The FBI launches a privacy investigation at University Medical Center (NV) after a Las Vegas Sun investigative reporter’s source produces copies of patient face sheets, saying they are regularly being sold to ambulance-chasing lawyers.

ONCHIT chooses members of the Health IT Policy Committee’s privacy and security workgroup.

CMA Consulting Services fires its CEO and former New York state Senate Majority Leader Joseph L. Bruno within hours of his conviction on two felony fraud counts. Competing bidders Thomson Reuters and Ingenix protested, the newspaper article says, when CMA was awarded a $159 million contract to build a Medicaid data warehouse despite his indictment earlier this year.

E-mail me.

HERtalk by Inga

The VA awards QuadraMed a $24 million contract for its Encoder Product Suite and training services.

MedAssets confirms its 2009 forecast, predicting revenues of $341 to $345 million. The company also forecasts 2010 revenues of $390 to $400 million.

The Georgia Department of Community Health will use recently awarded grant money to create a State Medicaid Health Information Plan, designed to manage incentive programs for EMR adoption. The $3.2 million in federal funds will promote the state’s to give all Medicaid providers access to an EMR and the ability to participate in health information exchange.

Community Memorial Health Systems (CA) selects Allscripts’ EHR, PM, and RCM products. Community Memorial Health System will host applications for 70 contracted physicians and a pilot group of 12 community physicians. The health system will also use technology from dbMotion to allow physicians access to a virtual patient record that includes aggregated clinical information from all the heath system’s computers.

Speaking of dbMotion, the company was chosen to provide an interoperable EHR for the Canadian province of Manitoba. IBM Canada is also participating in the project.

St. Vincent’s Medical Center (CT) picks Streamline Health’s Contractor Management Solution for workflow management to ensure OSHA compliance. Streamline Health released its third quarter numbers this week: a net loss of $296,000, compared to net income of $15,000 a year ago. Total revenues were $4.1 million, down from $4.4 million.

Streamline Health also negotiated a 45% tax credit from the state of Ohio, valued at about $214,000. The credit will help the company undertake a $2.75 million expansion project expected to create 25 jobs.

A UK study concludes that one in 10 handwritten hospital prescriptions contains a mistake. Poor handwriting, transcribing errors, and ambiguous prescriptions create most of the problems. Most mistakes are minor and few lead to serious patient harm. Not sure if that last part is suppose to make us all feel better.

Hospitalist management company PrimeDoc Management Services signs a three-year contract renewal with Ingenious Medical to provide automated charge capture, practice management, and reporting.

Nuance introduces a Dragon Dictation app for the iPhone that help users create e-mail, text messages, and notes. Despite the warnings that it downloads and stores all your contact, I added it to my phone. While it’s cool, so far it’s been less than 50% accurate for me. Does it mean I talk funny?

Deck Inga’s e-mail.

Microsoft to Acquire Sentillion

Microsoft will announce later today that it will acquire Sentillion, Inc. of Andover, MA. Terms of the acquisition were not announced. The transaction is expected to close in early 2010.

Privately held Sentillion, founded in 1998, sells patented solutions for single sign-on, context management, and identity management. It has over 1,000 hospital customers and over 500,000 users. It was named by KLAS as the #1 healthcare SSO vendor in its December 2008 report.

I interviewed Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group, and Robert Seliger, CEO and co-founder of Sentillion, about the acquisition on Wednesday.

Neupert says clinician users of Microsoft’s Amalga Unified Intelligence System, live in 115 hospitals, will benefit from Sentillion’s SSO and context management technologies. “Our goal is not to be an EMR,” Neupert said. “When we provide data and they want to take action on it, we want to make it easy for them.”

The companies signed an agreement this past June to incorporate Sentillion’s SSO and context management in Amalga UIS. The announcement quoted a Microsoft spokesperson as saying, “… for clinicians and others to readily adopt and get the maximum value out of a new platform like Amalga UIS, it needs to become an inherent part of the clinical workflows that drive the patient care delivery process. Our collaboration with Sentillion is designed to achieve that level of integration.”

I asked Neupert why Microsoft wants to acquire Sentillion rather than just continue the licensing arrangement. He said Microsoft can use Sentillion’s domain expertise in context sharing to create more solutions, particularly those that allow customers to continue with their best-of-breed strategies. “We want people to understand that best-of-breed is a reasonable path for them to pursue,” Neupert said.

“Our goal is not to just sell Microsoft products,” he said. “Our goal is to help create new innovation in the health ecosystem. What we are trying to enable is workflows that cross organizational boundaries.”

I asked him if there are important aspects of the announcement that might go unnoticed. “This shows that Microsoft is continuing to invest, the Health Solutions Group in particular, to make health an important vertical inside the company, making a series of thoughtful steps in acquiring domain knowledge and technology and people to make that investment practical,” Neupert replied.

I asked Seliger why he’s selling Sentillion now. “We are a healthy company, profitable, and growing … the next step is a perfect outcome. You take our business legacy and commitments to customers and preserve that, but also take it to new levels, new countries, new venues that we wouldn’t get to as quickly on our own … To build an entire organization with P&L behind it that says Microsoft is unprecedented. It’s a fabulous home for Sentillion.”

Seliger says the Sentillion management team will stay on. The company will be operated as a wholly owned Microsoft subsidiary from its Andover office, with Seliger reporting to Neupert.

Readers Write 12/10/09

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!

Catastrophic Insurance Coverage to Reduce Healthcare Costs
By Carl Witonsky 

Expanding on Dr. Dan Fields’ point number nine in his excellent 16-point program on how to reduce healthcare costs and improve outcomes, I think there is a potential to save $100 billion a year by employers buying catastrophic insurance for their employees and giving them an HSA account funded with $5,000.

The employee would then pay for all doctor, pharmacy, and outpatient visits with their HSA credit card. NO CLAIM FORMS would be created. The doctor would update the patient’s EMR with the patient complaint, clinical findings, treatments, etc. The catastrophic insurance would kick in when the employee’s out-of-pocket hits $2,500 (above the company-funded $5,000) so insurance claims would be confined almost exclusively to inpatient stays. 

The last time I checked, there were five billion claims processed a year in these United States. I estimate that four billion are not related to an inpatient stay. If the total cost for a typical physician claim is $25 between the provider and payor to process (current studies report that a two-doctor family practice costs $70,000 per year per physician for claims-related work), that is a $100 billion cost reduction per year.

I am continuing to research this subject and would be very receptive to critical comments and suggestions.

Clearly all the payors would be up in arms against losing their lucrative administration fees and doctors might  attempt to raise the price for office visits, so we will still need insurers / government to negotiate fair fee schedules. The key is to make health care insurance like home insurance — catastrophic-only — and reduce the enormous administration cost of the paper chase to the absolute minimum.

Carl Witonsky is managing director of Falcon Capital Partners of Radnor, PA.

Any Sufficiently Advanced Technology is Indistinguishable from Magic – Remember, Clarke’s Third Law?
By Shabbir Khan

I have been reading HIStalk for couple of years. In addition to saying that your HIStalk posts have always been timely and informative, I wanted to express my kudos to you and Inga for always staying objective.

I have also been reading Dr. Gregg Alexander’s posts on HIStalk Practice with great interest. I am in total agreement with him on the need for giving the physicians and their nursing / office staff a basic tool to help them build their own apps and user interfaces for documenting and sharing patient data with each other using lightweight portable devices.

Physicians have always proven themselves pragmatically wise in adopting and using a new technology if it works for them and if they see a real value in using it. They are not averse to adopting a new technology if it helps them in treating their patients while increasing their productivity. They have enthusiastically adopted a great variety of new technologies in the past. Some examples of the technologies adopted include the use of IV drip line, medical ventilators, and medical imaging equipment. We have also witnessed rapid adoption of many other technologies by the medical community including the use of fax machines, pagers, cell phones, transcription technologies, Internet, and more recently, smart phones (with computer brains) running on 3G networks.

These technologies have made physicians and nurses more productive, improved their workflow, and enabled them to spend more time with their patients. Importantly, these technologies have given the control back to the physicians, nursing staff, and ordinary technicians to use these technologies without needing any outside or specialized help. For example, today nurses routinely use an IV drip line to administer medicine to a patient intravenously without needing any assistant from an IV drip line specialist or from an IV drip equipment vendor. A lab technician can easily fax a lab report to a physician’s office without worrying about HL-7 compatibility on the other end.

Electronic health record systems of today put physicians at the mercy of EHR vendors. Therefore, Dr. Alexander’s post regarding the need for achieving more simplicity and giving more control back to the physicians reflects a more practical approach.

Today, each EHR vendor offers you a unique, “one shoe fits all” solution. Each vendor claims that customizing their system is easy and inexpensive. However, your intuition tells you that the reality is totally different. Using existing technologies and current processes to re-configure, re-program, re-build, and re-deploy poorly designed software is an extremely arduous, expensive, and a painfully slow process as it requires an army of non-clinicians to do it correctly, e.g., programmers who speak such a wide diversity of languages it’s as if they are still living in a Migdal Bavel today.

No wonder the adoption rates for EHR systems have stayed in single digits for so many years. This has been the case despite all of the brilliant marketing tactics used by the EHR vendors. The insurance industry has also been lobbying hard for faster adoption as it eliminates its own data entry costs and gives it a very powerful tool to reduce its medical loss ratios by getting its hands on all patient charts in the entire nation for free. Then, they’ll use the data, that was provided by the physicians to begin with, against the physicians after data mining it extensively.

In addition to the massive lobbying efforts of the insurance industry, other efforts for increasing EHR adoption are also failing, including the relaxation of the Stark Law and a variety of financial incentives being offered by the Federal and state governments.

Physicians are sticking to their paper charts for now.

Building a simple, but a separate smart phone application for each little thing is also not a good solution. Juggling through multiple apps during a very short session (15-20 minutes with a patient) will prove to be too cumbersome for the physician and their nursing staff. It will slow them down. The small size of an iPhone or similar smart phone (e.g., a palm prē) is another limiting factor that will force clinicians to stare at a computer screen for too long while flipping through a myriad of small screens just to get to the right page to enter or display the required information.

An ideal solution requires two important things to happen:

a) Availability of better hardware with larger screen size for quicker access to the data in a patient’s chart and faster means of data entry.

b) Development of a brand new class of software.

I live in Silicon Valley. Better hardware is coming soon (as early as the summer of 2010). However, development of the necessary software will continue to prove to be a more daunting task as it requires a totally new kind of thinking. It requires the development of a brand new and a revolutionary software technology that will be highly disruptive to the status quo.

Both Dr. Alexander and I have been looking for a sufficiently advanced technology that is indistinguishable from magic. Although I’ve developed pretty good intellectual property to make this magic happen (e.g., making it easier for the clinicians to define and build their own apps), it is very difficult to get funded in today’s environment to build such a disruptive technology.

Who wants to fund a Robert Gaskins or Dan Bricklin in today’s economic climate?

Shabbir Khan is a Silicon Valley entrepreneur who is proud of being a nerd.

Physician-Friendly Documentation
By Chris Joyce

Thank you for posting the interview with Dr. Hau of Shareable Ink. Dr. Hau’s comments really resonate with those of us that have been evangelizing for more intuitive documentation solutions and a different approach to healthcare IT for years. Every week we get calls from frustrated docs and CIOs that have purchased a big-box EMR, yet are struggling to adapt their workflow and make the jump. 

Fortunately, the industry is finally catching onto the source of the poor adoption rates — the user experience! Many HIS/EMR vendors have adopted a web and/or SaaS architecture which solves the IT deployment, cost, and support challenges, but doesn’t address the practical usability for the providers. We’ve seen the same issues with the adoption of EDC in clinical trials. These users are often mobile and offline in spotty wireless environments such as the OR, making a Web application that’s expecting primarily keyboard input unacceptable. Not to mention the horrible bedside manner of being behind a laptop during the encounter. 

The solution must be integrated so they have real-time validation, access to previous notes, and don’t have to re-enter patient demographics/history. At the same time, the interface needs to be natural and flexible so the provider can enter structured discrete data as well and notes / annotations to encourage more complete documentation. As Dr. Hau states, if the providers aren’t using it, it is worthless and you won’t be able to address meaningful use or safeguard against RAC audits.

For these reasons, we embraced the tablet in our Logical Ink solution where can truly eliminate paper without giving up the speed/intuitiveness of a pen interface that is so patient/physician-friendly. The user can combine the power of pen, voice and keyboard input instead of choosing just one approach. It is baked into the user experience instead of the “bolt-on” approach many take. We take advantage of the powerful computing device to make the form(s) interactive: interfacing with devices, validating the data in real time, and performing calculations. And the large screen maintains the familiar paper metaphor. Finally, we can work disconnected for periods of time and sync the documentation with the HIS/EMR via industry standards like HL7, for seamless integration into the hospital workflow.

I’m hopeful the industry is moving towards us and that more vendors will renew their focus on physician-friendly documentation.

Chris Joyce is founder and president of Logical Progression of Cary, NC.

News 12/9/09

From The PACS Designer: “Re: Google Chromium OS. Courtesy of InformationWeek, we can get an idea of what Google’s Chromium OS is all about, even though it won’t be released for another year.”

From Joe Bologna Sandwich: “Re: [health system name omitted]. I heard second hand that they will cancel their contract with [vendor name omitted] in January.” I’ve e-mailed the CIO. Sorry for the redacting, but this is a publicly traded vendor and a humongous contract, so I’d like to confirm the rumor if possible.

From Nancy: “Re: Bobbie Byrne. The pediatrician, Eclipsys alum, and former clinical director of CCHIT is leaving CCHIT to become CIO of a hospital.” According to her LinkedIn page, she is now VP of informatics at Edward Hospital (IL), having left CCHIT sometime this month after only seven months or so.

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.” Unverified. Spheris doesn’t file SEC reports any more, but management had said margins and revenue were down. I also noticed that Spheris is no longer listed on the portfolio page of Warburg Pincus even though it’s still showing in the Google cache of the page, so I’d say something is up.

From Anonymous Coward: “Re: NHS cutting back on IT project. Enjoy your writings a lot. I work for one of the Big Vendors that I wish you talked about more — we are doing some good stuff (finally….).” Budget deficits take their toll in Britain, with a proposed large scale-back or maybe outright scrapping of the $20 billion and overdue NPfIT project. The arguments are the same as here: do those big systems really pay their way in terms of outcomes or cost reductions? The Conservative Party has proposed moratorium on all government computer projects, claiming the Labour government has spent $162 billion on IT in the past 12 years and another $115 billion will come due in the next two years. Lots of interesting comments on NPfIT are here.

Thanks to our HIMSS contact for chasing down our inquiry (on behalf of a reader’s question) about how government employees are compensated for speaking at the annual conference.She says HIMSS works within federal guidelines and does not offer honoraria or expense reimbursement to government employees (as I assumed). David Blumenthal asked for nothing and was offered nothing.

I like the move by Francisco Partners to buy QuadraMed. QuadraMed has had more than its share of struggles, all of them conducted in the spotlight since it was a publicly traded company (albeit with little benefit since market cap was low and share price stagnant). It had some old preferred shares that were so favorable that those shareholders were getting much of the cash. It has good products (HIM, Affinity, and QCPR) that ought to be selling well, especially if the QCPR migration to Cache’ is indeed complete. Francisco Partners has been a good steward of the companies it has bought, getting their houses in order, distancing them from previous baggage, and clarifying their identities and strategies. I think it’s the best possible outcome for customers and employees. A reader tipped me off with perfect accuracy last night, so I watched the news ticker this morning to jump on the announcement as soon as it went out.

The Chicago inspector general will review the 13 bids the health department received for a mental health system, determining whether anything suspicious was involved in choosing Cerner over 13 other bidders. The system had disastrous financial repercussions, it’s claimed, when billing problems prevented collection of money from the state for services rendered.

I was a bit loosey-goosey in my description of the products of new sponsor BridgeHead Software, so their VP contact provided clarification. Just so I don’t do it again, here’s the verbatim quote, better than I could have done anyway:

BridgeHead provides healthcare data management solutions that combine backup and archive into a single platform that it easy for IT to manage.  While you mentioned it’s cool that we can “do business intelligence on a backup”, it’s actually the archive that provides that value. Our archive is able to capture data from a variety of sources (including DICOM data from various PACS), transform that data (dedupe, compress, encrypt, containerize), index the content and make it all searchable. This truly enables the EHR by providing a foundation for managing all the data sources that comprise the electronic health record, regardless of whether that data is actually “owned” by your primary EHR application. Backup complements the solution by providing point-in-time recoverability, and this is just one aspect of our larger disaster recovery/business continuance functionality.

The HIT Policy Committee’s NHIN Workgroup will meet next Wednesday. On the agenda: a review of objectives and NHIN Meaningful Use. The Webcast runs from 10 a.m. to 1 p.m. Eastern.

Wirral University Teaching Hospitals is the first UK client to go live on Cerner PowerTrials, which connects physicians and researchers to support clinical trial participation by patients.

Lancaster General Hospital (PA) releases data about its use of auto-programmed smart IV pumps, linking them to the Cerner Bridge Medical eMAR/bedside barcode checking system. Their results: nurse IV pump programming time was reduced by 25%, infusion pump programming steps were cut from 17 to seven, and reprogramming was cut by 90%.

In New Zealand, Auckland Hospital’s clinical systems go down hard for four hours when a UPS circuit board fries. Related: the health board spends $1 million for software to track requests for follow-up X-rays after doctors missed a request; 10 patients were overdosed on meds because the automated dispensing cabinets don’t check doses; patient systems at another hospital failed when a roof leak dripped water into a computer; and information entered on the wrong patient caused another patient to be given an unnecessary colonoscopy. For IT noobs, I know this is a splash of cold reality, like that first time you saw your objet d’amour in the dawn’s early without benefit of makeup.

Steve Stanic, formerly the National Director of the McKesson solution center for Perot Systems and CIO of Memorial Savannah, is named CIO of Mississippi Baptist Health System.

Charlie McCall’s lawyers want a new trial after finding out that the jury foreperson, a Stanford Law graduate, gave fellow jury members a definition of “reckless disregard”.

Dennis Quaid, livin’ large on the healthcare conference circuit, announces at his keynote at the ASHP Midyear the National Alert Network for Serious Medication Errors. What caught my eye, however, was the picture below Dennis’s of three hot blondes with violins, apparently holding as much pharmaceutical expertise as Dennis, pre-keynoting fresh from America’s Got Talent … ladies and gentlemen, blond Polish triplets with graduate degrees in fiddlin’!

Someone wanted to hear ideas that would save healthcare $1 billion a year, so here’s mine: stop paying healthcare people to screw around at conferences. If the knowledge is all that important, someone will cover it in a Webinar or journal article (or let everybody pay their own way to go to conferences like I do). I’m pretty sure the salaries, travel costs, and registrations add up to way more than a billion since it seems like half the hospital is junketing somewhere at any given moment and nothing useful ever seems to come of it except the attendees brag to everyone let behind at how enriched their professional lives are since having dinner at Bouchon or cutting up after too many flirtinis at the Donnie & Marie show. Patients, check your drug doses extra carefully this week.

Australia’s industry groups agree on certification criteria for medical software. The National E-Health Transition Authority also announced that the SNOMED CT-AU terminology database is available to Australian license holders (note to vigilant seekers of SNOMED misspelling sightings – Computerworld spelled it SNOWED).

CareFusion announces new Pyxis products at ASHP: drug-lab alerts on MedStation, a PDA-based pre-selection tool for nurses, a maintenance console for all MedStation and SupplyStation systems, and a new version of CII Safe.

E-mail me.

HERtalk by Inga

From Sandy Claws: “Re: Pam Pure. Do you know where she is and what she is doing? I would look and see if she is doing any work with Francisco Partners or Blueline Partners. My guess she is at least consulting with one of them.” Interesting question, especially in light of the QuadraMed/Francisco deal and the recent hire of two former McKesson bigwigs. Blueline owned, at least at one time, a large number of shares of QuadraMed.

Medicity announces the opening of its platform to third-party application development. Partners developing to Medicity’s iNexx API can leverage Medicity’s customer base of 700 hospitals, 25,000 physician practices, and 250,000 providers.

At its Executive Summit in Las Vegas, Allcripts announces its Professional EHR 9.0 release, as well as Allscripts Remote for BlackBerrys. The 9.0 release includes an enhanced user-interface and expanded disease management capabilities.

CliniComp names Phillip LaJoie, the former CIO of the Naval Medical Center and CTO of the Military Health System’s infrastructure arm, as VP of deployment.

On my Christmas list: smart slippers, like these designed by AT&T scientists that include electronic insoles with four pressure sensors and an accelerometer to measure how well you are walking. I’m not sure exactly what I’d do with them. Perhaps make my departing party guests try them in order to evaluate if they are walking well enough to drive home. AT&T is making major investments in telehealth products. Seems they want to establish a “foothold” in the growing telehealth industry.

Moses Cone Health System (NC) selects Streamline Health Solutions’ enterprise document workflow solution.

Gannett Health Services at Cornell University is now live on Point and Click EHR, which is designed for college health. A staff member calls the transition “incredibly challenging, but invigorating.”

St. Vincent’s Hospital Manhattan lays off 180 of its 3,800 employees to cut costs. The hospital cites “severe financial shortfalls” as a result of the recession and funding cuts. Those affected include managerial and patient care positions. Condolences. There’s never a great time to be laid off, but I’m sure this doesn’t make for a merry holiday season.

Duke University approves a new one-year Masters of Management in Clinical Informatics degree program to be offered by the Fuqua School of Business and the Duke Center for Health Informatics.

The personalized medical care segment of the personalized health and wellness market market could grow to $100 billion by 2015, assuming telehealth takes off. This segment includes telemedicine, HIT, and disease management services offered by traditional health and wellness companies.

No sooner than Charles McCall gets his due then another story of greed in healthcare emerges. The latest scandal comes courtesy of Canopy Financial and co-founder Jeremy Blackburn. Canopy filed for bankruptcy protection after the FBI began looking into alleged fraudulent financial statements that were created as part of a $75 million investment scheme. Blackburn has since resigned as president and his assets have been frozen. KPMG discovered the potential fraud after learning that Canopy was presenting financial reports to prospective investors that were supposedly audited by KPMG. In fact, KPMG had never been retained by Canopy to audit its financials.

If you work in the patient safety, quality of care, or regulatory compliance fields, check out a new social Web site just for you and your peers. Quantros launched the new site called Clinical Cafe.

Two health systems are among five recipients of the 2009 Malcolm Baldrige National Quality Award. AtlantiCare (NJ) and Healthland Health (MO) were both winners in the healthcare category.

The California Nurses Association, the MA Nurses Association, and some members of the United American Nurses combine to form National Nurses United. The new entity represents over 100,000 nurses.

Actuaries calculate that West Virginia could save over $1.1 billion by going digital and centralizing patient care. Savings would be seen by the government as well as private insurers and policy holders. The low-hanging fruit includes e-prescribing (estimated savings of $164 million), EMR ($317 million savings), and the creation of medical homes.

Thanks for the very sweet reader who sent Mr. H and me our own personalized Christmas ornament. I’m glad Mrs. H never reads HIStalk, just in case she happens to be the jealous type.

First, Congress considered taxing cosmetic surgeries. Now they are looking at tanning services. Seriously, what do those folks in Washington have against a little beauty enhancement? Will makeup be next? Or, heaven forbid(!), pumps?

E-mail Inga.

QuadraMed To Be Acquired by Francisco Partners

QuadraMed announced this morning that it has agreed to be acquired by Francisco Partners, a private equity firm, in an all-cash deal valued at $126 million. Shareholder approval is expected in the first quarter of 2010.

”Francisco Partners brings to QuadraMed extensive resources, expertise and a proven track record of helping healthcare technology companies sharpen their strategy and operational execution. Operating as a private company will also allow us to place more emphasis on generating long-term value for our clients with less distraction on short-term results for the public markets,” said Duncan James, QuadraMed president and CEO.

Francisco Partners partner Ezra Perlman was quoted as saying, “We are excited to become part of QuadraMed’s future success with this acquisition. We understand the critical role technology plays to drive quality care and to make healthcare more efficient. QuadraMed has a quality set of products, an extensive customer base, and a solid market position. We look forward to supporting Duncan and the Company’s management team as we go forward together to create long-term value for the Company’s customers, employees, and stakeholders.”

Other healthcare IT investments of Francisco Partners include API Healthcare, AdvancedMD, and Healthland.

The $8.50 acquisition price represents a 32% premium to yesterday’s $6.41 market close price of common shares.

HIStalk Interviews George Huntzinger

George Huntzinger is CEO and partner of The Huntzinger Management Group.

You’ve been in the business a long time. Tell me what lessons you’ve learned that newcomers would benefit from hearing.

The consulting business is really an interesting business. I’ve been in it since … I’m going to say 1984. Actually, it was probably before that because we did consulting at one of the software companies I ran prior to that. But it’s not an easy thing to do. A lot of people go out and try and start consulting companies from scratch. They do it with minimal experience and they find out right away that there’s a real science to doing this.

I think it takes people with some good experience who have had the opportunity to work for large organizations and have been successful at what they’ve been doing before. Who have had a good track record and mentors and people that have coached them along through the whole process. Who have experienced all the various things that you can conceivably experience in virtually growing and building a consulting business that is servicing whatever market or markets they choose to serve.

I guess the key thing is experience. It’s having been there, done that, and having enough experience to know that when you’re going at something, you know when to stop investing when you hit something that isn’t worth investing in, and knowing where to accelerate investing when it makes sense to crank up the burner a little bit from a financial perspective. To go at something hard and go at it hard in the right markets, and usually come out on top of that — if you read it right.

People start up their own small consulting outfits because they need a job or just wanted to work for themselves. How many of those succeed? What does it take to make a real firm out of it and not just a few people selling time?

What I think is really interesting is the world’s kind of a funny place and there’s space in it for everyone, so to speak. We have employees today that only want to be employees and never want to do anything. They’re very good consultants. They enjoy doing what they do and they never want to aspire beyond being the best consultant that they can be and they always want to be employees.

Then there’s other folks that we bring into solutions that we’re providing to our clients and they come in as subcontractors, so they single-shingle it. There’s some people that single-shingle it, but don’t want to be anything more than just that. I guess they want the freedom of being an independent. They want to be able to move around, and they want to be able to operate solely as a business as a sole-proprietor. 

You’ll find a tremendous amount of consultants out there that fall into that category. They’re not really interested in doing much beyond that other than taking on an engagement or two that might require one or two of their buddies to come into it that they know, to help them to fulfill something they can’t fulfill by themselves. I can name twenty people in that category today that just, are satisfied doing that.

What would be the advantages or disadvantages of a really small, maybe even a one-person shop, versus a real ongoing concern?

I think a lot of it has to do with freedom. As an employee, you’re wrapped up in all the controls that are put on you as an employee. So you’ve got your vacation limitation, you have your personal day limitation, you’ve got whatever benefits that people are putting in front of you — they’re the benefits you get. It’s the package that you’re buying.

You’re also buying security when you’re part of that, so that’s a really nice plan for people who also need people to be around them to prosper and grow. They’re not as independent in their thinking, whereas when you walk on the — I’ll call it the subcontractor or independent consultant — side of the fence, where they’re a small business unto themselves, they have basically ultimate freedom. They can buy whatever benefit package they want to buy. They can spend as much or little on it as they want. They can take as much vacation as they want to take. They can work on a project, then take a month off if they want to.

There are freedoms there that you have, but yet still get to work on projects with people and do things and interact and interplay with various resources. You know, fulfill that side of the needs in your life.

Should a customer care about if somebody makes a pitch and says, “Hey, it’s just me and I’m hands-on and you get me and not somebody else. I’m cheaper by the hour”?

It all depends on what the customer is buying. It’s a good question. Our business, we’re not a staff augmentation company, so that’s not where our head is today. I’ll just speak by way of example. We’re an advisory and management services company, where we assume full accountability and responsibility for either running a given function or running a given project or function. We’re taking on that role. Whenever you take on that role, they want somebody who’s really committed and there, and has a little depth behind the organization.

Because when you put that transaction together, there’s usually a little bit of risk that you’ll take and put some deliverables at stake. Some risk for meeting certain deadlines or making certain deliverables happen, or achieving certain goals that you lay out in your contract. They’re going to want some meat around that when they contract with you. That’s usually not a good environment for an independent, sole practitioner to flow into.

They’ll usually contract with the Huntzinger Management Group for a project that takes on and maybe requires six or seven resources to be deployed because you’re assuming full responsibility for accomplishing whatever it is they want you to accomplish. In that, you may bring in four employees and two subcontractors, but the Huntzinger Management Group is 100% at risk for doing that. The client is more willing to sign up with an organization who does that for a living, whereas an individual usually fills a staff aug spot.

Or, if they’re a project manager, they’ll usually not take on a key leadership role as a project manager. They’ll be a project manager as part of a team. There might be seven or eight project managers onboard along with a project director that oversees everything. It’s very hard for an individual to take on full accountability and responsibility for a given thing because they don’t have total control of it.

Do you think the cycle will ever end where consulting firms sell out to bigger companies, then bring back most of the people to form another consulting company?

You know, everything has a life cycle, doesn’t it? What we’ve experienced in the 20-25 years that I’ve been running consulting or running businesses … I spent a good portion of my career at Computer Sciences Corporation and I ran their healthcare business for 14 years. When we started there it was $10 million, when we left there was close to $400 million, so it was a nice run.

You saw Superior grow and prosper. You saw First Consulting and Healthlink or IMT Healthlink kind of grow and prosper, and then all get absorbed into these larger corporations. It’s interesting because a lot of the larger corporations create an environment that … they’re great companies, they’re great organizations, but for whatever the reason, it’s hard for certain consultants to grow and prosper in that environment.

It is not the same $100 million or $150-$250 million company that they were working in before, where it’s a little bit more family-oriented, less bureaucratic. There’s not this big umbrella of policies, procedures, and regimentation that lays over the top of it. They’re accustomed to having a little bit more of a free-form environment.

So these big organizations bottom and the next thing you know, it doesn’t work for a few very talented people. They spin off and go and start it over, as you see in the market today.

I don’t know how many new starts are out there today. We’re one of them. There’s a lot of people that go at it from different angles, but there are a lot of companies under $30 million today that are forming again. They’ll go through their cycle where next year, a few of them will consolidate. The year after, a few more consolidate, and then maybe they’ll get bought by the bigger guys again, whoever is there at that time.

You do business consulting for healthcare IT vendors. What kinds of trends are you seeing there?

We do business consulting on two fronts. We serve the supply side of the market and for the most part, it’s 99% healthcare. And when I say the supply side, I’m talking about those organizations that sell solutions or services to healthcare providers or payers. They come in the form of software companies, IT outsourcing companies, business process outsourcing companies, and even various forms of consulting companies.

There’s all different types of consulting companies. They all have a different set of needs than the provider side, so our strategy is a two-legged strategy. The first leg is selling to the supply side of the equation. I’ll talk about what we do there. The second leg is selling primarily to the provider side, the hospitals and health systems, and I’ll cover that in just a second.

But on the supply side, what their needs are: they are businesses that are trying to grow in their own discipline. They’re attempting to serve a client base. They have all the needs that a business has, in that they have to have a good business strategy, good marketing strategy, a good positioning strategy. They need an operating model that is efficient and effective. What we do for those organizations is help them improve their shareholder value or the overall value that they bring to, if it’s a not-for-profit, whoever the organization is that they’re serving.

We do business strategy, marketing strategy, operations analysis, and improvement work. We usually start out with various forms of assessments, whether it’s a business assessment or a functional assessment. We’ve done a number of those over the last couple of years for this. In fact, probably 50% of my client base today are suppliers to healthcare provider or payer sector. Our job is to help them become more effective and efficient in how they go at their particular market or niche.

On the provider side, for the most part, we concentrate on IT. As I said, we’re an advisory and management services company;  we’re not a staff augmentation business. We’re pretty high level in the IT organization. We do not have any barriers around size of organization, so we serve, I’ll say, not-for-profit organizations, $100 million not-for-profit hospitals to $2.5-billion large academic medical centers. We do everything from IT assessments, IT strategy, IT operations improvement work. We will take on the responsibility for running various functions within IT. We will also do, when I say take on the responsibility, also for projects. Everything from doing full selections or contract negotiation to overseeing the implementation of the solution we selected.

I have readers who run small startups. What needs do those small companies have and what mistakes do they make?

It’s rather interesting. There are a lot of software companies servicing the healthcare market today that are less than $10 million in revenue. They usually come out in the market with a solution. They’ve got a technology-based solution. They’ve got a couple of engineers that figured out how to build something that they’re taking to the market. There’s usually a need for it and they line up several customers. They start getting some traction, but they’re doing it in such a way that it’s kind of a shoestring approach to starting a business. They’re not necessarily capitalized very well.

So they got going, they’ve got traction, and they did it not necessarily in the most optimum manner. Now it’s how do I take the solution set that I have today and really blow it out? If it has national market opportunity and maybe they’ve got a couple million dollars worth of business, they have five clients, and you take a look at that. You do an assessment of their business and you find out that wow, these folks have built a great solution. But what they lack is how to take that solution in a grand way and really get exponential growth, how to take them from $2 million to $15 million in an 18-month period.

What we help them do is think through their business strategy, their marketing strategy. The marketing strategy includes how they effectively position themselves in the market, how they go after competition effectively, what’s the proper pricing strategy for their solution set. What’s the best way to increase the awareness and consideration of the buying population out there so that they get a fair hit rate and get that accelerated growth curve going?

That’s what we do and that’s one of the biggest problems that I think are confronting these smaller companies. We help them think through that and we will actually develop the tactical plans necessary to take them from their current state to that future state. They want us to oversee it in either a mentoring role or take on the responsibility as a senior executive of their organization to see it through. We’ve done that numerous times and we’ll do it again.

You’ve seen a lot of people and a lot of companies in the industry. What companies and people in healthcare IT do you admire?

I have been in this industry a long time, since 1969. I worked for and spent a good number of years at Geisinger Medical Center and spent 14 years of my formative years at Geisinger. I have a tremendous amount of respect for that organization. I like their model. They’re modeled after Mayo, but they’ve kind of went beyond that and they have their own model today. There are some people there, I’m not going to name them all, but there’s some people I’ve learned an awful lot from and a few of them are still there. I really have a great deal of respect for that organization.

When I did a long span, a 14-year span at CSC, Van Honeycutt, who was my boss for quite a few years , ended up being the CEO and chairman of the board there. I just learned a tremendous amount about how to run a business there and run it through thick and thin and have always been successful at running businesses in good and bad times. I attribute that an awful lot to not just Van, but a number of other executives that I had the opportunity to work with at Computer Sciences Corporation.

Rich Helppie and myself worked real closely together at Superior. I think we learned a lot from each other and we learned how to basically take that business and get it turned around and repositioned and take it forward. Whether it’s Rich or a couple of the partners that I work with today, I have a tremendous amount of respect for, and that’s why they’re my partners today. They are what made Superior successful as we came out of the turn there and began building not only a consulting business, but a really nice IT outsourcing and recurring revenue stream that we later sold to ACS. I can go on and name a hundred people, but I always learn from the people around me and hopefully they learn a little bit from me.

Any final thoughts?

My goodness, I just want to say thanks for the opportunity to have this interview today. I greatly, greatly appreciate that.

I just really and truly enjoy serving the healthcare sector. I’ve been in it all my life and I just thought it would be a lot of fun cranking an organization up on our own. We have four very good partners. I should probably take myself out of that category. I have three terrific partners, and we all have been there, done that kind of people. We’ve all run various businesses or parts of businesses and we’re very good at what we do and we’re all just having a ball doing this.

Monday Morning Update 12/7/09

From Interesting: “Re: Courtyard Group. Encore Health Resources (Dana Sellers and Ivo Nelson’s latest company) is in detailed talks and due diligence to merge with or acquire Courtyard Group. Courtyard Group recently had a large layoff because of decreased sales due to the ‘trouble’ they got into in Canada.” All unverified. I e-mailed Ivo, but haven’t heard back.

From Scritti Politti: “Re: Cerner in the UK. The editor of E-Health Insider likes their recent go-lives and UPMC’s involvement.” It’s hard to tell whether early problems really were Millennium or the terms under which NHS decided to implement it. As in Australia, a lot of the issues seemed to be related to localization, local support, and how the government wrote the contract and the implementation plan. I’m thinking it’s the Gartner Hype Cycle – NHS promised a lot, struggled early, and looked like a disaster, but the individual trusts doing their own thing with either Cerner or iSoft seem to slowly be coming up the curve and making good progress. Big government IT projects (including here) usually flop, which is why the VA’s VistA is even more remarkable (although the fat cat contractors weren’t involved early enough to mess it up – that came later).

From Todd Johnson: “Re: Stephen Hau interview and Shareable Ink. Stephen is absolutely correct. 100% physician adoption is the keystone to successful implementations, and you can only achieve that by enabling the physician’s natural workflow. Since the next wave on the path to Stage 6 EMR adoption is electronic physician documentation, vendors are turning their attentions toward how to efficiently capture notes. In my view, there are three critical success factors. (1) Systems must provide the speed of dictation or paper with the value of exchanging and analyzing structured information. (2) Physicians must have the freedom and flexibility to enter information in a way that is convenient for them as individuals. In the ED, a tablet PC might be most effective, while in a surgical setting, dictation is more logical.  Residents, the next generation, demand typing. (3) Revenue capture must be a byproduct to provide strong financial incentive for both the hospital and physician practice. Ultimately, you risk achieving 100% physician adoption if any one of these areas fail.” Todd is the president and co-founder of Salar, Inc.

From Former Bruin: “Re: UCLA Medical Center. Please confirm the rumor that UCLA Medical Center is looking to replace ClinicComp Essentris. I heard they are going through a selection process.” I e-mailed CIO Virginia McFerran, but she hasn’t responded. I’ll let you know if she does.

From Timber Roller: “Re: Epic. Are they changing their technology? They have a job posted for server systems that asks for experience with Linux, Oracle, or Microsoft SQL.” I hadn’t heard that, although maybe that’s for MyChart or portal stuff. It doesn’t sound specific enough to make me think they are abandoning Cache and MUMPS, but I’ll allow others to chime in.

From Maxwell Hammer: “Re: TIPAAA conference. I read this review of the lead speaker. That last line got to me.” Here’s the quote, source unknown and excerpted somewhat:

I was most troubled by the first part of the TIPAAA conference, which was a presentation by a VP from [vendor name omitted]. His job right now is to meet with hospitals, IPAs, HMOs, etc. … His basic pitch is that the money is there and you should help your physicians take advantage of it. The easiest way to do this is to buy them an EHR (using the Stark Law exemption), and then have them sign their ARRA money over to the hospital …Whenever someone questioned any of ideas, he would respond that they were just afraid of using an EHR and that they needed to embrace the changes and move forward … What drove me crazy was that the veneer was rather thin and that the entire pitch was about money; not about health care, improving quality, or doing a better job.

From Bernie Tupperman: “Re: Kaiser. This week’s e-mail from CEO George Halvorson outlines making chlamydia detection a priority.” Here’s an e-mail snip. I’ll say this — he’s the best, most easily understood writer/teacher I’ve seen in a CEO chair (I joked with Bernie once that surely the marketing people ghost-write his stuff and he says George really writes like this).

Early detection requires a care system that cares enough about women patients to make chlamydia testing and detection both a priority and an active agenda. That would be us … We know how well we are doing relative to the rest of America. We have the best scores … Our electronic medical record gives us an incredibly useful tool so we know who has and who has not had their tests. Combining our commitment to helping women detect and cure the disease with our systematic support of women’s care put us in a position where we do a better job then almost anyone on chlamydia detection … Smart people need to do smart things in a consistent way to get our care teams to those levels of success. Congratulations to our caregivers who care enough to make a difference in so many women’s lives.

You may have noticed a theme that several of the people we contacted to confirm rumors this time around didn’t respond. That happens pretty often, so even when we don’t mention that we tried and failed, it happens. Inga is good at chasing down stories, but sometimes our contacts are out of the office or don’t get back to us. As an example, she e-mailed someone at HIMSS to ask about expense reimbursement and/or honoraria for annual conference keynote speakers (since a reader wanted to know whether David Blumenthal’s expenses will be paid by taxpayers or HIMSS) but hasn’t heard back yet.

IT has improved patient safety nationally, 61% of reader respondents said. New poll to your right: what are your plans for the HIMSS annual conference in March?

Students in a University of Saskatchewan iPhone developer program design a physician diagnosis reference, although they are hamstrung a bit because of copyright issues with the AMA data that powers it.

Listening: the Hairspray soundtrack. I might be the only straight guy who likes the remake, singing along badly to Good Morning, Baltimore and I Can Hear the Bells. I’m also desk-drumming to Southern Culture on the Skids, reader-recommended surfabilly from Chapel Hill, NC, and more to my usual tastes, Brit rockers Travis.

Quantros and Allscripts integrate their respective products to create a Web-based care management solution.

An interesting problem: if 40 million people suddenly get health insurance, rural areas don’t have nearly enough primary care doctors to see them. The reason is obvious: the doctors go into specialties and geographic areas where the pay is better.

The economic planning committee of Taiwan, whose EMR usage is at 95% in hospitals and 56% in clinics, says it hopes to hit 100% within five years.

ONCHIT reorganizes, with five offices reporting to David Blumenthal: Economic Modeling and Analysis, Chief Scientist, Deputy National Coordinator for Programs and Policy, Deputy National Coordinator for Operations, and Chief Privacy Officer. The CPO will be appointed by HHS Secretary  Sebelius. 

Welcome and thanks to Philips, a new HIStalk Gold Sponsor. Talk to them about their fee-per-study iSite PACS replacement program, which lets you affordably move off your outdated, clunker PACS to a shiny new one. You can also check out what’s new, fresh off their RSNA announcements. Thanks to Philips for helping power HIStalk.

Michael Simpson’s deal as SVP of QuadraMed: $330K base, up to 50% bonus, 90,000 stock options, $50K relocation, expense account, $3,000 per month temporary housing, guaranteed 12 months’ severance plus regular bonus unless terminated for cause, and a year’s health coverage.

Shares in athenahealth hit a two-year high Friday afternoon after the company stated expectations of annual revenue growth (30%) and profits (40%) through 2014.

Bizarre: a UK student, unable to contact a female acquaintance on whom he has a crush, leaps to the conclusion that she has died. He buys an axe, breaks into the morgue of the local hospital, and spends 90 minutes inspecting documents, computer records, and bodies, all on Valentine’s Day this year. The judge orders him to get medical help.

E-mail me.

News 12/4/09

From Not Yet: “Re: contract gag clauses. Showcase Cerner site Homerton University Hospital NHS Foundation Trust rejects FOI requests.” The hospital declines to provide information to a journalist, claiming that “our contract with Cerner includes a confidentiality clause and as such disclosure of the information could give rise to an actionable breach of confidence.” Cerner wouldn’t sue if the hospital wanted to gush superlatives, so I’d guess that’s not what the records show.

From HITGradStudent: “Re: Health IT Facts. Is it any surprise that someone has hopped on the Chuck Norris bandwagon with HIT? Both a blog and a Twitter feed. Could use some HIStalk-style snark, though.” I’ll give it credit for being terse. The most recent post is pretty funny: “There is no we in Health IT. There is an I.”

National eHealth Collaborative (aka “AHIC Successor”, which advises HHS) is accepting nominations for its four board vacancies.

HHS will issue $235 million worth of HIT grants in early 2010 through the Beacon Community Program, which David Blumenthal calls a “proving ground for meaningful use of EHRs and health information exchange.” It seems like the decision has already been made to dump billions of taxpayer dollars at the feet of EMR vendors regardless of past history, so it’s a bit late to figure out how to make them work by plowing more money into areas with high EMR use. That’s just my opinion as one of a tiny minority of taxpayers who don’t believe that wild government overspending is the right way to encourage a “healthy” economy (since we’ve been doing that for years and it failed). Do you get the feeling that HHS and the rest of the ‘crats just can’t shovel the money out the door fast enough to keep the economic bear dancing? Anyway, you can leave a comment on DB’s blog if you like.

William Young, formerly CIO at Ellis Hospital (NY), is named CIO at Berkshire Health Systems (MA).

Patient Privacy Rights publishes its PHR Report Card. It’s not obvious, but if you click the vendor name on that page, there’s a lot of detail behind each. No More Clipboard gets an A, while everybody else sucks.

HIStalk readership always slows down in November and December since people are off for the holidays, but this past month was good: 70,680 visits and 93,300 page views, up 28.5% compared to last November.

A reader said to check this page for Siemens jobs since they aren’t listed on the Siemens site. He got a response from a Siemens recruiter from applying there.

Ireland stops its test of cell phone-blocking technology to prevent the smuggling of contraband into its prisons. The technology worked too well, knocking out cell phones at the hospital across the street.

Please join me in welcoming BridgeHead Software to HIStalk as a new Platinum Sponsor. Their tagline is “Enabling the EHR” and they offer enterprise data backup solutions used by over 450 customers. It provides a fully indexed, searchable information store (pretty darned cool that you can do business intelligence on a backup). They also offer a vendor-neutral PACS archiving solution, which could be crucial if all the folks in that recent survey really will be replacing their PACS and will need to migrate images. If you’re a Meditech user, their BH FileStore for scanning and archiving might catch your eye. White papers are here. Many thanks to BridgeHead Software for supporting HIStalk.

CHIME and AHA give their Transformational Leadership Award to BayCare Health System (FL) and CIO Lindsey Jarrell for their Cerner implementation.

A nice sale for Medsphere: 222-bed Kern Medical Center (CA) will implement OpenVista.

Carolinas HealthCare System chooses Omnicell’s automated dispensing cabinets.

Someone must be reading HIStalk for the Kindle. I got paid $12.30 for five months’ of subscription sales. I’m pretty sure the groupies will be along any day now.

New Hanover Regional Medical Center (NC) CIO Avery Cloud gets a nice picture in a local newspaper’s article about the group exercise program of the hospital’s senior management team.

Strong Hospital (NY) announces its EMR project, with HITECH covering $8 million of its $49 million cost. You will never guess what they bought — Epic! (irony intended — sometimes it seems a though Epic is getting every sale in hospitals of over 400 beds).

Sheikh Khalifa Medical City (United Arab Emirates) is starting the second phase of its Cerner implementation. ADT, HIM, pharmacy, and radiology are live, with CPOE, clindoc, lab, surgery, and ED coming up next.

What a brilliant video by Providence St. Vincent Medical Center (OR) — the Pink Glove Dance for Breast Cancer Awareness. Nurses, techs, doctors — everybody got in there and did a phenomenal job. Did I say it’s brilliant? I’m a crass cynic, but I admit I misted up a little. Everything I love about working in hospitals is right there. It’s not just me — it has nearly 3 million YouTube views and nearly 5,000 comments. A portion of the sales of the Medline gloves that are pictured will go toward providing mammograms for uninsured women. Thanks to Ann Farrell for sending the link.

Sounds like a pretty good job: Allscripts is looking for a Director, Education Development and Technology in Raleigh.

Speaking of jobs: Lead Business Intelligence Developer, Electronic Health Record Project Manager, Epic Project Managers.

A reader sent over a link to a treasure trove of online SMS memorabilia. Yes, industry sprouts, there was HIT before Epic and Cerner.

UAB says it has saved 93,000 nursing hours by using Cerner’s CareAware medical device bus to connect devices to the EMR. Retroactive vital signs charting time was reduced by 97% and patient-to-device association logging time was cut by 89%.

A Toronto doctor and professor creates a physician shift calendar application, allowing docs to trade off coverage with “the eBay of physician scheduling.” DocRoster is used by 2,000 physicians and Rosterware just got new capital sources and a board of advisors.

Driscoll Children’s (TX) chooses the CAREt System bedside medication administration system from PatientSafe Solutions. Never heard of it, but I think it’s some kind of successor to IntelliDOT. The CEO was chairman and CEO of Bridge Medical and founded Caremark before hooking up with this company in April. 

Massachusetts HIT companies are hiring in anticipation of ARRA: InterSystems (200 employees), Sentillion (25-30), and Picis (80 this year).

The head of GE Healthcare’s imaging division says the US market has bottomed out and he expects 2010 to be flat at worst.

Siemens, on the other hand, just reported a Q4 loss and says 2010 will be “challenging”. But, that’s for the whole German conglomerate, not just healthcare.

In Australia, iSoft acquires Patient Safety International, which sells an adverse event management system for hospitals.

Strange: Health Sciences, which publishes a health and wellness magazine, retires 2 billion shares of stock (current price: $0.0010, or a tenth of a penny). It’s latest health endeavor: growing marijuana for California’s phony medical use dispensaries, choosing as its research partner Greenway University, “formed to provide the highest quality training and education for the  medical marijuana/ cannabis industry.”

The good news for the hospital in which a patient’s watch was stolen while he sat unattended in the empty ED waiting room: video suggests that he had been dead 39 minutes before he was robbed. The bad news: ED staff didn’t notice he was dead until 50 minutes after that. It was the hospital’s second ED waiting room death, the first being a 33-year-old woman who died without being seen two years ago.

E-mail me.

HERtalk by Inga

From George Emerson” “Re: Meditech building. Here’s a picture of the view from the inside (taken during construction). Not bad, huh?” I’ll say. The view has got to be one heck of recruiting tool.

From Jimmy Chew: “Re: female healthcare bloggers. You should have been on this list!” Thank you Jimmy (and of course my mom) for suggesting I should have made the “Five Fierce Female Healthcare Bloggers to Watch” list. I was disappointed that Barbara Duck of The Medical Quack wasn’t named because I like her stuff. In any case, as long as I remain Mr. H’s favorite blogger, then life is good.

Butler Health System (PA) picks the PatientKeeper Platform and Physician Portal to improve physician documentation and workflow.

Washington Radiology Associates (VA) selects AMICAS PACS. The 26-physician group already uses several AMICAS products, including RIS and Financials.

TelaDoc Medical Services, a provider of telehealth medical consults, secures $9 million in funding to expand its operations.

The folks at Intellect Resources sent us this link to their new IRBeat podcast, a 40-minute overview of the HITECH act. For someone needing to learn the basics — particularly if you are involved in the ambulatory world — the content is very good: logically discussed, knowledgeable speakers, and good questions (“Eileen” is the moderator and she has an Irish accent, which of course makes the whole thing sound classier).

CIOs are concerned about their ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines. That’s the conclusion from CHIME, following a recent survey of its members. Two-thirds of the 176 CIOs participating in the survey said they were at least somewhat worried about their ability to implement standards-based applications. Respondents fear that IT application vendors won’t be ready to offer products in time and are worried by the need to implement upgraded or new systems. Other concerns include lack of funds and insufficient staff.

Hospira acquires hospital surveillance software developer TheraDoc for an undisclosed sum. In 2006, UPMC was TheraDoc’s biggest institutional investor, but UPMC’s ownership stake at the sale of the deal was not known.

GetWellNetwork announces a number of new hospitals clients and contract expansions, including with Loma Linda University Heart and Surgical Hospital and Thomas Jefferson University Hospitals.

Scott & White Healthcare (TX) engages Beacon Partners to assist in its $12 million, 15-month GE Centricity revenue cycle implementation.

The 250-bed Liberty Hospital (MO) successfully implements Eclipsys Sunrise Enterprise, including CPOE activation.

Alan Dowling, PhD, is named CEO for AHIMA, taking over for the retiring Linda Kloss. Dowling is an adjunct professor of information systems at Case Western Reserve University and earned a PhD in healthcare management and management information systems from MIT.

QuadraMed hires Michael J. Simpson as its senior VP for product strategy and development. Simpson comes from McKesson, where he served as senior VP and CTO for McKesson Provider Technologies. Last year a reader tipped us off after Simpson was removed as GM over Horizon Clinicals and moved to the UK to serve as CTO of the International Operations Group. Simpson is the second executive to come over from McKesson in the last month; QuadraMed recently announced the hiring of Michael Jarrett as VP of client services.

Hayes Management Consulting announces that more than 50,000 providers are now using its MDaudit Professional compliance audit software.

EDIMS names A. J. Sultan director of technology.

Send holiday jingles.

HIStalk Interviews Stephen Hau

Stephen Hau is President and CEO of Shareable Ink.

Everyone on your management team comes from PatientKeeper, a company that created a niche in the mobile healthcare technology. What’s similar and not similar with Shareable Ink?

That’s a great question. Shareable Ink is a very different company than PatientKeeper. When you take a look at the management team, as you pointed out, there are a lot of people who crossed paths at PatientKeeper. That’s because I spent twelve years at PatientKeeper.

As you know, I started the company and just left that six months ago. As I looked to start another company, I went out and thought of the people that I worked with in the past that would be good in a launching a new venture. Of course, I went to a lot of people that I crossed paths with at PatientKeeper.

What’s similar and not similar between the two companies and products?

I would say Shareable Ink represents a very different approach to healthcare IT. Shareable Ink is also a software company, but we combine digital pen and paper technology and some sophisticated enterprise software, form automation capabilities, and actually, a huge dose of pragmatism to deliver a very meaningful solution in healthcare.

As I look at the marketplace, I think the reality is that more than 80% of healthcare is still driven by paper. Shareable Ink makes existing paper-based processes like documentation, orders, and billing electronic with no change to workflows or individual routines. In fact, with Shareable Ink, no software is installed on-site, so we’re not “another IT project.” Actually, no training is required and we receive almost no support calls.

The result is that we’ve demonstrated 100% physician adoption and the entire organization realizes the benefits of electronic information. This is a different approach and it’s something to get really excited about.

Think about this: every year at HIMSS, what you see is vendors put up signage proclaiming that their products will reduce costs and generate phenomenal ROIs, improve outcomes and more. I believe that. But I kind of feel like there’s fine print or at least an asterisk that says, “All these benefits are only possible if doctors actually use the software.”

The industry’s dirty little secret is that physician adoption of IT is abysmal. And surely there are a lot of bad software products out there and doctors refuse to use them, but there are also a lot of robust, well-designed software products out there. Sadly, generally, they’re not well adopted.

We considered all of this when we started this new company, Shareable Ink. It’s my opinion that the issue is really not that of technology, it’s actually really about psychology. I think there are a lot of well-intentioned software designers out there that are tackling some of healthcare’s big challenges, and that’s great. The problem is that historically, they ask the doctors to completely change their workflow. And as I said, we took a very different approach. We’ve created a platform that produces electronic information without changing physician’s routines at all.

So much of the benefit of moving from paper to computers is to avoid illegible handwriting and to get information in discrete form rather than as a picture. Isn’t digitizing handwriting a step backwards?

I don’t think so. I think we’re taking a very pragmatic approach here. I can give you an example of our first large customer, which is an outsourced anesthesia billing company located in Michigan. They’ve got over 8,000 anesthesiologists under contract. Before Shareable Ink, these anesthesiologists would record their cases on paper anesthesia records. Some of the anesthesiologists would wait until the end of the month to FedEx these records to the billing service, where the envelope would be opened and the anesthesia records would come out. A human being, a biller or a data entry person, would actually key-enter all that information.

Other anesthesiologists would deliver the anesthesia records to someone in the back office that would essentially put the anesthesia record in a queue to keyed in. When the records finally reached the folks in Michigan or over to their overseas FTEs, often it would be too late to update incomplete forms or incorrect records because basically you have to chase down the anesthesiologist and say, “Hey, remember that case you did three weeks ago? Well, when was the anesthesia end time?”

With our system, the record is made available to the back office, literally, a few seconds after you complete the record. The paper form looks exactly like the forms the doctors used before we introduced our system. There’s literally no training whatsoever. But now, the records are processed immediately by the back office because information is available on our secure Web site — our Web portal — and the doctors are notified of any sort of errors they made in the anesthesia record within seconds after the form completion.

We did a study at a surgery center in Delaware. We were able to show they were able to improve form completion rates from 78% to 99%. Is this a step backwards? I would say no. I mean, what we were able to do, we were able to reduce a tremendous amount of re-work. We were able to, for this particular example, shorten AR days and vastly, vastly improve physician satisfaction.

What’s the benefit of offering a handwriting application as a software as a service instead of running it on a consumer-grade Windows application like Microsoft and others offer?

In my personal opinion, software as a service is hugely applicable to healthcare IT, so there are a few notable benefits. First of all, because we don’t have to install any software on-site, we’re not another healthcare IT project. This allows us to move very, very quickly. That’s definitely because our technology is off-site. We’re able to bring a lot of fire power, a lot of computationally-intensive functions to our technology.

As an example, rules and alerts, as I mentioned before, physicians, when they fill out a form and it lacks a key piece of information, perhaps related to some sort of PQRI initiative, we can send them an SMS message to their pager and e-mail, what have you, instantaneously, because all our capability is on the Internet.

Also, it makes it very easy for us to automate forms. One of the challenges out there, or course, is there’s a lot of paper. That’s both the opportunity and the challenge. Part of our philosophy here is that we don’t want to change anything a physician does, so we make it very easy to customize or utilize numerous different types of existing forms that an organization normally might have.

Separately, we provide the ability for so-called ‘third-party validators.’ I can give you a few examples. We talked about the outsourced anesthesia billing company, where they’ve got billers and clinical folks both here, stateside in the United States as well as overseas in India, in that example. The fact that anyone on the planet can help get involved in processing the data is a huge benefit to our customers because it allows them to keep costs low and also to operate on a 24×7 basis.

We are working with a very prestigious cancer center and they are doing drug orders using our system. The interesting background there is that those physicians, about a year ago, tried to bring in an electronic system to handle the orders of their oncology drugs. It’s a great idea, but in practice, it was such a change in workflow that the physician productivity just plummeted. It turned out that in practice, it just wasn’t a system that worked well for them.

What we’re doing with them now is we’re essentially taking the paper ordering forms that they’re using today and we’re making them electronic. The physician, essentially, does nothing different. They’re still ordering drugs through their existing processes, but because of the ability to support a third-party validator, the person in the pharmacy department is now validates the data and then takes the next step, which is to electronically submit the physician’s information into the electronic ordering system where all the rules fire and all the good things about having electronic information occur. These are some of the benefits of being able to have a software as a service model.

How does Shareable Ink work with existing applications like an EMR?

We have, behind the scenes, a tremendous amount of integration capability. Some of our customers can actually start before using the integration capability because at the end of the day, we know that by automating paper-based processes, we can co-exist with existing processes. There are other customers where it makes sense to have the integration capability in place before getting started.

I can give you some examples where, in fact, we are working with EMR companies to provide their customers a paper-based modality to get information into their EMR. I think when you sit across the table from a CEO of an EMR company, he or she will tell you that of course there’s a huge value proposition for going electronic.

But the challenge is still trying to get physicians to put fingers on keyboards. There’s a longstanding paradox in healthcare, which is — institutions want digital data, but physicians, who are the highest-paid workers in the organization, don’t want to compromise their productivity by having to key-enter data into computer systems. What we’re offering customers on a direct basis, as well as with some EMR channel partners, is essentially the ability to bridge existing processes into electronic EMRs or EHRs.

Physicians who don’t want to type often look at speech recognition instead of a keyboard. Where does Shareable Ink fit then?

I think transcription is an interesting analogy. In some ways, there are physicians who have migrated to transcription. Dictation transcription’s a way of getting electronic data into back-end systems. Obviously, there are a lot of physicians who resist that, who essentially feel, “We’ll document on paper.” What we offer has both differences and similarities.

In terms of differences, because we’re utilizing often templated, form-based data entry, we have the ability of creating a better kind of structured information. Because, for example, we know that if a physician is entering, for example, allergies — in this particular area — our system is smart enough to say, OK, these are allergies. The system will now choose words from a more specific lexicon knowing that it’s going to be plugged in. Or perhaps drug names. Not only that, after we process the information, we’re able to then, in a structured basis, interface the electronic system saying that this is a list of allergies, or this is a list of drug names.

Some of the similarities … if you take a look at how the dictation/transcription business has evolved over the last few years, I think what we’ve observed is that that particular segment has brought more and more sophisticated computer-aided technologies to support or help the transcription process. eScription’s a great example, where they take the audio from the physician and then take advantage of voice-to-data technology to take advantage of sometimes semantic reasoning to improve the transcription process. I think the analogy is that we’re taking advantage of some very cool, cutting-edge technologies to assist us in the handwriting to electronic data conversion.

We also have the ability to take advantage of something called the Mechanical Turk approach. That’s a community model that allows us to essentially co-mingle computer-based computation with human beings. Not only that, we’re able to break down the problem by using multiple human beings to essentially support the handwriting-to-text conversion process.

One thing I forgot to mention about the SaaS model: one of the key benefits that we allow our customers is getting started with our software with very little cost to them up front. We charge for our product on a subscription basis, so this allows many customers to get started very quickly without any sort of up front capital purchase. That’s a key advantage of SaaS models, obviously.

So you’re selling a new concept as well as a new product. How do you get the message out?

Well, I hope this interview helps. [laughs)

It’s all about HIStalk.

Yes. Well, it’s interesting, because it’s a new concept and at the same time, it isn’t. I guess in some ways the new concept is: wouldn’t it be great to get all of this electronic information and actually realize all these value propositions that you’ve been hearing for quite some time without changing physician behavior? In that sense, it’s certainly a new concept. But at the same time, I think we’re addressing a lot of known healthcare issues and I think the timing couldn’t be better.

Look at the ARRA legislation. Look at the demands of organizations to go electronic. But at the same time, realize that they need to have a pragmatic approach that’s cost-effective, that they know the physicians will actually adopt and use. I think it’s a great time for the Shareable Ink idea, especially in this time with the government pressure to meaningfully use these EHRs. Well, clearly, I think our approach falls under that category.

What’s your elevator speech when you’re talking to the hospital CIO or CMIO or head of an anesthesia billing company?

I think the message is different. In some ways, we have a high-class problem here. I mean, reality is, as I said before, 80% of healthcare is written on paper. The high-class problem is that there are many, many different applications that we can provide. With some of the customers we’re working with, we are doing physician documentation projects. We are doing nursing documentation.

I mentioned that we’re doing orders and obviously, we’re doing these anesthesia records. There are many different applications. I think in some ways, the pitch is, often we share our capabilities as a seamless way to create electronic information with no change in workflow and with a very, very kind of easy way for an organization to get started. You start with that reality or if you start with that capability, and very quickly what happens is that the CEO of the organization says, “Oh gosh, you know, I’ve got a problem that you could solve with your approach.” This is something we can actually address and realize some success.

So the message is really one of, I think, very, very innovative technology. A lot of fire power that happens behind the scenes, but coupled with a very pragmatic approach to realize those benefits, there has to be virtually no change in workflow. It has to be something that addresses both not just the technology, but the psychology of the organization.

News 12/2/09

From Ex-Cerner Guy: “Re: FirstNet. I am loath to come to the defense of my ex-employer, but ED/ER applications feeding an EMR are notoriously difficult to successfully rollout. It’s the nature of the ED physician. He does not care about generating a record for the floor or medical records — he cares about triage / diagnosis / treatment / discharge-or-admit-floor, with those words quickly strung together. It’s about treatment and discharge. And cost does not enter the picture. Ever. We NEVER won a deal with FirstNet as the ‘entry’ product — it was an add-on or check-the-box application. Did they not look at any of the other vendors? There are so many good small shops making great product. $1M for a report writer for about 200 facilities seems like a pretty good deal, so that number might be off a bit.  If they really received Report Writer for all users and facilities for $1M, they need to ease up.”

From Clint Gristwood: “Re: HIPAA firings. What do you think the over/under is on HIPAA-related firings or reprimands at Health Central Hospital in Ocoee for unauthorized access to Tiger Woods’ medical records?” I think the odds that employees have already peeked are 100%. The odds they will be caught and/or disciplined is 20%, even though the hospital will be watching. It’s a 141-bed facility and I have slight familiarity with IT there, so I don’t know how sophisticated their systems are with regard to role-based security and access monitoring. The tabloids would pay big bucks for copies. The Florida Highway Patrol was considering asking Health Central for the records, but it sounds like they’ll just write Woods a $164 reckless driving ticket and be done with it (I’m pretty sure he can afford it). Imagine the eBay price for the golf club his wife was supposedly beating him and his car with.

From LE: “Re: Siemens. I applied for a job there six weeks ago and there were many US jobs listed, over 100 I’m sure. Now, mysteriously, there are only nine internships listed.”

From The PACS Designer: “Re: Windows Live Mail. With the release of Windows 7 comes a new way to access multiple e-mail accounts. Microsoft has announced the availability of Windows Live Mail, which can make you more productive while online.”

From Inside Outsider: “Re: two doors. I agree, but only because this is radiology we’re talking about. Now, if this practice ever gets pushed through to more emergency healthcare — the extreme example being the ER — then I might begin to disagree. Those that come in the common man’s door are not sacrificing their healthcare; they are sacrificing time and amenities. Let’s hope it doesn’t get to the point where Mr. Bigbucks gets priority in the ER and Mr. Littlepennies suffers grave consequences because of it.”

From Certifiable: “Re: stolen identity. Patient at St. Anthony Hospital (IN) had identity stolen. Got bills in the mail for phones shipped overseas, ordered via Sprint. Patient suspected hospital system, hospital would not talk to her until Sprint got involved.”

Thanks to Barbara, a former Sarasota Memorial Hospital employee who set me straight on the Eclipsys announcement that the 50 millionth order had been entered in Sunrise there. It’s true: SMH was not a TDS user and all 50 million orders were entered into Sunrise, which is pretty darned amazing (that’s around 12,500 orders per day for 11 years). I don’t know what made me agree with the reader’s TDS comment since I remember when SMH signed on originally.

HHS Secretary Sebelius and National Coordinator Blumenthal will announce some kind of new grant program (Beacon Community Cooperative Agreement Program) on Wednesday.

Weird News Andy likes this picture, the result of burned out light bulbs at a New York hospital’s ED. He also noticed this sad ED story, in which a school counselor waiting in a hospital ED’s waiting room was robbed by three homeless addicts there, dying of a heart attack immediately afterward without ever getting to see the triage nurse despite having waited for 80 minutes. Aria Health had no comment, but the whole event was captured on surveillance video. It seems like every horrifically negligent patient care issue in EDs and nursing homes is recorded on security cameras, making you wonder if maybe they shouldn’t pay someone to watch the monitor in real time.

How could this happen? A toddler in South Africa being treated for hand burns has her legs amputated by surgeons in the 1,100-bed academic medical center.

Andrew Watt, MD is named VP at Southern New Hampshire Medical Center. He was already CMIO, CIO, and an ED doctor and formerly worked on ED systems for Meditech.

Reminders: the HIStalk events calendar is here and you can add yours for free. Put your e-mail address in the Subscribe to Updates box at your right to join 4,924 people who have already done so and maybe become the five thousandth subscriber (signing up makes you eligible to vote in the HISsies awards, which I’m doing differently this year). Click the crude Rumor Report box in the right column to send me juicy news anonymously (it even takes attachments). Use the Search HIStalk box to the right to dig through 6.5 years worth of HIStalk (maybe I’ve mentioned you or your employer). That is all.

Wisconsin will spend federal stimulus money to create the an HIE, to be dragged from the womb sporting the obligatory painfully contrived acronym WIRED (Wisconsin Relay of Electronic Data) for Health. The governor is looking for nominations (warning: DOC) for its board and committees.

OntoMed, an Ann Arbor, MI startup, is talking to University of Michigan Health System about helping it validate its COSMOS PC-based bedside monitoring and alerting system for the ICU. Their conveniently cutesy product acronym is even lamer than WIRED – COmplexity-based Stability MOnitoring System.

It was fun running pictures of the SMS reunion. In fact, I really like using any pictures that people (rarely) send me: department pictures, data center shots, IT people in their natural habitat, doctors using computers (those are hard to get), and anything related to healthcare IT. Send them my way, please.

Newsweek runs an article extolling Cleveland Clinic’s methods, declaring it “The Hospital That Could Cure Health Care”. Epic is prominently mentioned, although not by name (except for MyChart). CEO Toby Cosgrove is lauded for not hiring smokers to work there and declaring he’d do the same for overweight candidates if federal discrimination laws allowed it. He doesn’t think healthcare reform will do much to reign in costs. Technologies mentioned: clinical decision support, a smart IV system being developed there, MyChart, home monitoring, and powerful data capabilities.

Welcome to Sage, a new Platinum Sponsor of both HIStalk Practice and HIStalk. The Tampa, FL company offers a variety of physician systems, including the Sage Intergy EHR, practice management solutions, Sage Intergy RIS and PACS, community health applications, analytics tools, and EDI services. The Sage Intergy EHR Kit includes ARRA information, access to an online demo of Sage Intergy EHR and Sage Intergy, a presentation covering EHR benefits, and a practice case study. Thanks to Sage for their much-appreciated support of HIStalk Practice and HIStalk.

AMI is looking for a CIO for a 200-bed hospital in Kuwait.

Nuance announces Version 4.0 of its Veriphy critical result management system.

An e-mail about H1N1 claiming to be from the CDC is actually the carrier for a different kind of virus, a PC Trojan. The e-mail urges the recipient to create a profile on the CDC’s Web site, which is actually a phishing site that downloads the Kryptik Trojan.

E-mail me.

HERtalk by Inga

CCHIT certifies four new products under the newest programs announced in October. ABELMed EHR-EMR/PM, Version 11 received certification under the CCHIT 2011 Comprehensive program, while eHealth Made EASY, KIS Track, and Medios earned Preliminary ARRA 2011 certification.

Here’s the difference between the two certifications: the Comprehensive certification program “provides a more rigorous inspection of integrated EHR functionality, interoperability, and security in addition to full compliance with Federal standards.” CCHIT also includes an inspection process in the Comprehensive program that considers successful use at live sites and good usability. Additional certification announcements are pending, per CCHIT. And OK, I admit it — I’ve never heard of any practices using any of these products.

Driscoll Children’s Hospital (TX) selects CAREt System by PatientSafe Solutions (IntelliDOT) for beside medication administration.

KLAS reports there is a “huge gap” in provider satisfaction scores for PACS software. In acute care, GE Centricity PACS-IW scored 23 points higher than the lowest performer, Cerner. Infinitt was the best-performing community PACS vendor and Intelerad led the ambulatory PACS vendors. At the top end of the market, almost nine percent of large hospitals plan to replace their PACS. KLAS predicts the vendors most likely to be replaced include Merge, Siemens, eRAD, and Emageon.

eClinical Works adds a couple of healthcare systems to its client list. Portage Health (MI) is providing the eCW software to its 31 employed physicians and will interface the application with the hospital’s Meditech system. Also, Johnson Memorial Hospital (IN) will offer eCW to its employed physicians and use eCW’s Electronic Health eXchange to allow access for other physicians and hospitals.

In yesterday’s HIStalkPractice, a reader shared that eCW was the “clear-cut winner” in Health Industry Insights’ recent review of the ambulatory EMR market.

MedQuist signs an agreement to license Nuance’s SpeechMagic speech recognition engine and processing software. MedQuist will use SpeechMagic in its SpeechQ for General Medicine, a front-end speech application for all medical specialties. MedQuist, which seems to be churning out press releases in conjunction with the RSNA meeting, also introduces SpeechQ VTB for Radiology, which integrates speech recognition, automated coding technology, and Web-based billing services. MedQuist has also integrated a radiology search tool from Primordial Design into its SpeechQ for Radiology application.

The architects that designed Meditech’s Fall River facilities win an award for their work. The New England chapter of the American Institute of Architects and the Boston Society of Architects said the building shows “excellent site organization” that capitalizes on “great views”. Now I am curious what exactly the “great views” are from all those windows.

The Chatham County Safety Net Planning Council (GA) picks Orion Health to build the Chatham County HIE pilot, which will serve over 250,000 people.

Meanwhile, the Pennsylvania HIE (PHIX) issues a draft strategic plan for a 30-day public comment period. The plan is the same as everybody else’s – get stimulus money.

Continuum Health Partners is replacing multiple imaging systems with Horizon Medical Imaging.

General Leonard Wood Army Community Hospital implements ClinicComp Essentris inpatient clinical documentation, part of a 36-facility contract with the DoD.

The 18-physician Naugatuck Valley Radiology Associates (CT) claims its use of MedInformatix RIS, along with DR Systems PACS and Nuance PowerScribe voice recognition, has allowed the practice to achieve a 100% paperless environment.

Picis announces that several medical centers have selected Picis ED PulseCheck, including Scottsdale Healthcare, Antelope Valley Hospital, and Bayonne Hospital Center.

The CareTech Solutions folks informed us of their revamped corporate Web site, built with its CareWorks CMS content management tool. I can’t say I fully understand what makes a particular CMS tool robust or weak, but I can say the new site is easy to navigate, has a clean look with nice graphics, and contains a nice mix of written and multi-media content. I also see they are hiring in Ohio and Michigan, in case you are looking.

e-Prescribing in Delaware is up 150% one year after the state began funding e-rx start-up costs for the top 50 Medicaid providers.

The Champaign-Urbana Public Health District (IL) sets up a drive-through H1N1 vaccine clinic that allows patients to stay in their cars. Wait times averaged 45 minutes and 2,000 people received shots at the first clinic. Not as much fun as a drive-through Starbucks, but pretty handy nonetheless.

Despite Mr. H’s prediction that Twitter is a passing fad, Global Language Monitor proclaims “Twitter” the top word in the English language for 2009. In fact, it beat out Obama, H1N1, stimulus, vampire, and 2.0. Healthcare was ranked ninth.

E-mail Inga.

CIO Unplugged 12/1/09

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

Going Mobile
By Ed Marx

“I’m going home, and when I want to go home, I’m going mobile. … Keep me moving…Out in the woods, or in the city, it’s all the same to me. When I am driving free, the world’s my home. When I’m mobile.” Going Mobile, by The Who, 1971 Who’s Next, triple platinum album.

Remember the day you bought your first automobile? Mine was a ’73 green Chevy Vega with a six-cylinder aluminum block—not exactly a dream car, but she kept me moving. The above lyrics speak to the freedom and liberty attached to owning your personal set of wheels. Like a bird released from his cage, I remember cruisin’ town while cranking that song on my cassette deck. Ahh, those were the days….

Today, a similar concept of autonomy manifests in mobile computing. I recall, not too long ago, networking at social gatherings and realizing I needed access to my email, but my computer was all the way back home, plugged into a wall outlet. Thanks to ongoing advancements in technology, a Blackberry Storm now rides on my belt, putting email, internet and other info right at my fingertips, literally.

According to emarketer, 59.5M Americans used their smartphones to access the internet in 2008, and the researchers expect this number to climb to 134.3M in 2013. That’s one in every three people using mobile tools!

Has healthcare fully capitalized on this technological revolution? While the nearsighted would say yes, or worse—who cares?—the visionary battles against the restraints of tradition and skepticism. For the sake of our customers who are demanding access, we’ve got to drive mobile computing in or lose pace with society.

No institution wants to fall behind, especially once we start navigating the new highways and byways constructed by healthcare reform (Medical Home, Accountable Care Organizations, etc). An organization must intentionally merge their mobile computing strategy with the hospital strategic plan. Failure to act will run the risk of getting lost on the backwoods roads and putting their organization at a serious disadvantage.

Mobile computing provides a platform through which we can influence quality care, patient safety, and financial results. We call our mobile computing strategy mHealth. Although I cannot divulge this strategy or share specifics, one well-publicized example has to do with our OB/GYN physicians and the iPhone application AirstripOB. This mobile solution had a notable impact on clinical care and physician satisfaction. You can find other examples from forward-thinking healthcare organizations—sales force automation, intelligent devices, personal health records, patient registration, electronic health records etc. Today, iPhone alone carries thousands of healthcare-oriented apps. Some are trial balloons while others hold promise.

Other related strategies include connected health (cHealth), which I will define in a future post. Health Information Exchange, mHealth, and cHealth are all linked—a trifecta with potent force for the successful healthcare organization of the future. Accessing information anytime, anyplace, anywhere, anyapp, anymedia, anydevice, anyperson. And these are just the beginning.

The sage CIO is already engaged.

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 12/1/09

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!

Healthcare Solutions
By Dan Field, MD

1. Tort reform. Cap every state as has been done in California and Texas.
2. Medical justice panels. A jury by our peers. Medically trained arbitration panels to hear cases.
3. Eliminate doctors’ malpractice costs for patients who demand free care. If the government insists that ED docs see every patient (through EMTALA), they are de facto government employees for those patients and should receive government indemnification.
4. Limit advertising again. It was a bad move when they opened it up.
5. Research, publicize and reward best practices. The worst hospital at Kaiser today has a better record of sepsis prevention than the best Kaiser hospital two years ago. Some have had ZERO sepsis in two years. Sepsis costs $40,000 to $100,000 per patient and frequently adds to the nation’s iatrogenic death load. Replicate this through the major diseases and some of the $500 billion of savings we need to achieve becomes realizable.
6. Divest physicians of the benefit of profiting from ordering tests. A study shows a doctor who owns a scanner is seven times more likely to refer a patient for a scan.
7. Generics drugs for everybody, name brands for those who want to pay out of pocket (or from the HSAs).
8. Revamp medical reimbursement
9. Create a two-tiered medical system where everyone has catastrophic coverage and HSAs. Allow the rich and others to opt out for value-added service. This might be just enough incentive to keep some innovation moving forward. I seriously doubt most medication advances are necessary — seems to me they just add a molecule so they can extend the patent without any new, real benefit. First tier accepts all, including, pre-existing illness, with no rescission. Everyone pays same rate for basic tier, everyone gets a tax credit. Not sure how to deal with those that don’t work. Incentivize healthy behaviors — non-smokers with low cholesterol and great genetics are an attractive subgroup. Second tier insurance companies will compete for these stars with lower premiums. Veal calves with remotes and cancer sticks will be avoided like the plague and end up in the first tier or paying more.
10. Accept that disparities will continue but that they will be better and more morally acceptable disparities than before.
11. Allow true portability.
12. Give needles to addicts, along with access to treatment.
13. Strongly consider legalizing and decriminalizing drugs.
14. Realize that screening doesn’t save money for society.
15. People should have a right to unlimited end of life care … as long as they can pay for it.
16. All government officials must utilize the system they insist we follow, especially “the public option”.

Dan Field is a physician with The Permanente Medical Group.

CPOE – One Size Fits All?
By Mark Moffitt

The goal behind Computerized Physician Order Entry (CPOE) is worthy — replace handwritten physician orders using information technology to minimize translation errors and provide conflict checking at the point of entry. There’s only one problem: many physicians are not satisfied with CPOE. The reason I hear often by non-physicians is this: “Older physicians reject technology. The newer generation of physicians is more accepting.”

I admit I have voiced this sentiment in the past. But after working with physicians and having seen them embrace technology that makes them more productive, I’ve changed my view. My view now is that physicians accept technology if it helps them be more productive and they reject technology that makes them less productive — regardless of age. However, I have observed that physicians over 50 are less tolerant and more vocal than physicians under 40 when their workflow is slowed. Maybe because they have more work to do in less amount of time?

Most all in the industry know the issue. CPOE shifts work done by low-cost clerical staff on a hospital payroll to the highest-paid people working in a hospital. Compounding the problem, physicians are not always employed by a hospital. So the work is shifted from a hospital payroll to an individual physician. And time spent in front of a computer is time not spent with patients. And seeing patients equals making money.

Let me qualify my statements above with this: This discussion is restricted to CPOE in an acute care setting and does not apply to all physicians. Some physicians love the current model for CPOE. It works for them. It makes them more productive.

National adoption of CPOE is low. The 2008 KLAS CPOE Digest reports that less than 10 percent of hospitals are “doing some level of CPOE.” In only six percent of hospitals nationwide, physicians enter more than 50 percent of orders directly using the system.

CPOE adoption is affected by many factors. One factor is availability of CPOE. Another factor is ease of entering orders. Another is physician workflow.

Physician workflow is influenced by factors including specialty, size of hospital, employment model, practice size, etc. There is no one model for how physicians do their work. There are many models.

It’s possible that CPOE, once widely available, will be embraced by physicians and the nationwide adoption rate will rise quickly to near 100%. The other possibility is that the current CPOE model does not work for all physicians and CPOE adoption rate climbs slow and stalls at some level, say 50%. What outcome do you think most likely?

Given the money involved, I wonder why more research isn’t being done to find other models that provide the benefits of CPOE that doesn’t require a physician to sit at a computer and enter orders? Why, when many physicians have expressed dissatisfaction with the current model? Why, when the industry is spending BILLIONS, partially underwritten by the federal government, to implement CPOE and other technology in healthcare?

For what it’s worth I’m doing my part by researching a new model for CPOE. I call it CPOE without the “POE.” Not a replacement for CPOE, but an alternative to physicians entering orders on a keyboard. Same benefits, only a different model. I’ll write about this topic in a future article.

Mark Moffitt is CIO at Good Shepherd Medical Center in Longview, TX.

Those Who Believe in The Network Will Go Far
By Carl Byers

 As one of Mr. H’s and Inga’s biggest fans, I am lucky to have had the chance to meet them in my travels as CFO of athenahealth. It is therefore an honor to submit this post.

I soon will be far from the world of HCIT. As announced in June, in early 2010 I will step down from the job I have treasured for more than twelve years to live abroad with my family. My wife and I have dreamed of immersing ourselves in another culture before our kids (ages 11, 7 and 3) are too cool to hang out with Mom and Dad. We will be in Chile for 18 months, and we look forward to returning with new energy and a fresh perspective on the world and on our role in it.

As a finance guy, I am not a technology innovator or a clinical subject matter expert, so I can’t address the future of technology or patient care. What I can address is a question that I am often asked gingerly and respectfully: “How is athena able to achieve such a high value?” Last week, on a panel discussion in Boston, an audience member’s way of asking was far less discreet: “Everyone thinks you are overvalued. Why is that?”

There are all sorts of fancy answers from capital markets people to explain prices based on total addressable market, long term margin profiles, and Price-to-Growth ratios (in fact, a fellow panelist from Goldman Sachs gave this type of answer to the questioner). I won’t attempt to do that sort of analysis justice here. And, I certainly can’t tell you why stock prices jump around as much as they do, but I do have a clear point of view on athena.

Simply put, I think our company trades where it does because of the scope of our vision and the confidence people have in us actually accomplishing it. It was Warren Buffett who said that, in the short run, the market is a “voting machine” and in the long run it is a “weighing machine.” I have no idea what the votes will say from day to day or even year to year, but I know that the weight of our business will be extremely hefty over time.

How can I be so sure? The reason athena has done well as a public company is the same reason athena has done well in the marketplace — because we offer a better way to solve our industry’s most complex problems and the market is responding. athena is one of very few companies in our sector that is not hopelessly stuck in a software mentality, and the market understands that the days of software as we know it are limited.

From complex reimbursement processes, to clinical coordination, to patient communications, to research, the future of health care (just like the future of the rest of the world!), is not software; it is “The Network.” In 1992, I worked on the Clinton campaign staff in Little Rock. If James Carville were in HCIT, he’d put an even sharper point on it — “It’s the Network, stupid!”

The market understands this because outside of HCIT, The Network has already taken over. This shouldn’t be news. How long has it been since salesforce.com put that big “no smoking” sign on the word “SOFTWARE”?  For how many years has Sun Microsystems declared, “The Network is the Computer”? My boss and friend Jonathan Bush said it even more clearly a couple of years ago: “Software is dead… Dead. Dead. Dead.”

And yet everyone — from pundits in Washington to some of our industry’s best technologists — remains fixated on terms like “versioning,” “implementation,” and “interoperability.” Not only is client-server software fundamentally unable to succeed in this new reality (whether installed locally or hosted from a giant data center), it drives business models with much lower visibility, much weaker alignment of incentives with practitioners, much lower sustainable margins, and much lower lifetime value of a customer than does a software-enabled-service like athenahealth.

What the software mentality misses is that at its core, the problem with health care is one of supply chain coordination. Isolated practitioners typically know next to nothing about what care has occurred in a patient’s life outside of his or her own four walls. Creating software that asks practitioners to type into templates in isolated local databases will not accomplish much of anything given the broader coordination challenge. This is why EMR adoption is so incredibly low today. Only through the emergence of copious networks of information and related process-oriented services will the silos break down and will the coordination (and quality) actually improve.

In every industry (including health care), the only way such networks come about is when there are financial incentives to exchange information. PBMs, pharmacies, and manufacturers of pharmaceuticals seem to have figured out how to build networks, and they didn’t need federal interoperability standards to do it! All they needed was a strong financial incentive to get aligned and remove wasted effort from the supply chain so patients could get their meds without huge inventory write-downs or large commissions for middlemen.

Similarly, athena is focused on building real networks so that the supply chains that extend into and out of the physician office can improve — not just for the coordination of payment information with payers, but also for the coordination of physician order information with labs and pharmacies. athena is also building a network for coordinating schedule, payment, and results communications with patients and referring providers. And to do this, we don’t need to wait for federal transaction and software standards — we just need an opportunity to earn financial rent for having made it happen (and in the process having made physicians, their trading partners, and the industry better). Networks cannot be only about information, they have to relate to real work — and it is through accomplishing the work that revenue, profits, and value flow.

So, as I start a new personal chapter in the New Year, my answer to that persistent question and my message to our industry is this: those who believe in software alone will fall away; those who believe in The Network will go far. Companies that embrace this distinction and produce tangible improvements in the delivery of care as a result will help to bring about the health care vision we all seek.

Thank you for the opportunity to comment here on this very unique network of your own.

Carl Byers is senior vice president and chief financial officer of athenahealth of Watertown, MA.

Monday Morning Update 11/30/09

From DemoChic: “Re: NextGen. Pat Cline, President of NextGen, has been promoted to president of Quality Systems. His replacement will be Scott Decker, formerly of Healthvision, but in place at NextGen since 2007.” Rumor reporter Boba Fett said in June 2008 that these changes would happen. The announcement is here (warning: PDF). I was impressed with Scott (but not so much Healthvision) when I interviewed him in 2007. Maybe he said the right thing in the interview in naming Pat Cline as the person he who admired in the industry (he was hired by NextGen as SVP nine months later). It’s a strong team there.

From Cousin Carl: “Re: reader contest. Let’s hear ideas to reduce healthcare costs and improve quality with a minimum benefit of $1 billion in 500 words or less. The simpler and easier to implement, the better.” Sounds like fun. Anyone want in?

From Junior Mints: “Re: Eclipsys. Eclipsys failed to disclose that the 50 million orders entered at Sarasota Memorial actually go back to the days of the TDS 4000 system, which was later upgraded to TDS 7000, which was replaced with Sunrise. The company has never been forthright on this.” I knew the history, but in their defense, they didn’t specifically say Sunrise and it is true that Sarasota’s 50 millionth order was entered in Sunrise even though the first 30 or 40 million went into TDS. It also didn’t specifically say Eclipsys systems since TDS sifted through a variety of corporate hands before winding up as Eclipsys and Eclipsys bought Sunrise from HealthVISION (the Canadian EMR vendor, not Scott Decker’s previous employer). I think it’s a fair announcement that pays de-identified tribute to TDS, arguably the best system before or since when it comes to innovation, pro-clinician design, and patient impact. If a company wants to compete with the decades-old clinical systems that dominate the market, they need to do it the TDS way — put the development teams on the ground in a forward-thinking hospital to work with clinicians and target a specific customer demographic instead of a one-size-fits-all approach (TDS was aimed at big community hospitals and some academic medical centers with big iron hardware and internal technical expertise).

I hope your Thanksgiving was happy. Now begins the official season of not getting much work done in hospitals, so here’s to a month of fewer meetings, fewer project startups, and days with fewer annoying co-workers around.

Thanks to Steve Meyer for pictures from the recent SMS reunion. That’s Harvey Wilson and Jim Macaleer in the first picture. The second has Steve, Harvey, Vince Ciotti, and Jim Carter. If you work in the healthcare IT industry, you might give pioneers like these some mental thanks for creating it several decades ago. Steve was telling me how long some of them have been retired, so they must have made some nice money back in the day (or maybe hung onto their SMED shares until Siemens came knocking). I also said I hoped they raised a glass to those who aren’t with us any more, to which he replied that they did, using a phrase that I’m sure I’ll co-opt as my own: “Any day I’m still on the green side of the grass is a good one.”

Give Mediware credit for ambition, albeit unfocused. It acquires Healthcare Automation Inc. (home care software) and Advantage Reimbursement (home infusion reimbursement) from their single owner group for up to $8 million in cash. The company cites the 20% annual growth in home care, but the markets they’re already in (blood banking, medication management, BI) should be growing pretty well, too.

The Johns Hopkins Hospital is recruiting a chief nursing information officer, co-reporting to the CIO and nursing VP.

I mentioned the radiology practice that had two doors and different levels of service for insurance vs. cash-paying patients. I didn’t mention my opinion: I think it’s great. Patients get precisely the same medical care using the same personnel and equipment. Those willing to pay extra for shorter waits, a nicer waiting room, and a more personal experience have that option, no different than those folks willing to pony up for first class airline tickets even though everybody still lands together. Why not let providers make their profit from cash-paying nicety-seekers and let those profits subsidize the medical care of those who can’t or won’t pay the difference?

Christian Scientists are pressuring Congress to include a provision in healthcare reform legislation that would require insurance companies to pay church members who pray for patients from home.

The local paper has fixed their headline’s spelling error (is a rouge employee one of those mall cosmetics people?), but the story stands: two pathologists say Wentworth-Douglass Hospital (NH) is ending their contract of 28 years because they that discovered a rogue hospital employee got into the IMPAC PowerPath anatomic pathology system and inappropriately changed the names of doctors on the reports. The employee was fired and the doctors say they were, too. I’m going to hazard a guess that other unmentioned issues are in play.

The folks at Mikogo saw my post about the questionable marketing company award given to LogMeIn and pitched their own product as a free alternative. It looks cool: screen sharing over the Web, remote keyboard/mouse control, file transfer, a whiteboard, and session recording and playback. It’s good for Web conferencing, online demos or meetings, or remote support. They even have a native Mac client and free voice conferencing. Best of all, it’s free for both commercial and non-commercial use for up to 10 session participants with unlimited use (there’s no catch other than they offer a paid version for running larger meetings). I love this stuff and have tried several apps, so if this one works as advertised, a bunch of HIT people might find it highly useful. 

Welcome aboard to DIVURGENT Healthcare Advisors, a Platinum Sponsor of HIStalk. The company, which was started by healthcare veterans (I noticed that a pharmacist, PMP, revenue cycle expert, and physician are on the team) who strictly follow standard project management and project quality methodologies. Services offered include strategy, project management, vendor selection, clinician adoption, CDM, benefits realization, training, optimization, medication management, and interim leadership. You can also check out their white papers and blog. Job seekers might want to shoot them a resume since I see they are hiring. Thanks to the folks at DIVURGENT for their support of HIStalk.

Harris County Hospital District (TX) fires 16 employees for inappropriately accessing patient information and violating HIPPA (sic – see their internal form above), some of them doctors and nurses. Some of the employees got into the records of a first-year female resident who was shot in an attempted robbery in a Kroger’s parking lot. She’s expected to recover.

The controversial report on the Cerner FirstNet rollout in New South Wales by Professor Jon Patrick of the University of Sydney (Australia) is back online (warning: PDF) after would-be censors demanded it be removed. The new version takes a more academic tone and has more details, most of which are not flattering to Cerner’s product and, to a lesser extent, the people involved in choosing and implementing it. Some major points it contains: Cerner paid little attention to its Australian clients because the product is primarily driven by the US market, Cerner left a vital report writer application out of the contract that cost NSW an extra $1 million, and physicians hated nearly everything about FirstNet and its impact on their workflow. Who asked the university to pull the article down? Apparently the CIO of NSW Health, the FirstNet customer, at least as I read between the lines of this story. He claims he contacted the university, but didn’t ask to have it removed, but I’m having trouble believing that (I’d also be somewhere between surprised and shocked if somebody from Cerner wasn’t prodding him, but that’s wild speculation on my part).

Speaking of Jon’s article, a couple of readers said I shouldn’t have criticized the recent report by the Harvard people that found EMRs have had little cost or quality impact. I disagree. That article and Jon Patrick’s above are not rigorous clinical studies backed up by specifically required measurements and analyses, so readers need to look carefully at their data and methods. Both sets of authors are open source advocates and proprietary system critics, so when they rip commercial systems while lauding open source ones, you have to think about the subject they chose to write about, whether their data are optimal or simply conveniently available, and whether their conclusions are supported by their facts. In my opinion (and it’s only that), neither article is bias-free — no different than when readers complain that a vendor VP’s HIStalk guest article is “an advertisement” even when it’s fairly objective. And there’s reader bias, too – those who defended the Harvard article are themselves outspoken EMR critics. Both articles are useful and thought-provoking, but more open to challenge than if their authors had no known strong feelings one way or another. 

Providers are the main reason that EMRs haven’t met expectations, readers said (although not overwhelmingly). New poll to your right: have information systems improved patient safety nationally?

Ms. Adventure was telling you back in February that Dubai’s economy was in a free-fall, affecting its ambitious healthcare construction projects (“In one short year things have changed so much, from a thriving and booming town to a town that may not have a tomorrow.”) She had e-mailed me that she probably wouldn’t write more, giving me the feeling that she felt she was in some kind of professional or personal danger. In any case, she was right: Dubai is $60 billion in debt and that news is dragging down world markets (which seems quaint considering the free-spending US government is something like $12 trillion in the red and digging the hole deeper every time the bailout-happy Congress meets).

Marin Healthcare District (CA), awaiting the June turnover of Marin General Hospital by Sutter Health, says it will have to spend $1.1 million to convert PACS images because Sutter wouldn’t give them up without first going through court-ordered arbitration. The newly created district also has to replace Sutter’s systems and will pay ACS $55 million to install McKesson Paragon and support it for seven years.

It’s RSNA time, which I always forget until someone sends me announcement. lifeIMAGE will demonstrate its diagnostic imaging sharing platform, in use by Continuum Health Partners (NY) and Montefiore.

An attorney whose accusations of patient abuse in a New York for-profit mental hospital led to $110,000 in fines is suing the hospital, claiming the hospital retaliated by intentionally revealing mental health information about a relative and threatened to do the same to any patients who joined a 2007 class action lawsuit against it.

E-mail me.

An HIT Moment with … Greg Smith

An HIT Moment with ... is a quick interview with someone we find interesting. Greg Smith is a Certified Product Safety Project Engineer (NCE) and quality assurance manager for the MET SE Headquarters.

Your article, Not Suitable for Medical Use, suggests that special interests pressured OSHA to allow medical devices with unproven electrical safety to be used in the OR. How did that happen?

There are a combination of reasons that contribute to this, but the main reason is a perception that having this equipment correctly built and tested to national and international safety standards is too expensive. In reality, having a compliant product certified can cost as little as $5,000-$10,000, then between $2,000-$4,000 a year for testing laboratory audits to make sure the manufacturer is still building the units per the certification report and performing electrical safety testing before the equipment leaves the factory.

This cost, when adjusted to the hundreds and thousands of, for example, computers, is not a significant cost factor. The fact is, sometimes it costs more that this because these manufacturers are turning out non-compliant and hazardous equipment. We see this every day in the testing lab and during the unannounced factory inspections during the year. Our records show that if manufacturers were allowed to "get it right" on their own, they will, in most cases, not get it right. Most manufacturers making a product for the first time do not even know what standards apply to their products.

These special interest groups are pressuring OSHA, along with elected officials who know nothing about electrical safety. At the same time, electrical safety experts are constantly reminding OSHA about the reasons why this is a Federal requirement for equipment in the workplace.

There are no US regulations for imported products to be safety certified. Although the "CE" mark is legal in Europe, the EU is considering moving to a new system because they are being flooded with these "CE" self-declared products from Asia and other places. Why would we move to something like the SDoC (Supplier Declaration of Conformity) when this system is showing problems over time in other parts of the world?

Simply put, these groups want to speed up time-to-market at any expense. In this case, it is at the expense of safety for US consumers and workplace owners. Here is a great article on SDoC.

What are some real-life examples in uncertified medical devices cause harm to patients?

Just last year, a baby was burned at a NC hospital by a non-certified incubator. Some of these incidents really stick out, especially whey they make the news. Many incidents of shock are never reported, are only sometimes recorded in the OSHA logs, and not ever reported unless OSHA has a reason to examine these logs. Also, some incidents are prevented through the diligence of our biomedical technicians, who regularly test and repair equipment.

In recent years, incidents have decreased because many hospitals require medical equipment to be certified as a condition of purchase. At some less-vigilant healthcare facilities, patients are likely killed from leakage current, although this is difficult to prove because it is simply called "death from cardiac arrest". The science of electricity and specifically leakage current tells us of the hidden dangers, especially to patients who are vulnerable (e.g. during surgery). The National and International safety standards for medical equipment are in place because of these known hazards.

A skeptic might say that you have a vested interest in raising concerns about uncertified products since you’re in the certification business. What would you say to convince them your concerns are real?

Those of us who are passionate about safety spend many personal hours addressing these problems. Electrical safety experts include electrical contractors, electrical and other government inspectors, power company engineers, design engineers, and electrical equipment manufacturers. For an unbiased view of these issues, ask some of these individuals.

For example, these issues are discussed regularly in associations like the IAEI, the International Association of Electrical Inspectors, where all types of electrical safety experts help develop consensus positions on these subjects. Go to the IAEI Web site and read some articles on product safety and the need for third party safety certifications, . 

An important question here is: if we don’t ask our electrical safety experts, who are we going to ask? Would you consult a mechanic about an internal organ surgery? In a recent NC court case to exempt equipment from safety inspections, the "Code expert" for the plaintiff was a man who developed a way to get cat urine out of carpet. The electrical safety experts were ignored because science and facts are less exciting than rhetoric and hyperbole. Vested interest? There are many types. Some are based on science and a desire to keep others safe and others are based on haste and pure greed. We are in the business of product safety certifications because electricity kills people. 

IT departments are often involved with choosing portable computing equipment that includes batteries and electrical connections. What should they be doing to make sure these devices are safe for use in specific hospital areas?

Purchasing departments should specify that only certified products are to be procured. There are many valid safety certification marks and agencies ("CE" is not a safety certification). In these specifications, it should be mandated that patient area equipment needs to carry a UL60601 designation.

Regular (consumer) computer equipment is designed much differently, and even if it is certified, the standards are much different. The IT Standard, UL60950, allows leakage current levels five times as high as the medicals standard, and for good reasons.

Also, consumer IT equipment is not designed for the medical environment, as with laboratory equipment and consumer TVs and appliances. There are computers and monitors specifically designed and tested for patient area use. Typically, IT departments and administrators do not know the difference. Many facilities use isolation transformers in an attempt  to mitigate risk, but the equipment can be easily unplugged and leave patients and healthcare workers exposed to the risk of electric fire and shock or electrocution.

Should hospitals and practices regularly test computer equipment for safety when it is used in patient care areas?

All equipment for patient care areas should be tested on a regular basis. This equipment undergoes heavy usage and is prone to failure through wear, abuse, and environment. If the protective ground is lost, the risk increases, especially for equipment not designed for use in patient areas.

Biomedical technicians regularly see these conditions, providing safety testing and effecting repairs. These electrical safety specialists are on the front lines of patient and worker safety, and should be allowed to do their important jobs. There are regular attempts to cut this testing from budgets, so much attention needs to be paid to this profession and the unseen hazards they prevent.

News 11/25/09

From Dolphins Fan: “Re: Accretive Health. I finally had a chance to read the Accretive SEC filings. Ascension Health is their largest client as well as a major (11% stake) investor. I wonder how Wall Street reacts to a situation where the client supplying the largest share of company revenues is also someone who stands to gain big from the IPO? Take that major investor/client out of the revenue mix and this is really a pretty small company.”

From Chanice Kobolowski: “Re: Epic registry. Hospitals that need Patient Registry functionality should look into Phytel. Epic has a great deal of this functionality embedded in their integrated applications, but the true registry functionality is not present, in my opinion. Several Epic clients use Phytel for this need.”

From Kid Rockette: “Re: vendor installations. Is there a free source that says which hospitals are running which clinical information systems?” None that I know of, but I will defer in case anyone has a source. CHIME used to have something, I think, but I don’t know how current or pervasive it was.

From Goin’ Mobile: “Re: blog format. I often read your blog on my iPhone. Have you ever thought of running a WordPress plug-in like WPtouch iPhone Theme? It nicely formats the blog for mobile devices.” I have WordPress Mobile Edition running, although I need to upgrade it. I looked at the iPhone theme but it scared me since it seems to want to take over the master theme, which would displease the 99% of readers who are reading from a PC screen. Maybe I’ll get some expert to figure it out for me since I like the idea.

From Carol Queen: “Re: Flash ads. We are a sponsor and I vote against the flash ads. Let them use a link to tell their story. Flash is annoying and I actually ignore ANY Flash ads, anywhere.” A reader sent over an recent article whose finds were that most Flash ads are ignored, but text-based ads surprisingly aren’t (since they seem to offer solutions to whatever the reader is looking for). The bottom line was that simple ads work best on Web sites. Some sites ban animated ads, but I’m uncomfortable telling marketing pros which ads will probably work best even though I probably know pretty well from experience and personal preference.

From IT_Nurse: “Re: unions. In the September issue of Registered Nurse (a California nurse’s union magazine), there’s a 20-page tirade about the evils of HIT, including CDSS, CPOE, EBM, EHR, HIE, HIT, RCM, RFID, RTLW among others. Their conclusion: the whole industry is just a management ploy designed to replace RNs and should be resisted at every opportunity.” It’s really hard to take a professional group’s union seriously when they are so quick to lash out at everything that’s employer-related, all while using what they claim are the best interests of patients as a hammer to beat management over the head. They probably have a good point every now and then, but as a former manager in a violently unionized hospital, everything I saw first-hand was highly negative. You haven’t lived until you’ve seen striking union lab techs and nurses destroying hospital lab equipment, blocking ambulances and doctors from getting to the ED, and cursing and taunting the family members of patients trying to check on their loved ones. And, the union’s blocking of my attempt to upgrade some of my para-professional staff so I could pay them more  because it “would cause resentment” — meaning my people were paying mandatory dues to an organization who refused to let me increase their wages. Or, like this current example, where the Steelworkers Union (which represents non-professional hospital workers!) is suing a hospital for banning smoking on campus.

Analytics vendor Quantros licenses University of Michigan-developed technology that creates Patient Safety Indicators from discharge diagnosis codes for follow-up.

What’s driving me up the wall lately: crappy online slide shows that magazines put together for some reason. I get a teaser e-mail for “Top 16 Declining Tech Salaries for 2010” (you know who you are, eWEEK), click the link, and only then find out it’s the cheesiest, slowest, dumbest slide show in the world. Not only do I not need to see stupid clip art with what little story is there, I don’t need to click and click and click (of course, they love that since they are probably selling ads based on clicks). I will not waste 10 minutes watching a slideshow that contains content I could have read in literally 20 seconds had they not been so cutesy about it.

The Army creates the Joint Telemedicine Network for a relatively cheap $10 million, allowing X-rays to be transmitted among its far-flung facilities into the AHLTA EHR. Before it was implemented, soldiers being evacuated from the field often beat their X-rays to Landstuhl AFB, making trauma treatment within the Golden Hour impossible. Kudos to those named in the excellent Nextgov article as key players: now-retired LTC Alfred Hamilton, CMIO; LTC Nanette Patton, deputy CIO; Salvatore Granata, project manager; and MAJ Dan Bridon, director of command, control, and communications for the 30th Theater Medical Command at Bagram AFB, Afghanistan.

I’ve mentioned before that HIStalk’s sponsors, in most cases, aren’t just running ads — they are fans of what we do who read it and want to support it. Submitted for your approval: Quality IT Partners, a new sponsor who did a reverse sponsorship in putting the HIStalk intentionally ironic smokin’ doc on their page along with some nice words.

Thailand-based Hospital OS, an award-winning open source hospital systems vendor, is giving hospitals analyzed information back from their data: best practices, clinical guidelines, alerts, and an epidemic alarm system to track disease outbreaks back to their source.

Listening: Supergrass, British alternative that’s been around since the early 1990s. Reader recommended as something I’d like, which it is.

This brilliant MSNBC article speaks volumes: New York medical practices are using separate entrances and providing different levels of service for patients with and without insurance. Example: Lenox Hill Radiology takes insurance, requires 15 days to get an appointment, takes more than a week to give results by mail, and always has 20-30 patients crammed into its waiting room. New York Private Medical Imaging has a four-chair waiting room for its cash-only patients, gives appointments in two days, hands out plush robes instead of flimsy gowns, and doctors read the images immediately and visit personally with the patient immediately after. The separate entrances lead to the same techs, rooms, and equipment because it’s the same company with the same radiologists reading the images. Most interesting is that patients on the boutique side are warned not to tell the insurance patients about “their door” and employees sign a written policy agreeing to do the same.

The EHR of Mater Health Services in Australia holds the records of 1.4 million patients, connects 95 separate clinical systems, and handles 100,000 messages per day, integrated using InterSystems Ensemble.

Michael Nauman is named VP/CIO of Children’s Hospital and Health System (WI). Old news that I missed until now.

I’ve been really busy lately, so I’ve got a backlog of interviews and reader articles ready to go. Soon it will be time for the HISsies voting, additional ideas for the HIMSS event (shaping up nicely, I should add), and maybe some new stuff. It’s been a really good and fun year, even though I occasionally wish I’d done something more than work all the time. The thanks I’m giving, in no particular order: Mrs. HIStalk for putting up with me, Inga for making what we do fun, those in the military for the sacrifices they make, and the people who are in healthcare and healthcare IT for patients and not a bloated paycheck. And of course, every HIStalk reader, sponsor, guest author, and interviewee who makes me anxious to run to the computer as soon as I get home from work every day and stay there for way too long.

The plastics convention people aren’t just taking their show to Orlando after decades in Chicago, they’re running a Crain’s Chicago Business investigative piece on the authority that runs McCormick Place: (a) the CEO got the job after raising money for Rod Blagojevich and lots of its bigwigs are connected to the Daley political machine, including a former bartender given a $130K HR job because of connections; (b) despite extortionate charges, it loses a ton of money; (c) it taxes citizens directly, collecting over $100 million a year and borrowing $2.5 billion using the state’s credit line;  (d) McCormick Place West was a 2007 boondoggle that will fall short of paying itself by $500 million; (e) they’re laying off 500 people despite having added more senior managers; and (f) companies that contributed to political campaigns got contracts to service the facilities despite their markedly higher bids. If you are shocked by any of this, you obviously don’t know much about Chicago (I like to think President Obama is clean, but the fact that he worked his way up there makes me wonder since honest Chicago politicians are unheard of).

GE gets into the Web-based teleradiology business in India, planning to provide software and hosting to emerging markets.

LogMeIn’s remote support solution wins a healthcare IT award from a company that helps vendor sell stuff (“innovative sales and marketing solutions”). I’m sure there is no connection, especially since “hundreds of IT executives” voted for the winners “after previewing and learning about new technologies and services in private boardroom appointments”.

Nuance announces Q4 results: revenue up 3.9%, EPS $0.02 vs. $0.09, beating expectations. 

Strange: Apple says users void their warranty if they smoke around their Macs since the second-hand smoke is a biohazard for its techs. And, the Turkey Genome Sequencing Project gets a $900K grant to find ways to improve the immune system of turkeys, with the timing of the announcement being fortuitous since I assumed the purpose isn’t to enhance the quality of life for Thanksgiving-doomed turkeys, but rather to keep the cost low and the profit high in selling their carcasses.

What the authors of a Christian Science Monitor editorial hate about the Senate’s healthcare bill: mandatory insurance, HIEs, EDI, analysis of data for effectiveness research, and unprotected PHI.

Odd lawsuit: a woman has surgery without fentanyl when a drug-addicted nurse steals it, replacing it with water. She’s suing the nurse and the hospital.

E-mail me.

HERtalk by Inga

Sarasota Memorial Health Systems recently entered its 50 millionth order into Eclipsys Sunrise. I was having trouble grasping how many 50 million is, so I did some simple math. If you input 27,397 orders a day, it would take five years to enter 50 million orders.

Cascade Healthcare Community (OR) leverages Accenx ExchangeT to integrate its clinical information system to distribute lab results to community clinics and regional hospitals.

The Rochester RHIO says that over 100,000 patients have opted to share their health information with their participating doctors. About 500 physicians are participating in the RHIO, which uses Axolotl’s Elysium Patient Index to manage the patient data.

Iowa’s Medicaid program is the first recipient of a federal matching funds program for EHR. The $1.6 million grant from the CMS will allow Iowa to begin planning the activities necessary to implement EHRs.

The prolific folks at KLAS release a new report examining revenue cycle consultants and whether the returns are worth the investment. Perot Systems was the top performer in the extended business office category.

Meanwhile, KLAS says it’s making its performance evaluations shorter, based on feedback from providers and vendors. KLAS will also begin grouping questions on software into four main categories. The goal of the changes is to eliminate redundancy and focus on questions that best differentiate vendors.

The current poll to the right points out that EMRs have not been shown to improve quality or cost and asks who’s to blame. I think the ever-brilliant Mr. H left out at least one blame category (it’s probably due to all those long hours he has been working). I don’t think the issue is necessarily software nor providers needing to use the software better. Instead, perhaps we should look at implementers (who may be vendors, consultants, or internal staff) who fail to diagnose flaws in work processes and thus promote inefficient workflows. Of course, someone could still say the software doesn’t lend itself to efficient workflow (so blame the vendor) or that providers won’t change (blame hospital management).

Mr. H and I are facing some new competition in the blogosphere with the launch of HHS’s Health IT Buzz. David Blumenthal says he will use the forum to report on the progress of healthcare technology, health information exchange,  and the meaningful use of EHR, plus “create an open dialogue among members of the health IT community.” Kind of like what we do here but probably without Mr. H’s the good / the bad / and the ugly approach. Likely no music or shoe recommendations either.

Speaking of shoes, a special thank you to all our wonderful sponsors who support HIStalk and HIStalk Practice. Without your support, I would be resigned to last season’s shoe fashions, which would certainly make Clinton Kelly cringe.

Zynx Healthcare partners with the Healthcare Solutions division of Keane to integrate Zynx decision support solutions with Keane’s OptimumTM EHR.

The House passes a $10 billion loan program to help doctors and small medical practices purchase EMR and other HIT systems. The bill would allow loans of up to $350,000 per physician and $2.5 million for group practices. The bill has now moved on to the Senate.

Dr. Blumenthal took some time out from blogging to announce HHS’s plans to make $80 million in grants available to help develop and strengthen the HIT workforce. Seventy million dollars will be available for community college training programs and $10 million will used to develop educational materials to support the programs.

The nation’s most stressful job: surgeon. Also making the Top Eight list are general practice physician, physician assistant, and newspaper reporter (no mention of bloggers, though). The least stressful jobs include computer systems analyst and software engineer (i guess when you are creating software you can’t get too stressed about missing release dates or producing buggy software).

In yet another new report, KLAS looks at the anesthesia information (AIS) market, which is deemed “small and immature.”  Of the 100 organizations interviewed, almost all claimed holes in functionality for reporting and integration. However, all products had generally high marks for ease of use. The highest rated products were GE Centricity Perioperative Anesthesia,  Philips CompuRecord, Picis Anesthesia Manager, and Draeger Medical Innovian Anesthesia.

Health Industry Insights releases two separate reports, each assessing the offerings in the ambulatory EMR space. The reports looks at the one-to-20 provider market, as well as the 20+ provider space. Mr. H wasn’t willing to pony up the few thousand bucks required to look at the report details, so we are hoping readers will fill us in. Sage Healthcare reports they did “great, landing firmly in the upper right quadrant on both reports.” eClinicalWorks also says they did “quite well.”

The MGMA sends a letter to David Blumenthal, noting concerns that an inappropriate definition of meaningful use and an ineffective administration of ARRA stimulus funds could result in a failed implementation of ARRA, needless squandering of resources, and significant disruption of the health system. MGMA offered several specific recommendations, including instituting a pilot test prior to the start of the program to ensure that the process of demonstrating meaningful use is achievable and practical. The letter also encourages the National Coordinator’s office to monitor the EHR marketplace for cost-effective and efficient products and to ensure fair business practices. To William Jessee and staff: well-done. MGMA is voicing valid concerns that highlight the many gaps in ARRA legislation, and offers logical recommendations. We absolutely need the meaningful use requirements to be achievable and applicable. And, why not do some testing in advance to make sure that HHS, vendors and providers all agree what meaningful use looks like. I am not sure how necessary it is to have the government provide vendor oversight; I mean, if a vendor doesn’t have a product that works, won’t market forces address that?  Still, MGMA did a good job addressing what are likely major concerns of its members.

I am truly thankful for many things. Near the top of the list are HIStalk/HIStalk Practice and of course Mr. H and our readers. Some days I have to pinch myself to make sure it’s all real, that I really do get to spend my days reading and writing about the fun world of HIT, that people send me notes saying they like my stuff, and that I even make a little bit of money doing it. I’m also thankful for yummy food, good wine, college football, and days off. Happy Thanksgiving!

Holiday greetings or football bets here.

Readers Write 11/23/09

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!

Our Success with EHRs in an Ambulatory Environment
By Stephen L. Badger

Hindsight. It’s the corrective lens which turns progress into a milestone. Imagine that anesthesia, antibiotics, germ theory, and x-rays each once seemed more evolution than revolution. This may be the case, too, with healthcare IT.

A few hundred healthcare institutions are exploring IT — some because the clock is ticking on a federal mandate, and some because their leadership sees value for both practice management and patient care.

The George Washington University Medical Faculty Associates entered the exploration into electronic medical records in 2004. It was a time of tremendous growth in our service capacity. That growth left us drowning in the millions of pieces of paper associated with patient charts. Costs for processing and storing that paper were mounting daily and the records themselves were, at times, unrecoverable. It was an unyielding drag on staff and led to patient dissatisfaction and frustration. For us, electronic healthcare records were like direct pressure on a bleed.

Chart room before and after


Chart room remodeled

The remedy began with a document scan which would play out over nine months and capture over four million bits of paper. It ended with elimination of chart pulls, the elimination of more than 30 full-time staff members, and the elimination of paper records storage. Initial net savings was over $1.5 million, but the dividends are still being delivered through improved accuracy in coding and the conversion of office space. Our old record rooms are now used for executive physicals, nuclear cardiology, digital x-ray, and new physician administrative offices.

The impact on patient care is equally positive on a national scale. Because each physician looks at the same central patient history, redundancy in imaging and other diagnostic orders is reduced at a great savings to the patient and the broader health care system. The prospect of prescription error is controlled, too, because the various treating physicians are working from the same record. That means they are less likely to unwittingly order a prescription which may interact adversely with medication ordered for their patient by another treating physician.

Here at the MFA, our patients can renew prescriptions through an encrypted, private network which processes refill requests typically within 60 minutes. That same system allows the MFA to deliver prompt, targeted alerts about news like FDA drug recalls.

Our records are shielded by firewalls, biometric passwords, and routine data audits which show what staffers have entered a record, what they viewed, and how long they lingered on a page.

MFA patients check in for provider visits at electronic kiosks which are much like those at the nation’s airports. Patients scan in using their unique palm print to preserve security and they answer a brief series of questions to confirm basic demographic data and insurance information. As a result, our records are more up to date and complete.

The kiosk registration will evolve as we extract targeted data which helps us improve an individual patient’s care. We envision that this data may pose tremendous advantage in transforming overall patient care, too, ensuring our patients are being treated on a proactive basis.

These data systems also may be helpful in seeking patients who would likely be helped with clinical trials and research. The potential impact for expediting the quantity and pace of research, especially longitudinal study, is exciting and just one more reason we believe we are living through a milestone in medicine.

Healthcare IT is improving patient care, practice profitability, and has considerable potential as a tool in clinical research. It is nothing short of transformational!

Stephen L. Badger is CEO of The George Washington University Medical Faculty Associates, an academic multi-group practice of world-renowned physicians affiliated with The George Washington University. The MFA consists of over 550 physicians deploying the latest advances of technology and technique through more than 41 medical/surgical specialties.

Are You Sure it’s the Software?
By Fourth Hansen Brother

There’s been a lot of focus on HIStalk lately about the customer side of HIS. Having worked on the “bandit” side of things for a few years, then as a consultant, I’d like to add to what’s been said.

There is an enormous amount of variation in the quality and culture of IT departments serving hospitals and clinics. This has a major impact on the design, quality, and implementation of HIS software. Let me explain.

Most folks on the customer side seem to think that the major vendors don’t consult with the people in the front lines of software. The thought that, “Gee, if only a doctor or hospital IT system created their own software, then we’d finally have a decent system” is common.

Folks, I assure you that every major vendor hires doctors, nurses, pharmacists, and other similar professionals to participate in design, often by the hundreds. There’s no shortage of medical folks willing to be tempted out of healthcare by software vendors. In fact, that’s part of the problem. It’s where they come from.

Your software vendors also find design partners out in the healthcare world, either with formal agreements or informal visits and shadowing. Depending on the luck of the draw, that’s either a good thing or a bad thing.

As noted in a survey that Mr. HIStalk linked to recently, most healthcare workplaces have severe problems. Politics reigns supreme and confrontation about minor issues happens frequently. Refinement or modification of workflows becomes impossible in those environments. These problems are often invisible to vendors at first. Vendors can easily choose a design partner that may have a department that’s become a personal fiefdom of a internal political heavy hitter and has done things the same way for thirty years.

The opposite happens as well — a hospital that’s run by a “thought leader” with oddball workflows in place and little sense of practicality. Vendors may not have the perspective to see that the emperors have no clothes. Hitting these problems with a design partner can cause severe problems with early adapter customers, often resulting in years of workarounds and remedial development.

Often, the vendor doesn’t have enough money to have the in-depth relationship with multiple design partners that it takes to put good software together. Healthcare has more than its fair share of egos. And there’s been more than enough research to show that health care professionals don’t keep up in their education or change their ways, at least on the clinical side.

If a vendor chooses the wrong design partner, or selects a good employee from a bad workplace, chances are that it will show up in a major way in the early versions of the product. As the product matures, these problems can get straightened out with the help of good customers and hard work from the customer-facing staff of the vendor. If the vendor is good, then all of the staff are customer-facing, including developers and testers.

The culture of healthcare customers can create some longer term issues. Many customers have major issues with trusting employees. Often certain types of employees want certain other types of employees monitored or their workflows controlled. Management wants all sorts of reporting and controls as well. The mistrust in certain healthcare organizations is pervasive, omnidirectional, and vicious. The mistrust can result in product enhancement that is weighted heavily towards these issues.

If a vendor has a design partner and early adapters with the same cultural issues, the functionality may be there from the start. Otherwise there will be a struggle to keep up. Of course, regulation (can anyone say HIPAA?) can not only force functionality into the system, but require it in a certain timeframe, causing major development schedule disruptions for the vendors.

Quality of HIT departments can severely affect implementations, or course. The early adapter customers are often the higher quality operations. They can handle implementation practices on the vendor side that are still in development, have a good grasp of the workflows in the organization, and have quality folks who can come to agreements on how to proceed in a organized fashion. Then come customers in the next wave, who may not be the bright stars, who need firm implementation processes, vendor help with workflows, etc.

Then comes the average HIT department. They may have an idea on how babies are conceived, but they often don’t know how they’re born or in which departments. Want to have fun? Ask a CIO what happens in the L&D department. Then ask the L&D department! Or ask where in the hospital babies are born. The answer may surprise you.

Vendors eventually develop lists of these customers who need special help when adding new functionality or upgrades — or when the vendor is sending out a new batch of replacement implementers on a project running several years overdue.

Decisions about configuration are either made off the cuff by top executives with little consultation with the subject matter experts in their organizations or worse yet, take months to bring together hundreds of people for a “consensus” decision. Warfare usually exists in the upper levels, with vendors and consultants often getting caught in the crossfire.

Often, a particular piece of software can go through dozens of implementations with quality healthcare organizations, only to run into problems when traversing to the next level of customer. This usually catches both the customer and vendor by surprise. Often, the vendor gets the blame (and often doesn’t dispute blame, since they shouldn’t be saying that the folks that bought their product turn out to be complete idiots).

If you hear of a product having problems at a particular site, ask at what point the vendor is in the introduction cycle and ask what kinds of problems they are having, Investigation might reveal that it’s not the vendor at all.

Concept – Hospitals that Expect People to Rely on Trust
By Healthfreak

Let us think how it would be to go to a hospital where there will no recourse to legal lawsuits, no visits to courtrooms. Patients come in and get treated quickly — no waiting for 5- 8 hours for a small surgery on a finger — and go back HAPPY.

It is possible, provided some mistakes by the hospital, doctor, or staff are considered "human" and patients do not go overboard in demanding legal action.

What can one achieve by all this ? Quite a bit. One, with legal hassles out of the way, the entire staff will be motivated to provide  better and faster service and not resent their jobs. Equipment sold to the hospital  will be economical, since the vendor does not factor legal costs in his pricing. Hospital administrators will offer economical service to the same patients. The overall insurance premium per patient will also come down and drive down healthcare costs as a whole. This is exactly what the US is looking for today.

Yes, there will be a fear that this may allow malpractice to go unchecked, vendors to sell faulty equipment, etc. A small percentage of cases may happen, as in any society. This, however, should not deter the introduction of a concept which will reduce the overall cost of healthcare.

The guru of AoL (Art of Living) has said that " the health of a society is determined by how many empty beds are there in hospitals and how many prison cells are vacant". May be we can add "and how many courtrooms do not have cases relating to hospitals".

Too farfetched? Maybe today. Let us debate this a little more openly and I am sure it will trigger some hospital into leading the way.

Monday Morning Update 11/23/09

From The PACS Designer: “Re: Google’s Chromium OS. Google has just announced the Chromium OS, an open source project. Since it is a completely Web-based open source development application, it brings with it some interesting possibilities for developers and eventually users. The Chrome OS browser will still be used to access all of the Chromium OS applications that evolve from development efforts, and some of the new features will eliminate the need for a hard drive since solid state memory will take its place. Chromium OS Security is a new approach to address security flaws.” Video overview here. I’m buying the concept because the Chrome browser is shockingly faster than FireFox (and less surprisingly, IE) when it comes to running complex Web apps. I’ve moved to it almost completely, even though it has some annoying deficiencies (no Google toolbar and no drop-down history).

From Dr. Pepper: “Re: Flash animation in ads. It’s causing me difficulties in scrolling and appreciating the content of your Web site. Can you limit this or allow us to turn it off?” There are many ways, but here’s the easiest one: click the View/Print Text Only link at the bottom of a posting to bring up a nicely formatted, paper-sized Web page with a Print option. Even then, it would be great if you take an occasional look and/or click on the sponsor ads since they make the wheels go ‘round and often have interesting information to share (nearly all the sponsors are big fans of HIStalk beyond just running ads).

From Bernie Tupperman: “Re: Kaiser. US News & World Report named KP Medicare Advantage in Colorado as the best in the country for Medicare, with all the rest of the KP plans except one near the top of their markets.” I don’t have any first-hand experience with Kaiser, but the pitch from George Halvorsen’s  internal e-mail that Bernie forwarded is certainly compelling, not to mention big on IT:

When you are a KP Medicare Advantage member and have coordinated care, fully linked caregivers, prescriptions and tests done onsite in convenient proximity to the rest of our care team and then leave our coverage and have to go out into the wilderness of solo, unconnected, unlinked, uncoordinated doctors — and when your new doctors don’t even know what prescriptions other doctors have written or what tests your other doctors have taken — and when you can’t schedule an appointment electronically or order your refill prescriptions electronically or even send e-mails to your doctor — those patients feel like they have fallen into a time warp into a very primitive world.

From Cam Winston: “Re: Pennsylvania HIE. I’ve heard Medicity has been chosen as the vendor in a $10 million deal.” I’ve seen that mentioned, but not officially. I’m sure Medicity won’t issue a press release until the contract is signed. Obviously that’s a big win for them if so. That led me to think how long it’s been since they started sponsoring HIStalk and I think it was in 2003, the year I started writing it. I don’t know where the time has gone. Including this year — can it really be just three months or so until HIMSS?

I’ve been slightly involved in some software usability projects over the years, so I enjoyed these clips (above) of real-life user frustration with healthcare software. They’re from Healthcare Human Factors, based in University Health Network, Canada’s largest teaching hospital. Thanks to JustAThought for sending over the link.

The Harvard people who published the study (warning: PDF) saying EMRs don’t improve quality or save money don’t exactly come across as impartial academics in an interview with HealthLeaders Media. Some quotes: “The idea from this administration that we’re going to pay for health reform out of savings from electronic medical records is baseless propaganda … What kind of an idiot hospital administrator would buy a system that will actually decrease what you can bill to payers? These systems help them extract more money.”

Speaking of those Harvard authors, nobody seems to have noticed that they wrote Bleeding the Patient: The Consequences of Corporate Healthcare and seem to have a socialist bent (“only when the U.S. has a party of labor will we have a national health program … it’s going to take a broad strengthening of the left.”). They also founded Physicians for a National Health Program, which advocates single-payer national health insurance, so they have an agenda that goes beyond IT. They also advocate open source over vendor systems: “We should really think about whether we want to continue to use our public funds to promote private, entrepreneurial HIT systems that have a business orientation, or if we should use those funds for further development of less expensive, open-source HIT systems designed specifically to enhance the quality of patient care, just as the VA health system has done.” Not to quibble, but the VA didn’t get VistA for free — it spent what must have been millions if not billions to develop it, and unlike vendor system development, taxpayers footed the bill. Even though the authors seem to have strong opinions that bled over into what was supposed to be a research article, I can’t say I disagree with most of what they say.

Meanwhile, here’s how the authors did the research for their article. They matched up self-reported levels of hospital automation from HIMSS Analytics with Medicare Cost Reports and Dartmouth Health Atlas data over a four-year period, looking for a correlation between degree of computer use (calculated from the authors’ own formula), cost, and quality. They not only didn’t find any, but even the Most Wired hospitals showed no clear advantage. There are lots of limitations in their method (using Medicare cost data, using the limited quality measures in Dartmouth to extrapolate overall quality, and having incomplete data for some of the years). Do their conclusions hold water? Maybe in aggregate.

Here’s the same observation I always make when the Most Wired people use similar number-crunching to try to convince you that IT improves costs and outcomes — correlation is not causation. Also, the conclusion isn’t that IT isn’t worth it, only that they could not prove that it was from their approach. Still, I’ll go with their general conclusion since I’ve been saying it for years — if there was one rock-solid case study of a hospital that reduced cost or improving quality solely because of IT, that hospital’s competitors would be out of business, their IT vendors would own the market, and we wouldn’t be stuck with the unsatisfying conclusion that it’s not what you buy, but how you use it (actually, Kaiser may be that one rock-solid case study now that I think about it). Still, prospects who think they’ll be a notably positive exception keep the HIMSS exhibit hall full.

HIMSS paying people to watch EMR demos is a bad idea, 79% of you said. New poll to your right: studies are showing that EMRs haven’t done much to improve quality or reduce costs, so who’s to blame for that?

A Mayo Clinical family medicine clinic in Arizona notifies patients that it’s dropping Medicare because it doesn’t pay enough to cover the clinic’s costs. Patients will be fully responsible for a $250 annual administrative fee, office visit fees ranging from $175 to $400 each, and a physical, with the grand total estimated at $1,500 per year.

Some interesting quotes from jurors on Charlie McCall’s trial. Referring to Al Bergonzi: “We just thought he was a thug in a suit”. Of Charlie’s legal dream team: “They were a little more theatrical … It goes to show spending millions of dollars on your defense is not necessarily effective.”

Three Denver area provider groups (Children’s Kaiser, and Exempla) go live on their HIE.

Listening: 30 Seconds to Mars, a reader recommendation. Sounds good – hard progressive with a little grunge DNA in there.

Shaun Priest, a vendor VP (I’m not sure if I’m supposed to mention the company’s name), has a novel available on Amazon called Decisions that involves an HIT sales guy fighting his demons.

HIMSS isn’t the only big trade show bailing on Chicago because of cost. The CEO of the huge plastic industry trade show, which is leaving Chicago for Orlando after 40 years, blames the work habits of union workers rather their reputation for being nasty. “We heard over and over again that the electricians were nice, but they dragged their tails. Jobs that should take two hours, they dragged out to five or six.” The president of the Chicago Federation of Labor said it was a wake-up call, but the electrician’s union boss wasn’t so humble: “I think HIMSS would have left anyway. They took a parting shot when they pointed at electricians.”

Odd, but possibly effective: a British dancer with epilepsy plans to induce an on-stage epileptic seizure to raise awareness of the condition.

MedAptus announces that its system for capturing professional charges is available for BlackBerry smartphones and coming next year for the iPhone.

Tampa General Hospital, like everybody else, signs with Epic in a $90 million project. It was just announced, but rumor reporter Jerry Seinfeld told you about it here on November 6.

The CSI Companies, the Jacksonville, FL-based staffing company that Grady Hospital (GA) chose for its Epic implementation, says business is up 40% over the past four years to $21 million, mostly because of healthcare IT. It says EMR implementations typically require 20-40 employees for 2-4 years.

Odd lawsuit: a man whose ear was torn off by his son’s dog is transported to the hospital by New York City paramedics who brought the ear along on ice. The hospital said the ear was contaminated, so the paramedics tossed it in the trash. He’s suing the city for being deprived of treatment, so the city is suing the hospital for telling the paramedics to throw it away. And in Florida, a woman who claims her emphysema was caused by smoking is awarded $300 million in her lawsuit against Philip Morrris, claiming the company is responsible for her addiction.

Mr. HIStalk’s 10 Ways to Get Off on the Wrong Foot as a New Hospital IT Executive

1. Convene endless department meetings under the naive assumption that all problems, from understaffing to poor system architecture, are due to insufficient employee communication.
2. Insist on extensive cross-training and information-sharing, thereby alienating the experts who deliver most of the results, but who don’t like working in teams.
3. Mandate the use of overlapping software applications that require employees to record time and write status reports in multiple locations.
4. Fill leadership positions with people from your previous employer, communicating a clear message of distrust for the department that just hired you.
5. Spend time behind closed doors working on org charts, having meetings with high-level peers, and plotting strategy, all without ever getting to know the employees who have to actually do the work being planned.
6. Repeatedly state that you wouldn’t have been brought in from outside if things were going all that well, so obviously past accomplishments were bogus and everything must be immediately changed to the exact structure, policies, and practices of wherever you came from.
7. Compare the software applications in use with those great ones where you came from, implying that you’ll displace the existing ones at the first opportunity even though you know nothing about them.
8. Consider group consensus to be equal at best to your own anecdotal experience.
9. Convince the executives to increase IT funding as part of the job offer, then take personal credit for the resulting technology improvements even though they could have been achieved at any time had the money been freed up.
10. Repeatedly remind low-level employees that, unlike them, you get a reserved parking spot, a sweet office, and bonuses.

E-mail me.