News 11/20/09

From Sam Shem: “Re: mammograms. An independent body, after review and analysis of eight clinical trials, comes out with EVIDENCE that mammogram screening in under-40-year-olds has little or no value. What happens? The radiologists are up in arms and the Obama administration, in the person of DHHS Secretary Kathleen Sebelius, tells patients to just keep doing what you did last year. And they want to cut costs by a billion dollars over the next decade to pay for national health insurance? If anyone really believes this country will ever control the costs of health care, they are living in a dream land!” Interesting, too, that nobody’s paying much attention to the study that showed that electronic medical records haven’t improved outcomes or cost so far, even as the government is spending lots of money on those, too. At least EHRs have potential. In an economy where jobs are dying out, politicians don’t have the guts to make serious change since the people unhappy with healthcare don’t have the clout of those who like it just fine. I cited statistics here years ago saying that healthcare was making a staggering economy look robust because of rising costs, profits, and high employment, all unsustainable in a global economy.

From Fred: “Re: Lattice. Lattice has been threatening to sue KLAS for the past few months. I guess Lattice didn’t like their ratings.” Unverified. I hadn’t really heard of the Wheaton, IL company, which sells point-of-care systems to hospitals. Far more interesting to me is its company history. I’d heard the name in seemingly wildly different contexts, but it’s the same company: they wrote the first C compiler for the IBM PC in 1982, sold the company to SAS in 1987, developed programming systems for the System/36 and AS/400 in the 80s and 90s, then went private again in 1993 and started selling application software. I haven’t seen their scores.

From Interoperator: “Re: SNOMED-CT and ICD-9-CM crosswalk. Here’s a guided tour.”

From J. Lo: “Re: Epic. Do they have or will they soon have patient registry functionality? If so, will it meet NCQA standards for Patient-Centered Medical Home designation? Some say it’s coming in February, others say never.” If you know, please post a comment.

From Nasty Parts: “Re: another Sage resignation. Maureen Peszko, SVP of strategy and business development, resigned last week.” Unverified since I didn’t have time to ask Sage.

Charlie McCall is finally found guilty. I’m flabbergasted that his ultra-expensive legal team couldn’t get him off since that’s usually how it works (although they may wangle a light sentence). To paraphrase the otherwise ineloquent Gerald Ford, our long industry nightmare is over. And now that he’s as officially guilty as everybody unofficially knew he was, I hope he will be as uncomfortable in prison as McKesson’s shareholders were watching the stock drop due to his actions (with the help of inept McKesson management who paid premium dollars for what was obviously a house of cards).

A hospital in India is piloting software that will send retinal images to the iPhones of specialists, allowing quick diagnosis and treatment of retinopathy in newborns. The software was developed by i2iTeleSolutions, a Singapore-based telemedicine software vendor. As the company says, the iPhone is now an EyePhone.

Ministry Health Care (WI) starts its implementation of Marshfield Clinic’s CattailsMD EHR, a $40 million project.

Ben Rooks didn’t sound too keen on Healthport’s business model, saying it was trying “to convince portfolio managers and buy-side analysts that even though over 85% of revenues are related to release-of-information services, it really is a revenue cycle management company and should be valued as such.” Those efforts apparently failed, as Healthport withdraws its IPO citing poor market conditions, but almost admitting that having never made a profit might have diminished some of the market’s enthusiasm. The always-vigilant Ben, however, floated the possibility that maybe a bidder emerged to buy the company outright, which he called the “dual path” in filing the IPO as “stalking horse.” I love that Gordon Gekko talk. Blue Horseshoe loves HIStalk.

The MyMedicalRecords people announce their partnership with a Chinese technology company to build PHR and document imaging applications for that country. That might make more sense there than here since I’ve read that in China, it’s the responsibility of patients to bring their paper medical records with them when seeking medical services. I don’t know if that’s necessarily worse than our way of having each provider keep their little chunk of a given patient’s medical record, never to be combined.

The UK division of UnitedHealth acquires ScriptSwitch, a prescribing decision support vendor.

Greenway Medical Technologies starts up a series of Webinars covering HIT Regional Extension Centers.

Odd lawsuit: a hospital surgery tech is suing her former employer after she was fired for complaining about unsanitary OR conditions that included bugs, holes in the walls, rusty surgical instruments, mold, and biological fluids splatter in the rooms. She took pictures. What will become fodder for lame morning zoo radio shows is her claim that a scrub nurse “actually defecated inside her clothes during a surgery and continued to work with fecal matter pouring down her legs and onto the floor.” She didn’t get pictures of that, I guess.

E-mail me.

HERtalk by Inga

University Hospitals Geneva Medical Center and University Hospitals Geauga Medical Center (OH) go live on ISirona DeviceConX. The technology delivers patient medical device data to Eclipsys Sunrise EMR.

API Healthcare announces that Version 9.0 of its Navigator payroll and HR system is now in GA. Enhancements include a new user interface designed to facilitate integration with other API Healthcare applications.

HHS awards CSC an IDIQ contract, which has a three-year base period and four, one-year options. CSC will have the opportunity to compete with one other vendor for specific IT tasks defined in the IDIQ.

ACL Laboratories selects Accenx Exchange to provide EMR integration between ACL Labs and its customers. Accenx is a wholly owned subsidiary of Initiate Systems.

The OMB says about 5% of federal spending was paid improperly in 2009, including $54.2 billion for Medicare and Medicaid programs. Those programs actually had improper payment rates of 15.4% and 9.6%. I believe OMB Director Peter Orszag wants Americans to feel encouraged because better detection methods have uncovered more improper payments than in previous years. Orszag cites the example of an invalid doctor signature, which was much more likely to trigger an improper payment in 2009 than 2008. I wonder how much sooner I could retire if Mr. H improperly overpaid me 15% every month.

Yet another health insurer loses financial, health and personal information on patients. Health Net says an unencrypted portable drive went missing and contain data on 1.5 million patients. The company took more than six months to report the breach, leading Connecticut state attorney to chastise it for “incomprehensible foot-dragging.”

Informatics Corporation of America captures "Best of Show" honors across both Provider and Insurance categories at Everything Channel’s 2009 Healthcare IT Summit.

Florida’s online medical records system for the state’s 2.6 million Medicaid recipients is now live. The site, developed with Availity, allows patients and their doctors to access 18 months of Medicaid claims data.

Trinitas Regional Medical Center (NJ) settles with the federal government, agreeing to pay $3 million in a Medicare fraud lawsuit. The hospital admits no wrongdoing. Meanwhile the whistleblower who originally alleged Trinitas illegally inflated charges gets a nice paycheck from taxpayers.

Image Movement of Montana,  a grassroots organization that includes 30 Montana healthcare facilities, plans to implement DR Systems’ eMix, a cloud-based technology for the secure sharing of radiology images and reports.

E-mail Inga.

Former McKesson Chair Charles McCall Found Guilty of Securities Fraud

A San Francisco jury has found former McKesson chairman Charles McCall guilty of five of six counts of securities fraud. He was acquitted on a single charge of falsifying records.

Federal prosecutors said the former chairman, president, and CEO of HBO & Company covered up that company’s fraudulent activities, allowing it to be acquired by McKesson for $14.5 billion in January 1999. The fraud was discovered three months later, sending McKesson shares into a nosedive.

Former McKesson general counsel Jay Lapine was acquitted on all three charges he faced.

McCall was originally tried on the charges in 2006, but a mistrial was declared. He will be sentenced in March.

Readers Write 11/19/09

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!

Let’s Send Mom On A Cruise – Forever
By Peter Longo

Dear Siblings,

With all this chatter about healthcare, I started to think about Mom. It dawned on me that, at some point, Mom is going to need some sort of nursing home (that or she lives with one of you four). Either option is not cheap or an exciting alternative for her. We all know she wants to keep her independence and maintain her zest for life.

Recently reading one of the confusing healthcare articles, I deciphered that the cost of care for elderly is way up. Now, I thought “up” might mean a higher co-pay or more expensive bingo. No, we are talking big monthly costs. The article pointed out that putting an elder parent into a home in Tennessee costs, on average, $72,000 a year. Can you believe that? What possibly do you get for all that money? From my view of working in the healthcare software world, I have no idea where all that money goes. It sure does not go to buying my software.

I understand the basics you get for some of that money. For instance, it comes with medical care. Apparently there is a doctor who stops by periodically to check medications. Great. Also, there are nightly activities. I assume bingo, Pictionary, and probably crossword challenges. The money also pays for Mom’s food. Jell-O choices, Pasta Night, and caloric smart desserts. Don’t forget the occasional outings or field trips (I bet they go to see Graceland once a year). I did check and the one near me does not provide free Internet.

I love Mom just as much as you guys. She took care of us for years, so we have to take care of her. We have to be there for her and we will have to split this cost no matter how tough it will be. But wait, I found something even better! Right there in the newspaper next to the article I was pondering.

Next to the picture of several Senators claiming victory on some healthcare issue was an ad for a cruise. Think about it — the cruise can be Mom’s floating nursing home. A higher level of quality care at a lower cost. Yep, Brother Peter found the answer — send Mom on a cruise, forever.

The advertisement touted a cruise for as little as $250 a week. It you think about it, that would be $12,000 a year to live on the cruise ship, with food, Vegas-style entertainment, skeet shooting, and even slot machines included.

Yes, Mom will need some healthcare attention, but hey, these boats all have a doctor onboard. A real, live doctor. I hear they give a free trip to the doctor and their family in exchange of services. (Maybe Medicare should consider a program like this. Free trip, they give back free care for a week).

All those medications she is on … she can buy them at the ports of call! No mail order from Canada or another country. Every foreign port the ship docks in, she can refill her meds on the cheap. We all know medication is cheaper in every country other than America. The ship even keeps a supply of certain medications on board. Even surgeries are less expensive at these foreign stops.

But wait, there’s more. Food. Medicare-subsidized food or all-you-can-eat buffet. On the cruise, Mom can have her choice of restaurants each night. For lunch, she can have an outdoor barbecue by the pool or grilled salmon in the formal dining room. Breakfast of eggs the way she wants or maybe a trip to the omelet bar! If she can’t sleep, then how about a stroll pass the midnight buffet? All included in the price. (Tough decision — midnight buffet or choice of Jell-O tonight.) There is even a gym with a trainer to work off the extra calories!

I know nursing homes have magicians and comedians stop by, but think about a live, Vegas-type show. The stages on some of these cruise ships are huge. When is the last time you saw Billy Crystal stop by a nursing home to perform? Every night, Mom can get dressed up and really be entertained. Remember, all for a fraction of the cost of a nursing home.

I known we all live in different parts of the country, making it hard to visit Mom in a nursing home. But if she was on a cruise, we could make a fun trip out of it. We could bring the kids. “Hey kids, you guys want to spend a week at a hotel across from a nursing home or a week on a cruise playing with Grandma?”

This cruise idea saves us money, puts Mom in better care, better food, better entertainment, and a place to interact with friends. Now I see why so many old people are on those cruise ships. This is brilliant.

Let’s try to keep this idea a secret. We would not want the government to find out. They might choose to debate a “cruise” idea in Congress for several months. Then the next thing you know, we will see a picture of some Senators celebrating a victory for “CruiseCare” that only costs $120,000 a year. Money our taxes will pay. Let’s keep this idea low key for now!

Next stop for me; let’s see if the cruise will buy some medical software. Boss, I need to expense a couple of cruise trips …

Peter

News 11/18/09

From Xper: “Re: Cedars Sinai. The ED is live, including the docs — yes, CPOE at Cedars! — seems like anything really is possible. Nurses are live on the system now and so is registration and billing. They appear to have more food and PR junk than support calls, probably a good thing. Many Epic folks are on site to make sure this goes well, but it’s kind of cool to see all the leaders here during the 40 hour go-live and sitting in the actual command center. One of the better projects I’ve seen as a consultant.”

From Kate Spayed: “Re: Windows 7. Anyone know which EHRs are compatible?”

From Dick Scrushy: “Re: Mark Leavitt of CCHIT. You should interview him.” I asked this week. He said no.

From Industry Watcher: “Re: Cerner. More bad news for Cerner in the US. Saint Peter’s University Hospital in NJ has decided to replace all Cerner Millenium clinicals for two primary reasons: (a) Cerner continually presented work orders for work outside scope and, (b) physicians were starting to admit elsewhere because of issues with Cerner CPOE. McKesson’s Horizon was selected as the vendor to replace Cerner. By my count, that means Cerner has been replace seven times in the last 18 months.” Unverified.

From The PACS Designer: “Re: FDA and iPhone apps. Back in February of this year, there was some discussion about the FDA’s role when it comes to using an iPhone for a clinical procedure. Now that the interest in iPhone apps for healthcare is gaining momentum, it would be a good time for comments to be sent to the FDA on if or how the iPhone apps issue should be handled. It’s hoped that the FDA won’t slow iPhone innovation and only regulate iPhone apps that are part of a system design submission seeking FDA approval.”

From Former Colleague: “Re: death of Frank Canestrari. He passed away suddenly on Sunday, November 15th at his home. He was the president of Newbold/Addressograph Corporation. Frank led the organization for the past two decades.” The online guest book is here and services will be at noon Thursday in Roanoke. 

David Brailer’s Health Evolution Partners takes an equity position in CambridgeSoft, which offers a long list of life sciences desktop software and scientific databases.

Keane announces that 13-facility Ernest Health has extended its agreement and will be installing Optimum Patcom at all sites current and planned. University Physician Healthcare (AZ) will also install several Optimum modules, including Patcom, HIM, scheduling, and document management.

The National Library of Medicine releases a draft of a crosswalk between SNOMED CT and ICD-9-CM, inviting users to give it a try and let them know how it goes. The intention is to automate much of the work required to turn clinical terminology into billing information. It was developed by SNOMED Terminology Solutions.

Intellect Resources is running a series of interviews it’s doing called IR Beat, kind of a radio show for HIT. The latest one’s on cloud computing and the one before is about Epic certification.

Dee Cantrell, CIO of Emory Healthcare (GA), is named CIO of the Year by the Georgia CIO Leadership Association.

A hematologist and his programmer son, both from New Zealand, are named finalists in a healthcare software contest for their warfarin monitoring system for patients at home. Their blood thinner system works like a glucometer, with patients testing a drop of blood in an INR electronic reader and then receiving electronic advice (along with their doctor) of dosing changes needed. I think there are already warfarin point-of-care test kits for home use, but the software is darned cool.

The London newspaper says Summary Care Records will be uploaded to the NHS spine by the end of next year, also warning that everybody’s records will be available except those who specifically opt out. The timing of that announcement wasn’t so great since NHS Hull announced a data breach by a former employee the same day.

UPMC will manage 30,000 PCs with Verdiem Surveyor, a centralized system that enforces and monitors PC power policies without disrupting users. UPMC says it will reduce PC power consumption by half and save $1 million per year.

Medversant may be crass in using the Fort Hood shootings in its PR pitch, but it still has an interesting idea — continuous credentialing, where provider licenses are constantly checked against OIG and DEA records, but also against general Web information such as social networking sites, articles, and blogs. Also interesting: its recent study found that 1.9% of practicing medical professionals did not have a license and 18.7% had expired or falsified credentials or malpractice judgments.

E-mail me.

HERtalk by Inga

A new study by the Harvard School of Public Health finds that the use of EMRs has not had any effect on healthcare cost or quality. I’m sure some HIT critics will point to the study as proof that we should stop spending billions on EMRs. I personally side with Masspro’s Dr. Karen Bell, who believes the findings highlight the need to focus on helping physicians, hospitals, and the public health system use technology more effectively.

NYU Langone Medical Center launches the first phase of its EHR implementation, taking live its Trinity Center faculty group in Manhattan. Patients can also now access the practice’s SmartChart portal.

The National Institutes of Health’s Fogarty International Center grants Indiana University and the Regenstrief Institute a $1.3 million award to establish the East African Center of Excellence in Health Informatics. The center will focus on increasing the capacity of EHRs in the region and teaching East Africans to use electronic tools to solve healthcare problems. The center’s director claims that Kenyan clinics using EMRs are able to serve two to four times more patients than those using paper records.

GetWellNetwork appoints Michele Perry COO, tasked with helping to “lead the company to a new level of growth.” She was previously involved in three IPOs, so perhaps that’s the “next level” the company has in mind.

A new KLAS report takes a look at Allscripts a year after its merger with Misys. KLAS surveyed 200 Allscripts clients and found declining customer satisfaction in several key areas. However, Allscripts remains the “most-considered” vendor in outpatient EMR purchases (which sounds about one step better than always being the bridesmaid, never the bride). The release of v.11 created challenges, though clients on versions 11.1.5 or higher are seeing positive results. About 85% of Misys EMR users who plan to replace their EMR say they’’ll go with Allscripts Professional EHR, which is being offered at a relatively low migration price.

Meanwhile, Forbes has a nice write-up on Allscripts iPhone app, Allscripts Remote, which gives physicians real-time access to patient data, fast communication with ERs and the ability to e-prescribe (the article says “e-mail prescriptions,” but I am assuming the author meant e-rx.) Allscripts Remote also made New York Times columnist David Pogue’s listof the top health-related iPhone apps. Right up there with PeriodTracker. Really.

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Singapore General Hospital actives Eclipsys’ Sunrise Patient Flow solution at its 1,500 bed facility.

Using reporting tools from EDIMS, 22 New York and New Jersey area hospitals are providing their state health departments daily H1N1 influenza data. Details include the number of patients by county with flu-like symptoms and a breakdown of those with respiratory and/or GI symptoms.

Over half a million users are now live on Sentillion’s single sign-on and context management solutions.

Community health organization Neighborhood Healthcare (CA) selects eClinicalWorks’ PM/EMR and Enterprise Business for its 115 providers across 11 locations.

Computerworld releases its annual salary survey of IT professionals. Not surprisingly, the economy has had an impact. Salaries were flat and bonuses and benefits were reduced or eliminated. Nonetheless, IT folks remain satisfied with their career choice, though they may be feeling stress over job security. If you are a CIO, you’ll likely find the best-paying jobs in the mid-Atlantic, with compensation averaging $172,000 a year.

CliniComp contracts with Multi-Services Group to provide training services at military treatment facilities using CliniComp’s inpatient documentation solution.

Cost management company Broadlane acquires Healthcare Performance Partners, which provides Lean Healthcare and Six Sigma consulting services.

Harris Corporation also makes an acquisition, buying Patriot Technologies, a provider of integrated and interoperable HIT solutions for the federal government.

Business associates are largely unprepared to meet HITECH’s data breach-related obligations. One-third of surveyed business associates (billing, accounting and legal services, claim processors, pharmacy chains, and offshore transcription companies) were not aware that HIPAA’s privacy and security regulations applied to them. Comforting.

DigitalPersona says its biometric fingerprint reader, which is incorporated into the Picis ED PulseCheck product, is being used by 150 hospitals.

E-mail Inga.

Healthcare IT from the Investor’s Chair 11/17/09

Update – The IPO Market Return

Or in the words of Santayana, "Those who cannot remember the past are condemned to repeat it."

As I write this post, the IPO market continues to rock and roll. As some confidence returns, investors look for new places to put money, and perhaps dress their year-end performance results with some nice IPO bounces. Wall Street is, of course, happy to oblige, especially in our own little corner of the economy, healthcare information technology.

Accretive Health’s IPO prospectus continues to wend its way through the bowels of the SEC. Management has no doubt endured the begging of numerous middle market firms trying to catch a few crumbs left after the four big banks received 95% of the available dollars. Given the size of the offering ($200 million), 5% economics is still over $800 thousand in fees left up for grabs, so you can’t blame folks for wanting a piece of it.

First of all, it’s an impressive transaction to be on, and nobody wants to blink. Second, there are a few small bragging rights: “They could have picked anyone, but they chose us”, I’m sure managing directors or partners will tell other prospects. But finally, as I said, even if they put two more banks on for $400K each, it’s high margin and extraordinarily easy business.

Recall our earlier discussion on IPOs with organizational meetings, drafting, etc.? That’s all been done before the new bank shows up. All that remains for the lucky new co-manager(s) to do is hold a few basic diligence calls, draft a memo to their firm’s commitment committee (the inter-departmental group that approves participation in equity transactions), and then take some slapping around by said committee as they ask the bankers the ritual hard question in this situation: “Doesn’t this set a bad precedent, to put our name on the cover for only (or perhaps less than) 5% economics?”

In the end, however, I’m confident Accretive will have its pick of underwriters. A fee’s a fee, especially in this market, and in my experience, the average managing director level banker will spend less than half an hour working once hired, farming it out to VPs, associates, and analysts. (readers who would like a Who’s Who of roles in a bank, please feel free to submit a question).

Meanwhile, HealthPort is concluding its road show this coming week as it works to convince portfolio managers and buy-side analysts that even though over 85% of revenues are related to release-of-information services, it really is a revenue cycle management company and should be valued as such.

Ask the Chair

I really appreciate the comments and questions I’ve received, both posted and e-mailed, so please keep them coming as I aim to inform and educate, not just ruminate. Let’s take a few:

Who coaches the management of publicly traded companies on what they can and can’t say?

It’s actually a combination of people, but last word is given to the lawyers. Part of the role of the board, I believe, is to help mentor first time public company CEOs, helping them strike the right line between promoting their stock (which is, after all, part of their job) and telling only truth. There are also investor relations professionals who do this for a living, though I’ve found their quality varies dramatically. Further, it will come as no surprise that, in both my prior lives as research analyst and investment banker, I’ve always tried to share my views on good Street communication, and I’m sure other bankers and analysts do as well.

At the end of the day, however, given the myriad SEC rules and regulations on stock promotion and our litigious society (and class action lawyers who don’t wait for the phosphors to fade on a negative press release to file a claim), it’s corporate counsel who often has the last word. This has been even truer since the adoption of SEC Regulation FD in 2000. Reg FD (for Fair Disclosure) was adopted to eliminate (really minimize) the phenomenon of selective disclosure that was rife on Wall Street. Companies would often tell their favorite analyst (who usually seemed to have a buy rating on the stock) a material fact before others, allowing him or her to share it with their best clients. Clearly that puts the investing public at a disadvantage, so the SEC adopted FD and lawyers suddenly had a lot more press releases to vet.

Let’s say I’ve been burned by the stock market and would like to invest some money, say $50,000, in a healthcare IT startup. Is that a good idea and how would I go about doing it?

Individuals investing in private, early stage companies are known as “angel investors”. There are pros and cons to making investments like this.

In theory, the readers of this blog, as well as being charming and perceptive, should know more than most anyone about the prospects of a healthcare IT startup. Recall that legendary investor Peter Lynch advised us to invest in what we know. A few things to think about beyond the obvious questions of “is this a good business?” are: “Do I trust and respect the judgment and integrity of the entrepreneur?” “Does this seem like a fair price for the company?” and dozens of other questions.

I think the first question to ask before an individual invests in a private company is, “How much do I care about that $50,000?” If you need it for Junior’s college tuition or your retirement in the next five or ten years, don’t even think it. Venture investing (which is what this is) is extremely high risk, that’s part of why venture investors demand high returns. Further, most startups fail (and HCIT is a tough area for success). VCs protect themselves there by investing in a portfolio of companies to diversify away some of their risk (typically, they expect multiple failures or break-evens for each success).

Also, ask yourself how you’ll get your money back: will the company be sold or go public? How much more money will they need? Angel rounds are usually early in a company’s life cycle, and subsequent money raised could well dilute your investment (lower the percent of the company you own). If you think you have the opportunity to invest in the next Epic Systems or athenahealth and are willing to take a flyer, more power to you, but caveat emptor (and good luck).

And finally, Matthew Holt wrote:

Ben I think you should take Ms. Faulkner on a fake road show, and then write that up.

Judy, if you (or one of your staff) are reading this and you would like the opportunity to hit the road and meet with the high and mighty of Wall Street to share your views of the sector and the publicly traded companies that make it up, I’d be thrilled to accompany you. I am pretty darned confident we could have the trip sponsored by a brokerage firm who’d also make a hefty donation to your favorite charity.

And if you agree, I’ll also go buy five lottery tickets and take a trip to Vegas, because it’s clearly my lucky day 😉

Thanks for reading, have a great Thanksgiving, and keep those posts and e-mails coming.

Ben Rooks
The Chair

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

CIO Unplugged – 11/15/09

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

Why Healthcare IT Lags
By Ed Marx

Last week, one of our hospitals went live on CPOE. My boss and I were there as part of the ribbon cutting ceremony and to commend IT and the hospital for their hard work. When we met in the entryway, he eyed my attire with surprise. I was wearing scrubs, a violation of the dress code.

“Ed,” he said. “I bet you caused a lot of trouble growing up.”

“Yes, I did.” I liked coloring outside lines then; and I still do today.

But, why do I? Shouldn’t a leader be a good model to his followers?

I attended a national meeting with my healthcare IT (HIT) peers. Had you been a casual observer, however, you would not have pegged us as technology leaders. For all anyone could tell, we were glockenspiel salespersons. Our celebrated keynote, the government czar encouraging the adoption of HIT, was relying upon paper notes—yes, the physician who rightly wants our nation to lose the paper chart in favor of the electronic health record used hardcopy notes. And the audience was copiously taking notes…on paper. Need I say more?

Besides coloring outside the lines, I’m a fierce competitor. I aim to win every race I start. I’ll only accept defeat gracefully if I know I’ve poured my all into the competition. When I cross that finish, my tank had better be empty. In the same way, the lack of HIT progress aggravates the heck out of me.

Why are we so far behind other industries? Look in the mirror. That’s right. Time to come clean. It’s because of you and me. Granted, there are numerous other valid excuses, and I will touch on a few. But at the end of the day, the buck stops with us. When I lose a race, I don’t blame my blister, my clothes, the event management, the weather, the course, the timing chip, my equipment. I lost because of me.

Stop reading and let this sink in. You and I are the reason HIT lags.

But there’s hope. If HIT lags because of us, we can reverse the situation and make IT strategic in our industry and career.

When I asked my Tweeters and Yammers for ideas, here’s what they sent. Thanks to all of you.

Some reasons why we lag:

· Leadership

CIO’s not leading

CIO’s not culturally relevant

CIO’s reporting to CFOs

C-Suite not understanding or acknowledging HIT strategic value

CIO’s fear of failure

Leaders tend to be older and less receptive to technology

Decision makers often have clinical backgrounds, an area that has a bias for rigor, analysis, and is slow to change

· Healthcare Complexity

Burdensome government regulations stifle attention and consume financial resources

Payment systems and processes

Lack of standardization

Piecemeal approach to application deployment

Clinical and legal liability

Fragmentation – hospitals are silos of individual services, often used by independent practioners, all with differing cost and profit structures

Complexity is so great that leaders don’t want to deal with it

Incentives to innovate and minimize inefficiencies, if they exist, are contained to a specific workstream – not the entire ecosystem

Adoption of any new treatment or procedure in medicine has traditionally been slow because of the need for long-term testing and proving of safety and efficacy. This approach has transferred to the adoption of anything “non-medical”, new or different like HIT

· Financial Resources

Lack of margin to focus on innovation

HIT investments are not appropriately correlated to outcomes

Historical under investment

· Healthcare Culture

Healthcare by nature is precise, protocol-driven, and we teach the need to be "in control" at all times. While this is true for clinical care, the same mentality in other areas (IT) hinder change

A corollary to the above- By nature, people with these characteristics self-select into healthcare, making the climb that much more steep

A schism exists between IT and those who provide hands-on caring service to patients

Much like the traditions connected with our clinical training counterparts, HIT leaders are still promoted and recognized for experience and longevity

Social-cultural issues; change resistant

"High touch" aspect of healthcare views HIT as intrusive

HIT must be proven safe before it can be used, where as in other industries, if you test and fail there’s little harm

Waiting for next big thing

Lack of market-driven demand

Knowing and holding information is power and HIT threatens that power by enabling easy sharing of information

CIOs are in a unique and coveted position that allows us to observe and tie together the healthcare ecosystem, first within our own gates, and then beyond. The single biggest change agent to move HIT from laggard to leader is not healthcare reform. It’s you.

Ways to reverse our situation:

· Stop throwing up your hands and blaming the environment

· Take responsibility

· Take calculated risks and color outside the lines

· Take proactive actions internally and externally at the local, state, and national levels

· Challenge the status quo

· Tackle the tough issues and demonstrate HIT investment value realization

· Model innovation and technology use

· Get deeply involved with your clinicians and live their processes

· Be disruptive

· Stop traditional hiring and promotion practices. Instead, favor talent

· Look outside of healthcare for new ideas

By the way, I wore scrubs at the GoLive so no one would mistake me for a chaplain, a lawyer, or a glockenspiel dealer. The color matched the rest of the IT team on the ground and fosters a close working relationship with clinical staff. I was proud to wear it, to show I cared. And because I love to surprise my people.

So…I commission you to help your organization and physicians understand the strategic value of HIT. You hold the salve to heal what ails healthcare today.

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.”

Monday Morning Update 11/16/09

From HITMarqueen: “Re: OR cameras. I’m curious if you have any thoughts on the recent ruling by Rhode Island’s Dept. of Health that requires video cameras be installed in all Rhode Island Hospital operating rooms to monitor patient safety during surgical procedures? This is in addition to a $150K fine for the most recent wrong-site surgery at the hospital.” The state had to do something. Rhode Island Hospital has done five wrong-site surgeries since 2007, most of them really stupid (three wrong-side brain surgeries and the most recent gaffe, operating on the same finger twice instead instead of the two intended fingers — how can you make excuses for that?) Surgeons weren’t marking their sites and time-outs weren’t being done, which sounds like a great reason to revoke their privileges. The state ordered the hospital to assign someone to watch the camera for at least a year, observing every surgery to make sure the marking and time-outing are done (sort of like a football replay official, I guess). They’re darned lucky to be allowed to keep their OR open. Want to bet it’s not just the OR that has problems?

From H. Boc: “Re: Pano Logic devices. HBOC had one of these years ago. Whenever money was nearby, a little hand would come out of the box and snatch it. Then a voice in the box would tell you that the software was going through an upgrade and would be delayed for install.” That must have been a Pathways box. Maybe it handed back a side letter.

From Connie Ripley: “Re: content management. I’m curious to get an idea of how many healthcare or HIT companies are taking Content Management seriously? I see this as an area in dire need of improvement and I can tell you straight from the trenches that it’s not for the faint of heart.”

From Mercy, Mercy Me: “Re: parking garage advertisement. This is what attracts doctors to use CPOE.” UPMC Mercy has the right idea since you only have a few areas in which you can get the attention of doctors: the parking lot, the doctor dining room or lounge, and the chart completion area. Once they get them on CPOE, they can add nag screens for subtle messages of propaganda. Or, send them off to re-education camp

From Peter Gunn: “Re: HIMSS. Dang! I was dying to go to HIMSS last year in Chicago, but I live in Atlanta, and now that HIMSS is here in Atlanta, it sounds like it’s not worth going!” I’ll go out on a limb and say that it’s been years since it was worth going if you consider just the official offerings — the self-congratulatory opening session, lame keynotes, mediocre educational programs carefully limited to ensure vendor access to providers in between, having HIMSS-sponsored and ad-filled publications thrust into your face at every turn, and being herded to the exhibit hall like cattle in a slaughterhouse. The best thing about HIMSS is all the non-HIMSS people and events. They haven’t figured out a way to screw that up yet (although the uber-commercial tone threatens to keep providers home, which would then make the conference pointless). You could get most of the value of the conference by not registering at all, just hanging around the public areas of the convention center and attending non-HIMSS events. That would save you only $640 of the total cost, though. There are many things I don’t like about the conference, but I still go.

From Michelle Flaherty: “Re: EHR vendors. QHR will acquire Clinicare, a KLAS winner (Chartcare). Both companies are in Canada. Also, Noteworthy Medical Systems, acquired early this year by CompuGROUP Holding AG of Germany, is sunsetting its non-ASP product.”

From Just Checkin’: “Re: HIMSS shindig. So admittedly we’re not even to Thanksgiving, but given the need to schedule time off way in advance, I gotta get organized. Will the annual shindig take place at HIMSS? If so, is there a date?” I theorize that the beginning of winter gets people thinking about HIMSS, even though it’s a while away (I’ve booked an ultra-cheap hotel already myself and need to pay my $640 registration fee before it jumps to $740 on December 15). I’m still working on details of the reception with the sponsoring company. It is horrifically expensive to put these on — you could have a swanky evening in the best restaurant in Atlanta and still spend a lot less than it costs per person to offer just  a couple of drink and snacks in a private reception. When we first did it in Orlando, I was naive enough to think that we could just buy out some big restaurant and spend $75 per head for an open bar and dinner, but that brings other challenges: which places are available during HIMSS, how many can they hold, how do people get to and from, is it suitable for mingling and having a speaker or two, and how many slots does the sponsoring company want for their own use. It’s also a tough sell to vendors since many of the attendees will be HIStalk readers who work for other vendors. I’m hoping for the usual Monday night, but it’s still up in the air.

Speaking of which, it will be HISsies voting time soon. To prevent the usual ballot box stuffing, only those on the e-mail blast list will be able to vote this year. If you want in, put your e-mail address in the Subscribe to Updates box.

HIE service provider MobileMD gets $4.75 million in a VC funding round led by Health Enterprise Partners.

Athenahealth is awarded a patent for its athenaNet billing rules engine. Shares rose almost 5% Friday after the announcement, closing near their 52-week high.

An MIT research assistant creates SixthSense, a combined camera and projector worn around the neck that turns any surface into a screen and input device for smartphones, which he says will allow low literacy citizens of India to use software applications as their gestures are translated into commands. The TEDIndia demo video is amazing. If you’ve seen Minority Report, it will look familiar. Manufacturing costs are estimated at $350. The audience went bonkers, especially when he used his hand as a screen in the picture above.

Here’s my response to the announcement that HIMSS won’t be going back to Chicago because it’s too expensive: duh. Everybody who has every been involved in conference planning is well aware that strong unions, expensive hotels, and rife corruption have made Chicago a terrible place to hold a conference (not to mention that it snows in April, as we now know, although that was a plus to HIMSS because it kept people in the exhibit hall instead of doing something fun). If HIMSS was shocked (no pun intended) by the electrical costs of the most recent conference, then it didn’t do its due diligence and the vendors who had to pay those ridiculous costs ought to be mad. I’ll predict now that exhibitors will be griping after the Lost Wages conference that everybody bailed on the exhibits to go to the casinos and shows.

September’s Harvard Meeting on an HIT Platform (the “HIT should work like an iPhone” meeting) was invitation-only, but they’ve posted videos and an executive summary (warning: PDF). It includes Aneesh Chopra and Todd Park talking about turning NHIN into the “Health Internet”, hoping to make a lot of patient data available around which new applications could be built.

A non-profit hospital paying its CIO over $500K is not clearly excessive, say 64% of survey respondents. New poll to your right: is it OK that HIMSS offers cash payment to conference attendees who attend vendor demos?

The Madison paper covers the construction of Epic’s second campus, with the four buildings now halfway finished and one occupied. It says the company will add another 200 employees this year for a total of 3,400, including a Netherlands office with 35.

Speaking of Epic, this comment from a David Blumenthal e-mail (that I get, for some reason) seems to be a shot at MyChart and Epic’s other data sharing programs that work only for Epic-using hospitals: “… we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries.” Glen Tullman was also talking apparently talking about Epic (since he’s made similar comments elsewhere that named them specifically) in my interview with him this week:

“We need an interoperable system no different than the ATM networks that we use, no different than cellular networks. We have many different competitors, but they’re all using — they’re all connected to a network exchanging information; and of course, no different than the Internet. That’s the model that everyone ought to be forced to play in. We have some holdouts who are really not supporting this idea of full interoperability. So if I could change one thing, I would say we’ve got to much more aggressively push on interoperability.”

I had a question I would have asked had we not been running short on time: “Wouldn’t Allscripts do the same thing if it had the same chance as Epic?” Not for unsavory reasons, but because having big market share in an area provides some fast, cheap interoperability opportunities that are great for patients in those areas, even if they don’t tie into whatever regional or national networks that are being considered.

Exempla Lutheran Medical Center (CO) goes live with its Epic EMR. The three-hospital cost: $85 million, plus another $4 million for its physician practice.

Tampa-based Tech Data forms a healthcare business. Stimulus dollars may not be doing much good for unemployment, but they’re bringing a lot of companies into healthcare that weren’t interested until the taxpayer money chummed the waters. All I’ll say to the prospects they’ll try to convince of their newfound interest: lots of companies got out of healthcare just as fast as they got into it when the expected profits didn’t materialize. It’s not like we’re a new industry.

The ACG Boston 2009 Fall Conference & Private Company Showcase is this week in Boston. Speakers: John Halamka (of course), Todd Cozzens of Picis, and Carl Byers of athenahealth. Cost to attend the 3.5 hour conference – $330.

A doctor in China loses his job and his license after investigators checked computer records and verified that he was playing online computer games at work while a five-month-old baby he was supposed to be monitoring died.

Apple files a patent for its long-rumored tablet PC.

University of Maryland Medical System will float a $250 million bond sale, with a portion of the proceeds to be spent on clinical systems.

Merge Healthcare will sell $27 million worth of new shares to pay off debt. Shares are worth eight times what they were a year ago, but still barely more than 10% of what they sold for three years ago. It also has expanded its offerings in China.

E-mail me.

CCHIT Chair Mark Leavitt Announces Retirement

The Certification Commission for Health Information Technology announced today that its chair, Mark Leavitt, MD, PhD, will retire from the organization in March. A search firm has been engaged to recruit his replacement.

Steve Lieber, HIMSS president and CEO and chair of the CCHIT Board of Trustees, said the board “accepts Mark’s decision with reluctance” and says the search for his successor will be “open and transparent.”

News 11/13/09

From Vendor Bribes: “Re: Amazing bribery to EMR buyers via HIMSS.” The HIMSS Takin’ HIT To the Streets campaign (gag, even for Doobie Brothers fans) leaps that last boundary of member organization common sense —  they’re paying people to attend the sales presentations of their vendor members. I’ve been watching the remake of the old miniseries V and I think maybe vendor visitors have taken over Steve Lieber’s body since the previously furtive and tentative vendor-HIMSS gropefest has advanced to a full-on public consummation.

From Dr. Know: “Re: HIMSS. I think that HIMSS needs a shock to the system. We all recognize their priority is to serve the interests of the vendors and not hospital end users. Therefore, I wonder whether an organized boycott of this year’s conference is in order?” I’m not a fan of boycotts. If members and attendees don’t like how they are being represented, they know their options. Without providers as attendees and members, the vendors would bail quickly.

From Ryan: “Re: HIMSS. Not sure why Siemens would pull out of HIMSS 2010 in Atlanta, as they have an office in Alpharetta.” They still would have to buy horrendously expensive exhibit space, pay people to work the show, pay union carpet sweepers and power strip deliverers, and bring in people from places a lot further away than Alpharetta. All to reach the mostly non-decision makers (competitors, consultants, and people who don’t influence hospital IT purchases) who pad out the otherwise impressive attendance numbers. Siemens did it before (as SMS) and this time around, Cerner can’t shame them to prospects since they’re not coming either.

From Hockey Dad: “Re: EMR ratings. 2,556 primary care physicians (family doctors) rate their EMRs. Results published in Family Practice Management from AAFP.” You have to subscribe to read, but Hockey Dad sent a PDF. The article admitted some unavoidable bias (self-selected respondents, too many vendors to ensure adequate sample sizes for all, and different levels of expectation based on practice size) and accordingly warned about taking the results as anything significant. They didn’t really name overall winners, but the closest thing to it placed the top 10 as (1) e-MDs, (2) MEDENT, (3) Praxis, (4) Amazing Charts, (5) eClinical Works, (6) Epic, (7) Practice Partner, (8) Allscripts Professional, (9) Centricity, and (10) Aprima.

From Demetri Noh: “Re: survey. Got this survey, which appears to be from a rival group of HIMSS.” Or “HIMMS”, if you like their version. It’s not clear who funded the research firm’s survey. It’s a great time to be starting up a HIMSS alternative, if you ask me, although I don’t know if that’s the point of the survey.

From Billy Bong: “Re: radiologist. This can’t be good for the industry.” An Atlanta doctor who runs a radiologist coverage service faces 20 years in jail, charged with letting unlicensed employees write up his interpretation reports for images he didn’t bother to look at.

From Craig Powerplay: “Re: AHA Solutions. They understand their endorsed products only to the extent that they need to believe people will buy it. They only make money if the endorsed product/ service sells. When we negotiated with them, we didn’t see much understanding in what our product was, but they did understand this:  press hard for a high yearly endorsement fee and a high percentage of each sale. We passed — our margin would have been near zero.”

From The PACS Designer: “Re: RSNA iPhone review. With the popularity of the iPhone in healthcare increasing, you may want to check in at the RSNA for a presentation by Presenter Dr. Krishna Juluru, an assistant professor of radiology at Weill Cornell Medical College. Along with others, he will be discussing the use of the various healthcare apps in radiology, and how they can improve the care process.”

Listening: Amorphis, another of those Finnish progressive metal bands that I like.

I interviewed Allscripts CEO Glen Tullman on HIStalk Practice. If you decide to check it out, drop your e-mail address in the Get Instant Updates box on that page and you’ll be the first to know when we run something new there (it’s a separate e-mail list since not everybody who reads HIStalk follows physician practice software).

Cris Assif is named managing partner of consulting firm Entrust Healthcare.

A reader forwarded an e-mail from Duncan James, president and CEO of QuadraMed, welcoming Michael Jarrett as the new VP of client services, coming over from McKesson but also sporting QCPR experience from its previous owners Per-Se and Misys. Linda Baum and Linda Benson were wished well in future endeavors required to take place elsewhere.

I can’t find any updates on Charlie McCall’s trial. If you’re in San Francisco, you could wait outside the court house and snap a picture for me, and maybe thrust a recorder in his direction while asking accusatory questions that might startle him enough to answer.

EDIMS, the Livingston, NJ based vendor of emergency department systems, is supporting HIStalk as a Platinum Sponsor, so thanks to the folks there. Its EDIMS flagship product is live at 39 sites, has documented over 12 million encounters, and is used by EDs that document 100% of their patients compared to a national average of 40%. It offers a quick registration kiosk, nursing documentation, graphical patient tracking, an alert-driven nursing dashboard, CPOE, order sets, charge capture, prescription writer, medication reconciliation, and lots of other features. I appreciate their support.

McKesson announces Horizon Connect, an interoperability product. For home buzzword-counters, the press release included these: solution suite, seamlessly, discrete, actionable, workflow, collaboration, continuity, aligned, continuum, and ubiquity.

Epic Systems is among the financial backers of Porchlight, a Madison prevention and treatment agency for homeless veterans.

Iowa State University researchers develop software that converts CT and MRI scans into 3-D representations that can be navigated by joystick, making them useful for doctors for planning surgeries and for teaching. As one said, “2-D is guessing and 3-D is knowing.” The product has been commercialized as a $4,995 PC package that uses Xbox controllers. The above image is a converted cardiac CT.

St. Vincent’s Catholic Medical Center (NY) replaces its PC desktops with a virtual desktop infrastructure, speeding up their network since the zero client cubes do screen scrapes of VMware server-hosted applications. The 3x3x2 inch Pano Logic devices have USB plugs that connect to a virtualized Windows desktop server in the data center — no moving parts, minimal energy consumption, and minimal footprint.

Medical Mutual of Ohio will roll out Intuit’s Quicken Health Care Expense tracker to its 1.6 million members. A consumer advocate says easy-to-read bills are good, but reminds, “Even if you are armed with this information, it’s not as if you shop for health care directly. You go with your insurance company. It’s unclear that the information really translates into any new buying power.”

Sam Heard, the doctor who runs Ocean Informatics in Australia, is profiled in a newspaper article. His company developed openEHR, a “shareable EHR” chosen by Sweden as the basis of its national eHealth infrastructure. Its template designer is pictured above.

The nursing school at Case Western Reserve University gets a $1.3 million grant to develop avatar-based software that teaches patients to communicate with their doctors. They envision it running on a kiosk outside the doctor’s office to coach patients on what to ask.

A critical results related lawsuit verdict: the doctor of a hospitalized 18-year-old woman who had just given birth orders blood tests, which showed a serious infection. The hospital lab didn’t get the results to the doctor in time to avoid a complete abdominal hysterectomy. The jury returns a $2.3 million verdict against the hospital.

E-mail me.

HERtalk by Inga

Design Clinicals reports that it’s on track to double its revenue and product sites for FY09. Its MedsTracker medication reconciliation product is now live or in implementation mode at 18 sites. Mr. H interviewed founder Dewey Howell a couple years back when the company was in the midst of its first installation.

Hewlett-Packard agrees to pay $2.7 billion to acquire 3Com. The acquisition strengthens HP’s position as a one-stop shop for corporate customers.

Trinity Health plans to install seven of Elsevier’s online clinical decision support solutions across several of its facilities.

Picis recognizes winners of the Picis 2009 Customer Recognition Awards, selected based on their use of Picis solutions to improve their financial and clinical operations in the ED, OR, or ICU.

Allscripts contracts with DecisionOne to provide hardware infrastructure support to its clients. Allscripts internal hardware service personnel will integrate with DecisionOne’s field service organization. Sounds like a good move as it allows Allscripts to focus on the software side of the business. Having an internal field service team is less critical in today’s server/PC world than it was in the good old days of proprietary hardware.

HIMSS announces it will head to Sin City for the 2012 Conference and Exhibition. According to the Chicago paper, HIMSS chose Las Vegas over the Windy City because of the high cost of labor at McCormick Center, with electrical service at this year’s conference costing 4-10 times as much as it did in Orlando the year before. I love Chicago, but like the Vegas choice simply because the average February temperature is about sixteen degrees higher.

Iowa Health System deploys McKesson’s Horizon Medical PACS solution at 34 locations throughout Iowa.

Healthvision calls its third quarter “healthy” based on its closing of 97 transactions, including 13 new customer engagements.

Intel’s Digital Health Group introduces a mobile handheld device designed to assist people with dyslexia or vision problems. The Intel Reader uses a camera to capture text and converts it to digital text. The device then reads the text aloud. List price: $1,499.

API Healthcare signs an agreement with Logicalis to offer remote hosting services to API clients.

Premier Purchasing Partners awards Meta Health Technology a 36-month contract to provide Premier members special pricing and terms for Meta’s patient chart abstracting and Electronic Physician query software products.

Scott A. Storrer takes over as president and CEO at MEDecision. The transition has been in the works since Storrer joined the company in 2008. Founder and current CEO David St. Clair will retire December 31, but stay on the board for one more year.

First Citizens Bank agrees to market mPay Gateway’s patient payment system to its physician practice clients.

Indian police arrest the head of an outsourcing company for allegedly selling the medical records data of patients treated in a British hospital. An undercover investigation revealed Vikas Dhairyashil Bansode had thousands of records that included confidential clinical and financial information. Bansode and his accomplices obtained the records from IT companies contracted to convert the paper records to digital. The group then sold individual records to middlemen for as little as $6 each via Internet chat rooms.

Senator John Kerry introduces legislation to help small medical practices become eligible for SBA loans to cover EMRs and e-prescribing costs. Funds could be used for both hardware and software.

A whopping 94% of healthcare organizations don’t think they are ready to comply with the privacy and security provisions included in the HITECH Act. The new regulations, which go into effect in February, extend existing HIPAA rules including increased enforcement, penalties, and audits. Funding is the biggest barrier.

The University of Colorado Hospital signs a contract for multiple Lawson enterprise applications to enhance HR and overall business operations.

Healthwise, a non-profit provider of consumer health information content, lays off over 10% of it 222 employees. It has traditionally provided printed materials, but the market is shifting to electronic sources. Healthwise is now focused on providing content via EMRs.

E-mail Inga.

HIStalk Interviews Paul Meyer

Paul Meyer is co-founder, chairman, and president of Voxiva.

Tell me about Voxiva.

We’re a mobile technology company that had a crazy idea nine years ago that mobile phones had something to do with health. We’ve spent the last nine years building a platform and building mobile health solutions around the world.

It seems that the premise of the company is that expensive computers and ubiquitous broadband connectivity aren’t really necessary to connect the public to health services and to health experts. Is that true? And is it true in the U.S. as well as in the developing nations that you’ve worked with?

Absolutely. In the developing countries where we started working, the Internet just wasn’t a reality at all. Cell phones were the only game in town. Everyone was thinking about how you extend certain information systems to most of the world’s people. The cell phone is the only tool you’ve got at your disposal.

But over the last couple of years as we’ve started doing work here in the U.S., we’ve realized the same thing is true here. Statistics are pretty amazing. There’s some great data from Pew on relative reach of the Internet versus cell phones. It’s still a pretty striking gap. 

There are a lot of populations, particularly underserved and low-income populations, that still don’t have very good access to the Internet. Yet 90% of people here have cell phones. And, it’s not just that they have cell phones — their cell phones are with them in their pockets and on their bed stands.

If you think about how can technology be leveraged to help drive behavior change and improve patient adherence and compliance, you may as well use the technology tool that’s in their pocket.

Do you think the iPhone got people thinking about the possibility of having a smart phone deliver a fairly rich application?

I think iPhones have done an amazing job of opening people’s eyes up to the possibility. People ask me a lot why the U.S. is thought of as so far behind the rest of the world in terms of mobile health. There are a couple reasons. 

In the rest of the world, in emerging market countries, there was no alternative. There was no Internet to reach those people. Necessity being the mother of invention, people went right to mobile.

Secondly, the U.S. is the only country in the world where you actually pay to receive text messaging on cell phones. That’s also been a barrier to the adoption. Not just to health applications, but mobile applications in general. But I think that’s starting to change. Certainly the iPhone has done a lot to open people’s eyes to the possibility that cell phones could be used in powerful ways to make you healthy.

Now, with that said, when I ask someone what their mobile health strategy is and they say, “We’ll build an iPhone app,” My response is always, “Well, what are you doing for the other 95% of the people?” I think you would do well with an iPhone, but ultimately, if you want to try to reach a big chunk of the population, you need to use other tools — whether it’s SMS or voice response or other ways of using a mobile phone — and not assuming that everyone’s going to have the iPhone, because they don’t.

I think people who travel outside the U.S. are sometimes surprised by that we’re fairly primitive in our cell phone technology. Do you think that’s a barrier, or is it going to improve?

I think it’s getting better. I talked about a couple of the reasons, but in some ways the real reason that the U.S. is behind on mobile is because we have the Web. If you think about all of the innovation that went into the dot-com era, all these Web-based business models, many of our best and brightest minds spent ten or fifteen years innovating on tools to use the Web.

In the rest of the world, where the Web was not a reality, that kind of innovation and creativity went into optimizing mobile devices. That’s why, in some ways, the rest of the world is so far ahead.

After nine years of doing this in places from Peru to India to Rwanda to about 14 countries where we operate, when I’m now spending a lot of time here in the U.S. working with our clients here, my not-so-subtle message is, we’re here to help you learn from what they’ve done in Mexico, what they’ve done in India or Rwanda  in terms of leveraging mobile technology to improve healthcare.

That makes me think of India’s technical advances in the 1990s when they couldn’t afford mainframe computers and therefore created a generation of PC and Web developers that drove the industry. Could the same thing happen with cell phone development?

I think it has. I think you’re seeing that. I think that’s exactly what’s happened.

I think obviously the U.S. is waking up to this. Secretary Sebelius last week gave a great speech. There was a mobile health summit hosted by the National Institutes of Health in Washington. Secretary Sebelius gave an incredible speech talking about the importance of mobile phones in healthcare. It was really refreshing to hear.

I would say there’s so much discussion and focus right now on electronic health records, my fear is, as the government is gearing up to spend all this money on all these high-tech incentives for EHR adoption, is that we’re spending way too much time talking about the plumbing and not enough time talking about how all this technology is actually going to make people healthier.

One of the things I was really gratified to hear in her speech last week was that the importance she attaches to mobile phones as a tool for really informing and engaging your power in patients, seeing the mobile phone as the obvious extender of electronic health records. I don’t want to diminish the power of Web-based EHRs and other tools that are out there, but I think they’re getting a fair bit of attention.

I think that people aren’t paying enough attention to the fact that we already have, in the U.S., 300 million cell phones. In my view, those are 300 million untapped health behavior change devices that are ready to be put to work.

Did you get a sense that the government really understands the difference between just making providers theoretically more efficient as opposed to actually changing health?

I think certainly some people do. I think we’re working with the government on a really exciting initiative that isn’t announced yet. Secretary Sebelius alluded to it in her speech last week. It’s a major mobile health service focused on pregnancy and providing information by text messaging to pregnant women and new mothers to help make a dent in the pretty horrifying maternal and infant mortality statistics in the U.S. We’re working with the mobile phone industry through the CTIA, Johnson & Johnson, and a bunch of federal partners. 

I think the HHS and the federal government partners that we’re working with really see this initiative as a very high-profile demonstration of the power of mobile phones to really improve health and impact one of the biggest health crises facing the country.

There are certainly some real believers in the government in mobile health. My advice to them has been, as the government is spending all these billions of dollars on health IT, they want to be sure that they actually do some things that are actually visible and tangible and beneficial to patients. 

The government is run by politicians who ultimately want to appeal to voters. You don’t want to be the politician that explains how you spent 20 or 40 or whatever billion dollars on improving the technology to improve health care, and yet have none of it visible or beneficial to patients in a way that they can perceive.

I think it’s really important to identify ways — and again, obviously you know my bias — but I really believe that mobile health is probably the best way of extending some of the value of health IT to patients to help support them, engage them, inform them, and help them live healthier lives.

We send much of our public health expertise out of the country since we already have clean water and vaccines, but our healthcare system is still centered around the idea of episodic treatment interventions. Are population-based public health interventions a tough sell here?

We have huge problems here. The United States has the second-worst infant mortality rate in all of the developed world. It’s staggering. It’s unconscionable that we’re about the richest country in the world and have infant mortality rates at such staggering proportions.

We’ve looked a lot at the data and it’s pretty concentrated. The high infant mortality rates are highly correlated to lower-income women, primarily African-American. The Hispanics actually have relatively better birth outcomes. So African-American, lower-income, low educational level, highly concentrated in the South. That’s the part of the country that has the worst birth outcomes.

We then took some of the Pew Research data and looked at the Internet vs. cell phone penetration among the sub-populations with the highest infant mortality. There was just a 20-30% gap between broadband Internet and cell phone penetration in the population that we’re trying to reach.

African-Americans and Hispanics are disproportionately much higher users of SMS and other mobile data services because they have a relatively lower level of internet access. If one is looking at how to extend and improve health services and extend healthcare to under-served and low-income populations, the mobile phone is an even more indispensable tool.

We’re doing a lot of work with people focused on serving the Medicaid population, but as healthcare reform is happening and all of a sudden the country is figuring out — how are we going to actually start extending healthcare to 30 or 40 million people that don’t have it right now?

These tools are really important for a couple of reasons. The lower-income people that don’t have access to healthcare right now are disproportionately high users of cell phones. But secondly, the idea of actually automating some of this interaction and giving people the information and the tools to take care of themselves is a way of actually reducing the burden on the healthcare delivery system.

We already have an over-extended healthcare system. With 30 or 40 million more people coming into it finally at long last, it’s going to be even more of a burden. We’re looking at some of these alternative ways of engaging patients. I think it’s going to be more important.

Do you think it’s counter-intuitive for the average person to understand that poor and less educated people are heavier users of cell phone technology?

I think that people are often surprised when I show them that data. I think people assume that technology usage and income are just correlated on a straight line basis. That just doesn’t actually get borne out when it comes to cell phone usage.

If you were trying to make the case that this technology works for health improvement, what examples would you give?

There have been a lot of really good published data. I was looking at a study just today from Norway on smoking cessation. In a randomized clinical trial looking at people that were involved in a smoking cessation program, half of the study group was also enrolled in an SMS texting support service to enhance the program. It doubled the rate of quitting.

We’ve done a lot of work in improving adherence and compliance in HIV/AIDS care treatment. There have been some really, some good studies showing improved efficacy of weight loss programs when enhanced by a mobile service. It’s still early, but I think there are some good initial studies showing the improved health outcomes in these kinds of interventions.

I think this approach works for everybody, but I think particularly if you start looking at thinking about serving low-income and under-served populations and how to leverage technology and engage with them about their health, the Internet can’t be the end of the story.

There’s another data point from Pew of people with chronic conditions. Only 50% of them have Internet access. If you can get 100% adoption of some Web-based tool, then you’re still only halfway there.

Anyone who is looking at how to engage and support people in their health, particularly but not exclusively in some more under-served populations — I just think people would have to explain why they wouldn’t take this kind of an approach.

Your background in political and humanitarian causes, along with the source of funding for the company’s projects, almost make it sound more like a non-profit public health think tank than a for-profit vendor. How is Voxiva like and unlike the traditional software vendor?

I grant you that I personally and Voxiva have had a somewhat circuitous past to the U.S. healthcare system. We basically just saw big problems to solve. We saw a big opportunity to leverage to solve those problems. We may think a little bit differently than traditional public company, but ultimately, we’re driven by trying to solve problems. Like helping developing world health systems track disease outbreak better or that and things we’re focusing on now, of trying to help give people the information and support to live healthier lives.

We focus on trying to leverage and define innovative solutions for solving important problems. We believe if we can do that, we’ll get paid for it and make money at it. Henry Ford had a pretty good line on this — a company whose only purpose is making money or has no reason for being.

Finding problems to solve and eventually figuring out how you’re going to get paid by people for having and creating value has, I guess, certainly been our philosophy in terms of building a business.

Who’s your customer?

We market to public health and government health. We’ve also got those public health agencies and government healthcare providers. We market it to insurance companies. We’re working with one of the insurance companies. We market to pharmaceutical companies that are paying us to create adherence programs, and also the big employers. We’re beginning a little bit of work with some provider networks.

You were quoted as saying that Voxiva’s ideal employee is part McKinsey consultant, part Microsoft engineer, part Peace Corps volunteer. What are the employees and work environment like?

I said that probably six or seven years ago when it was relevant toward developing world business. We do blend a lot of skill sets. We’ve obviously got a lot of engineers. We’ve got a lot of health people.

We were started by — I guess I don’t know what you’d call me, an entrepreneur — a technologist, and a medical anthropologist. I think the three founders roughly had the very skill sets that we have tried to combine. What makes what we do interesting and also makes it hard is that we really do try to live at this intersection between technology and health and behavior change and sociology.

We’re not your people that write code. We work with our partners and our customers to come up with solutions that are really going to make people healthier. It’s not just a matter of taking, for example, content of a smoking cessation program or pregnancy educational materials and squeezing them into the 160 characters you can fit into a text message. It’s really about developing interactive engagement services that can improve health and change behavior.

I don’t think we have anyone that actually perfectly embodies all of the skill sets we need, but we definitely have tried to attract people that check more than one box and blend some of the various skills from the overlapping the Venn diagram of what Voxiva is.

Any final thoughts?

There are 300 million cell phones in this country that are sitting idle. We use them to vote for American Idol. That’s really what we’re using them for here, other than sending text messages and making phone calls. I think the healthcare system in this country can put them to work and do a lot more. I think people ought to be thinking about how. We’d love to help.

News 11/11/09

From Downwit-IT: “Re: HIMSS. Following Cerner and Meditech, Siemens has made the decision to pull out of the upcoming HIMSS conference. No booth, no representatives traveling to Atlanta. Siemens will reach out to its customers and prospects via virtual, Internet-based means.” Unverified, although I don’t see their name on the exhibitor list. Anybody else not going?

From Keenen I. Wayans: “Re: AHA Solutions. Would you look favorably on a product that earned their endorsement?” It wouldn’t influence my opinion, but I’d like to hear what everyone else thinks. It’s a pay-to-play award, but that alone doesn’t make it worthless, I guess.

From Larry Fink: “Re: stock. If you compare the ten year-stock performance of Cerner and Eclipsys, the difference is mind-blowing. Cerner is up 948% over ten years (including 106% this year); Eclipsys is up just 18% over ten years.”

From Nasty Parts: “Re: Sage. Jason Dvorak, most recent VP of sales, resigned last week. Multiple sales execs have also resigned recently. Rumor is that Sage Healthcare is interviewing to hire a new company president.” I invited Sage to respond directly. “2009 was a very positive year for Sage Healthcare. With the opportunities that exist in this marketplace today, Sage plans to expand the leadership team with the hiring of a Division President in the near future.”

From Anon: “Re: Being John Glaser. The title sends a message that the subject is a narcissist.” I made that title up because Being John Malkovich popped into my head, knowing that John is anything but a narcissist. I didn’t see the movie, by the way, but Ebert’s review made me think it was appropriate: “Malkovich himself is part of the magic. He is not playing himself here, but a version of his public image — distant, quiet, droll, as if musing about things that happened long ago and were only mildly interesting at the time.”

From Wounded in Plano: “Re: Dell. The Dell-Perot merger has already started to see the loss of healthcare talent that Dell sees as dead weight. Dell is sending projects overseas (including clinical EMR support), laying off ‘expensive’ talent and focusing on a manufacturing mentality in a consulting world.” Unverified.

From The PACS Designer: “Re: Sectra’s loss. TPD is deeply saddened upon hearing of the accidental death of Sectra’s president, Dr. John Goble, in a helicopter crash. The selection of Thomas Giordano as acting president is a move in the right direction to continue Sectra’s strong presence in this country.  My deepest condolences go to his family, co-workers, and friends.” Goble, 58, had led US operations for the company since 1997.

From Funny: “Re: SEEDIE. Very. And it could be funnier if it wasn’t so true.” I’ve mentioned SEEDIE and the Extormity EHR before, pretty funny parodies (although also ironic in its criticism of technology — the site is down at the moment with a MySQL error). I didn’t notice until now that they’ve been putting out phony news items, also funny:

After a raucous 3 minute debate, the SEEDIE board of directors voted against PHR standards that would force certified EHR vendors to interoperate with personal health record systems using a common set of data standards.

“Our members advocate a walled garden approach, with a distinct preference for proprietary PHR applications that treat interoperable vendors as untouchable members of a caste system,” said SEEDIE executive director Sal Obfuscato. “Like Farmer Brown in the tale of Peter Rabbit, we want to keep all those rapidly multiplying PHR companies from nibbling our electronic health record cabbage.”

Today is Veterans’s Day. If you served, thank you. If you didn’t, thank them.

Firefox has been inexplicably bogging down constantly for me, requiring me to three-finger salute it, so I switched back to Chrome. Darned annoying, though: you can’t get Google Toolbar for Google Chrome. Sounds like they have some healthcare IT DNA in there somewhere.

Ingenix will acquire CareMedic, a Florida-based vendor of revenue cycle solutions for hospitals, in an all-cash deal whose terms were not announced.

Welcome and thanks to Quality IT Partners, new to HIStalk as a Gold Sponsor. The Mt. Airy, MD company, which will be nine years old next month, offers its consulting clients (hospitals, health systems, long term care, payers, pharma, etc.) first rate services at a value-based cost structure. The company almost never advertises, so I was pleased to hear this from Director of Business Development Bruce Werner: “The President of our company (Mark Debnam) and I have been following HIStalk for quite some time and we recently got our leadership team hooked on it as well.  The leadership team unanimously voted to invest in HIStalk. You and your team have done a great job with the site and we are proud to be a sponsor!” Inga and I appreciate that.

John Piano, the founder and CEO of tissue and organ EMR vendor Transplant Connect, is named Better Man for 2009 by GQ Magazine, which recognizes “charitable work, volunteerism, and/or community involvement.” He received the award at the Gentlemen’s Ball (really). I don’t know if physical appearance was judged (it’s GQ, after all, not that I have any idea whether he’s attractive or not) but his company helpfully included lots of flattering photos.

The Carolina eHealth Alliance will use Oacis HIE from TELUS to power its health information exchange, starting with 12 EDs in South Carolina’s Lowcountry. The product includes an EMPI and the Oacis Clinical Viewer.

Weird News Andy hacks this story up: researchers funded by a Gates Foundation grant say their cough-analyzing software, which will run on cell phones or MP3 players, can diagnose disease by measuring coughs.

Kronos announces several new Q4 sales, along with financial results that include $672 million in FY revenue and $143 million EBITA.

Being a non-profit wage slave, I don’t pretend to understand the “variable prepaid forward contracts” that Cerner founders Neal Patterson and Cliff Illig just exercised ($64 million worth). Somehow they get money now for shares to be sold in the future (three more years in their case). All I know is it’s one of those fancy hedging strategies that sometimes gets people in big trouble with the IRS.

Mayo Clinic and Steelcase study the influence on the latter company’s computer furniture, which was designed for Mayo to help doctor and patient view a computer monitor together for teaching.

Idiotic lawsuit: a man goes into a deli and claims he was bitten by the owner’s cat. He’s suing for $5 million.

HERtalk by Inga

The VA Heart of Texas Health Care Network expands its collaboration with CliniComp, adding the company’s Esentris Critical Care solution.

Jordan Hospital (MA) selects ClaimTrust InSight Denials for claims denial management.

eClinicalWorks adds another IPA to its client list with the signing of Catholic Independent Practice Association (NY). The IPA purchased 150 PM/EMR licenses to connect community physicians and will work with eCW to tie into the HEALTHeLINK RHIO.

Former Allscripts-Misys and Emdeon exec Ray DeArmitt takes over as the executive VP of sales for NotifyMD.

Hoag Memorial Hospital Presbyterian (CA) expands its partnership with Surgical Information Systems with its purchase of the SIS’s anesthesia, BI, and tissue management products.

NextGen Healthcare just completed its user group meeting in Washington DC, reporting attendance of over 2,700 and featuring keynote speakers Newt Gingrich and Howard Dean. The hot topics: ARRA, healthcare reform, interoperability, and patient-centered medical homes.

iSirona appoints John Cooper chairman of the board, replacing iSirona founder Dave Dyell, who will continue to serve as CEO. Cooper’s previous gigs executive roles at Sungard, Eclipsys, and SMS. Totally off subject, but am I the only person who thinks of that song by the Knack every time I see the iSirona name?

The healthcare sector added 28,500 new jobs in October, 10,000 of them in hospitals.

OhioHealth selects ProVation Order Sets to automate its creation and management of evidence-based order sets.

If you are a regular HIStalk reader, the details in this report will not surprise you. Scientia Advisors expects the global HIT market to grow 11% over the next four years, with the US setting the pace. Most new investment will go towards EHRs. Lower-cost remote hosting will increase in popularity for smaller hospitals and clinical decision support systems will continue to impact the clinical diagnostics area. SaaS and open-source models will drive down pricing, they say.

HealthBridge selects Mirth Meaningful Use Exchange for its interoperability infrastructure. Once implemented, HealthBridge will become one of the first HIE’s to enable physician access to the NHIN.

CSI Tech wins the implementation contract for Grady Health System’s (GA) $40 million Epic installation. The inpatient and ambulatory installations will take 18-24 months. CSI Tech already handles Grady’s ongoing internal IT needs.

Here’s an iPhone application I don’t need but wouldn’t mind seeing one day. Lit: A Game Intervention for Nicotine Smokers is in development at Columbia University’s Teacher College and will be released within two years. The application is designed to emulate the physiological responses smokers get from smoking and would involve blowing into the device’s microphone. The RWJF is funding $150,000 for the project. With cigarettes costing an average of $5 or more a pack, it will be interesting to see how the application is priced.

Hayes Management Consulting announces it will be offering services for ARRA-funded Regional Extension Centers, including EHR readiness assessments and planning, clinical workflow redesign, EHR selection, and HIE development.

MEDSEEK honors seven clients who earned a total of 15 eHealthcare Leadership Awards at the company’s 13th Annual Healthcare Internet Conference. They were selected from over 1,100 applicants.

Kaiser Q3 numbers: operating income $336 million; net income $569 million. These numbers are significantly higher than last year’s when the company suffered major investment losses. Meanwhile, enrollment dipped about 63,000 to about 8.58 million.

E-mail Inga.

Being John Glaser 11/10/09

While waiting for my annual physical, I enrolled in a research study. (About every other year, I participate in a research study. Two years ago, a sleep apnea study involved me spending the night in an iron lung with electrodes in my mouth and all over my head and chest. Not conducive to a good night’s sleep).

My current study centers on healthy behaviors. The study is intended to improve the health behaviors of people who are fundamentally healthy (my blood pressure, cholesterol, weight, etc. are fine) through a set of pretty modest interventions. Armed with a pedometer, a Web site for recording progress, and an every-other-week call from Maria (my “health coach”), I am supposed to:

Have one multi-vitamin each day. Duck soup.

Eat three or fewer servings of red meat each week. This takes some thought and planning, but is not that hard.

Eat five to seven servings of fruit or vegetables each day. Since I usually eat one meal a day, this has proven to be a real challenge. I tried to persuade Maria that onion rings were a vegetable. As was a cup of coffee (coffee beans come from plants) and vanilla ice cream (vanilla beans also come from plants). She wasn’t buying it. But I have been able to drink some fruit juice during the day and toss down a banana and apple, allowing me to meet this goal.

Walk 10,000 steps a day. During a normal day “at the office”, I will walk 3,000 steps. This means I have had to find an hour each day to walk to get the other 7,000 steps. Finding that hour takes some planning — for example, getting up early to walk before work. (This has turned out to be an enjoyable experience — it’s quite cool to watch the sun come up over the Capitol Building and the Washington Monument).

So far, three months into this six-month study, I have been pretty good at meeting my goals. Maria has not scolded me.

This experience has reminded me that maintaining health, restoring health, or ensuring that a disease does not progress requires that patients engage in “health behaviors.” And it has reminded me that instilling such behaviors is a multi-faceted undertaking. I am not as well versed as those that have deep experience in this area, but this study experience seems to indicate that four factors must be present.

Focus. You have to know which behaviors are the ones that must change or be performed. This can be different — lose weight, take medications, take it easy after surgery, or stop smoking — across patients and situations.

Information. The patient needs information. This information is diverse — the linkage between the behavior and health, specific data about the behavior (e.g., coffee is not a vegetable), and behavior alternatives (how many steps is a game of racquetball?)

Tools. For example, my pedometer and the Web site to daily record whether I met my goals. Depending on the behavior, there can be other tools. Some do not involve IT, like nicotine patches. Some do involve IT, such as measurement and transmission of blood pressure.

Motivation. The desire to alter one’s daily routine to adopt a more healthy routine is probably the most important factor. It is also the most complex and difficult factor. Why would I get up an hour earlier to walk when I can use that valuable time to sleep? Motivation requires motivators (desire to please, guilt, basic type A behavior to achieve a goal, interest in living long enough to play with grandkids). It requires the removal of barriers that could discourage a motivated person, such as limited access to providers. It requires feedback on progress. It requires a social structure of family or friends that are supportive. And it requires the other three factors.

We will never have a reformed or transformed health care system unless we are broadly able to engage patients in managing their health. Cost reductions and outcomes improvements in treating chronic diseases require a motivated patient. Reducing unnecessary treatments is greatly facilitated by an informed patient. Improvements in the quality of care are helped by patients who make good decisions about which providers and health plans to choose.

We can help engage patients. Clearly we can provide tools and support access to information. While recognizing its complexity, we can also help with motivation.

Motivation opportunities range from making whatever IT is involved easy to use (reducing a barriers for a motivated person) to offering graphs of progress and corny but effective “attaboy” generated phrases to avatars that exhibit motivating emotions such as disapproval to online communities of others who can offer support.

While the opportunities can be listed, we have limited understanding of how to apply IT to motivate.

I need to go eat an apple. Otherwise Maria will yell at me.

 

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System and is also on temporary assignment as Advisor to the Office of the National Coordinator. He describes himself as an "irregular regular contributor" to HIStalk.

Monday Morning Update 11/9/09

I decided it was time to update the About page, which answers questions I’m sometimes asked (why did I start HIStalk, why am I anonymous, how I decide what to write about, etc.)

Respondents to my most recent poll have a slight preference for not having the FDA regulate clinical software. That’s pretty close considering that vendors usually have the strongest feeling about that and are likely to click No. New poll to your right: what do you think about a hospital with over $1 billion in revenue paying its CIO over $500K? That’s not a loaded question – I’m just curious. Note: if you’re still seeing the old poll, clear your browser cache. 

HIStalk interviews are highly educational, depending on who I’m interviewing, anyway. If you have someone in mind (and, better yet, if you can hook me up), let me know. The ideal subject: someone who works for a non-profit organization on the front lines of something HIT-related, is doing creative work that the industry could learn from, and comes across as interesting on the telephone since that’s how I do them.

Meditech held its Physician/CIO workshop recently (I assume it was recently, anyway, since the write-up doesn’t say when or where it was held). Paul Egerman was one of the speakers, meaning I would have enjoyed it.

Meditech also just filed its 10-Q. For the quarter, revenue was down 4%, but net income swung from a $27 million loss to a $20 million gain (EPS $0.57 vs. -$0.76), mostly due to investment write-offs last year. Product revenue was down a slightly alarming 16%.

The Chicago Department of Public Health (CDPH) still can’t bill for mental health services because of Cerner problems (the article is in some kind of union publication, but it seems solid). They are using a different system for billing since fixing Cerner remains “an active process.” This conversion says it all. [Alderman]: "You’re saying that after 18 months you’re unable to work out technical glitches that prevent us from billing the state?” [CDPH commissioner]: “That is correct.”

Some nuggets from the just-published 2009 HIMSS Security Survey (thinking ahead to ARRA, since stimulus dollars are tied to privacy and security, not just Meaningful Use): 

• 61% said information security gets less than 3% of the IT budget, nearly unchanged from 2008.
• Fewer than half of the organizations have a C-level security officer.
• 74% have conducted a formal risk analysis, of which 52% found patient data to be at risk. Those problems took longer than six months to correct, said 40%.
• Most of them collect audit logs (firewall, application, server, intrusion detection, etc.) and review them manually.
• Electronic data sharing is already big (91%) and about to get bigger (HIEs, other hospitals, PHR vendors, and NHIN led the list), with 41% adding new security controls for that reason.
• Most used wireless security and electronic signature, with 67% encrypting transmitted data, 60% encrypting e-mail, 44% encrypting stored data, and 39% encrypting mobile device data. Only 29% had single sign-on.
• A third said their organization had experienced medical identify theft, although most reported no consequences.

From the Eclipsys earnings call: Sunrise 5.5, due out in the first quarter, will have a “more intuitive user interface”; the company is banking on heavy CPOE use by its customers to influence new ARRA-related sales; margin improvement efforts, much of them related to internal procurement costs, will consume $1 million in outside consulting fees each quarter but will pay for itself starting in the second quarter; they will target 600 hospitals of greater than 150 beds that do not have a recent-vintage clinical system; MediNotes / PeakPractice underperformed because it was run as separate businesses; demand for Premise / Patient Flow has slowed; 60% of their sales were to existing customers.

Cardinal spinoff CareFusion sells MediQual Systems (the Atlas clinical database vendor) to quality database vendor Quantros.

Speaking of Cardinal, neither it or CareFusion is doing all that great after the spinoff. Cardinal lost money (EPS -$0.11 vs. $0.69) and CareFusion’s Q1 profit was down 28%. Optimism was expressed.

Wound Management Technologies will buy the healthcare assets of VirtualHealth Technologies for $1 million in cash, 4 million shares, and royalty payments. I’ve written about the latter company before, surely one of the most bizarre business combos around: medical office software and gold mines (insert your own joke here). 

Interesting: Microsoft Research develops the $800 SenseCam, a low-res, wearable camera that takes two pictures per minute. It’s designed to help Alzheimer’s patients by letting them review pictures of their day, which seems to help them remember events long term since Alzheimer’s patients may store memories normally but can’t access them.

Henry Schein CEO Stanley Bergman on EHRs: “Electronic medical records will reduce the cost of health care, errors will be reduced, the quality of health care will go up. We don’t know exactly how long it will take, but it’s going to happen in the next few years. And we are the exclusive distributor for the number one player in this field, Allscripts.”

A Commonwealth Fund survey of primary care doctors finds that the US is way behind in several healthcare categories: access to care, providing financial incentives for healthcare quality, and using IT. Only 29% of practices provide after-hours care (other than the hospital ED). Less than half use electronic medical records, well behind the 90+ percent of several other countries. That’s despite spending twice as much per person as other countries.

Cleveland Clinic launches a site to teach student nurses how to use EMRs.

Some AMA members are upset that the organization’s trustees endorsed the House’s health reform bill without asking its members first (doesn’t HIMSS do that all the time?) Delegates will vote Monday on whether the endorsement should be withdrawn.

TELUS announces availability of its new mobile solution, TELUS MobileCare, for homecare providers.

HCA International wins the 2009 Innovation Award for its use of PatientKeeper Physician Portal.

HHS will award contracts to build out the Nationwide Health Information Network by the end of the year.

E-mail me.

News 11/6/09

From Ryan Nichols: “Re: CIO salaries. In 2004, you posted salary data for a number of CIOs, including some fairly high ones like Shands. How accurate was that data? Was there some other reason for some salaries to be off the scale, >$500K?” The salaries came directly from IRS reports, so they show exactly what a CIO was paid in one year, skewed only if that person quit and got lump sum benefits. Not true in most cases, including Shands — 2008 tax records show they paid Joan Hovhanesian $708K, more than everybody except the CFO (who made barely more) and the CEO, who got $1.26 million. Sweet, although not up there with what they pay Urban Meyer to coach football ($24 million over six years).

From Jerry Seinfeld: “Re: Tampa General. Heard a rumor that they will move to Epic from Siemens. Going to the board for final approval.” Unverified.

Listening: Travis, alternative rock from Scotland that sounds like an upbeat, pop-tinged Radiohead.

Eclipsys announces Q3 results: revenue down 5%, EPS $0.07 vs. $1.58, although most of the Q3 2008 earnings came from a one-time tax treatment. Without that, earnings were down 47%. The company also announced that North Mississippi Medical Center has chosen Sunrise.

QuadraMed announces its Q3 numbers: revenue down 7%, EPS $0.02 vs. $0.12.

Cleveland’s MetroHealth has had Epic for ten years, so Judy was there Thursday for the celebration.

An undercover journalist in England buys detailed medical records of British patients from two chat room “salesmen”, apparently provided by India-based transcription center employees. One said, “We can do really good business with these leads. These leads will give you diagnose, entire diagnose of all the customers, what the customer is facing … The floor managers, they are working as freelancers for me.” The records came from London Clinic, which doesn’t outsource transcription, but some of its doctors hired a local firm and may not have been aware that their information was being sent to India. In a quick marketing reaction, Atlanta-based Webmedx assures customers that all of its employees are US-based and therefore aren’t out of the reach of US laws.

HuffPo covers EMR stimulus money and the vendor marketing techniques being employed to go after it: “cash for clunker” rebates, interest-free loans, Walmart sales, and the Stimulus Tour. John Glaser is quoted as saying that ONCHIT will start tracking EMR prices and marketing claims, looking for any stimulus-related misstatements like the ones Siemens claimed Cerner user to steal its customers (and sued them over it, although it has settled, which I’m not sure I know until I read it in this story). HIMSS was invited to comment but, not surprisingly declined, knowing it might step on some diamond toes. I was amused that John Halamka was identifed as “John D. Halambra” in the article.

USA Mobility announces GA of I-LAND, a two-way emergency messaging system for hospital and government campuses that gets through in emergencies because it doesn’t use public networks.

Over 97% of healthcare organizations say they have behavior problems with doctors and nurses, according to an ACPE survey. Examples: yelling, cursing, insulting, refusing to work with each other, throwing objects, trying to get someone fired or disciplined unjustly, and harassing sexually. Many of the problems happen in public or in front of patients. Here’s an interesting one from the respondent comments: male surgeon says to female nurse, “You must be deliberately screwing up. No one could be so stupid as to be this incompetent.” Nurse replies, “If you don’t stop insulting me, I am going to drag you out into the parking lot and kick your ass.” Surgeon reports nurse to administration, nurse gets fired. Only 22% of respondents said doctors had been terminated over incidents, while 61% said nurses had.

Maybe this is related: a couple of readers Googling for the doctor road rage story may have uncovered an important trend — there are a lot of those stories in the news. Doctors have beaten motorists with Thermos bottles, punched women drivers in the face, and pinned a pregnant woman against a wall with an SUV. Do they teach anger management in medical school?

Dann from RelWare says the Fall Technology Conference of Midwest HIMSS in Grand Rapids this week drew over 400 registrants. He took a picture of someone reading HIStalk during the sessions, which creeps me out the couple of times I’ve seen that at HIMSS (I write it entirely alone with only e-mail contact, so seeing someone read it in person makes me feel exposed).

I missed a couple of graphics from Mark Moffitt’s Web services article (you code geeks will love it because it shows a little bit of programming and some XML). I also ran across this video in which doctors talk about it and give a quick glimpse or two.

NHS is threatening its suppliers CSC and BT with termination if they don’t hit the November dates that were set earlier this year for bringing patient systems live. Sounds great, other than the previous suppliers it tried to hardball walked away. I tried to suppress the sophomoric cackling as I read the name of the hospital that went live this morning on Lorenzo, but I couldn’t — NHS Bury. 

My UCSF sources told me in August that it was stopping its Centricity project (finally verified by UCSF in mid-October). They also said that Epic would be brought in as soon as the lawyers killed the GE contract. Right again, apparently, as negotiations with Epic are underway and, if all goes well, implementation will start in the first quarter. I snooped around and found a copy of the e-mail online (warning: PDF). The GE experience must have been ugly: “I understand the frustration in our prior efforts over the past several years, and the concern that we are facing another two years of this work. However, because we are going with an established, proven system, we can have much greater confidence that in two years we will have the tools that our clinicians need to improve the quality and safety of the care they provide.” Wonder what that Strike 1 cost them?

Speaking of Epic, I got a nice note from Dr. Lucy, aka #1 Dinosaur, who was surprised to find that people assumed her EPIC FAIL line in her anti-EMR blog post that I mentioned referred to that Epic (she’s a fan of FailBlog and was riffing on that about EMRs in general). She does, however, stick to her guns in not buying an EMR for her practice, with her reasons listed in this post:

A man in the back spoke of the new EMR he had just purchased for $30,000. Once all the numbers were crunched, though, it turned out he was only going to see about $3,000 in P4P bonuses. The response, delivered somewhat more softly than the stentorian tones of the main presentation, was that his return was more likely to be in the areas of quality and lifestyle. I imagined presenting a proposal to an insurance company — actually to any kind of business — and saying, "Now, you’ll only make back about 10% of your initial investment, but you’re likely to see improvement the areas of quality and lifestyle."

And speaking of EMRs, cost is a big concern for doctors, but 58% of them know nothing about ARRA. 

Philips and the biggest insurance company in the Netherlands start a pilot project to develop home monitoring programs there.

This strikes me as bizarre: the MyMedicalRecords people engage a clinical trials company to help bring its monoclonal antibodies assets to market. An earlier announcement says it acquired the technology when it did a reverse merger with Favrille, Inc. in January 2009, although all the Phase III trials results I could find indicated that all of Favrille’s products were flops. The news didn’t seem to help the parent company’s share price, now down to less than eight cents, about a quarter of what it was worth in May.

Pharmacy OneSource acquires the MedBoard in-hospital drug delivery tracking system from MedKeeper.

Strange: a Phoenix doctor’s office gets 1,000 hang-up calls a day from a man angry at a former practice employee with whom he had a relationship. He’s done it for months and says he will keep it up for 25 years. They can’t block the calls because he’s in Jordan.

eHealth Ontario’s $236 million contract, signed quietly a few weeks after its CEO and board chair quit after a bidding scandal, will give 5,700 doctors a connected EMR – less than a fourth of those practicing in the province. The backlash over Ontario’s problems has stalled approval of a request from Canada Health Infoway for $500 million of what is basically stimulus money, although its audit was clean. That non-profit has spent $1.5 billion so far.

State government in India, annoyed that private hospitals obligated to treat poor patients are turning them away, directs them to post a count of empty beds daily on the Web page of the Director of Health Services. The newspaper article concludes that “If this works as planned, it will mean that patients will no longer have to share beds, limiting cases of infections.”

David Grant USAF Medical Center (CA) goes live in six weeks on ClinicComp Essentris CPOE, repository, and alerts.

Seton Family of Hospitals (TX) says its Sychron desktop virtualization saves caregivers 30 minutes each per day since the “roam button” allows them to save a session, leave, and then pick up where they left off on another PC without logging in again.

IMS, the big seller of patient and prescription data, sells itself for $5.2 billion, the largest buyout of the year. Thank them if you believe drugs are too expensive since they specialize in telling drug companies how to wring the most profit out of their products.

The SEC settles with imaging vendor Merge Healthcare and its former CEO and CFO for improper revenue recognition that overstated net income by 230% for three years, resulting in a $500 million hit in market cap when it was discovered. The former suits will pay a combined $870K. I read the original complaint and it said Merge did what an insider told me that HBOC did in the 90s — shipped empty boxes to customers when products weren’t ready so the revenue could be recognized anyway.

The whistleblower who turned in a Texas hospital group for paying doctors kickbacks for referrals gets a 20% share of the settlement amount — $5.5 million. Anybody know a really crooked hospital that’s hiring?

Q3 results for AMICAS: revenue up 121%, EPS $0.05 vs. -$0.02, handily beating estimates of $0.01 and guiding up. The one-year share price graph is above (they’ve nearly tripled).

Odd lawsuit you’ve already seen: the woman mauled by another woman’s pet chimpanzee has already sued its owner for $50 million, but now her family wants to sue the state of Connecticut for another $150 million because it didn’t prevent the attack.

E-mail me.

News 11/4/09

From The PACS Designer: “Re: Windows 7. Microsoft has released a 90-day trial copy of Windows 7 for IT professionals to use in testing Windows 7.”

From Charles Chips: “Re: road rage story. The doctor was found guilty on all counts.” Thanks for the link. After some soul-searching, I’m going to pass on running specifics even though I said I would once the jury had reached a verdict. The person’s in enough trouble already (looking at up to 10 years in jail) without having the details trumpeted to the industry just because their employer is an HIT vendor and just because I happen to know that. I’m a Golden Rule kind of guy, so I’ll sleep better knowing that, right or wrong, I didn’t go against my conscience. You can probably Google it.

This moment brought to you by Weird News Andy: “Snoring less improves your golf game. Yes, a bit late except for those in Florida, but remember it for the spring.” Another reason to seek treatment for sleep apnea — the handicap of golfers studied improved by three strokes. I like that the UK newspaper, obviously scratching their heads at not having a photo of a CPAP-wearing golfer on the links, stuck in an unrelated picture of Barack Obama holding a golf club.

Ingenix Consulting names John Nackel as CEO, replacing Ted Chien.

Thanks to the reader who sent over the six best practices for medication administration from CALNOC, which dramatically reduced errors in several large hospitals. They are simple: (a) check the medical record against the med; (b) don’t get distracted; (c) leave the label on the med until it’s given; (d) use to methods of patient identification and explain the med to the patient; (e) chart the med immediately after giving it; and (f) check the Five Rights. Bedside bar code verification isn’t on the list. I supposed you have to assume that if these steps reduced errors, they weren’t doing them before, but it’s not much of a magic bullet for those looking for one.

eHealthOntario issued another $236 million in contacts after CEO Sarah Kramer resigned in July over excessive consulting expenses. A political opponent is outraged that the government made no announcement about the new agreements, saying “It’s very ominous that at the height of the controversy around the billion-dollar boondoggle at eHealth, the government slipped another $236 million out the door.”

MD Buyline jumps on the ARRA EHR bandwagon, offering an odd lot of services (a glossary, a list of Web links, customer survey results, etc.) Maybe their services have improved since I was pressured to subscribe to them years ago.

The Advisory Board Company reports Q2 results: revenue up 1.2%, EPS -$0.14 vs. $0.32, but a lot of that loss was one-time write-offs. Shares that were in the high 60s three years ago are at $25.45 now, dropping the market cap to around $400 million. None of the executives are big holders, with even the president holding only around $350K worth.

A guest editorial in a Toronto newspaper says the Canadian government’s H1N1 vaccination rollout “looks like rush hour at a Mexican bus terminal” (I’m a bit uncomfortable with that choice of words). It lauds, however, a clinic that used its scheduling system to book vaccinations and its EMR to verify that recipients were high risk, resulting in no patient waiting. It summarizes, “If there were a Group Health Centre in every Canadian community, the H1N1 vaccination campaign wouldn’t make us look like a Third World country. We need more effective primary health care in Canada and we need to seamlessly link primary health care to public health.” Don’t we all.

London hospitals are testing a “digital patch” that allows wireless patient monitoring, with information being downloadable into a smart phone or integrated directly into EMRs. Toumaz Technology, which makes the Toumaz Sensium, says its on-board chip extracts critical information and not just raw data, working over low-power radio.

Here’s a fun blog post complaining about EMRs from the perspective of a family practice doc who can’t get information about his or her ED patients. What’s notable: the gripes (“The Emergency Department EMR from Hell”) apparently involve Epic (it’s too detailed to summarize). I really liked this comment from an anonymous reader of that site, though:

“Medicine is often compared unfavorably to the airline industry in its failure to use checklists to avoid mistakes. Well, I’m pretty sure there’s no checklist that requires a pilot during take-off to go into the cabin and ask who ordered the fruit plate. But the forces that run modern medicine (including our professional societies) feel that there is no administrative task too trivial that it should not be allowed to interfere with the doctor’s interaction with his patients. This trend is only exacerbated by making an EMR the focus of the physician’s concentration. Basic point: anything that reduces the time and mental energy a physician has to bring to direct, one-on-one patient contact is BAD.”

From accidental Googling, I see that Sharon Howard, formerly of Sage, is now VP of marketing at RelayHealth.

I editorialize on PR-fueled H1N1 data reporting in my guest editorial at Inside Healthcare Computing this week. I must have had too much soda since I sound manic: “Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah (‘headaches’ become ‘migraines’, ‘a cold’ becomes ‘the flu’, and ‘getting sick from too much Super Bowl beer, wings, and guacamole’ becomes ‘food poisoning’).”

I see HHS got a few EMR comments on its site, some of which are good. Here’s a snip of one I agreed with as a contrarian: “The fictional scenario of showing up unconscious at some distant medical center, alone and without ID and contact information, and needing instant treatment that solely depends on an EHR (not on physician judgment) is so rare as to be nil.” Most medical care is delivered near the homes of patients, so it would be a stretch to justify spending a lot of interoperability money to avoid the oft-told “unconscious in a Florida ED on vacation alone and avoided a penicillin allergic reaction” fable that happens, but rarely.

In England, three thumb drives are lost that contained information on 76 cancer patients, stored in unsecured Word documents.

Odd lawsuit: a woman sues her former lover, the married head of the OB-GYN department of Greenwich Hospital, claiming the doctor used the OR for their trysts, told her to get Hepatitis C vaccine afterward, and illegally injected her with Botox. He says she’s out to get him after he dumped her at his wife’s insistence, saying the former mistress posted Internet comments under his wife’s name that called him “a pervert”.

John Fontanetta MD, CMO of ED systems vendor EDIMS and a practicing ED physician, is named a Top Emergency Doc in a survey by New Jersey Monthly Magazine.

A psychiatry magazine says stimulus dollars won’t encourage psychiatrists to buy EMRs because the Meaningful Use criteria will be aimed at generalists controlling chronic physical disease. A New York state mental health official says quality indicators exist for psychiatry if HHS really wanted to use them to define Meaningful Use for that specialty. He also pointed out that hospitals look harder for physical conditions whose treatment generates revenue, which has encouraged vendors to focus on the broader market.

Fletcher-Flora announces GA of its lab outreach portal. 

Jeff Arnold, a founder of WebMD, launches Sharecare.com, which features expert advice from “celebrity physicians”, big-name hospitals, and “Knowledge Partners”, advertisers who provide answers marked as sponsored comments. Oprah is a backer.

E-mail me.

HERtalk by Inga

From DragonGuy: “Re: conversations meeting. Had a great Dragon conference in Vegas last week. Dragon 10.5 will (we all hope) partially solve the ‘Citrix issue’. The room was mostly filled with Epic-based hospital IT people wanting to improve the experience for their docs:  Kaiser, Cleveland Clinic, and similar.”

Drummond Group, which provides interoperability/performance testing and certification, announces that it will apply to become an EHR certifying body once ONC releases its requirements. I think mixing things up a bit and giving CCHIT some competition isn’t a bad thing. Of course the introduction of choice is bound to lead to strife, with certifying bodies and their constituents each claiming superiority. Perhaps competition will reduce certification fees, which would be especially appealing to smaller vendors. Now that Drummond has announced its intentions, will other entities step forward as well? Could be fun to see what unfolds.

Perot Systems is now Dell Services Global Business Unit, following Dell’s purchase of 90% of Perot’s outstanding shares. Perot CEO Peter Altabef was named president of the division.

Hospital have had a total of 126 mass layoffs (50 or more employees) through the end of September, which exceeds the 112 layoffs for all of 2008.

dbMotion opens a regional office in Singapore to address the growing demand for EHR solutions in Asia-Pacific.

Mediware reports a 184% increase in earnings over last year, and a 9% jump in revenue. Shares climbed 15%  based on its better-than-expected numbers.

West Penn Allegheny Health (PA) makes plans for a new medical school, as well as an overhaul of its 700 member physician practice group. Despite a $34.6 million loss for the nine-month period ending March 31, West Penn is investing big money in EMRs for its physician offices.

McAllen, Texas once again makes healthcare headlines. The area’s largest hospital system agrees to pay the federal government $27.5 million to settle allegations that it paid doctors illegal kickbacks to refer patients to its facilities. The government claims that South Texas Health Systems disguised payments to doctors in a series of sham contracts that included medical directorships and lease agreements.

St. Rose Hospital (CA) deploys Horizon Cardiology CVIS from McKesson. Meanwhile, Crittenton Hospital (MI) selects McKesson’s Horizon Enterprise Revenue Management solution.

The seven-physician Toledo Orthopaedic Surgeons group selects SRS EMR.

HHS says it’s taking HIPAA violations seriously, imposing significantly stiffer penalties for HIPAA breaches. The maximum penalty for a civil violation jumps from a mere $100 to a hefty $25,000 fine. The penalty cap was also raised from $25,000 to a whopping $1.5 million.

Following what seems to be low-tech techniques, VHA helps 28 hospitals in Oklahoma and Arkansas improve ER traffic. Most of the EDs made significant reductions in wait times and LWBS rates, despite increases in patient volumes. I was surprised that VHA did not attribute the improvements to some new HIT tool. Instead, old-fashioned internal competition and communication were the main forces at work. One VHA official says, “The real driver for improvement for these hospitals is not comparing themselves to national standards, but with each other. Once a hospital administrator sees that another hospital has achieved success, he or she picks up the phone and asks how.” Now that’s innovative.

Bermuda’s primary hospital and urgent care center are getting rid of paper processes and installing MEDHOST’s EDIS.

CareTech Solutions reaches an agreement to acquire IGCN, which helps hospitals build and manage Web sites.

Moses Taylor Hospital selects ClaimTrust’s InSight Denials to track and analyze claims.

Cortland Regional Medical Center (NY) contracts for ProVation Order Sets to automate evidence-based order sets.

E-mail Inga.

Readers Write 11/2/09

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!

Web Services, A Real-World Example
By Mark Moffitt and Kevin Hornberger

In this article, we will give an example of the use of a “transactional” Web service to request and return clinical data.

GSMC processes about 90,000 patients per year, 1,700 per week, or 250 per day in our Emergency Department (ED). ED physicians at GSMC use MEDHOST to record each patient visit. MEDHOST is a “best-of-breed” ED application. MEDHOST is interfaced to our hospital information system (HIS), Meditech Magic, using HL-7. Meditech and MEDHOST stay in sync by way of HL-7 data transfers. In this example, think of Meditech as our HIS and clinical data repository (CDR).

GSMC developed an iPhone web application that physicians use to view clinical data. GSMC ED physicians wanted to use this application to pull up a list of patients assigned to them. Then, they can access clinical data like lab and radiology (audio dictation) on the iPhone. This information (list of patients) is not included in the HL-7 messages sent from MEDHOST to Meditech.

We could modify the HL-7 transaction from MEDHOST to Meditech to include this field. The GSMC iPhone app would then query Meditech (CDR) to get a list or patients associated with an ED physician. This effort would require modifications to MEDHOST and Meditech to process and store this data. See Figure 1.

An alternative approach is to keep the data in MEDHOST (source) and get it using a Web service when needed. See Figure 2. The advantage to this approach is:

1. Only one copy of data exists.
2. Implementing a Web service is easier than having multiple vendors modify an HL-7 message.
3. It is easier to maintain – the Web service only needs updating when changes are made to the underlying MEDHOST database.

GSMC uses a Web service developed internally using XML over HTTP. The Web service receives a physician identifier, constructs an SQL message and queries the MEDHOST database, and returns the result in a Web service. See Figure 3. The return message contains a list of patients assigned to a specific ED physician. Figure 4 is a return message (with patient identification altered to keep confidential).

Most CDRs in operation today perform two functions: 1) provide easy access to data spread across multiple systems, and 2) serve as a data store for analytics and decision support.

It is fairly easy to construct a Web service to get data from different systems. Web services with direct access to data sources eliminate the need for a CDR with respect to providing easy access to data spread across multiple systems.

New technologies in the business intelligence (BI) space may eliminate the need for a CDR for analytics and decision support. I will be writing about this topic in my next article.

I acknowledge that this is a simple example of the power of Web services. To take Web services to the next level, aka a Service-Oriented Architecture (SOA), you need interoperability and other features. Interoperability, unlike the example above, requires cooperation and coordination from vendors, something not always easy to obtain. MEDHOST is working further on its web services to provide a full SOA.

Figure 1

Figure 2

Figure 3

Figure 4

Mark Moffitt is CIO and Kevin Hornberger is a senior software developer at Good Shepherd Medical Center in Longview, TX.

Strategic IT Investments in the Operating Room: Why Now is The Time
By Kermit Randa, FACHE, CPHIMS

By now it’s obvious that the current economic downturn has not spared hospital organizations. With capital markets inaccessible to many hospitals, the financing for major investments and physical plant expansion is suddenly unavailable. Additionally, income from hospital endowments, which is often dependent on equity investments, has been dramatically reduced. The recently passed economic stimulus for healthcare and especially the $19 billion for adoption of an electronic health record may offer hospitals some funding relief in the long term, but initial funding for hospitals will not begin until 4th quarter 2010. In addition, the regulations for determining funding and eligibility are still being debated and finalized.

Long-term assistance may be on the way, yet demands on hospitals remain high for now and the foreseeable future. These demands include the need to maintain a high level of quality, operate ever more efficiently, continue with patient safety initiatives, comply with regulatory requirements and attract and retain talented clinicians. Certainly, this is not a time for “business as usual” and it offers a real opportunity for renewed leadership, strategic vision and action.

The traditional response to tough economic conditions is to put current project expenditures on hold or to implement an “across-the-board” belt-tightening budget process (“Every department needs to reduce their expenditures by 10%”). This latter approach, while appearing straight forward and fair, may have unintended consequences. But where can an organization begin to effectively navigate through these unprecedented times?

One sound approach involves a back-to-basics look at the economic underpinnings of hospital organizations and the importance of the hospital operating room (OR). According to recent HFMA studies, today’s OR is the economic engine of most hospitals – accounting for up to 60% of a hospital’s revenue and some 35%-40% of the hospital’s expense. Over 60% of the hospital’s margin typically comes from surgical patients. Based on data from DJ Sullivan Healthcare Consulting’s database of 700+ ORs, each empty but open OR suite costs a hospital an estimated average of $1,000 per hour (including pre/post op staffing and anesthesiology costs). The OR is also a primary source of up to 50% of hospital-based errors. The impact of the OR is felt well beyond the perioperative department, according to the AHA’s Quality Center, “Because the OR is a primary source of admissions, it is virtually impossible to streamline hospital-wide flow without first streamlining patient flow through the OR”.

Optimizing the performance of the perioperative department can significantly improve performance of both the perioperative department and the hospital. Through the use of new perioperative information systems coupled with improved work flow processes, hospitals can expect the following improvements in their OR:

• More accurate scheduling resulting in a more rational schedule
• Increased on-time case starts due to an effective pre-surgical screening and documentation process
• Improved quality of care and patient experience by reducing redundant data collection through an integrated digital record
• Reduced supply costs by using preference cards automatically maintained on actual usage, not “what was used last time”
• Documented cost-per-case averages to offer greater access to surgeons with higher margin case mixes
• Generated comparable metrics showing cost-per-case by surgeon by procedure so that standardization decisions can be made based on full information and not just purchasing data
• Published empirical performance outcomes to demonstrate quality and efficiency to other surgeons and the community using analytics and business intelligence tools
• Web access to create a path of least resistance for surgeons and their offices
• Consistent and predictable surgical days for which everyone can plan
• Integrated Anesthesia record driving increased efficiency, charge capture, and safety

To enable hospitals to make a perioperative IT investments now, some healthcare IT vendors have already announced special subscription pricing models that enable hospitals to fund such initiatives from operating budgets rather than capital budgets that may be currently on hold. Hospitals can begin these projects now, spreading payments over a longer time horizon, realizing a positive ROI more quickly.

Surgeon and OR Staff Recruitment and Retention

Another strategic consideration for moving forward with an investment in perioperative IT is that it can be a powerful motivator in attracting talented surgeons, residents, and OR clinicians.

According to James Pennington, Chief Information Officer, JPS Health Network, located in Ft. Worth, Texas, “Our hospital has long been a preferred institution for incoming residents due to its diverse levels of patient acuity, service lines and our use of advanced technology.  We recognize that top new residents understand the benefits of advanced IT solutions in the provision of care and expect them to be available”.

One way to increase OR revenue is to attract surgeons with high volume practices from competing hospitals.

The Centers for Medicare and Medicaid Services (CMS) reports that the average surgeon reimbursement from Medicare has decreased by some 7% over the last three years, resulting in surgeons seeking hospitals that can demonstrate efficiencies that will enable them to maximize volume and revenue for themselves and consequently the hospital. I believe that if the following key considerations are met, surgeons will be willing to consider moving their OR schedule to a different provider if:

• Surgeons’ referral patterns are not disrupted
• Surgeons can perform at least one more procedure daily
• They see an improvement in lifestyle (earlier leave times, reduced extended hours)
• They have regular access to OR time using an easy, repeatable process (e.g. guaranteed block times)
• The OR documents high satisfaction ratings from patients and staff

The use of a robust information system that is well integrated into the workflow of a perioperative department can be a key underpinning in recruiting (and retaining) talented surgeons and other perioperative staff.

Conclusion

This is a time for leadership. Recognizing the perioperative department as the economic engine of the hospital offers many opportunities for change that can result in quick economic wins. Prioritizing this area to ensure the ability to gain and maintain economic advantage is a critical step. A robust perioperative system is one of many improvements that can be made relatively quickly with significant and early ROI payback. The strategic long-term benefits can be even more significant. While such investments may seem counterintuitive in challenging economic times, they can in fact result in both tactical and strategic advantages that will lead to financial success for the organization.

To take on this initiative, support from senior management is essential. It requires focus, team work, leadership, and the final key ingredient – courage.

Kermit Randa is Senior Vice President, Surgical Information Systems.

CIO Unplugged – 11/1/09

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

Best and Worst of Leading
By Ed Marx

“It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way.”

So begins Dickens’s classic “A Tale of Two Cities.” With leadership comes the good and bad, day and night, the best and the worst.

We recently underwent layoffs, something I wish didn’t exist. The impact affects all levels from analyst to deputy. As I agonized over these decisions, I reflected on the complex aspects of leadership. I’ve come to understand that the absolute worst is also the absolute best. One in the same. Let me explain.

Worst

Betrayal. Although I advocate “go to grow”, I also preserve a spot for any employee with an interest to groom for a future role. I pour myself into that person. I invest time and resource. Then, despite the path I create for them, they leave prematurely. I once had a rising, star manager dump their promising position, and healthcare, for a few extra bucks.

Moral Failure. A breakdown of social conscience happens too often. A shining star burns himself, shearing the people around him and the company brand. Infidelity. Embezzlement. Integrity meltdowns. When this happens within my circle of influence, my heart breaks for all involved.

Discipline. Poor performance demands correction. Nevertheless, most leaders can’t discipline much less give a decent annual review. I struggle with it, and I’m guilty on all counts. But long term, I know that effective discipline is a sign of true compassion and care. I call it tough love, and it’s hard to administer consistently.

Best

Fruit. Seeing someone grow. You sow, then watch for the seedling; you fertilize, and watch them blossom. Double best when they germinate others and replicate themselves. We recently promoted this analyst to Director, and—Shazam!—a star was born. We looked like geniuses.

Team. Start with a mashup of individual players who can achieve good outcomes and shape them into a team that accomplishes great things. I’ve been on more than one turn around, and it all happened because of the pooling of incredible individuals who were better together. 1+1 = 3.

Promotion. It brings me joy to promote someone, or to recognize them publically, perhaps nationally, through a professional society. Double best if there is a significant salary bump/bonus associated.

Absolute Worst and Best

Sacrifice.

The worst: I give up personal things to fulfill my leadership calling. I’ve given up the freedom of full expression as my actions are witnessed by many and monitored by others. I gave up my childhood dream career…

The best: …Yet I’ve found myself in incredible places and roles. And, oh, what rewards! To lead is to serve, and sacrifice is the sacred prerequisite to serving.

Dying to Self.

The worst: Pride and confidence. My reality- I’m right and I’m not comfortable accepting other’s opinions. The truth- I don’t know as much as I think I do, and I need others. Despite my experience, education, and knowledge, I force myself to move from micro manager to macro manager. I resist the urge to jump in (most of the time).

The best: failing forward. I set the vision then allow my people to strive, thrive, and make mistakes. For all involved, humility is the key to growth.

Layoff.

The worst: Telling someone they no longer have a job when it’s not related to their performance. I agonize for days and don’t sleep the night before. I understand the impact to career, self-esteem, and family—I’ve been there.

The best: But if it must be done, I want to be the one to deliver the news personally. I want to support my people in the most challenging career circumstances they face. I need them to know they matter, they’ll make it, and I care. Love can be practical, yet it’s too often forsaken.

Death.

The worst: The death of an employee or a family member of an employee. I see your faces.

The best: I’ve tried to attend every funeral. I weep with those who weep and rejoice when they rejoice. If a person/family suffers, I want to offer support, lead them through it.

Leadership is never easy, never to be abused, and never for self-promotion. It’s both pleasure and pain, joy and sorrow. Leadership is a calling.

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.”