TPD’s List of iPhone Applications

TPD’s List of iPhone Apps – Update #4
By The PACS Designer

Input from HIStalkers and some further research helped expand the number of iPhone applications for this updated list. Newly added applications are marked with an (N).

Hopefully the expanded list provided with this update will get more users of iPhones the education needed to do better in their daily job performances.

Monday Morning Update 10/12/09

From Defiant One: “Re: University of Missouri. Don’t know if you had heard, but the CIO position there was also outsourced to Cerner. That’s a really bonehead move considering the amazing progress they have made since a Hunter turnaround in 2003. They won the CHIME collaboration award and now give away the position to Cerner.” Inga is trying to connect with MU, which is what they call themselves for some reason (odd: UM calls itself MU just like University of Kansas Medical Center calls itself KU Medical Center – are dyslexics running the Midwest?)

From Lou Mannheim: “Re: athenahealth. Maybe it got lost this week with their buy of Anodyne, but did anyone else find it interesting that athenahealth is now working with IBM for their BPO? Vague filing and no press release. Anyone know what they are doing together? Interesting given the Dell/Perot deal.” SEC filings indicate that athenahealth signed a five-year deal on October 2 to have IBM provide business services from India and the Philippines. Some of athena’s claims work was being done offshore, so I suspect this is routine.

From Ex-Cerner Guy: “Re: Bellevue lawsuit award. Ellis Hospital was more or less forced by NY State to take Bellevue over, so it should be interesting to see if NY State has written some sort of indemnification or protection into the merger agreement.” This relates to the $43 million jury award I mentioned last time in which the since-acquired 40-bed Bellevue Hospital was sued for mishandling the resuscitation during a baby’s birth in 1984. The 24-year-old woman, who has since graduated from college but uses a wheelchair, was awarded $20 million to pay home health aides, $15 million for future pain and suffering, $6 million for past pain and suffering, and $2 million for medical expenses and loss of earnings. So in a single judgment, a 40-bed hospital is on the hook for $43 million for a patient who didn’t even die (it would have been far cheaper if she had, apparently). How do you manage healthcare costs and not address cases like this? If the patient had the same injuries but wasn’t awarded the money, where would she have come up with the supposedly needed $20 million? This is another form of cost-shifting: hospitals insure themselves at great expense against awards like these, thus sticking everyone with the tab and giving insurance companies nice profits.

From Lou DiPisquale: “Re: EMRs. I have a friend looking for some suggestions for a home health/parish nursing EMR that is fairly inexpensive (her work is grant funded). Do you know of any basic EMRs that would be a good fit?” I’m calling in a lifeline since I’m a hospital guy and the home health EMRs we used were not inexpensive. Anyone have suggestions?

Cerner shares continue their tear, closing Friday at $84.41. The three-month graph above compares CERN (blue) to the Dow (red). If shares hit $89.70, Neal Patterson’s holdings will be worth a cool half a billion dollars.

HIMSS is looking for a Director of Government Services whose responsibilities will include “managing the Government Relations growing book of business for government services contracts” and “Develop programs and initiatives related to recruitment and retention of commercial organizations involved in the Payer and/or Life Sciences aspects of healthcare.” Wonder what that’s all about?

I was hoping for better news from my poll that asked how the employers of readers are doing economically compared to six months ago. Their situation is better, say 49%, while 31% say it’s worse and 20% say things haven’t changed. I suppose that’s not terrible, given that only a third are worse off now than before. Now here’s a fun new poll to your right: does your primary care doctor use an EMR and is that important to you?

This tech-savvy doctor, entrepreneur, and IT investor in Mumbai seems fun. He likes his job because “I get women pregnant – and get paid for it!” (he’s a fertility specialist). He’s got cool technology on his practice’s site and some creative informational cartoons and courses. The VP of one of his angel investments lists the Top 10 reasons that doctors in India don’t use software in their practices, observing that “Most doctors are very poorly organised, and don’t even bother to keep records of their patients. They often do not remember anything about the patient ; and forget even his name ( as many patients have learned the hard way).” India’s Top 10 is not much different than the US Top 10.

Peter Witonsky, president of iSirona, e-mailed to say that University Hospitals Geneva Medical Center is live with his company’s DeviceConX , which is sending GE critical care monitoring data to Eclipsys Sunrise.

Inga’s off to MGMA this weekend, so keep an eye out for a perky, curious female furtively taking notes for her daily recap on HIStalk Practice. Inga and Dr. Gregg Alexander have conspired to produce some fun HIStalk/HIStalk Practice magnets that some of the sponsors will be giving away in their booths (the booth list is here). 

Speaking of conferences, the American Academy of Pediatrics one starts Saturday in DC, where I’m one sponsor of the Pediatric Office of the Future exhibit (divided into sections: Patient Access, Enhancing Workflow, Advanced Communications, and Care Management and Quality). I made a primitive and snarky PowerPoint to run on my little display that hopefully Dr. Gregg Alexander can turn into something presentable that won’t embarrass him as a Pediatric Office of the Future team member. I had an unworkably last-minute brainstorm that we have a little meet-and-greet with Dr. Gregg, but our day jobs don’t leave much time for event planning. At least give him a little nod if you see him around.

Jonathan Bush red shorts at Health 2.0 mystery solved, courtesy of Matthew Holt. Jonathan heard that Glen Tullman of Allscripts would be appearing remotely on huge video monitors, so he re-enacted Apple’s brilliant 1984 commercial where the runner shocked the mindless drones to life by hurling a hammer into the video image of a thinly disguised IBM overlord. Now that’s funny.

Speaking of Glen Tullman, Forbes chats him up. He predicts Allscripts will double its count of doctor users next year, observing that “We are watching what will be the fastest transformation of a major U.S. industry in history”. He observes that it took ATMs 10 years to proliferate while EMRs till take only three, but he didn’t mention that banks paid for their own ATMs as their own rational business decision and that EMRs have been around for decades with minimal user interest until taxpayers were volunteered as their underwriters.

I like to Google HIStalk occasionally to see who’s talking about me. I ran across this nice mention on The Huntzinger Management Group’s site. “The Huntzinger Management Group is a Platinum Sponsor of the HIStalk Web Blog and supportive of the interactive communication among healthcare organizations. HIStalk is a fantastic place to read the most up-to date healthcare IT news.” I appreciate the sponsorship, but the kudos are even better and I appreciate them. I know it’s hokey, but when I write HIStalk the picture in my mind is of a bunch of us (providers, vendors, consultants, etc.) standing around swapping stories with beers in hand. That quote gets the “interactive communication” part right since I’m even happier sharing the ideas of others than I am my own.

An article covers the cash flow improvement at Kentucky Medical Services Foundation in its use of the Professional Intelligent Charge Capture application of MedAptus.

Apelon releases the latest version of its open source Distributed Terminology System on SourceForge.

Korea IT Times is running a series on what it calls u-Health, which means ubiquitous technologies that improve health and well-being of the general population. I like the term. This is another international example where you could read the whole article without realizing it’s not talking about the US. “Information system analysts and Web developers may also feel threatened when u-healthcare consumers and u-healthcare providers dictate specific information management functions and requirements instead of relying on the experts. Poor and inadequate ubiquitous technologies and interfaces will not be tolerated and will fall by the wayside.”

Speaking of EMR problems that are international, Finland is behind on its legal mandate to roll out EMRs and e-prescribing by 2011 because expanding it to a national level exposed problems with incompatible software. They’ve decided it’s easier to change the law.

Another doctor who’s not afraid of using a computer: this cardiologist made $40 million day-trading his way through the late 1990s, but gave only the losing trade information to his accountant. When the market collapsed, he had to underreport IRS losses to avoid triggering an audit for the gains. He’s looking at big fines and jail time for $16 million worth of tax evasion, not to mention the $476K he already paid for Medicare fraud.

University researchers in Canada say their open source OSCAR EMR, used by 600 doctors so far, could be rolled out a heck of a lot cheaper than the widely panned $1 billion eHealth Ontario project. One reason, its physician developer says with a straight face, is that “we don’t have very many high-priced executives and consultants”. I found the user group page here and also this video demo.

Mediware’s CFO quits to become CFO of an IT security firm.

The good times just keep rolling for eHealth Ontario. CTV News finds that $2.1 million of severance was paid to seven executives fired from its predecessor, Smart Systems for Health, when the new political administration took over.

eClinicalWorks will include Healthwise patient instructions and online health information library with its EMR and patient portal, respectively.

E-mail me.

News 10/9/09

From Bush vs. Tullman: “Re: Health 2.0. Was at Health 2.0 for the Jonathan Bush and Glen Tullman panel. Bush came out in red boxing shorts and a blazer! I will say Bush and Kibbe made some good points. Was disappointed that Tullman didn’t even show and came via teleconference.” Maybe Glen shares my belief that if it’s really 2.0, it shouldn’t require hauling in a ton of carbon-burning attendees to sit in a room together to watch oddly named startups hoping to find buyers for their no-revenue companies —  err, helping empower patients via the Internet. Still, it sounds like fun. I’d rather have the noobs pitch their businesses to a panel of money guys, like my semi-favorite show Shark Tank (“You’re dead to me now.”) Maybe I can get rich guys like JB and Glen to be on an HIStalk shark panel at HIMSS and they could actually invest in some HIT bootstrapper’s venture.

The response to a USA Today article on medical scribes is getting me riled up, with smug know-it-alls weighing in with uninformed comments like these: “I guess the older doctors who aren’t computer literate need scribes.” I’m trying hard to censor the profanities that I’m itching to write. Do you think less of your “younger” CPA if he or she isn’t typing into your 1040 form while you’re talking? Would you be happier if your lawyer stared at a PC screen instead of the jury? Does the President tickle the ivories on a laptop sitting in front of him while meeting with heads of state? Do even Steve Jobs and Steve Ballmer type their own meeting minutes while running Apple and Microsoft? Sure, the information needs to be entered into the EMR, but who says the doctor has do their own typing to get it there? Kiss your EMRs-for-everybody plans goodbye if the best method you can come up with is having doctors do all the data entry, the only highly paid professionals shamed into using tools whose benefit they question just because someone else thinks it’s a good idea (why not make patients enter their own information into a PHR? or schedule their appointments and ED visits on the Web? Or, for that matter, eliminate their own financial “scribes” and pay doctors by credit card before leaving the office?)

Law firms chosen to represent the state of New York in class action suits are heavy donors to state controllers. Among the “pay to play” firms is the one that made $80 million in engineering McKesson HBOC’s $1 billion settlement. 

Medical City (TX) goes live with the On-Cue patient itinerary system, a NASA-developed, AI-driven resource optimization system that servers as the “air traffic controller” for getting inpatients and outpatients where they need to be as orders and department backlogs change. I’m impressed with the credentials of the execs (former NASA and Philips people, with even the sales VP holding two master’s degrees from excellent schools).

The VA and DOD have finished the first of three phases of the military’s lifetime record program, the VA CIO says, making their systems interoperable. Phase II is making the records available on NHIN and Phase III involves making all information available during care delivered anywhere and at any time.

A reporter from one of the biggest national newspapers e-mailed to ask if I have examples of vendor non-disclosure contract language as mentioned in Ross Koppel’s interview. I’ll be the anonymous middleman if you can e-mail me examples (or use the Rumor Report form to your right, which accepts attachments like a contract scan).

Cerner keeps getting press for its H1N1 reporting project, which some lazy newspapers are reporting as some kind of exclusive arrangement initiated by Uncle Sam. I had mentioned that the Feds won’t get much data from big academic medical centers unless Epic jumps on board, to which Sunquest e-mailed me to mention that 60% of Epic’s customers and over 70 academic medical centers run LISs from Sunquest, which has been reporting infectious disease data to CDC and states since 2005.

A new HIMSS Analytics report (warning: PDF) says hospitals will struggle to meet ARRA funding requirements, with less than 25% of them live on nursing clinical decision support needed to track measurements such as A1c diabetics under control, smokers offered cessation counseling, and patients receiving VTE prophylaxis. This is an excellent, meaty report that crosswalks system capabilities to ARRA requirements and shows where the industry stands in having the necessary systems implemented. If you are a CIO whose hospital plans to collect stimulus money (or a hospital systems vendor), you should study the expected criteria and how your hospital compares nationally. Some hospital bed ranges have only single-digit penetration of systems that will probably be needed, meaning they had better get on the stick if they want handouts.

Lots of events have been posted to the HIStalk Events Calendar, which also lists events on the main page of HIStalk. You can add yours (free).

Like today’s posting? Add your e-mail address to the Subscribe to Updates box to your upper right and you’ll be the first to know whatever’s important. You might be surprised by the number of e-mails I get from people who thank me for (a) giving them an intense introduction to how the healthcare IT industry really works; (b) reporting some piece of information that made or saved them millions; or (c) making them feel more connected to the industry while traveling. You would spend hours a day to get the information you get here in minutes (and some of what’s here isn’t available anywhere else). The downside is that you may find me annoying, but hopefully that’s a trade worth making (and there’s always Inga as the sweet, sexy one in any case).

Speaking of handouts, they’ve driven us to this kind of headline: Kidney patients, job creation are focus of e-records initiative. University of Buffalo’s practice plan and Computer Task Group embark on a $29 million project ($7 million coming from the state), that “should improve health care.” It sounds like a separate project from the HIE announced there a few weeks ago, but I’m not sure since the practice plan is involved with both.

A hospital in Wales selects a Web-based diabetes care management tool from Hicom Technology.

The Y-12 National Security Complex in Oak Ridge, TN licenses EMBOS, an EMR developed for its 4,500 employees, to Healthcare Technology Partners LLC. The system was developed for Y-12 to help the Department of Energy meet the government’s EMR push. I found nothing on the company, other than it was started by former Y-12 executives. 

The mysterious HisserVideo e-mailed to say that he (or she) posted two more funny HIT cartoon videos. CIO: “Didn’t you just send me a press release about a 30-hospital group implementing Super-2000? How could it work for them?” Sales Guy Steve: “Those hospitals are in El Salvador and we sort of just gave it away to get a tax break to offset profits on our Salvadoran coffee business.” He worked my Vision Center observations into the third video, with Sales Guy Steve explaining its expansion: “We are taking over the space where we used to have the QA team.” Sales Guy Steve responds to the product expert’s observation that he knows little about his client except their bed count: “Because I was once having dinner with Bob [the CIO] and the bottle of wine was $414 and Bob said that was funny because they have 414 beds. Pretty neat that I remembered that, huh?” You can add comments to the YouTube page suggesting future installments.

Sentillion is placed in the “visionaries” quadrant of Gartner’s Magic Quadrant for User Provisioning, even more impressive considering that Sentillion was the only healthcare-specific vendor evaluated. That jogged my memory to go back and re-read my interview with Sentillion co-founder and CEO Rob Seliger from two years ago. “People often say that healthcare is slow to adopt technology, yet you can look at the amazing equipment from imaging systems to robotic surgery that is used. I don’t see a fear of technology in healthcare, just an avoidance of technology that’s an impediment to healthcare delivery. Vendors often miss that. We work really hard to get that right.”

It’s a good time to be an HIT vendor shareholder, at least if you bought at the right time. Above is a chart comparing Cerner (blue), Eclipsys (red), Allscripts (green), and the S&P 500 (gold) for the past 12 months. If you had the foresight to buy at the lowest price in the previous year and sold today, your money would have more than doubled with Cerner, nearly tripled with Eclipsys, and quadrupled with Allscripts.

The Toronto Star dissects the ambitious Smart Systems for Health initiative, which started out with grand ideas that turned into a money pit. By 2005, the agency had spent $260 million but accomplished little, triggering an operational review that characterized it as poorly regarded, short on strategic direction, and subject to inadequate oversight. By then the tab had run up to $458 million and the agency had over 300 employees. A year ago, it was dissolved and replaced by eHealth Ontario, now the subject of its own accusations of bloat, wasteful spending, and underachievement. The total now stands at over $1 billion. On Wednesday, Health Minister David Caplan resigned the day before an auditor’s “scathing” report criticizing the project was released. The auditors also uncovered government executive pay problems, where salaries were funneled through local hospitals to bypass government salary limits. Former CEO Sarah Kramer provides a statement that says, basically, that she was on the hook for quick results, the board knew exactly what she was doing, and, while people think a lot of money was wasted under her watch, it was a fraction compared to the amount that was blown before she took the job.

It didn’t take long for the lawyers to jump on the Broward General “reused IV” newspaper article. A personal injury law firm is “taking a proactive stance” to “educate and protect”. Translation: they opened 24-hour-a-day call center offering “free legal advice” from a “legal intake professional” (which I would guess means an offshore call center rep). Apparently the firm is a fixture on daytime TV in South Florida, or as one local puts it, “They are most ubiquitous during Unemployment TV (AKA, the morning talk shows, soap operas, and early afternoon game shows).”

The Wall Street Journal sees opportunity for vendors like Apple and RIM as hospitals replace pagers with smart phones. The article mentions a Stanford trial of accessing Epic on the iPhone, UPMC’s giving doctors and nurses BlackBerrys, and THR Presbyterian’s use of AirStrip OB.

Another Missouri hospital outsources application hosting to Cerner, this time Heartland Health. Eight hospital employees are being canned as a result, apparently.

Forbes profiles Epic. “But the hottest company in the electronic medical records industry is a secretive Wisconsin outfit called Epic Systems. It does little marketing or advertising, shuns acquisitions, never issues press releases and tries to stay out of the headlines. The privately owned company admits it once put up a billboard that said ‘Marketing Sucks … Epic Systems.’” It quotes KLAS as saying Epic is winning 40% of big-hospital sales, which seems low to me since I almost never hear of anyone else selling a big site.

E-mail me.

HERtalk by Inga

From Maathai: “Re: MGMA must-have trinkets. We will be handing out cards for people to ‘Plant a Tree’. They take the card, log on to a Web site, and select one of 16 countries where Seed the Future has a reforestation project going. We are hoping to have 1,000 trees planted before the end of the year. We also have recycled cardboard pens, but I don’t think they are as exciting as planting trees.” I’ll definitely be popping over to The Origins Healthcare Solutions booth (1006) to help make the world a greener place. Maathai also noted they are handing out stickers and will randomly hand out $50 bills to people wearing the stickers. That’s the kind of green I’m talking about.

From Ernestine: “Re: Health 2.0 conference. Lots of payer and consumer market here. So far it is a disappointment. Sitting in a session now and half are gone, even with cocktails to follow, and it is the first full day.”

From Dr. Love: “Re: Health 2.0 and Jonathan Bush. I don’t think we fully understand what he is wearing.  He’s a strange dude.” athenahealth’s Jonathan Bush and Allscripts’ Glen Tullman participated in a “Cats and Dogs” panel, which was suppose to pit “major IT vendors” and Web-based “clinical groupware” vendors. The athena folks tell me that JB was having a little fun with the whole show-down theme and was wearing his boxing shorts. I’m looking forward to seeing the video.

While at the Health 2.0 conference, MDLiveCare announces it will be the first telehealth company to partner with Google Health. The partnership includes the exchange of medical data between MDLiveCare and the Google Health PHR.

Just days after announcing its purchase of Perot Systems, Dell says it’s closing a desktop computing plan in Winston-Salem, NC. Six hundred people will lose their jobs next month, and another 300 by the end of January.

In a more positive announcement, Dell reveals plans for a new smart phone using Google software and running on the AT&T cellular network. The phone will use Google’s Android operating system.

Voalte, our favorite pink pants-wearing vendor, announces the results of its pilot installation with Sarasota Memorial Hospital. Using Voalte’s iPhone-based voice, alarm, and texting product, Sarasota’s nurses were able to provide faster response times for patients and reduce overhead paging by 78%.

CCHIT announces that vendors and developers can start applying for modular certification programs focused on meeting meaningful use requirements. The Preliminary ARRA 2011 program is limited to meaningful use standards spelled out in the ARRA legislation and will provide a certification label identifying which objectives the EHR technology supports. CCHIT is also launching its 2011 Certification program.

MedicAlert Foundation teams with SNOMED Terminology Solutions to provide SNOMED CT controlled medical vocabulary as part of its MedicAlert EMIR service.

David Blumenthal tells an AHIMA audience that the growth of EHR will create at least 50,000 new positions in HIT. 

E-mail Inga.

An HIT Moment with … John Shagoury

An HIT Moment with ... is a quick interview with someone we find interesting. John Shagoury is president of Nuance Healthcare.

Is the rich nature of the physician narrative getting too little attention in the rush to get codified data for interoperability?

Yes, as the healthcare industry and more recently policymakers work to make electronic health records commonplace, I believe that the concept of preserving the physician narrative has yet to receive adequate attention.

While the HIT Policy Committee has recognized “electronically capturing data” as part of the “meaningful use” criteria, the rich nature of the physician narrative needs to be specifically identified. In order to ensure that patients’ medical records do not suffer in quality, and that caregiver communication via shared notes does not lack necessary detail, electronic health records must not be reduced to point-and-click templates alone. The physician narrative should be accounted for and measured as part of quality care tracking under the American Recovery and Reinvestment Act.

This past June we surveyed more than1,000 of our physician customers on the topic of “meaningful EHR use” and learned that 94 percent of physicians surveyed either “agree” or “strongly agree” that capturing physician narrative as part of the documentation process is necessary for complete and quality patient notes. When you’re dealing with patient care and people’s lives, codified data only gets you so far. We must not forget that physicians treat people with problems, not just people’s problems; the details found in the physician narrative help to personalize the record, leading to high quality, patient-specific care.

Providers want a fast, sure payback on their capital investments. What’s your message to them?

If a healthcare organization is making any investment, including a capital investment in healthcare IT, it needs to align with a step-by-step workbook that outlines actual cost and benefits. All investments should be well supported with project goals at the technical, user, stakeholder and strategic levels. In addition to goals, the following should be crystal clear: what needs to be measured; how it will be measured; and how often it will be measured.

Another option to a capital purchase is an investment in a hosted (on-demand) solution. Regardless of what model an organization uses, I’d counsel providers to do both statistical and qualitative predictions and measurements. With the example of speech recognition technology (which is offered by Nuance as either a capital or on-demand purchase), an organization should estimate and measure the amount of traditional transcription cost that is expected to be saved, the projected physician satisfaction and efficiency levels gained, as well as quality improvement of patients’ health records.

While there’s no clear-cut playbook for which method of IT delivery fits which healthcare organization, working with an experienced vendor can help to ensure you invest in the right solution for your individual organization’s needs. Additionally, as the industry is increasingly identifying traditional transcription as an opportunistic area to boost efficiency, improve quality and reduce costs, we are seeing more organizations choose the on-demand model. It should be interesting to see if this trend continues.

While a capital purchase allows for full control of on-site software management, as well as data, security and process control, for many the on-demand model is more compelling. With on-demand, instead of installing software onsite, hosted software runs on the vendor’s servers. The vendor hosts the application and makes it available for users to access through Web browsers (via secure passwords). All of the customer’s data is stored at the vendor’s site; all maintenance of the software and server hardware, data backups, and tedious details of that nature are handled by the vendor. Healthcare organizations simply pay a monthly fee depending on their activity level; there are few extra costs or tasks associated with management and upkeep of the program for the customer. In addition to the benefit of less investment up front and fewer responsibilities on program updates and management, upgrades also happen automatically, and any glitches are the responsibility of the vendor.

The industry has taken some widespread negative PR and patient lawsuits over undelivered and uncommunicated critical patient results. Nuance acquired Vocada and its Veriphy solution in fall 2007. Was that a timely acquisition and will it be strategic going forward?

The decision to add critical test result management capabilities (CTRM – Veriphy) to Nuance’s healthcare portfolio was indeed strategic. The timely and accurate reporting of critical test results from the lab or diagnostic imaging group to the treating physician is an important aspect of patient safety. Unfortunately, and despite many regulatory and accrediting requirements, the typical “systems” for delivering and managing critical test results are mostly manual, disjointed, inefficient, prone to error, and frustratingly inconsistent.

In a recent study led by Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, it was found that more than seven percent of clinically significant findings were never reported to the patient. As part of the study, the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers were reviewed. Casalino’s team extracted records that contained abnormal results for blood tests or X-rays and other imaging studies, and then searched for documentation that the patient had been properly informed of the finding in a timely way. After many interviews with physicians associated with the uniformed patients, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.

Clinical laboratories are tasked with performing more than 10 billion tests per year and while critical results generally comprise less than two percent of all lab findings, the timely communication between the lab, physician, and patient is always crucial. Through use of critical test results management technology (Veriphy), leading medical centers like Virginia Commonwealth University Medical Center are automating the communication of patients’ critical findings so patients do not have to second guess if their results are normal and doctors do not have to worry about liability if a patient is not notified. VCU performs as many as 340,000 procedures annually, they went from being only 49 percent effective for critical message delivery and today critical results are communicated to the right caregiver within 13 minutes of being identified 99 percent of time. Phone tag is no longer relied on to ensure critical patient care.

Going forward, and increasingly as results like VCU’s become known, we expect Veriphy to be identified and deployed at more radiology, lab and even hospital-wide as healthcare organizations work to improve caregiver-to-caregiver communication and speed high-priority patient care.

Where are Nuance’s healthcare R&D dollars being focused?

With expertise in speech recognition, clinical communication and documentation, as well as diagnostic imaging, our R&D dollars are directed at expanding upon the capabilities and technological advancements we are already recognized for across the healthcare industry.

As mentioned earlier, preserving the physician narrative as part of patients’ electronic health records is extremely important. We will continue to improve the recognition capabilities of our speech solutions, expand our already formed relationships with EHR vendors and work to perfect natural language processing capabilities. We believe that data extraction and analysis of the unstructured clinical narrative, as well as the conversion of the unstructured narrative to structured, discrete documentation is critical for improved ongoing patient care.

Moving forward, we will continue to focus on ways for our customers to find value from the physician narrative for caregiver utilization in real-time, as well as to drive extensive analysis for enhanced care and operations moving forward. We will also remain focused on supporting current and emerging standards associated with HL7 CDA implementation guides to ensure the data the our customers capture is accessible and shareable for use within their enterprise, regionally and nationally as deemed appropriate.

With unnecessary imaging procedures costing between $3 billion and $10 billion annually, we will also work to expand upon and promote our RadPort solution as a viable, and cost-effective, solution for managing high-tech diagnostic imaging utilization. Earlier this year, Nuance co-founded the Imaging e-Ordering Coalition, which is an alliance of leading healthcare providers, technology companies and diagnostic imaging organizations working to promote electronic decision-support (e-Ordering) as a solution to assure that all patients receive the most medically appropriate diagnostic imaging test for their specific condition.

RadPort is an electronic decision-support tool that provides ordering physicians with clinical information at the time they are ordering a patient’s exam. By producing a "utility score" for the requested exam, physicians can assess the medical appropriateness of the exam to ensure it will be reimbursed by the patient’s health plan and most importantly to verify that it aligns with the patient’s conditions and care needs.

In addition to decision support, we are working with many customer sites to collate and analyze their ordering, documentation and patient outcome data via a Rubik’s cube like data warehouse, called RadCube. Over time medical groups can determine how often their providers’ selections of higher utility scans improve patient outcomes. RadCube collects a tremendous amount of data, automatically structures and classifies it and then provides a visualization of current activity to drive improved care, business and management decisions.

What does the short- and long-term picture of healthcare IT look like from the company’s point of view?

For the first time, healthcare IT is in the spotlight. In the short-term, we’ll see a combination of big promises from vendors that are simply unable to deliver matching technological advancements alongside market leaders that have been focused on addressing specific healthcare pain points for some time.

It is an exciting time to be in healthcare. As healthcare reform has captivated the nation, HIT has also risen in recognition and priority. As part of the American Reinvestment and Recovery Act, $19 billion is allotted for incentive payments starting in 2011 under Medicare and Medicaid for providers determined to be “meaningful EHR users.” As we anxiously await the definitive meaningful use definition, which is expected in the spring of 2010, Nuance is working to educate policymakers on how speech recognition can help national EHR adoption and utilization.

It is proven that a major EHR usability hurdle for physicians is the task of typing. Speech recognition does two things to improve EHR utilization.

• It makes physicians more productive. Because the majority of people speak faster than they can type, clinical documentation can be done more efficiently when speech recognition is applied; this allows doctors to spend more time practicing medicine.
• By allowing physicians to speak vs. type, they are empowered to create a highly detailed narrative of the patient encounter that can not be fully represented in structured templates alone, or perhaps would not be as complete if a physician was tasked with typing the note. EHRs will only be valuable if the information captured within them supports improved, ongoing patient care. We believe speech recognition can help to improve the quality and detail of information captured in patients EHRs and will be more broadly used in the short-and-long term.

In addition to speech recognition as core to EHR workflow, we are also working to educate policymakers on Capital Hill about the value of electronic, evidence-based clinical decision support to help eliminate medically unnecessary diagnostic exams. The technology, RadPort, rates medical imaging exams (at the time a doctor is ordering them) on a scale of appropriateness of 1-9. The rating is based 100 percent on the likelihood in which this particular exam will or will not contribute to positive outcome for the patient (will it help them?). Nuance is also a co-founding member of a national Coalition (The Imaging e-Ordering Coalition), which supports providing physicians with guidance regarding the ordering of patient-appropriate imaging services. Obama has talked exhaustively about the importance of reducing unnecessary exams and we are confident this technology can help.

Over the next 3-5 years, the healthcare space will move from IT laggard to more of a leadership position. The meaningful application of IT to healthcare is incredible and necessary. It can drive advancements in efficiency, cost savings, and patient care. Whether it’s clinical decision-support or applications to document the patient encounter without the keyboard or pen, we’ll see doctors’ tech toolkits evolve with new solutions to improve care.

Moreover, we’ll see the impact that strategic enterprise-wide HIT can have on a healthcare organization as a whole. The ultimate long-term goal will be interoperability and the availability of a patient’s medical history across any care-providing site, affiliated or not. With the right application and management of HIT, we can expect to see improved patient care and physician efficiency, while the cost burden associated with the current health care system is dramatically reduced.

News 10/7/09

From Alborg: “Re: Herb Conaway’s bill. Good news! I researched the status of the 5/2009 Assemblyman Herb Conaway’s bill (first reported at HIStalk) to make non-CCHIT certified EHR systems illegal in the state of NJ, and it seems that they shelved it without action. Two things helped kill the bill: the fact that the HHS finally threw the Sherman Antitrust Act-busting CCHIT "under the bus" on 7/16/2009, leaving CCHIT’s future murky in 2010 and beyond as EMR vendors will flock to the new ONC certification, and the bad press that started all over the ‘net with nothing but the bad facts about this bill and its main sponsor, Assemblyman Conaway, who had HIMSS associations and had received corporate lobbying money.” I’m a political illiterate, but I wonder if he just introduced the bill to return a favor incurred somewhere along the way but never really thought it could or should pass. I can’t imagine that a politician (even a doctor like him) suddenly decided this was his hill to die on unless someone was prodding him.

From S. Silverstein: “Re: HIT vendors selling ‘de-identified’ clinical data to pharmas (with the latter’s increasingly public record of ghostwriting of scientific articles favorable to their products, salesmanship of drugs for non-approved uses in violations of FDA guidelines, suppression of adverse clinical trials results, etc.). The vendors are perhaps opening up unnecessary cans of worms that will bite them when civil libertarians start taking notice. See: Ohm, Paul, Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization (August 13, 2009). University of Colorado Law Legal Studies Research Paper No. 09-12. Available at SSRN. Perhaps vendors should stick to their core business of HIT production, which — as regulation of HIT increases — will require even more focus.” I think a lot of the work being done hides conveniently behind the concept of “anonymization” as an absolute; a simple technique of magically rendering highly sensitive personal data untraceable. Sounds good to a lay person, right? It even sounds technically reasonable as long as you’re thinking of someone having only one data element (just your birth date) instead of multiples (your birth date and ZIP code) and one database (a prescription file) instead of multiples containing joinable fields (prescriptions plus driver’s license records plus a grocery store loyalty card database). It’s like security in general: rarely absolute, secure only if there’s not enough incentive for someone to go to the trouble to crack the code.

An associate professor of pathology at University of Missouri criticizes his employer’s decision to outsource to Cerner, pointing out that the political appointees that make up the university’s Board of Curators have led the university to a 102nd place ranking among 110 national colleges (in their defense, it’s right up there with a lot of other big, football-obsessed easy admission state schools like Oklahoma, Nebraska, and Tennessee). Some snips, obviously fueled by a few rounds of tenure: “It appears he [University president Gary Forsee] is prone to make the same top-down decisions that were unsuccessful when he directed a large communications network … The medical school’s administrative residency program is on probation and is undergoing critical review; a major factor is that the Cerner system is so cumbersome that resident training is compromised … Three years ago, the radiology department dropped a Cerner software program because it was seriously flawed.”  

Sarah Kramer, the former eHealth Ontario CIO who was fired for handing out no-bid contracts, is accused in a CBC article of doing something similar at her previous job as CIO of Cancer Care Ontario. Accenture was told it didn’t make the final vendor cut for a $5 million surgery wait time application, but an Accenture senior partner friendly with the CIO was allowed to make an oral presentation criticizing the two short-listed vendors, resulting in Accenture’s being awarded the contract three days later. And in the least shocking news of all, the $5 million system turned out to be a $20 million system. That’s one side of the story, anyway. I’m guessing there are two.

Former Google Health bigwig Adam Bosworth launches Keas, a Web site that provides individualized care plans. It sounds like a rather pedestrian idea, but he’s got a big executive team, an army of stock art models, and grand plans to let providers create plans (not medical advice, the terms of service make clear) to which patients can subscribe as easily as buying an iPhone app. My money would be on the usual revenue sources, i.e. drug company advertising and trying to get deep-pockets insurance companies to buy bulk subscriptions for their patients. Apparently all the good domain names were taken, leaving the company to link its futures to an obscure New Zealand parrot (the kea) shown in its logo.

Speaking of Google Health, it proudly announces that two more insurance companies have signed on, rocketing the total to three (with just a few hundred to go) after 20 months, which is decades in Internet time.

Weird News Andy approves this message: “Impending lawsuits? Nah!” An anonymous caller to the compliance hotline of Broward General Medical Center (FL) reports that a nurse is using the same IV fluid bag and set on multiple cardiac stress test patients. True, the hospital found. They’re warning 1,800 patients to get hepatitis and HIV tests. The nurse quit and left the country.

Ingenix announces that its CareTracker EMR has new Surescripts-certified e-prescribing capabilities.

Kathleen Sebelius tells Cerner and its customers that President Obama thanks them for being “a health partner in this ongoing battle.” This refers to Cerner’s H1N1 network, to which 200 hospitals are contributing data. It sounds like they’re flagging ED admissions with elevated temperatures, which doesn’t seem all that specific (I seem to remember that some county or state health departments already track that). I’m also not sure what the government would do faced with an obvious local flareup (drop ship Purell? redirect Tamiflu supplies?) but at least they’ll know (except in communities served by large academic medical centers that are more likely to be running Epic than Cerner).

Speaking of Cerner, the local paper covers its prospects, citing a William Blair estimate that HITECH will goose Cerner sales by as much as $8 billion. They have a great picture of the three founders beaming. Another article describes Neal Patterson’s emotional recounting of the healthcare experience of his wife Jeanne, who has breast cancer.

Cerner announces its uCern social networking site, the uDevelop development platform, and the uCern Store for buying applications. I don’t know anything more about those offerings since only Cerner customers can access them. It sounds interesting, anyway, although the all the hospitals I’ve worked at would not have contributed apps because (a) it’s not our core business; (b) we don’t want some rube hospital calling us up demanding support for something we wrote for our own use; (c) we don’t want to help our competitors who might buy our stuff; and (d) we have irrational fears of being sued if something goes wrong. My experience is that hospitals are mildly willing to help out a vendor’s customer peer provided they feel technically or medically superior and hopefully geographically distant to them, but nobody’s going out of their way to make it happen.

Tressa Springmann, VP/CIO of Greater Baltimore Medical Center (MD), is named to the advisory board of Maryland’s HIE, CRISP (Chesapeake Regional Information Systems for our Patients). I made fun of the tortured acronym a few weeks back and got a nice note (and a music recommendation) from Johns Hopkins CIO and CRISP board member Stephanie Reel, who explained that they just tried to pick a name that reflected their intentions. Always quick to jump at the chance to provide unrequested and likely unwanted advice, I suggested Chesapeake RHIO, to be acronymized into CHERHIO (the jaunty English greeting, not the oaty breakfast cereal).

Open source BI vendor Pentaho acquires the assets of SaaS BI vendor LucidEra. The companies have raised nearly $50 million of capital between them.

I had planned to attend Mayo Clinic’s symposium on healthcare last month since they were kind enough to invite me (as did Dr. Natalie Hodge, the “iPhone Doctor” and co-founder of Personal Medicine International), but day job logistics got in the way. They have session videos up, though, so I will need to check those out. I’m watching Natalie right now, in fact.

QuadraMed launches its ICD-10 Countdown Program, which includes the Quantim ICD-10 Coding Simulator, educational tools, and services to help providers convert to ICD-10.

The press seems shocked that Bellevue Hospital (NY) got a tip that Joint Commission was on its way and sent a staff e-mail urging the discharge of “patients that do not need hospitalization” and having supervisors check to make sure patient documentation was complete. Surely they don’t think that hospitals just conduct business as usual without regard to an impending survey, even now that they are unannounced? Or that Joint Commission isn’t aware of its multiple roles of accreditor and vendor? You used to be able to pay them (and maybe still can) to do a mock survey to make sure you were ready for the real thing, kind of like cramming for the SAT to get a score you couldn’t have obtained without help.

Was this really how stimulus money was supposed to work? General Hospital in Nashville says it will get more than enough stimulus money to cover the remaining $3 million cost of its EMR project, but wants to borrow city money to finish it since that chicken has to come before the financial egg.

E-mail me.

HERtalk by Inga

Routine use of electronic health records can improve the quality of preventive care and help manage chronic disease in primary care practices, according to a primary care study.

athenahealth signs an $30 million agreement to purchase AnodyneHealth Partners, a SaaS business intelligence provider. Anodyne will continue to market its BI solution as a standalone product. In addition, athenahealth plans to integrate the service into the athenaCollector platform. The deal includes a cash payment of $22.3 million with the potential for additional consideration of $7.7 million, based on the achievement of certain business and financial milestones. Neither Mr. H nor I had heard of Anodyne before, but understand they traditionally serve large and enterprise-size medical groups. Jonathan Bush says the Anadyne purchase should help them get their foot in the door at some of the larger institutions.

Blue Shield of California makes $29.6 million available for pay-for-performance bonuses. Medical groups and IPAs can qualify by demonstrating the performance of quality care using such measures as diabetes care, patient experience, managing ER visits, and deployment of IT.

The Wyoming Department of Health grants a $4 million, three-year contract to ACS to provide an EHR and HIE for the state of Wyoming.

Baptist Healthcare System (KY) becomes the first health system to simultaneously implement both the access and business management modules of McKesson’s Horizon Enterprise Revenue Management solution. Baptist Hospital Northeast went live August 15th.

In a $54 million stock deal, Nuance Communications acquires eCopy, a provider of document scanning solutions. Nuance plans to combine eCopy’s touch screen technology with its existing multifunction printer desktop solutions.

3M Health Information Systems, McKesson, and Executive Health Resources sign a strategic agreement to offer RAC Advanced Services. The joint solution will combine 3M’s coding and billing solutions, McKesson’s InerQual medical necessity criteria, and EHR’s physician advisors to conduct second-level reviews.

The use of smartphones by physicians is expected to increase from 64% today to 81% by 2012. A more “mature” and proficient physician audience will emerge and the Internet will become physicians’ primary professional resource. Look for physicians to use their smartphones for everything from administrative tasks to patient monitoring.

The Bronx RHIO selects Axolotl’s Elysium Exchange to power its HIE. Participating providers will be able to electronically exchange via existing EHRs, or, with Axolotl’s Elysium EMR Lite product.

Summa Health System (OH) selects Wolters Kluwer Health to provide its ProVation MD software for cardiology procedure coding. Summa plans to use the software at its three cardiac cath labs at Summa Akron City Hospital.

People keep asking when we are going to get on Facebook. Yesterday, I decided to forego all my much more important tasks to set up a site for myself (Inga Histalk) and an HIStalk Fan Club. Now, in addition to reading HIStalk, HIStalk Practice, and Twitter, you have one more way to stay in the know/surf the Web and pretend you are working.

I’m Denver-bound this weekend, headed to the national MGMA conference. We’ll be posting a Must-See Vendors guide later this week, plus I’ll be sending in daily updates. If you are attending, feel free to pass on any tips for sessions to attend or booths with must-have trinkets. Be sure to visit our great sponsors, who will be handing out a limited supply of HIStalk magnets (I’d bet everyone would think you were really cool if you brought one back to put on the lunchroom fridge). Special thanks to the multi-talented Dr. Gregg Alexander who created the magnets and who regularly writes on HIStalk Practice and still finds time to practice full-time.

E-mail Inga.

Readers Write 10/5/09

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 are Changing the Industry, Slowly
By Mark Moffitt

It’s an age-old argument in healthcare IT. Which is better, the single vendor or best-of-breed approach to software?

The single vendor approach has had the advantage, namely less risk from integrating systems, for a number of years.

The best-of-breed approach offers systems with better functionality and/or ease of use, but integrating systems from different vendors is a challenge. Small and innovative vendors are often the leaders in best-of-breed systems.

HL7 has not evolved past “piping” data from one system to another. Interoperability? Not using HL7. But web services offer a way to provide interoperability between systems.

This is the same technology that brought us the World Wide Web or Internet, online banking, Google, Amazon, eBay, the dotcom bubble and bust, and online communities. It is diminishing the primary benefit of the single vendor approach — ease of integration.

I predict Web services will bring more competition into the healthcare IT space and lower costs where vendors compete on functionality, innovation, and flexibility. It will open the door to smaller, more innovative vendors.

Web services have been around since the late 1990s, yet the single vendor approach still dominates the industry. Change has been slow as the sunk costs of single vendor software present a significant barrier to change. In addition, vendors of single vendor systems do not promote Web services for interoperability for obvious reasons.

But those barriers are about to be swept away by much more powerful forces.

Change is coming to healthcare regardless of the outcome of current healthcare reform efforts, in the form of 1) higher volume as baby boomers march through old age (Chart 1); and 2) lower reimbursement as healthcare cost as a percent of GDP falls. This change will be forced on the USA as a consequence of competing in a fiercely competitive global market.

The Obama administration is increasingly signaling that the United States will not continue to be the world’s consumer and importer of last resort. The clearest statements came last month from Larry Summers, White House economics director, in a speech at the Peterson Institute for International Economics and in an interview with the Financial Times. The United States, he said, must become an export-oriented rather than a consumption-based economy and must rely on real engineering rather than financial wizardry. Tim Geithner, the US Treasury secretary, and other top officials have spoken similarly of rebalancing US growth.

Healthcare costs are like a “tax” on the economy. That tax is much higher in the US than in other countries (Chart 2). Healthcare cost as a percent of GDP cannot continue at current levels if the USA is to compete against other global economic powerhouses in the 21st century. Unrelated to this discussion is the likelihood that the dollar will continue to devalue to level the playing field for USA exporters (Chart 3).

Web services are beginning to make inroads at the grass root level as healthcare IT shops are forced to find ways to provide more and more functionality in the face of stagnant or shrinking budgets. This trend will only accelerate as healthcare confronts a new reality.

It will take time to dislodge Epic, Siemens, GE, Cerner, et al, from their perch atop the healthcare IT food chain. I predict that these vendors will fight the inevitable reordering of the industry like others before them in other industries (read the book: “The Innovator’s Dilemma”). And like those before, them these vendors will not change because they are stuck in the business model that got them to the top.

But change is coming and it is unstoppable. It will bring about a leap forward in ease of use and flexibility at a much, much lower cost. The trend for the cost of healthcare IT systems is down, not up.

The primary beneficiary of these changes will be physicians and other care providers in the form of real and tangible productivity-enhancing features and functionality. They are going to need it.

It will be fun and exciting for some in the industry. For others, it will bring job losses and stress.

Fasten your seatbelts. It is going to be a thrilling ride over the next ten years.

Chart 1

Chart 2

Chart 3

Source for chart. OECD publishing. Rights and permissions. Allows websites and blogs to use excerpts of their publications with attribution and URL.

Mark Moffitt has worked in healthcare IT for 25+ years and has a BSEE, minor in computer engineering from University of Texas at Austin and an MBA from Vanderbilt. He is currently (de facto) CIO at Good Shepherd Medical Center in Longview, Texas.

Fee-Based Clearinghouses Defy 80/20 Rule
By Jim Denny

Mr. Revak raises an interesting premise about the costs associated with use of clearinghouses, based on the 80/20 principle. However, I’d like to offer some additional perspective on the value of using a Web-based clearinghouse.

I would agree that it is hard to justify paying for transactions if all you are getting is a dumb pipe to the payers. To justify the fees that clearinghouses would charge, they must deliver meaningful value beyond transaction processing. You should expect to receive some form of SLAs (Service Level Agreements) around performance, reliability, service levels and response times, first pass rates, etc.

It is also importation to remember that not all clearinghouses make money on a “per transaction” basis. Some, Navicure included, charge a flat monthly fee unrelated to claim volume — much like Internet service providers and cable television companies do. Indeed, any of these would prove to be prohibitively expensive if users were charged each and every time they used the service.

And, as noted above, Web-based clearinghouses can provide added value that goes well beyond simple claims processing. These services deliver business intelligence that can greatly enhance a practice’s business operations, such as real-time claim tracking; analysis of paid vs. contracted fees; coding and data entry error patterns; rejection and denial trends; and staff productivity reporting.

In addition, users benefit from the ever-widening scope of information available from Web-based clearinghouses. The claims engine employed by these firms get bigger and smarter with each claim processed because the “claim brain” benefits from the broader community of practices. In effect, thousands of practices could be making the same mistakes with given payers, resulting in repeated rejected claims. With online functionality, the error can be corrected automatically without each practice needing to fix its own system. And when new payer edits are applied, practices can rely upon their clearinghouse to integrate the policy change, so they don’t have to invest staff resources in keeping up with countless payers making endless modifications.

Certainly, in these difficult economic times, it makes sense for practices to take a critical look at how they invest their resources. But they must ensure they are looking not only at the price tag for any given solution, but that they also consider the overarching value they may receive.

Jim Denny is president, CEO, and director of Navicure of Duluth, GA.

Let Us Rise to the Occasion: It’s Not About the Technology We Offer; Our Value is in Changing the Way a Medical Practice Works
By Lindy Benton

Since February’s announcement of the federal stimulus package including electronic medical record incentives, the healthcare industry’s attention has focused mostly on the money: how physicians can get paid to implement an electronic medical record (EMR) — and how much vendors can make in the process.

I fear that we are neglecting one of our most unique — and critical — duties as vendors of healthcare technology, which is to align ourselves to the needs of physicians.

Let’s not forget why the federal government decided to pay for our industry to embrace automation. It wasn’t to install our technology; it was to change the way medical practices operate. Our nation needs — truly deserves — more value for what it spends on healthcare. As President Obama so bluntly put it, we’re even missing the basics:

Healthcare is the only area where you still have to fill out five different forms – when you go into a bank you don’t have to do that. You’ve got an ATM. …Sometimes you see their [healthcare] files and it’s all stuffed with papers, and nurses can’t read the doctor’s handwriting. AARP tele-town hall Tuesday July 28, 2009

The real issue at hand is changing the way a medical practice functions from the moment the patient walks into the door. Today, patients groan when they see a sign-in list teetering on a shallow window sill below a hand-written sign that declares, “Tap if you need help”. In the future, we need patients to be comforted by the precision and security of the technology and corresponding workflow that supports their physician.

There’s good evidence that the time is right for change. In these turbulent economic times, patients are anxious because money is tight, preventive care has been neglected, and long wait times for appointments just add to the frustration. Physicians are just as apprehensive. Reimbursement is down, expenses are up, and for many, the work is less and less professionally satisfying. Yet, faced with these challenges, most physicians don’t see technology as a savior. In fact, many see the stimulus package as just adding to the frustrations of the current economic environment.

It’s no surprise that physicians are fearful: EMRs haven’t had a stellar track record. In 2005, then-Arizona Governor Janet Napolitano issued an executive order for all healthcare providers to install EMRs by 2010. A May 2009 report found that as many as 20 percent of medical practices in Phoenix have or are canceling their EMR contracts as a result of training, functionality or affordability issues. Cancellations were especially prevalent among smaller medical practices, according to the HealthLeaders-InterStudy report.

As vendors, our challenge is to stop focusing exclusively on the EMR — getting physicians implemented as quickly as possible and then moving on to the next client. An EMR is a wonderful tool, but the national healthcare reform debate isn’t about tools. It’s not even about technology.

In order for physicians to not only implement an EMR, but to automate their workflow, they need us. Instead of worrying about how they are going to afford the staff training, maintenance, and continual upgrades of an EMR, physicians should be assured that the vendor they choose has the intellectual resources to be consultative to their needs so they can deliver efficient, affordable and high quality care to patients. They need vendors who can be partners — who can be experts, trainers and consultants on how to integrate technology into day-to-day operations. Physicians want a partner who can guarantee qualified information technology and be the professionals who help them navigate the complexities of an EMR.

As healthcare technology experts and as fellow Americans, it’s our calling — our responsibility — to make sure physicians get a positive return on their investment. In turn, patients will experience the value of the technology we offer.

The healthcare information technology industry should be proud of delivering on its past promises to produce cost savings, efficiencies, and even better patient outcomes. If we stay focused on truly creating value for medical practices, we’ll ensure that the stimulus package’s HITECH Act doesn’t become another Cash for Clunkers — a short-term stimulus that doesn’t get to the core problems. Instead, let it become our legacy.

Lindy Benton is chief operating officer of Sage Software Healthcare Division of Tampa, FL.

Monday Morning Update 10/5/09

From Cernerfan: “Re: Barts 18-week backlog in thousands.” In England, Cerner Millennium is blamed for the jump from 1,700 to 23,000 patients whose referrals don’t meet the 18-week target from referral to treatment at Barts and the London NHS trust. They’ve been live since April 2008, so the “things are shaking out” excuse is getting a bit long in the tooth.

From The PACS Designer: “Re: Google Sidewiki. Google has a new feature called Sidewiki that permits useful information to be added to any web page. The Cleveland Clinic is using Sidewiki to add heart disease information to enhance details about the disease and its prevention.” I have to admit that I hate this idea with a passion. Users can now take control of Web sites, splattering unvetted comments onto any site without the owner’s permission or involvement (they call it “contribute to any web page”, in other words, even those to which you weren’t invited to contribute). Who’s to say that the nasty comments on Cerner.com didn’t come from a competitor? It’s a step backward for sites like this one that already allow nearly unrestricted comments, but exercise some control to keep the conversation civil, the facts accurate and relevant, and the personal attacks limited. Using some third-party tool also splits off what should be a threaded conversation, with Sidewiki hijacking for Google’s benefit conversations that could have been better served with existing technology. Sidewiki is a really bad idea, but I’ll predict that Google will kill it anyway after it gets wrapped up in a few slander suits over malicious postings. In fact, I seem to remember that a similar technology met a timely death for exactly that reason not too long ago, although I don’t remember its name.

From EHR Geek: “Re: FierceHealthcare. Rumor is that Mr. HIStalk was named one of FierceHealthcare’s Nine Healthcare Bloggers worth a click. We love us some Mr. HIStalk!!” Thanks to the folks there for the mention.

From Electric Slide: “Re: vendor evaluation. Are hospitals that are evaluating vendors still using Gartner’s Magic Quadrant, KLAS, or HIMSS Analytics? Given ARRA, it would seem like the value has diminished and both charge a lot of money from the vendor side.” I’ve always thought that, for major purchases like clinical systems, hospitals mostly went with less logical criteria: (a) how enamored the hospital executives are with the vendor’s vision, executive charm, and marketing fervor (all of which usually are negative signs rather than positive, but are widely accepted); (b) whether they just want to dump an incumbent and try their biggest competitor as something new; or (c) CIOs choosing the option that looks like the least work and risk for IT (i.e., just buy more stuff from current vendors). I can only speak to the selections I’ve been involved with personally, but those (oddly, for science-based organizations), usually ended up being influenced by intangible BS like the Vision Center, personal relationships that really should have required the hospital executive to recuse themselves from the selection, or either buying the same system as a competitor (to show them up with better utilization) or what they didn’t (to avoid being labeled as imitative). Any resemblance to an orderly process driven by the needs of clinicians and their patients was purely coincidental.

From J-Lo: “Re: HIMSS. Enjoyed your reception, but it was hard to hear and kind of frustrating that people stayed in their typical cliques rather than a whole bunch of mingling. I did meet several new folks cuz I made the effort, but maybe, just maybe you and Ms Inga could come up with a way to integrate your guests a bit more.” I agree completely. We need some gregarious event ambassadors to get people talking (I had high hopes for the strippers from year before last, but as I should have known, spirited conversation wasn’t their long suit). Former A-V club geek Dr. Gregg Alexander has promised to help out with improved presentation logistics now that we won’t be constrained by the limited capabilities of a hotel ballroom, so I’m looking forward to fog machine effects and maybe Inga flying in on a wire.

From NHIN-a-new: “Re: NHIN. This exclusive confab last week may be worth analysis – did we just hear the sound a door opening? Looks like ONC is exploring a really interesting way to apply the NHIN to the reality of consumer environments. Think linking the ATM network to your cell phone – now that would be a ‘cool technology of the week.’ As long as there is enterprise aggregation of data we need the structure the NHIN provides in standards and specifications (the work going on inside the NHIN project on details specs and governance issues is absolutely amazing!)  And this session shows a way to coordinate these two innovations.” John at Chilmark Research reports that the government’s intentions for the Nationwide Health Information Network maybe be changing from a data exchange platform for provider data to a “Health Internet” that is more driven by and beneficial to consumers. That makes sense based on some of the buzz around new federal CTO Aneesh Chopra and his interest in “government as a platform”. I’ve been saying all along that “meaningful use” ought to be based on the data providers contribute electronically rather than paying them for simply replacing paper with EMRs, so perhaps this is a step in that direction. Everybody (except the government and its Medicare payment rules) knows you ought to be paying for the result you want.

From Lips Kudlow: “Re: EMRs as medical devices. This is truly frightening. It would result in the decimation of an already beleaguered Canadian EMR software industry, not to mention smaller added-value healthcare software vendors. It wouldn’t surprise me if the large vendors (Cerner, Meditech, et al) have lobbied Health Canada to issue just such a ruling, since large companies typically have a vested interest in stifling innovation and competition from upstarts.” Health Canada releases a notice stating that software “use only for archiving or viewing information or images” is a Class I medical device and systems that manipulate, analyze, edit, measure, or graph information are Class II medical devices. That means vendors must be ISO certified to sell those products in Canada. The definition of “patient management software” is a bit vague and sounds as though it was intended to cover physiologic monitors (note the reference to “active diagnostic devices” and “monitoring a physiological condition”), but I’ve e-mailed for clarification.

I’m back on the job, so thanks to Inga for keeping things under control while I was away. She did great, if you ask me. I’ve got a lot of catching up to do and will unavoidably mention items she already covered, but it’s all new to me.

Regional Medical Center (SC) is always doing something newsworthy when it comes to Cerner, whether it involves board members fighting over parliamentary procedure in approving its Cerner contract or having its employees crying racism over including a banana-wielding gorilla in its post-project celebration. Now its board argues bitterly over its proposed $1.3 million purchase of medication dispensing cabinets from Cerner, specifically debating whether Cerner is a sole-source supplier in that marketplace (uhh, ever heard of Pyxis or AcuDose?) The CFO says they decided that only Cerner could provide the cabinets since theirs are “integrated”. Board members argued, shouted, and insulted each other to the point of having to be gaveled down by the chair. Cerner still gets the business, or at least I think it did based on the somewhat confusing recap.

A-Life will connect its Actus computer-assisted coding system to the Ingenix Web.Strat encoder.

Plains Regional Medical Center (NM) learns that its mammography information was hacked two years ago in a breach at the University of North Carolina at Chapel Hill, which provided its previous system for generating mammography follow-up letters.

A reader asked if GE is still selling Centricity Lab in the UK. Inga asked GE and we appreciate their response: “The business has decided to shift its strategy away from forward production on the Centricity Lab product. The demand for it is, perhaps, as strong as ever yet currently concentrated in smaller, community-based EMR settings. We really need to focus on maximizing the personalized service we can deliver to the existing install base and will continue to service and support all current installs (as well as honoring all current orders).”

In Ontario, the hospital CIO who was involved in issuing $3 million in no-bid consulting contracts to a former co-worker steps down. Diane Beattie and her employer, London Health Sciences Centre, have agreed to part ways, but now the politicians are arguing over the $451,000 in severance pay she will receive for her 21 months on the job. Her contract called for severance of a full year’s salary plus a month of pay per year of service. Maybe someone ought to investigate who approved that kind of a deal, which is somewhere between remarkable and nuts (her employer says it’s a “standard contract for senior staff in teaching hospitals”).

Oracle’s Larry Ellison on cloud computing: “I remember I was reading W and I read that ‘orange is the new pink’ and ‘cloud is the new SaaS’ or ‘cloud is the new virtualization’ … maybe I’m an idiot, but I have no idea what anyone’s talking about. It’s just complete gibberish … I’m going to access data on a server on the Internet and that’s cloud computing? … These people who are writing that crap are out there. They’re insane.”

HHS secretary Kathleen Sebelius will address the 6,000 attendees of the Cerner Health Conference on Tuesday, talking about healthcare reform. Any irony is unintentional.

Beaumont Hospital (MI) CIO Paul Peabody will retire after 35 years there, part of an executive restructuring. 

My poll on who readers would like to work for given comparable jobs offer drew 527 responses, which I’m guessing indicates some level of either fraudulent voting or vendors encouraging employees to vote for the home team. Anyway, take it for what it’s worth: Epic won with 30%, followed by McKesson (17%), Meditech (13%), Cerner (12%), Eclipsys (11%), GE (11%), and Siemens (6%). New poll to your right, raising a moistened finger into the air to detect a shift in the winds of economic change: over the past six months, how has your employer’s economic situation changed?

The layoffs just keep on coming at Texas Health Resources.

Cerner digs deeper into the life sciences, licensing its Discovere system to clinical trials vendor Quintiles. Part of Discovere is the former First Genetic Trust technology that Cerner bought somewhere along the way. Quintiles signed an agreement with that company back in 2001 and took an equity position in it. The Discovere modules include biobanking, research registries, public health investigator workflow, clinical trials management, and adverse event reporting.

I ran across an overview (warning: PDF) of Cerner’s LifeSciences, which apparently involves selling patient data from the EMRs it hosts. “Through our data mining of our vast warehouse  of electronic health records (EHRs), you can accelerate development processes and reduce business risks. This is when Cerner LifeSciences makes it possible to analyze anonymous, HIPAA-compliant, EHR-derived data for efficacy and safety.” That’s an interesting business. Long-time readers will remember that I’ve cautioned previously about providers selling off their data rights since they have more value than you might suspect. Cerner is pretty smart to include contract language that allows them to sell anonymized customer data to drug companies, getting it free, in essence, from its IT customers.

Several hospital nurse executives provide testimonials about the contribution of the Kronos employee scheduling solution to their Magnet designation.

West Tennessee Healthcare CIO Jeff Frieling gains additional responsibilities as VP of hospital services.

Another big hospital CEO retirement payout: Valley Medical Center (WA) gives its CEO a $1.73 million retirement bonus even though he’s not retiring. The hospital put the money aside in 2003, payable if the CEO retires after his 60th birthday or if he is fired or demoted (!). He’s still working at $900K per year and still has a separate pension plan for whenever he really does retire, courtesy of the local property owners whose taxes support the hospital. The hospital issues the boilerplate lame excuse that every other over-paying hospital uses: “It’s a highly competitive market, and our board feels that in order to keep someone of Rich’s caliber, he needs to be compensated as such.” Are they admitting that it’s such a dump that nobody would sign on for the pittance of, say, $500K? $250K? Like Wall Street, nonprofit hospitals are clearly out of control in their executive pay practices.

This is interesting: the orthopedics chair at Bronx-Lebanon Hospital Center (NY) e-mails an unsolicited testimonial to the vendor of an iPhone aviation pre-flight checklist app. The doctor had modified the templates to create pre-surgical checklists for total hip, total knee, and arthroscopy, one of which reminded him to check a particular patient’s lab result. The outcome, in his words, was “a life was saved.”

TeleTracking Technologies acquires small RTLS vendor RadarFind.

Odd hospital lawsuit: the family of a man who died of a heart attack in the ED sues the hospital, claiming the ED doctor let him die so he could steal the patient’s $16,000 Rolex.

SUNY Stony Brook will expand its use of PatientKeeper, adding its ePrescription and Pay for Performance modules. ePresciption will be live by the end of the year in time to qualify for the 2010 Medicare incentive payment. PQRI will also be running in time to get that incentive.

UK stock analysts postulate that the three divisions of Misys (healthcare, banking, and treasury and capital markets) could be split off into their own companies to increase shareholder value, also guessing that Allscripts will be the first since it’s about the only bright spot the company has. Meanwhile, some nuggets from the Allscripts-Misys earnings call: (a) “Some of our competitors are talking about a pause; we’re surely not seeing it.”; (b) Allscripts is working with Henry Schein in implementing the big North Shore-LIJ deal recently announced; (c) a new factory-type Enterprise rollout has cut deployment time and hours by 50%.

A reader sent in a flyer for a series of invitation-only Apple executive briefings covering the iPhone in medicine. The ones in Chicago, Reston, and New York are over, but sessions in Boston and Cupertino will be held later this month (we geeky programmers are amused at the address of Apple’s executive briefing center: 4 Infinite Loop). I’m certain it was oversight that Inga and I haven’t received our invitations yet.

GE Healthcare’s joint venture with Bangalore’s Wipro is enhanced to become GE Healthcare’s sole vehicle in India. GE CEO Jeff Immelt predicts that healthcare products and services developed cheaply in India will be exported to the US, helping manage healthcare costs here.

Former FCG president Steve Heck joins Impact Advisors as VP after a couple of years at Navigant.

This doctor doesn’t mind using a computer: a former pediatrician is ordered to appear before North Carolina’s medical board, charged with failing to report his DWI arrest and for using the PC of a practice for which he was working to write pornographic stories.

A Children’s Boston research article says EMR data can be used to help doctors identify domestic abuse. The most positive correlation for females was for injury, poisoning, and alcoholism. For men, it was mental health conditions.

E-mail me.

News 10/2/09

HERtalk by Inga

From: Coding Guy “Re: ER Documentation System. I can tell you from compliance training I have received from HBMA and networking with other compliance officers, that providing prompting for higher services is a no-no. It’s similar to having superbills where there are no checkboxes for non-billable services – if you’re not providing a mechanism for recording non-billable services it could get attention. I’m not a lawyer but I do have access to very good counsel and providing provider feedback that hints of guiding upwards for bills is definitely to be avoided.  Most OIG investigations are triggered by disgruntled employee tips, so any bad messaging and training around a system like this could lead to unwelcome attention.”

More than three-quarters of healthcare executives surveyed by PricewaterhouseCoopers LLP agree that the secondary use of EMR data will be their organization’s greatest asset over the next five years. Essentially, it is all about data mining, and how it can be used to improve patient care, predict public health, and reduce healthcare costs. However, PWC finds that the lack of standards, privacy concerns and technology limitations are holding back progress.  PWC just published  “Transforming Healthcare through Secondary Use of Health Data,” which calls for public-private collaboration and government incentives to collect, share and use health data; to establish standards; and to redefine technical architecture to allow interoperability.

Here’s a keynote address I would have loved to hear. Ron Galloway spoke at the Healthcare Facilities Symposium & Expo this week and said that the Wal-Mart’s distribution of eClinicalWorks “is the biggest thing going on in healthcare right now.” Galloway also predicts that between the company’s plan to get its 1.4 million employees’ health record formatted electronically and the projected 22 million patients visiting its EHR-equipped clinics by 2014, Wal-Mart is positioned to be a major force in HIT.

Surgical Information Systems (SIS) names St. Anthony’s Medical Center (MO) an SIS Center of Excellence, based on its “best practices” use of the SIS Solution. Within a year of installing SIS, St. Anthony increased efficiencies in several areas, was able to increase OR caseloads 5%, and decreased late case starts by 4%.

Jewett Orthopaedic Clinic, a 32-provider, seven-office clinic in Florida, selects the SRS hybrid EMR. Speaking of SRS, I noticed that Evan Steele was recently interviewed on the EMR and HIPAA blog. His take on ARRA and stimulus money: “The cost associated with reduced productivity that a high-volume, high-performance physician would incur by entering the data to meet the meaningful use requirements dwarfs the incentives being offered and the relatively small penalties which start six years from now (in 2015).”

Allscripts announces its first quarter numbers, which include non-GAAP revenue of $167.5 million compared to $164.7 million last year. The non-GAAP revenue numbers take into account the 2008 and 2009 revenue numbers of both Allscripts and Misys Healthcare. GAAP revenue was $164.9 million versus $92.8 last year and earnings were $.15/share. The company exceeded Wall Street estimates of $.14 cents/share earnings. During Allscripts’ investor call, the company indicated its recent deal with North Shore-Long Island Jewish was worth just over $10 million, but had a potential value of more than $75 million, depending on how many physicians signed on. Investors seemed pleased, with shares on Wednesday hitting their highest point in nearly two years ($20.61.)

Southeastern Regional Medical Center (NC) plans to implement Allscripts suite of care management solutions, by the way. The hospital will use the web-based SaaS  product to enhance continuity of care across the organization and prepare for Medicare’s RAC program.

CVS pharmacy customers now have the ability to download their prescription histories into HealthVault.

Ingenix expands the e-prescribing capabilities of its CareTracker EMR solution and is now SureScripts-certified.

Emergisoft releases its iPhone Simulator, which will allow physicians to customize the iPhone for use with Emergisoft’s physician documentation in the ER.

HHS Secretary Kathleen Sebelius releases a report detailing how The Columbia Basin Health Association (WA) was able to improve health care using HIT. After implementing an EHR, the community health center initiated automated tools to increase the monitoring of diabetic patients. Within six months, the facility documented dramatic increases in overall care for its diabetics, including a 55% jump in the number who received foot exams and a 34% increase in eye exams.

Virginia Blood Services purchases Mediware’s LifeTrak software to manage its blood donor records throughout central Virginia.

iMedicor successfully completes a pilot project involving 225 pharmacy outlets using iMedicor’s information exchange portal. All the outlets successful implemented iMedicor’s direct-to-pharmacy electronic prescription refill technology, which is available at no charge to physicians and pharmacies.

eMED-ID introduces a wearable device that uses GPS technology to track a person. Their target market includes people prone to wander, such as Alzheimer’s patients and those with autism. No mention if it is appropriate for straying boyfriends.

Broadlane, a cost-management company for healthcare providers, names Greg Ericson CIO. Most recently Ericson worked for a medical device company, but I’d love to hear more about his stint at the Home Shopping Network.

API Healthcare announces the general availability of its Acuality Patient Classification System. The software helps hospital to assess patient care requirements to make appropriate staffing assignments.

A mere week or so after its official launch, Humedica says it’s entered a long-term partnership with Anceta, the healthcare informatics subsidiary of AMGA. The association selected Humedica as its exclusive partner to develop a nationwide data warehouse and clinical analytics platform.

Doylestown Hospital (PA) selects MedQuist to provide RAC consulting services and software.

Mr. H finally found an Internet connection and checked in long enough to say he doesn’t miss any of us. (Well, that isn’t really what he said. That was just my interpretation. His exact words: “Life sucks 90% of the time. This is that other 10%.”)

Maybe he will smile just a bit upon learning that Fierce Healthcare named HIStalk to a list of  Nine Healthcare Bloggers Worth a Click. Editor Anne Zieger says that “if you’re in health IT, there’s no excuse to miss HIStalk.” And, Dodge Communication put HIStalk on their list of Top 10 Twitterers for healthcare marketing and PR Professionals, saying HIStalk is “a great way to hear the perspective of those professionals working in the trenches.”  Many thanks!

E-mail Inga.

CIO Unplugged – 10/1/09

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

Work-Life Balance…Debunked!
By Ed Marx

The first thing we boys did after disembarking the school bus was head north for the neighborhood 7-Eleven. Liberated from a day of junior high classes and a numbing thirty-minute bus ride, we hungered for entertainment. Pinball was the current rage, and we all sought the coveted crown of The Who’s, “pinball wizard.” Grasping the corners of the machine, I’d let my fingers become one with the flipper-buttons, slapping the ball into the pins and rails and racking up points. In the heat of the moment, I’d jiggle and rattle the sloped table, eager to outscore my buddies. And then…it happened. My overzealous manhandling would cause the dreaded tilt—the machine disengaged—and my silver ball drained straight down the middle. Even as I write this, I can hear and feel the ominous skull-pounding, buzz. I lacked the perfect touch between allowable manipulation and sheer force. Tilt!

We all go through life encountering a fair amount of tilt. The abundance of balls we’re juggling come crashing to the floor because we can’t manage them all. The contemporary word for the phenomena today is “balance.” Stores carry dozens of books on the subject, and magazines print oodles of articles trying to help us live balanced lives and avoid a tilt scenario.

As CIO’s, our careers are demanding and change is a common constant. Yet families are our support and our hobbies provide fulfillment and, thus, both deserve our time. We desire to perform well in all aspects of life. It’s how we’re wired.

I never experienced as much imbalance, or tilt, until I tried to seek after the elusive balanced life. I’d read all the articles and believed the myth. Like the man chasing the end of the rainbow, I found a pot of disappointment instead of gold. In my stressed effort, I tried to run faster.

At last, it occurred to me. In this information age, the balanced life is not achievable. Nor should it be. We fool ourselves into thinking that life is made up of set components with solid boundaries that stack neatly together like Tetris, with micro interfaces where convenient.

I advocate a different approach—Life-Work Integration. We all look for ways in which to maximize areas of our lives without having a negative impact on our values and ideals. We all desire to live a life of significance. I had the privilege of speaking on this theory at a recent healthcare professional society meeting. The President had heard me touch on the subject a year back while giving a talk on mentoring; he thought the concepts would be of value to his society. Based on the session feedback, the ideas resonated with the majority of attendees.

Balance implies that you give up something on one side of a scale until both sides are even—an exchange. Integration, on the other hand, is fluid and dynamic, bending and blending endeavors—time sharing. I don’t want to allocate 50 hours for work, 10 hours for fitness, 25 hours for family, 50 hours for sleep, etc. I want to bend and blend—to work 60 hours one week but 30 the next. I want to symphonize the flow of all my roles and responsibilities. I may have a desire to get up early and complete an outstanding task, or catch all my daughter’s daytime dance recitals. I may need an extra 10 hours per week to perfect the Argentine Tango with my wife, made doable by combining practice with our weekly date night. I don’t turn off my connectedness to any aspect of life. It is fluid and dynamic, bend and blend.

Here are some everyday examples of integration. One that serves me well is my virtual office. This setup untethers me, further enabling bend and blend opportunities. I carry a single device, and my digital schedule reflects all of my life roles, including my “honey do” list. No more home phone, multiple email addresses, or home PC to slow me down. I network socially through a single portal. Ninety-five percent of my athletic events have, in some aspect, included one or more family members. And I try to bring at least one family member on every business trip. I leverage systems, as well. I belong to an athletic club offering multiple locations. Depending where I start my day, I find the nearest club, all of which are preprogrammed in my GPS. Then there are repetitive tasks. You can hard wire these so you have more time and energy to focus on things that will have greater impact. Andy Stanley states that “systems can have a greater impact on behavior than mission statements.” For some tips on how to maximize the time you do have, see Green Standard Time.

A strong foundation will enable life-work integration and help avoid tilt. Some key aspects:

• Develop and maintain a strategic plan for your life
• Make sure principles/values are well defined and unmoving
• Ensure your life passion is identified and calibrated
• Surround yourself with accountable relationships and mentors
• Embrace technology to master time and leverage efficiencies (don’t let them master you)
• Create margin and set boundaries
• Develop systems to support your principles and plans
• Expand your creative capacity
• Adopt a consistent worldview and belief system (for me this is based on my faith)
• Man up and make tough choices

The last one is the hardest. Many people go through the process of prioritizing and discovery but then fail in the execution because they won’t pull the trigger on the difficult choices that would propel them to the next level. No one can do everything; and creating healthy boundaries often means eliminating the “good” in order to keep the “great.” Yet, out of a fear of change, of hurting others, or other perceived pains, some continue down the same path, trying to find an unachievable balance.

Take some time to reflect on this post and the possibilities of life-work integration. Review the elements of a strong foundation and how they might keep you from Tilt.

You can do it!

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

News 9/30/09

HERtalk by Inga

From: Overworked “Re: UCSF cancels GE Centricity project & lays off 33 IT analysts & support staff. Was this reported already somewhere? I work with a pharmacist who was formally laid off from UCSF last week and given 2 months severance pay. Apparently UCSFMC cancelled their GE Centricity project three weeks ago and he said he knows of 33 IT analysts and IT support folks that were laid off. He says the GE project budget was blown out of the water within 1 year and it had been going on for over 3 years – he had been on board for 3+1/2 years. He says it wasn’t even close to being implemented. I thought it was interesting that I couldn’t find anything in the press – but forgive me if I’m telling you old news.” Unverified. Dang. Mr. H always accuses me of not reading what he writes but I don’t think we have any official word that UCSF ha terminated its relationship with GE. However, UCSFWatch did send over a note last month suggesting things were not going well. The medical center management had hired Kurt Salmon Associates to figure things out and at that time GE-related activity was on hold.

The North Shore-LIF Health System (NY) announces it is subsidizing up to 85% of the EMR implementation and operating costs for over 7,000 of its affiliated physician. Participating doctors can received subsidies of up to $40,000 each over five years to implement Allscripts EHR. The initial agreement with Allscripts includes licenses for 1,200 doctors and one analyst suggests the deal is worth $20 million. In any case, it’s definitely one of Allscripts’ largest sales ever. North Shore’s subsidy program includes a unique twist: physicians will be subsidized at a rate of  either 85% or 50%, depending on whether or not they are willing to allow North Shore to use the EHR to report and share their performance data and allow them to compare it against a set of nationally care and outcome metrics.

Allscripts also announces that Baptist Memorial Health Care (TN) has selected Allscripts EHR/PM to automate its 65 employed and 3,100 affiliated physicians.

Meanwhile, a Jeffries’ analyst upgrades Misys to a buy and predicts the company will sell off each of its three divisions. Speculation is that the first division to go would be the Allscripts segment, which would appeal to buyers like “GE Healthcare and similar major players.” Analyst Milan Radia says, “”Our upgraded price target reflects our view that we are now approaching an end game in the transformation of Misys.”

A reader forwarded the attached copy of an email sent to all the ER docs at his hospital. He explained to me the ER recently adopted a new documentation system and is now paperless. However, authorities are now questioning if the system is in compliance with billing regulations because it prompts users to add certain items in earn a higher level service. If the “experts” determine that the system is out of compliance, the hospital will likely need some sort of fix from the vendor. In the worst case, the hospital (and presumably others in its chain) will have to revert to paper for some amount of time. I asked a reader his opinion, and he believed that technically the system was “legal” because the doctor still has to approve the code. However, he suggests it is a tricky game that can invite “serious auditing.” Any other opinions?

If you are a careful reader, you will have noticed that Mr. H left me to my own devices this week while he is out gallivanting the world. We always joke about how I would handle things if some major IT story broke while he was out of pocket, like someone buying Cerner or Judy Faulkner resigning from Epic. I’m thinking that Xerox’s acquisition of ACS was just a warm-up for some really big, breaking story during Mr. H’s next vacation. Investors, by the way, appeared lukewarm on the merger, and Xerox’s stock price fell 15% on Monday. The $5.7 billion cash and stock deal allows Xerox to expand its footprint into the services business, not unlike HP’s EDS purchase last year and Dell’s recently announced bid to buy Perot.

Cerner and the University of Missouri announce a $100 million partnership that reassigns about 100 workers from the UM Health System to Cerner. The plan calls for the creation of the Tiger Institute of Health Innovation, which will be tasked with designing innovations to improve patient care and population health. University and Cerner officials say the collaboration could improve patient safety and save the state $1 billion (sounds optimistic.) As part of the 10-year agreement, the university and Cerner would split profits from any new developments based on the amount of money each invests in the institute. A portion of the proceeds would be used to continue funding the institute. Former Ascension Health CIO Sherry Browne will lead the institute.

Accretive Health, a provider of RCM services, files for  a $200 IPO.

HHS Secretary Kathleen Sebelius announces $27.8 million in ARRA awards, including 18 grants totaling $22.6 million for EHR implementations. The balance will support various HIT projects, including HIEs and helping existing health centers use existing EHRs to improve patient health outcomes. Think how fun it must be to be Sebelius, handing out millions of dollars to grateful recipients every couple of weeks. Almost as good a gig as Santa Claus

The Hannaford Charitable Foundation presents Health Quest (NY) a $50,000 donation to help fund its CPOE project. This is the second such gift from the foundation that was created by the Hannaford supermarket chain. Health Quest is investing about $60 million to overhaul its IT infrastructure, including implementation of a Cerner system.

Freshmen at Indiana University are embracing the school-supplied PHR, with 40% already using the program just weeks after the start of school. NoMoreClipboard.com is the PHR vendor.

The State University of New York at Stony Brook expands its deployment of PatientKeeper products, adding the ePrescription and Pay for Performance applications.

Nuance Communications announces the availability of version 9 of its eScription application. Among other changes, version 9 offers advancements in document quality review and administrator efficiency.

The Lake Erie Regional Health System/TLC Health Network is awarded a $4 million grant towards a $5.6 million IT integration project between the Brooks Memorial Hospital and TLC Health Network facilities. The grant is part of $436 million in funds being distributed through the Health Care Efficiency and Affordability Law of New York State.

RelayHealth says that both Hill Physicians Medical Group (CA) and Montefiore Medical Center (NY) have improved care collaboration, patient satisfaction, and specialty treatment prioritization using RelayHealth’s referral management service. The product, which was co-developed with Hill Physicians, facilitates secure health information exchange between primary care providers and specialists.

West Georgia Health System signs a seven year deal with Perot Systems for revenue cycle services to the hospital organization. Perot just recently provided the health system support services to implement MEDITECH 6.0.

Speaking of Perot, I was sad to hear that the individual charged with insider trading ahead of Dell’s proposed purchase of Perot was one of the heroes in the 1979 Iranian hostage rescue. If you aren’t familiar with the story, Ross Perot spearheaded a mission to rescue two of his employees held hostage in an Iranian jail. Reza Saleh was an EDS employee at the time and led the mob that broke into the prison and ultimately rescued the hostages. The SEC has now charged Saleh of making $8.6 million in illicit profits from the Perot/Dell deal.

Hudson Headwaters Health Network, a network of 16 community health centers in upstate New York, receives a $7 million grant to finance HIT and a medical centered home initiative.

A new report from the Information Technology and Innovation Foundation finds that Finland, Sweden, and Denmark are the clear global leaders in terms of EHR adoption in hospitals. Those countries also ranked far better in their use of electronic prescribing and CPOE. At least we beat the Brits and New Zealand.

University Hospitals (OH) makes plans to rent a closed school to train more than 4,000 employees on its new Eclipsys Sunrise EMR system. The health system wants 6-day-a-week, 24-hours-a-day access to the school from January to June.

Cumberland Consulting Group is named one of 2009 Best Small Firms to Work for by Consulting Magazine.

The CDC issues $4.37 million in grants to fund four new Centers of Excellence in Public Health Informatics. The recipients will use the funds to enhance HIT and improve the detection of and response to emerging public health interests. Winners are Harvard Pilgrim Health Care, Indiana University, the University of Pittsburgh, and the University of Utah.

Warning: if you are an HIT purist, feel free to mosey along and not read this last note. For the rest of you, here is an amazing statistic: more than 2 billion applications have been downloaded from Apple’s App store since July, 2008. More than 85,000 apps are currently available, and only about 18% of the downloaded apps are paid for. However, the average cost of paid applications is growing and US revenues for applications will grow 10 times between 2009 and 2013, reaching $4.2 billion. I downloaded my first paid application recently: Scrabble ($4.99) and I am totally addicted.

E-mail Inga.

Xerox to acquire Affiliated Computer Services

Xerox announces plans to buy ACS for in a $6.4 billion cash-and-stock deal. The deal is worth $63.11 per share, which is a 34% premium over Friday’s closing price.

Monday Morning Update 9/28/09

From Evan Marcos: “Re: conference invitations. Amen. After a lifetime in healthcare marketing, this is how the VIP scam works. Target a slice of C-level pigeons (CEO, CFO, CIO, CNO, etc) who need a few days off to relax. Next, choose a speaker panel of political hacks, policy wonks, executive has-beens, and think tank blowhards. Throw an innocuous agenda that yaks about the obvious in a fabulous, expensive resort. Now, the hook. Market the VIP ‘Summit’, ‘Roundtable’, or ‘Executive Leadership Council’ to healthcare C-levels and tell them they can attend for next to nothing but airfare in exchange for 20-30 minutes of their time talking to a vendor. Second hook, market the ‘executive lead opportunity’ to vendors wanting badly to make their quarterly numbers and find low-hanging fruit in exchange for a mere $30,000 – $50,000 (which pays for the conference and salaries for the organizers). Now, market the everloving stew out of it with aggressive, relentless, pit bull sale folks in a boiler room. I’ve been on both sides of the invitee list and I assure you there’s rarely anything truly positive to come from it except for the salaries and commissions to the organizing company. And I think you know who the top two or three offenders are.”

From Larry Leotard: “Re: new company. I saw an analysis that said new SaaS companies need to assume negative cash flow for 3-4 years because when you get paid monthly, the cash comes in slowly compared to selling licenses. Sales expectations in start-up biz plans are always too optimistic. Anyone can sell 10 hospitals, but getting to 40 is hard.”

I’m taking a little break, so Miss Inga will be presiding for a few days. Please treat her with the appropriate deference and civility as she is a delicate flower.

The newly opened Jane Pauley Community Health Center (IN), a collaboration between Community Health Network and the local school system, is using the GE Centricity EMR, merging physical and behavioral data. Its namesake, the former news anchor and Mrs. Garry “Doonesbury” Trudeau, was on hand.

Salem Hospital (OR) signs for PureSafety’s Occupational Health Manager.

The PACS Designer is putting together a list of iPhone apps designed for healthcare people to use on the job. Send me the names of those you like and I will forward to TPD for a future Readers Write article.

In Australia, the Royal Flying Doctor Service is rolling out a new EMR for its remote patients.

Some employees of Regional Medical Center (SC) are crying “institutional racism” after a hospital ceremony recognizing the IT people involved in its Cerner project kicked off with someone in a gorilla suit handing out bananas while “Hail to the Chief” played in the background. The committee who planned the program always starts off with that music to introduce the CEO and the theme of the program was, “We’re Bananas Over You”, but that explanation didn’t appease those who were offended. The trustees get into the act, claiming the hospital tried to “sweep things under the rug,” so the hospital is sending everybody off for diversity training.

I’m happy to announce that we’ll be having another blockbuster HIStalk event at the Atlanta HIMSS conference in March. Sponsors have stepped forward, a topnotch venue has been secured, and liquor trucks are being diverted from all over the Southeast to stock it up. More details to follow, but mark down Monday, March 1 in your planner. Your event ideas are welcome.

Former ONCHIT head Rob Kolodner retired on September 22 after 31 years of public service. A job darned well done, I say. In his e-mail announcement, he said, “I am delighted to not only to have had the honor to serve our nation’s veterans for almost three decades, and be able to help them in their time of need after so many of them put themselves in harm’s way on our behalf, but also to have had the privilege of participating in VA-wide and nationwide activities to improve the quality, safety, and efficiency of patient-centered health care. Hopefully, this time we will finally succeed in achieving sufficient health reform to trigger the transformations in health and care that we so desperately need in the US.” 

Bayer announces Contour USB, a plug & play glucometer that launches diabetes management software on a PC.

West Georgia Health System chooses Perot for revenue cycle services in a seven-year agreement.

An insurance company executive recommends three areas of focus for HIT startups: electronic connections for families, caregiver coordination, and population health.

Boston Medical Center, which just gave former CEO a one-time $3.5 million parting gift at her retirement, will close an ICU and lay off its 40 workers. The selectively generous facility will lose $170 million this year. Maybe it has board members from Merrill Lynch.

Newly announced Davies winner Urban Health Plan (NY) was able to create alerts and clinical decision support rules on its eClinicalWorks EMR the same day that CDC issued its H1N1 guidelines.

Odd lawsuit: an ambulance chaser and a Florida hospital are suing each other after the malpractice lawyer demanded records of all the hospital’s adverse events going back to its opening in 1934. The lawyer claims he’s thinking about getting a colonoscopy and wants to know how many perforated colons have occurred there. So why not just ask for those specific records? “"I could have a family member contemplating another procedure,” he said evasively. Or a client — he’s suing the hospital over a client’s perforated colon.

E-mail me.

News 9/25/09

From Been There: “Re: Humedica. It’s a good thing they raised $30 million because with a CEO, CMO, CTO, CFO and five vice-presidents (among just 40 employees), they might be a touch top-heavy. One other observation: no VP of Sales. I hope their solutions sell themselves.” Humedica, a “next-generation health care informatics company”, launches itself in a blaze of buzzwords. I don’t know any of the people on the board or management team, but it’s got a lot of investment people in charge, especially from Leerink Swann (one of the companies that provided its $30 million in seed money). It sounds like they’re doing population-based data analytics stuff. I’m going to guess that the company was formerly Health Insight Technologies since I see some people and address overlaps. If so, that means they’re going to be selling de-identified patient data, which means they have to figure out how to get hospitals to give it to them. Hoping to cash in on Uncle Sam’s proposed effectiveness and outcomes studies, I’ll postulate, since they seem in an awfully big hurry to gear up.

From Fan of Mr. HIStalk: “Re: Accretive. They are backed by the same VC money as Exault, an HR outsourcer created form BP’s HR department that went public and was picked up by a big player. Ascension says, ‘We will give you 14 of our hospitals in Michigan to try this in at no cost to us. If you succeed, we will let your take over all of our RC functions. If not we can just ask you to go away. We have had more than one client curious and concerned about what Accretive might launch in the RC space. It is lucrative and prime for re-engineering."

From Carrie Ann: “Re: Newsweek’s Top 500 Green Companies rankings. I thought it was interesting who made the list and who was not on it. Equally interesting is the criteria they used (which is up to speculation and debate) as well as the categories said companies fall into. For instance, Cerner made the list under Technology yet McKesson is listed under Retail. Things that make you go hmmmm.” Here’s the healthcare list and technology is here. Cerner snuck in only because, being in the software business, it doesn’t create greenhouse gas, acid rain, or toxic emissions. Otherwise, it earned a 4.04 score (on a 100-point scale) for green performance reputation.

From Fuzzy: “Re: ACS. I work for ACS in their healthcare solutions division and there has been absolutely no word of a furlough, mandatory or otherwise. And we’ve no end in sight for the contract that I’m currently assigned to.”

From BostonGuy: “Re: BIDMC. Interesting issue about ER physicians charging more at night.” SEUI’s organizers are making a fuss about the $30 ED surcharge for patients seen between 10 p.m. and 8 a.m., parking their billboard truck outside the Four Seasons where the hospital’s community leaders are meeting (a pretty swanky place for a hospital meeting — rooms start at $500).

From The PACS Designer: “Re: Linux desktop. Linux, the open source software platform, is finding more uses as developers build more applications using Linux as a server operating system. One area of growth for Linux is desktop applications, and one of the desktop systems that is free is Gnome. Gnome just released its latest version, Gnome 2.28, which adds support for Bluetooth devices, and should gain new mobile users who want a desktop view for their netbooks and phones.”

Jobs: System Analyst: SQL Server/Web Developer, CMS Operations Specialist, Epic Beacon Consultant, Java Developer.

I keep getting “you’re invited” e-mail blasts, urging me to attend one conference or another. I figure maybe I’m getting a VIP offer of free attendance for some reason. Nope – only after I’ve skimmed a mountain of marketing prose do I find that my “invitation” entitles me to pay the same exorbitant registration fee as everybody else.

British police appeal to the public to help find a man who stole two PCs from St. James Hospital last month. The new HP laptop and desktop contained “vital” radiotherapy software for cancer research that had not been backed up.

London Health Sciences Centre, stung by a whistleblower’s disclosure of an auditors’ report showing that its CIO had issued $3 million of no-bid contracts to friend, takes decisive action. It launches an investigation to find the whistleblower, saying the report was confidential. Not the smartest PR move I’ve seen.

Piedmont Healthcare expands its use of NextGen’s PM/EMR.

Dragon NaturallySpeaking 10 Standard with Headset – $29.99 after rebate and pretty cheap shipping. Saw it in the ad and thought someone might be interested.

The prospect of getting stimulus money has brought new HIEs out of the woodwork, so here’s yet another: Camden Health Information Exchange (NJ). Noteworthy Medical Systems will run it, I’ve heard.

A British shoplifter is arrested after a judge questions the veracity of her doctor’s note that claimed she couldn’t appear because of an appointment. Said the judge, “I have never seen a doctor write that clearly.”

The customer service director of a UK Internet service provider sends out a mass marketing e-mail pitching the company’s new billing system, but accidentally attaches a CSV file with full information on all the nearly 4,000 people who had signed up for it, including their contact and logon information. Among those whose information was contained in the file were a local hospital and New Scotland Yard.

Susan Neimeier joins medical device connectivity vendor Capsule Tech as chief nursing officer.

Red Hat announces Q2 numbers: revenue up 12%, EPS $0.15 vs. $0.10, beating estimates for both revenue and earnings. Nice.

E-mail me.

HERtalk by Inga

From My Fair Lady” “Re: KLAS appoints UPMC to board. This should be interesting. With UPMC owning a stake in dbMotion, how can they possibly be unbiased in their approach to interoperability platforms?”

From Joe Wilson: “Re: CEP America Chart off. Here is some clarification from the CIO of California Emergency Physicians – MedAmerica. Though Picis was quickest with regard to timing, they were missing two of the six elements of the case. Since CEP gave the cases out in advance, timing was far less important than having a complete chart. CEP declared Wellsoft the ‘winner’ by five seconds based on both quality and timing.”

From Alex DeLarge: “Re: foreign healthcare. Remember A Clockwork Orange? We ought to make all our legislators read these anecdotes and then challenge them to keep repeating that our healthcare is the best in the world.” 

Sun Life Family Health Center (AZ) selects the browser-based InteGreat EHR for its six clinics. InteGreat is a division of MED3OOO.

The 180-provider Jackson Physicians Alliance (MI) inks an agreement with Cielo MedSolutions to purchase licenses for Cielo Clinic software.

The SEC charges two men with running an $8.6 million insider trading scheme in connection with Dell’s recent agreement to buy Perot. One of the men, who has done work for Perot, apparently got wind of the pending Perot acquisition. Less than three weeks ago, he and a buddy then purchased over 9,000 Perot call options. The SEC was not amused.

It’s been the best of times and it’s been the worst of times for IT provider InfoLogix. The company announces a new contract with Albert Einstein Healthcare Network (PA) to develop Web-based eLearning software to support its EMR implementation. InfoLogix also releases word that it received a deficiency letter from NASDAQ stating that it no longer meets the minimum $1.00 per share requirement for continued listing, though they have until March 15, 2010 to regain compliance.

Hewlett-Packard retires the Electronic Data Systems name, renaming it HP Enterprise Services.

The Hospital of Central Connecticut selects Ingenious Med’s IM Practice Manager for electronic charge capture.

The Ottawa Hospital partners with EDCO to implement its Solarity and Solcom  products to digitize, store, and route paper documents electronically.

Former MinuteClinic CEO Michael Howe joins MEDNETWorld.com’s board of directors. Interestingly, Howe also is the former CEO of Arby’s, which may or not come in handy when dealing with HIEs.

LibertyHealth (NJ) launches EDIMS’s nursing documentation and charge capture systems. The health system implemented EDIMS’s CPOE and physician documentation systems in March.

Outpatient Surgery Center of Jonesboro (AR) selects ProVation MD software to document GI procedures.

Halfpenny Technologies’ new Web-based portal allows physicians to order lab procedures and view results.

Vermont Information Technology Leaders and Allscripts reveal plans to enter into a strategic alliance. Allscripts will extend preferred pricing to Vermont physicians, with both organizations focusing on providers in small practices or rural areas.

Doctations appoints Jerry Kolosky chief operating officer. He was a VP for 3M Health Information Systems.

The Washington Health Information Collaborative extends grants to 34 physician practices, health clinics, and hospitals in small and rural communities across the Pacific Northwest. Providers will receive up to $20,000 each to invest in IT to improve health care. First Choice Health is contributing $500,000, the largest single donation.

WellSpan Health’s York Hospital implements AeroScout’s Wi-Fi solution for asset tracking.

In case you missed it,we posted an interview with athenahealth’s Jonathan Bush on HIStalk Practice yesterday. Bush, in his ever-amusing, passionate, and irreverent way, gives the low-down on the company’s new program that guarantees athenaclinical users six months’ free service if  they fail to qualify for government stimulus money. Here’s a sample: “I believe that every single doctor that we give a proposal to on athenaClinicals will actually make more cash as a result of being on athenaClinicals than not. I couldn’t say that for (the last) five years, and I still can’t say that about any of the other software products that I’ve seen.” While you are over on HIStalkPractice, sign up for e-mail updates so you don’t miss any other cool stuff.

E-mail Inga.

Readers Write 9/23/09

Thoughts on the Proposed Acquisition of Perot Systems by Dell
By Ralph P. Fargnoli, Jr.

The Dell acquisition of Perot means that Dell wants to be taken seriously in the HIT market, providing PCs, servers, and strategic outsourcing and consulting services to the HIT industry and beyond. As others before them, they are interested in their piece of the $2 trillion market. With Perot, they have a name recognition factor going for them.

With Dell focused on services with the Perot acquisition, they need to keep the Perot management that understands the HIT market. If they are not successful holding onto the people that made the Perot acquisition attractive, some of their HIT verticals will disappear from the market. Perot is the recognized player in HIT services, not Dell.  

This will also drive competition for the benefit of the HIT market, as HP and IBM also have a recognized HIT services group. Overall, it can be a win for Dell and the HIT market as there are more choices for HIT adoption along the technology vertical.

As it relates to the consulting business, we believe it is a positive because over the long term, the acquisition removes a layer of competition due to strategic focus and revenue needs of public companies. We saw this with the acquisitions made by ACS, IBM, CSC, and others. The billion-dollar players cannot meet Wall Street expectations being everything to everyone. That opens the gate for Beacon Partners to grow.

Ralph P. Fargnoli, Jr. is the president and CEO of Beacon Partners, Weymouth, MA.

Order Set Software: Clinician-Focused Design is Key to Adoption
By Stephen Claypool, MD

Few physicians will argue that standardized order sets are valuable tools. Paper versions have been around for decades and typically enjoy high adoption rates because they are easy to use and don’t disrupt the clinical workflow. But they are also time-consuming to create, nearly impossible to keep current and cannot be altered when a patient’s needs fall outside the norm.

For these reasons — and because they are key requirement for HITECH funds — more hospitals are seeking to automate the development and use of order sets. Unfortunately, many are discovering that their physicians are far less receptive to electronic order sets than they were to their paper-based counterparts.

The problem is that too many order set applications are designed by engineers with little or no understanding of actual clinical workflows. They work, but not in a way that actually drives efficiencies for physicians.

To avoid adoption problems, it is important to evaluate the software through the eyes of the clinicians who will be using it. Starting with the basics, any order set application should include:

• A large selection of prebuilt, yet customizable, order sets based on nationally recognized best practices
• Templates for creating new order sets
• Links to trusted medical content
• Robust authoring and editing tools
• Ability to track reviewer comments and version changes
• Easy integration with any EMR/CPOE system
• User-friendly navigation requiring little training to achieve proficiency

Beyond the basics, order set software must offer features and functionality that enhance — rather than complicate — authoring and use at the point of care. For example, applications with a sizeable library of orderable items will eliminate the need for manual re-entry. Software with an underlying structure that is data vs. text-based will streamline mapping and simplify integration into EMRs or CPOE.

The solution should also deliver intuitive clinical decision support during authoring and at the point of care. “Intuitive” is key, as it avoids alert fatigue by taking each order in context and delivering only meaningful alerts or recommendations.

Formatting is also important. Like their paper-based counterparts, electronic order sets should be easy to read and make clinical sense. The trouble is that many applications are too rigidly constructed, which can hamper treatment of conditions (e.g. meningitis) that fall outside routine protocols. Yes, the elements of the order set must be mapped to specific orderable items, but an appropriate level of flexibility must be built in to allow for necessary alterations to the sequence in which individual orders are issued.

On the back end, maintenance is the greatest long term challenge facilities face with evidence-based order sets. Look for an application that automates medical content monitoring and delivers alerts when new evidence or guidelines are available.

Creation happens once and maintenance is forever. Thus, a powerful maintenance component must be considered alongside the format, functionality and the intuitive nature of order set solutions.

Stephen Claypool, MD is a practicing physician and vice president of clinical development and informatics-clinical solutions with Wolters Kluwer Health.

Healthcare Clearinghouses and the 80/20 Rule
By Nick Revak

The Pareto Principle, also know as the 80/20 rule, states that, for many events, roughly 80% of the effects come from 20% of the effort.

Variations of this principle can be applied to a wide range of situations, including healthcare EDI transactions. That is, 80% of a provider’s EDI transactions will be exchanged with 20% of its payers.

Here’s another one. In software development, 80% of results are achieved with the first 20% of effort.

Providers would do well to heed the 80/20 rule when considering their EDI transaction strategy. Providers should consider building their own connections to their top 3-4 payers (Care/Caid/Blue) and leave the rest to a clearinghouse. This will result in the provider saving 80% of the transactions fees while leaving 80% of the effort to the clearinghouse.

Nick Revak was a senior developer with Healthcare Data Exchange (HDX) for many years and is currently an independent consultant/contract programmer on assignment to Stanford University Medical Center.

Healthcare Litigation Reform Versus Pay for Performance
By Greg Park

Defensive Medicine is a significant factor in healthcare costs. In fact, studies by The Harvard School of Public Health found that eight percent of healthcare spending is directly related to physicians ordering tests, procedures, and scheduling visits primarily to reduce malpractice exposure. These numbers are nearly twenty years old, but logic tells us they have compounded since the study was first published.

Three out of four physicians recommend some form of malpractice reform. And why not? Fees for malpractice insurance have skyrocketed to a point where many physicians simply pack their bags for less risky waters. Worse than that, medical students understand these conditions and are opting more for specialization and research rather than direct patient care. 

But is the issue really that physicians are so worried about being sued that they over analyze? Or is the problem of over-analysis a symptom of the volume-based practices that exist today?  Isn’t it much easier to diagnose an unknown medical condition with a sledgehammer of tests when your daily office queue exceeds forty patients? Aren’t we as a nation rewarding this behavior by continuing our payment methods that reward tests, but turn a blind eye to results?

No, malpractice reform is either another distraction or a means to treat the symptom rather than the disease. 

Let’s dig further into this issue and support those who are promoting evidence-based medicine and the financial rewarding of physicians with positive outcomes that follow established medical pathways. Agree that there will be those clinical situations that exist outside the norm, or where the chance of positive outcomes will be slim. These are high-risk situations that need to be examined differently, but whatever we do we do not want to create disincentives for care.

There are deeper issues than malpractice reform, single-payer systems, and public options that are not the focus of our public debate. We need to discuss how physicians can spend quality time with patients while maintaining their practices. We need to discuss how to grow the ever-shrinking demographic of general physicians while giving them the time to review a deluge of medical information published daily. 

Perhaps we even need to discuss why medicine must be a for-profit industry. Economists will tell you that competition and the pursuit of wealth creates strong markets, but do we really want our healthcare professionals wondering how to squeeze profits from the system? I believe that those driven to the industry are motivated beyond personal profit and are focused on providing care. Quality care.

I know many of you are debating these topics in your think tanks, ivory towers, and specialized committees, but this is pure Latin to a majority of Americans. The general debate going on now is distraction which prevents us from considering how the fundamental beliefs of our system must radically change.

Greg Park is national account and product manager at DB Technology.

News 9/23/09

From Shane O’Keefe: “Re: Boingboing. Healthcare UI is on it it today.” It’s a Minnesota HHS app screen shot. I thought sure it was from my hospital since we’ve got an app that’s a dead ringer, PF keys and all. One of our clinical apps at a hospital I worked at jumped from merely unattractive and clunky screens to what nurses called “the DOS screen,” some kind of function the vendor must have slapped in there in the early 1990s without ever finishing it. Every time a group got trained, you could stand outside the door and hear the universal gasp when it came up, a moment every bit as horrifying as the chest buster scene in Alien.

From The PACS Designer: “Re: search in 3D. If you want to save some clicks while searching and scrolling for information, try SpaceTime 3D. TPD entered HIStalk in the search box and selected Who is Mr. HIStalk and got some interesting links about our Mr. H. and his fame in the healthcare space!” Now that’s pretty darned cool. I was captivated at being able to flip through images of Web pages with the scroll wheel, although maybe the attraction was that I was reading about me.

From Barb Wyerr: “Re: CCR data exchange between practices in Wisconsin. I am a physician interested in learning who accomplished this task.” I didn’t get the name from the rumor reporter, so shoot it over if you know. Thanks.

From Raphel Cherry: “Re: Accretive Health. They are indeed a rising star in the area of revenue cycle management. They perform end-to-end accounts receivable process enhancement for hospitals, working closely as a partner with the internal staff rather than an outsourcing service. Their forte is analyzing PPO contracts between insurance companies and hospitals. The system they developed for this is very effective at finding areas of discrepancy between the contracts’ stated amount and actual reimbursement, giving hospitals an edge in appealing claims. It’s a good value proposition for the hospitals because they only charge a percentage of the incremental revenue recovered. So far they have invested very little in marketing because they have been able to build a strong backlog on word-of-mouth referrals.” I notice that its Web site is not only primitive, it’s running a DotNuke add-in that has a lapsed license (it comes up first thing when you Google the company). They must be real tightwads, a characteristic I admire in a business.

From Hilton Valentine: “Re: Accretive Health. I believe Accretive Health is owned or at least partially owned by Ascension Health. Ascension essentially seeded it by outsourcing revenue cycle work and workers from Ascension Health Hospitals in Michigan and Indiana. They have consolidated those people, systems and processes from their not-for-profit hospitals and I believe their long-term goal was to also provide services outside of Ascension Health and take the company public.” I think you are right. Accretive is listed among the many, many portfolio holdings of Ascension Health Ventures. Ascension is obviously doing just fine and about to do a lot better after the IPO. In snooping through Ascension’s tax records, I believe we have a new winner in the highest paid non-profit hospital CIO category – $803K. The legal counsel,  CMO, and several VPs make over $1 million, the CFO nearly $2 million, and the CEO over $2.5 million. It spent $700K on lobbying and has its own advocacy department. All are puzzled about how to bring exorbitant healthcare costs down.

From Billy Bear: “Re: ACS. They have mandated a one week ‘furlough’ for all employees. In other words, an enforced week’s vacation without pay. In a generous gesture, the Tucson based Midas+ division management negotiated to take the burden on themselves with a two week ‘furlough’ each. Meanwhile ACS posted a profit of $97.5 million on revenue of $1.696 billion in its fiscal fourth quarter.That’s down from a profit of $98.6 million in same period in 2008, but despite the economic downturn, ACS had its second-best quarter ever in terms of new business signings. It added accounts valued at $271 million.” Unverified.

Salar, the Baltimore clinical document solutions vendor I mentioned the other day, is named one of Baltimore’s Best Places to Work. The Fells Point company is hiring, their spokesperson let me know, and among its clients are Johns Hopkins, UMass, UPMC, and George Washington. 

My doctor’s EMR pleased me again. I got an e-mail yesterday that my lab results were in. Clicked the link, signed into the portal, and not only were all my results there, my doc had put a comment at the top of each set, adding stuff like “looks good”, “everything’s normal”, etc. I thought it was very cool, like getting another session with my doc without having to drive and fork over a co-pay.

Cerner shares are on a tear once again, screaming up to $75.17 at Tuesday’s close. That values the whole shebang at over $6 billion and Neal Patterson’s shares at an amazing $420 million. One analyst speculates that Dell wants to get into the software business and might be interested in Cerner, CPSI, or Eclipsys.

Things you can do on HIStalk: (a) sign up for e-mail updates using the form at the upper right of the page, thus ensuring that you, like 4,680 of your peers who have already signed up, can pedantically recite fresh fact after fact to your impressed colleagues who didn’t have your enviable foresight in signing up for updates of their own; (b) search through all the stuff written here since June 2003 using the Google-powered search box, also to your right; (c) check out the sponsor ads to your left (Founding, Platinum, Gold) and give the folks who keep me spouting nonsense the chance to see some return on their investment; and (d) see the cool stuff to your right: text ads, the Rumor Report button that lets you tell me your darkest secrets, a jobs list, the latest posts from the discussion board, and the most recent comments left on HIStalk posting (you are missing out if you don’t read those). And I almost forgot: the HIStalk Calendar is bulging with fun events.  Lastly, pat yourself on the back in my stead since I appreciate your reading here.

Mark Amey, formerly of Ascension Health, is named CIO over several healthcare units of University of Southern California. Don’t blame me for scalping Mark in the picture – it was some kind of arty USC photographer.

HIMSS announces the 2009 Davies winners: MultiCare Health System, Tacoma, WA (organizational); Virginia Women’s Center, Richmond, VA (ambulatory); and Urban Health Plan, New York, NY and Hearts of Texas, Waco, TX (community health). 

Listening: reader-recommended Anberlin, hard-rocking emo from Winter Haven, FL. On tour now crisscrossing all over the US. I like it when readers say, “I think you’d like this” and I do.

This is one of the most bizarre HIT-related press releases I’ve seen. The MyMedicalRecords PHR people proudly announce that they’ve paid $250,000 for an 80-million person marketing database (provided by a company whose Web site doesn’t even work). Tons of irrelevant and frankly embarrassing details are included, like how the company will pay for it, how annoyed spam recipients can unsubscribe, that they bought cell phone numbers along with the usual e-mail and street addresses, and how competitors can’t use the same database. So, let’s review: would you trust your sensitive healthcare information to a company that brags on its newfound spamming capabilities? What the hell were their PR people thinking? 

Australia’s health department cancels a contract for a desktop software package that would have provided stopgap interoperability functionality. The biggest practice management vendor decided not to participate, saying the timeline was too short and the budget too small. “Clearly, this is just another little pilot where the initial work consumes the whole budget, and there is no provision for ongoing support.”

Nobody had much to say about Dell’s acquiring Perot. Here’s your chance. I’ll probably run a Readers Write on Wednesday, so feel free send me your opinion piece. Who wins and loses? Does Dell do another healthcare acquisition? And since grabbing up consulting companies seems to be cyclically imitative, who else might buy or sell?

Speaking of Perot, the family will supposedly make $400 million on the sale, boosting the $2 billion fortune of Ross Junior and the $5 billion pile of Ross Senior. There’s that theory that even if you redistributed all the country’s wealth evenly, the same tiny percentage of people who have it now would get it all back in a few decades. I tend to believe that.

Blessing Hospital (IL) integrates its AtStaff ClairVia patient acuity system with its EMR to calculate acuity and workload on the fly from patient assessments.

A WebMD co-founder is involved with a startup called SampleMD that will replace traditional doctor drug samples with downloadable vouchers and co-pay coupons that are sent directly from doctors to pharmacies. Sounds good other than that pharma will get even more prescribing and patient data that’s none of their business.

Thanks to Kermit, who e-mailed me bright early Monday morning about the Dell-Perot deal, allowing me to scoop all the pros, which being shallow and insecure, makes me happy.

A BIDMC doctor wants patients to read the notes that doctors record in the chart, electronically or otherwise, and urges removing obstacles such as high copying costs or requiring the chart to be read only in the doctor’s presence. Mentioned is a $1.5 million national study that will see how doctors and patients like it when patients can read the chart notes.

Weird News Andy mines this gem: an ED nurse is handcuffed by a Chicago police officer and locked in his squad car after she tells him he can’t get blood samples from a DUI suspect until they’re admitted. She’s suing, saying, “We work hard. We get abused. We get yelled at. We get, you know, beat up. And to have a police officer treat an emergency room nurse that way goes against so many things.”

E-mail me.

HERtalk by Inga

Picis is declared the winner of a live “Chart-Off” during the California Emergency Physician Annual Partnership Meeting. The challenge pitted EDIS vendors against each other in documenting an electronic patient record, with Picis ED PulseCheck winning over competitors that included Cerner, Wellsoft, and T-System.

Schuylkill Health (PA) deploys SafeTrace Tx transfusion management software, which is offered through Global Med Technologies and its Wyndgate Technologies division.

Rex Healthcare (NC) signs a multi-year agreement with MEDSEEK to design and implement a clinical portal.

Apparently the locals are pleased by the economic boon provided by Epic’s annual user conference, which started Tuesday. The 3,600 attendees are expected to provide a $2.5 million boost to the economy. As I wore my boots this weekend, I thought about all the fun events planned for the the Wild West-themed meeting: horse and carriage rides, a tug-of-war tournament, mechanical bull rides, and a cow-chip tossing. Yee-haw!

Community Hospital South (IN) goes live on GE Centricity Enterprise 6.1 and Monitored Care. The combined solutions will help the hospital capture clinical and medical device data into their existing Centricity EMR system.

Two new healthcare systems successfully launch Siemens Soarian Clinicals: Ingalls Health System (IL) and St. Peter’s Hospital (NY), both of which went live in the spring.

Quality Systems, the parent company of NextGen, appoints Philip N. Kaplan COO of NextGen and the QSI dental unit. Kaplan resigned as a board member in order to take over the COO role. Craig A. Barbarosh, an attorney who specializes in organizational restructuring, becomes NextGen’s newest board member.

I got my first news bit from Weird News Andy, who said, “If ANYBODY would be interested in this, it would be you.” Apparently there’s a movement afoot (no pun intended) in the UK to ban stiletto heels in the workplace. Which is obviously just plan wrong and a violation of women’s civil rights, as suggested by the proposal’s critics. The gals on my side argue that stiletto heels give women a power advantage in male-dominated workplaces because the shoes make them appear taller and enhance their sex appeal. Someone needs to throw shoes at those crazies supporting function over fashion.

KLAS adds four members to its advisory board: Russell Branzell, CIO, Poudre Valley Health System; Chuck Christian, CIO, Good Samaritan; Jessica Grosset, CIO, Mayo Clinic; and Rasu Shrestha, chief of enterprise imaging software, UPMC.

Speaking of KLAS, the prolific research firm’s latest report looks at customer satisfaction for hospital staffing software, finding a significant gap between the vendor solutions favored by nurses and other stakeholders. Nurses prefer RES-Q Labor Resource Management and McKesson ANSOS One-Staff. Kronos Workforce Scheduler is their least favorite option. On the other hand, the financial and HR people types strongly favor Kronos over other options for its strong reporting capabilities and anticipated cost savings. That probably makes sense both ways.

MEDHOST is selected to provide the ED solution for Cox Healthcare (MO).

IASIS Healthcare goes live with the Medicity Novo Grid in two of its six regions. The implementation facilitates health information exchange between IASIS and providers, regardless of whether the providers use electronic or paper records.

If you are wondering how US healthcare compares to the rest of the word, this article includes a number of “real-life” anecdotes from American travelers. For the most part, patients reported care was good and much cheaper than comparable services in the US.

ACS State Healthcare wins a $4.5 million, two-year deal to develop the Kentucky HIE.

Blessing Hospital (IL) goes live on AtStaff’s ClairVia Patient Acuity system, which is integrated with the hospital’s Eclipsys EMR.

Officials at Phoenix Children’s Hospital calculate a $140,000 savings in license fees after implementing Orion Health’s Rhapsody Integration Engine. The hospital made monitor data available to clinicians within the hospitals. They’re adding a second Rhapsody interface, this one to establish bi-directional information exchange between the pharmacy application and EMR for another $180,000 in savings.

The local paper provides detail on the McKesson EMR go-live at Three Rivers Health (MI).

CareTech Solutions partners with Peak Positions to provide a turnkey organic SEO program to improve the search engine ranking of hospital Web sites.

This new iPhone case looks pretty handy, complete with its flash option and credit card holder. All it needs is a removable side pack for lipstick.

E-mail Inga.

HIStalk Interviews Tom Liddell

Tom Liddell is executive director of the Michiana Health Information Network of South Bend, IN.

Every RHIO and HIE sounds successful, but clearly some aren’t. What yardstick should they be measured against?

I think the yardsticks they should be measured against are sustainability from the standpoint of broad-based community support. That would be support not only from the institutional community — hospitals, laboratories, radiology centers — but from the physician and clinical community as well. That’s the foundation of an exchange in a medical service or medical trading areas.

The second one is, they really do have to have an economic or financial model that is accountable not only to the servicing organization but to the physician provider. In our particular market, we ask financial participation from most, if not all of the parties that are involved. That’s been an interesting secret, because then the value is not only perceived, but it is realized. You actually then have to deliver.

The third thing, I think, is the actual delivery of results. In our particular case, we are extremely focused on enabling the physician provider to have what we call 100% of the data in relevant care of an individual. So physician-led care that is driven by as much appropriate information that should be available.

If you have all those things, I think you then really have that sustainability, and it can provide a good long-term success.

What are some of the most innovative aspects of your service?

In terms of innovation, our approach is to try to be innovative in the service delivery components. By that, we do probably two things that are unique. We are standards based, so whether it’s HL7 or CCHIT qualifications or the emerging meaningful use qualifications, we try to stay pretty close to those bodies of work.

In doing that, there are times when we have to shape an interface delivery service where there’s an electronic health record that’s not quite there. But we try to have its origination as close to the standards as possible. I don’t know if it’s innovative, but we think it is, and we still get the job done.

I think the second innovation that we came to a few years ago was we said we want to have some available service for every provider, be it fax replacement, pushing clinical results, or, what we call clinical messaging: a community health record that is extendable, meaning over 9, 10 years worth of data, or interface integration.

Innovation is an innovation in service. We have something for everybody. If you’re a nursing home, we’re going to make you more efficient. If you’re a specialty provider, anything that you’re copied on that a primary care doc orders is coming your way, whether it be through a delivered portal or through your integration or interface integration.

The other thing that we’ve done, which I don’t know if it’s innovative, but it’s really working, is that we are one pipe into that physician provider. We are really taking care of so much of the burden that a physician practice would have if they had to go out and say, “Hey, I need to connect to laboratory, and then I need to go to this hospital, and then I need to go to that hospital.” We literally take it all the way down through the vendor and watch results go into that electronic health record. That’s been a huge spark and fuel that’s been there.

The last thing that we do is what I would call it a best-of-breed provider. I believe that the market is still pretty early with an incredible amount of business opportunity, meaning I think we’re going to see a ton of innovation over the next five to ten years. We are not, “Hey, it’s only going to be Cerner’s architecture.” While we think it’s great, we see that Axolotl had a fit for us, and we see that Medicity might have a play with their box. We also see that there are places where something like the Mirth engine might fit.

So we’re a best-of-breed, meaning we want to keep ourselves open to not being only locked into a single vendor, a single strategy.

How many employees do you have and what do they do?

We have 14 full-time, two part-time, and two interns. They’re largely boxed in three areas. The first area is our development area. That is the area that we have services around the creation development, the deployment of, that which is exchanged. That could be anything from standards creation for an interface bringing a new hospital onboard, bringing a large multi-site physician provider practice and literally doing that development. That’s coding interfaces that’s creating the roadmap for those things. In some cases it’s sort of boring, benign, making sure that we have a common set of standards that are deployed. That’s the development group.

We then have the service and operations team. That’s where hardware, technical, and application support reside. That’s everything from working with our servers and data farms to data management to our Oracle database as well as we have other database management tools to the team that runs what we call our frontline services. We try to, if anything, overemphasize that first-line service, and that we answer calls all the time. There’s no other drop boxes for that. We believe that that’s important, because if anything, it’s right at that point that that coordination and service needs to be there. That’s that group.

The third group that we have houses what we call our physician services. That’s comprised of anything that relates to the physician or clinical service that goes out to the community. They do all statements of work, all integrational projects around, whether it be pushing results to our clinical messaging system and rolling it out for a hospital. We do work with Dragon, those kinds of things and add-on products. It’s really enablement in that physician clinic space for that.

Inside of that, sorted of grafted on to that group, we also have what we call the institutional team. That’s just one person working on the institutional side to make sure that their efforts are coordinated. That’s your hospitals, labs, etc.

The last little group we have is really myself and one other guy that do what we call our business development, which is when we go and talk to a new customer, RFIs and RFPs. What we’ve done is we actually outsource with one of our partners, one of our owners, some technical services. You can almost say we’ve got two additional FTEs that do technical capacity work for us.

Our interns — we’ve done a couple of things. We have a medical student — in fact his whole summer was dedicated to, and is still keeping track, and he’ll be back in the holiday season — we’ve been studying what we call medication management. Everything from how many people have adopted by county, by specialty, to what’s happening on medication reconciliation and what a patient needs in the hospital. It takes about 24 months to set up a service properly.

The second intern we have is a programming intern. We’ve really tried to call out both clinical users as well as people that are more in the technical line of services out there.

You are working with the GAO on PHI disclosure. What are your thoughts around that?

I guess I could say we completed the first round of work. We were the first place they called, so I guess that was exciting. They were very nice and accommodating. A team from Atlanta came and spent the better part of a day and into the next day. We went through everything.

It was actually a great example where we were able to bring security specialists from the institutions and we lined up basically according to the services. If you were doing clinical messaging, we hooked them up with a clinic, so that they could understand how that would go. If you were doing interface integration, we brought them over, and a CEO of a 25-provider oncology group showed them how they their release and how their information kind of flows. And then we did a roundtable with them in the afternoon.

I think it was a very eye-opening and kind of a learning process for those guys. I think what they also understood in the end was that we are mimicking the delivery and replacing the delivery mechanisms that are already in place today. If a provider is copied on a laboratory result, we’re basically just improving that method of delivery and really making it more secure in that. So I think it was beneficial there. Then we had a follow-up and help them see what other exchanges are operational across the country that they could coordinate with.

It’s very important, because as ONC not only lets funding out at the state level, that coordination be able to monitor if those dollars are going out appropriately. Are they being spent appropriately? Is there security and protection for that individual consumer? I think these are important integrations to that.

Many people wouldn’t think of Cerner in the practice EMR area. What’s been your experience with that product?

In my experience from my WebMD days and when I was a senior VP of product management and had a lot of work in developing an EHR, you start to see the tremendous capabilities that the tools that they’ve built have. They are committed clearly to making sure that the enterprise, whether it’s an institution, clinic, laboratory, etc., are able to be co-joined, commingled, and integrated into that process.

They’re working their tails off to change perception and image. I can only tell you that it’s pretty operational for me, with my sleeves rolled up, that the product itself has an incredible set of capabilities. If anything, you want to try to gear those back. That’s probably easier to do in the long run than to try to catch up and add an incredible set of features.

One of the nice things that I have the benefit of is for those that use the component, which is more of an EHR in our market, it’s not a question of “could we do something?” It’s how they want to do it. For me, that’s actually pleasing, because I can have a discussion that says, “Do you want to proxy to your inbox for something that was just ordered or copied to inpatient/outpatient?”

Unfortunately we want to make healthcare simple, but it’s a pretty complex enterprise, especially around health information.

Having said that, like anything, there are lumps along the way. We busted our tails to make sure that e-prescribing and all those things are up. There’s a lot of parts that are moving, whether it is Surescripts RxHub or whether it’s having a clinical summary available in an HTML or XML format.

In fact, we had a strategy call yesterday with two other executives. We do it regularly, and it went almost two hours. They can tell you they’re listening. I can tell you we’ve had a pretty significant summer in terms of adding providers to their core business as well.

How sustainable is your business model?

First of all, there’s been these naysayers out there saying, “Should we work to build these kinds of businesses and services?” I guess I would say you have to have value, and if you deliver value, I think people come and are willing to pay for those services.

Certainly health exchange has an element of a political aspect to it, but I don’t mean on the national level. I mean certainly against the competitive entities and those kinds of things. But once people get beyond the notion “don’t compete on health information; compete on everything else” you can start to make the exchange sustainable — you can make that case for doing that.

But I think in all things there has to be that perceived value. One thing I do know is when you settle all the noise around it, there has to be an entity that is a facilitator of those common services, whether it’s building a referral management network, whether it’s moving or integrating data. At least it’s demonstrable in places where you don’t have that. It doesn’t get off the ground, or it doesn’t sustain, because there’s nothing to sustain itself with.

I’m certainly not naïve to say, “Are there risks in any business?” Certainly there are, but the big key, I would say, is that you’ve got to be willing to adapt. When I came in 36 months ago, the only real interfaces that we were going on were basically from suppliers and I just said, “Listen, in twelve months, we’re going to be able to deliver any piece of data we have to an EHR and have it happen in there.” Well over 65% of our total market has data integrated into their electronic health record, and we feel that by the end of next year, 15 months from now, we can be over 80%.

What effects are you expecting from HITECH?

It’s been almost a tsunami so far, in that it certainly has caused all of healthcare IT to have to think differently. I don’t mean just on the funding level potentials, but to say, “How are we going to work together in and out of markets? How are we going to work together at the state levels? What can the role of a health exchange be whether it’s a working component of the extension centers or whether it’s how we pass data from exchange to exchange?” We’re in the throes right now of connecting two different exchanges just in our particular state where we can move relevant data.

I think in the end, what it’s doing for us, or will do for us is, if anything, accelerate the level of activity that’s there. By that, I mean the services that we can deliver. It’s certainly bringing awareness to those things.

I think in the long run, what I hope doesn’t occur are some of the unnatural effects. As an example, in e-prescribing, it’s great to adopt it, but if it’s adopted in a silo, I don’t know that there’s a clinical benefit, that the clinical benefits are harder to get to. There is a clinical benefit long term, but I don’t know that the patient realizes that other than maybe a medication error. You have to kind of look at it holistically and say, “But if I can do that in a more organized, methodical way inside the complement of my full EHR, I’ll have a better perspective on the patient.” I use that as an example.

Overall, it’s great. It’s exciting. It’s causing the coffee to be made late at night and early mornings, but that’s why you play the game.

Why is Indiana so strong, do you think, in interoperability and informatics?

I think there are a few things. First of all, there’s a history of innovation across the state in terms of health IT. In the market that we serve, Northern Indiana and up in through Michigan, we had early adoptions early on — early adoption both by hospitals and by physician practices of automation.

In this particular market, there have been some pretty innovative companies that have gone on and created applications, and they’ve moved down the road. When you look to the central and southern parts of the state, both with our public universities as well as Notre Dame to the north, there’s a commitment to life sciences; there’s a commitment to health information technology. We have institutes across the state that have created products.

I think one of the things that happened is that all of a sudden, we pop up, and then a group in Indianapolis pops up. You look in Cincinnati and you can almost see a corridor developing from, I would say, the middle of Michigan all the way through Tennessee that is sort of powerfully evolving health integration, health exchange.

I think those are some of the core properties as to why there’s success.

The other thing we have going in Indiana is that we are committed as a group. We got together over a year ago and just said, “How do we start to work even more closely together? What makes sense is while we’re competing, we’re still committed to doing these kinds of things that enable it.”

We found a great working relationship in the people that are across the state that are very committed to an approach that not only takes us through Indiana, but through all the neighboring states here in the Midwest.

Anything else that you want to add?

Look at the seeds of where we are. We’re ten years old. We have services in a variety of areas that help our sustainability. We’ve had significant financial commitments in growing this exchange. All those things are all reflective of the commitment that our particular market has to the products and services that we’re about.

It’s interesting — this particular exchange started from the seeds of a workgroup that I participated in in 1994. There’s a long history of people concerned with where healthcare is going and moving, and asking, “How do we become parts of the process?” There’s been a long-term commitment to health information technology. There’s been a commitment for me in a market that I’ve been basically been around my whole life. So, there’s kind of a personal passion as well.

I guess the last thing that I would say is that I can’t say enough about the commitment of our people. They not only feel that they’re into something that’s very important, but there’s a personal mission that they have. Many of these people could be in other places, frankly even making more money, but their level of commitment is incredible. And their creativity is pretty incredible as well. So, I would compliment that in our team.

Dell To Acquire Perot Systems

Dell announced this morning that it will acquire Perot Systems Corporation for $3.9 billion. The all-cash transaction is expected to close in the November to January time frame.

The $30 per share offer for Perot represents a 68% price premium to Friday’s close.

Perot will become a services unit within Dell as it attempts to diversify beyond hardware sales. Perot President and CEO Peter Altabef will say on, Dell says.