2009 Reader Survey Results

Thanks for participating in my reader survey. Here are some high points that I took from it.

• A little less than half of readers have ever posted a comment to an article. (Try it! Everybody has something to say or share.)
• The most important elements of HIStalk are news (4.61 on a 5.0 scale), rumors (4.44), humor (4.31), and Inga (4.30).
• 95% of readers say HIStalk influences their perception of products and companies.
• 77% of readers say they have a higher interest in companies mentioned in HIStalk.
• 79% of readers say HIStalk helped them perform their job better in the past year.
• 99% say HIStalk has influence on the industry.
• 92% said the HIStalk’s posting frequency is “about right”.

Here are some specific comments and suggestions I pulled out as representative of what readers provided. The most common comment was “don’t change a thing,” which I appreciate as well. Your feedback on any of these is welcome.

• It’s more important about NOT changing your basic tenets: provide an accurate, concise summary of what’s happening in the industry, sorting out the rumor mill facts, letting us hear from interesting people in the industry and the new ideas and people in the industry. You are the only one providing this unbiased service and I really appreciate it. Thank you.
• The site is pretty ugly and difficult to read. Us vendor folks could mentor you in design if you ever asked 🙂 I know, but I like it amateurish because, well, I’m an amateur. I admit to having zero aesthetic ability.
• Too many Flash ads. Several readers mentioned that the animated ads are distracting. The immediate solution was to offer the View/Print Text Only link at the bottom of every article that shows only the article itself. I will also pass the suggestion of static-only ads along to the sponsors, although it’s their call.
• More writing about smaller companies. I would love to, but it’s hard to separate the PR from reality sometimes. I’ve been burned before about what I hoped would be an honest appraisal of a technology or company only to have the marketing people swoop in to spin the facts.
• Don’t run unsubstantiated rumors. I like the dichotomy that a few readers made the same comment, yet rumors are the second most popular feature. I try to get confirmation and often do, but not always. I don’t run all the rumors I get, so I have to walk a line between what sounds likely but with the understanding that sometimes the rumor is wrong. The good thing is that if it really is wrong, someone in the know will usually correct me quickly and I always run those corrections.
• I would like to change HIStalk discussion forum. I’d like to see it used more, but I’ve learned to live with the fact that HIStalk readers just don’t like posting to a discussion board. They are doing better in posting article comments, though.
• HIStalk is Mr. HIStalk’s unique thing; don’t change anything because I trust Mr. HIStalk’s judgment. Thank you.
• Paragraph headings with vendor/site/technology/main-topic keyword, to allow skimming. That’s really hard since we cover a lot of ground in one posting (that would be a ton of headlines). Other readers suggested some kind of online compendium of items grouped by vendor, provider, or product, which would be pretty cool but a big of a pain to maintain. Thoughts? I’m sure I could find some cheap labor to pick through each HIStalk post, cull out items by company or person, and then add them to a specific page for that company or person. Would anyone find this useful enough to be worth the expense?
• Have scheduled online chats. I’ve tried those and participation wasn’t very good. I’m not sure people like chats in general, plus their synchronous nature requires being in front of a PC at a specific time.
• Don’t let your "interviews" be PR spots for their products or companies. I try, but it’s sometimes hard to derail the subject from their agenda.
• Do a podcast version, e.g., interviews with actual HIS users with experiences to share. I’m not a fan of podcasts, but I’m looking at recorded Webinars as a good alternative. Stay tuned.
• Make it your full time job as it should be netting you around $2 million a year by my estimates if you were charging what it is worth. This would allow you to do a better job building your portfolio by extending your brand. Of course you would have to ‘out’ yourself which won’t be a bad thing. OK, I admit I included this reader’s comment here just because it flatters me.
• This is a hard question because you do such an incredible job. The only change I can think of to more strongly encourage people to do reporting ("it takes a village to make a great blog even greater"), especially from conferences that everyone does not have time to attend, and coach people on how to develop pithy content vs. vague comments, "here’s three things I hadn’t heard before" vs. "the conference was ok, but fewer vendors were there.” That would be great, although I’m always wary (from experience) of assuming that good readers will happily transition into good writers. I respect the fact that some folks just want to read and leave, but having a few more readers who are more involved would be super.
• If you comment on someone else’s dialogue, make your comments a different color, or make there’s different all of the time so it is easy to tell who is "speaking." Man, I have struggled with this one. I post reader comments in blue, but that still leaves quotes from articles. I’m open to ideas.
• I would look for success stories in healthcare delivery (the real stuff, you know, when a doc/nurse and a patient interact, and that interaction is enhanced by technology); we all need to see them and remind ourselves why we do what we do. That would be great. I wish I got more of those stories.
• Resolve the HIStalk-HIStalk Practice weirdness. They seem to repeat some information, and they don’t apparently link to one another. HIStalk covers everything, while HIStalk Practice covers physician practice technology. Sometimes the same item appears in both, but only when it’s appropriate. The idea was that HIStalk Practice would cultivate a new audience interested in ambulatory topics and not the more hospital-centric topics that appear on HIStalk. We interviewed individual doctors about their EMRs, for example, for HIStalk Practice, something we probably wouldn’t have run in HIStalk. While some readers follow both, we expect each to have a majority of readers who don’t look at the other. It will take some time to figure out if that’s indeed the case.
• Give yourself a break–you must work enormous hours. I do. I need to quit my day job one of these days, but I would need to find something that would offset the income I would lose using the time I would gain. And, some activity that would keep me in the industry since there are plenty of bystander writers out there, but not as many participant ones.
• Might be interesting to profile healthcare providers and hospitals more to get a feel for what’s happening out where systems are used. You’ve done it occasionally, but most of your interviews and profiles are from vendors. That would be great, assuming provider people would participate. We will try to get more of those.
• Do more for job placement or available positions. Maybe by region? I’ll consider that.
• Still don’t understand the difference between Inga’s section and Mr. HIStalk, except for the footwear comments. It’s only to let you know who is writing, especially if we express an opinion. Inga often writes first, so if she covers an item, it goes in her section. Since we’re kind of chatty and personal, there would be “weirdness” (to use the reader’s word above) if you didn’t know who was “talking”.
• I use IE6 w/ virtually no security, but I still never see any "…on your right" columns/content. Vendor ads are on the left, your editorial paragraphs are in the middle, blank space on the right. How about a "setup your browser for this site" FAQ link? I’m always the last to know about IE problems because I don’t use it. Readers e-mail fairly often saying that something is wrong with HIStalk’s layout, ads, or signup forms. Invariably they are using IE. If someone readers HIStalk on IE6 or 7 and everything works like it does in Firefox, let me know what settings you’re using (screen shots?) and I’ll pass it on.
• HIStalk is a fantastic contribution to the industry – someone should write a "good guy" story about you! Please keep it coming!! That one was me preening again. I’d rather be anonymous, though. As the very few people who have known me for years as Mr. HIStalk will attest, I’m uncomfortable talking about it.
• Having Deb Peel pose as Inga in Chicago was a scream. I agree. She was fun, as were our other sash-wearers.
• You’re a game-changer… many people I know don’t pick up the trade rags anymore. Thank you. I haven’t read any of the glossies for years, so it isn’t just me.
• Because I am new to this site and HIT but interested in learning as I go (you are my tutorial) I would love a decode area where I can find out exactly what acronyms like CCHIT and HIMSS stand for, etc. I figure I can start with a glossary and then take it from there. It would help me if users would provide some of the definitions.
• Since I am new to healthcare (vendor side), HIStalk has been VERY instrumental in helping me learn both sides of the industry and issues. I would like an occasional "101 learning piece" for the newbies- maybe in the form of a subject and the Seasoned folks can comment. "What I wish I knew when I was new…" or something like that. HIStalk has been like being the new kid in school but the cool kids still let you hang out with them. Thanks SO much! Best of luck! That’s a fun idea. If I could ever get people to read and post to a discussion form, that would be a perfect vehicle. Maybe I need a redesigned forum, although you wouldn’t believe how hard it is to keep spammers out.
• Do you have a day job (I assume the answer is yes), a family, hobbies? Yes, yes, and yes. Well, OK, I really don’t have any hobbies other than HIStalk.
• Thank you for including peer-review journal articles in your analysis and not limiting your reporting to just the commercial press. Happy to do it. If you see something interesting that I can get full text for, I’m happy to critique it.
• You can get started on vendor-independent Webinars – specifically to cover new technology usage in real hospitals/practices, and provide business cases that others could emulate. These would have to be done by healthcare providers. Working on that. I agree completely.
• The work you guys do has been invaluable to my career. I reference your work often (and give much deserved credit), and you have provided keen insight into the industry’s inherent complexity and overarching issues. My time as a journalist taught me a lot about the value of curating and meaningful dispensing content, and I can recognize editorial value when I see it. You guys nail it. Thank you.
• Some of the questions in this survey seem more commercial than the tone you have historically taken with this blog. Please don’t tell me you are being seduced by the money available for more directly pushing sponsors or others products! It’s the same old survey. I have plenty of sponsors and make zero effort to get more, other than writing HIStalk as usual. I’ll be honest: it’s great to not have to worry about that.
• Brilliant job, don’t know how you do it, but so glad you do, I am completely your fan! Keep going and add more contributors to write guest columns like "Being John Glaser". Expert judgment is one of our best assets. The washout rate for guest columnists is high, but I would like to have more of them since I enjoy what they have to say as well.
• Make links easier to see in Firefox. Working on that now.
• Put up an industry events page or calendar. Working on that now.
• You provide the conscience to this crazy business. If you’ve made one person in power a more honest person, then you’ve done a great service to us all. Thank you.
• A great job. I’ve gotten our CMIO and our CIO to read it. Of course, when his name appears in a report he’s not too happy, but hey, at least the stuff is usually accurate, even if we can’t figure out who named names.

Monday Morning Update 5/11/09

From Stan van Man: “Re: Sage. I just got an e-mail from one of the people who was cut at Sage who told me that Sage Healthcare RIF (don’t you love that acronym) was 500.” My company contact tells me that Sage North America reduced headcount (employees plus open positions) by 500, but that’s throughout all of Sage, not just Healthcare (which took a relatively minor hit).

From Dr. Lyle: “Re: Cerner MPages. I’m a long-time Cerner user and have many bruises to show for it. However, I am cautiously optimistic about MPages as it appears to be what many of us have been asking for: a Web-like front end to the data and functionality in the system. At the very least, it allows users to use HTML and similar programming to create a user interface which displays disparate data in the way they want, such as creating a diabetes screen that brings together meds, labs, physical exam findings, and evidence-based findings. At the very most, there may be some opportunity for interactivity via data input (e.g. change a variable to see how it affects the data) and ordering (e.g. meds, tests) on that very screen. In other words, they are beginning to go down the road of separating the data from the application and interface and allowing end-users to create the displays and customized functionality we believe will work best for us. While this might seem like common sense, most EMR vendors continue to work in a closed, three-tier system (data, application, and interface) that does not allow for this level or ease of customization. It could lead a new paradigm of what an EMR is and does, shifting EMRs to become a platform that holds the data and applications, but allowing interfaces to be in the hands of the users.” Dr. Lyle refers to his blog entry on EMR usability. I liked that idea going back to the mid-1990s, when vendors or users of character-based systems turned them into something that looked slick and brand new by using screen-scraping tools like Attachmate or Seagull to create GUIs that could even tie multiple applications together under the covers. It would be cool if a vendor app could provide functions and tags that would work like ColdFusion or PHP, giving users control of the display and maybe extending its functionality by doing lookups into other systems, links to Web content, or databases or running self-developed functions. Customizing screens, screen flow, and reports is most of what users want to change, not the underlying database or internals, so that would be powerful.

Speaking of MPages, I found this site, run by techies at UW, Stanford, and UAB, which is trying to build an open community of MPages developers.

From Josh: “Re: reusable components. I thought it was worth reiterating a point in your 5/6 update: ‘What healthcare needs are small, specialized systems that interact.’ This diametrically opposes the notion of ALL of the major HIS vendors to date. The idea of small, standards-based reusable components rather than monolithic, interconnected systems is called Service Oriented Architecture (SOA). There are a number of successes in other industries and the core notions (Enterprise Service Bus, Agile development, composite views, etc.) are readily understood in the software development community. What seems not to have been done is the transformation of provider requirements to force deconstruction of these systems. I’ve long been flabbergasted at the interface inflexibility in most commercial HIS offerings and the uselessness of data we generate in applications not intended by the designer. It’s time that the providers start dictating detailed requirements to our vendors – and SOA may be the mechanism to do that.” That is an interesting paradigm – CIOs have pushed the “off the shelf” idea to the point that prospects rarely put system design issues into their contracts, either accepting the product as-is or choosing a different one. When I worked for a vendor, I hated the idea that we couldn’t do something specific for a customer unless we rolled it into the base product, which either meant we had unhappy customers or a Frankensteinized product with a bunch of jerry-rigged bolt-ons added just to make some weird customer happy (usually one of our biggest customers, no surprise there, who bring both unreasonable influence and illogical processes to the table). I like where this discussion (and the one above) are going. If software could be customizable while remaining supportable, everyone wins.

I just posted a summary of the 2009 HIStalk reader survey. I didn’t e-mail blast it since not everyone cares about it, but if you’d like to know what readers suggested and what I think I can accomplish, check it out.

England’s Department of Health gives BT $150 million in advance payments despite what the Guardian says is “years of delays, system failures, and overspending …” and a temporary government ban on Cerner rollouts because of system problems.

I’ve hosted a visit by Traveling HIT Man, my new BFF (that’s him, helping me edit today’s post). He’s looking for the next stop on his HIT tour (see the pics of where he’s been), so if you’d like to have him come to your place, let me know and I’ll send him your way. 

HHS announces members chosen for the Health IT Policy Committee (advises ONCHIT on interoperability) and Health IT Standards Committee (advises ONCHIT on standards and certification). Both committees hold their first meetings this week in Washington.

Odd: two motorcycle riders in India, one of them a Dell software engineer, ride around pulling the scarves of girls for some reason. Locals caught them and beat up one of them, but the Dell guy escaped, only to be arrested later and charged with criminal intimidation and assault with the intent to outrage modesty. His punishment is to sweep the floors of a local hospital for one hour per day for a month.

Patient Safety Technologies, the sponge counting system company, names board chair Steven Kane as CEO following the pursuing of other interests of David Bruce, former president and CEO.

Cooper University Hospital (NJ) gets a local newspaper mention for going live on its $30 million Epic project.

The swine flu is coming and humanity will be wiped out! Old-timers have heard this before, in 1976, and we even had a vaccine then (although it had a couple of minor problems: it didn’t work and people who got it sometimes died. But hey, some people died who didn’t get it, so evidence is inconclusive.) Concerned Americans who heard about today’s crisis on celebrity gossip sites have responded to this serious risk to their health by drinking, speeding, smoking, having unprotected sex, chowing down on superhuman junk food portions, and taking a bottomless pharmacopeia of dangerous prescription and illicit drugs. 

President Ford — uhh, Obama — has a great health care plan, other than it will cost $1.5 trillion. I’ll let Sen. Ron Wyden of Oregon speak for me: “You go to a town meeting and people are talking about bailout fatigue. They like the president. They think he’s a straight shooter. But they are concerned about the amount of money that is heading out the door, and the debts their kids are going to have to absorb." The article wisely observes that “one person’s wasteful spending is someone else’s bread and butter,” saying that doctors, hospitals, and drug companies are going to raise holy hell about any attempt to pay them less, even for good reason.

Chinese hackers break into Cal-Berkeley’s health sciences servers, giving them access to the health data of 160,000 students and relatives. Nobody noticed for six months.

The UCLA Medical Center employee who pleaded guilty to selling celebrity medical records to the National Enquirer has died of breast cancer.

A university does the “buy some old drives from eBay and see what’s on them” test. What they found: Lockheed Martin ground-to-air missile plans and its personnel records, medical records, pictures of nursing home patients, correspondence from a Federal Reserve Board member about a $50 billion currency exchange, and security logs from the German Embassy in Paris.

Speaking of which, thanks to the reader who reminded Inga about the need for offsite PC backups (since my trusty USB hard drive sits two feet from the PC, giving it little chance of selective survival in a fire or disaster). I’m doing a 15-day free trial of Carbonite.

Here’s what I love about hospitals: a 17-year-old high school athlete goes to the ED of Kadlec Medical Center (WA) with a shortness of breath. She is correctly diagnosed by the ED staff as having a pulmonary embolism, almost unheard of in young, healthy patients. The next night was prom night, so the peds staff brought in her dressed-up boyfriend and classmates, made her up in her prom dress, took pictures, set up a CD player and disco ball in her prom-decorated room, and provided a candlelit dinner for the couple (with Jello for dessert, of course, since it’s a hospital). “We are totally blown away by what they did,” the mother said.

E-mail me.

News 5/8/09

From Ellis Dee: “Re: ARRA. A hospital that has a large outpatient makeup but very little inpatient appears to get significantly less ARRA reimbursement for EHR since the calculation only mentions inpatient. I’d be curious if this is just a legislation snafu that will generate enough complaints to include outpatient. It seems EHR investments and continuum of care applies even more so to outpatient.”

From Roy G. Biv: “Re: HHS. Is it me or is the new health IT web site a little thin? For some reason, they also changed the domain from www.hhs.gov/healthit to healthit.hhs.gov. My take is they implemented a new portal vendor, while the last site was home grown and content managed by HHS directly. I included a link to the Internet Archive ( Wayback Machine ) of a cached version of the site a year ago – a lot more content – and bigger print.” Before, after. It looks like it might be portal software from the former Plumtree Software, which was bought by BEA, which was bought by Oracle (the software version of a Matrushka doll).

From Looking for Answers: “Re: Cerner. What is Cerner’s MPages, why are people so excited about it (to make a video), and does it give Cerner an edge?”

From X-Sage: “Re: layoffs. 1,000 layoffs announced by Sage in England during briefing on six-month financials earlier this week, with Sage Healthcare getting hit once again starting on Tuesday.” One reader put the healthcare cuts at 200 people with more to come. In the mean time, one stock analyst likes Sage stock OK, but says getting into healthcare was a mistake, especially now that Allscripts and Misys have merged to create a formidable competitor.

From Revenue Randy: “Re: Sutter EMR project. Get ready for Son of Sutter … Stanford Medical.”

If you’re a doctor shopper looking for OxyContin in Virginia, now’s your chance: the state database that hackers hijacked is the one that healthcare professionals check to identify drug-seekers. It’s now offline. Mr. Limbaugh, your prescription is ready.

Porter County, Indiana was sued last year for $3.4 million by a management software vendor that claimed Porter Hospital used its software without permission after the hospital was sold to for-profit Community Health Systems. The county argued that the new owner should have worked out a deal with the vendor, so they paid $200K to get out of the suit. Now the hospital has countersued the county, claiming a contract clause makes it the county’s problem. The county is threatening to counter-counter-sue the hospital for the $200K.

I’ll say this, having worked for a non-profit hospital bought by a chain: a former non-profit’s employees sleep behind enemy lines because everyone in the community suddenly hates you, even though you’re going to work in the same building with the same people. Appropriately so in my case: the company running my hospital was a truly impressive bunch of sleazebags and scoundrels who gravitated to healthcare only because the money was good and fraud wasn’t often detected. A classic line from our brand new 24-year-old hospital president in his first real job, speaking to our long-time CFO who predated him by decades: “We need to use less oxygen.” We snickered at his stupidity, but he went on to make dozens of millions running the slimeball organization, somehow avoiding jail time unlike many of his peers. If you were a patient in our hospital back then, I am truly sorry our management brought in clearly incompetent doctors whose only attribute was that they would take orders from a 24-year-old MBA using patients to rise through the ranks. I have a lot of stories, unfortunately.

The State of Massachusetts is considering ditching fee-for-service payments to doctors and hospitals and instead giving them a capitated yearly payment. This is an interesting thought: “… because doctors and hospitals would have to work together more closely to manage the budget, the hope is they will better coordinate care for patients, which could improve quality.” Catfight!

A WHO advisor provides an opinion on the US healthcare system, one question being what advice he would have for the President: “My advice would be to avoid a search for villains (e.g. insurance or pharmaceutical companies) or panaceas (e.g. the electronic medical record), neither of which will be very productive.  Instead, Americans need an intelligent public policy debate that both builds strong consensus for the goal of universal coverage and fosters understanding of the consequences of the structural fragmentation of the existing system and why this has to be addressed.  Expanding coverage without tackling this underlying problem will be very costly, so equal attention needs to be given to both fairness and efficiency if the U.S. is to move towards a system that is both universal and affordable.”

Non-profit Global Patient Identifiers, Inc. and software vendor MEDNET announce a partnership in which MEDNET will issue cards with GPII’s Voluntary Universal Healthcare Identifier and also donate in kind to GPII.

Not satisfied with wasting your personal time Twittering? Now you can reduce your company’s productivity as well with the aptly named Yammer, a near-clone of it aimed at private networks (it reminds me of the old Groove before Microsoft bought it). It might be useful, although I don’t see much benefit over a decent e-mail and IM system (why does everyone fret about blocking unnecessary e-mails when most people just delete them anyway?) The New York Times kind of liked it. It’s free to join, but to get more control and security features costs the employer $1 per user per month (so unlike Twitter, it might actually have a business model other than being sold).

Cambridge Consultants rolls out a Bluetooth-enabled inhaler that follows Continua standards in allowing inhaler usage data to be collected and placed into PHRs.

This sounds interesting: a Silicon Valley startup called PreviMed starts a Healthcare Innovations Lab to evaluate HIT innovations from the user perspective.

This is a big deal: Citrix announces the availability of its free Citrix Receiver for the iPhone, which allows running XenApp hosted applications (Cerner, McKesson, Microsoft, Oracle, and SAP are specifically mentioned).

Microsoft lays off another 3,000 employees with the likelihood of more to come.

Listening: Catatonia, alternative rock from Wales, defunct since 2001, with a startlingly pretty lead singer.

Two New Jersey men plead guilty to making $300K by stealing medical equipment from New York Presbyterian Hospital and selling it on the Internet. One was a hospital equipment specialist.

Like an ED on diversion, I’ve been too busy to accept new e-mails (or at least to reply to them). I always catch up eventually, though, even with the equivalent of at least two full-time jobs that are wearing me down steadily.

I think this is new, but I can’t tell since HIMSS doesn’t date its news items (damned annoying). They’ve got a simple online estimator of Medicare incentive payments under ARRA (if you’re a member, anyway).

I goofed: I said the Kingdom of Jordan is a Medsphere customer that was recently quoted a saying open source would cost them at least as much as commercial applications. I knew they were implementing VistA and found 2,000 Google hits linking Jordan with Medsphere (Medsphere proudly ran press releases announcing that the Jordan people were considering them). Medsphere lost that business to Perot.

Interesting details on the GE-Intermountain partnership. Development costs of whatever they’ve been working on since February 2005 are $300 million, with Intermountain paying $100 million and GE chipping in $200 million. Intermountain gets royalty payments (that makes them a vendor, so keep that in mind as they hit the presentation circuit and offer site visits). Brent James is a smart guy, but I would question whether this quote reflects reality: “"It means our ability to deliver good care is going to explode at the same time the costs are going to drop profoundly.” Duly noted: I will be watching for Intermountain’s quality numbers to ramp up and their costs (and charges) to fall precipitously. If either happens, that will be the first time an IT system ever had that kind of effect.

SAIC gets a $158 million contract to maintain and enhance some aspects of AHLTA and CHCS for the Department of Defense.

A security company sues the SEIU healthcare worker’s union (you Easterners know them as 1199) for not paying its $2.2 million bill. The surveillance and counter-intelligence group, made up of former FBI and CIA agents, was hired to spy on the union’s own members: to conduct surveillance of the union’s offices, to intimidate union members coming and going, and to protect SEIU’s visiting executives while they secretly met with hospital CEOs and legislators. At least that’s what the National Union of Healthcare Workers, a newly formed competing union, says (also accusing SEIU union bosses, shockingly, of pillaging union assets). SEUI is suing them, of course.

E-mail me.

HERtalk by Inga

Allscripts announces Cardinal Health is its latest Allscripts MyWay reseller. Interesting move on Cardinal’s part, especially since the spinoff of CareFusion suggested Cardinal was restructuring to increase focus on its core drug distribution business.

A psychiatry fellow blogs on East Coast versus West Coast medicine. She observes that medical hierarchy is more obvious on the East Coast, e.g., doctors wear one color scrubs and nurses another. Though East Coast doctors are more blunt, they are not necessarily "meaner" than their West Coast counterparts. The most important observation: psychiatrists on the East Coast dress significantly more fashionably than those on the West Coast (see above – not a psychiatrist, but definitely one nicely dressed East Coast doctor.)

Eclipsys reports a first quarter loss of $.9 million or $.02 per share compared to last year’s $.3 million/$.01 share profit. Revenues came in above Wall Street expectations, however. Quarterly revenues were $130.2 million, with is above analysts’ $125.5 million estimate and about 5% higher than last year.

The 40 doctors at Lenox Hill Interventional Cardiac & Vascular Services implement Professional Intelligent Charge Capture by MedAptus.

This week I was having a battery problem with my laptop, so I gave Dell a call to diagnose the issue. While running diagnostics, we discovered that in addition to a failed battery, my disk drive had some serious errors and needed to be replaced. So, I pulled out the external hard drive that I have had for a year and half and never used – it was still nicely shrink-wrapped in its box. I feel as if I dodged a bullet and wondered how many times a day consumers and businesses lose precious data to hardware failures because, like me, they are too lazy to back up data?

API Healthcare announces three new hospitals and health systems are now utilizing its human capital management solutions.

An Australian hospital bans the use of its new EMR system after its second failure in three days, including a two-hour outage. An official is quoted as saying, "Staff report the electronic medical records system is so cumbersome that senior medical officers who previously saw 8-10 patients in a shift, are only getting through 5-7 because they spend so much time trying to access or enter information."

GE announces plans to invest $6 billion by 2015 on its "healthyimagination" initiative, aimed at delivering lower-cost medical equipment and care around the world, while increasing earnings at its medical systems and bioscience division. The strategy includes $3 billion in R&D on new medical systems and services, $2 billion in financing, and $1 billion for GE technology to support HIT and heath in rural and underserved areas. GE’s big plans for improving healthcare around the world almost makes me feel guilty for complaining about the $350 I just shelled out to GE to fix my broken oven.

Bridges to Excellence publishes a study entitled Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation. And we needed a study to figure this out?

Healthvision adds 10 international clients in Q1.

Cedars-Sinai Medical settles Ed MaMahon’s malpractice suit from last year in which he claimed doctors failed to diagnose his broken neck, discharged him without taking an x-ray, and later botched two spine operations.

Content management vendor Open Text enters into a purchase agreement for competitor Vignette. The total transaction price is about $310 million.

Perot Systems announces plans to lay off 450 employees to offset lower project-based revenue. The reduction is expected to save $30 million annually.

QuadraMed reports a first quarter net loss of $200,000, less than the $1.1 million loss reported for the same period last year. Quarterly revenue was flat at $35.1 million.

The Ohio Department of Administrative Services selects APS Healthcare to manage the provision of disease management and health and wellness services for 50,000 state employees.

As Mr. H recently pondered, had did we survive in the olden days when we only had three network channels to keep us amused?  For the curious (and non-squeamish) you check out Wired Science’s 10 best surgical videos. Really now, are our lives more complete once we can observe a a sex-change operation?

E-mail Inga.

News 5/6/09

From Seth Hazlitt’s Nephew: “Re: Sutter. The Sutter project situation reminded me of your Universal Rules for Big EMR Rollouts™, specifically number five: ‘All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and […] will vanish without a trace at the first sign of trouble, like when […] the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.’ Is Jerry Padavano still with Sutter? How long until Jon Manis vanishes without a trace? A year and a half ago, Sutter said it had already spent $500 million, up from the original projection of $150 million. By early this year, it was up to $1 billion. As of this point, what exactly did Sutter get for their $1 billion+ investment?” My Universal Rules piece was a pretty big hit, I have to say. As for Sutter, it’s hard to say other than I was incredulous when they first announced how much they were planning to spend, which turned out to be a small fraction of the final estimate. What healthcare needs are small, specialized systems that interact, but that can be customized and managed locally and individually without making the whole enterprise-wide deployment as vulnerable and as unintelligent as the lowest common denominator of the systems that make it up.

From Pat Cremaster: “Re: Sutter. They couldn’t fund the EMR because of stock market losses and the decision to fully fund employee pensions (too bad other companies make similar promises to employees, but rely on government intervention when their pension goes belly up). It’s also a shame that our healthcare delivery industry requires investment income to fund it.”

From Ian Miller: “Re: e-prescribing. DICOM and HL7 standards are available as free downloads, but the specification of NCPDP SCRIPT Standard for e-prescribing medication costs $655. Wouldn’t it increase adoption to let anyone (like an open source developer) take a shot at creating the e-prescribing killer app by offering the NCPDP SCRIPT specification for free?” I’ve never understood why organizations charge for that kind of documentation when e-mailing out a PDF costs nothing. I admit I’m suspicious about non-profit motives when I see that.

From Lisa Lopes: “Re: HIMSS conference proposals. It is a shame that one must submit them so far in advance. You really have to be thinking about it. So much can change in a year. I always liked roundtables, but there aren’t as many of them anymore. Panel discussions allowing for interaction between panelists themselves and with the audience, I think, are superb vehicles for communication of issues that healthcare IT professionals are dealing with.”

From Lazlo Hollyfeld: “Re: ARRA. After all of the talk about ARRA boosting health IT purchases, clinical spending looks like it will be slowing since everybody is waiting to see what happens over the next 9-12 months. On the other hand, waiting to purchase an EMR system until next year is going to cause some potential difficulty in getting up and running to get paid. Talk about your unintended consequences. Meanwhile, the revenue cycle management vendors just keep humming and moving along as profit margins continued to get squeezed along the entire provider spectrum.” 

From Tom Servo: “Re: Pam Pure. I heard she got a hefty severance package, like $6 million, and new bedrooms and a security system for her horse farm. Meanwhile back at the employee ranch, merit increases were eliminated, profit sharing was eliminated, hours were increased, the fear mentality set in, and people were replaced by terrible Indian outsourcing. Shades of the finance industry.”

From The PACS Designer: “Re: HIStalk’s top 2% ranking. TPD found a website called /URLFAN that rates the popularity of Web sites. Happy to report to Mr. H, Inga, and HIStalk readers that our Web site is in the top 2% of over 3.7 million websites at #80,672. Thanks go to every one of you who contribute to HIStalk to make it the site to go to for the latest health care information and reader comments and writings!” Link.

To think we missed narrowcast content like this when there were just three networks and no Internet: this Web page deals exclusively with hospital food around the world. You will be shocked that most hospital food is dietician-approved, yet thoroughly unappetizing. Captive employees, of course, are shafted by their hospital employer on overpriced cafeteria meals (and the minuscule employee discount is one of the first budget cuts made). The most heinous act you can commit in a hospital, other than abducting a newborn, is daring to refill your $1.75 waxed paper cup from the soda dispenser like every fast food restaurant lets you do, thereby costing a billion-dollar hospital operation a budget-busting three cents. Boot camp recruits and prisoners eat the same prepackaged food from the same soulless food service outsourcers, so it’s about what you would expect (maybe openly rebellious employees and doctors should be punished with a Nutriloaf diet).

Since we’re on the “how fancy do your hospital buildings need to be” debate, this story from India is interesting: Lessons From a Frugal Innovator, subtitled “The rich world’s bloated health-care systems can learn from India’s entrepreneurs”. Example: heart bypasses are done under local anesthesia, but they have triple the IT adoption of US hospitals. Columbia Asia, a US company mentioned here before that operates hospitals in poor countries, is featured. “Columbia Asia … left America to escape over-regulation and the political power of the medical lobby. His model involves building no-frills hospitals using standardised designs, connected like spokes to a hub that can handle more complex ailments … Its small hospital on the fringes of Bangalore lacks a marble foyer and expensive imaging machines—but it does have fully integrated health information-technology (HIT) systems, including electronic health records (EHRs).”

I doubt Medsphere will include this quote in its marketing materials even though it’s coming from a high-profile OpenVista customer. Jordan’s technology minister, when asked about using open source, said this: “It will cost you more, by the way. We are working in the hospital sector, using open source. I think that in the beginning, the cost will be higher. In the long run it could be better. You have to develop software to interface with the open source, which will cost you more.”

Shareholders of IBA Health approve changing the company’s name to iSOFT Group, reflecting the brand name of the product and company it acquired awhile back.

A newspaper editorial observes the institutional nonsense that pervades every hospital. “Part of the problem is the computer. If the medication isn’t listed there, you don’t get it. It might just need to be renewed or re-entered, as meds have a sort of built-in renewal date. ‘Would you please call the doctor and check?’ you ask. ‘I will put a call in,’ is the reply, which is code for you won’t be getting that medication for a good long time. If you hear, ‘the pharmacy will have to be called,’ then you might want to call a friend and see if they can bring you some Tylenol … Something has taken a nurse’s good judgment away and has allowed a computer to trump it; has allowed her to look directly at a new IV line and conclude, beyond reason, that there is no IV medication prescribed. Something has forced doctors to have fewer firsthand conversations with their patients, for shorter periods of time, and to share less information.”

John Halamka got a ton of press that proclaimed him a visionary for having a VeriChip implanted in 2005, but he finally admits everyone who hooted and howled back then about the lack of utility in having under-the-skin medical data was right. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.” One of my satirical news item on April Fool’s Day 2006 was this: “CIO Logs Full Year Without Showing Up at the Office. (BOSTON, MA) John Halamka, Chief Information Officer of CareGroup Health System, did not spend a single day at work in 2005, according to a Boston Globe review of expense records. Health system officials had no comment. ‘Check my vitae – I hold six positions in five organizations, plus I do a lot of speaking,’ Halamka stated in response to a reporter’s question. ‘I can’t say I started out planning to miss all of 2005 in that one job, but it just worked out that way. What I give them in quality more than makes up for any perceived shortfall in quantity.’ A CareGroup source told the Globe that discussions are underway to track Halamka’s location by the identity chip implanted in his arm last year. ‘I’d rig the damn thing up to a doggie fence and give him a few volts when he wanders, ‘ said the source.”

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HERtalk by Inga

Perot Systems releases its first quarter earnings: EPS $.24 vs. $.23 on $621 million in revenue, down from $680 million.

Harvard Medical School closes temporarily after a probable case is identified, an MIT student who picked up the virus while in Mexico and possibly shared it with colleagues at the Harvard Dental School.

SCI Solutions announces it has signed an agreement with Saint Thomas Health Services (TN) for SCI’s Schedule Maximizer and Order Facilitator solutions.

Medical transcription company Administrative Advantage selects the ZyDoc Medical Transcription platform.

Final attendance figures from HIMSS: 27,429 total registrants, down 6% from last year, and 907 exhibitors, down 4%. Over a fourth of attendees were first-timers, indicating a high churn rate.

The 60-bed Bates County Memorial Hospital (MO) selects the MedGenix financial and patient management system.

Authorities investigate a $10 million extortion demand for the safe return of over 8 million patient records and 35 million prescription records that were allegedly hacked from the Virginia Department of Health Professions computers. The FBI is assisting Virginia state officials investigate the incident that came after hackers infiltrated the Health Professions computers last week. They posted this boast on the home page: “I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.” This fool is going to be so easy to catch that it isn’t even funny. Hey, we’ve got your $10 million – where can we meet you?

The Robert Wood Johnson Foundation awards Project HealthDesign $5.3 million. The project, whose mission is to support the creation of a new generation of personal health records, is based at the University of Wisconsin.

MEDITECH adds Vitalize Consulting Solutions to its list of approved advanced clinical consulting vendors.

Virtual Radiologic receives FDA clearance for vRAD RACS, Virtual Radiologic’s own PACS solution. The company will roll out the software to its affiliated radiologists over the next several months, replacing the commercial software it licenses.

Some news in honor of Cinco de Mayo: thieves in Mexico realize that everybody is wearing blue surgical masks because of H1N1 fears, so they’re donning their own to blend in with the crowd when making their getaway.

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Being John Glaser 5/5/09

One of the greatest inventions of all time is the three-by-five card. Compact. Sturdy. Lightweight. Portable. Blank on one side. Lines on the other side. The three-by-five card has many uses.

The three-by-five card is at the core of my efforts to organize my work life. This card lists those things that I need to pay attention to, or ask about, or do in the next one to two weeks. If you were to look at my three-by-five card today, what would you see?

• Budget. I think this entry is permanently on the card since it seems we are always dealing with the budget – putting it together or monitoring it. Our operating and capital budgets have to be flat next year. At this time, our managers are making good progress on achieving this target. But our hospitals are not finished with their budgets, so they may cycle back in the next couple of weeks and ask us to make further cuts. Terrific.
• COMPASS. COMPASS is the name for our major revenue cycle initiative. We are working with Siemens and Accenture to standardize our revenue cycle processes and data and implement the systems needed to support that standardization and improvements. Like the budget entry, COMPASS will be on my card for years to come. We are moving well. Good progress is being made on the Newton Wellesley Hospital (our first implementation) plans. Progress continues on developing the governance and new management models that are integral to the project and are a big change for our hospitals that are used to autonomy. And outreach efforts are doing a nice job of helping people understand the capabilities of the Soarian system and the new processes. As is true for any large project, there are always issues and challenges that need attention from time to time.
• NWT Frm. I have no idea what this means. I apparently had something in mind when I wrote this, but I have forgotten what it was. If I haven’t figured it out in two weeks, I will presume that I took care of it and cross it off the list.
• Clin Ops Agenda. Clinical Systems Operations is a meeting of several IT leaders who discuss major clinical systems issues and strategies. We have a meeting in a couple of weeks and I’m trying to line up the agenda. While still in flux, it looks like we’ll have discussions about (a) the effort required to close the gap between our current clinical system features and the features we think we will need to qualify for Stimulus financial incentives; (b) an overview of our strategy to enable medical record coders to code entirely from the EHR and not need to pull the paper record; and (c) a discussion of the project demands for our Clinical Data Repository team – we need to help them prioritize.
• Common clinicals. It is time to return to the strategic conversation of how common should our clinical systems be and, given whatever degree of commonness we choose, how should we go about making that plan happen? We last had this conversation three years ago. In many ways we are making good progress towards that goal of commonality – our EMR implementation will be completed this calendar year, progressive adoption of services (in the SOA sense) continues, and the Brigham and Mass General are working together on Acute Care Documentation (ACD). However, we need to step back and broadly consider our current approach, which is best characterized as incremental and progressive homogeneity. We need to frame some overarching questions that need to be addressed, e.g., should we view this as a catalyst for broad transformation of care at Partners or will we focus largely on reducing the complexity of our portfolio of clinical systems? And we need to define the process for answering those questions. While we need to return to this discussion, we have to moderate the pace. The Brigham and Mass General will be consumed by the ACD and Medication Administration projects for a couple of years and we need to be careful that we don’t unnecessarily distract those efforts. And in many ways, the COMPASS project is plowing the ground for are still under developed organizational prowess at broad standardization of data and processes.I expect that FY10 will be spent developing and revisiting our common clinical systems plans with execution of the resulting plans beginning in FY11.
• Staff e-mail. Every month I write an e-mail to the IS department. This e-mail is a combination of news, strategic outlook, and overview of major initiatives. I have been doing this for nine years. I need to write this month’s e-mail. I haven’t figured out a topic. Presumably having this entry on the card will lead to a burst of inspiration at some point.
• Agility. We had an IS team look at improving our agility. They did a great job and I want to implement a number of their recommendations and advance the work that they started. But I haven’t gotten to it. This line has been on my three-by-five card for a long time. I need to get off my butt and do something about it.
• Jess – yard. Our middle kid Jessica lives in a condo (two units total) with two buddies in South Boston. My wife and I own the condo – rent more or less equals mortgage payment. But this does mean we are landlords, and as landlords, we need to deal with the tiny back yard. The plan is to turn the back yard from a sea of mud and weeds into somewhere young ladies and their boyfriends (assuming they pass the background checks) can hang out. Some yard plans have been developed. I need to let Jessica know which one we will go with. I’m OK with putting in a patio. The water fountain that spouts a 20-foot tall “geyser” every hour on the hour will get wacked from the plan.

There are other items on the three-by-five card, but I have probably bored you by now.

For those of you who have yet to discover the three-by-five card, I encourage you to check it out. No batteries. No worries about an operating system crash. Easy to read. You can drop it down the stairs and it doesn’t break. And you don’t need to stay in the lines when you write on it.

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

Monday Morning Update 5/4/09

From Deborah Kohn: “Re: Kaiser’s PDF formatted PHR. PDF Healthcare is a Best Practices Guide (BPG) and Implementation Guide (IG), published in 2008 by two standards development organizations (ASTM and AIIM). PDF Healthcare is not a vendor, product, or service, nor is it another standard. PDF Healthcare describes little known attributes of the Portable Document Format, an international, open, ISO-ratified and published standard that is freely viewable on almost every laptop/desktop around the world, to facilitate the capture, exchange, preservation, and protection of health information, including but not limited to personal, handwritten documents, structured or unstructured clinical notes, structured laboratory test result reports, (unstructured) word processed reports, electronic forms, scanned document images, digital diagnostic images, photographs, and signal tracings. Until members of the PDF Healthcare Committee were told by HIMSS09 staff members that as an ‘unsanctioned HIMSS09 event’ our PDF Healthcare demonstration in the Hyatt Hotel McCormick Place had to ‘cease and desist’, PDF Healthcare was successfully demonstrated to an enthusiastic audience. One demonstration showed how clinicians in Southern California securely exchange patient health information with only a 3G phone, encrypted USB drive, and a printer.” I found the above participant slide on the AIIM site, so maybe someone can chime in as to whether it’s going anywhere.

It really bugs me that HIMSS locks up every possible meeting venue so that nobody can do anything without HIMSS approval anywhere near the conference site, the one time a year where people can connect without add-on travel costs (I’m pretty sure the most interesting events would be unsanctioned). I still say there needs to be a conference designed for the benefit of attendees, not exhibitors, with more and better educational sessions that are cutting edge, not submitted a year in advance with occasional unvetted conflicts of interest. A non-profit or small company shouldn’t have to spend GE-like dollars just to get a once-a-year audience in Neon Gulch.

From Curiously Underfunded: “Re: stimulus. Does anyone know how the physicians will go about collecting the stimulus funds? I keep reading about the qualifications, etc. but have not been able to find anything about how to apply!”

Jon Manis, CIO of Sutter Health, posted a comment in the HIStalk Forum about its Epic project. Not to be outdone, Neal Patterson (or so he says) posted the full text of Jon’s e-mail to staff (thanks to the readers who sent a copy of the e-mail to me as well). The original post by Francisco Respighi was a bit more speculative, inferring mass layoffs, which may or may not be the case. None of this is to cast judgment on Sutter, of course, but to call attention to what’s going on in the industry in general. Sutter has to run like a business, so if they are forced to make tough decisions that change long-term plans, then they probably aren’t the only one.

Speaking of Sutter, it signs a contract for Ingenix Impact Intelligence, giving doctors in the Sutter network access to metrics, utilization, and disease management information.

EHRtv posts its HIMSS interview with Jonathan Bush, conducted at the HIStalk reception. I’m really impressed with the video quality of what Dr. Eric Fishman has put together – it’s like watching TV, complete with high-quality titles, transitions, and great audio. Many people think YouTube is the standard for Internet video, not realizing how bad their proprietary compression and streaming technologies are (great for putting up cell phone video of a dog chasing its tail, but not great for anything you want to watch or listen to for more than 60 seconds). Some others of the many interviews he’s posted: David Winn of e-MDs, Tee Green of Greenway, and former Congressman Richard Gephardt. It’s really interesting to see and hear these folks directly. I saw Dr. Eric and he was working his butt off at HIMSS, seemingly everywhere with his camera crew. I think EHRtv is brilliant. I keep bugging him about how it works technically, so he’s probably pegged me as a fanboy stalker.

Thanks to everyone who completed my reader survey. I’ve already got a to-do list of reader-stimulated ideas that I’ll be putting in place. One expressed concern that the survey implied big HIStalk changes, even though it’s the same old survey I’ve been using for years. Not so — I’m not looking for new sponsors, planning to make any part of HIStalk a fee-based subscription, or adding new kinds of advertising (to answer specific speculation). I’ve been extremely fortunate that companies e-mail me saying they are interested in sponsoring, I e-mail back a rather primitive information sheet on page views and all that, and they either sign up or I never hear from them again. Probably 90% of those who get involved do so simply because they derive value from reading HIStalk and want to give something back (I know that sounds hokey, but I’m happy to report it’s absolutely true). Anyway, if you like HIStalk in its decidedly amateurish form, you will be pleased to know it’s not going to get any slicker (but you will like a few tweaks that were suggested, I think). I sent Inga the results Friday evening and got her “wow, they really like me!” reply minutes later, so she’s happy she scored well in the “what parts of HIStalk do you like” question (I rated her highly myself). And the question that had us both preening: “Over the past year, reading HIStalk has helped me perform my job better.” Those answering yes: 79%. That’s the ultimate metric and I’m really proud of it.

One other item from the survey. I’m surprised at how many industry newcomers read HIStalk to learn about healthcare IT (a third of readers have been in HIT for less than 10 years). I’m going to do whatever I can to better serve that audience. Some folks said they are ashamed to admit that they don’t know some of the acronyms or products I mention, while others said they would find great value in having HIStalk content segregated by topic (so if you wanted to see everything about Cerner, for instance, you could look in one place). I don’t know where I’ll find the time, but I may try to put together something like that in some kind of encyclopedic format, maybe with reader contributions (that screams Wiki, doesn’t it?)

People have asked about being able to view article comments easier. Options:

1. Click the Show Comments link at the bottom of an article to display the comments posted for it.
2. The Recent Comments list in the right column shows the most recent commenters and which post they commented on.
3. I just added a new Comments Page that shows the first few lines of the 30 most recently posted comments. If you see one you like, you can click the title to jump to the article, or click the commenter’s name (below the blue box) to jump directly to that comment (this is a new WordPress plugin that I installed to try to address the reader’s comment question).

Picis is offering a free Webinar called Best Practices to Help Improve Clinical and Financial Performance in the ED on May 12.

The local paper covers the ED computerization of A.O. Fox Memorial Hospital (NY). It’s McKesson, I believe.

Most of you (60%) don’t know or don’t care about Oracle’s acquisition of Sun, according to the last poll I ran. It will be a good thing for HIT, said 22% of respondents, while 18% said it will be bad. New poll to your right: if you are in hospital management, is the financial mood better or worse than it was in early winter when both the economy and the weather were bleak? Some say it’s looking up in general, so I’m interested in what’s going on at your place.

Someone posted a YouTube video of a demo of Cerner PowerChart using MPages at Lucile Packard Children’s Hospital at Stanford. MPages allow creating scripts or Web pages (including AJAX apps) that launch from tabs on the Millennium application screens. It’s pretty cool to see information widgets being dragged and dropped to create a custom Web page like iGoogle.

On HIStalk Practice: Dr. Lyle on information overload, Dr. Gregg Alexander on the creatively maladjusted, and our usual medical practice-related news and snark. If you want to be a guest author, either one-time or ongoing, let me know.

Markle Foundation releases its report (warning: PDF) on “meaningful use” and “certified or qualified” EHRs. Its seven principles: clear metrics are needed; use of information and not software alone should be the goal; use of existing electronic information such as medication lists and lab results should be rewarded first; ambitious goals should be phased in; EHR certification must include capability to achieve meaningful use and to also address security and privacy; ARRA support should include lightweight, network-enabled systems and not just big iron EMRs; and patients and families should be able to put their EHR information in whatever personal health record system they like. A bit different from the HIMSS “buy more stuff” approach, although both emphasized outcome metrics. The gripe with both: representation was heaviest from vendors and high-profile nonprofits whose people have the time to spend on non-revenue generating activities (unlike the average small-practice doc who’s trying to survive and, despite the preponderance of healthcare they deliver, who is also minimally represented by all these thought leader think tanks proposing their future).

Jay Parkinson gets more press than anybody else who’s running a three-doctor practice for primarily healthy, young, cash-paying patients, so it’s not surprising that Newsweek picks up his story, complete with the requisite hipster fawning (although at least omitting the usual GQ-like stubble-and-black-pants photo shoot), but also pointing out that his radical model benefits himself as a capitalist more than society in general. He follows the usual script, bashing insurance companies, EMR vendors, “old people” (meaning anyone on the wrong side of 40, apparently), and anyone who doesn’t spend their day on Facebook (“We’re starting with those who get it. Facebook started in 2004 at Harvard. It wouldn’t have started with old people. But you know what sucks? Now your mom is friending you.”) You know what sucks? Having a problem like a heart attack or chronic illness and learning that your franchised 2.0 photogenic IM-and-Facebook doctor doesn’t want anything to do with you. That’s where most of the value (and expense) of the healthcare system exists, not in having someone willing to bike over to your loft to prescribe sore throat ampicillin before your midnight poetry reading.

Hospital layoffs: Metrohealth Medical Center (OH), 270, Reading Hospital (PA), 106.

The former IT director of a Houston non-profit organ donation center pleads guilty to deleting its electronic data (including backups) after she was fired in 2005. She’s facing up to 10 years in jail.

Where will this fit in the PHR and financial responsibility market? Quicken Health Expense Tracker, a free, Web-based tool available for customers of a few insurance companies.

Number of hits Googling “swine flu”: 263 million. Number of deaths of US citizens from it: zero. Value to TV stations, newspapers, and J&J, the makers of Purell: priceless.

EMR vendor MedLink International says it has signed a deal with CBS Radio to develop what it seems to think will be a WebMD competitor, a revenue sharing portal tied to six New York affiliates of CBS (formerly Infinity Broadcasting, currently in near-collapse after Howard Stern left for Sirius). Unlikely. In the mean time, the one to beat might be Everyday Health, a mashup of several other sites that bought Revolution Health’s old site and draws more traffic than WebMD.

Odd: an illegal alien who gave up custody of her severely brain-damaged four-year-old daughter while fighting a drug charge and being evicted for not paying rent is fighting deportation and trying to regain custody. The daughter is a citizen since she was born here; at stake is the potential multi-million dollar proceeds of a lawsuit against Vanderbilt University Medical Center, which the mother claims caused her daughter’s problems by puncturing a vein.

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CIO Unplugged – 5/1/09

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

Do You Have What it Takes?
By Ed Marx

I landed on the bottom of the ocean, staring up at the surface. Before I could process what happened to me, I was ripped out into the watery abyss. I paddled toward the light, broke through, and gasped for breath. Only seconds before, I’d been standing high upon a rocky outcropping along Kauai’s Na Pali coast

Spring Break of ’88 began well. Free tickets to Kauai to visit my in-laws and introduce them to our baby boy. During his grandparent cuddle time, my wife and I made our way down Kauai’s north shore to get an intimate look at the magnificent Pacific. We took advantage of a photo op before heading back up the lone path. I stood at the edge of the rock several meters above the ocean surf. I smiled, said “cheese,” and a second later, we were both overcome by a wave that took me out to sea.

Bloody knees, winter surf, rocky shoreline, I was in danger. Swimming parallel to the shore while outmaneuvering the breakers was not easy. Pummeling waves and the force of the undertow zapped my energy. I was scared. Gradually working my way closer to shore, I prayed the waves would not crush me against a wall of boulders lining the island. Three to four people met death that way every winter on Kauai. After much prayer, my feet touched solid ground. I scrambled up cliffs before the tide reclaimed me.

Although I’m an active tri-athlete, I’ve purposefully avoided the ocean. I’ve tackled lakes and rivers but never the open sea. I’m still afraid. Then an opportunity opened up for me to race in one of the sports foremost events, Escape from Alcatraz. I considered passing it up but instead said yes. If I didn’t face my fear, it would own me. On June 16, I hope to make swim way across the San Francisco Bay, avoiding all sharks and undertows.

I once feared public speaking, too. Now I love it. Despite a familiar nervousness that arises before each gig, I press on. To practice and hone the skill, I now look for speaking opportunities.

I feared challenging business peers, respectfully, of course. After I overcame that, I conquered a fear of challenging my managers. Iron sharpens iron, as they say. We experience growth by pushing each other onward toward a greater purpose.

Many who feel “stuck” in their careers are likely limiting themselves out of fear. Are you afraid to rock the boat? Do you comply dutifully with every request even though you know a better way? One way to accelerate your career is to continually pursue growth; second, is a willingness to combat fears—not letting the own you.

Do you fear getting fired for speaking up? How about being wrong or laughed at? I’ve been there, too. Others fear success and the additional performance expectations that come with it. Embrace your fears. Confront them. Then experience freedom.

One of my present fears is dancing an entire song with our Argentine Tango instructor. I can handle learning an individual move, but the pressure of a complete dance with an expert just kills me. I sweat. I forget how to speak. I even forget the move we just learned. But I’m smart enough to understand that unless I tackle this head on, my skills will not grow beyond what I know today. And that is unacceptable. I won’t tolerate complacency. You shouldn’t either.

Reflect and write down your fears. Be brutally honest with yourself. Then attack them one-by-one, with purpose. You will be amazed at the results. And I’ll bet you’ll find you’re not alone. Not only will you grow, but so will your family and employer.

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 5/01/09

From Francisco Respighi: “Re: Sutter. Massive layoffs soon to be announced (by mid-May) at Sutter Health Information Services. According to an enterprise-wide communication today from Sutter CIO Jon Manis, the poor economy is to blame for the layoffs and the de facto termination of the Epic project. The economic downturn has in turn meant that affiliates cannot fund the adoption of the Epic EHR (an interesting spin, since it was Sutter Corporate, and not the affiliates, that mandated adoption in the first place). Officially, the Epic project is merely delayed at Sutter. However, the announcement then goes on to say that nearly all Epic staff will be terminated. Nowhere in the communication from Mr. Manis is the enormous cost of the Epic project itself cited as a root cause of the current fiscal crisis at Sutter.” Unverified. If you can confirm (say, with an electronic copy of the e-mail) then talk to me.

From Del Fuego: “Re: CCHIT. Bobbie Byrne has updated her LinkedIn profile to indicate that she works for CCHIT now.” Link. The pediatrician and former Eclipsys SVP is now clinical director at CCHIT.

From The PACS Designer: “Re: Twitter brain waves. Mr. H is skeptical about the usefulness of Twitter, so TPD wants HIStalkers to judge and comment about a University of Wisconsin participant in Epicland who used his brain waves to complete ‘GO Badgers’ by focusing on the R and S on the screen to complete the Badgers cheer! To complete the assignment, the participant focused on the letter N to complete the statement ‘Spelling with my brain’. The messages can be sent by focusing on ‘Twit’ at the bottom of the screen. Next, TPD wonders if he can spell a brainy ‘Faulkner’?” Link. At least we now know at least one Twit who thinks before Tweeting.

From Bogo Pogo: “Re: HIStalk. Any plans for a mobile version?” I confess that I don’t exactly know what that means. I can read HIStalk on the BlackBerry Bold and it reads fine, so I assume it’s hitting the WordPress Mobile plugin that’s been in place since the beginning. Is there something else needed to support mobile devices? Say, I could write the whole thing as a series of Tweets!

From James: “Re: Kaiser flash drive. The USB drive is password-protected (I got mine today) and the clerk gave me a wireless keyboard to enter my password twice. The data file is a PDF so almost anyone can view it if you have the password.” I’ve always been a big fan of using scanning and PDFs as a simple but highly cost effective (and paperless) electronic medical record. I like Kaiser’s approach.

Listening: great surf music from The Neptunes.

Just announced: athenahealth’s Q1 numbers: revenue up 41%, EPS $0.12 vs. $0.09, hitting earnings estimates.

Doylestown Hospital is featured on Apple’s iPhone 3G page for rolling iPhones out to docs, including giving them mobile access to Meditech. I got my Consumer Reports today and was amazed at how well Apple did in the computer reviews: #1 in all three laptop screen size categories, #2 in desktops, and #1 in support in both desktop and laptops by far (81% and 84%, respectively, blasting the #2 vendor with 55% and 61%, respectively). Of course, Apples cost twice as much, so you could buy two of anybody else’s and keep one as a spare for the same money.

Medicity and Intermountain Healthcare will host a free Webinar called “A Data-Driven Approach to Improving Hospital and Physician Care Collaboration” on May 14. And speaking of Medicity, the company’s new CMO, Gifford Boyce-Smith, will speak on translational medicine at the Delaware Health Sciences Alliance research conference next Wednesday.

McKesson employees in Carrollton, TX spent time putting together care packages and notes for wounded veterans in VA hospitals last week. Nationally, 14,000 McKesson employees created 16,000 of the packages.

David Blumenthal follows the current administration’s mantra: we believe in the free market in theory, but sometimes it doesn’t work and the government can manage it more efficiently (which generally means: Bush and his cronies were dangerous fools and anything Republicans advocated must be repudiated by expensive and massive retaliatory government intervention). Speaking Thursday about healthcare technology, he said, “It is clear that this field has not advanced (enough) … when left exclusively to the private sector so there is a public role” Sounds good, except when surveyed, the public didn’t give a whit about healthcare IT. Your benevolent government knows best, as it constantly reminds us.

I just realized that it’s almost the end of the month as I write this, so I checked the HIStalk stats (that’s Inga’s territory, so I generally stay out of it). Shazam! Over 90,000 visits and 126,000 page views for April, breaking the record set in March by over 15% and up 66% from a year ago. I can only say thank you for contributing to that number by reading. I can’t imagine the stats going up since surely it’s at the saturation point, but I was saying that a year ago. Maybe the industry is bigger than it looks sitting here alone and staring at a keyboard and monitor for hours.

CERN shares hit a 52-week high today, topping at $54.71 and closing at $53.80. Above is a five-year stock chart that you can’t read because I had to shrink it to fit, but it shows Cerner share price (blue), McKesson (green), Eclipsys (gold), and GE (red). Go Neal (he’s not just doing it for you – he owns $303 million worth himself).

Bored at work? Try Internet sensation Swinefighter. It’s lame, but addictive.

Jobs: Senior VP of Sales, Technical Project Manager, VP, Finance and Administration.

Consumer Watchdog says it has proof that Google used paid lobbying firms to try to influence the government on the economic stimulus act, which it speculates (without proof) means the company wanted the right to sell medical data. Google says it was lobbying to support healthcare IT standards and to protect consumer privacy. Consumer Watchdog says fine, prove it by releasing your lobbying records. End Act 1.

It’s like one of those cheesy used car companies that offers to loan you down payment money until your tax refund comes: IBM makes $2 billion available to customers who don’t have the patience for their government checks to arrive. Come on in, everybody rides!

Siemens announces Q2 numbers, with revenue and profit up big.

Another doctor criticizes electronic medical records in a national publication, Time in this case in a story called How to Fix Health Care: Four Weeds to Remove (Larry wasn’t one of them). One of the four weeds identified as choking off the medical garden is Computerize Everything. “It’s a complex topic that boils down to this: If we who do the medicine thought more computers would save us money, we’d buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country’s medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time-consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it’s pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.”

Sams’s Club says it’s ready to sell eClinicalWorks (although it manages to spell the company’s name wrong in the headline, putting a space before the “Works” part). I did a Google site search to find the page, which doesn’t come up in the site’s own search.

In Europe, Ronald Verni, former CEO of Sage Software, is named non-executive director of charge master software vendor Craneware.

An Ohio State University medical professor and cervical pathologist says his employer demoted him, cut his pay by 60%, and took away his laboratory after he publicly accused the university of botching tests for human papillomavirus. He’s concerned about the incorrectly diagnosed women, but the $100 million he’s suing for will apparently assuage his anguish. Since every TV addict in America feels qualified to judge people based on a superficial knowledge of whatever’s being judged, I’ll side with him since he sounds sincere and is amply qualified.

E-mail me.

HERtalk by Inga

From Newlywed: "Re: Nobel Prize winner’s survey on women and mood lifting. Heck yeah … I think he is dead on. For me, sex and eating … helllooo? Unfortunately, I travel for my job, so I don’t spend many nights at home for the sex with my perfect, divine husband. But man, do I get to eat!"

From Lynn Vogel: "Re: MD Anderson and facilities. Appreciate your comments re: importance of facility ambiance to patients. Cancer patients face significant challenges and in many cases truly ‘life or death’ choices. Notwithstanding Mr HIStalk’s views about the relationship between the egos of healthcare CEOs and their facilities, it is easy to dismiss the importance of surroundings in providing a supportive and comfortable environment in which such choices can be made. And I would venture a guess that those most critical of healthcare facilities are those who have not had to experience them from the patient’s point of view."

DocuSys and CPSI team up to install DocuSys’ anesthesia solution at at Muskogee Community Hospital (OK). I have actually been to Muskogee, the town that Merle Haggard was proud to call home. I am pretty sure I ate some ice cream from Braum’s. Ymmm.

Silver Hill Hospital (CT) signs a five-year agreement with Medsphere to provide implementation, training, and support of Medsphere’s OpenVista EHR.

Froedtert & Community Health (WI) signs up for Epic Systems’ Care Everywhere network. The Care Everywhere network is designed to connect EMR information between different Epic systems and as well as third-party EMRs. Froedtert & Community Health is the second health system to sign up for the network, which the health system claims cost them $60,000.

McKesson promotes Randy Spratt to the newly created position of Chief Technology Officer. Spratt will also maintain his current role as executive VP and CIO.

Note to all you road warriors: while in a plane, experts recommend you sanitize your hands before eating and drinking, after retrieving something from the overhead bin, or after returning from the restroom. A little Purell and you cut your chances of getting infected by at least 40%.

Virtual Radiologic posts first quarter net income of $1.39 million ($0.09 per share), compared to $2.00 million ($0.12 per share) in the prior year period. Adjusted net income was up 40% from last year, coming in at $2.51 million, compared to 2008’s $1.88 million. Revenues rose to $28.6 million for the quarter, up 23% from last year.

Online learning and survey vendor Healthstream releases their Q1 financials showing net income of $878,000 versus $66,000 last year. First quarter revenue grew 19% over the previous year to $13.6 million.

If you are considering bariatric surgery, here’s some good news. Individuals with bariatric surgery reduce the prevalence of disease by 25%, compared the morbidly obese. Also, the rate of post-surgical complications has fallen 21% since 2002. Overall complication rates have also dropped (from 24% to 15%). Fewer complications also translate into lower cost of care.

Merge Healthcare announces its third straight quarter of positive net income. For the first quarter, Merge had net income of $2.8 million compared to a $7.9 million loss a year ago. Revenue was up 11% from 2008.

Researchers at Brigham and Women’s Hospital (MA) and Massachusetts General Hospital find that the use of integrated computerized medication reconciliation tools and process redesign were associated with a decrease in the number of unintentional medication discrepancies.

E-mail Inga.

Readers Write 4/30/09

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note to the US Healthcare System: Treat Me Like a Dog
By Peter Longo

I think everyone knows the US healthcare delivery system seems to have more challenges than solutions. From my vantage point, working in healthcare technology,I sometimes wonder if we can ever put all the crazy puzzle pieces together. I never thought that one day, soon after a long overdue physical and a trip to my dog’s vet, I would deem it in so need of repair that I begged to be treated like a dog.

Recently my beloved dog Hamlin’s digestive system grew tired of his “Cowboy Chow” dog food. Without a moment’s notice, my wife quickly went out and purchased him three other kinds to choose from. (I wonder if tonight I complain about dinner, will my wife run out to three different restaurants and find me something I prefer?)

Even the newly purveyed dog food did not settle Hamlin’s stomach. My wife, busy escorting three kids about town, informed me I had to take him to the vet. Since I work for a healthcare technology firm, I assumed going to a doggy doctor would be fun and enlightening; a respite from seeing human hospitals and doctor offices.

Hamlin and I eagerly pranced into the office with me ready for the inevitable “doctor wait”. Interestingly enough, I was greeted at the counter by a smiling receptionist calling out Hamlin’s name. But of course, they were expecting him because he had an appointment! Wow, novel concept here I thought.

Next I had my wallet out, ready to be accosted for money before I could even get a quick question in. Before I could eject my credit card, the side door opened and a smiling “nurse” asked Hamlin to come this way. (I assumed they were smiling because they were going to make a fortune out of me). Guarding my wallet, I followed our escort down the hall. I was still dazed from the fact they were expecting us and recognized Hamlin.

As we entered our exam room, I was perplexed to see a shiny new notebook computer on display. Before I could gasp in shock, the vet walked up behind me, introduced himself to Hamlin (the patient) first, then to me. Casually, he turned toward his shiny new laptop and within two key strokes had Hamlin’s medical record on the screen. My dog’s entire record. Looking like the complete geek that I am, I jumped at the vet asking to see everything on the system.

Eyeing me as though I might be in need of medical help myself, he leaned back to show me Hamlin’s electronic medical record. His life history, his owners, where he was born, any past medications he had, everything. Even his lab results were in there. The polite but guarded vet then showed me three other exam rooms, all equipped with shiny new laptops, all with Hamlin’s record available on them.

After a quick and thorough exam, the vet punched a few more keystrokes. He electronically ordered various lab tests — right then and there! I asked him about the firm that performs the tests and he told me the lab he uses provides great service and is top notch. He said the lab results will be sent back electronically and into Hamlin’s file directly! (In a moment of serendipity, I later discovered it was my company’s software providing the lab with the tools to accomplish this small miracle).

As I left the room and approached the front counter, a nurse had a prescription waiting for me along with three cans of super special dog food. Now I was really confused — is it not the patient’s job to walk the prescription and files to the front counter? Did my paper shuffling job just get outsourced to a computer? Adding to staff’s perception of my total geekiness, I asked how she did that. With a slight chuckle, she showed me the computer screen where the doctor requested it from the exam room. It just angered me to see such efficiency. I know my kids feel Hamlin deserves only the best, but better healthcare service than me? Adding injury to insult, I paid only $55 for the visit.

Hamlin’s enlightening experience really made me think of my own recent medical episode. A few weeks earlier, I went to my annual check-up. I scheduled the appointment and diligently showed up on time. As I checked in to see my doctor, one hand shoved a clipboard in my face, while a second hand went for my wallet. No verbal communication yet. Even though Hamlin theoretically can’t speak, he was treated to verbal communication and a custom greeting. I then proceeded to brush up on pop culture in a six-month-old People Magazine (I did not know Britney had a second baby and broke up with K-Fed?) while waiting 27 minutes for my appointment. If only someone told me how long my wait would be — but hey, that would take the fun out of guessing when I would be home.

I finally entered my exam room to be greeted by a nurse,a sheet of blank paper and a $.25 pen. She took my vitals. Later, my doctor sashayed in with that same high tech paper but a more expensive pen (with a drug company’s name on it) to drill me further. As all checked out fine, he indicated he needed some lab work to complete the exam. Amongst some forms floating on a table (uncomfortably near my half-clothed rear end) he found an order sheet. He checked a few things here and a couple things there then gave me the nod to transport the paper across the hall; then my lab orders and I waited some 18 minutes more.

A couple of weeks after my exam, I received my lab results “in the mail.” Next to each test result, the doc was kind enough to scribble an “OK.” Then a nice hand-written note claiming, “All looks OK, see you next year.” I put that report in a sophisticated manila folder and filed it. Why did I have to have this manual, impersonal, medical experience right before my vet visit?

Dazed and confused after leaving the vet, I wandered back to our house. Upon opening the door, my three kids showered Hamlin with love. They rubbed his back, gave him endless kisses and asked him easy softball questions. “Have you been a good boy?” My wife brought over doggie treats and “king” Hamlin relaxed on his back as the kids indulged him full of treats. My life quickly went to the store to find him “the best food money can buy.”

I was left standing at the door waiting to even be recognized. I sure did not get any kisses, let alone a back rub. I put myself on the couch and wondered if anyone was going to fetch me a treat. I would have been happy if one of my three kids just pushed the remote closer. As I stared at a blank TV screen, it dawned on me … I really need to be treated more like a dog.

News 4/29/09

From Ralph Curmudgeon: “Re: Kaiser’s flash drive PHR. Kaiser’s offer of the flash drive has the same inherent problems as shoving a stack of papers and an x-ray folder in the patient’s hands. Unless the drive is encrypted and the patients have the computer skills to use it, it’s effectively worthless. Besides, I’ll wager >50% of them end up getting lost – just like the paper records. The average Joe and Jane out there – particularly the elder ones – aren’t ready to haul around electronic records in the pocket or purse – heck, they can hardly understand their treatment bill. Now injecting them with a re-programmable chip in their upper back – like Rover – that’ll work.”

From The PACS Designer: “Re: Seesmic/TweetDeck. As Twitter gains more popularity, there are enhanced free applications that will manage all your Twitter favorites and also allow you to manage photos and videos to give you a ‘video Twitter’. One of them is Seesmic, created by a French company, which competes with another application called TweetDeck. TweetDeck has had some memory leak problems that are now supposedly fixed according to Adobe, so Seesmic appears to be the better choice to track Mr. H’s, the Candid CIO’s, and Labsoftnews’s Twitter posts along with others.” Link. At the risk of sounding tragically un-hip, I have to admit that I’m already sick of Twitter even though I do basically nothing with it. At least blogs required minimal effort to actually write and post the usual vapid, dull comments. Twitter makes it easy for Twits to expel a never-ending, 140-character flatus stream of “what I’m doing right now” self-indulgent babbling (as long as the activity allows keeping at least one hand on the keyboard) that puzzlingly finds an audience of people willing to read it. People complain that they have no free time, yet they apparently use what they do have screwing around with World Wide Waste of Time applications that provide the illusion of usefulness.

From Leon Poncey: “Re: cyber-attack. Thought this might be interesting to HIStalk readers.” Link. An interesting recap of an incident in California where unidentified individuals crawled into several manholes (they’re never locked, of course) and cut eight fiber cables, causing a loss of 911 service, cell signal, landline telephone, broadband, alarms, ATMs, credit card terminals, utility monitoring applications, and the hospital’s internal network (which apparently had some unexpected dependencies). Repercussions were fascinating: the hospital went to paper, stores accepted only cash, and employees were sent home. The only technology that worked was one of the oldest and least sexy: ham radio (I can say that because, being a nerd, I will admit that I was once a ham radio operator, at least until I noticed that it was like Twitter: the technology was ample to interconnect people from all over the world, but the people using it invalidated the entire premise because they had nothing interesting to say).
 
From Alter Ego: “Re: Halamka’s blog. I think he’s getting a bit egocentric, kind of full of himself. Does anyone really need to know about the details of his work spaces?” I already assumed he was full of himself, although I don’t know him. I actually kind of enjoyed the post that has pics of his digs at Harvard, BIDMC, and his home office, which is just a chair and a MacBook Air (I certainly enjoyed that post more than those Zen ones where he gets all moist talking about some bizarre flute he has dedicated his life to playing, his tea ceremonies, or climbing rocks). And, I have to defend us bloggers since there’s always some reader who launches ballistically when a couple of sentences didn’t hit his or her interests precisely. I get an e-mail something like this: “Oh my GOD I don’t read HIStalk to get (humor, music recommendations, guest articles, etc.) and I want the time back that it took me to read (the three sentences out of hundreds). Stick to the facts and leave that to the professionals (comedians, music critics, professional writers, etc.)” Apparently just skipping over those few words is too much of a challenge compared to writing out a complaint, so I have no idea how those folks can read a newspaper (“Oh my GOD I don’t follow stocks so please stop running that crap and stick with the sports and leave the investment talk to stockbrokers”). If Halamka wants to write about tooting his flute, then that’s his right, and anyone who can’t stand that should probably just read the personality-free trade rags.

From Deborah Kohn: “Re: HIPAA. I completely agree with your reply. Just a history reminder of this complex law. Prior to 1996, the public was demanding two things: 1) greater portability of health insurance between jobs, and 2) confidentiality protection of personal information and privacy protection of the individual – with a focus on health information. Consequently, the 1996 Kennedy Kassebaum Bill (K-2) or Public Law 104-191 or the Health Insurance Portability and Accountability Act (HIPAA) (and, given the 2009 ARRA HITECH Act, this 1996 law could be viewed as version 1.0 or 1.a), was introduced with the following legislative goals: Title I – Portability, which contains only one major component — ensuring that individuals between jobs are able to carry their health coverage forward or obtain similar coverage. Title II – Administrative Simplification, which contains four major components, which are the most publicized: 1) Unique Identifiers (for Employers, Health Plans, Health Providers, and Individuals); 2) Electronic Data Interchange and Coding Standards (the Transaction Set and the Code Set); 3) the Confidentiality and Privacy Standards for analog and digital records / documents (the Minimal Disclosure of Individually-Identifiable Health Information, the Control Over Sharing this Information with Outside Entities, and the Ability of Patients to View Their Information and Receive a Record of Access to Their Information); and 4) the Security Standards for digital records / documents (the Administrative, Physical and Technical Safeguards).”

The last plea of this particular telethon: if you haven’t completed my reader survey, would you? I’m already making my to-do list from the responses so far, but it’s not too late to register yours.

Not willing to take the chance that the government will define “meaningful use” of EHRs in a way it doesn’t like, HIMSS goes ahead and preemptively makes up its own definition and sends it off to CMS and ONCHIT for what they hope is rubber stamping. Its recommendations:

• Name CCHIT to be the EHR certifying body (no surprise there).
• Adopt interoperability per the specs of HITSP and IHE.
• Implement increasingly stringent metrics. For hospital systems, HIMSS wants metrics to be ratcheted down no less often than every two years to allow “health IT companies to make necessary modifications to their products, including the rewrite of legacy enterprise EMRs as necessary.” (Question 1: what enterprise EMRs are not legacy? Question 2: does anyone really expect products to be rewritten?)
• Evaluate best-of-breed and open source technologies fairly in their demonstration of meaningful use (note that HIMSS throws in a half-hearted but still eyebrow-raising acknowledgment that free software that competes with the products of its vendor members, saying “use of open source options can be cost-effective for some hospitals.”)
• For the first two-year phase (FY11), measures include use of lab, pharmacy, and radiology systems, along with a CDR (interfaced to “the patient accounting system” for some reason). Discrete clinical observations (allergies, problem list, vitals, I&O, flowsheets, meds) are recorded electronically, but electronic physician documentation is not required. Auto-capture of NQF quality measures is required. Hospitals exchange electronic information, but it can be in the form of scanned documents.
• For the second phase (FY13), 51% of orders must be entered by CPOE, e-prescribing to outside pharmacies must be in place, and systems follow whatever data output standards HITSP and IHE devise.
• For the third phase (FY15), CPOE goes to 85%, bedside eMAR/barcode verification is in place, evidence-based order sets and reminders are in use, and information exchange is underway with public health organizations and subunits of a statewide or national exchange. There’s a line about analyzing “pharmacokinetic outcomes resulting from patient medication interaction” that makes no sense to me.
• Most of the practice-based EMR recommendations are similar: clinical data display with CPOE capability and doctors entering their own orders, e-prescribing, and quality measures, followed by clinical decision support and interoperability.

My opinion: a pretty nice job. The standards are straightforward and measurable, although the practice EMR document doesn’t get specific about physician usage percentages like the hospital one does. It looks to me like they basically took the HIMSS Analytics EMR Adoption Model and made Stage 3 (minus the diagnostic imaging requirement) the first phase and Stage 5 the second (along with part of Stage 7 – capturing data in CCD format). Fairly ambitious, but it may go back to Obama’s early question about “what would it cost to get all hospitals to Stage 4”.

Microsoft creates a version of its Amalga data analysis tool for life sciences. They claim it connects information in ways that allow researchers to make new discoveries.

Cerner just announced Q1 numbers: revenue up 2%, adjusted EPS $0.52 vs. $0.47, beating estimates of $0.51 by the usual Cerner penny (but light on revenue, so shares are pricing down). Nobody I know is buying Cerner systems, but they are managing their business with great skill, working the recurring revenue stream and managing expenses to keep Wall Street happy. 

UK’s NHS threatens to give BT and CSC the boot if they can’t get their Cerner and iSoft systems, respectively, up and running in at least one large hospital by November.

Joel Selanikio of Georgetown University (and of his own company, DataDyne) wins a $100,000 Lemelson-MIT Award for Sustainability for developing the open source EpiSurveyor mobile healthcare survey software.

Continua Health Alliance wins the American Telemedicine Association’s award for innovation. The ubiquitous John Halamka’s quoted congratulations on behalf of HITSP are included for some reason.

Palomar Pomerado Health is offering, without a prescription, the personal genetic testing kits of Google-backed 23andMe.

Southeastern Regional Medical Center (NC) promotes Eric Harper to CIO.

Sutter Health is reluctantly turning Marin General Hospital (CA) back over to the county next summer, so that means it will need new information systems. ACS gets a $55 million contract to install McKesson Paragon and support it through 2017. Former El Camino Hospital CEO Lee Domanico is running the transition team that will take over. The hospital originally said it couldn’t afford to pay him more than $264K, but he will make up to $779K a year under his two-year contract signed in January, a large pile of money for running a 235-bed hospital.

The University of Nebraska and the technology transfer organization of its medical center are suing Siemens Healthcare Diagnostics for patent infringement, claiming that Dade Behring knowingly sold laboratory testing systems that used technology the university had patented and licensed exclusively to Abbott Laboratories. Siemens AG bought Dade Behring in 2007.

Kathleen Sebelius is confirmed to become HHS secretary, but none of HHS’s 18 other key positions have been filled. I want Obama to succeed, but so far he’s just a cooler version of Jimmy Carter – lots of lofty goals, but incompetent when it comes to execution (how many times has he apologized for one gaffe or another in just his first 100 days or so?) Anyway, she’s in, but without a team.

A new study published in Archives of Internal Medicine found that computerized medication reconciliation reduced medication errors by 28%.

Total margins for Pennsylvania’s hospitals have dropped 12% in the past two years to –6.3% due to portfolio losses and more uninsured patients.

E-mail me.

HERtalk by Inga

From Old Coot: “Re: John Wennberg. ‘Too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives.’ In other words, let the old folks die off peacefully – and quickly – and spend more money handing out condoms to kids who won’t use them. Wennberg, who is no spring chicken, better watch out. His kids will be slipping that potassium chloride mickey into his Metamucil one evening. I wonder how Wennberg’s parents are doing these days . . ."

From Hair on Fire: "Re: insecurity. Glad you got back at Mr. HIStalk for his snarky comments about your insecurity (or was it his?) with your comment about the Code Blue band :> We chicks need to stick up for ourselves – and one another!” Thanks for the chick support. However, Mr. H created his comments  after mine, so I didn’t really have a chance to get back to him, although I did chastise him for letting the world know I was insecure (am I insecure about that?) The secret is now out. Will the adoring fans be disillusioned?

From John d’Glasier: "Re: Twitter. Doonesbury says it all: Tweets for twits. Twitter is adolescent narcissism.You can’t possibly said anything worth reading in 140 characters unless you believe American Idol, Survivor, and Are You Smarter Than a 5th Grader? represents the zenith of American entertainment – preparing you well for pop culture acceptance of anything without meaning, gravity, or importance." Here’s the strip. I was totally with you, John, right until the subtle slam on American Idol, which happens to represent the most entertaining three hours of my week (after reading Mr. H’s posts, of course.)

From Lucy Padovan: "Re: shoes. At the height of the dot-com era, some well-meaning but alcohol-befuddled colleagues thought I should be nicknamed e-babe, odd since I’ve never bought or sold anything on eBay in my life. Nonetheless, a friend sent this link to me and I wanted to pass it on. This is just shoe lover to shoe lover." What is there not to love about sexy crocodile pumps that retail for $2,650 that you can steal for a mere $630?

Clara Maass Medical Center (NH) successfully implements Axolotl’s Elysium Exchange, enabling ER, inpatient, and outpatient records to be shared electronically across the health system.

I have enjoyed reading the various posts about fancy hospital building, bloated budgets, etc. Here is my two cents. I visited a friend once who was at MD Anderson. If one day (God forbid) I wind up with cancer, MD Anderson is where I want to go. It felt comforting, current, and everyone was efficient, friendly, and supportive. The pretty building made a difference. Another time during my traveling days, I had the unlucky chance to spend the night at a hospital in a major city. At the time I didn’t know this, but it this hospital is considered one of the best in the country for the type of emergency I was experiencing. While the staff was great, the hospital itself was old and tired-looking and my room was dreary. I actually knew enough about healthcare to understand that such things don’t affect the quality of care, but, the lack of aesthetics didn’t aid my overall comfort level. So I am of the mindset that if someone wants to donate millions on pretty buildings, I’d like to say "thank you" on behalf of all of us average patients who rather be sick in an attractive facility.

United Hospital System (WI) selects Eclipsys Sunrise Enterprise clinical solutions for its multiple hospitals and clinics.

Medfusion names Bill Loconzolo chief technology officer. Medfusion provides online communication tools for healthcare practices.

A Nobel Prize winner finds the top five mood-lifting activities for women are: sex, socializing, relaxing, praying or meditating, and eating. (No mention here if the Nobel Prize person is a man who believes in the power of suggestion, but it’s not a bad guess.) Exercising and watching television followed closely. Near the bottom of the list were cooking, “(day-to-day) taking care of my children,” and housework. If you are in need of advice on how to be happy, Dr. Lobe has some tips for you. And if you are a woman, let me know how well these these five activities are working to increase the joy in your life.

Hard to miss finding information on swine flu, especially with all the tweets, podcasts, and up to the minute postings by the CDC/HHS, WHO, and every news agency out there. Personally I prefer the Google map that displays confirmed outbreaks by location (helpful for planning my next vacation.)

MED3000 gets a mention in a Wall Street Journal article that looks at various tactics by employers and insurers to motivate people to make healthier choices. Money, by the way, seems to be a good incentive.

Picis announces that the VA has selected Picis Critical Care Manager for its Veterans Integrated Service Network 12, aka the Great Lakes Health Care System.

Let’s hope that the US health crisis never gets this bad. A Japanese woman with headaches during labor is turned down by 18 hospitals that refused to accept her due to overcrowding or overly busy doctors. She had a brain hemorrhage and went into a coma, but a hospital that finally accepted her delivered the baby by Caesarean before she died eight days later. The Japanese ER crisis is blamed on a number of factors, including the aging of the population, economics pressures, and professional and legal issues. ER doctors are overworked, poorly compensated, and risk criminal prosecution (not civil) over malpractice issues. The government estimates that currently Japan has half the number of ER doctors required to serve the population (about 2,500 to serve 127 million people.)

E-mail Inga.

Monday Morning Update 4/27/09

From 13th Floor Elevators: “Re: traffic tickets covered by HIPAA. The clerk must have consulted our hospital’s HIPAA officer, who says employees who have babies can’t use hospital e-mail to tell their colleagues as it would be a HIPAA violation. This HIPAA thing needs a lot of rework. And, when was the last time you heard anything about the ‘portability’ in HIPAA?” HIPAA was a pretty good 1.0 effort, but it’s hopelessly outdated, seldom enforced, and watered down by special interests. Pre-Internet privacy laws and information systems are relics that really should be rewritten. As for portability, I don’t see much improvement, especially if you have a pre-existing condition (does “pre-existing” mean before you were born?)

From KitKat: “Re: MD Anderson Cancer Center. Layoffs Monday, with 16 anesthesiologists getting the pink slip.” MDA is looking for $280 million in budget cuts and will start cutting employees within a month. The best thing about the article was this reader comment: “I’m STILL trying to figure out why the new buildings at MD Anderson had to be so over the top lavish; almost like a shrine to cancer.” It’s not just MD Anderson. Lots of hospital executives I’ve known love building fancy structures as a substitute for the imaginary careers they gave up in private industry, always daydreaming that they would be running big for-profit businesses and flying around in corporate jets if they weren’t so selfless. It’s always rationalized that the community wants those magnificent edifices, despite the evidence that suggests what the community really wants is easier hospital parking, reasonable rates, a chance to get in and out of the ED without taking six hours, and interacting with employees who at least pretend to be empathetic. Unfortunately, those big buildings seem to make all of those attributes worse. I would trade all that architecture for a couple of good nurses (especially since you can’t see that imposing facade from your room anyway). Like financial institutions, when you’re selling an intangible, you have to convince customers that it’s real by spiffing up the storefront.

That reminds me of that consumer survey early in the stimulus talks about where they wanted to see healthcare money spent. IT was dead last. Fancy buildings would probably have been there, too, if respondents were asked to rate their importance. So why don’t we give our customers what they want instead of what we think is good for them? Maybe that’s more of that good old paternalism, where you just tell the patient not to worry their pretty little heads because the doctor knows best. You and I are healthcare consumers and patients, so if asked what we would really like to see changed, I bet it would be the easy stuff like what I mentioned above and not buying new IT systems. We want to be respected, informed, consulted. We don’t want to be inconvenienced, harmed by medical error, or infected. We would like to be able to afford the care we need. If IT (and those fancy buildings) can do any or all of those things, consumers will love it, but just having the IT without delivering the results won’t impress anyone except nerds.

 

I think I need to write a novel since I have this great story idea stuck in my head. Here it is. A fictional foreign industrial conglomerate, despite a generations-long history of shameful behavior (using death camp labor, bribing prospects to get business going back 100 years) wins a huge government contract. Champagne corks are popped back in the home office, stiff executives clumsily attempt fist bumps. Now comes the key scene: at that moment, dozens of unsmiling federal agents crash through the office door, armed with search warrants and evidence boxes. The big government contract had been a sting operation! The conglomerate has been caught red-handed after decades of improper government contracting! I’m trying to decide whether to portray the company’s competitors has having set up the sting, but I need to give that more thought. I’m picturing Dennis Quaid as the humorless government agency head, Maureen McCormick as his love interest, and maybe Rod Blagojevich in his big-screen debut as the conglomerate’s ranking executive. I dunno … not very believable, I guess.

The new BusinessWeek says EMRs may be a waste of government money in The Dubious Promise of Digital Medicine. Points: evidence that EMRs improve patient safety is scant, vendors like selling off-the-shelf systems that are hard to implement and maintain, and HIT special interests have kept government oversight to a minimum. Individuals are called out: Newt Gingrich for playing a heartfelt futurist when he’s getting paid by vendors, Nancy DeParle for having high-dollar Cerner connections, Glen Tullman for working his Obama connection, and McKesson’s lobbyists pushing policy ideas on members of Congress and of the Administration to reward clients for using their aging systems. Several negative hospital EMR experiences are cited. Also mentioned: vendors are pushing for CCHIT as the certifying body, knowing that a group led by a former vendor executive and started by HIMSS will provide a friendlier audience than FDA. OK, the article is all over the place and certainly sought out whatever high-profile negative stories it could come up with, quoting only those who had a bad EMR experience (who never blame their own organizations for choosing or implementing it poorly, of course – everything is the vendor’s fault). Worth a read, but only because lots of people will see it. Its conclusion, however, is entirely reasonable: we’re spending billions on systems developed even before the Bush administration (HW, not Shrub) that haven’t exactly lit healthcare on fire so far. As a taxpayer, you’re taking a bet with billions that a prudent gambler wouldn’t. Water under the bridge, though, so there’s no point pontificating about it now.

Is Apple developing a Mac Tablet and would it be a great platform for EMRs? Good article, good reader comments.

An interesting article on 12-employee Precept Health, a New Zealand startup struggling financially but winning big business over companies like Philips for ICU monitoring.

New poll to your right: what’s the impact of Oracle’s acquiring Sun? From my cheap seat, it looks like the showdown to be king of the technology world will be between Oracle and Google. The worst aspect is that Oracle gets MySQL, Oracle’s main (free) competitor that powers much of the Internet (including HIStalk). Oracle hates Microsoft, which is already wheezing, and can inflict serious damage on it by attacking its Office and SQL cash cows with Sun’s free alternatives. Since Oracle is still buying everything in sight, what if it picks up Red Hat? (IBM better strike fast if it still wants to be a playa). Microsoft hasn’t made a good acquisition in years. Proclarity in 2006, maybe, but that’s niche; I can’t think of anything else other than Visio in 2000 since the Great Plains deal didn’t make sense to me. Everything else seems to be add-ons to fix holes in existing products, not anything innovative.

Interesting in the definition of “meaningful use” of EHRs? The VA will provide a live audio broadcast of Tuesday’s NCVHS meeting, which will attempt to create one.

Fujitsu announces its new EMR in Japan: HOME/EGMAIN-GX V2  (don’t they have marketing people over there who could come up with a name that might actually be remembered?) The only Web pages I could find were in Japanese, but it appears to do orders, meds, bed management, and diagnostic imaging.

Reader survey. Important. Complete, please. Thanks.

The economy may be wearing you down a little, but at least nobody’s moving you to a desert and planting bombs in your front yard. Major Patrick Baker is a citizen-soldier and chief nursing officer at Madison County Hospital in London, Ohio, deployed since January to Balad, Iraq as Flight Commander, Flight Clinical Coordinator Team of the 332nd Expeditionary Medical Group, the largest trauma center in Iraq. He organized a charity marathon in Iraq to coincide with one in his hometown, recruiting 400 airmen, soldiers, and sailors to help raise $8,400 for the American Heart Association in honor of his six-year-old daughter Ellie, who was born with multiple heart problems. Tired of manufactured “heroes” like shallow TV stars and exorbitantly paid athletes? You can e-mail a real one. HIStalk Practice contributor Dr. Gregg Alexander knows him and sent me a link to the video.

Senator Jay Rockefeller (D-WV), chairman of the Senate Finance Subcommittee on Health Care, introduces legislation that would create an HIT Public Utility Model that would provide grants to safety net providers that would cover the cost of implementing open source systems plus five years’ maintenance. It would also create a HIT Public Utility Board within ONCHIT to over see the program. He says, “Open source software is a cost-effective, proven way to advance health information technology – particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field – by making health information technology a realistic option for all providers.” I like it. Jay’s kind of doing his own thing here without being steered by lobbyists and HIMSS, proposing a solution that could put more HIT in the field without just dropping big dollars on private companies. I just wish that, when we talk about open source, it covered more application ground than VistA. It’s good, but not exactly cutting edge, and the number of potential community members is limited to those who happen to know MUMPS programming. 

Kaiser Permanente offers members a $5 USB flash drive containing their basic medical information and recent encounter data. A secretary downloads the patient’s data while they wait. But, they have to show up in person to get it. The article omits the most important fact: how do doctors access that data in case of emergency, which is the whole point of getting the USB drive in the first place? Hopefully it is easy, does not require loading anything on the doctor’s PC, and doesn’t require a password if the patient is brought in unconscious. Maybe someone should invent a hardware or software token that would positively identify a PC user as a doctor so they could be given elevated privileges to open the medical files of patients.

Forbes profiles Steve Schelhammer, a former teacher and yearbook salesman who formed disease management company Accordant Health Services, sold it for $100 million, and is now CEO of Phytel, which analyzes EMR data to find non-compliant patients and sends them messages asking them to schedule a visit. Practices pay for the service, but benefit from increased visits.

E-mail me.

News 4/24/09

From Harry Reems: “Re: EHR certification. Do hospitals using an internally developed EHR have to get CCHIT or someone else to certify it to be eligible for HITECH incentives?” I’ll throw out a guess of “yes” given the inordinate confidence placed in CCHIT so far to decide whether a given product is one taxpayers should help pay for, but surely someone knows more than me.

From Eldridge Dickey: “Re: Dubai. I’m curious how bad things have gotten there after all the healthcare IT activity last year. Not much reporting in the mainstream news.” Ms. Adventure provided a bleak assessment in February, but has not sent updates since. First-person reports are welcome.

From The PACS Designer: “Re: VA private cloud. InformationWeek reports that the move to create ‘private clouds’ as a test bed for a cloud computing platform is gaining momentum among the advanced IT developers. Even the VA has started to experiment with a private cloud called ‘Health Associated Infection and Influenza Surveillance System’.” Link.  

An update on the federal raid at Siemens Medical Solutions in Malvern, PA. Nobody’s saying officially what the feds were looking for, but rumors are that it could relate to an earlier whistleblower lawsuit claiming that Siemens did not give the government its lowest prices. That would align with who did the raiding: the criminal unit of the Defense Department. It may be connected to the $267 million contract the company won just three weeks ago to sell imaging equipment to the DoD. There’s a lot at stake since supplier fraud falls under the Federal False Claims Act (aka qui tam), which calls for damages equal to three times the overcharge plus up to $11,000 for each individual “false payment demand,” meaning each bill, invoice, contract, etc. Every one of the biggest judgments and settlements under that act involved healthcare: Tenet ($900 million), HCA ($731 million), HCA again ($631 million), HealthSouth ($325 millon), and a slew of drug companies and miscellaneous specialty care organizations. Siemens has previously admitted and paid billions in damages for bribery, falling under the US Foreign Corrupt Practices Act since it’s a German firm. Interestingly, Siemens may have paid those big fines because the alternative was being banned from bidding on government contracts (the CEO of the company’s US subsidiary was reported to have said that he expects the company to get $75 billion of the $787 billion in federal stimulus money). All of that is unverified speculation, although I’m a pretty good speculator.

Listening: Garageland, defunct Pixies-like New Zealand indie pop.

Jobs: Meditech Financial/Billing Expert, McKesson Analysts, Senior Cisco Wireless Expert.

Housekeeping: if you want to get HIStalk before your competitors and co-workers, put your e-mail address in the Subscribe to Updates box in the upper right corner of the page (you should have seen the server load when I sent out the Siemens raid story, which thanks to a reader tip, went out here long before any of the industry press found it, probably by reading their own HIStalk e-mail update). The search box in the right column will dig through almost six years of HIStalk to find your name, your company’s name, or whatever industry term you like. HIStalk’s sponsors are an important part of the mix, so peruse their ads and check out what interests you (I need to thank Founding Sponsors Medicity and Nuance since I haven’t done that recently). And if you want to send me a rumor or something I’d find interesting, click the ugly green Rumor Report box to do that easily. Thanks for reading, by the way.

I get quite a few e-mails listing things individual readers love or hate about HIStalk (almost always the same things, just with opposing opinions). The best way to register your opinion is by completing my short, once-a-year reader survey. I’m not going to beige HIStalk down by turning it into a committee-run snoozefest that everybody tolerates but nobody loves since we’ve got plenty of industry choices for that, but I do reconsider my direction each year when the survey runs (it’s pretty much the same survey I’ve been using for years). Some are great ideas that are a bit lofty for a day-job guy, like undertaking major investigative reporting, convincing hospitals to provide detailed success stories, etc. (kind of amusing since people who work no more day job hours than me complain that it takes 10 minutes to read – it takes me FOUR HOURS to write it after I get home plus Inga’s time, so playing Woodward and Bernstein is probably not in the cards). Anyway, I promise to read and consider every survey response.

CPSI’s Q1 numbers: revenue up 2.1%, EPS $0.37 vs $0.32.

Hospital layoffs: Ministry Health Care (WI), 60 employees; Shriner’s (HI), 10.

The 21 horses that died during a Florida polo match suffered a medication error when a compounding pharmacy incorrectly prepared a vitamin product.

The King of Pork, Senator John Murtha of Pennsylvania, brings home the bacon to fund a desolate, barely used (three flights a day) airport bearing his name in the middle of Nowhere, PA: $200 million in earmarks for what watchdogs call a “museum piece” with fewer than 10,000 passengers a year (its only flights go to Washington Dulles) that will get a second runway, joining the $8 million air traffic system installed in 2004 that has never been used because there are no employees to run it. His Military Interoperable Digital Hospital Testbed, also in Johnstown, got $5 million of Murtha Money, which one might at least hope has something to do with the DoD-VA interoperability projects going on instead of just paying Northrop Grumman contractors to fly back and forth from DC on the taxpayer time (that’s probably the three flights a day).

Microsoft’s Q3 report: revenue down 6%, EPS $0.33 vs. $0.47, the first time the company’s quarterly revenue has ever decreased. Announced: no employee merit increases this year, no earnings guidance will be provided, and the upcoming quarter isn’t looking any better than the last one.

Healthcare Growth Partners releases its Q1 HIT transaction report (free PDF download). An interesting observation about recent M&A transactions: they involved either premium deals or fire sales.

One HIStalk reader always finds and sends bizarre healthcare news items, so here’s his latest. A male nurse whose former job was a stripper is suing his personal care home employer for sexual harassment, claiming he was propositioned, called a “pretty boy”, asked for lap dances and to provide bachelorette party performances, was slapped and pinched in the rear, and was referred to by elderly residents as “one of them go-go boys” and a “hootchie-kootchie dancer.” He claims he was fired because he’s a 55-year-old man who was not taken seriously by the mostly female nursing staff.

I’ve let Inga gradually do more of the research and writing for HIStalk Practice, so she posted solo last night while I attended to pressing day job duties. She’s cute and 1000 ccs of fun, but insecure: she e-mailed me almost immediately afterward to say, “I’m dying … was it OK?” Isn’t that adorable? I think she craves validation, so if you want to suck up shamelessly, she would probably be your immediate BFF.

Kryptiq sells its Choreo health plan contracting division to health plan software vendor Portico Systems to focus on its Connect IQ medical communications network.

Free Australian PHR vendor miVitals goes belly up for lack of funding because it has no partnerships like its big-name competitors, according to the Washington Post. With all the interest in PHRs (misplaced, I think), you would think its assets would be worth something. Perhaps this is the first of a wave of dot-com like PHR failures given that most of them don’t charge anything, usage is low, value is questionable even for free, and the big boys are using their clout. If you think doctors don’t like using technology that doesn’t fit their routine, try getting the average patient to do so.

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HERtalk by Inga

From John Moore: "Re: Health 2.0 conference. Health 2.0 remains an event that has a lot of cheerleaders, groupies, and technologists and unfortunately, not enough consumers/patient stories in how they are actually using all of these new Health 2.0 solutions coming into the market. The Health 2.0 companies who present don’t help their cause either, as virtually none of them presented any meaningful stats on consumer or clinician adoption and use of their technologies. That being said, there were some highlights including John Halamka, BIDMC and Roni Zeiger of Google Health talking through the problems of administrative data being exported out of a hospital to a consumer’s PHR, e.g., e-Patient Dave. Also, John Wennberg, lead author of the Dartmouth Atlas, gave a great presentation, best of show really, with real numbers about what is and is not working and some of the hard choices that need to be made, e.g., too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives."

Have an opinion on the how to define "meaningful use" in the HIT world? The National Committee on Vital and Health Statistics executive subcommittee schedules a gathering April 28-29 in Washington to figure it all out. The public is welcome and we’ve embedded a mole in the proceedings who will give us an update.

Ingenious Med, a provider of billing tools for inpatient physicians, raises $1 million in VC money to beef up its sales and marketing efforts.

West Penn Allegheny Health System files a complaint in US District against regional rival UPMC and Highmark, alleging conspiracy to protect one another from competition.West Allegheny’s chairman says, "We believe that for several years UPMC and Highmark have engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly." The financially troubled West Penn Allegheny announced operating losses of $9.1 million for the quarter ending December 31, leading UPMC to issue a statement calling the lawsuit frivolous and a  "tactic to divert attention from their own operating and financial difficulties." Can’t we all just get along?

Bate County Medical Hospital (MO) selects the web-based OpusClinicalSuite EMR for its 60-bed hospital.

Shameless plug: if you are not reading our new HIStalkPractice site, you are missing out. This week we had two excellent columns that are definitely worth a read. Dr. Gregg Alexander’s piece entitled, "Two Thirds of the NHIN by 2010 (or, Not Your Daddy’s CHIN)" is thoughtful, humorous, and well-written. Dr. Joel Diamond writes on the need to expand the use of natural language processing in EMRs, and throws in some hilariously immature humor in the process. We are also posting news and commentary twice a week on topics of particular interest to those in the ambulatory care space. Check it out and sign up for e-mail updates so you can keep up with all the cool happenings.

HIStalk sponsor MEDSEEK is hosting a free webinar April 29th discussing the patient-centered medical home and why it should be important to hospital executives. Here’s the link to sign up or learn more.

Valley Baptist Health System (TX) decides to outsource its IT services to PHNS and help the hospital complete its EHR implementation. The 10-year agreement allows Valley Baptist’s employees to remain as employees, but will be managed by PHNS.

An apparently confused city treasurer in Albany, NY sites potential HIPAA violations as the reason she cannot release copies of forgiven parking violations to city council leaders. Council members call the explanation "absurd."

Three ER docs and a computer guy rock Delaware in a band called Code Blue. Sounds like the perfect BFFs for Mr. H.

Gwinnett Medical Center (GA) contracts with InfoLogix to provide a wireless infrastructure assessment, followed by the development of a a customized mobile deployment strategy.

Random musing: the last couple of days I have followed Twitter, particularly noting the messages about the Health 2.0 seminar. At least half a dozen Twitterers were sending updates on virtually every word being said by the speakers. While at times interesting, I had to finally step back and ask myself if all these tweets were really adding value. I wanted to know what’s going on in the forest rather hear about every last tree. Am I the only one who feels that way? I’ve never been a huge fan of webinars or podcasts, probably for the same reason. In the past, I’ve worried if the problem is that I lack sufficient curiosity, but now I’m thinking the real issue is information overload.

Emergency room visits are up while the number of emergency departments are falling, according to a new Picis-sponsored study. As a result, patient satisfaction and ED performance have fallen over the last 10 years. The details are included in the final report, "Profiling Success: Managing Emergency Services in the Largest Health Systems,” which includes specifics on best practices from top performing hospitals.

St. Joseph’s Healthcare System (NJ) plans to implement the INFINITT Enterprise-wide PACS solution.

E-mail Inga.

Federal Agents Raid Siemens Medical Solutions Offices in Malvern, PA

Federal agents from the Defense Criminal Investigations Service raided the offices of Siemens Medical Solutions in Malvern, PA today, according to a Philadephia TV station. Agents armed with search warrants secured employee workstations, seeking documents related to the company’s military contracts.

UPDATE: Inga contacted Siemens and received this response:

Statement Regarding Government Inspection at Malvern Facility of Siemens Medical Solutions USA, Inc.

Malvern, Penn., April 22, 2009 — Siemens Medical Solutions USA, Inc., the U.S. operation of Siemens Healthcare, has been served with a search warrant. Siemens Medical Solutions USA, Inc. has and will continue to cooperate fully with the Government’s investigation.

Readers Write 4/22/09

Sense of Reality
By Greg Weinstein

I have been working on clinical systems and integration in an academic medical center for 20 years now and I am watching with growing concern the frenzy of the standards writers. Prior to going to HIMSS, I took the time to read some of the HITSP specs – specifically. the C32 document sections related to medications. Everyone has a problem with sharing medication lists and everyone wants to do it right. But while C32 has over 30 data elements for each medication record (down to the lot# and bottle cap style) the only thing required was the text of the drug name. When I asked people how they could build a data sharing system (NHIN, RHIO, HIE) with only that requirement, they answer that, within each exchange, the “details need to be agreed on”. This sounds a lot like the failure of HL7 v2, though with a lot more baggage.

I visited the IHE Connectathon at HIMSS. What I saw was not encouraging, but entirely predictable. The scenario demonstrated a patient moving through a series of care facilities with CCDs used to transfer the patient’s record. Naturally one site included only the medication names (actually they stuffed long strings with the names, routes, frequencies, dose all together into the name field) and embedded this in their CCD. The next site expected to receive the medication name, route, dose, etc. as separate fields and was unable to import the data. The demonstrator began manually re-entering the data by reading the long multi-element strings and using the data entry form of his own system. This might have allowed entry of the data into his system, but almost certainly lost the data “provenance” (that it arrived via a specific signed CCD). 

After a few minutes, the crowd became restless and he gave up, skipping the last four medications. He then generated his CCD and transferred it to the next system in the scenario, which, amazingly, only saw the medications from the last CCD, where four medications had been omitted. In fact, the contents of the multiple CCDs reflected the system limitations of the various systems more than they did the actual patient state being represented in the scenario.

Against this background of non-success, we see CCHIT certification scenarios of ever-increasing complexity and new HITSP requirements to include every data function ever conceived. And then we see published research stating that no one has proven that any of this actually improves outcomes.

Regarding CCHIT, the entire focus of application certification is wrong. We ought to be asking providers to support certain functions. The CCHIT approach of application certification implies that a single system needs to do everything. Why couldn’t a provider choose to use more than one piece of software so long as their practice did what was needed?

I sincerely hope that someone will be able to calm the waters, make rational decisions on what data is most valuable to share (medications, allergies, problems, labs, images, and “documents”), and how to go about it.  Without some focus and reasonable expectations, we may waste an entire generation of software development activity, kill innovation, and crush smaller companies, all without tangible benefit.

MUMPS to Java … Caveat Emptor
By Richie O’Flaherty

I couldn’t let this pass un-commented, having had some direct experience in language translations many years back in which the organization I was a part of translated a number of applications (mostly in-house developed) from Meditech MIIS and MaxiMUMPS. While most of the pain occurred in the MaxiMUMPS translations due to extensive non-ANSI standard extensions in the language implementation, a common theme (pronounced "fly in the ointment") became apparent in the implementation of the resulting application.

This was the shocking performance impact of the translated code. Differences between how language components are coded in the source and destination languages can have crippling effect on the translated application. A primitive operator in the source language may or may not exist in the target language. If it doesn’t exist, an equivalent piece of code must be written and invoked everywhere it occurs in the source application code. That may involve many instructions or even many lines of instructions as well as overhead to invoke and clean up every time it is used. 

The difference in the number of machine cycles to execute these "equivalent" components can (and did) bring the translated application to its knees, requiring rethinking of hardware configurations as well as targeted application redesign in the resulting language to salvage the very life of the system which was the principal IT solution for a major outpatient clinic.

I am not a Java programmer so I cannot offer perspective on speed and efficiencies that Java may bring to the table, only that this is and was the massive piece of the iceberg in our translation efforts involving MUMPS. It should be noted however, that MUMPS (and MaxiMUMPS) cut their teeth supporting an impressive number of simultaneous users on hardware that had but fractional MIPS ratings. That these outmoded dinosaurs are yet running applications anywhere is a sure sign that the possess a level of efficiency that should be at minimum respected, but more advisedly investigated when seeking to translate them to anything. Iron is certainly cheap(er) these days, but I reiterate — caveat emptor.

Do You Know What’s In Your Medical Record?
By Deborah Kohn, Principal, Dak Systems Consulting

One must go back to ePatient Dave’s main point (albeit difficult to find given all the exchanges and text): "Do you know what’s in your medical record? THAT is the question worth answering."

It doesn’t matter if the data are stored on paper, on analog photographic film, or on a digital storage medium. The only way one will be truly responsible for one’s health is to get copies (analog or digital) of one’s complete, episodic medical record, review the record with one’s provider(s) if necessary, and if errors are are found, correct them. Because one deals with people, processes, and technologies, data inaccuracies occur all the time!

However, since the 1970s, patients have been allowed to access the information contained in their medical records, and since HIPAA "I", patients have been allowed to add addenda to their records. Similar to obtaining and correcting the data contained in one’s credit report, one must ask to do this.

As a health information management professional for over thirty years and long-time member of the American Health Information Management Association (AHIMA) whose banner remains "Quality Information for Quality Healthcare", I never NOT obtain copies of my episodic medical record for review, archive, and information exchange purposes. Hopefully your readership will do same.

For example, as a health information management professional (fortunately or unfortunately) I knew only too well that when I was hospitalized five years ago my clinical records (created and stored in both analog and digital formats) would contain inaccuracies. One operative report contained my correct demographic information in the report header but described me as male (I’m a female) with inoperable colon cancer in the report body. (Either the surgeon or the transcriptionist had mistakenly switched the dictation based on another case that day). Subsequently, these data were coded as such for billing /reimbursement purposes (ICD/CPT) and clinical purposes (SNOMED), making no difference had the data populated a Google or Microsoft or other PHR.

In summary, to answer another question asked in one of the blogs, " Who’s going to validate and correct the data?", the good news is that health information management professionals working in all types of healthcare provider organizations are not only trained but tasked to validate these data. The not-so-good news is that given staffing constraints and other similar issues, it is not and never will be possible to audit 100% of the medical record content in 100% of the cases. Therefore, only YOU, the patient, can and must review and correct the data.

News 4/22/09

From Susie Adamo: “Re: CCHIT. Definitely adding headcount. They just hired Bobbie Byrne, who is a pediatrician who recently left Eclipsys, where she ran clinical strategy.” Unverified – not yet reflected on her LinkedIn profile or on the CCHIT site.

From Stella Artois: “Re: Being John Glaser. I love the column. I had dinner with John one night, touched his shirt sleeve, and didn’t wash my hands for days (despite all infection control precautions). He is my idol and I do so love his latest inspirational post that I am handing it out to wannabe CIOs.” John’s postings may be less frequent as he starts his ONCHIT gig in a couple of weeks, so he may be busy and/or muzzled. I replied to his e-mail asking if he’ll get to bunk over in the Lincoln Bedroom, run up a big expense account tab, and enjoy the thanks of a grateful nation. He said he’s not sure about all that, but he’ll be able to to see the Capitol from his office window. Well, that’s fairly cool.

From The PACS Designer: “Re: Oracle buys Sun. Mr. H. and HIStalk readers know that TPD has been fond of Oracle for their focus on the healthcare space. Now, an Oracle-Sun Microsystems combination will bring a powerful offering of open software solutions that prospective customers can choose to meet their upgrade needs. Additionally, Sun Microsystems storage solutions can further enhance the performance when integrating numerous databases within the enterprise to create a neutral archive.”

From Californian: “Re: the data model that nearly killed Joe. It’s from Epic. Would you have the courage to publish this factoid?” Apparently I would. Still, to single out Epic wouldn’t really be fair since the problems he describes mostly involve (a) caregivers who didn’t use the system; (b) caregivers who didn’t deliver patient care all that well; and (c) caregivers who were using a system that they claim wasn’t designed well for their work (or could it be that their work wasn’t all that well designed and standardized that no amount of programming could support it?) and (d) caregivers dealing with patient information stuck in the the never-ending and very deep chasm between outpatients and inpatients (which are actually the same patients, of course) created by different billing rules (they don’t even speak the same language, such as “episodes” vs. “visits”). Nobody puts a gun to the head of a hospital and/or practice group to buy a company’s software, so if it doesn’t work well for their situation, I’d put the blame on the user for voluntarily choosing it. I wouldn’t be able to critique the data model without seeing it and neither would a patient who experienced what they felt was substandard care, no matter how technical their background. I doubt any hospital could say with certainty that they don’t have stories just like that one in their own place.

A Hartford Courant article points out astronomical non-profit salaries even while big company CEOs and Wall Streeters take their public lumps: UPMC’s CEO made $3.3 million in 2006 and hospital CEO Gary Mecklenburg made $16.5 million the year he retired. One state United Way CEO made $1.2 million in a year. From the article: “Every year I sit in editorial board meetings in which CEOs of nonprofit hospitals come to press their case for more public money. They want taxpayers — bus drivers, small-business owners and public school teachers — to send them more to cover the hospital’s charity cases. And every year I can’t help but think: Before you come asking for more public money, you need to reassess your own remuneration. Until top salaries are more in line with, let’s say, the salary of a U.S. Supreme Court justice, a position that currently pays $208,100 and has no trouble attracting top talent, the poor-mouthing is a little too self-serving.”

Is this reasonable? An uninsured man had what he admits was life-saving surgery. He couldn’t pay the bill, so the hospital turned it over to a collection agency. His only asset is his house, so he’s going into bankruptcy but will still have to sell the house to pay up. He calls it a “gross injustice” and wants people to demand “affordable health care”. If the hospital writes it off for him (not unusual when the press runs stories like this), someone else gets stuck helping the hospital make its margin. Should surgeons be paid less, or drug and supply companies, or hospital CEOs ($300K in this case), or nurses? The “healthcare should be cheaper” argument requires a corollary that “someone is overpaid,” so who? If someone asked him before the surgery, “You will die unless you’re willing to sell your house,” wouldn’t he have done it? Healthcare is run like a semi-business, but we seem to want it to be a charity again like it used to be (without the multi-million dollar CEOs plotting takeovers and layoffs, anyway).

HERtalk by Inga

From Large and In Charge: "Re: consultants. I have plenty of consultant names now. Thank you! More than I expected." 

From John T: "Re: ICE. So, now that there is a new acronym in the marketplace, ICA finally has a solid place in the market. We’re an ICE Vendor – pretty cool. Actually, downright cold!" In case you missed it, ICE stands for Integrated Community EHR.

Dr. Lyle, a regular HIStalk commentator has initiated his own blog entitled, The Change Doctor. His initial post focuses on the "Three Is" for EMR adoption. One likely to create some controversy is Dr. Lyle’s take on interoperability: "While many say that we don’t have enough, I’d actually argue that we are so obsessed with this issue that we are losing the forest for the trees. In other words, let’s get doctors using systems first, and worry about interoperability later."

Ontario Systems signs a multi-year contract with Memorial Sloan-Kettering Cancer Center, which includes the purchase of Ontario Systems Revenue Savvy software.

Montefiore Medical Center’s IT subsidiary Emerging Health Information Technology signs a multi-year hosting agreement with the North Shore-LIJ Health System (NY). Emerging will provide support for a portion of North Shore’s computer network.

The folks at Vitalize Consulting Solutions collected almost $2,000 for the hungry during the HIMSS conference. Vitalize accepted food donations and cash to benefit the Greater Chicago Food Depository. Wouldn’t it be great if more vendors used such creative "marketing ploys?"

2008 was something of an off year for Cerner’s Neal Patterson, who received 8% less compensation than the previous year. His total package — including base pay, stock options, use of the company aircraft, and other benefits — was approximately $3.5 million.

Perot Systems signs a multi-year agreement with The Christ Hospital (OH) to provide revenue cycle services.

RelayHealth introduces FastTrack5010, a online informational resource center to help health insurers prepare for and comply with new HIPAA 5010 transaction standards. The deadline for the new claim version, by the way, is January 1, 2012.

The FCC approves $35.6 million to fund the development for five telehealth networks to link rural hospitals in nine states. The Rural Health Care Pilot Program is allocating the money, plus an additional $10.4 million for the Alaska Native Tribal Health Consortium to connect rural healthcare providers.

EHNAC announces a new accreditation program for application service provider-based EHRs. The new ASPAP-EHR (catchy name) is seeking participants for both its ASP and HIE accreditation programs. Do we seriously need another certification program? And really seriously, enough with all the acronyms already.

The ever-turbulent MedQuist names Dominick Golio as CFO. Golio previously served as North American CFO for D&M Holdings.

The Children’s Hospital of Pittsburgh of UPMC celebrates the grand opening of its new campus with a ribbon-cutting ceremony. The first outpatients are being seen this week and the hospital officially opens May 2nd.

The New York eHealth Collaborative partners with InterComponentWare and Surescripts on a prototype project to facilitate prescription routing and the the delivering of  prescription histories.

Tenet Healthcare announces its preliminary Q1 numbers. Net income is expected to be $178 million compared to a $31 million loss in 2008. EPS is projected to be $.37/share compared to last year’s $.06/share loss.

TeraMedica Healthcare Technology and Compressus partner to offer an enterprise-wide solution to provide comprehensive clinical workflow, data management, and a unified view to the resident EMR system. Teramedica is a provider of enterprise imaging and information management solutions, while Compressus specializes in interoperability and workflow solutions.

The New York State Department of Health selects APS Healthcare and Thomson Reuters to manage its state Medicaid clinical practice utilization review program. The program examines how Medicaid patients utilize medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care.

The LA Times explores the huge industry of outsourced transcription to Asian countries. In the Philippines, 34,000 transcriptionists generated $476 million in revenue last year. Experts predict revenues to exceed $1.7 billion by the end of 2010. Most work costs $.10 to $.15 per line and is delivered within 24 hours. In the Philippines, a fast transcriptionist can earn about $6,000 annually, which is about three times a nurse’s salary. The median income for American transcriptionists is $31,250 a year.

Kentucky Lt. Gov. Dan Mongiardo proposes that Northern Kentucky University become a national laboratory for testing the financial viability of EHRs and is seeking up to $500 million in federal money to get it started. His proposal includes a study of how healthcare providers can set up cost-effective e-health systems. I suppose a good way to make it cost-effective is to have the government give you $500 million up front for an EHR. Mongiardo happens to be running for a US Senate seat that becomes open next year, so one has to wonder if his actions are at all politically motivated. Nothing like working to get a little extra pork for the home state!

I was flattered that Matthew Holt forwarded me an invite to the Health 2.0 conference that starts Wednesday in Boston. I won’t be able to make it, but if you are attending, make sure Matthew wears his Inga 2.0 sash.

E-mail Inga.

What Will Oracle’s Acquisition of Sun Microsystems Mean for Healthcare?
By Orlando Portale

Reading about the acquisition of Sun by Oracle yesterday brought back some fond memories for me. I recall a discussion that my team had while sitting in the lobby of Oracle’s headquarters in 2003. We were there to meet with John Wookey, the head of healthcare (now at SAP) to discuss how we would continue to align Sun and Oracle’s business development programs. 

While hanging around Oracle’s lobby, my team began discussing how a potential Sun/Oracle merger made a lot of sense. Our products fit together very well and both companies had a strong culture of innovation. We discussed how Oracle had embraced Java as its standard for software development and the many deals we had captured together. Unfortunately, the discussions didn’t go anywhere, although in hindsight, it could have been a game-changer. Better late than never, I guess.

In my view, the acquisition of Sun by Oracle is synergistic for the following reasons:

• Oracle invested millions in standardizing all of its applications to Java. Therefore, outright ownership of Java is a plus for Oracle. IBM has also embraced Java, but Oracle will have increased leverage over them.
• Oracle and Sun already have a large installed base in common. Many of the largest databases in the world run on these platforms.
• Sun recently acquired MySQL, the open source alternative to the Oracle database. Oracle can now control MySQL’s destiny and any negative revenue impact it could have had against its own flagship database product.
• Sun and Oracle have always been in the anti-Microsoft camp. Sun owns Open Office, a robust and cheap alternative to Microsoft’s cash cow. This represents another opportunity for Larry Ellison to stick it to Microsoft. In addition, there are opportunities for tighter Open Office integration with Oracle enterprise applications (e.g. Peoplesoft, Siebel), thereby obviating the need for third party Microsoft licenses.

What effect will the acquisition have on the HIS software vendors?

Cerner has a sizable installed base already on Oracle. Most of these systems are hosted on IBM hardware under the AIX operating system, and NOT on Sun Solaris. Cerner has always refused to support Sun’s Solaris OS. That may change now, if Larry Ellison drops a dime. During my time at Sun, I tried to broker a meeting between Sun CEO Scott McNealy and Cerner CEO Neal Patterson. McNealy was eager, but Patterson said he saw no reason why they should speak. "Open systems, Java, Solaris … who cares.” Hello Neal, it’s Larry calling.

With respect to Cerner and Oracle, here are three potential scenarios:

1. Oracle Wins/IBM Loses = Cerner + Oracle + Solaris OS
2. IBM Wins/Oracle loses = Cerner + IBM DB2 + IBM AIX OS
3. Status Quo = Cerner + Oracle + IBM AIX

Note:  Other vendors such as Epic have a MUMPS installed base and are mostly hardware and operating system agnostic. Therefore, I believe this acquisition will have a minimal impact on Epic.

The other area of interest for healthcare customers will involve the status of Sun’s SeeBeyond SOA/Integration platform. At one time, SeeBeyond held considerable market share in healthcare, particularly for  HL7 messaging and system integration. However, in recent years, Sun has let SeeBeyond slip by the wayside. Oracle could gain considerable traction in the healthcare space by bolstering investment in SeeBeyond. This is a particularly useful platform for enabling HIE/NHIN integration. 

What will Oracle do with Sun’s assets after the acquisition?

First 180 days:

1. Rapidly cut Sun’s sales, marketing and back office functions by integrating them into Oracle.
2. Consolidate the Sun software and R&D organizations into Oracle.
3. Create a separate hardware division. Consider either continuing the hardware business or divesting the assets to companies such as Fujitsu or Cisco.

Post 180 days:

1. Oracle will begin create tightly bundled system stacks which incorporate hardware and software components. Oracle will now have all layers of the systems stack under its umbrella, including the storage, server, operating system, programming language, database, Web services, etc. If Oracle goes to market with integrated system stacks, it could put considerable pricing pressure on its hardware competitors.
2. Integrate Sun’s open source cloud computing solution infrastructure with Oracle technology. These solutions are ideal for startup companies looking for cheap entry level systems.

What will be the potential impact on IBM, HP and Dell?

From a hardware stand point, HP and Dell may have the most to lose.  Today, both companies have captured significant revenues from their relationship with Oracle. If Oracle retains Sun’s hardware business and begins going to market with integrated hardware and software systems, it will find itself in a channel conflict with HP and Dell. Will HP and Dell be forced to work more closely with IBM to capture DB2 deals? This is problematic as well, given that IBM already sells competitive hardware platforms and can embrace a similar integrated system strategy. Should this scenario play out, clearly HP and Dell will be at a disadvantage by virtue of not owning the components of the software stack.

IBM will need to revisit its long-held Java strategy, including its heavy dependence on Java for the Websphere platform. IBM will seek assurances from Oracle that it will have equal access to Java in the future. Otherwise, the only other major development platform for IBM to embrace would be Microsoft’s .NET. A shift by IBM away from Java and toward the Microsoft .NET platform would be a monumental and costly move. In years past, when confronted with this situation, IBM would just release its own new proprietary competitive development platform, but IBM no longer has that leverage in the industry. Hello, Sam, it’s Larry calling again.

Orlando Portale is Chief Innovation Officer, Palomar Pomerado Health District, San Diego, CA, and former GM Global Health Industry, Sun Microsystems.

Monday Morning Update 4/20/09

From Leonard Smalls: “Re: CIOs. The selection of the HIMSS chair best highlights all that is wrong with healthcare IT. He was an X-ray technician, went to work for a healthcare IT vendor, and then to his hospital, where he is now CIO. He was groomed by vendors and HIMSS with little information technology education and experience other than vendor applications. This is what is wrong with healthcare IT. You can’t be just a good manager and join the right organizations to be an effective CIO. You must have information technology education and real-world experience in the layers below the application layer in order to make effective decisions about systems and how to integrate them. If not, you become a vendor-whore (pardon the language). I see this repeated often in healthcare organizations. Those in the industry need to stand up and shout when the emperor has no clothes.  Otherwise, sit down, be quiet, and quit complaining about crappy software in the healthcare IT space.” This is the “CIO as the technician in charge vs. generalist change leader” argument that never seems to end. One camp says hospital CIOs should be doctors and nurses, another says they should be the same kind of person you’d want for COO or even CFO, while the old-schoolers says the CIO should know the bits and bytes. I’ve yet to see a convincing correlation between CIO effectiveness and their background since so much depends on leadership style and the organization they work for. I do believe that hospital CIOs are too cozy with the idea that everything revolves around vendor software, often because that’s all they know. Look at how chummy CIOs are with vendors with HIMSS and CHIME – is that an admirable win-win position or is it an incestuous relationship? Either way, that’s why it’s an uphill battle for open source applications, internal development, or simply optimizing the use of what’s already been bought. Those less-sexy efforts rarely get you on the A-list of advisory boards, speaking engagements, and rah-rah magazines. Plus, lemming hospital executives are swayed by vendorspeak, too (“vision centers” are for non-IT execs looking through a gauzy and deceiving lens, for the most part, not CIOs) and not encouraging their CIOs to blaze any trails.

From Svetlana Stalin: “Re: two million visitors. This very intelligent and sometimes bizarre Web comic strip relates to your recent achievement. Congratulations!” Link.

From Bashkirian: “Re: the data model that nearly killed Joe. Heard the vendor was Epic. Can anyone confirm?” I believe ample clues were provided to draw a conclusion about the vendor, although the conclusions about the magnitude of the problem and who’s to blame for it could certainly vary.

From Speedo: “Re: MED3OOO. Heard Tom Skelton has inked a big deal with Tenet.”

From IT Manager: “Re: Carilion. Carilion Clinic’s EMR implementation is going as smoothly as any I have seen at several other health systems. I think we are rolling out Epic at all of our hospitals and ambulatory sites faster than anywhere else in the US. Carilion’s 140-bed hospital implemented Epic smoothly on all applications just a few months after the 800-bed Carilion Medical Center went live.”

President Obama names 36-year-old Aneesh Chopra as chief technology officer of the United States in his Saturday morning radio address. Chopra is Virginia’s secretary of technology, but more relevant to healthcare, was previously managing director of The Advisory Board Company, the publicly traded healthcare consulting and advisory firm, where he led the CFO group. His LinkedIn profile shows no technology experience or education whatsoever (that should drive Leonard Smalls, whose comment about CIOs is above, crazy), although his Democratic party participation is impeccable. Jeff Bezos, Bill Gates, Eric Schmidt, and other big-name visionaries had been touted for the job, so many are scratching their heads as to why he was chosen and what he brings to the table. HIMSS gave him a state advocacy award in 2007, so I’m sure a fawning press release applauding his selection is imminent. I wouldn’t get too stoked: he’s not a member.

Interesting: Gibson General Hospital finds a Russian hacker’s exploit on its e-mail servers that allowed them to be used to forward spam all over the world. Palisade Systems, whose packet management technology was used to detect and fix the problem, ran the press release. One case study involved using the company’s PacketSure Procotol Management Appliance to limit peer-to-peer traffic for a university.

The latest newsletter (warning: PDF) from Intellect Resources has thoughts on how to tell your kids that you’re out of work (advice you’ll hopefully never need). Check in, too, with Traveling HIT Man (their version of Flat Stanley) to see where he’s been. He may find his way to HIStalk Intergalactic Headquarters someday.

Would you please complete my reader survey? I do it every year to help me keep HIStalk on track. Thanks.

A pharmacy technician whose job was the subject of layoff rumors kills the pharmacy manager, a co-worker, and himself at Long Beach Memorial Medical Center (CA).

Anonymous whistle-blowers claim (and press-obtained documents seem to confirm) that the Australian government is rushing its Cerner systems into production without any medication functions working, presumably to get something live to avoid embarrassment in next year’s elections. The $70 million system was ripped by an unnamed health IT expert, who predicts hospitals won’t use it: “No one likes using it because it’s shit. It’s totally inflexible.”

The folks at Digital Healthcare Conference (May 6-7 in Madison, WI) are offering a special $295 registration rate (use code HISDC) for provider readers of HIStalk. It’s a pretty high-powered speaker list and a nice facility (Fluno Center for Executive Education, above). I’d go if I could get off from work.

Those pink-pantsed boys at Voalte have got their marketing on despite being a start-up. This funny video makes fun of an unnamed competitor that should be obvious to everyone, a la Apple vs. IBM (Voalte isn’t a sponsor or anyone I know, by the way, for those who may think I have a hidden agenda – I just find their product interesting and their approach fresh).

BIDMC CIO John Halamka says sending clinically unreliable administrative data to Google Health for PHR use was a mistake in retrospect, as evidenced by the head-scratching conclusions e-Patient Dave found when he viewed his own records there and found a long list of medical conditions that he mostly didn’t have (but had been tested for). BIDMC is shutting down the ICD9 feed and trying to map their homegrown software’s data to SNOMED-CT instead of sending free text. e-Patient Dave, who is the public face of the problem, is advising Google and BIDMC. Not to minimize his contributions, but couldn’t Google have spent a few of its gazillion dollars to actually talk to one of the many informatics experts in the industry instead of just happily blowing in whatever data BIDMC said it could send and calling it mission accomplished? Honest to God, we’ve got real-life doctors, nurses, informatics PhDs, and nomenclature and taxonomy experts everywhere and nobody ever asks them, instead just sending off a bunch of marketing types and programmers to hack out something that looks cool even if it is somewhere between medically useless and medically wrong. Show of hands: who out there would have told Google that it was a fantastic idea to use claims data as a clinical tool? (like, “The doctor tested you for cancer once, ergo, you must have cancer.”)

If top dogs Google and Harvard’s BIDMC (and Uncle Sam, who’s putting a lot of faith in aggregating data from iffy and undocumented sources) can’t figure out this data quality issue, what does that say about an industry that’s about to spend billions on a national data exchange? Who’s going to validate and correct EMR data that’s being whisked electronically all over the country? (or, more importantly, who will use it knowing its limitations, which is the reason that PHRs are of limited value today?) Here’s what e-Patient Dave wisely said about the fiasco: “I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry. And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.” I was talking to Robert Connely of Medicity (formerly Novo Innovations) and we agreed that interoperability is a piece of cake compared to the next mountain to climb: semantic interoperability (I’m getting this data element from you, but tell me what it really means). Vendors don’t always document that even in their own databases (see the healthcare data model critique that I wrote about earlier).

The Australian Business Journal profiles the resurrection of IBA Health, parent of British software company and NPfIT vendor iSoft. Some fun talk from IBA’s chairman about that iSoft acquisition, which initially was going the other way as the much larger iSoft was to acquire IBA, but then iSoft’s market cap dropped from $3 billion to $300 million. “It had lost 90 per cent of shareholder value and its management team and we ended up as the underdog bidder — the pissy little Australian company — wanting to take over a British institution. They did not treat us seriously. I guess there was a bit of colonialism involved. They had hoped an American company would take them over. Instead, I came back with a slingshot and we took it over.”

Speaking of IBA, it acquires Hatrix, an Australian vendor of eMAR systems.

Alaska, already the most pork-heavy state, zips through a bill pushing electronic medical records, hoping to grab some stimulus money.

A Huffington Post article by Deane Waldman (a doctor) decries poor usability in clinical systems. “I can access my Excel spreadsheets on either MAC or PC but I cannot see a chest X-ray and lab results using the same program. Inpatient files are coded (and secured) separately from outpatient records making it impossible easily to compare them … The Obama administration is encouraging the development of EMR and that is wonderful. The scary part is that I know they will do it wrong. They will do ‘business as usual’ … As a colleague on Twitter wrote recently, ‘IT tends to focus on back-end programming and loses sight of the front-end [the users]. Without usability, software is [and EMR will be] useless’ … the screen in the hospital on which I am supposed to electronically sign my letters: it has 74 icons! Talk about incomprehensible. The needs of the end-users must drive the design.”

CCHIT takes the first step toward its expansion to certify long term care systems, putting together a LTCS Advisory Task Force. The CCHIT apple didn’t fall far from the HIMSS tree: keep the paid headcount down, use volunteers to do all the real work, keep expanding, and figure out multiple revenue streams. None of that is bad, necessarily.

GE’s Q1 earnings sucked less than expected: EPS $0.26 vs. $0.43, but the GE Capital news just keeps getting worse: its earnings dropped 58% to $1.12 billion, but without a favorable, one-time tax treatment, it would have lost $153 million. GE Healthcare wasn’t exactly a bright spot, with revenue down 9% and profits off 22%.

Reading Hospital (PA) will lay off 250 employees.

Turns out the cure for the nursing shortage was a recession. The RN position vacancy rate in Massachusetts is only 4%, with new grads scrambling to try to find jobs. Mass General has a 2% vacancy rate, BIDMC is laying off some nurses, and Children’s has nothing for new grads.

Top military doctors in Iraq aren’t happy with its new tracking system for wounded soldiers. The new system, Theater Medical Data Store (TMDS) replaced Joint Patient Tracking Application (JPAT). I wrote about JPAT awhile back, citing this article and others. Lt. Col. Mike Fravell was a Landstuhl Regional Army Medical Center CIO and VA fellow who built JPAT himself, where it found a wide and appreciative user audience, but his initiative annoyed top brass determined to spend big money on the TMDS replacement system. He was transferred out to his own Siberia. The main complaints about TMDS involve data loading time (it’s run from servers in Virginia) and multiple information links for each patient, making easy interpretation difficult. An army vascular surgeon sounds like his civilian counterparts: “I know JPTA is dead, but our current system is not functional. As we do more with less putting the administrative burdens on the doctors is ludicrous.”

Odd lawsuit: a woman is suing Boulder Community Hospital (CO) and nearly a dozen doctors, claiming that the hot water bottle placed underneath her while she was in labor exactly two years ago left third-degree burns on her buttocks.

E-mail me.

News 4/17/09

From Rick Weinhaus MD: “Re: Cheezborger and usability. I agree completely. I also found Dr. Bradford’s special article in January on usability, as well as the comments, right on the mark. The promise of EHRs to improve patient care, reduce costs, and minimize errors will never be fulfilled until the software becomes more usable. As a physician, I have had first-hand experience with several EHRs. On the basis of these experiences and my sense of what mental models I actually use in taking care of patients, I have proposed two EHR design idioms to improve work flow and reduce cognitive load. If any readers would like to see detailed descriptions including graphics, they are posted as threads on the EMR Update website.” Link 1, Link 2, Link 3. Jim Bradford’s excellent article is here.

From Pete Potamus: “Re: war game EMR predictions. How about making EMRs easier to use? This includes personalization by physician or nurse, select versus enter, dictate complex orders in ‘human’ terms; use voice recognition and personalization to present the order for review and approval. Physicians and nurses are busy people. Make it easy and they will use it. Design it so they do more work and they will resist using it. But who wouldn’t respond the same way?” I like the idea, but everybody says the same thing and the products are still never really retooled. Apple creates its own market every time it adds its considerable design expertise to otherwise pedestrian and commoditized products. Why hasn’t it happened with healthcare software? I see only two possible answers: (a) customers are buying anyway, so the redesign isn’t necessary to make sales; or (b) vendors don’t expect to get ROI from doing it even though prospects say they want it. 

From Val Kelly: “Re: Epic layoffs. The last number I heard was about 400 people who were asked to resign in January and February. It’s hard to say for sure since they were told not to talk about it.”

El Camino Hospital gets a second campus and CMIO Eric Pifer gets a hospital president’s job. Interesting financial tidbits: ECH has $400 million in cash and $1.1 billion on the books (note to self: recheck the definition of “not for profit”). Not to worry though – projections are that the new place needs a daily census of only 42 patients to throw off $11 million in annual profits … sorry, margin contribution … starting the third year.

Hedge fund Tremblant Capital discloses that it has taken a 6% stake in Eclipsys.

Listening: The Cliks, an outstanding hard-rocking Canadian band (which happens to be all-LGBT). I’m desk-drumming to Oh Yeah (seventh song down in the player). And I admit I don’t watch much TV, but I’m liking 30 Rock (smart women like Tina Fey are hot, yes?) and I’m enthralled with Brit talent show singer Susan Boyle (while the cynic in me says it could be a stunt since she surely had to audition in front of someone to get there, but watching the sniggering, superficial audience and judges reduced to slack-jawed awe and near tears is still priceless). I could get pop culture if I had more time.

The son of British TV magician Paul Daniels, an IT support manager with an NHS trust, is charged with fraud for allegedly engaging a company to perform phony IT work and skimming a fee in return for approving the invoice.

JPS Health Network (TX) mulls over a potential $150 million project to implement electronic medical records, hoping to suck up some stimulus money but still worried about the upfront cost. Nobody wins those deals except Epic, so you know they’ll be calling Judy if they get their nerve up.

South Nassau Communities Hospital (NY) goes live on the Forerun ED dashboard application commercialized from BIDMC.

It’s reader survey time! It’s a quick, non-annoying way for you to let me know how to make HIStalk better for you. Here’s the link. Thank you.

A reader asked if the HIMSS presentations can be downloaded yet. They were giving a link at the conference, but the member pages don’t show the 2009 files yet.

TeraMedica will partner with Compressus Inc. to create a workflow and data management tool that will make all of an enterprise’s imaging systems and databases available from a single worklist and will support data exchange.

Natividad Medical Center (CA) hires Kirk Larson from Cerner as CIO, intriguing the local paper because he stands to make more than previous CEO ($185K and up to a 30% bonus). Seems kind of rich for a 172-bed county hospital to pay up to $240K for a CIO to run what must be a fairly small IT shop.

Two companies selling MUMPS-to-Java conversion try to convince the DoD and VA to give them a big contract to turn VistA into a semi-new system that will run on something newer than aging DEC Alphas. The estimate to develop a new system: $15 billion (!). The estimate to convert VistA to Java: $125 million over 2-5 years, including replacement servers. The problem with that kind of porting is that all the internal expertise has to start over with a new language and database (and the fact that the resulting source code is next to unreadable and free of comments to provide documentation, at least in my limited experience). And I miss the Alphas, personally.

The local health district is trying to figure out who will help Petaluma Valley Hospital (CA) pay to replace its retired A4 hospital system with Meditech. Perot told them Meditech was a logical fit, which seems kind of self-serving since it owns the former JJWILD and needs work for those people. The hospital’s parent company has Meditech and PVH can jump on for $2.8 million, but they’re worried about parting ways when the hospital lease is up.

Bad Philips numbers have investors worried about GE’s, to be reported Friday. I’m not sure how anyone could expect good GE numbers given their big exposure to bad markets (construction, manufacturing, big-ticket healthcare equipment, aviation, and of course albatross GE Capital), but maybe they will surprise positively. The stock price is at 1995 levels, but then again the Dow itself is at 1997 levels.

Backup tapes from Penisula Orthopaedic Associates (MD) containing information on 100,000 patients are stolen from a courier’s vehicle.

This is an excellent first-person story by a technologist about how bad healthcare data models nearly killed him in facilities with supposedly state-of-the-art EMRs, leading him to conclude that any kind of nationwide health network will never work. HIT people should read every word since it dashes the notion that having an EMR means improving care. “Medical personnel at urgent care and the hospital who interacted with me all used a version of the same electronic health information system (the ‘system’). It became clear that everyone was fighting that system. Indeed, they wasted between 40% and 60% of their time making the system do something useful for them … I was in ER for 20 hours before being admitted to the intensive care unit (ICU) where I spent another 28 hours. Throughout my stay, I was hooked to network attached monitors that incessantly sounded alarms to which no one responded. I was asked 11 times to repeat my medical history, medication, and allergies to as many different medical professionals. I was seen by seven doctors each of whom asked me similar questions. Five doctors were never to be seen again. All doctors mumbled something about putting their findings into the hospital’s electronic records system – most did not according to ICU nurses. No one read my allergist’s detailed report about my condition and health history.”

Groups line up against the Australian government’s plan to use patient medical records to detect Medicare fraud. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see.”

Tech Mahindra acquires Satyam for $578 million, giving it 425 acres of land, 48,000 employees, and a big footprint (not to mention a reputation sorely in need of repair, but not unsalvageable). It’s hard to believe IBM didn’t beat that bid.

Odd lawsuit: a woman microwaving hair removal wax and apparently not following instructions overheats it, then spills it as she tries to take it out of the microwave. She was burned on the thigh and chest. She’s suing the wax manufacturer for $160 million.

E-mail me.

HERtalk by Inga

From Deborah Peel: "Re: stolen laptop at Moses Cone. The new security protections for health IT in the stimulus package require encryption of data, which will help prevent thieves from being able to use personal data in the future. But that is not enough to prevent future privacy violations like at Moses Cone. Strong state laws and medical ethics that require patient consent before medical records are disclosed were violated, but victims will have to go out and hire their own lawyers to sue hospitals and vendors to enforce these rights and protections. The stimulus package empowers state AGs to defend citizens’ privacy rights in HIPAA, but in 2002, HIPAA granted rights to hospitals like Moses Cone and over 4 million other ‘covered entities’ to disclose YOUR personal health information to outside vendors like VHA for any ‘healthcare operations’ or business use like ‘improving care’ or ‘reducing costs’ without your informed consent. Congress should have closed this giant privacy loophole in HIPAA, too."

From Large and In Charge "Re: EMR consultants. My large practice in the Midwest is looking at EHR options. Can you recommend any consultants?" If you are a consultant and/or have any names to recommend, let me know and I will forward to Large and In Charge.

The County of Los Angeles signs a contract for iMedConsent, an informed consent and patient education system by Dialog Medical. The product includes thousands of consent forms and patient education documents, plus provides digital capture of signatures and other annotations.

Allina Hospitals & Clinics settles a lawsuit with the state of Minnesota over high interest rates charged on medical debt. The not-for-profit Allina will pay patients $1.1 million to settle a dispute over whether the health system broke state law by charging patients double-digit rates on certain outstanding medical bills. Allina maintains its actions were legal.

Utah implements a new task force to stop the state’s pharmaceutical drug problem. The Utah Pharmaceutical Drug Crime Project will work to eradicate the selling, buying, stealing of prescription drugs. Utah, by the way, has the country’s highest rate of non-medical painkiller abuse. (Who’d a thunk it?)

The for-profit HCA expects its Q1 profits to much better than last year’s, in part due to higher inpatient volume and better controlled expenses. Pre-tax income is projected to be $600-$650 million for the quarter compared to $344 million last year.

I am wondering if Twittering is going too far? Do we really need our doctors Twittering during surgery?

Regardless of the answer to that question, I am loving Twitter and have decided there are really two types of users: The Tweeterers (those who use Twitter to send out information) and Tweetees (those who primarily follow others to glean information.) I suppose there are also in-be-Tweeters who do a bit of both. I am primarily a Tweetee, though I do send out the occasional pearl of wisdom. IngaHIStalk if you want to follow.

IASIS Healthcare (TN) contracts with McKesson for the Horizon Medical Imaging PACS solution. IASIS is a 16-hospital system with approximately 2700 beds.

QuadraMed announces an agreement with e-MDs to provide QuadraMed’s hospital clients with the eMDs EHR/PM software for its affiliated physician groups. Sounds like e-MD is looking for a way to compete head-on with ECW for the hospital-supported physician EHR deals.

Gateway to Care, a large FQHC system in greater Houston, selects Sevocity EHR as the system’s only funded EHR solution. Five of the organization’s health centers will implement Sevocity by August for over 200 physicians and other users.

So far this month, it looks like five new ambulatory products have achieved CCHIT 2008 certification.

I nominated Mr. H for this award, though its doubtful they would accept an anonymous blogger. But they should, don’t you think?

E-mail Inga.