News 6/3/09

From Blogger: “Re: Microsoft. Microsoft Health Solutions group blurs traditional relationship to media by building up inside relationship with bloggers. Should bloggers (not worried about HIStalk) disclose who pays them to attend conferences? What if companies like Microsoft give you early access to information and insider info — do you owe your allegiance to them?” I would say the blogger should disclose that fact, but you have no way of knowing anyway. Reader beware: if a blogger seems to have an unwaveringly positive opinion of a company or product, even in the face of negative news developments, then they may well have sold their soul intentionally or otherwise. I can only say that if I went to a conference or other trip at a company’s expense (which I’ve never done), I would say so when I wrote about it (and just to make sure, I’d probably rip them roundly just to err on the side of fairness, which means nobody will be inviting me anyway). I can’t speak for Microsoft except to say that they’ve never offered me anything.

From The PACS Designer: “Re: 2D/3D workstations for MDCT. There have been a lot of marketing claims by vendors that their MDCT workstations outperform their competitors. Well, now there’s been a 2D and 3D face-off conducted at the International Symposium on Multidetector-Row CT by Diagnostic Imaging Magazine. The result is they’re all quite similar in performance, thus no one can really claim to be the best.”  

Several folks have added events to the HIStalk calendar, so thanks for that. You can post your event here for free.

Microsoft buys Rosetta Biosoftware, a Seattle-based genomic software vendor owned by Merck. It will add gene analysis and clinical trials capabilities to Amalga Life Sciences.

Hospitalists Now, a hospitalist provider, gets a $3.5 million investment to help bring its administrative and patient care software to market. Its Web site says only “under construction” and “medical software solutions.”

A Connecticut doctor takes the concierge medicine route, taking on 250 patients for an annual retainer of $1,800 as a “country doctor with all the modern technology.” She says her practice prevents hospitalizations. “I have kept four or five patients out of the hospital in just this past year. I don’t let my patients go to the emergency room alone. I meet them there, and because I know them very well, I don’t have to practice defensive medicine. I can arrange for visiting nurse services or delivery of a hospital bed where necessary and have the patient home the same day. And when they do have to be admitted, I am in frequent communication with their specialists, and we care for them together.”

Ingenix acquires AIM Healthcare Services, a Nashville-based medical claims company.

One of the funniest things I’ve read lately: Joel Diamond’s take on abbreviations on HIStalk Practice.

An investigative report by The Arizona Republic says the lack of electronic medical records in Maricopa County’s jail system has cost taxpayers millions in lawsuit-related costs and contributed to its loss of accreditation. Strangely enough, if you read about the terribly backward paper and crude database systems they use, it sounds pretty much like the average hospital. They’ve passed on previous recommendations: “The software, the implementation, did not deliver the result that was promised. That was a business judgment. What’s the point of spending $5 million and buying nothing but trouble?” But, one late-breaking factor has led them to immediately change their tune and start EMR shopping: they will apply for $2 million in federal stimulus money to buy the system they declined to purchase with their own funds.

A Medicaid HMO privatization program started in five Florida counties in October 2006 isn’t drawing rave reviews: patients say they can’t get appointments, 25% of doctors in the two biggest counties have dropped out because of red tape, state officials can’t get even basic data about the program’s treatments and prescriptions, and the largest HMO company involved (which admitted stealing $35 million from another state program) opted out because profits were too low.

CFO Magazine runs a rebuttal by Al Borges, MD to its pro-EMR article.

Who knew it would be lobbyists who got stimulated? Big lobbying companies are creating new groups whose entire raison d’etre is to figure out how to lap at Farmer Obama’s trough. “Sinclair said he is awaiting clarity on the bidding process for electronic medical records systems, especially in terms of how the money would flow and to which agencies. Starting in 2010, the state will make grants available to hospitals, physicians and clinics for purchasing health information technology systems, according to its Web site, which tracks stimulus projects. With health information technology projects, Stanton also sees a change in the playing field. He said the challenge is in dealing with members of the executive branch, instead of ‘going down to Congress and begging a legislator to put an earmark,’ as both have different levels of complexity and difficulty.”

Speaking of lobbyists, GE Healthcare, anxious to ensure that healthcare reform doesn’t hurt its imaging revenue further, hires on a slew of former government officials as lobbyists, including the former chief of staff of Sen. Max Baucus, chair of the Senate Finance Committee. 

AHA mounts its own emergency lobbying campaign, hoping to derail the Senate Finance Committee’s deliberation of a reform issue that would require hospitals to provide charity care if they want to remain non-taxpaying. Meanwhile, the provider group that offered to reduce the growth of healthcare costs by 1.5% over ten years came up with this: prevent more infections, keep patients safer, use more technology, and simplify forms. One of the presenters was the CEO of a “non-profit” hospital who was paid $6.2 million in 2007, according to federal records, but absurd executive salaries weren’t on the list.

This hard-sell EMR Web site is courtesy of “America’s #1 EMR Medical Systems Expert,” who does not provide credentials to validate that claim (and who apparently caters only to one-patient medical practices, given the last line of the pitch).

Tasmania is looking for vendors of radiology and PACS systems, just in case any vendors are looking for prospects.

Software developer RxVantage gets $500K in VC money. Its systems let drug reps practically become a member of a doctor’s office staff, letting them book appointments, send samples, and “be able to to see office preferences for meal types and hours for sample drops.” The company claims it is “focused on developing smart technology to help improve patient care.” If you can overlook the flawed healthcare system it supports, it actually sounds pretty cool.

Stevens Institute of Technology (NJ) announces its IT graduate certificate for healthcare professionals.

Odd lawsuit: a man with a 30-year record of violent crime who took hostages at a campaign office of Sen. Hillary Clinton sues Frisbie Memorial Hospital (NY) and its psychiatric services provider, claiming they cause his actions by failing to treat a previous suicide attempt in which he ate antifreeze-laced soup.

E-mail me.

HERtalk by Inga

Picis announces new agreements with 18 hospital clients to use its integrated clinical and financial ED solution. Twelve of the hospitals have already gone live this year and six more are scheduled to go live within the next month.

Allscripts hires Eileen McPartland to serve as its COO, taking over for interim COO Lee Shapiro. Shapiro will continue in his role as President. McPartland has served as executive VP of global sales for Misys PLC and previously worked at Oracle. Allscripts also announces SYNNEX will distribute the MyWay product through its SYNNEX Healthcare Solutions Division.

The non-profit Vermont Information Technology Leaders names David Cocharan, MD as its president and CEO. Cochran is the former VP of strategic development at Harvard Pilgrim Health Care.

Sunquest president and CEO Richard Atkin accepts the role of president of the board of American Interfaith Camps (AIC). The North Carolina-based AIC provides an environment for children of different backgrounds to “eat, pray and grow together as friends both in body and spirit.” The camp looks like it is in a beautiful setting (lots of woods and water.) Good stuff.

The Premier healthcare alliance acquires Phase 2 Consulting (PC2), a division of RehabCare Group. PC2 provides consulting services to hospitals and health services and will complement Premier Consulting Solutions.

Amerinet and Perot Systems ink a deal that makes Perot’s revenue cycle solutions available to Amerinet’s acute and alternate care site members.

Former Vanguard Health System VP Orlando L. Alvarez, Jr. is named senior VP of physician strategy and business development for the Sisters of Charity Health System (OH).

All Children’s Hospital (FL) selects Mediware’s BloodSafe remote release blood system.

HealthGrades names the 340 winners of its Outstanding Patient Experience Award, which recognizes the top-ranking 15% of hospitals in terms of patient experience. The ratings are based on patient satisfaction results from the HCAHPS survey and included questions rated to clinician communication, staff responsiveness, cleanliness, and noise levels. In glancing at the list, I was somewhat surprised to see the absence of some institutions traditionally recognized for providing top medical care, including Cleveland Clinic, Mayo Clinic, MD Anderson, ULCA, and Johns Hopkins. Personally, if faced with a life-threatening illness, I’d choose the best care over noise levels and nice nurses.

The Canadian Sunnybrook Health Sciences Centre contracts for Eclipsys’ Sunrise Patient Flow solution.

Merge Healthcare reaches a definitive agreement to purchase Etrials for about $18.3 million in cash and stock. Last month Etrials rejected a $14.5 million bid from Bio-Imaging Technologies.

Healthcare Informatics releases its HCI 100 list, which ranks the top HIT companies by revenue. Not surprisingly, McKesson is number one (again), followed by Cerner and CSC. In the $3.5 billion consulting company category, CSC was the highest ranked, followed by Perot. HIStalk sponsors CareTech Solutions and Vitalize Consulting Solutions made the top 10. In the $22 billion HIS vendor category, the top three were McKesson, Cerner, and Siemens. In the $2 billion a year physician practice management category, Allscripts took the spot by a wide margin. I also noticed that on the overall list, both athenahealth and eClinicalWorks were ranked much higher than last year (now 31 and 39, respectively.) Here’s some interesting math (or mindless, depending on your point of view): the total industry represents about $27.5 billion a year in revenues and the 16 HIStalk sponsors on the list account for 21% of those revenues.

Dan Lemerand reports that the HIStalk Fan Club on LinkedIn now has 712 members. Also, I have 200 connections on LinkedIn (always happy to have more) and 360 followers on Twitter. I can only imagine how Susan Boyle feels.

CIO magazine lists its 2009 CIO award winners, which includes companies shown to create “new business value by innovating with technology.” The list includes plenty of corporate giants, including IBM, Dell, and FedEx. Also recognized: tiny Midland Memorial Hospital (TX), with reported revenues of $155 million, and 261-bed Chester County Hospital (PA), with revenues of $190 million.

The Northern Californian IPA Hill Physicians Medical Group discloses it had a net loss of $4.4 million last year, due to unrealized investment losses of $7.4 million. Hill’s 2008 HMO revenue was $420 million; operating operating was $3 million.

Cerner launches a Smart Room to be on display at the company’s Dubai office. Cerner says this is the first-of-its kind high-tech hospital room created in the Middle East.

Here is one of Mr. H’s favorite kind of stories. A Michigan woman is suing Starbucks, claiming that an employee improperly secured a lid of her coffee, causing it to spill on her lap, inner thighs, and legs. The incident occurred three years ago when Irene Bruno purchased the coffee through a drive-through window. Bruno now seeks a minimum of $75,000 in damages, alleging she has suffered “extreme humiliation and embarrassment” due to the coffee spill scars still visible on her body.

E-mail Inga.

CIO Unplugged – 6/1/09

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

It’s Not About You
By Ed Marx

I dreaded visits from Battalion HQ. Bravo Company operated fine without big brother coming down and creating more work. As a twenty-year-old platoon leader, I had to gauge what level of involvement was beneficial versus what was busywork. I understood the need and benefit of our association with well-intentioned HQ, but at times, enough was enough before they only caused agitation. I made every effort to keep standard operation policies from becoming the frontlines. HQ existed to help my troops complete their mission, not create diversion and roadblocks.

I then recall with trepidation my promotion to Captain with orders to HQ. As the Battalion Motor and Movement Officer, I was responsible for the readiness and mobility of the 40M dollars worth of vehicles in our five line companies. Operating my unit and making sure our companies were prepared to deploy at a moment’s notice while contending with the inherent HQ bureaucracy of my position was tough.

Over time, I became…one of them. I found myself so focused on my HQ efforts that I lost site of the reason for my position. I was building a world-class organization and process but inadvertently choking our line companies agility required for mission execution.

Those Army leadership experiences shaped my belief that corporate exists to serve those who did frontline work.

As our country emerged out of the American Revolution, similar conflicts took place. Our young republic was deeply concerned about the national government growing too large and powerful to the point of snuffing out state rights. Conversely, federalists were worried that too much state independence and freedom would unravel the fragile democracy. Perhaps the greatest balance was brought forth not by the constitution itself, but in the principles espoused in the Federalist Papers. Two hundred years later, these papers still carry important lessons and ideas for corporate America. They help bring perspective and balance to the relationship of corporate HQ versus line company relationships.

It’s easy for those of us who hold HQ positions to forget that we exist to serve line companies. In healthcare, the frontline is anywhere care is delivered. In a single hospital, clinics and departments see patients. In multi-hospital systems, the hospitals themselves interface with patients. I continually struggle with this reality. In and of themselves, the strategies, structure, and process I create are important. At the same time, they become hurdles too high for frontlines to jump, therefore impeding progress. When HQ is physically separated from the frontline, the challenge is exasperated. In such cases, be extra vigilant.

Here are some actionable ideas to help us remember our appropriate HQ role:

· Frontlines is where care is delivered and what drives revenue:

Beyond government/accreditation/safety mandates, are your requirements perversely impacting clinical care?

Beyond government/accreditation/safety mandates, are your requirements perversely impacting revenue?

· HQ by definition is overhead, a “tax” burden on the frontline:

Keep costs low as possible

Keep demands on frontlines to a minimum

Regularly question your own demands and those of your peers

· Seek to understand before striving to be understood:

Leaders, spend equal amounts of time on the frontlines as you do in your safe, remote office

Send staff routinely to the frontlines to gain customer perspective and understanding

· Engage frontlines in all aspects of your area and avoid mandates:

Include them in strategic planning

Be extremely transparent with costs

Provide options with well thought out pros and cons

Discuss and gain perspective before making mandates

Ask them the tough question “am I helpful?” and then listen

· Policy & procedures:

Eliminate as many policies as possible

Stop creating new policies unless absolutely necessary

Develop common operating principles

Say “yes” more than you say “no”

Many governments, armies, and companies grow the complexity of HQ at the expense of frontlines and eventually lose their sense of purpose. Their pride turns into arrogance as HQ shines brightly, yet the dull of the frontlines quickly tarnishes any fleeting glory. I plead guilty on all counts! Balance is a must. Once you become more concerned with your area performance than with frontline success, you have lost your reason for existence.

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

Readers Write 6/1/09

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!

The Psychology of Health Information Technology: What’s Missing?
By Mark Hochhauser

I’m a psychologist whose spouse works in a hospital pharmacy implementing an EMR system. My interest is the missing psychological aspect of the current drive towards electronic medicine.

Behavior change theories

Assumptions about the ability of various electronic health systems to change physician and patient behaviors are not based on an understanding of behavior change principles. Information may help change someone’s knowledge, but changing their attitudes and behaviors is much more difficult.

For example, about 20% of US adults still smoke, down from about 50% in 1964 when the first Surgeon General’s report on smoking was published. That represents about a 60% reduction, but it has taken 45 years to get there. Why does anyone assume that information alone will lead to behavior change when that conclusion not supported by the evidence?

One goal is to give physicians and patients information that will lead to behavior changes by both groups (and healthier patient outcomes), but nowhere have I seen any references to the behavior change literature. For example, relevant behavior change theories such as the 1) Health Belief Model, 2) Stages of Change Model, 3) Consumer Information Processing Model, 4) Theory of Planned Behavior and 5) Implementation Intentions Model are absent from the HIT literature. How can behaviors change when HIT programs are not based on any understanding of behavior change theories? What you’re left with are trial-and-error programs.

Limited patient health literacy

Presumably patients will become more active participants if they get more information via electronic patient records. Missing from that assumption are any insights from health literacy research. The 2006 “Health Literacy of America’s Adults” [http://nces.ed.gov] estimated that 14% of adults had “below basic” health literacy, 22% had “basic” health literacy, 53% had “intermediate” health literacy, and 12% had “proficient” health literacy. What level of health literacy is needed to understand health information and complicated health information tasks such as keeping and updating electronic personal health records? Not everyone is as smart as you.

Lack of an evaluation plan

Years ago, when I reviewed prevention proposals for federal agencies, they recommended that 15% of the budget be spent on program evaluation. Although I’ve read extravagant claims for the future benefits of EHRs, I have yet to see a decent program evaluation plan described in the literature. Unless an appropriate plan has been developed with experimental (EHR, CPOE, etc.) and control groups (no EHR, CPOE, etc.) along with relevant definitions and measurements of physician and patient behavior changes before, during, and after implementation, there will be no way to scientifically determine whether these programs work or do not work. Hype is not an evaluation plan.

Conclusion

Getting physicians and patients to change their behaviors is harder than anyone seems to recognize. The absence of key psychological perspectives in the development and implementation of HIT programs means that they will probably not be very effective. Psychologically, current HIT programs represent the triumph of hope over evidence.

Mark Hochhauser, PhD is a readability consultant in Golden Valley, MN.

Since consumers rely on quality and cost information in many other segments of their lives, I believe it is the consumer who will soon begin to drive improvements in quality and price transparency in healthcare. Further, the American Recovery and Reinvestment Act of 2009 will result in the industry’s increased adoption of technologies that are critical to creating the environment of transparency that consumers will demand.

As consumers become more and more involved in their care, they are coming to realize that better information about cost and quality will allow them to make better, more informed choices. Just as they can book hotel rooms anywhere around the world—and find data on cost and quality that is readily available—they will begin to expect the same in healthcare. Providers operating in a competitive environment will be forced to improve the quality and cost of care if they are to compete effectively. In addition, transparency will encourage these consumers to reward high quality/low cost care. Over time, consumers will not tolerate a healthcare system without quality and cost transparency.

Hotels and healthcare

Already, today’s consumers feel that the current state of information is inadequate. They rarely have cost and quality details about healthcare services, and even physicians rarely have comparative information on the quality of their own care or of the care of physicians to whom they refer patients[1].

Quite unlike decisions about a hotel stay, the unique characteristics of healthcare decision-making includes a high degree of risk and value–both perceived and real. Healthcare decisions therefore necessitate that consumers maintain a high level of involvement in the decision-making process. Unfortunately today, most consumers overall could spend considerable time and effort to uncover a minimal level of information to make their final purchase decision. Further, even though they have researched the service, sometimes the end-user experience differs greatly from what they expected, since the healthcare delivery processes includes many touch points. This variance in the consistency of services and involvement of diverse processes in the system raises additional issues of cost and quality transparency.

Opportunities and solutions

Cost and quality transparency would help patients to make informed choices about their care, encourage private insurers and public programs to reward quality and efficiency, and compel providers to improve services by benchmarking their performance against others[2]. To develop and implement a national strategy for health care quality measurement and reporting, for example, the National Quality Forum (NQF), a private not-for-profit membership organization, was incorporated in 1999. NQF is also involved in standardizing health care performance measurement and reporting. Some of the selected projects include cancer care quality measures, mammography standards for consumers, cardiac surgery performance measures and nursing care performance measures. Some effective state-driven transparency efforts[3] in the US include various programs such as the Pennsylvania Health Care Cost Containment Council, California health care reform, Florida Compare Care and the Massachusetts Health Care Quality and Cost Council.

The demand for details and quality in the form of report cards and rating systems for hospitals has also provided business opportunities for private companies. Some of these report card providers are:

• “Consumers’ CHECKBOOK,” which provides “desirability” ratings for hospitals based on surveys of physicians, risk-adjusted mortality figures, and adverse outcome rates for several surgical procedures
• “Leapfrog Group,” which surveys hospitals on about 30 safety practices and then combines them to provide an overall safety score
• “HealthGrades,” which rates hospitals by individual procedures and conditions[4].

These report card providers may differ in the methodology of their rating systems, so it’s become important for consumers to have a broad perspective in order simply to evaluate these ratings.

Key conclusions

Going forward, the cost and quality transparency and standardization of services will act as key purchase drivers and contribute to the success of a healthcare system.

Therefore, if stakeholders in the health sector wish to look forward to assured profits from this industry, they have to execute activities such as in-depth planning, deployment, execution, and monitoring of various parameters which can equip them to deal with customer sensitiveness for quality and cost transparency. What might the role of technology play in this arena?

[1] Collins SR and Davis K. Ibid

[2] Collins SR and Davis K. Transparency in Health Care: The Time Has Come, The Commonwealth Fund.2006 Available at:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=361215. Accessed February 6, 2009

[3] Health care price transparency: A strategic perspective for state government Leaders, Ibid

[4] Hospital report cards: Making the grade. The Harvard Medical School Family health guide Available at: https://www.health.harvard.edu/fhg/reportcards.shtml . Accessed February 6, 2009.

Colin Konschak is a managing partner at Divurgent.

EMRs are more than Electronic Filing Cabinets with Advanced Health IT – Improving Care and Lowering Costs
By Rich Noffsinger

The act of digitizing patient information won’t lower costs or improve care on its own. Improvements cannot be accomplished without aligning patient, provider and payer interests. Health IT contributes to this alignment by integrating critical patient, clinical and insurance data – enabling stakeholders to leverage multiple sources of information at once to personalize care, improve quality and lower costs.

Similar to how the Internet reformed the investing and travel industries by opening up access to information that was once siloed or guarded, health IT will enable a level of information sharing that simply does not exist today – between doctors and patients, laboratory and other health care providers, health care facilities, insurance companies and providers, etc. It will also allow us to apply computing power throughout the health care supply chain.

Once we unleash these kinds of processing capabilities such as modern analytics, we will see rapid advances in closing gaps in care, revealing wasteful spending, the application of evidence-based treatments, and even broadening medical research. However capitalizing on this data and computing power requires a Herculean level of interoperability and participation.

The value is not simply in digitizing health information; rather, the ROI comes from what you can actually do with the data electronically – through advanced tools and IT strategies like clinical decision support, predictive modeling, comprehensive risk stratification and evidence-based medicine.

By ignoring sophisticated health IT tools and technologies, patients, payers and providers miss opportunities to leverage the volumes of medical guidelines, insurance rules, treatment comparisons and best practices – that can improve health care and lower costs.

Rich Noffsinger is CEO of Anvita Health.

Monday Morning Update 6/1/09

From Tired of it: “Re: quality. If I hear one more consultant say ‘quality is the new battleground’, I am going to fire every single one of them. We are right now in four-year process to get paid for implementing an EHR. Last I checked, that makes quality last at this point, economically. Consultants love to sell quality ideas and analytic solutions.”

From Frank Pulver: “Re: NAHAM. Attendance is down 25-30% this year, but lots of hospital representation and some outstanding presentations.”

From Pedro Fumar: “Re: Top Ten American Healthcare Myths (warning: PDF). It is over 100 pages, is kinda pithy, but nonetheless contains a lot in interesting stuff, particularly when looking at European solutions. There is a chapter on IT.” It’s from Pacific Research Institute, a think tank that seems to be somewhere between conservative and Libertarian (right in my sweet spot, in other words). Some pretty good insights: “The sad reality is that as much as we’d like for politicians to be able to create technological revolutions, they just aren’t very good at it … Private businesses are quite good at adopting the right technology at the right time—and finding innovative solutions to improve productivity. When government tries to grease that process, it often gums up the gears. You end up with something resembling a classroom in a D.C. public high school. There are plenty of computers, but not enough textbooks, or even kids who can read … Politicians love to talk about HIT as though it will automatically save costs … A 2005 study by the RAND Corporation concluded that HIT could save our health care system around $77 billion a year … Americans spend $2.3 trillion a year on health care. So potential savings as a result of HIT are only 3.3 percent of our total medical spending. That’s like a family cutting its housing costs by moving from a house with 21 rooms to a house with 20.”

Participation in the “Is CCHIT free of HIMSS influence” poll to your right is high, with 91% saying “no” so far. 

Thanks for the couple of folks who posted events to the brand spankin’ new HIStalk calendar. Feel free to click the Submit Event link on that page.

Speaking of the calendar, I Googled to find events I might want to put on it. Big mistake: there are for-profit companies everywhere (many of them associated with the rags) that are shilling conferences. They all feature big-name speakers, who I assume are paid (since it’s a for-profit conference, why not?) and don’t mind missing work. There’s an $800 conference on HIT stimulus money (run by a magazine). There’s an EMR one run by a conference company that urges immediate registration, despite having no posted agenda and a registration form (including asking for credit card info) that nowhere mentions what it costs. There’s a $1,600 version run by a magazine that features the latest in buzzwords: deep dive, galvanize, futurist, and symbiosis. Here’s a radical thought for folks who work for cash-strapped providers (is that redundant?): stay home instead of going to conferences. Radical, I know, but when hospital employees are losing their benefits and even their jobs, I could not sleep fitfully in a $300 a night hotel room and sit in swanky ballrooms listening to peers from places highly unlike mine give their standard stump speech, bracketed by wide swaths of time left open for receptions, recreation, and schmoozing with vendors. More importantly, if the place those speakers work is so darned smart, why are they struggling like everyone else? Encouragingly, a couple of the conferences offered an online version that eliminates all the time and money wasted on travel, so that’s better. But, I’ll stick with the premise that conferences occasionally give you safe, mildly useful information that passes for change, but real innovation is something you have to sweat out on your own.

MedAssets will promote the Web-based, front-end patient access tools (including scheduling, orders and self-service) of SCI Solutions as part of its offerings to improve net revenue.

TeraMedica and its partner Sun Microsystems announce the availability a pre-configured image viewing and management solution that presents images from multiple modalities and providers as a single view.

The Verden Group releases its Q1 Insurer Ranking Report (warning: PDF). Spoiler alert: Aetna drops a few spots, while small market LifeWise Health Plan takes #1.

A VP of the Cox cable company describes (by audio) his company’s interest in healthcare technology, which comprises 10% of its overall business. He talks about telemedicine in rural areas. My short attention span kicked in at the three-minute mark, so there’s 12 more minutes that, like Nixon, I can’t account for. I don’t get the whole podcast thing, which takes 15 minutes to absorb what would be a 30-second read, but it has fans, I guess.

Hospital operator Tenet and physician practice systems/services vendor MED3OOO form a joint venture that will offer services to doctors in Tenet’s service area, including those Tenet employs. The new MED3OOO Practice Resources will offer management services and technology. Tenet owns 20% of MED3OOO. Correction: Tenet owns 20% of the newly created entity, not of MED3OOO itself.

Old news I missed: Emdeon will acquire fraud management company The Sentinel Group.

Elected to the board of medical exam and actuary company Hooper Holmes: Larry Ferguson, former CEO of First Consulting Group and Daou; and Ron Aprahamian, former CEO of Compucare and chairman of Superior Consultant. The announcement didn’t mention that the company did not support their election, which occurred only after Aprahamian led a proxy fight. He’s a big shareholder with 3 million shares, which sounds fantastic until you learn that the share price is $0.49 and market cap is only $34 million.

Microsoft asks Alberta Children’s Hospital for its technology wish list for hospitalized children through its program that provides PCs, software, Xbox consoles, and wireless connectivity. I had a smart alecky comment about asking for Macs, but it felt Scroogish since they’re doing an undeniably good thing.

A doctor in Australia uses his EMR to successfully defend a medical board’s claim that he mismanaged a patient. A family member claimed his exam lasted only one minute, but the medical record showed it took more than seven minutes. His conclusion: “His mother gave evidence to the board of what she thought, but I gave evidence from the computer.”

IT saves the career of another doctor. A hospital ED director accused of sexual assaulting a co-worker as she replaced the printer toner in his office is cleared after IT staff verified that he didn’t have a printer there.

A Harvard Business blog discusses the declining trend of virtualized company management, using Eclipsys as its focal point. On replacing Andy Eckert as CEO, primarily because he didn’t want to leave California to be where the company is (Atlanta), “Pead said this week in an address to customers, ‘You can’t deny how effective it is to be able to sit down and have lunch with another leader and resolve an issue quickly.’ My sense is that he’s right and we all know it. However, many companies seem not to want to acknowledge it.”

I’ve mentioned Natalie Hodge before – she’s the pediatrician who started Personal Pediatrics, a concierge practice that does house calls. Some interesting nuggets from this interview: (a) she says there is no need for an actual office since everything fits in the trunk of her car; (b) she plans to affiliate with other physicians (“a fleet of iPhone Doctors,” the article says) and to offer them iPhone access to company tools once Version 3.0 comes out, and (c) the “old model” of running an office cost her office $200K, while the new one provides the same revenue with only $50K in costs. She’s gone all dot-com: moved to San Francisco, hired PR people (thus the artsy black and white pic above, which I like), and is looking for a startup CEO.

The local paper profiles Geonetric of Cedar Rapids, IA, which is moving from designing Web sites to creating a personal health record or consumer portal type of product. I played around with their Backpack Tool for kids, which is pretty cool.

A huge Northern California IPA announces that it took a surprise loss last year, mostly because of investment losses, but also discloses that it spent $7 million on EHR implementation last year.

A reader called out a typo in Inga’s mention of BIDMC’s cost savings using Nuance eScription. The savings cited was $5 million since 2003.

Amy Rees Anderson, CEO of MediConnect Global, is named to the Utah Technology Council’s board. MediConnect’s site lists several services, but its bread and butter is retrieving medical records for lawyers and insurance companies. “MediConnect specializes in providing medical record retrieval services to the organizations that need them most-law firms involved in mass tort, medical malpractice and personal injury cases and insurance brokers and underwriters … turn soft medical record retrieval costs into concrete billable expenses.” As best I can tell, they simply call up hospitals or doctors, ask to have paper medical records sent to them, and then scan and send them on. That’s an interesting business, especially since she started out selling Web-based physician systems. Smart.

The CBS Evening News runs a piece on BIDMC, whose employees sacrificed to save jobs that would have otherwise been eliminated due to a $20 million budget shortfall.

Fresh off the “most e-mailed” list of articles from the Orlando newspaper is one detailing salaries of the folks who run the non-profit hospitals there, including the CEO of Florida Hospital ($1.1 million) and its parent, Adventist Health ($3.5 million), which the author dryly notes is “not bad for a faith-based nonprofit” since that paycheck is bigger than those for the folks who run Mayo and Hopkins … combined.

Medical diagnostics vendor Hologic will use products from Loftware in deploying Oracle’s supply chain applications. If you’re involved with healthcare labeling or the GS1 standards for global supply chain, they’ve got resources, including a GS1 white paper (warning: PDF), which I had to look at since I’m not very familiar with GS1. I was more comfortable with their Hopkins case study involving lab sample labeling.

I mentioned InQuickER a few months back, an online ED appointment scheduling application that I could find next to nothing about. The Atlanta profile does a short writeup on it. Patients pay $24.99 to scheduled an ED slot online and are guaranteed be seen within 15 minutes of the scheduled time. I’m skeptical, of course: if you can make an advance appointment, why are you going to the ED? Are EDs like restaurants, where reservations trump walk-ins? If EDs are already overburdened, why are they making the experience more pleasant only for those who pay extra? Come on, people, use those retail clinics that are everywhere unless you truly need ED services.

On that theme: if you’re a highly paid executive and don’t want to hang around the sick and underfunded people that hospitals attract, Adventist Bolingbrook Hospital will treat you better for a price, offering executive health coordinators and an “executive health lounge.”

A fire that requiring shutting off power at St. Vincent’s Medical Center and St. Luke’s Hospital in Jacksonville, FL took computer systems down Thursday. They were back up that same evening. I always like this quote: “Patient care has been unaffected,” which seems to imply that those systems weren’t doing much for patients anyway.

iSoft sells to its first hospitals in Italy.

Ralph Webb, who designed LDS Hospital’s lab system and developed the first patient wristband ID, died this week in Utah at 80.

E-mail me.

News 5/29/09

From Nasty Parts: “Re: Allscripts. They will announce the acquisition of Medfusion and Medem shortly, bolstering their physician connectivity capabilities.” Consider it unverified and, until further notice, untrue. Hypothetically speaking, it seems to make good sense and there’s some history there — Allscripts and physician connectivity vendor Medem have worked together and Allscripts bought 3% of the company and $2 million of its debt in 2004, while the former Misys Healthcare Systems created its consumer portal with Medfusion, which is based in Cary, NC, next to Raleigh.

From Inside Ohio: “Re: Propractica (StreamlineMD CCHIT-certified EHR). Heard rumors that it has gone out of business.” Not so, according to Sean Mullen, president of the company (who, when I called him, started off by brusquely saying he’d never heard of HIStalk, which I tried to overlook). I got voice mail at the listed telephone numbers, but one of the support reps gave me Sean’s cell phone number, saying they have a new phone system. Sean says StreamlineMD was formed May 1 when EMR vendor Propractica merged with Professional Receivables Control, an Akron practice management systems company. Business is stronger than ever, he says (it might be even stronger if humans answered the telephone numbers listed on the Web site – that’s some pro bono advice).

Listening: Anvil, since I saw a VH1 commercial for what sounds like a great new underdog documentary (not “mockumentary” like Spinal Tap, even though the lead guitarist’s name is Robb Reiner) about this early 80s Canadian metal band that went nowhere, but influenced everyone from Metallica to Megadeth and still trudges on today. Ebert gives the movie three stars, calling out funny-sad scenes that led to their obscurity, like their bad, barely English-speaking management booking them in Japan for a 9:45 a.m. concert. I like to see old has-beens finally win, so I’m rooting for them to make a comeback, even though their music is kind of Whitesnake-y at best.

I always enjoy getting the latest Medicity newsletter, so it was even better to see HIStalk mentioned in it (for naming the company’s booth as the coolest one at HIMSS and also your voting its merger with Novo Innovations as the smartest vendor strategic move). It also included results from a survey of 24 Medicity Novo Grid customers, in which more than 60% of those who connected their EMRs said they saw improvements in patient care, staff efficiency, cost, and hospital relationships. Both of the company’s CHIME focus groups received 100% “top box” scores (excellent or very good). They’re also offering 25 customer video case studies on CD that are free for the asking.

McKesson takes it in the shorts for suing a former pharma sales employee who bolted for medical supply competitor Henry Schein in 2004 even though he hadn’t signed a non-compete agreement. The judge dismissed McKesson’s suit, he countersued, and a jury just awarded the former employee $5 million and his new employer $6 million. McKesson says it will appeal.

New poll to your right: is CCHIT free of influence from HIMSS?

Greater Baltimore Medical Center (MD) rolls out ED clinical documentation from crosstown vendor Salar, integrated with its Meditech system.

In the least-shocking news I’ve heard lately, Grady Hospital (GA), like pretty much every large medical center buying clinical systems these days, picks Epic for its $40 million project. Losers: Cerner, McKesson, and Siemens (although I certainly would have put Eclipsys above at least one if not two of those). Oddly enough, Grady chose Epic on price, which must be an industry first since they are invariably more expensive than everyone else. Here’s my prediction: Epic’s honest, but I bet Grady made some estimating error that will cost them at least double that $40 million, probably involving labor, maybe their own since they are struggling and may optimistically think they can do a lot of the work without paying expensive outsiders.

NAHAM (National Association of Healthcare Access Management) is having its annual conference right now in Las Vegas. Our friends at SCI Solutions are there, no doubt, and QuadraMed is showing its new consumer portal for scheduling. Reports from the field are welcome.

New insurer payment rankings from athenahealth: Humana goes to #1 as the best payer. The industry as a whole improved over last year as well, with claims paid 5.3% faster and denial rates down 9%.|

I took action on a suggestion readers have made a few times over the years: there is now an HIStalk Calendar to keep track of industry events (there’s also a link at the top of each HIStalk page and links to upcoming events in the right column). Some cool features: users can submit their own events, it accepts rich text and graphics, and each event has a link to see a map and current weather. You can even download an event to your calendar, e-mail it, or share it on Twitter and a bunch of other online services. Feel free to share your events, although you won’t see them until I approve them (to keep out the inevitable spammers).

Cerner names Michael Battaglioli to the newly created role of chief accounting officer.

Jobs: Health Care Revenue Cycle Consultant, Senior Cognos Developer, Meditech Nurse Informaticists.

Atul Gawande, maybe the best healthcare writer there is, covers McAllen, TX in his latest piece in The New Yorker. The issue: the town is poor and rural, but second only to Miami in healthcare costs per person. Local doctors blamed everything from obesity to lawsuits, but analysis revealed something none of them said: overuse of medicine, especially specialists and implantable devices, sometimes for the express purpose of enriching a hospital or a doctor. “Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.” I’ve been far less eloquent and entertaining than Atul, but my motto echoes his conclusion: people and companies are guided by economic principles that will lead them to the most profitable activities, so you can change their behavior only by intentionally or otherwise redirecting their profit motive to something more desirable. If you pay for procedures, you will get lots of procedures. If you pay for quality (assuming you can define it), you will get quality.

University of North Carolina Health Care and IBM create a data warehouse to support projects related to grants, clinical trials, quality statistics, and the study of diseases.

Health officials in a Chinese province are forced to make a public denial after a widespread Internet rumor suggested that many of its doctors got AIDS after having sex with a female drug rep in return for prescribing her company’s products. The press-unfriendly police “briefly detained” a former patient who was believed to have started the rumor, after which he apologized, even though other doctors said it wouldn’t surprise them since medical bribery is standard procedure. A Chinese economics researcher stated the obvious about medicine in both China and the US: drug companies have access to information to tell them who’s prescribing, so it’s not surprising they try to influence the holdouts.

Former IBMer Walter Groszewski is named VP of business development at Medsphere.

Accenture, always geographically creative in avoiding paying US taxes, moves its “headquarters” from Bermuda to Ireland. If you want to buy American, it ain’t them (which you already knew since many of its employees work in cheap labor countries like India and the Philippines). It’s not just them, of course — I’ve been to the Caymans and all those corporations headquartered there must have short executives since their entire corporate office fits neatly in a standard post office box. Not their fault – Uncle Sam should just close the loophole by saying if you do more than $1 million in business here, you’re taxed the same as a domestic corporation.

A CBC article criticizes eHealth Ontario’s contracting practices, claiming that nearly $5 million in deals were signed with Courtyard Group and Accenture (begorrah!) without seeking other bidders. It also criticizes the organization’s salaries, noting that 164 employees make over $100K and hiring consultants keeps other names off that list (the CEO is paid $380K plus she got a $114K bonus five months after she started). Two consultants listed as SVPs on its site cost $1.5 million a year, including flights from their homes, per diem, and hotels. Most personally, it notes that one consultant listed as SVP was charging $3,000 a day as a consultant, while the company his wife owns got $300K in contracts, billing $300 an hour read newspaper articles and check holiday voicemail greetings. The CEO’s rebuttal: we chose single-source vendors because of urgency and we had to pay market rates to get the best people available. You will want to read at least some of the 200+ comments left, one of which notes, “This is one of the many reasons why we have a 50 billion deficit. We are no better than the US….ridiculously high salaries for top level management, high bonuses, over-priced contracts, unnecessary projects, no accountability and worst of all a government that no one has any respect for.”

E-mail me.

HERtalk by Inga

John Halamka claims that speech recognition technology and computer-aided medical transcription have saved Beth Israel Deaconess Medical Center $35 million since 2003 and reduced report turnaround time from five days to less than an hour. They have 3,000 physicians using Nuance’s eScription.

New York City agrees to pay $2 million to the family of a woman who collapsed and died on the floor of the psychiatric ward at Kings County Hospital Center last year. The patient had waited more than 24 hours to be treated and lay on the floor for more than an hour while workers did nothing to help her.

Streamline Health Solutions CEO Brian Patsy admits that overall business has slowed during the current recession, but says its hosting business is picking up. Streamline had 10 major deals in 2008 and eight involved hosting. Only one of four major deals in 2007 involved hosting.

HIT outsourcer Phoenix Health Systems partners with Sungard Availability Services to offer hospitals disaster recovery services.

Mayo Clinic finds that when surgical teams participate in preoperative briefings prior to cardiac surgery, communication is improved, errors are reduced, and costs are lowered. Teams participating in the pre-op briefings reduced miscommunication problems during surgery by 53% and decreased their medical supply waste. I’m now analyzing the amazing parallels between surgery and marriage.

McKesson declares a regular dividend of $.12/share of common stock, payable July 1st to all stockholders of record on June 10th.

Optimum Lightpath signs an exclusive agreement with GetWellNetwork to provide the Interactive Patient Care solution to New York metropolitan area hospitals. Optimum will package the Interactive Patient Care solution technology with its 100% fiber optic network to provide television-based communication systems in patient rooms.

Elsevier Health Sciences appoints Chris Dillon managing director for its Clinical Decision Support group. Dillon is a former VP of marketing for both Misys and McKesson.

Legacy Hospital Partners (TX) enters a 10-year agreement with PHNS to deploy clinical, EMR, and financial applications.

DeKalb Medical (GA) selects MRO Corp. to provide its ROI Online software and services. In case you are slow like me, “ROI” stands for release of information, as in managing the release of medical record information.

Misys reaches a new three-year financing agreement to help repay the debt created from the Allscripts merger. The $335 million deal involves five different banks and includes a term loan and a revolving credit facility. Funds will be used to repay $150 million in bank debt plus $190 million to ValueAct Capital.

IASIS Healthcare (TN)  signs a two year consulting agreement with Precyse Solutions. Precyse will provide IASIS medical staff with peer-to-peer training for quality clinical documentation.

A West Virginia woman sues a hospital after a parking gate arm comes down on her head, knocking her unconscious. The woman, who was on oxygen and used a walker, claims the hospital was negligent because traffic cones had directed pedestrians to walk near the parking gate arm.

Here’s a curious quiz. The results suggest I am a liberal (since I like the idea of slapping authority figures and don’t have a problem drinking out of anyone’s wine glass).

E-mail Inga.

Readers Write 5/27/2009

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!

CIOs: Sell Your Board and Executives on the Big Picture
By Ivo Nelson

If you think your IT staff and budget will decline in the next five years, think again. By 2010-2013, hospitals will be in full-scale EMR implementation mode. At the same time, they will be reengineering their revenue cycle processes and systems to accommodate some level of healthcare reform, while preparing for conversion to ICD-10.  

All of this activity will be on the same scale as converting to DRGs (1983) AND converting to Y2K (1999) AND implementing HIPAA (2003) times two (or more). And keep in mind, because these changes are mandated by the government, ALL hospitals and physicians will have to comply at the same time.

If you think your vendor contracts will cover all this, think again. If you think you’re at the top of their priority list, think again. If you think you’re going to get a break when you wind down your EMR implementation, think again.

Why?

I’ve met with over 60 CIOs in the last couple of months,  looking for insights into their strategies, concerns, and challenges.

The ARRA HIT stimulus bill is on everyone’s mind. Most CIOs have done more PowerPoints in the last couple of months than in the last five years due to inquiries from their CEOs and boards who smell money. The focus is the stimulus money and how their hospital is positioned to receive the maximum amount from the government. They allude to an END, when the EMR is implemented and demonstrates “meaningful use”, some minimal level of interoperability all within the boundaries of HIPAA security and privacy regulatory changes.

The ARRA HIT stimulus is just the start. Healthcare reform will change reimbursement to true pay-for-performance, requiring billing systems to be based on outcomes and quality. Additionally, if bundled payment is adopted, it will require unparalleled coordination to bring the hospital, physician charges, and other services into a single rate. Any emphasis on coordination of care requires a level of interoperability that doesn’t exist today. 

On top of all that, the impending ICD-10 coding conversions requires the number of diagnostic codes to swell from 13,500 to 120,000. For inpatient procedures, the number jumps from 4,000 codes to 200,000 codes. The IT implications are huge. The impact on the hospital operations process and analytics will be even greater.

Quality is the new battleground. Once we are required to produce consistent quality reporting as a requirement for incentive payments (and eventually to avoid penalties), the game changes. Quality comparisons among competitors will be posted on the sides of buses, billboards, magazine ads, and on the TV. Quality care will be the first thing patients look for when it comes to the well-being of themselves, their family, and their community.
The usual Press-Ganey patient satisfaction measure will become almost irrelevant. Patients will endure long lines, rude staff, and will sit on the floor if they believe they will receive higher quality of care.

For the CIO, there will be immense pressure to be agile in producing reports to manage and report quality. Many are already coming to the sad reality that, after spending tens of millions of dollars on their EMR, all they have is a transaction system that doesn’t produce information. An entirely new genre of HIT now emerges around healthcare analytics. Remember, reimbursement will likely be tied to this information. Losing revenue because IT can’t produce reports, systems aren’t integrated, or vendors aren’t responsive isn’t going to be a conversation any CIO wants to have with his/her CEO or board.

Interoperability/Community Connectivity? Obama’s view of community connectivity is the sharing of patient information between heathcare organizations regardless of their competitive stance and strategy with each other. Our president greatly underestimates the power of local political will. Connectivity is contemplated, in the short term, only when organizations use it to capture a greater share of referring physicians – damn the community good. Elaborate arguments  will justify the self-serving, digital capture of community (e.g. referring) physicians. There is a good chance ‘connectivity’, in the Obama sense, will eventually be defined in the courts.

Most CIOs are aware of the issues around interoperability. Most are participating on some committee on the state or local level as per their boss’s direction. Most roll their eyes at the naïve, non-healthcare participants who see the healthcare exchanges and interoperability as the holy grail.

Most realize they are being required to respond to some government mandate that doesn’t completely comprehend the data complexities that exist within the walls of most organizations. One organization has  92 different definitions for glucose and another has 16 different ways to define death. And they’re going to talk to each other? It’s a good thing there are some smart people on the ARRA HIT Standards Committee.

Of course, all of this is going on while we’re in a recession and CFOs are ratcheting back on capital and asking CIOs when their staff will downsize post-EMR implementation. It is not just that the CFOs are asking for reductions, it’s that the credit markets have tanked and the money simply isn’t there. It’s one thing for a CFO to say we need to reduce expenses; it’s another thing for a hospital to find out they have no credit because the bond market has tanked.

If I were a CIO, I’d be adding a few slides to my PowerPoint presentation to include ALL of the potential changes coming down the pipe, not just the stimulus incentives. I wouldn’t do a full-scale strategic plan, but I would dig deeper into a staffing analysis and make sure I didn’t prematurely reduce or redeploy staff. I’d create some what-if scenarios on the high and low end of change. I’d also take more advantage of the current access to my board and executives to educate and "sell" them on the bigger picture. Yep, and all this needs to be done while you’re trying to get the printer to format labels for the lab accurately.

The budget cycles are starting now for 2010. Make sure you get all of your cards on the table. I know it’s not all defined yet, legislation isn’t passed, and some changes may be a moving target. Like it or not, this is a government that makes decisions. The stakes are high. Now is not a time to be timid.

In the words of the great Wayne Gretzky, “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.” Let’s keep the puck on the ice. Go Red Wings!

Ivo Nelson is chairman of Encore Health Resources, a healthcare IT consulting organization.

From DVR-Challenged to an EHR?
By Gregg Alexander

Bringing real change to healthcare information integration will never happen until the focus is off of the “technology” and onto the training, education, implementation, and ongoing usage support of such complicated tools. Period.

Of course you can force the horse, but he he’ll die of dehydration if he can’t figure out how to drink. Geeks docs get it, but most clinicians are not geeks and couldn’t care less about technology if it doesn’t:

1. Make their lives easier;

2. Strengthen their profit margins;

3. Help them be better doctors, AND;

4. Come with ongoing, easy-to-access, stupid-simple support.

Number 4 is probably the most important, yet most often shortchanged component of these quadrangular conditions. Both the technology and the issues it is trying to support (healthcare issues) are far too complex for the general masses of providers to wrap their brains around all together. Just being a clinician is hard enough. Giant new learning curves for techno-tools which – let’s face it – don’t really hold much fascination for most normal folks are off-putting, even repulsive.

Here’s what I hear: “With pen and paper, I can be a decent doctor (#3), get by financially (#2), and I already, almost innately, know how to use them (#1). Sure, paper has a ton of associated problems, but until there are sufficient helpmates (#4) to hump me over that technological learning curve mountain, I’ll do what I know and spend my extra time trying to get the hang of my DVR. By the way, speaking of computers, what’s this Twitter thing? Is it … (hushed) … sexual?”

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com. He writes regularly for HIStalk Practice, but we decided to put him on HIStalk this time just for fun.

Blade Server Review – Main Features and Values
By The PACS Designer

There has been a lot of press lately about blade server architectures, so TPD thought it would be a good idea to highlight some of the main features of this type of architecture.

A blade is a plug-in device that is installed in a chassis. Its Wikipedia description reads, "The name blade server appeared when a card included the processor, memory, I/O and non-volatile program storage (flash memory or small hard disk(s)). This allowed manufacturers to package a complete server, with its operating system and applications, on a single card / board / blade. These blades could then operate independently within a common chassis, doing the work of multiple separate server boxes more efficiently. In addition to the most obvious benefit of this packaging (less space-consumption), additional efficiency benefits have become clear in power, cooling, management, and networking due to the pooling or sharing of common infrastructure to supports the entire chassis, rather than providing each of these on a per server box basis."

Blade servers and storage systems generally consume 50% less energy than traditional servers. They also occupy much less floor space, so valuable real estate can be put to better use. They also require fewer cables, have smaller power needs, and fit into 19" slots in a chassis.

Blade servers won’t replace mainframes any time soon, but they will be deployed for Web solutions and  cloud computing. An effort to move mainframe software to external users through conversion to SOA and REST solutions would typically be good for installation on blade server/storage systems, provided adequate security methods have been installed.

IBM’s partnership with Sentry Data Systems, which serves pharmacies and hospitals in over 20 states, is an example of a cloud solution that was deployed to reduce power consumption and  meet the growing needs for servers in a smaller operating space with less cabling.

Since the genie is out of the bottle, so to speak, for Web 2.0 and cloud computing, we will be seeing more need for blade systems solutions in the years ahead.

News 5/27/2009

From Lazlo Hollyfeld: “Re: regional health IT extension centers. They are being passed of as a critical component to assist 1-3 physician practices with EMR issues. Is it just me or does anyone else think that they are going to be a complete boondoogle? I recently heard a prominent official compare their design/purpose to QIOs. If this is the case, ONCHIT is largely going to piss away at least $700M over the next few years with very spotty results.”

From The PACS Designer: “Re: ICU LifeGuard. Baptist Hospital of South Florida has installed an intensive care solution called ICU Lifeguard that can detect subtle changes in a patient’s condition. The system permits 24-hour-a-day monitoring of patients undergoing intensive care at a central work area to improve the chances for intervention should alarms be activated during times when direct care is not present.” Link. I think that’s just their name for Visicu’s eICU.

American Sentinel University, an accredited (DETC) online school, will give incoming students in three Master’s programs up to 18 hours of credit for Cerner Millennium coursework.

The board of Grady Memorial Hospital (GA) will choose a vendor for its $40 million infrastructure upgrade on Wednesday.

A couple of folks have sent articles or comments that have run elsewhere (their own blogs or someone else’s) with the expectation that I will use them. Unlike other blogs, I use only original material. Reader submissions are encouraged if they haven’t appeared anywhere else.

The CMIO of Wheeling Hospital will present a Medicity-sponsored Webinar on June 18 called “Enhancing clinical effectiveness and efficiency through patient-centered care collaboration”. If I have some time this weekend, I’ll be rolling out a new HIStalk events calendar to make it easier to find programs like this.

Intellect Resources will offer a free HIT career search workshop in NYC on June 3.

Cerner will add 40 tech support jobs in Dublin, Ireland by the end of the year.

Kaiser Permanente uses HealthConnect to gather data for a study that found 11% of its patients got whooping cough because their parents didn’t get them immunized. Their chances of getting the infection are 23 times that of children who got all their shots.

Forbes interviews Denni McColm, CIO of Citizens Memorial Hospital of Bolivar, MO. This quote is about the technology being used to monitor patients at home: “We’ve also seen some decline in our admission rates for home health patients. They take vital signs, weight and blood pressure every day, and it’s automatically fed into our system … it’s submitted to electronic medical records through phone lines. It can also remind them to take their medication. They get a reminder to step on the scale, take their blood pressure and put this on your finger. And sometime in the next hour, when their phone isn’t busy, it dials in the information. The sky’s the limit about how much care can be provided at home. One nurse can sit in a room and monitor 40 patients and be alerted to any anomalies, which you can’t do if you have to go through their home or see them one at a time.”

Lee Memorial Health System (FL) gets board approval to spend $68 million to roll out its EMR system (Epic, I believe) to its four hospitals and all employed physicians, although it’s hoping to offset that cost with up to $40 million in ARRA money.

A great answer for hospital overutilization: encourage people to die somewhere else.

A CBS News piece covers electronic health records in the ED at Inova Fair Oaks Hospital (VA), covering (but not by name) Picis ED PulseCheck. Tidbits: Inova spent $200 million over 10 years for its IT solutions. A doctor in a three-doc practice had an interesting comment about ambulatory EMRs: “I’m not doing unless I get a benefit from it, right? Is it going to make me any faster? No. Is it going to make my patient care any better? I don’t see that.”

3M Canada donates patient coding software to the HIM program of a Canadian college.

Patient check-in software vendor Phreesia gets a writeup in a New Brunswick business journal, mostly because it’s doubling its employees in Canada to 100 in addition to 49 in New York.

Natural language processing coding and billing systems vendor A-Life Medical buys out UPMC’s interest in its inpatient coding solution, setting up a new management team.

Three-employee Acuitec, a Birmingham, AL-based joint venture between a local entrepreneur and Vanderbilt University, is marketing a Vanderbilt-developed periop system.

E-mail me.

HERtalk by Inga

Retail clinics in grocery stores and retail chain stores are more likely to be located in areas with a lower population of black residents, lower poverty rates, and higher median incomes. In other words, poorer neighborhoods are less likely to have access to one of the country’s 1,000 or so retail clinics.

NHS patients concerned with privacy risks will now be allowed to delete the electronic summaries of their treatment records from the national database.

Epic earns top honors in a new KLAS report highlighting pharmacy information systems and integration. Epic scored high for its tight integration between EpicRx and its other EHR functions, as well as for customer service and support. Siemens Pharmacy and GE Centricity Pharmacy were the second- and third-ranked products. The report also noted an increased demand for integration between core clinical systems and pharmacy software. The tighter the integration, the bigger the impact to patient safety and the increased likelihood of physician adoption and satisfaction.

The New York Times explores some of the more less conventional ways hospitals are trying to connect with the public to attract patients, donors, and doctors. Twittering from operating rooms, posting surgeries on YouTube, and patient blogging are some of the ways hospitals are trying to stand out among competitors. Remember the good old days when doctors didn’t advertise? Now you have brain surgery on the Web and baseball stadiums named after your local healthcare system.

The former head of a closed Detroit hospital agrees to pay $350,000 for violating state public health code and privacy laws after medical records were found burning on his farm. Dr. Soon K. Kim must also hire a contractor to dispose of any remaining records. Assuming the burning did the trick, the settlement amount sounds a little excessive. But, what do I know?

Mt. Washington Pediatric Hospital (MD) selects PerfecTIME time and attendance software to automate the workforce management process for its 600 employees.

IT employment continues to drop from its 4.058 million peak in November. By the end of April, only 3.87 million workers were employed in IT. Don’t expect things to turn around until at least the end of the year.

AT&T is partnering with device monitoring companies and other high-tech firms to advance telehealth applications.

HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announce the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The HEAT team will focus on investigating Medicare fraud, including investing in new technology for fraud detection.

Seattle Radiologists deploys Corepoint Integration Engine to monitor its IT environment and enhance its radiology workflow and application environment.

Why do we women have to suffer so much for fashion? Experts are now finding that women who wear too tight jeans run the risk of suffering a nerve problem called meralgia paresthetica. Seriously, what man would possibly look our way if we were wearing jeans that look like maternity pants from the 1980s?

E-mail Inga.

News 5/22/09

From Deborah Kohn: “Re: ONC’s deadline to publish guidance on Regional Extension Centers. I can’t speak for the Secretary of HHS nor the National Coordinator of HIT, both of whom as you know officially took office only a few / several weeks ago, respectively. However, in Monday’s (May 18, 2009) published Implementation and Operating Plan ‘in fulfillment of the 90 day deadline established by Division A, Title XIII of ARRA’, ONC added that a notification for funding availability for the regional extension center grants will be published by the end of FY 2009, and that awards are anticipated to be made in early FY 2010. (That’s the federal gov’s FY, October 1).” Here’s a little plug for Deborah (which she didn’t ask for) for her contributions.

From The PACS Designer: “Re: RIS/PACS integration. Smaller hospitals need to find solutions that make them more cost efficient and competitive, and what better way than to employ a fully integrated RIS/PACS solution?Chinese Hospital of San Francisco has just made such a move recently by installing a RIS/PACS from the same vendor, gaining better coordination of its scheduling to enhance the flow of patients for its MDCT procedures.”

From Kelly Greene: “Re: why the feds should stay out of healthcare.” Link. NIH spends $178K to determine why Thai prostitutes (both women and transgender) get HIV, $400K to figure out why Argentinian gay men engage in risky sex while drunk, and $2.6 million to teach Chinese prostitutes to drink less while working. Imagine what they’ll do with the billions in stimulus dollars headed their way.

From Fish n’ Chips: “Re: Sutter. $1B spent, Burlingame is live on Epic, and this by any measure is a successful EHR implementation? Sounds more like the Fed dumping megabucks into the economy and announcing all is well.” I doubt they spent anywhere near the full billion the project was rumored to cost, but I’ve not seen numbers one way or another. I bet most of it was on labor after the initial hump of hardware and licenses, so stopping early probably saved a big chunk.

From CDiff: “Re: Wolfram Alpha. If you have not played around with Wolfram Alpha yet, you can explore all sorts of things and the response time is pretty good. The extended overview screencast on the far right side is impressive. Unfortunately, when I asked for some basic data on healthcare, HIS, and women’s shoes, the program could not provide it, but perhaps some day soon.” I lost interest when searching for HIStalk turned up no hits. I’m finding no deficiencies in Google that would lead me to look elsewhere for search, but maybe those folks will come up with a better mousetrap.

Listening: Guster, witty and melodic Boston-based alternative rock.

Cerner says ARRA could boost its revenue up to $600 million a year, a 33% increase.

Industry long-timer Bob Restagno, who worked for Florida’s Dynamic Control and all the companies that it became all the way through McKesson, died last weekend at 69 after a long fight with cancer. Condolences.

A reader asked if I would consider putting HIStalk on Amazon’s Kindle. I aim to please, at least if there isn’t too much work involved (there wasn’t), so here you go. Amazon sets the price without author involvement, unfortunately, so I see they’ve pegged it at $1.99 per month instead of the “free” that I would have made it. I admit the new Kindle is pretty cool: thinner than a pencil, holds 1,500 books, downloads directly over WiFi, and costs $359. If you try reading HIStalk on it, let me know how it works out. I’m a little bit tempted to get a Kindle – the $9.99 price for books seems like a good reason to go paperless (except you can’t buy used books like I do). You roadies would probably love it.

The Washington Post follows up its somewhat critical HIMSS piece with another that goes after CCHIT. The title is more exciting than the article: “Group Seeks Sway Over E-Records System — Health Association With Ties to Stimulus Lobbying Effort Pursues an Oversight Role.” All it says is that HIMSS created CCHIT, lobbied for big stimulus dollars, and now recommends CCHIT as the EMR certifying body. “Critics in the health-care industry have expressed concern that the certification commission is too close to information technology and health-care companies to be the best judge of what equipment doctors and hospitals ought to buy. Although the group is funded through a contract with Health and Human Services, it is run by a former HIMSS executive and one trustee also is the president of the trade group. Several board members work for technology vendors.”

In the UK, NHS Wandsworth passes on Cerner Millennium, saying it’s not suitable for the clinic model there.

IBM announces real-time data analysis software called System S (Stream Processing System) that helps users recognize patterns in huge amounts of data, making it useful for the financial and healthcare industries. A company example is monitoring all of a hospital’s databases in real time, including monitor data, to let caregivers know about emerging patient problems (if you trust your data and your own ability to interpret it, anyway). I think a better use of it (which they didn’t think of yet, apparently) would be healthcare fraud detection.

Some big-name healthcare people form the Institute for Interactive Patient Care, which will advocate for patient engagement via bedside technologies as a way to improve quality and decrease cost in the context of healthcare reform. Among the members of its advisory board are David Nash (Thomas Jefferson University), Leah Binder (The Leapfrog Group), Michael O’Neil (GetWellNetwork), and Barbara Summers (MD Anderson).

I was thinking about ARRA as I read the press release above since nobody’s talking about anything except EMRs. ARRA puts all the financial eggs in one basket: electronic medical records for providers. It funds nothing that benefits patients directly, like consumer information and tools to manage wellness. In other words, it encourages automating the treatment-focused model that is responsible for putting the US healthcare system right up there with those of Slovenia and Cuba. We lead the world in sophisticated interventions, but those are expensive compared to avoiding the need for them in the first place.

The money guys who funded Premise got an internal rate of return of 79% when Eclipsys bought the patient throughput company for $38.5 million in cash on December 31. Their current holdings, some of which are healthcare-related, are here.

CareTech Solutions wins medical marketing awards for creating a virtual Wall of Hope for MetroHealth (OH) and a content management system for the Chris Evert Children’s Hospital (FL).

Hotel Dieu Grace Hospital (Ontario) rolls out Bosch Security Escort to all of its 2,200 employees. Its wireless fob lets employees send an immediate “code white” to security staff and tracks their location until help arrives.

A Florida ophthalmologist hopes to make money from his sideline business, QuikView Medical Records, software for eye doctors.

Germany’s CompuGROUP increases revenue by 36% in Q1, the headline blares, making it clear the real story will be in much smaller print: earnings were down, with EPS $0.05 vs. $0.13 (I assume that’s Euros, not that there’s anything wrong with that). The company bought 51.6% of EMR vendor Noteworthy Medical Systems in February.

An Ohio health department executive is being investigated after complaints that he was selling drugs over the Internet, which he denies. The probe has already uncovered the fact that he doesn’t hold the degrees he claimed when hired, however.

White Pine Systems gets a $225,000 early-stage investment from a State of Michigan-supported fund. It’s a PHR vendor running under the name SPINN (Secure Personal Information & Notification Network).

St. Luke Hospitals (KY) goes live with IntraNexus SAPPHIRE Patient Financial Management.

Enjoy the Memorial Day holiday. Please don’t forget that its purpose, other than to give you a long, pre-summer weekend, is to honor those military members who died in service to our country.

E-mail me.

HERtalk by Inga

Sentry Data Systems releases a new mini-site for the Deficit Reduction Act (Section 6002). The site includes detailed explanations of the compliance requirements issued by state Medicaid directors, an overview white paper, and additional resources.

I like most everything we post on HIStalk Practice, but I found the recent post by Dr. Joel Diamond to be hilarious. Entitled “What’s Wrong with ICD,” it will likely relieve any 300.4 that you might have.

Axolotl appoints Robert Scarbrough director of IT operations. He’s a former VP of IT for Swope Community Enterprise Services.

I visited the Huntzinger Management Group’s website today and checked out their “First Quarter Highlights” page. It was flattering to see that their HIStalk Platinum sponsorship made the top of the list! Other top Q1 happenings included a HIMSS Gold Sponsorship and the securing of several key engagements, including multiple not-for-profit, community-based, and academic healthcare organizations. That’s George Huntzinger, of course, formerly of CSC and Superior Consultant.

If you are attending MUSE International next week, send us some updates from the field. This year’s meeting is in one of my favorite cities, Vancouver, which I expect is especially beautiful this time of the year. A few of our sponsors will be exhibiting, so stop by their booths and tell them thanks for supporting HIStalk. Those listed on the exhibitor’s guide include API, Vitalize Consulting, PatientKeeper, MEDSEEK, Ingenix, QuadraMed, and Stratus Technologies.

Docusys announces a partnership with Medusind Solutions, an end-to-end revenue cycle management service company.

The Buffalo, NY-area HIE HEALTHeLINK negotiates special EHR pricing on behalf of its physician members. HEALTHeLINK is also setting up a demonstration lab that includes demo EHR software for each of the participating vendors. Area physicians looking for EHR solutions will have access to the lab to evaluate the different EHR products.

Mediware signs an agreement to acquire SciHealth, Inc., the designers of the Insight business and clinical intelligence software package.

As many as 29% of Americans would consider traveling abroad for medical procedures, even if they are routinely performed in the US. If the quality were equal to what you get in the US, but significantly cheaper, as many as 40% would consider treatment abroad. In case you are wondering, 30% of us would go abroad for plastic surgery, if we were without insurance and the procedures were cheaper and quality of care was good.

St. Luke’s Hospital (MO)  extends its use of Thomson Reuters’ Micromedex solutions with the addition of the Micromedex physician portal and medication reconciliation tools.

Nine St. John Health System (MI) employees file a $1.5 million lawsuit against their employer, claiming the hospital owes them for unpaid sick days. Last year the hospital announced it would no longer pay employees for sick days accumulated prior to 1995 because it could not afford the $4 million-plus cost. Attorneys are seeking class action status, which could extend the suit to 1,400 employees. The lawyers are also claiming age discrimination since all the affected employees have at least 14 years tenure with St. John.

Over the next few months, healthcare HIS recruiter Intellect Resources is offering free career management workshops across multiple US cities. The 45-minute "Managing Your Career Search" presentations are designed for HIT professionals who need to organize their job search. First stop is NYC on June 3rd.

The ONC extends a $102K grant to the American Hospital Association to measure the adoption and use of EHR by hospitals.

Coordinated Health (PA) selects Allscripts Enterprise EHR and PM for its 50 physicians an 50 mid-level providers and PTs.

Ochsner Health System (LA) selects MedAssets to provide revenue cycle services.

For the first time, HealthSouth founder and federal prison inmate Richard Scrushy testifies under oath that he did not know about the $2.7 billion accounting fraud that put his company into financial jeopardy. That fraud led to the shareholder lawsuit that put him in the witness box.

Check out the cool Webinar coming up May 27th from the folks at Hayes Management Consulting. Topic: physician adoption of EHRs.

UnitedHealthcare and CalRHIO partner to facilitate the transfer of patient information to EDs. UnitedHealthcare will pay CalRHIO to deliver the clinical data of its members to hospital EDs.

E-mail Inga.

News 5/20/09

From SamanthaRN: “Re: West Tennessee Healthcare (Jackson-Madison County General Hospital). Cuts Baylor program, stops 403(b) matching contributions, cuts benefits, but continues construction and expansion.” Unverified.

From Candy Albicans: “Re: certifications. For a few of us, the FY is starting soon, or has just started. Which means, what do we do for the year for our career? I’m trying to figure out what I want to go with. We have CPHIMS, PMP, HL7 Cert, ITIL, HFMA, and vendor certifications.” Personally, I would first look at academic credentials – certainly a bachelor’s if you don’t have one, a master’s if you do, or maybe even a second master’s (an MBA if you have a healthcare credential or vice versa). Or, a master’s in project management or IT. I like certifications only if they are immediately useful – if you’re doing apps work, especially with Epic, it’s probably worth it to get certified if you want to keep doing that.

From Stan the Man: “Re: ONC. Did they miss the deadline to publish guidance on Regional Extension Centers? ‘The Secretary shall publish in the Federal Register, not later than 90 days after the date of the enactment of this title, a draft description of the program for establishing regional centers under this subsection.’”

Jon Manis, CIO of Sutter Health, provided this communication Monday to HIStalk’s readers concerning Sutter’s layoff notices that went out that day. “In previous HIStalk post I committed to giving you the facts about Sutter Health’s Information Services (IS) staffing review. I make good on that commitment today. Due to the continued economic decline, today we are announcing a staffing reduction and restructuring. This decision was one of the most difficult I’ve ever had to make. We are much like a family here at Sutter Health, so having to lose even one of our valued employees is especially difficult for all of us. Today is an extremely hard day for all of us, and we’re doing everything we can to fully support our employees. Unfortunately, 121 of our employees based at our IS facility in Rancho Cordova received notification that they will lose their jobs on July 17, 2009. These are dedicated and talented professionals who have provided tremendous value to our organization. Unfortunately, these staffing changes are necessary. We have a higher responsibility now more than ever to our patients who pay for health care to be good stewards of our resources and to keep our services affordable. To fully support our employees whose positions are being eliminated, we will not be asking them to report to work after today. We want to give them the next two months paid, before severance benefits begin, so they can focus full-time on finding new job opportunities. They will have the full support of an extended Human Resources team and comprehensive outplacement services. Sutter Health and our affiliated hospitals and physician organizations continue to employ approximately 1,500 IS staff in Sacramento and other communities around Northern California who support innovative technologies, like our Sutter-wide EHR. Our commitment to advanced clinical technologies and our enterprise EHR has not waivered and will not change. What has changed is our access to capital and that has impacted our aggressive deployment schedule. We recently launched our first hospital-based EHR in Burlingame – by any measure a very successful EHR implementation. However, due to the economic downturn, hospital-based installations will not resume until sometime after 2009. In addition, we will accelerate the completion of our EHR rollout to our affiliated physician organizations.”

From Neal’s Pizza Guy: “Re: Cerner layoffs.” Cerner’s reduced NPfIT scope of work leads to layoffs of unspecified numbers in the UK. 

From Redmond Radical: “Re: Microsoft. Huge attaboys at Microsoft on Peter Neupert’s team last week as their strategy to destroy certification scores a big win. Peter’s testimony before Congress and in private meetings pays off. Amalga, their lead product, ceases to to have a market if you have interoperability. Don’t the academics from Boston know they are being played?” Interesting theory, but Amalga (along with a lot of other Microsoft products) doesn’t really lose value with interoperability since it provides visibility into a hospital’s own data and workflow. The argument would have been stronger using HealthVault as an example, but I don’t necessarily think Microsoft is all that interested in certification in any case (bring up HIPAA and their ears will perk up). 

From Pat Hanns: “Re: Meditech. I have to quibble with the 2,000 hospital customers you cited. Around 250 are international with just clinical systems, 250 are HCA running an aging and customized version of Magic clinicals, and 250 use only 1-2 applications such as lab. That leaves about 1,200 US hospitals: 600-700 on the old Magic product and balking at large upgrade fees, 500-600 on client-server (not really a true C/S like Paragon), and four on Release 6, their new Focus programming language/database. That adds up to about 2,000, but I will surely defer to anyone from Meditech who can clear up the confusion and publish a list of the actual sites.”

From HIT Man: “Re: ONC. I watched a live feed of Dr. David Blumenthal addressing a room full of healthcare IT and government types at VCU in Richmond Monday. Dr. Blumenthal was, in a word, uninspiring. All he could say about his 8+ years of using an EMR as a provider is that it had once caught a potential drug/drug interaction he was prescribing and he was once able to see the results of an imaging study he was about to order but that had been done already a few weeks before. I know he has only been on the job for four weeks, but there was nothing in his 15-20 minute speech (no notes, no slides) to indicate that he is going to bring much insight, vision, or managerial capability to his national coordinator role. I would like to be very, very wrong about this.” I think it’s too early to judge him on one speech, especially considering the number of them he’ll eventually give (or any speech at all, actually, since glibness isn’t a prerequisite for the job). I would be more worried if he were the typical politician: a glad-handing oratorical machine willing to advocate whatever cause interests the backs to which he owes scratches.

The Washington Post article about HIMSS and ARRA seems to have interested lots of folks. Let me be clear: as a trade group, HIMSS did exactly what it is supposed to do, did it skillfully, and played by the rules. That was the back story of the article: you have to admire HIMSS for having the patience and the influence to get the Obama administration to make EMRs a centerpiece even though the EMR track record is spotty at best. Whether HIMSS represents the interests of the majority of its members, many of them people like me who have seen ineffective IT projects first-hand, is the question, although lots of them probably had good intentions in supporting spending taxpayer dollars on healthcare technology. I’ve said for years that the whole “advocacy” effort isn’t something I care about. Like most government expense enabled by lobbying, I’m skeptical of the stated outcomes (other than putting a lot of government money in private hands quickly, which was the real hot button). None of that matters now – it’s a done deal. I’ll stick with my story, though: all of us provider members gave HIMSS the credibility to push the profitable agenda of its vendor members through to a naive and desperate administration willing to buy the “cost reduction and patient benefit” story (which may indeed turn out to be true, although against historical odds). I’d rather be in a providers-only organization and leave HIMSS to the more lucrative part of its mission: moving vendor iron.

Speaking of the Post article, it spawned a ton of comments, some thoughtful, most vitriolic along party lines.

A reader points out DataBreaches.net, run by an anonymous healthcare professional.

The Nashville paper mentions Credence Health as a potentially successful startup. It offers clinical intelligence and key indicator tools.

The name of a Mississippi cardiologist arrested for human trafficking and prostitution is … no kidding … Dr. Weiner. He is accused of using a “Sugar Daddy” Web site to solicit companionship. All those taxpayer-raping financial industry CEOs are walking around free and this guy is the focus of a sting involving consenting adults voluntarily bartering for items each has that the other wants? Please.

DR Systems announces its Canadian license for Unity RIS/PACS.

Jobs: Director of IS, Soarian Superuser, Cerner CPOE Activation Support.

An Australian market research firm rolls out business intelligence software for doctors in return for tapping into their EMR data, which it will sell (de-identified, it says). It was previously paying doctors directly to get access to their de-identified prescribing data.

Unrelated PC news: I switched from Carbonite to Mozy for online backups because (a) several readers said they use it, but more importantly, (b) Carbonite installs a bunch of Roxio peer-to-peer and disk watching services that were hanging up my PC, doubling the boot-up time. Mozy is working great and it’s free for a basic account. And here’s why I have a barely detectable anti-Microsoft bias: some of our crap software at work requires IE and was dragging (no surprise since IE is a pig), so I figured I’d upgrade to IE8 and take advantage of some of those touted Microsoft improvements. I should have known I was in trouble when the install program said it also had to update Windows to load IE8 (!!) It rebooted and took me right to the XP blue screen of death. It eventually recovered after several reboots, but then I noticed that some of my programs were hosed (the firewall program had lost its mind and needed to be reconfigured from scratch and Rhapsody wouldn’t play music). Firefox upgrades itself every week or two and I’ve never had a hitch and never had to reboot. Guess which browser doesn’t suck?

Eclipsys PeakPractice (the former Bond Clinician) earns conditional CCHIT 08 Ambulatory certification pending completion of advanced ePrescribing requirements.

Thanks to MED3OOO for remaking their sponsor ad without the animations and transitions that some readers said they find distracting. I appreciate their noticing the reader survey results and taking that step on their own. Also, a reader asked to have the links underlined in HIStalk Practice like they are here, so that’s done, too.

Maryland’s governor was to have signed a bill today that requires private insurance companies to give doctors financial incentives to use EMRs (sounds kind of socialist, doesn’t it, to be telling one private industry group how to conduct business with another?). Also required by the bill: a statewide HIE.

RelayHealth announces H1N1 tools: a questionnaire and educational content for physicians and antiviral prescribing pattern information for CDC.

A BIDMC study says patients will trade some privacy for the convenience of electronic medical records and expect to have computers play a positive role in their medical care, including self-care.

Strange: on the subject of accountability for medical software bugs, AMIA says members don’t agree enough to allow it to have an official opinion. Of course, it has software vendors as corporate members, so you can probably guess which side those particular members are on.

Another example of government efficiency: CMS and ONC says they need nearly $1 billion worth of IT systems just to track ARRA incentive payments.

E-mail me.

HERtalk by Inga

From: Charlie Brown “Re: shoes.I have learned so many things about healthcare IT from you and Mr. H. It has given me many  insights. Fantastic stuff. I will have to show my wife your picture (of my shoes on LinkedIn). She will want to buy a pair. With two kids in university programs, that hobby has been curtailed.” Gentle reader: here is another insight. A great pair of shoes is cheaper than psychotherapy, a convertible, or an affair. Time to pony up.

A businessman is found guilty of grand theft, embezzlement, and tax evasion for selling human body parts donated to UCLA’s medical school. Ernest Nelson earned $1.5 million over a four-year period selling cut-up heads, torsos, and other parts to pharmaceutical research companies. Nelson schemed with the director of UCLA’s willed body parts program, paying the director $43,000 in return for gaining access to bodies. The director pleaded guilty last year; Nelson faces up to 10 years in prison.

MEDSEEK announces it added five new hospitals and health systems in the first quarter of 2009.

Rhode Island Hospital agrees to examine and revise its surgical safety procedures after a surgeon begins operating on the wrong side of a patient’s mouth. Over the next two weeks, surgery will be suspended for at least two to three hours in each specialty so that doctors and nurses can review policies and consider how they applies to each type surgery. It was the fifth reported surgical mistake at a Lifespan health system hospital within the past five years.

Picis announces its ED PulseCheck version 4 is now a CCHIT Certified 08 Emergency Department EHR.

HHS releases $500 million to the Indian Health Service as part of ARRA. Eighty-five million dollars is allocated for HIT, with the balance earmarked for construction of healthcare and sanitation facilities and health equipment.

I’m sure that this “problem” is not unique to the UK. Over 25% of UK employees are so work obsessed they can’t resist using a laptop or PDA before going to sleep. And of that group, 57% do so for 2-6 hours every week. Sweetly, 96% say the last thing they do before going to sleep is kiss their partner goodnight.

North Dakota becomes the third state to develop an Web-based registry that allows residents to input their medical treatment preferences. The service will be voluntary and involve a yet-to-be-determined fee. The Secretary of State’s office will house the repository, which will allow instant access to a person’s healthcare directives.

Texas State’s Student Health Center selects Medicat as its EHR vendor. The health center goes live this month using electronic records and will add online forms for students and secure messaging by the fall.

Informatics Corporation of America (ICA) grows its number of users by 165% during the first five months of 2009. ICA also reports a 400% rise in client engagements in 2008 over 2007, resulting in a 150% growth in revenues.

Planned Systems International secures a government contract to provide workflow enhancements to the Armed Forces Longitudinal Technology Application (AHLTA). In March, Military Health System officials announced plans to make the $4 billion AHLTA system more functional and interoperable with the VA’s VistA.

A local newspaper interviews David Laurello, president and CEO of the Massachusetts-based Stratus Technologies. The company has been serving up state-of-the-art, industry-standard technologies since 1980, which far exceeds the lifetime of most computer hardware makers.

St. Elizabeth Healthcare (KY) goes live on IntraNexus SAPPHIRE Patient Financial Management software. They’ve been an IntraNexus customer since 1997.

The state of Michigan is now able to track obesity rates in children as part of its state-wide Michigan Care and Improvement Registry portal. The portal includes height and weight fields, enabling officials to spot BMI tends across the state.

A few weeks ago, Mr. H mentioned that Traveling HIT Man, an ambassador for Intellect Resources, had been busy helping him write HIStalk posts. More recently he has spent time with me, working and leading the Inga lifestyle. Intellect Resources’ version of Flat Stanley is supposed to accompany his caretakers on work engagements, but I have found he is quite the party guy as well. He seems to like champagne.

E-mail Inga.

An HIT Moment with … Dave Dyell

An HIT Moment with ... is a quick interview with someone we find interesting. David Dyell is founder and CEO of iSirona of Panama City, FL.

Everybody’s talking about EMRs. Should they be talking more about integrating device data with them?

In a lot of ways the conversation should be one and the same. When you consider the HIMSS EMR Adoption Model, it shows that any Stage 3 hospital or above has implemented electronic nursing documentation. What it doesn’t show is that much of the data, including device data, is still written on paper to be transcribed into that electronic chart later. Meaning that a physician could be looking at physiological data that is 3-4 hours old by the time it is available in the EMR. I believe the latest data shows over 70% of the market has reached Stage 3, yet most facilities we speak with are still writing vitals on paper and transcribing them later.

We believe that part of the EMR adoption model should be to automate as much of the point of care workflow as possible and thereby truly create a paperless EMR. Its also important to note that device integration is not exclusive to the EMR. Many departmental systems have nursing documentation modules and integrating devices to those can provide a similar value proposition to integrating to the EMR. Examples are ED, Critical Care, OR, Anesthesia, OB, etc.

You’ve worked with integration engines for many years. Those tools opened up entirely new product possibilities for hospitals without requiring major internal or external IT resources. How is that like and unlike tools like iSirona’s that integrate devices?

While there is an aspect of what we do that provides interface engine-like functionality, device integration is really about automating the workflow at the point of care. The bits and bytes of managing data from the device and translating to a format needed by the EMR is engine-like, but interface engines never really touched the workflow directly. They were and still are for the most part a back-end, lights-out kind of tool that only interacts with other IT systems.

In order for a device integration solution to truly impact the workflow it must provide integration points to the end user, the clinician. Whether that be positive patient ID functionality to tie the patient to the devices being integrated or an authentication system that allows the caregiver to review all the collected data prior to delivery to the EMR, it must integrate to the workflow.

Let’s say a hospital’s chief medical officer wants 2-3 examples of real-life major care improvements made possible by your products. What examples would you cite?

A great example is the ability to help reduce in-house codes. More accurate and timely information clearly enables the physician to make on-the-spot decisions and better identify those patients trending towards a code. The average length of stay in the ICU to recover from a code is 14 days and the daily cost per patient is over $5,000.

Another example would be supporting fall prevention protocols. By integrating smart beds to nurse call systems, caregivers can be made aware when a patient that should be stationary is attempting to exit the bed. Along the same lines, the bed can tell us when a ventilated patient’s bed has been lowered below the recommend 30-45 degrees, thereby alerting a caregiver to help prevent ventilator-associated pneumonia.

Considering that these types of incidents are being considered for inclusion in the CMS “never-event” list and thereby would not be eligible for reimbursement, this can have a definite impact financially on the organization.

How fast growing is the volume of electronic data sent by medical devices, how can it be used, and what changes should clinical systems vendors be considering to use that information effectively?

Traditionally the amount of data captured by clinicians related to what the devices can actually output was very small. Some of the data is not necessarily clinically relevant, but the larger issue is there is just not enough time for a single person to collect all of the data potentially available from the devices. A single medical device may be capable of generating 300+ pieces of discreet data, while a given EMR flowsheet may only require 8-10 of those to be typed in.

When you remove the manual data entry task, which is so time consuming, you can then expand that data set to something that is much richer and can have a very positive impact on patient care. As the acuity of our patient population has grown, so has the use of medical devices and the sheer amount of data our caregivers are required to capture. A recent study showed nurses having spend an average of 147 minutes per nurse per shift on documentation, much of that from devices.

Many of the EMR and CIS vendors have decision support algorithms that analyze this data to help provide guidance to caregivers. Having that data set automated ensures the accuracy and timeliness of the data and gives the algorithm a richer set of data to work from. Using solutions like ours that provide positive patient ID ensures the data is charted to the correct patient, giving the caregiver comfort that the guidance being provided is for the correct patient. Clinical staff are then better able to predict and prevent adverse outcomes such as in-house codes, sepsis, and ventilator-associated pneumonia. We have multiple clients and other industry experts that tell us repeatedly that one of the problems with failure to rescue or recognize deterioration of patient conditions is poor quality of data.

Over my years of working with interfaces, we watched the laboratory industry push CIS and EMR vendors to the point now that we can see lab results even from outside reference labs back into our systems within seconds of the analysis on the specimen being completed. That gives our physicians great access to the chemistry of their patients. As we have discussed today, much of the physiology is still written down and typed in later, meaning that a physician logging into CPOE is faced with current chemistry, but potentially 3-4 hour old physiology. This forces a call to the floor to request current vitals, etc. and thereby devalues the CPOE experience to the physician. It is important that IS and EMR vendors recognize the workflow around device data capture and ensure their systems support the automation of this important part of the care process.

iSirona is a small company with at least one well-known competitor. How will you differentiate your offerings and compete with an established player?

I am glad you finally asked a sales question. Product, product, product. We built our product with the help of clinicians to ensure that we solved their needs. Just automating a clinical step was only going to bring marginal value to our customers. Automation alone saves time and allows for greater accuracy, but that has to be countered by associating the device to the correct patient to insure data is documented to the correct patient. Also, iSirona was built with a patient’s mobility in mind. iSirona’s system architecture ensures continuous data capture across multiple care environments and even through ‘cold spots’ in the hospital’s wireless network.

Additionally, we want the caregivers, regardless of EMR, to have the ability to view, select, and comment on the data they are charting. Our clients have the choice between using iSirona or the core clinical system for data authentication and charting additional required documentation. For clients choosing to use the core clinical system, iSirona provides and embedded solution for minimal impact to clinical workflow.

Our goal is to assist our clients in simplifying patient data collection while improving the quality of care and patient safely. We will continue to listen to our customers and prospects and ensure that we remain the visionary in this space.

Monday Morning Update 5/18/09

From JB Good: “Re: Adena. Do you know who Adena went with for an EMR?” Meditech, I believe. They must not have used the HIMSS Online Buyer’s Guide or done their tire-kicking at HIMSS since Meditech doesn’t play there.

From The PACS Designer: “Re: Windows 7. TPD has posted previously about some key new features of the upcoming Windows 7 release. Now, Dr. Bill Crounse’s Microsoft blog has a post on the Windows 7 platform and it appears to highlight some additional features when it comes to its potential use in the healthcare process.” I dunno … if Bill wasn’t drawing a Mr. Softy paycheck, I’d swear he was pitching Apple. “you just want your computer to work … works better … visually pleasing … graphics are simply stunning.” Windows? Seriously? It’s always mixed news when a vendor tells you how great their new versions are, implying that what you originally bought wasn’t so great. They weren’t saying that when you first forked over the cash for Windows ME … err, Vista. Personal users only have to pay and install, but for corporate users, it’s a major, non-strategic IT project to replace everybody’s desktop OS and train people to support it. I’m still fumbling around with that damned productivity-sapping ribbon bar on Office 2007 at work (no way I’d install it on my home PC), so I’m waiting for Microsoft to convince me that they have a clue.

From Neal’s Pizza Guy: “Re: UK. Redundancy plans were announced at yesterday’s Cerner UK town hall with 20-100 associates to be future endeavoured. Those in the firing line include Solution Delivery Consultants, System Engineers and Learning Consultants.” Unverified.

From Ukelele Bill: “Re: Stanford’s Epic implementation. It’s been mentioned before. How much are they spending and what are the problems there that anonymous posters have mentioned?”

An Eclipsys spokesperson disputes the comments left earlier by Eckert’s Sweetheart Deal. In summary: (a) ECLP shares rose from $16 when Andy Eckert started as CEO, rose to $26, and ended 2007 there. Shares have declined this year, but still outperformed the S&P 500. (b) KLAS scores for Sunrise Clinical Manager rose from 5th to 2nd place during his tenure. (c) Eclipsys has more clients and a larger market share than in 2005 and continues to win new business. (d) the company had 2,000 employees when Andy took over as CEO and now has 2,700, of which 700 are in India, so the company’s presence there was additive. (e) Phil Pead and the BOD asked Jay Deady to stay on and he has agreed.

Here’s the five-year chart of ECLP (blue) vs. the S&P 500 (red), just in case you’re scoring at home. From the day Andy Eckert took over as CEO until now, shares are down 12%. How does that compare to its main competitors? Non-conglomerate, publicly traded HIT vendors are as scarce as hen’s teeth, but Cerner is up 33%, QuadraMed is down 19%, and CPSI is down 8%. McKesson shares are down 15%. NextGen parent Quality Systems is up 69% over the same period as an example of a vendor selling mostly practice-based systems. The S&P has dropped 26% since October 2005.

Cerner and its customer Mayo Clinic request a federal gag order against a former Mayo physician and professor, accusing him of violating trade secrets for speaking at a conference about natural language processing software he developed. Mayo says Peter Elkin stole a backup and offered to sell the software, while the Elkin says Cerner and Mayo just wants exclusive rights to sell his product without paying for it. Mayo says he signed over his rights, while the Elkin says the application isn’t part of what he signed over to Mayo and he hasn’t received promised royalty payments anyway. Elkin left last year to become VP of Biomedical and Translational Informatics at Mount Sinai Hospital (NY).

St. Mary’s Hospital (MD) goes live on Cerner CareMobile bedside medication scanning.

Several of my reader survey respondents asked to hear more from provider IT shops about innovative things they’ve done, little-known systems they are using successfully, and ways they are responding to organizational demands. Inga and I would enjoy hearing from hospital IT people. Reluctant to go on record? I’ll leave you and your organization anonymous (places I’ve worked don’t want employees out there giving interviews either, so I understand that). E-mail me.

GE Healthcare has another round of layoffs, but doesn’t release numbers.

Children’s Boston announces a biomedical technology development fund to underwrite technology commercialization research projects at the hospital. The non-profit is hooking up with a bunch of drug and device vendors, which I admit confuses me (research universities and hospitals dabbling in for-profit industries makes me uncomfortable). Community hospitals and colleges deliver services to patients and students, respectively, without having that other cash cow, which I admire since it forces them to execute their primary mission well.

More EMR-related music humor, this time by Dr. Sam Bierstock and his An Introduction to the Electronic Musical Record. You won’t get the deadpan humor until halfway through or so. His upcoming release: Sorry, Man, but Your Bypass is Considered Cosmetic. His video with the Managed Care Blues Band is here and a tribute to veterans here.

Kaiser Permanente is fined $250,000 after 21 employees and two doctors inappropriately accessed the electronic medical records of Octo-Mom in January. Kaiser had already fired 15 people, reprimanded eight others, and self-reported the violations to the state, so it was surprised by the fine. I don’t get it myself: is that really going to diminish the chances of it happening again compared to firing the transgressors?

A new Washington Post article called The Machinery Behind Health-Care Reform says HIMSS successfully maneuvered public policy to benefit its members. “It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars … Corporate members include government contractors such as Lockheed Martin and Northrop Grumman, health-care technology giants such as McKesson, Ingenix and GE Healthcare, and drug industry leaders, including the Pharmaceutical Research and Manufacturers of America … runs a trade show for technology vendors, publishes a health technology newspaper and operates a research unit to help members find new markets …” Also mentioned: Steve Lieber admits that HIMSS had to lobby hard to get then-President Bush to include his one line about EMRs in his 2004 State of the Union speech. Now I’m feeling stupid for being a HIMSS member – I’m just giving its vendor lobbying work credibility by boosting the headcount.

OK, I’m going to acknowledge the elephant in the room and say this out loud. It’s time to split off the provider part of HIMSS into its own organization or form a new provider-only group. HIMSS is deviating further and further from my interests through its pro-vendor lobbying and its glitzy trade show that charges vendor members to connect with provider members. I like vendors just fine, but we each have our own agendas. I resent it if even a little of my paltry $140 in dues was used to convince a struggling administration to use taxpayer money to goose sales of HIT products. HIMSS took up the membership slack because TEPR was lame and AMIA was academic. It would be nice to have an alternative for us provider people, like women who just want to go out to dinner together without feeling like they’re being hit on constantly. Maybe it’s just me since nobody else is complaining.

Uh oh … President Obama publicly hailed the $2 trillion of healthcare savings over the next 10 years offered by industry groups, but he misunderstood. Those groups now say they did not pledge specific cuts. Obama’s healthcare reformer Nancy-Ann DeParle said “the President misspoke,” but then changed her own story, saying he cited their offer correctly. Does a “target” of raising the “rate of increase” to 1.5% within ten years really count as reform? The American Hospital Association was appalled at the thought that struggling hospitals can afford a reimbursement decrease according to its president, who made $1.5 million last year, and its executive VP, who took home $822K. UPMC President Jeffrey Romoff, who made $4.5 million last year after taking a pay cut, was not quoted.

Video game Hysteria Hospital is coming to the Wii. “Hysteria Hospital challenges players to race up and down hospital floors, treating testy patients with crazy ailments while saving your emergency room from turning into mass hysteria.” Now if someone would just create actual hospital software for the Wii …

E-mail me.

CIO Unplugged – 5/15/09

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

Accelerating Healthcare IT Adoption
By Ed Marx

To Teach, To Heal, To Discover—Six words that captured the essence of the mission of the academic medical health system where I served as CIO. Along with our affiliate Case, we consistently ranked in the top 10 of NIH grant awardees. We had the infrastructure, bench, and leadership to move quickly on opportunities and maximize value. Non-academic centers attempting to secure grant funding faced incredible odds against giants like us. We grew at their expense. Grant-funded organizations are well-oiled machines.

Today, I serve in a largely non-academic, community hospital based environment, but our vision is equally compelling. As ARRA/HITECH releases numerous incentives and billions in grants, academic centers are best prepared to apply for and secure those dollars. They have the infrastructure, primary investigators, and experience that granting organizations look for. But are they the venue best for accelerating innovation? I’d argue that community hospitals are the “new” best venue for taking ideas from bench to bedside.

Community hospitals don’t have costly infrastructure, professional staff overhead (whose sole focus is securing grants and conducting research), nor the incentive to keep applying for grants. Rather, community hospitals operate on the frontlines. They can accelerate the pace of change by bringing forth products based in the reality of where the majority of care is delivered—the non-academic settings. Am I saying that great contributions from academia are futile? Never! But, it is time to purposely expand grant opportunities to include community hospitals.

Shortcomings in the community hospital model are easily overcome by forming collaboratives with other members of the healthcare community. For instance, in our market, we have created joint applications with area universities, vendors, and governments. Where we are weak, our partners are strong, and vice versa. Our broad-based applications include multiple stakeholders. Grants pursued will lead to a practical application of technology that can be adopted universally, not just in one particular institution.

Community hospitals are leaders in the adoption of modern HIT. At Texas Health Resources, we have surpassed many academic contemporaries in areas such as CPOE and quality outcomes. Davies and Baldrige winners are largely non-academic. HIE leadership in our area is driven by community hospital management, not academia. While “rock star” CIO’s often come from academic institutions, they largely play symbolic, albeit, important roles. Traveling, speaking, and creating vision. Whereas community hospital CIO’s are typically close to the ground dealing with the practical realities and bringing translational research leadership to bear.

Both types of organizations have an important place. As government and non-government agencies begin the arduous process of selecting grant applications, my hope is that they will understand the importance of funneling some of the dollars towards community hospitals and accelerating HIT adoption.

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 5/15/09

From Eckert’s Sweetheart Deal: “Re: departure. According to Eclipsys records, Mr. Eckert will reap $6-9M for achieving numerous operational goals. Let’s see: ECLP stock price is lower than when he took over in December 2005 (not that); Eclipsys KLAS scores are lower across the board (not that); ECLP has fewer customers today (not that); customers are leaving in droves and are unhappy (not that); a quarter of the company has been outsourced to India (maybe that?) Guess it’s not just financial companies that overpay their CEOs.” Jay Deady: stay or leave?

From The PACS Designer: “Re: Adena Health System. TPD congratulates Marcus Bost, CIO of Adena Health System, for the successful completion of an EHR system as it is never easy when attempting to transition an organization from paper to digital record keeping through EHR implementation.”

From Kid Schlock: “Re: Kadlec Medical Center’s prom setup. Lovely story, and not to minimize the positive impact on the patient and family – but – this was done on an episode of Grey’s Anatomy a couple of seasons ago. Life doesn’t always imitate art, sometimes it just imitates cheesy TV.” I’m convinced that everything you need to know about life can be found in Lonesome Dove.

From Slap Maxwell: “Re: Omnicell. If Omnicell is dedicated to customer service, why did they lay off so many nurses? In fact, all of them, I think.”

From SmallTown CIO: “Re: HIMSS. In the latest HIMSS Weekly newsletter, the new HIMSS Online Buyer’s Guide Ideal Database for Providers is unveiled. It may be me, but I can’t locate Meditech in any of my searches. Give it a shot and see if you have better luck. How good could the database be if a major vendor has been left out? Hmmm … Meditech pulls out of the HIMSS show and now mysteriously disappears from their vendor database – coincidence?” No coincidence – check out the Become a Listing Company page, which basically says, “For a price, we will pimp out our provider members to our vendor members.” HIMSS exhibitors get a free listing. So, my reaction: (1) I’m not surprised since HIMSS is one big sales job, conveniently enabled by a 50:50 provider-to-vendor ratio that provides ongoing matchmaking income, at least until providers get tired of being sold like meat and walk; (2) the site is “powered by” HIMSS Analytics, which apparently in this case “analyzes” only those companies that pitch cash into the kitty (so much for objectivity); (3) I would hope that there’s no CIO dim enough to look to HIMSS to provide suitable vendors; (4) how the hell much money does HIMSS need to rake in, and for what? The shilling never stops. Meditech has 25% of the hospitals in the country, something like 2,000 of them, with 98% customer retention, affordable products, and the cojones not to exhibit at the boat show just because their competitors do. I just might spring the $395 to put my own caustic message in their “database” since HIStalk should qualify as a publication.

From ORISpilot: “Re: Toronto. The eHealth office in Toronto, Ontario was held to task on the consultants that they hired to help build the Pan-Canadian EMR are paid from $650 to $1000 per day. Here’s a quote: ‘The one-year consultants’ tally for 2007-08 was $32.9 million, rising to $34.3 million between April ’08 and March ’09.’ They hired MBAs and networked linguistics graduates. Guess what? They have virtually no clinicians working in that office.” All those hired guns despite having 166 of its own employees being paid over $100K. The CEO blames competition from stimulus-frenzied US companies, no different than hospitals that lamely say they are forced at gunpoint to pay $2 million CEO salaries because the market demands it (which, as I always say, must mean that they are real dumps if nobody will come for less).

Listening: Hard-Fi, excellent, highly original British indie (Clash meets Elvis Costello and a dance beat). Brilliant marketing: they record every concert and sell it as an autographed CD.

And this: HITECH: An Interoperetta in Three Acts by Ross Martin, MD. Brilliantly conceived, written, and performed. Not to mention acted: watch his expressions throughout, remembering that this appears to have been filmed straight through with no flubs. Don’t dare stop listening until the big finish, which I won’t spoil (I’ve watched it like 10 times and I’m mesmerized). He would be a great pairing with Dr. Sam and the Managed Care Blues Band. I need to give him some kind of HISsies award to coerce him into performing at the next HIStalk event at HIMSS.

You have hopefully noticed that I have acted on a reader survey suggestion and added underlined links.

Who knew that Andy Eckert didn’t even live in Atlanta while serving as president and CEO of Eclipsys? He was in California while the rest of the company was in Atlanta or Malvern or Pune or wherever. Note to companies: if the hotshot you’re recruiting to run the place won’t even move to your town, keep looking. That’s just nuts (but not unique to Eclipsys in HIT-land, unfortunately). The stock dropped a little on the news of his resignation, but not much. Reader Cam Winston called his shot on February 25 right here in HIStalk: “I’ve heard a rumor that Philip Pead, former CEO of Per-Se, has joined the board of directors of Eclipsys and that he ‘may’ replace Andy Eckert by year-end. As CEO of Eclipsys since 2005, Andy has failed to turn around this second-tier HIT company.”

I will immodestly boast that I was the first to post the Andy Eckert news just after it came out at 7:00 a.m. Eastern (thanks to ECLP for sending over the announcement) while the pro journalists were tucked away in their beds. I checked a couple of minutes later and the site was groaning under the load – who knew people would be up and reading at that hour? I can see only minimal info about who’s on, but here are some interesting ones. Countries: India, Dubai, Israel, UK, Germany, Canada and Australia (tons from India, so hello to readers there). Organizations included HHS and NIST. Companies: Eclipsys (duh), Perot, Picis, Allscripts, and GE (industrious early risers all). Schools: Duke, Penn, Hopkins, U. Chicago, Michigan State. Money people: T. Rowe Price, JPMorgan Chase.

Jason Dvorak, formerly of TeraMedica, has joined Sage Healthcare as SVP of sales.

A biomedical scientist in a UK hospital is accused of pursuing recreational human anatomy: he supposedly hooked up a Webcam in a room where on-call nurses slept and stored porn on hospital PCs.

This Hong Kong CIO who has worked in US healthcare IT takes a dim view of bloated hospital IT departments that buy big packages that take lots of people to install and manage. “Are they really doing that much? I would say here in Hong Kong we do much more per dollar spent. One of the Adventist hospitals in the US has more than 100 employees in IT and more than 30 of them are implementing and maintaining Cerner.” He also says that HIT systems are relatively easy to develop, vendors don’t know how to turn one implementation into an off-the-shelf package, and systems aren’t designed with user customization in mind.

Genesis Health Clinic (IA) chooses the hosted PM/EMR from Waiting Room Solutions (odd name: sounds like something to entertain patients). Never heard of it, but it looks kind of cool (you can upload audio files to it) and the price runs from $49 to $600 per doc per month. I’m suspicious that they don’t list the names of anyone involved on the site (I always assume it’s Chinese hackers in disguise). Being a pretty good snoop, I tracked it down to Lawrence Gordon, MD, medical director of a reference lab in New York.

St. Joseph’s (AZ) signs for Clinical InfoNET videoconferencing from Clinical Information Network, which they’ll use to provide communications between consulting and community docs.

Wireless health monitoring vendor MedApps signs a deal with Microsoft to provide device data to HealthVault. 

What’s keeping Google Apps from dominating the office software world? It offers only remote storage that may not comply with the privacy requirements of businesses. And, people trust the company less than they once did. On the other hand, it just signed a 30,000-user deal, its largest yet.

Being cynical, I like this article that says interoperability initiatives provide bigger bang for the buck. “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth. —-President John F. Kennedy. Imagine if President Kennedy in his famous speech didn’t stop at this point. Instead, he started describing the rocket. Assume he demanded a rocket with only two, or maybe four stages; that he insisted on a specific type of fuel, or certain weight and speed. Would the American space program have succeeded? I doubt it, and you should too. The Obama administration’s plan to spend $19.2 billion on electronic medical records as the sole path to achieve health care automation is the equivalent of Kennedy dictating to NASA the specifications of the rocket carrying Neil Armstrong to the moon.”

This makes encryption look cheap. Non-profit hospital operator Health Quest, stung by an ED laptop theft that triggered an Office of Civil Rights corrective action plan, will spend $50 million to change its software and improve security.

Online systems vendor A.D.A.M., which provides reference libraries and patient education material in its healthcare product line, creates a CTO position and hires Keith Cox, formerly of Microsoft, to transform the company into a cloud-based computing solutions vendor.

Hospital layoffs: Park Nicollet (MN), 240; Loyola (IL), 440; Geisinger South (PA), 179.

Johns Hopkins Hospital expects that a former patient registration employee will be charged with the fake driver’s license scheme in Virginia.

Police in Mt. Airy, NC say a Russian hacker got into the business computer of a local drugstore.

E-mail me.

HERtalk by Inga

From Patrick Henry: “Re: healthcare reform. Regarding cutting healthcare costs, here is a suggestion: if politicians at all levels were required to have healthcare and retirement benefits that were adjusted each year to match the average of every American, then we would see a lot more movement. It would still be motivated by self-interest, but that self-interest may start looking a lot more like what the rest of us are interested in.”

From An Interested Party: “Re: meaningful use. I am inviting you to view www.meaningfuluse.org as your one-stop resource for the national dialogue around the stimulus package. Please join me in this critical discussion.” I got this message in my email via a LinkedIn message. I am trying to decide if his approach belongs in the category of creative marketing or just plain old spam. In any case, www.meaningfuluse.org is a new site sponsored by Compuware and AMDIS. As is obvious from the name,  its focus is on “meaningful use” discussions and the impact of the HITECH legislation.

ProMedica Health System selects Sectra as its RIS provider. ProMedica will integrate the RIS with their existing Sectra PACS solution.

Fifteen hospitals are currently participating in the Louisiana Rural Health Information Exchange telemedicine initiative, including six running Healthland EMR.

Following a $10 million operating loss in the first quarter, Hennepin County Medical Center (MN) announces plans to eliminate 75 to 100 FTEs by the end of June. The hospital employs about 5,000 people.

Orion Health appoints Anna Theriault Vice President of Alliances for Orion Health North American and Europe Middle East and Africa. I think that her title must set some sort of record for its length. Clearly she’ll need a really big business card. Theriault was most recently the Healthcare Services Sales Lead for Cisco in the US and Canada.

Seven AT&T employees in San Jose are sent to a hospital for nausea and vomiting and another 21 are treated at the scene, after becoming sicken by an overwhelming stench. The culprit: decomposing food left in an office refrigerator. Apparently one brave employee (who had poorly functioning nasal passages) began cleaning the common refrigerator, using a 409-type cleaner. Another employee tried to combat the odor with a different chemical spray. Before long, the fumes overwhelmed several workers and 325 employees were evacuated from the building. Rescue came in the form of the fire department’s hazmat team, who were summoned to snuff out the scents.

Allscripts announces a technology coalition designed to educate physicians about opportunities aligned with the ARRA. The EHR Stimulus Alliance includes Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft, and Nuance. The Alliance is sponsoring The EHR Stimulus Tour, which includes “hundreds” of virtual and physical events for physicians. While I am sure the educational offerings will be of excellent quality, the whole program seems like creative marketing to me. (Have I been hanging with Mr. H so long that I am turning cynical? Or perhaps I’m just reading too many press releases from too many companies announcing how they are helping providers benefit from ARRA.)

The folks at SCI Solutions passed on that their client Flowers Hospital (AL) was named the top performing hospital based on CMS quality of care data. The Commonwealth Fund sponsors a site named www.whynotthebest.org, which includes a list of the hospitals scoring in the top 1% for quality measures.

The local paper provides an update on University Hospitals’ (IA) Epic implementation.The switch started in December and doctors began CPOE this month. Despite a few complaints from doctors wanting their paper back, Hospitals’ VP for information systems Lee Carmen says things are going pretty smoothly. The hospitals reduced the number of clinic visits for a couple of weeks in order to adjust to the new work flow. So far, 1,200 system issues have been noted. Carmen claims the system is working exactly as they expected.

Blogger Doc Gurley addresses the age old question: how to ask a doctor out. She advices that you don’t ask out your own doctor; points out that just because a doctor doesn’t wear a ring doesn’t mean he/she is not married; and warns that just because your crush is a doctor, that he/she is rich. I remember once thinking a particular doctor was pretty hunky and I was curious of his status because he didn’t wear a ring. A bold friend of mine called up the office and said she was with the local medical auxiliary and needed to know his wife’s name for a party invite. I was bummed when the receptionist supplied a name. Just as well. He probably had a ton of medical school debt.

E-mail Inga.

Eckert Steps Down as Eclipsys CEO

Andy Eckert has stepped down from his role as President and CEO of Eclipsys and will leave the company, Eclipsys announced this morning. He has been replaced by Philip M. Pead, an Eclipsys director and former chairman, president, and CEO of Per-Se.

According to the announcement, Eckert "has decided to leave the company after accomplishing a number of important operational goals." A quote from Eckert also cited his family ties in California as a reason for his departure.

Pead joined the Eclipsys board on February 17 of this year.

News 5/13/09

From Louis Crabb: “Re: acronyms. This site is useful.” Link. It sure is. I tried some fairly obscure healthcare IT acronyms and they were all there. Some cool tools are bundled with the search, too. Industry noobs should look there for starters when facing an unfamiliar acronym. Good find.

From Dean Sittig: “Re: tagging articles by vendor. Why not just have them use the Google site search option, or go to Google and enter: topic site:histalk2.com. I’m a big fan of search, not a big fan of human-curated site indexes. That is what killed Yahoo.” I agree, but I’m not quite sure why Google doesn’t seem to index everything on the site. It also doesn’t separate interesting stuff from trivial mentions. I suppose it would be like indexing the newspaper – technically correct, but still only somewhat useful in trying to locate useful content.

From The PACS Designer: “Re: CCR. Since the Continuity of Care Record (CCR) created by the ASTM International E31 Healthcare Informatics Committee has been out for awhile, it was great to read that Microsoft has incorporated the CCR into their Amalga Unified Intelligence System offering. TPD was a member of the E31.28 Technical Subcommittee for Electronic Health Records that created the CCR document for caregivers and patients.” Link.

From Stifler’s Mom: “Re: Wal-Mart. I thought you’d appreciate this article about a reluctant Wal-Mart clinic visit.” Link. It’s a fun story by an admitted anti-Wal-Mart bigot who left its contracted retail clinic impressed. “As I head out into the brightly lit parking lot, I realize that this has been the easiest, most gratifying (and sociologically fascinating) trip to the doctor I’ve ever experienced. I realize that when it comes down to it—it being my thin wallet, of course, and, well, my health—there is really no way of getting around the truth. Wal-Mart did not save my life. But damn if it didn’t give me what every hard-working American deserves. And damn if I didn’t feel, dare I even say it, lucky.”

Pretty good Q3 numbers for Mediware: revenue up 4%, EPS $0.06 vs. $0.04, which the company attributes to its Hann’s On acquisition and its partnership with IntraNexus.

Welcome to new HIStalk Platinum Sponsor e-MDs of Austin, TX. They’re new to HIStalk, but are also a Platinum Sponsor of HIStalk Practice, which we appreciate. They have the coolest-looking Web site I’ve seen, which includes an EHR Discussions blog with a lot of ARRA information. Here’s Dr. Eric Fishman’s interview with founder David Winn, MD, FAAP, who says he wrote his initial product in Paradox and PAL (we old-timers know about that). Thanks to e-MDs for supporting HIStalk.

Four hospitals and 15 clinics in UAE are live on Cerner Millennium.

In Australia, the New South Wales Department of Health announces a $74 million statewide health information exchange.

This is a good interview (in six parts) with Omnicell CEO Randy Lipps. Talking about his experience with his hospitalized child: “I was looking at a nurse who was highly paid and highly trained, and it seemed like 75% of her work was what a clerk would do. Because my daughter was on a ventilator there were a lot of disposables. My daughter had dedicated nurses, and I saw the entire cycle. When the next nurse came in she would start fumbling around the drawers, looking for stuff. I would tell her where the previous nurse had stored her stuff. The each had their own secret stash of supplies because the supply chain within the walls of the hospital was so broken. They all had their own system to make sure they had the materials they needed for their jobs.” And speaking of competitor Pyxis: “Pyxis was a Street darling before they were acquired by our big competitor. They are a division of Cardinal now. They are a great company and I wanted to mimic them so much. When they got taken over by a large company, they stopped investing in R&D, and they stopped investing in customer service. In healthcare, especially with hospitals, it is not about selling product but creating a partnership.”

OK, so the big healthcare lobbying groups offered to cut healthcare costs. Sort of. Or, maybe cut the rate of rise a little (like me saying I’ll take less of an annual increase if you’ll let me keep goofing off as an employee). They agreed to everything, but nothing. They offered self-serving reform to make sure real reform doesn’t flare up. Remember Medicare Part D, the drug company windfall profit assurance act, that was pushed through by Congressman Billy Tauzin, who immediately quit to become the president of PhRMA, the drug company lobbying group that benefitted most from his political maneuvering? Those reform-minded folks are at the table, of course, with newfound heartfelt concerns about Joe Sixpack. There’s a long history of scumbaggery by some of those groups and the politicians who take their money. Want real reform? Impose it without their involvement. If they offered $2 trillion, $20 trillion should be about right for starters.

Massachusetts tried and failed to curb medically unnecessary ED visits, apparently, as the 47% rate of inappropriate utilization hasn’t changed, but costs have spiked 17% over two years.

Don’t forget that you can see recent comments on this page I created.

Jobs: Cerner CPOE Activation Support, IMPAC Mosaiq Consultant, SVP of Sales.

Michael William Freeman, son of Medicity RVP of sales Bill Freeman, has a role as Morgan Gutherie in the season finale of The Mentalist. Check him out next Tuesday at 9 Eastern.

McKesson is interested in acquiring more medical device companies from Israel, saying that country has companies that excel at linking medical devices with information technology.

A Cerner software guy invents Web Bootstrapper, a technology used in Cerner’s PHR that tailors a Web site’s display based on the speed of the device connecting to it, such as smart phones.

McKesson’s practice management people are staying in Dubuque, the GM says, now that the company’s office has moved to a technology park after leaving downtown Dubuque and laying employees off.

Famous neurosurgeon Ben Carson of Johns Hopkins (mentioned by Hopkins CIO Stephanie Reel when I interviewed her and holder of an amazing 50 honorary doctorates) is on the board of Physician Capital Group, started by a friend of his. Doctors input their fee-based activities into a BlackBerry or iPhone and the company pays immediately, but takes 12% as a commission while it waits on its own check from the insurance company.

Open source software is touted as a good solution at the first Philippine eHealth and Telemedicine conference. I tracked down the company of one speaker, myCare2x, an Germany-based open source system (PHP, Apache, MySQL) that has a fully online live demo.

Nuance Communications files its Q2 report: revenue up 13%, EPS $0.03 vs. -$0.13 (and $0.24 not counting asset amortization).

You knew it was coming: the husband of the first US resident to die of H1N1 is suing pork producer Smithfield Foods, whose Mexican farm is where “some believe” is where the virus originated.

E-mail me.

HERtalk by Inga

Johns Hopkins Hospital is the latest medical facility to warn patients of potential data theft. The hospital sent a letter (warning: PDF) dated April 4 to the Maryland attorney general’s office alerting them that a former employee was suspected of fraud involving fake Virginia drivers’ licenses. The hospital first learned of potential problems on January 20 and notified 10,000 patients of their suspicions April 3.

Kathleen Sebelius names nine staffers to the Office of Health Reform. This is the office tasked with spearheading HHS’s efforts to pass health reform this year. A quick glance at the list suggests the staffers are mostly political appointees (former Obama campaign staffers and the like) along with one doctor.

Our HIStalk Hero of the Week is Medicity, which donated $5,600 worth of IKEA furniture to help Ronald McDonald House Charities furnish a new wing at Cincinnati Children’s Hospital Medical Center. The sofa and assorted tables and chairs were originally acquired and used to furnish Medicity’s booth at HIMSS.

Even in a recession, vanity prevails. The number one surgical procedure nationwide last year was breast augmentation and the top non-surgical procedure was Botox injections. Over 355,000 breast augmentations were performed in 2008 at an average cost of $3,900. That’s a lot of implants.

Shareholders of HealthSouth file a civil lawsuit against founder Richard Scrushy, asking him to pay $2.6 billion for his alleged role in a HealthSouth fraud scheme. Shareholders are asking Scrushy to repay salary, bonuses, and stock deals, as well as personal plane flights and breast implants for a singer he was promoting. Regardless of how the suit is settled, it’s unlikely Scrushy still has much money of his own. He’s in prison on a state bribery charge.

Merge Healthcare aligns with Shanghaie Kingstar Winning Co, a Chinese healthcare IT company serving over 800 hospitals. The arrangement allows Kingstar to offer its clients Merge’s document imaging solutions.

UNC Hospitals (NC) select MediClick to provide its Contracts & Analysis solution to manage supply contracts and purchased services agreements.

The LA Times releases an interview with Farrah Fawcett, which includes plenty of criticism for UCLA Medical Center’s failure to protect her privacy. When details of her cancer appeared in the National Enquirer, Fawcett was convinced the leaks originated from UCLA. She and her doctor eventually set up a sting operation, which led to an investigation by UCLA officials, who tracked the leaks to one particular employee. At the same time, UCLA repeatedly asked Fawcett to donate money to the hospital for a foundation to be set up in her name.

AMICAS posts $11.3 million in revenues for the first quarter, compared to $12.8 million the first quarter of 2008. Net loss for the quarter was $1.2 million, or $(.03) per share, compared to last year’s loss of $467,000 ($.01) per share.

An English plumber visits his GP’s office after experiencing tremendous pain and bleeding from his belly button. The GP removes a 4 cm fetus, which was determined to be his parasitic twin – an identical twin brother that had died in their mother’s womb. Here’s the really icky part. The plumber had his brother’s fetus placed into a jar and took him home.

E-mail Inga.

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.