Monday Morning Update 3/30/09

From Anon: "Re: McKesson. Layoffs Friday, specifically in Provider Technologies. About 120 employees." I heard that from a couple of people, one of whom put the number at 400-500, but saw no announcement.

From SpeedD: "Re: Meditech. I have heard a rumor that Meditech is allowing employees to buy stock this year." I e-mailed the press contact for confirmation, but haven’t received a response.

From The PACS Designer: "Re: Windows 7. InformationWeek has an excellent video on the key features of the upcoming release of Windows 7, which is expected to happen in late September. TPD likes the DirectAccess, AppLocker, and the  Branch Caching feature in this new enterprise software application. Another nice feature is when you are on the Internet, you are automatically connected to the enterprise server, so you have the same application look that you would have at your employer’s headquarters." Link.

From Bobby Orr: "Re: APACHE. Cerner did buy that and Project Impact and tried to combine them into a Web-based tool called Critical Outcomes (or something along those lines). Don’t know of anyone using the new tool but it seems like everyone still running some version of APACHE."

From Gene D’Machine: "Re: IBM’s healthcare practice. Half of them laid off, I hear." I heard that, too. IBM certainly seems to be doing all it can to alienate providers right as it tries to get business from them.

Chicago weather: 1-2 inches of snow Sunday (I’m writing this Saturday) and a high of 50 this weekend for HIMSS. Not exactly San Diego, is it? The coat check girls will make a fortune.

Speaking of Chicago, the Tribune covers the business affairs of new White House healthcare czar Nancy-Ann DeParle: she made at least $3.5 million over two years from fees and stock gains, the White House won’t allow her to be interviewed and wouldn’t answer questions about her business history, and neither she nor the White House have released any financial disclosures.

I’ve been to busy to make any kind of HIMSS plan, so I figured I would try the MyHIMSS09 Calendar. The idea is pretty cool: each session has a link to click to add it to your calendar. What I didn’t like: the calendar itself takes up a ton of Web page and there’s no print function, so it will be a bulky set of Web page prints (not a real calendar, just a list of sessions). You can send individual sessions to Outlook, but not the whole set (and not to Gmail). And, every time I tried to remove a session, it locked up my PC with a monstrous CPU utilization from Firefox Javascript, so I’ve got stuff on there to cross off. The session search/browse was also a bit clunky, not allowing searching by session number, by CEU offered, or by presenter (that I could find, anyway). I’m sure I will end up marking on the little pocket version that I hope they haven’t eliminated.

Trey Lauderdale of Voalte, Inc. has arranged an informal NCAA viewing party after the HIStalk HIMSS event Monday evening at Theory sports bar, 9 W. Hubbard St. (a couple of blocks from the Trump). If you’re still hungry, they serve upscale barbeque and Mexican and they’ve got $5 burgers on Monday, which beats the heck out of Sysco prisoner food at the convention center or the usual room service blandwiches that leave you stuffed but unsatisfied. I think Trey is buying the beer. If Theory fills up, he’s got some backup bars next door.

EHR Scope has a new spring edition ready for download. It has several articles on EHR selection and implementation.

Thanks much to new HIStalk Platinum Sponsor Cumberland Consulting Group of Brentwood, TN, which has grown to over 50 employees in its six-year existence. It’s a 2008 Music City Future 50 winner and a Consulting Magazine 2008 Best Small Firm to Work For winner. I like this statement: "Reflecting on their Big 4 consulting background, Cumberland’s founding partners were struck by the waste of talent that occurred because of competing priorities and big company bureaucracy." What they do: IT planning, systems selection, implementation, PM, and IT improvement, and just about everything EMR related. I checked the HIMSS directory and it looks like managing partner Jim Lewis will be holding down the fort at Booth 4475, so please let stop by and them you that you appreciate their support of HIStalk like I do.

Speaking of HIMSS, our annual guide to what HIStalk’s sponsors are doing there will be ready for your online reading and downloading shortly. Please show those folks a little booth-visiting love in your exhibit hall travels. Their support of HIStalk and its readers is entirely voluntary and self-initiated: they e-mail for information, I e-mail it to them, and sometimes they e-mail back that they’re in (and many times, don’t). Inga and I don’t advertise, solicit, take calls, provide fancy statistics, reveal our identities or location, or otherwise hand-hold prospective sponsors (I just don’t have the time, working full time in a hospital, and I figure it’s pretty clear what we do here). You can see how cool they are by keeping an eye out for "We Power HIStalk" signs in the HIMSS exhibit hall and stopping by for a howdy. I’ll be doing that myself (incognito, of course).

Everybody likes to speculate who Oracle will buy next, apparently unfazed by the historical 99% rate of being wildly wrong. With a Red Hat rumor in the air, one research firm takes some swags that include Allscripts and Cerner in healthcare. At least the addition of Allscripts is new.

Olympus Medical Center (WA) gets approval for a $2 million GE Centricity practice EMR purchase. This board member must know hospital IT: "There are going to be changes. I just feel them. And I think all of them are going to cost money."

Hospital layoffs: Regional Medical Center at Memphis (TN), 86; Immanuel St. Joseph’s (MN), 100; Jackson Hughston memorial Hospital (AL), 70-80; Barton Healthcare(CA), 43.

Jobs: NextMD Template Designer/Developer, VP of Human Resources, Cerner CPOE Activation Support, Regional Sales Director.

The Orange County Business Journal profiles Sheldon Razin, founder and chairman of Quality Systems Inc. (the NextGen people), saying he took $2,000 of his own money and created a company now worth $1.4 billion. I should have bought shares: they’re up 2,000% since 2000 and even up 10% so far this year.

New on HIStech Report: our interview with Gary Zegiestowsky, CEO of Informatics Corporation of America, which has commercialized Vanderbilt-developed clinical technology that, in Gary’s words, "leverages data across clinical settings and aids decision-making and improved patient outcomes."

Interesting: WSJ covers "brain gyms," where members "work out" with mental fitness software. Scientific evidence is lacking, but previous research found that the brain can rewire itself with new neural connections in response to mental activity, such as cognitive training. Sounds like a good business to get in on early.

Emageon announces that the company has settled what it says is a meritless lawsuit against its acquisition by AMICAS. It also reports that revenue was down 34% in 2008, with net losses of over $42 million.

I saw Dennis Quaid in a very confusing and awful movie called Vantage Point last week. He had a strange expression throughout, looking crinkle-nosed like he had just gotten a whiff of some foul odor (I think that was his effort to convey discipline and focus). Not even close to his excellent Right Stuff performance. Perhaps he’ll show clips at HIMSS.

Odd lawsuit: a teenager having her tonsils removed in 2006 falls as nurses tried to help her sit up on the OR table. She claims headaches and files suit (three years later) for $8,000 in medical expenses and $992,000 for suffering, future medical expenses, and disability. Who wants to be a millionaire?

E-mail me.

News 3/27/09

From Skippy Van Oakes: "Re: Keith Hagen. Was the personal reason that he thought that QuadraMed shouldn’t be put up for sale? Chatter on the Yahoo! Finance boards would indicate a distinct possibility." The press release quote from interim CEO Jim Peebles made me wonder: "I am eager to focus on the ways in which the Company can further unlock its potential and increase shareholder value." His additional comments suggested more R&D and positioning for HITECH money rather than a change in ownership, but I understand those who assume quotes referring to shareholder value mean that all options are on the table. I like the company, QCPR is an excellent product, and they are a franchise when it comes to HIM technologies. Their only disadvantage is size compared to the competition. Some of the Yahoo posters took Oracle’s announced acquisition of Relsys this week as a signal of more healthcare interest, but clinical trials software offers a vastly different vertical sales opportunity than the average mid-sized hospital.

From ILoveLA: "Re: Cedars. I heard a rumor that the clinical project at Cedars-Sinai has been halted." I didn’t hear that, but I did hear they got rid of a bunch of Perot people and replaced them with Deloitterers. That’s not verified, but the source who told me should know.

From New York Cynic: "Re: RealAge. They just set back PHRs and online health information technology about a year." No doubt. Over 27 million people have taken the 150-question RealAge test on the Internet, which purports to calculate your biological age based on personal characteristics rather than date of birth, but was actually collecting targets for drug company advertising, including specific quiz answers and e-mail addresses. RealAge says it discloses everything and doesn’t let the advertisers have the data. Scumbags or not? I’m leaning toward no (the communication came directly from them and users should have expected the worst given the vague privacy agreement), but I bet smoke is coming out of Deb Peel’s ears for their using patient information to kick off personalized marketing blitzes. If we’re ever going to control healthcare costs, can we afford to let wiley drug companies hard sell to often clueless consumers and their customer-friendly doctors willing to oblige? Also gone unnoticed by most: RealAge is owned by Hearst (which paid $100 million for it in 2007), which also owns First DataBank, Zynx Health, and Medscape. This guy saw it coming: "I would think that the 8 million submitters of private medical information would feel a little uncomfortable when their data got acquired by a major publisher, but I haven’t seen any real journalists exploring that angle yet. Oh well, at least it wasn’t a life insurance company."

From Victor Franko: "Re: Emergisoft. Joe DeSilva was probably the best thing to happen to Emergisoft in its history. The company’s bottom line was better, the product was significantly improved, employees were motivated, and customers were happier than before he started. I’m disappointed that the company didn’t have the class to recognize his contributions."

From Bobby Orr: "Re: Eclipsys SCM. Look for announcement of a major SCM win at prestigious teaching and research organization in the Northeast."

From Cleon Jones: "Re: Sutter. A major obstacle in its implementation was organizational and process (making decisions upfront, defining realistic charters, establishing governance, and managing user expectations). They are prime time for a Federalist champion or a good organizational management consultant looking for a challenge. Their IT budget is allocation to individual affiliates and there is not tight corporate governance, so there is little corporate funding available. Consider the first implementation a prototype evaluation."

From Home Provider: "Re: medical homes. A report says their savings will be less than or equal to the monthly fees paid since they will be serving too broad-based a population." Link.

I’m hearing that Orlando Portale, CTO of Palomar Pomerado Health, may be under consideration by House Speaker Pelosi as her appointee to the government’s new HIT advisory board.

A UK hospital chooses MEDITECH v6.0 EPR, a big win given the hospital’s huge project budget and planned scope.

I’m hearing a little buzz that economic pressures are causing some vendors to claim they can’t integrate with third-party systems or, when that doesn’t discourage the customer, charging them a high interface fee plus annual maintenance. Apparently they would rather not share the sandbox play-time, so they are taking their ball and going home. The government and customers want interoperability, but it’s not in the best interest of vendors to allow too much customer independence. That will be interesting to watch. 

Bankrupt Nortel Networks, praying desperately for stimulus crumbs, will demonstrate some new IVR applications at HIMSS.

A UK hospital is chastised for scrapping PCs still containing patient medical records.

Health Robotics announces the early release of its ivStation Profile at a Dubai conference, a biometrically secured IV dispensing system similar to profile-secured dispensing cabinets like Pyxis. Gaspar DeViedma, formerly of Eclipsys, works for them.

HIStalk odds that Rob Kolodner will cash in on his ONCHIT stint by taking a high-level, mostly ceremonial vendor or lobbying job instead of heading back to the VA: eight to one.

McKesson is testing the UK HIT waters for a return following its failure to win NPfIT contracts in 2003, but also after project stumbles opened the field back up again.

Part 4 of our HITECH vendor question series is up on HIStalk Practice.

It’s hard to believe this survey’s conclusion, even though it does appear in JAMA. Only 1.5% of US hospitals have comprehensive clinical systems running in all units, with the number increasing to only 7.6% if you count just one or more units. CPOE for meds is at an embarrassing 17%, with 45% of respondents saying they have no plans to implement it at all. The decision support survey elements are skewed, obviously allowing respondents to count them as implemented even if not for physicians (example: only 17% do meds in CPOE, but 46% say they have drug-allergy alerts, obviously in the pharmacy system). You might argue whether some of the requirements to be considered "comprehensive" are really practical the way vendors have designed them (physician notes, drug-lab interactions, and nursing assessments), but those are not unreasonable criteria. The EHR-less hospitals blamed upfront cost nearly 3/4 of the the time, while a third questioned ROI and the abilities of their IT shops. So, smug hospital types snarking on poor physician EMR adoption have little to brag on since penetration may be higher in practices even though the excuses are the same. So, assuming Santa Obama defuses the major argument by using our money to buy EMRs, where will hospitals get all the IT and informatics resources? (not to mention that the ROI gets better when someone else pays, but the overall benefit doesn’t change). And if you thought the 1.5% number was appalling, consider this: having it running doesn’t mean using it to improve care or reduce cost, it just means it’s available.

New York Presbyterian gets a CNBC mention for using CPOE to reduce adverse drug events by 80%. Watch closely and you’ll see Eclipsys SCM on the screen.

At least this data breach involves paper: a Mass General billing manager leaves a stack of charge slips on the Red Line T, including treatment information (for an HIV-positive patient, in the newspaper’s example). That patient’s anger is the opposite of what we IT people usually hear: "I was really angry at first because I thought everything in the hospital was supposed to be electronic and things wouldn’t get lost, and to find out someone took their work home, private information wasn’t supposed to be taken home, … to find out it was left on the subway, that wasn’t cool. It wasn’t secure. It wasn’t in a briefcase. It was secured in a rubber band."

CareTech Solutions, ranked #1 in KLAS for extensive IT outsourcing, announces the launch of its US-based technical and clinical information system support for hospitals, including proactive system monitoring. Continuum Health Partners (NY) has already signed up.

An interesting quote on Wal-Mart’s selling of eClinicalWorks: "I often state that Wal-Mart is not a store, it is an Information Technology company. Their servers in Arkansas have the capacity to store everything on the internet two times over. It is in the area of electronic health records where they may have the most impact, through EHR software sales and applying EHR standards to millions of future customers in their health clinics. If it were king of Wal-Mart, I’d go ahead and store a patient’s records on their Wal-Mart Money Card. Why not? Wal-Mart may also become the largest referrer of medical care in the nation, by sending patients in their clinics to physicians when those patients have more serious healthcare needs. Ask a doctor, referrals are the lifeblood of a medical practice."

The rumors were apparently correct: IBM will fire 5,000 Americans and ship most of their jobs off to India, increasing the number of foreign workers it employs to even more than the current 71%. I guess that’s where the "I" comes from, leaving just a lot of BM to save healthcare now that Uncle Sam’s money has made it worth their time. So buying a US-made Toyota is not buying American but hiring IBM and its mostly offshore workers is? Rumor is Big Blue is smelling the pheromones of Satyam, too.

I had a good personal EMR encounter today. My doctor’s clinic uses them (Centricity, I think) and has integrated them nicely into the practice. I checked out the screens and they were very logical and easy to use. All my info was in there, easy to find, and even though the monitor was badly placed (on the desk, meaning his back would be to the exam table), he didn’t really focus on it until we were nearly finished. He would have use eRX on my prescription except I had no idea where we get them filled (that’s a Mrs. HIStalk task) so he printed off a quite nicely formatted copy. I don’t know how much work he has to do after hours (forgot to ask), but as a patient, it was definitely no worse than a paper chart and probably better. The assistant was pretty comfortable logging my vitals in there, too. Best of all, I left there better than I went in, always a crapshoot in our expensive but inconsistent healthcare system.

An interesting NEJM editorial by new ONCHIT David Blumenthal states his opinion that CCHIT’s certification is fine for covering basic capabilities, but doesn’t address user-friendliness or their suitability to meet HITECH’s quality and cost goals. Also, an interesting disclosure: GE’s paying him.

Sheldon Razin, chair of Quality Systems, Inc. (parent of NextGen), is awarded the 2009 Excellence in Entrepreneurship award from the Orange County Business Journal.

St. Mary’s Medical Center (WV) is lauded by the local paper for its use of APACHE in managing ICU patients. They credited it with saving 21 patients. I’m too lazy to look it up, but I seem to remember that Cerner bought it awhile back.

E-mail me.

HERtalk by Inga

From LTC: "Re: Twitter.Take a look at my page. I’ll shamelessly admit that I thought of your sexy LinkedIn & Twitter pic when I posted mine!" LTC includes the following in her bio: Driven hospital software seller by day, pastry chef wannabe with a shoe fetish nights & weekends. Obviously she’s now my new BFF.

Beth Israel Deaconess Medical Center (MA) reduces the number of planned layoffs from 600 to 150, following $350,000 worth of donations from department heads and various cost-cutting measures.The 13 medical department leaders pledged enough money to save about 10 jobs (very nice.) Beth Israel is also delaying raises, temporarily reducing benefits, and offer some employees early retirement.

Capario (the company whose name I still haven’t figured out, but I’m careful to include only one ‘R’) announces three new contracts with provider groups to help members reduce claims processing costs and improve RCM. In case you missed it, Capario was formerly know as MedAvant.

Mr. H just bought me some cool new software that improves my ability to post photos. I have it just in time for HIMSS, so please pack your camera and share your pics with us. We’d particularly love some shots from the HIStalk/Ingenix soiree, as well as any other parties you attend (since Mr. H and I haven’t been invited to many and we want to see what we are missing.) If the exhibit police don’t stop you, send us photos of your picks for best and worst booths. Of course, shots of fancy shoes are always exhilarating.

PinnacleHealth (PA) selects MobileMD to provide its HIE and Enterprise Access technologies and services.

Spectrum Health commits to a three-year contract with MEDSEEK to create an "interoperable eHealth ecoSystem." I think that is a fancy way of saying Spectrum is going to use MEDSEEK’s products to connect its hospitals, providers, consumers, and patients.

Grad student Valerie McCleary wins the 2009 Beacon Partners Scholarship, worth $7,000 and an all-expense-paid trip to HIMSS. She’s working on a Masters in Arts in Health Informatics and Information Management at the College of St. Scholastica.

The Louisville HIE picks 3M Health Information Systems to provide its EHR banking system and interoperability solution. InterComponentWare (ICW) will design and build the HIE network to provide free health record banking services to the greater Louisville area.

Faculty members from Wake Forest and Duke University collaborate on a commentary that stresses the need to clarify the legal ownership of patient records. In order to make use of potentially valuable clinical data for medical research or improving patient outcomes, regulators must create a new system of patient-initiated control of health records.

Pharmacy OneSource, a SAS solution-provider for pharmacy applications, announces two new hospital system clients. Lehigh Valley Health Network (PA) has implemented the Sentri7 and Quantifi systems and Bethesda Memorial Hospital (FL) is now using  ScheduleRx.

Allviant, a division of Medicity, joins the Arizona State University Center for Services Leadership. Allviant’s president Lilian Myers has also been named to the center’s advisory board.

The bankrupt BearingPoint consulting practice plans to sell substantially all of its businesses as part of a restructuring agreement with its senior creditors. No word on who’d like to buy the healthcare consulting segment.

FusionCIO interviews Kaiser Permanente CIO Phil Fasano and asks him about KP’s decision to outsource IT services to IBM. Says Fasano, "We spent an awful lot of time and energy looking at our operations and looking at organizations around the world that had capabilities that could partner with us and help us to really accelerate the high performing IT function that we have at Kaiser." Does that mean KP believed they weren’t getting it done on its own?

A CDW survey of HIT professionals finds that hospitals that spend 40% or more of their IT budgets on infrastructure have more providers reporting "outstanding" performance from their clinical applications. Hospitals spending less money had only 29% of their providers report outstanding performance.The survey also found found that 67% of respondents described applications as "critical" to patient care compared to 50% who believed infrastructure was critical to patient care. CDW sells infrastructure, as you might have inferred.

A NEJM article  concludes that putting more money into existing HIT may be the wrong approach for delivering long-term benefits. Instead, the authors recommend that HHS mandate development of a new platform that will support a variety of individual applications, making the data "liquid" and providing an easy way for providers to change systems. Good authors: Kenneth Mandl and Isaac Kohane, both MD/PhDs from Children’s Hospital Boston’s informatics program.

AARP publishes a list of top hospitals, based on surveys of physicians and various hospital ratings.The magazine also created an interactive map that lists the top-ranked hospitals by geographic area.

E-mail Inga.

Being John Glaser 3/26/09

What Enables an IT Organization to be Agile?

Years ago, healthcare organizations would develop five-year strategies and have reasonable assurance that those strategies would be viable over that period of time. The pace of change makes such long term strategies less tenable (and possibly delusional). The pace of change does not eliminate the need for strategies, but it does place a premium on agility.

An agile IT organization has means to sense changes in the environment, triage important from spurious signals, alter strategies to respond to new opportunities, and redirect resources to carry out its new plans.

There are six major steps that can be taken to improve agility.

Application selection
The choice of new applications often centers on features and functions. However, those who are selecting a new application should pay equal attention to the capabilities the application has for desired changes. Is it easy to interface or integrate with other applications? Are there robust approaches that allow the organization to develop custom software that extends the application?

Project phases
Rather than waiting 18 months for the organization to see the first fruits of its application implementation labors, efforts should be made to deliver a sequence of smaller implementations. Pilots, staged rollouts, or the implementation of a portion of the application are not always doable. However they enable the organization to shift resources after a specific, smaller implementation phase rather than waiting until a lengthy implementation has been completed.

Staged release of capital and new IT positions
The capital and operating budget process can result in a form of “carved in stone” commitment of resources to specific projects. In contrast, the organization can make an overall IT budget commitment based on an expected set of initiatives. However, the leadership can release that commitment quarterly following an assessment of any needed changes in direction. In effect, there is an annual authorization of the budget, but a quarterly appropriation of the capital and operating budgets.

Cross trained IT staff
Some IT staff positions require deep expertise and it is not realistic to expect that those staff are interchangeable with other expertise-based IT staff. However, there are several IT positions that have characteristics that enable some degree of interchangeability. For example, good project managers can handle financial systems and clinical systems projects. These staff can be cross-trained or cross-exposed to different applications. This cross training can enable these staff to be applied to a reasonable range of projects.

Technology standards
On one hand, standards would appear to constrain agility. They narrow the field of choices for an organization. On the other hand, standards improve agility. In the absence of standards, organizations often make significant investments in attempting to integrate technologies that were never designed to be integrated. The result can be an increase in IT costs (which reduces agility since the financial resources available for other initiatives are smaller) and make applications and infrastructure difficult to change (which hinders agility) because of integration complexity.

IT alignment
IT agility requires that the IT leadership and organization understand the organization’s strategies, challenges, and priorities. With this understanding, the IT organization is in a position to effectively engage in discussions of IT alternatives and approaches.

Related to alignment are the processes the organization uses to make decisions. Governance structures that are fuzzy, opaque, and unsupported hinder agility. Decisions can take forever and run an unacceptable risk of being poorly embraced.

Achieving agility will require tradeoffs with other organizational properties and goals. It’s hard to be agile and efficient. However, agility may be more important than other properties such as efficiency, customer service oriented, or brilliance at project execution.

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

News 3/25/09

From GoSox: "Re: ONCHIT. Glaser to take six-month post as Blumenthal’s operations guy." John had shared his plans with me earlier, so your rumor report was an excuse to pester him to say something on the record. He did: "I am planning to spend six months at ONC, beginning in early May, as a Special Advisor to ONC. I will retain my position as CIO at Partners and be on loan to ONC. I plan to work with ONC and the field to help develop the programs and plans needed to implement the healthcare IT portion of the Stimulus Bill. There are still some i’s to dot and t’s to cross so this is arrangement is not final. I look forward to the opportunity to work with the Federal Government and all of the healthcare stakeholders."

From Dwarf: "Re: rumors. A former employee says Medhost let 12 people go this week (unverified). Also, at a recent ENA conference, Emergisoft did not man their booth and sales people were allowed in to inquire about new jobs."

From The PACS Designer: "Re: Fugoo. TPD loves digitally connected solutions and now there is another one called Fugoo. This new solution is for a Digitally Connected Appliance or DCA. So, if you want to access your coffee pot to brew java via a wireless network, you add a Fugoo box to a coffee maker that is Fugoo-enabled. Only problem is there are no Fugoo-enabled devices that will be available until the holiday season later this year!" Link.

From CYA: "Re: escrow agreements. CIOs need to review their software escrow agreements (and review the whole contract while you are at it). Worried about a vendor? Pull the contract right now. It is prudent to demand a statement of financial viability. If you cannot get such a statement from a vendor, you will at least have on file that you requested it and were thinking proactively. Your CFO may need proof of your request in the event of an issue arising. This is simple CYA work that one health system is requiring as a result of a recent failed vendor and the fallout that ensued. Remember the old adage ‘no one gets fired for choosing IBM’. There are bound to be a few mid-and small-tier vendors that do not survive in this economy. Ask your account manager if there have been layoffs at their firm. If the answer is yes, dig deeper. Build a contact list of other client facilities (CIOs) in the event you need to learn how other IDNs are handling the issue of a closed vendor. If you enforced an escrow agreement in your contract, build in contingency plans for execution of this escrow NOW for vendors that may be on the rocks. In most situations, the language for these escrow agreements is boilerplate fodder without much in the way of specific step-by-step procedures. Ask yourself if you truly have the staff to maintain a system if a vendor closes (even if you do have the escrow). Once a vendor starts cutting staff (intel), it is too late to make an escrow agreement have any value in terms of how you actually implement what has been escrowed … you only become ESCREWED. Additionally, make certain you obtain the PERSONAL contact information for key IT personnel at your vendors. The vendor will not provide this, so ask these personnel (those you know) for it directly. If personnel are let go from a vendor due to layoffs, those personnel become your assets during a product transition wait period. If there are any others that have experience (pro and con) with the escrow process when a vendor has closed its doors, please chime in. Hopefully you do not experience this, but given the economy you need to make this often overlooked CYA process a top priority in your IT department."

From Pat Patterson: "Re: Carilion losing money. Holy mismanagement, Batman! This the same company that was profiled in the Wall Street Journal recently as a near monopoly. In their profile, WSJ showed how the Roanoke region’s insurance costs went from lowest to highest during Carilion’s domination and subsequent raising of rates."

From HIT Insider: "Re: Sutter. It’s my understanding that many of the hospitals are not planning on switching to Epic due to the high costs, and will stick with the original vendor. I think Eclipsys has a few clients in the Sutter Health universe. Not sure who else."

From Dock of the Bay: "Re: Sutter. I am not at all surprised. As an outside M developer, I was amazed at the costs involved. Almost reminded me of the TARP bailouts. The money never seemed to stop. The second thing that made a big impression on me was Epic and their lack of interest in working with outside developers. I’m not sure if they wanted all the money for themselves, but it made for difficulties when trying to support the project. As a fan of open source software, I think I would have been inclined to go with VistA (VA) and develop it for user needs and requirements. The cost of the basic software is certainly not an issue. Free!"

Monitor 3 reported over the weekend that Joe DeSilva, CEO of EDIS vendor Emergisoft, had left the company. I e-mailed a contact there for a statement. Newly announced CEO Jordan Davis, a former regional sales VP who took the CEO job Monday, e-mailed me that same day. "Thank you for your inquiry and the opportunity to address recent events. Much has occurred in our industry, and Emergisoft is certainly not immune to the pressures that other healthcare software companies and providers are experiencing. We have recently realigned the company to meet the challenges of our clients, our investors, and the economy. The tough decisions have been made, but they are now behind us, and they were designed to grow the company, not shrink it. Our realignment has strengthened the chief executive position, bolstered our financial structure, and positioned Emergisoft to efficiently deliver our CCHIT-Certified ER solution to our clients and to the market. Our commitment to superior client satisfaction is the primary driver in all we do, and that will continue. I look forward to meeting you at the HIStalk reception. See you at HIMSS, booth #8051." I admire that, actually, jumping right in there with a personal and straightforward e-mail, pitching the booth number, and mentioning the reception. I’m sure he would be happy to say hello if you’re inclined to drop by the booth.

QuadraMed President and CEO Keith Hagen steps down for personal reasons, replaced in the interim by James Peebles, a company director and industry long-timer. His stated goals are to increase R&D, get QCPR certified by CCHIT, and to increase shareholder value. A national search is underway for a permanent CEO. Also announced: CFO/SVP David Piazza will take on additional responsibility as COO.

An OB-GYN sues a Utah hospital, claiming the CEO forced him out and that nurses falsified charts to make him look bad. He also claims he dictated a chart note that contradicted the nurse’s fraudulent changes, but the hospital deleted it from the EMR. The HIPAA audit trail should prove it one way or another, and surely the hospital won’t publicly claim that its systems don’t have one.

Penn researcher Ross Koppel’s new JAMA article concludes that healthcare IT vendors enjoy contractual and legal protections that keep them out of trouble even when their products cause patient harm.  Anyone who has signed a vendor contract from either side of the table knows that vendors disclaim most responsibility, saying it’s the licensed user’s job to notice software or hardware errors and prevent them from harming patients (like when an allergy warning doesn’t display or a dose is calculated incorrectly). HIMSS unleashed a vindictive and wildly pro-vendor barrage against Ross in 2005 for daring to write an article describing patient harm that occurred with a hospital’s IT implementation, but I expect they’ve got bigger, multi-billion dollar fish to fry this time.

Listening: American Hi-Fi, excellent and refreshing pop-punk with highly melodic guitars, somewhere between the Pixies and Cheap Trick. My head’s tired from bobbing. Kind of like when Mrs. HIStalk sat me through the Mama Mia DVD last week, a truly horrible non-movie with no plot, no singers, and no problem keeping my attention because I really like ABBA music despite all the theatrical distractions (Slipping Through my Fingers and Waterloo were always my favorites, so now they are re-stuck in my head after decades because Bjorn and Benny are genius songwriters).

Ricky Roma’s piece drew some fun interest, as I expected. I hope his cheek is OK from having his tongue jammed in there for all that time. Agree with him or not, he’ll make you think.

Irritated sent over an internal sales memo from his or her big vendor employer, part rah-rah and part carefully cushioned reorg news. I’ve never worked in sales, but every announcement I’ve read says the same thing, so the vendor here makes little difference: we’re doing great but we have to cross the goal at the end of the quarter, we have to get at every deal table and fight for market share, we need to be more agile and show more knowledge in the sales process, we will move to regional sales teams with specialty team backup, and we must reduce sales cost by cutting duplication. The same thing everyone else is doing, in other words. They should bring in Ricky Roma.

GetWellNetwork adds two pediatric content suites to its PatientLife System, some of the eventual 160 educational titles that KidsHealth (part of Nemours) will create for PatientLife.

The folks at Clinical Architecture, who do clinical content and decision support consulting for vendors, are offering a free 15-minute consulting session at HIMSS. 

You may have noticed the cool magazine-style layouts that we make available as part of HIStech Report (like this PDF). A freelancer does these for me and he’s looking for more print publication and layout work. If you’re interested, let me know and I’ll connect you with him.

UpToDate clarified their subscription options for patients seeking evidence-based health information. Some topics are available via free online access, but the full version is available at $19.95 for a week or $44.95 for a month.

E-mail me.

HERtalk by Inga

California’s attorney general files a civil lawsuit against seven private medical laboratories, claiming they defrauded Medi-Cal of at least $100 million by regularly overcharging the state for tests by up to 400%.

Shands HealthCare (FL) selects Micromedex CareNotes System from Thomson Reuters to improve patient education across its eight hospitals.

Demand for drug and alcohol rehab centers is on the rise as the global economic crisis grows, with current or former financial professionals making up a good bit of the volume.

St. Mary’s Hospital of Michigan activates Eclipsys Sunrise Pharmacy in an on-time, under-budget project. 

Martin Memorial Health Systems (FL) adopts TractManager’s Conflict of Interest Disclosure Statement system to capture and track disclosures of board members, committee members, and physicians. Sounds like something our new administrator might want to look into.

Jackson Memorial Hospital (FL) notifies the public that a disk drive that contained the driver’s license information of 200,000 visits was stolen earlier this month. Authorities believe the theft target was the disk drive rather than the data (how do they know?)

PatientKeeper announces that its client base doubled in 2008 to over 30,000 users from new customers and expanded installations, triggering a 40% growth in head count and the hiring of two new executives. 

RSNA appoints Mark G. Watson to executive director, the position he has held on an interim basis since September. He’s been an assistant executive director for the last 15 years.

Fremont-Rideout Health Group (CA) selects QuadraMed for its revenue collection process. The three-hospital system is supposedly replacing applications from Allscripts-Misys and 3M Health Care with QuadraMed’s Revenue Cycle and Quantim Health Information Management solutions.

Nuance Communications summarizes the radiology workflow and productivity improvements at three different RadWhere installations.

Physicians Medical Group of Santa Cruz County (CA) implements Elysium Virtual Health Record from Axolotl.

A quick peek at the weather forecast has me convinced that spring has not yet made its way to Chicago. At least my version of spring.

One in five American workers are uninsured, according to a new study, a big jump from the one-in-seven number of the mid-1990s.

IV maker Hospira hopes to save about $150 million by eliminating 10% of its workforce over the next 24 months.

A California HealthCare Foundation report concludes that patient kiosks improve satisfaction by reducing waiting times and offering greater privacy and convenience, but less than 10% of hospitals have implemented them.

HIT vendors are experiencing above-market stock performance since President Obama’s election. Investors believe that the government’s economic stimulus plan will benefit companies such as athenahealth, NextGen, Cerner, and Allscripts.

Cleveland Clinic selects Infolinx WEB by Infolinx System Solutions for the tracking of study-related patient files. The solution includes RFID capabilities to manage paper records.

E-mail Inga.

Being Ricky Roma, or Tales from the Dark Side, Episode V – The Empire Strikes Gold

Today’s posting is all about gold. After my last note, someone had posted a suggestion that all negotiations should follow The Golden Rule. I agree that “doing unto others” serves all people well, both professionally and personally. Yet this note will be about the other golden rule, the one which brings order to the Dark Side: he who has the gold makes the rules.

In our HIS universe, The Dark Side’s source of power is actually derived from HIS executives who control the allocation of countless bags of gold. As a hospital IS exec who has this gold, you bear a fiduciary duty to your organization to impose your rules when setting out on a process that ends with dispersing cash to deserving (or undeserving) vendors. After my last post, another reader astutely noted that this duty is shirked in “three out of every four projects,” lending much cred to my assertion that “you (collectively) don’t know the power of the Dark Side”. 

Most research on this topic concludes that today’s software project failure rate is around 66%. We on the Dark Side know this. We earn BILLIONS of dollars selling you $3 worth of software or services to deliver $1 worth of value. This 3:1 cycle powers the Dark Side. 

We pay good sales people hundreds of thousands of dollars. We employ armies of storm troopers who are better paid, better trained, and often better looking than their opposite number at the hospital in order to keep this so. We build illusionary demos that touch upon your deepest desires. We learn which ones of you can be taught, fought, or bought. Right before HIMSS, we do things like send Mephisto shoes to all the Ingas in our sales forecast. And occasionally, when we sense that one of your best staff have enough midichlorians, we purchase their soul and lure them away to join us. 

As compensation for all these efforts, you continue to pay us $3 for every $1 of delivered value. We sell you software that doesn’t work and you keep coming back for more. This is power!

Can you just image Jacques Cousteau narrating a documentary on this unique ecosystem? “‘ere we see zee energetic ZIO, bizily darting in en out among zee magnifizent coralz near zee ocean floor, building and rebuilding two of heez three nests, over and over again; blissfully unzaweare of zee predators stealing heez eggs right in front of heem… What vill become of zis endearing creature?”

In real life, you need look no further than the musings of this HIStalk post over the past several weeks for some outstanding examples of where HIS vendors are putting the golden rule into solid practice. HIStalk readers were more than a little upset to learn that Allscripts CEO Glen Tullman was whispering in the ear of our new president to “help” to determine where the billions of dollars of federal stimulus funds ought to be deposited (I wonder if he mentioned the 3:1 ratio? “um, Barack, Mr. President, Sir … we’re actually going to need more like $6B for this thing. $4B will be for projects that we already know aren’t going to work out…”).

Our new Healthcare Czar, Kathleen Sebelius, is/was on the Board of the very architects of the Death Star itself. And now, right after the passing of the stimulus bill and just before HIMSS, there is indignation that Wal-Mart is entering the EMR market with eClinicalWorks (did anyone really think Girish was sitting idly by while Glen had his feet up on the table in the Roosevelt Room?) I, for one, am anxiously awaiting Jonathan Bush’s raise in this particular hand!

As an industry, you have become adept at giving away your power. The gold starts with you, but you are not using it to make the rules. 

Don’t agree? A month from now, you are going to let an actor, Dennis Quaid, who recently suffered through the scare of all scares, tell you how to do a better job in delivering safer healthcare. I recall being at Mardi Gras one year when Mr. Quaid was King of the Bacchus Krewe, throwing beads to half-naked women. That seemed at the time to be a position of pretty high authority. He does have quite a lot of gold as well. These credentials obviously give him the power to start making some healthcare rules. I hope he says to buy more software …

What is the answer? Just like it was for the fictional Luke Skywalker, it is to look within. "Do, or do not; there is no try," Luke was told. Your Board, CEO, VP, and general public should be asking the same thing of you. Why is it acceptable to you that two out of every three of your projects fail?  Why is it OK that you give away 66% of your gold in exchange for something that did not achieve its goals? Why do you and your staff forego the diligence that you would invest in your own personal spending when buying HIS software based on a sales demo and a visit to a showcase site? Why do you keep paying for, and keep buying, s@#! that don’t work? 

Are we on the Dark Side that good?

Ricky Roma is a vendor sales guy who understands that only one thing counts in this world: get them to sign on the line which is dotted.

Monday Morning Update 3/23/09

From Francisco Respighi: "Re: Sutter. Sutter is mothballing its $1 billion (and counting) Epic project, blaming the economy. After Mills Peninsula, no new hospital implementations are planned. In the announcement by CIO Jon Manis, Sutter does states that individual affiliates may press ahead if they come up with their own plans and funding – this allowing Sutter to avoid a headline grabbing announcement that explicitly states the obvious: the Epic project is gigantic bust." Kudos to the anonymous reader who tipped us off early this month that the project scope had changed. I don’t know that the project is necessarily a bust, but I do know that when John Hummel was CIO there, he was explicit in saying that Sutter’s clinicians would not use CPOE or other doctor-centric technologies in his lifetime (and he’s alive and well, albeit with Perot). Sutter was talking the project up two years ago. It’s odd that the corporate office won’t pay for the systems, but its individual hospitals are welcome to, which usually implies some kind of "corporate IT isn’t providing value" issue since it’s the same money regardless of which pocket it comes from. Capital funding seem to be the problem, so they must not have bought licenses and hardware up front.

Here’s the full text of Sutter’s internal announcement, provided by a reader: SUTTER HEALTH COMMITTED TO THE EHR; ROLL OUT TIMELINE CHANGES DUE TO ECONOMY. Given the current economic downturn, Sutter Health is revisiting its capital investment plans to make sure it is balancing the needs of our patients and communities, the uncertainties of the economy and the realities of a changing health care environment with our goal of remaining healthy, viable and successful over the long term. In addition to assessing timelines associated with facility construction and imaging projects, Sutter Health is adjusting the timeline for its integrated electronic health record (EHR).Our immediate focus continues to be our first hospital implementation at Mills-Peninsula Health Services in Burlingame, CA and our three remaining medical foundation implementations. We’ve already fully implemented the EHR in five medical foundations, which connects more than 2,000 physicians in the coordinated care of our patients across much of Northern CA. Our Sutter-wide EHR now encompasses information about the care of more than one million patients. We are committed to implementing the EHR at all of our acute care hospitals, however, we will not be able to install the EHR as quickly as we’d like. We do not have definitive plans for another acute care implementation in 2009 after Mills-Peninsula and we will not, at least in the near term, be issuing a definitive facility construction schedule or acute care implementation schedule. We continue to analyze all available data about the federal health information technology funding. However, the potential implications do not affect current decisions relative to the timing of our EHR roll out. Respectfully, Jon Manis, SVP, CIO, Sutter Health.

From Kiwi Pete: "Re: Kaiser. Kaiser Permanente is to be commended for making a very difficult decision in these uncertain times. I congratulate Phil Fasano for going out on a limb and facilitating this decision. Having the courage to make a strategic decision of this magnitude is the mark of a true leader. This strategic decision will ensure a strong platform for future years and solid employment and a foundation for managing costs and providing a high level of clinical care. Yes, some staff have been displaced and many will find employment with IBM. I strongly believe that healthcare providers need to begin to share facilities as one method of containing IT costs and Kaiser Permanente in their own way are making a strong statement." KP turns over data center management to IBM in a seven-year, $500 million deal that gives 700 KPers the pink slip, joining 160 others axed because of economic conditions in general. Even KP says the majority of those 700 won’t be joining IBM. KP had already made one difficult decision involving IBM that turned out to be spectacularly wrong and shockingly expensive, blowing through close to a billion dollars in having IBM develop an electronic medical record that was abandoned in favor of Epic in 2002. They made a strong statement with that deal, too, but not one that either organization cares to mention publicly.

Here are a few excerpts from Phil Fasano’s e-mail to staff about the IBM deal, courtesy of a reader: "Kaiser Permanente is announcing a strategic relationship with IBM that will enhance the technology that powers the services we provide to our members, patients, and caregivers. IBM will bring its globally recognized technology leadership to KP’s data center operations and some associated functions. As a result, about 700 people in KP’s data center operations will transition out of KP and become eligible for employment with IBM. Concurrent with the IBM announcement, we are also taking the difficult step of eliminating an additional 160 IT positions to enable us to operate as efficiently as possible during these extraordinary and challenging economic times … our strategic relationship with IBM will allow us to leap ahead in our technology capabilities and reach our goals faster than we could on our own. We also expect to see a net savings over the term of the contract which, along with today’s staff reductions, will help to support our goal of providing affordable health care for our members … While decisions that affect staff in this way are never easy, I assure you that KP is committed to providing assistance to affected employees, particularly in the current economic environment. Employees whose positions are eliminated will receive 60 days’ notice with full pay and benefits and a severance package, including continued KP health benefits. In addition, KP provides comprehensive employment, career, and personal counseling services to help employees in transition."

From Rogue: "Re: Huntzinger. Did I hear right that former CEO Rich (‘I sold it all to ACS’) Helppie came out of retirement to form a company in CA with several former SUPC employees? Is retirement really that boring for these guys, or did they lose it all in the stock market? If I made that kind of $$$, I don’t think I’d be back at the grind so quickly, no matter how much fun HIT may be." Rich is back, this time at Santa Rosa Consulting. I’m guessing it’s an amalgamation of boredom, ego, and simply doing something you know you’re good at. Maybe money, but I don’t think Rich is starving. Money or not, nobody wants to feel washed up, especially when they aren’t.

From Garrnut: "Re: WSJ article. Talks about patients educating themselves about their own health issues and  use of patient information and mentions WebMD and UpToDate." Link. I didn’t realize UpToDate comes in a consumer version (both a free one and a $495-a-year version that’s the same reference doctors use).

From Monitor 3: "Re: Emergisoft. The board forced terminations of a number of good employees including CEO Joe DeSilva, who evidently had turned the company around and improved its image during his tenure. But now it looks like they are in serious skeleton crew mode." He’s no longer listed on their executive page, but I saw no announcement. I have an inquiry in with the company.

I’m back after a little break. Thanks to Inga for capably holding down the fort. Once I’ve plowed through several hundred e-mails, I’m sure that relaxed feeling will be a distant memory.

Jack Horner, former informatics pharmacist, CIO, and interim CEO of Major Hospital (IN) since July 2008, gets the permanent president and CEO job.

Community-based health center network HealthNet of Indianapolis gets a $2.5 million private grant to implement eClinicalWorks.

A hospital in Pakistan goes live with an electronic surveillance system for pneumonia. Clinics can read a child’s RFID bracelet using a Nokia cell phone to display patient information on a secure Web site.

A hard drive containing scanned ID information on 200,000 hospital visitors is stolen from the data center at Jackson Memorial Hospital (FL). Not only was the drive stolen from the data center, it wasn’t backed up, so the hospital has no way to notify those whose information it contained. The hospital speculates the drive was stolen for personal use by persons unknown, although it’s hard to believe someone would assume that kind of risk when you can buy a huge, new hard drive for less than $100 these days. But, thieves are stupid.

I had speculated that Rob Kolodner would be replaced as ONCHIT at the pleasure of the new HHS secretary, but was corrected by several folks that his position was civil service rather than a political appointment. None of that matters, as it turns out, since he’s being replaced by academic and Obama insider David Blumenthal (I had the big scoop if I hadn’t been vacating since a well-connected reader assured me it was going to happen the day before the announcement, but I wasn’t around to run it). IT geek or not? WSJ quoted from a NEJM article he co-wrote with John Glaser: "The idea of health IT transports some enthusiasts ‘to almost a dreamlike world of health care perfection in which the work of doctors and the care of patients proceed with barely imaginable quality and efficiency,’ they wrote. But for many doctors, especially those in solo or small practices, it ‘conjures a very different image — that of a waiting room full to bursting, a crashed computer, and a frantic clinician on hold with IT support in Bangalore.’" His January article for The Commonwealth Fund called The Federal Role in Promoting Health Information Technology didn’t stray much from the party line: the government should help fund EMR purchases, encourage interoperability, and push quality via EMR use. He did take a little dig at minimally useful clinical decision support. His opinion was pretty much the same in a 2006 article.

Want to bet that HIMSS is burning the midnight oil to (a) publicly applaud Blumenthal’s selection; (b) suck up to make sure he’s not some kind of anti-vendor rogue since he’s not a HIMSS member; and (c) beg him to speak at the conference so the keynote lineup doesn’t look so irrelevant (actor Quaid, KP big shot Halvorson, blundering former Fed economist Greenspan, and an astronaut).

David Shaeffer, formerly of Eclipsys, has joined IT solutions provider GTSI.

Vitalize Consulting Solutions takes its food drive online, letting donors buy groceries (at substantial discounts to retail) for the Greater Chicago Food Depository. You can also donate at their HIMSS booth.

Forum Health (OH) files Chapter 11, citing debt load, population decline, union contracts, and the economy.

IBM is rumored to be close to acquiring Sun Microsystems for $6.5 billion.

A new iPhone 3.0 software feature: tethering to Windows laptops, meaning users won’t need air cards.

Wisconsin hospitals are hiring teams of lobbyists to help them get a piece of the stimulus pie. 

Patients in England are being monitored via Web-based instruments and are sent text message or e-mail communication when something’s amiss.

Keesler Medical Center (MS) becomes the first Air Force facility to use EMRs, having gone live in January on T-System.

Hospital layoffs: New York’s Health and Hospitals (200), Nemours (DE).

A reader asks if anyone knows about an ARRA item that will make hospital bonds more attractive to lenders. It was supposedly mentioned in a CHIME presentation. If anyone knows about it, let me know and I’ll summarize here since it sounds relevant to HIT.

Big HIMSS goodies for CHIME members willing to sit through focus group meetings (sales pitches). " … you can receive an honorarium in the form of money, an iPod touch or Amazon Kindle 2." Nice to know that objective technology decisions for non-profits start off by having vendors bribe provider executives to listen to a spiel. Say, how much do you charge to actually sign a contract?

Jobs: Epic Consultants, Pre-Sales Engineer, Ambulatory Consulting Services Director. Weekly job blasts are yours for the asking.

McKesson Medication Management and a neurosurgeon are hit with a $38 million lawsuit award for a herniated disk repair that left a patient bedridden. The surgeon injected dye that was not appropriate for the type of surgery he was performing, with McKesson joining him on the expensive hook because its pharmacy people supposedly discarded the drug’s packaging before sending it over. The doctor had been sued nine times previously and hit with a state fine for bad medical practice. The surgeon carried no malpractice insurance and avoided a previous lawsuit’s judgment by declaring bankruptcy. McKesson says it will appeal its $5 million part of the payment. Given the award, however, it’s no wonder that you could easily die in a Florida ED because no neurosurgeons are willing to take your trauma case.

We’ve talked a lot about the heparin error involving the Quaid twins, but a reader sent over the California HHS’s report on the Cedars-Sinai incident. The findings: the twins were given heparin 10,000 units/ml as a line flush instead of the hospital’s approved 10 units/ml after pharmacy techs stocked 100 vials of the stronger product in the drug dispensing cabinet. Of those, 14 vials were believed to have been administered to three patients, so reversal drug protamine sulfate was given to two of those patients (the twins). The floor stock heparin had not been double checked despite being considered a high-alert, high-risk med; it was also missing the green labels reminding staff that it required a second check as hospital policy required. One pharmacy tech said he was not aware of the policy. Nurses could not recall what they administered, one said she couldn’t recall if she read the label first, and some doses were given without documenting on the MAR. Early reports said the heparin was prepared wrong in the pharmacy (that would be odd) and therefore I concluded that bedside barcode checking wouldn’t have mattered since the label would be correct but its contents wrong. In this case, the heparin was pulled from the drug dispensing cabinet (as it is 99% of the time) and barcoding would have caught the error. Pyxis machines are candy stores full of potential errors unless hospitals are extremely vigilant in how they’re stocked and monitored, of course, offering Cardinal an opportunity to sell the add-on that barcode checks the stocking function (surely Cedars has bought it by now).

Carilion Clinic (VA) loses a big chunk of its assets due to investment losses, is struggling to keep doctors, and says its Epic EMR system is the "single biggest factor" in its $20 million loss in FY08 (although that expense was planned).

CEOs, performers, and pro athletes seem to be escaping any damage from the recession, so this is no surprise: Oracle’s Larry Ellison, already worth $50 billion and making $85 million a year in salary, will add $230 million a year in much-needed income now that Oracle has approved a dividend.

A promotional documentary being filmed features the VA TeleHealth Clinic of Craig, CO.

The Social Security Administration goes live with the first piece of NHIN, using electronic records to process disability claims via the open source NHIN Connect Gateway from Harris Corporation.

Investigation of a UK hospital’s high death rate finds that receptionists were triaging patients, meds weren’t being given, and patients were left so long without food or water that they were drinking out of flower vases.

HIMSS says (again) that registrations are on track compared to last year, but a reader noticed that only 12 hotels out of 64 are showing as full on the housing site. Maybe that’s par, but it sounds low.

CCHIT will hold a HIMSS conference town hall session on certification of open source EMRs. It’s Monday, April 6 at 2:00, but CCHIT will provide remote access as well. For all those conspiracy theorists who think HIMSS and CCHIT are the puppets of proprietary EMR vendors, watch this session carefully. My prediction: the conclusion will be that anyone is welcome to have their EMR certified as long as the tests are passed and the money paid (which is true today). And to be honest, what else could they say? If you believe that CCHIT certification is vital to ensure interoperability and reduced risk for purchasers (plenty of folks don’t, but that’s another story), then they really have nothing to offer except to waive or reduce the certification fee for organizations that receive no income from licenses.

E-mail me.

News 3/20/08

HERtalk by Inga

From: Telephone Man. “Re: New iPhone OS. Yesterday Apple released iPhone OS 3.0. In the presentation at minute 43:35 Apple introduces J & J Life Scan, a Glucose monitoring device application. I would expect a flurry of healthcare iPhone applications (*cough,cough*) to come out over the next few months, now that iPhone 3.0 has been seeded.”  Agreed. In addition to the introduction of new applications, users like me will appreciate the little things such as the ability to cut and paste between applications, attach photos in text messages, and view email in landscape mode. Apple did not announce a release date.

From: John Boy. “I wanted to let you know how much I appreciate all the work you guys do in keeping us informed of all the happenings in healthcare. You’re like a reach arm for all of us out here and I can’t imagine how much time you put into it. I look at it every day to see what’s happening.”  Thanks. It does take some time, which is why I am not too surprised Mr. H (or perhaps Mrs. H) selected an Internet-less vacation destination.

Speaking of Mr. H, he’ll be back with the Monday Morning update sometime this weekend.

If you are interested in hearing what 12 of the leading EHR vendors are saying about the passage of HITECH, visit HIStalkPractice or click on one of the links to your right.  The two latest questions: “How is your company defining “meaningful use” of an EHR and how will ensure your customers can reach that level?” and “Providers will be required to implement ‘certified’ software to participate. Who should perform the certification and what criteria should they use?”

President Obama appoints David Blumenthal national coordinator of HIT.  Blumenthal is a Harvard medical professor and director of the Institute for Health Policy at MA General Hospital.

A Center for Connected Health study concludes that online diabetes management programs may improve the quality of care delivered.

Cumberland Valley Medical Services selects Advantedge Healthcare Solutions to provide medical billing and practice management services for its 23 employed anesthesiologists and CRNAs.

A study commissioned by the Pharmaceutical Care Management Association concludes that as e-prescribing rates rise, savings will more than pay for the $19 billion in economic stimulus adoption incentives. The report claims that if current e-prescribing rates were to double, it would result in a $22 billion reduction in drug and medical costs over the next 10 years.

Medsphere Systems invites 16 HIT consulting companies to participate in its new Medsphere University training and certification program. MaxIT is the Medsphere’s first “certified partner.”

Two studies by CSC conclude that financial incentives contribute to the overall HIT adoption rates. The analysis examined CPOE adoption rates among Massachusetts hospitals, the use of e-prescribing, and the use of EHR among ambulatory physicians. Adoption rates for these activities were significantly higher among Massachusetts providers than the rest of the country. The report attributes the success to the number of financial incentives available to providers.

Former Eclipsys sales executive Greg Lusch joins scanning technology vendor IBML as business development director for the healthcare market.

MedAptus raises $6 million in financing, led by Boston Millennia Partners. MedAptus intends to expand its Intelligent Charge Capture software offerings.

Google selects MIE’s WebChart Enterprise EHR for its two onsite employee health clinics.

Authentication and access management vendor Imprivata announces that Box Butte General Hospital (NE) has implemented the OneSign Platform.

The mayor of Monroe, LA is pleased by CPSI’s decision to open a new call center in his town. CPSI’s expansion is expected to create 100 new jobs over the next three years.

BCBS of South Carolina selects Med-Vantage’s HealthSmart Enhanced Provider Directory and Measures Exchange solutions to improve improve consumer transparency.

State lawmakers in Hawaii introduce a bill to build a statewide HIE that would be managed by a state coordinator.

Cardiovascular Specialty Services of North Texas (CSANT) contracts with Greenway Medical Technologies to deploy Greenway’s PrimeSuite and PrimeEnterprise EHR/PM solutions. CSANT is a 50 physician, 18-location specialty group.

MMR Information Systems partners with The Latino Coalition to offers MyMedicalRecords PHR in both English and Spanish. Felicitaciones!

McKesson Specialty Care Solutions introduces a fully integrated e-prescribing solution for oncologists and other specialty physicians to participate in Medicare’s E-RX incentive program. Using RelayHealth’s eScript, providers will be able to electronically file medication renewals and refills directly from McKesson’s Lynx Mobile solution.

Medical transcription service provider MxSecure successfully completes a document management software interface at Roanoke Neurological Associates (VA). The interface allows transcribed documents to be imported into the practice’s Allscripts document management system.

RCM vendor Medical Data Systems promotes Gene Schneider to chief operating officer.

Frost & Sullivan presents GE Healthcare the award for Growth Strategy Leadership of the Year, in recognition of the growth of its imaging informatics business since acquiring Dynamic Imaging.

Massachusetts General Hospital and North Shore Medical Center contract with BridgeForward Software to help with HL7/EMPI integration for a new ambulatory care center. Radiologists from both hospitals will use BridgeForward’s Viaduct platform to integrate reports from Massachusetts General’s RIS to North Shore’s PACS.

FQHC HealthNet in Indiana receives a $2.5 million grant to equip its 110 providers with the eClinicalworks PM/EMR solution.

Email Inga.

News 3/18/09

HERtalk by Inga

Kaiser Permanente plans to cut 860 workers at its data and IT centers as part of a $500 million outsourcing deal with IBM. Included in the seven-year deal, IBM will take over most of KP’s data operations, affecting about 700 employees.  Most of the affected staff is based in California, though KP also announces layoffs for 160 more employees across the country. KP CIO Phil Fasano says that about 40% of the displaced employees will find jobs within IBM. KP says that the average laid off employee will receive eight months worth of pay and benefits. Our condolences. fds

On HIStalkPractice, we just posted the first in a series of five questions posed to 12 vendor executives.  The topic centers on the HITECH stimulus package and its impact to electronic health record.  This first question:  What changes will your company or area make, both for the short and long term, in preparation for HITECH legislation?

As I was working on our Second Annual HIMSS Information Guide, I noticed that Vitalize Consulting Solutions is teaming up with the Greater Chicago Food Depository to raise food and funds for the Chicago needy. The Vitalize folks tell me they are taking monetary donations at the booth, as well as promoting a virtual food drive. They’ve also sent packages of soup mix to attendees around the country.  If you were a lucky soup mix recipient and bring it by Vitalize’s book (#3055), Vitalize will donate both the soup and one dollar. LOVE it.  Much better than all those trinkets that won’t fit into your suitcase. 

Johns Hopkins chooses the LiveData OR-Dashboard solution.

IBM announces a research project with Brigham and Women’s Hospital (MA) to create an online radiology theatre to allow teams of medical experts to simultaneously make rounds on a patient via a Web browser. Using live streaming audio/video, medical experts will be able to discuss and review patient data and post analysis.

The US DOD Military Health Systems commits to a $2.4 million deployment of VisualDX, a database created by Logical Images that includes 900 visually identifiable diseases and clinical information.

Virtua Health (NJ) selects Microsoft Amalga for its four-hospital system.

Blessing Hospital (IL) contracts with Eclipsys to deploy Sunrise Enterprise revenue cycle solutions and integrate them with Blessing’s existing Sunrise clinical solutions.

St. Joseph Medical Center (MD) brings in an outside “restructuring team” to manage the hospital, after the CEO, COO, and VP of operations take administrative leave. The executives took leave two weeks ago amid a federal investigation involving the hospital’s relationship with a physician group.

Heatlhcare management firm Beacon Partners hires former Poudre Valley Health System CIO Russell Branzell as a vice president.

A Deloitte Services survey finds that 56% of us want access to a online PRH connected to our doctor’s office and 55% want to communicate with our doctor via email. In addition, 68% of consumers are interested in home monitoring devices and 38% are very concerned about privacy and security.

HIE technology provider Accenx is now offering fully managed, remote hosting of Initiate Patient for its healthcare clients. OhioHealth is the first customer to use the combined solution.

Just exactly does this happen? A Shreveport, LA grocer finds stacks of medical records and MRIs in the dumpster at his store. The charts are as recent as 2006 and belong to a local doctor.

Email Inga.

Being John Glaser 3/16/09

Virtually all major technology innovations result in good changes in society and introduce new problems.

The automobile opened up the country and accelerated commerce. It also spurred global warming and people died on the highways.

The Internet enabled new ways to find information and forge communities. It also supported new forms of identity theft and eased access to unsavory material by children.

The television brought diverse entertainment and education into the living room and enabled the real-time participation in world events. It also contributed to sedentary lifestyles and the homogenization of culture.

Widely deployed interoperable electronic health records will bring good changes and introduce new problems. While the net impact of EHRs will be positive, we should acknowledge that their use also brings a downside. EHRs are no different in that regard than any other major technology innovation.

Individuals and organizations that point out these problems should not be discounted as Luddites, narrow thinkers, or resistant to change. While some of the con-EHR commentary can be discounted, we need to listen to it.

The point is not to pooh-pooh those that point out problems. The point is to understand the new problems and devise ways to mitigate or remove their impact. Seat belts and emission controls were steps taken to reduce the problems created by automobiles. Various applications have been developed to reduce Internet-based identity theft. The explosion of TV channels enables a wide range of cultures to express their voice.

Those who note that EHRs can hinder the connection between a provider and a patient, add too much time to simple tasks, and result in problematic privacy intrusions are right. EHRs will do these things.

We have to find better ways to make these problems less of a problem.

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

CIO Unplugged 3/15/09

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

The Borderless Office
By Ed Marx

One year ago, I posted Culturally Relevant Leadership. Not a key performance indicator, but a lifestyle. I was so proud of my new office furniture that I posted pics on FaceBook and even bragged, “Look! No room for paper or pen.”

Now I believe even this is passé.

Then I smugly considered myself advanced as an executive who worked at home two days per week. Whoa, what a concept. Lately I’ve wondered why do I have an office in the first place?

I asked the same question of peers and staff and received many reasons why we couldn’t possibly liberate ourselves from the box. I have yet to hear one reason that I couldn’t logically counter. I’m all about forcing myself to learn new ways of operating and leading. I’m also into adopting and leveraging emerging technologies. But now I must commit to expanding self-imposed boundaries. Pushing the organizational culture. Releasing myself—and my staff—from unjustified fears.

A healthy leader spends little time boxed in an office. We’re out visiting our customers and our people. If you’re worried about losing contact with your staff, read Staying Tethered to a Disconnected World. At home or, anywhere outside the box, I get more done in less time. That leaves margin to network with staff, round more with customers, and focus.

Let’s ignore for a minute the actual cost of building out space and look at the operational budget impact. Average office space costs might range from $20-$40 per square foot per year. Assuming your office is 200 square feet, that is $4,000 – $8,000 per year. In the 24x7x365 world we live in, what is your percent occupancy time? It should be tiny, probably under 5%. Now expand this analysis for your staff and your entire office footprint. The amount of waste is self-evident.

On March 31, I’m turning my rhetoric to action and entering a month-long trial with my courageous Chief Medical Information Officer. We will shutter his office and share the space formerly known as the CIO Office. We’ve already eliminated office phones. For the times we do need physical space—or so we rationalize—we will have one. Otherwise, we’ll conduct our business from our “virtual offices.” Armed with mobile devices, we carry with us everything we need. Our office is us. Not some physical space with borders.

Presuming a successful trial, this will become our method of conducting business. I’ll expect my direct reports to follow, and we’ll go from 5 offices to 1. I envision a cascading effect throughout my division. We will save close to a half-million dollars for each floor we clear. Employee satisfaction, productivity, and retention will climb.

You can’t reach a specific benchmark, get the tattoo to prove it, and then stop evolving without losing relevance. If you don’t believe it, reread Tradition.

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

Monday Morning Update 3/16/09

HERtalk by Inga

From: Sundance Kid. “Re: Anthony Rodgers joining the Office of the National Coordinator? Tony is a very HIT-savvy leader currently Director at Arizona Health Care Cost Containment System. One well placed call from Head of Homeland Security to Secretary of HHS and he is in!” Not sure if this means that Rodgers would want the DC gig.

From: Johnny B-good. “Re: Hospital CEO salaries. I hope that the same rules are applied to the Banking Execs who’s salaries I’m paying (unlike these Hosp execs.).”

USF Health and Allscripts initiate a pilot program called Paperfree Tampa Bay that aims to convert 100 percent of physicians in the Tampa Bay area to electronic prescribing. Program leaders view this as a first step toward the implementation of EHR in the region and is expected to create 100 jobs in the region. We chatted with Allscripts CEO Glen Tullman about the initiative, and have posted the interview on our HIStalkPractice site.

President Obama nominates NYC health chief Margaret Hamburg commission of the FDA.

HIMSS claims that total conference registration “parallels” last year’s record-breaking figures during the same time last year. The numbers suggest that those staying home to save money seem to be balanced by attendees making plans to learn more about how to get their share of the stimulus pie.

Here’s a study that many vendors may hope gets swept under the rug. Researchers from the University of Minnesota find that the use of HIT has little or no effect on patient safety. The AHQR-funded study also suggests it may be “too early” to judge HIT’s overall effectiveness.

Surgical Information Systems now integrates with Cardinal Health’s Pyxis Supply Technologies.

According to the local paper, Catholic Healthcare Partners (OH) is nearing a decision to invest $100 million over the next five years for an unnamed EMR. The organization includes 32 hospitals across the Midwest.

KLAS releases a report entitled “The Rise of eClinicalWorks: Separating Fact from Fiction.” KLAS examines why ECW is growing faster than any other EMR vendor and whether if it could sustain the grown and still provide effective support. While customers expressed strong satisfaction on functionality and cost, support was noted by many users as the worst aspect of their ECW relationship. Users also claim that integration with other clinical systems was a challenge.

MedAvant Healthcare Solutions changes its name to Capario to better reflect the company’s revenue cycle solutions and renewed focus on growth. OK, I give up. What does “capario” mean anyway?

Document indexing vendor InDxLogic names Susan Thomas to its board of directors. Thomas is the former Chief Medical Officer for GE Healthcare ITS.

Baton Rouge, LA implements a telemedicine program that allows ED doctors to begin testing patients as they are being transported by ambulance. Funds for the BR Med-Connect program came from the US Department of Homeland Security. Can someone explain the Homeland Security connection?

Ochsner Medical Center (LA) posts ER waiting times online, giving patients the chance to select which of Ochsner’s four hospitals can see them the soonest.

Current and former physician employees of Medical Edge Healthcare Group (TX) file a suit against the company, charging them of improper billing and practices that violate state laws prohibiting corporate control over physicians. The doctors say Medical Edge used “deceptive accounting practicing” and charged them unfairly for taxes, benefits and other expenses.

Fifty physicians are set to receive their first rewards for participating in New Jersey’s Bridges to Excellence Program, which is designed to recognize and reward providers that demonstrate safe, timely, effective, and patient-centered care.

Meridian Health (NJ) selects TeleHealth Services to provide television-based services in the patient rooms of three hospitals.

San Mateo County (CA) pays the federal government $6.8 million to settle charges that the county medical center intentionally inflated its numbers of acute care beds in order to receive bigger Medicare payouts. San Mateo claims that any overstatements were unintentional.

The American Hospital Association reports that 53% of all US hospitals reported overall losses in the fourth quarter of last year. The aggregated overall margin for the quarter was -8%, compared to a positive 5% for the same quarter in 2007.

Third-party benefits administrator First Service Administrators appoints CareMedic CEO Sheila Schweitzer to its board of directors. 

Mr. H is taking a few days off, so the posts this week may be short and sweet. Email me.

News 3/13/09

From Six Sigma: "Re: HIMSS keynote speakers. You failed to mention 2004 when HIMSS had hiker Aron Ralston, who cut off his own arm with a pocket knife to escape a fall in a rocky canyon. Now this was classic poor HIMSS programming. And let’s not forget co-keynoter, Tom Wolfe, the noted author and White House fellow for not going home again." I actually was trying to remember the arm-cutting guy but couldn’t think of his name, so I fell back to Dana Carvey as the "why is he keynoting?" example. But, HIMSS likes affordable C-list celebrities (Ben Vereen, for example) who seem hot until you think about when you saw them last in something important. Hold for Mr. Piscopo, please.

From The PACS Designer: "Re: Windows 7 beta. TPD has been watching for Microsoft to offer in its pending operating system Windows 7 Beta more solutions that will be usable by both Windows XP and Windows Vista users. With the addition of the system owner being able to shut off applications, the Windows 7 solution can win more advocates in the business world where having extra bandwidth available for business use is a valuable asset. Also being able to turn off Internet Explorer 7 can allow other Internet solutions to be employed." Link. I still hate using Office 2007 since I can never find Page Setup, Zoom, or Paste because of that damned ribbon, but Vista is OK.

From Andy: "Re: you said you liked weird stuff, right? What exactly is the procedure code for this?" A woman is airlifted to a Maryland hospital after being injured during a romantic escapade involving an electric saber saw. Hospital ED people can tell some bizarre stories (say, they would be great keynote speakers). At least this one’s not on YouTube yet.

From Kiwi Pete: "Re: movement. Or, is it more haste, less speed?" HHS is looking for people to serve on the HIT Standards Committee and HIT Policy Committee, with nominations for both due by March 16.

From Taxpayer: "Re: stimulus bill. Any thoughts on this? I’m a worker bee that sees so much squandering of good $ in HIT that I’m convinced the same thing will happen to stimulus $. Happy for never-ending employment, though." Link. The article by open source supporters says proprietary systems will turn into "poorly performing, opaque national Health IT at a high price." Maybe, but I don’t see that open source solutions are ready to step in as replacements (except maybe for VistA in specific circumstances), at least unless someone starts up the equivalent of a Red Hat to reduce the risk (real or perceived). On the ambulatory side, free/cheap EMRs exist, but are not dominating the market, which means upfront money isn’t the only problem. Hospitals waste a lot of capital on expensive applications that are woefully underused and fail to deliver ROI, but that’s usually the fault of the hospital and not the vendor (they bought it, superficially installed it, didn’t like it, and stopped using it, all without any serious effort or commitment). I doubt results will be any better now that the goal has changed to a quick selection, a subsidized purchase, and rapid go-live. I’m more in favor of getting the national infrastructure in place and then plugging in whatever appliance you want to exchange information with it. The value is in the network, not market-differentiating bells and whistles running on a local PC (I say that with great hopes for clinical decision support, but I’ve worked with it and it’s not really supporting many clinical decisions except to ignore the constant, unhelpful cookie cutter warnings). On the other hand, products and support aren’t fully commodotized, so as it stands today, there may be strong, valid reasons for choosing one commercial product or vendor over another. If there was a perfect system, we would need only one and that’s not the case.

Speaking of which, I like this quote by Mark Smith of CHCF on the stimulus bill: "It’s the land rush and the gold rush and the GI Bill of Rights all rolled into one."

Inga and I will be taking some possibly overlapping breaks over the next few days. We need to rest up for HIMSS, although I’m not sure that coming back to an inbox full of hundreds or thousands of messages will do it for me.

Riding on some Oprah quotes from Dennis Quaid (which were wrong, since he still thinks bedside barcoding will fix IV compounding errors like the one that affected his twins), Detroit Medical Center puts out a press release touting its own system. It’s actually Cerner’s, which would not have prevented the Quaid error either since it’s not used inside the pharmacy for IV prep, at least not as far as I know. There are hardly any systems that will detect mislabeled products when the barcode doesn’t match the contents of what it’s attached to. The hospital is awfully proud of the pro sports teams it takes care of, rattling them off at the end as though people who wield balls and pucks are more important that regular Joes.

Some folks who missed the HIStalk reception cutoff asked me to post that they’d like to meet similarly situated people at the Trump’s lobby bar during the same hours, a kind of Overflow Reception of the buy-your-own-drinks variety. I may swing by incognito just to see what’s happening there, so be rowdy.

FBI agents raid the offices of Washington, DC’s CTO (the previous job of Obama’s newly named US CIO), reportedly arresting an employee and a contract worker for bribery.

Just about everybody who’s been in the industry for more than a few years knows who George Huntzinger is, but here’s a refresher: he was president of CSC Healthcare for many years and also COO for the gone but not forgotten Superior Consultant, one of the class acts of HIT consulting. He’s now at The Huntzinger Management Group of Plains, PA, which in a remarkable non-coincidence, shares his name. A couple of HMG’s partners are also former SUPC folks who have decades of experience in running businesses, doing M&A work, etc. HMG offers consulting services to both providers and vendors, such as business assessments and planning, marketing strategy services, operations effectiveness, IT effectiveness, and full program management and PMO services. The Huntzinger Management Group is a new HIStalk Platinum Sponsor and I am delighted to have their support.

Listening: Pink Floyd’s Wish You Were Here, an incredible, moving tribute to LSD-fried (and now deceased) founder Syd Barrett. I rediscovered them after watching the Which One’s Pink documentary recently.

McKesson is the latest HIT vendor to pony up to make a patent troll go away. The troll’s strategy: find companies using technologies vaguely similar to a patent it bought with lawsuits in mind, sue everybody and his brother for infringement in a friendly court’s jurisdiction, then generously offer to settle if the target company agrees to buy a license that costs just a little bit less than mounting a legal defense. Everybody caves in every time except Epic, which happily offered to trade legal punches until the weaker fighter hit the canvas.

It’s nine years in jail for the New Zealand health district CIO accused of defrauding his employer of $11 million US by submitting phony IT maintenance invoices paid to himself.

Enterprise Software Development is a new and appreciated HIStalk Platinum Sponsor. The company offers management consulting, supplemental staffing, software services, implementations, integration, and infrastructure support (among other services). Solutions expertise includes Cerner, Eclipsys, Epic, Siemens, MEDITECH, and McKesson. Some familiar client names are here. Thanks to the folks there for supporting HIStalk.

Massachusetts Senators Kennedy and Kerry bring home the pork, getting $143K of federal taxpayer dollars for the South Shore RHIO, among other spending items like sewer repairs and a bus. I guess that passes for cheap stimulus spending these days.

Perot Systems will spend up to $60 million on a new campus, stimulating India’s economy instead of ours. It’s also talking to five Indian hospital chains about implementing "hospital software that is available in the US and UK," which sounds like Cerner.

A report says Connecting for Health will lose its standards-setting role to a new group under the Department of Health, opening the door for more NHS organizations to choose their own systems as long as they can interoperate via a common infrastructure. Some have argued that stimulus money will encourage healthcare IT like the UK’s, which aren’t fairing so well, but it sounds like they are actually gravitating more toward our model, with certified commercial products being chosen locally but exchanging information on a common network.

E-mail me.

HERtalk by Inga

From Code Red: “EMRs, ROI, and physician adoption. I think if the market actually realized the savings and efficiencies, there would not be a need for government forced market demand to move these products. I think the reality is that the current generation products do not provide these things, or why would a doctor not adopt them? The current generation of products have low adoption and high abandonment because they force the wrong workflow into the clinic and the doctor. Many EMR products ignore the doctor’s need to enter original thoughts and observations which do not appear on a pull down list. My fear is that the HITECH spending is going to freeze spending and investment on next generation products that would be adopted, and create artificial market demand on old school products certified based on the rules from the old school vendors. So, no better mouse trap for the next few years, just ‘bridges to nowhere’ in HIT.” Hasn’t the industry spent the last 15 years or so trying to come up with the better mouse trap? Maybe it’s time to try something new. Plus doesn’t new business provide vendors increased revenues for product reinvestment?

Thank you for all that sent over the great footwear suggestions. Did I forget to mention that in addition to gorgeous and comfortable, they need to be affordable enough for someone on a blogger’s salary?

UTMB (TX) remains on life support after regents approve a proposal to keep the Galveston hospital and school open. Now the organization needs to find $1 billion from philanthropic and government sources to fund the rebuilding of the hospital, which was heavily damaged in Hurricane Ike.

The FDA clears Sunquest Information Systems’ latest Blood Bank software application.

The HHS creates a new Office of Recovery Act Coordinator to manage the distribution of the $137 billion in ARRA funds. HHS veteran Dennis Williams will lead the office and serve as Deputy Assistance Secretary for Recovery Act Coordinator. That really rolls off the tongue.

PatientKeeper is mentioned in this article about Caritas Christi Health Care (MA) and its $70 million technology project. At first glance, it sounds as if the Caritas IT staff actually created the PatientKeeper technology, which is not the case. I asked for clarification from Susan Worthy, PatientKeeper’s director of marketing. Her reply: “PT Barnum says any publicity is good publicity. Not sure that’s true. I sent a note to the editor regarding the inaccuracy.” I’m with PT.

Greenway Medical Technologies celebrates its 1,000th connection of PrimeExchange, Greenway’s interoperability engine.

Poor communication at US hospitals costs $12 billion per year, according to business school researchers at the University of Maryland. Communication failures result in unnecessarily long hospital stays and account for 54% of total losses. The $12 billion figure is equal to about 2% of hospital revenues nationwide and definitely cuts into the average hospital’s 3.6% margin. Leaders at the school’s Center for Health Information and Decision Systems believe that improved IT would streamline communication among caregivers and reduce inefficiencies.

OSU Pathology Services (OH) selects McKesson’s Revenue Management Solutions.

Some Congressmen take a closer look at the healthy salaries earned by many hospital CEOs. The IRS says the average CEO salary is almost $500,000, with a small group averaging $1.4 million. Republican Senator Charles Grassley would like to introduce legislation that puts more pressure on hospital boards to keep salaries in check.

Beth Israel Medical Center implements Meta’s Electronic Physician Query software to improve clinical documentation.

Availity promotes (warning: PDF) Russ Thomas to the role of President and COO. Thomas joined Availity in 2008 as an executive VP and COO and was previously president of Gold Standard.

PHR provider HealthTrio will leverage Dossia’s technology platform to advance the clinical data integration within HealthTrio’s PHR and EHR products and increase online record access.

The Rochester RHIO goes live with eHealthConnect Image Exchange, a service by eHealth Global Technologies to automate access to patient images. The service ingrates with Rochester’s Axolotl Elysium system and connects to the PACS imaging services at eight radiology providers.

As Mr. H mentions, I once again have the opportunity to take charge of the blog while he taking a break in some Internet-less location. Feel free to drop me a note. It makes me feel important.

E-mail Inga.

Sam’s Club to Sell eClinicalWorks EMR Bundle

A New York Times article reports that Wal-Mart will begin selling small-practice physician systems through its Sam’s Club division, pairing Dell hardware with software from eClinicalWorks in a complete package that include installation, ongoing maintenance, and training.

Marcus Osborne, Wal-Mart’s senior director of healthcare business development, was quoted as saying, "We’re a high-volume, low-cost company and I would argue that mentality is sorely lacking in the health care industry."

Sam’s Club will offer the package this spring starting at under $25,000 for the first physician in a practice and $10,000 for each additional doctor. Ongoing costs will be $4,000 to $6,500 per year.

The package will include a Dell desktop or tablet PC installed by Dell technicians and software-as-a-service applications from eClinicalWorks.

Wal-Mart says it got the idea from its own in-store clinics, which use the same technologies. It says it’s role is simply to bundle the products together into an affordable and accessible offering. "We’re the systems integrator, an aggregator," Osborne said.

David Brailer was quoted as saying, "If Wal-Mart is successful, this could be a game-changer."

I’ve asked Girish Kumar of eClinicalWorks for more information. Meanwhile, your comments are welcome.

UPDATE: notes from speaking with Girish Kumar Wednesday afternoon. Sorry that they are terse and a little raw, but I had 15 minutes between meetings at work and Girish was in the car on the way to the airport.

If a physician buys from Sam’s, will it be the same product, implementation services, and support that eCW offers directly?

Absolutely. We’re trying to make it simple. Everybody says EMRs are hard and implementing change is hard. We realize that. We’ve been doing SaaS since 2003 and have invested a ton on a data center. We wanted system that is ready out of the box, configured, with content, although it will still require on-site implementation and services. It’s the same in terms of product, services, training, but faster and easier to deploy.

Why would a customer buy from Sam’s? Do they save any money? Can they choose a no-services option?

Wal-Mart used its Sam’s Club division because it has a lot of small business customers as corporate members. They buy ongoing stuff every month, not just simple things like gloves and bandages, but have a corporate account and buy copiers, payroll software, etc. They don’t have to go into Sam’s. You call a corporate number, get an assigned representative, talk to them about what you need, and the item is shipped. eCW salespeople will still show the product and talk to the customer. There are packages we want to give them that are pre-configured. The customer will not pick blindly – they will still consult with an eCW person.

Will Wal-Mart do its own advertising and marketing?

There will definitely be a significant campaign. They have 200,000 healthcare professionals today as members, mostly as doctors.

Any projections on volumes?

I have to keep that confidential, but there was a lot of planning on the eCW side. Investments have increased, made the company even more ready. This can have a significant impact on how physicians look at, evaluate, and purchase EMRs. We would like to see taking it away from being a niche sales process, where sometimes we confuse the customer, to make it a very streamlined process so that a customer can make an educated decision. They know how many days to go live, how many days training, cost, etc. eCW does 30 Webinars every week that every customer has access to with a live attendant and all Sam’s members will be able to avail themselves of that.

We believe we are the largest SaaS EMR in the country with 4,000 physicians. If we include hospital customers hosting affiliated physicians and RHIOs, that’s another 4,000. That’s 8,000 today of our 25,000 physicians. We’re trying to leverage that scale to make it easier and cheaper to deploy.

Do you anticipate any product changes?

For primary care, we spent two years working with New York City. We put into the product all the content needed to run a primary care practice – templates, order sets, clinical decision support. That is years of content that we jointly developed. That is all pre-packaged with the product – it’s not just the software any more. On the specialty care, we have about 50 specialty databases. All of that will be available pre-configured when they sign up. When the trainer shows up, all the content will be there and if we want to change it, we can change it together. We will go live with a comprehensive data repository with clinical decision support at no extra cost for the content.

A primary care doctor can go live with the system as it is, with rich content.

What does this to do the competitive landscape?

We’ve always taken tremendous pride on our leadership on price and functionality. 97% of eCW customers surveyed said their total costs met their expectations when they bought and implemented eCW. 93% of physicians said the EMR met or exceeded expectations. I still have to worry about the 7% and I lose sleep about it more than I take advantage of the 93%, but if a package with those numbers is readily available, people will ask the question: if I’m able to get a comprehensive product that people are happy with at this price point with content and support, why should I spend more? Price visibility will be black and white. No longer will you see those quotes saying an EMR will cost $300,000. You will see more informed questions, pricing pressure, and frankly, higher expectations if content is provided. I don’t want to take six months to implement PM and another six months for an EMR. This is a unified product we’re offering, by the way, both EMR and PM. We’re offering five days of implementation on site with the Sam’s Club package and they can buy more for $750 a day plus travel, but our track record is that we can do it in five days.

What are the benefits to eClinicalWorks?

There are many benefits. We want to be a company with 100,000 physicians using our product and 100 million patients whose lives are positively affected by it. There’s a lot more work to be done, but this platform gives us more opportunity.

News 3/11/09

From Paul Pott: "Re: grocery code barcode article. Didn’t you write some commentary awhile back? Maybe Dennis Quaid should read it …oh, wait, he is too busy solving the problem with his easy solutions." A couple of readers recalled a piece I wrote two years ago called Want to Anger a Nurse? Make Smug Coments about Grocery Store Barcoding. And regarding Dennis Quaid, I should say that I have no problem with his being mad, disillusioned, distrustful, litigious, and now vocal. Its HIMSS that I have a problem with, putting him onstage in an HIT keynote as though we are ignorant to medical errors without having a layperson challenging us at a conference, particularly one who suffered no loss other than some panicky moments (unfortunately, there are plenty of people whose experience with medical errors is far more tragic). Well, HIMSS has made some odd keynote choices before (Dana Carvey, for example) and I suppose this one’s no worse when the objective is simply to pay a big celebrity to bump up the cool factor. Maybe he’ll do something interesting like have someone from Cedars on stage with him (I’m predicting that).

From xtremegeek: "Re: Akron General Hospital. Heard they laid off over 100. Can anyone confirm?" The body count was 145, according to an article in today’s Plain Dealer.

Fountain Valley Regional Hospital (CA) is using video-equipped robots to connect doctors with patients. It is law that every IT system intended for nurse use must have a contrived acronym name chosen by contest (as a thinly disguised ploy to increase rank-and-file support, of course, and highly insulting to nurses if you ask me), so theirs is called ERNI. A patient is quoted: "They said a doctor was going to talk to me and then it came wheeling around. I just figured that was the new era. I didn’t feel like it was impersonal at all."

IBM works with a hospital in Denmark to develop a 3D anatomical view of available EMR information, allowing doctors to click on a body part to drill down into related information. Sounds cool, although I don’t see how it affects outcomes.

Analytics vendor Enclarity raises $5.5 million in Series C funding, bringing its total to $22 million.

Marlin Equity Partners acquires billing and collections vendor MDeverywhere, adding it to a stable that includes MedAvant. I Googled HIStalk to see if I’d mentioned MDeverywhere previously and darned if I didn’t mention a company by that name (maybe not the same one) in my 12th-ever HIStalk post, June 30, 2003. That was right after I boldly predicted that Epic would no longer be a serious HIS competitor because it had just signed the Kaiser deal (which I also predicted would fail). Well, I was young and foolish and so was Epic back then, so you will have to forgive us both.

Thanks to GetWellNetwork of Bethesda, MD, a brand new Platinum Sponsor of HIStalk. Premise Chairman CEO Eric Rosow (now Eclipsys) introduced me by e-mail to GetWellNetwork Founder and CEO Michael O’ Neil, we did a Moment With, and he must have gotten a lot of response because here they are a new sponsor. The company sells interactive patient care solutions (bedside education, safety, pathways, pain assessment, etc.) and patient entertainment and communication systems. I appreciate their support.

The medical director of O’Connor Family Health Center (CA) tries to make the best of its transition to an EMR, saying he doesn’t regret it despite (a) the fact that it cost $250,000 and required an army of people; (b) patient backlog was up and revenue down for three months after go-live; and (c) their vendor has gone belly-up since their implementation and product support ends in two years. I bet that particular Mrs. Lincoln really liked the play.

I bet HIMSS was hoping for some rosy survey results about ARRA after all the cheerleading it did for it, but HIT professionals think differently: only a third of them believe all those HIT stimulus provisions will end up saving healthcare dollars.

Thanks to those who RSVPed for our HIMSS reception and apologies to those who missed the cutoff (some folks took heed when I wrote Saturday that the cap was imminent). The most common titles of attendees: VP/EVP/SVP/RVP (76), CEO/Chairman (45), and Director (40). I’m happy to see that some of my provider-sider peers jumped in there too, with some doctors, nurses, IT people, and CIOs. Title counting aside, thanks to every single person who signed up – it means a lot to me. It never ceases to amaze me that people pay at least a little attention to an anonymous blogger who’s sticking to his nonprofit hospital IT day job (as some of you less impressed readers have recommended).

A reader had posted a comment about IntrinsiQ, the folks who sell the IntelliDose oncology system. Inga connected with Jeff Forringer, the company’s new president, who was good enough to provide a response. "Thanks again for reaching out to me directly. As I said in my initial response there is no planned reduction in force for 2009. As a matter of fact we plan to invest even more in software development and client service this year. Overall I think you’ll be happy to hear where IntrinsiQ is heading – especially given your concerns about the ongoing importance of our clinical software business. While we’re still putting the operational roadmap in place to achieve our goals, here’s an overview of our vision. (a) Extend the improvements we made in version 3.8 to the e-nurse and charge capture modules to the order writing module in our 3.9 version this year. (b) Use these changes in the underlying architecture to develop a light version of the product that can be used by smaller facilities. (c) Continue our cooperative approach with full service EMR vendors to be the oncology module that makes their systems better. (d) Use our data processing and analytical skills to provide sites with information about how they practice and how that compares to the rest of the country. (e)  Develop new modules and services that help sites improve the quality of care. On the software management side I have made two changes. I hired Rich Gray as the GM of our software division. Rich was with IntrinsiQ for a number of years and has rejoined. Rich’s experience with the software, healthcare  IT space and his clinical background are a great addition to the team and will help us reach our goal of becoming a bigger part of helping sites improve the quality and understanding of care The other management change that I made was to promote Steve Hamann to the management team. Over the past 2 years Steve has led the effort to improve IntelliDose’s user interface and the underlying architecture. I hope this gives you and ideas of where we are headed. I would be happy to talk more about what we would like to do long term, the commitment of our board to the process and how the software and data business work together if you are interested."

Philips expands its headcount by 30 in its Belfast office, the Northern Ireland location that was formerly part of the acquired Tomcat Clinical Systems.

QuadraMed announces Q4 results after Tuesday’s market close: revenue down 6%, EPS $0.14 vs. $0.52 (after excluding a one-time tax treatment from last year).

We did an interview with Cheryl Iseberg, COO of Renaissance Resource Associates, an HIStalk Platinum Sponsor that provides consulting services for GE Centricity Enterprise, Picis, Epic, and other systems.

Another example that consumers don’t think doctor bills are real: someone complains to a TV station that if a doctor doesn’t write off charges for a test his insurance company said he didn’t need (after refusing to pay for it, of course), his credit score will suffer because he’s not planning to pay the bill.

Jobs: Project Office Manager (NC), MEDITECH Financial/Billing Expert (national), Director of Business Systems (CA), MEDITECH Consultant – Advanced Clinicals (national).

A RAND Corporation study says pay-for-performance plans sell a lot of IT, but haven’t improved healthcare quality, based on its review of a big California project. The problem: doctors weren’t interested in major change when only a couple of thousand dollars a year was at stake.

MEDSEEK is offering a free Webinar in its series on eHealth, this one on Wednesday, March 18.

Southern Arizona HIE is working with Wellogic to roll out more electronic patient information. Also mentioned: it hopes (like everybody else) to get a slice of the Obama Pork Pie (actually, I shouldn’t say that since I’m almost but not quite convinced he had no choice).

CVS Caremark closes 16% of its MinuteClinic locations, placing them on a "seasonal schedule" to supposedly reopen later. I’ll give its PR people credit for putting a positive spin on closing stores because of poor sales: they are doing it "to align with consumer demand."

The Conficker worm is still out there, infecting networks at two hospitals in Scotland last week and requiring a two-day downtime that forced the rescheduling of cancer patients.

Maybe this is an argument for EMRs: the family of a 60-year-old woman who died of an E. coli infection gets a $2.6 million jury verdict from a hospital. They had taken the patient to the ED, which drew positive blood cultures, but the nurse put the paper result in a folder on the doctor’s desk, where it went unreviewed for 12 hours.

E-mail me.

HERtalk by Inga

From Spicey: “Re: HIStalk/Ingenix reception. You guys should be flattered it’s sold out … everyone thinks this is the ‘must do’ of HIMSS!” We are flattered that so many want to attend this sure-to-be-fun event hosted by the wonderful Ingenix folks. I hear the location (Trump Hotel) is gorgeous and I am sure the food will be divine. If, by chance, you did RSVP and your plans change, let us know if you can’t make it. We’d love to free up some spots for people who missed the cutoff (some of whom are e-mailing frantically hoping to get squeezed in, but we have a space limit).

From Shoe Diva: “Re: HIMSS footwear. I went shopping a couple of weeks ago for comfy shoes … none of those beautiful shoes for me. I swore last year I would resort to black tennis shoes. What about you?” This is one of life’s biggest dilemma: function versus fashion. Why can’t someone design a gorgeous shoe that you can walk around in all day without killing your feet and your back? And, that is also suitable for Chicago’s potentially frigid weather?

Speaking of HIMSS, the obvious buzz this year will be around HITECH, including how each vendors have the perfect solution and what providers will need to do in order to get their money. Coming in a distant second, I predict a good deal of talk of products and services to help providers adapt to a more consumer-driven healthcare world. Next, look for cool ways to use your PDA.

Thirteen hospitals reach HIMSS Stage 7 EHR ranking and all but one are part of Kaiser Permanente. NorthShore University HealthSystems (IL) was the other system to make the list for three of its four campuses. Interestingly, all Stage 7 honorees use Epic for their core HIT system.

A new study suggests that as many of half of the country’s physicians will determine that HITECH financial incentives are not enough for them to move forward on EHR adoption. Avalere estimates that the average solo or small group practice will spend $124,000 over five years to adopt EHR and will receive $44,000 in incentive payments. That’s a $14,000-a-year deficit compared to an estimated $8,500 a year Medicare reimbursement penalty for non-adoption. The biggest problem with this argument, however, is that it does not address any potential savings and efficiencies physicians gain as a result of implementing EMR, such as reduced transcription costs, savings on charts and chart storage, lower malpractice rates, etc. And what about the value of improved patient safety?

Health Systems Solutions announces it will de-register its common stock and stop filings with the SEC following the collapse of its planned Emageon merger and the fraud investigation of its principal investor.

The US unemployment rate continues to climb and now sits at 8.1%. Meanwhile, healthcare remains one of the few bright spots, adding 27,000 more jobs in February.

Integration firm Bostech Corporation partners with HIT consulting firm Orchestrate Healthcare to promote open and integrated healthcare technology solutions.

Allscripts-Misys finds a buyer willing to pay $26 million for its medication services business. A-S Medication Solutions will pay Allscripts $8 million in the 4th quarter and $3.6 million per year over the next five years in return for A-S sales and marketing services.

St. Joseph’s Hospital Health Center deploys RelayHealth’s IntegrateRX Prescription History to aid with medication reconciliation.

CHRISTUS Health implements Picis LYNX E/Point in 18 of its acute care hospitals and plans to add three more sites soon.

The Department of Justice files suit against Community Health Systems (CHS) for allegedly defrauding Medicaid of $47.5 million. A whistleblower originally alerted officials of possible fraud after three New Mexico hospitals and CHS allegedly collected disproportionate share payments to which they were not entitled.

The 235-bed Children’s Hospital (LA) successfully installs Sunquest LIS specimen Collection Management and Encompass Web-based ordering, resulting, and reporting systems.

Satyam Computer Services starts a competitive bidding process to find an investor willing to acquire a majority stake in the scandal-ridden company.

Memorial Hospital and Health Care Center (Indiana) migrates to Corepoint Health’s Integration Engine.

For $199, you can purchase a new genetic test that predicts the risk of male and female hair loss. Though I personally would hate to lose my hair, I’m quite fond of bald men, so I wonder why a guy would waste this kind of money? I suppose the idea is that if you are going to go bald, you can take medications early to slow the hair loss, though apparently the meds include a threat of “sexual” side effects. Men: bald is sexy.

Ambulatory surgery center operator AmSurg selects ProVation MD software by Wolters Kluwer Health.

A new P4P survey reports that P4P payments have grown to over 7% of physicians’ total compensation and 4% of hospitals, with some physician programs producing 30% of physicians’ compensation. Since 2006, the percentage of programs reporting quality improvements due to P4P has doubled and more than half of P4P programs cite measurable increases in their providers’ clinical quality.

The Alaska Native Tribal Health Consortium awards GCI $250,000 to provide a statewide broadband network to give health care provides more ready access to patients’ EHR.

WestCare Health System (NC) implements Preferred Medical Marketing’s Estimator PRO software to provide patients written estimates for expected payments due.

The Michigan Health & Hospital Association commits to a three year contract with ECRI Institute Patient Safety for ECRI to provide support for the Association’s patient safety data collection and analysis project.

Residents strolling their Aurora, CO neighborhood find personal medical documents littering their streets. Apparently the “trash” came from a healthcare facility eight miles away and included names, addresses, social security numbers, and other personal data. The healthcare facility is uncertain how the papers got there and is investigating.

Finally, a San Diego State University study finds that there are more indoor tanning salons than either Starbucks or McDonalds. Did my tax dollars help pay for that study?

E-mail Inga.

An HIT Moment with … Larry Pawola

An HIT Moment with ... is a quick interview with someone we find interesting. Lawrence M. Pawola, PharmD, MBA is Associate Dean of Academic Practice and Program Director, Health Informatics, Operations and Curriculum, at the University of Illinois at Chicago.

Describe the MS in Health Informatics at the University of Illinois at Chicago (UIC), what kinds of students are attracted to it, and what graduates are doing.

As one of the oldest programs in the industry, the HI/HIM programs at UIC have a long history of excellence, consistently preparing graduates who become leaders in the Health Information Management and Health Informatics professions.

The HIM program was established in 1965 and has graduated many of the top contributors to this profession. Coursework in health informatics was originally built in the early 1990s, with the Master of Science in Health Informatics degree formally established at UIC in 1999. We are by far the largest and one of the oldest health informatics graduate education programs in our industry. Our multidisciplinary program is housed in the Department of Biomedical and Health Information Sciences in the College of Applied Health Sciences, which is one of the six primary health discipline colleges located on our campus just west of downtown Chicago.

UIC, being one of only several universities having all medical disciplines on one campus, is recognized as a national hub of medical research, being designated by the Carnegie Foundation as 1 of 96 “Very High” Research universities, as well as consistently ranking in the top 50 of national universities in federal research funding.

The Master of Science program has been delivered in an online fashion for the last twelve years. Courses have been built to better understand the social and behavioral attitudes and issues that inhibit the effective use of information technology in healthcare organizations. Our faculty guides students to assimilate theory and apply it to everyday activities. Many times, the students work in groups, sharing their professional perspectives, as they discover new knowledge.

Our goal is to produce graduates who can assume higher-level staff, management, and other leadership positions in a variety of healthcare, supplier, payer, and consulting organizations; they will lead their organizations to achieve greater value from their systems investments. UIC’s HI/HIM alumni are highly coveted and have created an elite network of industry leaders. They have been hired by a number of leading healthcare providers, leading supplier companies, and consulting firms. Their achievements are recognized by their individual companies, organizations and agencies, as well as national industry groups such as AHIMA, HIMSS, and AMIA.

Keep in mind that our Master of Science degree is not our only online program. Our highly-respected BS in HIM is a blended program, offering students the opportunity to combine classroom instruction along with online courses. We also offer an online Post-Baccalaureate Certificate in Health Informatics that consists of three courses, as well as a seven-course Post-Master’s Certificate in Health Informatics that offers those with a graduate-level degree an excellent credential signifying they are highly proficient in the analysis, evaluation, implementation, and control of healthcare information systems and related technologies.

We are very excited about the launch of our new online Post-Baccalaureate Certificate in Health Information Management that will permit healthcare, business, and IT professionals to be eligible to sit for the RHIA certification exam. We will begin accepting applications for that program in late April.

Students from all of the health disciplines are attracted to our programs. We have physicians, nurses, pharmacists, medical and radiology technologists, therapists, technology and computer science professionals, engineers, and other professionals in our programs. Because we are online, students come from all over the United States and the world. Military personnel serving overseas, as well as professionals from India, China, Korea, and several other countries have participated in our courses.

Studies have indicated that there aren’t enough people trained in health informatics to advance electronic medical records. Do you agree it’s a problem and, if so, what’s the solution?

Yes, this is definitely a problem, but frankly, this has been a problem for a long time. The recent stimulus bill will set a number of activities into motion during the next few years, which will further increase the demand for informatics-trained professionals.

At UIC, we have been scaling our HI/HIM programs and preparing to educate even greater numbers of students while maintaining quality at all levels of instruction. Industry-experienced faculty have been hired in anticipation of increased enrollments and we have modified our student enrollment/registration, research, and advising processes to accommodate this growth. We emphasize quality and service, which are hallmarks of our programs. Furthermore, our courses continually change as the industry demands new knowledge and experience, so keeping an eye on what is needed for success is critical to maintaining an edge on what the industry requires.

People working in healthcare information technology must realize their customers are highly educated individuals who demand the best of customer service and response. Clinicians, for example, are trained to assess evidence as an essential element of any decision-making process. The ability to research an answer and support one’s conclusions and recommendations with evidence has become a critical skill set in today’s healthcare society. This is also a requisite skill set for people who support information technology and electronic medical records.

Having worked in this industry for almost thirty years, I, like others, realize the evolution toward electronic health records is a series of long-term projects that change culture, processes, attitudes, and jobs. Organizations need to grow into most effectively using EHR capabilities; these aren’t “slam-dunk” solutions. As a result, there will be a need for trained informatics professionals through the next 10 to 20 years and beyond.

While the government’s stimulus program may provide a jump start, the solution requires formal training and continued education over many years. The industry needs experience. Educational programs like UIC represent one of the tools of a total solution set required for the long term.

Are you seeing increased interest in your program because of economic conditions?

Yes, our enrollments have significantly increased during the last two years. We have more applications for our programs at this point in our summer and fall enrollment cycles than we have ever had before. I have talked to others here at the University of Illinois at Chicago and they said that the “hot areas,” such as engineering during the last major economic downturn back in the 1990s, have always been good arenas for individuals to reinvent themselves for new careers and employment when the economy begins to pick up again; health informatics is definitely "hot”.

This economic downturn is not any different than any past one. The current conditions have forced many workers to think about their futures, to assess new working careers, and to try something different. This is a definite opportunity to retool oneself to be eligible for a position that is in high demand in a growing industry, and will have a tremendous impact on all of our futures. With the new administration’s desire to emphasize electronic health records, the future is bright for individuals who have requisite skill sets in informatics.

What surprises me is the intense interest we receive from physicians, nurses, pharmacists, and other clinical professionals. In spite of having relatively stable employment through most economic downturns, a number of clinical professionals are students in our programs, partly because they not only desire to take advantage of opportunities in their current positions, but also to become educated to take on even greater responsibilities and leadership.

Though our program is not specifically meant to attract just healthcare professionals — in fact about half of our students come from backgrounds other than clinical — our curriculum emphasizes skills that will give everyone rounded backgrounds to be successful in healthcare. We need to remember that these are complex software systems and to successfully use them, a number of issues must be understood, dealt with, and solved. One does not need to be a clinician to be successful in our informatics programs and in the healthcare information technology industry.

Economic stimulus funds will likely change the healthcare IT industry. Do you have any predictions on what will happen?

I have talked with a number of consultants, supplier representatives, providers, and students during the last few weeks, and as expected, there is a wide variety of opinions. But in spite of the best of intentions, I don’t believe there will be a mad rush for systems in the next few months. Like other segments of the economic recovery plan, the stimulus is somewhat vague in many areas; wise providers will wait for some period of time until there is better definition of what demonstrates success under the stimulus. The plan will result in incentive payments for those providers who demonstrate meaningful use of their EHRs. We will see a last minute push to purchase and implement new systems as we get closer to deadline dates, with a resulting crush on experienced resources, and a cry to change the legislation and move the deadline.

Most everyone agrees there will be entrepreneurs developing and pushing their ideas as the best available solutions, so one needs to exercise caution as they purchase. Historically and generally speaking, healthcare organizations have had difficulty realizing value from their information technology investments. Because of the push for new systems during the next two years, and with many new users implementing complex functionality into resistant cultures for the first time, there is tremendous risk that money will not be spent wisely.

My advice for any organization is to conduct thorough planning and evaluation, make well-thought-out selection decisions, and understand how your business operations will be affected by new technology. Build on the available experience in the industry and seek high value and return from the investment you are making. While the money may be available and the “candy store” is now open, spending it wisely requires thought and careful effort. As I said earlier, these are long-term projects that require significant cultural, behavioral, and process modifications for every organization to achieve success.

Do you enjoy working in higher education after a long career as a management consultant?

Yes, very much. This is the right spot for me at this point in my career.

I spent over twenty years as a management consultant and have a plethora of stories about client situations and business travel difficulties. I have never regretted my many years in consulting at American Hospital Supply Corporation (remember it?) and with Dorenfest & Associates. I respect the people I worked with and learned much from them. I worked hard to achieve good results with my clients and always gained additional knowledge from each one of them. These experiences have helped position me to lead and grow this academic program.

Higher education is not without its own set of problems. With decreasing budgets and increasing competition for students, academia is very much like any other business. An understanding of basic business principles, such as strategic planning, marketing, and management is as critical to success in the academic environment as it is to any healthcare consulting or software business. My additional experiences as a consultant have taught me to appreciate these challenges, to be patient with the change process, and to respect others for their attitudes, personalities, and agendas. While a large university like ours may appear to be slow to change on any given day, comparing a snapshot of today to one taken a year ago will illustrate tremendous changes. My organization has smart, committed people. We have terrific students with the maturity and desire to learn. The Dean in our college and the campus administration support me, providing me with the opportunity to build something I truly believe in to be a leader in our industry. What more can I ask for?

Monday Morning Update 3/9/09

From Bill Swerski: "Re: negativism. I can’t tell you how much I look forward to your news blogs. They just keep getting better and more informative. Your statement regarding not worrying about the economy and working harder is one of the most prolific statements I have heard in the past few months. The negativism to me is what is hurting the economy. This single quote needs to be plastered on billboards, bathroom stall walls, and anywhere else a Sharpie can be held! Our statement here for the bad times is ’Suck it up, cupcake!’"

With those kind words, let me say for the record that I’m just as hard-hit and discouraged as anyone else (my IRA and 401k are down 60%, so I’ll probably be working until I drop). I also don’t like the idea that I did the apparently unfashionable — paid my mortgage and taxes on time, lived within my means, and didn’t start crying for help because my house payment went up while its value went down, so there’s no bailout in my future (except paying for one to help the irresponsible people). Still, whatever degree of intelligence, ambition, and resourcefulness I had hasn’t seeped out of me just because others (some of them elected to high office) made truly boneheaded decisions. I’m knocked down, but not out. If your priorities were based entirely on accumulating wealth, it’s a great time to re-evaluate. One of my favorite sayings: I’ve never seen a hearse pulling a U-Haul.

It may already be too late, but if you want to attend the Monday, April 6 HIStalk reception at HIMSS, please RSVP immediately as we are just about to hit the cutoff of 300 (or it may have been 400 — hopefully the Ingenix folks sponsoring kept better notes than I did of what we decided). Please don’t RSVP if you aren’t sure you’re coming since someone else will lose their chance. Pretty nice digs: the 92-story Trump International Hotel is right on the river at the Loop and North Michigan. We will be in the largest room, the Grand Ballroom, which has views of Lake Michigan and lots of historic buildings through 24-foot windows. If you are the sort that likes to hobnob with movers and shakers, the RSVP list includes 27 CEOs and presidents and 56 VPs so far, plus an assortment of financial types, media people (what are they doing attending a blogger’s event?), and friends of HIStalk (that’s all of you, of course, but some of these are names you would know from reading). Thanks to Ingenix and Ingenix Consulting for sponsoring and for everybody attending. If it’s a great event, it will be because of the cool folks who chose to be there.

Speaking of the reception, a reader informs me that the NCAA basketball championship tips off the same night at 8:21 Chicago time. I wouldn’t have known since the only sport I care about is college football, but I know people obsess over their brackets and all that. Hopefully it won’t be too much of a conflict. That reader suggested a post-party viewing event and is looking into underwriting a modest one (heck, all you need is some Chicago dogs, a keg, and maybe … just thinking out loud … a couple of cheerleaders).

Gwen at Healthcare IT Jobs was curious about the University of Illinois at Chicago’s online MS in Health Informatics program whose ad is running to your right and on Healthcare IT Jobs, so she assembled some information (warning: PDF) about it, just in case you are curious. People often decide to further their education when the economy is unfavorable, so it’s a timely topic.

CalRHIO and OCPHRIO will launch a statewide system providing secure access to patient information in 23 Orange County, CA EDs in July. The Orange County group will use CalRHIO’s electronic platform, which I believe (but the press release doesn’t say) is Medicity.

Hopefully your Daylight Saving Time switchover went OK.

Young adults ages 19-29 make up the larges group of uninsured citizens, all 13.2 million of them. One reason: they’re too old to stay on the plan of their parents, but their employers don’t offer coverage or they can’t afford it. These are the folks, of course, who will have to bail out Medicare, fund the retirement of all of us baby boomer geezers, and pay massive interest on the federal debt racked up trying to keep an economic balloon with a hole in it inflated. Somehow I’m not feeling real good about their willingness to do that when the time comes.

A New York Times op-ed piece called The Computer Will See You Now seems to have gripes about EMRs that aren’t really described too well, but seem to be: (a) using the computer in front of patients is intrusive; (b) standard questions must be asked in order even when they clearly don’t apply; (c) the doctor might swear in front of patients when the computer does something wrong; and (d) computers lose context because doctors can’t underline, write bigger, or otherwise highlight something important. From those observations, the author suggests further studies are needed and perhaps EMRs should be maintained only on tablet PCs. That’s a pretty big and unconvincing leap from the anecdotal experience of one user, but lay readers will unfortunately assume it is authoritative since the Times ran it.

The Minneapolis-St. Paul paper highlights Amcom and VisionShare, healthcare software companies that "are proof, even amid all this economic turmoil, that we can build growth companies by making health care and other industries simpler and more efficient." Probably true.

Lobbying experts say Nancy-Ann DeParle’s industry ties shouldn’t disqualify her from being health czar, saying experience "on the other side" is not a negative because you need people who have worked in the field. I would ordinarily agree, but much of the Obama stimulus and reform plan is prescriptive in specifically advocating and advancing EMRs and she has profited greatly from being involved with companies that sell them. Still, I agree that shouldn’t rule her out. I think some in the industry would have preferred someone who has actually worked in healthcare, but I suppose at high-profile levels you’re always going to have someone who has risen to heights above the majority of us who actually do the work as non-profit employees.

Healthcare expert Dennis Quaid revisits Cedars Sinai with Oprah’s TV people and cameras, "to see what steps have been taken to ensure a similar mistake won’t happen again." Apparently the best case study on medical errors involves his twins, who unlike some victims had no lasting ill effects whatsoever, and the best investigator for the job is their actor dad. I thought his movie Everybody’s All-American was pure dreck, so I plan to call up Oprah to film me as I meet with studio executives to demand an explanation of how they will make sure something that horrifying never happens again. Dennis, of course, can do whatever he wants at Cedars because he’s hanging a potential lawsuit over its head, so they have to grit their teeth and pretend he’s got insightful thoughts as he lords around the place with the TV crew catching his good side. He’ll be great at HIMSS in any case since actors can make you love them by just being whatever you want them to be (I bet actors would make great salespeople).

A Massachusetts doctor who writes best-selling novels says the inspiration for his latest, The Second Opinion (# 1,563 on Amazon) came from a visit to his own doctor, who was too busy entering information into the computer to make eye contact. "I started thinking about electronic medical records and HIPAA (Health Insurance Portability and Accountability Act, which requires standards for electronic medical records and also helps to ensure patient privacy.)  So that’s what I wrote about."  

Nuance announces that its SpeechMagic has been rolled out in 12 London sites of HCA.

GE and Siemens are upset that Obama’s plan calls for cutting government spending on MRIs and X-rays, so they’re threatening to turn the lobbyists loose to argue that it would deny seniors "life-saving medical services" (taking a cue from HIMSS in using the term "advocacy" instead of the much less noble-sounding "special interest lobbying"). Like everybody else, they’re all for cutting massive healthcare expenses as long as it doesn’t cost them anything. Another entirely impartial group, the American College of Radiology and its radiologist members, also doesn’t like the plan. Both like to raise the specter of "actuaries" making medical decisions.

Healthcare IT mecca Beth Israel Deaconess Medical Center is on track to lose $20 million this year and layoffs are apparently coming. The Most Wired folks are always stretching to try to correlate IT investment to outcomes, so I expect they’ll modestly look away.

Some highly insightful equities research: an analyst notes that AMICAS offered $1.82 per share to buy out Emageon, so his target price is $1.82.

E-mail me.

News 3/6/09

From Bignurse: "Re: concierge practice. The New York State insurance department says that a New York City physician’s concierge medicine practice ‘amounts to insurance and requires a license’." Link. State insurance regulators order AMG Medical Group to shut down its $79-a-month practice. They are obviously wrong – if it was insurance, you couldn’t touch it for $79 a month. A bad call by the state, if you ask me.

From Leland Palmer: "Re: KP. Hearing any chatter that their CTO is seeking pastures of the greener variety?" Not so far, anyway.

From Harold Kumar: "Re: layoffs. The IT department at my hospital is sure to get hit next round. I am really worried." Worry is not a constructive action – it doesn’t change the odds that the next pink slip will have your name on it. Stop reading the negative financial news, work harder than you ever have, and keep your eyes open for opportunities. It’s all you can do. No matter how tough the times, some percentage of people will do even better than they did before and there’s no better place to do it than here. All of us in hospital IT are feeling the same way, I expect.

From CS Guru: "Re: Cedars-Sinai. Grand kudos to the folks at Cedars-Sinai as they went live this weekend with the full Epic revenue cycle suite. It is the biggest Epic install for revenue cycle ever (except of course KP). This is a huge success by all measures, but mostly for new CIO Darren Dworkin. The word is they are closing the command center early as support calls have slowed to a drizzle."

As you would hope, new health czar Nancy-Ann DeParle has resigned from Cerner’s board.

News flash headline from HIMSS: "Quaid to address ‘broken healthcare system’". Great! An actor who’s never worked in healthcare, who didn’t finish college, and who showed no interest in healthcare whatsoever until Cedars Sinai overdosed his twins on heparin is ready to tell industry experts what we’re doing wrong. I guess the non-celebrity parents of the other Cedars-overdosed baby weren’t invited because they don’t have The Right Stuff (my favorite Dennis movie, but he’s also been in some real crap, like Jaws 3-D and Wilder Napalm). He could bring his brother Randy to talk about Christmas Vacation.

Bret Jones of Leerink Swann was one of the best HIT analysts in the financial industry in my opinion, recently doing a ton of work following the stimulus goings-on and setting a contrarian (and accurate) tone in saying it wouldn’t boost the bottom line of vendors until at least next year. I say "was" because the company sent e-mails indicating that a "change in personnel" cause it to drop coverage of HIT companies and his bio page gives a 404 error. I assume he’s gone.

The country’s newly announced and first CIO, Vivek Kundra, booted Microsoft’s office tools in favor of Google Apps when he was CTO of the District of Columbia and said in a Thursday conference call that he wants the government to use more cloud computing.

Brooke Army Medical Center chooses the anesthesia system of DocuSys.

A New Zealand IT healthcare IT executive says governments should provide incentives for clinicians to use IT. Panelists said Australia’s e-health policies are falling behind UK, Northern Ireland, and New Zealand (the US wasn’t mentioned). Suggested initiatives include a SNOMED terminology project, a national provider and citizen health ID, and a user authentication system. Actually, the US was mentioned in lauding the potential of telehealth, with a Hawaii project as the poster child. An Intel healthcare guy said, "I’ll be honest; vendors are sometimes as much to blame for [e-health] challenges as policy makers; there needs to be a shift to [coalitions of] healthcare providers."

Vitalize Consulting Solutions announces its acquisition of 70-consultant r3 Health Partners of Santa Ana, CA, expanding its West Coast capabilities. Vitalize Chairman and CEO Bruce Cerullo dropped no hints that I could detect in my interview with him a few weeks ago.

A Washington hospital’s board approves motions to decline to participate in assisted suicide and to approve a $6 million EMR upgrade. The minutes do not indicate whether the decisions were related.

Thanks and welcome to new Platinum Sponsor 3M, specifically its transcription, dictation, and document and chart management business. Thanks to 3M for supporting HIStalk and its readers. It’s really gratifying that even in tough times, companies still want to support what Inga and I do.

The military’s Tricare system is cross-checking prescriptions for duplicate therapy and drug interactions, alerting the pharmacist to discuss the issue with the patient’s doctor. Also mentioned: a DoD/VA partnership with the FDA to track adverse drug events. The article slips in referring to AHLTA as "Altha," but it’s still interesting.

Jobs: Clinical Pharmacist, Director of Business Systems, EpicCare Ambulatory Consultant, Cerner CoPath Plus Consultant.

A couple of folks have had trouble registering for the HIStalk reception at HIMSS (probably some browser setting-specific Javascript error if I had to guess) so the folks at event sponsor Ingenix added e-mail and telephone options. Problems aside, something like 150 people registered in the first day. It’s RSVP only, so if you want to come, you might want to sign up before we hit the cutoff.

Vince Balsamo of Cisco e-mailed to say that someone either shares his name or used it in posting a recent comment. In any case, it wasn’t him.

I don’t know where expensive conferences are finding enough attendees willing to miss work and spend big money on education, but here are two: the X3 Summit on health design (notice the eye-rolling misspelling of Johns Hopkins as John’s Hopkins, which sounds like a Hopkins owned by a prostitute’s customer) and the HealthCare New Media Marketing Conference (warning: PDF). I know I’m a cynic, but here’s an idea: stay home and try to save your struggling non-profit employer instead of screwing around at conferences that cost thousands of dollars by the time you add in travel cost and missed work. I’m still puzzled that all these 2.0 and new media conferences still require you to travel to some remote site to physically sit in front of a speaker who’s pitching the benefits of online video and connecting with audiences via new media. That’s not exactly living the message.

Interesting: Pennsylvania’s state senate wants to copy an Altoona health clinic that treats patients whose incomes fall between Medicaid and private insurance. The mostly volunteer-staffed clinic treats 3,500 people a year for $207 each vs. the $4,470 it would take to insure them. The idea should appeal to everybody except insurance companies (which is why everybody else likes it) and hospitals, who would somehow have to be paid for rendering inpatient services. I would be surprised if it will scale, though, given the requirement of using volunteer doctors whose supply is finite.

Listening: Trion, symphonic progressive, on Prog.FM via my little Aluratek USB radio gadget. I know prog is pretentious, soulless, and overwrought, but I still like it.

Orthopedic surgeon and Time writer Scott Haig writes a piece critical of government-pushed EMRs. He says hospital-forced CPOE turned a lot of docs off and left them puzzled how to handle orders like "patient may wear her own flannel nightgown" and also made it less obvious how long it would take for a living, breathing nurse would find the order and act on it. "Before we had them on every countertop, computers held such promise for us in medicine: doctors and patients live in a world of painful, pressing questions, the answers might be in there. Or so we thought. Twenty nine years from the night I first sat in a hospital in front of a computer screen the questions persist. And I still don’t see the profit-maximizing, cost-controlling physician with his nationwide computer treating patients any better than the great physicians I’ve known have. With pen and paper, personal commitment to each patient and judgment born of practical experience. None of which I have found in a machine." I’d like his arguments better if they weren’t all about him.

MUSC chooses Horizon Enterprise Revenue Management from McKesson. CIO Frank Clark mentioned that deal when I interviewed him a year ago, so I’m not sure why it took that long to be announced.

Picis announces Picis InSight ED Charge Rules and Picis LYNX E/Point, two products that simplify ED documentation of infusions and injections. They say 15% of ED revenue comes from those items but is often lost because of deficient documentation.

API Healthcare has joined up as an HIStalk Platinum Sponsor. You may have noticed a new name for the #1 time and attendance vendor (seven years’ running) formerly known as api software, inc. (all lower case, so I like the name change since all upper or lower case names drive me nuts, ee cummings included). The name change was announced (warning: PDF) this week to emphasize that, unlike some of its competitors, it will tend to its healthcare customers instead of chasing new ones in other industries. New web site, too. The company was acquired by Francisco Partners in November and brought on J.P. Fingado as president and CEO. He and I have swapped e-mails a few times since about this and that, but it was still a pleasant surprise to have them sign on. I appreciate their support.

The Boston paper’s photo site shows two images (#3 and #12) of the da Vinci robotic surgery system. Reader Andy says, "While not in the typical bailiwick of your IT coverage, it is technology, and it is really cool." Agreed.

Baxa acquires ForHealth Technologies, the Daytona Beach, FL developer of the IntelliFill i.v. and IntelliFlow RX pharmacy robotics and software products.

eHealth Initative founder CEO Janet Marchibroda quits to become chief healthcare officer at IBM, thus neatly closing the loop: pushing hard for stimulus money from an independent non-profit, then cashing in with IBM once Big Blue got a whiff of the green chum in the HIT waters that resulted. I expect we’ll see more of this as companies (especially the big ones) try to beef up their lineups to improve their chances in the ARRA lottery.

A Medicity white paper says that CalRHIO’s Medicity-powered HIE project is "shovel ready", has a sustainable business model, and is ready for rapid expansion.

February’s HIStalk stats: 74,599 visits, 106,055 page views, 3,804 active e-mail subscribers. Not bad for a short month (both are records, in fact). We might hit the two million visit mark by HIMSS.

E-mail me.

HERtalk by Inga

From Nurse Chris: “Re: Who invented the hormone patch. Inga, my BFF … you know it had to have been a man who invented the testosterone patch. Heaven forbid they take any personal responsibility for our low libido 😉 It must be something wrong with us…” ‘Nuff said.

Google Health introduces a new sharing feature that allows users to invite others to view their health records. The “Share This Profile” enhancement works similar to Picasa or Shutterfly when a user sends you an e-mail link and password to view their photos. Also new from Google: the ability to print a wallet-size listing of your medications and allergies.

After losing $22.5 million in state funding since October, the College of Medicine at the Medical University of South Carolina plans to trim at least $3 million in expenses. Officials plan to consolidate programs and eliminate jobs.

The board of directors of Virtual Radiologic Corporation approves a $5 million re-purchase of common stock. Dr. Sean Casey, the company’s co-founder and chairman, also plans to sell up to 1 million shares to diversify his holdings.

Providence Alaska Medical Center implements Philips VISICU to connect off-site critical care specialists to ICU patients.

Patient Care Technology Systems announces successful implementations at three hospitals. Moses Taylor Hospital (PA), Providence St. Vincent Hospital (OR), and Stafford Hospital Center (VA) all have the Amelior EDTracker software in place.

Pediatric Associates (WA) selects Greenway Medical Technologies for its PrimeSuite EHR solution. The 70-physician group is the country’s largest pediatric practice.

An independent study concludes that Midland Memorial Hospital (TX) has reduced patient deaths, medical errors, and infection rates since implementing Medsphere’s OpenVista EHR.

Christiana Care Health System (DE) selects the financial decision support software suite of MedAssets.

Monroe Clinic (WI) becomes the first site to benefit from the integration of Epic’s Radiant RIS and the AMICAS PACS.

Catholic Healthcare West will test the EverOn patient monitoring technology from Israel-based EarlySense. The EverOn device is a wireless patient supervision system installed underneath the hospital bed mattress. EarlySense just raised $2 million in private placement from shareholders.

7Medical Systems announces it added 11 new contracts in the fourth quarter for 2008. 7Medical provides on-demand PACS, teleradiology, and EMR solutions.

Healthcare data exchange vendor Certify Data Systems hires Jeffrey Rideout, MD as its Chief Strategy Officer. Rideout previously served as chief medical officer at Health Evolution Partners, and as the global leader of the healthcare division at Cisco Systems Internet Business Solutions Group.

An anonymous donor provides an $880,000 grant to establish a Medication Management Research Network at the University at Buffalo’s New York State Center of Excellence in Bioinformatics and Life Sciences. The organization will use electronic medical record data to research how specific health care decisions impact patient outcomes and health care costs.

The 24-bed Eastern Plumas Health Care (CA) goes live on its $750,000 EHR system from Healthland. The local paper reports that it meets “HIPPA” security regulations.

A jury finds a veteran guilty of altering his medical records to collect more benefits. He apparently fixed up his records a bit so that his tonsillectomy and circumcision looked like a heart attack, thus earning him an extra $200,000 in benefits. He now faces 30 years in prison and a $1.5 million fine.

A 35-year longitudinal study finds that kids who had the most friends grew up to be the adults with the most wealth, indicating the same social skills used to build friendships also serve you well in the workplace. Typically our social worlds consist of an inner circle of five core people, an additional layer of 10, then another 135 or so. Based on my social success in junior high, I am stunned I never made the Fortune 500 list of wealthiest people.

E-mail Inga.