CIO Unplugged – 1/1/09

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

CIO reDefined: CIO 2.0 Chief Innovation Officer
By Ed Marx

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker “CIO” itself is not limited to “Chief Information Officer.” No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post continues a series on how the “CIO 2.0” will push the boundaries of conventional thinking surrounding the role. We continue with the “Chief Innovation Officer.”

Neglecting science credits finally caught up with me my senior year of high school. I’d hoped to coast through my last year and focus on non-academic pursuits. Instead, I was stuck taking Physics while friends took basket weaving, under water firefighting, and equivalents. Deep into the first semester, my grade sunk low enough to negate my eligibility for tennis and soccer. I became desperate. While negotiating with my teacher, he said if I came up with a unique physics project that would blow his socks off, he’d consider it extra credit worth one letter grade.

Partnered with a classmate in a similar predicament, I set out to demonstrate how human energy could be converted to electricity to power an appliance. For a couple of seventeen-year-olds with little experience and no formal instructions, this required some serious innovation. We found an old bike and welded it to a stand. We purchased a used car alternator, pirated a battery, and “borrowed” an appliance. With some help from my classmate’s dad, our prototype worked. We impressed our teacher enough to raise our grade and keep us in good standing with parents, coaches, and our future universities.

Innovation is not reserved for youth. On the contrary, it is the price of admission for the CIO 2.0. We must have the talent to innovate, or at the very least, the vision for innovation. If we are unable to innovate, we must gather others around us who have this core talent, and then give them the freedom required for success.

I previously described an innovation that came about via a Glorious Mashup. We codenamed the innovation “CareTube” and trusted it would revolutionize training, especially for time- and pride-sensitive clinicians. It would also enhance our already high CPOE adoption rates. More recently, we worked with Microsoft and Infusion to create a new model for enhanced physician and patient communication. At a Gartner conference, our model was voted the most innovative application of technology.

The above innovation is scheduled to be featured by the keynote speaker at the Consumer Electronics Show later this month in Vegas.

For IT to become strategic and make a difference, IT leaders must innovate constantly. Remain decidedly against the status quo. Always ask, “How can this be leveraged or improved?” “What new use can be created out of…?” “What if…?” Change scenery regularly. Play games like Cranium or build with Rokenbok, anything that stimulates you to piece the world together differently. Read insatiably then set aside time to think, giving absorbed knowledge time to sift and settle. Understand when is the right time for the right innovation.

Are you innovating? If yes, model for others and replicate yourself. If no, then begin to or find and release those who are.

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.”

Eclipsys To Acquire Premise for $38.5 Million

Eclipsys announced this morning that it will acquire patient flow systems vendor Premise of Farmington, CT for $38.5 million in cash. Closing is expected within 15 days.

News 12/31/08

From The PACS Designer: "Re: 2008. TPD is blown away by the success in 2008 for HIStalk! Never did I expect the famous healthcare luminaries that agreed to be interviewed! Wishing HIStalk and everyone else a better and more prosperous 2009. Happy New Year!" Thanks to TPD for his regular-as-clockwork, bite-sized educational postings. Keep in mind that he and I have never met or spoken – he posts just to help educate HIStalk’s readers. Thanks, TPD!

This will be a little short since I’m just getting back in after a short trip to KCMO. The barbeque at the couple of places I tried was good, even if the sauce they bury it in is jaw-clenchingly sweet and heavy, more like ice cream sundae topping than anything you should put on meat (like KC Masterpiece or what they put on barbeque down south at the Sonny’s chain – mostly corn syrup, molasses, and fake liquid smoke). Once you scrape that off, it’s pretty good. By state, I’d rank the barbeque as TX, NC, MO, GA, and TN (OK, AL, and AR should be in there somewhere, but my experience is limited).

Andy sent a link to a story about struggling hospitals, with the focal point being Shands AGH in Gainesville, FL, the town’s first community hospital that will be shut down in 2009 to save money, 12 years after it was bought by Shands Healthcare. The CEO of Shands blames bad debt and reduced Medicaid payments.

I found Greg Hall’s analysis of the crippling effect of institutional debt in healthcare fascinating, the idea that industries that created phantom wealth in the form of leveraged debt and tax advantages. "Examine the notion of ‘capacity utilization.’ Without debt, excess capacity is not viewed as a problem. Consider the local fire department. Paid staff resides at stations 100% of the time, regardless of emergency conditions. 100% state of readiness. Imagine if the fire station had to pay a mortgage: it would then be forced to convert its unused (excess) capacity to a cost, and in turn focus on raising revenues to support its excess capacity. This is exactly the case with hospitals (and many other large U.S. businesses)." It’s dead-on for hospitals. Every one I’ve worked for, including those that showed a huge ‘surplus’ (non-profitese for ‘profit’) still could not finance even predictable costs through operational profits; they were always going to the bond market. And, I’ll throw in my psychological theory that supports Greg’s concept: the hotshot MBA CEOs who now run many/most hospitals instead of the previous crop of MHA-trained ‘administrators’ aren’t satisfied with just keeping a hospital running efficiently and serving the community; they have to show their for-profit counterparts that they’re business sharpies, so the preferred outlet is community dominance and building massive Taj Mahospitals. That’s the coin of the realm when it comes to community hospitals: beating your competition and erecting awe-inspiring buildings that generate obvious community pride, but with highly questionable community value. One might postulate that much of today’s economic ills were caused by B-school grads, many of them who found their way into healthcare as their widget of choice, who were taught that growth is everything when it comes to businesses, stocks, and assets. Just making a nice profit is not sexy enough. As a result, the churn of leverage and acquisitions and vertical integration caused a mess that will not be easy to get out of, even with those $1 million and up hospital CEO salaries. Hospitals, unfortunately, were just as greedy, just less honest about it in claiming it was all for their communities, large chunks of which already couldn’t afford their services.

A reader sent over a BlueCross BlueShield of North Carolina memo that asks doctors to support elimination of "highly problematic privacy provisions" that it claims could be included in the economic stimulus package. I mentioned the Confidentiality Coalition’s similar demands last week (BCBS Association is a member of that group and that’s mentioned in the memo). Some items they don’t like: requiring patient authorization for disclosing PHI for treatment or payment purposes; requiring EMR users to keep records of non-verbal PHI disclosures; and allowing individuals to opt out of interoperability projects like HIEs and RHIOs (!!). That’s about as arrogant as the sham that BCBS is "non-profit" while sucking in huge chunks of healthcare expense for administrative functions that seem to more often hinder it rather than help it. All I know is that BCBS makes a ton of money (nearly $200 million profit in one year not too long ago in NC alone), pays its executives ridiculously handsomely, and occupies buildings that are decidedly non-Spartan.

Hollywood will surely make a movie about this: Cigna refuses to pay for a liver transplant for a 17-year-old leukemia patient, saying the procedure is experimental, even after the patient’s doctors report a six-month survival rate of 65%. Nurses and local citizens picket the insurance company, after which Cigna grudgingly agrees to pay for the procedure "out of its own pocket." Hours after Cigna relents, the patient dies before the transplant can be done. The family is suing. This is where our American cultural view of death kicks in: from what I’ve read, other countries accept death when it’s inevitable, while here, no expense is too great to prolong life even for a short time. A liver transplant costs several hundred thousand dollars and uses a donor liver that someone else won’t get. I don’t know the case, but to an objective (i.e. non-family) observer, would that patient have been the best use of the limited resource of dollars and livers? It would be nice not to have to make that choice, but insurance requires balancing unlimited demand with limited resources, with the result of doing that poorly what we have today — huge costs for heroic but ultimately often unsuccessful interventions, especially in the elderly in the last few weeks of life.

North Mississippi Medical Center will replace its EMR system at a cost of $28 million, approved this month by the state.

The New York Times covers the city’s subsidized rollout of eClinical Works and its pay-for-performance project. "As for Dr. Benovitz, he said that if the city had not recruited him, he would still be using paper charts, which had a comforting tangibility, a record of life that could be held in his hand and paged through like a book. But he was happy to invest the roughly $40,000 over three years to implement the project in exchange for the city’s expert advice, though it has temporarily slowed him down, with two patients filling the time in which he used to see three." Unless somebody convinces medical schools to drop their income-protecting student enrollment quotas, let’s hope the 33% reduction in capacity really is temporary since the EMR won’t do much for patients who can’t get an appointment.

I might be the only person left who remembers the Atlanta-based technology company Healthdyne. The company’s founder, Pete Petit, is named board chair of Georgia State University, where he earned his MBA. 

An interesting test case may set a precedent for the practice of telemedicine. A doctor prescribes generic Prozac for a 19-year-old without examining him after the Stanford student requested the drug via an Indian Web site (now gone, but I found an image in an archive above), which forwarded the request to the doctor as its contractor. The student killed himself. The doctor will go on trial for practicing medicine in California without a license, but the prosecution has to prove that the student was in California when he requested the drug and that it’s illegal for an out-of-state doctor to write and fill prescriptions across state lines. With all the talk about how to streamline and nationalize healthcare (not what it’s being called, but what it is), you would think that someone would suggest removing all the state-specific regulations relating to privacy, patient care, prescriptions, state billing, etc. and replace them with a national standard. Nobody talks about the inefficiency they create and the questionable benefits they provide.

OK, I’m beginning to think everyone involved in the would-be Emageon-HSS deal is nuts. The fighting lovers are embracing again, with HSS saying the consummation will happen in February 11, financed by Stanford International Bank after all. Why did Stanford bail out last week, then? According to the CEO of HSS, "This extension will also allow us additional time to complete our integration plan for our technologies." Maybe I’m clueless, but I don’t see that the integration plan has anything to do with the legally binding agreement HSS made to do the acquisition by an already-passed date. Plan whenever you want, but when you sign to do a deal with a given set of terms, the negotiation is over. Blaming the bank seems ridiculous since it has the same parent company as HSS. At least Emageon will supposedly get $9 million of HSS’s escrowed money if the deal falls through again. Is this saga really going to give prospects a good feeling?

Have a good New Year’s. Fun stuff coming! (HISsies, HIMSS stuff, and so on). Thanks for reading.

E-mail me.

Monday Morning Update 12/29/08

From Blueware: "Re: promotion. Jyran Glucky was promoted from Lead Architect to Vice President of Application Development at BlueWare." I have to admit that I’ve never heard of the company and had to Google them. From its overly busy site, it’s hard to figure out exactly what they offer, but it has something to do with EMRs. And despite a press release about this promotion, there’s not a list of management anywhere I could find in the jumble, so I don’t know who else is involved.

From IntelliDOT: "Re: layoff. IntelliDOT in San Diego laid off 12 percent of its employees due to slow sales." Unverified. We’ll check it out.

Listening: Rachelle Ramm, a hard-rocking California beauty. Which reminded me of my old favorite, Swedish all-girl metal band Drain STH.

The New York Times writes up the Marshfield Clinic’s technology. A good quote from AHRQ’s Carolyn Clancy, who says the clinic "understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet." That’s the positive, but the negative is this answer about the $50 million per year (!!) the clinic spends on systems: "People ask about return on investment, but that’s the wrong question. This requires the usual leap of faith that knowledge will yield good things — better care, doing things smarter and, yes, saving money in the long run." That’s a pretty big leap. Excellent article.

The Emageon saga continues, dragging the company’s name further in the mud. Would-be acquirer Health Systems Solutions, Inc. says its major shareholder, Antigua-based Stanford International Bank Ltd., won’t provide the funds for the acquisition to go through. Emageon CEO Charles Jett seems to be the outraged spokesperson, but he’s not a major player given that he was ousted from the board last summer after an ugly proxy fight with Oliver Press Partners. Now it could be that Stanford is just playing with the stock behind the scenes, safely tucked away in Antigua outside US jurisdiction, but it makes more sense that they’ve found something they don’t like about Emageon and their carefully created legal structure gives them an out that they’ve chosen to exercise. Or, that billionaire owner Allen Stanford and Oliver Press don’t get along, like Gordon Gekko and Sir Larry Wildman in Wall Street (Stanford really is a Sir, the first person knighted by Antigua, where he holds dual citizenship along with the USA).

Jobs: Cerner Millennium Senior Analyst (Healthcare Performance Group), Director of Clinical Information Systems (Snelling Executive Search), Director of Nursing Informatics (Johns Hopkins Medicine), PharmD (Parker Healthcare IT), CareVue Technical Specialist/Clinical Engineer (Cedars-Sinai Medical Center), C-Level Sales Executive (Company Confidential). Drop your e-mail address here and get a weekly jobs list.

West Virginia University Hospitals gets certificate of need approval from the state to spend $18 million on new hardware and a data center for its $90 million Epic project, although they’re short on capital and will delay the data center construction.

Odd: Mississippi lawmakers are considering increasing cigarette taxes to help support struggling hospitals, saying, ‘We have been leaving untold millions of dollars on the table." That’s what happens when politicians start seeing your money as theirs, although there’s no doubt smokers will cost the state a lot more than that.

The number of hospitals laying off in 2008 has already beaten the 2003 record, although the number of laid off employees is relatively modest at 9,700 who have filed for unemployment because of mass layoffs.

Kryptiq is awarded a patient on encryption of healthcare information in a way that prevents the servers it sits on from decrypting the data. Hopefully they’ll use it in products rather than as the subject line in nasty infringement lawyer letters.

Two employees of Samaritan North Health Center (OH) are indicted for identify theft and money laundering for getting names of the recently deceased from the newspaper obituaries, looking up their information in the hospital’s computer system, then taking out loans in their names.

The Bahrain Medical Journal will start publishing online with free access, even allowing readers to do whatever they want with the articles as long as they cite them properly. Leading the conversion to an open access journal was senior editor Dr. Mohammad Al-Ubaydli, author of the book Free Software for Busy People and author of an editorial (warning: PDF) in the current issue urging Bahrain to adopt open source instead of proprietary EMR systems.

UK patients, worried about NHS’s plan to store patient information in a national database, are choosing to instead carry their information on a smart card that doctors update via USB port after each visit. The card’s distributor pays doctors to download patient data, mention of which elicited this reader comment: "An other way for doctors to make a quick buck!! They are already been paid twice. Once by the taxpayer and the other by the drug companies. Its about time we patients had access to our own medical data."

The first 10 episodes of Children’s Hospital (inexplicably spelled Childrens’ Hospital) are now up on the WB, semi-entertaining in an Airplane kind of way. "A hospital is a place for smart people to take care of people who aren’t smart enough to keep themselves healthy."

Resident: You’re the attending physician and I need to get your permission. I need to cut this kid open.
Attending: Why? She’s got a broken arm.
Resident: Says who?
Attending: The X-ray.
Resident: Please. I don’t trust those – they’re not even in color.

Speaking of online series, Lisa Kudrow stars as an Internet-based psychologist who does three-minute Webcam sessions on the largely improvised Web Therapy.

Red Hat’s Q3 numbers: revenue up 22%, EPS $0.12 vs. $0.10.

E-mail me.

News 12/24/08

From Tom Tubow: "Re: blogs. I was thinking about why I read HIStalk instead of the other blogs and I realized: theirs feel like work, yours feels like fun." Thanks for noticing, but it’s by necessity. I have a short attention span, so you won’t get many long, weighty theoretical essays from the standard roster of self-anointed, frowning experts here. I’m more Howard Stern than William F. Buckley. If you leave here both informed and entertained after just a few minutes, Inga and I have done our jobs.

From Long-Time Reader: "Re: article. Here’s one from the Denver paper on local EMR integration." Link. It’s about the Colorado RHIO.

From Josh: "Re: McKinsey report. Puts 2/3 of what it believes is $650 billion excess cost on the backs of ‘specialty outpatient care’ providers, noting that ‘current outpatient reimbursement methods reward providers for delivering more care, or care that is higher intensity.’" Link. The conclusion is so obvious that it’s often missed: professionals will perform whatever services they can get paid for. If you’re paying for diagnostic imaging, expect a lot of diagnostic imaging to be done. Don’t expect providers to cut their own income just because it might be beneficial to a particular insurance company or society in general ("first do no harm, but second, make sure to bill what’s paying well this month.")

From The PACS Designer: "Re: file sharing. Another cool online application TPD recently found is drop.io, which gives online file-sharing possibilities to those who work in teams to accomplish tasks and goals." Link.  I was annoyed that the only "how to" help is by video, which I generally refuse to watch online unless it’s something stupid on YouTube, but theirs is by DemoGirl, of whom I’ve been a fan for years. The service looks cool … you can password protect files, e-mail them in, and share them selectively. Not the cheapest, starting at $20 a month, but pretty slick.

From He Hate Me: "Re: Microsoft. I hear they’re putting a presentation together for Daschle’s team. Maybe Amalga HIS isn’t as far away as people are saying." I hope Daschle’s smart enough to recognize that Microsoft’s healthcare toe-dipping hardly makes the company an expert (its Azyxxi acquisition and Visio add-ins aside). Lots of folks, including those who have actually worked in healthcare as something other than a recent growth target, could give him the unbiased scoop if that’s what he wants.

From kb: "Re: Epic. You’ll be happy to know Epic will be contesting another frivolous lawsuit from Acacia. Doesn’t sound like Epic was the only one named in the lawsuit either." I assume that was the one by Document Generation Corp. that I mentioned last week. I said then I was surprised that Acacia, if it’s really behind the suit, would want to tangle with Epic again. I was reading something the other day about how many corporate infringement lawsuits are filed by shell companies with zero to five employees and a no assets other than a patent, using the high cost of mounting an infringement defense as leverage to extort money from big companies. No wonder other countries are eating us alive in everything from manufacturing to science — we’re too busy suing each other to actually produce anything.

From Darth Tater: "Re: HIMSS. The HIMSS staffers must be deluding themselves – probably being from Chicago, they think they have some special ‘in’ with the administration. They need to learn what happens once people move inside the beltway. More to the point, HIMSS is hardly the only source of information. John Halamka mentioned during a HITSP meeting last week that he was testifying earlier in the week. I am aware of other projects where they are personally working with specific Senators – more directly than ‘staffers.’ And anyone that thinks IEEE, RSNA, AMA, etc. etc. aren’t in front of people also doesn’t know what they are talking about." I give credit to the incoming administration – they’ve got people believing that their vote and participation count, so thank goodness for that. The reality is, though, that not everybody will leave with a lollipop. Not everyone will be happy with the direction. Not all groups have the influence they think they do. Politicians are good at saying "maybe" when they really mean "no way." And despite the good work that a lot of people do in healthcare IT, HIMSS is, using its own words, a trade association of vendors, and those don’t typically carry a lot of weight. That’s where being vendor-heavy probably curtails their influence.

UPMC Presbyterian reaches Stage 6 of the HIMSS Analytics EMR adoption model, joining 23 others.

What do lobstermen, victims of ice storms, and potential users of electronic medical records have in common? Maine’s finance authority agrees to extend financial help to all three.

Motion Computing, maker of the C5 Mobile Clinical Assistant, gets $6 million in new funding. The press release says the C5 has been deployed to over 4,000 healthcare organizations, which is a lot more than I would have guessed. They must be selling lots of them in other countries since I’m pretty sure their hospital penetration is nowhere near 50% here and even that would only be 3,000.

Listening: Skarlet Blue, hard-rocking Aussies. Video here. Catchy and nicely done.

I had the HIStalk server upgraded again today, as I nearly forgot to mention. There were times, especially on weekday mornings between 9 and 11 Eastern, when you may have received a "page not found" error because the user load was redlining the Apache service, which means … well, that too many people beat you to HIStalk before the memory ran out. It’s hard to believe I could once get away with a little $4 a month shared Web hosting hosting account. Anyway, hopefully it will work better now.

EnovateIT partners with Metrologic to provide 800 bedside medication barcode scanners for Novant Health (NC).

AC/DC singer and local resident Brian Johnson dedicates a music room in his name at Sarasota Memorial Hospital (FL), paid for by the foundation of former Who bass player John Entwistle, who died of a cocaine-induced heart attack in 2002.

Deborah Peel’s Patient Privacy Rights is upset by a letter (warning: PDF) from Confidentiality Coalition to Congress. What it says (despite that group’s name): healthcare IT is so important to healthcare and the economy that principles like accounting of disclosures, consent for TPO, and "unnecessary" notification of a privacy breach should be scratched from any HIT plan the government undertakes. Don’t let patient privacy stand in the way of progress, in other words, kind of an eminent domain on PHI. The group behind it appears to be Healthcare Leadership Council, a self-described "business league" that spent $1.6 million on lobbying last year. Some of the members are predictable (drug and medical device companies, GPOs, and the Big Three drug distributors) but I don’t understand why a few non-profit hospitals have signed up (and Vanderbilt’s School of Nursing). Their main pitch seems to be that US healthcare is a great value because of all the "unparalleled improvements in the field" brought to you at high cost by the folks who would rather not have their gravy train derailed.

Forbes uses athenahealth’s payor ratings to determine The Worst Places to Be Sick and Poor. The bottom five states: Virginia, Florida, Georgia, Texas, and … drum roll … New York, which takes nearly 140 days to pay Medicaid claims despite billions spent on software. You know it’s going to get worse as states, especially those addicted to growth, find their coffers empty and, unlike Uncle Sam, they can’t just print more money.

RelayHealth wins a consumer engagement award for its connectivity offerings for consumers and providers, specifically its Results Distribution Service.

University Hospital in Dubai signs up with Epic. Judy is actually quoted. Come to think of it, that’s an opinion I’d like to hear: does Judy think the government should subsidize EMRs since she’s selling all she can without its help?

The Philadelphia paper debates the cost and benefit of electronic medical records, talking to Doylestown Hospital and Abington Memorial. It also invites the public to attend one of those local discussion groups that HIMSS is arranging to generate policy recommendations for the Obama administration. I would expect the lay people to suddenly be heavily in favor of healthcare IT investments they were unaware of previously since HIMSS is facilitating, but I’ll defer to anyone who was actually there.

A Kansas urologist develops cell phone software that protects highly unskilled and overconfident teen drivers from killing themselves and the rest of while yapping and texting while driving. It blocks the phone while the key is in the ignition. Ingenious.

A former Cedars-Sinai billing employee is charged with setting up a fake laboratory company and submitting patient bills that insurers paid via a post office box, using the identities of over 1,000 patients.

The British Medical Association fights a government plan to open up patient databases to researchers, including those from private companies. They say companies could harvest (or "hoover," as they say) patient names in order to market to them.

University of Wisconsin-Madison will put up signs warning patients that their doctors might be taking drug company money for research or consulting (without doing anything about it – kind of like those "unauthorized solicitors" signs in airports that let you know Moonies are around, but still leaving you on your own to deal with them. The medical school dean wants doctors to report the money they receive, with one example cited being an orthopedic surgeon who checked off the maximum amount — over $20,000 year — which in his case was actually $400,000 a year for eight days of work. Of course, patients still have to decide what to do even if they know Doc is pocketing drug company money, so it probably won’t amount to much.

Paul, an HIStalk reader in the UK, sent this message: "My current organisation is a New Zealand based Systems Integration Company, called Simpl, and they have been commissioned by 10 of the leading District Health Boards in NZ to procure a system which could potentially be a national standard across New Zealand. We would very much like to publicise the fact this procurement is underway and invite interest from any USA software providers that believes they have a solution that could fit. I suggested HIStalk may be a great way to alert the USA market to this potential. Up to 10 New Zealand District Health Boards are seeking to procure technology that will support the transformation of healthcare delivery by providing an individual-centric health management system that is health provider agnostic. Therefore the solution must address not only their hospital PAS requirements, but also enable seamless access to an individual’s health information by registered health practitioners / qualified health professionals wherever they work (hospitals, the community and primary care, rest homes etc) and even by the patients themselves. This procurement is being managed by Simpl, a New Zealand based Systems Integration company that specialises in Healthcare." The tender system is here and the reference number is 24585. I have the RFI, but I think you can get it there, or contact Paul.

The Nashville business paper reports that business is great at Brentwood-based 24-employee credentialing software vendor Sy.Med Development, on track for $3.2 million in sales this year. The piece has some interesting business pearls from the CEO, such as "You can change industries rather easily and hard work, belief and passion can make up for lack of knowledge."

A former Wachovia VP in the Miami area gets three years in jail for helping an accomplice with a $48 million Medicare fraud and money-laundering operation.

UnitedHealth Group launches its free public Web portal, myOptumHealth.com, run by its health and wellness subsidiary. The site run ads for United’s insurance products and will also sell advertising space (there’s already a Cymbalta ad running on the front page, I see). You can fill out a PHR online.

Oracle claims its DB Machine is the most successful launch in company history.

Emageon says its would-be acquirer, Health Systems Solutions, Inc., is taking too long to close the deal. Emageon says HSS is giving it the runaround by continuing to make due diligence requests despite a signed merger agreement, avoiding setting a closing date, and claiming Emageon misrepresentation. Emageon stock tanked on the news Monday, down $0.92 to $1.30. HSS is smaller than Emageon, so you never know if they’ve run into financing problems since that’s about the only valid excuse unless they’ve really found a skeleton in Emageon’s closet.

Enjoy your holiday(s), whatever they might be. I’ll be around if you want to e-mail me.

 

Twas the Night Before Christmas
By Inga

‘Twas the night before Christmas, when all through IT
Not a creature was stirring – not a single PC.
The charges were updated by users with care,
In hopes that more money would make its way there.

The doctors were finished, all smug in their heads,
While nurses were checking on every last bed.
And the CIO in his office, and I in my cube
Had cleaned up our e-mails (and watching YouTube).

When out from MS-Windows there ‘rose an odd chatter,
I switched off Minesweeper to check on the matter.
Away to the Internet I flew in a flash,
Launched open HIStalk and hoped nothing would crash.

The tune on Pandora was silenced at once
My laptop moved slowly – it seemed to take months.
When, what to my wondering eyes should appear
But a miniature Mr. H and Inga, that dear.

With my VGA driver, so lively and quick
I knew in a moment it must not be a trick.
More rapid than eagles, his rumors they came,
And he whistled, and grumbled, and called them by name.

“Now Neal! Now Vern! Now Hammergren and Judy!
Now Glen! Now JB! Now Pappalardo and Andy!
To the top of Web page! To the top of the crawl!
I know all your secrets! Yes I do know them all!”

With news and some gossip, those wild rumors fly
The leaders read closely, hoping they’ll not win The Pie.
So onto HIStalk the top dogs would click
To read Mr. H and his Inga, with all of their shtick.

And then, in a twinkling, I heard a new sound
My disk drive was churning and chugging around!
As I drew down my head to refresh the screen
Out popped Mr. H – an amazing sight to be seen!

He was dressed in polyester, from his head to his foot,
He had quite the old-fashioned programmer look.
A bundle of gadgets he had flung on his back,
As well as the Blackberry, still new from the pack.

His eyes – how they twinkled! His dimples how merry!
He looked ready to scribe a new fun commentary!
His droll little humor was clear from the start
This was man who made blogging an art!

The stump of a pipe he held tight in his teeth
And a light was encircled on his head like a wreath.
He had a kind face and pooch at his belly
So this was who turned vendors’ knees into jelly?

He was quiet and quick – the picture of stealth
As he checked out the tech things in our office of health.
A wink of his eye and a twist of his head
He noted our software and computers by beds.

He spoke not a thing as he took a keyboard,
I recalled how his words were stronger than swords.
Then touching his finger upon the word “send”
Today’s posting had clearly come to an end.

He sprang to my laptop and gave a short whistle
Then into cyberspace he went – as fast as a missile.
But I heard him exclaim as he slipped out of sight
“Happy Christmas to all, and to all a good-night!”

E-mail Inga.

HIStalk Interviews Jonathan Bush, CEO, President and Chair of athenahealth

You’ve been in front of the media a lot lately. Cynics might say that you’re looking for a piece of the action of what Obama wants to spend on healthcare IT or trying to keep your competitors from getting it. What’s the real story?

The truth of the matter is, I don’t want anyone to get the shiny brass toy. Shiny brass toys are bad. The reason for the sudden burst of exposure is less about trying to get our share of the shiny brass toy fund than it is to try to stop the shiny brass toy fund.

The Bush Administration started with PQRI and pay-for-performance. The Obama Administration, in our opinion, should actually take the $50 billion and put it into pulling more quality data out the other end of the sausage maker, rather than mucking up the gears of the sausage maker by giving out specific EMRs.

I don’t want the Obama investment in healthcare to end up looking like the Congressional investment in General Motors, which is to say I don’t want really, really bad, dead things that ought to die sooner to be kept alive longer by a well-meaning federal government. I want software companies to die as quickly as is humane.

If the federal government gets in there and starts handing out free subsidies, then the providers of the world have to say, “Well, gee, I know it sucks, but if it’s free, does it suck that much, or maybe I should give it one more swing?” That’s what scares me to death. That’s why the interview with Wall Street Journal and with Fox and anybody else who will talk to me, including you. To make sure the Obama folks hear us saying, “Please don’t kill the emerging technologies by subsidizing the established and dying technologies in order to have something to do.”

Is the track record of doctors and hospitals who have already implemented the available technology good enough that we should be subsidizing more of the same?

The hyperbole is almost ringing as you ask. You’re the ultimate insider and I know that you know that the answer is no.

The folks who have installed this stuff are experiencing negative ROI. That’s why the RAND Institute came out with the study that showed that it’s 19% slower to have an EMR. There’s no pay-for-performance revenue to cover that 19% slowness. None of the supply chain is connected to EMRs, so all the laboratories and specialists and X-ray machines and PET scanners and mammogram machines aren’t connected to EMRs. There’s an incremental administrative cost in keeping the EMR current by typing results into the chart from these other sources of medical information.

Everybody knows in their heart of hearts that without a massive increase in pay-for-performance … it’s not really even performance at this point, it’s really pay-for-data … without a massive increase in pay-for-data in hopes that will prime the pump and we’ll figure out how the data maps to performance later. I’m sitting here looking at a row of plastic white yachts in Boca Raton and I’m thinking, “What is the definition of a yacht? A hole in the water into which one pours money.” I think of EMRs a lot like that … data yachts.

You mentioned the RAND study, which Cerner paid for at least part of. It seems they’re getting their money’s worth since Obama’s people are citing that big cost savings number like it’s gospel.

Wouldn’t it be tragic if the guys who went out early to buy this stuff got screwed? And the guys who follow along to buy the negative ROI stuff get a neutral ROI because the "I" is zero because the federal government showed up?

I don’t believe that the federal government should be involved in shiny brass object purchases. It’s like the difference between management and governance on boards of directors. The goal of the board of directors, or of the government, is to set the rules of the road for the CEO. In life and society, the goal of government is to set the rules of the road for companies. If the government intervenes and actually becomes a participant, there’s all kinds of adverse skewing that’s going to go on.

Certainly this is a world class case in point. If we end up with a Marshall Plan for EMRs, we will subsidize the approach to this that has not worked, that is certainly, among the readers of your site, clearly known to be a failed approach. We’ll keep those established players, those dominant buffoon gigundo companies, alive a little bit longer. It really feels like subsidizing General Motors. Who else would help save America from having access to cars that nobody wants?

I really feel that way about these big EMR, clinical, software-only business model companies. Nobody wants them. They’re being told that they should have them, but in their hearts, if you look at their Id, they don’t want them.

What’s nice about athena, and many other companies that are emerging, there’s a turn of companies that have actually triggered the Id. It’s good for society, and by the way, deep inside, I want it anyway. That’s what you want. That’s what the market does – it defines those things.

Should the government be in the business of pushing a specific, prescriptive technology rather than just saying, “Here are the quality and cost standards. You find the tools and methods that allow you meet them”?

You just said it. The fact that your question is phrased like the answer speaks of the irony of the mode we’re in. These are some of the most brilliant, well-meaning folks I’ve seen in the federal government in a long time. If they show up and put a fork in a lot of great innovation, it would be tragic. 

I don’t think they will, honestly. I don’t think that the folks that I’ve spoken to, who are close to Obama and close to Daschle, are going to go with a Marshall Plan, “Please buy expensive shiny brass objects so the economy will be bigger.” I haven’t heard that from the folks in healthcare.

It could go either way, so we’re still very nervous and trying to get people to hear us even though we’re so tiny.

People say healthcare is behind all these other industries, especially the financial industry, which was probably the heaviest technology-using sector before it fell. Is healthcare fundamentally sound enough that now’s the time to automate what it is today?

There’s another question, which is, "What’s the right business model when you do load up on automation?" Never mind the status of the technology. What about the business model that drives the innovation of the technology?

In the financial services space, for example, in banking, nobody buys software to manage their checking account. They go to a bank and the bank provides software as part of the whole bank account experience. It’s a service. The fact that they’re increasingly enabled by software is a pleasant side effect and not the point of the business. Similarly, the Depository Trust Corporation, which settles trades for equities … they don’t sell the software. They provide it for free to all the different traders and entities that settle stock transactions. There’s huge software there, but they don’t sell you the software and say, “Good luck coordinating with everybody else.” They provide you coordination and you use software to make it easier for them to provide you with that coordination.

You mentioned the financial services sector. Very few players in the financial services sector are buying software. Most of the consumers in financial services, all of us that experience financial services software, aren’t buying the software and setting it up. Someone else is doing that and we’re using it and paying for it with our use. That’s what healthcare needs to get to. Athena’s there, but the rest of the world isn’t, and the world will get there.

I don’t even care if athena doesn’t make it. I really don’t. I really care that the model gets to a place that’s scalable, that can map to results. I honestly think we will be part of it and so it’s easy to say such things, but I really think that, most important is that we get out of this very Soviet idea of everybody has to do things according to our national standard and all of the software products will do at least sitting with our national standards.

Let go of all of that and say instead, "What results get you the most money? OK, I will deliver those results and will be morphing myself left and right to get there."

What did you think of the HIMSS recommendations to the Obama administration?

I didn’t read them yet. I just got an e-mail from HIMSS and all it said was, “It’s not February, it’s April, be sure to be there,” so I don’t know what they are. Tell me what they are.

$25 billion for certified, interoperable EHRs to bring everybody to Stage 4 of the HIMSS Analytics model …

Crap is my answer. Crap. I want to go back to the … wasn’t it John Glaser who had the three tracks? Track 1 is a little bit of money for anybody who buys an EMR. Track 2 is more money for people who can provide data. Track 3 is a ton of money for people who can provide clinical results. It made me say, "Aha, they are getting out of the muck of which tools and toys people use and saying, you guys figure it out, this is what we’re going to pay for." That made a lot of sense to me.

The idea that HIMSS is saying, “Oh, we need you to help us get tools and toys” betrays the boat show nature of the HIMSS community. “Hey, we need these big, shiny boats and we need these engines and I really gotta have this really important radar array.” No you don’t – you just have to get to the dock on time. Stop thinking of it terms of the toys and tricks and tools that you need. They’re thinking about it in terms of the inputs rather than the outputs. When I hear people talk about toys rather than results, my cynical genes act up.

The government talks about quality and software as the answer, but much of the complexity and R&D for software has to go into meeting the government’s own arcane reimbursement requirements. Is there an irony that the government wants patient care systems, but by its own financial practices, ensures that few development dollars will be left to build them?

No question. That’s the ultimate irony. But, of course, the irony within the irony is if it were really good software, they’d figure out how to handle that documentation in the background so the doctor could get back to care.

I’m reminded, amazingly, of athenaClinicals, where the documentation experience has nothing to do with the codes. We handle the codes. The doctor does what they do and if the doctor’s documentation experience doesn’t map passively-aggressively through modules of clicky-click to the right level encounter, we say, “By the way, you’re at a Level 3, did you feel this was a Level 4?” and the doctor might say, “Yes, I did feel like it was a Level 4.” And then the system will say, “Does that mean you did these other things that you didn’t click on?” and the doctor could say, “Yes, I did.”

That’s much less regulatory risk than the doctor is exposed to with a paper chart that no one can read. In fact, if the doctor is clicking on object-oriented data exclusively for the purpose of hiding from the OIG, that’s a crime. That’s a national waste of clinical resources. It’s athena’s job, and only athena’s job, which annoys me, to get that out of the way. We will handle the paperwork for the OIG and Medicare and Medicaid and we will make sure you are in the straight and narrow, that nothing in spirit or in documentation is inappropriate. We will keep you from doing something inappropriate. Among the inappropriate things we’ll keep you from doing is wasting your time away from patients being passive-aggressive with the federal government when you could be treating patients.

We have actually taken out malpractice insurance because we want to be in the same spot as the doctor.

You must feel pretty good about the Best in KLAS announcements.

I love KLAS when we’re at the top and I have questions about their methodology when we’re not (laughs). I get skittish when someone asks me to endorse KLAS when we’re at the top because I know that someday we won’t be and it won’t be for the right reasons. In the mean time, yes, I couldn’t be happier.

The majority of your implementations involve getting doctors paid. How would you explain that to someone who thinks the effort should be directly on patient care?

If I were more mature, I’d say, “Tell me more about this impacting patient care directly. Show me the regression analysis between your vision of what that means and healthcare quality.” Then I’d let them dangle because they don’t know. Documentation of standards for evaluation and management levels is driving much more of the quest for clinical quality than people admit. If I were really sophisticated, I’d be able to let somebody see that for themselves and have a major change of heart.

To me, where we actually are, as opposed to where EMRs tell us to be, and where various keynote speakers with all these things about access to care and total cost and total quality tell us to be … where we actually are, the practical, tactical details of where we are right now, is we don’t know what we ordered and we don’t know what happened to what we ordered. If we can answer those two questions, where every doctor in America knows exactly what they ordered and they know exactly what happened to those orders, the impact on real, genuine Institutes of Medicine-level clinical quality is tremendous. Tremendous. But that’s not even in the discussion right now.

At athenahealth, I’ve got 549 providers who are on athenaClinicals. For those providers, I know exactly what they ordered and I know exactly what of those orders never happened, never turned into a result. The number are devastating. It’s like over 50% of what a doctor orders never turns into a result for that doctor. Who cares that stuff the OIG wants to see if 50% of what a doctor ordered evaporates right after he orders it? That’s much more significant financially and clinically. No one talks about that because standalone EMR software can’t answer that question.

Revenue cycle management is suddenly the hottest thing in the industry, which is good for athena but also brings in new competition. Is that good or bad?

Obviously it would be great if there was no such thing as a free market and nobody decided to go build a competing solution to athenaClinicals and Collector, but that would keep us from running as hard as we are. I have the emotional maturity to acknowledge the benefit of the fact that there will be other competitors someday.

My sense is that the people at American Express are able to struggle through acceptance of the fact that there is also Discover, Mastercard, and Visa. I’m OK with the idea that there will be other revenue cycle management networks in the country someday. I’m ecstatic that they’re not out there today, but I’m accepting of the fact that it’s OK for the world that they be there someday.

I don’t want to be so arrogant as to say, “I want competitors.” To hell with that. I don’t. I wish everyone would suddenly get amnesia about how well we’re doing and not come in here. I accept that it’s good for the world that they won’t get amnesia and they will come in and they’ll push our price down and push our quality standards up. That’s OK.

Athena stock took a dip in the fall, but has rocketed back like there was no economic crisis. What’s different about athena that has let it avoid taking a price hit?

I don’t know. We did have an investor day and the timing of the recovery, back in the 30s of our stock, mapped very closely to that investor day. I’m assuming that by getting athena … we’re a very small company, relatively speaking, amongst public companies with a very small number of shares, again relatively speaking … so bringing 80 key investors in for the day and seeing who we really are and what the DNA of athenahealth is and what it promises, those 80 people could get hungry and really treat our stock with respect.

If we were bigger, it would be harder to get the whole wide world to treat our stock with the respect that it deserves, but luckily we’re small, so the elite of the investment community have said, of course, long term, Obama not Obama, Daschle not Daschle, in the end, regardless of the short signals, athena is a way to a good future and that’s got to pay off. I was ecstatic about the result and it really was a function of the 80 people who showed up at the door.

What will you do with the messaging company you bought?

We build another product that looks like Clinicals and Collector, which is to say we build an integrated, percentage-of-revenue priced, fiduciary principled, patient-compliant service. We’re not there yet. Meanwhile, we’re selling 17 cents a reminder calls. When we get it right, it’s going to be a full-on … for a small percentage of your revenue, we’ll answer 100% of your phone calls and treat every single patient you have like a Russian prince.

Is that a change in practice where you will actually take on some of the patient-facing work for doctors as a service provider?

I don’t see it as so much a change in practice. Our job is to be the best in the world at getting doctors paid. Athena’s mission statement is to be the most trusted business service for medical groups in the United States. If you want to do that, when you do research on what doctors want and what they trust, it’s people who get them paid for doing the right thing. They hate people who get them paid for doing something that they later regret they did and they hate people who don’t get them paid.

Our hedgehog, to use a business school term, is to be the best in the world at getting clinicians paid. If our strategy is to get these guys paid and connecting with patients is a key part of getting them paid, it’s no change in strategy. It’s a change in tactics.

You said early on that you hoped to preserve the company’s culture as the company grows. Have you been able to do that?

I started with an immature notion of preserving the culture. What I’ve learned is that I’ve preserved key elements of the culture, but if I was wiser, what I would have said is that I don’t want to preserve the culture, I want to keep the culture current with the journey.

For example, I’ve become much less of the class clown. Watch that Wall Street Journal interview. I didn’t even recognize myself because I was so struck with the weight of the questions and she was so thoughtful … it’s a different thing from a blonde guy jumping up and down “saying look at me, look at me" because I’m afraid no one will pay attention to me, to, “People really are paying attention, make sure you don’t mess up this answer.”

That’s my journey. There’s a similar arc to the character of our whole culture at athena, of our personality as a company. I do want to preserve what’s important about our culture, but I think what I mean to say is I want to preserve the notion of being true to our culture wherever it may be at each stage of development. Write that down and find out later whether that was the beginning of the slippery slope to evilness. I don’t think it is.

I need to be more mature, more subtle, less desperate for attention, more secure as a CEO than I did when no one had ever heard of us. We want to make sure that each iteration of our culture as we grow has the same level of integrity. I’ll die before I let go of the culture we have right now. Will our people and will our CEO lose their career, lose their reputation before letting go of the principles that are appropriate for the hour? That’s what’s consistent.

What’s appropriate for the hour will change year over year. I’ve seen that. I’m witnessing it right now. But the integrity of sticking to those principles of the hour or of the year or of the decade is the maker or breaker of whether we get to keep playing.

Monday Morning Update 12/22/08

From HIMSS Staffer: "Re: conference call. On a Friday HIMSS conference call, HIMSS staffers bragged about being the sole source of information for congressional staffers and the new administration. Said that was something they had worked towards for the past couple of years. Not everyone is convinced that vendors that develop systems that don’t even talk to themselves (Epic at Stanford, Kaiser, and PAMG, for example, can’t share information) should be driving this discussion. Nor that EMRs are going to improve quality or cut costs."

From UKIE: "House calls. Pioneering company uses system built on Adobe LiveCycle ES to enable housecall physicians to provide care to patients anywhere." Link. Janus Health, a San Diego developer of technology for house call doctors, develops a Web portal for charting and communication that lets doctors work from anywhere. I’m a little suspicious, though, at the gigantic announcement on the site that the company has secured a "broad" patent for any kind of house call-related technology, its prominence and wording suggesting that infringement lawsuits against companies with even unrelated house call technology is possible.

Ingenix Consulting, of which the former Healthia Consulting is now a part, is doing a big project and needs up to 50 clinical implementation consultants. Check their job page (although this posting is fresh and may not be up for a couple of days). I know a lot of folks have been cut loose in the past couple of months, so this is one of few big-scale hiring efforts I’m aware of. Healthia, of course, sponsored the HIStalk event at HIMSS last year, which was chock full of cool, smart healthcare people (that’s the Healthia people above, who look quite happy even though they were not having spirituous beverages like everybody else). 

Lots of hospitals have been cutting back on travel and education. I’m not sure that’s a bad thing. It seems like having people constantly running around to conferences and hearing the same messages makes them all think alike. Healthcare is notoriously imitative, where nobody is willing to do anything original or risky unless they can find a handful of other hospitals that have already done something similar (meaning nobody’s doing anything original or risky, of course, since everybody is average by definition). Tough times may finally unleash some desperation-inspired creativity.

New poll to your right: do you agree with the HIMSS recommendations to the incoming administration?

Lisa Romano is promoted to VP and chief nursing office of TeleTracking Technologies.

Henry Schein Practice Solutions launches DDX, an application that connects dental practices to dental labs (or medical practices to medical labs). The requirements page recommends Schein’s Labnet system on the lab end, though, so it may not be all that useful unless everybody is running Schein apps.

CCHIT opens a 31-day public comment period on the 2009 certification criteria, including those for PHRs.

WSJ has a video interview with Microsoft’s Steve Shihadeh, which also featuring gratuitous shots of a Microsoft sign and flag. Nothing new.

The Picower Foundation, a big philanthropic organization with $1 billion in assets, shuts down after getting burned by Bernie Madoff’s $50 billion Ponzi scheme. The foundation was started by a big Alaris Medical Systems shareholder who pocketed $1 billion when the company sold out to Cardinal Health. On the other hand, Jeffrey Picower, the Alaris shareholder, has had his own business and charitable dealings questioned by the SEC, with the now-defunct foundation being one. You know economic news is grim when a $50 billion fraud case barely makes the front pages among all the bailout stories involving several additional zeroes.

Hospital layoffs: Piedmont Medical Center (SC), Monmouth Medical Center (NJ). At OHSU (OR), executives take a 20% pay cut and may forego bonuses that averaged nearly 40% of base pay, holiday parties are canceled, and salary freezes and layoffs are coming. Cleveland Clinic has implemented a hiring and salary freeze for non-patient care positions.

In happier news, congratulations to the information systems department of Southeast Georgia Health System, which wins the holiday door decorating contest ("holiday" being the bland but legally acceptable substitute for "Christmas" or "Hanukkah" or "Kwanzaa" or any other observances that might conveniently fall into the December/January timeframe when the vast majority of us celebrate Christmas but can’t call it that).

Technicians working on the computerized security system at a brand new New Jersey psych hospital inadvertently unlocked all the doors on at least two occasions, allowing at least one patient to elope (that’s the word that came to mind since I’ve heard it used to refer to psych patients getting out, but it probably sounds funny to non-healthcare people, kind of like the annoying, contrived use of "naive" to describe patients who aren’t big narcotics users, i.e. "opiate-naive").

Three VPs leave clinical trials software vendor Etrials as the company restructures. The new CEO is Denis Connaghan, who you may remember from his HIT days at IBAX under Jeff Goodman. The announced plan: "get as many of our people close to our customers, and, really, to remove layers from the organization and become really customer-focused." If that’s a new plan of action, then no wonder the old CEO got himself eloped.

I’ll be around writing here and there this week (maybe), but if you won’t, have a wonderful Christmas, Hanukkah, Kwanzaa, Festivus, New Year’s, or National Bicarbonate of Soda Day.

E-mail me.

HERtalk by Inga

A couple of former Misys execs find new homes. SciQuest names Gamble Heffernan VP of marketing and Charles Lambert accepts an interim post as finance director for Helphire. Hefferman was the Misys VP of Community Solutions and Labert served as CFO.

ACS names David Bywater managing director of the Healthcare Solutions unit.

Healthcare informatics company Med-Vantage appoints Peter Goldbach, MD its new president and CEO.

Mission Regional Medical Center (TX) selects the IntelliDOT Phlebotomy Specimen Collection system.

CHIME awards several educational scholarships to its members. The winners of the CIO Boot Camp Alumni Scholarships are Robert Eardley, associate CIO at University Hospitals in Cleveland; Diatta Harris, director of IT at Erickson Retirement Communities (MD); and Nanda Lahoud, administrative director of value realization at THR. CHIME also presented the Edge Scholarship to Carol Roosa, CIO at Monadnock Community Hospital (NH) and the CHIME Women’s CIO Scholarship to Bridget Haggery, VP/CIO at Oregon Health & Science University.

St. Agnes Hospital (MD) names Dr. Norman Dy as physician director of pay for performance and core measures. (that’s a title I’ve never heard)

A former ER nurse is named  president and CEO of Pocono Health System/Pocono Medical Center. The hospital board of directors chooses Kathleen E. Kuck, who has spent the last year serving as interim president and CEO. During the last year, her achievements include the implementation of an EMR.

WellPoint Foundation president Caroline S. “Caz” Matthews joins the Perot System board of directors.

IPC acquires North Florida Hospitalists and Orange Park Hospitalists (FL). IPC now has over 600 physicians on staff, serving over 300 facilities.

Ochsner Health System (LA) implements WebDefend software at its seven hospitals.

Presbyterian Healthcare Services (NM), Marin Medical Practices Concepts, Inc. (CA), and St. John’s Medical Group (MO) select Medical Present Value to automate the payor contract management process.

The CEOs of two California medical companies are charged with billing Medicare over $3 million for equipment not provided patients or for items they knew patients didn’t need.

St. Joseph’s Hospital and Medical Center (AZ) plans to add a videoconferencing system to connect hospital specialists with referring physicians in the community. The Clinical InfoNET system will also be used as a CME tool.

SAP announces that MetroSouth Medical Center (IL) has selected and implemented its enterprise applications solutions across its healthcare system. The SAP applications include financials and procurement tools.

E-mail Inga.

News 12/19/08

From Larry Fine: "Re: Philips is sunsetting the CareVue Classic product (formerly from Agilent, and before that, HP). We are looking for clinical systems engineers with CareVue, bedside devices, RDBMS, and HL-7 experience to help support our extensive CareVue Classic deployment (150 ICU beds) until our Epic inpatient go-live in about a year. I have placed ads on DICE and the HL-7 organization’s web site and even sent a message to the HP Alumni mailing list, but no bites so far (or no credible ones, anyway). I would be interested in hearing any other ideas from HIStalk readers about how to reach potential contractors or recruits that could provide this support and then transition to Epic device integration support." I didn’t use Larry’s real name because my policy is not to unless someone asks specifically, but he’s CTO of a big hospital. You can comment on the article with your suggestions. My suggestion is self-serving: run a highly cost-effective listing on HealthcareITJobs.com, which takes seconds. The CareVue sunsetting is leaving quite a few hospitals in a lurch, pushing some too quickly into clin doc systems that can’t match its ease of use.

From The Alchemist: "Re: new site. Well, healthcare advocates, why wait until 2010 for the World Health Organization to embarrass the United States Health System with a world ranking lower than our present 36th? Someone apparently has been concerned about the state of health for the United States to implement a new web site for quality health measures worthy of our national western lifestyles." Link.

From Chad Greer: "Re: TeleVox. oneHITwonder has unfortunately received incorrect information about TeleVox and the support of our popular HouseCalls reminder system. TeleVox will absolutely continue to support all customers utilizing HouseCalls, regardless of the version. Paying a subscription is not a requirement as of 1/1/09. For customers that want to utilize the advanced features and capabilities of the ASP version, they can elect to pay a subscription fee for the service upgrade. TeleVox prides itself on being High Tech with a Human Touch, over 16,000 customers respectfully deserve accurate information that only TeleVox delivers. We apologize to any customer who has been mislead by this information. Thanks in advance for helping clear the confusion about misleading information that can travel fast in this day and time." Chad is the VP of sales and marketing for TeleVox.

Document Generation Corp. files suit against Allscripts, Cerner, Sage, McKesson, Misys, Meditech, Epic, and Eclipsys for infringing on its patient for "computer-assisted document generation." A little homework suggests that patent troll Acacia Research has filed suits using the company’s patent before. Acacia makes a living filing ridiculous nuisance lawsuits against companies that claim infringement, but they rarely go to court because the company conveniently offers a "license" that costs a little less than mounting a legal defense against its eye-rolling claims. Acacia said it was the company’s only licensee in a 2007 suit against 19 EMR vendors, according to one source.

Jobs: SIS Project Manager, Product Design Engineer/Analyst, Manager of IT Technical Support, Eclipsys Clinical Consultants.

Sunquest will acquire the Outreach Advantage outreach lab package from Pathology Associates Medical Laboratories, a Providence Health and Services subsidiary in Spokane, WA.

Accentia, an India-based healthcare solutions provider, gets a $22 million contract to provide services to "a chain of hospitals in the US" that include transcription, coding, and billing. It will hire 5,000 employees. The chain was not named, but one might suspect HCA from timing and deal size. Obviously whatever hospital group it is doesn’t want its offshoring known.

New go-lives for Picis: Kennedy Memorial Hospitals (NJ), Edward Hospital (IL), California Pacific Medical Center (CA), Inova – Mt. Vernon (VA), Central Washington (WA), and Valley Baptist (TX).

A board member of troubled Canadian L&D software vendor LMS Medical System quits along with the president and CEO, that last one interesting because she’s threatening to sue the company. Another former employee is threatening legal action for improper termination. Two of what must be very few survivors start wearing all the hats between them: the interim CEO is the CFO and a board member; the interim COO and CTO keeps his old job as product development VP. Shares are at 2 1/2 cents in case you need some last-minute stocking stuffers or something cheaper than gift wrap.

Tobias Samo, formerly of The Methodist Hospital (TX), joins Eclipsys as CMO.

RIM turns in nice quarterly numbers on BlackBerry sales (and I’m not just saying that because I’m packin’ a Bold).

Standard & Poor’s threatens to cut GE’s credit rating over its GE Capital exposure.

Listening: Shinedown, radio-friendly hard rockers out of Jacksonville. You don’t have to be a drug-ingesting, illiterate loser to like it, but you’ll probably do the pigeon-necking thing because it’s melodic (try The Sound of Madness). The guitarist is quitting after tonight’s show in Flint, MI, although he’s not blaming Flint.

Something to consider as the government becomes the financier and partner of big chunks of what’s left of American industry: in Scotland, the government decides to impose a dress code on healthcare workers for infection control and cost saving reasons. White coats for doctors are out, as are ties. No pens in pockets, no long-sleeved shirts, all hair must be tied back.

Emanuel Medical Center (GA) suspends all employee benefit accruals for 2009 — vacation, holiday, and sick time — hoping to avoid layoffs.

BIDMC rolls out proximity security from Third Brigade. The company says its Deep Security system protected users from the IE zero-day vulnerability even before Microsoft sent out a patch.

Penang Adventist Hospital in Malaysia will use SAS for financial planning and budgeting.

Kimball Health Services (NE) chooses HMS. It’s impressive that the 20-bed critical access hospital is aiming for CPOE and bedside barcoding.

I’m pretty sure Dennis Quaid doesn’t really need the $750K settlement that Cedars-Sinai will pay for overdosing his twins with heparin, especially since they’re fine and apparently incurred no medical expense. Their suit against Baxter over what they said was confusing drug packaging has been dismissed, which I’m not sure I knew. And, it’s important to note that the settled suit was only on behalf of the twins; Quaid and his wife could still sue the hospital. It’s a shame it happened, of course, but untold numbers of people suffer far worse outcomes every day from medical mistakes. You can find and discipline everyone involved, but then you’ll have a big empty hospital since everybody working there is human. I wish I knew the answer or had confidence that anyone else does, but neither is the case. Suing the hospital got him a HIMSS opening keynote gig, of course (why?) Alan Greenspan will be there too, so maybe he can explain why he let the economy go to hell under his watch.

One thing that caught my eye in the HIMSS panhandling memo to the not-yet-President: a call for a higher profile HIT official (Senior Health IT Head? … interesting acronym). You can bet they’ve got someone in mind, a safe, vendor-friendly choice who’s on board with its CCHIT/HITSP agenda. But, their attempts to influence legislation in the past have been a bust, so hopefully cooler heads will prevail than to just shovel $25 billion at doctors to get them to use systems they may not want. I have to say that, as a provider-sider, I’m kind of embarrassed that HIMSS lined up for Uncle Sam’s dwindling trough like all the loser industries that failed due to their own stupidity, but now think it’s a good taxpayer investment to override the free market’s valuation of their services. It’s called free market Darwinism – let it work even if it hurts.

El Camino Hospital (CA) will buy the assets of Community Hospital of Los Gatos from HCP. Eric Pifer, MD, who joined El Camino as CMO/CMIO last year, will be president of the hospital when ECH gets it running.

Court documents suggest that Siemens Healthcare may have paid $15 million in bribes to five Chinese hospitals from 2003-2007 to get $295 million worth of business (great ROI, but illegal). One hospital’s radiology director supposedly got $65,000 to ensure the hospital bought a $1.5 million MRI from Siemens.

A group of dentists holds a teleconference to formulate recommendations for the new administration, which include cross-training medical and dentistry students on each other’s field, sharing computerized records, and addressing liability concerns related to sharing data. They think doctors and dentists need to talk more. What I didn’t know: Pitt has a dental informatics program, the only one in the country.

AED-SATELLIFE, a Watertown, MA nonprofit, provides solar powered PDAs to healthcare workers in Uganda for accessing medical information. It also runs HealthNet, a global communication network linking healthcare workers through its satellite (thus the SATELLIFE name). I see they’re looking for developers and users to join their open source data collection, analysis, and reporting platform. I couldn’t find their financials to decide if they’re a good charity.

Odd: a "medical marijuana club" in California (where else?) plans to add a new kitchen for its pastry chefs, who make pot brownies and other drug-laced goodies sold from deli-style cases (that’s really it above).

Bizarre lawsuit: Florida Hospital Ormond Memorial sues the descendants of the long-dead man who in 1962 donated the property the hospital sits on, trying to weasel around the donor’s stipulation that the land be used only for a hospital. The hospital wants to sell the land to whoever wants it for $16 million and move to a new location. The hospital didn’t bother to contact the descendants, so the lawsuit came out of nowhere and they’ve had to hire lawyers. Says the donor’s widow: "I don’t know anything about it. Nobody called me or anything." Stupid or cold? I can’t decide.

Another: California’s Supreme Court rules that Good Samaritans trying to help accident victims can be sued for damages if they injure the person. The case involves a 27-year-old woman, whose friend pulled her out of her wrecked car thinking she saw smoke and worrying it might explode, but allegedly causing paralyzing injuries. The victim’s lawsuit against her (former) friend can continue.

E-mail me.

HERtalk by Inga

The Joint Commission issues a Sentinel Event Alert discussing the possible safety risks related to medical devices and HIT implementations.

Boston Medical Center eliminates 250 jobs and cuts various clinical services in an attempt to address $114 million in funding cuts.

St. Joseph Health System selects Allscripts to provide Enterprise EHR and PM to 100 affiliated physicians.

BCBSA extends its relationship with AT&T Business Solutions, awarding its two multi-million dollar national contracts to serve as its primary networking services provider.

The Commonwealth Fund launches a new Web site that tracks performance data for hospitals. Unlike other rating sites, WhyNotTheBest.org is not providing rankings. In other words, KLAS-like information on hospitals, but without the rankings. I wonder if there is a need for something similar in the HIT world? Sometimes I wonder if the whole ranking process affects accuracy because I know it can cause vendor hysteria. For example, certain companies clearly push their happiest clients to the ratings site to assure a high rank. The vendors focus on that earning that #1 spot, and I bet some execs have bonuses tied to it. If you are a company without the time and money resources to monitor your KLAS ratings, does that make you a lesser company? Is the company with the #1 rating really that much better than #2? A #1 ranking certainly gives a company a great excuse to issue a press release. Too bad it’s considered lame to send a press release saying, “We were only .001 points behind #1, so we’re pretty great, too.” Perhaps if everyone weren’t so focused that top spot, we’d feel more comfortable that data is truly meaningful.

In a survey that seems to be financed by pharmaceutical companies, Manhattan Research finds that 40 million US adults have elected not to have a prescription filled because of the cost. Women and patients with neurological and mental health conditions were the ones most likely to skips their meds. Sildenafil citrate was not on the list of the most-missed medications.

A Miami physician receives a 30-year prison sentence and is ordered to pay $8.3 million for her part in an $11 million Medicare fraud scheme. Her medical assistance gets 14 years.

Dear Santa: You know I love my iPhone, even though I seem to drop it all the time and lose it in the bottom of my purse. I’m thinking this pretty pink case (or perhaps one of these) may be the answer. I’ve been good. Love, Inga.

E-mail Inga.

Being John Glaser 12/18/08

The National Alliance for Health Information Technology (www.nahit.org), an organization jointly sponsored by the American Hospital Association and CHIME, held a board meeting earlier this week. The organization discussed its strategy of working with providers and others to develop and disseminate “real practices.”

Real practices refers to practices that healthcare organizations have developed to help ensure that their system implementations are efficient, effective, and provide the value anticipated by the organization when they approved the project. These practices could surround applications such as CPOE, revenue cycle, and business intelligence. These practices could address project management, clinician engagement, vendor partnerships, and CIO-Board relationships.

For several reasons, the stakes have been raised for healthcare IT investments.

Increasing reimbursement and quality improvement pressures have put commensurate increasing pressure on successful electronic health record implementations. As their strategic importance and operational criticality increases, implementations that run too long, cost too much, or don’t deliver significant organizational gain will be less tolerated.

In addition, the credit and stock market challenges mean that there will be fewer IT investments. If the organization is going to fund, for example, one investment and not four others, that one investment had better deliver the goods.

The national healthcare IT agenda forms a parallel thread to the above.

The national agenda has been very focused on adoption. The low adoption rates of CPOE and outpatient electronic medical records have led to this agenda. But increasingly, it is understood that this focus is too narrow. Adoption isn’t the point. Effective use, improved care, and reduced costs of care are the point.

Hence the national agenda is evolving to augment adoption directed initiatives, e.g., financial incentives to implement an EHR, with initiatives directed to helping providers improve care using the technology.

These two threads converge to a materially heightened emphasis on execution.

Whether or not an organization is successful in implementing an application and realizing value is dependent on the vendor and implementation partner chosen. However, success is much more dependent on the organization’s skill in managing the implementation and realization of gain.

This skill can be greatly enhanced if a healthcare organization understands the “real practices” that other organizations have successfully used.

Sharing best practices is not a new idea. Association conferences are designed to share lessons learned. The value of consultants is often the experiences they bring from other organizations.

And while it is not a new idea, it is an idea that is becoming significantly more important. We might have gotten by with sub-optimal implementations in the past. We won’t be able to get by with them in the years ahead.

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

HIMSS Issues Healthcare IT Recommendations for the Obama Administration

HIMSS issued its healthcare IT recommendations for the Obama Administration and Congress this morning, stating that "2009 is the year for healthcare reform in the United States." The recommendations were assembled by a 100-volunteer work group that convened from September through December, led by the chairs of the HIMSS Advocacy & Public Policy Steering Committee and Government Relations Roundtable.

The themes of the recommendations are:

• Using at least $25 billion of federal money to get providers to a mid-level stage of EMR adoption
• Elevating the ONCHIT office with more authority and visibility
• Pushing CCHIT and HITSP standards as a condition of government assistance
• Expanding telehealth
• Reviewing privacy policies

HIMSS recommends:

• Spending at least $25 billion of federal money ($5 billion per year for the next five years) to help hospitals and practices adopt EMRs, not including additional money for federal and state providers.
• Paying providers to achieve Stage 4 of the HIMSS Analytics EMR adoption model by the end of 2014 in the form of grants, loan, and tax benefits.
• Making funding available only for purchase or upgrade of CCHIT-certified products that meet HITSP interoperability specifications, claiming that "CCHIT has help streamline the EHR market by serving as a trusted source to guide providers when adopting health IT product."
• Expanding Stark exemptions to cover "additional healthcare software and related devices" that are CCHIT certified and that meet HITSP interoperability specifications.
• Codifying and funding HITSP as the National Standards Harmonization Body for five years.
• Codifying a "Senior Level Health IT Leader" in the administration to oversee a national healthcare IT strategy, saying that "ONC has not been codified into law and does not have adequate authority to coordinate health IT activities through all federal departments and the US."
• Authorizing a coordinating body to advise the administration on healthcare IT and coordinate the standards work of HITSP and CCHIT.
• Conducting a White House summit specifically on reforming healthcare with IT to generate consensus and solutions within 90 days of the inauguration.
• Urging Congress and the Secretary of HHS to establish a "patient identify solution."
• Supporting "the routine updating of codes and coding systems for effective healthcare delivery and payment."
• Mandating that reimbursement by paper checks be prohibited for payors and providers of federally funded programs, replacing them with direct deposit by December 31, 2010.
• Expanding the FCC’s Rural Health Care Pilot for telehealth.
• Paying providers for telehealth services.
• Providing incentives for providers and payors to participate in HIEs and the Nationwide Health Information Network.
• Creating a roadmap for using PHI.

News 12/17/08

From MM: "Re: EMR. $83 million for an EMR? Unbelievable! Who besides me thinks EMRs cost a little less than an order of magnitude too much? I don’t blame vendors entirely. I blame the conceptual model used in the industry (CDR-centric that duplicates data already available electronically). Epic has the right idea with regards to customizing a solution based on the unique systems in place at a given facility. They have the absolute wrong pricing model – $75+ million for an EMR! Facilities basically hand over to Epic all the financial gains of moving to an EMR to Epic. All vendors are trapped in their financial and conceptual models. What entity will drive innovation and disrupt the healthcare IT market with a new model? Comments welcome."

From Kenny Rogers: "Re: Novo Innovations. I hear it’s about to be acquired or maybe to acquire another company." Well, I’ve heard that too, with Medicity supposedly being the suitor. No confirmation yet, but I’m not sitting on it just in case it’s true and the real journalists scoop me because I’m stuck in some meeting at work when the news breaks or Kipp e-mails me. I was highly impressed with both Novo and Robert Connely when I interviewed him in 2006 (I guarantee it’s worth a read or re-read even now — I keep dropping hints that I’d like to have a redux with him). Medicity, of course, has rocketed out of relative obscurity to become a game-changer, which would only be enhanced with Novo’s smart agent technology to connect and synchronize multiple sources of information (hospitals, practices, etc.) Now I’ve been a loud-mouthed critic of RHIOs since the beginning, but it’s becoming clear that there are two dissimilar types: (a) the impulsive "let’s put on a show" kind where two life-and-death competitors in one market swear they’ll smoke the technology peace pipe, only to be quickly crushed by the reality of their intense mutual hatred and financial naivete; and (b) the kind that is more thoughtfully designed to have a broad participant base, a solid business model, and a quick path to actually moving data instead of endlessly arguing about the shape of the conference room table. Medicity is mostly associated with that second type, which not surprisingly, is more collectively successful. Novo made its name with individual non-RHIO groups that just wanted a slick, painless way to share information at a low cost. That’s a powerful match, if indeed the rumor is true.

From The PACS Designer: "Re: wireless mesh. Wireless access at times can be frustrating in that the signal gets lost when you are in a dead zone. Within institutions, it can be even more critical if a wireless disconnect occurs during a critical time of treating a patient. Now, a concept that has been around for a few years is starting to gain some traction and it is called ‘wireless mesh’. The wireless network consists of wireless radios that overlap each other, so if one wireless radio disconnects from users, another picks up the additional users, thus maintaining continuous wireless connection through a self-healing process. Also, placement of the individual wireless radios in both inside and outside locations can provide campus-wide service to users. Wireless mesh is also referred to as a ‘mesh cloud’ by some, as it is another cloud concept to consider for your work environment." Link.

From Slick Willy: "Re: Best in KLAS. Always interested in your take on it." Methodology arguments aside, the results are hardly shocking. Epic dominated all the big hospital categories (EMR, billing and patient management, pharmacy, and even radiology) and had its usual strong showing in ambulatory. I can never figure out USA and its wins in surgery and enterprise scheduling because I’ve never known anyone who uses it. athenahealth was #1 in practice management in the 2-5 and 26-100 physician categories, which is maybe a surprise move up the rankings rather like Epic a few years back. I suppose an outsider might be surprised that the big companies did poorly: GE and Siemens had one winner each (in PACS and lab, respectively), Cerner had zero, and McKesson two (Paragon for small hospitals and ERP, although the latter is a pretty big win against non-healthcare vendors like Oracle). Eclipsys had a win, but only for the EPSi decision support product it just bought. MEDITECH has the most customers, but no wins. Everybody must have waved their white flags and high-tailed it because Epic continues to take whatever business it wants, with these rankings giving it yet another selling point it doesn’t really need.

From Bobby Orr: "Re: GE Playbook 101. Acquire, re-org, and then lay off a few years later. Not good news for the former IDX team." He’s referring to the story I ran earlier that GE Healthcare will be cutting jobs here and there, most likely some of them in Burlington. Show of hands: who really respects what GE has done in healthcare IT? (I’m typing with two, so there’s my answer).

From Francisco Franco: "Re: BlackBerry. The Bold is a major winner. I have tried them all (iPhone, Tilt, Curve, Palm, Treo, etc.) going back 11 years now. And by the way, we are close to allowing Macs on our network here. VMWare Fusion is the answer." FF gave me some Bold setup tips, which I appreciate. That’s an interesting idea for the Macs using Fusion (above).

From Susan Sweet: "Re: layoffs. Just curious why you have not reported on the layoffs at the HCA corporate campuses in Nashville. I was one of 109 IT&S employees which were laid off on Thursday, Dec 4 and there have been continuing layoffs in the other corporate areas as well. Have I missed the news?" I missed it. HCA laid off corporate staff including 109 in IT, giving them the part-time option (80% accepted) that most likely means fewer hours and benefits. IT was hit the hardest of the 2,600 Nashville employees. Like several other companies that now regret it (the Chicago Tribune owners, for example), HCA got cute with a leveraged buyout and is getting eaten alive by the overwhelming debt it required ($27 billion in HCA’s case). There was a time in a go-go economy when leveraged anything was good — houses, cars, businesses. Not now. Everybody’s grandparents were right — borrowing money to finance today’s fun is a really bad idea (as Uncle Sam will probably find out the hard way).

GE sticks with its 2008 earnings estimates, but says it won’t forecast earnings at all going forward. Jeff Immelt says GE Capital will still make more than half its usual profit next year, about $5 billion, which is surely optimistic.

Microsoft will issue a critical Internet Explorer security update Wednesday following discovery of a vulnerability that lets hackers gain control of PCs without doing anything more than getting unsuspecting users visit infected Web sites.

Colorado Governor Bill Ritter brags on the Colorado RHIO, which kicked off its live trial two weeks ago. Despite having spent $8 million plus unstated private money, the RHIO says it needs more federal or private money to actually roll it out beyond the current three users: University of Colorado Hospital, Denver Health, and Children’s Denver. On the other hand, not asking for federal money is so 1990s.

Washington University and BJC HealthCare (MO) sign for the mdlogix Clinical Research Management System.

SCI Solutions rolls out its new Web site.

It’s corruption as usual in Chicago, according to claims: a Cook County commissioner (who kind of looks like Corporal Agarn from F Troop to me) reportedly leans on MedAssets to give part of its hospital billing contract to a minority-owned subcontractor run by the commissioner’s crony and campaign contributor, after which the crony’s firm bills MedAssets $40 per hour per employee instead of the agreed-on $17 per hour. MedAssets drops the subcontractor, so another pal of the commissioner, the hospital board’s audit committee chair, proposes that the board audit MedAssets after receiving only one bill. MedAssets is turning the matter over to its lawyers, eliciting an eloquent response from the commissioner: "He’s full of s— … "If [MedAssets President John Bardis] continues to imply those things and slander me, I will sue the s— out of him and go after him to the fullest extent of the law."

I poked a little fun at our pals at HIT Transition Group the other day, so Marty pokes a little back. I liked this better, though, being a fan of caustic cynicism: "And who wouldn’t want to be a bank these days? Remember when American Express was a credit card — er, charge card company? That was before last month, when the government started using the Fiscal Shock and Awe technique that proved so effective as a post-invasion strategy: throwing pallets loaded with cash at banks, no embarrassing questions asked. Amex was immediately pacified: Don’t call us a credit card company, call us a Bank Holding Company." He’s speculating that insurance companies will use health savings accounts to get into the banking business, also mentioned by Susanne Madden when I interviewed her. Insurance companies are like dowsing rods for dollars: if anybody’s got money, they’ll find it.

Congratulations to those HIStalk sponsors who won Best in KLAS, announced Monday morning: Allscripts (Enterprise EHR, ambulatory EMR 26-100 physicians); Greenway (PrimeSuite Chart, ambulatory EMR 2-5 physicians and 6-25 physicians, PrimeSuite Practice, practice management 6-25 physicians); Nuance eScription (back-end speech recognition); CareTech Solutions (IT outsourcing – extensive); Hayes Management Consulting (topping the list of professional services firms). Listed as Market Segment Category Leaders: Sunquest CoPath (anatomic pathology – over 200 beds); Sunquest Blood Bank (blood bank – over 200 beds); RelayHealth HTP RevRunner (revenue cycle – patient access); QuadraMed Pharmacy (community pharmacy – 200 or fewer beds); MEDSEEK eConnect Physician Portal (clinical portals); Allscripts Care Management (acute care discharge planning); Sentillion Vergence (single sign-on); Virtual Radiologic (teleradiology services). If you’re a sponsor and I missed your win, let me know. Surprising, isn’t it, how many HIStalk sponsored nailed their categories?

Lame duck HHS Secretary Mike Leavitt announces his own voluntary privacy initiative to the NHIN Forum, including what the press release calls the "Leavitt Label," his personal Good Housekeeping Seal of Approval. It’s one big-ass Label, given that the template (warning: PDF) runs 12 crammed pages of not-very-clear questions that would baffle the average citizen for whom it will supposedly benefit. Other than that, it was just a laundry list of the usual feel-good, detail-free principles that nobody could really be against, proposed by a political lifer in the last days of his four years as Secretary. Update: after sleeping on it, I’ve decided the questions are really pretty good since they are intended for vendors. The template is actually just six pages, plus another six of instructions. I’m still not sure about the ego behind pre-anointing it with the secretary’s name, but it may encourage some good conversations about disclosure.

IT people often call network stuff "plumbing," but this hospital CIO is the spokesperson about real plumbing. Kym Pfrank of Union Hospital (IN) extols the virtue of PEX plastic water piping in the hospitals big expansion project. The quote quickly segues into information about RFID badge tags, but then goes back into non-IT territory with talk about corridors and water pumps. That’s a busy guy.

PDA drug information provider Epocrates cancels its $75 million IPO plans. It’s already received $86 million in VC money. My April 21 comment when it was announced: "Clinical reference provider Epocrates, fresh off its iPhone stage time with Steve Jobs and apparently unafraid of a terrible stock market, files for a $75 million IPO. It’s profitable, anyway." I was actually being nice since I thought they were nuts, but then again I’m just a non-profit working stiff, not a captain (or even private) of industry.

Streamline Health’s Q3 numbers: revenue up 11%, EPS $0.00 vs. $0.00. A tiny company, but the guy running it (Brian Patsy) is supposedly interesting.

Christine Cournoyer, Picis president and COO, is elected to the board of BJ’s Wholesale.

Orchestrate Healthcare wins Best in KLAS for technical services, which I mention because they’re is running a text ad to your right to announce that fact here.

IT job prospects in North Carolina have gone "from bad to worse," the Raleigh paper says, reciting a litany of recent layoffs that includes Misys and Allscripts.

Odd: a Chicago company called Global Medserv Inc. (which I couldn’t find on the Web, but that is apparently involved in electronic medical records) offers to buy a failed but publicly traded golf course company just to get on the American Stock Exchange cheaply. I think the company may be DGF Medserv, a transaction processor that shares an address and telephone number with several chiropractic companies.

Siemens will pay $1.6 billion to settle charges of bribery and kickbacks to earn business. How good was the case against them? "We have been dealt with very fairly," its lawyer said contritely.

Royal United Hospital Bath, NHS Trust extends its IT management contract with IBM.

The US Postal Service is investigating an identity theft case at Saint Francis Hospital of Memphis. The police chief, himself a victim when someone charged $900 on a Wal-Mart credit card using his recently deceased wife’s name, says he heard that the breach occurred when a hospital employee allowed a family member to get on a computer.

If you care about uninformed public perception, you might be interested that the only healthcare companies to make the "Most Trusted Companies For Privacy" list are drug maker Johnson & Johnson and WebMD.

E-mail me.

HERtalk by Inga

From Mati Hara: “Re: holiday party? Thursday night at (a Raleigh restaurant), Tom Skelton and Rich Goldberg are ‘hosting’ — but not paying — for a reunion of old and new Misys folks, including some HR types, various sales talent, senior implementation folks, a few marketing people, and a couple of financial gurus. Hmm … could something be up?” Every month or so, someone sends over a rumor that these guys are buying a company, but so far we haven’t seen anything to suggest they are about to make an acquisition. But, who knows? Yule-time fest or job fair?

Community Care Physicians (NY), a 190-provider multi-specialty group, selects Allscripts Practice Management. The group is already an Allscripts Enterprise (formerly TouchWorks EHR) user.

The Hayes Management Consulting folks sent us an e-mail saying that, in lieu of traditional holiday cards, they are donating to the Toys for Tots Foundation and Susan G. Komen for the Cure. Of course, that totally works for me!

The VA renews its contract with QuadraMed for $23.4 million: $19.9 million in software fees, $2.6 million in services, and $900,000 for travel expenses. The VA uses QuadraMed’s Encoder Product Suite.

The Columbiana County (OH) health commissioner resigns after pleading guilty to theft in office, accused of charging personal items to the county health district’s credit card.

Maybe there is something in the water in Illinois. The HHS is investigating Northwestern Memorial Hospital’s business dealings with hundreds of affiliated doctors. Everyone is being tight-lipped about the whole thing, but the hospital is cooperating.

USA Today examines ways ERs are trying to solve overcrowding problems. Dublin Methodist Hospital (OH) uses CPOE to speed the orders and results process; Scripps Mercy Hospital’s (CA) computerized tracking system monitors patients and available bed space; and Hudson Valley Hospital Center (NY) registers patients at the bedside using a portable computer. Other hospitals are establishing fast-track areas staffed by mid-level providers who can handle minor issues.

A medical journal documents a new sleepwalking condition described as "zzz-mailing,” or e-mailing someone while asleep.

California announces the formation of the California Center for Connected Health, a new organization to boost services to patients in remote and underserved areas. CHCF is providing the center $5.5 million in initial funding.

A Michigan doctor and a pharmacist are charged with running a painkiller scam involving more than 200,000 illegally prescribed doses of OxyContin.

Siemens donates a Ysio digital radiography solution to Children’s Health Fund (CHF). Hospitals will get chance to bid on the system, with proceeds benefiting CHF. Bidding starts at $99,999 and closes December 18th at 5:00 EST.

Dennis Quaid and his wife agree to a $750,000 settlement with Cedars-Sinai Medical Center over the 1000-fold heparin overdose error that nearly killed the couple’s twin infants. Their lawsuit against the drug maker Baxter Healthcare is ongoing.

The former City of Angels (CA) hospital CEO pleads guilty to paying kickbacks in a Medicare and Medicaid fraud scheme. Dr. Rudra Sabaratnam admitted paying a co-conspirator about $493,000 to recruit homeless patients and take them to the hospital for unnecessary services. The “patients” were also paid small sums for pretending to be ill. Sabaratnam will pay $4.1 million in restitution and faces up to 10 years in prison.

E-mail Inga.

Monday Morning Update 12/15/08

From Orlando Portale: "Re: Being John Glaser. I like John’s recent post, but I’m disappointed that he left off one of his key phrases, ‘Core Nucleus’. Recently, we attended a meeting at Brookings Institution, where he must have said ‘Core Nucleus’ at least 30 times! The absence of ‘Core Nucleus’ from his post would indicate that it’s not in the ‘Core Nucleus’ of his lexicon; therefore, we may conclude that it is reserved for special circumstances where a distinct focus on ‘Core Nucleus’ is his wont." Well, you know star chefs sometimes leave out a recipe’s key ingredient just to make sure you don’t steal their thunder. I also was pleased to notice that some readers got in the spirit of his glossary by using his key words in their comments on the article, which gets them extra style points. Very cool (see?)

From oneHITwonder: "Re: HouseCalls. The MGMA listserv reports that HouseCalls is changing its business model from selling software to being an ASP only. They announced that, effective just three weeks from now on 1/1, they will no longer support anyone who already has their product. Even if you’ve already purchased it, you still have to start paying a monthly subscription fee. They didn’t even bother to contact users, apparently." HouseCalls is sold by TeleVox of Mobile, AL, which ironically bills itself as "high tech, human touch" despite apparently not bothering to let its customers know it was about to make them unhappy. Granted, subscription licensing is somewhat new to the industry, but let’s not be stupid about it.

From GE Kills Healthcare: "Re: departed executive. Yet another example that GE Healthcare folks can’t cut it in real HCIT organizations. Allscripts COO Ben Bulkley is odd man out at Allscripts after one year on the job. Tullman paid a huge fee to Heidrick to get him just 18 months ago." His LinkedIn profile shows him gone as of September and now an entrepreneur-in-residence at San Diego’s CONNECT, where he was already a board member.

I didn’t want to run a second e-mail blast since it’s the weekend, but HITMan Dan wrote a great HIStalk piece on some cool, cheap techie Christmas gifts (with pictures). Guys, surely your sexy lady craves a USB Aromatherapy Burner. Mrs. HIStalk will be so surprised when she opens that necklace-sized package, especially when she finds out how sensible I was in paying only $5.99 for her gift!

The Wall Street Journal quotes athenahealth CEO Jonathan Bush on why any government healthcare IT investment should not include subsidizing software, which he compares to propping up Big Three car makers struggling under an obsolete business model. "The damaging side would be if help from the government ended up in the form of subsidies for broken approaches that have not worked … then broken purveyors of the broken approaches would be able to live longer and not die. Software isn’t the dominant approach in financial services or retail banking or anywhere else, and it shouldn’t be in health care."

I can never figure out how those wacky but wicked smart guys from Healthcare IT Transition Group make money since they give away a lot of stuff (I’m thinking they must have rich families who just let them do whatever interests them instead of working real jobs, kind of a dot-Mom thing). Their latest is a PC-based provider lookup offering, described by Michael: "Everybody wants some way to do provider searches, but we designed it with claims in mind. Say I’m a in hospital billing department looking up NPIs for physicians on claims, filling in missing (and now required) data on referring providers, secondary providers, etc. In a perfect world, my billing software would be smart enough to do that for me, but some systems are woefully sloppy about this. What we hear so far is that people are thrilled that there’s finally a tool like this." The download, with monthly updates, is free for your first state and $49 for each additional (I need to talk to the guys about value-based pricing since that sounds way too cheap, although in their defense, I see they are smartly offering a primo sponsor ad slot on the lookup screen, so some company will get their message on about a zillion desktops).

NHS executive David Nicholson finally admits that NPfIT isn’t really going so well. "If we don’t make progress relatively soon, we are really going to have to think it through again … We have said to Cerner and BT that they have to solve that problem at the Royal Free before we will think about rolling it out across the rest of the NHS."

The townies will fuss about this: Morgan Hospital and Medical Center (IN) will no longer draw labs for outside companies like LabCorp and Quest, saying the hospital was "unknowingly" giving its competitors a free service. The hospital defends its much higher prices (which cost one diabetic patient more than $400 extra out of pocket in one visit) by arguing they help cover unprofitable services and also provide higher value when results are posted to the hospital’s EMR. I’m beginning to feel really militant about the BS hospital pricing policies — the ever-increasing number of self-pay patients are supposed to swallow that aspirin with a phony $8 "list price" without a complaint while insurers get them for nothing. It’s as big a scam as the whole AWP pricing thing. Nobody pays list, other than those too poor to have an alternative. Hospitals whine about uncompensated care, but they screw cash-paying patients at every opportunity with a ridiculously high price-to-cost ratio. I don’t see how you can fix healthcare without fixing that. No wonder patients would rather go to India or Thailand to get the cash savings. One of these days I’m going to head over there for a first-person report on a medical tourism hospital.

Peter Witonsky joins medical device information integrator iSirona as president and chief sales officer, sliding founder Dave Dyell into the CEO-only position. I’ll throw out a guess that he’s Carl Witonsky’s son since he’s young and has a work history at Falcon Capital Partners, where Carl is the man.

Listening: new from Rise Against, hard rock with a punk edge (although their older stuff was harder). They’re from Chicago, so I’m thinking HIMSS should get them to do the opening song from last year’s conference, "This Is Our Time," previously warbled emotionlessly and repeatedly in Orlando by Disney day-jobbers, thankfully inspiring only a tiny bit of embarrassing execu-crunking. Also: Epica, Dutch goth-opera (try Track 2). I’m on record as not being against the idea of Simone Simons singing to me.

Open Health Tools Foundation announces a new project with Misys to develop server-based interoperability for HIEs.

Jobs: Director, Clinical Product Management (QuadraMed); Medical Director, Clinical Informatics (UW Medical Foundation); McKesson STAR Patient Accounting (Noesis Health). Weekly job blast signup is here.

I thought the osteopathic vs. allopathic (DO vs. MD) arguing was uneasily settled years ago, but it’s back at the University of North Texas, aka Texas College of Osteopathic Medicine, which is thinking about adding an MD degree to its DO curriculum despite the objections of the non-MD side of the house.

Everybody likes to weigh in on the "why doctors won’t use EMRs" issue, so here is my simplistic interpretation. Doctors, like 99% of people, want to be consumers of information, not creators of it. Develop systems that provide doctors with valuable data in the right context of patient care and you will sell lots of them, with appropriately positive patient benefits, since doctors are nearly universally in favor of delivering the best care they can. Develop applications that assume and require doctors to enter information for someone else to read and you will get kicked out of more offices than you can count. The model of forcing doctors to share their thoughts through manual electronic documentation is fatally flawed. There is no industry … none … where someone with the education and time value of a physician is expected to peck on a computer, especially in front of a client who’s only going to get seven minutes of time (I’ve never seen a CIO typing meeting minutes into a PC, yet they’re often the ones beefing about computer-avoiding doctors). There are no small business owners (doctors included) who will use tools they believe provide them no value; likewise, nobody would dream of trying to force those small business owners to use computers based on some kind of naive philosophic jihad against the inefficiency of paper-based recordkeeping. It’s no surprise that the best-selling physician systems involve practice management and billing functions that physicians don’t use personally (no different than in law and accounting office applications, in other words). It’s egalitarian wishful thinking that doctors will happily pony up to sit in front of a keyboard just because someone else thinks they should. On the brighter side, though, speech recognition is finally ready for prime time, better designed EMRs provide value to docs while still collecting information from them, and the "network effect" makes individually contributed information more valuable as more doctors interconnect.

Interesting: an Illinois children’s hospital (hopefully not the one the idiot governor was reported to have been extorting) reports the results of its FMEA on emergency IV meds, claiming the use of InformMed’s handheld calculator reduced emergency IV med risk by 88%.

Doctations will use clinical terminologies from Intelligent Medical Objects in its Web-based EMR.

Funny stuff from the Chicago Tribune’s media guy on NBC’s (owned by GE) moving Jay Leno’s cheap-to-make show to prime time: "NBC isn’t competing with ABC, CBS and Fox for the most viewers so much as it’s competing with GE Healthcare, GE Aviation and other parts of parent General Electric for the most profits." That’s true of GE Healthcare as well, of course.

AHA spends $4 million on lobbying in the latest quarter, some of it for "a better health information system."

Odd: Indiana driver’s license applicants can’t smile for their pictures any more because it interferes with face-recognition technology.

An Oregon Health & Science University employee’s laptop containing information on 890 patients is stolen from the employee’s hotel room in Chicago.

Forbes blames privacy laws for the failure of New York-Presbyterian to report the Plaxico Burress shooting to police, saying pressure to protect patient privacy may have confused them. "Privacy may be the biggest unfunded mandate of them all," it concludes, citing Modern Healthcare’s HIPAA cost figure of $43 billion over five years. The ED doctor who treated Burress without reporting it has been suspended. The hospital is getting some heat about its VIP policy from the local paper, which noted that Britney Spears was ushered straight to treatment in its ED after twisting her knee while filming a video in 2004, while everybody else waited for the usual hours

BlackBerry Bold Review

 

I’m not a big cell phone user and I’ve never owned a smart phone, so I’m either the best or worst person to review the new BlackBerry Bold smart phone. When AT&T offered to send a unit over for me to try, I figured it would be a good learning experience.

My first reaction (second, actually, after marveling at how small the box was) was how solid and balanced the Bold is. The next was that the display was shockingly high quality, like HDTV compared to analog. Video and sound quality are excellent. Watching a video on the Bold is like having a tiny DVD player in front of you (sorry for the stock photo above – I was taking a picture of the Bold, but my camera’s batteries died right as I was setting it up and the macro function was about as crappy as you’d expect for a $79 camera that I bought on sale at Circuit City, so welcome to Stock Photoville).

I didn’t really need a manual beyond the quick start guide. All the menus are clear and easy to navigate. A set of home icons takes you most places you’d want to go once you’ve got the Bold set up to suit you.

Connectivity is a strong suit, using regular cell, EDGE, 3G, and WiFi. It took seconds to have it running on my WiFi at home, bringing up Web pages very quickly. My Razr doesn’t connect from my desk at work because of low signal strength, but the Bold locks on every time (the only negative: I get a lot of HIStalk e-mails all day and the ‘vibrate’ frequency conducted to my body via the belt holster seems to be nearly identical to that of my stomach when it’s growling, so I keep thinking I’m hungry).

The browser worked just fine, showing full pages with amazing clarity and easy zoom-in by clicking the rollerball and fine-movement arrow pointer. Using it was entirely intuitive.

Big pluses: the keyboard is very well designed with a satisfying tactile feel. The rollerball is smooth and intuitive. Both are back-lit. No learning curve there.

The Bold works as a GPS, although I didn’t try that because the one in the car works fine. It has the usual camera and memory slot, of course, and a media manager application, voice command, etc. 

I connected to my e-mail accounts nearly instantly. You can open and even edit Microsoft Office attachments. I was waiting to have my car’s oil changed today and caught up on e-mail, checked the weather on AT&T’s MediaNet, approved some pending HIStalk article comments by clicking the e-mail link just like always, and read the headlines. There’s a reason people call it the CrackBerry. I’ve seen some of the really scary geeks at work carrying theirs into the toilet stall to prevent the "I need something to READ in here" syndrome.

Businesses will like the Bold, I think. It’s easy to use and is a taskmaster for its main business functions of calling, e-mailing, and texting. IT shops are already familiar with deploying and supporting BlackBerry devices as an extended PC desktop, with infinite enterprise configurability and security. The Bold is about as cool as you’re going to get without chucking out everything you know and like about RIM and going to the iPhone, which most folks seem to feel is superior for Web browsing, media handling, and availability of third party apps (your boss and your IT shop are probably just as happy that you do less of those activities on company time and equipment anyway).

Everybody wants an iPhone, of course, but businesses don’t usually take those decisions lightly (try to get permission to buy and connect a Mac to the network at most hospitals, no matter how arguably superior it might be). I think the Bold is like Hawaiian Shirt Friday at work — maybe not as cool as those iPhone-carrying 24/7 turtleneck-wearers, but still pretty darned cool for serious business.

I know some HIStalk readers are Bold and iPhone users, so feel free to comment. I’m a total noob with the Bold and am using it without connecting to the BlackBerry setup at work, so I’m missing part of the story.

Vendor Deals and Announcements

• IntelliDOT announces that 17 additional Health Management Associates sites have implemented its CBPC solution.
• Bon Secours health System (MD) completes its initial rollout of Vignette’s IDM to capture and digitize paper patient information and index the content for its EHR.
• BCBS of Minnesota names Jay Levine its new CIO and Colleen Connors senior VP of human resources and facilities.
• WellCentive Gateway announces the launch of two new HIT solutions designed to facilitate the sharing of patient data within a community.
• Parmer County Community Hospital and Collingsworth General Hospital (TX) will implement an ASP hosted version OpusClinicalSuite at their rural hospitals. Funding for the project comes from federal CAH HIT grants.
• Cancer Treatment Centers of America contracts with Sunquest Information Systems for the purchase of its Collection Manager software.
• The Dossia employer coalition will allow MediKeeper’s PHR software to its employees.
• The Daughters of Charity Health System extends its agreement with Perot System to provide full IT outsourcing services. Perot has provided Daughters similar services for the last seven years.
• Former Midmark Diagnostic Group President Michael Paquin is appointed to the board of CardioComm Solutions. Yury Levin also joined the board of the cardiovascular technology company.
• TeleHealth Services and Medcalm are partnering to release a new pediatric channel called Blue Monkey Planet. The channel will provide family-friendly wellness education content.
• Vangent is awarded a government contract to support and develop an upgrade to the EHR system used by the Indian Health Service.
• Patient Care Technology Systems announces that over 5 million ED patients visits have now been supported by its Amelior suite of products.
• Zix Corporation is rolling out an e-RX to 200 primary care physicians in Texas.
• Former AMISYS CEO Kevin Brown is named CEO of Casenet, a health insurance and managed care IS provider.
• The University Medical Center of Southern Nevada is deploying (warning: PDF) the Horizon broadband solution from InnerWireless.
• Scotland County Hospital (MO) is going live on Healthland’s EMR system.
• Streamline Health Solutions is integrating its enterprise document workflow solution into the MEDITECH Magic HIS at Massena Memorial Health (NY).

E-mail me.

Gifts for a Cool (Tech)Yule

By HITMan Dan

Do you know a fellow HISTalker who is difficult to shop for, or have you been described as such? Here are a few inexpensive gadget gifts with the techie in mind.

Create your Internet of Things that makes objects smart. Just label and tag your items, then run them over the detector to open your music programs or just about any other program. Tikitag supplies you with a reader and 10 tags and then, voila! your computer responds.

$49.95
Tikitag

Know if your suitcase needs to go on a diet before learning the hard way at the airport check-in desk. Airport luggage scales from any manufacturer are a must-have for consultants or frequent flying IT types (nothing is free with the airlines any more). They are available from just about any retailer for around $20.00. That beats the prices they charge for overweight bags!

$24.95
Edwards Luggage

Deadline got you stressed? No bubble wrap around to pop? This is just the thing. The electronic bubble wrap keychain claims to be just as good as the original stress buster and office annoyer. Keep this little gem around the next time your deadline is near.

$9.99
ThinkGeek

Not sure what to get the HERTalker in your life? Make this the Christmas she’ll remember with this USB Aromatherapy Oil Burner. One drop in the stick — instant office zen. Be sure to use this in a horizontal USB drive or you may not reach zen (you’ll be buying a new computer). 

$5.99
ThinkGeek

Disco might be dead (that’s a matter of debate for another article), but don’t let the kids use those old vinyl records for Frisbees just yet! This turntable from Ion turns those old records into mp3s in one step.

$87.99
Amazon.com

Can’t figure out how to move files over to that new computer you got for Christmas? This hard drive enclosure holds drives up to 1 TB and makes for easy transfer of those pictures, songs, and videos. Just pop it in and it mounts as an available volume.

$34.99
Newegg

Let the serious techie on your list deck the halls with silicone this year … recycled silicone motherboards, that is. These three ornaments in holiday colors, motherboards in another life, now bring Christmas joy to all techies.

$19.99
ThinkGeek

Keep your organization off the front page by preventing a data breach with the Iron Key USB Drive. You get 10 attempts at the correct password, then your data is mad totally unreadable. Seems pricey, but think of it as an insurance policy. USB drives are all too easy to misplace or lose, so at least make them inaccessible if they fall into hostile hands.

$69.99
Newegg

How many times does your PDA, phone, or music player die and you can’t find a place to charge it? Charging your device is as easy as some AA batteries. The new Energizer Energi To Go chargers allow you to place a call within 30 seconds on a phone with a dead battery. This is a great stocking stuffer for the serious airport traveler, or just to have in an emergency.

$14.99
Amazon.com

HITMan Dan receives no financial incentives for recommending any of the sites or products. Check prices online and in your local sales flyers.

Being John Glaser 12/12/08

Over the course of my 20-plus years as a CIO, I have developed a special vocabulary. Sometimes the English language just doesn’t have the right word or the right phrase to capture what I really want to say. Rather than risk being inarticulate or unclear, I make up new words or use existing words in a new way.

While this enables me to be clearer and really express what I want to express, the risk is that my colleagues won’t know what I am talking about. I thought that it would be useful to provide a glossary of Glaser-speak. You may decide to use some of these words yourself.

Duck Soup. The task we have to do will be easy and straightforward.

• You: We have to put together an outline of the project.
• Me: Duck soup.

Cakewalk: The task will be more than easy. We could do it in our sleep.

• You: We have to attend the meeting but we don’t have to do or say anything.
• Me: Cakewalk.

Non-trivial. The work that needs to be done is really, really complicated and difficult. There is a high probability that we are in for a gut-wrenching roller coaster ride.

• You: We have to implement 27 major applications in one week.
• Me: That will be non-trivial.

Boatload of trouble. A whole lot of trouble or bad news. Not your regular bad news. Some really, really bad news.

• You: The payroll system is down and it looks like it will be down for a month.
• Me: Sounds like a boatload of trouble.

How are we doing? We are in a boatload of trouble. Bad things have happened and we need to get out of here quickly. But I’m not sure what we have to do and I need to get your thoughts and ideas.

• Me: How are we doing?
• You: The data center has disappeared. We can’t find it. I think that we should run for the hills.

Gorbal 5000. A catch-all term used to describe the screwy technology that all vendors claim to have that will solve all problems that we might ever have. In addition to being a cure-all, the technology is very inexpensive. A myth. Brochure-ware.

• You: The vendor claims to have some interesting new products that represent a major leap in information technology. If they gave Nobel Prizes in Computer Science, the vendor thinks that they would get one.
• Me: Sounds like the Gorbal 5000.

Fat Chance. There is no way that that will happen. It is more likely that aliens will land today and take over the earth.

• You: The vendor would like you to visit their headquarters to learn more about their exciting new technology, the Gorbal 5000. They want to know if you can come early and play golf with their CEO.
• Me: Fat chance.

I look forward to the conversation. If I have anything to do about it, there is no way that we will ever talk again. I’d rather listen to fingernails scratching on a black board than listen to you again.

• The vendor: How about your team and our team get together for a one day session to explore how the Gorbal 5000 can increase productivity and enhance patient care?
• Me: I look forward to the conversation.

Fair enough. There are two uses for this term. One, you’ve been explaining something to me and you still feel the need to continue to explain it, but I get what you are trying to say, so you can stop explaining and move on. Second, you think my idea is a bad idea and you’ve told me, generally in a nice way, why it is a bad idea and now I get it. You’re right.

• You: Talk. Talk. Talk. Talk. Talk. Talk. Talk. Talk. …
• Me: Fair enough.

Or

• You: You’re wrong. You’re wrong. You’re wrong.
• Me: Fair enough.

Right on. A pleasant, but minor surprise.

• You: The meeting has been cancelled. You have a free hour.
• Me: Right on.

Gotcha. I understand the issue or the problem and I know you’re looking for insight and wisdom but I don’t know what to say, so I’ll stall and hope that something comes to me.

• You: We need to do something about world hunger and bringing lasting peace to us all.
• Me: Gotcha

Terrific. There are two uses for this word. One is nice work, good news, I’m pleased. The other is yuck, bad news, go ahead and ruin my day.

• You: The implementation has gone really well. The users are ecstatic.
• Me: Terrific

Or

• You: The users are really mad. They are heading down the hall and they want to skin you alive.
• Me: Terrific

Interesting. My initial reaction is that this is likely to be a very good idea. Or that the comment seems to be very insightful.

• You: I’ve figured out a way to bypass that problem that we had talked about. I think it will save us a big headache.
• Me: Interesting.

Very cool. A major league, exceptional idea. A deep, maybe profound insight into what we should do. Service-oriented architectures are an example.

• You: We should do a service-oriented architecture.
• Me: Very cool.

Correct. You have said something that is true. Or at least you have reached the same conclusion that I reached.

• You: We should try to do this project well.
• Me: Correct.

On the nose. After much discussion and perhaps going around and around, you have arrived at the right answer. I listened patiently until you got to where I wanted you to go.

• You: Maybe this. Maybe that. Maybe something else. Maybe something other than something else. Hey, wait a minute, how about we try it this way.
• Me: On the nose. 

Sometimes CIOs are accused of being unable to communicate with other members of the C-suite. The use of words and phrases such as above should solve that problem.

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

News 12/12/08

From Andy: "Re: Hey, Sexy Guy …" Link. The AvMed HMO sends out membership cards inadvertently listing the customer service line with an (800) prefix instead of (888). You get a recording (like you would with most HMOs) and the folks on the other end are equally nasty, but in a different way ("Hey there, sexy guy … we love nasty talk as much as you do"). Audio here. I can’t believe people haven’t figured out, after all these years, that not all toll-free numbers start with (800).

From Annonny: "Re: interesting article." Link. Massachusetts brings up a new Web site that allows residents to compare hospital quality and cost information. Theoretically, anyway: navigation is not very intuitive and you have to spell the hospital’s name perfectly (and the front page graphic and tagline are painfully distorted). I screwed around with it for several minutes and never did figure out how to compare two hospitals unless their names can be found within a single search (like within one city). Nice idea and the information is good, but the site’s design is really bad for the intended audience.

From OHio: "Re: The Breakaway Group. They have decided, yet again, to redirect focus and abandon a product offering. Previously, they were change management leaders, then RIS/PACS implementation leaders, then Lawson’s learning partner, then EMR implementation leaders. Lawson Healthcare ERP was the #1 focus of the company, then the group was terminated and they no longer offer those services. Is anyone else sick and tired of these opportunists that are not from healthcare looking to capitalize in this sector?" All unverified. I’ve had a good report or two about the company from trustworthy sources, so I wouldn’t write them off just because they’re looking for a niche.

From eScriptionGuy: "Re: increases. Nuance Communications today announced that the staff will not receive merit increases this year; however, they will partially pay year-end bonuses (despite missing internal organic growth goals). The former eScription business achieved their financial targets, but won’t receive merit increases or year-end bonuses." Unverified, but even if it’s true, I’d still be pretty happy just to have a job in this economy. Probably not what you wanted to hear, but I’m a realist.

From Kent Winkdale: "Re: Doctations. A friend saw their product at an informatics conference. It’s a Flash-based EMR that takes advantage of Web services and sounds impressive. Does anyone have experience with them?" Kent isn’t a company shill trying to get sly PR (I know him), but I don’t know much about Doctations or anybody on its management team or board, although Louis Cornacchia (president and CEO) invited Inga to their MGMA booth in October in an HIStalk comment (he obviously was a company shill trying to get PR, but we’re OK with that as long as it’s an executive and not a PRtist).

From HIT National Attention: "Re: athenahealth. Seems the entire national media is going to athena’s CEO when it comes to HIT. Every time I turn around, they are in the news. I am curious to know what they know we don’t – they do mostly rev cycle, right?" Jonathan Bush is a very smart guy who is also press-friendly and able to clearly express a long and objective view in an eminently quotable way. Like most CEOs, his knowledge base extends beyond athenahealth’s core business of revenue cycle and PM/EMR. I’m guessing he can explain it as well as anyone, plus be entertaining in the process.

From Mark Loes: "Re: Contra Costa County. Announced yesterday was the appointment of David J. Runt as the new Chief Information Officer of Information Systems division of the Health Services Department of Contra Costa County in Martinez, California. David brings over 27 years of progressive executive leadership in healthcare information technology to the role. Most recently, David was the Vice President, Information Services and Chief Information Officer for Sun Health in Phoenix, Arizona where he had a 10-year tenure. David will be joining the team at Contra Costa County on January 4, 2009."

Listening: Crimson Sky, female-led melodic prog-metal from the UK that I found while trolling Rhapsody. So obscure they’re not even on Amazon or Wikipedia, but they sound pretty good. Also: Traening, fine, lush, dramatic, complex music by a long-gone band from Denmark (a more popular successor group is here).

pMDsoft introduces its charge capture software for the iPhone, which it says is the first to market.

A source tipped us off to the new version of Microsoft CUI Patient Journey Demonstrator. It now uses SNOMED-CT and has new ECG and angiogram markup tools. The demo script is here (warning: PDF).

The Middle East arm of Indian tech company Wipro announces its HIS Lite information system for nursing homes and small hospitals, licensed as a monthly subscription.

Maricopa Integrated Health System (AZ) gets a local newspaper write-up for its $83 million EMR project. The article splashes on a little cold water near the end when it talks about the hospital’s almost-denied Joint Commission accreditation.

Frimley Park Hospital NHS Foundation Trust in Surrey, England chooses Picis CareSuite for surgery, anesthesia, and critical care.

Leerink Swann and Nasdaq OMX hosted a healthcare IT forum earlier this week featuring Glen Tullman of Allscripts, Steve Klasko of USF, and others. You can view the Webcast after signing up here, they tell me.

Speaking of Webcasts, several people have asked about having HIStalk run one on their behalf (implicit in that, I would hope, is that I’ve got a short attention span and am therefore BS-averse, so they would have to be entertaining and useful to someone other than the company trying to sell a product or concept). Do you watch them? Is it worth my time to do those? (my presumptive answer is no, but I’m always open to counterpoints).

Amanda Adkins, a Cerner manager over its Healthe government business and 2004 campaign manager for Sen. Sam Brownback, looks to be the next chairwoman of the Kansas Republican party.

Ray Ghanbari, former CTO of Ingenix, is named VP pf strategy and products at Vital Images.

Shenandoah Valley Medical System and West Virginia University Hospitals-East are working on a health information exchange in eastern West Virginia, connecting Shenandoah’s NextGen system to WVUH’s MEDITECH systems. In the mean time, the statewide West Virginia Health Information Network will RFP its HIE framework in early 2009.

Hospital layoff: Boca Raton Community Hospital (FL) – 39 employees.

Crossflo Systems buys the assets of three-employee Iameter of Belmont, CA, which offers hospital data analysis and process improvement tools.

AHIC Successor will announce its new name right after New Year’s.

Peter Neupert of Microsoft Health Solutions Group is named to the board of the Foundation for the National Institutes of Health.

E-mail me.

HERtalk by Inga

Red Hat invests in BI vendor Jaspersoft as part of a $12.5 million round of growth equity funding.

CSC releases (warning: PDF) a pretty gloomy report that summarizes the current and upcoming impact of our economic situation. The perfect storm is brewing, they say: Medicare/Medicaid cuts, declining margins, higher interest rates for capital improvement projects, more uncompensated care, and declines in elective procedures. In response, most hospitals have initiated such cost-cutting measures as delaying/deferring construction plans and IT projects. Forty-three percent anticipate needing to lay off staff.

Take a look at this RP-7 robot by InTouch Health being piloted at military hospitals. It allows for two-way audio and video interaction between a doctor, patient, staff, or family. The units are about $250,000 and weigh about 200 lbs.

Not that I am necessarily eyelash-challenged, but a girl can never be too rich, too thin, or have too many eyelashes. Thus, good news here on a newly FDA-approved product to enhance eyelash prominence (I am happy to accept samples of LATISSE and provide my expert evaluation).

Here is a question for you HIPAA gurus. The FBI is looking over the medical records of pitcher Roger Clemens to determine if he committed perjury after denying he ever used human growth hormones or steroids. Did Clemens have to give his permission?

A JAMA study finds that people are more likely to lose weight if they have a financial incentive to do so. Well, duh!

The Health Research Institute at PricewaterhouseCoopers publishes its 2009 list of top health industries issues. The economic downtown tops the list, technology ranks #6, and IDC-10 is #9. 

IT support and service provider ITelagen is a new reseller for the Allscripts MyWay platform. That’s the old Misys MyWay for anyone not keeping up.

The Memorial Hermann Healthcare System (TX) sells off a couple of non-campus medical billings for approximately $16 million.

In San Antonio, the Army and Air Force come together to break ground on a $724 million construction and renovation project at Brooke Army Medical Center and Wilford Hall Medical Center. The unified facilities will be named the San Antonio Military Medical Centers North and South.

In another sign that the economy isn’t all bad, Ryan Cos. announces the start of a new $25 million medical office project in Auburn Hills, MI.

This last weekend, I got my Christmas tree up and the lights on, so I am settling into the holiday spirit. A friend sent me a cool Christmas CD called “A Miracle Foundation Christmas” which will get even Mr. Grinch in the mood. One hundred percent of the proceeds for this $15 CD go to support the Miracle Foundation, an organization that runs several orphanages in India and provides children with such basics as food, clothing, water, shelter, medical care, and education. So, great CD, great cause, and includes Bob Schneider singing the sexiest version of “Silver Bells” ever.

A study by actuarial company Milliman, Inc. finds that low Medicare/Medicaid reimbursements to hospitals and physicians costs consumers and employers almost $90 billion. The report claims that annual health care spending for a family of four is $1,788 higher than it would be if the government paid rates similar to private carriers. The underpayment from public programs effectively shifts the uncovered costs over to employers and consumers. Not surprisingly, several big insurance companies paid for the study.

The NY State Health Department releases $47 million to Kingston Hospital to facilitate its combining with Benedictine Hospital. The money will be used to expand the ER, to fund the new Foxhall Ambulatory Surgery Center, and to pay hospital debt.

Washington, DC is also handing out money. The city extends $51 million in medical grants for three healthcare entities to improve primary and emergency care for children and the poor.

It’s apparently not a great time for a career in healthcare if you live in Minneapolis/St. Paul. In addition to the 300 jobs eliminated by Allina Hospitals and Clinics a couple of months ago, Fairview Health Services, Park Nicollet Health Services, and North Memorial Health Care are terminating 200, 600, and 233 employees, respectively. Good luck, all.

This survey claims that 27% of American adults say they are "extremely likely or somewhat likely" to create an online personal health record to help track their medical history and medications.

Only one in five hospitals collecting data on patient injuries or deaths from medical errors shares that information with managers or others who could implement measures to address the problems. This based on an AHRQ survey of 1,600 hospital risk managers. Which begs the question: why not share that information? Wouldn’t it help everyone to get better?

An AHRQ report suggests that doctors using e-Rx were more likely to write prescriptions for lower cost drugs that lead to savings. If e-RX were used by all doctors, researchers claim the savings potential could be $3.9 million per 100,000 patients per year.

David Muntz and Lynn Harold Vogel are named CHIME’s newest Board of Trustees members. Muntz is senior VP and CIO at Baylor Health Care System (TX) and Vogel is VP/CIO at UT-MD Anderson Cancer Center (TX).

E-mail Inga.

Readers Write 12/11/08

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

Low Cost IT Hospital Improvement Project
By Downin Katmandu, CIO

Our Information Services Department is working with our hospital’s Infection Control (IC) Department to create a system that sends a real-time, proactive notification of patients that present at hospital with chief complaints that might trigger operational or policy processes.

Due to the nature of our data collection process, specific diagnosis codes are rarely available during the admission/registration process. That being the case, we use the chief complaint as our primary data field for attempting to notify the IC department of patients that might benefit from more timely intervention by the IC staff.

The basis of our pilot study is to evaluate appropriate HL7 records and segments for keywords (keyphrases) defined by the IC department. If we find one of these words/phrases we will:

1. Send the IC department an email containing a message that does not contain patient identifiable information (PHI, re: HIPAA), but it will contain the chief compliant. The IC department can use this field to prioritize their processes.
2. Send a more descriptive file to a secure folder on the network
3. The file we send will contain the following fields:

Patient Information

Message Information: A04
Patient MRN                 
Patient Account Number        
Patient Name                
Patient DOB                
Patient Sex                 

Admission Information

Admit Source                
Chief Complaint       
Admit Date Time       
Admitting Doctor      
Attending Doctor      
Current Location            
Patient Class               

A04: Patient Registration
A01: Patient Admission

The file naming convention that we are using to store the detailed reports is Lastname-AccountNumber-ccyymmdd-hhmmss.txt.

This same system is used by the Admitting Department to receive real-time notification of incomplete registrations. Our hospital information system does not require a chief complaint during admission and registration processes, but our hospital policy states that it must be entered. We use this system to help audit compliance.

Software: MIRTH Interface Engine (www.mirthproject.org – Open Source)
Hardware: Low end PC or server
HL7 Feed: Clone from ADT Feed from HIS to Laboratory System

Keyword examples: influenza, tuberculosis, lice, pertussis, diarrhea, chlamydia, strep, pinworms, measles, blood in sputum, bloody sputum.

You Can’t Give It Away
By Catherine Huddle, VP Market Development, Sevocity

While the Big Three automakers extend their tin cups on Capitol Hill, we hear that at least one of the first four communities designated by HHS to receive Electronic Health Record (EHR) funding, Louisiana, submitted only half the applications of the 100 available $58,000 grants. So, you can’t even give EHR away?

I believe that part of the problem is that most physicians didn’t know about or understand the HHS program. Our company saw the first four community initiatives as an opportunity to get in front of physicians at the most opportune time. We sent multiple mailers and made calls to hundreds of physicians in the first four communities. What we learned:

• Mail that is not payment- or insurance-related may be ignored or lost. Less than 5% of our mail was returned, but over 80% of practice managers said they never received our mailing or couldn’t find it.
• Nearly all the office managers and physicians we talked to were unaware of the HHS program. Those who had heard about it were confused and didn’t understand the difference between the EHR program and the national HHS ePrescribing initiative.
• Trying to explain the available funding and the timing was difficult. If you review HHS’s Web site, this problem is clear — the process to obtain the funding is long and convoluted and the dollars to be expected is difficult to predict.
• Physicians do not believe they will see any material funding from HHS.

So, if physicians had a clear program that helped them fund purchase of an EHR would it make a difference? I think the answer is yes — sometimes.

Just like a tax incentive encourages a would-be home owner to become a home buyer, I believe that clear, timely payments for EHR adoption would incent the physicians interested in EHR to go ahead buy EHR. Funding is such a clear motivator for the group already interested that I think it helps explain why our company is achieving record sales in a very weak economy.

The new customers I talk with tell me they purchased after months or years of looking because our solution is CCHIT-certified/complete, but only requires a small down payment and ongoing monthly payments. Their risk is minimized because their personal investment is minimized.

While there is a segment of physicians that is already motivated to buy EHR and will do so with some clear achievable financial assistance, I believe there is another segment that wouldn’t implement EHR if you gave it to them – right now. This is the segment that is downright terrified of implementing EHR. They have read and heard the horror stories of six-figure EHRs that sit unused. They are concerned the EHR will slow them down, knowing their productivity is the lifeblood of their income.

As EHRs evolve, physicians experience the benefits, and EHR vendors improve, I believe this will gradually change. As vendors, it is up to us to make this happen. We must listen to our potential customers and design affordable and easy-to-use systems.

Low Cost IT Hospital Improvement Project
By Julie

Having worked in healthcare for 20+ years in both the hospital and vendor settings, I see many opportunities for low cost IT projects. Many in the hospital setting are not utilizing the power of the Intranet to provide Web-based access to policy and procedure manuals, the automation of manual calculations (e.g. heparin protocols), and the use of paging/text messaging. Many other types of info (links to emedicine, Medline, etc) could be of great help if provided at the clinicians desktop in an easy to use format.

CEO-Express provides a desktop application that I’ve used for years both personally and in business. The generic MD-Express has potential as well, if taken private label and customized. I have no financial ties to the company, but have found it extremely useful.

Access to well-written, searchable policies and procedures is critical, with staff members (both nursing and ancillary) frequently being forced to float due to variations in patient populations and workloads. Also, with the diversity among providers today, communication can be hampered by regional and international accents and dialects. Text-based paging/messaging can be a non-obtrusive method of improving communication.

Having worked for Cerner and seeing real and planned “bleeding edge” technology only to return to a severely challenged community hospital has been extremely frustrating. Financial limitations and the staff’s lack of exposure to or fear of even 20th century technology are disturbing. And to think this organization is not that physically distant from both Partners and BIDMC is amazing! While expert rules firing off text messages to communicate critical values to providers is technology available to some, there have to be workarounds for financially challenged organizations.

Some things to think about: while most people choose a hospital perceived or documented to be the best, most progressive, well-staffed, or well-funded, the reality is that if you or a loved one is involved in an accident or suddenly falls ill, you may not have the choice of where you go for care. The nearest hospital becomes your best or only chance for survival. If that hospital is severely challenged in any way, you or your loved one may not make it. Transport to another hospital depends upon the patient’s stability. For those without the clinical knowledge and understanding to evaluate the limitations of a facility and where the best care would be for a particular condition, you are at the mercy of whoever is providing care.

News 12/10/08

From Kentomatic: "Re: ComputerWorld 100 list just published. Several notable healthcare CIOs made the list." On it: Joseph DeVenuto, Norton Healthcare; Karen Graham, Cooper University Hospital; Jeremy Meller, Marshfield Clinic; and Gregory Veltry, Denver Health & Hospital Authority. Congratulations to all.

From Wompa1: "Re: Video of healthcare seminar. Cato Institute, a libertarian organization, did an event called ‘Does America’s Health Care Sector Produce More Health?’ You can stream it in Real Video or MP3." Link. I like the Libertarian message, but it’s been totally lost as the government nationalizes entire industries of incompetent businesses and runs the printing presses 24 hours a day to create funny money to pay for it all. At least they could bring back the Civilian Conservation Corps, which built some truly inspiring national parks back in the previous depression.

From Inspector Clouseau: "Re: rumors. How safe is your site and how traceable are the reported rumors?" If you e-mail me or use the Rumor Report, I delete your message, leaving no trace (even though I also use an anonymous Yahoo account). I don’t name names and I often rewrite stuff so that nobody can recognize the writing style. Since I don’t know who the tipsters are, putting me on the stand wouldn’t help, either.

From The PACS Designer: "Re: modular data centers. Microsoft is publicizing its vision of a future style for modular data centers  With their Generation 4 concept for a data center, the need for more computer resources can be quickly set up using vans loaded with the configurations needed for each customer who wants to employ Microsoft Live solutions." Link (warning: video).  

From At the Mouse’s House: "Re: Pyxis. Cardinal announces new Pyxis MedStation 4000. Pyxis literature in the hotel drop bag at the show includes a footnote that Cardinal may not offer the MS4000 for sale. Their press release makes no such disclaimer. Is it real or a concept?" Cardinal announced the launch of Medstation 4000 Monday, but that could mean anything, especially since some of its businesses will be spun off within months. I saw no mention or pictures on Cardinal’s site, which is usually a symptom of vaporware. Here’s how to find out: (1) corner a company exec in the booth and ask who the beta site was; and (2) tell them your Omnicell contract is almost up and you need to know how quickly they could get 4000 up and running in your place. Enjoy the Midyear.

From Rogue: "Re: cheap technologies. This company has a 10-number pad with a programmable display that administers patient questionnaires. Used in drug trials but neatest app. I saw a waiting room sleep apnea questionnaire that was on the chart before the doc walked into examine the patient. Full disclosure: I know the guy who owns it, but have no financial interest." Link. I usually delete stuff like this, but it’s from a hospital guy. Look or not – I’m neutral.

From Moishesdad: "Re: Glen Tullman. I have to believe he is going to be making the trip to DC at some point. Glen has deep ties with Obama. Given the news over the weekend about the push to EMRs, Glen would be an obvious choice. And for Glen, an elegant way to wind down at MDRX." It wouldn’t surprise me either way. And while we’re on the subject, here are some of the motley crew nominated for ONCHIT by you readers: Scott Shreeve, John Glaser (that one is recent, so he must have scored points with his Being John Glaser), Orlando Portale, and Mr. HIStalk (hah!). If you’ve ever read the congressional transcripts of all those politicians ripping viciously and personally into Brailer mostly because he was GW’s boy, then you would know ONCHIT isn’t for the faint of heart.

McKesson announces (actually, the press release says "unveils," which sounds more dramatic) results of its pharmacy performance survey, then launches right into a plug for highlighted "good example" Vanderbilt, which was touted in the next paragraph as having paid McKesson to improve its performance (what a happy coincidence!) McKesson also sponsors the Most Wired nonsense, so they’ve mastered the art of making supposedly industry-serving surveys nothing more than a Trojan horse for a commercial pitch.

Thanks to John Glaser for offering to write occasionally for HIStalk. I had e-mailed him asking if he knew any good CIOs who write well who might want to contribute here (assuring him I wasn’t like a recruiter asking, "Do you know anyone who would be interested in this job?" to see if you’ll bite). He offered to share his thoughts on occasion, which is quite an honor given his stature in the industry (and his sharply honed dry sense of humor). Give him a little love by dropping a nice comment onto his piece from today so he knows he’s appreciated by someone other than me.

Let’s hope that the former junior senator from Illinois and President-elect is the apparent first completely uncorrupt Chicago politician. Illinois governor Rod Blagojevich is busted by the Feds after trying to conduct an eBay-style auction of Obama’s former Senate seat. He also reportedly considered appointing himself to the office to give him a better chance to beat corruption charges (he could still do it, in fact, since Obama’s replacement is still his choice). He also suggested, according to affidavits, that he be named HHS secretary and also tried to take away $8 million in state money from a children’s hospital because one of its executives declined to give him a $50,000 political contribution. Odds are good that he’ll be the second consecutive Illinois governor to earn federal corruption jail time. The scary thing is that people from Illinois keep voting these scumbags into office, only to watch them get hauled off.

ANCC and Cerner announce that Abington Memorial Hospital (PA) is the winner of their 2008 Magnet Prize for innovative ANCC Magnet-recognized programs. One might be struck by the irony that Abington is a showcase Eclipsys site.

A laptop containing PHI of 50 patients is stolen from the cardiology department of Salem Hospital (MA).

Allscripts CEO (and Obama campaign policy advisor) Glen Tullman says he expects the incoming administration to promote EMRs and e-prescribing, although maybe spending less than the $50 billion Obama promised while campaigning.

HHS is looking for an ONCHIT policy analyst in DC, with pay topping out at $127K. I’m disappointed, of course, that they didn’t list it on Healthcare IT Jobs, but other jobs there include Epic Rx Trainer, Account Executive – Northeast States, Texas Regional Sales Manager, and Regional Sales Director.

A Harvard study finds that e-prescribing saves money if it informs doctors of the relative costs of various pharmacologic alternatives. That’s great, provided it takes the entire cost of therapy into account (required lab monitoring, likelihood of compliance for complex dosing schedules, true cost and not just phony AWP, side effect profile, etc.) It’s odd that everybody talks about consumer transparency, but nobody’s telling doctors what drugs, labs, and treatments cost. Surely among all those crappy dot-com business models some startup could have attacked that angle.

 
Brigham and Women’s signs for Omnicell’s SinglePointe medication management system, which provides automated distribution of all meds, not just those in the dispensing cabinet. I’m hating the name, of course, since it’s both conjoined and faux-Brit (like "centre" and "grille").

Software developed in Australia for GPS-equipped Nokia and Symbian phones allows security guards and other high-risk employees (including those in healthcare) to be tracked by supervisors. it also gives then a panic button that sends their location instantly when pressed.

Fifty Kaiser medical directors will be trained by an "anger management guru" in emotional intelligence, which takes just four hours (must not be some of the docs I know). Cut up in the class and see what happens.

GE’s Wisconsin-based diagnostic equipment unit will cut costs and jobs due to declining demand for big-ticket MRIs and CT scanners.

Everybody’s applauding (their words) Obama’s post-campaign, pre-inauguration HIT warblings. You may recall the same reaction back in 2004 when President Bush ("The Google") made his quickly forgotten Vanderbilt speech that claimed an unswerving commitment to technology-driven healthcare reform ("The president went to Vanderbilt and all I got was this CCHIT.")  Politicians get elected making rhetoric-filled promises, a tiny minority of which actually amount to anything, but then again, I’m a cynic with a long memory. I hope I’m wrong.

Interesting: a hospital in Thailand aims to become a "hospital without walls" in three to five years, using technology to deliver its services anywhere. Steps so far: a wireless network, electronic medical records, and patient TVs that allow doctors to use the EMR by inserting their ID card. Coming: home monitoring and telemedicine. That could be done by any number of institutions here, of course, except for one big roadblock: getting paid for it.

Pittsburgh has few jobs that don’t involve non-profits, but never underestimate the economic power of being a highly compensated healthcare middleman. Highmark Inc. is on a hiring tear, especially for techies. Experience in writing claims denial routines and indecipherable patient communication letters preferred (sarcasm mine).

DoD starts testing of Google Health and HealthVault.

I saw this headline ("Your mouth can signal your overall health") and wasn’t thinking about the gum condition it is actually about. I was instead picturing a tonsil-baring scream or curse-laden begging for Dilaudid, which isn’t usually a good sign, either.

Oakwood Healthcare Systems (MI) freezes hiring, postpones a hospital improvement project, and delays computer upgrades. It will get really interesting if the Big Three pink slips start flying, which should be the case if they have such a crappy business model that even government oversight ("Car Czar") is more innovative and nimble. Even Beaumont is throttling back.

E-mail me.

HERtalk by Inga

From Lauryn Hill: "Re: holiday gifts. You inspired me with one of your recent posts regarding a company that is donating money to a food shelf instead of having a holiday party. We have decided to donate money to a food shelf in honor of our clients who we would normally send gifts to at this time of year. We are sending the clients a letter letting them know of the donation. Not the same as a box from Godiva, but I think this year is exceptional." Godivas are great, but nothing beats food on the table. A couple of weeks, ago a reader commented that when companies cancel/scale back their holiday parties, it’s bound to hurt the local economy and those in the hospitality industry. I can’t disagree. However, I’ll never forget the first time I helped deliver food and holiday gifts to families many years ago. My life seemed pretty rosy after seeing the one-bedroom home shared by three generations. Grandpa was sleeping on a mattress in the living room and everyone had coats on. The only heat they had was coming from the stove’s gas burners, which were set to high. So thanks, Lauryn, for helping make a difference.

Here is an oldie but a goodie. If you’re a manager worried that budget cuts and trimming the holiday festivities will negatively affect morale, try handwriting a note of appreciation to staff. That advice comes from a Harvard Business School expert, no less.

A survey conducted by CHIME, NAHIT, and AHA Solutions finds that hospitals are delaying capital projects and cutting capital and operating budgets in order to cope with the financial crisis. Though overall hospital employment is still rising, one in four hospital CIOs and CFOs claim to have recently laid off workers and/or instituted a hiring freeze. Fifty-seven percent of the respondents also indicated they are deferring IT equipment purchases and 52% are lengthening time frames for HIT implementations. More than a third of CIOs are reducing spending on outsourced IT services.

Wen Chyan, a 17-year-old Texas high school student, creates a polymer that could help prevent hospital infections. It can be used on catheters, breathing tubes, and other medical devices. His feat earned him a $100,000 college scholarship as part of the national Siemens Competition in Math, Science and Technology. What does one invent to follow that up?

The Arkansas nurse who stole accessed and disclosed a patient’s health information for personal gain is sentenced to two years probation and 100 hours of community service. The US District judge who sentenced Smith recommended that she spend some of her community service hours educating others on the consequences of violating HIPAA. Hey – maybe she’ll do a column for HIStalk!

The University of Oklahoma College of Nursing contracts with Medsphere for the OpenVista EHR solution, including implementation and support. Medsphere offers a discount as part of its Academic Incubator program, designed to help educate students in nursing and medical schools about HIT and clinical informatics.

The 105-physician Sadler Clinic (TX) selects NextGen for its EHR, enterprise practice management, patient portal, and image control solutions.

Sunquest Information Systems receives FDA clearance for its Sunquest Transfusion Manager.

Kaiser Permanente is ordered to pay a former radiologist $3.9 million for forcing him to resign after he tried to improve hospital standards. He quit after his supervisor accused him of racism and sexually harassing behavior toward a male technologist.

E-mail Inga.