Being John Glaser 12/9/08

Last week we held a meeting of the Partners External Integration Committee.

Partners has and is pursuing a wide array of clinical affiliations with other providers in its region. These providers include other academic medical centers, community hospitals, physician practices, health centers, and university clinics. Sometimes these affiliations focus on a specific area, e.g., oncology, and sometimes they are broad, reflecting the mixture of patients and conditions that are seen.

The systems support being requested by these affiliations is all over the map. Merged networks and shared desktops. Access to the other’s e-mail and phone directories. Structured clinical data being transmitted from one system to the other. PDF-like summaries being sent for particular events. Share medical logic that informs one organization when something happens (or doesn’t happen) at another organization. Reports of affiliation activity. Whole scale movement of an application from one organization into the other.

I am a big believer in the national agenda and activities that are focused on advancing interoperability. And I spend a non-trivial amount of my copious free time helping to further those initiatives.

But when I look at the external integration challenges we are facing and I compare that to the national agenda, I think it’s a lot more complex and messier out here in the wilds of Boston than moving structured test results into an electronic health record, as important as that movement is.

And the diversity of integration approaches (and each of these affiliations has their unique combination of integration needs) is compounded by the need to create governance structures for each affiliation that deal with issues such as budget, who is responsible for what pieces of the integration, policies for re-use of data, and mechanisms to enforce the policies, e.g., privacy, of one organization over the staff of the other.

We (Partners) will work our way through these issues. That’s the role of the External Integration Committee. But I suspect that other organizations are also working their way through these issues. It’s probably not a bad idea to augment the national conversation to include conversations that center on the messy reality of very diverse IT approaches to supporting clinical relationships (and patients) between multiple organizations.

This will give me more opportunities to avoid real work at Partners and visit the very fine city of Washington DC.

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

An HIT Moment with … Ralph Fargnoli

An HIT Moment with ... is a quick interview with someone we find interesting. Ralph Fargnoli is president and CEO of Beacon Partners.

Many of the big consulting players have been acquired: FCG, Superior, Healthlink, JJWILD. The smaller ones seem to be hot properties now. What does that trend mean and what kind of consolidation is happening?

I look at the consolidation as an opportunity for an increase in market share. The larger firms were acquired by what I would call the mega-sized companies, i.e. CSC, IBM, and Perot, for their particular strengths that compliment or enhance existing service lines.

With most of the large firms off the market, the mid-level and smaller firms are hot because they, too, have the people and service lines to help the mega-firms gain healthcare market share and enhance service line offerings. With the shortage of experienced healthcare IT, clinical, and operational professionals, demand has made all of us an acquisition target.

What I see as a potential conflict issue is that most of the mega-firms have products and services that provide solutions, i.e. software, hardware, offshoring, and data centers, that can be a solution or answer to a client’s challenges. So the question is: are the provider organizations getting unbiased, not self-serving, recommendations based on what else they have to sell?

How is the mix of consulting services that clients want changing?

Provider organizations want help from consulting firms that have proven success and results. With the economy in a recession and unemployment increasing, clients will want to see projects that can translate to savings and improved cash flow moved higher on the priority list.

While IT adoption can be key to these projects, IT remains a tool. Many organizations can improve their results just by reviewing their operational work flows and improving the efficiencies of patient care.

How do you see vendors and consulting firms changing their businesses to weather bad economic conditions?

Vendors will cut employees and will look to consulting firms to fill the gaps when the demands outstrip their internal resource supply. As demand for project assistance increases or slows, consulting firms will adjust their workforce size accordingly. Firms like Beacon Partners will look to have a balance of employee consultants with well-vetted contractors.

Many of those in the vendor and consulting industries affected by layoffs will end up working for provider organizations as full-time or contract employees. In addition, vendors and consulting firms will look very closely at expenditures and cut back areas that are not essential. The good companies will do everything possible to make cuts other than employees. That means conferences and all their related costs, travel, sponsorships, and charitable goodwill may be cut.  

I believe that good firms will also do a self-assessment to determine their business plan moving forward to be prepared for the turnaround and the new administration’s impact on the healthcare industry.

What healthcare changes do you think the Obama administration will make and what will healthcare and healthcare IT look like in 3-5 years?

I think that President-Elect Obama will start the discussions early in his administration for universal healthcare based on the Massachusetts model. Senator Kennedy, who is ill and is fighting for his healthcare legacy, has already set the stage for the healthcare reform debate.  

President-Elect Obama wants mandated coverage of all children, but not adults, which the Kennedy and Massachusetts model promote. So far in Massachusetts, there have been positive results with increased insurance coverage, but there are issues regarding access to primary care and the cost of the program.

Unfortunately for the Obama administration, the economy is the top priority and will need all the government funding and attention probably for most of 2009.

The President-elect does see the adoption of healthcare IT as a way to save billions of dollars and reduce medical errors. The question is does it carry enough weight and create enough jobs to be part of the stimulus package expected to be pushed through Congress in early January 2009?

In three to five years, I see universal healthcare for all, a modified payment system based on preventative measures, quality and results. I am still a cynic that Washington sees things at the 50,000 foot level and the real challenges to reducing costs and improving care are at the day-to-day operational level, of which I am not sure anyone in Washington has a grasp.

The issues that surround healthcare reform go way beyond technology adoption. Most are a huge cultural challenge, and one that cannot easily be forced to change.

What should vendor and providers be doing while they wait for economic conditions to improve?

Anyone in business who goes through these economic cycles knows that you need to survive for the turnaround. Diversity of services and products is important, and in the healthcare industry, there is still opportunity to grow and prosper.   

As with any company that has gone through an economic growth cycle, in tough times, a thorough review of internal programs and people is a must.

For the software vendors, the last thing I would do is cut my R&D. The market will return and the better prepared they are, the more they will prosper and gain market share.

On the provider side, refocus efforts on operational improvement projects that can help clients reduce costs and increase cash flow and patient access to care. If they have IT projects started or about to start, I would recommend that they keep moving forward with them because the expected benefit may not be realized until long after the go-live date, which may coincide with the economic recovery, making their organization more competitive.

Monday Morning Update 12/8/08

From Bucky DeVol: "Re: ONCHIT. The Halamka rumors are not true. He might be talking to Daschle’s people, but he’s not going to DC." He’s leading in the poll to your right, although Dan Nigrin has been written in three times (he swears someone is doing that as a joke – Inga asked him about it from an earlier reader’s comment). Other write-in nominees include Jeannie "Bill becomes a Law" Patterson (sic), Charlie McCall, and Justen Deal. You people are fun.

From Steve-O: "Re: stories you cover. How do you decide what goes in HIStalk?" I include whatever interests me as someone working in hospital IT every day, which hopefully also interests you as well. Grade me: over the past month, what useful information did you get from what sources? I pick what you can use, summarize ruthlessly, get it to you fast, and encourage reader feedback to add value. I also go after stuff that nobody else is talking about and filter out the 99% of BS "news" that nobody cares about. You’re the ultimate judge, though, since the only person I know I please 100% of the time is me.

New to your right: I installed the Google Friend Connect social networking app. It looks interesting, especially as they roll out new widgets. Give it a try if you like. 

The Charlie McCall nominee got me going, so I found this book that has his endorsement from him back in his pre-HBOC CompuServe days: "To survive and succeed in a decade of rapidly changing technologies and increasing global competition for service companies, we must strive to ‘change the rules of the game.’" Your punchline is as good as mine.

Listening: Flyleaf, sweet chick rocker warbling with a positive message (check the video of their World Vision trip to Rwanda and the bio of the lead singer). Very nice.

Carondelet St. Mary’s (AZ) goes live on Amelior EDTracker integrated with ultrasound asset tracking from Sonitor Technologies.

HSW International acquires 14-employee DailyStrength in what TechCrunch calls a "mercy acquisition". It’s one of many Rounded Arial sites that hoped to become the MySpace for health with a mixture of good intentions and profit motive, although it seems deceiving to run a VC-funded dot-com under a .org address.

I mentioned Gartner’s EMR report for the VA and DoD that said only Epic and Cerner could meet their needs. If someone has a copy of that report, please send it my way. It’s important: vendors and DoD are pushing for proprietary vendor solutions, while the VA’s unparalleled success with open source, standards-based VistA makes it wary of that approach (but the VA, apparently, is badly outnumbered). Open source is already a mere footnote to the hospital systems business and losing its VA poster child makes it irrelevant, unfortunately, even though non-adopters always cite cost as the main reason they stick with manila folders.

Tim Clover, CEO of T+ Medical, added a comment to the mention here about discontinuation its trial by the Norfolk and Norwich University Hospital for diabetes care, saying my mention was inaccurate. Which it was, at least through omission: I referenced the use of the product in general and later noted a story saying the hospital had stopped using it, but I didn’t mention that it’s being successfully used by a several others. He should have just e-mailed me, but I’ll overlook that by approving his comment that plugs the product.

Mark Tepping, CIO of Bridgeport Hospital and a 35-year member of HIMSS, tells me he’s retiring. Food for thought: his wife, a former neuro nurse, said the spouses of patients often expressed regret at waiting too long to do all the things they planned together, so he’s not making that mistake. He’ll send over an e-mail address for anyone who wants to get in touch.

 
Original Version – Google Cache

 
Current Version – Site

Curious: above are the original (from Google’s cache) and current (from the HIMSS site) versions of the HIMSS press release referring to the organization (for the first time ever, as far as I can tell) as a trade association. That troublesome phrase has been quietly expunged. I guess we still don’t know if it is or not.

We’ll be introducing some guest writers and some fun "HIT Moment With …" subjects shortly in our never-ending effort to make HIStalk more useful. It will be time for the HISsies and HIMSS-related activity before you know it! If you want to get involved in some way or have suggestions, shoot me an e-mail (although remember I work a zillion hours a day between my job and HIStalk, so I’m always in catch-up mode).

USP gets out of the medication error reporting business, sending MedMarx off to Quantros and MERP to ISMP (that’s a lot of acronyms, but if you don’t know what they mean, the story won’t interest you anyway).

Housekeeping: plunk your e-mail in the Subscribe to Updates box to your right to help knock my server offline as it tries to simultaneously deliver e-mail updates to 3,302 people at once. Make it even worse by clicking on the Email This to a Friend graphic right below it to tell a few pals about HIStalk. The Google-powered Search function roots through 5.5 years and many millions of words of HIStalk to find whatever interests you (yourself, your company, or your hated rival). Click the crude Report a Rumor to Mr. HIStalk graphic to send me confidential info anonymously.

Microsoft convenes a healthcare provider symposium in Redmond, talking up its "partner ecosystem." I’m not sure that touting a partner’s Visio add-in for analyzing patient flow shows a lot of innovation and leadership, but I wasn’t at the meeting.

An AHRQ-funded article in Annals of Emergency Medicine doesn’t inspire a lot of confidence. Respondents from 65 hospitals reported insufficient space, too many patients to care for properly, and inadequate access to computers and electronic medical records (I can only see the summary since I don’t subscribe).

Hospital layoffs: Yakima Regional Medical and Cardiac Center (WA), Carlisle Regional Medical Center (PA), University of Toledo Medical Center (OH).

Nurses at Lawrence Memorial Hospital (MA) are doing a study to see if music calms patients waiting for endoscopies. They’re using Internet streaming radio from Pandora to choose music that the patient likes instead of the usual Muzak. I suggest HIStalk Radio, although patients might clench up from some of the hardcore tunes (playing now: Union Carbide Productions, Noir Desir, and the Blue Stingrays).

Civilians treated at the Yokota Air Base hospital in Japan weren’t billed because the Coding Compliance Editor software wasn’t set to send bills without human intervention.

London hospitals want NHS to compensate them for unplanned legacy system maintenance needed because NPfIT is years behind.

Nuance announces Q4 results: revenue up 41%, EPS $0.09 vs. -$0.02. Nice. A conference call comment supports what I’ve been saying about hospitals insisting on non-capital ways of buying systems (or, more precisely, expected system benefits): "We are finding customers, even some of our larger hospital customers, who express preference for a subscription pricing or a transaction-based pricing, a form of leasing in effect, rather than an upfront capital payment. As we said in the prepared comments, we benefit from that over time. It’s economically superior to us over time but it does have a different revenue stream over the course of this year." Everybody benefits except those companies on too shaky financial ground to make the transition to stretched-out payments, so subscription pricing will definitely be used by big vendors to outsell smaller ones whose products may be superior. You have been warned.

Vendor Deals and Announcements

• CPSI announces its 100^th sale of its PACS solution ImageLink.
• Deb Bradley is D2Hawkeye’s new VP, Chief Client Solution Executive. Bradley has spent the last 13 years at Trizetto, serving as VP of Product Management, VP of Sales Support, and Director of Care Management roles.
• Maxell Medical Imaging (NY) selects Aspyra’s Access RAD RIS/PACS solution.
• Phoenix-based DiCOM grid, Inc. announces that Michael V. Wall is its new CEO. Wall previous worked for Intel, Cray Research, and IBM.
• Children’s Hospital of Philadelphia contracts with Acuo Technologies for a new archiving solution that will become the basis of CHOP’s medical imaging management platform.
• gMed releases (warning: PDF) a gastro-specific EMR named gGastro.
• Nuance reveals a new on-demand solution named Veriphy 3.0, designed to help healthcare provider organizations communicate test results. Nuance also announces it has integrated its RadWhere radiology application with DeJarnette Research System’s PACSware Intelligent Router product.
• Mediware’s blood and medication management systems will be installed across 40 South African hospitals as part of an agreement with the Provincial Government of the Western Cape.
• Associated Cardiovascular Associates (NJ) picks Sage Software Healthcare’s Intergy EHR/PM solution for its 38 doctor practice.
• VMware is now successfully deployed at St. Vicent Catholic Medical Centers of New York.
• Emdeon premieres a new US Healthcare Efficiency Index to monitor healthcare business efficiency as the industry moves away from paper. Phase 1 of the Index estimates the total annual savings potential to be nearly $30 billion for medical claims-related transactions. The Index also suggests that the direct deposit of medical payments could provide an $11 billion annual savings.
• Consulting firm HighPoint Solutions adds a new Quality and Compliance practice to address the increased regulatory requirements and related information technology issues in the life sciences industry.
• Eric Silfen, MD is named the new (and first) chief medical officer and VP of Philips Healthcare. Silfen was previously in the department of biomedical informatics research at Philips Research North America, and also spent time working for HCA.
• Orion Health’s Rhapsody integration engine will be employed for the SouthEast Alaska Regional Health Consortium. Rhapsody will link healthcare information across 18 remote Alaska Native communities.
• The Hawaii Medical Service Association is launching a new online care service that will connect patients and physicians via the Internet or telephone. The cost of a visit will be $10 for members or $45 for nonmembers.
• Baptist Health (AR) claims to have realized over $1 million in savings since implementing Thomson Reuters’ Clinical Xpert CareFocus. The CareFocus solution has improved pharmacist efficiency and increased documented clinical interventions by about 30%.
• The state of New Jersey is bailing out six financially distressed NJ hospitals where access to health care services is threatened. A total of $44 million will be distributed to provide care for the uninsured and low-income residents. About half of the money went to Jersey City Medical Center.
• MedCurrent Corporation introduces a new Web-based, real-time insurance eligibility verification application that is being targeted to radiology practices. Currently the MedCurrent Verify program will connect with over 350 insurers.
• Medical Imaging Northwest (WA) is teaming up with Compressus to implement a single enterprise-wide worklist solution that integrates digital imaging and data management systems at its multiple sites.

E-mail me.

News 12/5/08

From Cheryl: "Re: low-cost IT projects. I have been starving to hear stories like these! Leonard and Larry shared common problems, not hospital-specific issues. I am always on the lookout for how others are doing things better, especially solutions that can become best practices. To discover how these guys solved solved problems with easy-to-implement, cost effective solutions makes my little heart sing. Thanks for a truly valuable read! I want more! Cheers to Leonard and Larry. My new BFFs." If you, too, want to be Cheryl’s BFF (and who doesn’t?) then e-mail me your own small-project success stories. We may focus on big-ticket, multi-year endeavors most of the time, but somebody’s job could be saved by executing a quick and dirty project whose idea came from here, so give it up.

From Barney Chavous: "Re: BlackBerry improvement project. Can you provide contact information for Leonard Kravitz?" Ordinarily, no — I always provide a fake name unless someone asks specifically that I run their real name. In this case, Leonard (Lenny Kravitz, get it?) says it’s OK since a couple of folks asked: he’s Chris O’Connor, MD, FRCPC, Director of Medical Informatics, Trillium Health Centre, Mississauga, Ontario. He’s also involved with Open Source Order Sets, a project to roll out evidence-based content in Canada shared among contributors (great idea). You can e-mail him there. I found a BlackBerry writeup about the project he mentioned, which included his picture above. They did a Q&A and I liked this from him (it’s from 2006): "It is now remarkable to me, that in 2006, people are still using receive-only numeric pagers. It is the worst possible communication tool one can use, and yet it is the norm in medicine today. I still remember Pager Liberation Day: the day I released my pager and it sailed down to the bottom of the garbage pail and I never saw it again. That was fantastic and I have never looked back."

From OK in UK: "Re: iSoft. Any idea what happened to Paul Richards?" Link. Richards is replaced as iSoft’s managing director of the UK and Ireland by Adrian Stevens of Agfa. I don’t know where he went.

From Jade East: "Re: e-prescribing bonus. How did you guys come up with a maximum incentive of $1,600 per year? I cannot find anything that shows a capped amount." We actually said "average," not "maximum." That number has been reported in several articles, including the one we referenced that quoted a CMS administrator directly.

From Katrina Waves: "Re: insurance requiring that providers pay for claims appeals. Do you know of any documentation to substantiate this?" The reader did not provide a link, but being an intrepid Internet sleuth, I came up with this BCBS of NC document (warning: PDF – relevant part above). Want to know why they’re doing it? Because they can. 

From H.I. McDonough: "Re: newsletter editorial. That was a great column. I wonder if anybody got it?" I wrote a particularly manic guest editorial this week for Inside Healthcare Computing called Camping Out for a Cerner Black Friday Door-Buster Special: Mr. HIStalk’s Plan to Stimulate the HIT Economy By Encouraging Unrestrained Holiday Season Greed, in which I advocated an HIT Black Friday sale (with major sarcasm). Above is an amuse-bouche clearly illlustrating my run-on sentence enthusiasm. Eat my literary dust, Pliny the Elder.

I have to learn to quit shooting off my mouth now that I have more readers. A nice person from Vanderbilt (you will be meeting him soon in "An HIT Moment with …") apologized that their article about moving from an HIT-rich environment to the technological boondocks seemed smug (my word). A good point: the article actually argued that the high-tech hospital has the responsibility to teach its trainees to work with more common low-tech systems like paper charts. I asked him to be our guest in a mini-interview and he’s up for it, so stay tuned. That’s pretty cool, especially instead of apologizing (a sly move!) he could have ripped me a new one for my cheekiness, although if he reads here, he’s probably used to that.

I ran a rumor of a possible ONCHIT candidate, so now you get a chance to influence Tom Daschle’s decision (I’m sure he reads HIStalk religiously and appreciates the counsel). A new reader-suggested poll to your right asks who should follow Brailer and Kolodner in the government’s big HIT chair. Vote for one or write in your own choice since that’s what democracy is all about.

Dann, the keeper of the HIStalk Fan Club on LinkedIn, tells me that over 400 folks have signed up. I see several familiar names and faces as I scroll through the list, so hello to everybody there. LinkedIn is doing some cool things, providing a discussion forum within groups and offering tie-ins to other apps (I’ve added the HIStalk RSS to my profile so you can see story excerpts right from there). I was also trying out a cool UK-based collaboration / social networking app called Huddle when I noticed that it, too, can be connected into LinkedIn as a widget. I was thinking about doing some kind of private workspace for groups (fan club members, CIOs, sponsors – obviously I’m looking for an excuse to play around and find a problem for the Huddle solution since it looks like fun). As always, Inga and I will approve all connection requests since LinkedIn is now a competitive sport, much like getting your high school yearbook signed by the cool kids or at least bunches of the not-so-cool ones. I see some of the magazines have started their own fan clubs (losers!) but I’m pleased that HIStalk’s did it on their own (we’re kind of a self-starting crowd). Thanks to everyone involved, especially Dann.

This is cool: Josh Nesbit (that’s him above on the right), a Stanford student of international health and bioethics, sets up a telemedicine-like project for a hospital in Malawi, where Internet connectivity and even electricity is uncommon. He used a freeware SMS messaging application to connect the hospital with volunteer health workers, often poverty-stricken locals themselves, who were given prepaid cell phones to exchange information with the hospital. He’s hoping to add solar panel charging for the phones and the ability to send images. Other researchers are porting the application to the Google Android mobile platform, which would eliminate the cost of the laptop. His blog (click his name above) has specific details about the types of messages being sent and the impact on patients. Bravo.

Speaking of texting: a physician volunteer in the Congo performs a life-saving arm amputation on a 16-year-old while following text message instructions sent to him by a London colleague.

Booz Allen has declared the need for the VA to modernize it and work with DoD on common systems, according to a report uncovered by Nextgov. Interesting: Gartner looked at EMR systems and found that only those from Cerner and Epic would meet their requirements. The price tag (read carefully because you’re the one paying): $1.4 to $5.2 billion over six to 17 years.

The State of New York is requiring that new hospital clinical systems connect to the Statewide Health Information Network, meaning that Mount Sinai has to run its application to spend $34 million on Epic by that group next week.

Florida Hospital (FL, duh) will use RFID to track implantable medical devices.

Quinnipiac University researchers will study whether the use of integrated sensors in the Healthsense eNeighbor system (movement detection, door sensors, bed and toilet sensors) reduces hospitalization and improves independence.

St. Vincent Indianapolis Hospital (IN) will use per review software from startup Acesis.

Some healthcare IT folks (unnamed) met with Amazon and other vendors at Harvard Medical School this week to talk about cloud computing.

We already told you this on August 1, but Perot Systems officially announces that it will roll out VistA to two hospitals and a clinic in Jordan.

Eleven children with cancer in South Australia were overdosed on etoposide due to a computer error that first arose in January 2005 and was just now discovered. The kids are all OK.

A UK hospital cancels blood tests this week due to computer problems from the Conficker worm, which exploits a Microsoft server service vulnerability.

Cleveland Clinic has been panned hard in the past for its doctors (starting with its CEO) making big bucks from vendors whose products they use on patients. They aren’t saying that practice will stop, but its online physician roster will list each doctor’s financial disclosures (only companies, not amounts, but they claim they’ll add that later, maybe). The CEO’s disclosures are above. Every vendor should do what a couple of drug companies started: post every payment they make to doctors online. If it’s such an above-board practice, surely those docs won’t mind everybody knowing.

Scottish patients, including some minor celebrities, get a letter from a hospital advising them that a doctor may have inappropriately looked at their electronic medical records. The police are involved.

Detroit’s major employers are begging for handouts and threatening to take the economy down with them (much of that due to out-of-control healthcare costs), but Henry Ford’s suburban hospital — all $360 million of it — will offer walking trails and cooking lessons when finished. The CEO has zero healthcare experience, having worked at Ritz-Carlton. It’s located safely away from downtown, out where private insurance grows tall. As a hospital marketing VP I used to know always said, "We serve all, but market to few."

An interesting study: the performance of radiologists seems to improve if they’re given a photo of the patient along with the pics of their innards. They put the pictures right into the PACS.

SunTrust announces its eligibility and claims system for physician offices and hospitals.

Ohio State University’s medical school will give every student an iPod touch loaded with reference materials.

Kaiser Permanente gets a writeup for its Oakland, CA innovation center, which evaluates healthcare technology offerings from Intel, Motion, and others. The only person quoted is a doctor, but hopefully they have other kinds of professionals doing the evaluations as well.

E-mail me.

HERtalk by Inga

I don’t know much about the world of brokering domain names, but it sounds like if you are savvy and able to secure a name before anyone else thinks it’s a great idea, the business could be profitable. HealthCareSolutions.com just sold for $55,000 and HIPAA.com went for $23,500. Curiously, www.inga.com seems to be already taken.

Glen and Trish Tullman donate $1 million to the Juvenile Diabetes Research Foundation to accelerate the development of an artificial pancreas. Their son and niece both have Type 1 diabetes. They made a similar donation to the organization in 2006.

AT&T announces plans to cut about 12,000 jobs, which represents about 4% of the company’s total workforce. Capital expenditures for 2009 will also be reduced from the 2008 levels. The company’s wireless, video, and broadband business, however, will continue to add clients to meet growing demand.

A lawsuit is filed on behalf of the Texas Faculty Association, asking that the UT System’s decision to approve massive UTMB layoffs be declared void. The lawsuit claims the decision to lay off 3,800 people violated the Texas Open Meeting Acts because the regents conducted the discussions behind closed doors. The lawsuit also questions why the UT regents purchased only $100 million worth of flood insurance and why the UT System can’t re-allocate surplus funds to prevent the layoffs.

InteGreat signs a 14-year ASP agreement with the West Virginia HealthCare Alliance to provide an EMR for its 30 network physicians.

Medical transcription provider MedQuist will pay $6.6 million to settle whistle-blower lawsuits, accused of knowingly overbilling federal clients like the VA and DOD.

Officials with the Louisiana Health Care Quality Forum claim that recent hurricanes have hampered efforts to recruit primary care physicians for a federally funded EHR demonstration project. The project has the potential to bring the state $29 million for physician practices to defray EHR costs. During the first four weeks of the application process, only 50 doctors came forward.

A survey of healthcare workers at 102 nonprofit hospitals finds that 67% of the respondents believe there is a link between disruptive physician behavior and medical mistakes. Eighteen claimed they knew of a mistake that occurred because of an obnoxious doctor. In addition, the non-profit Institute for Safe Medication Practices found that 40% of hospital staff members claimed to have been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7 percent said they contributed to a medication error.

WebMD repurchases 640,930 shares of its common stock for $12.8 million.

Sage announces its fiscal year earnings, reporting a 12% increase in revenues and a 6% increase in organic revenue growth — excluding the healthcare division, which saw an 11% revenue decline. When the healthcare’s group results were included, organic revenue growth was only 3%. On the bright side, the company says the North American management team is now in place and driving operational efficiencies.

RSNA names Gary J. Becker, MD its new president. Becker is a professor of vascular and interventional radiology at the University of AZ college of medicine.

E-mail Inga.

Readers Write 12/4/08

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. Use your real or phony name (your choice – we’ll substitute a phony one unless you ask specifically to be named). Submissions are subject to approval and become the property of HIStalk.

Low Cost IT Hospital Improvement Project
By Leonard Kravitz, Informatics Director

We gave Blackberrys to all members our interdisciplinary ICU  team — physicians, nurses, social work, pharmacy, dietician, etc. It was a total of 39 devices. Most staff sign up for a device when they start their shift, although some have their own device (like the ICU director and physicians). These are text-only, no voice.

They provided a huge improvement in communication efficiency. There was no more wasted time trying to find the physician or nursing trying to find pharmacy about a missing med. The bottom line is faster, more efficient care for patients and reduced errors.

The total cost is around $17K. The only reason it is that much is because we are running the devices over a cell network. We will be moving to VoIP over Wi-Fi in the next year and costs should fall to $5K/year.

What is good about this is that it’s technology that works and makes a big difference. Text-only is not disruptive, it has a time-stamped, legible message, it can be sent to many people at once, and the pagers can receive alerts from our clinical system.

The key to success is giving devices to everyone on the team, which increases the value of the network.

Low Cost IT Hospital Improvement Project
By Larry Spannel, Hospital CIO

We discovered a significant opportunity to improve customer service for our nursing and clinical staff. Like everyone else, if a problem occurred with their computer equipment, the nursing staff was expected to call the Help Desk and arrange for service. We found that this rarely happened.

When a nurse or physician had a problem with a workstation, they would leave it and find one that worked. They never had time to call and report the broken device. It was not unusual for a nursing unit to have a large number of its workstations out of service before IT was aware of the problem. In our heavily automated clinical environment, this was a real concern.

We asked our Help Desk and Field Services staff to think of a better way to ensure that all of our nursing unit workstations were available all of the time. They developed an equipment rounding plan where our field services techs visit every nursing station, every weekday. The techs inspect every workstation and printer, and fix any problems they find.

We piloted the rounding program for a couple of weeks to see if it would be effective. We were amazed at the reception we received from the clinical staff. They loved the fact that they did not have to worry about equipment availability anymore, and that they were no longer tied up making calls to the Help Desk. Where once our clinicians had a very low regard for IT support, the techs are now welcomed and appreciated for their work.

The program was so successful that we quickly implemented it for our emergency department and all of our nursing units. The program is cited as an example of excellent customer service throughout the hospital. It was a zero-cost change since we rearranged the work of our existing staff to do the rounding.

The Impact of Technology on Diabetes
By Marc Winchester, President
Digital Healthcare Inc.

Diabetes is a pervasive chronic disease that affects the coronary, neurological, renal and vision systems of over 22 million Americans with an additional 50 million termed as "pre-diabetic". If left untreated, it will remain the leading cause of lower limb amputations, end stage kidney failure, and blindness in the working age population. In terms of economic impact, the disease has no equal. Conservative estimates indicate that the annual cost of diabetes is now well over $100 million.

Technology has a critical part to play in the assessment of risk, diagnosis, treatment, and management of the disease. In order to manage the condition, technology needs to be pervasive across the care continuum.  

It may surprise some to learn that diabetes can be prevented and, in the early stages, it can be reversed. This requires lifestyle change and increased awareness among the high risk population group. The role of technology in the first instance is one of supporting public health communications. Patients need to have access to simple risk calculators that can predict early onset; Personal Health records need to be easy to use and easily accessible. However, it is important to realize that those at most risk tend to also be the most technology-averse. Until this issue is addressed, technology won’t have an impact on the care process until after a patient’s initial diagnosis.

When a patient presents to the primary care physician with diabetic symptoms, a series of tests is performed to confirm diagnosis. Most medical record systems are more than capable of storing the information. However medical record systems must identify those at risk through general health, genetic, and lifestyle data. A real advantage would be a system that assesses risk and red flags patients before they have full-blown diabetes.

As the disease progresses, physicians are left with a series of options to arrest its progress through pharmacological intervention, lifestyle advice, and ultimately, referral to secondary specialists, such as endocrinologists or ophthalmologists. Efficient referrals must aim to manage the patient through a defined "care pathway," but patients rarely comply with such instructions. Technology should integrate contact management systems to ensure that patients are "nagged" by whatever means to follow up on their prescribed care plan.

In order for technology to have a real impact on chronic conditions, it must integrate diverse components into a workflow similar to that used in manufacturing processes. At Digital Healthcare, we have found the way to achieve this is to place detection technology in the primary care setting and have an automated pathway send high resolution images and data to a clinical specialist. The specialist systematically assesses the risk and recommends the next treatment option, which is also defined in the pathway. So far, we have saved the sight of thousands of people around the world using this approach.

Until we see the convergence of technology with public health policy, evidence-based medicine, and uniform reimbursement strategies, simple disconnects will continue to contribute to many more deaths and the continuing rise in health insurance premiums.

Clinical Software Review -  Microsoft CUI – Secondary Care
By The PACS Designer

The Microsoft Common User Interface has been released for review and user input based on Microsoft’s Silverlight platform.  We will be reviewing Secondary Care for Brian Johnson.

To proceed with this lesson you need to have Microsoft’s Silverlight platform installed on your system.

We are going to launch the Patient Journey Demonstration. Once you are on the Patient Journey Demonstration page, you are going to be navigating to the Secondary Care section, so click the "Launch Button" under "Secondary Care". Follow the steps below to learn the best method for navigating:

1. Brian Johnson has been sent to the ECG Laboratory for a stress test. Brian is in Exercise Test Room One. While waiting for a message to appear on your screen, click "Molecule triggers allergy attack" in the "Health News box" to view the article, then close it. When the message pops up for viewing his test results, click the "View LIVE ECG" button in the message.
2. Next, you will see Brian’s ECG images. The message requested that you look at V4, V5, and V6. Click the down arrow to the right of "Select a lead" then click "V4" to view the ECG image.
3. Next, click the "white box" below "V4" to view "V5". Then click "white box" again below "V5" to view "V6". When done, click "V6" to return to all ECG images.
4. At the left under "Chest Pain Clinic" click Brian Johnson’s "View Results" to see the data.
5. Move your pointer over "Stage 4" that is on your extreme left and click the "Red Box" in the upper right corner to expand it. Next, move your pointer up to the numbers " 0 thru S" in the upper right of the screen and click the second "Red 4".  Again, click the small "Red Box" to expand it and when done viewing it click again to return.
6. Next, click "Known Allergies" to see Brian’s allergies. When you are done, click the "Up Arrow" to the right to close.
7. Click "Search Care Pathway Library" in the lower right hand corner, then click "Angiogram/Angioplasty" to see other aspects of Brian’s health record.
8. At the bottom of the screen, click "Review results" in box marked "Angiogram" to see Brian’s angiogram. Click the "Play Button" to run the viewer. Next, on the left side of screen under "Select Run," click the down arrow and then click "LAO 30 Cranial 26" to view the 3D image, then use your pointer to move the 3D to the left and right for slower viewing.
9. For the last step in this review, click the "Show Guide" in the upper right corner to view all the capabilities of the online viewer. The "Show Guide" can be accessed for each viewing screen for more information by clicking "1. Registrar landing page" through "5. Angiogram" for this Microsoft CUI. Close "Show Guide" when done.

This completes the third and last review of the Microsoft Common User Interface (previous lessons are here and here). Please let us know your feelings about this new concept from Microsoft.

News 12/3/08

From Former Siemens Employee: "Re: CEO. Healthcare CEO abruptly resigned last Friday AM. Announced at RSNA yesterday." Link. Jim Reid-Anderson lasted only seven months to the day, having replaced Erich Reinhardt, who resigned April 30 after new compliance issues broadened the apparent scope of the company’s multi-billion dollar bribery problems.

From The PACS Designer: "Re: open source for virtualization. The virtualization space has been supported by proprietary software from mainly IBM and VMware. Now, open source Linux developers have added a Kernel Virtual Machine or KVM to compete in the virtual marketplace. HIStalk sponsor Red Hat has added KVM to their version of Linux. Michael Ferris, Red Hat’s director of product strategy, had this to say in an InformationWeek article: ‘adding KVM to Red Hat Enterprise Linux will reach new customers who might not otherwise have considered Red Hat as their virtualization vendor.’" Link.

Listening: the new reissue of Murmur, the debut album of R.E.M. from 1983. I keep forgetting how much I like them. So much so that went to this year’s Accelerate and it sounds fine, too. Thinking man’s (or woman’s) alt-rock. I’m air-drumming and making intense-looking facial gestures as I play Cuyahoga from Life’s Rich Pageant, pretending to be Keith Moon except with zero rhythmicity.

Tomorrow is Readers Write day, so it’s not to late to send me over something.

Health Level Seven and The Health Story Project announce an implementation guide for making information from narrative radiology reports available to EMRs.

Hospitalist application vendor Ingenious Med brings on Hart Williford as CEO. He was previously with Memorial Health of Savannah.

Jobs: Regional Sales Director, VP Sales, Epic Security Consultant.

A reader sent over an e-prescribing article featuring Glen Tullman of Allscripts from Ode Magazine, whose self-described audience is "intelligent optimists."

Someone passed along a juicy but totally unsubstantiated rumor about Rob Kolodner’s potential replacement at ONCHIT (it’s a political appointee job, as you probably know). The job seeker being speculated is a Man in Black (no, not Johnny Cash). It would be a big pay cut, but a giant ego boost for the Harmonizer. Sure, it’s probably totally off the wall, but fun.

New York Presbyterian Hospital suspends an employee for failing to report that NFL star and bonehead (was that redundant?) Plaxico Burress sought treatment after shooting himself in the leg while carrying an illegal weapon in a crowded nightclub. The hospital itself is also under investigation for failing to report the shooting to police. Mayor Bloomberg makes it clear he wants Burress behind bars since there’s an automatic 3 1/2 year penalty for illegally carrying a loaded gun. "It’s pretty hard to argue the guy didn’t have a gun and it wasn’t loaded. You’ve got bullet holes in and out to show that it was there." He also said, "It’s a chargeable offense, and I think that the district attorney should certainly go after the management of this hospital." Burress just signed a five-year, $35 million contract in September, but the Giants realized he was a flake and made most of the money contingent on his nearly non-existent good behavior.

I’ve been saying all along that hospitals are struggling with reduced occupancy, investment losses, and uncompensated care, all sure to hit IT. The feel-good publications pretend it’s business as usual, but here’s the clincher if you needed one: 30,000-employee Intermountain Healthcare stops its employee 401K matching for at least a year and scales back its holiday parties. Hospitals can save money in many ways (shouldn’t the lipsticked Centricity be doing that for them?) so I would have to suspect that this is a way to create voluntary attrition.

Nebraska Medical Center signs for McKesson Horizon PACS.

Intellect Resources shared the results (warning: PDF) of its survey on the economy’s impact on healthcare IT. Lots of companies are reducing headcount or freezing hiring as we’ve been saying. In the mean time, IR has some pretty sweet-sounding positions open.

A 32-year former employee of UCLA Medical Center pleads guilty to selling Farrah Fawcett’s medical records to the National Enquirer. Farrah should be suing the Enquirer if you ask me. You have to go after demand, not supply.

Snelling Executive Search, which did the "101 Healthcare IT Marketing Ideas" booklet with Chuck Christian that I mentioned in March, will be doing a HIMSS presentation in Chicago about CIO job changes, voluntary and otherwise. Contact VP Steve Bennett if you’d be willing to chat about the topic from experience (or if you’d like a free copy of the booklet, which I have – it’s great). They’re also turning the IT marketing booklet into a full-fledged book that HIMSS will publish, so if you have ideas or case studies, Steve’s your guy there, too.

Results of a new Deloitte survey show that the CIO role is not well defined, nobody knows what they’re supposed to be doing, and CIOs themselves are equally confused. The conclusion is that there’s no one-size-fits-all CIO and their ideal function is to make IT so innate to business process that their job becomes obsolete, freeing them up to move on to other senior management roles.

I’m still marveling that HIMSS called itself a "trade association" of 350 corporations in a press release, apparently for the first time. At least that’s an honest explanation for all the lobbying it does (I admit I never got Advocacy Day – why would provider people like me march on Washington to bug low-ranking political aides to spend more taxpayer dollars on healthcare IT?) As I always say, it’s Ladies Drink Free: we ladies (members) get liquored up for nearly nothing while the men (vendors) pay full price just to be around in our potential moment of weakness. I like both providers and vendors, but being represented by the same group just seems strange, especially if you’re watching from the sidelines as a patient (would you want your doctor joining the Pharmaceutical Research and Manufacturers of America and chumming up with drug companies for their marketing and lobbying work?)

Cincinnati Children’s chooses AMICAS PACS.

The Hartford business paper highlights (their photo above) bed management software vendor Premise, now running in five of the country’s eight top hospitals listed in US News & World Report.

I forgot to extend my usual best wishes to those heading off to RSNA (is it a trade association?) I hope your travels were pleasant and the subfreezing weather is gone by April when the rest of us get there to enjoy our winter flashback. I see O’Hare got buried in snow Sunday and flights were messed up all over the country as a result (the bad news: it’s supposed to snow every day with highs Thursday and Friday of 24 and 25, respectively. That’s Fahrenheit, unfortunately).

Speaking of Chicago, I ran across this by accident: Bistro HIMSS, a chance to wildly overpay for union-produced concession food right on the McCormick Place show floor. Actually, $23 a head to keep prospects captive in the hall isn’t bad, so make your reservations now. Maybe I’ll buy an HIStalk table and hold court.

Payer software vendor Medecision names Scott Storrer, formerly of Cardinal Health, as president/COO and James Adamek as SVP of sales.

Who says doctors can’t be skilled at using a computer? This British surgeon is accused by six female patients of fondling their breasts, one of whom claimed he did so while working the computer with the other hand and breathing heavily all the while.

Glyn Hayes, a British doctor and "undisputed elder statement of primary care informatics" is named an Honorary Fellow of the British Computer Society.

The Montgomery paper writes a nice article on the DoD-VA integration project, describing a real-life example of its use in a veteran’s treatment.

Vanderbilt rather smugly announces the results of their survey that describes the tragic disappointment and disillusionment doctors experience when they leave the technical nirvana of Vandy ("Health Information Technology-Rich Training Environment") and have to deal with "less modern facilities," i.e. the non-Vandy, non-Ivory Tower real world. I try to like them, but they make it so hard. It doesn’t matter since they’re obviously in love with the mirror.

Hospital layoffs: Portsmouth Regional Hospital (8 employees); Oregon Health & Science University (coming soon); Fairfield Medical Center (20-25 employees); Pinnacle Hospital (21 employees). if yours hasn’t, it will.

Interesting: a UK hospital uses BlackBerry devices to alert nurses when recurring patients are admitted, bringing nurses together who know the patient’s background. Orion Health helped develop it. It decreased length of stay: lung cancer patients from eight to six, lower GI from nine and a half to five. It’s also being used for patients with MRSA or C.diff.

Nuance announces Veriphy 3.0 for verified notification of critical lab results.

iSOFT wins a big pharmacy management system contract with Western Australian Department of Health.

E-mail me.

HERtalk by Inga

Red Hat donates cash for 800,000 meals this holiday season rather than host a holiday bash for employees. In addition, the employees are running canned food drives and collected coats for the needy. Well done.

SCI Solutions closes its fiscal year with 43 new clients across 63 hospitals, bringing its customer total to 300.

Virtual Radiologic also reaches a customer milestone with the recent live of its 1000th medical facility. I also see that Virtual Radiologic is now partnering with Brazil teleradiology provider Pro-Laudo.

Poudre Valley Health System (CO) is named the 2008 Malcolm Baldrige National Quality Award winner in healthcare, based on high scores in clinical quality while effectively controlling costs (in the 99th percentile); patient loyalty (in the top 1% in the US); and employee satisfaction (top 3%, plus top 1% for physicians). Poudre Valley was also named the top hospital for nursing quality by the American Nurses Credentialing Center. Pretty darned impressive.

Israel’s Clarit Health Services commits $25 million for Carestream Health’s RIS/PACS solution.

Sentillion appoints Colin Wicks as its UK Regional Sales Manager. He previously worked for ICL (now Fujitsu Systems) as well as various identity and access management VARs.

Here’s a pretty disappointing statistic: only 2% of valid US prescriptions are being sent electronically to pharmacies. Will Medicare’s upcoming 2% bonus program (an average of $1,600/year per doctor) make a significant impact, or will most doctors still resist?

An Archives of Internal Medicine study indicates that physicians with EHRs pay less for malpractice settlements.

Fujifilm Medical Systems acquires its first proprietary RIS system with its purchase of Empiric Systems.

Ten percent of physicians who vaccinate privately insured children may discontinue that service because they lose money on it.

Outpatient facilities are not adopting PACS as fast at inpatient facilities, according to a new KLAS report. In addition, community-based hospitals have lower adoption rates than larger independent or IDN hospitals. Lack of finances seems to be the primary barrier.

Christmas is just three weeks away (wow!) and HIMSS a mere 17 weeks (it seems like we were just in Orlando). We already have nine companies lined up for HIStech Reports, but still have a few openings for companies that want us to do an in-depth executive interview. You can e-mail me.

I am not sure if these two announcements are related, but, Streamline Health Solutions names (warning: PDF) an interim CFO, then two days later says its Q3 results will be delayed “to provide additional time for the completion of necessary audit work and to finalize the results.” Donald Vick Jr. was named interim CFO to replace Paul Bridge, Jr., who resigned last month after learning his employment contract would not be renewed. Streamline’s financials will be revealed December 15th.

I feel kind of bad about this story, but in a twisted way it makes me feel marginally better about my 401K’s declining value. In August, Nuance offered speech recognition software vendor Zi Corporation an $.80/share buyout. Zi rejected the bid, claiming the offer was too low. The stock price at that time was about $.70/share. Like the rest of the market, Zi’s stock price has plummeted and today closed at $.34/share. Nuance has made a new offer, offering an all-cash deal equal to about half the original bid. Zi’s board of directors must decide this month whether to accept or reject the deal.

I was a little late getting my news to Mr. H tonight, in part because a friend of mine made me take a quick ride on his vintage Vespa. I feel incredibly hip.

E-mail Inga.

CIO Unplugged – 12/1/08

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

Does IT Matter…Five Years Later?
By Ed Marx

In Nicholas Carr’s 2003 opinion piece for the Harvard Business Review, he threw a grenade on the IT dinner table. Carr argued vehemently that IT no longer mattered. He leveraged this high profile editorial into a best-selling, thought-provoking book in 2004, Does IT Matter? Carr’s central argument states that the strategic importance of IT has diminished over time; that IT has become nothing more than a commodity providing little competitive advantage. Consequently, according to Carr, companies should rethink their investment in IT. He also laid out his agenda for IT management, examining implications for business strategy and organization. Carr’s thesis was both embraced and vilified.

Written in the IT boom years’ post-internet “bubble,” does the economic downturn change the game?

As I observe and research, I see fatalists and opportunists at odds. The fatalist has accepted Carr’s pronouncement as fact and has become complacent, allowing the administration to marginalize IT. Opportunists, on the other hand, see the circumstances as the tipping point to reinforce, or for the first time, position IT as strategic.

I interpret Carr’s compelling arguments as a call to action. During these dour economic times, IT has a heroic opportunity to be a catalyst for prosperity, a key differentiator. This means I cannot sit back and accept current fate, allowing IT to dissolve into a simplistic commodity. To advance my organization, I hunt for and seize strategic opportunities. The economy will not determine my destiny if I choose to leverage it as a clarion call and make every effort to expand our services while lowering costs.

I have my department reaching out to select vendors and changing our value proposition from transactional to transformational relationships. It’s not about broad generalizations. Success is about the individual organization, its circumstances, and ultimately, you—the IT leader.

As organizations look to cut spending, IT is not immune. As discussed in my post “Brigades, Battalions and Budgets,” continual across-the-board expense reductions will underscore IT as a commodity and a cost center to be managed—Exhibit #1 for Carr. Call me competitive, but I believe that companies who lay low and marginalize their IT will have a much lengthier recovery period. In contrast, those companies that seize the opportunity and invest in IT strategically will not only perform better but do so at the expense of their competitors. Some of our current work is going to change our competitive dynamic.

Think. Brainstorm. Mashup. Research and develop strategies that will propel your organization forward. Even if your company is panicking and relying solely on expense reduction tactics, present ideas that demonstrate bottom line reduction and top line growth. Insist on having your voice heard. Demonstrate ROI through IT’s transformative and innovative power.

For competitive reasons I cannot share details, but we are doing these things. A risk-free example from my past happened at a community hospital. Our historic 45% market share in this two-hospital town was starting to plunge. Our across-town rival was replete with cash given their enviable position as part of a regional health system. Our Board decided that the best antidote was not to reduce expenses but to make strategic investments in IT. One year after the implementation of affiliated practice-based EMR’s, clinical inquiry application, and software to link referring physicians, our market position flipped. We saw a 20% swing, especially in hearts, births, orthopedics, and neurosurgery. We were featured nationally.

I have additional career examples, but I believe the point is made. Yes the economy is tough, and the fatalists are seeking to marginalize IT. But the time is right to forcefully lay hold of this opportunity and (re)establish IT as strategic and foundational for your organization’s long-term success.

Demonstrate the strategic power of IT.

It matters.

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.”

An HIT Moment with … Denni McColm

An HIT Moment with ... is a quick interview with someone we find interesting. Denni McColm is CIO at 74-bed Citizens Memorial Healthcare of Bolivar, MO.

Citizens Memorial won the Davies Award and has reached Stage 6 of EMR adoption from HIMSS Analytics. Beyond the industry recognition, what IT-driven changes have you seen with regard to patient satisfaction, provider satisfaction, staff turnover, expense, and clinical outcomes?

Across our service lines, we have over 40 publicly reported quality measures (hospital, home care, and long term care). Before Project Infocare, we were above the national average on only 39%, or 15, of those measures. Today, we are above the national average on 80%, or 36, measures. We’ve been recognized for quality with state recognition for both home care and long term care.

On financial measures, since we’ve implemented Project Infocare we’ve seen an increase in net revenue of over 35%, while only increasing our staffing by 4%.

What projects are you working on?

We are doing more training with staff on effective use of the EMR within the context of a patient encounter. For some users this comes naturally, but for most physicians and nurses using the computer during the visit effectively takes practice. We failed to do this well as we implemented and we are refocusing on it now. The training method is called MUSE and is offered by The Robertson Group.

We are also implementing a patient portal, expanding our HR suite of products, utilizing automated infection and quality measure alerting, building ambulatory quality measures into the workflow during a typical ambulatory encounter, bringing more providers on with speech recognition, and interfacing portable vital signs monitors and glucometers throughout the organization.

In 2009, we’ll also be implementing an EMR for our affiliated cancer center and for our Miles for Smiles mobile dental unit.

What system capabilities or tools would you say have had the most significant impact on improving patient care in your hospital?

The EMR, just for providing access to the information providers need to care for patients. CPOE in that it gives us a more direct line of communication from the physician to the caregiver and automated quality measurement extracted from the EMR.

What impact will economic conditions have on your IT department and the hospital?

Secretly, we hope it will slow things down for us, but the more likely scenario is that IT will be more in demand as the organization seeks tools to help become more efficient. I also think that part of the national economic stimulus will be directed into health care. Obama is already uttering the phrase “electronic medical records.” And, whatever form healthcare reform takes, IT will be needed to help adapt.

What makes you happiest and most excited about working in IT in a tiny rural hospital?

The opportunity to put IT to use making a difference in the quality of care and service my friends, neighbors, and family receive. And, the ability to pursue the projects that will really make a difference for care providers and patients. OK, deep down, I also love it that we are so far ahead in terms of IT adoption compared to so many large hospital systems, including the ones here in southwest Missouri.

Monday Morning Update 12/1/08

From Jane Grierson: "Re: Whitwell Middle School’s paper clip site. This noteworthy school project has been in existence for a few years. However, the recent magnanimous contributions of MEDSEEK, a healthcare IT company with (as far as I know) little to no ties to public schools, etc., yet great Web products, deserves the biggest THANK YOU at this most appropriate time of year. If Peter Kuhn (last I heard, President) and Jay Drake (last I heard, CEO), representing all MEDSEEK staff, are still around — or whomever — the 11 million named and nameless souls will not be forgotten." Link to the school’s Children’s Holocaust Memorial site (the paper clip connection: they were invented by Norwegians and worn by them in national unity to protest Nazism in World War II, for which occupying Nazi forces would sometimes arrest them). The comment above comes from someone in the industry (phony name substituted by me) who isn’t from MEDSEEK.

From Matt Montini: "Re: insurance companies charging providers for appeals. This example is one of many that makes it clear that this nation does NOT need ‘healthcare reform.’ What it badly needs is ‘healthcare insurance / reimbursement / payment (or whatever synonym one wants to use) reform.’ By correcting the terminology, only then will we be able to change a hideous, broken system that is the root of all access problems, transparency issues, the un-insured, the under-insured, etc."

From Billy Kilmer: "Re: IT initiatives. I really liked the article about IT initiatives under $25,000. How about a request for the ONE coolest hospital gadget/process that is REALLY improving care from the patient’s point of view? And everybody’s best IT-implemented idea that made the patient experience better?" Great idea. Let’s hear from the hospital IT people (just e-mail me). I’ll keep the responses anonymous unless told otherwise since I know that worries people.

Did you have a good holiday? Hope so.

Listening: The Distillers, melodic and creative punk with a quite talented and pretty but foul-mouthed female lead singer. I’m also listening to AC/DC, but only indirectly since it is apparently an NCAA requirement that every college football game have gratuitous, testosterone-eliciting background music in a fixed ratio of 80% AC/DC to 20% Metallica.

Fujitsu Siemens launches its ESPRIMO MA tablet PC for healthcare, based on the Intel Mobile Clinical Assistant spec. In less rosy news, Siemens is selling its 50% stake in the company to Fujitsu for $567 million and it’s cutting 700 jobs in Germany due to poor market conditions.

Charge master software vendor Craneware is named Scottish software company of the year.

A bizarre use of technology: a rifle’s scope attached to a video monitor lets the spotter of a blind hunter direct his gun so he can kill animals for sport.

St. John’s Hospital (IL) will go live on MEDITECH Monday, an event written up in the local newspaper. It noted that early cost estimates were $20 to $30 million, which seems like a lot for a one-hospital MEDITECH implementation other than it’s 734 beds, which would surely be one of the biggest MEDITECH hospitals.

Another vendor "good news" item: MedVentive just finished a Thanksgiving drive for the local food bank. The company says it also tripled its sales force and launched two new products.

Inga says she was having a bad day when she mentioned the "good news" thing and enjoyed mentioning a couple of items, but please don’t send more. It was fun when CEOs were writing, but now the PR people have been mobilized just to get their companies mentioned.

Raymond James is doing a two-minute survey on healthcare IT spending for 2009. You can participate here.

Students at Taiwan’s Ming Chuan University develop a prize-winning hospital software package that includes a real-time doctor advice system, patient monitoring, and a staff locating system.

Cerner opens an office in Riyadh, Saudi Arabia.

Online health and wellness vendor Aperture Health announces that Kevin Moley has joined its board. He’s a former HHS deputy secretary and US ambassador as well as former CEO of Integrated Medical Systems. The company’s business model is to run targeted ads with health information and share the revenue with members.

George Washington University Hospital increases employee satisfaction with hospital communication by 33% by using solutions from Netpresenter: "broadcasting" to individual PCs via interactive PC screensavers, digital signage, and emergency alerting.

A Microsoft study finds that lay people screwing around on the Web trying to self-diagnose often mistake their common symptoms for rare diseases, a situation the authors call "cyberchondria."

The Nashville paper writes up the use of RFID-based patient tracking system systems in hospitals, not really saying anything new, but providing a glossy and short overview for lay people.

Mike Webb, 55, IT director at Central Peninsula General Hospital (AK), was killed on the job Wednesday by a distraught former employee. A PACS administrator who was fired Tuesday returned Wednesday morning with a semi-automatic rifle and opened fire on his co-supervisors, Webb and hospital radiology director Margaret Stroup, who was critically injured. Webb had been on the job less than a year, moving to Alaska from Southern Tennessee Medical Center. The suspect, Joseph Marchetti, formerly managed cardiac databases at Nebraska Medical Center. He was shot dead on the scene by Alaska state troopers when he fired on them. Condolences.

An interesting healthcare information technology advocate: IntraHealth International, a Chapel Hill, NC non-profit that works with software developers in Africa to deploy open source healthcare applications to African practitioners (among its other healthcare projects in developing countries). It apparently has a subsidiary site for IntraHealth Informatics and is looking for volunteer designers, developers, and documenters.

Four University of South Florida physicians want an investigation into the firing of a colleague by the Bay Pines VA Healthcare System, claiming the hospital singled him out because of his 2003 complaints about computer system flaws that threatened patient safety. The doctor, a USF professor and founder of the hospital’s nephrology department, admits he was frustrated with network problems that kept doctors from getting critical patient information and protested by dumping his computer into a trash can in a public hallway. The VA fired him on November 7 for refusing to sign a memo from the new dialysis unit chief about unit changes.

Indian IT services company Tata Consultancy Services will commercialize its WebHealthCentre patient portal, originally developed as a social project to help deliver rural patient services such as health information, telemedicine, personal health records, and medical consultations.

A Harvard psychiatrist whose endorsement of antipsychotic drugs for children led to a 4,000% increase increase in the diagnosis of pediatric bipolar disorder is found by Congressional investigators to have been profiting handsomely from drug companies selling products used to treat it. Joseph Biederman violated Harvard’s policy on reporting outside income by failing to acknowledge drug company payments of up to $1.4 million. He twisted J&J’s arm to fund his research center at Mass General, listing three goals in its annual report that included "move forward the commercial goals of J&J." One executive from the drug company urged prompt payment of a $3,000 honorarium to Biederman, warning his superiors that Biederman has "a very short fuse … not someone to jerk around." Parents who are suing drug companies over harm caused by the expensive drugs want to depose him. Also exposed: an NIH-funded radio psychiatrist who extolled the virtues of such drugs without disclosing his $1.3 million payments from drug companies for giving marketing lectures. And: the chair of Emory University’s psychiatry department, who earned $2.8 million from drug companies over seven years and failed to report nearly half of it to the university. Kudos to Sen. Charles Grassley (R-IA) for outing the scumbags, of which there is apparently ample supply.

E-mail me.

News 11/26/08

From Jupiter Jones: "Re: insurance companies and Susanne Madden interview. Boy, the ice is going to get thinner and thinner under the insurance apologists as Verden’s predictions start to ring true. BC of NC and LA (and maybe others) just published a new rule: providers must now PAY for any APPEALS. That’s right – the insurance company mis-pays a claim, which happens every single day, and the doctor has to pay at least $50+% of the claim to appeal it. I’m not kidding. If that doesn’t look like the result of ‘…they all sit in a room and think of creative ways to simultaneously drive up prices and reduce the attractiveness of the product, even if it means scaring off a bunch of their customers…’ then I don’t know what does!"

From Todd: "Re: virtual HIMSS. I filled out my virtual HIMSS satisfaction survey with these remarks. 1) Presentations could have been more substantive. A major health system talks about clinical transformation in a greenfield exercise in Australia? Interesting, but comparatively easy. How about someone who has been through the trenches of clin tran in a large, established health system? If a presenter is doing an ‘all happy story of IT implementation,’ you can guess it’s not reflective of your audience’s reality. I understand there are dozen or hundreds of applications for these speaking positions to choose from. 2) All the Web 2.0 stuff was unnecessary and confusing and some of it froze. There were only a handful of Webinars to manage. This wasn’t Orlando with 27,000 people. One page with all the presentation links would have done it. 3) Weak vendor turnout. Would have really liked to see some online demos of various new business and clinical apps (OR, bed management, ICU, med rec, etc.)  Premise and others, what made you decide not to participate? 4) If it were free, cherry picking a presentation or two would have been a nice diversion for the day, but of course it’s not free if you don’t work for a hospital."

From Wompa1: "Re: demand. Not exactly IT related, but it certainly could affect hospital revenue and spending." Link. Since I’m a big fan of economic theories, this Keynesian one is fun: when consumer demand drops, businesses decrease production rather than lower their prices. HSA guru John Goodman says that’s true in healthcare, where patients defer self-pay elective surgeries in tough times, leaving hospitals with less profitable insurance and charity cases.

From Eliza Cummings: "Re: jobs. Is there a way we can have a forum to look for software sales jobs? There is a boat load of great sales people and this is such a small industry that we really need to focus on who are the vendors that are looking." Absolutely. You can post jobs or resumes in the Jobs Offered/Positions Wanted section of HIStalk Discussion. You have to register, but it’s free (e-mail me first if you’re using a generic Hotmail or Gmail account since I usually delete those otherwise because of spammers). Any other ideas on how I can help?

Informatics Corporation of America wins two of five innovation award categories at the Healthcare IT Summit: greatest market potential and most innovative presentation. The company was also nominated for best new technology and best value. All were for its clinical interoperability products, which were originally developed at Vanderbilt.

Nova Scotia wins a public sector technology award for its EMR linked with lab and rad results. Nightingale Informatix is its partner on the project.

Ochsner CIO Lynn Witherspoon credits SIS with increasing virtual capacity of the hospitals ORs after Hurricane Katrina.

Dr. Deborah Peel posts this critique of Google Flu Trends on the Patient Privacy Rights site, along with Google’s response to her inquiries. I have to say that, of all the healthcare privacy issues to fight, this one seems pretty inconsequential, but that’s just my opinion.

Emageon acquirer Health Systems Solutions gets a CEO interview on Fox Business. He says they have the interest and the financial backing to make more acquisitions and will be doing so.

RTLS vendor Awarepoint gets $13.3 million in Series D financing.

Here’s a way to cut your IT costs: arrest the CIO who’s robbing you blind. The New Zealand health district that I mentioned previously saw its IT spending drop from $8 million a year to $2 million the year after it fired the CIO who is accused of stealing $17 million over six years by submitting fake invoices. A board analyst says he asked the CIO about budget-busting server maintenance costs and was told, "What to you want me to do – turn the f…… things off?"

HIMSS "applauds" (does it have little hands somewhere?) Tom Daschle’s appointment as HHS secretary, apparently joining every other industry in hoping for some Uncle Sam handouts. HIMSS says it’s looking forward to "working closely" with Daschle, Obama, and every citizen of Washington, DC and its suburbs to make sure the feds help pay for technology that supposedly already pays for itself. HIMSS calls itself both a membership society and a vendor trade association in its press release, which is the first time I recall hearing anyone there publicly admit the latter. Does that mean we all belong to a vendor trade association?

Jobs: ANSOS Consultant (MA), Program and Project Manager (CO), Senior Product Manager (UT). Gwen at Healthcare IT Jobs is feeling expansive for the holidays and will give a free job listing for each one bought before December 31 if they mention HIStalk. You know it’s hard to get people relocated and working over the holidays, but that’s a great time to recruit and interview to be ready for January.

The folks at Nuance confirm that eScription co-founders and co-CEOs Ben Chigier and Paul Egerman are giving up day-to-day responsibilities, serving as advisors going forward. Nuance announced its $363 million eScription acquisition in April.

Lawmakers in Indonesia support a bill that requires HIV/AIDS patients in its remote Papua province to be implanted with microchips to allow them to be tracked and punished if they deliberately infect others. Strangely enough, the guy with that bright idea is a doctor and member of parliament. "Seeing that the number and spread of HIV in Papua is so high, I’ve been researching it and found online that microchips can be used in humans, so I am convinced that this can help us detect signals related to the spread of HIV in society." Well, at least he used the Internet to come up with his bizarre recommendation. What the hell is he thinking when he talks about "signals?"

IBM launches a cloud computing validation service, with the first customer being Allscripts and its online backup and recovery service that will move to IBM’s technology in the spring.

Francisco Partners closes its acquisition of labor management systems vendor API Software, also naming its new board members, all of whom have deep healthcare IT experience.

Medical University of South Carolina will require 1,200 employees to take four days off without pay starting in January. It will also lay off a dozen others.

Odd lawsuit: a woman in labor in the hospital is started on an epidural, but a physician’s assistant sneaks into her room and steals her fentanyl. He is arrested, claims the narcotic was for his dying dog, and pleads guilty and serves probation. The woman and her husband are suing the hospital and the PA two years later, claiming the hospital was negligent in hiring him, took too long to get her another dose, and seemed more worried about apprehending the PA than taking care of her labor.

An official in India asks people to not trash hospitals after patients die, even if the doctor involved was negligent.

Here is some vendor good news sent my way after I expressed fatigue with the other kind that has everyone in a funk:

• Sunquest is running a company program through the end of the year to support the World Vision humanitarian organization, encouraging employees to donate.
• Inpatient practice management system vendor Ingenious Med says it recently hired new employees in sales, marketing, development, account management, and implementation and is looking for more developers and implementers.
• Coding vendor CodeRyte will hire 25-30 people in 2009.
• Marc Winchester of Digital Healthcare, which offers the Retasure retinal imaging service, says revenue is up 75%, headcount is up 125%, space is up 100%, and patients served has increased 1,350%.

Have a great holiday. I will be eating turkey, watching football, and maybe writing a little HIStalk stuff if I can’t resist the siren song. If you need me for anything, now is a great time to e-mail me since I’m not in my usual frenzy to keep caught up.

E-mail me.

HERtalk by Inga

From Gatelynn: “Re: Mary Staley-Sirios. I so enjoy reading your info, especially the one noted below. Very inspiring. It makes you take a pause in all our hectic work lives to be successful for our companies and ourselves. I thought it was worth the time for me to say – THANK YOU!!! I hope you slip a few more of these in every once in awhile.” Gatelynn is referring to the post on former Baylor Healthcare System VP Mary Staley-Sirois leaving the corporate world to serve as VP of non-profit MediSend.

From Dr. Nick: “Re: Facebook. Are you and Mr HIStalk on Facebook?” Not yet, anyway. I kind of like that idea, actually. Maybe I’d learn secret details about our readers’ lives.

Intermountain Healthcare (UT) is adding additional Agfa Healthcare technology, including integrating IMPAX PACS systems for its 21 hospital facilities and 150+ clinics.

MEDSEEK donates its web portal and content management system to Tennessee-based Whitwell Middle School. The website will facilitate communication between the school, students, and the community. MEDSEEK’s system will also host a separate site dedicated to the school’s Children’s Holocaust Memorial and Paper Clips. I hadn’t heard of this project before, but apparently Whitwell students collected 11 million paper clips, representing six million Jews and five million others killed by the Nazis. A German rail car once used to transport Jews to concentration camps was donated and then filled with the paper clips. The memorial now permanently resides on the school grounds.

Epic also has the good neighbor thing figured out. So far this year, the company has donated about $356,000 to local Verona, WI organizations. Recipients include the public library, the food pantry, the police and fire departments, and area schools. In addition, Epic has donated over 300 PCs and laptops to the school system over the last two years.

CareTech Solutions is one of 11 companies in Michigan awarded tax incentives aimed at creating additional jobs. The Michigan Economic Development Corp. approved a $38 million credit over 10 years to encourage Caretech to expand in Michigan instead of Ohio. If Caretech accepts the deal, the company will build a new data center in Troy and create 400 direct jobs.

The HIMSS folks say that attendance at their recent virtual conference and expo was up 65% from April. An estimated 2,800 attendees logged in during the two-day event.

The Louisville paper profiles local medical billing company Zirmed, which is building new office space to accommodate its growth. Between 2003 and 2007, the company’s revenues have grown 465% and are expected to hit $35 million this year.

The AMA would like at least another year before enforcing a new Joint Commission policy that denounces disruptive, intimidating, or abusive physician behavior. It’s not that the AMA wants to allow its doctors another year to be bad; rather, they’d like clearer definitions for what constitutes bad behavior. Sounds like an opportunity for Miss Manners.

The Michigan State Medical Society is establishing the first state-sponsored physician network to connect 15,000 physicians. The service will be free to members; nonmembers will be charged a yet-to-be-determined fee.

I noticed in a recent post on Loftware’s blog that the Sisters of Mercy Health Systems’ supply chain division has added specific terms in contract language that require the use of GS1 standards in transactions and in production processing.

Nuance Communications announces a Q4 profit of $22 million ($.09/share,) which is much improved from its $3.41 million loss for the same quarter last year.

I am taking off to hang with family for the next few days and I can’t wait. I went to a friend’s funeral last week, which made me especially aware of my many blessings. It’s easy to take for granted so many things in life, such as health, financial and physical security, our loved ones, and our many freedoms. Life is short and uncertain, but I have a renewed commitment to living my dreams today. I hope everyone has time to give some thanks this week and perhaps make some time to reflect on how you can live your life’s passions — today. I am incredibly thankful to HIStalk, Mr. H, our sponsors, and our readers, because this is one fun job! Happy Thanksgiving all!

E-mail Inga.

An HIT Moment with … Steve Aylward

An HIT Moment with ... is a quick interview with someone we find interesting. Steve Aylward is General Manager, Health & Life Sciences, at Microsoft.

With Medstory, HealthVault, and Amalga, Microsoft is dabbling in some seemingly disconnected technology areas that have different audiences, but without hitting the home care area that Steve Ballmer focused on in his HIMSS 2007 address. What is the company’s healthcare strategy?

Let’s address the last question first: Microsoft is committed to improving health around the world through software innovation. Our goal is to advance a vision of unifying health information. We’re working in collaboration with a wide range of health and IT leaders across provider, health plans, and life sciences organizations in both the public and commercial sectors.

In order to improve care, health, and quality of life, it’s critical that people across the healthcare system have access to the right information at the right time. Microsoft is in a unique position to accelerate that transformation through our tremendous reach, with a platform that spans from the consumer to the enterprise, and the ability to develop cost-effective technologies that others can use as a platform for further innovation.

HealthVault and Amalga are pivotal products in our efforts to unify health information and make it readily available to the people making decisions about health — whether a family health manager, chronic disease patient, emergency department physician, researcher, or anyone else in the health system. HealthVault enables individuals to collect, store and manage their personal health information and use it with a wide range of health and wellness applications or share it with physicians to better manage a condition. Industry leaders like Aetna, Cleveland Clinic, Kaiser, and Beth Israel Deaconness are turning to HealthVault with the goal of providing patients, employees, and health plan members with the tools to improve their interactions with clinicians and their overall health and wellness. These organizations share Microsoft’s belief that putting the individual in control of their health information, and enabling them to share it, opens up new and cost-effective opportunities for improving health.

Relative to what Steve Ballmer discussed at HIMSS, when you visit www.healthvault.com you’ll see a lot of partners who have connected their applications and medical devices — many of which are used in the home. HealthVault account users can automatically collect and store data from their glucometers, blood pressure cuffs, pedometers, weight scales, and more into their HealthVault accounts. The individual can then choose to share that data with their physician, family members, or as part of an inpatient admission. This hits toward the home care area that Steve touched on at HIMSS.

Amalga helps healthcare organizations address the challenge of continuously aggregating, managing and effectively utilizing a growing amount of data from disparate sources — regardless of how many different systems the data is stored in. This enables healthcare organizations to bring together their data in one single view. Once in that single view, they can make better, more informed decisions across their clinical, financial, and administrative areas.

The bottom line is that most healthcare organizations have a sleeping infrastructure that needs to be awakened (wish I’d thought of that line myself, but I have to credit a customer). Microsoft is a large part of that infrastructure, with everything from Microsoft Office to Microsoft BizTalk Server to Microsoft SQL Server to Windows. It may not be a model most would think of first when it comes to solving healthcare issues, but we’ve taken our role of adapting horizontal software to an incredibly complex market very seriously. There are plenty of examples we can share, but I recommend that your readers visit www.microsoft.com/health for a glimpse as to what we’re doing across Provider, Health Plans, Life Sciences, and Consumer Health sectors. The video that Steve showed at HIMSS is also posted in the lower left corner.

Bad economic conditions are sure to hit healthcare providers hard with more uncompensated care and tougher lending markets. When IT costs come under the microscope, how can technology, including that provided by Microsoft, prove that it’s paying its way?

Those tough economic conditions are already here. As an industry, we are approximately less than two months behind the tsunami that the financial services markets have already experienced. Many of our healthcare provider customers are turning to us to brainstorm how IT can help them navigate through this difficult time. Those customers are seeing their overhead costs skyrocket as a result of manual, paper-based processes and manual workflows, and it’s extremely difficult for physicians to avoid costly, acute situations without all of a patient’s information at their fingertips.

The bottom line is that our customers are looking for technology solutions that drive top-line revenue, reduce costs, as well as enhance patient safety and the overall patient experience. Each of our solution areas are being defined in one of these main categories. Look at Penn State Milton S. Hershey Medical Center. They came to us wanting to reduce ER wait time and improve the overall experience for cardiac patients in the emergency department. They implemented Microsoft Visio (along with a solution from the Orlando Software Group) and were able to lower patient abandonment by three percent, reduce the average length of an ER visit by 22 percent, and lower the time to be seen for minor emergences into the 70 percent range.

What Microsoft products or services should hospitals and other providers know about but probably don’t?

I can’t even begin to count the number of healthcare organizations who’ve deployed products that aren’t being used to their full advantage. Microsoft Office is a great example of this. Many real-world processes already are documented in Microsoft Office. The interface is familiar and what many healthcare providers use at home. So, we’ve turned Microsoft Office into an application development platform that brings the ease and familiarity of Office to more complex enterprise solutions, helping to drive adoption and acceptance. This is what we call an Office Business Application.

There are so many examples of innovative things being done with Office Business Applications or Microsoft Office, and I wish I could share them all. But here are three that might be of most interest to your readers:

The Patient Safety Screening Tool (PSST) is an Office Business Application developed by Accent on Integration (our partner) and Microsoft, and piloted at Vanderbilt University Medical Center (VUMC) to reduce the rate of sepsis, an in-hospital acquired infection that is deadly if not caught early. The capability is designed around the Office tools (primarily Microsoft Office InfoPath, Microsoft SQL Server, and Microsoft Office SharePoint Server). For significantly less than they would have spent on professional services, VUMC has been able to prevent the deaths of several patients — in a matter of weeks rather than months or years. This tool has enormous potential to be used with other in-hospital acquired infections, such as those on Medicare’s “never events” list.

Secondly, we’ve worked to improve the patient experience by integrating Xbox and Windows Media Center with a clinical information system (CIS). This has enabled patients to use Xbox for the “fun stuff” like e-mail, IM, and gaming, but the CIS integration is key. It can enable the patient to understand more about their care team and what to expect during their stay. I know many of your readers have been skeptical of such technology uses in the past, but I think they were hung up on the inpatient e-mail capability (meaning “acute care patients, seniors, and the Luddites will never use it”). The real value of this is to better inform and educate the patient as to what to expect during their stay. It can also be of great value to family members who visit the patient and who confer with the care team.

The third example is something that we recently shared with the Microsoft Healthcare User Group involving Operational Excellence. One of the most prominent children’s hospitals in the U.S. (together with USC Consulting) has used our tools to improve the turnaround time on their lab results by 50 percent.

It’s important to note that with these applications, we’re doing similar work with Health Plans and Life Sciences organizations and moreover, we’re really taking a close look at how they connect with the entire healthcare ecosystem, including providers and patients.

Bill Gates scorned IBM back in the 90s, saying its demise was imminent because of IBM’s reliance on old, cash-cow products and outdated business methods. IBM pulled back from the brink and thrived. Now Microsoft is "the establishment" and gets that same kind of criticism from the next generation of upstarts such as Google, Apple, and open source vendors. Is there a sense of urgency to change the status quo, and if so, how?

I wasn’t at Microsoft in the 90s so it’s difficult for me to comment, but I will say this. We’ve grown now to more than 900 professionals who wake up every day focused on the need to improve healthcare around the world. That 900 includes physicians, researchers, scientists, developers, and sales and marketing professionals. We’ve put an incredible amount of energy into working with our partners and the community to create specific vertical applications on our platform for healthcare, as well as point solutions such as HealthVault and Amalga.

In my professional career, I’ve never been around people who carried such a sense of urgency to change the status quo. Probably Microsoft’s biggest strength that I’ve seen in my nearly three years here is our ability to be self-critical. We have the opportunity to take a step back and look at industry challenges, whether it’s patient safety, moving from paper to electronic records, or cutting costs that stem from inefficient processes. And we have the opportunity to really think about how our products can be used to solve these challenges. How can we work with partners to build an entirely new solution, such as the Patient Safety Screening Tool, on the Microsoft platform?

We try to be as hard on ourselves as many of your readers are. We’ll keep going after a problem or an issue until it’s solved. We want to be strategic partners to our customers. We understand their needs and we’ve brought people on board, such as physicians and researchers, who can work with us to provide even deeper insight.

Can consumerism in healthcare take hold in a down economy, and if so, how will Microsoft support it?

Even in a down economy, consumers are still demanding better care, a better patient experience, and more personal communication with their doctors. The “millenials” (those under 30) are changing the game very, very quickly. They’re coming out of school expecting technology to be there. Those same people are now entering the workforce and taking care of their parents’ health. They demand solutions that support IM, social networks, gaming, and instant access to information — from anywhere.

To stay competitive among peers, healthcare organizations need to meet these consumer demands. Microsoft is certainly playing a large role here with Windows Mobile, MSN and Messenger as examples. What we’re doing with HealthVault, for instance, is just the tip of the iceberg in terms of connecting consumers to their healthcare information. It’s the consumers’ data, and as an industry, we need to break down the barriers that have prevented them from accessing it. Everyone from vendors to providers, physicians, and payers need to come together and empower consumers to manage their data, engage with their health plans and physicians, and truly take control of their health.

Monday Morning Update 11/24/08

From Fourth Hansen Brother: "Re: big time Philips layoffs." Link. Philips will cut 1,600 jobs in its healthcare unit, along with raising prices and cutting other expenses. The North Andover, MA headquarters will get hit with100 layoffs.

From Aries Ram: "Re: Intel. Heard at the mid-year ATA show there was a small demo of Intel’s new home monitor. Comments were not endorsing, primarily based upon how data was displayed. Also, they had a slow booth at NAHC. Philips was busy … and picking up additional customers after Intel’s recall of acquired product.It isn’t always about the bells and whistles. Get the users to weigh in on the product."

From Alias Unknown: "Re: The MedicalPhone. The MedicalPhone website was down for a day or two earlier this week after they received press mentions. Glad to see it’s back up." Here’s the link again.

I’m tired of gloom and doom news. Let’s hear more about positive company developments and maybe something about the charitable causes companies will support during the holidays. On the business front, EnovateIT e-mailed over its list of 2008 accomplishments: gross sales up 35%, headcount doubled, square footage expanded eightfold, and new customers and products. Anyone else? 

The Wall Street Journal investigates questionable practices in UPMC’s liver transplant program and the shady transplant surgeon it brought in and later fired, but casts the net wider. "UPMC is a nonprofit hospital system whose income is largely exempt from taxes. Yet, it is increasingly run like a for-profit company, paying its executives high salaries, jumping into new activities and expanding abroad … Its chief executive, Jeffrey Romoff, earned $4 million in the fiscal year ended June 30, 2007, and 13 other employees earned in the roughly $1 million to $2 million range. For their transportation, UPMC leases a corporate jet. Earlier this year, UPMC relocated its headquarters into Pittsburgh’s tallest skyscraper, the 62-story U.S. Steel Tower."

Brigham and Women’s is using IVR/speech recognition technology from Vocantas to collect information from patients who have started new drug therapy. The company has developed applications for discharge follow-up, disease management, and running emergency call lists.

The Project Valour-IT fundraising challenge will wind down this week, ending on Thanksgiving Day. You can donate here to help cover the cost of a several wounded military member’s rehabilitative technology. The $54,532 raised so far is a long way from the $250,000 needed. Thanks.

I wrote Thursday about nurses in the UK using cell phone software to monitor data entered by chronic patients at home. The celebration was premature, as it turns out: the hospitals using the t+ Medical software have ditched it already, saying it was too cumbersome to put into practice.

Picis offers a free report on business intelligence tools.

I don’t have the courage to look at my 401K or IRA balances, but I figured it was time to check out HIT stock prices over the past six months since I don’t hold those:

• Google: down 58%
• Siemens: down 55%
• GE: down 54%
• QuadraMed: down 51%
• Allscripts: down 51%
• McKesson: down 46%
• Cardinal Health: down 45%
• NASDAQ Composite:  down 44%
• Dow Jones Industrial Average: down 36%
• Eclipsys: down 36%
• Cerner: down 30%
• Microsoft: down 30%
• Perot Systems: down 25%
• Athenahealth: down 23%
• HP: down 22%
• Quality Systems: down 9%
• CPSI: up 27%

Landmark Medical Center (RI) is operating under a court-ordered supervisor and seeking a buyer. Among other examples of bad healthcare conditions, the article mentions that 10 of New Jersey’s 80 hospitals have shut down in the last two years.

It appears that Oklahoma State University Medical Center is on the brink of closing or selling out to St. John Medical Center, with its Web site turned into a plea for state government help. It might be the only hospital Web site in existence that doesn’t say where the hospital is (Tulsa) or how to contact it.

The Social Security Administration wants to develop a system that can extract medical records information for disability claimants from EMR systems using the Continuity of Care Document format. It’s being piloted now at BIDMC and Cleveland Clinic.

An argument between Muskogee Regional Medical Center (OK) and local surgeons goes to the state’s Supreme Court. The hospital insists that two surgeons must be on ED call for 192 hours per month, based on its bylaws that require around-the-clock coverage. The doctors say the hospital gets federal money for ED coverage and should hire its own.

Vendor Deals and Announcements

• Parkland Health & Hospital System (TX) implements Innovation’s PharmASSIST pharmacy automation systems across its nine pharmacy sites. PharmASSIST is integrated with the Cerner PharmNet system to process 6,000 prescriptions a day.
• SecureCare Technologies’ Sfax solution is now integrated into Addison Health Systems’ WritePad EMR.
• Interactive patient care system provider Skylight Healthcare Systems signs an agreement to deploy Skylight ACCESS for Cancer Treatment Centers of America’s new facility at Western Regional Medical Center.
• Edward Hospital and Health Services (IL) will implement Allscripts’ Enterprise EHR/PM solution for 50+ providers. Another 40 providers will use just the Allscripts’ PM solution.
• Centegra Health Systems (IL) signs a long term service agreement with Perot to provide support for its IT platform and assistance implementing a clinical system and other technologies.
• Brigham and Women’s Hospital (MA) will use Vocantas’ CallAssure interactive voice response system to study the effectiveness of using automated telephone follow-up systems to manage chronically ill patients using commonly prescribed medications.
• Former Cerner sales leader Mike Fiorito is named the new chief sales and marketing office for LifeWatch Services.
• Children’s Health System (AL) will deploy Eclipsys’ Sunrise solutions at its new $500 million facility opening in 2012.
• Acesis announces the release of Clinical Product Review Suite, a new product designed to automate the peer review process for hospitals and other healthcare providers.
• Harold Miller is named president and CEO of the Network for Regional Healthcare Improvement.
• Twelve critical access hospitals in North Dakota launch a pilot program focused on improving patient safety through automated and shared data collection. The Critical Access Hospital Quality Network with use Clarity Group’s Healthcare SafteyZone Portal.
• Western Missouri Medical Center completes installation of DR Systems’ PACS solution.
• Rodney Schutt is named Asprya’s new CEO, having previously been with Luminetx, Smith and Nephew Orthopaedics, and GE Healthcare.
• Seattle Children’s Hospital selects DatStat to provide its staff tools to improve enterprise research and to facilitate feedback from employees, patients, and patients’ families.
• Wexford-Mercy PHO (MI) selects WellCentive Registry to help improve clinical quality outcomes and streamline the care delivery process.
• BCBS of Vermont says it has saved almost $500K using VUE Compensation Management’s compensation management technology.
• Orthopedic Associates of Meadville (OH) selects SRS’s EMR solution for its five-physician practice.
• Daniel Kohl is named the new president and CEO of clinical documentation service provider Spheris.
• Bert Fish Medical Center (FL) selects Xceedium’s GateKeeper technology to provide secure remote administration services.
• Mediware Information Systems acquires the assets of pharmacy management software provider Hann’s On Software (HOS). The purchase, which includes $3.5 million in cash plus potential operational performance monies, adds 320 pharmacy facilities to Mediware’s client base.
• dbMotion is named winner of the Healthcare IT Summit’s Innovation Award in the Best Case Study Presentation category. The winning presentation focused on dbMotion’s implementation at UPMC.
• Healthvision solutions is a new reseller for MediSolution’s Virtuo BI solutions.
• The Defense Health Information Management Systems Program selects Base Technologies to provide teleradiology support services for Medweb’s PACS solution in war zones.
• CCHIT announces three new members to its board of trustees. Meighan Girgus, EVP for the American Heart Association; Wes Rishel, VP for Gartner; and Dr. Bruce Taffel, VP/CMO for Shared Health. They will serve staggered, three-year terms.
• Lynn Hudson, national EMR product manager for HealthPort,is a new member of The Electronic Health Records Association Executive Committee.

E-mail me.

News 11/21/08

From Wayne Twitchell: "Re: Boston Globe article. If you’re charged with something serious like manslaughter, do you get the local city/town lawyer to defend you, or do you go into one of the big city firms who have a lot of resources and do a lot of extra things (pro bono work, research, etc.) that a small local firm can’t do? I go with the big city firm. The defense and the outcome could be the same, but it’s my life we’re talking about. Granted, the national (or local) healthcare situation is different in that we’re all paying insurance and there’s the perception that our costs are going up because big city hospitals are getting more money for the same things that community hospitals do. But I think it’s unfair to compare a big hospital or hospital system to a community hospital just because they do some of the same stuff." 

From The PACS Designer: "Re: digitally connected patients and SOA. Intel has entered the digitally connected patient field with a new FDA 510(k) approved application called the Intel Healthguide which allows clinicians to monitor remotely the activities and conditions of their patients. Additionally, Intel will be using service-oriented architecture (SOA) to accomplish the monitoring tasks." Link.

From Unknown1: "Re: health benefits. I think it would be very interesting for you to do a poll on the current health benefits employers are providing their employees this year due to increasing costs of services, economy, etc. Here is a link describing the new plans UnitedHealth Group is providing all its employees. They are only offering plans with HSAs; annual deductibles of $4.6K per family and nearly $10K for annual out of pocket expenses. It is very disappointing to see a leading healthcare insurance company treat its employees the way it treats the providers — squeezing every last dime out of them." Link.

Listening: Camper Van Beethoven, 80s college radio eclectics whose music crosses all genres (and who knock out a respectable Pink Floyd cover).

CCHIT is only halfway covering its budget through certification fees so far, so they’re wondering if Obama will fund them after their federal contract ends on April 19. Seems like just about every Bush HIT goal didn’t amount to much except to get David Brailer a cushy post-government job (thriving RHIOs, EMR adoption, a strong ONCHIT, adoption of VistA, etc. were all kind of a bust) but at least CCHIT has had tangible results. Whether that’s good or bad depends on who you ask.

The Decatur paper writes a feature on St. Mary’s Hospital (IL) and includes a photo of its MEDITECH system.

Google’s SecondLife killer, Lively, dies early in its FirstLife.

Also kaput: the print version of PC Magazine, bowing out after a 27-year run to become an online-only publication. At the rate print publications are shrinking and dying, we’ll have plenty of trees.

To your right: put your name in the Subscribe to Updates box to join thousands of readers who get instant notification when I write something new. Or, right below that, click the Email This to a Friend icon to pop up a handy-dandy form to easily e-mail everyone you know to convince them to read HIStalk and help reduce the neurotic behaviors that Inga and I exhibit when we worry about being unpopular. The Search HIStalk box Googles through the 5.5 years of HIStalk, while clicking the ugly green box below it lets you send a confidential message (with attachments, even) to me like we were spies or something. And please, if you have the interest, please click some of those sponsor ads to your left to avoid me having to explain to some Internet hotshot company VP why they aren’t getting clicks and therefore will not be renewing their sponsorship, which will then raise those neurotic behaviors all over again.

AHRQ gives University of Texas School of Health Information Sciences at Houston a $1.3 million grant to train six students for five years on HIT. They’re working on interesting projects.

Jobs: Soarian Consultants (MA), Epic Resolute Consultant (PA), Multiple Epic Positions (CO).

Henry Ford Health System gets an eHealthcare award for its Web site.

Struggling Canadian EMR vendor MedcomSoft sells its Canadian Medworks 4.0 customer base to HTN for $85,000. Could be related to this announcement, in which a Canadian investment company places a $100,000 loan "to a third-party company in the healthcare/technology sector … to undertake a strategic acquisition." Seems like those numbers should have some additional zeroes to be worthy of press releases.

UCSD (CA) chooses FairWarning for privacy auditing.

Kindred Healthcare (KY) will use Allscripts Referral Management.

Document management vendor DB Technology names Charles Wilson as CEO.

At least it isn’t more Cerner problems: Royal Free Hospital in Hampstead has its ambulance booted. The private towing company said signs were clear, but the ambulance’s tracking equipment showed it was left for just one minute while the driver helped a patient into a dialysis facility.

Also in the UK, nurses are monitoring patients who transmit data to hospitals by cell phone. The t+ Medical software costs around $30 per patient per month.

And still again in the UK, IT systems three London hospitals are shut down and ambulances diverted after the Mytob mail worm is discovered on some PCs.

Unrelated: kudos to Rep. Gary Ackerman of New York, grilling the CEOs of the Big Three auto companies on why taxpayers should underwrite their continued incompetence: "There is a delicious irony in seeing private luxury jets flying into Washington, D.C., and people coming off of them with tin cups in their hand, saying that they’re going to be trimming down and streamlining their businesses. It’s almost like seeing a guy show up at the soup kitchen in high hat and tuxedo. It kind of makes you a little bit suspicious. Couldn’t you all have downgraded to first class or jet-pooled or something to get here? It would have at least sent a message that you do get it." 

A reader points out another way to help disabled war veterans (other than clicking the Project Valour-IT graphic to your right): donate money or raise puppies for Canine Companions for Independence.

Lofware announces Web services capability for its print server.

A New York Times article profiles American Well, which offers 10-minute virtual patient visits with physicians by Internet webcam through insurers. Interesting: AIG is providing malpractice insurance and it’s cheap enough that the health plans are paying for it instead of charging the docs. The company is a HealthVault partner. Almost everyone on the leadership team came from TriZetto.

Acquisition expert Derek Eckelman joins Sunquest as VP of business development.

Mammoth Hospital, which is anything but mammoth at 17 beds but is in Mammoth Lakes, CA, implements DeviceLock USB security. Some nice quotes are included from IT operations supervisor Paul Fottler. Sounds pretty cool: network admins can lock out USB ports, WiFi and Bluetooth adapters, peripheral devices, ports, printers, and other plug-and-play devices on PCs, even by day of the week and time. It also enforces encryption policies. It’s $42 each. PC Magazine gave it four stars and the company has some interesting free downloads: Plug and Play Auditor, Active Ports, Active Shutdown, and several other utilities.

The iCEphone, originally developed for the British military by The Medical Phone Ltd. of Edinburgh, Scotland, will be sold in a medical/emergency software configuration.

E-mail me.

HERtalk by Inga

From Tammi: “Re: holiday parties. My company doesn’t have holiday parties, but this weekend while chatting at the coffee shop, a couple mentioned their son runs a high-end restaurant in the Denver area. Included on his property is a venue which is booked a year in advance for corporate holiday parties. The companies are calling in great numbers to try to get out of their bookings.” In our unscientific poll to the right, it looks like 41% of companies are either cancelling or scaling back parties this year. I’m predicting a related decline in Alka-Seltzer sales as well.

With all this gloomy news about layoffs and poor financial results, I have decided I need news that lifts my spirits. Thus, the rest of today’s HERtalk will contain only good news. Up near the top is athenahealth’s plan to add 100 new jobs in 2009 in its new Belfast, ME facility, which already employs 140.

I also heard that Digital Healthcare, a provider of a retinal health assessment solution, just raised an additional $5 million in funding to expand operations. The NC company employs a number of former Misys folks, including former VPs Marc Winchester and Scott Sanner.

I am sure that Peter S. Amenta, MD, PhD is happy to be appointed the new dean for UMDNJ-Robert Wood Johnson Medical School. He has served as interim dean for the last two years.

Scott P. Serota, President and CEO of BCBSA releases a statement saying, “BCBSA and the 39 member Blue Cross and Blue Shield companies today announced support for every individual being required to have coverage and all insurers being required to accept everyone regardless of their health status.” For anyone who has ever been declined insurance, this is a comforting statement. AHIP had a similar endorsement today, announcing support for guaranteed coverage without pre-existing exclusions. (OK, I recognize that insurance for all has its issues, but remember, I’m having a happy post day).

Here is a technology I want to hear more about. M*Modal launches AnyModal CDS Mobile for the iPhone. Apparently the SaaS technology allows clinicians to dictate via the iPhone. The product uses “speech understanding” services that allow the dictation to be captured, understood, and transcribed real time, giving physicians the ability to immediately review and sign off on the document.

Speaking of iPhones, I’m betting this poor woman will be happier in divorce than she is in marriage. She discovers that her husband has e-mailed some “personal” photos of himself to another woman via his iPhone. He claims the Genius bar experts at the local Apple store said it’s a known iPhone “glitch” that photos sometimes mistakenly attach themselves to an e-mail address. The skeptical wife sends a question to an Apple discussion board, asking if other users agree with the Genius. The consensus: the marriage has the glitch.

Without a doubt, this story helped lift my spirits. Former Baylor Healthcare System (TX) VP of clinical transformation Mary Staley-Sirois leaves the corporate world to serve as VP of Global Program Development for MediSend, a non-profit humanitarian organization that provides medical aid, healthcare education and technology, and other services to hospitals in developing countries. Staley-Sirois will apparently take her extensive experience from Baylor and from Healthlink before that to grow the organization’s worldwide healthcare initiatives. Love it.

E-mail Inga.

Readers Write 11/19/08

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. Use your real or phony name (your choice). Submissions are subject to approval and become the property of HIStalk.

IT Projects Resulting in Savings (for $25,000 or Less)
By Southeast CIO

These are based on my personal (15 years) experience in hospital IT. Some of these may be a little dated.

Medicaid Eligibility Double Check Before Aged Receivables Go to Bad Debt Agency
Annual Savings: $50,000

Hospital sometimes help patients apply for Medicaid, usually after the patient receives treatment. The patient is usually placed into some type of Medicaid-applied status. When the application is approved or denied, the status is changed. Sometimes all that works and sometimes it does not. We created a batch process that identified any self pay/indigent patient/guarantor ready for bad debt and applied that information against the Medicaid Eligibility source/TPA. Even in these HIPAA-friendly days, a second check will find an organization money.

Resigned/Terminated Employee Automatic Dis-enrollment from Benefit Plans
Annual Savings: $20,000

The base HR package didn’t automatically term benefits. HR had to dis-enroll employees manually from programs. Sometimes that would not happen in a timely manner or a step was missed. The option is to either buy an expense add-on module or script the series of key strokes. Scripting can resolve this problem, eliminating part of an FTE and saving benefit dollars.

Intranet Application That Assigns Registrars To Patients/Rooms, Reduces Overtime
Annual Savings: $15,000

Some hospitals provide bedside registration, especially for maternity wards. Registrars were constantly on the phone or going back to the main office for their next assignment. We created a basic application for the Intranet that could be updated showing next assignment. Registrars could access that from their mobile laptops on carts and indicate when done. Overtime went down, registration productivity went up. We also used instant messaging for these employees (policy was no IM at that organization).

Fax Server to Retain Surgical Case Documents Faxed To/From Physician Offices
Annual Savings: $50,000

Faxing with MDs office always has its challenges. On occasion, surgical cases are delayed, increasing overtime and frustrating many involved. A fax server that retains inbound and outbound faxes eliminates a lot of headaches.

Microsoft License Discounts for Educational Organizations – Teaching Hospitals
Annual Savings: $12,000

Microsoft provides discounts for educational organizations. A 400-bed hospital usually provides some type of education to residents, etc. Even if it is on a small scale, it will sometimes help qualify.

Reduction in Hospital Bill (claim) Hold from 5 to 4 days
Annual Savings: $35,000

Most HIS systems are set to hold charges for X days after patient discharge. The point is to enable all charges to be entered, scrubbed, then dropped on a claim. When most HIS systems go in, to be careful, bill holds are sometimes set high. With good charging processes and focus, you can reduce these days. Interest earned on one day of charges billed and paid one day earlier adds up.

Small Revenue-Enhancing Projects: The Rule of the Year for 2009-2010
By AgedObserver

You’ve preached for a long time that our industry, in many cases, has adopted technology for the sake of technology, without examining the fundamental reasons of “why” and “what benefit” (CPOE is the best example). There have been countless multi-million dollar projects in the last 10 years where the end result has been average technology, combined with poor execution, resulting in lousy adoption and no demonstrable ROI. 

Instead of accelerating the entity, the attempted technology has slowed the organization’s progress, and in the hindsight of today’s economic environment, has placed provider organizations at risk because hundreds of millions of dollars poorly invested has escaped from their bank accounts.

Jim Collins identified some key aspects of how leading organizations use technology as an accelerator, thereby “avoiding fads and bandwagons yet becoming pioneers in the application of carefully selected technologies.”  Clayton Christensen talks about innovation needs, not for the sake of innovation, but to move the business forward in a steady, directed fashion.

In today’s environment, where capital for large technology projects is very scarce, it’s important that every project be aimed at providing additional revenue to the organization for work already being done, i.e., if you’re leaving money on the table because you don’t have the right technology (square peg/round hole or one-size-fits-all) and you can get a vendor to guarantee financial improvement, you have a winning solution. Large projects don’t work today because the manpower and up-front costs lead to extended (if any) return on investment for the purchaser.  

Small, focused, revenue-enhancing projects should be (my prediction is they will be) the rule-of-the-year for 2009/2010. The tie between the clinical activities and revenue is obvious, but so many technologies put a 10-foot wall between the two, or try to solve only one part of the two sided-puzzle, and hence don’t resolve true issues and put more money into provider’s hands.

The Future of Primary Care
By TornMD

The NEJM just had a roundtable on saving primary care, with big names in the field talking about the usual things: medical home, changing reimbursement, etc. Personally, I don’t see how anything but a drastic increase in salary will attract people to the field. I’m also not sure those are the people you want as your doctor.

Even though most EMR systems are targeted to internists, more technology is not going to change the everyday workings of a primary care provider. I did an informatics fellowship, so I’ve never practiced more than three sessions per week, always in an academic setting (with two sessions of supervising residents). Though I’ve found my patient care sessions very rewarding, there’s no way I could have managed a full week of it. Primary care is just not that intellectually satisfying.

As our department chair told us when I was finishing residency (2001), there’s no future in primary care. PAs and NPs can handle 95% of the cases we see (as evidenced by the excellent PAs I work with in our walk-in clinic). I often feel that dealing with lower back pain, URIs, and diabetes management is a waste of an MD.

The reward I get from primary care is probably what most people in private practice find the most frustrating. Being in an academic setting without productivity constraints, I have (a lot of ) time to spend with patients. The whole medical home concept — case management, explaining lab results, dealing with specialists — is a lot of what I do (especially since I speak Spanish and may be one of the only providers who can talk to patients without a translator). It’s also a lot of what patients appreciate. I often feel much more like a psychologist than a doctor; however, I don’t need an MD to do what the patients appreciate most –  listen.

There will always (I hope) be people who go into medicine because of the rewards of patient interaction, but the current system makes that less and less viable. Because of the lack of intellectual challenge in primary care, I believe the only way to attract the “best” is to couple it with research or teaching and to work where patients really need you. I was miserable during my private practice sessions when I saw well-insured patients for yearly checkups, STDs, or blackberry thumb. When I see Medicaid, non-English speaking patients for diabetes control or atypical chest pain, however, I feel that I’m actually contributing and fulfilling my role as a physician. Unfortunately, a Medicaid-focused private practice is not really financially sustainable.

Reports: Obama Chooses Daschle as HHS Secretary

The Washington Post reports that President-elect Obama has chosen former Senate Majority Leader and South Dakota Democrat Tom Daschle as Secretary of the Department of Health and Human Services. Sources also report that Daschle will be given broad healthcare policy responsibilities that include expanding healthcare coverage while reducing costs.

Daschle’s book, "Critical: What We Can Do about the Health-Care Crisis," called for a healthcare oversight entity similar to the Federal Reserve Board. He was supporter of the failed Clinton health plan in the early 90s.

The Republication National Committee is already criticizing the choice of Daschle, an early Obama backer, saying that both Daschle and his wife work for lobbying firms.

News 11/19/08

From Jamie Sommers: "Re: Payerpath. Word is that Art Glasgow, the Payerpath president, resigned from Allscripts-Misys today on a town hall conference call. He was a good guy and the reason why Misys bought Payerpath in the first place." Unverified.

From The PACS Designer: "Re: federated identify. You will be hearing soon about a new concept called federated identity. Microsoft and other software firms are working on bringing this concept to fruition in the next year or so. Cloud computing requires a better method of identifying users that won’t overload requests for additions to Active Directories. Microsoft has a software download called Services Connector that provides the ability to identify authorized e-mail addresses from federated databases through its Live ID software when logging on to a cloud service." Link.

From Fourth Hansen Brother: "Re: FDA. Have they been cheating in medical devices?" Link. FDA scientists claim that agency executives pressured them to change their findings so that medical devices could get marketing approval. 

NotADupe claimed last time that a marketing person planted the Clara Barton comment about an Allscripts product at AMIA since it sounded pretty rosy and "I was at AMIA and I didn’t see Allscripts/Misys there." I thought it sounded legit, although it was borderline because it was so positive. My Allscripts contact saw the mention and quizzed all the marketing people there to make sure someone didn’t go rogue and post a fake comment here, then cast the net wider to see what Clara Barton was talking about. There was indeed an Allscripts demo at AMIA, although a brief and informal one. Jacob Reider MD, the company’s medical director, did a five-minute demo of Allscripts Prenatal at the Primary Care Informatics Working Group on Saturday night in front of around 40 people. The product isn’t GA yet, but I’m sure you’ll hear more when it is. I also appreciate that Allscripts was ready to go after anyone on their side who tried to mislead readers here, which is fortunately unnecessary since everything was above-board.

From HITPundit: "Re: Partners. There is a good read in the Sunday Boston Globe about the Partners effect. I thought it was about patients? Non-profit status for most of these places is a joke." Link. Of course it is. The story is about how Taj Mahospitals get paid more money to deliver average care for certain services than their less-ritzy but better-outcome competition. It mentions Mass General’s $686 million expansion and Partners’ $1.7 billion in profit in the last four years, while Caritas Christi was borrowing money to pay for oxygen tanks. It also mentions Partners’ leveraging its patient perception to manhandle insurance companies, resulting in 30% higher payment than similar hospitals (although Children’s Boston has the highest rates in Massachusetts). The quote HITPundit liked came from the chairman of Partners’ board: "Some are able to spend more than others. It’s our fortune that we’re probably in the lead on those investments. And several hospitals aren’t able to keep that pace. And that’s what I, as a businessman, call market forces, if you will." I thought this snip was interesting: "And it is there, in the workaday world of hospital care, that the hospitals’ reputation for unmatched excellence fades – and with it much of the rationale for the higher payments they receive for such treatments. The growing, if still inadequate, body of data available about hospital quality paints a fairly consistent picture of the care at the Brigham and Mass. General: often good, but rarely extraordinary, and sometimes inferior to the care available at other hospitals."

From Pacstech: "Re: stolen records. How about an arrest warrant for the idiot that allowed the records to be stolen? With 25 beds, how many people in medical records are we taking about here?" Bags of paper medical records stolen from Down East Community Hospital (ME) wash up on a local riverbank.

From HCC Princess: "Re: CMS. CMS is auditing 30-40 Medicare Advantage Plans. Claims from 200 random members will be audited and apparently any unsubstantiated claims will be extrapolated across the entire plan’s membership base. CMS is looking to recover a lot of money."

From Vern Den Herder: "Re: Epic. A healthcare organization in Connecticut recently signed with Epic. Wondering who?"

From Vince Ciotti: "Re: the $25K IT project. Spending more in IT won’t get you squat for recognition. Spend less! Use the $25K as rewards for ideas in a cost-cutting campaign that solicits ideas from your IT staff. $10K to the winner, $5K to runner-up, etc. Have finance vet the ideas and only the ones finance says will produce real ROI (that is, reducing someone’s budget next year) get considered. In the 100+ IT assessments we’ve done with The Hunter Group and Navigant Consulting, some of the best ideas have been given to us by IT staffer we interviewed. Why pay us to find them – get them yourself from your own staff!!"

Computerworld writes up Midland Memorial Hospital’s OpenVistA implementation, although emphasizing "cheap" rather than "works just fine" (the "old code" remark was snarky, especially given that many commercial products are older than VistA, which was rolled out in 1996). The hospital’s project was named as a winner of a 2008 InfoWorld 100 award.

I admit that I’m old-school patriotic, not a fair-weather flag-waver, so I was happy to join in the Valour-IT Veterans Day fundraiser, which ends next Thursday (Thanksgiving Day — how appropriate). My 401k may be hitting a rough patch, but I can darn sure find a few dollars to help buy a severely injured soldier, sailor, or airman some technology to help them recover from devastating war wounds. Their sacrifice (and that of their families) isn’t diminished one whet by the fact that I don’t always agree with the orders they are given (I’m sure they’re not always thrilled about it, either, which is all the more reason to get them back on track). It costs around $700 to provide a laptop with assistive technology and I was happy to provide one to someone who deserves it. Being a 19-year-old kid surrounded by the constant threat of harm and miserable conditions far from home is bad enough, but being shipped back to your family missing limbs has to suck big time. All donations of any amount are welcome and are tax-deductible.

Barry Chaiken MD, formerly of McKesson and BearingPoint, is now CEO at Medting of Palma De Mallorca, Spain (field trip!) Never heard of them, but it looks like a physician collaboration platform for sharing cases that can include media.

TELUS, the Canadian telecommunications company that bought Emergis a year ago, which had previously bought Dinmar in 2006 (and therefore its Oacis clinical system), creates TELUS Health Solutions and says it will invest $100 million over three years in it.

SCI Solutions wins two marketing awards: one for its ad graphics and the top award overall for its Access Management magazine.

CodeRyte gets $13 million in Series D funding, for a total VC funding of $50 million.

It took Inga awhile to get confirmation from some earlier reader rumor reports, but she has verified officially that Ingenix has acquired Global Works Systems, Inc. and will make them part of Ingenix Consulting.

This stock analyst says GE is in big trouble, calling it "a bank disguised as an industrial conglomerate" and an over-leveraged one at that, saying that if GE fails, it "could trigger the mother of all bailouts." I’ve speculated all along that its GE Capital exposure was a lot more than Jeff Immelt was owning up to. Speaking of which, may we assume that Intermountain’s CareCast pig-lipsticking project is either dead or at least so far behind that no one could possibly still care?

Right after I wrote the above, along comes a GE Healthcare press release touting "Digital Day One" without ever really saying what it is, although data-sharing and new hospital construction are mentioned. I read the release three times and I still have no idea what they’re talking about, with no clarification available on their site because the press release isn’t there at all. Marc Probst is quoted, so Intermountain is involved, apparently with regard to "timely sharing of newly published medical breakthroughs and best practices."

But speaking of GE, this Motley Fool analyst tries to figure out which company is more screwed up: GE (GE Capital) or Siemens (bribery).

Half of primary care physicians say they’d get out of medicine if they had an alternative, all because of insurance and government red tape. Everything said there is pretty much what Susanne Madden said when I interviewed her.

University of Toledo’s McKesson EDIS implementation is written up on its site.

Former Cerner sales guy Mike Fiorito is named chief sales and marketing officer of cardiac monitoring services vendor  LifeWatch Services. Hopefully he’ll direct better press release writing since I had to read the first two paragraphs of this one at least five times to make sense of it (and I read a ton of press releases).

Texas Health Resources demonstrates a patient-doctor relationship tool built on the Microsoft’s Surface computers, that "wave your hand over the coffee table" gadget that Steve Ballmer kept yapping about in his HIMSS keynote. More important applications have already been built for it, however, as Harrah’s has Surface computers running in Rio Casino "allowing customers to flirt and order specialty drinks using the technology."

Children’s Health System (AL) picks what sounds like the entire Eclipsys Sunrise product line. A big peds hospital customer is a great opportunity, but I’ve never seen one yet that wasn’t a pain in the adult-sized ass. I guarantee that a six-hospital IDN with one peds hospital will spend 50% of the entire project effort just accommodating the sometimes bizarre but indefatigably argued practices in peds, always defended with the reminder that "kids aren’t just little adults." Sometimes I think they’re as unlike general community hospitals as a veterinary hospital, occasionally for good reasons.

Odd: a former New Zealand health district CIO goes on trial for stealing $11 million US by submitting false invoices. He had "grand properties," a luxury car collection, and a 150-foot, 17-bedroom yacht.

Misys CEO Mike Lawrie on the prospects for Allscripts-Misys: ""Everyone recognises spending in US healthcare is out of control and is projected to consume 17 per cent of [gross domestic product]. And they’ve just spent a trillion bailing out the financial system. There is a limit to how much money you can print. And my view is there’s no way, with a new administration, [rising costs] can be left unchecked. And technology will be part of the solution."

Spheris names former Pediatric Services of America CEO Dan Kohl as president and CEO.

Glenn Dennis is named president and COO of Perry Biomedical Corporation, which makes hyperbaric oxygen chambers. He was previously with DataLoom, Exigent, SoftMed, and GE.

Chinese Internet company Baidu.com reels when it’s found that a chunk of its paid search revenue comes from unlicensed medical and drug customers, whose paid links were mixed in with real results based on popularity. Its a lot like Google, making its founder a billionaire.

Kenya has an ambitious plan to connect all hospitals over the Internet for telemedicine, ordering supplies, and providing second opinions. It will also support TelePresence, Cisco’s high-quality videoconferencing tool.

East Tennessee Heart Consultants brags on its IT outsourcing to Claris Networks, claiming it costs less and is more reliable.

Hospital layoffs: Beaumont Hospital (MI), 500 employees; MetroHealth (OH), 25 employees.

The University of Texas System, reorganizing UTMB after Hurricane Ike damage and massive layoffs that started this week, brings in Kurt Salmon Associates to help develop a plan.

E-mail me.

HERtalk by Inga

A computer virus at Barts and The London NHS Trust causes a system shutdown that lasts more than 24 hours. E-mail and Internet access were affected, but not the Cerner application (finally there is an issue that couldn’t be blamed on a Cerner application).

Speaking of hospitals across the pond, several are facing closure because they are not attracting enough patients. Recent reforms allow patients to choose where they’d like to be treated, which has shifted traffic to the more successful medical centers.

The University of Missouri and Cerner are winners of CHIME’s Collaboration Award for using HIT to help UM family physicians and patients manage chronic diseases.

NightHawk Radiology Holdings announces the appointment of David M. Engert as CEO, following the resignation of Dr. Paul E. Berger. Engert is a former McKesson and Quality Care Systems exec. Berger, who co-founded NightHawk along with his son Jon, will remain as non-executive chairman of the board. Jon Berger, an SVP and board member, has also resigned from both the company and board.

Barcode POC provider IntelliDOT and latric Systems sign an agreement that formalizes pricing for interfaces, implementation, and maintenance for customers using Iatric System interfaces between IntelliDOT and MEDITECH solutions.

Beginning in January, the Seton Family of Hospitals (TX) is implementing a new dress code for nurses and other patient care employees. Tattoos must be covered and piercings limited to earrings and a small nose stud. I personally prefer fashion accessories to permanent body adornment, but tattoos don’t particularly bother me (assuming everyone has had the appropriate hepatitis screening), although I find I can never quite look someone in the eye if they have a nose ring or piercings in their eyebrows. Even though they have no effect on the quality of care, I suppose some patients would be more at ease if they didn’t see a naked lady tattoo while getting a blood draw.

Eclipsys claims they’ve exceeded sales targets for the EPSi budgeting and financial decision support systems for the first three quarters. Their announcement doesn’t mention if their sales goals were set too low or whether the sales have translated to higher profits, but, it’s still good to hear that someone is making headway in these economic times.

A friend mentioned that his employer (a law office) is downsizing its holiday bash this year. Rather than renting a steak restaurant for an evening of expensive food and drink, they’re having a holiday luncheon delivered to the office. Some of the party savings will be donated to charity. It got me wondering what other companies are planning; hence the new poll to your right. This year, Mr. H and I are planning a Virtual Holiday Party. We are thinking perhaps setting up an online chat and he’ll drink his beer while I sip on my wine. Mr. H is tight with his money, so he still hasn’t decided if we can bring dates to the affair. Meanwhile, according to the Raleigh paper, the Allscripts-Misys folks will have a chance to act like one big happy family at their convention center holiday bash.

Red Hat chairman Matthew Szulik is named E&Y’s 2008 Entrepreneur of the Year for turning his company into a billion-dollar business. Glen Tullman of Allscripts was a finalist in the Technology division.

MedcomSoft announces its Q1 results. The news remains bleak for this 2007 Best in KLAS winner, now desperate for a buyer. Revenues were down 10% year on year and the net loss was almost $800K.

Former VeriChip CEO Scott R. Silverman regains control of the company after a $5.4 million purchase of common stock. In addition, the company purchased all intellectual property rights related to its human implantable RFID technology. Silverman claims he is eager to “re-ignite” the company.

Virtual Radiologic appoints Kevin H. Roche to its board of directors. He’s a managing partner at Vita Advisors and formerly the CEO of Ingenix and general counsel for UnitedHealthGroup.

Thomson Reuters releases its annual study of the top cardiovascular care hospitals.

Peter Dolphin is named VP of business development for Beacon Partners. He was most recently the VP of sales at eScription, and before that worked at IDX Systems (GE Healthcare).

E-mail Inga.

An HIT Moment with … Liddy West

An HIT Moment with ... is a quick interview with someone we find interesting. Liddy West is a principal with West Consulting and is working on the VUHID project.

What is GPII, who’s involved, and why is it a non-profit?

Global Patient Identifiers Inc. is the company started by Dr. Barry Hieb and myself to manage the Voluntary Health Identifier (VUHID) project. Barry, who left Gartner’s healthcare consulting group in August to work on VUHID full-time, has been focused on this effort part-time for a number of years, beginning with the work he led on two ASTM International standards that describe how to achieve unambiguous patient identification and improved privacy of clinical information.

As a medical doctor and a computer scientist, and through his wide network of industry leaders, Barry has thoroughly vetted the VUHID concepts and design from both practical and technical perspectives.

And, to your question as to why we’re a non-profit, one of our basic beliefs is that a universal patient identifier can neither be mandatory nor managed by any government. Nor can it be commercial in that neither patients nor providers can be asked to pay for it. That is, we believe that such an initiative should take costs out of the system, not add costs.

Citizens push back hard every time someone brings up the idea of a government-sponsored healthcare ID number, yet a RAND study advocates spending billions to create such a system. What are the benefits of an ID number and why does it have to cost so much?

We wholeheartedly agree with many of the objections to creating a massive, expensive, government-controlled national identification system. And based on our estimates, it simply doesn’t have to cost so much! That’s the beauty of the VUHID approach: cheap to develop and operate, no big software engine or data base of identifiable patient information, and no government agency to oversee it (lots more details at www.vuhid.org).

So, not only vastly cheaper to implement, but essential to making the healthcare delivery system more efficient. The RAND report (warning: PDF) estimates that savings running to tens of billions of dollars annually can be achieved if effective electronic clinical information exchange is implemented. Errors in current patient identification techniques estimated to be 8% or higher represent a major barrier to achieving these economies. And the benefits?

• The ability to accurately link patient records among participating providers for a dramatic reduction in duplicate registrations and more convenience for patients and staff.
• Reduced costs and medical errors. Fewer duplicate or unnecessary tests because patients are identified correctly and providers have access to clinical information from encounters across an HIE.
• Enhanced privacy protection. With VUHID, patients can elect to protect certain aspects of their clinical information based on data type and provider type.
• VUHID also reduces the risk of medical identity theft since no patient information is associated with the VUHID identifier.

He’ll blush to see himself referred to as the leading authority on the topic, but you’ll note that Barry’s work is cited no less than a dozen times in the RAND white paper.

We’ve only recently worked through the ROI model for VUHID and believe it will be vastly cheaper than the RAND estimates — by a factor of 500! In fact, one of our advisors who is involved with an emerging HIE project has reviewed our model and agrees that proposed VUHID pricing represents a “no brainer” decision for HIE executives based on savings and benefits described above.

How do you get around the inherent layperson fear of a government-controlled health ID number?

Again, it’s our intention to keep government out of it. We’re working with HIEs and EMPI vendors, taking a ground-up approach vs. a top-down, government-driven approach.

Now, if the government, state or federal, would like to sanction what we’re doing, we’d be happy to talk! Barry has presented VUHID to Rob Kolodner at ONC who is very supportive, but as you know, Congress specifically prohibited spending federal money on this effort several years ago.

We’ll continue to work with organizations such as HIMSS, NAHIT, IEEE, AMIA, JCAHO, Liberty Alliance, and the RAND Corporation, all of which have public statements supporting the need for more accurate patient identification methods. VUHID has good visibility with these organizations, as well as physicians’ groups, patient advocacy groups, and HIEs. We’re working to gain more traction as initial deployments are accomplished and real-world experience with the system is gained.

Some high-powered and well-funded groups surely have a strong opinion about the health ID concept. GPII is a tiny nonprofit. How will you get your message out and convince people that there’s no hidden agenda?

Well, as I mention above, we’ve been heavily involved in outreach efforts for some time. But, there’s a lot to do. This is really our biggest challenge, as we’re trying to raise funding to complete development and testing of the VUHID Web server, develop outreach and education programs, and build momentum with HIEs and EMPI vendors. Right now, it’s missionary work, with a little funding for technical work, getting the company set up and bare necessities (thanks again, Judy, for the grant from Epic).

As to hidden agendas, no one has ever come away from a discussion with Barry on this topic with any such suspicions. His dedication and our business model leave little room for doubt that we sincerely believe that this is the right thing to do and a necessary part of the infrastructure of a reformed US healthcare system.

Now that you’re out on your own as a consultant, what are the most interesting trends you’re seeing?

I’m seeing renewed interest in revenue cycle … or maybe that trend just comes back around every 10 years or so. But if you look at the age of the applications that are running the business side of most healthcare organizations, and the kludge of interfaces and bolt-ons that have been added over the years to keep them going … well, I’ve always thought there’s opportunity in this area. The current economic environment might just be the incentive for these organizations to finally take the risk on newer technology.

Also, I’m one of those people who believe that RHIOs or HIEs — whatever the acronym evolves to — are quietly taking hold, will persist and expand … with or without government mandate or funding. Maybe more successfully without government intervention! So, I believe systems integrators with infrastructure, tools, and the ability to “herd the cats” are companies to watch.

And relative to government, I do believe they’re here to stay when it comes to HIT. Many of the people I’ve talked to in Washington and here in Arizona who make or influence policy really do understand the benefits and challenges. The work of ONC has been important and hopefully will be continued under the new administration.